Written by: Dr. Anne Zauderer, Riordan Clinic

www.RiordanClinic.org

Introduction

This course is designed to give you a foundation for how our bodies were designed to utilize, process and eliminate food. This is a critically important process and when it goes wrong it can lead to a state of dis-ease in the body.

Outline

• Inflammation – How our ancestors ate

– What is inflammation?

– What foods trigger inflammation

• Leaky Gut – Anatomy Review

– What causes leaky gut

– Systemic effects

– Autoimmunity

• Ways to Heal the Gut – Foods to eat and avoid

– Supplements

Digestive System

Components of Digestive System

• Mouth – Teeth mechanically break down food – salivary glands release enzymes that begin digesting

carbohydrates

• Stomach – Big muscle – mechanically churns food – Release of acid – breaks protein bonds

• Small Intestine (duodenum, ilium, jejunum) – Absorption of nutrients – Removal of waste

• Large Intestine (colon) – Removal of water before waste is eliminated

Gut Barrier System

How Our Ancestors Ate

Understanding how our ancestors ate is vitally important to understanding how our bodies have evolved to metabolize food

What did our ancestors do differently?

1. They were reliant upon their senses to decipher what was palatable – any meal could be their last!

2. They hunted, grew, and prepared all of their own food

3. Meats and sweets were a luxury

4. Quantity of food was less

What has changed in our modern diet that makes us so sick?

Inflammation!!

We are eating more foods that are triggering the release of

inflammatory mediators – leading to an imbalance in our body’s ability to regulate inflammation

What is Inflammation?

- Inflammation works by breaking down damaged tissue

- Inflammation is healthy when:

- Localized and visible (redness, heat, swelling)

- Inflammation is unhealthy when:

- Systemic and undetected

- Speeding up wear and tear of organs

- Unhealthy inflammation is caused by excessive pro-inflammatory regulators

The KEY is Balance

Pro-Inflammation Anti-Inflammation

Out of Balance

Pro-Inflammation

Anti-Inflammation

What does inflammation have to do with my diet?

1. Ancestral Diet

2. Agricultural Revolution

3. Industrial Revolution

4. Convenience/Fast Food Revolution

Book Recommendation:

The Omnivore’s Dilemma by Michael Pollen

Four Major Dietary Shifts

1700

Agricultural Shift

Ancestral Diet

BC

Industrial Revolution

Fast Food Revolution

Dietary Shifts Timeline

1800 1900

2000

Improvements in Agricultural Tech

nology

Criteria for Dietary Analysis

1. % Whole Food

2. Ratio Omega 6:3 Fatty Acids

3. Glycemic Index

4. ORAC Score

Oxygen Radical Absorbance Capacity

Whole Foods

Whole Food: a food in its original state

that has not been altered, canned, boxed, juiced or preserved

Example:

Apple Apple sauce Apple Juice

Omega 6:3 Ratio

PRO- inflammation

ANTI- inflammation

Omega 6 Fatty Acids

Omega-6 fatty acids Arachidonic Acid (AA)

Sunflower, safflower, corn, cottonseed oil

Omega-3 fatty acids EPA and DHA

Coldwater fish, grass-fed animals, flax seeds

Glycemic Index

Glycemic Index

• “High Glycemic Foods” – Table sugar, white flour, potatoes, juices – Rapidly enter the bloodstream – Strain the pancreas to over-produce insulin – Over time, insulin resistance develops

• “Low Glycemic Foods” – Vegetables, whole fruits, dairy, meat – Slow entry into the bloodstream – Insulin levels remain relatively low

Consequences of High Glycemic Foods

• Roller coaster between high & low blood sugar – Adrenal exhaustion, poor stress tolerance – Creates carbohydrate cravings (“quick energy”)

• High insulin activates delta-5-desaturase – promotes conversion of omega-6 to AA – high insulin is pro-inflammatory

• Sugar, white flour, added fats low %whole foods – Low ORAC score phytonutrients have been

refined out higher oxidative damage

ORAC Score

ORAC – Oxygen Radical Absorbance Capacity (ORAC units per 100 grams)

Ethnographic record 229 hunter-gather cultures*:

