The Digestive Immune Connection in Children

1. The Digestive Immune Connection in Children Dr Mary Bove ND

2. Human Digestive System The physiology of the digestive tract, the subjective experience of the symptom, health behavior, and treatment outcome are strongly affected by psychosocial factors.

3. Enteric Nervous System (ENS) • May be called the 3rd part of the ANS • Vast network of neurons widely dispersed throughout the gut • ENS is a dominant regulator of gut function via the action of peptide and non-peptide neurotransmitters

4. Enteric Nervous System • Regulation of secretory processes, such as gastric acid secretion and motility • Broader role in the regulation of mucosal defense, the gut immune response, and sphincter function • Alterations in regulation of gut function by the ENS are connected to conditions including achalasia, inflammatory bowel disease, biliary dyskinesia, tachygastria, and irritable bowel syndrome

5. Brain-Gut Interactions • Processes modulating responsiveness to stressors along the brain-gut axis involve neural pathways, immunological and endocrine mechanisms • ENS function, central processing, and autonomic regulation play an important role in the brain-gut dialogue • Stress and emotions may trigger neuroimmune and neuroendocrine reactions via the brain-gut axis

6. “Intestinal reactivity to words with emotional content ….” • Study compared healthy controls with nonpsychiatric irritable bowel syndrome (IBS) patients and IBS patients with comorbid phobic anxiety disorders with respect to rectal wall reactivity during exposure to everyday words with emotional content. • Outcomes showed that 70.3% of the subjects responded either with increased or decreased rectal tone during exposure to anger words, 75.0% when exposed to sadness words, and 76.6% when exposed to anxiety words. • We observed significant group differences in the frontal brain to sadness (P < 0.001) and anxiety (P = 0.013) distracter words, and threshold significant group difference to anger (P = 0.053) distracter words. • Rectal wall reactivity during the word series significantly predicted frontal amplitude to the same word series, indicating a close interaction among mind, brain, and gut. Blomhoff S, Spetalen S, Jacobsen MB, et al,Dig Dis Sci (2000 Jun) 45(6):1160-5, ISSN: 0163-2116

7. Cultivating Healthy Beginnings • Maternal Uterine Environment • Maternal Infant Digestive System • Maternal Infant Immune Connection • Maternal Chronic Stress Connection Children begin to develop preferences to flavors, music, voices and even stories while in the mother’s womb

8. Maternal Connection • History of yeast infections, intestinal dysbiosis, IBS, insufficient digestive enzymes, low fiber diet, constipation • Chronic stress, chronic inflammation, environmental toxic exposure, zinc deficiency, medications, allergies • Immune Overload – allergen exposure, leaky gut, environmental toxic exposure, chronic stress, low SIgA

9. Infant Connection • Immature digestive system • Establishment of healthy balanced microbiota • Immune system immaturity and hyper-exposure in utero • Vaginal birth verse C-section • Breastfeeding or formula feeding

10. Microbiota The microbiota is intimately involved in numerous aspects of normal host physiology, from nutritional status to behavior and stress response

11. Role of Intestinal Microbiota Digestive function Fermentation of substrates Competes with other bacteria Assimilation and absorption of vital nutrients Immune System – Innate & Adaptive Galt- gut associated lymphoid tissue Mucosal immunity, SIgA, Barrier fxn (mucin) Healthy skin

12. Getting a Good Start • Infants have a sterile gut leaving the womb • Exposed to bacteria via birth canal, skin, and meconium. • In breast milk • Bifidobacteria develops rapidly in the first 3 days.

13. The Importance of Microbiota • Up to 2 yrs to complete colonization of microbiota • Wide diversity of microbes early in life preps the immune response • Antibiotics disrupt normal flora growth and colonization. “It is estimated that a course of antibiotics may disrupt normal micrbiota colonization for up to three months post use.” De la Cochetiere et al: Early intestinal bacterial colonization and nectrotizingenterocolitis in premature infants: the putative role of Clostridium, Pediatr Res Sep;56(3): 366-70,2004

14. Probiotics and Illness • Studies show probiotics improve infant weight gain, gut maturation, and immune secretion function.* • Many common illnesses which effect children can be treated with probiotics *Gut Immunity, and the Environment; Keys to long-term health, J.Saavedra MD, Clinical Applications of Probiotics in Human Health,Sept.2007

15. Diarrhea* Allergy* Atopic dermatitis Sinus infections Ear infections Autistic Spectrum* Common cold URI Colic Dental caries Urinary infection IBS, IBD* Probiotics and Illness PediatircProbiotics, Impact on the development of a normal immune system, Naturopathic Doctor News and Review Feb; 3(2) 10-12, 2007 *Traver,D.Probiotcs in the Treatment of Autism Spectrum Disorder; Clinical Applications of Probiotics in Human Health, Sept.2007

16. Prevention of Atopic Disease • A Finnish study; L. GG/ rhamnosus • Reducing atopic disease in infants • Administer to the pregnant mother in third trimester & breastfeeding and the infant. • Occurrence of atopic disease dropped 50% in the probiotic group and stayed low for full 4 years w/o further supplementation of probiotics Kalliomaki M et al: proibiotics and prevention of atopic disease: 4 year follow up of randomized placebo-controlled trial, Lancet 361:1896-1871, 2003

