Course Breakdown: GUT MICROBIOTA - Wisconsin Chiropractic Association
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
3/29/2021
GUT MICROBIOTA
©Jeff Lavell, DC
Normal anatomy of lower GI
Aspects of the microbiome
Fiber/pre‐biotics
Course Pro‐biotics
Breakdown: Abnormal Gut Pathology
• Gut dysbiosis
• IBS/IBD
• Leaky gut
• SIBO
Gut Protocols
©Jeff Lavell, DC
1
3/29/2021
Prevalence of Digestive Issues
• Rarely mentioned as a health problem, more of an
inconvenience!
• 38 million Americans are victims of digestive disorders,
including Crohn’s disease, ulcerative colitis,
diverticulitis, celiac disease, IBS, constipation,
diarrhea, GERD, candida and food allergies.
• Economic impact of digestive disorders is $142 billion
per year (1), compared to $124.5 billion for cancer, $58
billion for neurological disorders, and $88 billion for
circulatory problems.
• “Sufferers from IBS (the most common gastrointestinal
disorder) incur an estimated $10 billion more in direct
medical charges per year than a similar control group
of people the same age and gender.”
• From Weston A Price Foundation
• (1) Peery AF, Dellon ES, Lund J, et al. Burden of Gastrointestinal
Disease in the United States: 2012 Update. Gastroenterology.
2012;143(5):1179‐1187. ©Jeff Lavell, DC
Common Complaints
• Poor taste • Slow bowels
• Gas • Loose bowels
• Bloating • Sticky bowels
• Nausea • Irregular bowels
• Burning/heartburn
What The Patient Thinks
Is Right/Normal
• Tums • Loose stools
• OTC Prilosec • Constipation
• Pepto Bismol/Malox • “It’s just the way I
• Rx: Omeprazole am”
©Jeff Lavell, DC
2
3/29/2021
What we should think
• That most patients have conditions that
can be helped and basic physiologic
principals apply regardless of patient or
condition.
• We will approach this as a “system” and
utilize basic physiologic and nutritional
principals to address key areas to create
the clinical outcome we desire!
©Jeff Lavell, DC
Large Intestine
Anatomy
• Colon (large intestine)
• Ileocecal valve
• Ascending colon
• Transverse colon
• Descending colon
• Sigmoid colon
• Rectum
©Jeff Lavell, DC
3
3/29/2021
Large Intestine
• the mucosa of the large intestine does
contain a large number of goblet cells.
Goblet cells are specialized epithelial cells
that secrete mucus.
• The mucus produced by the goblet cells act
as a lubricant to ease the passage of feces
©Jeff Lavell, DC
Absorb water (although the majority is
Absorb absorbed in small intestine)
Colon Feed
Feed bacteria
• Produces Vitamins
Functions
Promote defecation
Promote • Should take 18‐24 hours from mouth to excretion.
©Jeff Lavell, DC
4
3/29/2021
Role of Water in
Bowel Function
©Jeff Lavell, DC
Action of colon with water
• Water reabsorption is a main function of the large intestine. It can absorb 300 ml, or about a cup and a
half, of water a day.
• This water removal dries out the feces. If food moves through the large intestine too quickly, it will not
have sufficient time to absorb water, which will result in the passage of watery stool, or diarrhea. By
contrast, when food residue remains in the large intestine for an extended period of time, too much
water can be absorbed. This can result in constipation, which is defined as a hard stool or difficulty
passing stool. Constipation may be due to a lack of fiber in the diet.
• Any remaining nutrients from food are absorbed here before sending the indigestible matter to the
rectum.
• The colon absorbs vitamins that are created by the colonic bacteria, such as vitamin K (especially
important as the daily ingestion of vitamin K is not normally enough to maintain adequate blood
coagulation), vitamin B12, thiamine and riboflavin.
• Source: Guyton and Hall Textbook of Medical Physiology
©Jeff Lavell, DC
5
3/29/2021
Everybody
Poops
©Jeff Lavell, DC
Bristol Stool
Chart
©Jeff Lavell, DC
6
3/29/2021
“All Disease
Hippocrates
Begins In The
Gut.”
©Jeff Lavell, DC
Gut Health & Microbiota
• Gut health is multifaceted.
• Nutrition, environmental toxins, and ability to
eliminate waste all have huge factors in gut
health.
• Recent research has shown gut health even
has a key impact on brain health! (more on
that later)
©Jeff Lavell, DC
7
3/29/2021
What We Know About The Gut Flora So Far…
1 2 3 4 5 6
10x the number Contains 150x Is 2 to 5 pounds Half your stool is Your gut is as Diversity is the
of bacteria in the more genes as in of your weight. microbial mass. individual as your key, as close to
gut as there are our genome. fingerprint. 1000 different
cells in the body! bacterial types
are possible.
Source: Dinan, Tmothy G, Caterhine Stan "Psychobiotics: A Novel Class of Psychotropic" by Timothy G. Dinan, Catherine
Stanton, and John F. Cryan. Biological Psychiatry, Volume 74, Issue 10 (November 15, 2013), published by Elsevier
Source: Noah Fierer. Forensic identification using skin bacterial communities. PNAS April 6, 2010 vol. 107 no. 14 6477‐6481
©Jeff Lavell, DC
Microbes are part of the whole body health
influence of the GI tract Gastrointestinal
Microbiota
http://journal.frontiersin.org/article/10.3389/fnint.2013.00070/full
http://www.nature.com/nrmicro/journal/v11/n4/fig_tab/nrmicro2974_F1.html
©Jeff Lavell, DC
8
3/29/2021
• Gut flora helps you to maintain weight or even
lose weight!
• Palmas V, Pisanu S, Madau V, et al. Gut microbiota
markers associated with obesity and overweight in
Italian adults. Sci Rep. 2021;11(1):5532.
• Stanislawski MA, Dabelea D, Wagner BD, et al. Gut
Gut Health For Microbiota in the First 2 Years of Life and the
Association with Body Mass Index at Age 12 in a
Weight Loss? Norwegian Birth Cohort. mBio. 2018;9(5):e01751‐
18.
• Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel
BL, Duncan A, Ley RE, Sogin ML, Jones WJ, Roe BA,
Affourtit JP, Egholm M, Henrissat B, Heath AC,
Knight R, Gordon JI. A core gut microbiome in obese
and lean twins. Nature. 2009 Jan 22;457(7228):480‐
4. doi: 10.1038/nature07540. Epub 2008 Nov 30.
©Jeff Lavell, DC
E. Coli is a major bacteria in the gut
• Somewhere between 300 and
1000 different species live in the gut,
with most estimates at about 500.
However, it is probable that 99% of
the bacteria come from about 30 or
40 species.
• Source: Beaugerie L, Petit
JC (April 200Microbial-gut
interactions in health and disease.
Antibiotic-associated diarrhoea".
Best Pract Res Clin Gastroenterol
18 (2): 337–52
©Jeff Lavell, DC
9
3/29/2021
Potential
Harmful and
Beneficial
Functions
• Generalized scheme of
predominant groups of
colonic bacteria, indicating
how the genera may exhibit
potentially harmful and
beneficial functions.
