Guard Your Gut!, Schemes and Mind Maps of Cardiology

Download Guard Your Gut! and more Schemes and Mind Maps Cardiology in PDF only on Docsity! 4/16/2015 1 Guard Your Gut! Richard Collins, MD Susan Buckley RDN, CDE South Denver Cardiology Assoc. Guard Your Gut!  Americans spend more than $942 million dollars on over-the-counter antacids, and a whopping 13.6 billion dollars on prescription acid suppressants each year  $725 million is spent on laxative products each year in America  The cost of irritable bowel syndrome in the United States has been estimated at $1.7-$10 billion in direct medical costs, with an additional $20 billion in indirect costs, for a total of $21.7-$30 billion  Constipation is the most common gastrointestinal complaint in the United States! 4/16/2015 2 Do You Think We Have Gut Issues? Defining Digestive Health  Good digestive health indicates an ability to process nutrients through properly functioning gastrointestinal organs, including the stomach, intestines, liver, pancreas, esophagus and gallbladder.  Most people who are in good digestive health are of appropriate weight and don’t regularly experience symptoms like heartburn, gas, constipation, diarrhea, nausea or stomach pain. American Gastroenterology Association 4/16/2015 5 The Second Brain  A big part of our emotions are probably influenced by the nerves in our gut  “A gut feeling” “Butterflies in the stomach” “Sick to my stomach” when we hear emotionally troubling news  95% of the body's serotonin is found in the bowels, not the brain  70% of our immune system is aimed at the gut to expel and kill foreign invaders. Gut Complaints Constipation Diarrhea  Irritable Bowel Syndrome Gastro esophageal Reflux Disease – Heartburn Gas/Bloating 4/16/2015 6 Constipation Constipation is one of the most common gastrointestinal complaints in the United States. More than 4 million Americans have frequent constipation, accounting for 2.5 million physician visits a year Around $725 million is spent on laxative products each year in America. Chronic Constipation CC is defined as infrequent stools, difficult stool passage, incomplete evacuation, and prolonged time to pass stool for at least 3 months  Prevalence of ~15% of adults in America  Female predominance Can be caused by medications, medical conditions as well as diet 4/16/2015 7 Constipation  Fiber: 25-40 grams per day. Try for 2 cups of fruit and 2 ½ cups vegetables per day  Add Fiber slowly!  Vegetables, Fruits, Legumes, Whole Grains  Psyllium, Glucomannan, Acacia, Guar Gum increase stool frequency  Water: 6-8 8oz. Glasses per day  Tea can be constipating  Exercise often – very helpful in prevention  Limit foods high in fat/sugar Supplemental Fiber  Supplements that include psyllium are geared toward dealing with constipation by bulking up the stools.  Supplements that contain inulin and oligofructose can stimulate growth of beneficial bacteria in the intestines, which also reduces constipation. 4/16/2015 10 Other Benefits of Dietary Fiber Reduces total & LDL cholesterol  • Improves glycemic control in type 2 diabetes  • May protect against type 2 diabetes  • May help prevent colorectal cancer Helps with weight loss Fiber & Cholesterol Reduction High fiber intake is associated with a 40%- 50% reduction in the risk of CHD and stroke compared with low fiber intake  Each 10 gram increase in fiber intake/day is associated with:  14% relative risk reduction for all coronary events  27% reduction for coronary death 4/16/2015 11 Fiber and Diabetes  High glycemic load diets and a low cereal fiber content diet increase risk of type 2 diabetes  • Randomized, crossover study • 2 diets: 24 grams vs. 50 grams fiber/day with same macronutrient & energy content  • High-fiber diet associated with: – Improved glycemic control – Improved lipid profile Fiber & Colorectal Cancer Prevention  Magnitude of CRC risk reduction: 50%-75% • Dose associated with decreased CRC risk: Varies @ 25-50 grams/day  Duration of intervention associated with decreased CRC risk: 10-20 years  Type of fiber associated with decreased CRC risk: Unclear at this time – eat BOTH 4/16/2015 12 Fiber Side Effects  Abdominal bloating  • Gas  • Cramping  • Minimize side effects by:  – Starting with small amounts and slowly increasing until stools become softer and more frequent  – Increasing fluid intake  Beano, Digestive Enzymes Food Label  Total Fiber is listed under “Carbohydrates” on the food label 4/16/2015 15 Diarrhea  Limit foods and drinks that contain caffeine: coffee, strong tea and cola  Eliminate milk and milk products for a time. Use lactose free