gi eﬀects in clinical pracce - genova diagnostics, inc. · gi eﬀects in clinical pracce:...

GIEffectsinClinicalPrac1ce:FocusingontheGutRebeccaHunton,MDAugust23,2017

TheviewsandopinionsexpressedhereinaresolelythoseofthepresenteranddonotnecessarilyrepresentthoseofGenovaDiagnos1cs.Thus,GenovaDiagnos1csdoesnotacceptliabilityforconsequencesofanyac1onstakenonthebasisoftheinforma1onprovided.

LahnorPowell,ND,MPHMedicalEduca6onSpecialist-Asheville

RebeccaHunton,MD

www.drhunton.com

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•  Discussnovelpa1entpopula1onswheretheGIEffectstestmaybeindicated

•  DiscussrecentpublishedstudiesthatsupporttheuseofGIEffectsinthesepopula1ons

•  Discuss3interes1ngcasestudiesthatdemonstrateu1liza1onofGIEffectstes1ngmaderealclinicaldifferences

Objec6ves

•  Autoimmune/CFS/Fibromyalgia•  IBS/IBD/GERD/EE•  Thyroid/Hormone•  Proac1ve/Preventa1ve•  MetabolicDysfunc1on/Weight•  MoodandNeurologicIssues/Diseases•  Cancer/SeriousDiseasesandCondi1ons•  Engineers

NewPa6entPathways

•  Autoimmune/CFS/Fibromyalgia/SkinCondi1ons•  IBS/IBD/GERD/EE•  Thyroid/Hormone•  Proac1ve/Preventa1ve•  MetabolicDysfunc1on/Weight•  MoodandNeurologicIssues/Diseases•  Cancer/SeriousDiseasesandCondi1ons•  Engineers

NewPa6entPathways

•  Autoimmune/CFS/Fibromyalgia•  IBS/IBD/GERD/EE•  Thyroid/Hormone•  Proac1ve/Preventa1ve•  MetabolicDysfunc1on/Weight•  MoodandNeurologicIssues/Diseases•  Cancer/SeriousDiseasesandCondi1ons•  Engineers

NewPa6entPathways

YouWantMetoDoWhat???

Ifyouhaven'twatchedthefollowingTEDtalks,Ihighlyrecommendthem:(TEDisanonprofitdevotedtospreadingideas,usuallyintheformofshort,powerfultalks(18minutesorless).TEDbeganin1984asaconferencewhereTechnology,EntertainmentandDesignconverged,andtodaycoversalmostalltopics—fromsciencetobusinesstoglobalissues—inmorethan100languages.

•  Foodforthought:Howgutmicrobeschangeyourmindhdp://www.tedmed.com/talks/show?id=293045

•  Howourmicrobesmakeuswhoweare:hdps://www.ted.com/talks/rob_knight_how_our_microbes_make_us_who_we_are?language=en

•  Type1DiabetesandtheMicrobiomehdp://www.ted.com/talks/jonathan_eisen_meet_your_microbes?language=en

•  MindAlteringMicrobes:TEDxCalTech:hdps://www.youtube.com/watch?v=FWT_BLVOASI

•  Thegutflora:Youandyour100trillionfriendsTEDxBrusselshdps://www.youtube.com/watch?v=Af5qUxl1ktI

•  JessicaGreen:We’recoveredingerms.Let’sdesignforthathZp://www.ted.com/talks/jessica_green_good_germs_make_healthy_buildings

TEDTemplate

NewsBriefsandAr6cles

WhyAutoimmune?

Lupus.2014;23(6):518-526.

Int.J.Mol.Sci.2016,17(3),431

WhyNeurologicDisease?

Objective:

Methods:

Results:

Conclusions:

Go to:Go to:

Neurology. 2016 Nov 29; 87(22): 2324–2332.doi: 10.1212/WNL.0000000000003391

PMCID: PMC5135029

Gram-negative bacterial molecules associate with Alzheimer diseasepathologyXinhua Zhan, MD, Boryana Stamova, PhD, Lee-Way Jin, MD, Charles DeCarli, MD, Brett Phinney, PhD, andFrank R. Sharp, MD

From the Department of Neurology (X.Z., B.S., C.D., F.R.S.), MIND Institute (X.Z., B.S., F.R.S.), Alzheimer's Disease Center (L.-W.J.,C.D.), Department of Pathology (L.-W.J.), and Proteomics Core Facility, Genome Center (B.P.), University of California at Davis,Sacramento.

Corresponding author.Correspondence to Dr. Zhan: [email protected] to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at theend of the article. The Article Processing Charge was paid by the authors.

