Optimizing the Gut Microbiome!

dr-pincott-header-pinkingrid-croppedMicrobiota refers to the individual microbes in the body (about three pounds in weight), whereas the microbiome refers to the genome of these microbes, of which there are about 4 million. The gut microbiome is essential for the maturation and the development of the enteric nervous system.
For the past 30-plus years I have made taking a probiotic one of my “Foundations for Health”, in other words I prescribed them to all of my patients. As more research emerges, we are seeing that this practice is not only important for the gut health and the immune system, but also very important as an anti-inflammatory. They will lower lipopolysaccharides or LPS (endotoxin) a potent inflammatory compound. LPS is a component of the outer membrane of gram-negative bacterial cell walls. LPS can be measured by itself, and if elevated suggests that the gut is permeable to LPS allowing it into systemic circulation. In ALS and Autism, LPS is dramatically elevated. High levels of LPS are also found in the obese population and in Alzheimer’s patients. In the case of beta-amyloid production in the brain causing Alzheimer’s, the question is: why is the body trying to protect the brain against inflammation with this overproduction of beta-amyloid? Measuring anti-bodies against LPS more routinely might be the better approach to dealing with the cause of inflammation starting in the gut. LPS or endotoxins cause inflammation, increased intestinal permeability, impaired cytochrome P450 detoxification system, impaired mitochondrial performance and pain sensitization. SIBO, for example, promotes the absorption of endotoxin. Lowering the total microbial load (TML), which includes bacteria, viruses, yeast, bacteriophages and endogenous viruses, reduces inflammation in the body.
The Hygiene Hypothesis is gaining popularity, as we don’t see as many immunological or severe neurological diseases in developing countries with poor hygiene. Soil-based organisms are critically important for enhancing diversity and health-giving properties of the human microbiome. Babies born by Caesarean have lifelong consequences for immunity and inflammation as they lack the inoculation from the vaginal flora. Another problem in today’s medical practices is the gross overuse of antibiotics. With the very real threat of antibiotic resistance just around the corner, and the impact antibiotics have on the microbiome, we must put a focus on eliminating them from practice completely, and instead turn to natural alternatives.
Another important aspect of gut micrbiome health is the use of prebiotics. Prebiotics are fibres that were consumed by our hunter-gatherer forbears at around 125 grams per day. By modern comparison, the average North American only consumes about 5 grams! Fibre enhances the balanced production of three short-chain fatty acids: acetic acid, propionic acid and butyric acid.
In his textbook, Brain Inflammation and Textbook of Clinical Nutrition and Functional Medicine, Dr. Vasquez explains in detail the inflammatory connection, and dysbiosis of the microbiome. In the 1990s, dysbiosis referred exclusively to gastrointestinal dysbiosis, but now dysbiosis is found in the mouth, sinuses, genitourinary tract, skin and parenchymal tissues. Each type of dysbiosis corresponds with a different pattern of inflammation, such as dermatitis, vasculitis, reactive arthritis and certain autoimmune diseases. In clinical practice these patients exhibit sustained, low-grade inflammation. Underlying contributors are mitochondrial impairment, metabolic dysfunction, pro-inflammatory diet, multifocal dysbiosis, psycho-emotional and physical stressors, hormone imbalances, xenobiotic toxicity and immune system imbalances.
Promedics is pleased to provide Canadians a few of the Klaire Labs Probiotics. We all have our favourites in our practices, but you may want to branch out and try a few new ones. Klaire Labs provides research linking the microbiome to brain health and their benefits for Alzheimer’s Disease and Autism, as well as diabetes and immune diseases.

Gut Talk Along the HPA Axis
During treatment protocols, it is critical to follow a low-carbohydrate diet. Following high-carbohydrate meals, there are rapid fluctuations in blood glucose, depletion of serotonin and dopamine, B-vitamins and magnesium. All of these changes contribute to glycation, insulin resistance, depression, anxiety and neurodegeneration, hence, the importance of optimizing the microbiota using high-potency probiotics.

