Digestion (week 4)

Question 1

functional categories and frameworks

Answer 1

cofactors (vitamins and minerals)

mucus membrane support

tissue repair

digestive stimulus

replacements

immune modulators

glandular extracts

adaptogens

Question 2

Cofactors (vitamins and minerals)

Answer 2

Provide the micronutrients required for catabolic and anabolic chemical reactions

Supply the required nutrients for form and function, including the activation, regulation, and building blocks (substrates) needed for enzymes to work

EX: Zinc is the mineral cofactor for carbonic anhydrase, the enzyme responsible for synthesizing HCL

Question 3

mucus membrane support

Answer 3

Soothe tissues and bolster the protective mucus coating of the upper GI tract and intestines

EX: Demulcents – licorice root, aloe vera, slippery elm, etc.

Often used to soothe and restore mucous membranes before other approaches like increasing acidity

Question 4

tissue repair

Answer 4

Increase the supply of readily available and easily absorbed nutrients that speed the processes of cell renewal and tissue repair

EX: L-Glutamine promotes enterocyte proliferation, regulates tight junction proteins, lowers inflammation, and protects enterocytes against
cell death during high oxidative stress

Question 5

digestive stimulants

Answer 5

Elicit the body’s own digestive secretions:

EX: Digestive bitters
-Stimulate the secretion of hydrochloric acid
-Gentian root

EX: Choleretics
-Stimulate the release of bile
-ACV, turmeric, dandelion root, and dietary choline or lecithin, etc.

Question 6

replacements

Answer 6

Direct addition of digestive or hormonal compounds either synthetically produced, animal-based, or plant-based

Our goal is always to support the body’s innate ability to produce its own hormones, enzymes, digestive juices, etc (endogenous), however, there are times when supplying an outside source (exogenous) can help overcome long-term imbalances, allow the body to reset and regain its own function, or compensate for a permanent loss of function

EX: Betaine HCL, ox bile, digestive enzymes

Question 7

immune modulators

Answer 7

Directly inhibit, stimulate, or modulate the production of transcription factors on immune-related genes (influence gene expression), immune signaling compounds, and function of immune cells

EX: Nettles, quercetin: mast cell stabilizers, reduce histamine release

EX: Colostrum: produced by mammals after birth, contains immune factors like antibodies, exerts immune effects in the GI tract

Question 8

microbiome modulators

Answer 8

Directly alter microbial populations via inoculation, prebiotics, or antimicrobials

Probiotics – inoculation with living microbes
* EX: Saccharomyces boulardii reduces Clostridium difficile infection. When S. boulardii is given to antibiotic-exposed mice or patients with diarrhea, normal microbiota is re-established more rapidly
-Helps re-establish healthy symbiosis between multiple populations of beneficial microbes
-Oregano oil - broad-spectrum antimicrobial activity

Question 9

Glandular extracts

Answer 9

Not just organs – includes endocrine glands

Oral consumption is theorized to be effective based on three main categories:
-hormonal, enzymatic, and nutritive

Remains controversial in terms of hormone content, digestion of bioactive components, safety (non-standardized), etc.

Backed by biological rationale as well as traditional, anecdotal, and clinical evidence
-EX: Adrenal – low adrenal output or recovery from stress
-EX: Pancreas – serves as a glandular (endocrine) as well as a replacement because it contains pancreatic enzymes (exocrine)

Question 10

adaptogens

Answer 10

over 50 plants have been reported to fit the criteria of being adaptogenic in their action.

increase the body’s ability to cope with internal and external stresses

stimulating effects after both single-time use and prolonged use, leading to increased working capacity and mental performance under stressful and fatigue inducing conditions without increasing oxygen consumption

normalize the functions of the body irrespective of nature of stressors

no negative side effects

Ex: red ginseng normalizes stress hormone levels and has been shown to reduce visceral hypersensitivty of IBS

Question 10

The 5 R’s in restoring gut health

Answer 10

remove, replace, reinoculate, repair, rebalance

Question 11

Remove:

Answer 11

In this step, you are looking to remove stressors and irritants. This can include things like foods that directly burden the north-to-south process in some way, microbial infections or overgrowths, or foods that someone may be allergic or intolerant to. Medications may also serve as an irritant, but you want to avoid recommending someone discontinue a prescription medication without oversight by a prescribing physician. So, in this step, we may think about elimination trials or testing to help identify food hypersensitivities or intolerances, or we may consider microbiome modulators like antimicrobials and antifungals to help remove the obstacles to optimal function. It is important to know that this “removal” may be short-term. We don’t want to let our thinking get too boxed in to “remove, remove, remove.”