Received 2016 Mar 8; Accepted 2016 Aug 24.

Copyright © 2016 American Academy of Neurology

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in anyway or used commercially.

This article has been cited by other articles in PMC.

Abstract

We determined whether Gram-negative bacterial molecules are associated with Alzheimerdisease (AD) neuropathology given that previous studies demonstrate Gram-negative Escherichia colibacteria can form extracellular amyloid and Gram-negative bacteria have been reported as thepredominant bacteria found in normal human brains.

Brain samples from gray and white matter were studied from patients with AD (n = 24) andage-matched controls (n = 18). Lipopolysaccharide (LPS) and E coli K99 pili protein were evaluatedby Western blots and immunocytochemistry. Human brain samples were assessed for E coli DNAfollowed by DNA sequencing.

LPS and E coli K99 were detected immunocytochemically in brain parenchyma and vesselsin all AD and control brains. K99 levels measured using Western blots were greater in AD compared tocontrol brains (p < 0.01) and K99 was localized to neuron-like cells in AD but not control brains. LPSlevels were also greater in AD compared to control brain. LPS colocalized with Aβ in amyloidplaques and with Aβ around vessels in AD brains. DNA sequencing confirmed E coli DNA inhuman control and AD brains.

E coli K99 and LPS levels were greater in AD compared to control brains. LPScolocalized with Aβ in amyloid plaques and around vessels in AD brain. The data show thatGram-negative bacterial molecules are associated with AD neuropathology. They are consistent with

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Neurology. 2016 Nov 29;87(22):2324-2332.

Copyright 2016 American Medical Association. All rights reserved.

Association of Proton Pump Inhibitors With Risk of DementiaA Pharmacoepidemiological Claims Data AnalysisWilly Gomm, PhD; Klaus von Holt, MD, PhD; Friederike Thomé, MSc; Karl Broich, MD; Wolfgang Maier, MD;Anne Fink, MSc; Gabriele Doblhammer, PhD; Britta Haenisch, PhD

IMPORTANCE Medications that influence the risk of dementia in the elderly can be relevantfor dementia prevention. Proton pump inhibitors (PPIs) are widely used for the treatment ofgastrointestinal diseases but have also been shown to be potentially involved in cognitivedecline.

OBJECTIVE To examine the association between the use of PPIs and the risk of incidentdementia in the elderly.

DESIGN, SETTING, AND PARTICIPANTS We conducted a prospective cohort study usingobservational data from 2004 to 2011, derived from the largest German statutory healthinsurer, Allgemeine Ortskrankenkassen (AOK). Data on inpatient and outpatient diagnoses(coded by the German modification of the International Statistical Classification of Diseasesand Related Health Problems, Tenth Revision) and drug prescriptions (categorized accordingto the Anatomical Therapeutic Chemical Classification System) were available on a quarterlybasis. Data analysis was performed from August to November 2015.

EXPOSURES Prescription of omeprazole, pantoprazole, lansoprazole, esomeprazole, orrabeprazole.

MAIN OUTCOMES AND MEASURES The main outcome was a diagnosis of incident dementiacoded by the German modification of the International Statistical Classification of Diseasesand Related Health Problems, Tenth Revision. The association between PPI use and dementiawas analyzed using time-dependent Cox regression. The model was adjusted for potentialconfounding factors, including age, sex, comorbidities, and polypharmacy.

RESULTS A total of 73 679 participants 75 years of age or older and free of dementia atbaseline were analyzed. The patients receiving regular PPI medication (n = 2950; mean [SD]age, 83.8 [5.4] years; 77.9% female) had a significantly increased risk of incident dementiacompared with the patients not receiving PPI medication (n = 70 729; mean [SD] age, 83.0[5.6] years; 73.6% female) (hazard ratio, 1.44 [95% CI, 1.36-1.52]; P < .001).

CONCLUSIONS AND RELEVANCE The avoidance of PPI medication may prevent thedevelopment of dementia. This finding is supported by recent pharmacoepidemiologicalanalyses on primary data and is in line with mouse models in which the use of PPIs increasedthe levels of β-amyloid in the brains of mice. Randomized, prospective clinical trials areneeded to examine this connection in more detail.

JAMA Neurol. 2016;73(4):410-416. doi:10.1001/jamaneurol.2015.4791Published online February 15, 2016.

