AHS Slides_DrBG and Tim Gerstmar

The Rainforest In Your Gut Brief Tour of the Biome, Why It’s Messed Up and How To Fix It Art Credit ‘The Happy Enterocyte’: By Gill Danielsen, associated with lab group that studies enterocyte membrane trafficking

You're here! We're so glad, we thought you'd be with Gary Taubes!

Dr. Tim Gerstmar, ND
Seattle, WA
Private Practice
Dr. BG, PharmD
San Ramon, CA
Co-Author of Jillian’s Story
The Rainforest In Your Gut

Bacteria YOU All HAIL OUR BACTERIAL OVERLORDS!

GUT BRAIN IMMUNE ENDOCRINE BIOME

Overview
Impact of Ancestral, Paleo Diet
Brief Tour of the Rainforest in Your Gut
Role of Ancestral, Fermented Foods
Intestinal flora, the who, what, when, where, and how and Why it's messed up
Eliminating SIBO/Intestinal Permeability
Self quiz - are your guts messed up? Do you have chronic disease?
Stool testing
Antimicrobials - prescription and natural
Recolonization - probiotics and fermented foods
Other supportive adjuncts - detoxification, chelation, neurologic (improve vagus tone)
Q&A (as time permits or after presentation)

My daughter, Missy ‘N’ Story
Chronic constipation, occasional bloody stools
What failed?
What worked? 2 weeks of Paleo

My niece, Jillian’s Story
Mild autism at birth, poor muscle tone
What failed?
What worked? Paleo diet, probiotics, digestive enzymes

Brief Tour of The Rainforest Biome
Emergent Layer ( Lumen ) GI contents, Feces
Canopy ( Interface/Lumen ) – Commensal microbial community, Biofilms
Understory ( Mucus ) – Protective layer, ‘Food’ for microbial fermentation (fucose)
Forest floor ( Epithelium ) – Enterocytes, Microvilli
Photo Credit: Author Permission

Gut = THE Immune System (60-70% immunoglobulins in gut)
Gut = 2 nd Brain (~500 million neurons, serotonin, microbial)

Dirt: The New Prozac

Role of Ancestral Diet: Fermented Foods
Grandma used to knead mustard against cement patio
Special ingredient: d-i-r-t
Pao cai
Photo credit: http://eatingasia.typepad.com/eatingasia/2010/04/shan-pickle-its-whats-for-dinner.html

Gut-Brain-Adipose Axis
GABA  ‘chill-laxing’
Microbial Endocrinology
(Microbial) Obesity
Turnbaugh et al. Nature 2006
GABA-rich Fermented foods
Italian cheeses
Pao cai (Chinese pickle)
Shoyu
Kim chee, fermented squid (jeotgal)
Sauerkraut
Yogurt
Vinegars
Fermented soy products
Fermented black raspberry juice (L. brevis)
Gut IQ?
Comprehensive Stool Data Analysis (CSDA)
Culture
DNA PCR
Urinary Indican (dysbiotic bacteria degrade tryptophan (5HT precursor) into indican)

Phases of Digestion: Cephalic, Gastric, Intestinal

SIBO/Leaky Gut/Permeability
Blunted, denuded, or absent microvilli
Missing: brush border dipeptidases and enzymes to breakdown poly-, disaccharides; lactase; carriers for fructose (GLUT5) and trace minerals (zinc)
Photo credit: Author Dr.Finlay’s Permission

M-A-J-O-R Malabsorption
Starch and FODMAP intolerances
Fermentation, auto-intoxication (alcohol, NM toxins), bloating, gas
Protein intolerance (Putrefaction), ‘hard-gainer’
Fat intolerance
UNDIGESTED
Protein
FODMAPs F ermentable
Oligosaccharides
Disaccharides
Monosaccharides
And
Polyols
Fructose (GLUT5)
Fructans (polymers of fructose), FOS, Inulin
Lactose
Zinc, Magnesium
Photo Credit: Open Access, Creative Commons

