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Why Am I Not Getting Better?Why Am I Not Getting Better?

Gluten Intolerance Group of Greater DallasGluten Intolerance Group of Greater DallasSaturday July 21, 2012Saturday July 21, 2012

byby

Ron Overberg, Ph.D., C.C.N., R.D., L.D. Ron Overberg, Ph.D., C.C.N., R.D., L.D.

(Certified Clinical Nutritionist and Registered Dietitian)(Certified Clinical Nutritionist and Registered Dietitian)

Why Am I Not Getting Better?Why Am I Not Getting Better?

• The latest numbers indicate that as many as one in every 5 people have some form of gluten-sensitivity. Eur Rev Med Pharmacol Sci. 2010 Jun;14(6):567-72

• Key point:

• After an average of 12 years on a GFD, 31% of patients still have increased inflammation in their intestines. Gut 2005;54:769-774.

Why celiac disease is underdiagnosed in the US

• Under-performance of small bowel biopsy during endoscopy may be a major reason that celiac disease remains underdiagnosed in the United States, physicians did a small bowel biopsy in only 43 percent of the more than 13,000 patients having an endoscopy during this 6 year period.

• Men were less likely to have a biopsy as compared to women. This may provide a clue to understanding a long-observed curiosity: the lopsided gender ratio among patients with celiac disease.

Why gluten-free may not be healthyPosted on June 28, 2012 by Stone Hearth News

• Are products labeled “gluten-free” healthier?

• Take a good hard look at those labels.

• “Just because a product says it’s gluten-free doesn’t mean it’s healthy,” he said.

• The gluten-free product likely contains as many calories as gluten options, Haub said, because a gram of sorghum, corn or rice flour appears to be metabolically similar to a gram of wheat flour.

ARRAY 3WHEAT/GLUTEN PROTEOME REACTIVITY &

AUTOIMMUNITY

Why Array 3 Testing?

• Present multiple symptoms complaints (CFS, FMS)

• Abnormal immune cell count and function

• Blood-brain barrier permeability, depression, autoimmunity

• Thyroiditis, Arthiritis, Myocarditis, Dermatitis, Endocrinopathy, Polyendocrinopathy, Osteoarthritis, Pernicious Anemia

• Complain of chemical hypersensitivity

• Always go over the health history, over and over again!

POSITIVEREACTIONTO:

GLUTEN-REACTIVITY

WHEAT &GLUTEN-REACTIVITY

WHEAT-SENSITIVITY

LECTIN-SENSITIVITY

AUTOIMMUNEREACTION

Wheat

WGA

•-Gliadin15 MER

•-Gliadin17 MER

•-Gliadin33 MER

•-Gliadin17 MER

Glutenin21 MER

GluteomorhpinProdynorphin

Gliadin-tTG2 Complex

tTG2

tTG3

tTG6

Client 1, age 6

Client 1, age 6

• Gluten Sensitivity Gene TestHLA-DQB1 Molecular analysis, Allele 1 0301

HLA-DQB1 Molecular analysis, Allele 2 0502

Serologic equivalent: HLA-DQ 3,1 (Subtype 7,5)

Interpretation Of HLA-DQ Testing: Although you do not possess the main HLA-DQB1 genes predisposing to celiac sprue (HLA-DQB1*0201 or HLA-

DQB1*0302), HLA gene analysis reveals that you have two copies of a gene that predisposes to gluten sensitivity (any DQ1, DQ2 not by HLA-DQB1*0201, or DQ3 not by HLA-DQB1*0302). Having two copies of a gluten sensitive gene means that each of your parents and all of your children (if you have them) will possess at least one copy of the gene. Two copies also means there is an even stronger predisposition to gluten sensitivity than having one gene and the resultant immunologic gluten sensitivity may be more severe.

Client 1, age 6 (adult ranges)

Client 2, age 21

Client 3, age 43

Client 4, age 17 (adult ranges)

Client 5, age 13, Gluten Addiction, (adult ranges)

ARRAY 1MUCOSAL GLUTEN REACTIVITY SCREEN

• Total Secretory IgA• Alpha-Gliadin IgA + IgM• Transglutaminase 2 IgA + IgM

• A quick, convenient test before there is mucosal damage

When To Use Array 1• Do you have mucosal abnormalities? (The mucosal lining is

the tissue which lines various passages and cavities exposed to the air - such as the mouth, nose, GI tract, vagina. and the lungs. It is the first, the earliest response of the immune system to allergenic foods.)