Question 12

Replace:

Answer 12

In this step, we want to focus on replacing key nutrients that may be missing from the diet. So, incorporating a nutrient-dense, properly prepared, whole- food diet is at the heart of this step. Also, ensuring that there is enough stomach acid, digestive enzymes, and bile being produced and secreted to ensure digestion and absorption. Adding bitters, HCl, vinegar, digestive enzymes, or bile support can be incredibly helpful to get someone back on track.

Question 13

Reinoculate:

Answer 13

Here, we are working to fortify and diversify the beneficial populations of the gut microbiota. This is where we would use probiotic-rich food and drinks like sauerkraut, kombucha, kefir, kimchi, miso, etc. In some cases, probiotic supplements will be helpful. Additionally, ensure that the diet is rich in
enough prebiotic fiber and starches to serve as food for healthy bacteria to flourish. Foods rich in prebiotics include garlic, asparagus, onions, leafy greens, whole grains (quinoa, oats), apples, flaxseed, lentils, and jicama - if tolerated.

Question 14

Repair:

Answer 14

Once we have removed obstacles, replaced nutrients or digestive aids, and started working on balancing the microbiome, it is time to work on repairing the integrity of intestinal walls. This involves adding essential key nutrients for tissue
repair like l-glutamine, gelatinous broths and/or collagen peptides, zinc, and vitamins A/C/D/E, etc.

Question 15

Rebalance:

Answer 15

In this last step, I like to think about addressing the many lifestyle factors that also play a role in optimal health. This means encouraging a client to
realize the value of good hydration, stress management, daily movement, recreation
and creative self-expression, social connection, and of course, good quality sleeping- all of which will allow the nutritional work you are doing to be effective.

Question 16

phytonutrients

Answer 16

phytochemicals

bioactive compounds found in plant foods - associated with many health benefits

~10,000 types

some top subtypes relevant to digestion: carotenoids, chlorophylls, curcumoids, organosulfur compounds, terpenes, and polyphenols

Question 17

Carotenoids

Answer 17

re, orange, and yellow pigments

beta-carotene, lycopene, lutein, and zeaxanthin

potent antioxidants

beta-carotene can reduce LPS-induced intestinal inflammation and increase the expression of tight junction proteins (barrier function)

Question 18

chlorophylls

Answer 18

green pigments needed for photosynthesis in plants

potent antioxidants

detoxification of heavy metals, environmental pollutants, and aflotoxin

anti-inflammatory properties and promote the healing of wounds and support tissue regeneration

act as internal deodorant

Question 19

curcuminoids

Answer 19

includes curcumin

possess antioxxidant, anti-inflammatory, and potentially anticancer properties

reduced relapse rates and symptoms in patients with IBD (crohns disease and ulcerative colitis)

Question 20

organosulfur compounds

Answer 20

sulfur containing phytonutrients in alliums (garlic, onion, shallot) and cruciferous vegetables (broccoli, cauliflower brussel sprouts)

include allicin and sulforaphane

antioxidant, anti inflammatory, and potential anti cancer effects

can be clinically useful in SIBO and have roles in detoxification and immune regulation

Question 21

terpenes

Answer 21

large component of the essential oils

include limonene, linalool, and menthol

aroma and flavor

antioxidant, anti-inflammatory, and antimicrobial properties

EX: oregano’s antimicrobial properties from terpenes carvacrol and thymol

Question 22

polyphenols

Answer 22

possess strong antioxidant and anti-inflammatory properties

exert beneficial effects on the intestinal microbiota

over 8,000 known types of polyphenols widely distributed in foods

ex: flavonoid (many subtypes including anothocyanins in berries and catechins in tea and cocoa beans)

ex: flavonols (quercetin)

Question 23

polyphenols

Answer 23

secondary metabolites:
-not directly involved in the growth, development, or reproduction of the plant
-response to environmental stress
-protective properties conferred to humans when consumed
-can be toxic if consumed in excess

metabolism of polyphenols:
-microbes in the gut break down complex polyphenols into smaller metabolites that can be utilized by the body
-microbial metabolites contribute to the overall health benefits associated with polyphenols

Question 24

polyphenols impact on digestive tract

Answer 24

Prebiotic: -act as a food source for beneficial bacteria such as Bifidobacteria and Lactobacilli Microbial diversity: -associated with increased microbial diversity -ex: polyphenols in cranberry, grape, pomegranate, and EGCG from green tea boost levels of Akkermansia muciniphila which helps to promote mucosal integrity and mitigate diabetes and obesity intestinal barrier function: -individuals who consumed a polyphenol rich diet exhibited reduced levels of zonulin (a marker of intestinal permeability), higher levels of short chain fatty acids such as butyrate, and reduced levels of pathogenic microbes antimicrobial effects: -inhibit the growth of harmful bacteria or pathogens