Guarner F. Digestion 2006;
73(Suppl 1): 5-12
©Jeff Lavell, DC
What Does The Gut
Microbiota Do?
1 2 3 4
Digestion Synthesize nutrients Immune system Neurotransmitters (1)
(1) Source: O’Mahony, S.M. et al. “Serotonin, tryptophan metabolism and the brain gut
microbiome axis.” Behavioural Brain Research 277 (2015): 32‐48
©Jeff Lavell, DC
103/29/2021
Gut Microbiota And Nutrition
• Several bacterial genera that are common in the distal intestine
(e.g., Bacteroides, Bifidobacterium, and Enterococcus) are known to
synthesize vitamins. Thiamine, folate, biotin, riboflavin, and panthothenic
acid are water‐soluble vitamins that are plentiful in the diet, but that are
also synthesized by gut bacteria. Likewise, it has been estimated that up to
half of the daily Vitamin K requirement is provided by gut bacteria [1].
(1) Source: Eur J Cancer Prev. 1997 Mar;6 Suppl 1:S43‐5.
Intestinal flora and endogenous vitamin synthesis. Hill MJ.
©Jeff Lavell, DC
Gut Flora & The Neurotransmitters They Contribute
Gamma‐
Dopamine Serotonin aminobutyric
Acid (GABA)
©Jeff Lavell, DC
113/29/2021
An Example: serotonin
• “Peripheral serotonin is produced in the digestive tract by
enterochromaffin (EC) cells and also by particular types of immune
cells and neurons. Hsiao and her colleagues first wanted to know if
gut microbes have any effect on serotonin production in the gut
and, if so, in which types of cells. They began by measuring
peripheral serotonin levels in mice with normal populations of gut
bacteria and also in germ‐free mice that lack these resident
microbes.”
• “The researchers found that the EC cells from germ‐free mice
produced approximately 60 percent less serotonin than did their
peers with conventional bacterial colonies. When these germ‐free
mice were recolonized with normal gut microbes, the serotonin
levels went back up—showing that the deficit in serotonin can be
reversed.”
• ‐ See more at: http://www.caltech.edu/news/microbes‐help‐produce‐
serotonin‐gut‐46495#sthash.Q76q5fdw.dpuf
©Jeff Lavell, DC
• Recent research supporting a role for the
Gut microbiota in maintaining normal brain
Health function offers the intriguing possibility that
the therapeutic targeting of the gut
And The microbiome might be a viable strategy in in
supporting CNS health (Forsythe et al., 2010).
Brain
Source: Grenham S, Clarke G, Cryan JF, Dinan TG. Brain–
Gut–Microbe Communication in Health and Disease.
Frontiers in Physiology. 2011;2:94.
doi:10.3389/fphys.2011.00094.
©Jeff Lavell, DC
123/29/2021
Bacteria In Your Gut And Mood
• Originally studied in mice in 1990 (in Mankato!) researchers first noticed that
stressed mice were more likely to get sick, and theorized that the bugs caused
the infections.
• So they decided to test if the microorganisms that relate to disease are affected
by stress. When they added norepinephrine to a petri dish of bacteria there was
a huge increase in growth of the bacteria, the non norepinephrine dishes did not
show that at all.
• Then, to see if bacteria could induce stress, mice were fed a liquid solution of
Campylobacter jejuni, a bacterium that can cause food poisoning in humans but
generally doesn’t prompt an immune response in mice.
• When he ran them through a plexiglass maze raised several feet above the lab
floor, the bacteria‐fed mice were less likely to venture out on the high,
unprotected ledges of the maze. In human terms, they seemed anxious. Without
the bacteria, they walked the narrow, elevated planks.
• Therefore, introducing a pathological bacterium into the gut will cause a change
in behavior.’
• This has begun to show in human studies as well.
©Jeff Lavell, DC
Gut Health &
Inflammation
• Studies have shown elevations of
TNF-α, IL-1β, IL-6 with poor gut
health.
• Source: Grenham S, Clarke G, Cryan
JF, Dinan TG. Brain–Gut–Microbe
Communication in Health and
Disease. Frontiers in Physiology.
2011;2:94.
doi:10.3389/fphys.2011.00094
©Jeff Lavell, DC
133/29/2021
Vagus nerve innervates the digestive tract.
Poor vagal activity = decreased pancreatic enzyme secretion, poor
gallbladder function, and poor gut function overall. It also suppresses the
intestinal immune system and decreases intestinal blood flow.
Nerve Impact This leads to increased growth in pathogenic yeast and bacteria, that cause
intestinal permeability or leaky gut, leaky gut causes a state of chronic low
grade inflammation.
With Gut Inflammatory cytokines produced in the gut travel through the blood and
Health they cross the blood‐brain barrier.
Inflammatory cytokines once they get into the brain activate the microglial
cells.
Microglial cells are the immune cells of the brain and once they’re activated
by these inflammatory cytokines this is basically inflammation of the brain.
©Jeff Lavell, DC
Nerve Impact With Gut Health
80% of total So the gut
Enteric nervous serotonin in the communicates
system body is located in with the brain via
The enteric It is considered generates the cytokines and gut
nervous system to be separate intestinal motility enterochromaffin opiates and gut
has been from the and enzyme cells in the gut peptides like
referred to as the autonomic release and then and this is used neurotensin and
second brain. nervous system. it provides primarily to substance-P.
incoming input to regulate •Source: Wikipedia
the vagus nerve. peristalsis and
motility.
©Jeff Lavell, DC
143/29/2021
Fiber
Supporting A Healthy Gut
“In populations in which fiber constitutes a major
portion of the diet conditions such as diarrhea,
hemorrhoids, gallstones, hiatal hernia, varicose veins,
appendicitis and heart disease are unknown”
Denis Parsons Burkitt
(28 February 1911 – 23 March 1993)
©Jeff Lavell, DC
153/29/2021
Fiber
•Benefits
• Decreases GI transit time
• Increases water retention without osmotic
imbalance
• Provides a substrate for symbiotic colonic
bacteria
• Reduces glycemic load of foods ingested
• Improves transit time in the gut
• Reduces haustra formation in diverticulitis
• Improves tone of GI smooth muscle
• Note: the vast majority of diverticulitis
cases are caused by insufficient dietary
fiber
• Any downside???
©Jeff Lavell, DC
Gas!
©Jeff Lavell, DC
163/29/2021
Fiber
•Two basic types:
• Soluble
• Insoluble
©Jeff Lavell, DC
Soluble Fiber
• These include mucilages, pectins, and gums.
• These substances form a gel which mixed with
liquid and increase bulk.
Found abundantly in:
• Avacados (10.5 grams • Peas(split peas 16
per cup) grams per cup)
• Artichokes (10 grams • Lentils (15 grams per
per cup) cup)
• Prunes • Barley
• Flaxseed • Carrots
• Oats • Potatoes (particularly
• Legumes (varies by the skins)
type, but most around • Apples
13-15 grams per cup) • Psyllium
• Berries
©Jeff Lavell, DC
173/29/2021
Insoluble Fiber
•This fiber does not gel.
