What is CIRS - Chronic Inflammatory Response Syndrome

How to Know if You Have Chronic Inflammatory Response Syndrome?

Illnesses caused by biotoxins are on the rise. Since I’ve begun testing my patients for Chronic Inflammatory Response Syndrome (CIRS) markers in my practice, I’m surprised at just how prevalent this condition is turning out to be.

Up to 25 percent of the population is thought to have the gene HLA, which makes them more susceptible to biotoxins. Though anyone can be impacted by biotoxins, these people are much more sensitive and therefore more likely to have symptoms strong enough to send them to the doctor.

Part of this apparent uptick in biotoxin illness is also due to the improvement in diagnostics. We are realizing the body’s reaction to mold, Lyme, and other biotoxins are unique in each person, which is partly why strategies for identifying and correcting these problems have remained largely underdeveloped until recently.

If you’ve been struggling with chronic health issues, you may want to consider getting yourself checked for Chronic Inflammatory Response Syndrome.

What is CIRS?

So what is CIRS? Chronic Inflammatory Response Syndrome or CIRS is a condition with a wide range of symptoms which are triggered by a biotoxin – usually mold. The term CIRS was coined by Dr. Ritchie Shoemaker to describe when a body’s immune system is out of whack. In some people this could mean the immune system is simply weakened, while in others it’s running rampant.

You can also get CIRS from common chronic sinus infections with MARCONS and tick borne illnesses like Lyme disease ticks, fish that’s been contaminated with ciguatera, and infections from a brown recluse spider bite. Essentially, CIRS is a dysfunctional reaction of the body’s immune system in response to a biotoxin. In my practice, I’ve seen the symptoms range from manageable to debilitating.

The different markers that we can test for, and the differences in how symptoms present, make CIRS a difficult condition to diagnose. Though diagnostics are improving, there still needs to be a cluster of symptoms and an improvement in treatment response for a CIRS diagnosis to be made.

Unfortunately, it’s not unusual for a person with CIRS to go years, even decades, without a proper diagnosis. However, if we can pool our knowledge and spread the word about the differences in this condition, I believe we can make a major difference in awareness and treatment of CIRS. This is part of the reason I’ve begun testing most of my patients for biotoxins and CIRS markers.

Waiting For A Diagnosis Might Not Be The Answer

There are numerous symptoms of CIRS, different biomarkers, and the toxins also differ. This complicates the diagnostic process and is part of the reason CIRS has gone largely ignored by conventional medicine. But just because an illness is complex and not fully understood, it doesn’t mean we should shy away from helping people heal – we just need to adjust our approach accordingly.

Testing and treatment often have to happen side by side when tackling CIRS. Sometimes the response to different treatments actually help in achieving a complete diagnosis. Symptoms, biomarkers, and testing must be used to correctly diagnose CIRS.

Some common symptoms of CIRS include:

  • Cognitive difficulties such as brain fog and trouble concentrating
  • Fatigue and weakness or chronic fatigue syndrome
  • Unexplained weight gain
  • Frequent urination, excessive thirst, dehydration
  • Fibromyalgia
  • Visual insensitivity
  • Post nasal drip and sore throat
  • Numbness and tingling
  • Digestive issues
  • Mood swings
  • Tinnitus
  • Static shocks
  • Vertigo
  • Metallic taste in mouth

If you have some of the symptoms associated with CIRS, you should make an appointment with a doctor who is experienced in dealing with this condition. If you’re in need of a New York certified functional medicine doctor, you can request a consultation here.

Testing for Chronic Inflammatory Response Syndrome Due to Mold

Some of the biomarkers for the different underlying causes of CIRS overlap, some are different. These are some of the biomarkers seen in mold patients which have been the most common forms of CIRS I’ve found in my practice.

CIRS due to mold exposure has a couple of characteristic markers, including high levels of

  • C4a – An activation protein that can cause inflammation, free radical production, and damage to tissues if too high.
  • TGF–beta1 – A cytokine in the immune system that has both anti– and proinflammatory effects.
  • MMP–9 – An enzyme that helps with tissue repair and is a significant marker of CIRS.
  • ACTH / Cortisol – A hormone that can be elevated and lead to weight gain in CIRS patients.
  • VEGF – A protein that causes blood vessel formation.

CIRS due to mold exposure is characterized by low levels of:

  • MSH – A hormone that is anti-inflammatory and typically low in CIRS patients.
  • ADH – This hormone regulates the amount of water your body removes and is associated with dehydration, frequent urination, and excessive thirst.
  • VIP – A neuroregulatory hormone that is associated with inflammation
  • Visual contrast ability – You can take the VCS test, which is simple and can be done at home.

