Back Clinic Gastro Intestinal Health Functional Medicine Team. The gastrointestinal or (GI) tract does more than digest food. It contributes to various body systems and functions. Dr. Jimenez takes a look at procedures that have been created to help support the GI tract’s health and function, as well as promote microbial balance. Research shows that 1 in 4 people in the U.S. have stomach or intestinal problems that are so severe that it interferes with their daily activities and lifestyle.
Intestinal or digestion problems are referred to as Gastrointestinal (or GI) Disorders. The goal is to achieve digestive wellness. When an optimally working digestive system is on track, an individual is said to be in good health. The GI tract protects the body by detoxifying various toxins and participating in the immunological processes or when the body’s immune system interacts with antibodies and antigens. This combined with supporting the digestion and absorption of nutrients from an individual’s diet.
Now and days, mostly everyone has a gluten sensitivity or a gluten allergen in their bodies. This could happen to anyone whenever they are eating gluten-contained food or products and suddenly feel unwell or their gut acts differently throughout the day. Or they actually get tested by their physicians and realizes that they have celiac disease. In the last article and the previous one after that, we talked about the 8 products that have hidden gluten in them; as well as the introduction of the wheat zoomer we use for our patients.
Here at Injury Medical Clinic, Dr. Alexander Jimenez consults with our patients about certain zoomers that can actually aid the patient�s body. In this article, we review the factors that affect test results such as medication and fasting after taking the Wheat Zoomer, as well as, focusing heavily on the mechanism of the intestinal permeability, the structure and function of the epithelium. We also focus about important immunomodulatory metabolites, epithelial cell types and the roles in the epithelial barrier.
Intestinal Permeability
Let�s start with the mechanisms of intestinal permeability. The main purpose of the intestinal epithelium is to keep the good things in and the bad things out. While the system is complex and ever changing, it still sends out a message to the host and maintain balance both physical and biochemical as a protective barrier.� There is an abundance of antigen sampling to regulates the flow of nutrients in the host�s body, as well as, keeping an eye on the body by the mucosal immune system. Not only that, if you have an injury or an acute inflammation, the intestinal epithelium will support tissue repair by coordinating with microbiota.
Another thing that the epithelium does is that it responds to the microbial signals that will make our bodies tolerate any continuous exposure to commensal bacteria. But we do want to keep the good bacteria in our bodies but get rid of the bad bacteria, so our bodies feel good. The intestinal epithelium also convey microbial signals to the mucosal immune cells, while promoting a coordinating immune response to battle against commensal bacteria and the enteric pathogens, since these two microsomes should not be in places they are not allowed in.
While the epithelium is battling with the bad bacteria in our system, it also regulates the B and T cell response to either, control inflammation, squash inflammation, or cause inflammation on the intestinal barrier, depending on the situation. Plus the epithelium locally regulates the immune response at the intestinal barrier by influencing innate and adaptive immune responses to the body�s intestines.
However, if there is something disrupting the intestines, like chronic inflammation or leaky gut; the epithelium barrier can be compromised. In order for us to fix a leaky gut, we must learn what is causing the inflammation in the first place. The epithelium is home to many microbes, immune cells and can determined if we need the immune response on any harsh exposure. If we can learn more about these mechanisms, then we can calm down the inflammation by resetting it back to its calm, natural state.
But the immune cells in our intestinal epithelium can also cause disruption on our gut by leaking out of the protective barriers and attacking the pathogens anywhere in our system. So epithelial permeability can not only cause inflammation but prevent it in our intestines, which is both good and bad depending on the situation.
Dr. Alexander Jimenez consults with our patients with natural alternatives of healing inflammation in their gastral intestines.� If he can find the sources of what causes the inflammations in your gut, then he can work with aiding them with functional medicines while informing you what they can do to heal your gut.
Now let�s looks at the intestines and the many microsomes that they contain. Here are some microsomes we will be discussing as well as what is their key roles in the intestines; so we can figure out how to prevent a leaky gut.
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The Mucosa
This is in both the small intestines and the large intestines and are completely different. The small intestines has one mucus layer and has limited microbes inside it�s mucosa, while the large intestines has an attached inner mucosa and a loose outer mucosa. The mucosa plays an important role in the intestines because it can tell �Friend� from �Foe� in the immune system.
Important Tight Junction Proteins
The tight junction is an important function in the intestinal epithelium as it is one of the barriers that separates what comes in and what comes out in our gut.
Actin: Are the structure and functions of tight junctions. But they constantly disassemble and reassemble actin filaments if they are anti-Actins. It is controlling the tight junctions cells as it acts like a contractable belt by pulling or contracting the junctions in the intestinal cells.
Zonulin: They are the �gatekeeper� proteins that are responsible for opening or closing the tight junctions. Zonulin acts the mortar of the intestines and is associated when gluten sensitivity is present, if there are low counts of zonulin thus causing inflammation.
LPS(Lipopolysaccharide): These sent out a signal to the tight junction permeability as they find signs of bacterial endotoxin by translocating across the epithelial barrier and entering circulation. LPS is made up of gram negative bacteria in the GI tract. LPS outside the epithelial cell wall and reacts to fatty acids, which can lead to obesity for individuals.
Cell Receptors Involved in the Barrier Integrity
These cells are protectors of the epithelial barrier walls as they strengthen the immune intolerance and digestive tract, as well as causing or preventing inflammation when necessary.
G Protein Coupled Receptors (GPCRs): GPCRs are the main players of the immune system in the epithelial system. A wide variety of substances can bind with GPCRs depending what the substances are. Short chain fatty acids, omega-3�s and any food that we eat is fermented by our gut and stimulate repair on the epithelial barrier. However if there is a consumption of low or zero-fiber in our diet, the food will not be fermented and causes inflammation.