•Found in:
• Wheat
• Brown rice and other unrefined grains
• Unprocessed vegetables
• Fruits
• Green leafy veggies
• Edible seeds (sunflower, pumpkin, &
sesame)
©Jeff Lavell, DC
Mop vs. Broom
•Soluble and insoluble fibers ought
to be eaten mostly raw.
• Eating Raw is like a broom.
• Cooking breaks down fiber
and instead of getting a
broom you end up with a
mop.
©Jeff Lavell, DC
183/29/2021
How Much Fiber?
•12-17 grams is adequate
•20-35 grams is ideal
©Jeff Lavell, DC
How Much Water
When Increasing Fiber?
•A few people will report bloating or an
increase in constipation when taking fiber.
• This is due to two factors:
• Too much fiber, too soon
• Too little water with the increase
in fiber
• Different fibers will absorb
anywhere from 3 to 5 times
their weight in water
©Jeff Lavell, DC
193/29/2021
Non digestible starches that selectively stimulate
the growth of symbiotic bacteria in the colon.
• FOS: fructooligosaccharides
• Arabinogalactans - from larch tree
• Galacto-oligosaccharides
Prebiotics • Inulin
• Lactobacilli and bifidobacteria use
these as a substrate to grow upon
©Jeff Lavell, DC
Brain Maker
“It’s important to get back to foods that are rich in
prebiotic fiber—which is a unique type of fiber.
Foods like jicama, Mexican yam, asparagus,
dandelion greens, garlic and onions are foods
that contain high levels of a particular type of
prebiotic fiber that’s called inulin. Inulin is really
helpful in terms of nurturing good gut bacteria.
Our healthy gut populations use prebiotic fiber
such as inulin to multiply and to increase their
metabolism, and facilitate the creation of amino
acids, the provision of vitamins, the reduction of
gut permeability, and therefore inflammation.
They even facilitate the creation of serotonin and
dopamine!”
Source: Brain Maker: The Power of
Gut Microbes to Heal and Protect
Your Brain–for Life. David Perlmutter
Little, Brown, Apr 28, 2015
©Jeff Lavell, DC
203/29/2021
Prebiotic: 2’‐
FUCOSYLLACTOSE (2’FL)
Supports a Healthy
Microbiome
Chemically equivalent to the most
abundant Human Milk
Oligosaccharide. Not normally
consumed by adults.
• Selectively supports the growth
of beneficial bacteria
• Supports a healthy microbiome
• Elison, E., et al., Oral supplementation
of healthy adults with 2'-O-
fucosyllactose and lacto-N-neotetraose
Baseline 2’FL intervention
is well tolerated and shifts the Microbial Phylum Microbial Phylum
intestinal microbiota. Br J Nutr, 2016. Diversity Diversity
116(8): p. 1356-1368.
©Jeff Lavell, DC
• Deficiencies in butyrate producing
bacteria and decreased colonic
expression of the butyrate transporter
monocarboylate transporter-1 have
been observed in IBD patients.1,2
• Clinical trials have indicated resistant
starch supplementation significantly
increased butyrate concentrations.3,4,5
• Butyrate regulates neutrophil function,
increase tight junction protein
expression, and reduces cytokine and
chemokine release.6
• Butyrate has also been shown to
promote fluid and electrolyte
absorption in the gut.6
• Green Bananas are a low FODMAP
food, therefore green banana
resistant starch would be a low
FODMAP ingredient.
1ThibaultR et al. 2010. Inflamm Bowel Dis.
Resistant Starch
2Machiels K et al. 2014. Gut.
3AlfaMJ et al. 2018. Clinical Nutr.
4Venkataraman A et al. 2016. Microbiome.
5Baxter NT et al. 2019. MBio.
6Shin A et al. 2018. Clin Gastroentero Hep
©Jeff Lavell, DC
213/29/2021
Fermentate:
Also known as: Whole food fermentate, dried
fermentate, yeast fermentate or dried yeast fermentate
• Nutritious whole food product made using a
unique, specialized fermentation process.
• Made using specific yeast strain Saccharomyces
cerevisiae (bakers yeast)
• Fed proprietary nutrients
• Specialized anaerobic fermentation process
• Immune-related benefits
• Prebiotic-like properties
• May modulate the composition of the gut
microbiome1
• 1Pinheiro I et al. 2017. BMC Complement Altern
Med.
©Jeff Lavell, DC
Fiber and prebiotics
It’s been estimated the average American
consumes about 5g a day of prebiotic fiber in
comparison to our Paleolithic ancestors, who
may have consumed as much as 135g in a
single day.
Source: Brain Maker: The Power of Gut Microbes to
Heal and Protect Your Brain–For Life David
Perlmutter , MD, FACN, ABIHM is a Board-Certified
Neurologist and Fellow of the American College of
Nutrition
©Jeff Lavell, DC
223/29/2021
Probiotics
©Jeff Lavell, DC
Probiotics
function
through a
variety of
mechanisms
O’Toole, P.W. and Cooney,
J.C. Interdisciplinary
Perspectives on Infectious
©Jeff Lavell, DC Diseases, 2008:175285.
233/29/2021
• Note: all the lactobacilli require sugar to grow
Probiotics • Unprocessed fermented foods are rich in these bacteria
• Bacteriocin production is also generally regarded as
a probiotic trait
©Jeff Lavell, DC
Lactobaccillus acidophilus
Bifidobacterium bididum
Probiotics L. bulgaricus
• Note: all the lactobacilli
require milk sugar (lactose) to
grow
• Unprocessed fermented foods
are rich in these bacteria
©Jeff Lavell, DC
243/29/2021
Lactobacillus acidophilus (including LA‐5®)—The LA‐5 strain has been
evaluated for its ability to interfere with the communication between
other types of bacteria, thus promoting a healthy balance of microbes.
