In our regular Monday Lecture Series, Dr. Cheng will present on Ketogenic Diet (KetoDiet for short) for Weight Loss and Health. Topics to be discussed include:

1. What is Ketogenic Diet?  Why (healthy) fats are good for you.  Why carbs are bad. KetoDiet, it‘s health benefits.
2. Why is KetoDiet a foundation for all chronic disease?
   1. Case studies of KetoDiet and nutritional therapy for autoimmune diseases like psoriasis, skin rash.
3. Nutritonal KetoDiet (for health or for chronic disease management) vs. Restricted KetoDiet (for cancer management).
4. How to eat on ketogenic diet, introduce some keto recipes.
5. Other factors in a healthy diet.
   1. Brief introduction to oxidative stress, mitochondrial health, and nutritional approach to health.
6. How to combine KetoDiet with our current weight management protocols to better manage your weight and other chronic diseases (autoimmune disorders, diabetes, heart disease and even cancer).

Date and Time: Apr. 2nd, 2018, Monday, at 1 pm.

Address: Cheng Integrative Health Center/Doctor‘s Weight Loss Center, 6149 St. Andrews Rd., Columbia, SC 29212 (across stree from Cici’s Pizza, in fornt of the K-Mart).

Dr. Richard Cheng, MD

Ketogenic means ketone producing.  ketone is produced when fats are digested.  So ketogenic diet means ketone producing diet, or in other words, ketogenic diet contains predominantly (healthy) fat, very little carbs and appropriate amounts of proteins. Ketogenic diet is different from Atkins diet, and is NOT a high fat diet.  The total calories one needs to consume is limited (to one’s needs).

Benefits of ketogenic diet:

1. weight loss
2. anti-inflammatory (anti-oxidant)
3. lower cancer risk
4. muscle strengthening
5. inhibiting appetite
6. reducing insulin levels (insulin inhibits fat release.  So this reduction in insulin release can help in more fat release and weight loss).

Ketogenic Diet:

1. Healthy fats calories, about 80-85% of the total calories.
2. Protein calories: about 10% of the total calories
3. Carb calories: 5-8%.

Healthy Eating Habits:

1. Intermittent Fasting: Every day there should a period of 13-18 hour without food intake, water is ok. One may choose either to skip breakfast or skip dinner.  Research shows this type of intermittent fasting boosts your mitochondrial (Mito) function.  Mito is the rechargeable battery in your cells.  Dysfunction of Mito is found to be a major contributor to most, if not all, chronic diseases esp. cancer, and aging, including obesity.
   1. Skipping breakfast. For example, if one finishes dinner at 7 pm, then do not eat anything until at least 8 am (13 hours fasting) or, even better, 11 am (16 hours).
   2. Skipping dinner: Don’t eat anything after 4pm.  Then eat breakfast at around 8-10 am (that’s 16-18 hours fasting).
2. Ketogenic Diet (see above). One other reason why I advocate ketoDiet is the drastic reduction of carbohydrates.  Carbs cause lots of problems, esp. today’s carbs are heavily contaminated by all sorts of pesticides, herbicides, more so than other foods.  Carbs like wheat are a major to cause to many GI problems such as leaky gut which contribute to our autoimmune diseases and symptoms.  Allergy is just one of them. (I have been on the KetoDiet for a while now.  I really feel the difference: improved stamina, reduced seasonal allergy symptoms (I used to take Zyrtec daily.  But now, even in this pollen season, I have gone a whole week without needing Zyrtec.  This is amazing since for the last 25 years, I have never, NEVER, skipped several days, let alone a whole week, without an allergy pill).

We will close at 12/25/2017, Monday, for Christmas holiday.

and close at 1/1/2018, Monday, for New Year holiday.

MICROBIOME AND  PROBIOTICS

          We have co-evolved with the microbiota. Probiotics are beneficial live microorganisms which when taken in adequate amounts confer a beneficial health effect on the host. Most are bacteria. Almost every society has consumed some type of fermented food. Using probiotics is SAFE. Approximately 5000 species of microbes reside in a healthy human body. 100 trillion microbes reside in a human body. This is 10 times the number of human cells and 100 times the number of human genes. Some people propose that we are not autonomous agents. Rather, we are biomolecular networks called “holobionts” with the host and microbial genomes referred to as “hologenomes”.