Patient Protocol for a Healthy Microbiome

  1. Avoid antibiotics. Use Echinacea Premium (can be taken all year long) or Andrographis Complex for optimal immune support without diminishing our friendly, beneficial gut bacteria.
  2. Nordic Naturals Fish Oils: 3000 mg per day of EPA and DHA for healthy integrity of gut mucosa as well as immune support.
  3. Smoothie: Greens First with Dream Protein for optimal protein and antioxidant status for patients with poor diets.
  4. Klaire Labs: Ther-Biotic Complete: 25 billion microroganisms per capsule for treatment of GI symptoms. Can be taken up to 4 times per day or more, or one per day for maintenance; ABx support for treatment during and after antibiotics; Ther-Biotic D for use during detoxification programs, and S. Boulardii for treatment of diarrhoea or dysentery.
  5. Diet low in carbohydrates, low in food allergens, low in alcohol.
  6. Citricidal Caps Plus: this has been my favourite remedy for dysbiosis for years. I always start my patients with 3 months of Citridical Caps Plus at 3 per day. Additionally, supplement with MediHerb Garlic at one per day, both taken at breakfast, and a probiotic taken at dinner. If not effective then I move them into a SIBO protocol.
  7. Get patients off proton pump inhibitors and other antacid drugs as much as possible (they contribute to SIBO).
  8. Look for deficiencies in folic acid and B12 caused by dysbiosis.
  9. Consider measuring antibodies to LPS in your difficult patients.
  10. Consider using GI MAP genetic testing, to diagnose and treat the microbiome very specifically in chronic disease management.

 

Women’s Health

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When I get female patients of reproductive age complaining of common ailments such as anxiety and stress, I like to review my Foundations of Health with them. I find simply following the basic guidelines outlined below can make a world of difference.

Insomnia: Sleep is always the first thing I inquire about with any patient. Getting enough sleep is necessary for a healthy immune system, maintaining a healthy body weight, memory, and it helps lower the risk of type 2 diabetes. Valerian Complex contains passionflower, zizyphus (good for dream disturbed sleep) and valerian. If the patient does not have a paradoxical reaction to valerian, it may be as effective as the benzodiazepines and valium in improving sleep quality. It is also a great muscle relaxant. It has been used at 1 tablet 3-4 times during the day for severe insomnia, panic attacks, restlessness, depression and anxiety.

Anxiety: The first thing to rule out is blood sugar irregularities and food sensitivities. Often by increasing protein intake, the blood sugar regulates and anxious reactions go away. Kava can be taken during the day, as needed (1-3 per day), for generalized anxiety disorder (GAD). It also improves the quality and recuperative effects of sleep and can increase sex drive. St. John’s Wort increases nocturnal melatonin and helps with sleep disorders, as well as anxiety. Causes increased photosensitivity, so do not use this herb in the summer months.

Mild to moderate depression: St. John’s Wort or Nevaton, and B-complex (deficiency due to the use of birth control pills) should be considered. Due to stresses of everyday life, most patients need extra B-complex to help with stress, anxiety and depression.

Hormone Regulation: Tribulus Forte is a herb that balances the hypothalamus. It has been documented in Bulgarian trials to benefit female infertility and enhance performance amongst athletes. Dr. Francesca Naish Fertility Clinics use it for PCOS on days 5-14 to help regulate the menstrual cycle to improve conception. Pituitary Support is provided by Chaste Tree, which supports fertility through normalizing progesterone levels by decreasing prolactin. Chaste Tree balances the menstrual cycle and eases many symptoms associated with PMS; is a dopaminergic agonist; can be used for endometriosis and fibroids; increases melatonin production by 60%; and, is used in the treatment of mastalgia and FBD.

Adrenal support or stress support: Most hormonal imbalances require adrenal support in the form of adaptogens such as Rehmannia Complex and Withania Complex. Rehmannia Complex acts as an anti-inflammatory for chronic inflammation via the adrenal glands and lowers ESR. It is great for autoimmune diseases such as Graves Disease, Hashimoto’s Thyroiditis, SLE and RA. Kerry Bone uses it with Boswellia Complex to further reduce inflammation. Keep in mind that Withania Complex contains licorice, so monitor blood pressure in susceptible patients. It boosts energy, increases endurance, stamina, and improves appetite in children. Nevaton (the Canadian formula does not contain Damiana) is known as a “road rage” formula for out of control stress, PMS, wired, aggressive and agitated patients. It also has an anti-depressant effect from the St. John’s Wort.  I also recommend my sheet on 53 Stress Reducers.

Estrogen excess in cases of uterine fibroids and menorrhagia, LivCo can be used to help with estrogen clearance through the liver, and Chaste Tree to balance estrogen and progesterone. Anti-oxidants (Vitanox), essential fatty acids (Ultimate Omega), Vitamin E, and anti-inflammatory herbs such as Rehmannia Complex, Wild Yam Complex, and Boswellia Complex. Wild Yam Complex contains Black Cohosh, and Shatavari, which normalizes estrogen production and balance.

Peri- and menopausal years: In addition to the above support consider Wild Yam Complex to help with irritability, PMS, hot flushes, excessive perspiration and depression.

Immune system support: Astragalus Complex supports the immune system of women who are adrenally exhausted by improving vitality, enhancing response to stress, speeding recovery from infection and post viral syndromes. I recommend taking it for months at a time. Echinacea Premium invokes an immune response through Hsp 70 (Heat Shock Proteins) expression. I recommend one per day, year-round for immune support.