The hygiene hypothesis states that a lack of exposure to microorganisms—both beneficial and potentially harmful—during early childhood increases susceptibility to development of allergic diseases by creating an imbalance in immune system development. Brenda has blogged on the topic before, and I’ve blogged about immune balance.

A recent study published in the Journal of Allergy and Clinical Immunology has found that gut diversity in infancy helps protect against the development of allergies.¹ The study involved 40 children: 20 with atopic eczema, and 20 children with no health conditions. Stool samples were collected from each child at one month and twelve months of age, and the DNA of bacteria present in the infants’ guts was identified. The diversity of gut microflora at one month of age was significantly greater in the healthy children than in those children who later developed allergies.

The researchers suggested that in the absence of stimuli from a diverse array of microbes, the immune system may overreact against harmless antigens in the environment, such as food. I have blogged on the topic of food sensitivities, as well, highlighting the importance of maintaining immune balance with a good balance of gut bacteria.

So how do infants acquire gut bacterial diversity? First, by vaginal delivery, through which they are inoculated with protective bacteria from their mother (which works best if mom is on a plant-based diet, eating prebiotic foods, and taking probiotics throughout the pregnancy); second, by breastfeeding, which delivers yet more beneficial bacteria and prebiotics to feed the beneficial bacteria establishing in the baby’s gut; three, without the use of unnecessary antibiotics, which decrease gut bacterial diversity; and four, with a healthy diet consumed by the mother. When any of these factors cannot be optimized, probiotics formulated for infants can help build the beneficial bacteria in the gut.

References

1.  T.R. Abrahamsson, et al., “Low diversity of the gut microbiota in infants with atopic eczema.” J Allergy Clin Immunol. 2011 Dec 6. [Epub ahead of print].

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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Atrazine is the most widely used herbicide in the United States. Over 75 million pounds of it are applied to corn and other crops, many in the Midwest. Atrazine is the most common pesticide contaminant found in groundwater, surface water, and rain in the United States. A recent study has found that women living in areas where atrazine water contamination is found are more likely to experience menstrual irregularities than women living in regions where there is no contamination.

I have blogged on the adverse hormonal effects of atrazine before. It has been found to turn male frogs into females, even at low concentrations. In 2009 atrazine was also linked to low birth weight in Indiana newborns, and menstrual irregularities have been found in women exposed to atrazine through agricultural work.

In this new study, women from two different cities in Illinois were compared with women from two different cities in Vermont. Illinois has the highest rates of atrazine water contamination, though the levels found in the study were still under limits set by the Environmental Protection Agency. The women in the Illinois cities were almost five times more likely to report irregular periods than the Vermont women, and more than six times more likely to go more time between periods.

Emily Barrett, a reproductive health scientist at the University of Rochester in New York stated, “These types of changes to hormone concentration and ovarian function could potentially lead to problems with fertility.” The study did not look at fertility, but hopefully more studies will address this.

Atrazine is sprayed on 75 percent of corn, as well as other crops. Corn is used in so many foods, and is used to make so many different ingredients in foods. This week, start reading your food labels to discover how widespread corn is. Then, take measures to replace the largest sources of non-organic corn with organic corn in your diet. It’s worth it. We’ve got to reduce our chemical exposure. Eating organic, when possible, is a big way to do that.

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In some people who take antibiotics, the uncomfortable side effect of diarrhea results. This happens because antibiotics disturb the gut bacterial balance. Antibiotics, aptly named as they are, work by killing bacteria—both good and bad bacteria. This alteration of gut bacteria can result in an imbalance that favors pathogenic bacteria, resulting in diarrhea. This is known as antibiotic-associated diarrhea (AAD). One of the most severe forms of AAD is Clostridium difficile-associated diarrhea.