          The GI tract contains 90% of these microbes in a symbiotic relationship. The large intestine is one of the densest microbial ecosystems on the planet. The vagina is like a sparsely populated prairie compared to the lower gut which is like a rain forest teeming with life. People are very different from one another, but they are consistent with themselves. Two healthy Americans’ microbial communities can differ by as much as 90%, but an individual’s distinctive ensemble of bugs tends to stay stable over many years.

          Microbes predigest our food, chemically modify the pills we take, shape our immune system responses, and repel infectious invaders. Nearly ¾ of the body’s immune cells are in the Gut Associated Lymphoid Tissue (GALT). The microbial inhabitants of the GI tract stimulate the immune system for optimal functioning.  GALT immune responses differentiate between beneficial and harmful dietary proteins (antigens) and beneficial and harmful microorganisms (bacteria, viruses, parasites).  Probiotics activate B-lymphocytes , T-lymphocytes and macrophages, stimulate the complement system, and reduce responses to “like-antigens”.  They digest nutrients and compete for nutrients with pathogens; modify the local pH to create conditions unfavorable to pathogens; produce bacteriocins that inhibit pathogens; scavenge superoxide radicals; stimulate epithelial mucin production; enhance intestinal barrier functions; compete for adhesions with pathogens; and modify and metabolize pathogen derived toxins.

          Probiotics have several mechanisms for their clinical effects:  1) direct interaction with intestinal cells with effects on intestinal barrier functions.  Skin and mucosal surfaces have adherent normal bacterial flora which provides protective barriers where neutrophils attack and macrophages engulf and ingest foreign bodies. The complement system stimulates and mobilizes the phagocytes (clean-up cells).  2) Interaction with immune intestinal B-lymphocytes stimulates plasma cells to produce antibody immunoglobulins such as increasing IgA.  Also, T-lymphocytes (which include killer, helper, suppressor and memory cells)  produce stimulating chemicals (lymphokines) and destructive chemicals (lymphotoxins).  3) They modulate gut microbes and compete for gut nutrients and metabolic pathways.  4) They directly antagonize intestinal pathogens.  And, 5) they create metabolic effects.

***I strongly recommend using probiotics to help manage constipation;  diarrhea;  irritable bowel syndrome;  infant colic; and, especially while taking antibiotics and after using antibiotics***  Probiotics are found in fermented foods such as  yogurt, beet kvass, kefir, sauerkraut, and, kombucha. The easiest way to consume adequate amounts are in powder or capsule form. I recommend for children 5 to 15 billion count capsules (which can be opened  onto food or mixed in a drink) daily, and for adults 15 to 30 billion count capsules daily. There is no upper limit and no adverse side effects.  NOTE: As we age, we tend to selectively lose one of the main players in our colon, namely Bifidobacterium species. The best way to restore them is to consume them (look for Bifido-rich yogurt or probiotic capsules) and to provide them with the food they need to live on in our colons: lots of vegetables, a little fruit, and limiting (toxic) doses of sugar that might feed competing species.

          ALSO NOTE: ***soil-based spore-forming bacteria are essential for our health. They are “pseudo-commensuls” because they pass through the gut rather than establishing a home there. Our ancestors regularly consumed them when eating wild foods and drinking from ponds and streams. The spores not only survive traversing through the hydrochloric acid and bile salts of the stomach,  they are activated to viably reach the intestines. An excellent product {that is unfortunately only available through a health care provider}  is called “Mega-Sporebiotic” from Microbiome Labs which contains Bacillus indicus, HU36; B. subtilis, HU58; B. coagulans; B. licheniformis; and B. clausii.

          I also strongly recommend reading the book by Dr. Josh Axe, MD called “Eat Dirt”.

          Six host factors disrupt our natural gut bacteria balance:  1)  Antibiotics: disrupt the number and relative proportions of gut bacteria. 2)  Infant Formula: breast feeding transfers bacterial diversity from mother to baby. Caesarian section delivery also disrupts this normal transfer of flora.  3)  Excessive hygiene.  4)  Our Western Diet high in animal proteins, fats , sugars and refined carbohydrates. 5)  Modern medical treatments such as artificial ventilation, skin-penetrating devices, tubes and catheters and their attendant antibiotic use.  6)  Age. 

          Our immune system co-evolved with parasites. Their absence can profoundly affect immune regulation leading to physical and psychological consequences. IgE immunoglobulin evolved to help manage parasites. Because of our overly cleanly environment with minimal parasites, IgE now responds to allergens with manifestations of Allergic Rhinitis and Asthma. People who are infected with hookworms have a lower incidence of auto-immune diseases than parasite-free modern humans. People who have been immunized with Bacille-Calmette-Guerin (BCG) are not only protected against developing tuberculosis, but they are less likely to develop melanomas.