The LA‐5 strain was also among several other lactobacilli that improved
Clinically outcomes in subjects with occasional constipation, as well as those with
lactose tolerance challenges.*
Documented
Strains That Lactobacillus paracaseissp. paracasei (L.casei 431®)—To support the
natural gut environment, this strain of lactic acidproducing bacteria
Work adheres to the intestinal tract and tolerates bile. This strain has been
studied in humans and mice for its ability to support the gut during
challenges and for its ability to help maintain the body's natural immune
Synergistically system response.*
With Prebiotic Bifidobacterium lactis (BB‐12®)—Bifidobacteria are very tolerant of both
Fibers. acidic conditions and environments that contain bile. Bifidobacteria use a
range of carbohydrates for energy (including GOS). Bifidobacteria are an
important factor in all native microflora and their numbers vary depending
on lifestyle, diet, exercise and age. Oral bifidobacteria have been shown to
temporarily colonize the gut, competing with other bacteria to effectively
support the natural bacterial balance.*
©Jeff Lavell, DC
Saccharomyces cerevisiae (brewers yeast) var. boulardii—
Historically, this microbe was used to support normal stool
Clinically consistency. In the gut, this yeast supports the growth of
some bacteria and inhibits others through competition and
Documented environmental modification of the gut.*
Strains That Inulin—Inulin is a complex carbohydrate that can be
Work digested by certain microorganisms, providing them with
energy. Inulin supports the absorption of calcium and
Synergistically magnesium.*
With Prebiotic
Fibers. Galactooligosaccharide (GOS)—Research suggests that
GOS is a preferred substrate for BB‐12. In mice, GOS
supplementation supported the active proteins and cells in
the gut mucosa, and increased the amount of short‐chain
fatty acid and lactate in the gut.*
©Jeff Lavell, DC
253/29/2021
“Research shows that friendly bacteria survive transit
through the acid environs of the stomach to the lower GI
when ingested with naturally fermented foods”
Source: P. Marteau. Survival of Lactic Acid Bacteria in a Dynamic Model of the Stomach and Small
Intestine: Validation and the Effects of Bile. Volume 80, Issue 6, Pages 1031‐1037 (June 1997)
©Jeff Lavell, DC
Eat Bacteria Rich Food
• Kimchee
• Kombucha
• Cultured yogurt
• Raw milk/Kefir
• Sauerkraut
• Fermented meats
• Fermented vegetable
• Source: Brain Maker: The Power of
Gut Microbes to Heal and Protect
By Gandydancer (original file) via Wikimedia Your Brain–for Life. David Perlmutter
Little, Brown, Apr 28, 2015
©Jeff Lavell, DC
263/29/2021
Acidify GI tract
(alkalizing)
• A number of ways to do it.
• Apple Cider Vinegar (a number of recipes
are available)
• Recipe I like is tablespoon Bragg's
Raw Apple Cider Vinegar 1
tablespoon raw local honey or maple
syrup 6 ounces of filtered
water…drink 3x per day.
• Supplement with products that acidify the
GI tract.
• Best one is of course Lactic Acid
producing products help.
©Jeff Lavell, DC
Gut Dysbiosis
©Jeff Lavell, DC
273/29/2021
Aberrant
Intestinal
Microbiota
• The intestinal microbiome
is established at birth
• Diets high in refined
carbohydrate and low
in fiber will alter the
biome and favor
unfriendly bacteria.
• A history of antibiotic
use will alter bacterial
gut composition
©Jeff Lavell, DC
Antibiotics & Gut Dysbiosis
• “The primary cause of dysbiosis is the use of
antibiotics, which kill >99% of the good
bacteria. Other factors that can cause or
contribute to the development of dysbiosis
include stress, birth control pills, and junk
foods.”
• Source: Ross Pelton, RPh, PhD, CCN.
Antibiotics, Probiotics, and Microflora.
Published Online: July 1, 2005.
http://www.pharmacytimes.com/issue/phar
macy/2005/2005-07/2005-07-9743
©Jeff Lavell, DC
283/29/2021
4 years of disturbance?
Abstract
• Antibiotic administration is the standard treatment for the bacterium Helicobacter pylori, the main causative
agent of peptic ulcer disease and gastric cancer. However, the long-term consequences of this treatment
on the human indigenous microbiota are relatively unexplored. Here we studied short- and long-term
effects of clarithromycin and metronidazole treatment, a commonly used therapy regimen against H.
pylori, on the indigenous microbiota in the throat and in the lower intestine. The bacterial compositions in
samples collected over a four-year period were monitored by analyzing the 16S rRNA gene using 454-
based pyrosequencing and terminal-restriction fragment length polymorphism (T-RFLP). While the
microbial communities of untreated control subjects were relatively stable over time, dramatic shifts were
observed one week after antibiotic treatment with reduced bacterial diversity in all treated subjects in both
locations. While the microbiota of the different subjects responded uniquely to the antibiotic treatment
some general trends could be observed; such as a dramatic decline in Actinobacteria in both throat and
feces immediately after treatment. Although the diversity of the microbiota subsequently recovered to
resemble the pre treatment states, the microbiota remained perturbed in some cases for up to four
years post treatment. In addition, four years after treatment high levels of the macrolide resistance gene
erm(B) were found, indicating that antibiotic resistance, once selected for, can persist for longer periods of
time than previously recognized. This highlights the importance of a restrictive antibiotic usage in order to
prevent subsequent treatment failure and potential spread of antibiotic resistance.
• Source: Jakobsson HE, Jernberg C, Andersson AF, Sjölund-Karlsson M, Jansson JK, Engstrand L. Short-Term Antibiotic Treatment
Has Differing Long-Term Impacts on the Human Throat and Gut Microbiome. Ratner AJ, ed. PLoS ONE. 2010;5(3)
©Jeff Lavell, DC
Antibiotics, Children & Food Allergies
Abstract
• Background: To assess the relationship between any systemic antibiotic prescription within the first year of life and the
presence of an ICD‐9‐CM diagnosis code for food allergy (FA). Methods: This was a matched case–control study conducted
using South Carolina Medicaid administrative data. FA cases born between 2007 and 2009 were matched to controls
without FA on birth month/year, sex, race/ethnicity. Conditional logistic regression was used to model the adjusted odds
ratio (aOR) of FA diagnosis. All models were adjusted for presence of asthma, wheeze, or atopic dermatitis. Results: A
total of 1504 cases and 5995 controls were identified. Receipt of an antibiotic prescription within the initial 12 months of
life was associated with FA diagnosis in unadjusted and adjusted models (aOR 1.21; 95 % CI 1.06–1.39). Compared to
children with no antibiotic prescriptions, a linear increase in the aOR was seen with increasing antibiotic prescriptions.
Children receiving five or more (aOR 1.64; 95 % CI 1.31–2.05) antibiotic prescriptions were significantly associated with FA
diagnosis. The strongest association was noted among recipients of cephalosporin and sulfonamide antibiotics in both
unadjusted and adjusted models.
• Conclusions: Receipt of antibiotic prescription in the first year of life is associated with FA diagnosis code in young
children after controlling for common covariates. Multiple antibiotic prescriptions are more strongly associated with
increases in the odds of FA diagnosis
• Source: Love BL, Mann JR, Hardin JW, Lu ZK, Cox C, Amrol DJ. Antibiotic prescription and food allergy in young children. Allergy,
Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology. 2016;12:41.
©Jeff Lavell, DC
293/29/2021
Gut Dysbiosis
• Imbalance of the good to
bad bacteria in the gut.
• Heavily involved in other gut
conditions, like leaky gut,
IBS, and IBD!
©Jeff Lavell, DC
Gut Disbiosis Symptoms
©Jeff Lavell, DC
303/29/2021
How to
Determine is
Dysbiosis
Exists?
©Jeff Lavell, DC
Gut Dysbiosis: IBD & IBS
©Jeff Lavell, DC
313/29/2021
• A syndrome has no definitive
diagnostic criteria.
Irritable bowel • More of a collection of symptoms
syndrome (IBS) that matches…disease of
elimination rather than
confirmation.