Question 25

Herbs & Spices

Answer 25

used across time and cultures to promote healthy digestion herbs: the leaves of a plant (fresh or dried) spices: roots, stems, flowers, seeds, and berries aid in the breakdown and absorption of nutrients provide comfort and relief to digestive system

Question 26

Herbs & spices

Answer 26

turmeric: -reduces bloating, prevents ulcers, gastric infections -reduces relapse/severity of IBS and IBD -rich in curcumin -increases microbial diversity in the gut -fatty acids and black pepper increase absorption cinnamon: -increases appetite, eases gas, burping, bloating in IBD -reduces H. pylori -rich in antioxidants and polyphenols -plays a role in blood glucose regulation ginger: -eases indigestion, reduce nausea -naturally increases digestive juices -increase peristalsis -anti-microbial and anti-inflammatory Cardamom: -healing stomach ulcers -reducing inflammation peppermint: -eases stomach discomfort and reflux -can cause transient (temporary) relaxation of LES slippery elm: -prebiotic -positively influences gut microbiota -treats heartburn/relux -increases mucous production and supports gut lining Fennel: -relieves bloating and gas -increases appetite caraway: -eases stomach cramping and nausea -dissipates gas garlic: -anti-microbial properties -contains inulin, a powerful prebiotic oregano: -anti-microbial -can be used to treat dysbiotic condition in the gut

Question 27

helping clients incorporate herbs & spices

Answer 27

help clients get more familiar + better access asking clients what they have, what are they open to trying? buying in bulk potted/planted herbs new recipes for clients: curries, roasting blends, perstos, gremolata, chimichurri

Question 28

probiotic rich foods

Answer 28

beneficial microbes aids in digestion nutrient breakdown and liberation nutrient conversion "fermentation is a health regimen, a gourmet art, a multicultural adventure, a form of activism, and a spiritual path, all rolled into one" -sandor katz

Question 29

Fermentation types

Answer 29

differ based on types of organisms, substrates, and environments Lacto-fermentation: -more lactic acid producing bacteria -requires low oxygen environment (anaerobic) Ex: kimchi, sauerkraut, kvass SCOBY: symbiotic colony of bacteria nad yeast -more acetic acid producing yeast and bacteria -form a cellulose-based biofilm Ex: apple cider vinegar, kombucha Kefir "grains" -both lactic and acetic acid producing bacteria and yeast -protein matrix called kefiran Ex: dairy kefir, water kefir grains Mycelium: mold and fungi -Ex: tempeh, miso (koji)

Question 30

Wild vs Cultured Ferments

Answer 30

Microorganisms: -Wild = naturally occurring microorganisms present in the environment Ex: lactobacillus bacteria on cabbage + salt and water -Cultured = direct inoculation with specific strains of microbes Ex: yogurt with starter culture Control: -Wild = less predictable and less control; flavor, aroma, and quality vary from batch to batch -Cultured = more control, consistent results Time and Speed: -Wild = slower fermentation process -Cultured = accelerate the fermentation process

Question 31

Purchasing Fermented Foods

Answer 31

not all fermented foods are created equal read ingredient labels: -look for probiotics low in added sugar/flavorings -organic, grass fed when possible -DIY Raw/Living vs Pasteurized -look in refrigerated section of store -metabiotics - still carry some benefits after fermentations have been cooked/killed

Question 32

Categories of Prebiotics: Fructans

Answer 32

Fructans: includes inulin and fructooligosaccharides (FOS) -Inulin: -soluble fiber -found in chicory root, jerusalem artichokes, onions, garlic, leeks

Question 33

Criteria for Prebiotics

Answer 33

1. resistant to gastric acidity and hydrolysis by mammalian enzymes and GI absorption 2. Can be fermented by intestinal microflora 3. selectively stimulates the growth and.or activity of intestinal bacteria associated with the health and wellbeing of the host selective =

Question 34

Categories of Prebiotics: Froctooligosaccharides (FOS)

Answer 34

-Froctooligosaccharides (FOS): -a group of prebiotics composed of short chains of fructose -bananas, onions, garlic, asparagus, wheat

Question 35

Categories of Prebiotics: Galactooligosaccharides (GOD)

Answer 35

Galactooligosaccharides (GOD): -made up of short chains of galactose -legumes (beans, lentils), human breast milk, some dairy products -commonly used as prebiotic in infant formulas

Question 36

Categories of Prebiotics: Pectin

Answer 36

pectin, or pectic oligosaccharides (POS). Pectins are soluble fibers found in fruits, particulary the skins of apples and citrus fruits. it can act as a prebiotic by promoting the growth of beneficial gut bacteria

Question 37

Categories of Prebiotics: starch or glucose derived oligosaccharides

Answer 37

starch or glucose derived oligosaccharides: resistant starch is a type of starch that resists digestion in the small intestine and reaches the large intestine intact, where it can serve as a prebiotic it is found in foods like unripe bananas, cooked and cooled potatoes, legumes, whole grains they are particularly good at increasing levels of bifidobacteria and SCFA in the colon

