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Table of Contents

About the Author ...... 3

Course Objectives ...... 6

Introduction ...... 8

Massage’s Role in Healthcare ...... 8

Massage and Mental Health ...... 9

Before You Get Started: Know Your Client’s Medical and Drug History...... 9

Unit One: Inflammation and Massage ...... 11

What is Inflammation? ...... 12

Types of Inflammation ...... 14

Antigens ...... 16

Cytokines, Inflammation, and Massage ...... 16

Inflammation and Free Radicals ...... 17

Impact of Inflammation and Massage on the Body ...... 18

The Cardiovascular System ...... 18

The Lymphatic System ...... 19

Lymph Drainage and Massage ...... 21

The Endocrine System ...... 22

The Nervous System ...... 23

The Integumentary System ...... 24

The Reproductive System ...... 24

The Respiratory System ...... 25

The Muscular System ...... 26

The Skeletal System ...... 26

The Urinary System ...... 27 2

The Digestive System ...... 27

Peristalsis and Massage ...... 27

Healing Inflammation ...... 28

Disruption of Healing ...... 28

Unit Two: Gut Microbiota ...... 29

Origin and Composition ...... 30

Function ...... 31

The Gut/Brain Connection...... 33

How and Why Gut Microbiota Become Imbalanced ...... 34

Leaky gut syndrome ...... 40

Gut Microbiota and Mental Health ...... 41

Appetite, Obesity, Gut Microbiota, and the Brain ...... 42

Massage and Gut Microbiota ...... 43

Unit Three: The Immune System ...... 44

The Innate Immune System ...... 44

The Adaptive Immune System ...... 46

Antibodies...... 47

The Five Immunoglobulin Isotopes ...... 48

Hypersensitivity Immune Reactions: The Four Types...... 49

Type One Hypersensitivity ...... 49

Type Two Hypersensitivity ...... 52

Type Three Hypersensitivity ...... 53

Type Four Hypersensitivity ...... 54

Autoimmunity ...... 54

Inflammation, Dysbiosis, and Autoimmune Disorders ...... 55 3

Stress & the Immune System ...... 57

Unit Four: Immunity, Gut Microbiota, and Diet ...... 59

Yeast ...... 59

Sugar and Artificial Sweeteners ...... 62

Vegetable Oil ...... 64

Fried and Fast Food ...... 64

Gluten and Refined Flour...... 64

Dairy ...... 65

Artificial Additives and Trans Fats ...... 66

Saturated Fats ...... 66

Conventional Grain-Fed and Processed Meats ...... 66

Soy ...... 67

Unfiltered Tap Water...... 67

Alcohol ...... 67

Healthy Alternatives ...... 68

Probiotics ...... 69

Probiotics, Gut Microbiota, and Immunity ...... 70

Probiotics and Inflammation ...... 70

Glossary of Terms ...... 70

About the Author 4

Tiffany Diaz has the passion and drive that would have made her a success in any profession she undertook.

In 1995, after serving her country in the United States Army, she attended the Utah College of Massage Therapy, in Salt Lake City, then returned to Fort Smith to launch her own massage therapy business. The venture thrived, expanding to three separate locations. However, after ten years, her business was threatened by her very success when the high volume of massages she was performing resulted in intense wrist and hand pain.

Demonstrating her determination to succeed, she searched for a solution to overcome this obstacle and discovered an alternative method that would allow her to continue her massage career. Without hesitation, she hopped on a plane and headed to Las Vegas to dip her toe in the world of Ashiatsu Barefoot massage. She immediately fell in love with this westernized version of the Asian style of deep tissue effleurage massage that incorporated her feet and toes, thus saving her hands. She returned to Las Vegas twice to continue her education and received her certification in the technique, becoming only the fifth person within Arkansas, and the first in Fort Smith, to attain the certification.

Tiffany continued to grow her business, utilizing the management skills she gained while obtaining a Bachelor’s Degree in Organizational Leadership. In 2011, a new chapter in the barefoot story was written when she became an instructor for Barefoot Masters and began sharing the technique with other therapists in Arkansas.

Teaching Ashiatsu became one of the most rewarding vocations she had ever experienced. She was so grateful to have found a way to share locally the knowledge that she had to travel so far to receive.

Tiffany taught the Ashiatsu Bar Basic course for five years and expanded her training to include Intro to Ashiatsu, Advanced Ashiatsu, Bamboossage, Fijian Barefoot Massage, and Pathophysiology in 2016. 5

While building a successful business, Tiffany returned to college and obtained an Associate of Applied Science nursing degree in 2014. She gained more experience working in the Emergency Room and cardiac stepdown unit. In 2017, Tiffany was awarded a Bachelor of Science in nursing degree and is currently working towards her master’s degree.

Tiffany’s pursuit of higher education is now leading her to expand her pathophysiology series to include online blocks tackling disease processes that are triggered by diet and inflammation.

The experience derived from twenty-one years in the field of massage therapy, combined with knowledge she attained via her continuing education and hands on nursing experiences, gives Tiffany a unique total understanding of the human body that is not found within either profession independently.

New methods in health care are beginning to center around individualized approaches to treatment. Tiffany’s experience in alternative holistic therapies of bodywork and the understanding of pathology triggers in relation to a person’s overall health are a key component in her perspective for total wellness.

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Course Objectives

Unit 1: Inflammation and Massage

 Students will learn the definition of inflammation, the common causes, how to differentiate between acute and chronic inflammation, and the types of immune cells involved in an inflammatory response.  Student should understand the physiological processes of an immune response, the effects of inflammation on all systems of the body, and ways massage therapy can be utilized to relieve symptoms.  Students will be able to define free radicals and oxidation, and understand their impact on inflammation.

Unit 2: Gut Microbiota

 Students will be able to define gut microbiota and explain how it is established.  Students will learn the gut brain connection and how massage can have positive effects on gut microbiota.  Students will understand the function of gut microbiota and the effects of unbalanced gut microbiota, including the links between gut microbiota, obesity, and inflammation, and factors that influence gut microbiota composition.

Unit 3: The Immune System

 Students will be able to define immunity and autoimmunity.  Students will learn the difference between innate and adaptive immunity, the four types of hypersensitive reactions, and the immune cells involved in the processes.  Students will understand the connections between the immune system, inflammation, stress, and gut microbiota, and how massage can support the immune system and provide relief for autoimmune clients.

Unit 4: Immunity, Gut Microbiota, and Diet 7

 Students will be able to define probiotic, probiosis, and prebiotic.  Students will learn how yeast, sugar, and other commonly consumed foods can cause damage to the body, as well as healthier alternatives.  Students will understand the connections between diet, inflammation, immunity, gut microbiota, and overall physical and mental health.

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Introduction

Massage’s Role in Healthcare

Medical intervention is curative in the cases of acute infections and injury, but only helps to manage chronic ailments. Long term medical care can become expensive and exhausting, often increasing the stress levels of the client. Many prescription drugs have undesirable side effects, especially with prolonged use. The downsides of traditional medical care have prompted many clients and health care professionals to turn to massage for help.

Massage therapy is supportive, not curative, care. For example, if you suffer from chest pains, you need a cardiologist, not a massage therapist. After diagnosis, massage therapy can be added to a regimen of supportive care. Massage helps improve circulation and breathing, which in turn helps the body heal and helps manage the condition to prevent future pain.

Massage can be used as supportive care in every field of medicine. Healthcare professionals recognize this; many hospitals and clinics have massage therapists on staff. An orthopedic surgeon may refer a client to massage for pain management or improvement in range of motion. Oncologists recognize the benefit of massage for clients suffering from lymphedema, depression, and other side effects of cancer treatments. As massage supports all vital body systems, it’s applications in healthcare are truly limitless.

The most important of these applications may be preventative healthcare. Massage therapy, when used in conjunction with proper diet, exercises, and other healthy lifestyle practices, will keep the body in optimal condition. Injury and disease, even chronic, may still occur, but the body will be much better equipped for it. The quality of life of clients who utilize massage and other preventative and supportive care is much better than that of clients with prolonged, unhealthy lifestyle habits.

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Massage and Mental Health

The link between mental and physical health is reflexive; when one is out of balance, the other will often follow. Patents with mental illnesses are often physically inactive, which can lead to a host of physical problems. Chronic pain and other physical conditions can be emotionally overwhelming, which can lead to clinical depression and other mental illnesses. Regardless of whether mental illness is primary or secondary, massage therapy can help.

Massage stimulates the production of the “feel good” hormones oxytocin and serotonin. Serotonin is a mood stabilizer; it also promotes restful sleep. This is especially important, as many people with mental illnesses suffer from insomnia. Oxytocin is sometimes referred to as the love hormone, as it’s responsible for that euphoric rush people associate with love. Oxytocin promotes relaxation, trust, and emotional stability. Increased production of these hormones is incredibly beneficial to clients suffering from mental illness.

Massage therapy not only promotes production of feel good hormones, but also suppresses the production of cortisol, a stress causing hormone. Massage also lowers heartrate and blood pressure, which further promotes relaxation.

Patents experiencing physical pain as a cause or effect of mental illness will also find relief with massage. Alleviation of physical pain will promote mental wellbeing.

Before You Get Started: Know Your Client’s Medical and Drug History

While massage can provide a number of health benefits, in some cases it may cause more harm than good. That’s why it is incredibly important to know your client’s medical and drug history. 10

Many clients with cancer may benefit from massage, but massage therapists should refrain from massaging near any tumors, ports, or recent surgical sites. Clients with cancers of the blood may require a lighter touch during massage.

Clients with chronic autoimmune disorders such as lupus or rheumatoid arthritis may find symptom relief with Swedish and light touch massages, but a deep tissue massage could trigger a debilitating flare of their condition. Other chronic issues such as osteoporosis and cardiovascular disease increase the risk of negative side effects during or after massage, especially if the therapist is unaware of the condition and uses potentially harmful techniques.

Clients on certain medications will also require special care during a massage. For example, a diabetic taking medication for neuropathy will be less likely to realize when a massage stroke is too deep, as their nerves are being suppressed by the medication. Chronic pain clients who take narcotics will have the same problem with determining pressure.

Always take a complete medical and drug history before you begin working on a new client. Obtain written permission from any physician treating the client for current illnesses or injuries. Familiarize yourself with the client’s condition and any techniques you should use or avoid while working on them. If the client is experiencing symptoms they haven’t sought medical treatment for, perform a physical evaluation and refer them to an appropriate healthcare professional.

Massage is contraindicated by several conditions, including:

 Pneumonia.  Advanced organ failure.  Hemophilia.  Fever.  Unstable High Blood Pressure.

There are other conditions in which massage may proceed, but localized areas should be avoided. These conditions include: 11

 Flare up of systemic inflammatory disease, such as lupus or rheumatoid arthritis.  Open wound.  Sepsis.  Frostbite.  Localized skin infections or rashes.

Treatment variations may be required for a wide variety of conditions. The massage therapist should modify techniques in cases of:

 Asthma.  Cancer.  Emphysema.  Immunosuppression.  Chronic digestive issues.  Hernia.  Pregnancy or recent childbirth.

Once massage has begun, check in with the client periodically during the massage to make sure they’re comfortable; if the client has a reflexive pain reaction, stop what you’re doing immediately and consult with the client before continuing.

With a full understanding of the client’s medical conditions and special needs, you can become a vital member of their health care team and provide them with relief they’re unable to find elsewhere.

Unit One: 12

Inflammation and Massage

What is Inflammation?

To understand inflammation’s effects on the body, we must first define it. A vital part of the body’s immune response, inflammation is the body’s attempt to heal itself after an injury, defend itself against foreign invaders, such as viruses and bacteria, and repair damaged tissue. Physical signs of inflammation are redness, swelling, warmth, and sometimes even pain and immobility. Inflammation is clinically denoted by the suffix “-itis.”

Beginning as irritation, inflammation is the body’s immediate healing process. Typically, irritation is followed by suppuration, or the discharge of pus. As the wound heals, masses of tissue, or scabs, form during the granulation stage. Without inflammation, infections and injuries would never heal and the tissue would continue to sustain damage.

During inflammation, a vast variety of the body’s immune cells are released into the blood or affected tissues to protect and defend the body against pathogens, stop the spread of infection, and heal the injury. The release of chemicals increases blood flow to the area of injury or infection.

Three main systems are involved in inflammatory response, and are triggered by the initial inflammation. These systems are: 13

 Compliment System: This is the first responder of the three systems, and will be discussed in much further detail in Unit 3. The cells of the compliment system are able to communicate with all other cells involved in the immune response.  Clotting system: This system is comprised of fibrous proteins that connect at site of injury. The clotting system traps pathogens and keeps infection from spreading to other areas of the body. As its name suggests, it also clots blood to stop bleeding after injury.  Kinin System: The main product of the kinin system is bradykinin, which dilates blood vessels, triggers pain response in nerve endings, and increases vascular permeability.