Lower GI
pathophysiology
• Highly related to the gut flora
Inflammatory balance in the gut (gut dysbiosis)
Bowel • Chief diagnostic criteria are:
Disease/Ulcerative
Colitis (IBD) • Bleeding mucosa
• Frank blood in stools
©Jeff Lavell, DC
•Symptoms may occur alone
Signs & Symptoms or in combination with other
symptoms such as:
• Bloating
• Abdominal
discomfort
• Increased
frequency of bowel
movements
• Painful bowel
movements
• Gas
• Diarrhea
• Constipation
• Increased mucus
production
©Jeff Lavell, DC
323/29/2021
•IBS is the most frequent GI disorder and
accounts for 30-50% of all referrals to
gastroenterologists.
• Poorly understood
• It is believed to affect approximately one-
Incidence fifth of the population, though it is
estimated that 60-75% of symptomatic
people do not seek medical attention
• Source: Madden JAJ, Hunter JO.
Br J Nutr 2002; 88(Suppl 1): S67-
S72
©Jeff Lavell, DC
IBS Classification Systems
IBS‐D IBS‐C IBS‐A
Diarrhea Constipation
predominates and predominates and Alternating
often relieves bowel movement constipation &
symptoms, increased often relieves diarrhea
mucus symptoms
©Jeff Lavell, DC
333/29/2021
Magnesium and IBS‐C
• What Does the Research Say?
• Magnesium does have a well-established reputation for its
laxative qualities. However, there does not appear to be any direct
research support for the use of magnesium as a treatment for IBS-C.
• Of interest is a study that looked at the relationship between
constipation and water, fiber, and magnesium intake. The study was
conducted in Japan with 3,835 subjects who were between the ages of
18 and 20. Constipation was not found to be associated with low fiber
intake or low intake of water from fluids. Constipation was,
however, associated with low intake of magnesium and low intake of
water from foods.
• The laxative effect of magnesium appears to come through two different
mechanisms. Magnesium relaxes the muscles in the intestines, which
helps to establish a smoother rhythm. Magnesium also attracts water.
• The increased amount of water in the colon serves to soften the stool,
helping to make stools easier to pass.
©Jeff Lavell, DC
Psychological
Symptoms
•Anxiety and/or depression frequently
accompany IBS symptoms to varying
degrees.
•If you have good patient rapport:
• Ask about psychological stress
• Make an appropriate referral
• Make nutritional recommendations
consistent with stress alleviation
©Jeff Lavell, DC
343/29/2021
IBD
©Jeff Lavell, DC
Dysbiosis
Defined
• Round JL, Mazmanian SK. The gut
microbia shapes intestinal immune
responses during health and
disease. Nat Rev Immunol. 2009
May, 9(5):313‐23
©Jeff Lavell, DC
353/29/2021
IBS vs IBD
IBD IBS
Symptoms Eye inflammation Abdominal pain
Extreme fatigue Cramps
Intestinal scarring Constipation
Joint pain Diarrhea
Malnutrition Bowel urgency
Rectal bleeding
Weight loss
Bowel urgency
Testing Extensive lab work Normal labs
Abnormal tissue biopsy Normal tissue biopsy
Other Autoimmune component No autoimmune component
©Jeff Lavell, DC
Deviations in human gut microbiota: a novel diagnostic
test for determining dysbiosis in patients with IBS or IBD.
RESULTS:
• Validation confirms microbiota dysbiosis was detected in 73%
of IBS patients, 70% of treatment‐naïve IBD patients and 80%
of IBD patients in remission, vs. 16% of healthy individuals.
• Source: Aliment Pharmacol Ther. 2015 Jul;42(1):71‐83.
Deviations in human gut microbiota: a novel diagnostic test for
determining dysbiosis in patients with IBS or IBD. Casén C et. al.
©Jeff Lavell, DC
363/29/2021
•The long‐standing assumption that ulcerative
colitis (UC) is an autoimmune disease has been
revised to incorporate evidence suggesting that
commensal microflora and their products are
auto‐antigens, and that UC is caused by loss of
tolerance towards otherwise harmless
IBD Autoimmune and components of the normal intestinal flora.
microflora • Source: Farrell RJ, Peppercorn MA. Lancet 2002;
359(9303): 331‐340
• Slide courtesy of Kerry Bone
©Jeff Lavell, DC
Further evidence of dysbiosis
•UC and Dysbiosis
• Compared to healthy people, UC patients have increased levels of IgG directed against the
normal flora1
• There may be an increased number of bowel bacteria in UC, but reduced counts of protective
bacteria such as Lactobacilli and Bifidobacteria1
• Lactobacilli numbers were found to be lower in UC patients during the active phase
• Sources:
• Cummings JH, Macfarlane GT, Macfarlane S. Curr Issues Intest Microbiol 2003; 4(1):
9‐20
• Bullock NR, Booth JC, Gibson GR. Curr Issues Intest Microbiol 2004; 5(2): 59‐64
©Jeff Lavell, DC
373/29/2021
• Gut dysbiosis
• These same factors may also play a major role in the
development of Type I diabetes.
• Researchers found that by simply providing
probiotics to animals with altered gut flora they
could reduce the incidence of the disease.
• Source: The “Perfect Storm” for Type 1
Diabetes The Complex Interplay Between
Intestinal Microbiota, Gut Permeability,
and Mucosal Immunity. Outi Vaarala,
Mark A. Atkinson, Josef Neu. Diabetes
October 2008 vol. 57 no. 10 2555‐2562
Clinical Note
©Jeff Lavell, DC
• There is suggestion that the misfolding of
proteins in the brain may be an etiologic
explanation for some neurologic disorders. Brain
inflammation, which may originate from the gut,
is one notable hypothesis behind protein
misfolding.
Misfolding of
•
Proteins Linked Source: De Theije CG, Wu J, da Silva SL, et
al. Pathways underlying the gut‐to‐brain
to Gut? connection in autism spectrum disorders
as future targets for disease
management. Eur J Pharmacol. 2011;668
Suppl 1:S70‐S80.
• Source: Soto C. Unfolding the role of
protein misfolding in neurodegenerative
diseases. Nat Rev Neurosci. 2003;4:49‐60.
©Jeff Lavell, DC
383/29/2021
Gut Health & Neurodegeneration
It appears that age-related changes in
the gut microbiota might be
Brain-derived neurotrophic factor, a bidirectionally linked to age-related
neurotrophin that protects and neurodegeneration.[4]
encourages survival of healthy brain • Connor B, Young D, Yan Q, Faull RL, Synek B,
cells and whose production may be Dragunow M. Brain-derived neurotrophic factor is
influenced by gut bacteria, is shown to reduced in Alzheimer's disease. Brain Res Mol
Brain Res. 1997;49:71-81. Abstract
be decreased in people with Alzheimer
• Friedland RP. Mechanisms of molecular mimicry
disease.[3] involving the microbiota in neurodegeneration. J
Alzheimers Dis. 2015 Jan 13. [Epub ahead of
print]
©Jeff Lavell, DC
Sulfide bacteria
•UC and SRB (sulfide reducing bacteria)
• In patients with active UC, there is an over‐production of hydrogen
sulfide which is toxic to the intestinal mucosa by competing with
short‐chain fatty acids (SCFA)1
• This appears to be due to an excess (or greater activity) of sulfate‐
reducing bacteria (SRB): such as Desulfibrio desulfuricans 1
©Jeff Lavell, DC
393/29/2021
• Patients advised to avoid nuts,
Dietary garlic, onions, red meat, and
Recommendations‐ cruciferous vegetables.
