Alcat Test_Food Allergy and Chemical Sensitivity Tests
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Alcat Test_Food Allergy and Chemical Sensitivity Tests

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If you think you are allergic to any kind of food, then use our Food Allergy testing procedure to determine the food that is not for you. With a food allergy test, you don’t have to down something ...

If you think you are allergic to any kind of food, then use our Food Allergy testing procedure to determine the food that is not for you. With a food allergy test, you don’t have to down something that you can’t take also called Food intolerance! Food sensitivity can be dangerous. You won’t know it, but it might end up being your worst foe! for more details visit https://www.alcat.com/

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  • So those who think anxiety is good for us- not necessarily the case
  • Explain some side effects of SSRI
  • indoleamine 2,3-dioxygenase 1 (IDO1) upregulation resulted in the increased kynurenine/tryptophan ratio and decreased serotonin/tryptophan ratio in the bilateral hippocampus. Increased pain, depression, anhedonia. If using Tryptophan, treat inflammation first or in conjunction with y or could worsen symptoms
  • Like GABA solve by going backwards.
  • Studies inducing colitis type inflammation showed increase in anxiety
  • Decreased excitability of enteric neurons which probably signal brain through enteric nervous system
  • Example people with high glutamate and low gaba may benefit most from l-theanine

Alcat Test_Food Allergy and Chemical Sensitivity Tests Presentation Transcript

  • 1. Anxiety and Your Patient A holistic, integrative approach for the general practitioner- Copyright 9/11/2012
  • 2. Epidemiology  Journal Clinical Psychiatry- most common psych disorder  15.7 million in the US  30% seek treatment  Present to general practitioners more than psychiatrist Copyright 9/11/2012
  • 3. What is Anxiety  Persistent fear response without identifiable specific trigger or  Prolonged response  Starts fight or flight response  Anxiety increases risk of inflammatory diseases  More prone to mistakes, less productive Copyright 9/11/2012
  • 4. Genetic?  Studies show may be genetic susceptibility with variants of retinoid- related orphan receptor alpha (RORA) gene to PTSD  Gene primary function to protect brain from stress  Gene Variant of BDNF gene Met66Met- smaller hippocampus on imaging and higher response amygdala to emotional stimuli with Copyright 9/11/2012
  • 5. Mediators- B.I.G  Brain (neuroendocrine)  Immune System- surveillance,  Gut  Vagus nerve 2 way communication system between brain and gut  All interact to form super information highway Copyright 9/11/2012
  • 6. Brain-Theories and Substances  Trigger  Arrives amygdala  To Locus Cereleus  Activation of sympathetic system  Prefrontal lobe  Response Copyright 9/11/2012
  • 7. Brain Connection- Pathway  r Trigger Amygdala Locus Cereleus NE CRH ACTH Adrenal Stimulation Copyright 9/11/2012
  • 8. Theories and Substance  Amygdala stores fear memories  Used Pavlovian conditioned and unconditioned stimulus  Substances affect amygdala can escalate or ameliorate anxiety Copyright 9/11/2012
  • 9. Brain Connection  Locus Cereleus primary NE center in brain  LC can be affected by other NT  LC connects to all parts of brain including hypothalamus  NE play role in HTN, behavioral changes and modulates HPA axis  Increased cytokines increase NE in hypothalamus via LC neurons Copyright 9/11/2012
  • 10. Brain Connection  Several factors seem to play a role here  NT such as GABA, Serotonin and Norepinephrine and glutamate have been assigned significant roles  The HPA with CRF axis gets activated as well  Cytokines can form de novo in the brain and trigger responses Copyright 9/11/2012
