Transcript Digestive Role in Children

The Digestive
Immune
Connection
in
Children
Dr Mary Bove ND
Human Digestive System
The physiology of the
digestive tract, the
subjective experience of
the symptom, health
behavior, and treatment
outcome are strongly
affected by psychosocial
factors.
Enteric Nervous System (ENS)
• May be called the 3rd part of
the ANS
• Vast network of neurons
widely dispersed throughout
the gut
• ENS is a dominant regulator of
gut function via the action of
peptide and non-peptide
neurotransmitters
Enteric Nervous System
• Regulation of secretory processes, such as
gastric acid secretion and motility
• Broader role in the regulation of mucosal
defense, the gut immune response, and
sphincter function
• Alterations in regulation of gut function by the
ENS are connected to conditions including
achalasia, inflammatory bowel disease, biliary
dyskinesia, tachygastria, and irritable bowel
syndrome
Brain-Gut Interactions
• Processes modulating responsiveness to
stressors along the brain-gut axis involve
neural pathways, immunological and
endocrine mechanisms
• ENS function, central processing, and
autonomic regulation play an important
role in the brain-gut dialogue
• Stress and emotions may trigger
neuroimmune and neuroendocrine
reactions via the brain-gut axis
“Intestinal reactivity to words
with emotional content ….”
• Study compared healthy controls with nonpsychiatric irritable bowel
syndrome (IBS) patients and IBS patients with comorbid phobic anxiety
disorders with respect to rectal wall reactivity during exposure to everyday
words with emotional content.
• Outcomes showed that 70.3% of the subjects responded either with
increased or decreased rectal tone during exposure to anger words, 75.0%
when exposed to sadness words, and 76.6% when exposed to anxiety
words.
• We observed significant group differences in the frontal brain to sadness
(P < 0.001) and anxiety (P = 0.013) distracter words, and threshold
significant group difference to anger (P = 0.053) distracter words.
• Rectal wall reactivity during the word series significantly predicted frontal
amplitude to the same word series, indicating a close interaction among
mind, brain, and gut.
Blomhoff S, Spetalen S, Jacobsen MB, et al,Dig Dis Sci (2000 Jun) 45(6):1160-5, ISSN: 0163-2116
Cultivating Healthy Beginnings
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Maternal Uterine Environment
Maternal Infant Digestive System
Maternal Infant Immune Connection
Maternal Chronic Stress Connection
Children begin to
develop preferences to
flavors, music, voices
and even stories while
in the mother’s womb
Maternal Connection
History of yeast infections, intestinal
dysbiosis, IBS, insufficient digestive
enzymes, low fiber diet, constipation
Chronic stress, chronic inflammation,
environmental toxic exposure, zinc deficiency,
medications, allergies
Immune Overload – allergen exposure, leaky
gut, environmental toxic exposure, chronic
stress, low SIgA
Infant Connection
• Immature digestive system
• Establishment of healthy balanced microbiota
• Immune system immaturity and hyperexposure in utero
• Vaginal birth verse C-section
• Breastfeeding or formula feeding
Microbiota
The microbiota is intimately involved in
numerous aspects of normal host
physiology, from nutritional status to
behavior and stress response
Role of Intestinal Microbiota
Digestive function
Fermentation of substrates
Competes with other bacteria
Assimilation and absorption of vital nutrients
Immune System – Innate & Adaptive
Galt- gut associated lymphoid tissue
Mucosal immunity, SIgA, Barrier fxn (mucin)
Healthy skin
Getting a Good Start
• Infants have a sterile gut leaving the
womb
• Exposed to bacteria via birth canal,
skin, and meconium.
• In breast milk
• Bifidobacteria develops rapidly in the
first 3 days.
The Importance of Microbiota
• Up to 2 yrs to complete colonization of microbiota
• Wide diversity of microbes early in life preps the
immune response
• Antibiotics disrupt normal flora growth and
colonization.
“It is estimated that a course of antibiotics may
disrupt normal micrbiota colonization for up to
three months post use.”
De la Cochetiere et al: Early intestinal bacterial colonization and nectrotizing enterocolitis in premature
infants: the putative role of Clostridium, Pediatr Res Sep;56(3): 366-70,2004
Probiotics and Illness
• Studies show probiotics improve
infant weight gain, gut maturation, and
immune secretion function.*
• Many common illnesses which effect
children can be treated with probiotics
*Gut Immunity, and the Environment; Keys to long-term health, J.Saavedra MD, Clinical Applications of
Probiotics in Human Health,Sept.2007
Probiotics and Illness
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Diarrhea*
Allergy*
Atopic dermatitis
Sinus infections
Ear infections
• Autistic Spectrum*
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Common cold
URI
Colic
Dental caries
Urinary infection
IBS, IBD*
Pediatirc Probiotics, Impact on the development of a normal immune system, Naturopathic Doctor News
and Review Feb; 3(2) 10-12, 2007
*Traver,D.Probiotcs in the Treatment of Autism Spectrum Disorder; Clinical Applications of Probiotics in
Human Health, Sept.2007
Prevention of Atopic Disease
• A Finnish study; L. GG/ rhamnosus
• Reducing atopic disease in infants
• Administer to the pregnant mother in third
trimester & breastfeeding and the infant.
