What Is Mast Cell Activation Syndrome
Low SIgA- Part 1
Shane Hemphill, MD
| Say your functional medicine provider ordered a stool test and it showed Low SIgA- what does that mean and how did it develop? The immune system makes T cells and B cells. The B cells produce secretory IgA (SIgA) which acts as a first line of defense against the entry of foreign substances into the body. These foreign substances include many things such as undigested proteins from the foods that we eat, bacteria, viruses, parasites, or even molds. In essence SIgA gives us insight into what is happening at our mucosal surfaces. The body’s mucosal surfaces – located at the eyes, ears, nose, throat, sinuses, gastrointestinal and genitourinary tracts, and skin are all entry points for potential disease-causing pathogens. Our body’s way of protecting these entry points is done with the release of SIgA. B-cells present within the mucosa are activated upon exposure to pathogens and allergens and thus produce SIgA in response. The SIgA then attaches itself to the invading bacteria, virus or other foreign substance, traps it in the mucosal surface and then neutralizes it. So what does it mean if your SIgA is low? If your SIgA is low, this means that you are less able to prevent invaders from getting into your gut mucosal lining. This lining can become inflamed and tight junctions that ordinarily keep toxins and undigested food particles out – break down. This causes havoc as now toxins and undigested substances are able to get access to our blood stream, causing inflammatory and immune reactions that lead to systemic symptoms throughout the body. Patients with low SIgA levels generally have increased risk of food sensitivities, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), intestinal permeability also known as ‘leaky gut’, autoimmunity, and other gastrointestinal infections. What causes low SIgA levels? Chronic infections are commonly associated with low SIgA. Assessing for problematic bugs including H pylori, Candida, Blastocystis Hominis, H. Pylori, Clostridium difficile are essential in this evaluation. Do keep in mind that many of these normally can exist in the bowel at low levels and not cause harm. Some of them only become problematic depending on their level in the body and others do it based on virulence. These can be assessed via a functional stool test. One interesting note is that these ‘infections’ are opportunistic by nature, meaning they also come about when SIgA levels reduce. Therefore it is not uncommon to see development of Candida in SIgA compromised clients. Medications are another cause of low SIgA. Anti-inflammatories, antibiotics and antidepressants are some examples. Studies have even shown an association between low SIgA and people that suffer from depression. Stress is another cause of low SIgA through increased cortisol levels. Stress can be in any form, including mental, emotional or even physical. One study has even demonstrated that persistent negative thoughts about ourselves can lower our own SIgA levels. Lowering stress and introducing stress reduction techniques is vital in maintaining this protector. Finally, poor dietary choices are another contributor to low SIgA. Certain nutrients such as Vitamin D, Vitamin A, Zinc and Glutathione are instrumental in supporting healthy SIgA levels. A good intake of dietary fiber and phytonutrients can also play a role in supporting a healthy gut microbiome. This can lead to the development of beneficial bacteria that promote healthy levels as well. Stay tuned for my next article which will discuss how we treat low SIgA. To schedule a new patient appointment, please call our office at 919-999-0831. Your Partner in Health! Shane Hemphill, MD |
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What Exactly Is Applied Kinesiology?