There are several tests that can help you identify if mold is the cause of your inflammation, and therefore your symptoms. These tests are useful If you suspect you have CIRS, I recommend the following:

  • The Visual Contrast Sensitivity (VCS) test checks for neuroinflammation, which is often caused by mold exposure. The VCS test checks your ability to see differences in colors, a common symptom of CIRS. It’s also only $10 and can be done at home, so it’s a good place to start.
  • There is a Mold CIRS Panel laboratory markers that you can test in the conventional laboratory. This panel tests for MMP9, TGF-beta1, MSH, ADH, and osmolality.

If you believe your symptoms might be caused by chronic inflammatory response syndrome, it’s so important that you make an appointment with a doctor familiar with this condition. I can’t tell you the number of times I‘ve seen patients who have gone from doctor to doctor trying to find the cause of their symptoms.

When CIRS is the suspected culprit of your symptoms, there are a number of things that can be done right away to ease your struggles. Intervention and remedies like eating specialized diets, taking supplements that support natural detoxification, sauna therapy, and mold remediation can help those with CIRS.

If you are in need of a New York functional medicine doctor who is experienced in CIRS, you can request a consultation here. Don’t wait until this condition becomes worse, you can begin the path to relief today.

Resources:

http://www.survivingmold.com/news/2014/12/what-is-cirs/
https://selfhacked.com/blog/dr-ritchie-shoemaker-pioneer-in-cirs-mold-with-guest-host-dana-howell/#Dr_ShoemakersBiotoxin_Discovery
http://www.survivingmold.com/diagnosis/lab-tests
https://www.vcstest.com/

 

Diagnosing CIRS: Your Complete Guide to Testing

Diagnosing CIRS: Your Complete Guide to Testing

CIRS or Chronic Inflammatory Response Syndrome is really an umbrella term for symptoms with a few different causes. It can be caused by tick borne illnesses, mold exposure, and more. Characterized by extreme exhaustion, weakness, and cognitive difficulties, CIRS is a debilitating condition that’s inherently complex.

The nature of CIRS makes it difficult to diagnose. Sometimes patients go years, even decades before a full diagnosis is made. Fortunately, our understanding of this disease and its diagnostic testing has gotten much better.

I’ve found that because the functional medicine approach examines the body as a whole, it’s better at diagnosing complex conditions such as CIRS. In my article How to Know if You Have Chronic Inflammatory Response Syndrome, I explored:

  • What is Chronic Inflammatory Response Syndrome?
  • Why waiting for a diagnosis might not be the answer.
  • Testing for mold exposure.

If you need more of an introductory to CIRS, I recommend you start there. In this article, you will find a comprehensive approach to diagnostic testing for CIRS. This is a guide you can use before you see a doctor, to help you determine if you possibly have CIRS – and what testing you can ask your doctor for to achieve a proper diagnosis.

Do You Have CIRS? Testing Before The Doctor’s Office

Before you even make an appointment with your doctor there are a couple things you can do.

First, see how many symptoms you have in the CIRS symptoms clusters below. This system was developed by Dr. Ritchie Shoemaker through the analysis of thousands of patients. People with Chronic Inflammatory Response Syndrome will have symptoms in eight or more clusters.

For example, if you are experiencing night sweats that counts as a positive result for the entire cluster of symptoms in the red box on the right. Even if you don’t have red eyes, blurred vision, mood swings or ice pick pain, because you’re experiencing night sweats that counts as a positive result for the entire cluster. You only need one symptom in a cluster for it to count. You may have symptoms that aren’t on this chart, but if you have CIRS you’ll have at least eight symptom clusters. You can see how many clusters you have right now.

Diagnosing CIRS: Your Complete Guide to Testing

Next, you can take the Multiple Systemic Infectious Diseases Syndrome (MSIDS) Horowitz questionnaire. This questionnaire allows you to assign 0-3 in severity on a number of symptoms that are commonly associated with CIRS that’s been triggered by Lyme disease. At the end, you’ll have a total score which will tell you how likely it is you have a tick-borne illness.

Finally, you can take a Visual Contrast Sensitivity (VCS) test. This is a simple test that costs $10. It checks your ability to distinguish between very similar colors. Those with CIRS often are unable to differentiate between similar shades due to neuroinflammation.

If any of these tests result in a trip to the doctor’s office, be sure to bring your results with you to your appointment. These tools are excellent resources for beginning your CIRS diagnosis.

Testing for CIRS

Remember, because there are numerous underlying causes of CIRS, there are also various tactics in tackling these diagnostics. You’ll need to go through these with a doctor who’s experienced in chronic conditions. You might not need every single test listed here. Your symptoms will tell your doctor where to start.

