Ch Christ stine Kessler M MN, A ANP NP-BC, C CNS NS, B BC-ADM, - PowerPoint PPT Presentation

Ch Christ stine Kessler M MN, A ANP NP-BC, C CNS NS, B BC-ADM, C CDTC, F FAANP NP Founder, Metabolic Medicine Associates King George, VA ckessler@maranatha.net

DISCLOSURES Ò Clarion Brands (Floragen) É National Study Chair: use of probiotics with antibiotics

OBJECTIVES Ò Describe t the i intimate l linkages b between t the g gut h hormones, , microbiome a and t the C CNS a and m metabolic h health (i (immune, , CV, p , pulmonary, n , neuro-psychologic, a , and e endocrine). ). Ò Develop a a s strategy t to p promote g gut m microbiome i integrity a and health he Ò Discuss t the b benefits a and l limitations o of p pre- and p probiotic use use.

BEFORE WE GET STARTED…. I need coffee. I really do!

IT’S P PUZZLING—WH WHY…. Y….? Ò Has there been a continuing increase in autoimmune diseases and obesity during the past 4 decades? Ò Do therapeutic diets improve CV health for some but worsen it for others? Ò Are asthma rates skyrocketing in developed countries, but not in ”less civilized” countries? Ò Are dogs actually beneficial for overall health?

TO K KNO NOW W WHAT’S H HAPPENI NING NG... We need to look to the gut as the biggest player in chronic health and autoimmune disease!

The Coffee (Heart & Cancer) Gene Conundrum FA FAST T vs vs SLOW metabolize zers Are yo you cr crazy? zy? SLOW = incr crease sed MI/ tach chy FA FAST= T= ca cardioprotect ctive ve Cornelius M, et al. Genome-wide meta-analysis identifies six novel loci associated with habitual coffee consumption. Molecular Psychiatry, online October 7, 2014, doi: 10.1038/mp.2014.107 (accessed 1/20/2016) Sagioglou C. & Greitemeyer T., Individual differences in bitter taste preferences are associated with antisocial personality traits, Appetite (2015), doi: 10.1016/ j.appet.2015.09.031. (accessed 2/20/2016)

“All disease begins in the gut” -- Hippocrates

THE G GENIUS O OF T THE G GUT Ò Gut-brain connections É Incretins—gut hormones (biodirectional via neurons & circulation) É Role in appetite regulation/ nutrient acquisition/ energy metabolism Ò Major immune functions É Houses > 70% of immune system É Leaky gut & inflammation Ò Major neuropsychiatric function É The gut is the “2 nd brain É Many neuropeptides in gut—all influenced by microbes É Gut has 80-90% serotonin (happy); 50% dopamine (motivation); acetylcholine (memory) & GABA Ò Digestion & Nutrient acquisition É Diabetes, dyslipidemia, weight excess, GI pathologies Î Microbiome (affects all of this)

HOW THE GUT IMPACTS THE ENDOCRINE & METABOLIC SYSTEM Ò Altered enterocyte integrity: Due to: É Lack of sleep É Exposure to toxins, viruses!!!!! É STRESS É Reduced blood flow (dehydration/shock/ischemia) Ò Altered microbiome Ò Leaky gut É Inflammation—autoimmune processes Ò Food intolerances & allergies!!! É Food intolerances common —GI upset, rhinitis, mental fog, “fluish,” anxiety, pain

FAST FACTS ON AUTOIMMUNE DISEASES Ò Autoimmune disease: body produces antibodies that attack its own tissues, leading to the deterioration/destruction of such tissue. É 139 diseases associated autoimmunity! Ò Autoimmune diseases, along with obesity & autism, have had an astonishing increase over past 3 decades! É A staggering epidemiologic & epigenetic change!!!!!! Ò Rare autoimmune diseases now becoming common-- É One in twelve Americans—1 in 9 women—will develop an autoimmune disorder!!

WHAT ARE THE AUTOIMMUNE DISEASES? Addison’s ’s d disease Ò Chronic recurrent multifocal osteomyelitis Ò Agammaglobulinemia Ag (CRMO) Ò Alop Al opeci cia ar areat eata Chu Churg-St Strauss Ò Ò Amyloi Am oidos osis Cicatricial pemphigoid Ò Ò Ankylosing s spondylitis Cogan’s syndrome Ò Ò Anti-GBM/Anti-TBM nephritis Cold a agglutinin d disease* Ò Ò Antiphospholipid s syndrome Congenital h heart b block Ò Ò Autoimmune h hepatitis Coxsackie m myocarditis Ò Ò Autoimmune inner ear disease (AIED) CREST s syndrome Ò Ò Axonal & neuronal neuropathy (AMAN) Crohn’s ’s d disease Ò Ò Behcet’s disease De Dermatitis he herpetiformis Ò Ò Benign m mucosal p pemphigoid De Dermatomyositis Ò Ò Bullous p pemphigoid Devic’s disease (neuromyelitis optica) Ò Ò Castleman disease (CD) Discoid l lupus Ò Ò Celiac d disease Dressler’s ’s s syndrome Ò Ò Chagas d disease En Endome metriosis Ò Ò Chronic i inflammatory d demyelinating p polyneuropathy Eosinophilic e esophagitis ( (Eo EoE) Ò Ò (CID IDP) Eosinophilic fasciitis Ò

