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Functional Med University > GI > Flashcards

GI Flashcards

1
Q

What is the signficance of Lipopolysaccharide Bacterial Endotoxin?

A

Major indicator of leaky gut
when WBC goes through phagocytosis, endotoxin is released
Can be measured in blood

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2
Q

What is a bacterial endotoxin

A

marker of transcellular leaky gut

connects gut to systemic inflammatory problems

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3
Q

What is Diamine Oxidase

A

marker of leaky gut

enzyme made in microvilli

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4
Q

What is histamine intolerance and how does it affect DAO

A

results from disequilibrium of accumulated histamine and capacity for histamine degradation- reduced Dao activity is a trigger

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5
Q

What factors contribute to histamine excess

A 
allergies
mastoycytosis
bacteria
GI bleeding
Ingestion of histidine or histamine by food/alcohol
DAO deficiency
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6
Q

Which tissue produce DAO

A

small intestine
colon
placenta
kidney

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7
Q

What is gut brain axis

A

Bidirectional relationship- influence each other

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8
Q

How does gut influence brain and vice versa

A 
regulation of mucosal immune system
GI motility
Epitherlial barrier function
Digestive and host metabolism support
Prevention of colonization by pathogens
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9
Q

What are Lipopolysaccarides

A

molecules present on surface of gram-negative bacteria that elicit a strong immune response

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10
Q

What are cytokines

A

messengers used by immune system to communicate with itself and other parts of CNS

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11
Q

What is the gut barrier’s function

A 
tight junctions
important as outside world goes in
located between cells
prevents paracellular flow
50 different proteins
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12
Q

What triggers reduced barrier function

A

Stress- physical and mental
Environment- chemical- medications and pollution
Dietary- Gluten, Dairy, food sensitivities, Alcohol, Poor diet

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13
Q

How does stress weaken the gut barrier

A

activates autonomic nervous system
primarily activates the sympathetic nervous system
SNS displays mild anti-inflammatory prosperities in the gut
Stimulates Secratory IgA

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14
Q

What is Secratory IgA

A

antibody produced in mucosal lining and role in immunity

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15
Q

How does SIgA help immune system

A

neutralizes pro-inflammatory antigens
down regulation is associated with stress and negative repercussions
Immunosuppressive effects of stress on SIgA can be attenuated by activating peroxisome proliferator activated receptors

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16
Q

What are some diet considerations regarding gut barrier

A

High fructose has negative role
Western diet in of itself can increase Lipopolysacharides
General Western diet not good for health of gut

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17
Q

How do nutrient deficient play a role

A

Vitamin A and magnesium- Retionic acid plays major role in experts of genes related to epithelial barrier and tight junction
Zinc- deficiency directly breaks down tight junctions and increases permeability
Vitamin D- huge in mucosal barrier function: preserve junction complexes and stimulate renew of epithelial cells, modulate immune function

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18
Q

How does GI induced inflammation affect Central Nervous system

A

mood disturbances and fatigue can be induced by LPS

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19
Q

What 2 disorders have been shown to be higher in LPS

A

depression and anxiety

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20
Q

What factors contribute to increased LPS

A

Obesity
High insulin, triglycerides and Cholesterol
Diabetes

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21
Q

What does LPS induced cytokines cause?

A

altered neuronal activity in amygdala
exitoxicity in neuron
increase in activty

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22
Q

How are inflammatory cytokines formed

A

systemic cytokines induce the production of immflamatoy cytokines in CNS via microglial activation

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23
Q

What happens if microglial is overactivated

A

potential for neurodegeneration

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24
Q

How do altered cytokines alter neurochemistry

A

cytokines act on central sites where blood brain barrier is weak or causes breakdown of blood brain barrier
Cytokines transported by selective transports by BBB
act on peripheral nerves that send information to CNS
eventual changes in mood, behavior and cognition

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25
Q

How to control this process and keep in appropriate range

A 
reduce SIBO
reduce endotoximia
reduce inflammatory cytosine production
Reduce intestinal barrier function
Improve BBB integrity
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26
Q

What is successful treatment for those with altered neurochemistry

A 
Exercise:  30-60 mins 4x a week- most effective
Reduce food sensitivities
Optimize gut health
Stool tests
Supplements
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27
Q

How to reduce cytokine production

A

Vitamin D
SOD- superoxide dismutase
Omega 3
Lipoic Acid- BBB stabilizer

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28
Q

How does zonulin affect autoimmunity

A

opens spaces between cells of intestinal lining
Leaky gut present- spaces allow larger protein molecules to get into blood stream
Body is prime to react to those proteins