Testing should include:

  • Mycotoxin testing – These tests can identify biotoxins in your blood created by mold.
  • Human Leukocyte Antigen (HLA) genetic test – An estimated 25 percent of the population have a genetic variation that makes their immune system bad at identifying and ridding the body of biotoxins. Sometimes when mold is an issue in a home,  the rest of the family only notices the problem after a person with the HLA gene becomes sick.
  • MARCoNS – Multiple Antibiotic Resistant Coagulase Negative Staphylococci (MARCoNS) live inside the nasal cavity. These can contribute to CIRS and need to be identified and treated.    
  • Mold CIRS Panel of laboratory markers. This panel tests for MMP9, TGF-beta1, MSH, ADH, and osmolality.

The following are biomarkers commonly associated with CIRS and should be tested:

  • Vasoactive Intestinal Polypeptide (VIP) – Normal range is 23-63 pg/mL. CIRS patients usually have lower levels.
  • Melanocyte Stimulating Hormone (MSH) – Normal range is 35-81 pg/mL. CIRS patients usually have lower levels.
  • Transforming Growth Factor Beta–1 (TGF Beta-1) – Normal range is <2380 pg/ml.
  • C4a – Normal range is 0-2830 ng/ml.
  • Antigliadin (AGA IgA/IgG) – Normal range is 0-19.
  • Adrenocorticotropic hormone (ACTH)/Cortisol – Normal range is ACTH 8-37 pg/mL. Cortisol in the a.m. 4.3-22.4 and p.m. 3.1-16.7 ug/dL. CIRS patients usually have higher levels.
  • Vascular Endothelial Growth Factor (VEGF) – Normal range is 31-86 pg/mL. CIRS patients usually have lower levels.
  • Antidiuretic hormone (ADH)/Osmolality – Normal range is ADH 1-13.3 pg/ml and Osmolality 280-300 mosmol.
  • Matrix Metallopeptidase 9 (MMP-9) – Normal range is 85-332 ng/mL.
  • Leptin – Normal range is 0.5-13.8 ng/mL for men and 1.1-27.5 ng/mL for women.

You should also have an Environmental Relative Moldiness Index (ERMI) test done. The ERMI test is a DNA-based test that’s used to identify specific species living in your home. This is beneficial because it helps identify potential mycotoxins that could be making you sick. Furthermore, it will help you know if you should have any mold remediation done in your home. Removing the cause of CIRS (in this case mold) from your life is the number one step in recovering your health.

Finding a Functional Medicine Doctor for CIRS

If you suspect you have Chronic Inflammatory Response Syndrome, it’s important you make an appointment with a functional medicine doctor who has experience in working with CIRS. If you don’t start with a doctor who’s knowledgeable in complex, chronic conditions it could end up costing you a lot more time, money, and energy down the road.

When potential CIRS patients come to me, not only do we begin diagnostics to completely identify the condition, we also start taking steps to alleviate the symptoms. Together we come up with a treatment plan that reduces any exposures, heals any outstanding infections, reduces inflammation, and supports natural detoxification.

As a certified New York functional medicine doctor with CIRS experience, I’ve helped thousands of patients get their life back from chronic, debilitating conditions. If you are struggling with your health, you don’t have to go through this alone – you can request an appointment here or call 212-696-HEAL (4325). When you catch chronic conditions early, the treatment is often easier, faster, and cheaper – don’t wait any longer, start today.

Resources:

http://www.lymeactionnetwork.org/wp-content/uploads/2015/06/MSIDS.pdf
https://www.vcstest.com/
http://www.survivingmold.com/diagnosis/lab-tests

Eggplant: the Good and the Bad

Eggplant: the Good and the Bad

A favorite in vegan and omnivore cuisine, eggplant, can be baked, roasted, grilled, and used as a pizza topping or in stir-fry recipes. It has a pleasantly bitter taste and spongy texture that may vary depending on the color/variety of eggplant selected. Dress your cooked eggplant with herbs, sauces, and condiments and you’ll be sure to please even the pickiest guest at your dinner table.

Like everything else in life, eggplant comes with the good and the bad.

It is a member of the nightshade family of vegetables along with tomatoes, potatoes, and all types of peppers and even some fruit.

GOOD. Eggplant contains a phytonutrient (plant chemical with nutritional benefits) and antioxidants, protecting from cells damage, supporting brain and heart health and a great source of fiber, copper, potassium and B vitamins.

BAD. Eggplant contains cholinesterase that blocks anti-inflammatory substances in the body and therefore promotes INFLAMMATION.

The amount of these substances may vary but usually small and good often negate the bad, however some patient may be very sensitive to those substances.

Especially people with high pre-existing level of inflammation will respond with more symptoms, usually pain, after eating eggplant and other nightshades (potato, peppers, etc). That is why we ask our patients to avoid those vegetables for 4-6 weeks during the elimination food plan. Upon reintroduction of these foods, some people will report increase in symptoms, usually inflammatory joint pain (osteoarthritis and rheumatoid arthritis) and some gastrointestinal symptoms (abdominal pain, bloating, diarrhea, etc.).

