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The Microbiome: Do You Have the Guts to Be Healthy?


Dysbiosis and the Many Roles of the Gut Microbiome

An ever-growing body of scientific research demonstrates the importance of the gut microbiome for digestion and overall health. The gut microbiome, which is defined as the population and its genome of the microorganisms that live in the ecosystem of the human gastrointestinal tract,[1]  mediates proper immune function, metabolizes drugs, eliminates toxins, and creates vitamins.[2]

Dysbiosis is a term to describe the state of an imbalanced microbial population; for example, when there are too many harmful bacteria and not enough beneficial bacteria.

Dysbiosis may be caused by a number of factors, including: [3],[4],[5],[6]

  • Genetic mutations
  • Diet (processed foods, high fat, high sugar)
  • Stress
  • Antibiotics
  • Early life exposure, i.e. C-section, bottle feeding
  • Food allergies

Dysbiosis is also associated with numerous diseases, such as: [7],[8],[9],[10]

  • IBS
  • IBD (Crohn’s disease, ulcerative colitis)
  • Cardiovascular disease
  • Chronic fatigue
  • Depression
  • Anxiety
  • Diabetes
  • Obesity

Truly the gut microbiome, directly and indirectly, affects overall health and quality of life. So what are the steps that you can take to restore balance and health to your patients’ gut flora?

The 4 R Approach, originally developed by Dr. Jeffrey Bland, may be an effective way for you to treat dysbiosis and get your patients feeling well again. It consists of Remove, Replace, Repair and Re-inoculate.

Step 1: Remove

The first step is to remove any food allergens or causes of inflammation. High-fat diets, the standard American diet and excess sugar are known to increase inflammation and damage gut microbiota communities.[11] Additionally, some of the most common food allergens that may need to be eliminated are: [12]

  • Dairy
  • Eggs
  • Wheat
  • Soy

Step 2. Replace

After allergens have been removed, it is important to replace the necessary elements for healthy digestion. This may include digestive enzymes (protease, lipase, and amylase). Digestive enzymes can increase nutrient absorption and be beneficial for multiple different digestive disorders.[13] Hydrochloric acid supplements to increase stomach acidity are also commonly used.

Step 3: Repair

The repair step involves healing the damaged intestinal tissues. Glutamine, vitamin A, and zinc are all known to improve nutrient absorption and the integrity of the epithelial barrier.[14] In fact, a double-blind placebo-controlled study showed that glutamine supplementation significantly improved epithelial barrier function in malnourished children.[15]

Step 4: Re-inoculate

To restore optimal gut microbiome health it is important to re-inoculate the gut with beneficial bacteria. Probiotic supplements can be a great way to reintroduce healthy bacteria including Bifidobacterium sp., Lactobacillus sp., and bacillus spore-forming species. Fermented foods are another highly effective way of getting probiotics. You might suggest that your patients eat:

  • Sauerkraut
  • Kimchi
  • Unsweetened yogurt
  • Unsweetened kefir

So remember: Remove, Replace, Repair and Re-inoculate! Following the 4 R’s may help in cultivating a healthy gut microbiome, and thus, a healthy mind and body!

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[1] Ghaisas S, Maher J, & Kanthasamy A. (2016). Gut microbiome in health and disease: linking the microbiome-gut-brain axis and environmental factors in the pathogenesis of systemic and neurodegenerative diseases. Pharmacology & Therapeutics, 158, 52–62.

[2] Alenberg LG & Wu GD. (2014). Diet and the Intestinal Microbiome: Associations, Functions, and Implications for Health and Disease. Gastroenterology, 146(6): 1564–1572.

[3] Ibid.

[4] Round JL & Mazmanian SK. (2009). The gut microbiota shapes intestinal immune responses during health and disease. Nature Reviews Immunology 9, 313-323.

[5] Song SJ, Dominguez-Bello MG, & Knight R. (2013). How delivery mode and feeding can shape the bacterial community in the infant gut. CMAJ, 185(5), 373-374.

[6] Ghaisas op. cit.

[7] Alenberg & Wu op. cit.

[8] Round & Mamanian op. cit.

[9] Flowers SA & Ellingrod VL. (2015). The Microbiome in Mental Health: Potential Contribution of Gut Microbiota in Disease and Pharmacotherapy Management. Pharmacotherapy, 35, 910-916.

[10] Ghaisas op. cit.

[11] Cani PD, Possemiers S, Van de Wiele T, et. al. (2009). Changes in gut microbiota control inflammation in obese mice through a mechanism involving GLP-2-driven improvement of gut permeability. Gut, 58(8): 1091–1103.

[12] Boyce JA, Assa’ad A, Burks AW, et. al. (2010). Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel. J Allergy Clin Immunol, 126(6): S1–58.

[13] Ianiro G, Pecere S, Giorgio V, et. al. (2016). Digestive Enzyme Supplementation in Gastrointestinal Diseases.  Current Drug Metabolism, 17, 187-193

[14] Lima AAM, Anstead GM, Zhang Q, et al. (2014). Effects of glutamine alone or in combination with zinc and vitamin A on growth, intestinal barrier function, stress and satiety-related hormones in Brazilian shantytown children. (2014). Clinics, 69(4): 225–233.

[15] Ibid.


Clinical Contributor

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Ramona Richard, MS, NC

Ramona Richard, MS, NC

Ramona Richard graduated with honors from the University of California with a Bachelor’s Degree in psychology and graduated summa cum laude with a Master’s Degree in Health and Nutrition Education. She also holds a Standard Designated Teaching Credential from the State of California, is a California state-certified Nutrition Consultant and a member of the National Association of Nutrition Professionals.

Ramona has participated in nutrition education in both public and private venues, including high school and college presentations, radio and public speaking for the past 20 years. She is the owner of Radiance, a nutrition consulting company, the Director of Education for Sanesco International, and a medical technical writer.

Disclaimer: The information provided is only intended to be general educational information to the public. It does not constitute medical advice. If you have specific questions about any medical matter or if you are suffering from any medical condition, you should consult your doctor or other professional healthcare provider.

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