Question 38

Categories of prebiotics: beta-glucan

Answer 38

Beta-glucan: a type of soluble fiber primarily found in oats and barley it has prebiotic properties and can stimulate the growth of beneficial bacteria in the gut

Question 39

Prebiotic-rich diet

Answer 39

polyphenols (lots of colors, tea, etc). jicama, jerusalem artichokes, onions, garlic, leeks, bananas, asparagus, legumes and pulses, whole grains, apples, pears, berries, citrus (rind), unripe bananas/plantain, cooked and cooled potatoes, cactus (nopales), chicory root products Excess may cause issues for some IBS, SIBO

Question 40

low-FODMAP diets

Answer 40

fermentable oligosaccharides, disaccharides, monosaccharides, and polyols in context of healthy system = beneficial to gut health in context of dysbiosis or digestive disorder = can feed pathogenic/opportunistic overgrowth and exacerbate symptoms low FODMAP diets often used to reduce symptoms in =IBS or SIBO helpful in reducing symptoms of gas, bloating, abdominal pain, diarrhea, and constipation long term use can reduce diversity and the amount of beneficial bacteria in the alrge intestine ideally used as short term approach to symptom management only

Question 41

low-FODMAP diets

Answer 41

Three phases Elimination phase: -all high FODMAP foods are restricted from the diet for a period of 2-6 weeks Reintroduction Phase: -individual FODMAP groups are systematically reintroduced -tracking specific triggers of symptoms -goal: identify personal tolerance to different types and amounts of FODMAPs (vs blanket elimination) Personalization phase: -diet is tailored to each individuals specific tolerances and preferences

Question 42

food first approaches to support digestion

Answer 42

previously: -phytonutrients & polyphenols -herbs & spices -probiotic rich foods -prebiotic rich foods this video: -mushrooms -leafy greens -broths/peptides -healthy fats -vinegars and citrus -water

Question 43

Mushrooms

Answer 43

consumed as food and medicines throughout human history nutrient dense: B vitamins, vitamin D, calcium, magnesium, zinc, iron, selenium, potassium, manganese, copper, phosphorous rich in phenolic compounds: anti inflammatory, antioxidant, anti cancer properties fiber content boosts gut health

Question 44

mushrooms: 3 kinds of fiber

Answer 44

Chitin, Chitosan, Beta glucans support growth of beneficial gut bacteria strains (bifidobacterium, lactobacillus, akkermansia, bacteroides) reduce inflammatory microbes like H. pylori and c. Difficile reduces firmucites to bacteroides ratio supports integrity of gut barrier increase SCFA byproducts butyrate and propionate support integrity of gut-barrier

Question 45

mushroom types

Answer 45

white button cremini portabella shiitake oyster morels porcini chantrelle reishi lions mane turkey tail chaga

Question 46

leafy greens

Answer 46

bitter greens stimulate the release of salivary amylase, stomach acid, bile, digestive enzymes high in folate folate: -required for cell growth and repair -folate deficiency can manifest as GI issues -folate deficiency recognized as risk factor for inflammatory GI conditions insoluble cellulose fiber in cell walls sulfoquinovose: unique carbohydrate in greens acts as a prebiotic rich in other beneficial micronutrients like potassium and phytonutrients like chlorphyll high in oxalic acid content -may be more of a concern for those with kidney disorders and possibly thyroid conditions -reduced by stemming/boiling

Question 47

how do you incorporate

Answer 47

kale spinach collard greens beet greens dandelion greens artichoke leaf cabbage watercress arugula mustard greens broccoli broccoli sprouts brussels sprouts bok choy romaine cooked leafy greens are easier to digest than raw forms

Question 48

bone broth

Answer 48

found in traditional diets worldwide liberates nutrients that are otherwise difficult to access great use of kitchen scraps contains vitamins and some minerals - increased with vegetables and sea vegetables glucosamine and chondroitin - joint health proteins and amino acids

Question 49

Collagen, Gelatin, and Collagen Peptides

Answer 49

Collagen protein: -the most abundant form of protein in the human body -found in connective tissues, bones, tendons, ligaments, and skin of animals -many subtypes -provide structure to skins, organs, joints, bones, and help regulate cell proliferation, migration, and differentiation Gelatin: -produced by cooking collagen-rich animal tissues in water -gelatin rich broth turns to jelly when it is cooled Collagen peptides: -hydrolyzed collagen or collagen hydrolysate -created with the addition of enzymatic aid -smaller peptides/lower molecular weight compared to gelatin -more soluble, can be mixed into cool liquids offer similar health benefits due to their high content of amino acids, such as glycine, proline, and hydroxyproline -powders can also be great additions to soups, hot teas -all dietary protein is important for structure and function of digestive tract