  • 11. Brain Connection  The major neurotransmitters implicated in the anxiety response  GABA  NE  Serotonin  Glutamate Copyright 9/11/2012
  • 12. Brain Connection  Serotonin is known as inhibitory NT  Derived from trytophan  Majority found in gut (90%)  Rest brain and platelets  Foods that irritate gut can caused excess release of serotonin leading to diarrhea (goal is to expel substance causing issue) Copyright 9/11/2012
  • 13. Copyright 9/11/2012
  • 14. Brain Connection  Serotonin depletion in prefrontal cortex leads to anxiety symptoms  Serotonin has 7 subtype receptors  5HT1a- related to anxiety  5HT3 in the chemoreceptor center brain can be stimulated by excess serotonin and cause nausea and vomiting Copyright 9/11/2012
  • 15. Brain Connection  GABA major inhibitory in the brain  Also found in Gut  Regulation of GABA system in amygdala important part of anxiety pathology  Pathway conversion excitatory Glutamate to GABA via enzyme glutamate decarboxylase Copyright 9/11/2012
  • 16. Copyright 9/11/2012
  • 17. Brain Connection- GABA  3 types GABA receptors- A, B. C  Deficiency in GABA receptors (A)- led to hyper activation of HPA axis  GABA-A (fast)– binding increase cl conductance so hyperpolarize post synaptic neurons to decrease excitation  GABA-B- inhibit Ca channels to reduce NT release, and K channels to decrease excitability Copyright 9/11/2012
  • 18. Glutamate  Excitatory NT (most abundant)  Several studies indicate that modulating glutamate receptors can improve anxiety  Mechanism not fully elucidated  Glial cells responsible removal of glutamate  Dysfunction or reduction leads to glutamate toxicity Copyright 9/11/2012
  • 19. Glutamate  Thought to be mediated through NDMA receptor  Needs glutamate, glycine and voltage for activation and opening channels  Open- Calcium influx  Excess calcium- neuronal injury  Fine line because activation NDMA needed for memory and learning Copyright 9/11/2012
  • 20. Norepinephrine  Increases symptoms of anxiety  When administered symptoms of anxiety- HR, diaphoresis, etc.  Controversy if NE from LC causative Copyright 9/11/2012
  • 21. Brain Connection- Other substances  CCK 4- provokes anxiety  BDNF- responsible for health, growth and plasticity of nerves (adaptability)  BNDF protects neurons from glutamate toxicity  Oxytocin- role in social phobias Copyright 9/11/2012
  • 22. Brain Connection- BDNF  Human study showed depressed individuals with lower BDNF  Those with lowest BDNF levels did not respond as well to anti-depressant treatment  Several studies show BDNF facilitates function of anti-depressant esp. SSRI Copyright 9/11/2012
  • 23. Immune Connection  The immune system is thought to be trigger  Chronic GI inflammation increases inflammatory cytokines and anxiety behavior  Immune system and neuroendocrine share many receptor sites and ligands  Cytokines (produced by immune system and also by brain) can regulate stress response in brain as well as endocrine system and behavior Copyright 9/11/2012
  • 24. Immune connection  Immune system when triggered produce cytokines  Ex. IL-6, IL-1, IL-2, IFN-gamma, TNF,  Peripheral cytokines can cross BBB  Stimulate HPA axis as well as cause brain (glial Cells) to produce de novo cytokines  Excess IL-6 act on neurons increase anxiety and cognitive deficits Copyright 9/11/2012
  • 25. Immune Connection  Cytokine can activate HPA axis  Increase CRH  CRH sensitize cells and facilitate effect of cytokines like TNF  TNF alpha injected in amygdala facilitated ETOH withdrawal anxiety  Inhibitor of CRH receptor decreased magnitude of anxiety response Copyright 9/11/2012
  • 26. Immune Connection  Interferon gamma stimulates enzyme indoleamine2,3 dioxygenase (IDO). This degrades Tryptophan (responsible for serotonin formation) to other inflammatory substances such as Kynurenine  17 B-estradiol could increases INF gamma thereby potentially increasing inflammation Copyright 9/11/2012
