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Gastroenterology

Autism Spectrum Disorder

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Elizabeth Mumper, MD, FAAP
The prevalence of Autism Spectrum Disorder (ASD) has increased dramatically in recent years, from 1 in 5000 (1975) to 1 in 2500 (1985) to 1 in 500 (1995) to 1 in 250 (~2001) to a current rate of about 1 in 50 children in the United States. A diagnosis of ASD is given to individuals who meet the criteria for autism disorder, Asperger syndrome, or pervasive developmental disorder not otherwise specified (PDD-NOS). Diagnosis relies on the presence of persistent deficits in social communication and social interaction with restricted or repetitive patterns of behavior. ASD can occur with or without intellectual impairment, language impairment, a known genetic condition, or other medical or developmental disorders.

Whereas ASD has conventionally been viewed as a neurological disorder, a new medical paradigm is emerging to help understand and treat this disorder. Here we interview Elizabeth Mumper, MD, about her approach to patients with ASD. She views ASD not as a brain disorder, but rather as a multisystem disorder associated with numerous medical problems that, when resolved, can improve patient outcomes dramatically. Some of these medical problems include gastrointestinal disease, immune dysregulation, oxidative stress, metabolic impairment, and mitochondrial dysfunction. In this interview we focus on metabolic patterns observed in ASD, including problems with methylation, transsulfuration, and mitochondrial function.

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Celiac and Non-Celiac Gluten Sensitivity

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Andrea Purcell, ND
Celiac disease is an autoimmune reaction to gluten that causes destruction to enterocytes in genetically susceptible individuals. Celiac disease is estimated to affect approximately one in 133 people, or less than 1% of the population. Non-celiac gluten sensitivity (NCGS) is a non–immune-mediated reaction to gluten without enterocyte destruction. Estimates on the prevalence of NCGS vary greatly, ranging from 0.6% to 6% of the population in the United States.

Most experts agree that NCGS is as common or more common than celiac disease and that both conditions are on the rise. Because the symptoms of both celiac disease and NCGS improve when a patient adheres to a gluten-free diet, a definitive diagnosis is not always confirmed. In this discussion, Dr. Andrea Purcell explains the importance of differentiating between celiac disease and NCGS for appropriate risk stratification and case management.

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Colon Cancer Prevention

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Tina Kaczor, ND, FABNO
Colorectal cancer (CRC) is the 3rd most common cancer in men and women in the United States. The lifetime risk of developing colorectal cancer is 1 in 5. Although family history and age are strong predictors of CRC risk, it has been estimated that modifiable risk factors may account for a substantial number of all CRC cases.

Despite the strong association between some of the non-modifiable risk factors and CRC, it has been estimated that as many as 70% of CRC cases might be prevented by lifestyle modification. Modifiable risk factors are influenced by diet, lifestyle, and evidence-based nutritional interventions, and these interventions can have a profound effect on CRC risk. An integrative approach can address modifiable risk factors that contribute to both increased CRC risk and to the disease process itself.In this discussion, Tina Kaczor, ND, FABNO, explains the importance of identifying and addressing modifiable risk factors of CRC.

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Culinary Strategies for Appetite Stimulation

Rebecca Katz, MS
Medical interventions, cancer, chronic diseases, and even aging can create changes in taste perception and appetite. Appetite loss can lead to cachexia, which worsens the prognosis of any chronic illness. Clinicians encourage their patients to eat more, and caregivers struggle to find ways to make this happen. In this discussion, Rebecca Katz describes culinary strategies to successfully stimulate appetite and provide nutrient-dense foods to patients who are compromised and under duress.

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Depression

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Kelly Brogan, MD
The Centers for Disease Control and Prevention estimates that 1 in 10 American adults meet the criteria for a diagnosis of depression. Most of these people are prescribed antidepressant medications, which are now the third most commonly prescribed drugs in America.

Adverse effects and poor clinical outcomes have caused innovative integrative physicians to evaluate and treat depression differently and to move away from the model of care dependent on selective serotonin reuptake inhibitors (SSRIs). Kelly Brogan, MD, is one of those physicians. Here Dr. Brogan discusses the rationale, strategy, and outcomes associated with her integrative treatment plan, which addresses the underlying causes of depression.

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Dietary Management of the Microbiome

Liz Lipski, PhD, CCN, CNS, CHN, LDN, CFM
The human microbiome refers to all of the microorganisms that live synergistically on and in the human body. The Human Microbiome Project, funded by the National Institutes of Health (NIH) is currently underway. Among the goals of this project are to identify 3000 microbial gene sequences, differentiate between the microbiomes of different parts of the human body, and identify relationships between the microbiome and health and disease.

Dr. Liz Lipski, PhD, educates consumers and professionals on the effects of diet on the microbiome. She teaches that the diets of healthy individuals should be different than the therapeutic diets needed for those with an imbalance in their microbiota. In this discussion, Dr. Lipski describes the dietary management of the microbiome in both health and disease.

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Emotional Eating

Deanna Minich, PhD
Emotional eating is defined as either eating instead of feeling, or as experiencing negative feelings about eating. In its most severe form, emotional eating manifests as pathological eating disorders, such as anorexia nervosa or bulimia nervosa. In milder forms, emotional eating manifests as binge eating, overeating, under-eating, or choosing unhealthy foods as a way to avoid or self-medicate emotional distress.