milk or soy or almond milk  Limit high fat foods: fatty meats, desserts, butter, margarine and greasy snacks  Reduce fiber for a short time  Eat several small meals rather than 1 or 2 large meals Diarrhea  If you have gas or cramping, avoid foods that increase gas like dried beans and beans, broccoli, cabbage, onions, Brussels sprouts, carbonated beverages, beer and chewing gum When diarrhea is no longer problem, resume normal diet 4/16/2015 16 Diarrhea  Anti-diarrhea medicines are often overused  Some people take them much longer than recommended as they try to end their diarrhea problems themselves, when they really should go to their doctor to find out what's causing the trouble.  The active ingredient in the most often used OTC diarrhea remedies is loperamide hydrochloride.  These medications should not be used for more than two days. Diarrhea  If diarrhea persists beyond that period, or if a fever or blood in the stool develops, a doctor should be consulted.  Loperamide should not be used in cases of suspected food poisoning from bacteria such as salmonella, e-coli, or shigella.  The pathogens that commonly cause sporadic diarrhea in adults in developed countries are Campylobacter, Salmonella and Shigella species; Escherichia coli; Yersinia species; protozoa; and viruses. 4/16/2015 17 Irritable Bowel Syndrome  Irritable bowel syndrome (IBS or spastic colon) is a diagnosis of exclusion.  It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause.  In some cases, the symptoms are relieved by bowel movements.  Diarrhea or constipation may predominate, or they may alternate (classified as IBS-D, IBS-C or IBS-A, respectively).  IBS may begin after an infection (post-infectious, IBS- PI), a stressful life event, or onset of maturity without any other medical indicators. Irritable Bowel Syndrome  Affects 5%-11% of the population  Peaks in the 3rd and 4th decades of life  Female predominance Not associated with serious disease or excess mortality Health care cost is significant Reduced quality of life! 4/16/2015 20 Probiotics  Lactobacilli –  casei  plantarum  acidophilus  reuteri  Bifidobacteria  VSL #3 (8 separate organisms: 3 Bifidobacteria, 1 Streptococcus, 4 Lactobacilli)  Saccharomyces – good for C.diff Probiotics  Live microorganisms  Help maintain natural balance in intestines  Promote a healthy digestive system  Sources: Yogurt, keifer, cultured milk products, sauerkraut, tempeh, miso 4/16/2015 21 Health Benefits of Probiotics  Can help prevent colon cancer   LDL “Bad” Cholesterol   blood pressure  Improve immune function & prevent infections  Improve mineral absorption  Prevent harmful bacterial growth in GI tract  Improvement of intestinal barrier function  Suppress pro-inflammatory cytokines  Modulation of pain perception Probiotics and their fermented food products are beneficial for health Journal of Applied Microbiology Volume 100, Issue 6, pages 1171-1185, 5 APR 2006 DOI: 10.1111/j.1365-2672.2006.02963.x http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2672.2006.02963.x/full#f1 4/16/2015 22 Shorten Duration of Intestinal Infections Treat Diarrhea Improve Symptoms of Irritable Bowel Syndrome Reduce Bladder and Urinary Tract Infections Manage Lactose Intolerance Potential Benefits of Probiotics Probiotics  Probiotics are commonly consumed as part of fermented foods with specially added active live cultures; such as in yogurt, soy yogurt, or as dietary supplements. Naturally found in fermented foods like buttermilk, sauerkraut, kefir, miso, tempeh 4/16/2015 25 Probiotics & Infectious Diarrhea  Cochrane review of 23 studies:  Probiotics reduced overall risk of diarrhea at three days by about 35%  Reduced mean duration of diarrhea by ~30 hours  Probiotics were a useful adjunct to rehydration therapy in treating acute infectious diarrhea in adults and children Probiotics & Infectious Diarrhea  5 systematic reviews: Overall reduction in duration of diarrhea by 17 to 30 hours  Probiotics were generally safe, with no serious adverse effects reported  Limited data suggest that the minimal effective dose is 10 billion colony-forming units (Lactobacillus sp.) given within the first 48 hours 4/16/2015 26 Contraindications/Side Effects  No known absolute contraindications to Lactobacillus sp., Bifidobacterium sp., S. thermophilus or S. boulardii  • Avoid in severely ill or immunocompromised people, or in children with short-gut syndrome or pancreatitis  • Occasional adverse effects: Flatulence, mild abdominal discomfort, usually self-limited  • No known interactions with medications or other supplements Probiotic Dosage  