Dan Kalish - 4.22.16 H. Pylori PPT

H. PYLORI ASSESSMENT AND TREATMENT
Dr. Daniel Kalish
INTRODUCTION
•
24 years of patient experience,
with over thousands of patients
world wide
•
Trained over 1,000 practitioners in
The Kalish Method of functional
medicine
•
2 years monastic training in Japan
and Thailand
WHY MENTORING & TEACHING
•
Was trained by naturopaths, DC’s and MD’s and have integrated
this information for ease of use by today’s clinicians
•
Working to pass on my clinical training to the next generation of
functional medicine doctors
LEARNING OBJECTIVES
• Learn how chronic stress affects cortisol levels and SIgA (Secretory Immunoglubulin A), leading to GI problems
• Learn why H. pylori treatment protocols frequently fail and how to design natural
programs to increase your success rate by integrating:
• Mastica gum
• GI anti-inflammatory and gut repair
supplements
• Probiotics
THE KALISH METHOD APPROACH
Reduce inflammation
through diet and lifestyle
changes
Strengthen SIgA levels
through adrenal protocols
Kill bugs
Lab testing + diet and lifestyle coaching = health
2 COMMON FAILURES
Practitioners use wrong sequence with treatments
Everyone wants to treat GI first?
Lab testing issues: most often used tests vs. most
accurate tests
THE THREE MAIN INITIATORS OF ILLNESS
Emotional stress:
How we perceive an event,
rather than the event itself,
is most important in
generating a stress response
Dietary stress:
Simple carbohydrate ingestion leads to rapid
elevations in blood sugar
which ultimately leads to ‘up
& down’ dysregulation via
insulin and cortisol responses.
Pain & hidden inflammation:
Pathogens in the gut (e.g.
parasites, bacteria, fungus)
are often sources of hidden
inflammation
ABNORMAL LEVELS OF CORTISOL (REMEMBER, IT’S
CATABOLIC)
• Promotes fat storage
• Undermines mood and
emotional stability
• Reduces Secretory IgA
• Interferes with ovarian
hormones
• Triggers inflammation &
allergies
• Reduces resistance to stress
CORTISOL STEAL
Acetyl CoA
Cholesterol
Pregnenolone
Progesterone
17α - Hydroxylation
17 - Hydroxyprogesterone
17- Hydropregnenolone
Androstenediol
DHEA – De-hydro epi-androsterone
11 - Deoxycortisol
Testosterone
Cortisol
5α - Dihydro testosterone
19 - Hydroxy testosterone
Androstenedione
19 - Hydroxy androstenedione
Estrone
Cortisone
Estradiol - 17α
Estradiol - 17β
B5
MUCOSAL BARRIER FUNCTION
• Mucous membranes comprise the primary interface between the external environment and the internal environment of the body
• Most absorption of nutrients AND toxins occurs across mucous membranes
• Most pathogens enter the body by binding to and penetrating mucous membranes
SIGA
• Secretory immunoglobulin A (SIgA): a mucous membrane
surface antibody produced by immunocytes in mucous
membranes
• SIgA provides first physical barrier of defense protecting
against pathogens (parasites, bacteria, yeast)
YOUR PATIENTS?
Gas
Acid Reflux
Fatigue
Bloating
Weight Gain
Anxiety/ADHD
Depression
Constipation
Low Libido
Diarrhea
Toxic
SYMPTOM CLUSTERS
• Patients relate to clusters of symptoms (i.e. fatigue,
heartburn, bloating), not to body systems or process at
work
• Symptoms change over time and may not parallel original
problem
• Key points: how do you uncover the origin of their health
problem, the two most important questions to ask every
patient
CORRECT BODY SYSTEMS IN ORDER THAT PROBLEMS OCCUR
Neuroendocrine
System
• Cortisol
• Thyroid
• Brain
•
•
•
•
Healing diet
Exercise
Sleep
Meditation
Detox System
GI System
• Treat h. pylori
• Probiotics
• Enzymes
• Support liver cells
• Further improve detox
HELICOBACTER PYLORI
H. Pylori
Causes damage
to stomach lining
and reduces
Common in
patients with
heartburn, GERD,
COMMON H. PYLORI SYMPTOMS
Ongoing need for HCl or
Digestive Enzymes
Duodenal/Peptic Ulcers
Constipation
Nausea
Belching
Upper Abdominal Pain
Heartburn/Reflux
Gastritis
Indigestion
H. PYLORI
• Causes damage to stomach lining and reduces stomach acid
production
• Common in patients with heartburn, GERD, bloating
• Easily acquired infection, leads to increased risk of ulcers and
stomach cancer
• Acquired from food
• Acquired from kissing
OXIDATIVE STRESS
• Poor stomach function leads to poor
digestion, so amino acids are not being
properly absorbed
• This leads to inflammation and oxidative
stress
PREVALENCE
• Bacterium most often enters body through uncooked foods
• One study documented 1/3 of cases through saliva/kissing
• Has been obtained from oral cavity as well as vaginal and prostate fluids
• Likelihood of infection is equal to a person’s age whether symptomatic or not
HELICOBACTER PYLORI
THREE BODY SYSTEM BREAKDOWN
Usually precipitated by the three main
Initiators of illness:
ADRENAL SYSTEM:
Increased Cortisol
• Emotional Stress
• Dietary Stress
• Inflammation
Decreased immune response in
stomach tissue/ low HCL
GI SYSTEM:
H. Pylori Acquired
Toxins
DETOX SYSTEM:
Nutrient Depletion
GUIDELINES FOR H. PYLORI
• Test for H. pylori – PCR/stool antigen/
blood antibodies
• Eliminate pathogen
• Replace healthy bacteria
• Retest to verify bugs gone and probiotics
have recolonized
• Repair leaky gut
LAB TESTING
Endoscopic
exams
Blood tests
Breath test
Stool antigen
testing
PROTOCOLS
H. pylori
treatment
Gluten free
diets
Treating
other
pathogens
H. PYLORI TREATMENT
Treat with prescription: Prevpac
• There are several prescription regimens that can be used to
treat H. pylori - the most common combination is a PrevPac:
amoxicillin, clarithromycin (Biaxin) and Prevacid for 14 days
• Other combinations might use metronidazole or tetracycline, or
an acid reducer other than Prevacid
Treat with herbs: Mastica
• Mastica Gum, Slippery Elm, DGL
• Probiotics: multi-strain, high potency
• GI Repair powder– Glutamine plus herbal support
CHILDREN WITH GERD
Fatigue/depression
Unable to focus,
concentrate or exercise
Nausea
Unable to attend
school
Stomach pain
JESSE - IS THERE AN INFECTION PRESENT?