A recent review of 22 studies, and a recent meta-analysis of randomized controlled trials, both sought to determine the effectiveness of probiotics on the prevention of antibiotic-associated diarrhea. In the review, the lead researcher stated, “Overall in twenty-two studies, probiotic prophylaxis significantly reduced the odds ratio of developing AAD by approximately 60 percent. This analysis clearly demonstrates that probiotics offer protective benefit in the prevention of these diseases.” A researcher presenting the results of the meta-analysis stated, “The preventive effect of probiotic use remained significant regardless of species used, adult versus child populations, study quality score and antibiotic administered.”

These findings were presented at the American College of Gastroenterology’s 76^th Annual Scientific Meeting in Washington, D.C. in late October. The acknowledgement of the beneficial effects of probiotics by such a group is encouraging. Certainly, the evidence is impossible to ignore. Next time you are prescribed antibiotics, ask your doctor about taking probiotics. If your doctor is not familiar with probiotics, educate him/her!

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Results of a recent study suggest that regular consumption of dairy-based probiotics may be associated with lowered risk of preeclampsia in pregnant women. Preeclampsia is a condition during the second half of pregnancy in which high blood pressure and protein in the urine develop. The exact cause is unknown, but it can lead to complications since the only way to cure it is to give birth. Preterm labor may need to be induced in certain preeclampsia cases.

In the probiotic study, published in the American Journal of Epidemiology, data were analyzed from 33,399 Norwegian women. It was found that the women who regularly consumed lactobacilli-containing dairy products also had a 20 percent reduced risk in developing preeclampsia.

While this study does not prove causality, it only shows an association; studies like these pave the way for further trials investigating just what is happening here. The researchers stated, “Further strain/species-specific investigation is warranted with the use of randomized controlled trials for further evaluation of the effect of probiotics on preeclampsia.” The researchers suggested two possible explanations for probiotic benefit to preeclampsia: a possible local effect on cells surrounding the embryo, and/or an overall reduction in inflammation levels.

Taking probiotics during pregnancy has also been found to reduce belly size after pregnancy, maintain healthy blood sugar, and even help reduce later allergic illnesses. Always be sure to talk to your doctor about taking supplements during pregnancy, however. You want to be sure your doc is also on board.

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Alzheimer disease is the most common form of dementia, accounting for 50 to 80 percent of all dementia cases. Dementia involves memory loss and other impaired intellectual abilities, all of which interfere with everyday life. Though most people with Alzheimer disease are over 65 years, up to five percent have early-onset Alzheimer’s, which usually appears during the mid-40s or 50s.

Beta-amyloid is a peptide found in plaques in the brains of people with Alzheimer disease. For a long time, it has been thought that beta amyloid-played a causative role in the neural degeneration of the disease. This may be a mistaken belief, however, as highlighted by a recent Phase III clinical trial on the anti-amyloid drug semagacestat. Patients in this trial were expected to improve on this drug, which interferes with the production of gamma-secretase, the enzyme that produces beta-amyloid. Instead, the drug “did not slow disease progression and was associated with worsening of clinical measures of cognitions and the ability to perform activities of daily living,” according to a press release put out by the drug manufacturer, pharmaceutical giant Eli Lilly. The trial was stopped before completion.

As it turns out, beta-amyloid is an antimicrobial peptide, and is suggested to be secreted by the brain in self-defense against infectious pathogens, as David Perlmutter, M.D. stated at the Institute for Functional Medicine’s 20^th Symposium this past summer. We know beta-amyloid plaque builds up in the brain in people with Alzheimer disease, but what if its presence was a self-defense mechanism rather than the actual root cause of Alzheimer’s?

In a recent study by researchers at Mass General Institute for Neurodegenerative Disease, we may have our answer. The researchers stated, “Rather than beta-amyloid acting as a sole independent initiator of neuroinflammation, our data raise the possibility that the peptide may be part of a response mounted by the innate immune system. An absence of the peptide may result in increased vulnerability to infection.”¹

Two main pathogens are implicated as possible triggers of Alzheimer disease: Herpes simplex virus 1, the virus known for causing cold sores of the mouth, and found in about 90 percent of all adults; and Chlamydia pneumonia, the respiratory bacteria known to cause pneumonia.