Aryl Hydrocarbon Receptors (AhRs): AhRs interact with a range of aromatic hydrocarbons like food and microbes both in and out of the gut. These receptors respond strongly to compounds found in cruciferous vegetables, thus preventing a heighten immune reaction and reducing epithelial damage as well as promoting functioning intraepithelial lymphocytes (IELs).
But if we are not eating enough cruciferous vegetables, the IELs are being produced less, the epithelial barrier is compromised and will cause inflammation.
Bile Acid Receptors (BARs): BARs recognize primary and secondary bile acid. The primary bile acids comes from the liver and then transformed into secondary bile acids by microbes. BARs play an important role in in metabolic regulation, however if there is suppression of bile in the GI tract; then the intestinal barrier is more susceptible to destruction. However, if you are producing a low bile count or obstructed bile flow, it can be the result of the microbes translocating to the small intestines and causing mucosal inflammation, SIBO and leaky gut.
Epithelial Cells Involved in the Barrier Integrity
These cells are very important to the intestinal epithelial barrier as they can either protect the barrier walls or can lead them to their demised.
Dendritic cells: Dendritic cells are presenting antigen cells that are found the epithelial layer. These cells sample and present antigens it to Tcells, thus activating immune response. Dendritic cells help the Tcells tell the difference between self and non-self because if we eat commonly consumed foods or foreign antigens are present, we don�t want our immune system to rise up�most of the times.
Goblet cells: Goblet cells are very important of the epithelial barrier because they provide the mucus barrier that coats and protects the intestinal walls. Without this mucus barrier, we will sick and any harmful bacteria will come in and out of the intestinal barriers.
Enteroendocrine cells: Enteroendocrine cells host receptors and produce a wide range of hormones, enzymes and neurotransmitters that affect or control our appetite, digestive functions, motility and interacts with microbial communities. However, these cells can either be beneficial or not if the host diet is in played.
M cells: Microfold cells or M cells are located over the Peyer�s patches and they constantly sample outside the intestinal epithelial barriers for any microbes that pose a threat. They also present antigens from the outside to the dendritic cells to activate the Tcell response, as well as consuming the antigen by neutralizing it. Without the M cells, we risk of losing tolerance to microbes, thus causing inflammation on our intestinal barriers.
Conclusion
In total, we now have a deeper knowledge of our gut system as well as taking an in depth look on what our intestinal gut goes through to stop inflammation. In order to stop leaky gut, we must change our eating habits gradually when we want a healthier life. Dr. Alexander Jimenez does discuss to our patients the importance of protecting our gut with functional medicine as well as, encouraging our patients to take that first step into a healthy lifestyle.
A majority of individuals today are aware about the gut-brain connection and how approximately 90 percent of their body’s serotonin is really generated in the gastrointestinal, or GI, tract as well as the way the gut-brain axis is associated with depression. Overall gut health involving a healthy population of gut microbiota can affect many facets of our well-being, therefore, it’s no mystery that the connection between the gut and chronic health issues, such as cardiovascular disease, diabetes and neurodegenerative diseases, are also significantly strong.
Berberine, an ancient mixture frequently utilized in a variety of medicinal herbs throughout several traditional treatments has been demonstrated to benefit as well as link the gut and the heart. Berberine is an isoquinoline derivative alkaloid found in numerous herbs. Although these berberine-containing herbs aren’t traditionally utilized in food preparations, the active ingredient has been identified and may be isolated from a variety of plant sources, such as Coptis chinensis, or Coptis or Goldthread, Hydrastis canadensis, or goldenseal, Berberis aquifolium, or Oregon grape, Berberis aristata, or Tree Turmeric, Berberis vulgaris, or Barberry, and Arcangelisia flava.
Berberine is most favorably known for its function in gut health, demonstrating activity which can help support gut microbial balance. In fact, scientists have shown a growing interest in many plant-derived compounds which affect bacterial direction and berberine is a pioneer in the group. Additionally, its a botanical proven to influence blood glucose, blood lipids and also the immune system. Researchers today have learned how berberine can provide these tremendous benefits.
Gut Health Equals Heart Health
According to evidence from a 2016 research study, the gut’s immune system is fundamental towards preventing a variety of diseases and it may often contribute to metabolic disorders. However, it might also help provide a treatment goal when observing systemic inflammation in insulin resistance. Moreover, modified gut immunity has been linked with changes to the gut microbiota, intestinal barrier function, gut-residing immune cells, and resistance to antigens which enter the gastrointestinal, or GI, system. Although this has been previously believed to raise the danger of esophageal ailments including, pathogenic infections and chronic inflammation, which may ultimately lead to chronic health issues.
In our currently hectic and stressful world, a growth in the numbers of chronic disease has begun to negatively affect our overall health health. The best instance of this increase in chronic illness is type 2 diabetes, abbreviated in this article as T2DM, which often coexists with hypertension and causes individuals to pursue nutritional advice in order to achieve healthy blood sugar levels. The information viewing T2DM alone are shocking. As of 2015, the Center for Disease Control and Prevention reported that over 30 million people in the United States had diabetes, where approximately three times as many had pre-diabetes. According to statistics, 70 percent of individuals with pre-diabetes will develop type 2 diabetes.
