Mood by Microbe - AIHM Conference San Diego 2022

Let's talk about depression. Who here has either dealt with or has a client who's dealt with depression? Yeah, depression is ubiquitous. Depression is a big concern. Sleeping issues, Maybe menopausal sleeping issues. Stress related sleeping issues. Anyone with me? Yes. Yes. So your gut bugs regulate all of that. And that's what we're going to learn about today, is that your microbiome contains more microbial DNA than you have human DNA. Those little critters make a big impact. And so by understanding how they work, what they do, how we can make the gut work towards health. It can be life changing for your patients. And I started all of this journeying trying to prove to myself that anxiety could get better. I come from a long family history of alcoholism and depression and anxiety and awful, awful mental emotional symptoms. I'm from Iowa. And the culture, thank you so much. The culture in Iowa is essentially do what your doctor says, take a pill and just push your way through it. That was the culture for my family. And so by the time I went to college, I was on two inhalers and six prescription medications. It was a lot. And we're finding that these numbers are only increasing over time. And practitioners like you, who want to learn the comma after the sentence of diagnosis, who want to learn about the why and then what to do, this is the information for you. And I'm really excited that you're here. My credentialing, I have a master's in clinical psychology and I have a medical degree in naturopathic medicine. I practice in Phoenix, Arizona and I hang out in Michigan. So today we're going to be talking about all sorts of good stuff related to the gut bugs. But really what I just want to focus on is psychobiotics. Who here's heard the term psychobiotic before? Right now, that's actually really impressive. Most people think that I'm trying to be coy when I say the word psychobiotics. A psychobiotic is a bacteria that has the ability to affect your mood and your mind. And the best book, if you're really excited about this topic, is called the Psychobiotic Revolution and you can find that online. Anderson Dinan and Sean. But it's called the Psychobiotic Revolution. It's charming. You will love it. We're going to learn about what is a psychobiotic and how the heck does that relate to my mental and emotional well being. And then we're going to actually go into a little bit of functional testing ideas and all of this will be encapsulated in real brilliant and beautiful Cases. And so let's get started. So we're going to talk about Amanda. Amanda is an amazing soul, but she had a really rough go of it when she was born. There was a very difficult delivery. And she was born emergency cesarean section. And we know that the birthing process is important for getting exposure to the right types of bacteria that will go with you for the rest of your life. And she did not receive that. And she was helicoptered to an emergency neonatal unit. She didn't get that skin to skin with her mother. And there was all sorts of stress and anxiety and fear. And so now we have this newly developing brain. The brain is being told the world is scary and dangerous, so it creates that Rolodex, right? This world is scary. Look at this. This is dangerous. Now she has this Rolodex of scary things happening. And she's missing those delicious bugs that she should have received when she got into this world. And so she was described as a very colicky baby. She had lots of stomach pain, gas and bloating. She would cry, she didn't sleep well, cause she was suffering. And then of course, mood. She had a lot of mood, dysphoria, depression, anxiety, very timid. She wasn't very interactive in the visits. And as a teen she was tried on all sorts of diets. And if any of you have children, you know how arduous that can be as a parent and as the child. Gluten free, sugar free, joy free, all of the free diets, right? And so when she was really little, those diets would work okay. They would get her a little bit of improvement. But by the time she was a tween, all bets were off. She wanted, if the little kids had a birthday party with cupcakes, she wanted to have that experience too. She was left out. And so it was no longer sustainable. And so her parents are looking for other solutions. Her triggers, the activating factors, I'd rather call them, are being told no. So then they're thinking, oh, she has oppositional defiant disorder. She also didn't like heat and they're from Arizona. So anytime that she got overheated, her nervous system would send her into fight flight freeze and her body temperature would go up. And then the other thing that was really difficult was anything between fasting. So, so some of us, we can intermittent fast and it's okay. But every time that Amanda was between meals by more than an hour, she would get really sick and then rage. She would have an emotional outburst. So of course the doctors are thinking well, we want to do gut stuff to try to help with her stomach upset. That makes sense, right? We'll put her on omeprazole and then she has these mood symptoms. So let's put her on mood stabilizers and antidepressants. She's 12 years old and she can't digest and she doesn't know how to brain properly. So we're going to treat her. And her symptoms got worse. She became more depressed, more timid. She started missing school. She's losing weight and her mood swings are worse and she's not getting better. She also started to develop tic like behaviors. She had verbal ticcing, auditory ticking. She would move and grab things out of the air and make very loud sounds, which of course is drawing attention to her in school. So they had to get a 504 plan, which is a plan for special needs classroom. And