Assomade - Relazione Dott. Ongaro


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Slide del Dott. Ongaro al convegno Assomade tenuto il 27 novembre 2010 presso l'Istituto Alberghiero "Alberini" di Treviso

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  • Mol Syst Biol. 2007;3:124. Epub 2007 Jul 10. Links
    Human disease classification in the postgenomic era: a complex systems approach to human pathobiology.
    Loscalzo J, Kohane I, Barabasi AL.
    Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
    Contemporary classification of human disease derives from observational correlation between pathological analysis and clinical syndromes. Characterizing disease in this way established a nosology that has served clinicians well to the current time, and depends on observational skills and simple laboratory tools to define the syndromic phenotype. Yet, this time-honored diagnostic strategy has significant shortcomings that reflect both a lack of sensitivity in identifying preclinical disease, and a lack of specificity in defining disease unequivocally. In this paper, we focus on the latter limitation, viewing it as a reflection both of the different clinical presentations of many diseases (variable phenotypic expression), and of the excessive reliance on Cartesian reductionism in establishing diagnoses. The purpose of this perspective is to provide a logical basis for a new approach to classifying human disease that uses conventional reductionism and incorporates the non-reductionist approach of systems biomedicine.
  • Assomade - Relazione Dott. Ongaro

    1. 1. FUNCTIONAL MEDICINE AN INTRODUCTION Dr. Filippo Ongaro, MD Board Certified Anti-Aging & Regenerative Medicine (ABAARM) Diplomate Functional Medicine (AFMCP) Certified International School Gynecological Endocrinology (ISGE) Medical Director ISMERIAN-Institute for Regenerative and Anti-Aging Medicine Treviso, Italy
    2. 2. 3 conditions, 3 specialities but 1 common pathophysiology Rheumatoid arthritis rheumatology Psoriasis dermatology Multiple sclerosis neurology
    3. 3. inflammation
    4. 4. Hypercholes- terolemia Statin Gastroesophageal Reflux Disease H2 blocker Depression SSRI Hypertension ACE inhibitor Migraines Triptan Osteoarthritis NSAID Irritable Bowel Syndrome Dicyclomine …the result is a focus on treating each symptom complex as a separate and distinct “disease” with a separate and distinct treatment.
    5. 5. It is apparent that – in its rush to diagnose – conventional medicine is focused on the branches and leaves of the tree… Cardiology Pulmonary Endocrinology Gastroenterology Neurology Organ System Diagnosis Urology/Nephrology Hepatology Allergy Signs and Symptoms Diet, Nutrients, Air/Water Psycho-social Environmental Inputs Physical Exercise Trauma Xenobiotics Micro-organisms &Radiation and not the trunk and roots. Mind and Spirit Genetic Predisposition Experiences, Attitudes, Beliefs
    6. 6. Cardiology Pulmonary Endocrinology Gastroenterology Neurology Organ System Diagnosis Urology/Nephrology Hepatology Allergy Signs and Symptoms Diet, Nutrients, Air/Water Psycho-social Environmental Inputs Physical Exercise Trauma Xenobiotics Micro-organisms &Radiation Fundamental Clinical Imbalances Hormonal and Neurotransmitter Imbalances Redox Imbalance + Oxidative Stress + Mitochondropathy Detox/Biotransformation/Excretory Imbalance Immune Imbalance Inflammatory Imbalance Digestive/Absorptive and Microbiological Imbalance Structural Integrity Imbalance 1. Communication - Outside the cell - Inside the cell 2. Bioenergetics/Energy Transformation 3. Replication/Repair/Maintenance/ Structural Integrity 4. Elimination of Waste 5. Protection/Defense 6. Transport/Circulation Fundamental Physiological Processes Mind and Spirit Genetic Predisposition Experiences, Attitudes, Beliefs
    7. 7. Functional Medicine and GI Health Gut flora, Gut Barrier and inflammatory process
    8. 8. What is “Leaky Gut”? Leaky gut is a form of gut dysfunction which refers to abnormal Intestinal or bowel hyper-permeability which occurs when the intestinal barrier is broken down. 5353
