Jul 9, 2015

Keeping Up With The Kalish's - How to be successful with a stressed out patient

by Dr. Dan Kalish

References to leaky gut and issues with the human microbiome have become so popular now it's quite stunning to see. Obvious sources of these problems all the antibiotics in our food supply and poor quality diets that promote inflammation are often discussed. There are a few aspects of this don't get that much attention which is the specific mechanisms by which damage to the gut lining impact immune responses and the role of stress hormone induced delving into catabolic physiology and how that plays a role.

First, SIgA, secretory immunoglobulin A, our first line of mucosal immunity protects us from invading pathogens and should, ideally, line all of our mucosal tissues, GI tract, sinus passages, respiratory tract and so on. When we get stressed enough, cortisol levels shift and cortisol's role in regulating the production of SIgA falters, leaving us with compromised mucosal immunity.

Now what happens is pretty interesting. We develop a break down of our mucosal immunity but how that impacts a given person varies. Some people end up with chronic sinus infections. Some have reoccurring bladder infections, or frequent colds and flus. And many, in my guess the silent majority, end up with chronic GI infections. In other words, when SIgA levels drop they drop universally in all the mucosal membrane tissues and we each in turn have different variations on the impact of this.

Clinically the presentations vary, "I have chronic sinus infections", "I have heartburn", I have bladder or yeast infections", I have constipation... On and on the many manifestations of this one problem ricochet around mimicking many problems. I've had consistently successful results addressing cortisol head on as part of the underlying strategy to reverse these chronic problems.

Also, this basic explanation is extremely helpful when we are confronted with so many variations on the theme. So that your next patients with sinus infections, bladder infections, vaginal yeast infections or GI problems can all benefit from the following explanation.

"I understand you have these chronic ________ infections. In my experience this has it's original in a weakening of your immune response in the mucosal or lining tissues of your body. And this lining tissue is all connected and shares in common this immune factor called SIgA. SIgA is under the control of cortisol so that when you are stressed and cortisol is impacted your SIgA levels drops and you'll be prone to picking up a ______________ infection. (Now here's the clinical punch line). If we can test and correct your cortisol I think we can stop this cycle of infection once and for all."

Now for the leaky gut part of all this.

When we are stressed and in our abnormal state we go into catabolic physiology meaning we start breaking tissue down. Classically we think of this as breaking down muscle tissue and losing lean body mass as a result of stress (unsightly and unhealthy too) but another tissue the body reaches for to break down is the GUT LINING. We break down the GUT LINING when we are stressed to liberate all the amino acids just sitting there and we burn them up for fuel through gluconeogenesis.

So the more stressed we become the more catabolic we become and the more gut lining we break apart. Eventually it gets bad enough to be "leaky gut". So one can have a leaky gut solely from mental and emotional stress you don't even have to have a parasite or take a round of antibiotics to get things started.

The converse is true as well, you can't heal a patients leaky gut with anti-parasitic herbs or special diets if they remain in a constant state of stress and in my experience most all of my patients are locked in a death grip with stress, losing the battle terribly. So.... one of the most important if not the most important ways to be successful with patients is to break folks out of that chronic stress cycle. In addition to lab work ups and diet and exercise I think the real behind the scenes make it or break it part of all treatment programs is our ability as healers to snap people out of the whirlwind of negative thoughts and sickness type behaviors that permeate our culture.

I meditate on average 2 to 3 hours a day. This allows me to de-stress and then when I'm with patients I can convey or transfer that "de-stressed" physiology to them simply by being present with them in a de-stressed state. I can model what it's like to not be stressed for them. I can explain this in words or not, it really doesn't matter, they "get it" instantly. They start breathing deeper, they start to have hope, they start to believe I can help them and we are off and running with a functional medicine based program to address their health concerns. Just like a parent models for a child or a duck imprints on a mommy duck I believe our main role is to "Be Present" Be Destressed" and model that for our patients. I believe at it's finest functional medicine, like all healing for all of human time, provides the physical health required to build a platform for the emotional and spiritual healing experiences we are all on this planet for.

-Dr. Dan

Dr. Dan Kalish

Founder of the Kalish Institute

Dan Kalish, DC, IFMCP, is founder of the Kalish Institute, an online practice implementation training program dedicated to building Integrative and Functional Medicine practices through clinical and business courses.