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29
Q

Causes of intestinal permeability

A 
IBD
NSAID therapy
SIBO
Celiac
Protzoal infections
Food Allergy
Chronic Alchohoism
Diarhea
Exercise
Increasing age
Nutritional Depletion
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30
Q

Factors contribute to autoimmune disease

A

Genetics
Environmental factors
Gut dysbiosis

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31
Q

What percent of genetics play a role in autoimmunity

A

30%

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32
Q

What environmental factors play a role in autoimmunity

A
  1. )Infections and toxins
  2. )Smoking
  3. )Chemcial toxicants: aluminum, silicone Tobacco, Glyphosate, Bisphenoal A
  4. ) Heavy Metals: mercury, infectious agents
  5. ) Emotional stress
  6. ) Drugs
  7. ) elevated lipid profile
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33
Q

How does the gut affect autoimmunity

A 
foods have gone transformation: new strain of grain- wheat, rice, soy and corn
more GMO in US than rest of the world
more chemical use
Dairy cows injected with hormones
chemicals in food
artificial sweeteners
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34
Q

what is a clean diet

A 
local and home grown
avoid refined oil
limit alcohol and caffeine
avoid allergens
avoid toxic food- farmed atlantic salmon, high mercury fish, non-organic dairy and eggs, dirty dozen fruits and veggies-
organic as possible
sugar free
GF, DF, non-GMO
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35
Q

What is the Enteric Nervous System

A

primarily responsive for Motility, ion transport and blood flow in GI
has more neurons than spinal cord

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36
Q

What are the laws of the intestines

A 
parastolic reflex
vast chemical warehouse- every class of neurotransmitter found in the brain is in the gut
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37
Q

What percent of serotonin is found in the gut

A

95%

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38
Q

What are Peyer’s patches

A

regulatory site for defense of foreign invaders in GI

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39
Q

What is immunoglobulin A

A

antibody playing critical role in immune response

provides first response to antigens ingested

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40
Q

Where is immunoglobulin A found( SigA)

A

in mucosal secretion

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41
Q

Are SigA inflammatory?

A

No, signal help from igG and IgE and then inflammation begin as phagocytes are called in and produce inflammatory response

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42
Q

Which system is responsible for sIgA?

A

Adrenals- specifically cortisol

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43
Q

Why to do stool testing

A

Look for beneficial bacteria as well as any dysbiosis, and other issues within the gut

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44
Q

What are some bacteria pathogens commonly found in stool testing

A

H. Pylori
C Diff
Campylobacter
E coli

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45
Q

what does a stool test with below levels mean?

A

increased susceptibility to pathogenic bacteria

Increased toxic enzyme exposure

46
Q

What are interventions for pathogens found in stool testing

A

ID cause of depressed bacteria

Provide probiotic support- lactobacillus acidophilus, bifidobacterium

47
Q

What are common digestive markers

A

Elatase
Triglycerides and incomplete fat digestion
Putrefactive SCHA- signifies undigested protein if high

48
Q

What is elastase

A

Pancreatic enzyme- typically seen with disorders such as diabetes, gallstone, and osteoporosis

49
Q

What markers are in gut immunology

A

Eosinophil Protein X- reflects inflammation and tissue damage
Calprotectin- elevated with IBD, IBS, Cancer, Food allergies
Fecal SIgA- immune systemic reaction
Anti-gliadin- gluten sensitivity

50
Q

Other markers on stool test include

A

PH levels
Occult- looks for GI bleeding
RBC count
Color

51
Q

What factors signify GI inflammation

A

Lactoferrin- iron binding- IBD not in IBS
WBC- general inflammtion
Mucus- acute GI inflammation

52
Q

What are effects on GI with lots of pathogen

A

Depletion of B12 and amino acids
Short circuit digestive enzyme
increases GI infection potential
Encourages GI inflammatory disease

53
Q

What factors contribute to disrupted flora

A 
too many sweets and carbs
overuse antibiotics
stress
poor digestion
inflammation
infection
exposure to toxins
lowered immune 
other unknown causes
54
Q

How to diagnose issues from stool testing

A

careful history
specific testing
organic acid testing
look for yeast, bacteria and parasites

55
Q

Goals for treatment of issues found from stool testing

A

restore normal flora
provide nutrients that will help
reduce toxic exposure
increase antibodies in GI tract SIgA