Low sulfur diet • Source: Roediger WE. Lancet
1998; 351(9115): 1555
©Jeff Lavell, DC
IBD Differential Diagnosis:
Crohn’s vs. ulcerative colitis
Crohn's Disease Ulcerative Colitis
Patchy areas of inflammation Continuous inflammation
Linear and serpiginous (snake‐like)
ulcers Continuous ulceration
Depth of inflammation varies: may be
transmural & deep into tissues
Depth of inflammation is shallow &
mucosal in UC
Fistulae (abnormal passageways
between organs) commonly seen in Fistulae seldom seen in UC
Crohn’s
©Jeff Lavell, DC
403/29/2021
Diet may contributes to these poor functional response and status
©Jeff Lavell, DC
Sartor and Mazmanian. Am J Gastroenterol Suppl (2012) 1:15–21
North and South Relationship
Abstract
OBJECTIVE:
Bile acids are derived from cholesterol and are potent physiological laxatives. The aim of this study was to investigate whether bile acid
synthesis is altered in constipation.
MATERIAL AND METHODS:
Female patients with constipation (23 IBS‐C, 4 functional constipation (FC)) were studied and compared with non‐constipated subjects (16
IBS‐D, 20 healthy women). Body mass index (BMI), blood lipids, lanosterol, sitosterol, colonic transit (oro‐anal transit time (OATT),
reference < or =4.3 days) and stool frequency were measured. C4 (7‐alpha‐hydroxy‐4‐cholesten‐3‐one) levels reflecting bile acid synthesis
were measured at 0800 h and 1300 h.
RESULTS:
When all the groups of constipated and non‐constipated subjects were compared, it was found that only stool frequency and OATT
differed between groups (p3/29/2021
Quest Diagnostics: Available Tests for the Differential
Diagnosis and Management of Inflammatory Bowel Disease
Test Code Test Name Specimen Type Clinical Use
70171 ANCA Screen with Reflex to ANCA Titer Serum Diagnose IBD; differentiate UC and CD
Includes titer for C‐ANCA, P‐ANCA, and/or atypical P‐ANCA.
16796 Calprotectin, Stool Stool Diagnose intestinal inflammation; differentiate
IBD from IBS; monitor patients with IBD
4420 C‐Reactive Protein (CRP) Serum Detect inflammatory disorders, including IBD;
monitor patients with IBD
16503(X) Inflammatory Bowel Disease Differentiation Panel Serum Diagnose IBD; differentiate UC and CD;
Includes ANCA screen with reflex to P‐ANCA,C‐ANCA, and atypical P‐ANCA titers; differentiate IBD from vasculitides
myeloperoxidase antibody; proteinase 3 antibody; and Saccharomyces
cerevisiae IgG and IgA antibodies.
17321(X) Lactoferrin, Quantitative, Stool Stool Diagnose intestinal inflammation; differentiate
IBD from IBS; monitor patients with IBD
8796 Myeloperoxidase Antibody (MPO) Serum Differentiate IBD from vasculitides
34151 Proteinase‐3 Antibody Serum Differentiate IBD from vasculitides
10295 Saccharomyces cerevisiae Antibodies (ASCA) (IgA) Serum Differentiate UC and CD
17609 Saccharomyces cerevisiae Antibodies (ASCA) (IgA, IgG) Serum Differentiate UC and CD
10294 Saccharomyces cerevisiae Antibodies (ASCA) (IgG) Serum Differentiate UC and CD
809 Sed Rate by Modified Westergren Whole blood Detect inflammatory disorders, including IBD
©Jeff Lavell,
*UC: Ulcerative Colitis, CD:DC Crohn’s Disease
Abstract
• AIM: To investigate patient‐reported outcomes
from, and adherence to, a low FODMAP diet
among patients suffering from irritable bowel
FODMAP syndrome and inflammatory bowel disease.
• CONCLUSION: These data suggest that a diet low
Diet For IBS in FODMAPs is an efficacious treatment solution
and IBD? in the management of functional bowel
symptoms for IBS and IBD patients.
• World J Gastroenterol. 2016 Apr 21;22(15):
Follow‐up of patients with functional bowel
symptoms treated with a low FODMAP diet.
Maagaard L1, Ankersen DV1, Végh Z1, Burisch
J1, Jensen L1, Pedersen N1, Munkholm P1.
©Jeff Lavell, DC
423/29/2021
Further Evidence
• Int J Mol Med. 2012 May;29(5):723‐31. doi: 10.3892/ijmm.2012.926. Epub 2012 Feb 24.
• The role of diet in the pathogenesis and management of irritable bowel syndrome (Review).
• El‐Salhy M1, Ostgaard H, Gundersen D, Hatlebakk JG, Hausken T.
Abstract
• Most patients with irritable bowel syndrome (IBS) believe that diet plays a significant role in inducing IBS symptoms
and desire to know what foods to avoid. It has been found that the intake of calories, carbohydrates, proteins and
fat by IBS patients does not differ from that of the background population. IBS patients were found to avoid certain
food items that are rich in fermentable oligo‐, di‐ and monosacharides and polyols (FODMAPs), but they did have a
high consumption of many other FODMAP‐rich food items. The diet of IBS patients was found to consist of a low
calcium, magnesium, phosphorus, vitamin B2 and vitamin A content. There is no consistent evidence that IBS
patients suffer from food allergy, nor is there documented evidence that food intolerance plays a role in IBS
symptoms. Abnormalities in gut hormones have been reported in IBS patients. As gut hormones control and
regulate gastrointestinal motility and sensation, this may explain the abnormal gastrointestinal motility and visceral
hypersensitivity reported in these patients. Guidance concerning food management which includes individually
based restrictions of FODMAP‐rich food items and individual evaluation of the effects of protein‐, fat‐ and
carbohydrate‐rich/poor diets may reduce IBS symptoms.
©Jeff Lavell, DC
Nutritional
Considerations
©Jeff Lavell, DC
433/29/2021
•Apples and pears contain pectins
• Pectins are a family of complex
Demulcent polysaccharides
Foods •Okra is a mucilage fiber
• Mucilaginous plants have the characteristic
"goo" or slime
©Jeff Lavell, DC
•Related to colon (large intestine) function
• Diffuse lumbar pain – may radiate into the groin or
lower abdomen
• Constipation and/or diarrhea
• Toxic bowel
Clinical • Flatulence – gas forming organisms will only thrive
in an alkaline GI medium
Correlations • Headaches
• TFL painful on palpation
• Palpation tenderness over the colon
• Transverse process of L4 nodular and tender
• L4 joint dysfunction
©Jeff Lavell, DC
443/29/2021
•Herbs such as: Boswellia, Celery Seed, Ginger, and
Turmeric are supportive of any chronic inflammatory
disease such as I.B.S., Crohn’s disease, Ulcerative
colitis, and arthritis.