•
•
•
•
•
Fatigue and insomnia
Awakened at night with stomach pain/GERD
Neurotransmitter (AA) depletion
Connection with Blastocystis hominis
Problems first started when under high stress situation
playing on college level sports team
INTEGRATIVE TREATMENT PROGRAM
Step 1: Adrenal support, stress reduction and antiinflammatory/digestive system healing:
• Adrenal protocols, GI repair products, addressing food allergies
Step 2: Treatment Phase:
• Antibiotics or herbal products to eliminate h. pylori
Step 3: Re-colonization:
• Introduction of probiotic, repair of GI tissues damaged
STEP 1: ADRENALS, STRESS AND DIET
THAT ADDRESSES INFLAMMATION
Begin patient on adrenal protocols,
coaching to reduce emotional stress and
proper diet for two months first. For diet
using one of two methods:
• General diet: eliminating gluten and
dairy, and rotating foods
• Use lab tests to determine specific
food allergies
Start anti-inflammatory repair
supplement program for some
Step 1 is first AND most important step:
Remember D-Day? ever take children
on a ski trip?
STEP 2: CLEANSING - KILLING BUGS
• Introduction of GI bug cleansing protocol
to kill bugs found on labs – may also
need to support liver detoxification
pathways
• When h. pylori present, address as
appropriate after 60 days of successful
adherence to Step One - some cases
also will require anti-inflammatory/leaky
gut repair program during this initial 60
days
STEP 3: RE-COLONIZATION, REPAIR, REEVALUATION
• Re-colonization of intestines with
healthy bacteria to continue GI repair
process
• May also use leaky gut repair
programs at this stage now that
pathogens gone
• Continued adherence to diet changes
• Retest two months after completion of
pathogen protocols, stop probiotics two
weeks prior to retesting
STRENGTHENING SIgA LEVELS THROUGH
ADRENAL PROTOCOLS AND STRESS MANAGEMENT
Test adrenal
hormones
Determine stage of
adrenal exhaustion
Treat adrenals and
clean up lifestyle
stressors
RESEARCH
Now we’re hearing that bugs and even worms may have a beneficial impact
on the immune system, yet many in functional and natural medicine have
been treating these for a while. Are these things bad or good?
This is from the Journal of Inflammatory Bowel Disease: The results
suggest a benefit of H. pylori infection against the development of IBD. As
patients had an incidence of H. pylori infection, this equated to a decrease
in Inflammatory Bowel Disease.
However, we have other studies like this in the Clinical Journal of Oxford:
10 patients with Hashimoto’s and an H. pylori infection were studied. Half
were treated for the H. pylori infection the other half were not. Those treated
saw a marked decrease in thyroid autoimmunity. This suggests that H.
pylori is bad and we want to eradicate it.
If some evidence shows H. pylori to be beneficial and other evidence shows
it to be deleterious, it tells me that timing may be a very important factor.
Exposure tends to be protective when it’s before 3 years of age, before the
gut microbiota stabilizes. If the colonization occurs later in life, this may be
potentially detrimental.
SUMMARY
KEY CONCEPTS:
• H. pylori causes damage to stomach lining and
reduces stomach acid production so amino acids are
not properly absorbed, which leads to inflammation
and oxidative stress
• Reduce inflammation through diet and lifestyle
changes
• Strengthen SIgA levels through adrenal protocols
• Kill bugs found on labs
• Re-colonization of healthy bacteria
CASE STUDY
• History: 36 year old female, working as a bartender,
works late nights, diagnosed as having depression
and an eating disorder
• Chief complaint: fatigue, stomach pain, occasional
nausea and vomiting, depression
• Physical exam: normal, normal blood work
• Triggers: include stress, high gluten diet
• Resolution: stomach pain cleared within 30 days of
treatment for H. pylori in third month of program,
depression resolved at end of 6 months
• Follow up: testing showed improved adrenal function
and elimination of H. pylori
PATIENT TIMELINE
1
Months
Consultation
2
3
4
5
6
7
8
9
10
11
12
Gluten free, anti-inflammatory
diet for at least 60 days
- Labs In Report of
Findings
Adrenal Test
(Saliva)
Stool Test
Organix Test
(Urine)
First Round Adrenals
Second Round Adrenals
Treatment of H. Pylori
Liver Detox
Nutrient Replacement, Esp. AA
FOLLOW UP TESTING AND KEY INSIGHTS
• Cortisol levels improved
• Elimination of H. pylori
• GI pathogens can trigger significant fatigue and
depression related problems
• Eating disorders, GI pain, nausea can all be signals
of H. pylori infection
• Stress exacerbates H. pylori, in a sense it’s a stress
related condition
THANK YOU