Natural remedies and botanicals utilized as herbal treatments which have been previously used to promote healthy blood sugar levels have been strongly evaluated in order to determine their safety and effectiveness. Numerous berberine research studies are being conducted, though these are mostly in vitro, or in cell cultures. A majority of in vivo research studies have used animals for the analysis. Despite the quality and size of those research studies, virtually all of the outcome measures throughout the last two decades are positive. One research study from 2012 looked at in vitro results to thoroughly assess the assumed mechanism of action by which berberine affects fat storage. The outcome measures using clinical therapeutics of berberine to observe participants with metabolic syndrome appeared promising.
Another research study evaluated and analyzed the use of berberine in human cell cultures to ascertain how it influenced preadipocyte, a precursor to fat cells, comparison and fat hormone as well as cell activity in patients with metabolic disease. The researchers demonstrated that preadipocyte differentiation was restricted by berberine, while leptin, adiponectin, PPAR?2, or the nuclear receptor known as the master regulator of fat cell biology and target of many diabetes drugs and/or medications, and C/EBP?, a protein necessary for fat cell differentiation, diminished. After several months, participants demonstrated a drop in their BMI and leptin/adiponectin ratio, showing that berberine could boost insulin sensitivity by limiting fat storage, which may also have beneficial effects in the regulation of blood lipid levels.
Concerning how berberine affects cardiovascular biomarkers, many assessments can be found in the literature. The administration of berberine in one analysis generated a substantial decrease in total cholesterol, triglycerides, and low-density lipoprotein cholesterol levels, with a marked rise in high-density lipoprotein. Furthermore, a meta-analysis of this anti-diabetic, hypolipidemic and anti-inflammatory effects of berberine were reviewed in twenty-seven randomized controlled clinical trials. The researchers have concluded that berberine is safe and effective due to its support of the cardiovascular system and the maintenance of healthy blood sugar levels, without any severe adverse reactions found in some of the other research studies. Berberine has also been demonstrated to restrict complex I of the mitochondrial respiratory chain, leading to a growth of 5′ adenosine monophosphate, or AMP and 5′ adenosine monophosphate-activated protein kinase, or AMPK activation. This seems to have a direct impact on energy metabolism as well as that in other structures and functions.
The neurological health effects of berberine have also been considered, particularly from the modulation of the dopaminergic system. Berberine has also demonstrated a possibility in the successful management of seizures, diabetes-induced memory malfunction and hyperexcitability. One animal research study investigating obsessive-compulsive disease found that berberine can promote anti-compulsive and/or anxiolytic effects because of its ability to boost brain monoamine levels. Another review from 2016 demonstrated berberine’s ability to reduce oxidative stress and supply neuroprotective benefits. The review further cites research studies which examine the botanical’s function in the evolution of amyloid plaques and intracellular neurofibrillary tangles. Berberine has found its function in the gastrointestinal, cardiovascular as well as brain worlds. Truly offering a wholesome dose of gut-heart-brain link, berberine is definitely one to consider.
Dr. Alex Jimenez’s Insight
Research studies have found that the relationship between a healthy gut, brain and heart is fundamental towards overall well-being. Natural remedies and botanicals, such as berberine, can help promote as well as support this gut-brain-heart connection, while other alternative treatment options, such as chiropractic care, can restore balance and encourage the human body’s natural healing abilities by correcting spinal misalignments of the spine. Furthermore, by establishing the proper relationship between the brain, the spinal chord and the rest of the body, chiropractic care can help regulate the proper structure and function of each system in the human body.
With the increasing number of gut health issues, it’s become a priority to find safe and effective treatment options to properly address these common problems. More and more research studies have found a connection between the gut, brain and heart. As previously mentioned, by both supporting and promoting the well-being of the gastrointestinal, or GI, system, the structure and function of a variety of other systems can be sustained. Natural remedies and botanicals, such as berberine, have been utilized for centuries as herbal treatments, however, other alternative treatment options can also be used to help improve gut health. Chiropractic care is a well-known, alternative treatment option which has been demonstrated to help promote the natural healing of the human body through the use of spinal adjustments and manual manipulations as well as other therapeutic techniques to correct spinal misalignments, or subluxations. Moreover, a doctor of chiropractic, or chiropractor, can recommend a series of lifestyle modifications, including exercise and nutritional advice, in order to help further improve the overall health and wellness of the human body. Maintaining the well-being of the gut can help boost brain and heart health as well.
Berberine Warnings
In large doses, berberine may lead to gastrointestinal irritation. Thus, it’s typically administered in divided doses and taken with a meal. In addition, researchers have revealed that berberine can limit particular cytochrome enzymes that also target a lot of different kinds of drugs and/or medications, including certain antibiotics. Inhibiting cytochrome enzymes influences the liver’s detoxification system, which will be required to metabolize and, finally, clear drugs and/or medications. For this reason, it’s essential to carefully monitor those patients that are using berberine if other medicines are used concomitantly. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Back Pain
Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
There has been a lot in the media lately about alkalinity and acidity in the body, but finding solid, straightforward information isn�t always easy. In short, acidity can cause a number of health issues. There are many benefits of bringing your body into balance.
What Is High Acidity?
The term acidity describes a condition where the body is affected by the excess production of gastric acids. Under normal conditions, hydrochloric acid is secreted by the stomach, aiding in the digestion and breakdown of food.
However, when this normal process is triggered in such a way that it causes overproduction of the acid, it can result in health problems. Acidity can be caused by irregular eating patterns, fad diets, alcohol consumption, stress, smoking, an unhealthy diet, and a sedentary lifestyle. Symptoms can include:
Indigestion
Burning in the stomach
Belching
Sour taste
Burning in the throat
Constipation
Nausea
Restlessness
What Are The Dangers Of High Acidity In The Body?
