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AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS In this particular case, one could rationalize that this patient has had evidence of a physiologic environment consistent with longstanding chronic inflammation. Atopy and asthma are obvious. Less obvious was that each pregnancy was complicated by symptoms of preterm labor, which is thought to be mediated in part by abnormal prostaglandin synthesis and degradation, i.e. inflammation. She also experienced unexplained ‚allergic‛ type reactions during two of the four pregnancies, one of which required hospitalization. Pregnancy places a tremendous stress on the immune system and hormonal physiology, requiring the host to adapt to a non-self fetus as well as adjusting to the hemodynamic and metabolic needs of the pregnancy. Pregnancy depletes nutrients as well as causes hormone imbalance and these may have been part of the pathway to the inflammatory responses that ultimately manifest themselves as chronic bladder pain. This chronic pain played a role in poor sleep andcertainly ‚stressed‛ the adrenal systems production of cortisol. So, we see a potentially common thread: atopy and asthma since childhood; pregnancy(stress and hormone imbalance) temporarily unmasks the patients underlying immune system imbalance, which creates the symptoms of preterm labor and ‚allergic‛ reaction; chronic bladder pain (inflammation) develops which further stresses the physiology; lack of restorative sleep due to pain, which may contribute to intestinal hyper-permeability and development of multiple food and chemical sensitivity; development of subclinical hypothyroidism and autoantibodies; development of autoimmune thyroiditis and Graves’ disease. We know that the balance of the cellular and humoral arms of the immune system is regulated in part by the hormonal environment with testosterone, DHT, DHEA and DHEA-S favoring a shift toward cellular (Th1 immunity and glucocorticoids, estrogens, and catecholamines favoring a shift toward the humoral (Th2) arm of the immune system. In this patient’s case, we could argue for a generally estrogen dominant hormone environment to her low cortisol, low 17-OHP, and weight gain; this may have been part of what tipped the scales further towards autoimmune thyroiditis. 80 2012 Once established, Graves’ disease is difficult to treat. There is little in the literature giving clinical guidance to the prevention and treatment of eye disease. Antibodies directed toward the TSH receptor are involved in eye disease, as expression of the TSH receptor has been shown present in the adipocytes and connective tissue of the diseased Grave’s orbital tissues. Very recent research has found a human monoclonal antibody which stimulates the TSH receptor and adipogenesis in the human Grave’s orbit via a known signaling cascade. Inhibition of this cascade may be a potential treatment strategy for Grave’s opthalmopathy. I find it fascinating that this patient has such a constellation of disease processes (atopy, asthma, preterm labor, interstitial cystitis, arthritis, and Graves’ disease) and the most logical link among these conditions is the immune system and inflammation. Although the etiology of interstitial cystitis is unknown, as is the cause of Graves’ and most autoimmune disease, recent interest in the use of hyperbaric oxygen therapy for urological conditions like interstitial cystitis has been reported in the Italian literature.(3) HBOT has been used in a variety of other inflammatory and autoimmune conditions. HBOT stimulates stem cell mobilization from the bone marrow and decreases oxidative stress in tissues thereby reducing inflammation and may have potential to help IC. IC may indeed be another manifestation of autoimmunity. This patient had undergone 10 hours of HBOT therapy in a mild chamber and had reported improvement in bladder symptoms. The cornerstone of treatment for this patient will be long term hormone management, nutritional support and anti-oxidant therapy. Periodic re-evaluation of food intolerances and monitoring of gut flora will aid in restoration or prevention of intestinal hyperpermeability. Summary Food Sensitivity is not a ‚food‛ problem. Rather, it is an immune phenomena driven by a myriad of variable metabolic imbalances occurring within the gastrointestinal tract, over time, within the unique genetic environment of the host, which culminates in some degree of immune activation. This immune
AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS activation is also manifest in unique, individually determined signs and symptoms culminating in a physiologic state somewhere along the gradient of asymptomatic to severe disease. It is always important to remember that the signs and symptoms of disease are only the outward reflection of an underlying physiologic derangement. These symptoms are a reflection of underlying metabolic imbalances and compensatory actions of the host; in some individuals the metabolic imbalance cannot be compensated for. This can lead to chronic inflammatory states, anatomic and functional damage, often resulting in the diagnosis of a formal disease process, such as Crohn’s, Celiac, or some other autoimmune disease. Understanding the development of Food Sensitivity is akin to the chicken-and-the-egg problem: which came first? Think, instead, of food sensitivity as an evolving phenomena which affects each individual differently. As an example, in an individual with a clean diet, relatively normal gut flora, and a well nourished and balanced immune system, food sensitivity may be a mild, intermittent process, resulting in inflammation for which their body can completely compensate. Their only symptom may be a mild headache or gut cramping which they do not even connect to the ingestion of the food. On the other end of the spectrum are those individuals who develop significant symptoms such as abdominal bloating, fatigue, and loose or foul stool after the ingestion of certain foods and those with established inflammatory diagnoses such as Celiac or Crohn’s disease. As an interested practitioner of any healing art, you have the ability to help your clients take immediate action to improve their health and wellbeing by identifying the role that foods can play in symptoms and disease processes. The patient can be simultaneously educated and treated using a simple elimination diet, allowing them to learn how foods can immediately affect their health. A food sensitivity panel, such as an ALCAT test, can allow your patient to identify a large number of foods that can activate their immune system. Eliminating these foods will reduce downstream inflammation allowing the patient to lose weight and reduce disease symptoms. 81 2012 Clinicians and patients must understand that the immune system plays a central role in the generation and mitigation of inflammation in the body. The immune system can be activated by undigested food antigens if the intestinal lining becomes permeable; certain food antigens, such as gluten, as well as imbalanced gastrointestinal flora, can contribute to gut inflammation and intestinal hyper-permeability directly. Digestion of natural, minimally processed foods is essential to absorption of nutrients and optimization of the gastrointestinal flora balance. The balance of these unique factors will ultimately dictate the immune response in the host. The future of wellness lay in part to our understanding of the immune response, foods, and the ‚invisible world‛ living within us. We have only seen the tip of the iceberg with regard to our understanding of the interaction between food and disease. Food sensitivity is a key factor in achieving gastrointestinal wellness. There are likely many avenues through which foods can interact within a particular individual to create wellness or disease. Until we know more, I counsel my clients to take these simple steps. Practical Tips For Your Patients 1. Eat a wide variety of ‚real foods.‛ ‚Real‛ foods are those that are as close to their natural source as possible; for instance, boxed cereal is not found growing from a tree! 2. Eat properly for digestion. This involves adequate chewing of food, eating small amounts of food with each bite, and taking time to consume a meal. This will set the stage for adequate stomach acidity, pancreatic acid production, bile secretion, and time to digest the food substance into its macronutrient constituents. These macronutrients are able to be further digested by the gut bacteria and/or absorbed by the intestinal tract. 3. Reduce inflammatory food intake using these options: a. Simple Elimination Trial: Gluten/Wheat, soy, corn, milk products, yeast.
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