17. Probiotics as an Immune Aid • Several studies have looked at supplementation of children in day care centers • Probiotics and the occurrence of URI, fever, and GI infection. The probiotic supplemented groups had significantly less occurrence of infection* • Probiotics are believed to enhance mucosal immunity, stimulate local innate immunity, improves oral antigen tolerance, and dietary metabolism. *Weizman Z at al: Effect of a probiotic infant formula on infections in child care centers: comparison of two probiotic agents, Pediatrics 115:5-9, 2005 *Hatakka K et al: effect on long-term consumption of probiotic milk on infections in children attending day care centres: double-blind, randomized trial, Clin Nutr Aug; 24(4):481-91,2005

18. Supplementing Probiotics • Infants up to 2 yrs old, pregnant and breastfeeding mothers • Bifidobacterium species including infantis, bifidum, breve, longum, lactis • 1 to 5 billion for infants • 5 to 10 billion children 12 to 24 m • 40 to 100 billion daily to mothers For non-breastfed babies include probiotics in the formula daily.

19. Supplementing Probiotics Children 2 to 5 years old • 20 to 40 billion daily Pregnant and nursing mothers • 40 to 100 billion daily to mothers • Bifidobacteria strains along with adult strains including Lactobacillus species including rhamnosus(GG), acidophilus, reuteri

20. Dietary Phenols Support the micorbiota Inhibit non-beneficial bacteria while having little effect on beneficial bacteria Antioxidant activity Tannins flavonoids, bioflavonoids, polyphenols, phenolic acids Fruits, berries, vegetable, herb, spices, cocoa, red wine, dark chocolate Huffnagle, G,. The Probiotic Revolution, Bantum Books, 2007 pg 274-277

21. Calcium and Probiotics Aids probiotic bacteria to adhere to the intestinal wall Discourages harmful bacteria from adhering to the intestinal wall Avoid calcium carbonate Food forms preferred Huffnagle, G,. The Probiotic Revolution, Bantum Books, 2007 pg 257

22. Ulmus fulva Althaea officinalis Astragalus root Matricaria rectita Hemp Seed Powder Oats Abrabinogalactan Green tea polyphenols Cinnamon Musa paradisiacal Fermented foods sauerkraut, miso, tempeh, yogurt, kefir, cottage cheese, kimchee Inulin- chicory root Therapeutic Foods

23. Secretory IgA • IgA is secreted by the various mucosal surfaces • SIgA values are sensitive to increased cortisol//DHEA ratio and sympathetic tone The main functions of SIgA are: • Viral and toxin neutralization • Plasmid elimination • Inhibition of bacterial colonization • Immune exclusion

24. Secretory IgA Mucosal immunoglobulin A (IgA) production is highly dependent on cholecystokinin release and is markedly suppressed by glucocorticoids. Glucocorticoids decrease duodenal cholecystokinin, decrease IgA, and leads to impaired mucosal immunity, increased bacterial adherence, and decreased tissue resistance.

25. Cholecystokinin Cholecystokinin may act to preserved mucosal immune function. Cholecystokinin may play an important role in maintaining the functional responsiveness of mucosal immunity during catabolic stress. Excessive sympathetic/ catecholamine activity causes inhibition of SIgA release from the mucosal immunocytes.

26. Cholagogue and cholerectic botanicals to support cholecystokinin production & secretion. Taraxacumofficinalis Curcuma longa Andrographispaniculata Agrimoniaspp Filipendulaulmaris

27. Infantile clinical picture suggesting digestive disturbance • reflex, GERD • cradle cap, seborrhea dermatitis, atopic dermatitis • restless sleep, irritability, insomnia • constipation, loose or smelly stool • asthma, URT congestion, diaper rash • copious ear serumen

28. Therapeutic Biopsychosocial Model Therapeutic approach of a biopsychosocial model targeting aspects stemming from physiological, emotional, cognitive, social, and behavioral sources is a whole approach to digestive wellness

29. Digestive Benefits of Herbs • Herbal medicines are a good match for GI complaints • Can be used in several forms for specific GI targeting • Used to preserve health and wellness • Offers specific remedies for specific pathological syndromes • Many can be added into daily diet

30. GI Demulcants • Marshmallow / Althea officinalis –root • Slippery Elm / Ulmusfulva – inner bark • Astragalus membranous – root • Licorice / Glycerrhizaglabra - root

31. Digestive Vulnerary Herbs • Calendula officinalis – flowers • Chamomile / Matricariarecutitia – flowers

32. Digestive Astringents • Witch hazel / Hamamelisvirginiana-bark • Blackberry / Rubusfructicosus-leaves,root

33. Digestive Nervines • Lavedulaspp – lavender flowers • Melissa officinalis – Lemon Balm • Matricariachamomila - Chamomile Flowers • Valeriannaofficinalis – Valerian Root • Nepetacateria - Catnip

34. Food is Medicine