AHS Slides_DrBG and Tim Gerstmar


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  • wonderful lecture....so informative PALEO PLUS = exemplary health

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  • Crosstalk – ‘carb repretoire’ polysaccharides GLYCOSAMINOGLYCANS –(N-acetyl-glucosamine)
  • B, subtilis S. Thermophilus Stimulate IFN Combat and kill mold, yeasts, fungi, candida otherwise no lush growth
  • An obesity-associated gut microbiome with increased capacity for energy harvest. Turnbaugh, et al. Nature. 2006;444(7122):1027-1031 • Purpose : To transplant microbiota from lean and obese mice into germ free mice to show the composition of the gut microbiota is important in determining weight • Results: Mice colonized with obese microbiota extracted more calories from food and showed a significantly greater weight gain than did mice that received the microbiota from lean mice • Suggests : Difference in caloric extraction of ingested food substances may be determined by the composition of the gut microbiota
  • Eat with our eyes…Mastication
  • 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
  • Intestinal Permeability Factors   Broad Spectrum Antibiotics -Pharmaceutical -Food chain: diary, eggs, industrial livestock, farmed fish -Water supply (chlorine, anti-coliforms) -Hand sanitizers/soaps (benzalkonium Chloride, triclosan, parabens, fragrance/phthlates, etc)   Dietary neolithic agents -Gluten -Dairy -Legumes (unsoaked, uncooked), SOY OY, carrageenan, guar gum, etc -Insidious n-6 PUFA vegetable oils -Food allergens: eggs, nightshades, whatever passes -Big Agra/imported produce and fruits   Antifungals -Natamycin; bromide pesticides, drugs   Excessive hygiene (DIRT DEFICIENCY)   Endurance exercise
  • Immunological cross reactivity between Candida albicans and human tissue. Vojdani A, Rahimian P, Kalhor H, Mordechai E. J Clin Lab Immunol. 1996;48(1):1-15. IgA and IgG serum antibodies to Candida albicans in women of child-bearing age. Manning-Zweerink M, Maloney CS, Mitchell TG, Weston H. J Clin Microbiol. 1986 Jan;23(1):46-52. 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. Antibrain antibodies in children with autism and their unaffected siblings. Singer HS, Morris CM, Williams PN, Yoon DY, Hong JJ, Zimmerman AW. J Neuroimmunol. 2006 Sep;178(1-2):149-55. Brain-specific autoantibodies in the plasma of subjects with autistic spectrum disorder. Cabanlit M, Wills S, Goines P, Ashwood P, Van de Water J. Ann N Y Acad Sci. 2007 Jun;1107:92-103. Maternal antibrain antibodies in autism. Zimmerman AW, Connors SL, Matteson KJ, Lee LC, Singer HS, Castaneda JA, Pearce DA. Brain Behav Immun. 2007 Mar;21(3):351-7. Detection of maternal antibodies in infantile autism. Warren RP, Cole P, Odell JD, Pingree CB, Warren WL, White E, Yonk J, Singh VK. J Am Acad Child Adolesc Psychiatry. 1990 Nov;29(6):873-7. Autoantibodies to cerebellum in children with autism associate with behavior. Goines P, Haapanen L, Boyce R, Duncanson P, Braunschweig D, Delwiche L, Hansen R, Hertz-Picciotto I, Ashwood P, Van de Water J. Brain Behav Immun. 2011 Mar;25(3):514-23. Klebsiella pneumonia: nitrogenase, etc [anti-collagen] – HLA B27 Yersinia, Candida, etc -- Hashimoto’s/Graves – HLA DR3 or DR4 Gut flora, enterobacter, candida, casein/gluten [anti-cerebellar, fetal brain protein] -- HLA-DR B1 gene is associated with both RA and infantile autism, implying that RA and infantile autism may have some common genetic background. Other immune-based genes found associated with ASDs include HLA-DR4,25,26 HLA-DR13,25 and HLA-A2.27
  • 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 Bohme M, Diener M, Mestres P, Rummel W. Direct and indirect actions of HgCl2 and methyl mercury chloride on permeability and chloride secretion across the rat colonic mucosa. Toxicol Appl Pharmacol 114: 285–294, 1992.
