addendum lecture module #2 secretory iga and mucosal...

Addendum Lecture Module #2 – Secretory IgA and Mucosal Barrier Remedies

Copyright of Kurt N. Woeller, D.O., Tracy Tranchitella, N.D. and Educational Research Association. This material may not be reprinted, distributed or

used without permission.

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The Mucosal Barrier and Secretory IgAFirst Line Immune Defense

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Mucous Membrane – Nutrient Absorption and Digestion

Primary follicle

SubmucosaLamina propria

M cell

VilliInductive site

Germinal center

Muscle layer

Peyer's Patch

FollicleIntestinal

Lumen

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MALABSORPTIONIN CELIAC DISEASE

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The Effect of Gluten Withdrawal on LaboratoryFindings of 90 Patients with Adult Celiac Disease

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OTHER CAUSESOF

MALABSORPTION

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Cryptosporidium

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Giardia

• Giardia infection results in topographical changes in

the gut including:

a.Villous atrophy

b.Blunting of brush border

c.Reduction of surface area for absorption

• Damage to finger tips of villi cause:

a.() lactase enzyme → lactose intolerance

b.() sucrase enzyme → sucrose intolerance

c.Damage to lacteals → inability to absorb fats & oils

• Results in crypt hyperplasia & crypt deepening

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First Line Immune Defense

Primary follicle

SubmucosaLamina propria

M cell

VilliInductive site

Germinal center

Muscle layer

Peyer's Patch

Follicle

Intestinal

Lumen

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Antibody Production

IgM

(Acute Response)

IgA

(Intermediate Response)

IgG

(Long-term Response)

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Structure &Formation

of sIgA

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Location of Mucous Membranes

Conjunctiva of the eye & the lining of the:

• Oral Cavity

• Nasal Cavity

• Pharyngeal Cavity

• Tracheobronchial Tree

• Alimentary Tract

• Urinary Tract

• Genital Tract

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GI Conditions and Diseases In Selective IgA Deficiency

•Autoimmune achlorhydria, pernicious anemia, villous atrophy.

•Infectious Clostridium, Giardia, Cryptosporidum parvum, Helicobacter pylori, Salmonella, Candida.

•Inflammatory celiac, Crohn’s disease, ulcerative colitis.

•Neoplastic lymphoma, stomach adenocarcinoma.

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Prioritization of Gut Treatment

1. Eliminating immune reactive and toxic foods.

2. Identifying and treating gut pathogens

3. Actively utilizing treatments to promote healing.

Stool Testing

GI Pathogen Test (#401-H)Comprehensive Digestive

Stool Analysis

• Specific test for GI Pathogens

• High parasite yield with 4 stool sample collection + antigen analysis.

• C. difficile toxin A & B

• H. pylori antigen detection

• Is NOT a comprehensive digestive stool analysis.

• Does NOT evaluate function

• Provides detailed analysis of gut flora + culture/sensitivity.

• Parasite detection yield often not as high as #401-H.

• May or may not give specifics to C. difficile A & B.

• H. pylori often not reported• Provides information

regarding digestion and inflammation.

• IS a functional digestive analysis.

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Things To Consider Clinically

• Some labs provide PCR analysis – may over analyze presence of pathogens.

• All stool testing has value and can be helpful clinically. You have to accept that no stool testing is perfect with regards to the analysis it provides.

• In most circumstances, it is worthwhile ruling out infections first as they often disrupt function.

• Inflammatory and digestive markers can be negatively influenced by infections and food reactions.

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Things To Consider Clinically

It would be ideal to perform both a GI Pathogen Screen (#401 or #401-H) and a Comprehensive Digestive Stool Analysis

(CDSA) together. However, this may not be financially viable for your patient/client.

Remember: food reactions and infections are primary drivers of digestive problems

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Mucosal Support Remedies

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Goal of Mucosal Healing

1. Nourish the intestinal lining and strengthen the first line immune defense.

2. Help protect the body against harmful and opportunistic organisms found in the digestive tract.

3. Reduce gut inflammation and improve wound healing 4. Helps with wound healing and reduction of inflammation 5. Alleviate gastrointestinal discomfort 6. Improve nutrient absorption7. Improve digestive system function and reduce the toxic

burden on liver and other organs.

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Acetyl-D-Glucosamine

• Is a component of intestinal mucous secretions important for the integrity of the mucosal lining.

• Anti-inflammatory action

• Research shows N-Acetyl-D-Glucosamine to be an effective component in the treatment in inflammatory bowel disease.

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Biotin

• Essential for cell growth

• Reduces inflammation

• Prevents against invasive candida

• Cofactor for various metabolic enzymes

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Bromelain• Anti-inflammatory

• Helpful in reducing and eliminating pain, aiding digestion, and accelerating healing.

• Prevent against strokes and reduces blood pressure.

• Derived from pineapple, its primary purpose as a digestive remedy is to control GI inflammation.

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Gamma Oryzanol

• A component of rice bran oil, has been shown to have antioxidant effects on the gastrointestinal mucosa.

• In research, gamma oryzanol shows improvement of gastritis in over 60% of the subjects.

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L-Glutamine

• Helps maintain intestinal barrier integrity

• Preferred fuel source of enterocytes and colonocytes in the digestive system.

• Helps maintain healthy levels of Secretory IgA

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Methylsulfonylmethane

• Binds to the intestinal mucosa

• Helps to regulate the interface between luminal components and cell surface. • As a result, substances such as allergens and parasites

cannot readily bind to the mucosa.

