functional medicine and nutritional genomics - American Association ...

AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS
Another possible measure of intestinal permeability in
the small bowel is the oral lactulose/mannitol challenge
test (69). In this functional assay, a patient
consumes a standard amount of a solution of mannitol,
a sugar alcohol, and the disaccharide lactulose in a
hyperosmolar solution. Individuals with increased gut
permeability of the small bowel absorb more lactulose,
which is not metabolized and excreted in the urine,
than individuals whose mucosa is normal. Mannitol, on
the other hand, is translocated at a relatively fixed rate
in all individuals. Thus an increased ratio of lactulose
to mannitol in the urine indicates enhanced intestinal
permeability (69).
Conducting a fecal calprotectin evaluation is another
test for measuring intestinal inflammation (70,71).
Calprotectin is a calcium-binding protein found in the
following types of white blood cells: neutrophilic
granulocytes, monocytes, and macrophages (70).
Calprotectin resists metabolic degradation and can be
measured in the feces. The fecal calprotectin test
makes use of the fact that the release of calprotectin
in the stool is associated with damage to the GI
mucosa and increased inflammatory processes (71).
b. Nutritional Influences in IBD
A variety of nutrients have been found to be deficient
in CD patients. Causes include malabsorption in the
small intestine, increased nutrient need because of
disease activity, low nutrient intake, nutrient loss due
to chronic diarrhea or increased transit time or effect
of medications. One study examining multiple nutrient
deficiencies found 85% of 279 CD patients had
deficiencies. Nutrients most frequently found deficient
were iron, calcium, zinc, protein, Vt. B12 and folate
(72).
It has recently been suggested that certain protective
nutrients and functional foods can provide protection of
the gut mucosa from the CARD15/NOD2 related
Th1-dominant inflammatory reactions (73). The amino
acids glutamine and arginine, the essential
micronutrients vitamin A, zinc, vitamin E and the B
vitamin, pantothenic acid are among these protective
nutrients. Evidence indicates that chronic H. pylori
infection is associated with elevated oxidative stress in
the intestinal mucosa, with increased levels of plasma
lipid peroxides and other markers of free radical injury
94
2012
(74). Therefore, supplementation with antioxidants,
including ascorbic acid, tocopherol, and food flavinoids
like quercetin (found in apples) and epicatechin
gallate (from green tea), may be beneficial. Shapiro
et al. (75) discusses the addition of polyphenols to
artificial nutritional formulas to improve the outcome of
patients with IBD. Five polyphenols in particular have
shown in animal and human studies to have benefit in
IBD by reducing inflammation associated with variations
of the CARD15/NOD2 and SLC22A4/A5 genes:
Boswellia, curcumin, epigallocatechin, quercetin, and
resveratrol (75-84). Prebiotics and probiotics are also
important substances that support proper function of the
GALT and lead to the repair phase of gastrointestinal
restoration (73).
Buddington and Weiher (85) proposed that, in
managing functional gastrointestinal disorders, the GI
system should be viewed as a flow system or ‚river‛.
The GI tract is a complex ecological system that flows
from top to bottom and requires nourishment to create
the appropriate ‚ecology‛ within the small and large
intestines (85).
c. Putting It All Together With The Functional
Medicine ‚4R TM ‛ GI Restoration Program
There is a slow-moving but growing awareness that
understanding the etiology at the genetic-molecularenvironmental
level may be just as important if not
more important than disease classification. ‚Functional
Medicine‛ – an evidence based systems biology
approach addresses this concept of underlying etiology
and root cause solutions and is now being encouraged
by the National Institutes of Health under the new
program NIH Roadmap, a route to accelerate medical
discoveries that will improve health (86). In essence,
functional medicine assessment is concerned with
understanding the antecedents, triggers, and mediators
of dysfunction that give rise to molecular imbalances
underlying the signs and symptoms of disease (6).
The following is a brief adaptation of the ‚4R TM GI
Restoration Program‛ that the Institute for Functional
Medicine pioneered for the management of gut
dysfunction and chronic disease. (6,87). It is a
conceptual framework with which to target therapies
aimed at improving GI function.