In one study, the presence of anti-HSV IgM antibodies was found to be an even bigger risk factor for the development of Alzheimer disease than even the “Alzheimer’s gene” APOE4 allele.² In describing how Herpes may lead to Alzheimer’s, the researchers state, “Recurrent reactivation of HSV might act as a potent stimulus to the brain microglia, increasing the level of cytokines and initiating a positive feedback cycle that gives rise to an increasing accumulation of pathological changes.”

DNA from HSV1 and from Chlamydia pneumoniae has been found in the brains of people with Alzheimer disease.^3,4 HSV1 was found in specific areas affected by Alzheimer’s, and Chlamydia was actually cultured from brain samples taken from recently-deceased Alzheimer’s patients, indicating the virus was alive in the brain.

Chlamydia pneumonia is also known as the “heart attack” bacteria, found in the intraclavicular space/fluid between gums and teeth. The best prevention for this, incidentally, is the use of Plaquers dental floss; dental floss with a handle. When the bacterium is found, orthodontal work should be performed. People with high levels of hs C-reactive protein (a marker of inflammation in the body) are at particular risk for mouth infection with C. pneumoniae bacteria. C. pneumoniae is associated with heart disease because it is also commonly found in the soft plaques of people who die of acute heart attack.

Dr. Perlmutter recommends L-lysine and vitamin D3 supplementation, in addition to a diet high in lysine, which includes whole grains, fruits, vegetables, cheese, yoghurt and fish, and is low in tofu and other soy foods high in arginine. It is thought that activation of the virus, as with cold sore outbreaks, is a sign the virus might be active in other areas, like the brain. Preventing this may be helpful for people with Alzheimer’s.

So, why do people get infections in the first place, and why do these infections get activated? Well, lack of vitamin D, which is more common than most people realize, and uncontrolled blood sugar levels and insulin resistance, both triggered by a diet high in refined carbohydrates and sugar, are factors which affect both cellular and adaptive immunity, making us more prone to viral and bacterial infections.

It is important to note that there is much more to this story than infections. Alzheimer disease is a multifactorial “perfect storm” of triggers—usually inflammatory triggers—that interact and overlap, creating the final neurodegeneration of Alzheimer’s. Infectious triggers are just one small piece to this puzzle. For general protection against Alzheimer’s, remove sugar from the diet, reduce saturated fat intake, and incorporate vitamin D, omega-3 fish oil, pre- and probiotics, fiber and digestive enzymes. Be sure to sleep well, eliminate regularly, get plenty of exercise and be happy.

References

1. Soscia SJ, et al., “The Alzheimer’s disease-associated amyloid beta-protein is an antimicrobial peptide.” PLoS One. 2010 Mar 3;5(3):e9505.
2. Letenneur L, et al., “Seropositivity to herpes simplex virus antibodies and risk of Alzheimer’s disease: a population-based cohort study.” PLoS One. 2008;3(11):e3637.
3. Itzhaki RF and Wozniak MA, “Herpes simplex virus type 1 in Alzheimer’s disease: the enemy within.” J Alzheimers Dis. 2008 May;13(4):393-405.
4. Gerard HC, et al., “Chlamydophila (Chlamydia) pneumoniae in the Alzheimer’s brain.” FEMS Immunol Med Microbiol. 2006 Dec;48(3):355-66.

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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I talk about probiotics a lot. I even have a PBS show on the topic—The Road to Perfect Health. I call your gut bacteria the Gut Protection System, or GPS. The word probiotics means, “for life.” Probiotics are defined as beneficial bacteria (sometimes yeast) that benefit the person taking them in some way. Many people relate probiotics to yogurt, because some yogurts contain probiotics. (Many don’t—if the probiotics aren’t added back in after pasteurization, there won’t be any probiotics in the yogurt due to high heat required during pasteurization. Plus, check the sugar levels in yogurt—yikes!)