    9. 9. Major Role of the Gastrointestinal Tract is To act as a barrier to finely regulate the trafficking of macromolecules between the external (food/microbes) and internal environment (systemic, cells, tissues, etc) When this complex barrier is broken, foreign macromolecules can enter, interact with the immune system, and result in an inflammatory response which can lead to a multitude of local intestinal and systemic extraintestinal diseases Fasano and Shea-Donohue, NATURE CLINICAL PRACTICE GASTROENTEROLOGY & HEPATOLOGY SEPTEMBER 2005 VOL 2 NO 9 2005 54
    10. 10. Why is “Leaky Gut” a Concern? Leaky gut is associated with numerous acute and chronic diseases:  Systemic inflammatory response syndrome (SIRS)  Inflammatory bowel disease  Type-1 diabetes  Allergies  Skin diseases  Asthma  Arthritis  Liver disease  Autism  more recently, obesity and metabolic syndrome 5555
    11. 11. Cytoskeletal changes disrupt the TIGHT JUNCTIONS between the epithelial cells leading to intestinal hyper- permeability.. What Causes Leaky Gut ? 5656
    12. 12. GI-Liver-Inflammation Connection Toxins ImmuneImmune ActivationActivation GI inflammation and leaky gut initiate a cascadeGI inflammation and leaky gut initiate a cascade of signaling events that can increase inflammationof signaling events that can increase inflammation.. Scharz B, et al. Intestinal ischemic reperfusion syndrome: pathophysiology, clinical significance, therapy: Wien Klin Wochenschr1999;111(14):539-48. Systemic Inflammation Antigens Localized Inflammation Digestion & BarrierDigestion & Barrier Integrity ProblemsIntegrity Problems Liver Stress/Liver Stress/ Kupffer CellKupffer Cell ActivationActivation
    13. 13. PGE2 LTB4 Free radicals Nitric oxide Kupffer Cells Increase Inflammation By Up-regulation of Immune Activity Activated Liver Kupffer Cell Cytokines: IL-1 IL-6 IL:-18 IFN-gamma TNF-alpha Mast Cell Macrophage Brain Blatties CM, Li S, Perlik V, Feleder C. Signaling the brain in systemic inflammation:the role of complement. Front Biosci 2004;9:915-31.
    14. 14. Altern Med Rev. 2004 Sep;9(3):297-307. Medical nutrition therapy as a potential complementary treatment for psoriasis--five case reports. Brown AC, Hairfield M, Richards DG, McMillin DL, Mein EA, Nelson CD. Abstract This research evaluated five case studies of patients with psoriasis following a dietary regimen. There is no cure for psoriasis and the multiple treatments currently available only attempt to reduce the severity of symptoms. Treatments range from topical applications, systemic therapies, and phototherapy; while some are effective, many are associated with significant adverse effects. There is a need for effective, affordable therapies with fewer side effects that address the causes of the disorder. Evaluation consisted of a study group of five patients diagnosed with chronic plaque psoriasis (two men and three women, average age 52 years; range 40-68 years) attending a 10-day, live-in program during which a physician assessed psoriasis symptoms and bowel permeability. Subjects were then instructed on continuing the therapy protocol at home for six months. The dietary protocol, based on Edgar Cayce readings, included a diet of fresh fruits and vegetables, small amounts of protein from fish and fowl, fiber supplements, olive oil, and avoidance of red meat, processed foods, and refined carbohydrates. Saffron tea and slippery elm bark water were consumed daily. The five psoriasis cases, ranging from mild to severe at the study onset, improved on all measured outcomes over a six-month period when measured by the Psoriasis Area and Severity Index (PASI) (average pre- and post-test scores were 18.2 and 8.7, respectively), the Psoriasis Severity Scale (PSS) (average pre- and post-test scores were 14.6 and 5.4, respectively), and the lactulose/mannitol test of intestinal permeability (average pre- and post- test scores were 0.066 to 0.026, respectively). These results suggest a dietary regimen based on Edgar Cayce's readings may be an effective medical nutrition therapy for the complementary treatment of psoriasis; however, further research is warranted to confirm these results.