Richard A. Laviano, DC, ND, FSBCT(c)
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My doctor has recommended applied kinesiology to rebalance my vagus nerve. Sounds like voodoo to me…. What exactly is applied kinesiology? The importance of the vagus nerve for so many of our bodily function has been proven again and again in multiple medical studies. The vagus nerve runs from your brainstem down to your intestinal tract and is the ringmaster of your autonomic nervous system, all things “rest and digest”. When the vagus nerve is out of balance, it has the potential to create widespread dysfunction from intestinal motility (think small intestinal bacterial overgrowth) to quick “fight or flight” reactivity, anxiety, and even panic attacks. A simple PubMed search of vagus nerve pops up34,789 results! We at CTW have come to rely on the finely tuned skills of practitioners expert in using modalities to rebalance the vagus. One of the most powerful, only in very experienced hands, is applied kinesiology (AK). Dr Rick Laviano of Falls Chiropractic and Injury in Raleigh explains below the role of AK. Applied Kinesiology (AK) is a neurological rehabilitation therapy. At the International College of Applied Kinesiology in 2005 (1) Dr. Walter Schmitt eloquently presented a model that thoroughly explains it. He explains AK as an assessment and therapy that positively affects neurological function. We quote it here and explain it more simply below. AK is a series of sensory receptor based diagnostic challenges followed by monitoring of manual muscle testing outcomes. All AK techniques are about creating sensory receptor stimulation that results in a net effect of excitation and inhibition leading to more optimal neurological function. These positive changes can be observed through somatic windows by changes toward normal in muscle facilitation and inhibition(muscle balance, range of motion, deep tendon reflexes) and through various autonomic windows that can also be monitored (pupil light response, blood pressure, heart rate, etc.) (pg. 1) AK uses muscle tests as well as other neurological tests to assess the state of your nervous system. When there is poor neurological function discovered, the doctor tries his or her best to find the neurological therapy that will improve it. For example, the brainstem (area of the brain just above your neck), controls most of the things in your abdominal cavity subconsciously like your heartrate, blood pressure, gut motility, gut valves, and liver detox. We can see how healthy the brainstem is by looking at reflexes that live there, like how fast your pupils react to a shining light, or how your jaw moves, or how your balance is, or how your blood pressure compares from one side to another (2,4). A physician trained in AK will use these nerdy tools to pinpoint what part of the nervous system may be dormant or over-excited. Then they will wake it up or calm it down through a targeted therapy such as rubbing, tapping, stretching, manipulation, eye movements, muscle/fascial work etc. AK specialists can be considered your body electricians! The ultimate goal is to improve function in the nervous system to thus improve total body health and wellness. Since the nervous system controls every function in our bodies, there have been many types of cases Applied Kinesiologists have seen over the years. Cases that are often seen include gut/microbiome issues. It is important that these patients understand that the gut microbiome is STRONGLY influenced by the state of their gut nervous system. Improving the integrity of the nervous system in these patients can greatly improve their quality of life. Another point worth mentioning regarding gut issues includes the trigeminal nerves. The largest cranial nerve in our brain is the trigeminal nerve. This nerve coordinates information regarding the teeth, jaw, head, and even your posture (3)!This nerve integrates (strongly connects) with the vestibular, ocular, and cerebellar reflexes that affect the health of the brainstem, even the health of the vagus nerve. By keeping the trigeminal nerve and its connections in the brainstem healthy, vagal tone is optimal! In treating gut problems, the priority is making sure that trigeminal, head, eyes, and balance organs are in tune with one another for the health of the autonomic nervous system including the vagus nerve and ultimately the gut. References: 1. Schmitt, Walter H., The Neurological Rationale for a Comprehensive Clinical Protocol Using Applied Kinesiology Techniques. Proceedings of the I.C.A.K. – U.S.A. Annual Meeting, Volume 1,2005-2006. p. 157-191. 2. Monaco, A., Cattaneo, R., Mesin, L., Ciarrocchi,I., Sgolastra, F., & Pietropaoli, D. (2012). Dysregulation of the autonomous nervous system in patients with temporomandibular disorder: a pupillometric study. 3. Cuccia, A., & Caradonna, C. (2009). The relationship between the stomatognathic system and body posture. Clinics, 64(1),61-66. 4. Applied Kinesiology Synopsis: David S. Walther. 1988. Your Partners In Health, Richard A. Laviano, DC, ND, FSBCT(c) and Ana Dávila, DC Falls Chiropractic and Injury, Raleigh NC Frances T Meredith, MD Carolina Total Wellness |
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Leaky Gut
Susan Denny, MD, MPH
Do You Have Leaky Gut?
If you suffer from a chronic health condition and have been researching how to improve your health, you may have heard of leaky gut. If that conjures up an unpleasant image of gut materials leaking in to your bloodstream, you are not far off. Leaky gut happens when contents from the small intestine spill into the sterile bloodstream from a damaged or “leaky” gut wall. This contamination of the bloodstream by digested foods as well as bacteria, yeast, and other pathogens is often the foundation for chronic inflammatory and autoimmune health disorders.
Leaky gut is referred to as increased intestinal permeability in scientific research and is increasingly being recognized as a common underlying factor in most inflammatory symptoms and disorders. As our body’s largest immune organ, the gut powerfully influences the rest of the body. Importantly, this includes the brain. Current scientific studies link intestinal permeability with inflammatory bowel disorders, gluten sensitivity, celiac disease, Crohn’s disease, type 1 diabetes, depression, anxiety, psoriasis, and many other chronic conditions.