  • AHS Slides_DrBG and Tim Gerstmar

    1. 1. 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
    2. 2. You're here! We're so glad, we thought you'd be with Gary Taubes!
    3. 3. <ul><li>Dr. Tim Gerstmar, ND </li></ul><ul><li>Seattle, WA </li></ul><ul><li>Private Practice </li></ul><ul><li>Dr. BG, PharmD </li></ul><ul><li>San Ramon, CA </li></ul><ul><li>Co-Author of Jillian’s Story </li></ul>The Rainforest In Your Gut
    6. 6. Overview <ul><li>Impact of Ancestral, Paleo Diet </li></ul><ul><li>Brief Tour of the Rainforest in Your Gut </li></ul><ul><li>Role of Ancestral, Fermented Foods </li></ul><ul><li>Intestinal flora, the who, what, when, where, and how and Why it's messed up </li></ul><ul><li>Eliminating SIBO/Intestinal Permeability </li></ul><ul><li>Self quiz - are your guts messed up? Do you have chronic disease? </li></ul><ul><li>Stool testing </li></ul><ul><li>Antimicrobials - prescription and natural </li></ul><ul><li>Recolonization - probiotics and fermented foods </li></ul><ul><li>Other supportive adjuncts - detoxification, chelation, neurologic (improve vagus tone) </li></ul><ul><li>Q&A (as time permits or after presentation) </li></ul>
    7. 7. Impact of Ancestral, Paleo Diet <ul><li>My daughter, Missy ‘N’ Story </li></ul><ul><ul><li>Chronic constipation, occasional bloody stools </li></ul></ul><ul><ul><li>What failed? </li></ul></ul><ul><ul><li>What worked? 2 weeks of Paleo </li></ul></ul>
    8. 8. Impact of Ancestral, Paleo Diet <ul><li>My niece, Jillian’s Story </li></ul><ul><ul><li>Mild autism at birth, poor muscle tone </li></ul></ul><ul><ul><li>What failed? </li></ul></ul><ul><ul><li>What worked? Paleo diet, probiotics, digestive enzymes </li></ul></ul>
    9. 9. Brief Tour of The Rainforest Biome <ul><li>Emergent Layer ( Lumen ) GI contents, Feces </li></ul><ul><li>Canopy ( Interface/Lumen ) – Commensal microbial community, Biofilms </li></ul><ul><li>Understory ( Mucus ) – Protective layer, ‘Food’ for microbial fermentation (fucose) </li></ul><ul><li>Forest floor ( Epithelium ) – Enterocytes, Microvilli </li></ul>Photo Credit: Author Permission
    10. 10. <ul><li>Gut = THE Immune System (60-70% immunoglobulins in gut) </li></ul><ul><li>Gut = 2 nd Brain (~500 million neurons, serotonin, microbial) </li></ul>
    11. 11. Dirt: The New Prozac
    12. 12. Role of Ancestral Diet: Fermented Foods <ul><li>Grandma used to knead mustard against cement patio </li></ul><ul><li>Special ingredient: d-i-r-t </li></ul><ul><li>Pao cai </li></ul>Photo credit: http://eatingasia.typepad.com/eatingasia/2010/04/shan-pickle-its-whats-for-dinner.html
    13. 13. Gut-Brain-Adipose Axis <ul><li>GABA  ‘chill-laxing’ </li></ul><ul><li>Microbial Endocrinology </li></ul><ul><li>(Microbial) Obesity </li></ul><ul><ul><li>Turnbaugh et al. Nature 2006 </li></ul></ul><ul><li>GABA-rich Fermented foods </li></ul><ul><ul><li>Italian cheeses </li></ul></ul><ul><ul><li>Pao cai (Chinese pickle) </li></ul></ul><ul><ul><li>Shoyu </li></ul></ul><ul><ul><li>Kim chee, fermented squid (jeotgal) </li></ul></ul><ul><ul><li>Sauerkraut </li></ul></ul><ul><ul><li>Yogurt </li></ul></ul><ul><ul><li>Vinegars </li></ul></ul><ul><ul><li>Fermented soy products </li></ul></ul><ul><ul><li>Fermented black raspberry juice (L. brevis) </li></ul></ul><ul><li>Gut IQ? </li></ul><ul><ul><li>Comprehensive Stool Data Analysis (CSDA) </li></ul></ul><ul><ul><ul><li>Culture </li></ul></ul></ul><ul><ul><ul><li>DNA PCR </li></ul></ul></ul><ul><ul><li>Urinary Indican (dysbiotic bacteria degrade tryptophan (5HT precursor) into indican) </li></ul></ul>