The triggering and corresponding response of each system is referred to as a cascade.

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Types of Inflammation

The inflammatory process is facilitated by inflammatory mediators. These mediators may be plasma or cell derived. The mediators attract immune cells to the area of inflammation, so the causative antigen may be destroyed.

Inflammation can be classified as either acute or chronic. Acute inflammation is the body’s initial response to harmful stimuli. It is the direct result of increased movement of plasma and leukocytes, particularly granulocytes, from the blood to the injured tissue. Granulocytes are immune cells that release toxic substances to destroy the harmful stimuli.

Acute inflammation begins within seconds following tissue injury. Whether the damage is physical or an immune response, three processes occur: increased blood flow due to dilation of the blood vessels, increased permeability of the capillaries, allowing fluid and blood proteins to move into the interstitial spaces, and migration of neutrophils, a type of granulocyte, out of the capillaries and venules and into interstitial spaces. Three of the most common causes of acute inflammation are harmful bacteria, injury to the tissue, and food-related reactions.

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Examples of conditions related to acute inflammation include, but are not limited to:

• Bronchitis.

• Infected ingrown toenails.

• Sore throat from cold, flu, or allergies.

• Scratch or cut on the skin.

• Intense exercise such as running, weight-lifting.

• Appendicitis.

• Dermatitis.

• Tonsillitis.

• Meningitis.

• Sinusitis.

• Physical injury, such as a hit or blow.

Chronic, or long-term, inflammation, which can last several months or years, may result from the failure to eliminate the root cause of acute inflammation. With chronic inflammation, the immune system is constantly activated. It damages the body and increases the chances of developing everything from allergies to Alzheimer’s. The most common causes of chronic inflammation are non-degradable pathogens that cause persistent inflammation, infections with some type of virus, persistent foreign bodies, and a hypersensitive immune system response.

Examples of conditions related to chronic inflammation include:

• Failure to eliminate the cause of acute inflammation.

• An autoimmune response to a self-antigen.

• A persistent, low-intensity irritant.

• Asthma.

• Peptic ulcer.

• Tuberculosis. 16

• Rheumatoid arthritis.

• Periodontitis.

• Ulcerative colitis and Crohn’s disease.

• Sinusitis.

• Hepatitis.

Antigens

In immunology, an antigen is a foreign particle, usually a protein, capable of inducing an immune response in the body. This property is known as immunogenicity. During the immune response, a variety of changes occur in the body. The body must first recognize the antigen, then internalize the antigen, process it to the immunogenic moiety, and present the antigen in a way the body understands. Once this process is complete, T-cell activation occurs and the response to the antigen begins.

Some antigens are recurring, meaning humans are exposed to them repeatedly over their lifetime. The flu virus is one of the most common of these antigens. The flu vaccination introduces antigens of the virus to the body. In a healthy immune system, T cells are activated and create a memory, of sorts, of the antigens. If the body is exposed to the virus again, the memory of the antigen allows the immune system to defeat the virus before the body becomes ill.

Cytokines, Inflammation, and Massage

Cytokines are small proteins produced and released by cells at the site of inflammation. They may also be triggered by stress or strenuous activity, such as exercise. Cytokines promote the production of lymphocytes, monocytes, and other cells that attack and destroy any antigens and promote tissue healing. Cytokines carry messages among body cells and play a vital role in the body’s defense system. They are 17

also responsible for many of the symptoms of infection, including fatigue, body aches, and fever. Tumor necrosis factor alpha is the cytokine that seems to play largest role in inflammation.

Researchers at the Buck Institute for Research on Aging conducted an experiment on eleven young, healthy male subjects. Participants rode stationary bicycles to the point of exhaustion. Upon completion, one random subject was selected for a massage. Biopsies were taken from the muscles of both legs before the exercise, as well as immediately after, ten minutes after, and two and a half hours after the activity. The subject who’d received the post exercise massage showed a decrease in inflammation causing cytokines. (“Massage reduces inflammation”, 2012).

Inflammation and Free Radicals

Free radicals are atoms that contain an unpaired electron. They typically form when oxygen interacts with other molecules. The odd electron wants to pair up, and steals an electron from a lipid membrane, the thin sheet of molecules that protect all cells. This is called lipid peroxidation. The destructive cycle continues as the now unbalanced lipid molecule steals an electron from the lipid molecule beside it. As the process progresses, damage to the cellular membrane occurs, leaving the cell vulnerable. Cell damage due to free radical destruction of the lipid membrane is called oxidative stress. Over time, it can lead to inflammation and chronic disease.

All cells, with the exception of red blood cells, contain small components called mitochondria. Mitochondria generate adenosine triphosphate, ADT, chemical energy, and influence nuclear DNA. They create energy through oxygenated metabolism, and free radicals are a byproduct of that process. Mitochondria help regulate apoptosis, which is the destruction of unhealthy body cells; they are vital to many body processes, and easily damaged by inflammation.

A small number of free radicals are produced as our bodies go through normal, physiological, energy production processes, like oxygenated metabolism. Healthy 18

lifestyle choices, like avoiding cigarette smoke and limiting alcohol consumption, will help keep free radical production to a minimum. When free radical production becomes abnormal, or pathological, damage to the body can occur.

Fortunately, there are defenses against chronic free radical damage. They include:

 Antioxidants. Vitamins A, C, and E are great sources of antioxidants. Antioxidants donate electrons to free radicals, so they don’t have to steal an electron from the lipid membrane.  Metal Carrier Proteins. These proteins create a protective bubble around iron and copper in the body. Both metals are prone to attack from free radicals.  Enzymes. Each of the primary free radicals has a corresponding enzyme that fights it.

Impact of Inflammation and Massage on the Body

While acute inflammation is a normal response, chronic inflammation is dangerous and has a negative impact on the body. Inflammation effects every system in the body and is the root cause of many diseases including heart disease, Alzheimer’s, rheumatoid arthritis, type 2 diabetes, irritable bowel syndrome, and Crohn’s disease.

Massage therapy can help alleviate inflammation and lessen its effects on the body. During a massage, the body experiences two types of responses: reflexive and mechanical. Mechanical responses are a result of soft tissue manipulation by the massage therapist. Reflexive responses are the nervous system’s reaction to that manipulation. These physiological responses affect multiple body systems.

The Cardiovascular System

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The cardiovascular system, also known as the circulatory system, consists of the heart, blood vessels, blood, lymph, and the lymphatic vessels and glands. It circulates blood and lymph through the body. Inflammation of the cardiovascular system can lead to serious health conditions such as heart disease and blood clots in the lungs, which can cause heart attack or stroke.

Inflammation in the heart is caused by the buildup of plaque in the walls of arteries, which narrows the arteries and increases the risk they will become blocked. While the connection between inflammation and heart attacks and strokes still requires more research, it is believed the body perceives this buildup of fatty deposits as abnormal or foreign, triggering an immune response. The body, in an attempt to heal itself, forms a protective barrier between the plaque buildup and the blood. Sometimes, the plaque will rupture, encounter the blood, and a blood clot forms. If the blood clot blocks the coronary artery, blood flow to the heart stops and the muscle dies, resulting in a heart attack. When blood clots effect the flow of blood to the brain, stroke occurs.

During massage, blood vessels are dilated. This enhances blood flow, increasing the amount of oxygen and nutrients delivered to body tissue. It also speeds up detoxification of carbon dioxide and other waste products from the body. While the vessels are dilated, blood pressure and heart rate temporarily decrease.

When working with a client with cardiovascular disease, the therapist should begin by massaging the limbs. Short strokes should be used as opposed to long, full limb strokes. Once the limbs have been massaged and circulation to them is improved, the massage therapist can turn their attention to the muscles of the trunk. Short, slow strokes should be used on the trunk as well, along with connective tissue cutting techniques to relieve fascial restrictions.

The Lymphatic System

Running parallel to the blood vascular system, the lymphatic system is a network of vessels and nodes that are responsible for the transportation of antigens, immune cells, 20

and fluids through the body. Inflammation of the lymphatic network can impact fluid drainage and leukocyte transportation. Since the lymphatic system plays a vital role in the regulation of the inflammatory process, inflammation of the lymphatic system can impact how the body reacts to inflammation elsewhere.

Lymphocytes are a type of white blood cell. They are produced in the bone marrow and travel through lymphatic vessels to other areas of the lymphatic system, including the spleen and lymph nodes. Lymphocytes work to remove antigens from the body; each one has a specialized receptor that facilitates the process. T cells and B cells are the two main types of lymphocytes.

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T cells are named after the thymus, the organ they mature in after being produced by bone marrow. There are two types of T cells: helpers and killers. Other immune cells consume antigens and present them to helper T cells for analysis. Once the helper cell’s receptor recognizes the antigen, it begins to divide and secrete proteins that activate killer T cells, B cells, and the rest of the immune system.

Killer T cells are aptly named. Their receptors analyze every cell they encounter and quickly destroy any that have been infected by the activating antigen. Both types of T cells are utilized by both the innate and adaptive immune systems.

B cell receptors are highly specialized; each is designed to intercept a specific antigen. Once that antigen connects to the receptor, the B cell releases a signal. Helper T cells react to the signal and produce proteins to aid B cell activation. Once activated, the B cell divides and multiplies, creating plasma cells and B memory cells. Plasma cells produce antibodies to the activating antigen at a rate of hundreds of thousands per minute. B memory cells have a long lifespan. As their name suggests, they remember the activating antigen. The next time that antigen tries to invade the body, B memory cells trigger a much faster immune response, often eliminating the invader cells before they cause any symptoms. B cells are a vital component of the adaptive immune system.

Research continues to prove that massage therapy increases lymphocyte production. In a study by Cedar Sinai, twenty-nine participants were given forty-five-minute massages. Participants were given IV catheters before the massage and blood samples were taken before, throughout, and after the massage. Samples consistently showed an increase in lymphocytes, with the highest levels recorded post massage. (Live Science Staff, 2010).

Lymph Drainage and Massage

When the lymphatic system becomes clogged with bacteria and other antigens, lymphedema may occur. The disease can be classified as primary or secondary. Secondary lymphedema is typically caused by surgical removal of lymph nodes, cancer, 22

or other serious illnesses. Primary lymphedema can occur at any stage of life, and researchers are still trying to determine possible causes. Lymphedema causes severe swelling and inflammation in the arms and legs.

Roughly seventy percent of the body’s lymphatic vessels are located just below the skin. Targeted massage therapy consisting of very light, rhythmic strokes can trigger movement within the vessels. Consistent massages can alleviate lymphedema and promote healthy lymphatic function. Understanding the role lymphocytes play in the immune system and the symbiotic relationship between immunity and gut microbiota, we can understand the importance of lymphatic massage to overall health.

A lymphatic drainage massage involves light, repetitive strokes that help move lymphatic fluid through the capillaries. Pressure is applied toward the heart, and the therapist’s hands remain relaxed and soft. Strokes should be repeated seven times, starting at the proximal lymph nodes and working distally.

The Endocrine System

As with the lymphatic system, the endocrine system plays a crucial role in the regulation of immune reactions. The endocrine system is a network of glands that produce hormones, which are then secreted into the bloodstream and distributed to target locations within the body. Inflammation of the endocrine system can affect hormone levels throughout the body.

Massage therapy has been shown to stimulate the production of neurohormones, which effect brain chemistry, mood, and overall health.

One of the neurohormones stimulated by massage therapy is dopamine. Increased dopamine levels result in enhanced fine motor skills, mental focus, and a general sense of well-being.

Serotonin levels may also be affected by massage. Serotonin helps regulate emotions and decreases erratic behavior. The hormone also promotes healthy sleep cycles and decreases over all stress. 23

A short massage that triggers the sympathetic nervous system may cause the body to release epinephrine, or adrenaline, which increases alertness. A longer massage may reduce epinephrine and cortisol levels, inducing restful, deep sleep. Deep, stress-free sleep allows for the production of growth hormones, which promote cell regeneration, healing, and overall wellness.

Trigger point and acupressure therapies also trigger hormone production. These therapies stimulate endorphins, “feel good” hormones that reduce physical pain and promote happiness. Oxytocin is another “feel good” hormone stimulated by massage therapy.

Clients with endocrine disorders, such as diabetes, will require special care during massage therapy. The therapist should confirm that the client’s blood sugar levels are stable before treatment begins. In the case of diabetes, special attention should be given to improve circulation to vulnerable areas, such as the feet. When working with a diabetic client, it’s advisable to have carbohydrates on hand in case of a hypoglycemic attack.

