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Immunology

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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Autoimmune Disease

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Kara Fitzgerald, ND, PhD
We have not made progress in our battle to ease suffering caused by autoimmune disorders. The National Institutes of Health estimates that between 14 and 22 million people in the United States have an autoimmune disease with the most common being systemic lupus erythematosus (SLE), multiple sclerosis (MS), type 1 diabetes, thyroid (Graves and Hashimoto), myasthenia gravis, scleroderma, and rheumatoid arthritis (RA). These disorders affect more women than men and are among the 10 leading causes of death for women in all age groups up to the age of 64. The physical, emotional, social, and financial burden of these diseases cannot be overstated.

Autoimmune disorders can be some of the most challenging illnesses to treat because etiology can be difficult to determine and disease progression can be complex and dangerous. With more than 80 different types of autoimmune disorders presently identified, the complexity begins with diagnosis. The wrong or delayed diagnosis can not only be frustrating for the patient but can also reduce the chance of successful treatment and possible remission.

Once a proper diagnosis is in place, conventional medicine looks to steroid and other drugs to help the patient manage symptoms. According to clinician, Kara Fitzgerald, ND, this is where an integrative approach can shine. We asked to her describe her clinical strategy.

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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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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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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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Hypothyroidism

Holly Lucille, ND, RN
An estimated 20 million Americans have some form of thyroid disease, and many cases remain undiagnosed. In diagnosed cases of thyroid disease, we still lack a clear understanding of causes and the accuracy of laboratory testing. Because an underactive thyroid can be so hard to diagnose, and lab tests aren’t a reliable measure of optimal thyroid function, integrative practitioners need to be aware of the diverse symptoms and contributing factors.

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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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Lyme Disease

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Ron Grisanti, DC, DABCO, DACBN, MS
Lyme disease is the most common vectorborne illness in the United States, with more than 25,000 new cases reported to the Centers for Disease Control and Prevention (CDC) in 2013. More precisely called Lyme borreliosis, it is caused by 1 of at least 300 different strains of the spirochete, Borrelia burgdorferi. The most well recognized vector of transmission is the Ixodes tick, but research suggests that fleas, flies, gnats, mites, and mosquitos might also transmit this disease to humans. Prompt recognition and treatment of early infection can lead to complete resolution, and medical authorities disagree about whether or not Lyme disease can become chronic.

Dr. Ron Grisanti has observed that untreated or ineffectively treated Lyme disease can progress to chronic disease that can affect the skin, joints, immune system, nervous system, or other vital organs. In the following discussion, he explains his approach to the identification and management of chronic Lyme disease.

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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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Traumatic Brain Injury

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Brandon Brock, DC, RN, NP-C, DACNB
Traumatic brain injury (TBI) is defined as any damage to the brain resulting from external trauma such as an impact injury or penetration of the skull. Of the many forms of TBI, concussion, or mild traumatic brain injury (mTBI) is one of the most common. Causes of TBI include falls, vehicular accidents, violence, sports injuries, or combat injuries. Physical manifestations of TBI can include skull fractures, hematomas, subarachnoid hemorrhage, contusions, or diffuse axonal injury. Symptoms of TBI range in severity from disorientation or headache to loss of consciousness or coma.

 

Long-term consequences of TBIs can include cognitive deficits, seizures, and neurodegenerative disease. Because the brain has an effect on all body systems, and all body systems have an effect on the brain, Dr. Brandon Brock views TBI as the “pinnacle of all metabolic disease.” In this discussion, he explains his comprehensive approach to the assessment and treatment of patients with TBI.

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