• Are you suspected of having Gluten Sensitivity or Celiac Disease

• Do you have relatives with Gluten Sensitivity or Celiac Disease • Do you have a family history of autoimmune Disorders• For those unable or who refuse to do a more comprehensive

blood test• For clients not responding as expected to any health concern• Saliva is the best way to detect gluten sensitivity early, even

before symptoms manifest. The gut has to be severely damaged in order for a blood test to be dependable. Because it uses a saliva sample, this test is easy to use with children

Secretory IgANative + DeamidatedAlpha-Gliadin-33-mer

IgA + IgM

Transglutaminase - 2IgA + IgM

Mucosal Immunity Gluten Reactivity Autoimmunity

Oral Fluid Assessment for Mucosal Immune Response to Gluten.

ARRAY 2INTESTINAL BARRIER HEALTH

ASSSESSMENT

• Actomyosin Network IgA• Occludin/Zonulin IgG, IgA, IgM• Lipopolysaccharides IgG, IgA, IgM

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The pathways of antigen invasion through Paracellular and Transcellular routes.

Breakdown of Actomyosin Network

Tight Junction Dysfunction

©Cyrex Laboratories, LLC

Client 5, age 13, (adult ranges)

Client 3, age 43

How and why did you get “leaky”

• Gut flora imbalance

• Followed by antibiotics

• Stress (Divorce, work, tractor, exercise)

• Poor digestion and allergies (gluten)

• Pharmaceuticals, aspirin

• Not enough sleep

“Leaky” Can Contribute To:

• Gluten sensitivity and celiac disease

• Food allergies (chicken or the egg?)

• Inflammatory bowel disease (UC, Crohns’s)

• Autoimmune diseases (RA, JRA, Psoriasis, Type 1 Diabetes, Hasimoto’s, SLE (80+))

• Neurological conditions (MS, Guillian Barre)

• Cognitive Dysfunction (depression, anxiety, schizophrenia, brain fog, etc.)

• Others (CFS, chronic yeast overgrowth)

Vitamin D3 – Role in Health

• Who knows their Vitamin D3 level?

• Who takes Vitamin D3?

• How to get Vitamin D3 from the sun?

• When do you take your Vitamin D3?

Recent Vitamin D Articles

• 25 (OH) Dà 1,25 (OH)2D3 ”the hormone”

• D and T-cells inhibit Th1 and Th2

• D and B-cells inhibit AB secretion and AutoAB production

• D inhibits antigen presenting by macrophages and dendritic cells

• D promote monocytes to macrophages and modulates their inflammatory response

• D multiple immunosuppressant properties

Vitamin D3 – Essential!

• What is your 25-OH Vitamin D3 level?

• What form do you take?

• How much do you take?

• It is so simple, why not take it?

Healing the Intestinal Tract: Total Load

• Support its function

• Structure – nutrients to repair

• Inhabitants - Use “Kill Agents” and beneficial organisms

• Avoidance: Foods, pollens, grasses, trees, algae, pesticides, herbicides, chemicals.

• Pharmaceuticals

• Stress reduction. Stop keeping up with the Joneses!

• Get enough sleep

Healing the Intestinal Tract: Support

• Immune 26, an egg powder which produced by repeatedly immunizing chickens with at least 24 inactivated bacteria including Shigella dysenteriae, Staphylococcus epidermidis and simulans, Escherichia coli (E. coli), Salmonella enteritidis and typhimurium, Pseudomonas aeruginosa, Klebsiella pneumoniae, Haemophilus influenzae, and at least 6 species of Streptococcus.

• IgG 2000DF, a highly concentrated, non-dairy source of serum-derived immunoglobulin antibodies and immuno-proteins

Healing the Intestinal Tract: Support

• Colostrum, provides transfer factor, Proline-Rich Polypeptides, lactoferrin and other immune factors

• Proline-Rich Polypeptides (PRPs) are an isolate from Colostrum. These stimulate the immune system to produce cytokines that regulate the duration and intensity of the body’s immune response. They balance over and under activity of the immune system.

• Transfer factor

Healing the Intestinal Tract: Structure

• Protein

• L-Glutamine

• Fats, inc. EPA / DHA

• Butyric acid

• Vitamin A

• Sialex (mucin)

• N-Acetyl Glucosamine

• Colostrum

• Vitamin D

• Probiotics

• Zinc carnosine

• Mastica

• Aloe Vera

• DGL, deglycyrrhizinated licorice

• Slippery Elm

• Marshmallow

• Okra

• Chamomille

• Irish Moss

Healing the Intestinal Tract: Flora

• Garlic

• Oregano

• Olive leaf

• Black Walnut

• Uva Ursi

• Caprylic acid

• Tanalbit

• Curcumin

• Beneficial bacteria

• Aloe vera

• Berberine

• Grapefruit seed extract

• Cranberry extract

• Monolaurin

• Cat’s claw

• Artemisinin

• Cranberry extract

• S. Boulardi

Healing the Intestinal tract: Avoidance

• Drugs:

• Medicines example: Aspirin

• Chemicals

• Foods

• Fungi, Molds, Yeast

• Food allergens: wheat, dairy, nightshades. Any food is a possibility!