The bottom line, if the level of inflammation in the body is low, one can enjoy eggplant and nightshades in moderation. But if you suffer from any chronic inflammatory conditions you might consider limiting your consumption of eggplant until the causes of inflammation resolved.

In our functional medicine practice, Dr.Klimenko and entire team of Healthy Wealthy & Wise Medical, P.C. will help you to understand which foods are best for you and why. Call our office 212-696-HEAL if you want to receive a medical consultation and guidance on how to improve your health.

For those who can and love to eat eggplant, enjoy this recipe.

Eggplant Caponata

Satisfying and versatile, eggplant can handle a variety of flavorful accompaniments, several of which give a kick to this Sicilian favorite. The tomato base is spiked with anchovies, garlic, and capers, creating a mouth-watering aroma and a burst of flavor in every bite. Serve as an appetizer, a main dish or as a side with your favorite fish.

Makes 4-6 Servings

Ingredients

  • 2 large Italian eggplants, peeled and cut into medium dice
  • 2 Tbs kosher salt
  • 5 Tbs extra-virgin olive oil
  • 1 red onion, thinly sliced
  • 4 medium garlic cloves, thinly sliced
  • 4 celery stalks, thinly sliced on an angle
  • 2 anchovies, in oil
  • 1/4 cup tomato paste
  • 1/2 cup red wine vinegar
  • 1/4 cup sugar
  • 1/2 cup capers, in brine

Preparation:

  1. Peel and dice the eggplants, peel and slice the onion, peel and slice the garlic, slice the celery.
  2. In a large bowl, toss the eggplant with the salt. Transfer the eggplant to a colander to drain for 2 hours. In order to facilitate the draining, top the eggplant with a heavy weight, such as a dinner plate topped with full cans.
  3. Heat 3 Tbs of the olive oil over medium heat in a large sauté pan. Add the onion and sauté until translucent, 4 to 5 minutes. Add the garlic and celery and sauté for 5 minutes more, or until the garlic softens but does not brown. Add the anchovies and cook for 1 minute.
  4. Add the tomato paste and stir to thoroughly combine. Cook for 2 minutes, or until the paste turns a deep red, almost brown, and starts to stick to the pan. Add the vinegar and sugar and stir until the mixture thickens, 3 to 4 minutes. Turn off the heat.
  5. In another large sauté pan, heat the remaining 2 Tbs olive oil over high heat until smoking. Add the eggplant and carefully toss it in the oil, letting it sear before stirring. Turn the heat down to medium and cook for 8 to 10 minutes, or until the eggplant is translucent and soft.
  6. Transfer the eggplant to the caponata mixture and cook over low heat for 3 minutes, until the flavors combine. Add the capers and their brine and stir to incorporate.
  7. Serve warm or at room temperature accompanied by toast points or crostini.
References
  • Worlds Healthiest Foods. “Eggplant” Accessed on 4 July 2016: http://whfoods.com/genpage.php?tname=foodspice&dbid=22
  • Whitaker, B.D., Stommel, J.R. “Distribution of hydroxycinnamic acid conjugates in fruit of commercial eggplant (Solanum melongena L.) cultivars.” J Agric Food Chem. (May 2003) 51(11): 3448-54. Accessed on 5 July 2016: http://pubs.acs.org/doi/abs/10.1021/jf026250b
  • Murray, Michael T., Pizzorno, J. The Encyclopedia of Healing Foods (2005). Atria. Excerpt on eggplant available at: https://doctormurray.com/healing-facts-eggplant/
  • Das, S. et al., “Cardioprotective properties of raw and cooked eggplant (Solanum melongena L).” Food Funct. (2011) 2, p. 395-399. DOI: 10.1039/C1FO10048C. Accessed 5 July 2016: http://pubs.rsc.org/en/Content/ArticleLanding/2011/FO/c1fo10048c#!divAbstract
  • EatingWell.com. “10 Healthy Eggplant Recipes.” Accessed 5 July 2016. http://www.eatingwell.com/recipes_menus/collections/healthy_eggplant_recipes
Sleep: Essential for Mind-Body Health

Sleep: Essential for Mind-Body Health

Adults and children alike are spending more time awake late at night to study, work, or have fun. All those late nights may be negatively effecting us. More than 20 years of research shows us that sleep is vitally important to physical and mental health.

Most of what we know about sleep and health comes from studies of what happens to the mind and body when we don’t sleep enough, or at all. In animal and human studies, living without sleep for even a few months resulted in death. Sleeping fewer than 8 hours a night on a regular basis is associated with increased risk for diabetes, heart disease and stroke, depression, colds and flu, and obesity.

While We Are Sleeping…

Sleep affects brain chemistry and has an important role in the functioning of the nervous, immune and endocrine systems. During sleep we develop and reinforce neural pathways involved in memory, learning, and emotion. New research suggests sleep helps flush toxins from the brain.

