Interest in the gut microbiome has exploded in recent years, with neuroscience research exploring the connection to mental health. This webinar will explore the origins and evolution of the gut brain microbial connection and discuss factors that cause microbial disruption and may contribute to neuropsychiatric disorders. Therapeutic modalities including ‘food as medicine’ strategies and mind-body practices that support a resilient microbiome are discussed.

CMBM course director for Food As Medicine, Kathie Madonna Swift, MS RDN LDN FAND

CMBM Education Director of Food As Medicine, Kathie Madonna Swift, MS, RDN, LDN, FAND

Aired Live on Wednesday, October 5, 2016

Learning Objectives

The attendee will be able to…

  1. To describe the evolution of the microbiota gut brain axis (MGBA)
  2. To examine factors that contribute to microbial disruption
  3. To identify potential therapeutic interventions for balancing the MGBA

CPE level: Level 2: General knowledge of the literature and professional practice in areas covered

Learning Codes:

2080 Microbiology, food toxicology
4040 Disease prevention
5320 Psychiatric disorders, anxiety (disease/disorder)

Presented in partnership with Dietitians in Integrative Functional Medicine

Food As Medicine

Kathie is the course director for The Center for Mind-Body Medicine’s ground breaking program, Food As Medicine. She will join James Gordon, MD and some of the leading professionals in mindful eating for a special presentation of our program, Mind, Mood, and Food at Esalen Institute in Big Sur, CA on April 15-20, 2018.