Question 50

Healthy fats: omega 3's

Answer 50

promote levels of bifidobacterium, akkermansia, and lactobacillus suppress e.coli and LPS increase SCFA production maintain integrity of gut lining salmon, mackerel, herring, sardines, walnuts, flax, chia

Question 51

healthy fats: extra virgin olive oil

Answer 51

increases bacterial diversity -bifidobacterium, lactobacillus, bacteroides reduces levels of opportunistic pathogens boosts production of SCFAs -reduces inflammation and improves gut barrier function higher polyphenol content linked to many of the benefits

Question 52

healthy fats: grass fed dairy fat

Answer 52

contains butyric acid (form of SCFA butyrate) -feeds the cells of the colon -butyrate alleviates some symptoms of IBD conjugated linoleic acid -anti-inflammatory ghee: removes dairy solids (proteins and sugars) and reduces intolerances

Question 53

vinegar and citrus

Answer 53

vinegar: -fermentation of a liquid containing alcohol into acetic acid -contains trace vitamins, mineral, amino acids, and polyphenolic compounds -acetic acid: increase stomach acid production and help lower pH of the stomach, indirectly increase bile excretion caution with acids: -may exacerbate ulcers or inflamed mucus membranes (focus on soothing inflammation first) -risk for tooth enamel erosion -quick mouth wash, dilution, straws, or using dehydrated vinegar in capsules lemon: -similar pH and nutritional benefits, aids in liver detoxification -maybe more tolerated than vinegar due to taste, sensitivity to base fruits, vinegar has higher histamine levels, or yeast sensitivity

Question 54

water

Answer 54

hydration is essential for digestion dehydration contributes to ulcers, reflux, constipation, bloating, nausea, bad breath, reduced saliva water is best sipped throughout the day be mindful not to dilute stomach acid during meals, or 30 minutes before or after

Question 55

supplements for digestion: upper GI

Answer 55

Upper GI: soothing + tissue repair in stomach mucosal membrane vitamin U -s-methylmethionine (SMM), high in cabbage -helps speed the healing of stomach ulcers vitamin A -anti-oxidant and help with cell regeneration Gamma Oryzanol -lipid extract from rice bran -reduce symptoms of stomach pain and inflammation Zinc Carnosine -acts as an antioxidant in the digestive tissues -speed the healing of peptic ulcers Mucogenic herbs: contributes to protective membrane -aloe vera, okra, marshmallow root, asian plantain, slippery elm bark -licorice root- reduce inflammation and increase protective mucous in the upper GI -lozenge and tea forms make contact with the esophagus -DGL or deglycyrrhizinated licorice to avoid adverse reactions (blood pressure) Melatonin -anti inflammatory, supports LES, can help reduce the occurrence of acid reflux and GERD L Glutamine: (see small intestine)

Question 56

supplements for digestion: upper GI

Answer 56

upper GI - stimulants for gastric secretions Bitters: -stoke the fire of digestion -tinctures, teas, or raw herbs -contact with taste buds to maximize effects Ex: gentian root, bitter melon, artichoke leaf, burdock root, dandelion, cinnamon Zinc: -mineral cofactor for carbonic anhydrase enzymes which are needed for stomach acid production

Question 57

supplements for digestion: upper GI

Answer 57

Upper GI - acid replacements dehydrated vinegar: -can be found in capsules for supplementation -minimized acid contact with mouth/esophagus hydrochloric acid: -made by parietal cells of stomach, available in supplment form -often found paired with pepsin, a protein digesting enzyme -powerful digestive aid and north to south trigger -requires practitioner and client education for safety

Question 58

Supplements: Liver & Gallbladder

Answer 58

Liver / Gallbladder: bile production / gallbladder health aforementioned northern digestive stimulants Bitters: -bile production and release Vitamin C (ascorbic acid): -enzyme cofactor required to turn cholesterol into conjugated bile acids -can reduce total serum cholesterol and triglycerides -improves bile consistency and reduce symptoms in patients with gallbladder stones Taurine: -incorporated into bile salt, increases the emulsifying quality of the bile -increases fecal bile salts -improves serum lipid markers Pancrelipase (porcine) -lipase enzymes aid with emulsification and digestion Beets: -contains betaine -helps with bile viscosity and acts as a methyl donor in the phase 2 detoxification Phosphatidylcholine -solubilizes cholesterol in bile -help maintain proper bile viscosity and flow

Question 59

Supplements: Liver & Gallbladder

Answer 59

Liver & gallbladder - bile replacement Ox bile: -sourced from cattle -bile salts act as an enzyme aid and a fat emulsifier to aid in the absorption of dietary fats and fat-soluble nutrients, help manage cholesterol homeostasis, and suppress the overgrowth of bacteria in the small intestines long term gallbladder issues and poor bile output, or who no longer have a gallbladder used with higher fat meals