    14. 14. Phases of Digestion: Cephalic, Gastric, Intestinal
    15. 15. SIBO/Leaky Gut/Permeability <ul><li>Blunted, denuded, or absent microvilli </li></ul><ul><li>Missing: brush border dipeptidases and enzymes to breakdown poly-, disaccharides; lactase; carriers for fructose (GLUT5) and trace minerals (zinc) </li></ul>Photo credit: Author Dr.Finlay’s Permission
    16. 16. M-A-J-O-R Malabsorption <ul><li>Starch and FODMAP intolerances </li></ul><ul><ul><li>Fermentation, auto-intoxication (alcohol, NM toxins), bloating, gas </li></ul></ul><ul><li>Protein intolerance (Putrefaction), ‘hard-gainer’ </li></ul><ul><li>Fat intolerance </li></ul><ul><li>UNDIGESTED </li></ul><ul><li>Protein </li></ul><ul><li>FODMAPs F ermentable </li></ul><ul><li>Oligosaccharides </li></ul><ul><li>Disaccharides </li></ul><ul><li>Monosaccharides </li></ul><ul><li>And </li></ul><ul><li>Polyols </li></ul><ul><li>Fructose (GLUT5) </li></ul><ul><li>Fructans (polymers of fructose), FOS, Inulin </li></ul><ul><li>Lactose </li></ul><ul><li>Zinc, Magnesium </li></ul>Photo Credit: Open Access, Creative Commons
    17. 17. Why Is The Gut Messed Up? <ul><li>Compromised Permeability </li></ul><ul><li>Absorption of substances not normally </li></ul><ul><ul><li>Food: undigested proteins, fats, gluten, casein </li></ul></ul><ul><ul><li>Pathogens: bacteria, yeasts, viruses </li></ul></ul><ul><li>Leaky gut, Small intestinal overgrowth (SIBO) </li></ul><ul><li>Food allergies start </li></ul><ul><li>Bacterial Translocation </li></ul><ul><li>Autoimmunity, CICs </li></ul><ul><li>Chronic Diseases of Western Civilizations </li></ul>
    18. 18. Persistence of Permeability <ul><li>Fibromyalgia (100%) </li></ul><ul><li>IBS (84%) </li></ul><ul><li>Hypothyroidism (54% v. 5%) </li></ul><ul><li>Rosacea (46% v. 5%) </li></ul><ul><li>Type 2, Type 1 Diabetes </li></ul><ul><li>NASH/Fatty Liver </li></ul><ul><li>Obesity </li></ul><ul><li>Congestive Heart Failure (35% small, 210% large int) </li></ul><ul><li>Autism (40% v. 0%) </li></ul><ul><li>1 st Degree Autism Relative ( 21.2% v. 4.8%) </li></ul><ul><li>Infantile Colic </li></ul>
    19. 19. Circulating Immune Complexes <ul><li>Increase with autoimmune disorders, sx and chronic disease progression: </li></ul><ul><ul><li>Against gut bacteria, gut yeast, undigested food </li></ul></ul><ul><ul><li>Affects any organ, any vessel, any joint </li></ul></ul><ul><li>Symptom improvements correspond with decrease </li></ul><ul><ul><li>In Candida vaginitis, resumption of menses correlated with lower IgG </li></ul></ul><ul><li>Anti-ovarian and anti-lymphocyte antibodies in patients with chronic vaginal candidiasis. </li></ul><ul><li>Mathur S, et al. J Reprod Immunol. 