  • 27. Immune Connection  Aging increases Cytokines such as INF gamma, TNF alpha  Dysregulates HPA feedback mechanism thereby increasing cortisol levels  Cortisol affects metabolism of tryptophan towards inflammatory along with direct effect hippocampus  Theorized one of reasons elderly more prone to depression/anxietyCopyright 9/11/2012
  • 28. Immune Connection  Studies show that TCA like imipramine and SSRI have anti-inflammatory effect  Decreases levels of IL-2, IL-1, TNF, IL- 6, INF gamma  These substances have immediate effect on NE and Serotonin but takes longer for clinical benefits (about time that it takes to have effect on cytokines Copyright 9/11/2012
  • 29. Gut Connection  Gut has over 100 million neurons  90% visceral neurons have connection with brain  95% all serotonin found in gut Copyright 9/11/2012
  • 30. Gut Connection  Studies showed that changing bacterial flora in mice changed behavior  Colonized germ free mice with gut flora from active or passive mice would change behavior accordingly  Mice treated with antibiotics- anxiety reduction.  Stopped antibiotics flora and anxiety returned to baseline Copyright 9/11/2012
  • 31. Gut Connection  Changes seem to be associated with change in BDNF (linked to anxiety and depression)  Stressor exposure changed bacterial flora in gut (decrease genus Bacteroides and increase Clostridium)  Stressor also increased inflammatory cytokines (IL-6, MCP-1) further affected other bacterial flora  IL-6 inflammatory cytokine Copyright 9/11/2012
  • 32. Gut Connection  Evidence that Lactobacillus Rhamnosus augments GABA function in brain via vagus nerve from gut (results lost with vagotomy)  Also lowered corticosterone levels Copyright 9/11/2012
  • 33. Gut Connection  Infectious colitis induces anxiety Bifidobacterium longum NCC3001 improved anxiety (results lost with vagotomy)  Bifidobacterium longum normalized behavior and BDNF mRNA but did not affect cytokine or kynurenine levels  Enbrel- decreased cytokines and improved anxiety but did not affect BDNF Copyright 9/11/2012
  • 34. Gut Connection  Since inflammation can directly affect flora of gut and flora can affect behavior  Could anything such as food sensitivities cause inflammation in gut and thereby exacerbate anxiety symptoms  Personal food sensitivity such as ALCAT may be an important adjunct as testing looks at immune response Copyright 9/11/2012
  • 35. Gut Connection  Study showed stress contributed to development of food allergies by increasing gut permeability therefore increased uptake of food antigen  Bacteria like H. Pylori has been shown to do the same in gastric mucosa, also increasing food sensitivity  Activation of immune system and cytokines Copyright 9/11/2012
  • 36. Gut Connection  Food sensitivities trigger gut permeability  Part treatment remove triggers  Heal gut  Bifidobacterium Animalis Lactis LKM 512 found to help to keep tight junction gut and decrease permeability  Decreased inflammation in elderly  Seems to suppress inflammatory bacteria Copyright 9/11/2012
  • 37. What to do?  When and if possible identify trigger  Gut symptoms- know can be variety of things from food sensitivity, to infectious or inflammatory trigger such as IBD to emotional stress (remember changes flora)  ALCAT may be helpful  Remove and or treat trigger  Consider probiotics with neuromodulatory effect Copyright 9/11/2012
  • 38. What to do  Consider other substances to decrease inflammatory cytokines while treatment is on going (curcumin, fish oil, and resveratrol, andrographis)- ?medical food  Tea Tree Oil (inhalation)- decreases TNF alpha, IL 1  If over weight start weight loss  Remember Adipocytes can generate cytokines as well Copyright 9/11/2012
  • 39. What to do  German Chamomille- inhibited release lipopolysaccharide which induce macrophage prostaglandin E2 (LOX-2 inhibitor  Maybe possess some anti-microbial properties (gut dysbiosis)  Contains Apigenin flavonoid- study show mild sedative via inhibition NDMA-R Copyright 9/11/2012