The Nervous System

The nervous system is the network of nerve cells and fibers that transmit nerve impulses between parts of the body. The brain and spinal cord, or central nervous system, are gravely affected by inflammation. Acute inflammation of the nervous system, as with the rest of the body, is a normal reaction to an antigen. Chronic inflammation, or neuroinflammation, can be detrimental. Commonly caused by traumatic brain injury, autoimmunity, or viruses, neuroinflammation is associated with degenerative brain diseases including Parkinson’s, Alzheimer’s, and Multiple Sclerosis (MS).

Like the endocrine system, the nervous system is improved by the stimulation of the parasympathetic nervous system that occurs during a massage. Many of the hormones produced during massage help to regulate healthy nervous system activity. Massage also 24

triggers responses from the nerve sensors in our skin and muscles. Depending on the techniques used, these sensors are either soothed and relaxed or stimulated into action.

Many disorders of the nervous system effect the way the body moves. Two of the most common symptoms of a neurological movement disorder are spasticity and rigidity. Swedish techniques are the most helpful at addressing these symptoms. In the case of spasticity, vibrations and gentle shaking over the affected area may also provide relief.

Massage also provides relief for less serious neurological symptoms, such as tension headaches and migraines. Prone position may increase headache pain, so it should be avoided. Swedish techniques as well as light pressure point therapy will improve blood flow, help the client relax, and alleviate symptoms.

The Integumentary System

The integumentary system, comprised of the skin, hair, and nails, is the organ system that protects the body from loss of water, pathogen invasion, and abrasion from outside elements. Early signs that the integumentary system has been compromised include dry skin, lack of skin elasticity, and skin discoloration. The client may be unaware of these symptoms, but they are easily spotted during massage. Inflammation of the integumentary system presents as acne, eczema, and vitiligo. Acne is the most common skin problem associated with inflammation.

During massage, the vessels and capillaries in the skin dilate and skin cell regeneration is stimulated. This helps to improve skin tone and elasticity. The body’s sweat glands are also stimulated, which increases the amount of toxins and waste released through the skin. Sebum production increases, increasing skin resistance to infection.

The Reproductive System 25

The reproductive system is a system of sex organs which work together for sexual reproduction. Chronic inflammation of the reproductive system, commonly caused by sexually transmitted infections such as chlamydia, affects both men and women. In men, inflammation may affect sperm production and function, leading to low sperm count or infertility. In women, inflammation can affect ovulation and hormone production, cause endometriosis, and also lead to infertility.

Massage stimulates hormone production and reduces inflammation, which in turn helps alleviate symptoms of reproductive disease. While there are no specific guidelines for working with a client with a reproductive disorder, stress reducing techniques will help the client cope with the psychological effects of their disease.

Pregnancy is one reproductive condition that requires modifications during massage. The client’s positioning should be based on comfort; prone position may be used early on, but is typically uncomfortable near the end of the first trimester. The massage therapist should use a very light touch when working on the abdominal and sacral areas, or avoid them completely.

The Respiratory System

The respiratory system is responsible for taking in oxygen and expelling carbon dioxide. The primary organs of the respiratory system are the lungs, which carry out this exchange of gases as we breathe. Influenza is a common virus that effects the lungs and triggers an acute inflammation response. Asthma, bronchitis, and emphysema are all chronic conditions caused by inflammation in the lungs.

While most people understand that massage relaxes the muscles being manipulated, many would be surprised to learn that untouched muscles also relax during the process. Massage eases tension and tightness in the muscles of the lungs. This increases lung capacity and slows respiration rates. The resulting deep, slow breaths help to further 26

relax the rest of the body. Relaxation leads to less stimulation of the body’s sympathetic nervous system, the regulator of the body’s “fight or flight” response.

Positioning is incredibly important when working with a client with respiratory issues such as asthma, emphysema, or bronchitis. The amount of time the client spends in the supine position should be reduced or eliminated entirely, as it may impede the client’s breathing.

The Muscular System

The muscular system consists of skeletal, smooth, and cardiac muscles. It permits movement of the body, maintains posture, and circulates blood throughout the body. Inflammation of the muscular system may cause myositis, or inflammation of the muscles. Muscle inflammation may be caused by intense exercise or an injury to the muscle, such as a pull, strain, or tear.

Massage helps to reduce thickening and restrictions in connective tissues, which allows for increased joint mobility. During a massage, circulation is stimulated, allowing more oxygen and nutrients to reach muscle tissue. This relieves muscle fatigue and stiffness and improves muscle tone. As muscle tone improves, stress on the bones decreases.

The Skeletal System

The skeletal system is the framework of the body, consisting of bones and other connective tissues, which protects and supports the body tissues and internal organs. Inflammation of this system may lead to rheumatoid arthritis, tendonitis, and bursitis.

The benefits massage therapy provides to the muscular system directly improve the health of the skeletal system. 27

When working with a client who has a broken bone or a disease of the skeletal system, such as osteoporosis, positioning is the most important factor for the therapist to consider and should be based solely on the client’s comfort.

The Urinary System

The urinary system consists of the kidneys, ureters, bladder, and urethra. Bacteria in any part of the urinary system can lead to infection, running the gamut of the mild discomfort of a urinary tract infection to a severe kidney infection, and result in inflammation.

The benefits of massage to the urinary system are similar to the benefits to the lymphatic system. Massage improves circulation and encourages the body to eliminate waste, which alleviates water retention and edema.

The Digestive System

The digestive system is comprised of several organs working together to ingest food, break that food down into usable fuel or waste, and then eliminate that waste from the body. Chronic inflammation can be detrimental to the digestive system, causing illnesses such as ulcerative colitis and Crohn’s Disease.

Massage relaxes sphincter muscles within the digestive tract and increases intestinal activity. Digestive benefits of massage include relief from constipation, gas, and colic.

Peristalsis and Massage

Peristalsis is the involuntary movement of muscles within the digestive tract. Peristalsis in the esophagus moves food into the stomach. Peristalsis waves in the stomach mix food with gastric chemicals, breaking them down before pushing them into 28

the small intestine. The cycle continues through the rest of the digestive tract. Peristalsis is vital for digestion and elimination.

Peristalsis can be disrupted for a number of reasons, including stress, diet, and inflammation. This can lead to acute or chronic constipation and Irritable Bowel Syndrome. Massage therapy can stimulate peristalsis and alleviate symptoms.

Rhythmic, full body techniques should be used to relieve peristalsis. The client should be in prone position and the therapist should focus attention on the sacrum and lumbar area. Soft, near pressure-less strokes can also be applied to the abdominal muscles to stimulate the digestive tract.

Healing Inflammation

The healing process begins at the onset of acute inflammation and may last up to twenty-four months. The best possible outcome is tissue regeneration, in which the inflammation site returns to its previous form and function. Full regeneration isn’t always possible, in which case resolution is the best possible outcome. The form and function of the inflammation site are not fully restored, but the injury heals. If resolution is not possible, the body will repair itself by replacing the damaged tissue with scar tissue, which neither looks nor functions like the tissue it’s replacing.

Disruption of Healing

If any of the processes of an inflammatory response are dysfunctional, healing may be disrupted. A few factors that may prolong healing from an inflammatory response include:

 Hemorrhaging: If the clotting system doesn’t function properly, more blood and fibrous cells will rush to the inflammation site. The excess blood increases the time it takes the body to clear damaged cells from the site. 29

Excess fibrous cells may join together to create adhesions, which may bind to and damage nearby organs.  Improper collagen production: Collagen production may be influenced by many factors including diet, disease, and exposure to environmental toxins. Under production of collagen may impair wound healing, while over production may lead to over healing, in the form of a thick, raised scar referred to as a keloid.  Contractures: Contractures may form on both internal and external body cells. They are caused when scars around the inflammation site contract excessively and impeded proper healing. Contractures may limit range of motion and cause damage to nearby organs.

Unit Two: Gut Microbiota 30

Gut microbiota, formally called gut flora, is the term used to describe the trillions of microorganisms that live in our intestines. The term microbiota is defined as a cluster of microorganisms that lives in an already established environment. Microbiota is present in multiple areas of the body, including the skin, mouth, intestines, and lungs.

It is estimated that the human intestine holds tens of trillions of microbiotas, composed of at least a thousand different microorganisms, which contain one hundred times more genes than the human body. These communities of microorganisms are so entwined with the human body processes, some scientists consider them to be an independent organ.

Origin and Composition

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One third of microbiota is common amongst all humans. The other two thirds are unique to individual bodies. Gut microbiota is established at birth and influenced by many factors. Babies who are born vaginally are exposed to lactobacillus, a healthy microbiota that helps infants digest breast milk. Babies born by C section are often introduced to an unhealthy skin bacterium called staphylococcus. Bacteria and germs present in the delivery area are also introduced into the baby’s gut microbiota.

It takes roughly three years for a child’s gut microbiota to resemble that of an adult’s. It continues to adapt and change throughout life, in response to diet and environmental factors. Breastfed babies are more likely to develop healthy gut microbiota than formula fed infants.

The stress a child experiences during infancy and early childhood can also have a long-lasting effect on their gut microbiota and, in turn, their brain function and overall health. Maternal stress, in particular, can have detrimental effects. Children learn how to react to stress by watching their parents and other caregivers; unhealthy learned habits and reactions leave the child vulnerable to illness throughout their lives.

Gut microbiota is primarily composed of bacteria, which is the component that has the most effect on the brain. For billions of years, bacteria were the sole inhabitants of Earth. During this time, they perfected a way of communicating with each other that now greatly benefits their human hosts. Some of the bacteria present are permanent, others are temporary and influenced by environmental and lifestyle factors.

Two largest groups of bacteria present in gut microbiota are Firmicutes and Bacteroidetes. Firmicutes are fat loving bacteria; high levels coincide with obesity, inflammation, and disease. Firmicutes absorb more calories from food than Bacteroidetes. They also regulate metabolic genes and decrease metabolism.

Yeasts, viruses, protozoans, and parasites are also present in the microbiota. The brain and the gut microbiota of a healthy individual weigh roughly the same.

Function 32

Gut microbiota does a variety of things for the body, including:

• Helping to digest foods the stomach and small intestines can’t. • Aiding in the production of Vitamins B and K. • Defending the body from unwanted microorganisms. The gut contains more immune cells than any other area of the body. • Maintaining proper digestion. Gut microbiota controls the acids and fluids present in the GI tract, as well as the contractions that move food through the digestive system. • Acting as a barrier to aid the immune system.

Gut microbiota aids in the digestive process of fermentation. This process breaks down undigested carbohydrate particles and produces short chain fatty acids. These short chain fatty acids provide energy to the colon and other parts of the body, increase lipogenesis, and aid assist the immune system.

The short chain fatty acids also increase the amount of mucus in the intestinal tract, which decreases intestinal cell permeability, deepens the crypts of the intestine, increases vascular flow, and stimulates tissue repair and renewal. These effects promote barrier integrity, and help prevent Leaky Gut Syndrome. 33

The Gut/Brain Connection

The human brain and gut are intrinsically connected. This is evident in the way our guts react to thoughts and emotions. If you think about your favorite food, your mouth may water. When you’re nervous, you may feel nauseous, too. If you’re anticipating something, you may feel “butterflies” flutter in your stomach.

These reactions occur because the brain and gut are connected by the enteric nervous system, which some scientists refer to as “the second brain” or “the brain in your gut.” The enteric nervous system is comprised of two layers of nerve cells that line the full length of the intestinal tract. The vagus nerve is also part of the enteric nervous system, and runs from the brain stem to the abdomen. It is the longest cranial nerve, and helps regulate heartrate, as well as digestion. 34

The enteric nervous system controls every step of the digestive process and is in constant communication with the brain. This communication is facilitated by the endocrine cells that line the gut. When necessary, they release hormones that carry signals to the brain. The gut also contains sensors similar to taste buds, which identify foods and trigger an appropriate digestive response.

In the above examples, the brain sent signals to the gut and the gut reacted. But, the reverse is also possible. While the signals are usually sent through the enteric nervous system, some microbiota produce neurotransmitters of their own. A distressed gut sends signals to the brain, and the brain’s reaction may be anxiety and depression.

This intrinsic link can make it difficult to diagnose both mental illness and digestive disorders, until the origin of the problem is defined. Clients suffering from stomach pain and irritability may not have a physical illness; they may be experiencing a physiological response to psychological stress. Clients suffering from anxiety and depression may not be suffering from mental illness; they may have unbalanced gut microbiota sending distress signals to their brain. As most gut microbiota can’t be cultured and analyzed, treatment trial and error are often the only way to diagnose and heal the source of the problem.