so now she's not academically getting her needs met. So this poor girl, as you can see, she needs a little bit of love. She needs to know why. That's what you guys are here to ask is why our symptoms are our bodies. Attempts at telling us that something is out of balance and to tell us how to put it back. What are our unmet needs and how do we meet those needs? Right. Our body in its wisdom, wants to heal. And our job as the healer is to stimulate the body to do that. So on presentation, she was very timid, underweight. It was difficult to assess her comprehension. So we don't have great baseline measures with that. But we did have a lot of stomach guarding upon doing abdominal exam, a lot of tenderness on palpation. We did some baseline testing. She hadn't had any labs or functional tests that were done, so we did that. Getting a stool analysis in a teenager is really fun, but it was worth it. What we did is just basic labs, cbc, cmp, thyroid ferritin. All of that was fairly unremarkable. And then we did stool analysis testing and genetic testing. What I want to focus on with the stool analysis testing is that we have a few things. And I copied this from her test report. This is a different test than you'll see later because I wanted to provide a variety of different labs that I like to use and show you how they can help. But this one showed inflammation. Makes sense. There's a lot of inflammation when there's a lot of gut pain. Now we have secretory IGA as a marker and that could give us a baseline when we initiate treatment, if it's working. I love having Baseline testing, we also had high amounts of dysbiosis, which are a lack of microbial diversity. And so we know that her bugs are out of balance. And the test will actually show you more specifically how they're out of balance. But we don't have all day today together, unfortunately, so we're going to be brief. The genetic test, I think, can be really helpful, but with genetic testing, we want to know about epigenetics. And I always try to educate my patients about that is, yes, you may have this light switch on the wall, but it may not be activated. That light switch may not be turned on and causing disease, but we can identify risk factors and help support those genetic pathways. So she has an ACADS gene. And so the ACADS gene is really interesting. Because she has this gene, it will cause the difficulty breaking fats into energy. And so when she would have those fat stores, if she was going into fasting, her body was not breaking it down efficiently. And so she was crashing when she was between meals. And so the solution for that was to increase L carnitine to aid in the transfer of fat into active, mobile, usable calories. And then we had her avoid a high fat diet and really emphasize frequent feedings and protein. And what we were looking at is to see if that would help with her endurance with her mood and with the weakness of her muscles, which it did. It was pretty great. She did get a lot better, but there was something missing. Everything wasn't quite better. So she still had digestive upset and she still had a lot of anxiety. And so let's go to the gut. Our happy little gut bugs, they've got our backs. So if we kind of try to distill everything down, what are the main things that we want? I want something that's going to help with anxiety. I want something that's going to reduce inflammation, because we have clinical evidence of inflammation in the gut. I want something that will help with high stress. Wouldn't it be amazing if there were actually microbes that helped with high stress? Like, we should all be putting it in our water every day. High stress support, right? So wanting something that would do that. And then of course, we want to support comprehension and mood and we can do this. This is the wonderful world of psychobiotics. So let's talk about psychobiotics a little bit. They work in four approximate systems. So the bugs in your gut, those happy little bugs that are hanging out in every single one of your guts, they were passed down to you from your ancestors, and they're all as unique to you as your own fingerprint. Wow. Isn't that fascinating that your gut bugs are as unique to you as your own fingerprint? And so, of course, the solution that works for you will be different. It needs to be personalized. Right. So your gut bugs affect your whole body. They're the drivers, they're the conductors, if you will. They are the bosses. The gut microbes are part of a complex system called your microbiome. And this has yeasts and it has bacteria, and it has the DNA and RNA particles and all sorts of other proteins. So you have all of this in your gut, and then they send signals to the nervous system. So your gut bugs regulate neurotransmitters like serotonin, the happy neurotransmitter. Right. Dopamine. That feel good. Neurotransmitter, gaba. Really important for anxiety, right? That's what we prescribe benzodiazepines for, is to try to increase GABA levels to help with anxiety. But your gut bugs can make GABA fascinating. See where we're going with this? This is good, right? So your gut bugs can make GABA, all sorts of wonderful stuff. And we also see that the gut bugs can actually interface with your vagus nerve. Vagus nerve. You guys are all brilliant, integrative. You all know vagus nerve, right? At least a little bit. Lovely. So your vagus nerve, I call this the on off switch to anxiety. By activation of the vagus nerve, we see that the nervous system is able to switch from sympathetic overdrive into a parasympathetic state. Relax, digest. So how do we activate the nervous system to help people get calm on command? Well, one way is through your gut bugs. So what's really interesting is there's new research that came out, and they found