While we are sleeping, the body manufactures hormones that repair damage caused by stress and the environment in which we work and play. Growth hormone cleanses the liver, builds muscle, breaks down fat, and helps normalize blood sugar. We also produce hormones that help fight infections. If we aren’t getting sufficient sleep, we get sick more often and take longer to recover. Lack of sleep increases inflammation, which is has been linked to heart disease and stroke.

Skimping on shut-eye is linked with obesity in adults and children. Lack of sleep interferes with the levels of ghrelin and leptin, metabolic hormones that signal when you’re hungry and when you’re full.

The amount of sleep you need varies based on age, activity level, quality of sleep, and genetics (e.g., some of us really are night owls). Infants typically require 14-15 hours of sleep per 24-hour period; young children about 12 hours; teens about 9 hours, and most adults 7-9 hours. A general rule of thumb for determining your sleep requirement: If you do not wake feeling refreshed, you may not be getting enough sleep.

Tips For A Good Night’s Sleep

Your bed is for sleep and sex only. Regular sex can improve sleep quality so don’t use your time between the sheets to deal with daily hassles–take that outside of the bedroom (or record in a journal). If you don’t feel sleepy, leave the room and do something relaxing until you feel drowsy, then, go back to bed.

Set a sleep schedule. This includes a soothing pre-sleep routine, such as a warm bath, reading or gentle yoga. Go to bed and wake at the same time each day. This entrains your body rhythms, making it easier to fall asleep. If you need a nap, get it in before 5:00 PM; limit to 20 minutes.

Surround yourself with cave-like ambiance. A sleeping space should be quiet, dark, and cool (between 60-72°). If you do shift-work, use blackout shades or an eye mask. Remove electronic devices, computers and TVs from your room. Research shows that use of digital devices within an hour of bedtime has a negative effect on sleep quality due to suppression of melatonin production.

Let the light in early and exercise regularly. Natural light helps regulates hormones that promote ideal sleep-wake patterns. Open the curtains as early as possible and get outdoors during the day. Also, exercise during the day or early evening makes it easier to fall asleep and increases the amount of deep sleep obtained.

Eat a Light, Last Meal of the Day. A light dinner eaten 2-3 hours before sleep is ideal. A full stomach interferes with sleep as the body works at digestion. Steer clear of spicy or fatty foods that can cause heartburn. If you need a bedtime snack, combine a carbohydrate and protein, such as almond butter on toast, Greek yogurt with sugar-free granola, or cheese and crackers. My favorite is almond butter and crispy apple. Avoid products containing caffeine, sugar or nicotine as their effects can last several hours.

Are You Sleep Deprived? Here are some symptoms of sleep deprivation:

Daytime drowsiness; fatigue

Poor memory; difficulty concentrating

Changes in appetite

Difficulty dealing with stress

Irritability

Muscle tension; impaired vision

Increase in accidents or clumsiness

You don’t have to pull “all-nighters” to become sleep deprived. A sleep debt of just 1-2 hours a few nights a week can affect your health and performance. To become fully well-rested and regain energy after a sleep debt, get an extra hour of sleep each night for one week.

If you experience any of the following the signs of sleep deprivation, talk to your healthcare provider about natural approaches to getting your sleep back on track.