When the body is acidic, it can affect everything from immunity to neurological function to bone health. The Japanese have linked acidity to degenerative diseases like arthritis, cancer, and osteoporosis.
An acidic body is also a very hospitable environment for bacteria and viruses to thrive meaning the person will often get sick more often. When the body is out of balance it becomes susceptible to conditions as simple as dandruff and as complex as diabetes. Interestingly, many people have reversed or gone into remission by simply bringing their body into balance.
What Is Alkalinity?
In order to understand alkalinity, you need to understand pH levels. This is the measure used to determine how alkaline or acid something is. A pH of 0 is at the acidic end of the scale and means the thing being measured is completely acidic. At the other end of the scale, a pH of 14 is totally alkaline. The neutral point is a pH of 7.
Different parts of the body have different pH levels, meaning that some parts are more acidic while others are more alkaline. For instance, blood typically has a pH that is between 7.35 and 7.45, making it slightly alkaline. The stomach, on the other hand, is highly acidic, registering a pH of 3.5 or lower. Making the body more alkaline is not about making it completely alkaline � you need some acidity, it is necessary for digestion and other processes � it is more about bringing the body into balance.
What Are The Benefits Of Alkalinity?
When the body has increased alkalinity, bringing it into better pH balance, it is healthier and has a decreased risk of chronic illness. There is also less likelihood of illness. When the body is in a better pH balance it can result in many benefits including:
More energy
Improved cognitive function
Slowed aging process
Weight loss
Lower cancer risk
Decreased risk of chronic illness
Increased immunity
How Can You Bring Your Body Into Balance?
The best way to bring your body into better pH balance is by modifying your diet. As a rule of thumb, animal based foods like meat, eggs, and dairy tend to be more acidic. A vegetarian diet rich in plant-based foods like vegetables and fruits tend to be more alkaline. While the body does need a diet that includes both acidic and alkaline foods, a diet of processed foods and foods high in fat and sugar can cause too much acidity. By adjusting the diet, eliminating processed foods, and maintaining a healthier, more vegetarian based diet, you can bring your body into balance and enjoy better health as a result.
Injury Medical Clinic: Elderly & Geriatric Fitness
Constipation is an uncomfortable and common side effect of lower back and leg pain conditions. Sciatic nerve pain can occur at the same time as constipation does, but can also alternate where constipation ensues followed by sciatica.
Finding lasting relief is crucial, but understanding the exact reasons why the symptoms occur is just as important. These two conditions can be related or they may be completely coincidental. But the more they occur together, or in succession, there is greater chance that some structural or body connection is happening between the two.
The Facts: Sciatica & Constipation
Investigate why the source process may be the same for both conditions in some.
Constipation,�known as a recurrent and chronic health concern which plagues some people their entire lives. It can be caused by a variety of anatomical reasons, but many of these are fairly easy to diagnose, despite being difficult to cure using traditional medical therapy.
Sciatica is very much the same in that it can be chronic, recurrent and sometimes treatment-resistant.
What these disorders have in common is that they are often linked by nerve compression conditions within the spine. The source can be central or foraminal stenosis, which leads to compression of one or more of the lumbar nerve roots.
It is also possible for cervical central spinal stenosis to cause sciatica and may contribute to constipation, as well.
Both conditions are associated with the mind and body processes, that is physical illness caused or aggravated by mental factors, i.e. stress or some type of conflict. Constipation can be linked to conscious and subconscious emotional issues, while sciatica is just starting to receive the same recognition as a possible mind and body disorder.
Constipation/Sciatica: Solutions
Sciatica cases where constipation is also present involves the nerve roots in the lower spinal regions. These types of symptomatic expressions will be blamed on a variety of structural abnormalities in the lumbosacral region, which include degenerative discdisease, herniated discs and spinal osteoarthritis.
An alternative explanation for many cases of constipation accompanied by sciatica is regional oxygen deprivation. The solution to this condition is the treatment option invented by Dr. John Sarno. This simple treatment can usually solve even the most harmful of sciatica concerns. But the therapy remains controversial as it helps some and not others.
Sciatica/Constipation: Analysis
Once the symptoms have been diagnosed, if symptoms are structural, then treatments should resolve them or at least help in controlling the pain. If various treatments have been utilized with no relief, then it could be misdiagnosis.
Another anatomical condition that could be responsible for the symptoms or the cause could be a combination of the aforementioned mind and body issues working together. An epidemic problem that the healthcare system and one of the underlying reasons why so many with back, neck and sciatica pain never find a lasting cure. Don’t be surprised if to find out the pain was inaccurately diagnosed. This happens to millions every day.
Constipation can also be a result of serious internal diseases or organ malfunctions. Request a complete workup, which includes appropriate diagnostic testing for any significant or chronic constipation case.
Sometimes, this combination of symptoms may indicate the first signs of cauda equina syndrome.�This is a medical emergency and must be treated immediately.
Many will disregard any notion that sciatica is caused by constipation. Constipation can cause sciatica check other websites. Doctors do agree that constipation is one of a many of causes of sciatica.
But the bowels and the lower back are different parts of the body. It is important to understand that all parts of the body are connected in some way or other.
Sciatica?
If there is pain in the lower back near the buttocks and that pain travels down one or both legs, then chances are sciatica is present. Sciatica has become a common lower back pain that doctors, chiropractors, acupuncturists and physical therapists treat frequently. The pain is characterized with a combination of dull and sharp aches that create a feeling of pins and needles. With nerve conditions pins and needles are the most common type of pain.
Sciatica is the result of sciatic nerve compression. Constipation is a non-spinal condition that can cause sciatica. Just trying to use the bathroom can cause pain by irritating the sciatic nerve.
