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


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.

Before Mental Health Month Ends..


ingrid-croppedDepression and anxiety are the world’s leading disabilities; recent studies show that one in six people are prescribed psychiatric drugs, and SSRI’s are the second-most common medication taken worldwide. Naturopathic physicians are in the perfect position to offer alternative support to this population of patients, mainly because they spend more than 8-10 minutes per visit with their patients, and thus can help identify underlying causes, and avoid Band-Aid solutions. What follows are some tips and recommendations to help you optimise your patients’ mental health.

Sanesco Neurotransmitter Testing: Sanesco and Neurolab have provided a large cohort (over 20,000 patients) study of data collected over the past 10 years, to validate the clinical application of urinary neurotransmitter testing, as well as non-drug interventions, to effectively support patients. (Sample report from Sanesco). You may want to consider this testing for your difficult patients who seriously want to get off their medications. Two retests are recommended within 8 months to help you navigate through the three phases of treatment, and achieve optimal HPA axis function.

Sanesco Tranquilent ($24.15 for 30 tabs): this chewable inositol 1000 mg, L-theanine 25 mg and 5-HTP 20 mg combination is effective for pediatrics (not more than 2 per day: see dosing recommendations) and adults (up to 8 per day). It is effective in the treatment of anxiety and obsessive thoughts, and supports serotonin and GABA production in the body. I encourage patients to keep these in their purse or desk and take as needed throughout the day and especially in the evening to help with sleep.

Sanesco Prolent ($56.95 for 60 caps): studies have shown that it is effective in crossing blood-brain barrier to promote melatonin and serotonin production, and help with blood sugar regulation. It contains NSB, a proprietary blend of plant-based fermenting enzymes, and has been shown to reduce toxins and enzyme inhibitors, making them more effective. Bioperine® in NSB™ formulas is another way Sanesco® aims to ensure optimal absorption and efficacy of its nutraceuticals. Not only has piperine been shown to improve digestion, but it also enhances neurological function. Piperine has shown anti-depressant-like activity by increasing the synthesis of 5-HT (serotonin) from 5-HTP (an ingredient in Prolent™)[xviii]. Studies have found that MPTP (associated with Parkinson’s disease) is inhibited by piperine, making it neuroprotective against Parkinson’s disease [xix]. Piperine is also thought to be neuroprotective to the hippocampus, a part of the brain essential for cognition and memory.
Prolent contains B6 20 mg, L-theanine 75 mg and 5-HTP 50 mg. Patients need to be monitored carefully when combining with SSRI’s. Dosed at two caps, taken in the evening or before lunch or dinner for cravings.

Other areas to support when treating anxiety and depression:

  1. Basic support for any anxiety and depression case: the treatment plan should include a B complex; Nordic Naturals Ultimate Omega fish oils or Vital Nutrients Ultra Pure Fish oil: 3000 mg per day; magnesium (Jigsaw Mag SRT), especially taken at bedtime for restless and poor quality sleep; and a multi vitamin and mineral complex (Vital Nutrients: Minimal and Essential). It has amazed me over the years how the above can help in a matter of weeks! Most people who live off the SAD (Standard American Diet) are terribly deficient. Many females are low in iron with serum ferritin less than 60. Once this is treated they feel so much better. (Vital Nutrients: Iron plus C)
  2. Adrenal fatigue: measure level of adrenal fatigue and burnout using salivary testing. Cortisol and DHEA levels can be measured as in the Sanesco testing. MediHerb Combinations to consider: AdrenoCo and Withania Complex (if no blood pressure issues) and Rhodiola & Ginseng.
  3. Thyroid support: many female patients do not have ideal levels of TSH, T3 and T4. Check for autoimmune disease with TPO. See recent blog on thyroid support.
  4. Brain support: for brain fatigue consider: Bacopa Complex and Ginkgo. Kerry Bone has told us he takes up to 9 per day of ginkgo when he is travelling and lecturing. Anyone over the age of 50 might want to take ginkgo to prevent strokes and MCD (mild cognitive decline).  Lions Mane, according to recent research, increases BDNF (brain-derived neuro-factors) in the brain and enhances memory.
  5. Anxiety and Insomnia: Kava Forte, Valerian Complex, St. John’s Wort (be careful of light sensitivity in summer months and is great for SAD: Seasonal Affective Disorder), Nevaton Forte or Mag SRT. The goal is 8 hours of restful sleep per night.
  6. Hormone support: women in peri-menopause and menopause need added support in addition to the above. Consider FemCo, Chaste Tree, Tribulus Forte, Wild Yam Complex and Withania Complex. Consider Vital Nutrients: Menopause Support or Mediherb Wild Yam Complex for hot flushes.
  7. Blood sugar regulation: Gymnema helps with cravings and blood sugar regulation. Dream Protein mixed with Greens First can be used as a morning smoothie for those too stressed or rushed to eat breakfast. It will maintain blood sugar until lunchtime. Even some children will take this combination especially before playing sports. A diet high in protein helps with blood sugar regulation and sugar cravings.
  8. Depression; Mediherb St. John’s Wort provides high levels of “flavonoid glycosides” which increase the bioavailabilty of hypericin, the main active ingredient in St. John’s Wort, to help with depression. Liquid St. John’s Wort does NOT contain any hyperforin.
  9. Food sensitivities: some foods can cause fatigue, anxiety and depression. A gluten-free diet, according to Dr. Mark Hyman in his “Broken Brain” docuseries, is the best diet for depression and anxiety.
  10. Parasympathetic balancing: unplugging from devices, exercise, yoga, meditation, and the Arts are all great for lowering cortisol. When patients are prescribed “The Arts”, visits to MD’s and hospitals are reduced by up to 40%! (Read my 30 Day Intentions handout!).

Until next month!