• All allergens lower your tolerance!

ARRAY 4GLUTEN-ASSOCIATED CROSS-REACTIVE

FOODS and FOODS SENSITIVITY

• Cow’s Milk• Alpha + Beta-

Casein• Casomorphin• Milk Butyrophilin• Whey• Chocolate (milk)• Gluten Grains• Oats

• Yeast• Coffee• Sesame• Buckwheat• Sorghum• Millet• Hemp• Amaranth

• Quinoa• Tapioca• Teff• Soybean• Egg• Corn• Rice• Potato

POSITIVE REACTION TO:

DAIRY-SENSITIVITY

IN VITROCROSS-REACTION TO α-GLIADIN

NEWLYINTRODUCEDFOODS ON GFD

OVER-CONSUMED ON GFD

SPECIAL COMMENT

Rye, Barley, Spelt, Polish wheat*

Cow’s Milk

•-Casein +•-Casein

Casomorphin

MilkButyrophilin

Whey Protein

Chocolate (milk)

Oats

Yeast

Coffee

Sesame

Buckwheat

Sorghum

Millet

Hemp

Amaranth

Quinoa

Tapioca

Teff

Soy Common food allergen

Egg Common food allergen

Corn

Rice Cross-reacts to wheat, but not gliadin

Potato

Client 1, age 6

Client 6, age 17

ARRAY 5MULTIPLE AUTOIMMUNE REACTIVITY

SCREEN• Parietal Cell +

ATPase• Intrinsic Factor• ASCA + ANCA• Tropomyosin• Thyroglobulin• Thyroid Peroxidase• 21 Hydroxylase• Myocardial Peptide• α-Myosin

• Phospholipid • Platelet

Glycoprotein• Ovary/Testis• Fibulin• Collagen

Complex • Arthritic

Peptide• Bone

• Cytochrome P450

• Insulin + Islet Cell

• GAD 65• Myelin Basic

Protein• GM1• α+β Tubulin• Cerebellar• Synapsin

Why Array 5

• 25% more likely• à Among 374 children in whom Celiac Disease was diagnosed before the

age of 2, 5% developed an auto-immune disorder while on a gluten-free diet. Of those who went gluten-free, had years of no symptoms, then went back on a gluten-containing diet, 3.65% prevalence of systemic auto-immune disease with less than 12 months of eating gluten 9.1 % prevalence for 13-36 months of eating gluten again, 26.3% prevalence for > 36 months of eating gluten again.

•• à This means 1 out of 4 people who were sensitive to gluten, went

gluten-free, eliminated all of their symptoms, and then began eating gluten again developed auto-immune diseases within 3 years. Gastroenterology 1999;117:297-303

• Autoimmune disorders occur 10 times more commonly in the Gluten Sensitive Enteropathy Celiac Disease than in the general population.CMLS, Cell. Mol. Life Sci. 62 (2005) 791-799

GASTROINTESTINAL

• Parietal Cell + ATPase

• Intrinsic Factor

• ASCA + ANCA

• Tropomyosin

HEART

• Myocardial Peptide

• α-Myosin

• Phospholipid

• Platelet Glycoprotein

THYROID

• Thyroglobulin

• Thyroid Peroxidase

ADRENAL

• 21 Hydroxylase (Adrenal Cortex)

REPRODUCTIVE ORGANS

• Ovary/Testis

MUSCULOSKELETAL

• Fibulin

• Collagen Complex

• Arthritic Peptide

• BoneNEURONAL

• Myelin Basic Protein

• Asialoglanglioside GM1

• α + β Tubulin

• Cerebellar

• Synapsin

LIVER AND ENDOCRINE

• Cytochrome P450

• Insulin + Islet Cell

• Glutamic Acid Decarboxylase 65

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Questions?Questions?

Ron Overberg, Ph.D., C.C.N., R.D., L.D. Ron Overberg, Ph.D., C.C.N., R.D., L.D.

(Certified Clinical Nutritionist and Registered Dietitian)(Certified Clinical Nutritionist and Registered Dietitian)

Certified Gluten Practitioner Certified Gluten Practitioner

NutriWellness & Environmental Health Center NutriWellness & Environmental Health Center -- DallasDallas

Email: Email: drron@nutriwellness.comdrron@nutriwellness.com

Phone: 972 239Phone: 972 239--11481148