Dose varies according to organism, indication and delivery method  • Limited data suggest that the minimal effective dose is 10 billion colony-forming units (Lactobacillus sp.) given within the first 48 hours  • The dosages of S. boulardii in most studies range from 250 mg to 500 mg per day 4/16/2015 27 Probiotic Dosage  Some labels are unreliable and have been found to overstate the number of live microorganisms  • No current evidence that higher dosages are unsafe; however, they may be more expensive  • Some studies show greater absorption of probiotics in dairy foods Probiotics  IBD (Inflamm. Bowel Disease) VSL #3  Antibiotic-associated Florastor, Cultruelle, Dan Activ diarrhea; C. difficile Bio K  Gut Transit Time Activia  Lactose intolerance All yogurts with live cultures  Irritable Bowel Syndrome Align  Immune Support Culturelle, Dan Active  Vaginal applications FemDophilus 4/16/2015 30 GERD Gastroesophageal reflux disease Commonly called “heartburn”  A condition caused by the reflux of stomach acid into the esophagus GERD is a potentially serious medical condition that carries a significant risk of esophagitis and other complications Gastroesophageal Reflux Disease - GERD  Affects nearly 19 million Americans  Esophageal syndromes: – Heartburn, chest pain – Complications: Esophagitis, stricture, Barrett’s esophagus, adenocarcinoma  Extra-esophageal syndromes: – Cough, laryngitis, asthma, dental erosions 4/16/2015 31 GERD and Lifestyle Modifications  Multiple recommendations that include dietary factors and management of GERD  Broadly fall into 4 categories: _ Check for food sensitivities! _ Avoid foods that may precipitate reflux _ Avoid acidic food that may cause heartburn _ Adopt behaviors that may reduce acid exposure GERD and Lifestyle Modifications  Foods that may precipitate reflux – Coffee, alcohol, chocolate, fatty foods  Acidic foods that may cause heartburn – Citrus, carbonated drinks, tomatoes, spicy foods  Behaviors that may reduce esophageal acid exposure – Lose weight, stop smoking, elevate the head of the bed, avoid laying down for 2–3 hours after meals 4/16/2015 32 Effect of Calories and Fat on GERD  Thirteen healthy subjects (19-31yo)  6-hour esophageal pH monitoring  Three solid/liquid meals of same volume were tested in random order on separate days:  – High fat (HF) meal: 670 kcal, 58% fat  – Balanced (B) meal: 670 kcal, 23% fat  – Calorie-restricted (CR) meal: 380 kcal, 25% fat Effect of Calories and Fat on GERD  Esophageal acid exposure (% time pH <4) was lowest with the CR meal  Reflux episodes were lower in the CR meal  There is good evidence that GERD is associated with obesity  The Nurse’s Health Study found a dose dependent relationship between BMI and symptoms  A large meta-analysis reports similar results in both men and women 4/16/2015 35 Proton Pump Inhibitors  Both PPI and H2 blockers significantly increase the risk of vitamin B12 deficiency in elderly patients.  B12 requires adequate gastric acid for absorption.  This population is already prone to deficiency in intrinsic factor, necessary for B12 absorption.  This lack of stomach acid also decreases the absorption of folic acid, iron and zinc.  H2 blockers (Tagamet, Pepcid, Axid and Zantac) decrease acid secretion by blocking histamine. Proton Pump Inhibitors  One study showed that high doses of PPIs, used for a year or more, could make people 2.5 more times susceptible to hip fracture than control subjects.  Lower doses decreased the risk factor to 1.5 times that of nonusers.  The longer these drugs are used, the higher the fracture risk.  This heightened risk of osteoporosis is probably due to the drastic drop in calcium and vitamin D absorption that occurs with these drugs.  Some experts believe the drugs themselves may hamper the body’s ability to build new bone 4/16/2015 36 Proton Pump Inhibitors  Regular use of acid-suppressing drugs is associated with increased risk of hip fractures, probably because of impaired calcium absorption.  Taking acid-suppressors also increases your risk of acquiring a food-borne intestinal infection or experiencing the overgrowth of bacteria in the stomach and small intestine. Enhance your Digestive Fire  Digestive fire is the body's ability to break down proteins, carbohydrates and fats into their basic building blocks of amino acids, sugars and fatty acids.  Food should be broken down into these teeny tiny particles to be best absorbed into the body.  This process starts in the mouth by chewing thoroughly, and continues biochemically through the use of stomach acid, digestive enzymes and bile.  