• Occurrence of atopic disease dropped 50% in
the probiotic group and stayed low for full 4
years w/o further supplementation of probiotics
Kalliomaki M et al: proibiotics and prevention of atopic disease: 4 year follow up of
randomized placebo-controlled trial, Lancet 361:1896-1871, 2003
Probiotics as an Immune Aid
• Several studies have looked at supplementation of
children in day care centers
• Probiotics and the occurrence of URI, fever, and GI
infection. The probiotic supplemented groups had
significantly less occurrence of infection*
• Probiotics are believed to enhance mucosal
immunity, stimulate local innate immunity,
improves oral antigen tolerance, and dietary
metabolism.
*Weizman Z at al: Effect of a probiotic infant formula on infections in child care
centers: comparison of two probiotic agents, Pediatrics 115:5-9, 2005
*Hatakka K et al: effect on long-term consumption of probiotic milk on infections in
children attending day care centres: double-blind, randomized trial, Clin Nutr Aug;
24(4):481-91,2005
Supplementing Probiotics
• Infants up to 2 yrs old, pregnant and
breastfeeding mothers
• Bifidobacterium species including
infantis, bifidum, breve, longum, lactis
• 1 to 5 billion for infants
• 5 to 10 billion children 12 to 24 m
• 40 to 100 billion daily to mothers
For non-breastfed babies include probiotics
in the formula daily.
Supplementing Probiotics
Children 2 to 5 years old
• 20 to 40 billion daily
Pregnant and nursing mothers
• 40 to 100 billion daily to mothers
• Bifidobacteria strains along with adult strains
including Lactobacillus species including
rhamnosus(GG), acidophilus, reuteri
Dietary Phenols
Support the micorbiota
Inhibit non-beneficial bacteria while having little
effect on beneficial bacteria
Antioxidant activity
Tannins flavonoids, bioflavonoids, polyphenols,
phenolic acids
Fruits, berries, vegetable, herb, spices, cocoa,
red wine, dark chocolate
Huffnagle, G,. The Probiotic Revolution, Bantum Books, 2007 pg 274-277
Calcium and Probiotics
Aids probiotic bacteria to adhere to the
intestinal wall
Discourages harmful bacteria from adhering to
the intestinal wall
Avoid calcium carbonate
Food forms preferred
Huffnagle, G,. The Probiotic Revolution, Bantum Books, 2007 pg 257
Therapeutic Foods
Ulmus fulva
Althaea officinalis
Astragalus root
Matricaria rectita
Hemp Seed Powder
Oats
Abrabinogalactan
Green tea polyphenols
Cinnamon
Musa paradisiacal
Fermented foods sauerkraut,
miso, tempeh, yogurt, kefir,
cottage cheese, kimchee
Inulin- chicory root
Secretory IgA
• IgA is secreted by the various mucosal surfaces
• SIgA values are sensitive to increased cortisol//DHEA
ratio and sympathetic tone
The main functions of SIgA are:
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Viral and toxin neutralization
Plasmid elimination
Inhibition of bacterial colonization
Immune exclusion
Secretory IgA
Mucosal immunoglobulin A (IgA) production is
highly dependent on cholecystokinin release
and is markedly suppressed by
glucocorticoids.
Glucocorticoids decrease duodenal
cholecystokinin, decrease IgA, and leads to
impaired mucosal immunity, increased
bacterial adherence, and decreased tissue
resistance.
Cholecystokinin
Cholecystokinin may act to preserved mucosal
immune function.
Cholecystokinin may play an important role in
maintaining the functional responsiveness of
mucosal immunity during catabolic stress.
Excessive sympathetic/ catecholamine activity
causes inhibition of SIgA release from the
mucosal immunocytes.
Cholagogue and cholerectic botanicals to
support cholecystokinin production &
secretion.
Taraxacum officinalis
Curcuma longa
Andrographis paniculata
Agrimonia spp
Filipendula ulmaris
Infantile clinical picture suggesting
digestive disturbance
• reflex, GERD
• cradle cap, seborrhea dermatitis, atopic
dermatitis
• restless sleep, irritability, insomnia
• constipation, loose or smelly stool
• asthma, URT congestion, diaper rash
• copious ear serumen
Therapeutic Biopsychosocial Model
Therapeutic approach of a
biopsychosocial model targeting
aspects stemming from physiological,
emotional, cognitive, social, and
behavioral sources is a whole
approach to digestive wellness
Digestive Benefits of Herbs
• Herbal medicines are a good match for GI
complaints
• Can be used in several forms for specific GI
targeting
• Used to preserve health and wellness
• Offers specific remedies for specific
pathological syndromes
• Many can be added into daily diet
GI Demulcants
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Marshmallow / Althea officinalis –root
Slippery Elm / Ulmus fulva – inner bark
Astragalus membranous – root
Licorice / Glycerrhiza glabra - root
Digestive Vulnerary Herbs
• Calendula officinalis – flowers
• Chamomile / Matricaria recutitia – flowers
Digestive Astringents
• Witch hazel / Hamamelis virginiana-bark
• Blackberry / Rubus fructicosus-leaves,root
Digestive Nervines
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Lavedula spp – lavender flowers
Melissa officinalis – Lemon Balm
Matricaria chamomila - Chamomile Flowers
Valerianna officinalis – Valerian Root
Nepeta cateria - Catnip
Food
is
Medicine