Question 60

Supplements: Pancreas

Answer 60

Pancreas - enzyme replacements animal sourced: -known as pancrelipase or pancreatin -glandular extracts of amylase, lipase, and protease (majority proteases) Plant sourced: -Ex: bromelain (pineapple) and papain (papaya) Microbe sourced: -can provide a broader spectrum of digestive activity (protein, carbohydrates, fats, fibers) Enzyme adaptation: -the concern that external enzyme supplementation may downregulate endogenous production -not much evidence for concern with moderate doses and periodic use

Question 61

Supplements: small intesine

Answer 61

Small intestine: soothing + tissue repair in small intestine mucosal membrane all of the aforementioned supports similar nutrients to those that we mentioned for supporting mucosal membranes of the upper GI (s-methylmethionine, vitamin A, gamma oryzanol, zinc, mucogenic herbs) L-glutamine: -amino acid -reduces intestinal permeability -speed up healing of peptic ulcers -normalizes the immune response and reduces inflammation -plays an important role in maintaining healthy gut microbiota diversity -improves gut barrier integrity by increasing. mucus production in the GI tract -available in capsules or powder form hydrolyzed collagen

Question 62

Supplements: intestines

Answer 62

intestine - immune factors Colostrum: -first milk after giving birth, rich in immune factors -dehydrate powder from goat or cows milk -protects against pathogenic infections and reduces leaky gut Quercetin: -reduces the release of histamine = lowers inflammation and tissue permeability in the gut Zinc and vitamin A: -speed tissue repair -support healthy levels of secretory IgA (peyer's patches) and T-regulatory cells: -sIgA deficiency s linked to allergic disorders, food intolerances, and susceptibility to dysbiosis and infection -deficiency in zinc and vitamin A linked to sIgA deficiency -vitmain A helps balance between Treg (pro-tolerance) and Th17 (pro-inflammation, tissue destruction)

Question 63

Supplements: large intestine

Answer 63

large intestine - prebiotics all of the afore mentioned supports found in probiotic formulas - extend the life of the probiotics synbiotics = formulas with pre + probiotics availability in food reduces need for supplemental may benefit those with severe GI issues who cant tolerate prebiotic foods Ex: acacia fiber, 100% soluble fiber may exacerbate some forms of dybiosis (SIBO) start slow and gradually increase as tolerated

Question 64

supplements: large intestine

Answer 64

large intestine: probiotics food sources first probiotic supplement allows for a more controlled, targeted approach many forms, strengths, single strains of bacteria vs multiple strains how to select the best probiotic? -research by condition -humans evolved to have thousands of different strains living in the intestines see reference materials for guide to researching and evaluating the evidence for the use of different strains with different conditions

Question 65

supplements: large intestine

Answer 65

large intestine - microbiome modulators/antimicrobials caution: risk for damaging beneficial populations with long term/excessive use -start low, slow, cycle on and off -concurrent use with probiotics taken during same period, different types of day Monolaurin: -derivative of coconut oil with strong anti-fungal activity -disrupts biofilms and can increase efficacy of other antimicrobial supplements Berberine: -plan alkaloid with strong, broad spectrum antimicrobial activity -lowers glucose, effective in non-alcoholic fatty liver disease due to impacts on microbiome Oregano: -antioxidant, broad spectrum antimicrobial

Question 66

supplementsL large intestine

Answer 66

large intestine - colonocyte energy and colonic transit all of the aforementioned supports. first, consider any supportive nutrients that worked well for upper GI and/or liver/gallbladder and pancreas short chain fatty acids -nutyric-cal-mag magnesium: -relaxes muscle fibers and hydrates stool -magnesium citrate most commonly used for constipation water: hydrates stool thyroid: full panel recommended for clients with constipation

Question 67

Types of Food Reactions

Answer 67

Immunologic: IgE allergies Ex: Peanut allergy rapid onset, allergic type symptoms Non-IgE hypersensitivities (IgG, IgA related) Ex: non-celiac gluten hypersensitivity slow onset, systemic and digestive symptoms Non-Immunologic: Functional intolerance (digestive) Ex: lactose intolerance primarily digestive symptoms

Question 68

Elimination Trials

Answer 68

an eating strategy that omits certain foods or food groups that are believed to be the potential cause of an adverse food reaction or other symptoms "trial" vs "diet" connotates temporary eating pattern designed to provide actionable information goal is to link reactions or symptoms with thw foods consumed two main phases: -elimination -reintroduction