Boswellia
• Celery seeds facilitate the clearing out of acidic
waste products in the joints.
©Jeff Lavell, DC
Gut Dysbiosis Functional Nutrition Treatment
©Jeff Lavell, DC
453/29/2021
©Jeff Lavell, DC
Coconut Oil & Gut Health
• The saturated fats in coconut oil have anti‐microbial
effects
• Contains lauric, capric and caprylic acids which are
known to be anti‐viral.
• It also has been shown to be anti‐fungal, affecting both
Candida and Malassezia. 1
• By helping to destroy the pathogenic bacteria and
fungus it is documented by research to improve overall
gut health.
• Rial SA, Karelis AD, Bergeron K‐F, Mounier C. Gut
Microbiota and Metabolic Health: The Potential
Beneficial Effects of a Medium Chain Triglyceride Diet in
Obese Individuals. Nutrients. 2016;8(5):281.
©Jeff Lavell, DC
463/29/2021
Dietary medium chain triglycerides (MCT),
which have been found to promote lipid
catabolism, energy expenditure and weight
loss also have an ability to improve both
intestinal microbiome and permeability.
Coconut Oil
“MCT‐enriched diets could therefore be used
and Obesity to manage metabolic diseases through
modification of gut microbiota.”
• Source:Rial SA, Karelis AD, Bergeron K‐F, Mounier C. Gut
Microbiota and Metabolic Health: The Potential
Beneficial Effects of a Medium Chain Triglyceride Diet in
Obese Individuals. Nutrients. 2016;8(5):281.
©Jeff Lavell, DC
A number of studies have shown promise when it
comes to coconut oil.
Lipids. 2009 Jul;44(7):593‐601.Effects of dietary
coconut oil on the biochemical and anthropometric
Coconut Oil profiles of women presenting abdominal obesity.
• This study showed 40 women were given either 30 grams (2
and Weight tablespoons) of either coconut oil or soybean oil for 28 days.They
were instructed to eat fewer calories and walk every day. These
Loss were the results:
• Both groups lost weight (about 2 pounds).
• Only the coconut oil group had decreased waist circumference
(belly fat) while the soybean oil actually had a mild increase in
belly fat. Coconut oil did not cause overall weight loss compared
to soybean oil, but it did lead to a significant reduction in belly
fat.
• The coconut oil group had increased HDL (good) cholesterol
levels, while the soybean oil had reduced HDL and increased LDL.
©Jeff Lavell, DC
473/29/2021
ISRN Pharmacol. 2011;2011:949686. Epub
2011 Mar 15.An open‐label pilot study to
assess the efficacy and safety of virgin
coconut oil in reducing visceral adiposity.
Liau KM1, Lee YY, Chen CK, Rasool AH.
Coconut Oil
and
In this second study this time involving
Weightloss obese men:
• 30 grams of coconut oil (2 tablespoons) for 4 weeks
reduced waist circumference by 2.86 cm, or 1.1
inches
©Jeff Lavell, DC
Whereas the primary fuel source for the energy‐hungry brain is
glucose, when insulin resistance and suboptimal metabolism
(hypometabolism) develops in the brain, both the brain's structure
and function are compromised. Ketone bodies provide a much
needed alternative fuel source to glucose that can recharge
metabolic processes within the brain, resulting in an almost
immediate improvement in cognitive function. (1)
Coconut Oil They are preferentially oxidized by the liver, and when provided in
large enough quantities, they give rise to ketone bodies. Due to
their smaller size they do not form micelles and are not stored in
adipose tissue. (2)
• Source: Effects of beta‐hydroxybutyrate on cognition in memory‐impaired
adults. Neurobiol Aging. 2004 Mar;25(3):311‐4. Mark A Reger, Samuel T
Henderson, Cathy Hale, Brenna Cholerton, Laura D Baker, G S Watson, Karen Hyde,
Darla Chapman, Suzanne Craft.
• Source: Hypometabolism as a therapeutic target in Alzheimer's disease. BMC
Neurosci. 2008 ;9 Suppl 2:S16. Epub 2008 Dec 3. Lauren C Costantini, Linda J Barr,
Janet L Vogel, Samuel T Henderson.
©Jeff Lavell, DC
483/29/2021
Avoid Gut Wrecking Foods
• The types of food choices that threaten the bacteria are foods:
1. Low in fiber
2. High in simple sugars
3. Foods that contain artificial sweeteners.
• Source: Brain Maker: The Power of Gut Microbes to Heal and
Protect Your Brain–for Life. David Perlmutter Little, Brown, Apr 28,
2015
©Jeff Lavell, DC
Bowel & Immunity
• The gut is constantly exposed to a high antigenic load coming from the diet
and commensal bacteria.
• The Gut-Associated Lymphoid Tissue (GALT) constitutes the most
extensive and complex part of the immune system and is capable of
efficiently distinguishing invasive pathogens from innocuous antigens.
• Source: Ramiro-Puig E, Pérez-Cano FJ, Castellote C,
Franch A, Castell M. [The bowel: a key component of the
immune system]. [Article in Spanish]. Rev Esp Enferm Dig.
2008 Jan;100(1):29-34.
©Jeff Lavell, DC
493/29/2021
Gut Chemicals
• Imbalances of gut bacteria can lead to the breakdown of the lining of the gut so that
chemicals, like Lipopolysaccharides (LPS), that should stay in the gut get into the
systemic circulation and amplify inflammation.
• Bacterial-derived lipopolysaccharides (LPS) play an essential role in the inflammatory
process of inflammatory bowel disease. A defective intestinal tight junction (TJ) barrier
is an important pathogenic factor of inflammatory bowel disease and other inflammatory
conditions of the gut.
• Source: Lipopolysaccharide Causes an Increase in Intestinal Tight Junction
Permeabilityin Vitro and in Vivo by Inducing Enterocyte Membrane Expression and
Localization of TLR-4 and CD14. Am J Pathol. 2013 Feb; 182(2): 375–387. Shuhong
Guo,∗† Rana Al-Sadi,∗† Hamid M. Said,‡ and Thomas Y. Ma
©Jeff Lavell, DC
• Gut Barrier Components:
• Lumen
• Commensal Bacteria
• Tight Junctions
• Intestinal epithelial cells
• Occludin family of peptides (see figure previous
Altered Intestinal slide)
Immune • GALT
Responsiveness • Mucosal barrier cells
• M-cells
• Goblet cells
• Paneth cells
• Intraepithelial lymphocytes
©Jeff Lavell, DC
503/29/2021
GALT & Leaky
Gut
• Too much intestinal permeability
(Leaky Gut) causes GALT to
generate more Immunoglobulins
(secretory IgA in particular) in
response to foreign proteins.