• 73% of societies studied hunted over half of the food from animals and fish

• All gathered a large variety of plant matter (leaves, roots, fruits, berries, seeds, nuts)

• Eaton showed these hunter gatherers:

– Were generally healthier than people today

– Rarely experienced degenerative & inflammatory disease

Ancestral Diet

*S. Boyd Eaton, MD, Emory University, NEJM, 1985

Ancestral Diet Composition

Protein: 19-35% of calories

Fat: 28-58% of calories - ratio of omega-6 to omega-3 is 1:1

- farther north = the higher the fat composition

Carbohydrates: balance of calories - leaves, shoots, buds, roots, fruits, seeds, nuts

- fiber, antioxidants, and phytonutrients

Characteristics of Ancestral Diet

Whole Foods 100%

Omega 6:3 Ratio 1:1 ratio

Glycemic Index Very Low

mostly lean meats & fish

ORAC Score Very High

large amounts of vegetable matter high in antioxidants & phytonutrients

Inflammation Balance Ancestral Diet

ORAC

Glycemic Index

Whole Foods

OMEGA 6 OMEGA 3

Agricultural Revolution

• Less diverse diet

• Less vegetable matter (less anti-oxidants)

• Egypt is prototypic agricultural society

• Cultures became less nomadic, more settled

• Marked increase in grains (omega-6 fats)

• Domesticated meat, fed grains (omega-6)

• Shift to pro-inflammatory omega 6:3 ratio

Characteristics of Agricultural

Societies

Whole Foods 90%

Omega 6:3 Ratio 5:1

excess omega-6 shifts the body chemistry in pro-inflammatory way

Glycemic Index Medium

ORAC Score Medium

ORAC

Glycemic Index

Whole Foods

Inflammation Balance Agricultural Revolution Diet

Industrial Revolution Diet

• The beginning of food processing

• Introduction of margarine & separated fats

• Extensive refining of grains

• Introduction of cheap refined sugar

• Displacement of nutrient-dense whole foods with nutrient-poor refined foods

• Greater risk of elevated blood sugar levels, which strongly shifts pro-inflammatory

Industrial Revolution Diet Characteristics

Whole Foods 65%

Omega 6:3 Ratio 10:1

excess omega-6 shifts the body chemistry in pro-inflammatory way

Glycemic Index High

ORAC Score Low

ORAC

Glycemic Index

Whole Foods

Inflammation Balance Industrial Revolution Diet

Fast Food Diet

• Widespread refining, processing, & manipulation of foods

• Very high refined carbohydrate intakes

• Very low intake of vegetables

• Hydrogenated trans fats and chemical preservatives for longer shelf life

• Eating on the run – meal preparation is not done at home

Fast Food Diet Characteristics

Whole Foods 35%

Omega 6:3 Ratio 20:1

excess omega-6 shifts the body chemistry in pro-inflammatory way

Glycemic Index Very High

ORAC Score Very Low

Inflammation Balance Fast Food Revolution Diet

ORAC

Glycemic Index

Whole Foods

The modern diet is 20 times more

pro-inflammatory with substantially fewer anti-inflammatory vitamins, minerals, and

phytonutrients

14 Anti-Inflammation Diet Principles

1. Eat a variety of fresh and whole foods 2. Eat more fish, especially coldwater varieties 3. Eat grass-fed lean meats, and game meats 4. Eat a lot of colorful vegetables 5. Use spices and herbs to flavor your foods 6. Use olive or coconut oil as your primary

cooking oils 7. Identify and avoid food allergens

Movie Recommendation: Food Inc.

14 Anti-Inflammation Diet Principles (cont.)

8. Avoid conventional vegetable cooking oils

9. Avoid or limit intake of all refined sugars (especially high fructose corn syrup)

10. Avoid or limit intake of refined grains

11. Limit your intake of dairy products

12. Snack on nuts and seeds

13. When thirsty, drink water or herbal teas

14. Eat organically raised foods

Organic Vs. Conventional

Why Eat Organic?? 1. Pesticides

• Long-term exposure at low levels

• Increased risk of nervous system diseases

• Canaries in the mine (outliers)

• How much is considered “toxic”?