that in your gut, around your gastrointestinal tract, is you have your enteric nervous system. You guys know about enteric nervous system, right? Yep, yep. Kind of Anatomy Physiology 101. In the enteric nervous system, there are cell communications of things called neuropods. And these neuropods are the interface between the bugs in your gut and the vagus nerve. So you have a gut bug, and it's like, I would like a cupcake today. It sends the signal. Neuropod carries that up the vagus nerve, it sends it to the brain, and then you're like, huh, I'm really craving a cupcake. Is there sprinkles around here? So your cravings are really your gut bugs sending up flags. And we can start to Learn who's down there by noticing what they're asking you to give them. And learning. Okay, yes, gut bug, you can have a cupcake, but not every day, right? So we know that they affect your nervous system, your immune system. 70% of your immune system is in your gut. The immune system is huge, right? And so this is the time of year where we're all getting colds and flus and all of those fun things that come with the holiday. And so if your gut bugs are asking you to eat the Snickers, the Twizzlers, and all of the Halloween candies and the extra piece of pie, because it's kind of a wash anyway, right? So your gut bugs are om nom, noming all of those high sugary foods, and then they're growing and they're taking over, and then suddenly your gut bacteria isn't as diverse, and you're not getting the right bugs in there in the right quantities to help you feel good and happy. So, so it goes back to the gut, your immune system, and then, of course, the endocrine system. Your endocrine system, your gut will directly impact your thyroid estrogen. There's bacteria like clostridia in your gut that can reactivate estrogen. And so that's why sometimes people have symptoms of pmdd. Why menopause can be so difficult, Andropause can be difficult because of how the bugs in your gut are attenuating your hormones, thyroid adrenals, everything. So if you have a patient and they're in that state where they're like burning the candle at both ends, and yet they're wired and tired, sometimes doctors will go for the adrenals. They'll try to support the adrenal glands. But if you have a patient who, when you support adrenal glands, that then get really, really anxious, there's something happening in the gut, whether it's the conversion of that herb or that complex, and you got to get back to the gut. So your gut is everywhere. Your gut does all of the things. Okay, So I also wanted to talk about psychobiotic use in children. I started with Amanda because she's a 12 year old. And the biggest question that I get asked is, are these psychobiotics, are they safe in babies and children? And the research is supporting use and clinical effectiveness and in children. And so I have a couple of articles that I pulled out here. This first study is Psychobiotic Interventions in children from 2022. And they discerned that there were no detectable negative side effects. And they actually suggested that there could be value using psychobiotic interventions in children between ages 6 and 25. They found that there was less stress, less anxiety, and improved cognitive outcomes. Not only are these authors suggesting that they could be safe, but that they could also clinically helpful. Then we have this next article, and this is a literature review. So they're looking at all sorts of publications on psychobiotic use in children. And they said that it was a safe and viable option for neuropsychiatric disorders in the child and adolescent population. What these authors are concluding is we need more research. So if any of you are out here and you're interested in research, study psychobiotics, because we need more availability of it. We need more good companies putting out high quality materials so that you can help people have results. Like what I'm going to show you that Amanda had. Okay, so there's a lot of psychobiotics out there. And I want to teach you about individual psychobiotics, but I do want to emphasize something really important that's often missed. And so when you think about. Imagine that there's 25 kindergarteners. Can you imagine 25 kindergarteners? They're all in one classroom, right? Okay, 25 kindergarteners. Let's say classroom A. Those kindergartners just got all of the cupcakes, right? So if you feed 25 kindergarteners cupcakes, what are we gonna see happening? Yeah, mayhem. Right? They're gonna be like all sugared. They're gonna be running around. So 25 of something isn't always the same as 25 of something. So we have that next classroom. So we have classroom A, and they're all hyped up on cupcakes. And then you have classroom B. And in classroom B, we gave all of those kindergarteners same number of kindergarteners. We gave them those little bats. Have you guys seen those bats? Like the Bandura study, those inflatable bats, and they will come whack each other with them. Yeah, Bandura, the bobo doll experiment. It's like a famous psychological experiment, social learning theory. So you give kids a bunch of bats and so now they're all running around whacking each other with bats. Right? So then that experience is different cupcake kids. Kids who are running around with bats. Now we have the third kindergarten classroom and we gave them all like a little bit of tea and you're playing nice music and there's kittens and it's nap time. Right? So we have three groups of kindergartners, but their experiences are totally different. Right? So what I'm trying to convey here is that you can have the same bacteria, but depending on their environment and who they're with, their behaviors may change. So some bacteria are adversarial to each other, some bacteria will fight