Download What Does Digestion Have to do with Hormones Anyway?

What Does Digestion Have to do
with Hormones Anyway?
A presentation by Dr. Holly Lucille, ND, RN
SPONSORED BY:
A Gut Check for Many Ailments!
“The gut is important in medical
research, not just for the
problems pertaining to the
digestive system but also
problems pertaining to the rest
of the body”
~~ Pankaj J. Pasricha, chief of the division of gastroenterology
and hepatology at Stanford University School of Medicine.
2
Outline
Principle Anchors
Digestive Review
Causes of Impaired Digestion
Consequences of Impaired Digestion
–  Adrenal Involvement & Allostatic Load
–  Thyroid Involvement
–  Impermeability & Inflammatory Response
–  Liver Involvement
•  Pathway to Healing
•  Decreasing Allostatic Load
•  Addressing Acute Concerns
• 
• 
• 
• 
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54-year old female presents with several
chronic complaints
•  Persistent fatigue
•  Stubborn weight gain
•  Trouble sleeping (both getting and staying to
sleep)
•  Absolutely no sex drive “I am dead down there”
•  Vaginal dryness
•  Hair thinning
•  Hot flashes and night sweats
•  Feelings of despair
•  Chronic stress and anxiety
•  Memory loss
4
CC: “I have menopause”
•  LMP: 16 months ago
•  Seen several practitioners
•  RX’d with BHRT, SHRT variety of doses/routes
•  Watches “Dr. Oz” religiously, tried “detox
patches”
•  No significant relief of symptoms
5
Laboratory Signs
• 
• 
• 
• 
• 
• 
E2 = 1.0 pg/ml
Pg = 20 pg/ml
L
Pg/E2 Ratio = 20
L
Testosterone = 17 pg/ml L
DHEA-s = 4.5 ng/ml
AM Cortisol 10 ng/ml H
(1.0-1.5)
(25-100)
(50-100)
(20-50)
(3-10)
(3-8)
•  Chemistry: slightly elevated LDL’s, Vitamin D 27
•  CBC: slightly low ferritin and RBC’s
•  Thyroid: slightly elevate TSH (4.2)
6
Anchor
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
PMS
Fatigue
Weight Gain
Night Sweats
Thinning Hair
Disruptive Circadian Rhythm
Mood Fluctuations
Depression
Anxiety
Etcetera
7
Anchor Point
“Medicine is not only a science; it is
also an art. It does not consist of
compounding pills and plasters; it
deals with the very processes of life,
which must be understood before they
may be guided.”
~Philipus A. Paracelsus
8
First Do No Harm
•  Listen
•  Least Invasive First
•  Many Modalities Before Drugs and Surgery
•  Hormone “Replacement” Therapy
HARM
9
Identify and Treat the Cause
•  Health Detectives
•  Think Things Through
•  Not Simply Suppress Symptoms
•  Get to the Root
•  Heal From the Inside Out
10
Treat the W(hole) Person
•  “Heal the Hole”
•  Usually Clinical Presentation is Multifactorial in
Cause
•  Self Knowledge, Beliefs and Attitude
•  Myriad of Relationships
11
Doctor as Teacher
•  Knowledge vs. Understanding
•  Understanding = Patient Empowerment
•  Solid Rationale Behind Recommendation
•  Normal Variants
12
Prevention is the Cure
•  Symptoms as Guidepost
•  Disconnect from the Deeper Issues
•  Real Disease Continues
13
Healing Power of Nature
“IN ANY SITUATION..HEALTH WILL
OCCUR WHEN THE CONDITONS
FOR HEALTH EXIST AND DISEASE IS
A PRODUCT OF CONDTIONS THAT
ALLOW FOR IT”
~Dr. Jared Zeff
14
Women’s Health & Digestion
•  42.2 million visits with diseases of the digestive system
as the primary diagnosis
•  More than 1 in 4 have at least one variety of GI
condition—that’s 60 – 70 million Americans
•  Gastrointestinal (GI) distress is more than twice as
common in women as in men
–  Malabsorption
–  Dysbiosis (e.g., possibly pathogenic yeast or
bacterial infection)
–  IBS
–  Leaky Gut Syndrome
–  Celiac Disease
–  Constipation
Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/nchs/fastats/digestiv.htm. Accessed March 10, 2011.