2. Nutrient Content

• Organic plants have to defend themselves, provide more nutrient protection to consumer (phytonutrients)

3. Environment

Dirty Dozen 1. Apples 2. Strawberries 3. Grapes 4. Celery 5. Peaches 6. Spinach 7. Sweet bell peppers 8. Nectarines (imported) 9. Cucumber 10. Cherry Tomatoes 11. Snap peas (imported) 12. Potatoes Source: Environmental Working Group www.ewg.org

Clean Fifteen

1. Avocado 2. Sweet Corn 3. Pineapple 4. Cabbage 5. Sweet Peas (frozen) 6. Onions 7. Asparagus 8. Mango 9. Papaya 10. Kiwi 11. Eggplant 12. Grapefruit 13. Cantaloupe 14. Cauliflower 15. Sweet potato

Leaky Gut

“All Disease Begins in the Gut”

Hippocrates, Father of Medicine

What happens when the gut system starts to break down??

The gut we have is not designed for the world we live in.

• Overuse of antibiotics

• Foreign food products (GMO, food science)

• Toxic chemicals (bioaccumulation)

• Preserved, packaged foods

Leaky Gut

• Constipation

• Diarrhea

• Heartburn

• Gas

• Bloating

• Burping

• Headaches/Migraines

• Depression/Anxiety

• Weight Gain/Loss

What Symptoms Are

Associated with Leaky Gut?

• Eczema

• Acne

• Hives

• Rashes

• ADD/ADHD

• Brain fog

• Muscle/joint pain

• Fatigue

• Allergies (Food & Seasonal)

Features of the Gut

1. Microbiome

2. Surface Area & Absorption

3. Gut barrier system

4. Immune system in the gut

Features of the Gut: Microbiome

1. Bacterial cells outnumber our own cells 10:1 – commensal relationship

Book Recommendation: Brain Maker by Dr. David Perlmutter

Microbiome

BUILDS DESTROYS

Fermented foods: - Yogurt (no sugar added) - Kefir - Sauerkraut - Kombucha - Miso - Tempeh

Antibiotics - Rx - Conventional meat - Conventional dairy

Probiotics Artificial Sweeteners - Splenda, Aspartame, Sucralose, etc

Foods high in inulin (fiber): - Asparagus - Onions - Artichokes

Chemicals - Chlorine - Fluoride - Pesticides/herbicides

Prebiotics Stress

Features of the Gut: Surface Area & Absorption

2. “Shag carpet” provides larger surface area for absorption

Features of the Gut: Gut Barrier System

3. Cells that line the digestive system should allow only the smallest particles through

Features of the Gut: Immune System

4. >60% of immune system is concentrated in the gut (area of great vulnerability)

a. Constant exposure to large amounts of dietary & microbial antigens

b. Mucosal immune compartment must be able to choose tolerance vs. clearance

c. Decision-making: T cells, B cells, dendritic cells

What Breaks Down our Gut Lining?

What Breaks Down our Gut Lining?

1. Gliadin (gluten) – celiac and non-celiac

2. Stress – reduced blood flow, altered motility, increased permeability

3. Dysbiosis – overexposure to antibiotics

4. Candida overgrowth – sugar and antibiotics

5. Environmental contaminants

6. Food additives, preservatives & pesticides

7. Drugs – NSAIDs, aspirin, ibuprofen, antacids

What does leaky gut have to do with the rest of my symptoms??

IMMUNE SYSTEM MESSENGERS!!

Immune-Mediated Inflammatory Response

Cytokines are immune system messengers

– Chronic states of inflammation are associated with alteration in the number of cytokines

– Something in the environment activates genes of cells within the immune system to produce cytokines

– Once released into the bloodstream, they trigger a cascade of other substances that control specific types of inflammation

Arthritis

Asthma

Dermatitis/Eczema

Crohn’s Disease

Inflammatory Bowel Disease

Hashimoto’s/Graves’

Immune-Mediated Inflammatory Conditions

Migraines

Neurodegenerative Conditions

Multiple Sclerosis

Osteoporosis

Cardiovascular Disease

Long Term Consequences: Autoimmunity

• The immune systems loses the ability to recognize “self” from “non-self”

• Immune system starts attacking our body’s own cells

• Long-term autoimmunity can lead to chronic disease state

Book Recommendation: The Autoimmune Solution by Dr. Amy Meyers

Autoimmune Conditions

• Hashimoto’s

• Graves’

• Celiac

• Multiple Sclerosis (MS)

• Rheumatoid arthritis

• Type 1 diabetes

• Addison’s Disease

• Sjogren Syndrome

• Cancer??