The study of the brain gut connection is relatively new in the scientific community and most research is being done on mice raised in germ and bacteria free conditions, in which gut microbiota can be manipulated. Research has shown a direct correlation between the health of gut microbiota and the physical health of the brain. (Belkaid & Hand, 2015). Further research may show that maintaining proper gut microbiota may decrease the risk of neurological disorders. In addition, healthy gut microbiota produces glutamate and gamma-amino butyric acid, two chemicals vital to healthy brain function.

How and Why Gut Microbiota Become Imbalanced

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The clinical term for imbalanced gut microbiota is dysbiosis. Dysbiosis occurs when the normally prominent, healthy species of gut microbiota are reduced or eliminated and competing species take their places. Several factors may cause dysbiosis, including:

• Diet, particularly the consumption of fructose and gluten. • Stress. • Alcohol consumption. • Infection. • Antibiotic use. Antibiotics are important drugs and often essential when overcoming disease and infection. However, they can destroy healthy gut microbiota. Overuse and under dosing may both lead to antibiotic resistant pathogens. The use of antibiotics in agricultural practices exacerbates this problem. Antibiotics are endocrine disruptors that confuse the body’s sex hormones. They also increase firmicute microbiota and decrease Bacteroidetes, which contributes to obesity. 36

• Environmental factors. We are surrounded by chemicals in air, the objects around us, the products we use on skin and clothes, and even the food we 37

consume. Industrial pollutants contaminate our air, water, and ground. Most are not health tested before use, and many accumulate in body’s fatty tissue, 38

disrupting endocrine production. Many environmental toxins mimic estrogen. These chemicals also build up in the liver and cause damage. The effects on the 39

body’s liver and hormone systems, as well as the environmental toxins themselves, cause dysbiosis. 40

• Physical trauma. • Overuse of antibacterial cleansers. • Birth control. Birth control pills are synthetic hormones taken daily, typically for long periods of time. They disrupt natural body hormones, disrupt microbiota, and lead to inflammation. The resulting microbiota imbalance leads to further hormone imbalance, which may cause anxiety and mood disorders.

When gut microbiota is balanced, the individual microbiota species interact symbiotically in a system of checks and balances. When dysbiosis begins, this system breaks down. Overgrowth of some species will cause damage to others, which in turn worsens dysbiosis. The relationship between gut microbiota and the immune system is directly affected, and disease may develop. Dysbiosis contributes to many mitochondrial diseases, such as autism and diabetes.

Leaky gut syndrome

The gastrointestinal tract is lined by one layer of epithelial cells, which are protected by a mucosal surface. The tract is designed to absorb nutrients and protect the bloodstream. Immunoglobulins in the mucosal surface bind to pathogens to keep them from attaching to intestinal walls.

Nutrients may pass transcellular, through the epithelial cells, or paracellular, between the epithelial cells. Cells in the gastrointestinal tract are connected by what’s referred to as a tight junction; these junctions serve as gatekeepers and protect the gastrointestinal tract. Leaky gut happens when integrity of the tight junctions is compromised. Without the gatekeeper, pathogens may pass through digestive cells and cause inflammation.

The breakdown in integrity of the tight junctions may be caused by gluten consumption. The process can also compromise the blood brain barrier and cause neurological effects. Lipopolysaccharide, or LPS, is the most inflaming bacteria that 41

passes through compromised tight junctions. It is found in most autoimmune clients. LPS also contributes to depression.

Gut Microbiota and Mental Health

Gut microbiota issues may cause depression, ADHD, anxiety, behavioral disorders, and memory issues. These mental health issues are most abundant in USA, where high 42

processed foods are most common. Unhealthy gut microbiota produces chemicals that cause depression. The higher a client’s inflammation levels, the higher their risk for dysbiosis and depression. This symbiotic relationship accounts for the cycle of inflammation, depression, and physical disease found in many autoimmune clients.

Gut microbiota can be balanced with lifestyle and diet changes, and mood will improve. This functions in reverse, as well. Anxiety, depression, and other mental health issues can increase intestinal permeability and cause dysbiosis.

Because microbiota can affect mood, it can also affect social behaviors and influence life decisions and intuition. ADHD is an excellent example of a mental illness caused by inflammation due to unhealthy gut microbiota. It is often treated with meds when it should be treated with diet. ADHD most prominent in Western children due to the high frequency of C section deliveries, formula feeding, antibiotic use, and consumption of processed foods. The rise in ADHD cases mirrors the rise in childhood obesity. Probiotics and supplements repair the gut and often provide the same effects as behavioral drugs. Many healthy microbiotas produce neurotransmitters that improve mood and reduce anxiety.

Unbalanced gut microbiota may also be responsible for the rise in autism. Gut microbiota influences the developing brain, so problems in the gut negatively affect normal, healthy brain development.

Appetite, Obesity, Gut Microbiota, and the Brain

Obesity is an increasing health crisis that causes depression, anxiety, cardiovascular disease, cancer, kidney disease, and neurological diseases. The combination of social stigmas and chemicals produced by unhealthy microbiota can lead to depression and isolation. Obesity can affect a fetus in utero, rewiring the appetite center of the baby’s developing brain.

Obesity is an inflammatory disease, directly related to gut microbiota. Obese clients typically have high levels of cytokines in their blood. Visceral fat around organs is 43

especially harmful, as it both becomes inflamed and causes inflammation in the surrounding organs. Diseased white blood cells may accumulate in visceral fat and dump toxins on nearby organs. Obesity produces hormonal and inflammatory responses, and can decrease the size of the hippocampus, causing memory loss.

Insulin, one of body’s most important hormones, aids in glucose absorption and interacts with receptors on cell surfaces. When glucose is constantly present due to high sugar or refined carbohydrate diets, cells reduce insulin receptors and become insulin resistant. This leaves a surplus of glucose in the blood. The pancreas increases insulin production to deal with the surplus glucose, and overproduction of insulin leads to type 2 diabetes. Surplus glucose and insulin overproduction also throw the rest of the body’s hormones off balance.

Some healthy gut microbiota help control blood sugar and regulate healthy glucose and insulin levels. In extreme cases, experimental fecal transplants are done to introduce healthy bacteria to the gut and improve blood sugar issues. Diversification of gut microbiota increases the health of the gut microbiota, and decreases the risk of disease. Exercise also promotes healthy gut microbiota by reducing firmicutes and increasing Bacteroidetes, and promoting microbiota diversity.

Massage and Gut Microbiota

Hormones play a major role in the composition and stability of gut microbiota, just as they do in inflammation. Stress hormones like cortisol leave the body vulnerable to unhealthy microbiota, which can lead to dysbiosis, inflammation, and illness. As we studied in Unit One, massage suppresses cortisol production and allows the client to relax. The suppression of “bad” hormones and the promotion of “good” ones helps to maintain healthy gut microbiota.

Massage reduces inflammation and boosts immunity; in turn, the immune system is better equipped to maintain healthy gut microbiota.

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Unit Three: The Immune System

The immune system is the body’s natural defense against foreign pathogens, or antigens, and viruses. Immunity is defined as the ability of an organism to resist a toxin or infection by the action of specific antibodies, or sensitized white blood cells. A healthy immune system is critical to overall health. Immunity involves both specific and non- specific components; the innate and adaptive immune systems.

The Innate Immune System

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The innate immune system, sometimes referred to as the in-born or non-specific system, is a subset of the overall immune system. Innate responses depend on a group of proteins and phagocytic cells that recognize features of pathogens and quickly activate to destroy the foreign invaders. Phagocytic cells consume the pathogens and any affected cells.

The innate immune system has two lines of defense: natural barriers and inflammation. Natural barriers include the skin and mucosal layer, which provide physical barriers to pathogens. The cells of natural barriers are capable of producing biochemical barriers like earwax, sweat, and antimicrobial peptides.

As discussed in Unit One, inflammation is one of the key components when it comes to protecting the body. Acting almost immediately, the innate system detects a threat to the body and inflammation is occurs, fighting the infection or repairing the injury. While the innate immune system is rudimentary, proper function is essential to overall health.

Gut microbiota and the immune system work together within a unique, well defined network of regulatory pathways to keep each other in balance. Hormones, cytokines, and metabolites are monitored within the system.

The innate immune system has a network of barrier immunities in place at all times to protect the body. Gut microbiota work to support and reinforce these barriers. This helps prevent pathogens from entering the body and allows gut microbiota to remain in place without having to compete for space and nutrients.

Gut microbiota is often the first line of defense against unhealthy microorganisms. One of the ways it protects the body is through colonization resistance. New microorganisms are introduced into the intestine, where they have to compete for space and nourishment with the already present microbiota. The microbiota simply refuses to make space for or share nutrients with the new microorganisms. Healthy, established gut microbiota ensure that unhealthy microorganisms don’t take over the body.

Innate immune cells, or dendric cells, line the gut and defend the body against unhealthy microorganisms, but recognize and tolerate normal gut microbiota. In turn, 46

gut microbiota helps to train and maintain innate immune cells. Gut microbiota condition innate immune cells to respond to pathogens quickly and efficiently. They do this by producing enzymes that stimulate innate cells and promote an immune response.

The innate immune system can also tell when gut microbiota is unbalanced and potentially dangerous to the body. When this happens, both innate and adaptive immune responses may be triggered.

The Adaptive Immune System

Through contact, ingestion, and inhalation, humans are exposed to millions of potentially harmful pathogens daily. The adaptive immune system, with its ability to recognize previous exposure to pathogens, plays a critical role in fighting infection and defending the body. However, adaptive immune responses are slow to react when it comes to exposure to new pathogens, taking a week or so before the responses are effective. During the first hours of exposure, we rely on the innate immune system to protect us from infection and illness.

Adaptive immune cells work to regulate and balance gut microbiota. The adaptive immune cells that have the greatest effect on gut microbiota are referred to as secretory immunoglobulins A, or sIgAs. One of the main functions of these cells is to protect the epithelial tissue gut microbiota interact with. Many studies have revealed a direct connection between secretory immunoglobulins A and the composition and distribution of gut microbiota.

In addition to secretory immunoglobulins A, the adaptive system uses the mucosal immune system to regulate gut microbiota. The mucosal system collects and analyzes microbiota and determines whether or not it is harmful to the body. If the microbiota is determined to be harmful, the adaptive immune system develops and produces antibodies specific to that microbiota. The adaptive immune system destroys the 47

unhealthy microbiota and makes record of it, so it can be destroyed more quickly in the future.

Unhealthy and unbalanced gut microbiota trigger an immune response, when the immune system is working properly. If the immune system is compromised, gut microbiota is left unregulated, which can lead to intestinal and digestion issues and inflammation, which may further weaken the immune system. If and when the immune system returns to proper function, it will resume its regulation of gut microbiota.

Antibodies

Antibodies are Y shaped proteins secreted by plasma cells in the blood. They are also referred to as immunoglobulins, and their function is to detect and destroy pathogens and aid in immune response. Each immunoglobulin contains a variable 48

region, or FAB, and a constant region, or Fc. The FAB varies based on the antigen captured by the antibody. As its name suggests, the constant region never changes. It determines what type of isotope the immunoglobulin is.

Immunoglobulins are composed of four chains, two heavy, two light. The constant region is within the heavy chains. The light chains of the antibody can be either kappa or lambda.

The Five Immunoglobulin Isotopes

The constant region of the immunoglobulin defines its isotope. The five isotopes are:

 IgM immunoglobulins take on pentameric structures once secreted into the bloodstream. They are held together by J chain disulfide bonds. IgM is the first antibody to be produced and expressed following exposure to an antigen. Its half-life is roughly five days. One of IgM’s main functions is to activate the compliment system. It is also the first immunoglobulin produced by the body, typically by five months in utero.  IgD is a membrane bound immunoglobulin. Instead of being secreted into the blood, they are expressed on the membranes of B cells. IgD cells are a marker of B cell maturity. Their full function is not yet understood.  IgG is the main immunoglobulin in the blood, lymph, cerebrospinal, and perennial fluid. The half-life of an IgG cell is roughly twenty-three days. IgG performs opsonization, a process by which it coats antigens so they can be easily destroyed. IgG is the only immunoglobulin passed from mother to child in utero.  IgE cells are attracted to basophils and mast cells. They bind to these cells; they can then bind to antigens and trigger degranulation. On their own, IgE cells have a half-life of only two days. When bound to a basophil or mast cell, the half-life increases to roughly two weeks. 49

 IgA is the main immunoglobulin contained in mucus. IgA is the body’s main defense against infections in the respiratory tract, the gut, and the genitals. It has a half-life of roughly five and a half days.

Hypersensitivity Immune Reactions: The Four Types

The immune system is designed to protect the body. But during some immune responses, the immune system damages the body instead. These are referred to as hypersensitivity reactions.

Type One Hypersensitivity

Type one hypersensitivity is the most commonly known of these reactions, as they are responsible for most allergic reactions. Type one reactions are facilitated by immunoglobulin E antibodies.