Why Is The Gut Messed Up?
Compromised Permeability
Absorption of substances not normally
Food: undigested proteins, fats, gluten, casein
Pathogens: bacteria, yeasts, viruses
Leaky gut, Small intestinal overgrowth (SIBO)
Food allergies start
Bacterial Translocation
Autoimmunity, CICs
Chronic Diseases of Western Civilizations

Persistence of Permeability
Fibromyalgia (100%)
IBS (84%)
Hypothyroidism (54% v. 5%)
Rosacea (46% v. 5%)
Type 2, Type 1 Diabetes
NASH/Fatty Liver
Obesity
Congestive Heart Failure (35% small, 210% large int)
Autism (40% v. 0%)
1 st Degree Autism Relative ( 21.2% v. 4.8%)
Infantile Colic

Circulating Immune Complexes
Increase with autoimmune disorders, sx and chronic disease progression:
Against gut bacteria, gut yeast, undigested food
Affects any organ, any vessel, any joint
Symptom improvements correspond with decrease
In Candida vaginitis, resumption of menses correlated with lower IgG
Anti-ovarian and anti-lymphocyte antibodies in patients with chronic vaginal candidiasis.
Mathur S, et al. J Reprod Immunol. 1980, Dec;2(5):247-62.
Prayers, perseverance, proteolytic enzymes, personalized paleoRx
Treatment:
(a) Proteolytic enzymes between meals (chews up CICs and eliminated in bile, feces)
(b) Maintain BM, bile flow
(c) Juicing supports raw, digestive enzymes
(d) Role of raw ancestral foods and beverages…

Eliminating SIBO/Leaky Gut, Eliminates Disease
IBS (elemental diet normalizes 85% LHBT with 66.4% v. control 11.9% GI improvements)
Pimental et al, 2004
Rosacea is a translocation of the gut flora +skin toxins (unabsorbed antibiotic)
Parodi A et al, 2008
Infantile Colic (L. reuteri; crying reduced 370 to 35 min; 24% v. 15% responders)
Savino F et al, 2010
Hypertension (L. helveticus)
Aihara K et al, 2005
Korpela R et al, 2005
Autism (DMSA chelator, mercury increases intestinal permeability)
Adams J et al, 2010
Photo credit: Author Dr. Finlay’s Permission. Finlay BB et al. Physiol Rev 2010; 90: 859–904.

Elemental Diets Coconut oil

Pharming the Gut
Host microvilli produce fucose, sialic acid, and other carbs which gut flora feed on
Bacillus Thetaiotaomega
Gut flora eat and consume, then excrete end-products including Vitamin B12 (coprophagy?), Vitamin K, Biotin, Riboflavin, Niacin, Folate
SEM of Bacteria in Mouse Ileum. Source: Ken Rozee et al., Microbe Library, ASM. http://schaechter.asmblog.org/schaechter/2007/08/microbial-endoc.html

Overwhelming Association of SIBO/Intestinal Permeability
Fibromyalgia (100%)
IBS (84%)
Hypothyroidism (54% v. 5%)
Rosacea (46% v. 5%)
Type 2, Type 1 Diabetes
NASH/Fatty Liver
Obesity
Congestive Heart Failure (35% small, 210% large int)
Autism (40% v. 0%)
1 st Degree Autism Relative ( 21.2% v. 4.8%)
Infantile Colic
Crohn’s Disease
Ulcerative Colitis
Celiac Disease
Asthma
Cystic Fibrosis
Interstitial cystitis

Gliadin-Busters: B. subtilis, B. lactis

Elemental Diet Eradicates SIBO/Leaky Gut
Antibiotics not work long-term in studies for IBS
14-Day Elemental diet controlled SIBO in IBS with long-term efficacy (n=93), Pimental et al
Results: 85% normalized LBT with 66.4% sx improvement (11.9% p < 0.001)
Why?
Eliminated food allergens: FODMAPs, gluten, dairy
Allowed healing of enterocytes
Sealing up of epithelial lining prevented undigest food to initiate circulating immune complexes
Functional enterocytes nurture beneficial gut flora and brush border enzymes produced for digestion of food

My Story
Hashimoto’s, 1992
What failed?
What worked?
Obesity, 2002
What failed?
What worked
Metal-Dysbiosis, 2011
What failed?
What worked?

