SHOW NOTES

What is Inflammatory Bowel Disease (IBD)? [0:35]

• Governing term that categorizes diseases that involve chronic inflammation of the gastrointestinal tract
• Crohn's Disease
  • Presents with inflammation throughout small intestinal tract, large intestine
• Colitis
  • Ulcerative colitis - ulcers in the inner lining of the colon & rectum
• Well-known autoimmune diseases
• Diagnosed in complex way
  • Scopes, biopsy, patient history

How does it differ from irritable bowel syndrome (IBS)? [1:50]

• Not an autoimmune disease
• Complex set of symptoms associated with gastrointestinal tract
  • Upper & lower combined
  • Accompanied with constipation, or diarrhea
• IBS can only be diagnosed after ruling out other conditions and autoimmune diseases such as celiac disease & IBD
• Multifactorial reason as to why they’re experiencing the symptoms
  • Food allergies, food intolerances, small intestinal bacterial overgrowth (SIBO)
• Correctly SIBO, if applicable, can improve symptoms greatly
  • SIBO breath test
  • Test to determine if overgrowth of small intestine bacteria is present, causing fermentation of carbohydrates
    • Causing dramatic discomfort - bloating, diarrhea, stomach distention
    • Sugar alcohols and simple sugars ending in “ose” are most common to ferment
      • Simple sugars - fructose, sucrose, lactose, maltose
      • Sugar alcohols - malitol, maltitol, xylitol, erythritol

Risk factors for having inflammatory bowel disease? [4:30]

• Family history - having a first degree relative that also has a form of IBD
• Classically diagnosed before age 30, but sometimes over age 50
• Genetic heritage
  • Ashkenazi Jewish population at highest risk (1 out of 18 people)
  • Caucasians at high risk
  • Any race can develop it
• Overuse of over-the-counter non-steroidal anti-inflammatory (NSAID) medications such as:
  • Ibuprofen (Advil, Motrin)
  • Naproxen sodium (Aleve)
  • Voltaren
  • Overuse or extreme sensitivity to these medications can trigger the genetic/family/heritage risk

• Location
  • Northern climate have higher risk
  • Canadians have highest rate of IBD at 1 out of 150 people
    • Potentially due to Vitamin D deficiency
  • In all of Dr. Pastore’s initial IBD patient work-ups , Vitamin D is not at a normal/optimal level

Complications of Inflammatory Bowel Disease [8:45]

• Increased risk for colon cancer
• Generalized inflammation throughout the body, not just intestines
  • Arthritis, joint aches & pains
    • Treated with over the counter NSAIDs, making it worse
  • Inflammation of the eyes
• Scarring of bile ducts, can lead to liver damage
• Increased risk of blood clots in veins & arteries
• Greatly increased risk for malnutrition & deficiencies
  • Can lead to other conditions such as iron deficiency anemia or vitamin D deficiency, causing more issues and symptoms
• Ulcerative colitis at risk for iron deficiency due to blood loss
  • Drops ferritin levels (iron transportation protein)
  • Getting less oxygen in the body than someone else
• Those with IBD typically can not handle traditional iron therapy / supplementation
  • Intravenous delivery to surpass digestion
  • Supplemental iron paired with amino acids for slow absorption, gentler on digestive tract
    • Ferrochel
• Dehydration from diarrhea and fluid/electrolyte loss
• Toxic megacolon -  colon and rectum enlarge & waste material builds up
  • Can lead to perforation, now at risk for sepsis
• Bowel obstruction
  • In lower part of small intestine or upper part of large intestine towards colon
  • Constriction from inflammation that prevents food material from getting through
  • Blockage that can require surgery
• Total colectomy (removal of the colon)

How is IBD treated? [13:15]

• In conventional medicine, with steroid anti-inflammatory drugs
  • Corticosteroid combined with an aminosalicylate drug
    • Mesalamine (Asacol)
    • Colazal
    • Dipentum
• Food & diet often not addressed, but should be
  • Eating a food you are negatively reacting to will exacerbate symptoms
    • Causing new symptoms such as nutritional deficiencies & inflammation
  • Remove the reactive food, symptoms of IBD lessen or disappear completely
    • Elimination of immune system burden
  • Dairy is #1 reaction Dr. Pastore has seen in years of practice
    • Thousands & thousands of people have benefited from dairy elimination diet

New study on connection between celiac disease & IBD [18:40]