Allergy is defined as a nonstandard reaction to molecules from outside the body. The triggering antigens are referred to as allergens. Common allergens include foods, mold, pollen, insects, latex, and perfumes. Type one hypersensitivity is typically a genetic predisposition; the client’s T cells are programmed to react to their specific allergen.

Type one reactions take place in two stages. Upon first exposure, sensitization occurs. The allergen molecules are breathed in or consumed, and dendritic cells and macrophages, the immune system’s presenting cells, transport them to the T cells in the lymph nodes. If the person is allergic, immune cells also present a co-stimulatory molecule to prompt the appropriate immune response.

Naive T helper cells collect the allergen and co-stimulatory molecule, becoming exposed for the first time. The naive T helper cells are now primed T helper cells. 50

Primed T helpers may, with the help of proteins called interleukins, become type 2 helper cells (TH2).

TH2 cells trigger the production of eosinophils, a type of granulocyte. These are white blood cells that release toxic substances, which damage both invading cells and the surrounding host cells. This process is called degranulation. Simultaneously, B cells begin releasing allergen specific IgE antibodies.

IgE antibodies attach themselves to receptors on another type of granulocyte called mast cells. When this occurs, sensitization is complete.

The second stage of type one hypersensitivity occurs upon second exposure to the allergen. When the allergen enters the body, it is intercepted by the IgE antibody carrying mast cells. Degranulation is triggered, along with the production of histamines, which promote inflammation. Inflammatory reactions may include: 51

 Narrowing of the airway, causing labored breathing.  Dilation of the blood vessels.  Edema (swelling).  Urticaria (hives).

These reactions typically take place within the first few minutes of the client’s second exposure to their allergen. However, late stage reactions may occur up to twelve hours after exposure. Late stage reactions involve the same T and B cells, granulocytes, and interleukins as an early stage reaction, with the addition of leukotrienes and basophils, another type of granulocyte.

If left untreated, type one hypersensitivity can lead to anaphylactic shock and, in severe cases, death. The three most effective treatments for a type one reaction include:

 Antihistamines, which block histamine responses that constrict the airway.  Corticosteroids, which decrease inflammatory responses.  Epinephrine, which constricts blood vessels and reduces the risk of anaphylactic shock.

Often, type one reactions appear to improve on their own before becoming severe. Because of this, it’s always important to seek medical attention during a reaction, especially if the client has no known allergies.

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Type Two Hypersensitivity

Type two hypersensitivity is also referred to as cytotoxic hypersensitivity. The immune system is designed to fight molecules that aren’t produced by the body. This is accomplished by a process called central tolerance; as immune cells are produced, any that are self-reactive are either destroyed or inactivated so they can’t harm healthy body cells. Sometimes, the self-reactive cells escape before they can be destroyed. A type two reaction occurs when these escaped cells damage normal body tissue. Self-reactive cells are typically tissue specific.

Antigens attach themselves to healthy body cells and may be intrinsic, which means made by the body, or extrinsic, which means not naturally occurring in the body. Extrinsic antigens may be caused by infection or medications. Self-reactive cells produce immunoglobulin antibodies, which attach to the antigens on the healthy cell, forming an antigen-antibody complex. These also occur during infections, but are damaging when formed around healthy body cells.

Four Cytotoxic Mechanisms of Type Two Hypersensitivity

The first cytotoxic mechanism of type two hypersensitivity is the activation of the compliment system. This system is a unit of small proteins that work together to create enzymes. The compliment system is designed to fight and destroy infections but, during a type two reaction, it destroys the healthy cells marked by self-reactive immune cells. As the compliment system breaks down the healthy cells, granulocytes called neutrophils are attracted to the site and begin degranulation. Free radicals are produced, causing further tissue destruction.

The second cytotoxic mechanism is also caused by the compliment system. C proteins combine to form a membrane attack complex, or MAC. The MAC inserts itself into the cell membrane of the affected body cell and allows fluids and molecules to move in and out of the cell. In this cytotoxic mechanism, the cell bursts and dies. 53

The third cytotoxic mechanism of type two hypersensitivity occurs when IgG antibodies clot with blood cells that have been bound by Cb3, one of the protein fragments of the compliment system. This opsonizes the cell, or marks it for destruction by phagocytes. Phagocytes then engulf and destroy the cell.

The fourth cytotoxic mechanism is called antibody dependent cell mediated cytotoxicity, or ADCC. In this mechanism, the bound antigen-antibody complex is recognized by immune cells called natural killer cells. The natural killer cells release granules that work much like the MAC, but also allow enzymes to enter the affected cell. The granules and enzymes work together to cause cell death.

Not all type two hypersensitive reactions cause cell death. There are non-cytotoxic type II hypersensitivities as well, in which the antibody disrupts cell function. This is called antibody mediated cellular dysfunction. Sometimes when an antibody binds to its antigen, it just gets in the way. When this happens, it can change the way the cell functions.

Type Three Hypersensitivity

Type three hypersensitivity reactions happen when antigen-antibody complexes deposit in blood vessel walls and cause inflammation and tissue damage. There are three main distinctions between type two and type three hypersensitivity.

• While type two reactions involve antibodies binding to antigens on cell surfaces, type three reactions occur when the antibodies bind to soluble antigens and become an immune complex. • The second difference lies in the actions of the complement system. The compliment reaction triggered during a type three reaction is much larger than that triggered during a type two reaction. • During a type two reaction, symptoms are experienced in areas of the body where antibody-antigen complexes are created. During type three reactions, symptoms occur in the areas where the complexes are deposited. 54

Immune complexes are less attractive to the immune system and, therefore, aren’t removed from the body as quickly. Instead, they are deposited in the basement membrane layer of blood vessels. Eventually, neutrophils are attracted and attempt to consume the immune complex through phagocytosis. Typically, this is not achieved. During the attempt at phagocytosis, the neutrophils degranulate, which causes further inflammation and damage to the tissue.

Type Four Hypersensitivity

Type four reactions are facilitated by T cells; it is sometimes referred to as T cell mediated hypersensitivity. In this reaction, a helper T cell recognizes the triggering cell and stimulates production of interleukins and enzymes. They work together to trigger killer T cells, which then destroy the targeted cell. A type four reaction occurs much the same as a healthy immune response, but targets healthy body tissue instead of an outside antigen. Symptoms of a type four reaction include localized swelling, redness, and warmth, as well as a fever. Type four hypersensitivity is involved in several systemic diseases like rheumatoid arthritis, multiple sclerosis, and inflammatory bowel disease.

Autoimmunity

When the immune system goes awry, as it does in hypersensitivity reactions, misdirected responses occur and the body attacks itself. This is referred to as autoimmunity; while present to some degree in everyone, it may cause a broad range of illnesses, collectively known as autoimmune diseases. Healthy gut microbiota can turn off these chronic immune responses.

Some of the more common autoimmune diseases are:

• Rheumatoid arthritis.

• Systematic lupus erythematosus. 55

• Celiac disease.

• Pernicious anemia.

• Vitiligo.

• Scleroderma.

• Psoriasis.

• Inflammatory bowel disease.

• Hashimoto’s disease.

• Addison’s disease.

• Grave’s disease.

• Reactive arthritis.

• Sjogren syndrome.

• Type 1 diabetes.

Inflammation, Dysbiosis, and Autoimmune Disorders

Autoimmune diseases can affect any part of the body, including the heart and blood vessels, central nervous system, joints, muscles, skin, glands, eyes, the digestive tract, lungs, and kidneys. A visible symptom of an autoimmune disease is inflammation which, as was discussed in unit one, causes redness, swelling, heat, and pain. While some autoimmune diseases stay localized, others effect multiple parts of the body. For example, type 1 diabetes can affect the glands, eyes, muscles, and kidneys. Autoimmune diseases typically fluctuate through periods of remission, where symptoms are fewer or non-existent, and flare-ups where symptoms worsen. As there is currently no cure for autoimmune diseases, treatment is focused on minimizing flare-ups, relieving symptoms, and preventing complications.

In the case of autoimmune diseases, the body overproduces cytokines and chemokines, leading to inflammation in the body. The response only worsens when 56

chemokines summon more immune system components, cells such as macrophages, neutrophils, and T cells to the area, resulting in more inflammation. While the root cause of autoimmune diseases is unknown, it is clear autoimmunity and inflammation go hand-in-hand. Other factors including bacteria, viruses, drugs, chemical irritants, environmental irritants, stress, and poor diet all contribute to an unhealthy immune system.

The symbiotic relationship between gut microbiota and the immune system enables the body to destroy unwanted pathogens, but remain self-tolerant. When dysbiosis occurs, this delicate balance is disrupted and immune homeostasis is lost. The body loses self-tolerance and the immune system develops antibodies against normal, healthy body cells.

The cycle of dysbiosis, inflammation, and autoimmunity can be difficult to break. As gut microbiota becomes imbalanced, it triggers an inflammatory response. The inflammation further alters microbiota, causing more inflammation. The process may begin with inflammation and follow the same cycle. Both the inflammation and dysbiosis affect the immune system. The innate immune system loses its ability to differentiate between normal, healthy body cells and harmful microorganisms and antigens. The immune system attacks, worsening dysbiosis and further increasing inflammation.

Research has shown that the composition of gut microbiota in clients with autoimmune diseases differs greatly from the composition in healthy people. (Wu & Wu, 2012). Many autoimmune clients, especially those suffering from autoimmune disorders of the digestive system, have unregulated bacteria in their gut microbiota and improve with use of antibiotics.

Research has also shown a direct correlation between gut microbiota and autoimmune diseases of the brain, such as multiple sclerosis. Studies with mice revealed a link between the absence of gut microbiota and degeneration of the brain’s protective myelin sheaths, similar to what occurs in MS clients. Further research is being done in the hopes of finding gut microbiota based therapies to prevent or treat the disease. 57

Frequent, short massages provide maximum relief for autoimmune clients. Because no two autoimmune clients are alike, customization of treatment is necessary. Any localized inflammation or swelling should be avoided. Positioning should be based on the client’s comfort; Swedish and mobilization techniques can be used. The massage therapist should begin with light touches and increase pressure based on the client’s comfort level. Intense pressure and deep tissue techniques should not be used.

Stress & the Immune System

No one lives a stress-free life. Some stress, like the temporary burst of energy and adrenaline one may feel before a job interview or giving a presentation, is considered good stress. This type of stress is responsible for our fight or flight instinct; without it, we may not perceive a potential threat. However, when stress becomes prolonged, it becomes dangerous.

Some people are predisposed to have “gut reactions” to stress. Typically, this behavior is learned from parents or caretakers during early childhood development. These reactions may also be a product of childhood trauma. Unhealthy reactions to stress increase production of disease causing hormones and chemicals. Reversely, positive emotions can trigger chemical and hormone productions that are beneficial to gut microbiota.

Chronic stress may be detrimental to one’s mental and physical health. Post- Traumatic Stress Disorder (PTSD) is an example of chronic stress. When someone suffers from PTSD, their fight or flight response is always activated, leaving them in a constant state of hyper awareness. This causes a spike in cortisol and other corticosteroids in the blood for longer periods of time. Short term exposure to these hormones comes with few side effects; long term exposure, however, can lead to mental and physical damage. People who suffer from chronic stress may experience anxiety, depression, insomnia and other sleep issues, high blood pressure, digestive problems, heart disease, and a weakened immune system. 58

Chronic stress creates chronic inflammatory conditions and lowers the immunity of those who are otherwise have a healthy immune system. Cortisol, a hormone released during the stress response, suppresses inflammation. When exposed to cortisol long term, the body develops a resistance and does not respond properly. Instead, the body produces higher doses of cytokines, which promote inflammation, leading to a chronic inflammation.

Aside from causing chronic inflammation conditions, prolonged stress and cortisol release also lowers the number of lymphocytes produced by the immune system, leaving the body more susceptible to illness and infection.

Chronic stress also has negative effects on gut microbiota, due to the gut brain connection studied in Unit 2. The stressed brain sends signals to the gut, and dysbiosis begins. The now unbalanced gut microbiota sends distress signals to the brain, which further exacerbates mental stress.

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Unit Four: Immunity, Gut Microbiota, and Diet

Diet plays a huge role in overall health. Eating properly is key to a healthy immune system. In the short term, a poor diet can cause stress, fatigue, and effect our ability to perform day-to-day tasks. Overtime, a poor diet may lead to more serious health issues including obesity, tooth decay, type 2 diabetes, heart disease, stroke, eating disorders, high cholesterol, high blood pressure, depression, and some forms of cancer. Vitamins E and C, probiotics, soluble fiber, beta-glucans, and catechins promote immune cell growth, restore proper balance in the gut, and help fight inflammation. When the body is not receiving proper nutrition, the immune system is weakened and, as with chronic stress, the body become susceptible to illness.