• Crohn’s

• PANDAS

• Psoriasis

• Ulcerative Colitis

• Interstitial Cystitis

• Restless Leg?

• Schizophrenia?

• Alopecia areata

• Lupus

• Myasthenia gravis

Ways to Heal the Gut

Many Factors

• Full symptom picture • Chronicity • Severity • Autoimmunity • Nutrient deficiencies • Genetics

Intensive gut repair programs are best done under the care of a physician

The Four R Program*

1. Remove

2. Replace

3. Reinoculate

4. Repair

REMOVE

REMOVE

• Food allergens – Most common allergens include: wheat, dairy, soy, eggs,

nuts/seeds, corn

• Food triggers/sensitivities – Cytotoxic food test

– Food journal

• Pesticides

• Exposure to environmental toxins – See charts in reference guide

Signs of a Food Sensitivity

• Headaches

• Bloating

• Fatigue

• Reflux

• Swelling of face, hands, feet

• Mood changes (depression, anxiety)

• Increased heart rate

• Pupil dilation

REPLACE

REPLACE

Low stomach acid

Reflux, burping,

clearing throat

after eating

Digestive enzymes

Undigested food

material or fat in

stools

Low Stomach Acid Chew food more thoroughly Bitter herbs and foods 10-15 minutes before eating Apple Cider Vinegar Bromelaine Betaine HCl Ascorbic Acid

Digestive Enzymes Pancreatic enzymes - Amylase - Lipase - Protease - Lactase - Maltase Increasing acid in the stomach will naturally stimulate release of enzymes

REPLACE: Supplement Support

REINOCULATE

• Prebiotic – soluble fiber that promote growth of good bacteria in the gut

• Probiotic – supplemental probiotic

organisms

Prebiotic Optimize immune function Facilitate bowel regularity Improve the integrity of the gut barrier Enhance mineral absorption Favorably modulate blood lipids Defend against harmful disease-causing bacteria

Probiotic Hypoallergenic Multi-strain 5-10 billion (maintenance dose)

REPAIR

Nutrients that Repair the Gut

Zinc Zinc protects the cellular membrane & is important in cellular growth Commonly affects the hair, skin and gastrointestinal system Beef, crab, oysters, peas

B Vitamins (methylated

forms)

Energy and metabolism DNA synthesis and repair Dark, leafy vegetables, liver, avocado, lentils

Magnesium Involved in over 300 enzyme reactions Needed for protein synthesis Required for synthesis of DNA, RNA and glutathione Almonds, cashews, spinach

L-Glutamine Principle fuel of cells that line small intestine Decreases bowel permeability Maintenance of body pH Meat, poultry, fish, whey protein

Nutrients that Balance the Immune System

Curcumin (Tumeric)

- Balances TH17 cells (contributes to autoimmunity) - Balances nuclear factor kappa-B (NF-kB) (which controls expression of genes that encode for pro-inflammatory cells)

Vitamin D - Supports regulatory TH3 cells of the immune system - Activates genes that regulate the immune system

Glutathione Supports regulatory TH3 cells and helps maintain balance

Resveratrol Helps to balance TH17 and NF-kB

Omega 3 Fish Oils Reduce inflammation

Where do I start??

5 Action Steps to Start Today

1. Get rid of sugar

- Hidden sugar: yogurt, bread, drinks, cereal, breakfast bars

2. Significantly reduce additives and preservatives

- Don’t buy anything in a box, choose organic

3. Increase good fats and proteins from organic and grass fed sources

- Good fats: avocado, coconut oil, olive oil (low heat), nuts/seeds

4. Decrease simple carbohydrates - Wheat, pasta, crackers, sugar

5. Drink more water

Dr. Anne Zauderer

azauderer@riordanclinic.org

316-682-3100