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) Feed bacteria Colon Feed Functions • Produces Vitamins 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/nrmicro297©Jeff Lavell, DC 4_F1.html 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 Microbiota in the First 2 Years of Life and the Gut Health For Association with Body Mass Index at Age 12 in a Norwegian Birth Cohort. mBio. 2018;9(5):e01751‐ Weight Loss? 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 10 3/29/2021 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 11 3/29/2021 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 function offers the intriguing possibility that Health 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 12 3/29/2021 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.