56
Q

What are common parasites and their presentation

A
  1. ) Blasotocytis Hominis- constipation, poor absorption, fatigue nervous, skin disorder
  2. ) Dientampoeba Faragilis- Diarrhea, fatigue, abdominal bloating
  3. ) Giardia- symptomatic to severe diarrhea
  4. ) Taenia( tape worm), asymptomatic- GI complaints vague- B12 may be decreased
57
Q

How do parasites affect the body

A

products emitted by bugs destroy and cause malabsorption

58
Q

What are organic acids and why test

A

measure acids in urine
cover microbial byproduct
provide good info for nutritional assessment, GI function, neurotransmitters and other

59
Q

What are recommended labs

A

Genova

Metametrix- atlanta

60
Q

What is specific about Benzoate

A

preservative in packaged foods- pickles, lunch meats
natural ingredient in cranberries
glycine and B5 required to remove from body

61
Q

Specifics for Hippurate

A

made as liver metabolizes bacteria

when see high levels= bacteria overgrowth

62
Q

How to remove excess benzoate

A

decrease sugar

increase prebiotic and probiotic

63
Q

How to remove excess hippurate

A

rule out high benzoate foods
increase Glycine
Increase B5

64
Q

Specifics for P-Hydorxyphenylacetate( HPA)

A

malabsorption of tyrosine due to low HCL in stomach
dysbiosis- rule out other anaerobic bacteria
lactose intolerance
malabsorption of phyenyalaine due to low HCL

65
Q

How to treat HPA

A

introduce probiotics, antibiotics- herbal and prescriptive and decrease sugar

66
Q

What is D-Lactate

A

organic acid that is neurotoxic

shows when lactobacillus audiophilus is too high- indicates iniability to absorb carbohydrates

67
Q

What is Citramalic Acid

A

metbolite of yeast- overgrowth of bacterial pathogens, clostridia

68
Q

How to treat high citramalic acid

A

antifungals, anti-yeast diet, probiotic, anti-yeast products

69
Q

What is Indoleacetic Acid- DHPPA

A

high with clostridia

70
Q

How to treat DHPPA

A

pre and probiotics, antibiotics, incorporation natural antimicrobials, decrease sugars and look for reasons for malabsorption

71
Q

What is Phenylacetic acid( PAA)

A

malabsorption of phenylalanine due to low HCL
possible gastric hypochlorohydria
suspect clostridia

72
Q

How to treat PAA

A

antibiotics, antimicrobials, pre and probiotics, decrease sugar, investigate possible malabsorption and mucosal support

73
Q

What is succinct acid

A

intermediate of citric acid cycle

key component of iron(low), riboflavin(L)- iron and riboflavin will show up low

74
Q

How to treat high succinic acid

A

correction of malabsorption, look for GF sensitivity, mucosal support agents, increase iron and riboflavin

75
Q

what is indoleacetic acid reason high

A

caused by unabsorbed tryptophan- from possible hypocholohydria

76
Q

How to treat high indoleacetic acid

A

increase HCL, look at why malabsorption and mucosal agents

77
Q

What causes high Tartic Acid

A 
tartaric acid containing foods such as grapes, raisin and wine
Arbainose rich foods
possible joint inflammation
Hyaluronic acid
yeast
78
Q

How to treat high Tartic Acid

A

Antimicrobials, decrease sugar

79
Q

What are P-Hydorxybenzoate and P-Hydroxyphenylacetate

A

Made from antibiotics, foods

80
Q

How to treat P-hydroxybenzoate and P-Hydroxyphenylacetate

A

pre and probiotics, natural micbrocial complexes

81
Q

What is high Indican acids

A

Poor protein digestion( tryptophan)
Bacterial overgrowth in small intestine( SIBO)
Possible not enough enzymes, parasites, fungal infections, indigestion of food, hypo motility

82
Q

How to treat high indican acids

A

ID reasons for protein malabsorption

INtroudcue lactobacillus

83
Q

What is Tricarballylate

A

Connects to Magnesium, calcium and zinc- binds to these minerals and blocks them

84
Q

How to treat high tricarballylate

A

introduce pre and probiotics

85
Q

What is the Intestinal barrier function test

A

gold standard in evaluating intestinal mucosa

86
Q

What does the internal barrier function test look at?

A

dietary proteins
enteric yeast- like candida
enteric aerobic bacteria( Esherichia coli and E. enterococcus)
enteric anaerobic bacteria( bacteroids Fragilis and Clostridium)
Should look at these proteins and antigens and body will process accordingly, but when barrier damaged body unable to process and leaks into system

87
Q

Why do we test for mucosal barrier?