1980, Dec;2(5):247-62. </li></ul><ul><li>Prayers, perseverance, proteolytic enzymes, personalized paleoRx </li></ul><ul><li>Treatment: </li></ul><ul><ul><li>(a) Proteolytic enzymes between meals (chews up CICs and eliminated in bile, feces) </li></ul></ul><ul><ul><li>(b) Maintain BM, bile flow </li></ul></ul><ul><ul><li>(c) Juicing supports raw, digestive enzymes </li></ul></ul><ul><ul><li>(d) Role of raw ancestral foods and beverages… </li></ul></ul>
    20. 20. Eliminating SIBO/Leaky Gut, Eliminates Disease <ul><li>IBS (elemental diet normalizes 85% LHBT with 66.4% v. control 11.9% GI improvements) </li></ul><ul><ul><li>Pimental et al, 2004 </li></ul></ul><ul><li>Rosacea is a translocation of the gut flora +skin toxins (unabsorbed antibiotic) </li></ul><ul><ul><li>Parodi A et al, 2008 </li></ul></ul><ul><li>Infantile Colic (L. reuteri; crying reduced 370 to 35 min; 24% v. 15% responders) </li></ul><ul><ul><li>Savino F et al, 2010 </li></ul></ul><ul><li>Hypertension (L. helveticus) </li></ul><ul><ul><li>Aihara K et al, 2005 </li></ul></ul><ul><ul><li>Korpela R et al, 2005 </li></ul></ul><ul><li>Autism (DMSA chelator, mercury increases intestinal permeability) </li></ul><ul><ul><li>Adams J et al, 2010 </li></ul></ul>Photo credit: Author Dr. Finlay’s Permission. Finlay BB et al. Physiol Rev 2010; 90: 859–904.
    21. 21. Elemental Diets Coconut oil
    22. 22. Pharming the Gut <ul><li>Host microvilli produce fucose, sialic acid, and other carbs which gut flora feed on </li></ul><ul><ul><li>Bacillus Thetaiotaomega </li></ul></ul><ul><li>Gut flora eat and consume, then excrete end-products including Vitamin B12 (coprophagy?), Vitamin K, Biotin, Riboflavin, Niacin, Folate </li></ul>SEM of Bacteria in Mouse Ileum. Source: Ken Rozee et al., Microbe Library, ASM. http://schaechter.asmblog.org/schaechter/2007/08/microbial-endoc.html
    23. 23. Overwhelming Association of SIBO/Intestinal Permeability <ul><li>Fibromyalgia (100%) </li></ul><ul><li>IBS (84%) </li></ul><ul><li>Hypothyroidism (54% v. 5%) </li></ul><ul><li>Rosacea (46% v. 5%) </li></ul><ul><li>Type 2, Type 1 Diabetes </li></ul><ul><li>NASH/Fatty Liver </li></ul><ul><li>Obesity </li></ul><ul><li>Congestive Heart Failure (35% small, 210% large int) </li></ul><ul><li>Autism (40% v. 0%) </li></ul><ul><li>1 st Degree Autism Relative ( 21.2% v. 4.8%) </li></ul><ul><li>Infantile Colic </li></ul><ul><li>Crohn’s Disease </li></ul><ul><li>Ulcerative Colitis </li></ul><ul><li>Celiac Disease </li></ul><ul><li>Asthma </li></ul><ul><li>Cystic Fibrosis </li></ul><ul><li>Interstitial cystitis </li></ul>
    24. 24. Gliadin-Busters: B. subtilis, B. lactis
    25. 25. Elemental Diet Eradicates SIBO/Leaky Gut <ul><li>Antibiotics not work long-term in studies for IBS </li></ul><ul><li>14-Day Elemental diet controlled SIBO in IBS with long-term efficacy (n=93), Pimental et al </li></ul><ul><ul><li>Results: 85% normalized LBT with 66.4% sx improvement (11.9% p < 0.001) </li></ul></ul><ul><li>Why? </li></ul><ul><ul><li>Eliminated food allergens: FODMAPs, gluten, dairy </li></ul></ul><ul><ul><li>Allowed healing of enterocytes </li></ul></ul><ul><ul><li>Sealing up of epithelial lining prevented undigest food to initiate circulating immune complexes </li></ul></ul><ul><ul><li>Functional enterocytes nurture beneficial gut flora and brush border enzymes produced for digestion of food </li></ul></ul>