Question 69

Elimination Phase

Answer 69

the more reactive foods removed in one trial, the more likely to clear results strict elimination for a minimum of 4-6 weeks to get baseline large elimination can be stressful, minimize eliminations with: -pregnant and lactating people -children -high stress circumstances -active or a history of eating disorders educate clients on food labels / hidden sources common reactive foods: gluten, dairy, eggs, soy, peanuts, shellfish, tree nuts, corn, and nightshades

Question 70

Reintroduction phase

Answer 70

prepare your client for reintroduction ahead of time: -written plan for reintroduction -food journal to record the process reintroduce over 3 days before moving to next food Be specific! Example: -use foods in their pure form (corn vs cornbread) -low lactose dairy vs higher. is it lactose sugar or dairy proteins? -milk and cheese separately -egg whites vs yolks -chicken vs duck eggs

Question 71

efficacy of elimination trials

Answer 71

some non-IgE reactions can normalize after 6 months to 2 years of elimination, but some may remain active longer true allergies and autoimmune triggers (gluten in celiac) should not be reintroduced evidence supporting elimination trials for many conditions including IBS, eosonophilic esophagitis, ADHD, skin conditions, arthritis, migraines, and more Free. Accessible within scope of nutritional therapy practitioners

Question 72

gluten free diets

Answer 72

celiac disease - a gluten free diet is necessary non-celiac: gluten containing foods can be a trigger -FODMAP content -sensitivity to prolamins in cereal grains -metabolic concerns with the high starch content of grains -complex immune interactions -presence of glysophate in wheat -increases zonulin levels and intestinal permeability in the gut -autoimmune thyroiditis however, going gluten free needs not be a blanket recommendation for the general population. many people can tolerate it

Question 73

dairy free diets

Answer 73

two things to distinguish: 1) lactose intolerance: inability to digest the sugar (lactose) 2) immunological response to dairy proteins Lactose intolerance (functional intolerance): -lactase enzyme deficiency in the small intestine -primary: no other GI issues -secondary: consequences of other gastrointestinal conditions. -low lactose dairy may be tolerated, and supplementation with exogenous lactose enzymes can reduce symptoms Dairy allergy or hypersensitivity (immunological reaction): -adaptive cells of the immune system reacts to proteins in milk -A2 certified cows produce different casein protein -goats milk products

Question 74

Low Lectin / low oxalate diets

Answer 74

referred to as "anti-nutrients" lectins: proteins that bind to carbohydrates, found in all plant foods agglutination: clumping effect, immune stimulant can be largely inactivated by cooking and enzymes Concerns: -bind to intestinal cells, trigger inflammations -impact intestinal permeability and tight junctions interference with absorption of key minerals (calcium, iron, zinc, phosphorous) is more relevant in super high lectin/low micronutrient diets lectin-containing foods also contain health promotion nutrients like prebiotic fibers and polyphenols

Question 75

Low Lectin / low oxalate diets

Answer 75

oxalates: -similar concerns as with lectins -can increase risk for kidney stones -some high oxalate foods are also power anti-inflammatories proper food preparation can reduce content: -soaking, sprouting, fermenting, boiling, steaming bio-individuality

Question 76

low histamine diet

Answer 76

we need histamine for many functions ~1% of the population experiences histamine intolerance inability to properly break down histamine histamine comes through three main pathways: -mast cell activation: immune cells that release histamine when activated -bacterial metabolism: byproduct from histidine (amino acid) consumption. Ex: enterobacter, citrobacter, morganella -dietary intake: aged cheeses, fermented foods, cured meats

Question 77

histamine metabolism

Answer 77

diamine oxidase (DAO): enzyme that degrades histamine low histamine diet: avoids histamine containing foods, foods that trigger the release of histamine in the body, and foods that block DOA activity: -alcohol, fermented foods & drinks, avocados, eggplant, spinach, some fish & shellfish, aged cheese, cured or processed meats, bananas, tomatoes, beans, papaya, chocolate, citrus, nuts, vinegar, and food dyes -black and green tea may also block DAO production food freshness: histamine may be reduced DAO supplements are available mast cell stabilizers refer for testing with primary care provider

Question 78

popular therapeutic diets

Answer 78

bio-individuality: there is no one-size-fits-all diet adaptability and resilience: -our goal is to reduce fear of food, and increase dietary diversity and resilience -components that may potentially have a downside exist in every food - we evolved to adapt/hormetic stressors Disordered eating: -any type of elimination does carry some risk for triggering restrictive forms of disordered eating -food restriction is not the only way to better health nutrient diversity: -diets that eliminate large food groups can be high in certain nutrients and low in others Evidence changes: -research is never done -stay flexible and open-minded