Sciatica happens when the sciatic nerve, which is the largest in the body, is compressed by an external pressure. Women in child birth and men who carry their wallets in the back pocket can experience sciatica.
Sciatica is treatable; if experiencing constipation and lower back pain at the same time, ask a doctor to test for sciatica. Doctors will order a CT scan, MRI, X-Ray or nerve conduction test.
Solving The Problem:
Experiencing sciatica related to constipation, then the first course of action is diet change. A fiber-infused diet that combines fruits and vegetables can relieve constipation. Or consider a fiber supplement.
Pain Reduction:
While waiting for constipation relief, there are various ways to reduce pain.
Take aspirin or ibuprofen, Anti-inflammatory medications reduce nerve and muscle inflammation, which alleviate nerve irritation.
Alternate hot and cold compresses, which reduce inflammation and sooth the pain. Can also be applied to the legs if the pain travels down the body.
Consider a firm mattress to support the back and alleviate any sciatica that may be the result from back strain.
A doctor may recommend several days of rest in order to allow the nerve damage time to heal.
Rules To Remember:
Do not bend or sit in a soft chair. Back support is critical.
Do not ignore the pain. Nerve pain heals within a week or gets worse.
Move slowly when standing or getting in and out of bed.
No heavy lifting & sometimes no lifting at all.
Good Nutrition & Chiropractic Treatment Contribute To Overall Well-Being
Dietary fat has several essential functions in the human body. First, it functions as a supply of energy and structural components for the cells and second, it functions as a regulator of gene expression, which influences lipid, carbohydrate, and protein metabolism, along with cell growth and differentiation. The effects of fatty acids on gene expression are cell-specific and influenced by structure and metabolism. Fatty acids interact with the genome. They regulate PPAR, and the activity or nuclear abundance like SREBP. Fatty acids bind directly with one another to regulate gene expression.
What’s the role of fatty acids towards disease pathogenesis?
Alternately, fatty acids behave on gene expression through their effects on specific enzyme-mediated pathways, such as cyclooxygenase, lipoxygenase, protein kinase C, or sphingomyelinase signal transduction pathways, or through pathways that require changes in tissue lipid to lipid raft composition which affect G-protein receptor or tyrosine kinase-linked receptor signaling. Additional definition of these fatty acid-regulated pathways can offer insight into the role dietary fat plays in human health as well as the beginning and growth of many chronic diseases, such as coronary artery disease and atherosclerosis, dyslipidemia and inflammation, obesity and diabetes, cancer, major depressive disorders, and schizophrenia. The effects of fatty acids on gene expression, however, have been widely described on inflammatory bowel disease, or IBD.
Fatty Acids and Gene Expression
The effect of fatty acids on gene expression was previously determined to result mainly from changes in tissue phospholipids or eicosanoid production. More recently, the discovery of nuclear receptors; such as peroxisome proliferator-activated receptors, or PPARs, and their regulation by fatty acids, has significantly altered this view. PPARs are ligand activated transcription factors that upon heterodimerization with the retinoic X receptor, or RXR, comprehend PPAR response elements in the promoter regions of different genes, that have an impact on gene transcription. PPARs bind various ligands, including nonsteroidal anti inflammatory medications, or NSAIDS, thiazolidinediones (antidiabetic agents) along with PUFAs and their metabolites. Several subtypes of the receptor are recognized (?,?,?) and are expressed in several different cells. PPAR? is extracted from the adrenal gland, with most of its numbers observed in the colon.
PPAR? has been implicated in the regulation of inflammation, and it has become a potential therapeutic goal in treating inflammatory diseases, such as IBD. It has been suggested that people with ulcerative colitis, or UC, have a mucosal deficit in PPAR? that could bring about the development of their own disease. Analysis of the mRNA and proteins within colonic biopsies demonstrated decreased levels of PPAR? in UC patients in comparison with Crohn’s patients or healthy subjects.
Using colon cancer lines, it has been demonstrated that PPAR ligands attenuate cytokine gene expression by inhibiting NF-?B via an I?B determined mechanism. Further research studies imply that PPAR activators inhibit COX2 by interruption with NF-?B. PPARs impair interactions with STAT and other signaling pathways as well as the AP-1 signaling pathway.
Animal studies support using PPAR for autoimmune inflammation. Inflammation decreased by ligands for PPAR. The direction of PPAR and RXR agonists synergistically reduced TNBS-induced colitis, together with improved macroscopic and histologic scores, reductions in TNF? and IL-1? mRNA, and diminished NF-?B DNA binding actions. Though clinical evidence is limited, the results of an open source research study with rosiglitazone, a PPAR? ligand as therapy for UC, demonstrated that 27 percent of patients achieved remission after 12 weeks of therapy. Thus, PPAR? ligands may represent a cure for UC, where double-blind, placebo-controlled, randomized trials have been warranted.
Of substantial curiosity, the capability to regulate PPAR nutritionally has been examined. Dietary PUFA demonstrated an impact during the regulation of transcription factors on gene expression. Fatty acid regulation of PPAR was originally detected by Gottlicher et al.. A choice of fatty acids, like eicosanoids, and metabolites are proven to activate PPAR. Both PPAR? and PPAR? bind mono- and polyunsaturated fatty acids. Thus, the anti inflammatory effects of n3 PUFA may entail PPAR and its interruption with NF?B, rather than only changes in eicosanoid synthesis.