Research has shown food to be a significant contributor to chronic inflammation. When the body is subjected to inflammation triggering foods daily, the immune system is always activated. Over time, the constant inflammatory response may cause weight gain, skin problems, digestive issues, and a host of diseases. Some of the most inflammation inducing foods include sugar and artificial sweeteners, vegetable oil, fried and fast foods, gluten and refined flour, dairy, artificial additives, saturated and trans fats, conventional grain-fed meats, processed meats, and alcohol.

The foods we consume also play a huge role in promoting healthy or unhealthy gut microbiota. Studies have shown that in just twenty-four hours, a change in diet can cause a significant shift in the composition of gut microbiota. Depending on the type of foods consumed, these shifts can be beneficial and promote wellness, or be detrimental and trigger disease.

Yeast

Yeast are single cell fungi that live on surface of all living things. They are part of healthy gut microbiota and beneficial in small amounts. Candida albicans is the most 60

common type of yeast in the body and lives in the digestive tract and vagina. Candida infections occur when the yeast is unregulated and allowed to grow out of control. These infections can be caused by many factors, including:

 Antibiotics. Broad spectrum antibiotics wipe out other elements of gut microbiota, leaving candida plenty of room to multiply. As its population increases, the yeast produces toxins that weaken the immune system.  Sugar. Sugar consumption feeds yeast, which allows them to multiply unregulated.  Hormonal changes. Natural and synthetic hormone changes caused by menstruation, pregnancy, menopause, and birth control use contribute to candida overgrowth.  Steroid use. Steroids disrupt the body’s natural hormone production, which contributes to candida infection.  Localized yeast infections weaken the immune system and cause symptoms throughout the body. For example, a vaginal yeast infection may contribute to leaky gut syndrome. Candida overgrowth may be a contributor to or a product of dysbiosis, and contributes to the continuous, worsening cycle of inflammation, dysbiosis, and chronic disease.

Candida infections are present in many clients with chronic illness. Like with dysbiosis, the infection may be the cause or result of many conditions. Symptoms of candida infections include:

 Teenage Acne.  Recurring urinary tract and bladder infections.  Frequent vaginal infections or jock itch.  Sugar cravings.  IBS, constipation, or diarrhea.  Memory and concentration problems.  Impotence or loss of libido.  Endometriosis.  Infertility. 61

 PMS and menstrual problems.  Irritability.  Chronic sinus issues.  Chronic skin issues.  Bad breath.  Pain or pressure in ears.  Fibromyalgia.  Chronic fatigue.

Women are affected by candida infections more than men due to anatomical differences, frequent hormonal changes, and the fact that women go to the doctor more often than men and, therefore, take more antibiotics.

Candida infections can be a chronic, reoccurring issue, but steps can be taken to regulate yeast grown and maintain healthy gut microbiota. However, these steps may involve difficult lifestyle and diet changes. Therefore, the first step is the client taking responsibility for their health and what they put into their body.

Candida infections are exacerbated by exposure to chemicals, so clients should minimize their exposure where they can. Natural, nontoxic cleaning products should be used at work and at home, and cigarette smoke should be forbidden. An air purifier and quality air filters will help minimize exposure to airborne chemicals. Synthetic fiber fabrics in both furniture and clothing should be avoided to further limit chemical exposure.

Drinking filtered, distilled, or spring sourced water will help maintain healthy candida levels in the body. Exercising at least forty minutes per week and spending time in a steam room or sauna will also help maintain healthy yeast levels by flushing toxins from the body.

In addition to a healthy diet, vitamin and mineral supplements help regulate candida levels. Echinacea, grape seed extract, garlic, and essential fatty acids are all beneficial to candida levels, as well as overall gut microbiota health. 62

Sugar and refined flour promote candida infections by feeding the yeast, and should be eliminated from the diet. Processed and prepackaged foods should also be eliminated to reduce chemical exposure. Alcohol contains large amounts of yeast, so it should also be avoided when trying to regulate healthy candida levels.

Chemical laden and yeast feeding foods should be replaced with healthy options such as vegetables and lean proteins, as well as grain alternatives like buckwheat and quinoa. Fresh, whole foods are always preferable to processed options. Frozen products are acceptable when fresh aren’t available. Buying organic will reduce exposure to pesticides, hormones, and antibiotics that contribute to dysbiosis and candida overgrowth. While diet and lifestyle changes go a long way in regulating candida levels, chronic infections may require prescription anti-yeast medications.

Some people are more sensitive to certain foods than others. To identify food sensitivities, the client should eliminate corn, dairy, eggs, fruit, and other candida causing foods from their diet. After a period of abstinence, the foods may be added back into the diet one by one. If symptoms of candida overgrowth occur after reintroduction, the client should permanently eliminate the causative food from their diet.

Sugar and Artificial Sweeteners

Sugar is everywhere; it is found in obvious foods such as soda, candy, baked sweets, and coffee drinks. Added sugar can also be found in granola bars, yogurt, and other seemingly healthy foods. When we consume excessive amounts of sugar, the glucose our body cannot process quickly enough causes increased levels of cytokines to be produced. Not only that, but excess sugar also inhibits our white blood cells’ ability to kill germs, leading to a weakened immune system.

When sugar breaks down in the digestive system, it becomes food for unhealthy gut microbiota. The more the unhealthy microbiota are fed, the more they grow, eventually overtaking healthy gut microbiota. Sugar and sweeteners in all forms can be damaging 63

to gut microbiota, and even slightly high blood sugar increases chances of dementia and depression.

Processed fructose, also known as high fructose corn syrup, can be especially damaging. It does not trigger insulin production or the feelings of being satisfied and full. Because of this, fructose is a leading contributor to obesity and diabetes. Processing fructose also depletes liver energy and triggers uric acid production, which leads to gout, HBP, and kidney stones.

Contrary to packaging and advertisements, artificial sweetener is no better than sugar. In fact, artificial sweeteners have been linked to an increase in bad gut bacteria, enhancement of the risk of glucose intolerance by altering the gut microbes, and a disruption in the composition of gut microbiota by decreasing levels of good bacteria. As with sugar, increased levels of cytokines are produced and white blood cells are unable to perform their tasks properly.

Simply eating foods with a lower glycemic index will help maintain balance. The glycemic index is a system used to rank foods by their ability to be broken down by the body. The lower the number, the easier it is for our bodies to process it. Low GI foods such as lentils, beans, whole grains, and nuts provide slow burning energy rather than the glucose spike and eventual crash that accompanies foods with a high glycemic index.

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Vegetable Oil

Vegetable oil, found in mayonnaise, crackers, potato chips, bread, and salad dressings have a high concentration of omega-6 fats, which cause inflammation. Ideally, the ratio of omega-6 to omega-3 fats in the body is 1:1. The typical American diet is closer to a 20:1 ratio. While omega-6 fats are essential and can be found in walnuts, pine nuts, avocados, and olives, they should be consumed in moderation. An abundance may cause hair loss, liver and kidney degeneration, miscarriage, arthritis, and the inability for the body to heal itself. To maintain a healthy immune system, it is vital to balance the omega-6 fats with omega-3 fats, which can be found in salmon and other cold-water fish, flaxseeds, kale, spinach, pumpkin seeds, wheat germ, and canola oil.

Fried and Fast Food

Fried foods, often prepared in vegetable oils, and fast food often contain trace amounts of phthalates, a substance used in plastic food and beverage packaging. Phthalates are chemical toxins that disrupt the endocrine system, have been linked to metabolic syndrome, and are associate with other markers for inflammation. Like sugar, processed and fried foods feed unhealthy gut microbiota. They also reduce the diversity of microbiota, which may lead to weight gain and disease. Limiting or eliminating the consumption of fried and fast foods can help eliminate an inflammatory immune response.

Gluten and Refined Flour

Mass produced, store-bought bread is often rushed through the fermentation process, not allowing the yeast to pre-digest some of the starch and gluten. Without this step, the bread may be harder to digest, causing inflammation in the lining of the 65

intestines. Inflamed intestinal lining leads to bloating, discomfort, and, eventually, inflammatory bowel disease.

Dysbiosis of gut microbiota caused by gluten consumption can be more difficult to reverse than dysbiosis triggered by other foods, as gluten sensitivity increases cytokine production. Inflammation caused by gluten sensitivity is damaging to the brain and causes fatigue, headaches, and, eventually, dementia. Gluten’s sticky texture inhibits absorption of nutrients and disrupts healthy gut microbiota. It also triggers inflammation, nausea, constipation, and diarrhea. Gluten sensitivity is marked by the presence of antibodies for gliandin, one of the main proteins found in gluten. An immune reaction to gluten can break down blood brain barrier, causing damage to all areas of the body.

Foods such as crackers, pasta, and breakfast cereals all contain refined flour. Refined flours have been processed to the point they no longer contain slow digesting fiber or nutrients. Because of this, the body can break them down quickly, raising blood sugar and insulin levels. This combination of events causes an inflammatory response in the body. Conversely, foods containing whole grains are more slowly digested, allowing the body to regulate blood sugar and insulin levels.

Dairy

Dairy products, apart from moderate amounts of yogurt, have been shown to disrupt the gut microbiome. They contain saturate fats and are common allergens. Commercially produced dairy products typically contain trace amounts of antibiotics, which disrupt healthy gut microbiota. The imbalance in good and bad bacteria in the gut can cause bloating and discomfort. Many people believe dairy products are healthy, due to their calcium content. However, they often cause more harm than good and better options are available. Non-dairy, non-inflammatory, calcium rich foods include sunflower seeds, carrots, figs, broccoli, sweet potatoes, tofu, and green beans.

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Artificial Additives and Trans Fats

Artificial additives, usually coloring or thickening agents, and trans fats do not occur in nature and are unidentifiable by the body. In an attempt to protect the body from these foreign invaders, immune reactions are set off when artificial additives and trans fats are consumed. Artificial additives have been linked to hyperactivity in children, a disruption in hormone function, and an imbalance in gut bacteria. Processed foods and snacks like muffins, frozen pizzas, cookies, and non-dairy coffee creamer contain trans fats. These fats can cause inflammation of the blood vessels, restricting blood flow to the heart or brain, which, as discussed in unit one, can lead to heart attack or stroke.

Saturated Fats

Saturated fat triggers inflammation of the white adipose, or fat, tissue. White adipose tissue stores fat instead of burning it for energy. As these fat cells take in saturated fat and grow larger, they release an inflammatory agent.

Conventional Grain-Fed and Processed Meats

Animals massed produced for consumption are likely to be fed an all grain diet that doesn’t at all resemble what they would eat in the wild to sustain optimal health. To keep the animals from getting ill, they are often given large doses of antibiotics. The antibiotics serve several purposes; they keep the animals from getting diseased, prevent the animals from getting sick from their unnatural diet, and help them gain weight more quickly. Meaning when the animals are consumed, higher concentrations of saturated fats, omega-6 fats, and leftover antibiotics and hormones are also consumed. High intake of animal fats can turn off the body’s appetite control system and cause over eating and obesity. Consuming antibiotics can be especially damaging to gut microbiota. 67

Combined, these factors contribute to an immune response in the body. Limiting the intake of red meat or consuming grass-fed beef will reduce the amount of fats and residual antibiotics found in the meat, as well as help balance the omega-6 to omega-3 ratio.

Processed meats contain high levels of saturated fats as well as preservatives, artificial additives, and inflammatory compounds that occur when meet is dried, smoked, or pasteurized, all of which register as foreign attackers to the immune system.

Soy

Many believe soy to be a healthier alternative to meat and dairy products, but that isn’t always the case. Many commercial soy products are genetically modified and over processed, and cause more harm to the body than good. Lactobacillus and Bifidobacterium, two incredibly beneficial types of microbiota, are especially susceptible to damage caused by soy.

Unfiltered Tap Water

Chlorine in tap water is used as a bactericidal to kill waterborne pathogens. However, overtreated water can kill colonies of gut microbiota. When mixed with natural compounds in the body, it may produce toxic byproducts that are damaging to many different types of body tissue. Unfiltered tap water may also contain minerals, heavy metals, and trace amounts of antibiotics, all of which may alter gut microbiota.

Alcohol

In moderation, alcohol may lower c-reactive proteins, which are an inflammatory biomarker, and probiotics found in some beers act as an anti-inflammatory. However, 68

the process of breaking down excessive amounts of alcohol creates byproducts that can damage liver cells, promote inflammation, and weaken the immune system. Moderation is key.

