Overview
                             Overview
                 A. Optimize GI Function
                  Antibiotic induced diarrhea
                  Intestinal dysbiosis (definition, causes, treatment)
                  Liver/GB Support
                 B. Heavy Metals
                  Prevalence
                  Signs & symptoms
                  Testing
                  Treatment options
                  Methylation in non-responders
                 C. Conclusion 
            Raj Patel, M.D.                                          
                                                                     
            A. Optimize GI Function   
            A. Optimize GI Function   
          1. Antibiotic Induced Diarrhea (AID)
                  Common complication from extended antibiotic use  
             
                  Probability increases with use of >2 antibiotics
                                Doxy + Flagyl for 10 d caused a significant increase 
                           in GI and vaginal candida counts than either alone.
                                       Maraki S.   J Chemother. 2003 Aug;15(4):369-73. 
                  Certain antibiotics more commonly associated with  
                           AID (Cephalosporins and Penicillins)
                  Clostridium difficile induced enterocolitis
                            Symptoms: diarrhea, abdominal pain, fevers
                            Incidence: only accounts for 10-20% of all AID cases
                                   E. Bergogne-Bérézin Int J Antimicrob Agents. 2000 Dec;16(4):521-6 
            Raj Patel, M.D.                                          
                                                                     
             
               Non-Clostridium AID
                                         
                                        
                                        
                        Common pathogens include Clostridium perfringens,      
                        Staphylococcus aureus, Klebsiella oxytoca, Candida species, 
             
                        and Salmonella species. 
                     Accounts for 80-90% of all AID cases
                        Clin Infect Dis. 1998 Oct;27(4):702-10 
              AID Treatment Options
                       Mild Symptoms: Saccharomyces boulardii
                                                   Probiotics
                                                   Bland diet
                                                   Drug holiday/Change antibiotics
                                  Elmer GW. et al  JAMA. 1996 Jul 3 ;276(1):29-30 Biotherapeutic agents. A neglected   
                                  modality for the treatment and prevention of selected intestinal and vaginal infections.
                        Severe Symptoms: Metronidazole
                                                       Vancomycin
             Raj Patel, M.D.                                               
                                                                           
       2. Intestinal Dysbiosis 
                                    
                                   
            a. Definition:         
         Term originally coined by Metchnikoff to describe altered pathogenic 
                    bacteria in gut.  Today, abnormal milieu due to bacterial and fugal 
                    imbalance.
         These abnormal bacteria have been shown to produce:
                    toxic products- endotoxins, phenols, ammonia, & indoles 
                    Macfarlane C et al.  Proteolysis and amino acid fermentation. In: Gibson GR, Macfarlane GT, eds.
                          Human  Colonic  Bacteria: Role in Nutrition, Physiology, and Pathology. Boca Raton, FL:
                          CRC Press; 1995:75-100.
          Chronic degenerative diseases - inflammatory bowel disease,
                                                                        ankylosing spondylitis, & RA 
                     Peltonen R, Nenonen M, Helve T, et al. Br J Rheumatol 1997;36:64-68.
                           Brandtzaeg P. Review article:  Aliment Pharmacol Ther 1997;11:24-37.
                        
           Raj Patel, M.D.                                       
                                                                 
          Intestinal Dysbiosis (con’t)
                                    
                                   
                                   
           b. Functions of the microflora    
              
              Immune stimulation
              Vitamin synthesis (B group & K)
              Enhancement of gut motility, digestion & nutrient absorption
              Improve epithelial function via increased SCFA production,    
                    decreased apoptosis, increased barrier integrity
              Inhibit pathogenic bacteria via decreasing luminal pH, decreasing   
                     epithelial binding, and decreasing epithelial invasion
              Metabolism of certain drugs
                    Holzapfel WH, et al. Int J Food Microbiol 1998;41:85-101.
                        Noack J, et al.  J Nutr 1998;128:1385-1391.
                        Gibson GR, Roberfroid MB. J Nutr 1995;125:1401-1412.
                        Sartor, RB. J. Clin. Gastro  2007;41:537-543
           
           Raj Patel, M.D.