References
  • Harvard Health. Sleep: What’s in it for You? http://healthysleep.med.harvard.edu/need-sleep/whats-in-it-for-you/health
  • Strickgold, R. “Sleep on It!” Scientific American. October 2015. 313(4): pp. 52-57.
  • Brondel, L., Romer, M., Nougues, P., Touyarou, P., and Davenne, D. 2010. Acute partial sleep deprivation increases food intake in healthy men. American Journal of Clinical Nutrition 91 (6): 1550-1559.
  • National Sleep Foundation. 2009. How much sleep do we really need? http://www.sleepfoundation.org/article/how-sleep-works/how-much-sleep-do-we-really-need.
  • Chang, A., et al., Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proceedings of the National Academy of Sciences (Dec 2014). 112:4, 1232-1237. http://www.pnas.org/content/112/4/1232.full.pdf
  • Harvard Health. Consequences of Insufficient Sleep. http://healthysleep.med.harvard.edu/healthy/matters/consequences
  • Van Cauter, E. & Knutson, KL. “Sleep and the Epidemic of Obesity in Children and Adults.” European Jl of Endocrinology. 59(1) pp. S59-S66. http://www.eje-online.org/content/159/suppl_1/S59.short
  • Rechtschaffen, A. & Bergmann, BM. “Sleep Deprivation in the Rat: Update of the 1989 Paper.” Sleep. 2002. 25(1): pp. 18-24. http://www.journalsleep.org/Articles/250104.pdf
  • Knutson KL, et al. Role of Sleep Duration and Quality in the Risk and Severity of Type 2 Diabetes Mellitus, Archives of Internal Medicine. 2006 Sep 18; 166(16):1768.
  • Gottlieb DJ, et al. Association of Sleep Time with Diabetes Mellitus and Impaired Glucose Tolerance, Archives of Internal Medicine. 2005 Apr 25; 165(8): 863.
  • King, CR et al. Short Sleep Duration and Incident Coronary Artery Calcification, JAMA, 2008: 300(24): 2859-2866. http://www.ncbi.nlm.nih.gov/pubmed/19109114
  • Opp, MR, et al. Neural-Immune Interactions in the Regulation of Sleep, Front Biosci. 2003 May 1;8:d768-79.
  • Cohen S, et al. Sleep Habits and Susceptibility to the Common Cold, Arch of Intern Med. 2009 Jan 12; 169 (1):62-67.
  • Colten, HR & Altevogt, BM, eds. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Institute of Medicine Committee on Sleep Medicine and Research. Washington, D.C.: National Academies Press 2006: 3. “Extent and Health Consequences of Chronic Sleep Loss and Sleep Disorders.” http://www.ncbi.nlm.nih.gov/books/NBK19961/
  • Spiegel K, et al. Impact of Sleep Debt on Metabolic and Endocrine Function, Lancet. 1999 Oct 23: 354(9188): 1435-9.
  • Zeng, Yawen et al. “Strategies of Functional Foods Promote Sleep in Human Being.” Current Signal Transduction Therapy 9.3 (2014): 148–155. PMC. Web. 16 Oct. 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440346/
  • Figueiro M, Bierman A, Plitnick B, Rea M. “Preliminary evidence that both blue and red light can induce alertness at night.” BMC Neuroscience. 2009;10(1):105.
  • National Sleep Foundation: Sleep Depression & Anxiety https://sleepfoundation.org/excessivesleepiness/content/the-complex-relationship-between-sleep-depression-anxiety
  • National Institutes of Health: Signs and Symptoms of Problem Sleepiness http://www.nhlbi.nih.gov/health/health-topics/topics/sdd/signs
Rheumatoid Arthritis Linked to Microbiome Changes

Rheumatoid Arthritis Linked to Microbiome Changes

Here is evidence that our health depends on who we host and what we grow in our guts! It is more them then us, so it is better keep “good guys” and get rid of the “bad guys”. The article below explains that gut bacteria Prevotella copri is directly connected to new onset of rheumatoid arthritis in patients.

Rheumatoid Arthritis Linked to Microbiome Changes

By Kristen Schepker

Rheumatoid arthritis (RA), one of the most common autoimmune diseases, may be triggered by changes in the microbial composition of the gut, according to a recent study by investigators at New York University.

There is a solid body of research indicating that intestinal bacteria affect the development and the severity of autoimmune disorders localized to the gut, such as inflammatory bowel disease (Mathis, D. eLife. 2013. doi:10.7554/eLife.01608).

What’s somewhat more surprising is that gut flora can also contribute to the progression of autoimmune conditions outside the intestinal tract. In one animal study researchers found that autoimmune arthritis could be rapidly induced in previously healthy, germ-free mice by introducing certain pathogenic bacteria into their intestines (Wu, et al. Immun. 2010; 32(6): 815-827).

Following this line of thinking, researchers at the Hospital for Joint Diseases, NYU School of Medicine explored the impact of intestinal bacteria on the “systemic immune response required for joint inflammation.” Specifically, they examined the relationship between specific bacterial clades and rheumatoid arthritis development (Scher, et al. eLife. 2013. doi:10.7554/eLife.01202).

The researchers collected 114 stool samples from RA patients, as well as non-RA control subjects at New York University’s rheumatology clinics. Forty-four of the samples came from patients with newly diagnosed, previously untreated rheumatoid arthritis; 26 samples were from patients with chronic but treated rheumatoid arthritis, and 16 came from patients with psoriatic arthritis, another poorly understood autoimmune condition.

The remaining 28 samples were from healthy people without any form of arthritis.

Unusual Suspect

In performing DNA analysis, the researchers discovered that one specific intestinal bacterium, Prevotella copri, occurred in significantly higher quantities in the fecal samples collected from the new-onset rheumatoid arthritis (NORA) patients than in all other patient groups.

P. copri was present in a striking 75% of newly diagnosed rheumatoid arthritis patients, and in these individuals, Prevotella tended to be highly predominant compared with other bacterial species.

In contrast, only 21.4% of the healthy controls carried this organism in their intestinal microbiota. The bug was found in just 11.5% and 37.5% of samples from chronic rheumatoid arthritis and psoriatic arthritis patient samples, respectively.