Awareness of probiotics is increasing. In 2007, about 58 percent of people surveyed were aware probiotics might be good for the digestive system. In 2011 that percentage increased to 81 percent. People are starting to get it.

What about prebiotics? Prebiotics are non-digestible food ingredients that promote the growth of beneficial microorganisms (like probiotics) in the gut. They are essentially food for the beneficial gut bacteria—the fuel for the Gut Protection System, if you will. Prebiotics are often soluble fibers, like FOS (fructo-oligosaccharides) and acacia fiber.

If you think about it, soluble fibers escape digestion, arriving in the colon (large intestine) largely intact. Then, beneficial bacteria use the soluble fibers like food. A fermentation process occurs, yielding beneficial compounds like the short-chain fatty acid, butyrate, which fuels intestinal lining cells, and lactic acid, which lowers the colon pH to a healthy level.

Prebiotics and probiotics go hand-in-hand. When these two are found together, they are often called a “synbiotic,” highlighting their beneficial relationship. Studies show that the prebiotic FOS is particularly helpful in increasing levels of beneficial gut bacteria, while inhibiting an increase in harmful bacteria.

If you’re taking a prebiotic, be sure to take it with a probiotic to get the added benefit and to ensure you’re giving the “food” to the right kind of bacteria—the good kind.

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Would you be surprised to know that eating a high-fat meal and/or high-sugar meal causes your arteries to not work in a normal manner? Let’s say we start the day with either coffee with cream/sugar and donuts, or same coffee/sugar with eggs and toast with butter/jam. And then for lunch or supper, we eat meals with high-fat meat, bread and butter, a baked potato with sour cream and butter along with an alcoholic drink (or even ice tea with sugar). Then we finish the meal with a nice dessert.

Each of these meals can cause your arteries not to function properly by the end of the meal which could last for several hours!¹ If you tend to eat this way, most of the day your arteries are constricted and not dilating normally in response to routine activities. The result, at the very least, is high blood pressure. This problem can be eliminated simply by cutting out the excess saturated fat and sugar, and adding probiotics or cultured foods high in bifidobacteria, in addition to eating plenty of vegetables throughout the day.

The above illustration of the diet-artery connection illustrates just one of the many ways to create a problem known as endothelial dysfunction, a condition that occurs when the cells lining the arteries, veins, and lymphatics don’t work properly.² There are a multitude of ways to cause the vessels to not dilate or constrict normally, and to cause the lining to leak (let’s call it leaky vessel syndrome). Endothelial dysfunction is a precursor to atherosclerosis.³ Here is a short list of endothelial dysfunction triggers:

1. Smoking, polluted air,⁴ food, and water⁵ – All of these create excess free radicals which are a major cause of endothelial dysfunction.

2. High blood sugar and/or high insulin levels – High blood sugar results in glycosylation (think of it like a sticky sugar coating) of the insulin receptor substrate, which eventually leads to an inability of protein kinase B (Akt) to increase endothelial nitric oxide synthase (eNOS) enzyme activity, resulting in low nitric oxide (NO) and poor blood vessel function.⁶

3. Microbes (bacteria, viruses, fungi and parasites), parts of microbes, and toxins made by microbes migrating from inside the intestinal lumen into the arterial, venous and lymphatic circulation – Microbes and their toxins activate white blood cells and they release bullets (anti-microbial peptides) named alpha-defensins that not only damage the microbes but the endothelial lining as well.

4. Stress – Stress increases cortisol, which can elevate blood sugar and insulin, again sugar coating receptors to result in low NO, and thus, endothelial dysfunction.

5 Aging – Aging decreases stem cells that help with repair processes, increases blood cortisol levels (see number 4), and decreases bifidobacteria levels in the colon. All of this leads to endothelial dysfunction.

