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2/24/16
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Nutraceu.cals and Your Health: Part I
Valerie Albri>on Oakley, PharmD, FAARM, ABAAHP
• I have no relevant financial or nonfinancial rela.onships to disclose.
Objec.ves
• Understand the importance of a comprehensive nutraceu.cal regimen for op.mal health and wellness.
• Discuss the func.ons of various nutrients in the body.
• Iden.fy clinical manifesta.ons and/or chronic disease states associated with certain nutri.onal deficiencies.
• Iden.fy common prescrip.on drugs that cause nutrient deple.ons in the body.
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Nutraceu.cals Defined
• The term nutraceu(cal is a hybrid of nutri(on and pharmaceu(cal.
• Defined as chemicals found as a natural component of foods or other inges.ble forms that have been determined to be beneficial to the human body in preven.ng or trea.ng one or more diseases or improving physiological performance.82
Nutraceu.cals
• The RDA and the RDI assigned for vitamins and supplements are recommended to merely prevent disease.74
• These numbers are not designed to maintain op.mal health.74
• These values do not account for individual differences, gene.cs, or current disease states.
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Everything Starts with the Gut • The largest endocrine organ in the body20 • The GI tract is the largest blood supply in the body using 1/3 of the blood flow from the heart75,80
• 70% of the human immune system is localized in the diges.ve tract.28
• 80% of the lymph nodes in the body are around the GI tract.10,65,74,75,80
• Metabolic ac.vity in the gut is greater than in the liver28,74,75
• Approximately 95% of the serotonin found in the body is synthesized in the GI tract17
Signs of Poor Gut Health75
• Irregular bowel movements • Chronic indiges.on • Restless sleep/waking up .red • Frequently cold for no reason • Depression without cause • Feeling stress without cause • Frequent mood swings and anxiety • Shakiness • Increase in pulse of 20-‐25 beats within 15 minutes aeer ea.ng
Dysbiosis
• Microbial colonies found on or in the body are normally benign or beneficial.
• These colonies carry out a series of func.ons like aiding in diges.on, protec.ng the body from the penetra.on of pathogenic microbes, and detoxifica.on.
• Imbalance of intes.nal bacteria causes an inflammatory disease of the gut known as dysbiosis.
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GI Symptoms associated with Dysbiosis
• Indiges.on – Belching, bloa.ng, flatulence
• Acid reflux/Heartburn/GERD • Abdominal pain • GI Dysfunc.on – Cons.pa.on and/or diarrhea
Addi.onal Symptoms associated with Dysbiosis28,75
• Frequent urina.on • Depression • Halitosis • Anxiety • Brain Fog • Arthralgias
• Fa.gue • Malaise • Skin rashes • Pruri.s • Palpita.ons
Causes of Dysbiosis28,75 • Antacids • Proton Pump Inhibitors • Diminished HCL • Poor nutri.onal status • Free Radical produc.on • Stress • Alcohol • NSAID • An.bio.cs • Viruses • Food allergies • Yeast infec.ons • Decreased enzymes
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GI Mucosa
• Protec.ve cell layer that provides the barrier between the inside of the body and the external world49
• Responsible for nutrient absorp.on49 • Plays an important role in protec.ng the stomach from ingested toxins, drugs, alcohol, pathogens, such as infec.ous bacteria or viruses.49
Gut-‐Associated Lymphoid Tissue (GALT)
• Produces two layers of defense mechanisms to a foreign pathogen or an.gen: secretory IgA (sIgA) and systemic IgE or IgG49
• sIgA effec.vely prevents infec.on, neutralizes viruses, and removes an.gens before they cross the mucosal barrier and reach systemic circula.on49
• If immunologically ac.ve materials escape the sIgA defense, GALT ac.vates a second line of defense inducing a systemic immune response through IgE or IgG49
Leaky Gut Syndrome
• Under normal condi.ons the mucosal barrier does not allow the flow of ma>er from the outside (lumen) to the inside of the body unless the ma>er goes through a protec.ve cell layer
• When there is damage to the lining of the bowel, permeability is increased. This allows molecules of all types the ability to go around the cells and get into circula.on, a condi.on known as intes.nal permeability or “leaky gut”9,19,49,75
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h>p://www.intes.nalbarriertest.com/img/mucosal_barrier_degrada.on.gif
Condi.ons associated with Leaky Gut Syndrome28,75
• Acne • Aging • Allergies/food sensi.vi.es • Arthri.s • Asthma • Au.sm • Candida infec.ons • Celiac Disease • Chronic Fa.gue syndrome • Eczema
Condi.ons associated with Leaky Gut Syndrome28,75
• Crohn’s disease • Fibromyalgia • ADHD • IBS • Liver dysfunc.on • Lupus • Psoriasis • Schizophrenia • Rheumatoid arthri.s • Ulcera.ve coli.s
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Nutrients for Gut Health28,75 • Probio.cs • Glutamine • EPA/DHA • Fiber • Diges.ve Enzymes • Querce.n • An.oxidants (oxida.ve stress is one of the main causes of intes.nal damage) – Vitamin A – Vitamin C – B complex – NAC – Zinc
Probio.cs