The NYU researchers further noted that in NORA subjects, an increase in Prevotella species was correlated with a reduction in beneficial microbes, especially Bacteroides, a key genus of bacteria that normally thrive in the human gut, especially in the Western world.

Further exploring the potential connection between Prevotellaand increased inflammatory responses, Scher’s team then colonized a group of mice with a lab-grown P. copri strain.

They found that P. copri colonization in mice induced inflammation in the form of colitis, but not joint disease. They attributed the development of inflammatory bowel disease rather than RA to the fact that the mice were colonized with a different strain of P. copri than the one found in the human subjects.

Cause or Co-factor?

It is not clear whether overgrowth of Prevotella is a triggering event for the inflammatory cascade that ultimately leads to RA, or whether the organism simply thrives in the context of systemic inflammation but is not in and of itself a causal agent.

What does seem clear is that a Prevotella-defined microbiome appears to promote inflammation in the context of a genetically susceptible host.

The connection between Prevotella and joint inflammation seems to be a T-cell mediated process.

The authors note that, “In RA, there is increased production of both self-reactive antibodies and pro-inflammatory T-lymphocytes. Although mechanisms for targeting of synovium by inflammatory cells have not been fully elucidated, studies in animal models suggest that both T-cell and antibody responses are involved in arthritogenesis. Moreover, an imbalance in the composition of the gut microbiota can alter local T-cell responses and modulate systemic inflammation.”

It is interesting that mice with genetic mutations that increase the risk of RA-like changes remain healthy if they are kept under sterile conditions. However, if these mice are exposed to certain species of bacteria sometimes found in the gut, they begin to show signs of joint inflammation (Ivanov et al., 2009Sczesnak et al., 2011).

While the new study’s results cannot conclusively implicate P. copri as the cause of rheumatoid arthritis, they do support a compelling argument that P. copri may predispose both mice and men to chronic inflammatory conditions.

A predominance of segmented filamentous bacteria like Prevotella in an individual’s intestinal microbial ecology predisposes to a reduction in the number and the function if of anti-inflammatory regulatory T cells, thus predisposing the individual towards autoimmunity, the authors explain.

Though not conclusive, this line of research open the door to a new realm of possible treatment options for rheumatoid arthritis.

Conventionally, the disease is treated with pharmaceuticals with often severe and noxious side effects. Should further research confirm the connection between P. copri and rheumatoid arthritis, antibiotic treatments or the use of probiotics rich in beneficial bacteria could become viable alternatives.

At the very least, this new line of work points to the microbiome as a previously unrecognized etiologic factor in the onset of a common but poorly understood disorder.

What Your Bowel Movements Reveal about Your Health?

What Your Bowel Movements Reveal about Your Health?

While discussion of poop is probably not a hot topic in your household, in our home it is the most important topic of discussion. “Honey,how was your poop today? Did you have a good one?” Jokes aside, composition of what you deposit into the toilet has important implications for health. Did you know the features of fecal matter–such as the size, color, shape, odor, and consistency indicate how well the gastrointestinal (GI) tract is functioning? Those same features also provide clues about how your body is (or isn’t) faring against threats of infection and more serious diseases like celiac disease, hepatitis, urinary tract infections, malabsorption disorders, inflammatory bowel disease (IBS), pancreatitis, and cancer.

To give you an idea of what healthy, normal stool looks like, check out the Bristol Stool Chart (see attached picture and diagnosed yourself). The healthy range for fecal matter is of a consistency that is not too hard, not too soft, and mostly solid–as opposed to lumpy, pellet-like, or liquid. Normal stool color is in the light-to-medium brown range and is not offensively odorous. Also, bowel movements (BMs) should pass easily from your body to the toilet.

5 BMs that Require Medical Attention (Unless you are aware of dietary changes or a medication that could produce the following types of stool, it’s advisable to seek medical attention if you observe the following changes in BMs).

Stool that is hard to pass, requires straining, or is accompanied by abdominal pain.

Black, tarry stool might indicate infection or GI bleeding, while bright red stool could indicate infection and/or bleeding in the GI tract or anus. Seek immediate medical attention.

White, pale, or grey stool could indicate problems with the liver, bile ducts, or pancreas.

Yellow stool could indicate serious infection or gallbladder problems.

Mucus in the stool can indicate inflammation, infection, or even cancer.

How Often Should You Go?

How frequently you have a BM is important, too. And, what’s typical for you may be different for other people in your family. For most people, daily BMs are considered the norm. No matter how often you poop, you should not have to strain or experience pain while excreting. Additionally, be aware that the appearance and frequency of BMs will vary based on what’s in your diet, sleep and exercise patterns, hormonal changes, travel, stress, hydration level, medications or supplements you are taking, and exposure to toxins (from nicotine to industrial toxins).

How Low Should You Go?