    15. 15. J Dermatol Sci. 1991 Jul;2(4):324-6. Intestinal permeability in patients with psoriasis. Humbert P, Bidet A, Treffel P, Drobacheff C, Agache P. Abstract A possible relationship between intestinal structure and function in the pathogenesis of psoriasis has recently brought about considerable interest. The purpose of this study was to evaluate the intestinal permeability in psoriatic patients by comparing it with healthy controls. 15 psoriatic patients and 15 healthy volunteers entered the study. Intestinal permeability was evaluated using the 51Cr-labeled EDTA absorption test. The 24-h urine excretion of 51Cr-EDTA from psoriatic patients was 2.46 +/- 0.81%. These results differed significantly from controls (1.95 +/- 0.36%; P less than 0.05). The difference in intestinal permeability between psoriatic patients and controls could be due to alterations in the small intestinal epithelium of psoriatics.
    16. 16. Q J Med. 1985 Sep;56(221):559-67. Small intestinal permeability in dermatological disease. Hamilton I, Fairris GM, Rothwell J, Cunliffe WJ, Dixon MF, Axon AT. Abstract Passive small intestinal permeability was investigated in 62 patients with atopic eczema, 29 with psoriasis and 18 with dermatitis herpetiformis, using the cellobiose/mannitol differential sugar absorption test. Urinary recovery of cellobiose and mannitol in patients with both psoriasis and eczema were similar to values in a control population, and were not affected by the extent or activity of skin disease. The cellobiose/mannitol recovery ratio was abnormally high in seven patients with eczema, six of whom underwent jejunal biopsy. Jejunal mucosal morphology was normal in five, and one patient was found to have coeliac disease. Cellobiose/mannitol recovery ratio was also abnormal in seven patients with psoriasis, and in 11 with dermatitis herpetiformis, seven of whom had a normal jejunal biopsy. These findings demonstrate that the passive permeability of the small intestine is normal in the majority of patients with atopic eczema and psoriasis. Increased absorption of macromolecules from the gut lumen cannot be ascribed to defective intestinal integrity, and is unlikely to be relevant to the pathogenesis of eczema. Abnormal intestinal permeability may be a more sensitive manifestation of gluten-sensitive enteropathy than jejunal biopsy in dermatitis herpetiformis.
    17. 17. J Pediatr. 2004 Nov;145(5):612-6. Effect of probiotics on gastrointestinal symptoms and small intestinal permeability in children with atopic dermatitis. Rosenfeldt V, Benfeldt E, Valerius NH, Paerregaard A, Michaelsen KF. Abstract OBJECTIVE: To determine whether probiotic lactobacilli may alleviate small intestinal inflammation and strengthen the intestinal barrier function in children with atopic dermatitis. STUDY DESIGN: In a double-blinded, placebo-controlled, cross-over study, probiotic lactobacilli (Lactobacillus rhamnosus 19070-2 and L reuteri DSM 12246) were administered for 6 weeks to 41 children with moderate and severe atopic dermatitis. Gastrointestinal symptoms were registered before and during treatment and small intestinal permeability was measured by the lactulose-mannitol test. RESULTS: During Lactobacillus supplementation, there was a significant decrease in the frequency of gastrointestinal symptoms (39% during the placebo period versus 10% during active treatment, P=.002). There was a positive association between the lactulose to mannitol ratio and the severity of the eczema (r=0.61, P=.02 after placebo and r=0.53, P=.05 after active treatment). After probiotic treatment, the lactulose to mannitol ratio was lower (0.073) than after placebo (0.110, P=.001). CONCLUSIONS: Impairment of the intestinal mucosal barrier appears to be involved in the pathogenesis of atopic dermatitis. The study suggests that probiotic supplementation may stabilize the intestinal barrier function and decrease gastrointestinal symptoms in children with atopic dermatitis.