6. Increased body fat, especially in abdomen – Even a modest gain of about 8 pounds (which can happen over a vacation) will cause endothelial dysfunction. “In normal-weight healthy young subjects, modest fat gain results in impaired endothelial function, even in the absence of changes in blood pressure. Endothelial function recovers after weight loss. Increased visceral (belly) rather than subcutaneous fat predicts endothelial dysfunction.”⁴

One of the mechanisms by which fat hurts the arteries is by releasing a cytokine known as resistin. Resistin has been shown to cause oxidative stress and decrease endothelial nitric oxide synthetase (eNOS) which is essential for nitric oxide (NO) production, itself essential for arterial health and function.

7. Physical inactivity – Merely by doing nothing, the process of ongoing free radical activity due to diet, stress and environment, will decrease nitric oxide (our natural vasodilator), superoxide dismutase (our own natural anti-oxidant) and citrate synthetase (the enzyme in our mitochondria involved energy production—essential to a healthy heart / blood vessel function). These natural sources of blood vessel protection return merely by walking briskly on a regular basis.⁵

8. Diabetes types 1 and 2 – Again, elevated blood sugar and either high or low insulin levels, as are seen in diabetes, will lead to endothelial dysfunction as described above.

9. Drugs which elevate or lower blood sugar and insulin – Many diabetic drugs can cause endothelial dysfunction by not maintaining steady levels of blood sugar and insulin. Insulin itself is one of the worst offenders.

10. Even children receiving second-hand smoke in a household with smokers, begin developing endothelial dysfunction at an early age.

References

1. Rudolph TK, et al., “Acute effects of various fast-food meals on vascular function and cardiovascular disease risk markers: The Hamburg Burger Trial.” Am J Clin Nutr. 2007 Aug;86(2):334-40.
2. Endemann DH and Schiffrin EL, “Endothelial dysfunction.” J Am Soc Nephrol. 2004 Aug;15(8):1983-92.
3. Davignon J and Ganz P, Role of endothelial dysfunction in atherosclerosis.” Circulation. 2004 Jun 15;109(23 Suppl 1):III27-32.
4. Romero-Corral A, et al., “Modest visceral fat gain causes endothelial dysfunction in healthy humans.” J Am Coll Cardiol. 2010 Aug 17;56(8):662-6.
5. Suvorava T et al., “Physical activity causes endothelial dysfunction in healthy young mice.” J Am Coll Cardiol. 2004 Sep 15;44(6):1320-7.
6. Wautier JL and Schmidt AM, “Protein glycation: a firm link to endothelial dysfunction.” Circ Res. 2004 Aug 6;95(3):233-8.

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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The atopic diseases of childhood—Eczema, asthma and rhinitis (nasal allergies)—are increasingly more common, especially in developed countries like the US. One of the main explanations for this increase is known as the Hygiene Hypothesis (I’ve mentioned it before.) The Hygiene Hypothesis states that children who grow up in ultra-clean environments lack the immune-building contact with everyday microbes. This lack of microbial interaction results in underdeveloped immune systems that lead to immune dysfunction.

Eczema, asthma and rhinitis all involve immune dysfunction. If an infant has one of these conditions, she is more likely to develop another one later in life. For example, many children with Eczema during infancy go on to develop asthma in later childhood. Further, if a parent has an atopic disease then the child is more likely to also be affected by an atopic disease.

A recent study found that a combination of probiotics (beneficial bacteria) and prebiotics (soluble fibers that feed probiotics) reduced asthma-like symptoms in infants with Eczema. In this study, 90 infants under 7 months of age received infant formula either with the synbiotic (pre- and probiotic) or just infant formula for 12 weeks. One year later, the infants in the group receiving the pre- and probiotics had a 20 to 28 percent lower risk of asthma symptoms.

Researchers are still trying to determine just how this works, but it is known that gut microbial balance works to “educate” the immune system, over 70 percent of which resides in the gut. A proper gut microbial balance plays a big role in early immune development. Truly, optimal gut health is the foundation of total body health.

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The immune system is a complex organization of coordinated responses to “foreign” invaders in the body. Foreign invaders include microbes—bacteria, fungus, parasites and viruses—as well as toxins and even food. As a matter of fact, one major role of the immune system is to not respond to food. As is seen with food allergies, however, the immune system is not always successful at this. Food allergies involve an overactive immune response to certain foods, which would normally be recognized as harmless. 