                                THE IMPORTANCE OF MULTIPLE SPECIES

          Although good bacteria can be found in small amounts in food, changing the entire ratio of gut bacteria requires substantial and consistent dosing with supplements providing potent levels of beneficial bacteria to enable their survival. {Therap Adv Gastroenterol. 2010 Sept;3(5):307-319.}  Two types of probiotic bacteria commonly used include Lactobacillus and Bifidobacterium. There are many specific types of the bacteria within each of these two broad groups, and health benefits associated with one type may be unique to that specific species and not hold true for others. This means that using multiple different species delivers better odds of reversing the negative effects of “dysbacteriosis”, a condition where there is an imbalance between good and bad bacteria. {Eur J Nutr. 2011 Feb;50(1):1-17 and Anaerobe. 2012 Aug;18(4):405-413.}

Probiotics and Allergy:  Lactobacillus and Bifidus reduce the risk of eczema for children when used by pregnant and breast-feeding women. Lactobacillus reduces symptoms of eczema/atopic dermatitis for children and adults. Probiotics prevent and treat food allergies. The neonatal gut starts out nearly sterile. Breast-feeding, the environment, use of antibiotics all influence the infant’s microflora. Probiotics play an important role in establishing and maintaining a child’s general health. There is also benefit in preventing upper respiratory tract infections.  Probiotics improve the endogenous intestinal barrier and enteral antigen balance; improve regulation of secretory inflammatory mediators; decrease the Th1/Th2 ratio and reduce serum IgE levels.

Probiotics for Infant Regurgitation:  In a randomized controlled trial, formula-fed infants (mean age: 6 weeks) received lactobacillus reuteri or placebo for 4 weeks. The median number of regurgitation episodes during the final 7 days was lower with active treatment than with a placebo: 1 vs. 4 episodes. {Eur J Clin Invest. 2011;41:417-422.}

Probiotics and Vaginosis:  The vagina and its microbiota form a finely balanced ecosystem dominated by  lactobacilli. Lactobacilli play an important role in maintaining a favorable vaginal acidic pH and hydrogen peroxide production. Probiotics can improve vaginal health, microbiota balance, and reduce and treat some vaginoses. For example, some women can prevent recurrent vaginal yeast infections by routinely douching with plain yogurt once per month. This replenishes normal vaginal flora with healthy probiotics that suppress yeast.

Probiotics for aspirin-induced GI damage: In a randomized trial, elderly patients taking 100 mg/day of aspirin who had unexplained iron deficiency anemia received L. casei (5.5 billion to 63 billion) for 3 months. Compared with a control group that did not receive probiotics, the L. casei group had significantly fewer small intestinal mucosal breaks and significant improvement in intestinal mucosal appearance. {J Gastroenterol. 2011;46:894-905.}

Probiotics before colonoscopy:  In a double blind study, constipated patients scheduled for colonoscopy received probiotics (Bacillus subtilis and Streptococcus faecium) or placebo 3 times daily for 2 weeks prior to the colonoscopy. Compared with placebo, the probiotics increased the proportion of patients who had a satisfactory bowel preparation (54.9% vs. 20.8%). {Dig Dis Sci. 1010;55:2344-2351.}

Probiotics may boost your mood. A gut full of beneficial bacteria seems to promote the production of brain neurochemicals that ease feelings of anxiety and depression, while an abundance of harmful  bacteria may actually trigger these symptoms.

                                                    TAKING “PREBIOTICS”

          Prebiotics are carbohydrates that feed the beneficial bacteria in your body. Prebiotics include: slightly green or under-ripe bananas; durum pasta or egg noodles; sourdough bread; boiled rice (especially arborio, S. Andrea, and originario); the pectin in green apples; onions, leeks, and garlic (raw or cooked); Jerusalem artichokes; asparagus; raw chicory root; cooked oats; blueberries; and cooked dried beans (pinto, black).

          Eating prebiotics feeds Akkermansia microphilia, a bacteria which helps to regulate the immune system; increases vitamin D receptors and helps to regulate their function; helps fat absorption; helps bile-salts to function as nutrient signaling molecules; and, causes decreased C. difficile in the gut. NOTE: CBD oil also helps to feed A. microphilia and helps improve gut health.