National Digestive Diseases Information Clearinghouse (NDDIC) web site. Available at: http://digestive.niddk.nih.gov/statistics/statistics.htm#sources.
Accessed March 10, 2011.
15
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, November 1996
Journal of Women's Health 2010;6 ;1-14.
Digestion Review: Heal the Whole
Mouth
•  Saliva (amylase)
Stomach
•  HCl, pepsin, chyme
Duodenum
•  Bile, pancreatic enzymes
Pancreas: Neutralize Enzymes
Liver: Bile & cholesterol
Gallbladder: Bile Storage
Small Intestine
•  Absorption of 90% of nutrients
Large Intestine
•  Waste products, bacteria, toxins
Rectum
•  Fecal matter
16
Causes of Impaired Digestion
•  Lifestyle (e.g., not chewing, overeating, food choices,
cooking)
•  Enzyme deficiencies
•  pH imbalances (e.g., hypochlorhydria, pancreatic
bicarbonate deficiency)
•  Endocrine imbalances (e.g., gastrin, cholecytokinin,
secretin secretion imbalance)
•  Aging
•  Stress
•  Certain disease states
•  Surgery, radiation, chemotherapy
•  Prescription medications (e.g., PPIs,H2 agonists,
antibiotics)
17
Pathway of GI Dysfunction
Impaired Digestion
Dysbiosis
Intestinal Toxemia
Oxidative Stress
Intestinal Inflammation
Intestinal Permeability
Defects
Lack of digestive enzymes, poor
diet, cooked foods, stress, etc.
Bacteria acting on undigested
food (endotoxins: skatoles,
phenols, formaldehyde etc.)
Toxemia and altered terrain
(e.g. pH) lead to gut flora
imbalance
Gut lining compromised by
continual attack of
endotoxins, oxidation and,
inflammation
18
Causes of Dysbiosis
• 
• 
• 
• 
• 
• 
• 
• 
• 
Impaired digestion
Hypochlorhydria
Antibiotics
Ethanol
NSAIDS
Stress
Slow transmit time, decreased peristalsis
Impaired immune status
Dietary factors (e.g. low fiber, excess meat)
Altern
Med
Rev.
2004
Jun;9(2):180‐97.
Gut.
2004
Jan;53(1):1‐4
19
Consequences of Intestinal Dysbiosis
•  GI symptoms (gas, bloating, constipation, diarrhea)
•  Chronic intestinal inflammation, IBD
•  Intestinal permeability defects
•  Increased endotoxemia
•  Increased risk of cancer
•  Hormonal imbalances & subsequent SYMPTOMS
•  Systemic reactions to bacterial endotoxins & antigens
Altern
Med
Rev.
2004
Jun;9(2):180‐97.
Gut.
2004
Jan;53(1):1‐4
20
Dysbiosis and Hormonal Symptoms
•  Effects of Candida
–  Hypoadrenia
–  Hypothyroidism
–  Liver dysfunction
tock S. Conquering Candida International Journal of Alternative & Complementary Medicine 1993;:24.
Trowbridge JP, Walker M. The Yeast Syndrome. Bantam Books London 1986.
Trowbridge JP. An Update on the Yeast Syndrome. Health News & Review 1992;2:10.
Smith LH Trouble in the thyroid: keeping out fires lit Health News & Review 1992;2:6.
Passwater RA, Cranton EM. Trace Elements, Hair Analysis and Nutrition Keats Publishing Inc Connecticut 1983.
