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AHS Slides_DrBG and Tim Gerstmar

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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
  4. 4. Bacteria YOU All HAIL OUR BACTERIAL OVERLORDS!
  5. 5. GUT BRAIN IMMUNE ENDOCRINE BIOME
  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

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