The immune system is comprised of two main branches: the innate immune system and the adaptive immune system. The innate immune system, also known as cell-mediated immunity, involves an immediate non-specific immune response, often against pathogens. The adaptive immune system, also called humoral immunity, involves a delayed, specific, organized response involving the production of antibodies that later recognize invading microbes so that a more effective immune response can be mounted. The innate immune system involves the production of cells called T helper 1 (Th1) cells, and adaptive immunity involves the production T helper 2 (Th2) cells. T helper cells are lymphocytes, a type of white blood cell. They are like the messengers of the immune system, sending signals that stimulate various immune responses.

Th1 and Th2 responses are joined by another type of T helper cell known as Th17. Th17 and Th1 responses are both associated with over-active immune responses, as is seen in autoimmune conditions, in which the body mistakenly attacks its own tissues. Both these responses produce inflammation by way of cytokines, the immune equivalent of hormones. These three types of T helper cells are all regulated and balanced by cells known as T regulatory cells, or Tregs.¹

Are you confused yet? Think of all these T cells as a four-way seesaw.  Th1 and Th17 are on two prongs of one end, and Th2 and Tregs are on two prongs of the other. When all is well, this seesaw is in balance, like a harmonized symphony responding appropriately to that which the body comes into contact.  If out of balance, you may see higher levels of Th1 and Th17, an indication of underlying autoimmunity as is seen with type 1 diabetes, celiac disease, rheumatoid arthritis, psoriasis, multiple sclerosis and systemic lupus erythematous. In contrast, higher levels of Th2 and Tregs are characteristic of allergic conditions like asthma, food allergies and hay fever, and with immune suppression.

How can we balance immunity? Well, probiotics are one solution. Since over 70 percent of the immune system is in the gut, probiotics are in the right terrain for immune system communication. Probiotics help balance immune response.  Gut bacteria essentially “prime” the immune system,² educating it so that it responds appropriately to what passes through the digestive tract—and to what may ultimately pass through the small intestine and into the body.

Omega-3 fatty acids also affect immunity, largely by helping to balance the inflammatory response—an important aspect of immunity. You see, inflammation is a necessary physiologic occurrence.  But too much inflammation spells trouble.  The omega-3 fatty acids EPA and DHA found in fish oil help to quell inflammation at the right time.  They help stimulate the production of resolvins, chemicals knows to help “resolve” inflammation—or end it at the appropriate time.³ 

Further, the proper digestion of food is necessary so the immune system doesn’t have to work too hard.  When food is not broken down properly, undigested food particles can aggravate the gut, causing inflammation and even leaking through a permeable intestine (also known as leaky gut) and entering circulation where yet more inflammation is triggered, in a downward spiral of excess inflammation (which is at the basis of most, if not all, chronic disease).

Also important is regular bowel elimination, which can be attained by the consumption of dietary fiber—at least 35 grams per day. A diet rich in fruits, vegetables and whole grains is essential, and a fiber supplement can help reach 35 grams, which can be difficult to obtain through diet alone.

In essence, the HOPE Formula—High-fiber, Omega Oils, Probiotics and digestive Enzymes—can help improve digestive health and improve immune balance. Brenda and I have been recommending this formula for years for many good reasons. With the HOPE Formula, there is hope that your health will improve. 

References

1. Cooke A, “Th17 cells in inflammatory conditions.” Rev Diabet Stud. 2006 Summer;3(2):72-5.
2. Round JL and Mazmanian Sk, “The gut microbiota shapes intestinal immune responses during health and disease.” Nat Rev Immunol. 2009 May;9(5):313-23.
3. Serhan CN and Savil J, “Resolution of inflammation: the beginning programs the end.” Nat Immunol. 2005 Dec;6(12):1191-7.