    18. 18. How can we help? 7373
    19. 19. Identify the Initiator • Poor diet • Medications • Infections • Toxins (metals, molds) • Inadequate digestive enzymes, hypochlorhydria, and altered pH • Imbalanced ecology • Impaired intestinal permeability • Altered neuroendocrine balance and autonomic function 7474
    20. 20. The 4R Program for Gastrointestinal Restoration Remove (the initiator) – Pathogens – Antigens – Toxins Replace (restore proper digestion) – Stomach acid if necessary – Pancreatic Enzymes if necessary Reinoculate (change the gut ecology) – Prebiotics – Probiotics Repair (provide proper nutrition to heal gut tissue) – Support of mucosal repair (gut nutrition) 7777
    21. 21. Nutrients that InfluenceNutrients that Influence GUT FunctionGUT Function • Fermentable fibers (e.g., fruits, vegetables, inulin)Fermentable fibers (e.g., fruits, vegetables, inulin) • Low allergy protein sourcesLow allergy protein sources • Specific amino acids (e.g., glutamine)Specific amino acids (e.g., glutamine) • Specific fractions of ColostrumSpecific fractions of Colostrum • Plantain extractPlantain extract • EPA (Fish Oils)EPA (Fish Oils) • Aloe vera concentrateAloe vera concentrate • CurcuminCurcumin • Rosemary fractionsRosemary fractions • Hop-derived iso-alpha and reduced iso-alpha acidsHop-derived iso-alpha and reduced iso-alpha acids Hla T. Dietary factors and immunological consequences.Hla T. Dietary factors and immunological consequences. Science. 2005;309:1682-1683Science. 2005;309:1682-1683.. 7979
    22. 22. Verein für Laktoseintoleranz / Die Zeit) 31 August 2008 (last version) IS MILK GOOD FOR YOU?
    23. 23. Most common food intolerances/Allergies • Milk and derivates • Gluten • Eggs • Products with yeast (wine, vinegar, breads) • Corn • Peanuts • Tomatoes, eggplants, peppers, potatoes) • Citrus fruit (oranges, grapefruits,etc) • Soy
    24. 24. Arch Dis Child. 1982 October; 57(10): 742–747. Food intolerance and food allergy in children: a review of 68 cases. A M Minford, A MacDonald, and J M Littlewood Abstract The clinical and laboratory features of 68 children with food intolerance or food allergy are reviewed. Young children were affected the most with 79% first experiencing symptoms before age 1 year. Forty-eight (70%) children presented with gastrointestinal symptoms (vomiting, diarrhoea, colic, abdominal pain, failure to thrive), 16 (24%) children with skin manifestations (eczema, urticaria, angioneurotic oedema, other rashes), and 4 (6%) children with wheeze. Twenty-one children had failed to thrive before diagnosis. A single food (most commonly cows' milk) was concerned in 28 (41%) cases. Forty (59%) children had multiple food intolerance or allergy; eggs, cows' milk, and wheat were the most common. Diagnosis was based on observing the effect of food withdrawal and of subsequent rechallenge. In many children food withdrawal will mean the use of an elimination diet which requires careful supervision by a dietician. Laboratory investigations were often unhelpful in suggesting or confirming the diagnosis.
    25. 25. Elimination diet for 6-8 weeks • Vegetables and fruit • Legumes • Spices • Whole grain rice • Fish (wild) • Olive oil • Poultry
    26. 26. ConclusionConclusion Dysregulation of the GI system resulting in gut hyper-permeability (Leaky Gut) can have a profound and far reaching impact on health and disease. 8484