There’s also evidence that the position you take to evacuate the bowels has health implications for the physical structures of the GI tract. So much so that some scientists indicate sitting to poop is a contributing factor in the development of colon and pelvic diseases. Before potty training, young children squat to poop in their diapers–they don’t sit. Yes, there’s a difference between squatting and sitting. The modern toilet places the thighs at a 90-degree angle to the abdomen, whereas squatting has a much deeper angle that gives more motility to the intestinal muscles and organs. Evacuating the bowels is much easier on the body in the squatting versus seated position. Toilet position should be a consideration for everyone over the age of five, but is especially important for the elderly, the disabled, and individuals with compromised mobility.

You can learn more about proper toilet position in this video:

https://www.youtube.com/watch?v=5P8L0r4JVpo

Resources

Mercola, J. “What You See in the Toilet Can Give You Valuable Insights into Your Health.” Accessed February 2015.

Monastyrsky, K. “Gut Sense: What Exactly Are Normal Stools?” Accessed February 2015.

Sikirov, D. “Comparison of Straining During Defecation in Three Positions: Results and Implications for Human Health.” Abstract. Digestive Diseases and Sciences 48, no. 7 (July 2003): 1201-5.

Step and Go. “Step and Go Ergonomically Correct Toilet Position.” Accessed February 2015.

 

Inflammation and " Leaky Brain" Syndrome

Inflammation and Leaky Brain Syndrome

Very commonly I see patients with significant emotional and cognitive problems that last for years. Either long standing problem with focus and concentration or decreasing memory could be the signs of “Leaky Brain” or increased permeability of the blood brain barrier. It is a highly suspected problem especially in people whose symptoms developed later in life.

Our brain is one of the most protected organs in the entire body and also, it is one of the most important one. The blood that brings nutrients to the brain goes through a protective barrier, called blood brain barrier.

This brain barrier ensures that only substances that can provide some type of functional asset to the brain are allowed through and that the brain will be compromised by invasive substances.

Leaky brain syndrome occurs when this blood brain barrier fails to keep out certain substances. This means that harmful substances are able to carry through the walls and find their way into the brain which can change the way that we function every day.

Quite often leaky brain syndrome is related to leaky gut syndrome. Both conditions are caused by the inflammation. The same factors that cause inflammation in the gastro-intestinal tract, like food sensitivity or imbalance of bacteria, may cause the inflammatory processes in the entire body and cause weakness of blood brain barrier. Once this barrier becomes compromised the brain can fall victim to damage from environmental toxins, like heavy metals, bacteria and more. In extreme cases with leaky brain symptoms one can start to experience major neurological or psychiatric conditions like ADD/ADHD, autism, chronic pain, depression and other mental illnesses.

As it’s fairly common to have leaky brain and leaky gut syndrome at the same time, and it is usually a good idea to focus on the treatment of both conditions at once. A specific diet and life style modification leading to decrease exposure to toxic factors must be implemented in the treatment of Leaky Brain syndrome. We often recommend supplement with omega-3 oil, anti-inflammatory botanicals and neurotransmitter support medication.

Feel free to call our office to schedule evaluation and receive adequate functional medicine treatment for your symptoms. To find a certified functional medicine practitioner in your area go to www.functionalmedicine.org

Gut Dysbiosis

Gut Dysbiosis

Recently a new patient came for a functional medicine consultation complaining of frequent colds. Jonathan was a 35 years old singer with history of frequent colds up to 3-4 times per winter season. The nature of his profession demanded faster recovery to perform, therefore he had no time to recover on his own, so he was treated with multiple antibiotics and steroids courses. Jonathan also had multiple complaints related to digestive symptoms (bloating, heartburn and constipation) and recently he developed skin hives after eating certain foods. Jonathan had classical symptoms of food sensitivity as a result of dysbiosis.

Dysbiosis is a condition that involves imbalance of beneficial and harmful microorganisms in the digestive tract. This imbalance can take place anywhere from mouth to the stomach and further down to small and large intestine. In our practice we diagnose and treat dysbiosis of different areas of gastrointestinal tract. As a result, patients’ chronic medical conditions get better.

Multiple environmental factors such as antibacterial and pharmaceutical medications, pesticides and toxins, unbalance diet lacking of vegetables and healthy proteins and fats are some of the factors affecting our gastrointestinal microbiome. When we host unhealthy microbiome we can experience multiple symptoms outside of the digestive system realm. For example, eczema and asthma are strongly connected to imbalance in the gastrointestinal tract.

Back to Jonathan. Based on his history and symptoms we ordered several tests that revealed candida overgrowth. After appropriate treatment involving  4R program (see our previous blog) and specific diet his digestive symptoms improved and he was no longer sick with upper respiratory infections.

Our gastrointestinal tract is a gate keeper to our health. It is always the first place to start treatment if you have any chronic medical conditions. Feel free to call our office if you have any questions or think you may have dysbiosis.