©Jeff Lavell, DC
• Pathogenic and commensal
microbes in the gut can mimic the
cell surface molecules of the host to
pass through the tight junctions of
the gut and gain access to the body
Molecular Mimicry • Once inside this results in
systemic changes that may be
detrimental to ones health, just
like the previous slide with celiac.
©Jeff Lavell, DC
513/29/2021
• Cross-reactivity is the reaction
between an antigen and an antibody
which was generated against a
different but similar antigen
• Because of molecular mimicry,
the immune system can mount
Cross Reactivity an immune response against its
own tissues.
• Modulating an over zealous
immune response is
necessary
• Reducing the flow of antigens
across the gut is imperative!
©Jeff Lavell, DC
Identify and remove Most Common gut
allergens:
01 02 03 04
Corn Wheat/gluten Soy Milk/Dairy
©Jeff Lavell, DC
523/29/2021
Gut Allergens Masquerade as
GI Disease
• Before making any specific supplemental suggestions it is
best to:
• Eliminate allergens that can mimic GI disease and cause
confounding results.
• Use an elimination diet for 2-3 weeks to rule out the Main
Four Allergens as the source of digestive problems.
©Jeff Lavell, DC
Leaky Gut
©Jeff Lavell, DC
533/29/2021
“A ballooned colon will
certainly let poisons
pass into the ‐Royal Lee 1959
circulating blood that
an intact colon will
stop”
©Jeff Lavell, DC
Lower GI pathophysiology
•Pathophysiology related to Gut
Permeability – i.e. permeability of tight
junctions (aka “leaky gut”).
• The gut regulates the absorption of
many nutrients based on the
permeability of the tight junctions
(spaces between cells).
• Most gut conditions have some
involvement of a leaky gut.
©Jeff Lavell, DC
543/29/2021
©Jeff Lavell, DC
Etiology
Three factors play a role in the
development of Leaky Gut:
1. Aberrant intestinal
microbiota
2. Loss of mucosal integrity
3. Altered intestinal
immune responsiveness
©Jeff Lavell, DC
553/29/2021
Clinical Note
These same factors may also play a
major role in the development of Type
I diabetes.
• Researchers found that by simply
providing probiotics to animals
with altered gut flora they could
reduce the incidence of the
disease.
• Source: The “Perfect Storm” for Type 1
Diabetes The Complex Interplay Between
Intestinal Microbiota, Gut Permeability, and
Mucosal Immunity. Outi Vaarala, Mark A.
Atkinson, Josef Neu. Diabetes October
2008 vol. 57 no. 10 2555-2562 ©Jeff Lavell, DC
Signs/Symptoms
©Jeff Lavell, DC
563/29/2021
Leaky Gut Syndrome has
been linked with many
conditions:
Leaky Gut & • Celiac Disease
Other • Multiple Sclerosis
• Fibromyalgia
Conditions • Autism
• Chronic Fatigue
Syndrome
• Irritable Bowel
Syndrome
• Eczema
• Dermatitis
• Ulcerative Colitis
©Jeff Lavell, DC
Medical Treatment Model
• Leaky Gut is not a recognized diagnosis in the medical
profession
• Often misdiagnosed as an intestinal infection or an
inflamed gut
• Often mismanaged with medications that actually
worsen the condition by causing more dysbiosis. For
example:
• Antibiotics
• Steroids
• Anti‐inflammatory drugs
• Colectomy
©Jeff Lavell, DC
573/29/2021
• Gut Barrier Components Affected by Intestinal
Permeability:
• Lumen
Altered • Commensal Bacteria
Intestinal • Tight Junctions
• Intestinal epithelial cells
Immune • Occludin family of peptides (see figure previous
Responsiveness • GALT
slide)
• Mucosal barrier cells
• M‐cells
• Goblet cells
• Paneth cells
• Intraepithelial lymphocytes
©Jeff Lavell, DC
Leaky Gut
NSAIDs &
Leaky Gut
Chemical
Consumption
and Food
of NSAIDs
Sensitivites
Intensity of pan and complications
increase with each repetition of
the cycle
Histamine
Worse Pain
Release
©Jeff Lavell, DC
583/29/2021
Leaky Gut Testing
• LOW secretory IgA is associated with leaky gut. Look
for this in the labs!
©Jeff Lavell, DC
IGG/IGA testing:
Cyrex Labs
©Jeff Lavell, DC
593/29/2021
ELISA/EIA (Enzyme Immunoassays) panels
• IgG testing is based on the findings that certain subclasses of IgG have been associated
with the in vitro degranulation of basophils and mast cells, the activation of the
complement cascade, (both of which are important mechanisms in allergy and
anaphylaxis) and the observation that high circulating serum concentrations of some IgG
subtypes have been measured in certain atopic individuals.
• Source:
• Berry, J.B., and Brighton, W.D. Familial human short term sensitizing (IgG S‐TS) antibody. Clin
Allergy 1977; 7:401‐406.
• Parish, W.E., Short term anaphylactic IgG antibodies in human sera. Lancet 1970; ii:591‐2.
• Stanworth, D.R., Immunochemical aspects of human IgG4. Clin. Rev. Allergy 1983; 1:183‐95.
• Brighton, W.D., Frequency of occurrence of IgG (S‐TS). Clin. Allergy 1980; 10:97‐100.
• Wintroub, B.U., and Soter, N.A., Biology of the mast cell and its role in cutaneous inflammation.
Springer Semin. Immunopathol. 1981; 4:55.
©Jeff Lavell, DC
• The Intestinal Permeability
Assessment gastrointestinal test directly measures
the ability of two non-metabolized sugar molecules to
permeate the intestinal mucosa. The patient drinks a
Genovea: Gut premeasured amount of lactulose and mannitol. The
degree of intestinal permeability or malabsorption is
Permability reflected in the levels of the two sugars recovered in a
urine sample collected over the next 6 hours.
• Used for leaky gut (urine test)
• Great test as it is done at home by the patient!
©Jeff Lavell, DC
603/29/2021
Lab Tests
•CDSA – Genova Diagnostics
• The Comprehensive
Digestive Stool Analysis
provides diagnostic tools
for analysis of digestion,
colonic environment and
absorption.
©Jeff Lavell, DC
Leaky Gut Trick
• 1500 mg pure GABA if they get
tired/sleepy within 30 minutes that
is an indicator of leaky gut due to
poor gut membrane junctions.
©Jeff Lavell, DC
613/29/2021
Therapeutic Goals:
A. Reduce systemic allergic reactions
Functional B. Improve immune competence &
regulation
Treatment C. Normalize bowel function
Strategy • Chiropractic
• Allergen identification & elimination diet
D. Balance gut flora
©Jeff Lavell, DC
A. Reduce Systemic Allergic
Reactions
Avoid the allergen
Avoid • IgG [ELISA/EIA (Enzyme Immunoassays) panels] testing
can be helpful, but the tests are very expensive
Improve Improve hepatic clearance of antigenic material
©Jeff Lavell, DC
62You can also read