Healthy Alternatives

While there are plenty of foods that should be avoided to maintain overall health, there are many more that should be enjoyed. Foods that decrease inflammation and promote healthy gut microbiota and immunity include:

• Wild Caught Fish and Game. Foods taken directly from the wild, completely unaltered by man, are unlikely to be contaminated with antibiotics and other chemicals found in commercially produced meats and fish. • Organic, Free Range Meats and Animal Byproducts. Beef, chicken, eggs, and dairy from healthy animals who are fed traditional, free range diets are free from the antibiotics carried by their mass-produced counterparts. • Bananas. Bananas help to maintain balance within gut microbiota. The potassium and magnesium they contain also help to reduce inflammation. • Fermented Foods. Fermented foods contain live, healthy micro-organisms that help eradicate unhealthy gut microbiota. • Blueberries. Blueberries help diversify gut microbiota. They promote healthy microbiota, strengthening the immune system. • Beans. When beans and other legumes are broken down in the digestive system, they feed healthy gut microbiota, strengthen digestive cells, and promote healthy immune function. • Herbs, ginger, teas, and coffee. • Healthy fats such as extra virgin olive oil, sesame oil, avocado, coconut, seeds and nuts. 69

For optimal health, clients should consume a diet high in fiber and Omega 3 fatty acids, and low in sugar. The Mediterranean diet is an excellent example of a gut healthy diet.

It can be difficult for some clients to consume all necessary vitamins and minerals through food alone. In such cases, supplements can be used to help maintain optimal health. Useful supplements include:

• DHA: an Omega 3 fatty acid that supports healthy brain function. • Turmeric: anti-inflammatory and antioxidant. • Vitamin D: a hormone produced by skin during sun exposure. Vitamin D is important for both bone and brain function.

Many clients find it beneficial to fast every 3 months. While fasting, the body converts fat into ketones, which act as fuel for the brain. This allows for healthy mitochondria production and stimulates new brain cell growth. To fast effectively and safely, the client should consume no food but plenty of water over a twenty-four-hour period.

Probiotics

Essentially, probiotics are foods that contain live microorganisms that offer health benefits to the people who eat them. The most common microorganisms found in probiotics are Lactobacillus, Bifidobacterium, Enterococcus and Streptococcus. These bacteria are commonly used in fermentation, the process of converting carbohydrates into organic acid or alcohol and carbon dioxide. Fermentation requires an oxygen free environment and yeast or bacteria, often both. Fermentation creates a low pH environment and destroys harmful, high pH bacteria.

Probiotics are found in fermented foods like kefir, yogurt, kombucha, kimchi, sauerkraut, and pickles. Probiotic consumption should be increased while using antibiotics to help minimize the dysbiosis and candida overgrowth. Consuming probiotics can also help improve depression and anxiety. Probiotics are often prescribed 70

by physicians; many hospitalized patients who are on heavy antibiotic regimens are given probiotics with meals, and some pediatricians prescribe probiotic ointments for breastfeeding mothers to place on their nipples for babies to ingest.

When discussing probiotics, we must also look at prebiotics, the foods that feed probiotic bacteria. The most common of these are greens, garlic, onions, and asparagus. These foods should also be added to the diet to help maintain healthy gut microbiota and regulate candida levels.

Probiotics, Gut Microbiota, and Immunity

When probiotics are introduced into the digestive system, they can rapidly alter the composition of gut microbiota. The ingested bacteria overtake unhealthy microbiota in the gut. This process is known as probiosis, the opposite of dysbiosis. As probiotics are digested, they produce metabolic compounds that suppress the growth of unhealthy microbiota.

In addition to inducing probiosis, probiotics can heal and strengthen the immune system. For example, Lactobacillus reinforces the intestinal barrier, which decreases gastrointestinal infections and diseases. Probiotics can also affect how the immune cells of the gut respond to microbiota.

Probiotics work quickly and can help the body recover from dysbiosis caused by poor diet. However, if probiotic use is discontinued and poor diet habits are resumed, dysbiosis can reoccur.

Probiotics and Inflammation

Research has revealed that many people who suffer from inflammatory diseases also suffer from inflammation of the gut. Gut inflammation weakens the intestinal barrier, which allows more bacteria and other harmful microorganisms to cross from the 71

intestinal barrier into the bloodstream, which in turn triggers an inflammatory response. Probiotics help strengthen the intestinal barrier of the immune system, which helps to reduce inflammation both within the gut and throughout the rest of the body.

Probiotics also affect how the gut communicates with the brain. The use of probiotics in clients with inflammatory diseases may decrease physical pain as well as the mental and emotional stress of living with an illness.

Probiotics also decrease the presence of C-reactive proteins and other biomarkers present in clients suffering from inflammatory disease. Continued research of probiotics may help develop targeted probiotic treatments for a wide range of diseases.

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Glossary of Terms

Acute Inflammation- any inflammation that has a fairly rapid onset, quickly becomes severe, and is usually manifested for only a few days, but that may persist for even a few weeks; characterized histologically by edema, hyperemia, and infiltrates of polymorphonuclear leukocytes.

Adaptive Immune System- also known as the acquired immune system or, more rarely, as the specific immune system, is a subsystem of the overall immune system that is composed of highly specialized, systemic cells and processes that eliminate pathogens or prevent their growth.

Adenosine Triphosphate- (ATP) a coenzyme that transports energy within cells to facilitate metabolism. Every cell in the body uses ATP to store and express energy.

Addison’s Disease- an endocrine disorder in which the adrenal gland does not produce adequate levels of cortisol. Symptoms include fatigue, nausea, and low blood pressure.

Adrenaline- a hormone secreted by the adrenal glands, especially in conditions of stress, increasing rates of blood circulation, breathing, and carbohydrate metabolism and preparing muscles for exertion.

Allergy- a damaging immune response by the body to a substance, especially pollen, fur, a particular food, or dust, to which it has become hypersensitive.

Anaphylactic Shock- an extreme, often life-threatening allergic reaction to an antigen to which the body has become hypersensitive.

Alzheimer’s Disease- a progressive neurological disease that causes degeneration of the brain. Early symptoms include forgetfulness and change in personality. As the disease progresses, the symptoms worsen to dementia. 73

Antibodies- a blood protein produced in response to and counteracting a specific antigen. Antibodies combine chemically with substances that the body recognizes as alien, such as bacteria, viruses, and foreign substances in the blood.

Antigen-Antibody Complex- An immune complex, sometimes called an antigen- antibody complex, is a molecule formed from the integral binding of an antibody to a soluble antigen. The bound antigen and antibody act as a unitary object, effectively an antigen of its own with a specific epitope.

Antigen- a toxin or other foreign substance that induces an immune response in the body, especially the production of antibodies.

Antihistamine- a drug or other compound that inhibits the physiological effects of histamine, used especially in the treatment of allergies

Antioxidant- a substance that inhibits oxidation, especially one used to counteract the deterioration of stored food products.

Apoptosis- the natural process of programmed cell death that occurs when a cell is no longer useful or becomes harmful to the body. Apoptosis is sometimes referred to as “cell suicide.”

Attention Deficit Hyperactivity Disorder- a neurological disorder marked by inability to pay attention and stay on task, hyperactivity, and impulsive decision making.

Autism Spectrum Disorder- a developmental disorder of the central nervous system that affects the ability to communicate and interact with others. Symptoms may also repetitive, obsessive behavior.

Autoimmune Disease- a disease in which the body produces antibodies that attack its own tissues, leading to the deterioration and in some cases to the destruction of such tissue.

B Cells- a lymphocyte not processed by the thymus gland, and responsible for producing antibodies.

Bacteria- a member of a large group of unicellular microorganisms that have cell walls but lack organelles and an organized nucleus, including some that can cause disease. 74

Bacteroidetes- one of two main groups of bacteria present in gut microbiota. Healthy gut microbiota contains more Bacteroidetes than Firmicutes.

Basophil- the least abundant granulocyte in the body. Basophils produce inflammation during an immune response and prevent blood from clotting too quickly after injury.

Beta-Glucans- sugars that are found in the cell walls of bacteria, fungi, yeasts, algae, lichens, and plants, such as oats and barley. They are sometimes used as medicine.

Bifidobacterium- anaerobic bacteria found in the large intestine. Bifidobacterium aid in fermentation and are often used as probiotics.

Biomarkers- a measurable substance in an organism whose presence is indicative of some phenomenon such as disease, infection, or environmental exposure.

Blood Brain Barrier- a complex, semipermeable membrane that regulates which molecules in the blood pass into the brain. For example, water and glucose are allowed to pass through the barrier, while pathogens and neurotoxins are not.

Bradykinin- a peptide that causes dilation of the blood vessels in response to inflammation. Increased levels of bradykinin trigger a fall in blood pressure.

Bursitis- inflammation of the bursae, the fluid filled sacs that cushion the musculoskeletal system. Bursitis is often caused by repetitive movements that put pressure on the joints, and most commonly occurs in the shoulders, hips, and elbows.

Candida Albicans- a yeast that is commonly present in healthy gut microbiota, but can develop into a fungal infection and harm the body if allowed to overgrow. Candida infections typically occur when the immune system is suppressed or compromised.

Catechins- a crystalline compound antioxidant found in tea and some fruits.

Celiac Disease- a digestive and immune disorder in which gluten consumption triggers an inflammatory response. Symptoms include diarrhea, gas, and fatigue. Celiac disease impairs the intestine’s ability to absorb nutrients and, if left untreated, may lead to malnutrition. 75

Cell Permeability- All cells are enclosed with a cell membrane. A selectively permeable cell membrane is one that allows certain molecules or ions to pass through it by means of active or passive transport.

Chemokines- any of a class of cytokines with functions that include attracting white blood cells to sites of infection.

Chronic Fatigue Syndrome- prolonged extreme fatigue that cannot be explained by a medical diagnosis. Chronic fatigue syndrome affects more women than men; it’s causes are not yet understood.

Crohn’s Disease- an autoimmune, inflammatory bowel disease in which the immune system attacks and causes inflammation through the full length of the gastrointestinal tract. Symptoms include diarrhea, abdominal pain, and anemia.

Chronic Inflammation- prolonged inflammatory response that involves a progressive change in the type of cells present at the site of inflammation. It is characterized by the simultaneous destruction and repair of the tissue from the inflammatory process

Clotting System- one of the vital systems for healing and repair after inflammation. The clotting system sends fibrin proteins to the site of inflammation; they connect and form a barrier to protect the body and keep infection from spreading.

Compliment System- a part of the immune system that enhances (complements) the ability of antibodies and phagocytic cells to clear microbes and damaged cells from an organism, promotes inflammation, and attacks the pathogen's plasma membrane.

Contracture- a permanent shortening or hardening of a muscle or joint that occurs when a muscle or tendon are clenched for large periods of time. Contractures are most commonly seen in people with spastic muscle issues.

Corticosteroids- any of a group of steroid hormones produced in the adrenal cortex or made synthetically. There are two kinds: glucocorticoids and mineralocorticoids. They have various metabolic functions and some are used to treat inflammation.

Cortisol- a steroid hormone produced by the adrenal gland in response to stress, pain, or low blood glucose. Pharmaceutically, it is referred to as hydrocortisone. 76

C-reactive Proteins- one of the plasma proteins known as acute-phase proteins: proteins whose plasma concentrations increase (or decrease) by 25% or more during inflammatory disorders. CRP can rise as high as 1000-fold with inflammation.

Cytokines- any of a number of substances, such as interferon, interleukin, and growth factors, that are secreted by certain cells of the immune system and have an effect on other cells.

Cytotoxic- toxic to living cells.

Dendric cells- immune cells that intercept antigens, then present them on their cell surfaces for evaluation by T cells. They also facilitate communication between the innate and adaptive immune system.

Degranulation- a cellular process that releases antimicrobial cytotoxic or other molecules from secretory vesicles called granules found inside some cells. It is used by several different cells involved in the immune system, including granulocytes (neutrophils, basophils, eosinophils, and mast cells.)

Dopamine- a compound present in the body as a neurotransmitter and a precursor of other substances including epinephrine.

Dysbiosis- an unhealthy change in the normal, healthy ecology of gut microbiota.

Eczema- inflammation of the skin that causes dry skin, rashes, and blisters. There are eight types of eczema and the severity of symptoms varies. Some types of eczema are believed to be autoimmune related.

Edema- the clinical term for swelling. May be caused by injury, inflammation, or build- up of bodily fluids.

Endometriosis- a disorder in which uterine tissue grows on surfaces outside of the uterus. Symptoms include abdominal pain, nausea, and abnormal menstrual cycle. If left untreated, endometriosis may cause infertility.

Endorphins- any of a group of hormones secreted within the brain and nervous system and having a number of physiological functions. They are peptides that activate the body's opiate receptors, causing an analgesic effect. 77

Enzymes- a substance produced by a living organism that acts as a catalyst to bring about a specific biochemical reaction.

Epinephrine- another term for adrenaline.

Extrinsic- not part of the essential nature of someone or something; coming or operating from outside.