  • 40. What to do  I have found neurotransmitter testing helpful  Even though no info on receptors, etc. I find it helps me to chose supplements or meds  Check for easy nutrient deficiencies B12, folate, red blood cell magnesium (easier than loading test)  Check cortisol/ACTH levels - helps in choosing tx Copyright 9/11/2012
  • 41. What to do- herbal  Valerian- blocks glutamate receptor  Jujube (Ziziphysis Spinosa)- inhibits glutamate receptor to decrease excitability  Kava- shown to improve anxiety  Concern with liver issues due to quality of Kava, parts used and inappropriate dosage  Passion Flower extract – thought to have GABA agonist properties Copyright 9/11/2012
  • 42. What to do  Tryptophan- just remember that inflammation can turn a good AA bad  Studies do not support St. Johns Wort for anxiety  Magnesium- modulates NDMA-R slow influx calcium- protecting neurons  Vitamin B12 studies show protects neurons NDMA-R glutamate toxicity Copyright 9/11/2012
  • 43. What to do  L-Theanine- studies suggests works thru GABA- A receptors  Other studies show affect on serotonin and dopamine NT  Personally noted that if dopamine on NT test high, theanine may have slightly anxiogenic affect  Good news- neuroprotective by decreasing formation glutamine to glutamate Copyright 9/11/2012
  • 44. What to do- HPA Axis  Lavender Essential oil stimulates PNS to decrease excitability  Lemon Balm- inhibitor of GABA transaminase (enzyme clears GABA)  Address HPA axis  Stress management  Cognitive therapy (enhanced with D- cycloserine for specific phobias) Copyright 9/11/2012
  • 45. What to do-HPA  Magnolia officianlis (honokiol and magnolol)- decrease corticosterone, increase 5HT in hippocampus, antimicrobial, decrease TNF alpha Copyright 9/11/2012
  • 46. What to do  If menopausal consider there may be a hormonal component  Changes in hormones such as estrogen, progesterone and testosterone can contribute to anxiety symptoms  I could correct other issues first to optimize results Copyright 9/11/2012
  • 47. What to do- Hormones  Several studies suggest estradiol can be anxiolytic  Estrogen increases the mRNA for trytophan hydroxylase enzyme (rate limiting step in production of serotonin  Effects in dorsal raphe and seems to occur binding ER beta Copyright 9/11/2012
  • 48. What to do- hormones  Can increase proinflammatory cytokines  Avoid with autoimmunity  ? One study suggest this effect may be at least in part influenced by presence of hydroxylated estrogens (2,4,16) and cortisol  Personal approach r/o autoimmunity, correct inflammation if present before this step Copyright 9/11/2012
  • 49. What to do- Hormones  Progesterone- anxiolytic or anxiogenic  Several studies suggest that effect on GABA receptors  Conversion to allopregnanelone Copyright 9/11/2012
  • 50. What to do- Pharmacological  SSRI, 5HT1a-R agonist- decrease inflammation, increase serotonin (E.g. Lexapro, Buspar)  Also seem to modulate NDMA-R  Benzodiazepene- GABA  B-Blocker (Inderal)- performance anxiety (stage fright, exams, etc.)  Block sympathetic symptoms, also acutely decrease endorphin levels Copyright 9/11/2012
  • 51. Some Concerns  Prolonged use SSRI can lead to osteoporosis  Shown eventual decrease in serotonin levels below baseline with chronic use  Benzodiazepenes addictive potential  Long term effect of beta blocker- depression, memory loss etc. Copyright 9/11/2012
  • 52. What to Avoid  Spirulina- increases, TNF alpha  Echinaccea- can potentially increase IL-6, TNF alpha  ?? Honey- works by increasing TNF alpha, IL 6, IL 1  Remember cytokines can stimulate HPA axis as well as activate amygdala and LC =NE anxiety  Caffeine blocks its receptors adenosine that slows HR and calms- Copyright 9/11/2012
  • 53. THANK YOU For more details visit https://www.alcat.com Copyright 9/11/2012