21
Candida and Hypoadrenia
•  Possesses E and P receptors and those binding
adrenal steroids
•  Exogenous sex hormones (HRT, OC) feed
•  Toxins have direct cytotoxic effect on adrenals via
increasing free radical activity and decreasing Tcell activity
•  Interfere with Acetyl CoE A which decreases
synthesis of adrenal steroids
22
Adrenal Anchor Points
•  Built in Back Up
•  “Stress Glands”
•  Produce Cortisol and Other Hormones
•  Controls the Immune Response in the GI Tract
•  Can be a Spectrum of Dysregulation
•  Compensative Mechanisms
23
Allostasis: The Problem
•  Modern day stress
response and
reaction occurs an
estimated 60 times
per day – stress is
persistent!
•  No fight, no flight, no
turn off
•  NO RECOVERY
PERIOD!
No
Recovery
Stress
Event
Nutrients
used
Hormones
Released
Body
Responds
24
Hormone Synthesis Pathway
25
Candida and Thyroid Dysregulation
•  Candida receptor sites can bind thyroxine and
render it physiologically unavailable
•  Candida is associated with zinc deficiency
•  Damage to the thyroid gland form candidainduced free radical activity and auto-immunity is
possible
26
Thyroid Anchor Points
•  Thyroid function is a relay race
•  Regulates aerobic and anaerobic metabolism of
every cell in the body
•  Proper gut flora required for
peripheral conversion
•  Nutrient dependent
27
Intestinal Permeability Issues
•  Catastrophic permeability defects are usually
only triggered by serious insults (i.e., trauma,
burns, and sepsis)
•  However, a low-level, chronic version of this gut
permeability problem may also occur = "leaky gut
syndrome“
•  LGS is increasingly suspected as an underlying
contributor to chronic autoimmune and other
diseases
–  IBS
–  Allergy
–  Asthma
28
Constituents of the Intestine
29
Diabetes
2008
;57:2555–62.
Gut Permeability and Inflammation
A Vicious Cycle
• Diet
• Lifestyle
• Disease
• Dysbiosis
• Diet
• Environment
• Dysbiosis
Release
of
cytokines
Local
and
systemic
inflamma0on
An0gens
and
endotoxins
exposure
• Chronic
disease
• Injury
• Allergy
• Environment
Increased
gut
permeability
Increased
intes0nal
absorp0on
of
an0gens
and
endotoxins
• Injury
(e.g.,
burns)
• Endotoxin
• Environment
30
GI Permeability
A Potential Cause of Autoimmune Disease
Immune reaction forms against antigen
T
Cell
B
Cell
Enzymes
An0gen
Enzy
m
es
Enzy
An0gen
Enzy
mes
mes
An0gen
Leaky gut
Enzymes
GI mucosa inflammation leads to “leaky gut,”
which allows transmigration of antigen
31
Abnormal Bowel Permeability and
Inflammation
•  Stimulates classic hypersensitivity response
•  Causes “non-specific” activation of inflammatory
pathways
–  IL6
–  IL1
–  TNF alpha
32
GI Permeability
A Potential Cause of Vasomotor Symptoms
•  TNF Alpha produced mainly by macrophages,
principle cytokine that mediates acute
inflammation
•  Stimulates inflammation in the endothelial tissue
cells, helps WBC migrate into the tissue space,
helps macrophages secrete IL1 and PGE2,
•  Creates diapedesis
‘’’HOT FLASH’’’
33
GI Dysfunction
The Overburdened Liver
•  Over ½ gallon of blood/min
•  Performs over 500 functions
–  Master organ of metabolism (blood sugar, fats, vitamins,
steroid hormones)
–  Metabolizes alcohol; breaks down medications
–  Maintains thousands of internal enzyme systems
•  Produces 500-1000 ml (≤1 quart) of bile per day
•  Increases Beta Glucuronidase, decrease in estrogen
metabolism
•  Causes
–  Toxic exposure
–  Poor digestion compromising liver
•  Bacterial overgrowth impact on liver
–  Diet
34
Pathway to Healing
Restore Healthy Digestion – Lifestyle
•  Food choices
–  Quality
–  Quantity
•  Dietary practices
–  Relax/focus
•  Blood flow to GI tract
•  Cephalic stage of digestion
–  Chewing
•  Mechanical breakdown
•  Chemical breakdown (saliva)
•  Relaxes lower stomach
35
Pathway to Healing
Restore Healthy Digestion – Enzymes
•  Digestive enzymes break food down into smaller,
absorbable components
•  Enzymes are produced by the body and present in
food:
–  Metabolic
–  Pancreatic
–  Plant/fungal based
•  However…
–  Production declines with age
•  e.g., amylase
–  Decline in food quality/enzyme intake from food
–  Culinary habits (enzymes destroyed through
cooking)
36
Acid-Stable Enzymes
•  Pure Plant Enzymes – also called
fungal or microbial enzymes
•  Acid-Stable
–  Not inactivated in gastric
environment
–  Offer digestive support in both
acid and alkaline conditions
•  Unlike pancreatic enzymes,
effective in patients with pH
imbalances
Human
DigesXon
and
AbsorpXon.
