By Kathleen Finn
Andrea Nakayama, CNC, CNE, CHHC, is a functional nutritionist based in Portland, Oregon. In this interview with Kathleen Finn she discusses the immune health, inflammatory bowel disease (IBD) and the importance of a thriving microbiome.
Kathleen Finn: Can you talk about your philosophy of gut health and how it relates to autoimmune conditions such as IBD?
Andrea Nakayama: When working with those with autoimmune disorders such as IBD, we need to look at how the microbiota drives our entire health system. We now know that 70-80% of our immunity is located in the gut.
Simply put, you can’t look at immunity without looking at gut health, and you can’t look at gut health without considering other immune disorders.
I tell my nutritionists in training to back it up to the gut. We back it up in terms of how we address the condition. We always look at digestive function because it’s where food meets physiology, and we eat at least three times a day. Start with the gut and digestive function no matter the condition.
KF: What recommendations do you give to patients with IBD in terms of diet, exercise and lifestyle?
AN: As a functional nutritionist, using the functional medical model, I look at the entire complex of the individual. It’s important to note that there is no one size fits all protocol.
The first line of questioning is: What is happening for the individual?
In cases of IBD, or what I call downstream issues, something triggered this condition upstream such as an infection, dysbiosis, leaky gut, detoxification issues, food allergies or sensitivities, which then instigated the immune system to launch an attack on the cells in the intestines. The triggers might be microbes, yeast overgrowth, or parasites that are responsible for the launch of an immune attack on the mucosal lining.
Then consider the individual, look at the genetics, when did the patient feel good (age and stage of life), and what is the situation now? How do they feel? What are their signs and symptoms? And track what happened in their history. With this foundational knowledge, we can then address their condition in a more specific fashion.
KF: How do you approach IBD cases?
AN: You can’t apply generic principles to patients with IBD. You can start with corrective measures and from here, drill down to more individual-specific protocols. Corrective measures include what I like to call ‘clearing the muddy waters’, which means removing any obvious instigators like those mentioned below and lifestyle factors (lack of sleep, self sabotage, alcohol misuse, etc.) that might add to the insult. Then the specifics are based both on trial and error (what works for the individual) and lab findings.
First steps include removing high inflammatory agents such as gluten, sugar, and dairy, and start food sensitivity testing. I first rule out IgE antibodies and look at IgG and then would consider IgA later to assess the state of the mucosa and IgM when looking for any active virus or infection.
Then, I work to rebuild the microflora with probiotic-rich foods and probiotic supplements. You can then drill down further and get specific as you come to learn the true imbalance.
Start food-wise to repair the damaged tissues. That might include incorporating aloe and fresh, ground flax seeds into the diet. You can keep drilling and dig further and further with diet depending on the individual – you might end up suggesting the FODMAP diet or an AIP Paleo diet. Again, this is dependent on the signs and symptoms of the individual and what you are able to determine from that detective work.
Start here, and see if they improve. Then ask the questions: Who is the individual? Can they be compliant? I adapt to what they can do. Is it a newly diagnosed teenager or a decades-long sufferer? Match your protocol to the person’s physiology and social/cultural leanings.
Research is showing us that we can turn on or off the genome, which can affect the expression of autoimmune disorders. We have some control when it comes to our genetic expression as the gut biome and genome are inextricably linked. How the genes express themselves is contingent on the environment. Diet and lifestyle are external factors that can play a role in affecting our cellular function.
KF: In your practice, what role do probiotics play in restoring gut health in patients with IBD?
AN: Probiotics are a key part of the healing protocol since managing the microbiota has a direct correlation to health.
So we ask the question, What is the population of the gut? Many people live with a less diverse microbiota due to exposure to environmental pollutants (pesticides, herbicides, pollution) antibiotic overuse, depleted soils and sub-optimal diets.
Probiotics lend a helping hand to the microbiota by increasing both diversity and amount. In some instances it’s vital to get specific with species and strains of bacteria to help move toward a correction of the imbalance. Start with a multi-strain probiotic, and build up to a therapeutic dose. Switch up strains based on research for particular signs and symptoms – diarrhea, constipation, bloating, gas, etc.
KF: Can you talk about what you term as upstream factors and how they affect IBD patients?
AN: When looking at anyone with IBD, you might need to combat the destruction from antibiotic use that patients might have used to address ‘upstream’ factors such as candida, clostridia or parasites. While the infection itself was a tipping point for gut dysfunction, the antibiotics could also contribute to the problem.
Either factor and, most particularly, the combination of the two, could result in the tipping point where the immune system gets confused and begins to attack itself. Because we don’t want to rule out the important use of antibiotics or antifungals to address identified infections, we want to be sure to support the patient or client with the intake of beneficial flora during pharmacological intervention. It should be noted that probiotics are to be taken at different times of the day than antibiotics.
KF: Explain the role of inflammation in autoimmune conditions and how practitioners can counsel patients to positively affect these conditions.
AN: Additional triggers in autoimmunity can include dietary factors such as gluten, corn, cross-reactive agents (foods that the body recognizes as gluten or dairy because of their molecular make-up – also called molecular mimicry) or infection.
In IBD, the immune system attacks cells in the intestines, which are programmed to be elevated, attacking other cells throughout the body. The goal is to decrease their cells hyperactivity.
The part of the immune system activated in an autoimmune condition like IBD is the adaptive arm of the immune system. This is the part that is influenced by diet, lifestyle and environment and involves antibody production. Once the immune system has been trained to identify something as a foreigner, it has memory that enables it to identify that foreigner and seek it out to destroy it in the future. When an autoimmune condition is present, the cells identified as foreign are self.
Therefore, our job as practitioners is to help the patient or client understand how to keep the attack (i.e., inflammation levels) low so that cells are not attacked by an overactive immune system. WHY the immune cells are hyperactive is due to the diet, lifestyle and environmental factors particular to the individual.
With autoimmune conditions such as IBD, usually it’s not the only organ being attacked. There is often a poly-autoimmune situation – another underlying condition in the brain, pancreas, endocrine system or elsewhere that may not have manifested into a full-blown diagnosed disease state. The goal of autoimmune protocols is to lessen inflammation – this decreases risk for other organ system impairment or failure.
Functional nutritionist and educator Andrea Nakayama is leading thousands of clients, students, and practitioners in a global health revolution focused on reclaiming ownership over one’s own health. Through Replenish PDX she helps chronically ill people chart their path to health, and in her school for practitioners, Holistic Nutrition Lab, she teaches health professionals the science and art of a functional nutrition practice. Andrea is also a co-producer of the Hashimoto’s Institute and is the recipient of the 2015 Impact Award from the National Association of Nutrition Professionals. Find out more at holisticnutritionlab.com