Editorial page 379

Supplemental content atjamaneurology.com

Author Affiliations: German Centerfor Neurodegenerative Diseases,Bonn, Germany (Gomm, von Holt,Thomé, Maier, Fink, Doblhammer,Haenisch); Federal Institute for Drugsand Medical Devices, Bonn, Germany(Broich); Department of Psychiatry,University of Bonn, Bonn, Germany(Maier); Rostock Center for the Studyof Demographic Change, Rostock,Germany (Fink, Doblhammer);Max-Planck-Institute forDemographic Research, Rostock,Germany (Doblhammer); Institute forSociology and Demography,University of Rostock, Rostock,Germany (Doblhammer).

Corresponding Author: BrittaHaenisch, PhD, German Center forNeurodegenerative Diseases, c/oFederal Institute for Drugs andMedical Devices, Kurt-Georg-Kiesinger-Allee 3, 53175 Bonn,Germany ([email protected]).

Research

Original Investigation

410 (Reprinted) jamaneurology.com

Copyright 2016 American Medical Association. All rights reserved.

Downloaded From: http://jamanetwork.com/ on 08/04/2017

JAMA Neurol. 2016 Apr;73(4):410-6.

AnnTranslMed2017;5(6):145

Case1:54YearOldMale

•  A54yearoldprac1cinggeneralden1stwhopresentedwiththemaincomplaintoffa1guethathasslowlyworsenedoverlast2years

•  HisMDdidbloodwork,toldhimhewasfineandwantedtoprescribeZoloofordepression–  “Wearen’tyoungbucksanymore”

•  History:–  Sleeping6-8hours,uponcetourinate–  EatsahealthierversionoftheSAD(makessandwichesathome,bringstowork,etc.)

–  Up20poundssincehis20’s–  Forceshimselftoexercise,recoveryslow(personaltrainer2xaweek)

–  Sexuallyac1ve11meaweek,wouldlikemore–  Hobbiesincludesurfing(too1red)andcarpentry(too1red)

–  Deniesanhedonia,changeinappe1teorsleep,iner1a

Case#1:54YearOldMale


FromHH Medica6ons/Supplements

•  Dexilant•  Flomax•  Fishoil•  Curcumin•  ProstateBlend


NotableLabs(PrimaryMD)

•  Testosterone566•  TSH1.02,totalT48.1•  CBC/CMPnormalandhealthy•  B12282•  PSA1.4•  Chol:212HDL64LDL110Trigs68

Tes6ngOp6ons

•  Adrenals•  Heavymetals•  Nutreval•  Autoimmune•  Mitochondria•  MTHFR

Case#1:54YearOldMaleFa6gue

Hisyard…


Case#1:54YearOldMaleFa6gue

•  Havetoknowyourpa1ent•  Allowthemtopar1cipateinchoices•  Givethemnutri1onalguidelines:

–  Thebacteriawithineatwhatweeat,ifwedon’tchangenutri1on,wewilltypicallyhavearelapse!

•  AlwaysorderDEXAwithlongtermPPI

Case#1:54YearOldMale-Treatment

•  Nutri1on:–  Fiber,fiber,fiberandfermentedfoods–  Avoidthesimplecarbsthatfeedyeast

•  PPI:slowweanoffu1lizingMas1cGumandOTCH2blockers(8weeks!)

•  B12andothernutrientsknowntodepletewhenonaPPIforalong1me

•  GIrevive(DFHproduct)•  UFIBandUFSpectrum(Metagenicsproducts)•  Diges1veEnzymes:DFHx3months

Case#1:54YearOldMale-Treatment

Case#2:20YearOldFemale

•  A20yearoldcollegestudentwith5yearhistoryoflineamorphea

•  Shehadfollowedwithseveraldifferentrheumatologistsatter1arycenters,hadtakenseveraldifferentbiologics,didhorriblyonmethotrexate

•  Asastudent,startedresearchingandwantedtotryalterna1veapproach

Case#2:20YearOldFemaleFollow-up

Case#2:20YearOldFemale–Follow-up

Case#3:55YearOldFemale•  Longtermpa1ent>10yearsthathadnotbeenseen

inawhile

•  DiagnosedCeliacasachild,ea1ngitbecause“nosymptoms”

•  DiagnosedMSin2005,cametomeandwetookherbackoffglutenandsurprise,thelesionsresolved!(alsohadposi1veceliacpanelatthat1me)

•  Diagnosedbreastcancerin2014,shewasbacktoea1nggluten(Nosymptomswithexposure)

•  AlsonowwithHashimoto’s

Case#3:55YearOldFemaleAeerRadia6on,7monthsaeerfirsttest

Case#3:55YearOldFemaleFollow-up

Case#3:55YearOldFemale–Follow-up

Ques1ons?

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–  Reviewaprofilethathasalreadybeencompletedononeofyourpa1ents

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