                                          SPECIFIC DISEASE BENEFITS

          Although research tying specific probiotic strains and species to particular diseases is still in its infancy, scientists have identified a few disease treatment benefits for six of the most studied probiotic species:

1. Lactobacillus acidophilus:  reduced diarrhea and improved bowel function in cases of radiation-induced enteritis. Increased HDL  (good) cholesterol.  Improved markers for metabolic syndrome, inflammation, and heart disease.  Improved allergy-driven immune response.  Improved markers  for ulcerative colitis and irritable bowel disease.   Increased control of blood sugar. Decreased   the DNA damage that can trigger malignant cell development.
2. Lactobacillus rhamnosus:   reduced diarrhea and improved bowel comfort in cases of radiation-induced enteritis. Improved markers for metabolic syndrome, inflammation, and heart disease. Reduced  allergic response to milk in milk sensitive patients. Improved markers for ulcerative colitis, Crohn’s  disease  and improved irritable bowel syndrome. Also, there is an important association with helping with weight loss.
3. Lactobacillus paracasei:  enhanced therapeutic management of minimal hepatic encephalopathy. Improved markers for metabolic syndrome, inflammation and heart disease in elderly patients. Improved markers  for ulcerative colitis.
4. Bifidobacterium lactis:  improved immune function in healthy elderly individuals. Greater weight  gain and less gut inflammation in preterm infants.  Improved  immune response and respiratory symptoms from birch pollen allergies in children. Increased control of blood sugar.
5. Bifidobacterium bifidum:  improved markers for liver inflammation and damage in alcohol-related liver disease. Improved inflammation profiles in ulcerative colitis.
6. Bifidobacterium longum:  reduced diarrhea and improved bowel function in cases of radiation-induced enteritis.  Increased  HDL cholesterol.  Improved  markers for ulcerative colitis and Crohn’s  disease. Decreased  the  DNA damage that can trigger malignant cell development.  They improve cognition and decrease stress physiology and behavior. {This was not noted when people were given Lactobacilli because different bacterial strains will cause different effects.
7. The probiotic Lactobacillus Reuteri lowers cardiovascular risk:  L. reuteri 30242 produces an enzyme called bile salt hydrolase which makes cholesterol less absorbable so that it becomes trapped in the gut and later excreted in fecal matter. Further cholesterol reduction comes from the organism’s ability to increase cholesterol metabolism, thereby promoting its breakdown and excretion. It additionally reduces inflammatory markers.  A proprietary product called “FlorAssist Heart Health Probiotic” is available from www.LifeExtension.com.  
8. Saccharomyces cerevisiae, is a yeast found in sourdough bread, which helps to normalize intestinal microbial flora and specifically relieve symptoms associated with irritable bowel syndrome. Also, Saccharomyces Cerevisiae-Derived Peptides (SCDP): 500 mg twice per day help to induce weight loss by limiting calorie intake by modulating appetite regulating hormones, reducing new fat production, reducing body weight and fat mass, and, most importantly, reducing the size and weight of dangerous abdominal fat. Having a waist circumference out of proportion to BMI is an important cardiovascular risk factor. A proprietary product is available from www.LifeExtension.com called “Eatless peptide complex”. {Additionally, Perilla frutescens is an herb in the mint family that has beneficial flavonoids, especially vicenin-2 and rosmarinic acid which inhibit excitatory nerve and muscle activity in the intestines, which relaxes gut motility and reduces pain perception. It reduces inflammatory signaling molecules. And, it also supports the intestinal barrier reducing permeability–leaky gut. A proprietary product containing 150 mg of Perilla leaf extract plus the probiotic Saccharomyces cerevisiae called “Tranquil Tract” is available from www.LifeExtension.com.
9. Another product combines a 15 billion colony forming unit blend of 6 different probiotics PLUS 4 types of BACTERIOPHAGES called “Florassist GI with Phage Technology”.  The addition of bacteriophages is designed to remove unwanted bacteria in the intestines to make room for the beneficial probiotics. Phage cocktails have been used successfully in numerous human clinical and therapeutic settings to treat common bacterial invaders, including staph, strep and E. coli. They have demonstrated an extremely strong safety profile. Phage therapy encourages the growth of healthy bacteria in the gut microbiome which can competitively reduce harmful bacteria. Developed more than 100 years ago, phage therapy is experiencing a revival with the rise of antibiotic-resistant bacteria.
10. S. salivarius strain BLIS M18 and Bacillus coagulans GBI-30, 6086 supplementation results in significant improvement in oral and gum health. S. salavarius produces enzymes that help break down dental plaque and neutralizes acid to maintain a healthy oral pH.  A low pH demineralizes teeth and creates an environment in which bad bacteria thrive. It produces “lantibiotics” that kill competing organisms associated with periodontitis and reduces levels of cytokines associated with gingivitis. Bacillus coagulans competitively inhibits the growth of Streptococcus mutans which contributes to tooth decay and also reduces the production of inflammatory cytokines that promote the inflammatory response. A proprietary product is available from www.LifeExtension.com called “Florassist Oral Hygiene”.
11. S. salvarius K12 promotes throat health by helping to regulate inflammation and reduce damage caused by organisms that reside in the throat. It produces locally acting lantibiotics that target and inhibit beta hemolytic streptococcal infections. Clinical studies demonstrate a significant reduction in strep throat infections in people supplementing with S. salivarius K12 lozenges. It also contributes to a reduction in viral sore throats attributed to a reduction in cytokine signaling molecules including interferon gamma. A proprietary product is available from www.LifeExtension.com called “Florassist Throat Health.”
12. The combination of Lactobacillus helveticus R0052 plus Bifidobacterium longum R0175 helps to restore normal neurochemical and hormonal balances that obviate the symptoms of anxiety and depression. This combination also helps to decrease anger and hostility scores and chronic stress levels, and improved mood scores, and reduced stress induced abdominal pain, nausea and vomiting. A proprietary product is available from www.LifeExtension.com called “Florassist Mood”.
13. Pu-erh Tea is a unique probiotic. It is made from Camellia senensis leaves in the Yunnan district of southwest China. Fully fermented black tea is aged under high humidity and molds and bacteria grow on the leaves. It has less caffeine than black tea and the bacteria produce a small amount of lovastatin which can help to lower lipids. It is an acquired taste because the tea may smell musty and taste stale.
14. Lactobacillus helveticus can improve sustained attention, especially in older adults.