Conclusion
Fatty acids regulate gene expression involved in lipid and energy metabolism. Polyunsaturated fatty acids, or PUFA, though not saturated or polyunsaturated FA, suppress the induction of lipogenic genes by inhibiting their expression and processing of SREBP-1c. This impact of PUFA suggests that SREBP-1c may regulate the synthesis of fatty acids to glycerolipids, among others. PPARalpha has a role in the adaptation to fasting by inducing ketogenesis in mitochondria. During fasting, fatty acids are considered as ligands of PPARalpha. Dietary PUFA, except for 18:2 n-6, are extremely prone to induce fatty acid oxidation enzymes through PPARalpha because of specific mechanisms. Signaling functions of PPARalpha pPARalpha is needed for controlling the synthesis of fatty acids. Further research is needed to conclude the full effects of fatty acids in relation to the regulation of transcription factors for gene expression in inflammatory bowel disease, or IBD.
Information referenced from the National Center for Biotechnology Information (NCBI) and the National University of Health Sciences. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
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Inflammatory bowel disease, or IBD, is a term used to describe inflammation of the gastrointestinal mucosa of unknown etiology. There are a selection of hypotheses associated to the development and perpetuation of IBD. Three main theories emerge from the literature. The first implicates a persistent intestinal infection; the second demonstrates that the upcoming signs of IBD are due to a defective mucosal barrier to luminal antigens; and the next suggests a dysregulated host immune response to ubiquitous antigens.
What are the nutritional components, if any, behind inflammatory bowel disease?
It is believed that IBD has both genetic and environmental components, therefore it’s immunologically mediated. Information gathered from IBD patients showing cytokine profiles, permeability defects, response to treatment and natural history of disease, may indicate a heterogeneous group of disorders that fall under the headings of ulcerative colitis, or UC, and Crohn’s disease, or CD. Previous epidemiological data on diet in UC and CD are conflicting, partly as a result of the heterogeneity of those diseases, making it difficult to get reliable statistics and publication bias, such as in the case of negative structures from breastfeeding.
Glutamine, Fiber and Fatty Acids
Diets high in glutamine, a significant source of energy for enterocytes, in addition to being the preferred fuel of the small intestine, are used with varying success. Glutamine is bekieved to exert its trophic effects on the small intestine by increasing protein synthesis and producing alanine for enteric gluconeogenesis. There is proof that glutamine protects the small intestinal mucosa during acute disease. However, oral glutamine supplements do not restore to normal the increased intestinal permeability discovered in patients with CD and these supplements do not beneficially affect the sufferers’ CDAI or C-reactive protein, also abbreviated as CRP, levels. Similarly, a randomized controlled trial demonstrated no benefit was connected to the usage of glutamine-enriched polymeric formulas in children with CD.
In animal research studies, dietary fiber has been implicated in keeping the integrity of the intestine, as well as in preventing bacterial translocation from the gut to the mesenteric lymph nodes. Short-chain fatty acids (SCFA, C1 to C6 natural fatty acids), are created by the fermentation of dietary polysaccharides in the common anaerobic bacteria in the colon. These SCFA are a source of energy for the colonocytes, which together improve sodium and water absorption, and promote blood circulation. Decreased quantities of SCFA, particularly butyrate, and a defect in the oxidation of butyrate from colonocytes, are indicated as a mechanism in the pathogenesis of inflammatory bowel disease. Evidence to support that concept requires the observation of the oxidation of C-labelled butyrate, demonstrated to decrease in patients with active UC in comparison with healthy controls. However, researchers have failed to reveal the differences between UC patients and controls in the oxidation of rectally administered C-labelled butyrate.
TPN supplemented with SCFA improved function adaptation to intestinal resection in rats. It remains to be discovered when patients with short bowel syndrome may make the most of SCFA.
Butyrate (C4 fatty acid) administered to UC patients contributed to remission levels like corticosteroids and mesalamine. In patients with CD, both intestinal biopsies and lamina propria cells packaged with butyrate had substantially decreased levels of inflammatory cytokines (TNF), possibly due to a reduction in NF?B stimulation and I?B degradation.
Eicosanoids are inflammatory mediators, which have also been implicated in the pathogenesis of chronic inflammatory damage in the intestine. Specimens from patients with IBD show enhanced eicosanoid formation. High dietary intake of omega-6 polyunsaturated fatty acids, abbreviated as PUFAs, which reduces omega-3 intake, and may contribute to IBD development. The benefits of fish oil, which contain n3 fatty acids, that were shown in certain inflammatory disorders, such as psoriasis and rheumatoid arthritis. Epidemiological observations of this very low prevalence of IBD in Japanese and Inuit populations consuming substantial n3 fatty acid fish provided a justification for utilizing n3 fatty acids in IBD. The n3 fatty acids are considered to compete with n6 fatty acids as precursors of eicosanoid synthesis. The n3 products reveal a series of 5 leukotrienes, which have considerably less physiological activity when compared with the arachidonate established series 4 counterparts. In addition, fish oil might have an anti inflammatory effect.
Rats fed with fish oil that had TNBS-induced inflammatory lesions in the intestine showed less prostaglandin- and leukotriene-mediated resistant response. Parenteral lipid emulsions enhanced with n3 fatty acids reduce diarrhea, weaken morphological changes and decreased colonic concentrations of inflammatory mediators in an animal model of acetic acid induced colitis.
