Nutrition Based Gastrointestinal FunctionDysfunction

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Nutrition Based Gastrointestinal
Function/Dysfunction
Autism One 2006 Conference - Chicago

• Peta Cohen, MS RD
• 11 North Dean Street
• Englewood, NJ 07631
• [phone]
• May 26, 2006

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Nutrition/Gastrointestinal Related Symptoms

• Low oral motor tone
• Dysmotility
• Reflux
• Constipation
• Diarrhea
• Maldigestion
• Malabsporption
• Leaky Gut
• Dysbiosis
• Bacterial
• Yeast
• Gas
• Altered Stools

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Nutrition/Gastrointestinal Based Behaviors

• Food aversions/avoidance/cravings
• PICA
• Posturing
• Drunken stupor
• Poor proprioception
• Toe walking/wide flat gait
• Self-stimulatory behavior, scripting
• Aggression toward self others
• Altered sleep
• Hyperactivity/sensory seeking behaviors
• Lethargy
• Anxiety/depression/irritability

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GI Facts

• Mouth to anus the GI tract is about 30 feet
• Small intestine is approximately 25 feet
• Surface area of SI equates to that of a tennis
  court
• SI is primary site of chemical digestion
• The epithelial layer of the GI is replaced every
  4 days
• Space between cells referred to as tight junctions

• GI tract is host to 80 of bodys total immune
  system
• GALT/MALT
• Gut ecology
• 100 trillion organisms
• Enteric nervous system is larger than CNS
• Vitamin synthesis
• Vitamin K
• Biotin
• First pass/Phase 3 Detox
• Metallothionein proteins

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GI FACTS

• Two types of digestion
• Mechanical
• Chewing, swallowing
• Peristalsis
• Chemical
• HCL, Sodium bicarbonate
• Enzymes
• Function is pH sensitive
• Accessory organs support gut function
• Pancreas
• Liver
• Gallbladder

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Gastrointestinal Function

• Sequence of Events
• Ingestion gtgt chewing moistening of food gtgt
  swallowing gtgt peristalsis gtgt acidifying gtgt
  initiation of protein digestion gtgt neutralization
  gtgt digestion gtgt absorption gtgt assimilation gtgt
  fermentation putrification gtgt elimination

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Maldigestion

• The inability to adequately digest ingested food
  due to
• Insufficient enzyme production
• Inadequate contact between enzymes and food
• Inappropriate pH
• Assessment
• Observation of stool
• Presence of undigested food particles
• Floating stool
• CDSA
• Chymotrypsin, Pancreatic elastase
• Long chain fatty acids
• Meat and vegetable fibers
• Natural Remedies
• Digestive enzymes
• Proteases, Lipase, Carbohydrate enzymes
• Betaine HCL, Sodium Bicarbonate

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Dysmotility - Reflux

• Symptoms
• Frequent ear and upper respiratory infections
• Night time waking
• Chronic cough
• Food avoidance
• Aggression/irritability
• Dietary Recommendations
• Avoid trigger foods
• Small frequent meals
• Promote adequate digestion

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Dysmotility - Reflux

• Pharmaceutical Interventions
• Proton pump inhibitors/H2 antagonist
• Bethanacol
• Natural Remedies
• Glutamine, DGL, Aloe, Mastica, Slippery elm,
  Marshmallow root
• Investigate food allergies, leaky gut, dysbiosis,
  H. Pylori

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Dysmotility - Constipation

• Symptoms
• Large hard stools
• Small pebbles/pellets
• Infrequent stools
• Very dry stools
• Straining to eliminate
• Foul breath/body odor
• Bloated belly
• Gas
• Irritability, spaciness

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Dysmotility - Constipation

• Dietary Recommendations
• Increase intake
• Fruits (be careful with dysbiosis)
• Vegetables
• Fiber
• Flaxseed
• Fluids
• Water
• Fat
• Essential Fatty acids

• Pharmaceutical Interventions
• Enema
• Glycerin suppository
• Benefiber
• Laxative
• Miralax (polyethylene glycol)

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Dysmotility - Constipation

• Natural Remedies
• Investigate opioid excess, food allergies,
  dysbiosis
• Aloe
• Buffered C
• Magnesium citrate
• NAG
• EFAs

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Dysmotility - Diarrhea

• Symptoms
• Frequent stool
• Loose stool
• Liquid to mooshy
• Very odorous stool
• Yellow, green and other color stool
• Urgent stool
• Soiling
• Dietary Recommendation
• Address
• food allergies/sensitivities, dysbiosis,
  maldigestion, malabsorption
• Initiate the right diet
• GFCF, corn and soy free, allergen free, SCD, BED,
  LOD