In:
Wardlaw
GM,
Hampl
JS.
Perspec.ves
In
Nutri.on.
New
York,
NY:
McGraw‐Hill;
2007:79‐109.
37
DigesXon
and
AbsorpXon.
In:
Grodner
M,
Anderson
SL,
DeYoung
S,
ed.
Founda.ons
and
Clinical
Applica.ons
of
Nutri.on:
A
Nursing
Approach.
2nd
ed.
St.
Louis,
MO:
Mosby;
2000:149.
Pathway to Healing
Evidenced based Botanical Intestinal Support
CLINICALLY STUDIED FOR EFFICACY IN YEAST BALANCE
•  Pau D’Arco (Tabebuia impetiginosa) Bark 300 mg/d
•  Undecylenic Acid (as calcium undecylenate) 300 mg/d
•  Caprylic Acid (as calcium, magnesium, and zinc caprylate
complex) 225 mg/d
ADDITIONAL SUPPORTIVE INGREDIENTS INCLUDE:
•  Vitamin A (as natural beta-carotene and mixed carotenoids)
1,500 IU/d
•  Zinc (as zinc caprylate complex) 1 mg/d
•  Grapefruit Fruit (Citrus paradisi) Extract 40:1 75 mg/d
•  L-Glutamic Acid HCI 150 mg/d
•  Calcium (as calcium carbonate, undecylanate, and caprylate
complex)300 mg/d
•  Rosemary (Rosmarinus officinalis) 4:1 4.5 mg/d
•  Thyme (Thymus vulgaris) Aerial Parts Oil Extract 4:1 4.5 mg/d
38
Pathway to Healing
Re-Establishing Normal Flora
•  Lactobacilli, Bifidobacteria and other bacteria are
integral to healthy GI function and balance
–  Produce important enzymes, nutrients,
antimicrobial substances, help to maintain immune
function, luminal pH and resistance to pathogens
(e.g., Candida)
–  Support of body’s natural detoxification processes
–  Improved digestion and nutrient absorption by
improving gut barrier health
–  Regulation of peristalsis; improved bowel function
–  Improved cardiovascular health (cholesterollowering effects)
39
Pathway to Healing
Resolving Dysbiosis
•  Probiotics are antagonistic to Candida albicans
and other yeast organisms
–  Development of yeast infections associated
with low lactobacilli population in vagina and
intestines
•  Probiotics decrease intestinal inflammation and
enhance mucosal integrity
–  Normalizes gut permeability
•  Probiotics modulate systemic immune activity
40
Viability of Commercial Preparations
•  Studies have shown low viability of Lactobacilli
and Bifidobacteria in unprotected commercial
preparations
•  Inspect the label
–  CFU = colony forming units
–  High number of CFU does not necessarily
indicate a better or more effective product
–  Evaluate genus and species for appropriate
applications
–  Number of CFUs should be based on expiration
date, not on ‘date of manufacture’
Immunol
Cell
Biol.