    26. 26. Impact of Ancestral, Paleo Diet <ul><li>My Story </li></ul><ul><li>Hashimoto’s, 1992 </li></ul><ul><ul><li>What failed? </li></ul></ul><ul><ul><li>What worked? </li></ul></ul><ul><li>Obesity, 2002 </li></ul><ul><ul><li>What failed? </li></ul></ul><ul><ul><li>What worked </li></ul></ul><ul><li>Metal-Dysbiosis, 2011 </li></ul><ul><ul><li>What failed? </li></ul></ul><ul><ul><li>What worked? </li></ul></ul>
    27. 27. Malabsorption v. celiac v. tropical sprue <ul><li>Brush border enzymes </li></ul><ul><ul><li>Maltase, sucrase, lactase, trehalase, saccharase, alkaline phosphatase </li></ul></ul><ul><li>Pancreatic enzymes </li></ul><ul><ul><li>Trypsin, chymotrypsin </li></ul></ul>
    28. 28. Probiotic Weight Loss (mice)
    29. 29. Dysbiosis 1. Pathogens 2. Imbalance Bacteria Yeast Parasites
    30. 30. Dysbiosis Intestinal permeability Inflammation Malabsorption/ Malnutrition Food sensitivity
    31. 31. How do you know? 1. Symptoms 2. Prebiotic challenge 3. Indican test 4. Testing
    32. 32. Symptom questionnaire 1. Significant health problems 2. Gas / bloating 3. Heartburn / GERD 4. Constipation / Diarrhea 5. Blood in stool / mucus / undigested food
    33. 33. Prebiotic fiber challenge ¼ – 1 tsp of inulin once-twice a day Lots of gas, bloating = positive test
    34. 34. Urinary indican test Measures tryptophan degradation by gut bacteria Requires chloroform
    35. 35. Stool testing
    36. 46. 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”
    37. 47. Diet STARVE THEM! Carbohydrates feed bacteria and other pathogens
    38. 48. Avoid: 1. Sugars 2. Most/all Fruits 3. Grains Other possible gut irritants: 4. Dairy 5. Soy 6. Alcohol 7. Other lectins – legumes, nightshades
    39. 49. Eat: 1. Vegetables 2. Fermented foods 3. Meats 4. Possibly some fruits 5. Coconut Time Frame: 10-60 days
    40. 50. Herbal Anti-microbials Anti-bacterials Goldenseal Oregano oil Oregon grape Chinese Goldenthread Yerba Mansa
    41. 51. Herbal Anti-microbials Anti-fungals Undecylenic acid Caprylic acid Uva ursi Cat's claw Pau D'arco
    42. 52. Herbal Anti-microbials Anti-parasitic Olive leaf extract Garlic Wormwood Black walnut
    43. 53. 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
    44. 54. Gut healing formulas Glutamine DGL Aloe vera extract Marshmallow Slippery Elm Gamma oryzanol MSM Spanish moss Calendula Chamomile
    45. 55. 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
    46. 56. Brain support Another presentation Increase brain output through vagus nerve 1. Modulate neurodegeneration 2. Reduce inflammation 3. Balance blood sugar 4. Neurotransmitter support
    47. 57. Dysbiosis Intestinal permeability Inflammation Malabsorption/ Malnutrition Food sensitivity
    48. 58. 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