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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A recent study published in the journal PLoS Biology has found that Candida albicans forms two distinct biofilm types according to what form the Candida is in—the sexual or asexual form.¹ A biofilm is a protective polysaccharide matrix in which microbial populations exist and are able to hide from the immune system and antimicrobials. As it turns out, when Candida is in an asexual form, it produces a biofilm that is impermeable to antifungals, antibodies and white blood cells. This asexual form makes up the majority—about 90 percent—of Candida cells in the body. The other ten percent are sexually reproducing Candida cells that form a similar looking biofilm that behaves differently and is susceptible to antifungals and to the immune system.

Biofilms are formed by more than just Candida, however. The National Institutes of Health (NIH) estimates that nearly 80 percent of chronic microbial infections are due to biofilms.² Dr. Maria Usman, MD has developed, and is refining, a Biofilm Protocol for use in children with gut disorders on the autism spectrum.³ She is seeing some success with this protocol, though it must be tailored to the individual and can cause a “die-off” reaction, also known as the Herxheimer reaction. (When microbes are killed they give off microbial toxins that can cause sickness-like symptoms that can make the patient feel worse before getting better.)

Another approach that can help get Candida and gut issues under control is the 4R Model.⁴ The Institute of Functional Medicine promotes this model as the best way to evaluate and treat patients with gastrointestinal complaints. The 4R model asks four main questions:

REMOVE—What may need to be removed? This may be pathogenic or potentially pathogenic organisms like Candida, bacteria or parasites. It can also be foods or toxins to which the person is sensitive or allergic.

REPLACE—What may need to be replaced? In this step, the use of digestive enzymes and HCl should be considered to ensure that they body is properly absorbing necessary nutrients.

REINOCULATE—What may the body need to be reinoculated with? This considers intestinal microbes and uses probiotics and prebiotics to reestablish intestinal balance.

REPAIR—What may be needed to repair a healthy mucosal layer? The use of certain nutrients, such as L-glutamine, to repair the mucosal layer are useful here. 

One probiotic—the probiotic yeast Saccharomyces boulardii—may be particularly helpful for those with Candida problems. Candida often occurs in people who have been treated with antibiotics. Antibiotics target bacteria, both good and bad, but do not affect Candida because it is a yeast, leaving no competition for Candida. This is where S. boulardii can be helpful, because it is not killed by antibiotics like other probiotic bacteria. Futher, S. boulardii has also been shown to inhibit Candida albicans.⁵ S. boulardii produces capric acid, and both have been shown to downregulate (reduce) the expression of genes associated with Candida virulence. Thus, the capric acid secreted by S. boulardii inhibits C. albicans hyphal formation, adhesion properties and biofilm formation.⁶ Probiotic bacteria have also been found to be helpful for Candida by helping to reduce and inhibit Candida, and by stimulating immune response against Candida.⁷ 

Bringing the gut back into balance takes a multipronged approach.  The 4R program can help address the multiple issues that arise when faced with digestive conditions like Candida overgrowth. 

1. Song Y, et al., “Alternative mating type configurations of Candida albicans result in alternative biofilms regulated by different pathways.” PLoS Biology. Aug 2011;9(8): e1001117.
2.  http://grants.nih.gov/grants/guide/pa-files/PA-03-047.html
3. http://www.autismpedia.org/wiki/index.php?title=Protocols/Usman
4. Jones DS (editor), Textbook of Functional Medicine, The Institute for Functional Medicine, 2005, p. 462-8.
5. Krasowska A, et al., “The antagonistic effect of Saccharomyces boulardii on Candida albicans filamentation, adhesion and biofilm formation.”FEMS Yeast Res. 2009 Dec;9(8):1312-21.
6. Murzyn A, et al., “Capric acid secreted by S. boulardii inhibits C. albicans filamentous growth, adhesion and biofilm formation.” PLoS One. 2010 Aug 10;5(8):e12050.
7. Wagner RD, et al., “Biotherapeutic effects of probiotic cacteria on candidiasis in immunodeficient mice.” Infect and Immun. 1997 Oct; p. 4165-72.

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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