with each other and create new problems for you, and other bacteria are beautifully synergistic and can get the results that you want. So when you're looking for probiotics or psychobiotics, you want to figure out, okay, are these the kindergartners with bats in this box, or is this what I want? And so you want to look at the actual clinical literature that's of the product being studied. And so what's really cool about the product that I'm in love with right now is that I get to see actual functional MRI studies on people taking the formulas of the bugs together. So I already know ahead of time how they interact in a combination. And so you want to look at brain studies, clinical formulation testing, and not just the individual bugs. So I will teach you about the individual bugs. Try to keep in mind, are they going to get along with each other or are they going to cause problems with each other? Right. Okay, so this is Bifidobacterium breve. And I want to tell you a little bit how to understand the strains of bacteria. So is kind of like if you have a breed of dog, not all dog is the same. You may have different breeds or different strains. So I have a cavapoo, and maybe you've seen her walking around the conference, and then maybe somebody else has a Great Dane. They're both dogs, they're both Bifidobacterium breve, but they're different strains, so they behave differently. Does that make sense? Different strains will behave differently. So when you're going to the store and you're picking up the bottle of Giaro or Clair or whatever it is, and you see, oh, there's Bifido Breve. You need to know, is this the strain of Bifido Breve that's more like a Great Dane, or is this a strain of Bifido Breve that might actually make me feel better? Right. So it gets tricky, doesn't it? But we've got your backs, my friends. It's okay. So Bifido breve, the strain. The strains will always have some long numbers and letters. My favorite strains that you're going to see in here will always start with a W. This wind clove. And this company always focuses on the actual formulations after they've been put together. And they study humans taking the formulations so we have Bifido Breve and this strain is particularly good at reducing Interleukin 6 TNF alpha. It's an anti inflammatory psychobiotic. So if you have evidence, whether stool testing or blood testing or other functional testing and you have evidence of inflammation, then this might be good to consider. Is bacteria in the gut that bring down inflammation. Then the next bacteria is Bifido longum. Bifido longum. We have three separate strains here that have been studied for efficacy in improving mental and emotional well being. This one here, the ccfm, the first one has been shown to increase gaba. Remember, we love gaba. If you're anxious, all of the GABA please. But also let's do some trauma informed work on why we might be anxious, why we feel the way we feel. But strains that can support GABA naturally in your body can be incredibly helpful. So this is a wonderful strain for that. The strain 1714 has been shown in the clinical literature to improve cognition to help with mental processing tasks. And then the NC is really good for negative emotional stimuli. So if you have somebody who struggles with arfid, which we're going to have an ARFID case if we have time today. If you have somebody who really struggles with taste, textures, misophonia, right? So noise, any sort of stimuli, hyper reactivity or hyper responsiveness, then this strain can be really wonderful for that Instead of just a sedative. Lactobacillus plantarum. I really like this bacteria. They did a really cool study and there were students who were taking tests and there were people who are in really high stress jobs and they did a study examining what their job stress perception was before, during and after utilizing this particular strain of probiotic. And there was clinically significant improvements. And I think that's really interesting because it's not just lowering your sense of stress, but rather your perceived stress so that you feel more like, I've got this. I feel more empowered, I feel like I can handle more. So if you have a patient and they're coming to you and they're like, I'm just burned out and I feel like overstressed and overwhelmed. And I know it's not that much, but I'm just, I'm struggling, doc. This might be a good strain for somebody who's dealing with that. And then we have the W62 which is really good for people who have a difficult time with cognitive processing when they're anxious, which is like half of us, right? Some of us go into fight flight, freeze and we become like the Judge Judy of logic. And then other people, they go into fight flight, freeze, and they're just like the empty box in the waffles. Like, there's no butter, no syrup, nothing. It's empty. My brain stops. Right, okay, so we have Lactobacillus rooteri, and that's really good for anxiety, depression. So this is nice because we're getting a little bit of anxiety reduction and mood boosting. And then we have a couple of other ones. I want to get ahead here because I know we started late and there's so many good cases I want you to see, but we can for sure you'll have access to this whole presentation. The psychobiotic that I really wanted to emphasize for Amanda is highlighted yellow here, and it's a wing clove product. Omnibiotic is how you can find it here in the States. And it's really particularly good because it's good for high stress, it's good for brain fog, it's not good for inflammation, it's good for anxiety, and it's good for mood, which are all of the main things that I was trying to accomplish with my patient. And so my goal was then to find a product that had a formulation with this in it that actually