          A probiotic that is 100 times more potent than the average probiotic is called “VSL#3” containing 3 species of Bifidobacterium, 4 species of Lactobacillus, and 1 species of Streptococcus. There are 450 billion bacteria in each flavored and unflavored packet that can be mixed into cold or room temperature beverage or soft foods, or a vegetarian capsule that contains 112.5 billion bacteria in each capsule. It can be obtained from www.vsl3.com. Prescription strength “VSL#3-DS” (double strength) contains 900 billion live cultures of bacteria. It is particularly helpful for gastrointestinal problems including IBS and Ulcerative colitis. There are no adverse effects nor risk of overdosing.

                                                   LEAKY GUT SYNDROME

          Leaky gut syndrome may be the underlying cause for developing and exacerbating auto-immune diseases.  Zonulin is a protein at the tight junction between the epithelial cells lining the small intestine which selectively opens up the space between enterocytes and allows certain substances to enter the body while keeping others in the gut.  It is thought that large protein molecules, foreign substances and even microorganisms can enter the blood stream when the space at the tight junction between cells in the small  intestine is wider than it should be. Antibodies then target these antigens that don’t belong in the body, and an immune response develops. Where an auto-immune disease develops is a function of the antibodies attacking similar proteins in the body. Thus, the same basic problem has many manifestations. The tight junctions between enterocytes are perpetually opening and closing in response to a plethora of stimuli such as food, hormones, inflammatory markers, and the dietary state. Certain microorganisms can hijack the cellular pathways at these tight junctions or increase the zonulin levels, leading to increased gut permeability. One of the most powerful triggers is gliadin, a protein found in wheat. Like gluten, it has been linked to celiac disease. The idea that a porous intestine directly leads to disease is controversial. However, physicians don’t know enough about the gut, which is our biggest immune system organ, so we need to acknowledge our ignorance and keep an open mind because this theory may indeed be an accurate explanation. Food sensitivities are real. I believe that probiotics are essential for management. Also, anecdotally, thousands of people have benefitted from a gluten/gliadin-free (wheat free) diet even if they test negative for celiac disease. Additionally, nutritional supplements such as glutamine can be beneficial. 

                                                                    DYSBIOSIS

          When the ratio 85% “good microorganisms” to 15% “problematic microorganisms” of a healthy gut is disturbed, a condition called “dysbiosis” occurs. Also, an overgrowth of certain organisms can cause this problem, such as an overgrowth of Candida albicans. For example, 2 phyla of anaerobic bacteria, Firmicutes and Bacteroidetes, are so-called “fat-bugs” because they are associated with obesity. Food emulsifiers and artificial sweeteners enhance the growth of these bacteria which also results in insulin resistance. These fat-bugs can cause food cravings and manipulate our behavior: they change the number of dopamine receptors AND also change the reward centers in the brain. We need the balanced 15% problematic bacteria to keep our GALT stimulated so that our immune system can help us to prevent and fight off an infection. The GI tract is really the external world inside us, so we need this protection.