If food particles are not adequately broken down, not only does digestion suffer but discomfort can ensue. 4/16/2015 37 Enhance your Digestive Fire  Gas, bloating, indigestion and pain are the most prominent symptoms of unbroken and partially undigested food molecules in the system.  If we are unable to adequately produce the factors that perform this function, even the healthiest of diets will cause distress.  Chewing food well and supplementing with a digestive enzyme at mealtimes is a surefire way to aid the body in its breakdown of food, thus ensuring a comfortable passage through the digestive tract. Heal the lining of the digestive tract from top to bottom  The lining of the digestive tract is where the outside world -- the food that we eat -- is not only absorbed into the body, but also interfaces with the immune system.  The majority of the immune system resides in the gut.  Problems that arise in the lining can be driven by inflammation, the immune response, anatomical changes or a combination of these factors. 4/16/2015 40 Ways to Support Healthy Digestion  Digestive enzyme support can also be obtained from fresh pineapple or papaya, which contain the enzyme bromelain, and other fresh vegetables and herbs.  Digestive enzymes in supplement form: Digest Gold  Processed foods, like canned pineapple, contain little enzyme activity since digestive enzymes are proteins, which are destroyed by heating, such as in the sterilization process.  So beginning a meal with fresh fruits or salad can provide support for healthy digestion. Digest Gold 4/16/2015 41 Ways to Support Healthy Digestion  Support the gastrointestinal barrier.  The gastrointestinal cell wall is the barrier between what you ingest and the inside of your body; therefore, the integrity of this barrier is vital to your health.  Support for the mucus that covers the cells in the gastrointestinal tract is very important, especially in the stomach.  The mucus layer is one way the stomach and upper small intestine protect themselves against the damaging effects of stomach acid. Ways to Support Healthy Digestion  Alcohol, over-the-counter anti-inflammatory drugs, called NSAIDS (e.g. aspirin), and the pathogenic bacteria, Helicobacter pylori can reduce the mucous layer, leading to lesions in the stomach and small intestinal tract walls. 4/16/2015 42 Ways to Support Healthy Digestion  Choline provides nutritional support for a healthy mucous layer and is found in vegetables such as cauliflower and lettuce.  Choline can be obtained from lecithin (phosphatidylcholine) as well, which is high in eggs and soybeans.  Some foods also help combat or protect against the damage of Helicobacter pylori, and these include catechins found in green tea, some spices such as cinnamon, carotenoids found in vegetables, and vitamin C, found in citrus foods. Ways to Support Healthy Digestion  Research studies have shown that the small intestinal tract barrier can become leaky under some conditions.  Cells loose their attachments to each other, resulting in a wall with holes between the cells instead of the cells forming a strong, connected and continuous surface.  When this "leaky gut" happens, molecules can get inside the body that normally wouldn't be transported through the intestinal cell wall.  With leaky gut, the things that shouldn't get in do, and those that should can't get where they need to be for adequate transport through the body.  The result is the body doesn't get the nutrition it needs. 4/16/2015 45 Ways to Support Healthy Digestion  Learn how to deal with stress effectively.  Research has shown that the intestine responds negatively to stress, during which the intestinal lining becomes leaky, absorption is less effective, and your body is unable to selectively take up the nutrients it needs.  Foods with a calming effect include herb teas, like chamomile.  Alcohol, caffeine, and refined carbohydrates, like table sugar, should be avoided when under stress  Eating meals at regular times and in a relaxed environment can also help decrease stress. Summary  Take care of your gut and it will take care of you!  You are what you eat  You are what you digest  You are what you assimilate!  Get lots of fiber, fruits, vegetables, whole grains, lean proteins, good fats and beans and legumes in your diet  Drink lots of water  Get probiotics and prebiotics on a regular basis 4/16/2015 46 Remember Make meal times relaxed  Take time to eat  Allow time for food to digest  Eat at regular intervals  Eat smaller amounts at any given eating episode  Take small bites  Focus on eating, not everything else