Loeschke et al conducted a placebo-controlled trial of n3 fatty acids in preventing relapse in UC. Patients in remission who got n3 fatty acids experienced fewer relapses than did those receiving placebo. Unfortunately, the favorable results of this research study did not last throughout the total amount of the two year research, possibly due to diminished compliance punctually. In a multicenter placebo controlled relapse prevention trial, Belluzzi et al found a significant drop in the relapse rate in CD patients given an exceptional formula designed to allow postponed ileal release of n3 fatty acids. A fish oil diet has been shown to increase eicosapentanoic and docosahexanoic acids in the intestinal mucosal lipids of IBD sufferers, also demonstrating a reduction in arachadonic acid. A gain in the synthesis of leukotriene B5 along with a 53 percent decrease of leukotriene B4 was shown in UC patients, whereas the fish oil treatment revealed a nonsignificant trend to faster remission. Fish oil supplementation results in clinical improvement of active mild to moderate disease, but was not associated with a significant reduction in leukotriene B4 production. Consequently, fish oil supplementation of the diet may provide some short-term benefit to people with CD or UC. Using probiotics and prebiotics has received much attention; the interested reader is referred to recent reviews in this area.
Clinical Implications
It is widely known that nutritional deficiencies are common in people with CD and UC, and people have to be expected, diagnosed and treated. There are no special diets which may be recommended for all patients with IBD; dietary therapy needs to be individualized. TPN or TEN may be necessary to restore nutrient equilibrium in selected IBD patients with malnutrition, but in adults these interventions do not provide an essential decision to modify disease activity. The omega-3 PUFAs in fish oil may reduce disease activity in UC and CD when used at the short term together with regular medical therapy. Their mechanism of action is to enhance the activity of the amino acids PPAR, or peroxisome proliferator-activated receptors, in the intestine, inhibiting the AP-1 signaling pathway and NF-?B, weakening pro-inflammatory cytokine receptor expression. Future research will focus on the identification and use of certain dietary lipids to reduce intestinal inflammatory activity and also to maintain long-term disease remission.
Information referenced from the National Center for Biotechnology Information (NCBI) and the National University of Health Sciences. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
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Inflammatory bowel disease is an umbrella term used to describe a group of gastrointestinal diseases characterized by chronic, ongoing inflammation of all or part of the gastrointestinal tract, or GI tract, such as Crohn’s disease, or CD, and ulcerative colitis, UC. While many factors have been determined to cause inflammatory bowel disease, research studies have concluded that nutrition can increase the risk of gastrointestinal diseases, including inflammatory bowel disease.
How does nutrition affect inflammatory bowel disease?
Nutrient deficiencies are common among individuals with inflammatory bowel disease, or IBD. Both complete parenteral and enteral nutrition can provide significant supportive treatment for patients with IBD, however, in adults those alone may not be helpful as a form of primary treatment. Clinical intervention using omega-3 polyunsaturated fatty acids found in fish oil could be beneficial for the nutritional regulation of IBD patients and recent research studies have emphasized the function of PPAR on NF?B action towards its possible beneficial impact on dietary lipids for overall intestinal functioning.
Nutrition in Inflammatory Bowel Disease
Specific antibody isotypes of essential milk proteins are located in both UC and CD patients. In CD, the antibodies are associated with disease. Although cultural origin, rather than the IBD disease condition, seems to be the primary cause of lactose intolerance, the avoidance of milk products by IBD patients is extensive. Lack of breast-feeding during infancy was associated with CD but not UC. Additionally, higher carbohydrate intake was recorded in CD. Others have suggested a deficiency of dietary fiber as a predisposing factor for IBD. The growth of UC has also been associated with higher intakes of polyunsaturated fatty acids (MUFA), n6 polyunsaturated fatty acids (n6 PUFA), sulphur-containing diets and vitamin B6.
Deficiencies
Inflammatory bowel disease is related to several nutritional deficiencies, such as anemia, hypoalbuminemia, hypomagnesia, hypocalcemia and hypophosphatemia, including deficiencies in folic acid, niacin, vitamins A, B12, C, and D, in addition to deficiencies of iron, magnesium and zinc. Further research studies are needed to determine if reduced levels of micronutrients are of some significance to the result of gastrointestinal diseases. Plasma antioxidant concentrations are lower in IBD patients, especially those who have an active form of the disease. Antioxidant action, evaluated by measuring selenium levels and erythrocyte glutathione peroxidase activity, is inversely associated with inflammatory biomarkers, such as TNF?. Hyperhomocysteinemia is more prevalent in patients with IBD, and is characterized with low serum as well as reduced concentrations of vitamin B12, folate and B6.
Several mechanisms are responsible for the malnutrition observed in IBD patients. Primarily, there’s a decline in the oral consumption of nutrients due to abdominal pain and anorexia. Second, the mucosal inflammation and related diarrhea reduces blood, protein, minerals, electrolytes and trace components. Paradoxically, multiple resections or bacterial vaginosis might have an adverse nutrient impact; and finally, herbal remedies may also cause malnutrition. By way of instance, sulfasalazine reduces nitric acid absorption, and corticosteroids reduce calcium absorption in addition to negatively impacting protein metabolism. Alterations in energy metabolism may result in increased resting energy expenditure and lipid oxidation in patients with inflammatory bowel disease. There are many effects of malnutrition and each can decrease bone mineral density, in addition to growth retardation and delayed sexual maturity in children. Osteoporosis may also be involved as a consequence of pro-inflammatory cytokine profiles.
Nutritional treatment may take on a range of forms including Total Parenteral Nutrition (TPN) and Complete Enteral Nutrition (TEN). The diets used are elemental, polymeric, and exception diets. Elemental diets contain nutrients reduced to their fundamental elements: amino acids, such as proteins, sugar for carbs, and short-chain triglycerides, such as fats. Polymeric formulas contain entire proteins, such as nitrogen, glucose polymers for carbs and long-chain triglycerides for fat or starch.