2000
Feb;78(1):80‐8.
J
Dairy
Sci.
2000
Apr;83(4):894‐907.
Curr
Issues
Intest
Microbiol.
2004
Mar;5(1):1‐8.
41
Pathway to Healing
Rebuilding Intestinal Mucosa
TARGETED INTESTINAL MUCOSAL SUPPORT:
•  L-glutamine 750–1,500 mg/d
•  N-acetyl-D-glucosamine (NAG) 375–750 mg/d
•  Phosphatidylcholine 75–150 mg/d
•  Gamma-linolenic acid (GLA) 200–400 mg/d
TARGETED GASTRIC MUCOSAL SUPPORT:
•  Deglycyrrhizinated licorice (DGL) 400 mg QD to
TID
–  Chewable form preferred
–  Take before meals
42
Nat
Med
J
2010
March;2(3):14–23.
Pathway to Healing
Protecting Intestinal Mucosa
ANTIOXIDANT SUPPORT
•  Quercetin 400-800 mg/d
•  Ginkgo biloba (24% ginkgo flavone glycosides) 40–80 mg/d
•  Vitamin C 1,000–2,000 mg/d
•  Vitamin E 200–400 mg/d
•  N-acetyl-L-cysteine (NAC) 150–300 mg/d
•  Zinc 45–90 mg/d
–  Consider copper supplementation at 0.75–1.5 mg to
accompany zinc intake
43
Nat
Med
J
2010;2:14–23.
Pathway to Healing
Removing Intestinal Toxins/Supporting the Liver
•  Xenobiotic burden is now unprecedented in human
history
•  Endocrine disruptors linked to hormone-related
conditions, autoimmune disease, cancer, etc.
Common
Hormone
Disrupters
Dioxins
Solvents
PesXcides
Phthalates
Polychlorinated
biphenyl’s
(PCB’s)
Parabens
Heavy
metals
Bisphenol‐A
•  Healthy diet is no longer adequate protection
•  Detoxification regimens can be simple or complex
44
Detoxication Factors
Glutathione,
NAC,
CoQ10,
Vitamins
C
and
E,
Selenium,
QuerceXn,
Milk
Thistle
Glutathione,
NAC,
Vitamin
B12
and
Folic
Acid,
Glycine,
Glutamine,
Taurine,
Calcium
D‐Glucarate
45
Pathway to Healing
Assisting Estrogen Metabolism:
Calcium D-Glucarate (CDG)
•  Calcium salt of D-glucaric acid naturally found in
fruits and vegetables
•  Works in intestinal tract
•  Involved in estrogen removal
•  Inhibits beta-glucoronidase enzyme
•  Reduces the number of estrogen receptor sites
•  Toxins and estrogens bound for excretion stay
bound
46
CDG Mechanism of Action
Glucuronic
Acid
ExcreXon
+
TOXIN
Congugates
(or
binds)
toxins
and
estrogens
for
eliminaXon
CDG
Beta
Glucuronidase
Inhibits
β‐
Glucuronidase
acXvity
Reverses
congugaXon
(releases
toxins)
47
Decreasing Allostatic Load
Controlling Cortisol
•  Effective Cortisol lowering – within 24 hours
–  Ashwagandha – stress resistance
–  L-Theanine – relaxation
–  Magnolia – anti-anxiety
–  Epimedium – neuroprotection
–  Phosphatidylserine – cortisol management
•  Maintaining healthy cortisol levels
•  Stress reduction and sleep improvement
48
An
open
label
pilot
study
of
the
safety
and
effecXveness
of
a
corXsol‐reducing
combinaXon
in
healthy
adults.
2006.
Unpublished.