Malabsorption v. celiac v. tropical sprue
Brush border enzymes
Maltase, sucrase, lactase, trehalase, saccharase, alkaline phosphatase
Pancreatic enzymes
Trypsin, chymotrypsin

Probiotic Weight Loss (mice)

Dysbiosis 1. Pathogens 2. Imbalance Bacteria Yeast Parasites

Dysbiosis Intestinal permeability Inflammation Malabsorption/ Malnutrition Food sensitivity

How do you know? 1. Symptoms 2. Prebiotic challenge 3. Indican test 4. Testing

Symptom questionnaire 1. Significant health problems 2. Gas / bloating 3. Heartburn / GERD 4. Constipation / Diarrhea 5. Blood in stool / mucus / undigested food

Prebiotic fiber challenge ¼ – 1 tsp of inulin once-twice a day Lots of gas, bloating = positive test

Urinary indican test Measures tryptophan degradation by gut bacteria Requires chloroform

Stool testing

So what are you going to do about it? 1. Diet 2. Herbal medicines 3. Prescription medicines 4. Gut healing formulas 5. Pre/Probiotics 6. “Brain support”

Diet STARVE THEM! Carbohydrates feed bacteria and other pathogens

Avoid: 1. Sugars 2. Most/all Fruits 3. Grains Other possible gut irritants: 4. Dairy 5. Soy 6. Alcohol 7. Other lectins – legumes, nightshades

Eat: 1. Vegetables 2. Fermented foods 3. Meats 4. Possibly some fruits 5. Coconut Time Frame: 10-60 days

Herbal Anti-microbials Anti-bacterials Goldenseal Oregano oil Oregon grape Chinese Goldenthread Yerba Mansa

Herbal Anti-microbials Anti-fungals Undecylenic acid Caprylic acid Uva ursi Cat's claw Pau D'arco

Herbal Anti-microbials Anti-parasitic Olive leaf extract Garlic Wormwood Black walnut

Prescription anti-microbials Broad spectrum or targeted by sensitivity testing Synergism - pair anti-microbials with natural compounds Example: Green tea extracts have been shown to reverse antibiotic resistance

Gut healing formulas Glutamine DGL Aloe vera extract Marshmallow Slippery Elm Gamma oryzanol MSM Spanish moss Calendula Chamomile

Pre and Probiotics Prebiotics – soluble fibers, “bacteria food” Probiotics – friendly cultures that have been extracted and can be given supplementally Human strain not cow strain Implantable, colonizing strains Personally: Start with probiotics only. Minimum 25 billion/day. Given with food. Later transition to lower doses with prebiotics included. MUST with antimicrobial use (natural or prescription), given at different times of the day. Fermented foods – eaten daily

Brain support Another presentation Increase brain output through vagus nerve 1. Modulate neurodegeneration 2. Reduce inflammation 3. Balance blood sugar 4. Neurotransmitter support

Dysbiosis Intestinal permeability Inflammation Malabsorption/ Malnutrition Food sensitivity

Feel free to contact us: Tim Gerstmar, ND Aspire Natural Health Redmond, WA (425) 202-7849 www. aspirenaturalhealth .com Facebook.com/AspireNaturalHealth I'm trying out Twitter/Tgerstmar Dr. BG, PharmD Email: RamaRaMAX @ gmail .com Using Science To Recover Health: Hurricane Jillian

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