Question 79

lifestyle support strategies

Answer 79

relate back to supporting the parasympathetic state mindful eating: -slow down and sit down -attend to tastes and textures -turn off distractions and devices chew properly -mastication -signals lower organs to prepare for digestion manage stress -stress associated with numerous GI conditions -stress takes resources away from digestion -help clients find practices that work best for them move your body -improved gut transit time, reduced constipation, improves postprandial glucose -lowers inflammatory compounds, normalizing stress response, improving circulation -simple/gentle movement can work remove unsupportive habits smoking: -associated with reflux, ulcers, GI cancer, ulcerative colitis -disrupts microbiome alcohol: -increases acid production -GI inflammation -disrupts the microbiome late night snacking -associated with reflux -interrupts fasting time needed for GI rest and renewal -interruption of MMC

Question 80

Vagal Nerve Stimulation

Answer 80

improves gastric motility, reduces symptoms of IBS, normalizes stress response -diaphragmatic breathing -laughing and socialization -gargling, singing, humming -manual therapy: massage, acupuncture, acupressure -cold water exposure -meditation build a referral network to serve your clients best

Question 81

Providing recommendation guidelines

Answer 81

comprehensive guidelines = educate your client on not just what, but also how and why what potential reaction can you prepare a client for? course of action if they do have adverse reactions: -temporarily stop the intervention to see if the symptoms resolve -lower the dose/frequency what concern/sign/symptoms were highly related to the recommendation and how could the supplement affect their physiology? if recommending more than one, do they start all at once? which one to start first and when to add the next?

Question 82

general + tailored guidelines

Answer 82

example of general supplement guidelines: -put a few days of space between dietary changes and supplement changes -begin only 1 supplement at a time -work up to full amount, increasing by 1 every 1-3 days -if at any point prior to the full amount you feel you've reached your ideal dose or experience a reaction, stop increasing and let me know additional guidelines per supplement increase guidelines for increased risk for irritation or adverse reaction

Question 83

Herxheimer reaction & first pass metabolism

Answer 83

Herxheimer reaction: -rapid die off of certain microbes -drastic reduction in carbohydrates, increase antimicrobials, or beginning probiotics -aggressive eradication protocols should be done with trained practitioners First-pass metabolism -a large portion of the nutrient rich blood coming from the intestinal venous system goes to liver first -allows the liver the chance to filter and process whatever is coming in -liver will feel the effects

Question 84

Prioritization

Answer 84

complex client = more important to come back to the foundations attend to the "low hanging fruit" or shiny new objects first greatest benefits for the least effort, cost, and risk: -what would have the greatest potential to benefit more than one foundation or sign/symptom at the same time? -is there one recommendation that could potentially reduce more than one symptom? -when considering supplements, which ones could easily be attained with therapeutic foods rather than a supplement? -is there a more affordable approach to try first? -are we following our north to south cascade?

Question 84

stay flexible

Answer 84

the path to health is not a straight line but Is instead more of a dance respect for bio-individuality err toward caution, rather than advocate for someone to push through the symptoms two people with same issues may do best with different approaches

Question 85

Case study: susan

Answer 85

primary concerns listed: -weight loss -lack of focus, motivation, fatigue -feels her depression has increased -irritable before meals, and sleepy after meals -upper GI symptoms: periodic heartburn, bloating, and a feeling of excessive fullness after meals -chronic constipation -craves sweets, but feels worse after eating -recurrent yeast infections -stress level is 7-8 -diet consists of a lot of grab and go snack foods high in carbohydrates, pastas, deli sandwiches, and some salads with limited protein and fat where do we start? symptoms may indicate low signaling and HCL production in the upper GI tract, overgrowth of yeast, slow motility - where to start? -not just what, but how is she eating? parasympathetic tone -factors that impair HCL production or LES function -culinary ways to support acid production (apple cider vinegar, sour and bitter foods) -move toward more nutrient dense, properly prepared, whole food diet -reduce refined carbs and incorporate lacto-fermented veggies -focus on simple & easy options -compromise on homemade vs store bought with staples like broths and ferments Next month: -symptoms generally improved, but some shifted -eating more fats in place of carbohydrate = developed more lower intestinal symptoms -discover history of gallbladder removal: -reassess macronutrient balance /add liver and bile support-consider ox bile with higher fat meals /review dietary fat quality /which types of fats are most/least upsetting /which fats might be most beneficial for susan in particular? ex: coconut oil can provide energy but also have an anti-fungal effect Another month later: -continued improvement -slight increase in sweets = candida symptoms -60 day low carbohydrate + boost antifungals /eliminate all grains and sweeteners /moderately limit sweet fruits and starchy veggies /incorporate culinary anti-fungal herbs and spices /add monolaurin-based supplement /add broad spectrum probiotic

Question 86

supportive approaches

Answer 86

build on small cumulative steps relies on assessing progress, and pivoting as needed aligns with our N>S process supports multiple parts of the digestive process conservative use of supplements, emphasizes food first approach supports more than one foundation lowers symptoms burden does not take place of appropriate medical care as needed