Decreasing Allostatic Load
Lavender Oil
•  Clinically studied •  Effective anxiety
relief without
common side
effects from
alternatives
•  Non-habit forming •  Convenient, once
daily dosing 49
Lavender Oil
HAMA
=
Hamilton
Anxiety
Scale
50
Safe, Natural Symptom Relief
•  Isopropanolic Black Cohosh extract
–  Over 90 published scientific papers and
presentations on efficacy and safety
–  Clinical research findings:
•  Up to 70% reduction in menopause
symptoms after 12 weeks of use
–  Hot flashes, night sweats, sleep
disturbances, mood swings
•  In one study, women experienced a 50% or
more reduction in daily hot flashes after four
weeks of use
•  Particularly effective for women in early stages
of menopause
Liske.
J
Women
Health
Gend
Based
Med
2002
Mar;11(2):163‐74.
Pockaj
BA
et
al.
Cancer
Invest.
2004;22:515–21.
51
Black Cohosh – Proven Safety
•  Initially considered a phytoestrogen – Proven Untrue
•  Now thought to act as selective estrogen receptor modifier
–  Acts like estrogen in brain, bone and vaginal tissue
–  Does NOT act like estrogen in breast or uterine tissue
•  In cell studies, did not promote growth of breast cancer
cells
•  Used safely in short-term studies by women with a history
breast cancer and women using tamoxifen or raloxifene
•  Does not increase breast density or risk of breast cancer
reoccurrence1,2
•  Does not impact liver function (no liver toxicity)3
•  No significant adverse effects
Zepelin
HH,
et
al.
Int
J
Clin
Pharmacol
Ther.
2007;45(3):143‐54.
Hirschberg
AL,
et
al.
Menopause.
2006;14(1):1‐8.
Naser
B,
et
al.
Menopause.
2011;18(4):
1‐10.
52
Additional Information
•  11 lb weight gain in last 2 years
•  Chronic post nasal drip
•  Alternating constipation/diarrhea, gas/boating
•  Occasional gastroesphageal reflux
•  Unexplained/undiagnosed occasional skin rash
___Past Medical History__
•  Chronic sinus infections with antibiotic use
•  MVA in 1987 with whiplash tx with PT
__ Family History__
•  Negative
53
Additional Information
•  G3 P3
•  Medication: occasional OTC sleep aid
•  Supplements: occasional “one-a-day”
•  Exercise: “used to” but currently none
•  Diet: SAD with heavy dairy “I love cheese”
•  Alcohol: 2-4 times per week, every weekend
•  Caffeine: two cups in the morning “to get going”
•  Stress: Increased with “full time mom” vocation
__Physical Exam__
•  Iris contraction test --- +
•  BP: 100/62
•  Slight ankle swelling
54
Assessment
1. Suspected HPA axis dysregulation
2. Suspected dysbiosis and subsequent permeability
issues
-CDSA: revealed dysbiosis, positive growth of Citrobacter
diversus, Candida albicans, non-Candida strains
(dubliniensis) No growth of Lactobacilli, low growth
Bifidobacteria , elevated Beta-Glucaronidase and
putrefactive SCFA
-Intestinal Permeability Assessment: elevated lactulose/
mannitol ratio
-Vitamin D: 24
55
Management
•  Diet and Lifestyle
–  BTD & Intentional Movement, dcr etoh & caff.
•  Safe, Natural Symptom Relief & Sleep Restoration
–  Black Cohosh
–  Lavendar Oil
–  Cortisol Managing Formula
•  5 R’s!
–  Remove irritants
–  Reinoculate with proper flora
–  Replenish nutrients & antioxidant support/enzyme
–  Repair the gut lining
–  Restore normal function the liver
56
Outcome
•  6 Week follow up:
–  Increase ability to fall asleep at night with less stress
during the day “fuse is longer”
–  Decrease in the incidence of hot flashes and
digestive disturbance, continued diarrhea
–  Lost 6 lbs, feeling more energetic
•  3 Month follow up:
–  Felt “remarkably better”
–  Absence of vasomotor symptoms
–  At an ideal weight
–  Healthy bowel movements
–  Hair filling in
–  “Happy again”
57
Conclusion
~~ Digestion has EVERYTHING to
do with “hormones”…..and
then some~~!
Thank You!
58