                                                 THE GUT-BRAIN CONNECTION

          The “Enteric Nervous System (ENS)” is separate from the Central Nervous System (CNS). It is composed of 2 thin layers of over 100 million nerve cells—more than in the spinal cord. The ENS lines the GI tract and controls blood flow, secretions and contractions. It also helps us to unconsciously “feel” (like a second brain) what is occurring in the GI tract. It has glial cells to support the gut neurons. It uses over 40 different neurotransmitters. It produces 50% of the body’s dopamine and 95% of the body’s serotonin. L. brevis can produce GABA. It has a barrier, similar to the blood-brain barrier, for protection. It may have its own memory (although it is not capable of thought). The gut and the brain are connected by the vagus nerve with about 90% of the signals going from the gut to the brain. {The vagus nerve also connects cardiac functions.} The bi-directional communication occurs by various physiological channels including autonomic pathways, neuro-endocrine pathways and neuro-immune pathways. People with Parkinson’s disease have the same protein clumps in the ENS as in the CNS. And, people with Alzheimer’s disease have the same neurofibrillary tangles and amyloid plaques in the ENS as in the CNS. {Thus, a gut biopsy may make earlier diagnosis possible.} 

          Both external and internal STRESS can create a challenge or a threat that disrupts an organism’s homeostatic balance. It can alter the composition and the function of the gut microbiota. For example, maternal stress can affect the fetal gut microbiome directly and through epigenetic factors. This can affect systemic dysregulation in early life and persist into adulthood. Potentiation of heightened anxiety may be transmitted because of this complex mixture of both biological factors as well as psychological factors that act in feedback loops. Chronic stress is associated with dysregulation of the hippocampal-pituitary-adrenal (HPA) axis. Irritable bowel syndrome results from a heightened gut sensitivity and limited ability to modulate an acute stress response.

          Vaginally delivered infants have a different and increased variety of  microbiotia than babies born by C-section. (Variability in flora becomes similar by about 8-weeks.) Hospital use of antibiotics and different feeding patterns (bottle vs. breast-feeding) also affect neurobiological development. Aging adults in long-term facilities compared to living in their communities have less diversity in their gut microbiome. 

          Changes in the microbiota may help to ameliorate psychological disorders. A probiotic cocktail has been associated with improving depression on the Beck Depression Inventory. L. helveticus can improve sustained attention in older adults. Polyunsaturated omega-3 fatty acids modify the gut microbiota resulting in improved cognition, dampened HPA activity with less anxiety and depression, and improved psychological well-being.

                                                THE GUT-HEART CONNECTION

          Probiotics can reduce both systolic and diastolic blood pressures. The greatest effect is found when the baseline BP is elevated and when the daily consumption is >100 billion colony forming units for over 8 weeks duration. Lactobacilli help to reduce blood cholesterol levels. Some bacteria express the enzyme bile salt hydrolase which affects intestinal cholesterol reabsorption. Yogurts help to decrease total cholesterol andLDL-cholesterol and improve the LDL/HDL ratio. There is an inverse relationship between fiber consumption and CVD: the more fiber ingested, the less the risk for CVD. Prebiotics stimulate bacteria to produce butyrate which helps to lower cholesterol, triglycerides and atheroma plaques.

          Modifiable risk factors include: 1) Obesity: Germ-Free mice (GF-mice) are a useful model. They are leaner than wild mice. When there is a fecal transplant from obese mice to GF-mice, they become fatter than from lean mice donors. 2) Cholesterol levels: certain gut microbes, such as Eggerthella, Pasteurellaceae and Butyricimonas alter the bile acid pool which modulates hepatic and systemic lipid and glucose metabolism. 3) Toxic burden: microbes can directly alter chemical activity and structure; produce metabolites that compete for detoxification pathways; and, affect expression of detoxification enzymes. 4) Leptin and Insulin resistance: microbial fermentation of dietary fiber produces a short-chain fatty acid called butyrate which increases leptin expression in adipocytes and improves insulin sensitivity. 5) Inflammation: gut microbes mediate inflammatory signals. Age-associated dysbiosis causes increased inflammation and increased CVD. 6) Nutrient deficiency: gut microbes synthesize B-vitamins, vitamin K and vitamin C and some are absorbed by the host. However, “greedy microbes” may preclude absorption. 7) TMAO and Heart disease: Trimethylamine-N-Oxide (TMAO) is produced via microbial metabolism of choline to trimethylamine (TMA) with subsequent oxidation in the liver. An increased amount of TMAO is an independent risk factor of increased CVD. It is microbial dysbiosis, and not dietary choline, which is the problem.