• Microbial dietary adjuvants that beneficially affect the host physiology by modula.ng mucosal and systemic immunity, as well as improving nutri.onal and microbial balance in the intes.nal tract.62
Probio.c func.ons28,62,75 • Make short-‐chain fa>y acids – Specific SCFA may reduce the risk of developing gastrointes.nal disorders, cancer, and cardiovascular disease64
• Help produce diges.ve enzymes • Act like natural an.bio.cs • Maintain op.mal pH of intes.ne • Help digest fats • Help with detoxifica.on • Protect against parasites • Helps maintain healthy intes.nal lining – Protects against food allergies
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Therapeu.c Uses of Probio.cs28,77
• Cons.pa.on • Lactose intolerance • Flatulence • Diarrhea • IBS • IBD • Intes.nal hyperpermeability (leaky gut syndrome)
Therapeu.c Uses of Probio.cs77
• Preven.on and treatment of vaginal, UTI, GI infec.ons • Immune dysfunc.on • Food allergies • Atopic Eczema • Preven.on of ETOH liver disease • Recoloniza.on post-‐an.bio.c use • Hypercholesterolemia – Produce propionic acid which decreases the synthesis of cholesterol
– Break down bile acids
Probio.cs
• Contraindica.ons – Pt with a severely compromised immune system should not use live probio.cs since the organisms may cross the lining and be absorbed
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Glutamine
• Most abundant amino acid in the body • Shown to be depleted under condi.ons of extreme stress on the body – Injuries, surgeries, prolonged stress, illness, heavy exercising, etc.
Glutamine
• S.mulates intes.nal mucosal growth and protects from mucosal atrophy42,57,75
• Prevents intes.nal hyperpermeability57
• Plays an important role in acid-‐base homeostasis 6,75,86
• Balances blood sugar6 • Increases energy6,92 • Improves mental alertness6 • Fueling source of the immune system6
• Immune support by increasing IL-‐6 and lymphocyte func.on57
Glutamine • Increasing glutathione57,75,91 • Needed for the metabolism and maintenance of muscle6
• Elevates GH6,85
• Promotes weight loss6 • Inhibitory neurotransmi>er6 • Regula.on of muscle proteolysis and can prevent loss of protein in the muscle54,75
• Protects the body from stress6 • Neutralizes toxins6
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Querce.n
• Bioflavonoid found in onions, blue-‐green algae • Shown to inhibit pathogenic bacteria while s.mula.ng the growth of beneficial bacteria, exer.ng prebio.c-‐like effects47
• An.oxidant and an.-‐inflammatory that works by decreasing mast cell and basophil produc.on13,14,75
• An.-‐inflammatory responses2,13
Querce.n
• Promote relaxa.on of cardiovascular smooth muscle (an.hypertensive, an.arrhythmic effects)
• Shown to have an.viral and carcinosta.c proper.es.2,13
• Protect low-‐density lipoprotein from oxida.on (prevent atherosclero.c plaque forma.on)2,13
• Prevent platelet aggrega.on (an.thrombic effects)2,13
In the beginning disease is difficult to recognize but easy to cure. In the end,
disease is easy to recognize, but difficult to cure. –
Anton Mesmer, 1777
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3 Stages of Stress
• Stage I (Alarm Stage) • Stage II (Resistance Stage) • Stage III (Exhausted Stage)
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Cor.sol
• A steroid hormone produced by the adrenal cortex
• Cor.sol has many important func.ons in the body: – It is responsible for proper glucose and fat metabolism
– Regula.on of blood pressure – Insulin release for blood sugar control – Immune func.on – Inflammatory response
Prolonged Cor.sol Produc.on76,88
• Immune suppression leading to increased number of infec.ons
• Feelings of fear, anxiety, worry, depression, helplessness
• Hyperglycemia • Insulin resistance • Central adiposity • Hypertension
Prolonged Cor.sol Produc.on76,88
• Memory impairment (hippocampal damage) • Hyperlipidemia • Impaired T4 to T3 conversion • Inflamma.on • Inadequate sleep • High levels correlate with defects in serotonin transporter
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Nutraceu.cals to Normalize Cor.sol
• Relora • L-‐theanine • EPA/DHA • DHEA • B complex • Adaptogens – Rhodiola – Ashwagandha
Relora
• Dietary supplement formula.on consis.ng of a blend of extracts of Magnolia officinalis bark and Phellodendron amurense bark
• Reduce cor.sol and increase dehydroandrostenedione (DHEA) levels in stressed subjects23,36,81
• Reduce feelings of stress and anxiety and enhance feelings of well-‐being36,81
• Reduc.on in stress-‐related caloric intake36
L-‐theanine35,40,53 • Amino acid contained in green tea • Provides a sense of relaxa.on and calmness – S.mulates alpha brain waves directly promo.ng mental alertness and deep relaxa.on
– Plays a role in the forma.on of GABA (an inhibitory neurotransmi>er)
• Decreases neuroinflamma.on • Improves learning • Decreases blood pressure • Supports the immune system
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Adaptogens
• Defini.on: Must be innocuous and cause minimal disorders in the physiological func.ons of an organism, it must have a nonspecific ac.on, and it usually has a normalizing ac.on irrespec.ve of the direc.on of the pathological state.