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Dysmotility - Diarrhea

• Pharmaceutical Interventions
• Address
• Maldigestion, malabsorption, inflammation,
  dysbiosis
• Treat with
• Anti-inflammatories, Anti-fungals, Antibiotics,
  Anti-parasitics, Secretin
• Natural Remedies
• Dietary fiber
• Benefiber
• Digestive enzymes
• Lipase, proteases, carbohydrate digesting
• Probiotics/prebiotics
• Lactobacillus, Bifido bacteria, Sacchromyces
  Boulardi
• Botanical antimicrobials
• Oregano oil, Berberine, Garlic, Grapefruit see
  extract, Caprylic acid, Essential Oils,
  Undecylinic acid, Plant tannins,

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Leaky Gut

• Increased permeability at the site of the tight
  junctions, allows for the free passage of
  endotoxins, microbes and partially digested food
• Leaky gut occurs as a result of maldigestion,
  food allergies, dysbiosis, inflammation, and
  nutrient insufficiencies
• Contributes toward food sensitivities,
  inflammation, and infection at a distant site
  (atopy)
• Assessment
• Food allergy/sensitivity profile
• Intestinal permeability test
• History

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Leaky Gut

• Dietary Recommendations
• Promote adequate digestion
• Remove offending foods such as gluten
• Address oxalates if necessary
• Supply adequate nutrients vitamin A, zinc,
  pantothenic acid, folic acid, glutamine
• Natural Remedies
• N-acetyl glucosamine
• Glutamine
• D-glycerrhized licorice (DGL)
• Slippery elm
• Marshmallow root
• Improve sulfation
• MSM
• Glutathione

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Dysbiosis

• Metabolic activity of GI flora
• Vitamin synthesis
• Biotin
• Vitamin K
• Fermentation of undigested carbohydrates
• Development of mucosal immunity
• Commensal bacteria colonizing in the first 2
  years of life provide the environment for immune
  development
• Production of Short chain fatty acids
• Mucous production
• Bile acid deconjugation
• Detoxification
• Phase III
• Elimination

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Dysbiosis

• A condition of altered/imbalanced gut flora
• Bacterial and fungal
• Contributes to disease
• Altered nutrition status
• Altered elimination
• Altered immune response
• Autoimmunity
• Atopy
• Contributes to total body toxic load
• Endotoxins
• Deconjugated toxins

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Dysbiosis

• Assessment
• History of antibiotics, steroids, hormone
  replacement therapy etc.
• Genetics
• Illness
• HIV, Diabetes, Cancer and chemotherapy,
  Hypothyroid, Mercury toxicity
• Observation and subjective reporting
• Organic acid test
• Stool culture

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Dysbiosis

• Treatment
• Dietary change
• SCD, BED
• Promote adequate digestion
• Digestive enzymes
• Improve gut pH
• Betaine HCL, Sodium Bicarbonate
• Probiotics
• Lactobacillus, Bifido bacteria, Sacchromyces
  Boulardi
• Ant-ibacterials
• Olive leaf extract, Grapefruit seed extract,
  Plant tannins, Garlic, Goldenseal, Berberine,
  Prima Una DAgato
• Anti-fungals
• Oil of oregano, Garlic, Grapefruit seed extract,
  Caprylic acid, Undecylenic acid, Colloidal
  silver, Plant tannins, Essential oils,
• Prebiotics
• Inulin, FOS

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Inflammation

• First line of defense of the immune system
• Cell mediated immunity TH1 activation
• Humoral immunity TH2 activation
• Neutrophils are mobilized and activated in the
  gut due to
• Cell or tissue damage
• Increased permeability
• Infectious process
• Assessment
• Endoscopy, Colonoscopy
• CDSA
• Calprotectin

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Inflammation

• Dietary Recommendations
• Eliminate allergenic and other offending foods
• Choose the right diet
• GFCF, corn and soy free, SCD, BED, LOD
• Pharmaceutical Interventions
• Steroids
• 5 ASA drugs
• Singulair
• Natural Remedies
• Use natural anti-inflammatories
• Quercetin, Bromelain, Prima Una DAgato,
  Boswellia Serrata, EFAs
• Promote adequate digestion
• Digestive enzymes
• Address Leaky gut
• Treat Dysbiosis

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Dietary Modification

• Clean up the diet
• Organic, fresh seasonal foods,
• Avoid hydrogenated fats
• Avoid high fructose corn free
• Avoid artificial sweeteners
• Avoid dyes and flavors
• Avoid preservatives
• GFCF
• Corn and soy free
• Allergen specific free
• SCD
• BED
• LOD

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Nutrient Supplementation

• Supply adequate amounts of
• Minerals
• Vitamins
• Essential fatty acids
• Antioxidants
• Digestive enzymes
• Immune support nutrients
• Botanical anti-inflammatories
• Botanical anti-microbials
• Probiotics and prebiotics
• Methylation and sulfation support nutrients
• Brain support nutrients
• Detoxification support nutrients

• Consider Additional Therapies
• PK flush
• Chelation
• Far Infra Red Saunas
• HBOT

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Thank You!