• Both autoimmune diseases
• New published paper May 13, 2020 titled The Association Between Inflammatory Bowel Diseases and Celiac Disease: A Systematic Review and Meta-Analysis by Pinto-Sanchez & colleagues
• Research team looked at 9791 previous studies, narrowed it down to 65 relevant studies
  • 65 studies completed from 1978 - 2019
  • 43,000 diagnosed celiacs & 166,000 patients with IBD
  • Goal was to identify statistic connection
• People with celiac disease have 10x greater risk of developing IBD
• People with IBD have a 4-fold increase risk of developing celiac disease
• Immunological cross-reactions transpiring
• Refractory celiac disease may not be celiac disease - could be microscopic colitis - or both
• Researchers believe next studies should investigate if those with either disease should be tested for the other, Dr. Pastore says yes - do it immediately
• Anyone with IBD should be tested for celiac disease
  • How to get tested for celiac disease: https://drrobertpastore.com/articles/2019-08-26-what-do-you-do-if-you-think-you-may-have-celiac-disease
  • Example: colitis on proper medications & treatment for IBD, but not feeling better, could have celiac disease too
  • If celiac disease is diagnosed, gastrointestinal symptoms reduce and likely able to reduce amount of medications with gluten-free diet
• Refractory celiacs following gluten-free diet should go through the testing mentioned in previous podcast to rule out IBD
  • https://drrobertpastore.com/podcasts/064-refractory-celiac
• Healthy celiacs following gluten-free diet, with normal blood work and no additional symptoms don’t need to be testing

Should IBD patients follow a gluten free diet? [26:20]

• Don’t immediately go gluten-free
• Go get an official positive or negative diagnosis
  • Continue consuming gluten and ask your physician if you’re at risk
  • Higher risk of having anti-gliadin type antibodies such as tissue transglutaminase
    • https://drrobertpastore.com/podcasts/063-tissue-transglutaminase
  • Immune system already heightened from condition - if reacting negatively to gluten it will show on diagnostic tests
• Even if negative for celiac, Dr. Pastore has a large IBD patient population that has non-celiac gluten intolerance
  • Not an auto-immune disease, but still causes inflammation and patient should follow gluten-free diet
  • Pay attention to cause & effect - when symptoms get worse after eating foods
• Diagnostic evidence from American Academy of Allergy
  • Identifying sensitivity or intolerance by short term food exposure, staying away from the food (a few days minimum), and exposing yourself again which causes a negative reaction
  • Do that 3x and identify patterns
• Gluten reaction + immune system can mimic morphine effect
  • Gluteomorphin
  • Alter brain chemistry

Avoiding foods you’re reacting to vs. following an Autoimmune Protocol (AIP) diet [31:30]

• AIP, FODMAP, classic elimination diets
  • Could be eliminating a food you’re actually able to eat and tolerate without issues
  • Is it sustainable long-term for the individual?
• Dr. Pastore believes in individuality and testing to determine immunological IgE & non-IgE mediated reactions
  • ALCAT testing for non-IgE reactions

Recommendations for those diagnosed with inflammatory bowel disease taking medication, but not feeling great [33:20]

• Ask doctor to get tested for celiac disease
  • If on an immunosuppressant medication, immunoglobulin testing levels could affect diagnosis accuracy (total IgA)
  • How to get tested for celiac disease: https://drrobertpastore.com/articles/2019-08-26-what-do-you-do-if-you-think-you-may-have-celiac-disease
• Comorbidities - two medical conditions existing at the same time - are common with autoimmune diseases
  • Example: rheumatoid arthritis + ulcerative colitis + celiac disease
• If celiac testing comes back negative, explore food reactions
  • 100% of Dr. Pastore’s IBD patients have had food reactions
    • Gut associated lymphoid tissue - bulk of immune system resides in gut
    • Autoimmune disease in gastrointestinal tract can be triggered by food
  • 4 tests to ask your physician for the following tests to get a true diagnosis
  • #1 - IgE rast blood test for foods & inhalants
  • #2 - IgG4 subclass
    • IgG alone has high rate of false intolerant foods
    • Hair test food intolerance tests not accurate
    • Mouth swab test not accurate
  • #3 - ALCAT test
    • Backed by Yale in double-blind studies
    • Up to 92-96% accurate
    • Shows intolerant foods without consuming them
  • #4 - Skin scratch analysis
    • Traditional allergist test
    • Inject small amount of potential reactants under skin to identify wheel rash
• Entirely eliminate reactive foods entirely to see a major reduction in symptoms
  • Stops the “masking phenomenon”
    • Body masks exposure to harmful substance with increased exposure by secreting chemicals to suppress effects
    • Eliminate the food, reduce the release of suppressing chemicals, worsens the reaction
    • Symptoms after exposure worsen with age

Provide your physician with Dr. Pastore’s information if they want further clarification - he WANTS to help educate physicians [43:20]

• Be an advocate for your own health
• www.drrobertpastore.com
• @drrobertpastore