CATEGORIZED AS AUTOIMMUNE DISEASES IgG4-related sclerosing disease Ò Eryt Er ythe hema ma no nodosum sum Ò Inclusion b In body m myositis ( (IB IBM) Essential mixed cryoglobulinemia Ò Ò In Interstitial c cystitis ( (IC IC) Fibromyalgia Fi Ò Ò Juvenile a arthritis Fibrosing alveolitis Ò Ò Juvenile d diabetes ( (Type 1 1 d diabetes) Ò Giant c cell a arteritis ( (temporal a arteritis) Ò Juvenile myositis (JM) Ò Giant c cell m myocarditis Ò Kawasaki disease Ò Glomerulonephritis Gl Ò Lambert-Eaton syndrome Goodpasture’s ’s sy synd ndrome Ò Ò Leukocytoclas Leu astic va vasculitis Granulomatosis with Polyangiitis Ò Ò Lichen p planus Graves’ d ’ disease Ò Ò Lichen sclerosus Ò Guillain-Barre s Gu syndrome Ò Ligneous conjunctivitis Ò Hashimoto’s ’s t thyroiditis Ò Linear IgA disease (LAD) Ò Hemolytic a anemia Ò Lu Lupus Henoch-Sc He Schonlein purpura ( (HSP) Ò Ò Lyme d disease c chronic Herpes gestationis or pemphigoid gestationis Ò Ò Meniere’s ’s d disease Hy Hypo pogammalglobulin inemia ia Ò Ò Microscopic polyangiitis (MPA) Ò IgA N Ig Nephropathy Ò Mixed connective tissue disease (MCTD Ò

CATEGORIZED AS AUTOIMMUNE DISEASES Mooren’s ulcer Ò Pemphigus Pe Ò Mucha-Habermann disease Ò Peripheral n neuropathy Ò Multiple s sclerosis Ò erivenous encephalomyelitis Ò Myasthenia g gravis Ò Pernicious a anemia ( (PA) Ò Myositis My Ò POEMS s syndrome Ò Na Narcolepsy Ò Po Polyarteritis no nodosa sa Ò Neuromyelitis optica Ò Po Polymyalgia rh rheumatica Ò Neutropenia Ne Ò Polymyositis Po Ò Ocular cicatricial pemphigoid Ò Postmyocardial infarction syndrome Ò Optic n neuritis Ò Postpericardiotomy sy Po synd ndrome Ò Palindromic rheumatism (PR) Ò Primary b biliary c cirrhosis Ò PA PANDAS Ò Primary Progesterone dermatitis Ò Paraneoplastic cerebellar degeneration (PCD) Ò Premature ovarian failure Ò Paroxysmal nocturnal hemoglobinuria (PNH) Ò Psor Ps oriasis Ò Parry Romberg syndrome Ò Psoriatic a arthritis Ò Pars planitis (peripheral uveitis) Ò Pure red cell aplasia (PRCA) Ò Pyoderma gangrenosum Ò Raynaud’s ’s p phenomenon* Ò Reactive Arthritis Ò

CATEGORIZED AS AUTOIMMUNE DISEASES Sympathetic ophthalmia (SO) Ò Reflex s sympathetic d dystrophy Ò Takayasu’s arteritis Reiter’s ’s s syndrome Ò Ò Temporal a arteritis/Giant c cell a arteritis Relapsing polychondritis Ò Ò Thrombocytopenic p purpura ( (TTP ) Restless l legs s syndrome ( (RLS) Ò Ò Tolosa-Hunt syndrome (THS) Retroperitoneal fibrosis Ò Ò Transverse myelitis Ò Rheumatic f fever Ò Type 1 1 d diabetes Ò Rheumatoid a arthritis Ò Ulcerative c colitis ( ( UC) Ro Rosecea* Ò Ò Undifferentiated connective tissue disease (UCTD) Sa Sarcoidosis Ò Ò Uv Uveitis Schmidt syndrome Ò Ò Vasculitis Va Ò Sc Scleritis Ò Vi Vitiligo Ò Sc Scleroderma Ò Wegener’s ’s g granulomatosis ( ( or Granulomatosis with Ò Sjogren’s ’s sy synd ndrome Ò Polyangiitis (GPA)) Sperm & testicular autoimmunity Ò Stiff p person s syndrome ( (SPS) Ò Subacute b bacterial e endocarditis ( (SBE) Ò Susac’s syndrome Ò https://www.aarda.org/diseaselist/

Front. Microbiol., 06 October 2015 | https://doi.org/10.3389/fmicb.2015.01050

FAST FACTS ON THE GUT MICROBIOME Ò The gut microbiome is the most complex ecosystem ever discovered É The richness & biodiversity is critical to the health (need healthy biota interaction) Ò We are home to vast numbers of microbial organisms (>100 trillion!) É The are > 1000 bacterial species in just a few bacterial phyla (Gut most diverse); É contain 150 TIMES as many genes as our human genome!! Ò Dominant human bacterial phyla: É Bacteroidetes, É Firmicutes, É Actinobacteria, É Proteobacteria! Ò Can go from good bacti to bad bacti…… Genome Med. 2016; 8: 39. Published online 2016 Apr 13. doi: 10.1186/s13073-016-0294-z (accessed 4/20/2019)

MORE O ON T THE M MICROBIOME Ò It contains 150 TIMES as many genes as our human genome!! (3.3 million genes) Ò We each have a microbial “fingerprint.” --unique microbial composition (species & ratios) Ò Gut microbiota have pathogenic and health promoting roles (“pathobionts”) Ò Can produce toxins and carcinogens Ò Balance is critical (“richness & diversity”): harmful if number of certain species in the microbiome is too high or too low Ò The richness of the biodiversity is critical to the health – need healthy biota interaction