Total Parenteral Nutrition (TPN)
Using TPN for the nutritional regulation of IBD is based on specific theoretical benefits, including how: gut rest may be beneficial since it reduces motor and transportation function in the diseased intestine; a drop in antigenic stimulation can remove the immunologic reactions to food, particularly in the presence of diminished intestinal permeability; TPN promotes protein synthesis in the gut which provides cell renewal, recovery, and alteration of impaired immunocompetence.
Researchers demonstrated remission rates of 63 percent to 89 percent with TPN in a large retrospective collection of CD patients which were difficult in standard medical management. But, Matuchansky et al highlighted that there have been high relapse rates (40%-62%) after two decades. It’s been implied that TPN be utilized exclusively in a nutritionally supportive function. In UC, there’s absolutely no evidence for much better results with TPN. Though remission rates of 9 percent to 80 percent are reported, TPN provided to patients with acute colitis seems to be beneficial as perioperative nutritional support. In patients with moderate disease, TPN is significantly more successful but isn’t better than steroid treatment, and so the invasiveness and price of TPN are unjustified. Any advantages related to TPN might be due to the nutritional regulation, rather than gut rest, as gut rest alone has no impact on disease activity. Accordingly, though TPN has a function in patients using a non-functioning gut or the brief gut syndrome because of excess resections, TPN is of limited use as a primary treatment in IBD. This isn’t designed to be an extensive breakdown of TPN, but it needs to be cautioned that in specialist centers, TPN is associated with complications like sepsis and cholestatic liver disease.
Total enteral nutrition (TEN), Elemental & Defined Formula Diets
TEN prevents possible toxic dietary variables and antigenic exposure, because there are only amino acids, sugar or oligosaccharides and very low lipid content. TEN isn’t associated with cholestasis, biliary sludge or gallstone formation, as can be observed with TPN. Atrophy of the small intestinal mucosa was discovered in animal models receiving long-term TPN, yet this atrophy is prevented with TEN. Additionally, a 6-wk TPN therapy in dogs led to marked decrease in pancreatic fat, a reduction in small intestinal mass as well as a decline in intestinal disaccharidase activity in puppies. Because of this, TEN is more preferable than TPN.
The subject of nutrition in gastrointestinal disorders which occur in IBD has been recently reviewd. In comparison to TPN, enteral nutrition yielded similar outcomes towards preventing and combating malnutrition. Though Voitk et al suggested that elemental diets could be an effective treatment for IBD, enteral nutrition as a primary therapy has failed to produce consistent results in several clinical trials. It’s correct that quite a few trials have shown remission levels in CD patients getting elemental diets, like the rates observed with prostate cancer treatment. But, it’s important to note that greater remission rates were detected in patients receiving steroid therapy versus standard diets when including all of the diet category fall outs (i.e., in an intent-to-treat foundation). The question remains concerning the best means of assessing the results when a sizable proportion of individuals receiving diet treatment fall out due to unpalatibility or intolerance. What’s more, a few research studies have demonstrated no distinction with elemental diets compared to steroid treatment. In children, elemental diets have been associated with higher linear gain, whereas in adults those diets maintain nitrogen equilibrium. The use of supplements in the context of pediatric onset illness was also reviewed. Therefore, enteral nutrition is simpler to use, is less costly, and it’s also a far better choice than TPN. Unfortunately, its unpalatability limits individual agreement, but with powerful encouragement this might be partly overcome.
The fat composition of enteral diets can influence the results that are obtained in the several clinical trials. Elemental diets include a reduced fat content, although a lot of healthier diets generally contain more fat, such as more lactic acid, which can be a precursor for the synthesis of possible pro-inflammatory eicosanoids.
Defined formula diets are often more palatable and more affordable than would be the elemental diets. When some researchers reported no gaps between utopian and defined formula diets in patients with severe CD, Giaffer et al discovered elemental diets are far more successful for active CD. A randomized double-blind study in Crohn’s patients revealed that elemental and polymeric, or characterized, diets differing only in their own source of nitrogen, were equally effective in lessening the Crohn’s disease activity index, or CDAI, also inducing clinical remission. Though defined formula diets supply less gut rest, they have the possible benefit of exposing the GI tract to the typical dietary substrates, which permit thereby for the complete manifestation of intestinal, biliary and pancreatic action. In animal research, it has also been discovered that luminal nutrition has trophic impacts on the intestine.
Can there be a beneficial effect of supplementing polymeric formulas with TGF-?1? In pediatric CD, reductions in pro-inflammatory cytokine concentrations and mRNA, paired with an up-regulation of TGF-? mRNA, was associated with enhanced macroscopic and microscopic mucosal inflammation. A meta-analysis along with a Cochrane review have demonstrated that in adults, corticosteroids are more effective than enteral diet treatment. It’s uncertain what is the use of supplements in adults with CD, even though there are some signs in Japan that enteral nutrition enjoys support as principal treatment. In contrast to this generally agreed part in adults of enteral nutrition being used to enhance the patient’s nutritional status because its principal advantage, in children with CD enteral nutrition has a far clearer benefit to enhance clinical, biochemical and growth parameters, and may as well have a steroid sparing effect.
Information referenced from the National Center for Biotechnology Information (NCBI) and the National University of Health Sciences. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
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Investigate why the source process may be the same for both conditions in some.
Sciatica cases where constipation is also present involves the nerve roots in the lower spinal regions. These types of symptomatic expressions will be blamed on a variety of structural abnormalities in the lumbosacral region, which include degenerative disc disease, herniated discs and spinal osteoarthritis.