Deanna Minich educates practitioners on approaches to help patients overcome emotional eating patterns. In the following discussion, she provides streamlined techniques, tips, and tools that clinicians can incorporate seamlessly into routine patient care.

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Fecal Microbiota Transplantation

Mark Davis, ND
Fecal Microbiota Transplantation (FMT), also known as fecal transplant, is defined as the therapeutic use of human stool or active stool extracts. It involves introduction of fecal flora from a healthy donor into the gastrointestinal tract of a patient for a therapeutic purpose. FMT has been used since the 4th century to treat severe diarrhea, and its first reported use in the United States was in 1958. US clinicians have administered FMT for a variety of conditions since the 1970s, but FDA regulations put an abrupt halt to physician-administered FMT in 2013. Dr. Mark Davis, ND, has extensive clinical experience administering FMT. Here he reviews the evidence for the efficacy of FMT in multiple disorders, explains how its use is now limited by policy, and gives practical information for clinicians who want to provide FMT as an option for their patients.

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Inflammatory Bowel Disease

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Ron Hoffman, MD
Inflammatory Bowel Disease (IBD), including ulcerative colitis and Crohn’s disease, affects 1.6 million people in the United States, with a higher prevalence in those who have a family history of IBD, who live in an urban area, or who live in a northern climate. Most patients are diagnosed with IBD before age 30, with onset most typically between ages 15 and 35 years. IBD is characterized by chronic inflammation of all or part of the gastrointestinal tract. Crohn’s disease can affect any part of the alimentary canal, ulcerative colitis tends to begin in the distal rectum and proceed to involve the rest of colon. Symptoms of IBD include diarrhea, abdominal pain, fatigue, and weight loss. Life-threatening complications can include bowel obstruction, perforated colon, or cancer. The conventional management of IBD emphasizes anti-inflammatory medications as well as immune-modulating and biologic medications as a means to modify disease progression. In this discussion, Dr. Ronald Hoffman shares insights from his decades of experience in treating patients with IBD using diet, lifestyle, and other integrative therapies to manage symptoms and control disease activity.

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Intestinal Permeability


Gaetano Morello, ND
Increased intestinal permeability is a condition in which intestinal lining is damaged or changed in such a way that allows relatively large particles to leak through the intestinal mucosa into the bloodstream. These particles can include toxins, undigested food, and waste. This can result in an inflammatory response, as the immune system responds to the perceived threats.

A weakened endothelial lining in the gastrointestinal tract can lead to a wide variety of health issues. Because of this, repairing the intestinal lining can be a key strategy creating significant positive clinical outcomes. An integrative approach employs natural alternatives to H2 receptor antagonists, as well as supplements to help strengthen the intestinal lining and reverse permeability.

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Irritable Bowel Syndrome

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Adam Rinde, ND
Irritable bowel syndrome (IBS) has a population prevalence of 10%-15% in the United States, with the majority of diagnoses made between the ages of 20 and 39 years. IBS is diagnosed when there are characteristic gastrointestinal symptoms in the absence of organic disease. Features of IBS include disordered bowel habits, bloating, abdominal pain, and aggravation of symptoms after eating. Symptoms are often intermittent or changing over time. Concerning symptoms that require specific diagnostic testing to rule out organic disease include onset after age 50, severe or progressively worsening symptoms, unexplained weight loss, nocturnal diarrhea, rectal bleeding, or unexplained iron-deficient anemia. Conventional treatments for IBS are aimed at symptom control. An integrative approach addresses the whole patient, including the hypothalamic-pituitary-adrenal (HPA) axis, immune factors, dysbiosis, and function of the migratory motor complex (MMC). In this discussion, Dr. Adam Rinde, ND, details emerging tests and protocols for the integrative management of IBS.

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Nonalcoholic Fatty Liver Disease

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Lyn Patrick, ND
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in the United States, with an estimated prevalence of 1 in 3 adults and 1 in 10 children. Strongly associated with obesity, diabetes, and dyslipidemia, NAFLD is defined as accumulation of fat in the liver with no secondary cause, such as alcohol consumption, steatogenic medication, or a genetic disorder.

NAFLD begins as clinically benign fatty liver and can progress to nonalcoholic steatohepatitis (NASH), which is characterized by inflammation of hepatocytes with or without fibrosis. It is estimated that 3% to 5% of the general population has NASH, a serious liver disease that increases a patient’s risk for liver cirrhosis and hepatocellular carcinoma. In this discussion, Dr. Lyn Patrick offers unique insights into the etiology and treatments of NAFLD and NASH.

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Small Intestinal Bacterial Overgrowth

Cindy Howard, DC
Small intestinal bacterial overgrowth (SIBO) is a condition in which an excessive number and altered composition of bacteria exist in the small bowel. SIBO is thought to result from a loss of homeostatic mechanisms that control bacterial growth in the upper gastrointestinal tract. It is conventionally treated with antibiotic therapy. Dr. Cindy Howard views SIBO as a condition that is influenced by diet, lifestyle, comorbid diseases, and overall health status. Dr. Howard’s unique clinical approach includes individualized protocols paired with calculated follow-up to ensure long-term treatment success.

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