Fermentation- the chemical breakdown of a substance by bacteria, yeasts, or other microorganisms, typically involving effervescence and the giving off of heat.

Fibromyalgia- an autoimmune disease that causes extreme fatigue and widespread tenderness and pain throughout the body.

Firmicutes- one of two main groups of bacteria found within gut microbiota. High levels of Firmicutes are associated with obesity, as they are able to absorb more energy from foods, which is then stored in the body as fat.

Free Radical- an uncharged molecule (typically highly reactive and short-lived) having an unpaired valence electron.

Gamma-aminobutyric Acid- an amino acid that inhibits nerve transmission and has a tranquilizing effect on the central nervous system.

Grave’s Disease- an autoimmune disease that causes the thyroid to overproduce hormones. Symptoms include tremors, weight loss, and anxiety.

Glutamate- an amino acid that facilitates communication between the cells of the nervous system.

Glycemic Index- a system that ranks foods on a scale from 1 to 100 based on their effect on blood-sugar levels.

Granulation- the part of the healing process in which lumpy, pink tissue containing new connective tissue and capillaries forms around the edges of a wound.

Granulocyte- a white blood cell with secretory granules in its cytoplasm. The four types are neutrophils, basophils, eosinophils, and mast cells.

Gut Microbiota- the name given today to the microbe population living in our intestine. Our gut microbiota contains tens of trillions of microorganisms, including at 78

least 1000 different species of known bacteria with more than 3 million genes (150 times more than human genes).

Hashimoto’s Disease- an autoimmune disease in which the immune system attacks the thyroid, inhibiting its production of hormones. Symptoms include weight gain and fatigue.

Hemophilia- a condition in which the clotting system does not function properly, leading to excessive bleeding, bruising, and anemia.

Hepatitis- a condition that causes inflammation of the liver. There are many types and causes range from viral infections, substance abuse, and autoimmune diseases.

Histamines- part of the body's natural allergic response to substances such as pollens. Antihistamines work by preventing the release of histamine from certain cells (mast cells), thereby blocking the allergic reaction.

Hormone- a regulatory substance produced in an organism and transported in tissue fluids such as blood to stimulate specific cells or tissues into action.

Hypersensitivity Immune Reaction- a set of undesirable reactions produced by the immune system, including allergies and autoimmunity.

Immune Complex- sometimes called an antigen-antibody complex, is a molecule formed from the integral binding of an antibody to a soluble antigen. The bound antigen and antibody act as a unitary object, effectively an antigen of its own with a specific epitope.

Immune System- the bodily system that protects the body from foreign substances, cells, and tissues by producing the immune response and that includes especially the thymus, spleen, lymph nodes, special deposits of lymphoid tissue (as in the gastrointestinal tract and bone marrow), macrophages, lymphocytes including the B cells and T cells, and antibodies.

Immunity- the ability of an organism to resist a particular infection or toxin by the action of specific antibodies or sensitized white blood cells.

Immunogenicity- an antigen’s ability to produce an immune response. 79

Immunoglobulins- any of a class of proteins present in the serum and cells of the immune system that function as antibodies.

Innate Immune System- also known as the non-specific immune system or in-born immunity system, is an important subsystem of the overall immune system that comprises the cells and mechanisms that defend the host from infection by other organisms.

Inflammation- a biological response to injury or pathogens. Symptoms of inflammation include pain, swelling, heat, and reddening of the skin.

Interleukins- any of a class of glycoproteins produced by leukocytes for regulating immune responses.

Intrinsic- belonging naturally; essential.

Irritable Bowel Syndrome- a disorder of the large intestine that causes abdominal pain, bloating, constipation, or diarrhea. IBS may be caused by infection or a problem in the gut brain connection.

Keloid- a thick, raised area on the skin formed by overproduction of scar tissue.

Kinin System- a vital system involved in healing after injury or inflammation. The kinin system produces hormones, proteins, and peptides that help process pain signals and regulate blood pressure.

Lactobacillus- anaerobic bacteria commonly found in healthy gut microbiota. They convert sugar to lactic acid, and are widely used as probiotics.

Leaky Gut Syndrome- a condition in which the tight junctions in the lining of the gastrointestinal tract are compromised and pathogens are allowed to pass through, creating inflammation and dysbiosis.

Leukocytes- a colorless cell that circulates in the blood and body fluids and is involved in counteracting foreign substances and disease; a white (blood) cell. There are several types, all amoeboid cells with a nucleus, including lymphocytes, granulocytes, monocytes, and macrophages. 80

Lipid Membranes- a compound that is structurally similar to fats and oils and forms the double-layered surface of all cells (lipid bilayer). The three major classes of membrane lipids are phospholipids, glycolipids, and cholesterol.

Lipid Peroxidation- the oxidative degradation of lipids. It is the process in which free radicals "steal" electrons from the lipids in cell membranes, resulting in cell damage. This process proceeds by a free radical chain reaction mechanism.

Lymphedema- a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system, which normally returns interstitial fluid to the thoracic duct, then the bloodstream.

Lymphocyte- a form of small leukocyte (white blood cell) with a single round nucleus, occurring especially in the lymphatic system.

Macrophage- a type of white blood cell that intercepts and digests pathogens through phagocytosis.

Mast Cell- a cell filled with basophil granules, found in numbers in connective tissue and releasing histamine and other substances during inflammatory and allergic reactions.

Membrane Attack Complex (MAC)- An abnormal activation of the complement (protein) portion of the blood that forms a cascade reaction and brings blood proteins together, binds them to the cell wall, and then inserts them through the cell membrane.

Meningitis- inflammation of the membranes that surround the brain and spinal cord, typically caused by virus or bacteria.

Metabolism- the chemical and physically processes that occur within a cell to convert nutrients into energy.

Metabolites- metabolites refers to both the molecules necessary for the process of metabolism and the molecules that result from metabolism.

Metal Carrier Proteins- A protein that transports specific substance through intracellular compartments, into the extracellular fluid, or across the cell membrane. 81

Mitochondria- organelles often referred to as the “powerhouse” of the cell. They convert nutrients and oxygen into cell energy.

Monocytes- a large phagocytic white blood cell with a simple oval nucleus and clear, grayish cytoplasm.

Multiple Sclerosis- an autoimmune disease in which the immune system attacks and destroys the protective membranes that surround nerve cells and inhibits communication between the brain and the rest of the body. Symptoms vary, but often include pain, fatigue, and loss of coordination.

Myositis- inflammation and degeneration of muscle tissue.

Neutrophil- the most abundant type of white blood cells in the body. Neutrophils are the first immune cells sent to the sight of infection or injury and are a vital component of the innate immune system.

Neurotransmitter- chemicals released by the nervous system to facilitate communication between cells of the nervous, muscular, and endocrine systems.

Omega 3-Fatty Acids- A class of essential fatty acids found in fish oils, especially from salmon and other cold-water fish, that acts to lower the levels of cholesterol and LDL (low-density lipoproteins) in the blood. (LDL cholesterol is the "bad" cholesterol.)

Omega 6- a liquid polyunsaturated fatty acid that occurs in some plant oils; an essential fatty acid. An unsaturated fatty acid whose carbon chain has more than one double or triple valence bond per molecule; found chiefly in fish and corn, soybean, and safflower oils.

Opsonizes- make (a foreign cell) more susceptible to phagocytosis.

Osteoporosis- a disease of the skeletal system in which bones become weak and brittle. Osteoporosis is typically caused by hormone changes or medications. The disease does not typically present symptoms and diagnosis usually occurs after a fracture. 82

Oxidative Stress- an imbalance between the production of free radicals and the ability of the body to counteract or detoxify their harmful effects through neutralization by antioxidants.

Oxytocin- a hormone released by the pituitary gland that causes increased contraction of the uterus during labor and stimulates the ejection of milk into the ducts of the breasts.

Parkinson’s Disease- a progressive neurological disease caused by under production of dopamine in the brain. The disease affects movement and causes tremors which increase in severity as the disease progresses.

Pathogen- a bacterium, virus, or other microorganism that can cause disease.

Peptic Ulcer- a sore on the lining of the small intestine, stomach, or esophagus. Peptic ulcers are caused by an increase in gastric acid due to bacterial infection or anti- inflammatory medication.

Periodontitis- an inflammatory infection of the gums that can lead to destruction of the jawline.

Pernicious Anemia- a decrease in the production of red blood cells that occurs when the body cannot properly absorb Vitamin B12.

Peristalsis- the involuntary constriction and relaxation of the muscles of the intestine or another canal, creating wavelike movements that push the contents of the canal forward.

Phagocytes- a type of cell within the body capable of engulfing and absorbing bacteria and other small cells and particles.

Phagocytosis- the ingestion of bacteria or other material by phagocytes and amoeboid protozoans.

Plasma- the colorless fluid part of blood, lymph, or milk, in which corpuscles or fat globules are suspended.

Post-Traumatic Stress Disorder- a mental health disorder triggered by a traumatic event. Symptoms include anxiety, insomnia, flashbacks, and depression. 83

Prebiotic- a food, typically plant fiber, that feeds probiotic bacteria.

Probiosis- healthy ecological composition of gut microbiota.

Probiotics- a microorganisms introduced into the body for its beneficial qualities.

Psoriasis- an immune condition in which skin cells build up and form a dry, scaly rash. Triggers include cold weather, stress, and infections.

Reactive Arthritis- joint pain, swelling, and stiffness triggered by an infection. Symptoms may begin within days or weeks of the infection.

Regeneration- the healing process of fully restoring damaged tissue to previous form and function.

Repair- the healing process of replacing damaged tissue with scar tissue. Repair occurs when regeneration and resolution are not possible.

Resolution- the healing process in which previous form and function of damaged tissue is partially restored.

Rheumatoid Arthritis- an autoimmune disease in which the immune system attacks the body’s joints. In severe cases, internal organs may also be affected.

Rigidity- inability to be moved or flexed.

Sensitization- a non-associative learning process in which repeated administration of a stimulus results in the progressive amplification of a response. Sensitization often is characterized by an enhancement of response to a whole class of stimuli in addition to the one that is repeated.

Sepsis- a complication that may occur during an infection, if the immune response creates inflammation throughout the body and pathogens are allowed to rapidly multiply. Symptoms include increased heart rate, confusion, and respiratory issues.

Serotonin- a compound present in blood platelets and serum that constricts the blood vessels and acts as a neurotransmitter.

Short Chain Fatty Acids- also referred to as volatile fatty acids (VFAs), are fatty acids with two to six carbon atoms. Free SCFAs can cross the blood-brain barrier via monocarboxylate transporters. 84

Spasticity- a condition of the central nervous system in which muscles are continuously and involuntarily contracted. Prolonged spasticity leads to the development of contractures.

Staphylococcus- a genus of bacteria with over forty species. Many are harmless and live in gut microbiota and on skin surfaces. Staph infections occur with bacteria overgrowth.

Sjogren Syndrome- an autoimmune disease in which the immune system attacks the cells that produce tears and saliva, leading to dry eyes and mouth. Sjogren syndrome typically occurs in conjunction with another autoimmune disease.

Sympathetic Nervous System- the part of the autonomic nervous system that contains chiefly adrenergic fibers and tends to depress secretion, decrease the tone and contractility of smooth muscle, and increase heart rate

Systemic Lupus Erythematosus- an autoimmune disease in which the immune system attacks the body’s healthy tissue. Nearly any body tissue may be targeted, including that of the skin, joints, and vital organs.

T-Cell- a type of lymphocyte produced or processed by the thymus gland that actively participates in the immune response.

Tendonitis- inflammation of the tendons, the tissues that connect muscle to bone.

Tuberculosis- a highly infectious bacterial disease of the lungs. Symptoms include fever, cough, and night sweats, though many cases are asymptomatic.

Type 1 Diabetes- an autoimmune disease in which the immune system attacks insulin producing cells in the pancreas, leaving the body unable to produce insulin. Type 1 diabetes typically develops during childhood.

Type 2 Diabetes- a disease of the endocrine system in which the pancreas does not produce adequate levels of insulin. Type 2 diabetes occurs when the body becomes insulin resistant and may be influenced by diet and lifestyle.

Ulcerative Colitis- an autoimmune disease that causes chronic inflammation in the large intestine. Symptoms include abdominal pain and rectal bleeding. 85

Vagus Nerve- the longest cranial nerve; facilitates the gut brain connection and helps regulate the heart, lungs, and digestive system.

Virus- an infective agent that typically consists of a nucleic acid molecule in a protein coat, is too small to be seen by light microscopy, and is able to multiply only within the living cells of a host.

Vitiligo- a disease of the skin that occurs when pigment producing cells don’t function properly. Loss of color may occur in large blotches on any area of the skin surface.

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