• Aids in toxin reduction and free radical elimination

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Quercetin

• Is a potent antioxidant

• Prevents the formation of certain inflammatory mediators helping to reduce inflammation overall and subsequent pain.

• Spares against vitamin C loss and stabilizes cell membranes.

• Stabilizes mast cell degranulation

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Slippery Elm

• Has anti-inflammatory activity

• Very rich in mucilage, a complex mixture of polysaccharides.

• Mucilage resists digestion by stomach acid and intestinal enzymes which allows Slippery Elm to promote soothing action throughout the entire digestive system.

• Can be helpful for constipation

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Tumeric

• Turmeric root has anti-inflammatory properties that inhibit COX-2 activity.

• COX-2 is an enzyme responsible for inflammation and pain.

• The low incidence of colorectal cancers observed in Asia is thought to be linked to high dietary intake of turmeric.

• Curcumin is a component of Tumeric which has antioxidant, anti-inflammatory and antimicrobial activity.

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Other Remedies

• Eleuthero (Siberian Ginseng)

• Milk Thistle Seed Extract

• Hawthorne Leaf and Flower Extract

• Deglycyrrhized Licorice Root Extract

ALL promote mucosal health and healing through decreased inflammation, toxin elimination, and

mucosal immune promotion.

Support Mucosa

www.BioMatrixOne.com3 capsules twice daily 15

minutes before meals

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Curcumin Complex

1 capsule twice daily with food www.nbnus.com

• Turmeric Phytosome(Curcuma longa) root,

dried extract, min. 18% curcuminoids & phosphatidylcholine complex

• 250mg/capsule

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Additional Options for Digestive Health

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Probiotics To Be Discussed During Module #5

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Multi-Flora Probiotics

1 to 2 capsules daily – 1 capsule equals approximately 20+ billion organisms.

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High Dose Probiotics

1 to 2+ capsules daily

2 capsules = 225 billion organisms

1/2 to 1+packets daily

1 packet = 225 billion organisms

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Camel Milkhttp://nourishinghope.com/2011/11/camel-milk-healing-or-hype

Camel milk contains no beta-lactoglobulin and a “new” beta-casein. Therefore it is not reactive to children with autism and even non-allergenic to those with

even the most sensitive allergy to milk and casein.

www.camelmilkassociationg.org

• Start with 2 to 4 ounces daily• Can increase as tolerated

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• Kefir is a culture of beneficial bacteria. It involves a fermentation process that breaks down sugar and enhances vitamin, mineral, amino acid production.

• Most commonly made from milk, but available from coconut, nut milk or even water. Camel milk is made into kefir too.

• www.bodyecologydiet.com – resource for information on kefir products.

• www.nourishinghope.com – Julie Matthews, CNC –has DVD’s and cookbook.

Kefir

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• Sauerkraut, kim chi, and pickles are examples of cultured vegetables. Other vegetables can be cultured as well: carrots, cabbage, beets, kale, etc.

• Cultured foods are another good source of probiotics, as well as nutrients and enzymes useful for digestion.

• Both kefir and cultured vegetables are nutritious and help to maintain the proper acid/alkaline balance in the digestive system.

• www.bodyecologydiet.com

• www.nourishinghope.com

Cultured Vegetables

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Julie Matthews, CNC –www.nourishinghope.com

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Other Options

• Cultured butter and/or ghee (clarified butter)

• Aloe vera juice – mix in smoothie, water or dilute juice. George’s is a good brand.

• Ground flax seed – ½ to 2 tablespoons daily

• Fiber supplements

TruFiber

www.nbnus.com or other resources online

• Prebiotic• Soluble fiber• Does contain inulin (be

cautious in SIBO)• Enzymes • Support healthy bacteria• 1 level scoop mixed in 8 to

12 ounces of water or dilute juice once to twice daily.

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• Butyrate – byproduct of bacterial fermentation on dietary fiber. Also, found in raw milk and butter, as well as Ghee (clarified butter).

• Beneficial in clearing high ammonia produced in the gut

• Supports against gut problems, i.e. diarrhea

• Supports the health of intestinal cells by decreasing inflammation – particularly the large intestine.

• Calcium/Magnesium, Potassium Butyrate available –600mg to 1200mg with food twice daily. Typical capsule is 600mg.

• www.EmersonEcologics.com – carries a wide supply, i.e. Body Bio.

Butyric Acid (butyrate)

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• Apo-Ketotifen, Novo-Ketotifen, Zaditen, Zaditor

• Oral administration – must be compounded by specialty pharmacy.

• Mode of Action: Antihistamine that blocks inflammation in the body – particularly the intestinal tract when taken orally.

• Helpful for “Leaky Gut” by decreasing histamine mediated allergic reactions along mucosal lining -particularly triggered by foods. This allows for gut healing to take place overtime.

Ketotifen

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• Adults and children 3 years of age and older - The usual dose is 1 milligram (mg) three times daily, 30 minutes before meals.

• Infants and children from 6 months to 3 years – ¼ to ½ mg three times daily 30 minutes before meals.

• For some adults upwards of 2mg three times daily is needed.

• 6 months or longer may be needed for full benefits –minimally a 2 month trial is recommended.

• Special Precautions: Epilepsy and Diabetes (have never seen problems).

Ketotifen

Thank YouKurt N. Woeller, D.O. & Tracy Tranchitella, N.D.

www.GIMasteryCourse.com

GIMasteryCourse@gmail.com