A

we use saliva and looks at functional status and whats compromising the environment, toxins, yeast, food sensitivities

88
Q

Posible outcomes for testing for mucosal barrier

A

Normal levles
Microflora imbalance- aerobic/anaerobic- should be 1:1
Food allergy or intolerance
Gut barrier Dysfunction
Immunodeficiecny
Test permeability- not as sensitive as intestine barrier function

89
Q

What is HPHPHA

A

an abnormal phenylalanine metabolic of clostridia- found in GI tract, urine samples from people with autism dn schizophrenia

90
Q

What is the structure of HPHPHA

A

benzine ring with 6 horizontal round- has hydro group and propionic acid and phenol group
only produced by clostridia bacteria

91
Q

How is Clostridia Dificille spread

A

by alcohol hand wash in hospitals

92
Q

What are the properties of clostridia bacteria

A

spores look like tennis rockets
strict anaerobic-die when exposed to O2
cause tetanus, diarrhea and botulism( food poisoning)
forms spores that are highly resistant to heat and antibiotics
100 species of clostridia in GI tract- not all pathogenic

93
Q

What are clostridia species that produce HPHPA precurose

A 
C. Sporogenes
C. Boulinum
C. Mangenoti
C. Ghoni
C. Bigermentans
C. Caloritolerans
94
Q

How does clostridia affect brain chemistry and behavior?

A

produces HPHPA
chemicals inhibit and deactivate enzyme dopamine beta hydroxylase so that dopamine builds up and becomes neurotoxic- which results in abnormal repetitive stereotypical behavior and agression

95
Q

How to treat increased HPHPA

A 
Vancomycin- oral
Flagyl
Lactobacillus acidophilus- or rhamnosus
IV glutathione or NAC
High protein diet( phenylalanine, tyrosine may increase production of toxic clostridia)
96
Q

What is the definition of SIBO

A

condition abnormally large numbers of bacteria are present in the small intestine leading to impairment of digestion and absorption

97
Q

What are common symptoms of SIBO

A 
bloating/abdominal Gas
Pain and cramps
Constipation/Diarrhea or both
Heartburn- methane
Nausea
Leaky Gut- food sensitivities
Neurological disorders
Malabsorption
98
Q

What disease are associated with SIBO

A 
IBS/IBD
GERD
Celiac and GS
Autism
Firbormyalgia- CFS
Interstitial Cystitis
Restless legs
Acne Rosacea
Diabetes
Hypothyroidism
Scleroderma
NASH
Cirrhosis and hepatic encephalopathy
Diverticulitis
99
Q

What is a key indicator for SIBO

A

when a patient reports dramatic transient improvement in IBS/GI symptoms after ABX Rx

100
Q

Microbes most commonly overgrowth in SIBO

A

Commensal Anaerobes- Bacteroids, Lactobacillus, Clostridium

Commensal Aerobes- Streptococcus, Escherichia Coli, Enterococcus, Staph, Lebsiella, Proteus Mirabilis

101
Q

What are preventative factors for SIBO

A

enzymes

GALT Immunity

102
Q

Which gasses are present with SIBO

A

Hydrogen, methane and hydrogen sulfide- flora produce H2 and CH4- not made by humans- excess gas causes symptoms

103
Q

Which breath test is most accurate for diagnosing SIBO

A

Lactulose Breath test as it is 100% food for organisms and can’t be absorbed in the body

104
Q

What does the SIBO breath test do

A

Measure hydrogen and methane in SI diffused into blood and exhaled after drinking sugar solution

105
Q

What is a positive SIBO breath test result

A

within first 2 hours:
Hydrogen- 20ppm over lowest preceding level
Methane=12 ppm over lowest preceding level
Combined=15 over lowest preceding level

106
Q

What is one other non SIBO condition with elevated methane

A

Methane induced constipation- CH4 levels greater than 2ppm at any time during lactulose test- 3 or above with major symptom of constipation= a cause for treatment

107
Q

What does the prep for SIBO breath test consist of

A

diet- no carbs and very specific foods
off antibiotics for 2 weeks before re-test unless doing treatment
Ideally no PPI for several days prior
lo laxatives, high dose magnesium, vitamin C for 4 days before test

108
Q

Treatment goals for SIBO

A

reduce bacteria/archaea
detox and support BB healing
Prevent relapse

109
Q

Treatment options

A 
If positive test: 
Diet- 
Elemental Diet
Prescription Antibiotics
Herbal Antibiotics
110
Q

How to prevent SIBO

A 
Diet
Prokinetics
improve possible hypochlorohydria
improve illeocecal valve function
Treat pancreatic insufficiency

Functional Med University (7 decks)

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