          The liver is a key player between the gut and the heart during nutrient deprivation (that is, fasting). In fasted GF-mice, the heart relies upon glucose metabolism for energy. Evolutionarily,because the heart needs a constant supply of energy to function, it has the capacity to use different substrates, depending upon availability. In mammals, fasting conditions cause an increased production of ketone bodies in the liver which results in increased ketone utilization by the heart, brain and other tissues. Gut microbes can cause increased acetate production which increases the pool of hepatic Acetyl CoA which is the starting molecule for ketone production.

          Gut pathologies and CVD: 1) Dysbiosis: animals with hypertension have an increased Firmicutes to Bacteroides ratio, and they have decreased bacterial diversity and richness. Also, they have decreased butyrate and acetate microbial metabolites with resultant increased inflammation. People with chronic CHF also have decreased microbial diversity and diminished important bacterial genra. 2) Small Intestinal Bacterial Overgrowth (SIBO): is associated with increased arterial stiffness and decreased Matrix Gla Protein (MGP), which when activated prevents the calcification of blood vessels. Decreased MGP is related to decreased vitamin K absorption by the small intestines and/or to decreased vitamin K production by colonic bacteria. Also, SIBO causes systemic inflammation which is associated with increased CVD. 3) Infections: Chlamydia pneumoniae and Helicobacter pylori infections are associated with increased CVD. Patients with chronic CHF had increased quantities of pathogenic bacteria, including Campylobacter spp, Shigella spp, Salmonella spp, Yersinia enterocolitica, and Candida spp in their colons. Bacterial DNA can be identified in >50% of coronary plaques. 4) Intestinal Permeability: A “leaky gut” allows bacteria and their metabolites to enter the blood stream, triggering an immune response, and allowing them to become associated with the heart. TLR4, a receptor of the adaptive immune system, binds to lipopolysaccharides which are a component of gram-negative bacterial cell walls. This binding initiates inflammatory signaling. In mice, if the TLR4 receptor is ablated, there is decreased atherosclerotic plaque formation. Increased intestinal permeability both induces inflammation and weakens coronary plaque stability. {Plaque rupture is the trigger for an acute MI.} Patients with chronic CHF have increased intestinal permeability compared with healthy controls.

                                         SUGGESTIONS TO HEAL A LEAKY GUT

1. Eat probiotic rich foods—fermented foods like kefir, yogurt and sauerkraut.
2. Eat raw honey and bee pollen.
3. Get a dog or a cat for a pet.
4. Swim in the ocean.
5. Get grounded: “Earthing”.
6. Regularly take soil-based, spore-forming probiotics, such as “Megasporebiotics”.
7. Eat locally from Farmer’s Markets.
8. Substitute for cow’s milk: such as coconut milk, almond milk, hemp milk, rice milk, goat milk or sheep milk.
9. Substitute for wheat flour: coconut flour, almond flour, manioc (tapioca) flour, sprouted ancient grain flours such as buckwheat, sorghum, amaranth, quinoa and millet.
10. Choose healthy oils: coconut oil (or manna), olive oil, flaxseed oil.
11. Substitute for sucrose (table sugar): honey (especially manuka honey), green leaf stevia, maple syrup.
12. ***Use BONE BROTH: it contains gut sealing collagen, key amino acids (proline, glycine, and glutamine), and easily absorbed minerals.

NOTES:

• Coconut products are high in lauric acid which kills pathogenic bacteria and fungi.Fermented vegetables enhance nutrient absorption and provide both prebiotics and probiotics.
• Fermented daily products (kefir and yogurt) provide probiotics and decreased lactose.
• Cooked vegetables, especially boiled or steamed) are easier to digest than raw and are packed with vitamins, minerals and antioxidants.
• Grass-fed meats and wild-caught deep sea fish have increased omega-3 fatty acids.
• Soil-based organisms help heal the gut. a) Bacillus subtilis elicits an immune response that supports healing the gut lining and suppresses pathogenic bacteria. b) Bacillus coagulans improves nutrient absorption. Spores are activated by stomach acid and bile salts and produce lactic acid in the intestines which helps to reduce inflammation.
• Medicinal mushrooms, such as Cordyceps, Reishi, Shiitake, Lion’s Mane, and Turkey Tail, help to balance microbes in the microbiome. They supply prebiotics to keep them fed. They boost the immune system, detoxify chemicals and heavy metals, and help to reduce histamine release. They inhibit pathologic immune responses in auto-immune disorders, destroy tumors and cancer cells, and help to fight viruses and Candida. They act as adaptogens to balance cortisol and stress responses.
• Blue-green Algae, such as Spirulina and Chlorella, are nutrient rich.
• Beneficial yeast, such as Saccharomyces boulardii destroy pathogenic bacteria and improve diarrhea; relieve intestinal gas and bloating; repair intestinal wall mucus membranes; strengthen GALT; help inflammatory bowel disease; help acne; and, help destroy Candida albicans.
• Bentonite clay (1 teaspoon 3x/day) can help with constipation and cleansing the intestines. However, too much along with not enough water can be constipating.
• Bone Broth is nutrient dense, easy to digest, full of collagen and the beneficial amino acids proline, glycine and glutamine. It helps to decrease inflammation and heal a leaky gut by restoring the mucosal lining. It provides easily absorbed minerals such as calcium, phosphorus, magnesium, silicon and sulfur. It contains glucosamine which helps to stimulate and heal the immune system. Beef bone broth is high in types 1 and 3 collagen which helps the skin and nails. Chicken bone broth is hight in type 2 collagen which helps the gut and joint cartilage. Fish bone broth is high in type 1 collagen which helps to produce human type 1 collagen which is found in 90% of the body. Drink 1 to 2 cups of bone broth daily “to heal and seal”.

                                       CONSIDERATIONS FOR THE FUTURE

1. Treating colitis with fecal transplants to re-establish healthy gut flora in patients who have received antibiotics with consequent resistant C. Difficile infections.
2. Banking a patient’s own microbiome before chemotherapy in order to be re-inoculated them afterwards to speed their recovery.
3. Treating babies with microbes that shape the immune system to stave off autoimmune diseases like asthma and psoriasis. For example, c-section babies, who miss out on their mother’s vaginal flora through a passage through her vagina, can be washed with their mother’s vaginal fluid after birth to give them a similar protective advantage.

An Interesting story:  Soldiers stationed in Morocco during World War II were getting gravely ill with dysentery, and no one could figure out why or how to stop it. They noticed that locals weren’t getting as sick. When Moroccans began to get ill, they would follow their camels and eat the droppings. Although  this seems disgusting, we now know that the droppings were full of B. subtilis bacteria which cured the disease.

Dr. Chuck Wile, Seminar Series at the Cheng Integrative Health Center, on 12/4/17

Fibromyalgia syndrome is a collection of symptoms without a known cause. Commonly people may experience pain trigger points and generalized pain, fatigue, sleep disruption, anxiety and depression, “brain fog” with difficulty concentrating, chronic headaches, touch sensitivity, environmental sensitivity, muscle spasms, muscle and joint stiffness, and bowel problems. Based on large amount of research, Dr. Dan Purser, MD proposes that the underlying cause for FS is copper toxicity. Because of a genetic defect, there is an excessive amount of the metabolite of hemaglobin, known as Pyrrole, which is bound to the body’s key antioxidant, glutathione, for urinary excretion, decreasing the quantity of glutathione. Also, excretion of pyrrole pulls zinc, vitamin B6 and other nutrients from the body. This creates an imbalance of the copper and zinc ratio in the body resulting in an excess of  “free copper”, unbound to ceruloplasmin. This “free copper” deposits in muscles causing pain and systemic toxicity. Molybdenum is a co-factor for enzymes that help to detoxify copper and other heavy metals. With FS, there is also a molybdenum deficiency. The detoxifying enzymes are consequently dysfunctional. Thus, the primary treatment for FS involves first supplementing with zinc and vitamin B6, then, slowly adding molybdenum. Additionally, supplementing with topical glutathione and other nutrients helps people to experience significant symptom relief. An additional hypothesis regards FS as a mitochondrial defect. Thus, supplementing with phospholipids, the adrenal hormone DHEA, various nutrients, and oxytocin has also been helpful.

Contributed by Dr. Chuck Wile, MD

-This again shows the importance of balance (or the lack thereof) of various nutrients, vitamins, as well as the importance of mitochondria in our health. Those diagnosed with FS should schedule an appointment to see us for a proper workup and treatment.  – Dr. Richard Cheng