Given what we know about the connection between gut health and immunity, it is vital to include a gut repair protocol in the treatment of inflammatory and autoimmune disorders. Repair of leaky gut begins with understanding why it developed in the first place. Reasons for leaky gut can include over the counter or prescription medications, antibiotic use, toxin exposure, hormonal changes, food intolerances, poor diet and others. After root causes are identified, a leaky gut protocol can help you improve your health, relieve symptoms, boost energy, make you happier, and clear your brain fog. Ask our office for advice on improving your overall health through a personalized leaky gut evaluation and treatment plan.
Your Partner in Health!
Susan Denny, MD, MPH
Long COVID
Susan D. Denny, MD, MPH
Over the past year I have seen an increasing number of patients with symptoms of post-acute sequelae of Covid 19 (PASC), also known as long Covid.
What is long Covid? As defined by the CDC, long Covid is a range of new, returning or ongoing health problems people can experience four or more weeks following SARS-COV-2 (Covid 19) infection. Symptoms can vary significantly by person and can include fatigue, brain fog, memory loss, anxiety, disturbed sleep, joint pain, gastrointestinal symptoms, loss of taste or smell or shortness of breath. Most of the patients I have seen with long Covid suffer from fatigue and brain fog and many have other accompanying symptoms.
In a recent systematic review of 57 studies comprising more than 250,000 survivors of Covid 19, most symptoms included mental health, pulmonary and neurologic disorders which were present 6 months after SARS-Cov-2 exposure. 1
How many people are suffering from long Covid? Clinical trials have shown anywhere from 31% to 69% of people who have had Covid infection will suffer from long Covid. This is a present and emerging health care crisis with tens of millions of Americans currently suffering and millions more at risk of developing this syndrome. Chances are that you or someone you know has long Covid.
How long does long Covid last? This appears to vary significantly by person. Some clinical trials have shown average length to be about 3 months while others have shown that symptoms may last more than a year. An emerging consensus is that most people have symptoms for 6 months or more.
Who gets long Covid? While some clinical trials show a relationship to acute disease severity, others have shown a significant risk for long Covid even in mild or asymptomatic cases. In other words, it is possible to develop long Covid even if you had no symptoms of acute Covid infection.
A study just published in Cell on January 24, 2001 followed 200 patients over two to three months following their COVID-19 diagnoses. The researchers determined four biological factors that they say are associated with whether a person will develop long COVID.
The first factor is the level of viral RNA in the blood at diagnosis. The second is the presence of autoantibodies—those that attack the patient’s own body. Third is the reactivation of the Epstein-Barr virus, a common virus that most people are infected with and recover from early in life. The last is Type 2 diabetes. Interestingly, the most predictive factor for long Covid was the presence of autoantibodies in the blood. 2
Several other studies have found significant autoantibody levels in patients with long Covid. In one study just published this month, researchers found signals of autoantibody activity that are usually linked to chronic inflammation and injury involving specific organ systems and tissues such as the joints, skin and nervous system in patients with long Covid. 3 We know that certain viruses can trigger the body’s immune system to begin attacking itself through a process called molecular mimicry. That appears to be a significant source of cellular damage and inflammation in patients who develop long Covid.
Another study published in Gut examined changes in the gut microbiome in patients with long Covid. They found that an altered gut microbiome composition is strongly associated with persistent symptoms in patients with COVID-19 up to 6 months after clearance of SARS-CoV-2 virus. 4
Can long Covid be treated? Yes. While conventional medicine has yet to find a medication to treat long Covid, a functional medicine approach to this illness works well. Addressing the root cause(s) of ongoing inflammation in the body from the viral over stimulation of the immune system is a top priority. Evaluation and treatment of increased intestinal permeability (leaky gut), gut dysbiosis and a disrupted adrenal axis works well to help rebalance the immune system, calm inflammation and improve symptoms.
If you or someone you know is suffering from long Covid, please contact our office to make an appointment with one of our functional medicine providers.
In health,
Susan D. Denny, MD, MPH
References:
- JAMA Netw Open. 2021;4(10):e2128568. doi:10.1001/jamanetworkopen.2021.28568
- Su Y, et al. Cell. 2022;doi:10.1016/j.cell.2022.01.014.
- Liu Y, et al. J Transl Med. 2022;doi:10.1186/s12967-021-03184-8.
- Gut (2022). DOI: DOI: 10.1136/gutjnl-2021-325989
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