Learn More

Questions and Answers

Can you please provide the complete reference for the study involving the 75 infants, where L. Rhanosus GG was given and outcome for ADHD?
Pärtty A et al. A possible link between early probiotic intervention and the risk of neuropsychiatric disorders later in childhood: a randomized trial. Ped Res. 2015;77(6):8223-8.
What do you recommend as primary resources for the beginner in this area of practice?
The Certificate of Training Module that will be released by the Academy on Nutrition and Dietetics in Integrative and Functional Nutrition will be an excellent way to get started.
If you want to dig deeper, check out the Integrative and Functional Nutrition Academy, www.IFNAcademy.com as it is a comprehensive, online program geared to dietitian/nutritionists and other qualified health care professionals.
How do you define “ultra” processed food versus processed food? What your definition of processed?
This has been formally defined by various groups – I included a couple interesting abstracts for further reading.
Appetite. 2016 Oct 1;105:611-7. doi: 10.1016/j.appet.2016.06.028. Epub 2016 Jun 24.
Consumers’ conceptualization of ultra-processed foods. Ares G1, Vidal L2, Allegue G3, Giménez A2, Bandeira E4, Moratorio X4, Molina V5, Curutchet MR6.
Author information http://www.fao.org/3/a-i4690e.pdf
Abstract
Consumption of ultra-processed foods has been associated with low diet quality, obesity and other non-communicable diseases. This situation makes it necessary to develop educational campaigns to discourage consumers from substituting meals based on unprocessed or minimally processed foods by ultra-processed foods. In this context, the aim of the present work was to investigate how consumers conceptualize the term ultra-processed foods and to evaluate if the foods they perceive as ultra-processed are in concordance with the products included in the NOVA classification system. An online study was carried out with 2381 participants. They were asked to explain what they understood by ultra-processed foods and to list foods that can be considered ultra-processed. Responses were analysed using inductive coding. The great majority of the participants was able to provide an explanation of what ultra-processed foods are, which was similar to the definition described in the literature. Most of the participants described ultra-processed foods as highly processed products that usually contain additives and other artificial ingredients, stressing that they have low nutritional quality and are unhealthful. The most relevant products for consumers’ conceptualization of the term were in agreement with the NOVA classification system and included processed meats, soft drinks, snacks, burgers, powdered and packaged soups and noodles. However, some of the participants perceived processed foods, culinary ingredients and even some minimally processed foods as ultra-processed. This suggests that in order to accurately convey their message, educational campaigns aimed at discouraging consumers from consuming ultra-processed foods should include a clear definition of the term and describe some of their specific characteristics, such as the type of ingredients included in their formulation and their nutritional composition.
Is almond milk considered a processed food?
I consider many commercial almond milks a processed food – you can check the label and notice different additives especially various gums, etc. which in some individuals may ignite an immune (reactive) response. We are beginning to see some almond milks appearing on the market without these additives! Here’s a link to a review of some popular almond milk products: https://healthyeater.com/almond-milk
My friend and colleague, Leslie Cerier’s books have recipes for homemade almond milk (yes, it is a bit of a chore!) – (Gluten Free for the Conscious Cook)
I think we will see more non-dairy “milks” without carrageenan, etc. in the future.
Please expand on zonulin. Is there a way to check levels? What is the evidenced based practice related to this?
Check out Dr. Alessio Fasano’s teams work on zonulin!
https://www.ncbi.nlm.nih.gov/pubmed/22902773
Intestinal permeability and its regulation by zonulin: diagnostic and therapeutic implications.
Fasano A1.
Clin Gastroenterol Hepatol. 2012 Oct;10(10):1096-100. doi: 10.1016/j.cgh.2012.08.012. Epub 2012 Aug 16.
Ann N Y Acad Sci. 2012 Jul;1258:25-33. doi: 10.1111/j.1749-6632.2012.06538.x.
Zonulin, regulation of tight junctions, and autoimmune diseases.
Fasano A1.
Yes, you can check levels of zonulin and antibodies to zonulin through labs such as Cyrex Labs and Dunwoody Labs.
What are some strategies or resources to help clients avoid histamines?
Diet! A histamine restricted diet is important and consider the use of enzymes specific to breaking down histamine (ex. DAO and HMNT)
Wien Klin Wochenschr. 2013 May;125(9-10):239-43. doi: 10.1007/s00508-013-0354-y. Epub 2013 Apr 12.
Serum diamine oxidase activity as a diagnostic test for histamine
intolerance.
Mušič E , Korošec P, Šilar M, Adamič K, Košnik M, Rijavec M.
Histamine intolerance lists:
http://www.histaminintoleranz.ch/en/introduction.html
What is the role of PPIs in disrupting the gut microbiome and how may we help patients move away from their use?
Here are a couple of recent papers on this topic for you to explore further!
Gut. 2016 May;65(5):749-56. doi: 10.1136/gutjnl-2015-310861. Epub 2015 Dec 30.
Proton pump inhibitors alter the composition of the gut microbiota.
Jackson MA1, Goodrich JK2, Maxan ME3, Freedberg DE4, Abrams JA4, Poole AC2, Sutter JL2, Welter D2, Ley RE2, Bell JT1, Spector TD1, Steves CJ1.
Gut. 2016 May;65(5):740-8. doi: 10.1136/gutjnl-2015-310376. Epub 2015 Dec 9.
Proton pump inhibitors affect the gut microbiome.
Imhann F1, Bonder MJ2, Vich Vila A1, Fu J2, Mujagic Z3, Vork L3, Tigchelaar EF2, Jankipersadsing SA2, Cenit MC2, Harmsen HJ4, Dijkstra G1, Franke L2, Xavier RJ5, Jonkers D3, Wijmenga C2, Weersma RK1, Zhernakova A2.
Can you please address numbers of servings? I understand the diversity aspect. How much to be relevant to human health?
I wish we knew exactly how many servings! Each person is unique so servings will depend on the individual’s needs but as a ballpark – I encourage at least 30 grams fiber per day and 1-2 small servings of fermented foods daily (if tolerated)
Can you speak to a long-term appropriate, flexible diet in patients who are left with a malabsorption/malnutrition profile as a result of surgical procedures like those related to bariatric surgeries (i.e. duodenal switch) or cancer surgeries?
I would want to assess the individual in order to personalize a therapeutic diet based on their needs as no too cases post-surgeries are alike. Sorry, but I would need to know more – certainly assessing nutritional status with micronutrient levels, fecal fat, etc. would be helpful to tailor the intervention.
On one slide that was just up for a sec (right before Yacon slide) Cassava was noted, but not discussed. So, is it also a good fermentable carb similar to yacon?
Yes, there is some scant research on cassava’s prebiotic potential.
Pro-inflammatory fructose, is that limited to high-fructose corn syrup or would this also include whole food sources of fructose such as fruits?
Prioritize exclusion of all HFCF foods and beverages! Total fructose load should be limited but that does not exclude fresh fruit – since remember fruit can also offer prebiotic potential to the gut! Bottom line- enjoy fruit in moderation.
I read somewhere that we need to limit daily fructose to 25g/day. Any evidence to suggest that limit? Where do we find the fructose information?
Check out the Bengmark paper as he does discuss fructose limits
Is there a way that you suggest checking for food sensitivities?
For over 2+ decades, I have been hoping for the “best test” to check for food sensitivities – we have explored many different companies and testing in the clinics I work at —and all have limitations. In my humble opinion, the gold standard remains the elimination diet…It is cumbersome, challenging, and time-consuming to go through the process which is why a RDN is key guiding a patient through the process! A food sensitivity test that has high specificity and sensitivity would be very helpful as a nutritional navigational tool. This being said, I want to add that many of my colleagues have reported good success with a number of different types of tests: IgG/IgA, (Genova, Cyrex Labs) MRT/LEAP (Oxford) , Alcat, …so in the end you have to do your due diligence and determine, to test or not to test?
Have you heard of the new plant based (pea protein) milk, Ripple? If so, what are your thoughts in recommending it for those who may be vegan, or lactose intolerant?
Yes, another new entrant into the non-dairy “milks”! Ok for vegans and also lactose intolerant, however, FODMAP folks may not tolerate as well. I was pleased to see it wasn’t loaded with gums! Haven’t tasted it yet, but reviews I read online are good!

Webinar Series

Did you miss the first webinar in this series? James Gordon, MD presented “Fundamentals of Mind-Body Medicine” on August 4, 2016. Listen to the webinar by following this link.