• These drugs either reduce stress reac.ons in the alarm phase or retard / prevent the exhaus.on phase and thus provide a certain degree of protec.on against long-‐term stress.84
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Magnesium
• Essen.al element that catalyzes more than 300 enzyma.c reac.ons74
• Involved in enzyma.c pathways which control mitochondrial ATP produc.on74,96
• Overall incidence of hypomagnesemia in hospitalized pa.ents can range from 7 to 52%4
• Deficiency linked with increased CRP levels26,41
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Func.ons of Magnesium4,74
• Growth • Sleep • Heart func.on • Wound healing • Natural muscle relaxant • Bone building • Muscle func.on
Func.ons of Magnesium4,74,96
• Decreases blood vessel constric.on • Improves glucose uptake by insulin • Prevents produc.on of chemicals in the body which increase inflamma.on
• Increases HDL • Important in immune func.on • Maintains normal rhythm of your heart • Blocks NMDA receptors • Promotes calmness
Symptoms of Magnesium Loss74
• Muscle weakness • Muscle cramps • Muscle twitches • Muscle soreness • TMJ • Irritability
• Fa.gue • Depression • Insomnia • Confusion • Memory Loss • Anxiety
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Vitamin D
• One of the cheapest and easiest interven.ons in medicine that would save the most lives and the most money.
• Actually not a vitamin but a hormone71,74 • Receptors are located in your bones, pancreas, intes.ne, kidneys, brain, spinal cord, male and female reproduc.ve organs, thymus, adrenal glands, pituitary, and thyroid gland.74
Vitamin D
• Vitamin D deficiency is now recognized as a pandemic.
• High rates of vitamin D deficiency – Vitamin D deficiency: < 20 ng/ml – Vitamin D insufficiency: < 32 ng/ml – 25(OH)D reference range: 32-‐ 100 ng/ml
Consequence of Vitamin D deficiency
• Atleast 17 varie.es of cancer 21,22,31,71 • Heart disease, stroke, HTN16,31,71 • Autoimmune disease, MS16,31,63 • Type I and II Diabetes 31,71,74 • Chronic pain16,24,32 • Osteoarthri.s 16,32,37,74 • Osteoporosis16,32,71,74 • Muscle weakness16,32 • Infec.ous Disease16,31,32,71,74
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Coenzyme Q10 • Fat soluble nutrient • Made in almost every .ssue of your body74 • The amount your body makes will decline with age74
• Func.ons as a powerful an.oxidant • Mitochondrial coenzyme essen.al for the produc.on of ATP in all cells45,74
CoQ10
• Increase sperm count and mo.lity8,44,76
• Stabilizes and protects the cell membrane from oxida.ve stress1,44
• Pa.ents with periodontal disease are frequently deficient in Q1030
• Helps to stop progression of hearing loss5,76 • Enhances energy efficiency of myocytes61 • Poten.al ADR: GI distress, headache, loss of appe.te, skin rash
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CoQ10 • CoQ10 levels are frequently low in cancer pa.ents76
• Low levels associated with an increased risk of melanoma metasta.s67,72
• Supplementa.on of CoQ10 has been shown to extend the life span of pa.ents with breast, colon, prostate, rectal, lung, and pancrea.c cancers50,51,66,76
• Dosages of 300-‐390 mg per day have resulted in complete regression of residual tumors in breast cancer50,51,76
N-‐acetyl-‐cysteine (NAC) • Modified version of the sulfur-‐containing amino acid cysteine • Potent an.oxidant which reduces the forma.on of nitric oxide • Regulates the inflammatory response and inhibits NF-‐kB11,12,39,52 • Restores glutathione levels6,15,73
N-‐acetyl cysteine (NAC)
• Reduces synap.c glutamatergic ac.vity46
• Effec.ve in figh.ng H. pylori infec.ons34,38 • Reduces homocysteine levels27
• Shown promising results in COPD pa.ents nearly doubling the eradica.on of bacteria compared to standard therapy, while reducing the number and dura.on of COPD exacerba.ons68,78
• Ac.vity increased in the presence of adequate vitamin C and E.
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Drug-‐Nutrient Deple.ons
• Beta blockers deplete the body of CoQ10 and melatonin
• Sta.n drugs drama.cally lower serum Co Q10 levels up to 40%24,60,69 – Give atleast 100 mg CoQ10 per day to pt on sta.n drug
• Sta.ns also deplete the body of folic acid, carni.ne, vitamin E, omega 3 fa>y acids, and glutathione
Drug-‐Nutrient Deple.ons
• Metormin depletes the body of folic acid, vitamin B12, and coenzyme Q10
• Oral contracep.ves deplete the body of B vitamins, folic acid, zinc, and selenium
• Estrogen replacement depletes the body of B vitamins • Benzodiazepines deplete the body of melatonin • SSRI’s deplete the body of folic acid and melatonin • Acid suppressing drugs deplete folic acid, zinc, B12, vitamin D, calcium, and iron
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