worked. And so we talked about this. Right. So product selection really matters. And so you want to make sure that the dosing is therapeutic. Interestingly, more isn't better. What they have found is that too few or an insufficient number of psychobiotics will get you insufficient results. But then if you just, like, fill it up, give them way too many, just eat the whole box and hope good things happen, it can actually create a paradoxical response. And so following the dosage instructions, that's where the studies have been conducted, is how they're dosing and telling you to do it on the bottle. We talked about clinical trials, we talked about viability. What's really wonderful about Omni that I love is it comes in sachets, because when you manufacture a psychobiotic, they can have problems with oxygen. And so every time if it's in a bottle and you have capsules in a bottle and you open it, these bacteria are continuously getting exposure to oxygen. And so that has to be considered when you're looking at the mathematics of viability is what is a pill when you first open the bottle, containing versus what is at the very end? Right, okay, so we'll talk more about that later. So product selection. This is some amazing research behind stress release. You'll see this in the presentation notes. It's Exciting. They did functional brain MRI studies. We're going to finish up here with Amanda. I gave her a psychobiotic and this is what it contained. It has those WIM cloak strains. This has been shown to accomplish the goals that I had for her. And this is her in 30 days. So her appetite was better. She gained five pounds and her digestion was better. Her stool was more formed, which is amazing. Teenagers hate talking about poop. But she was excited to come in and tell me about this because it was better, right? And her energy was better. She was able to get up and go outside. She was now going back to school, which was a huge, huge victory because we were worried she wasn't going to make it through school. School. And her mood was so much better. She said, I feel more cheerful, able to engage with others. And her interpersonal interactions were much better. Of course, they declined stool testing as a follow up because it was misery getting her to do it in the beginning, but hopefully next time. So Amanda, in six months, this is her riding a horse. So she start continued taking stress release, which was the probiotic combination we selected for for her. She's horseback riding. She's actually working at a ranch to volunteer to rehabilitate horses, which is really awesome. So she's like actually getting purpose. It's so good for her. The horse reflects her mood. So now she's got the space to do the trauma work. Remember her? She came into this world in a very traumatic experience. And so we want to heal the gut so that we have the pieces in play to get better, but we also want to make sure that we're healed. Healing the trauma. This is the last story, but there's amazing cases later in the presentation and I want to say thank you so much for allowing me to speak today. I have just a couple more minutes. If you have questions, I would be happy to answer them. Autism, adhd, similar patterns in the gut. Yes. The question was the patterns in the gut that we see in autism and ADHD is. One thing we do see in common with both ADHD and autism is dysbiosis, which is an imbalance of the gut bacteria, lack of microbial diversity, and a predominance of pathogens. In particular with autism, I see quite a lot of clostridia overgrowth, which you could do organic acids testing. And clostridia will actually block dopamine beta hydroxylase from converting into adrenaline. So then you end up with high, high amounts of dopamine and very low amounts of. Of adrenaline. And that could create a Lot of anxiety, but with lack of nervous system function. Yeah. So I would definitely recommend. We have free products if you want to try them. You guys just had a delicious breakfast. Now feed yourself yummy healthy gut bugs. And any other questions that I can answer for you? Yes. What's the best time to take it? Morning, evening, before? The question is, what was the best time to take it? And typically I recommend that my patients take it in the evening. You want it on an empty stomach and then when you're sleeping. So you take it before you go to sleep. And then you're in peristalsis. Right. So you have the bugs, they're going through the gut, they're doing their thing. So have them start at nighttime. That's a great question. What other questions? Maybe we have time for two more. Yes. Duration of treatment? Duration of treatment. This is a great question. Duration of treatment is typically give it three months to really make a big decision. And here's a hack too. Sometimes in the beginning, if you have all those adversarial kindergarteners with bats and new bugs are coming in, some people may hurx a little bit. And so if their stomach gets a little bit upset, then either maybe add in some activated charcoal to help with that, or you might just dose down and start with like half of a sachet and then slowly work your way up. But give it three months. Yes. And one time for one more. Yes. After they stop, do the symptoms return? These cases that I have here is they've been able to stop successfully. And then if something silly happens, like, oh, I went on a cruise and I drank every day and I kind of put myself back 10 steps, then it's like, yeah, let's get your bugs. Little tlc. So it depends a little bit on their lifestyle or obstacles to cure. Yes. Did you just. Any diet I love doing. So she's asking with these cases, do we do any dietary changes or just psychobiotics? In the cases that I selected for today, there were no dietary changes made. I like to be as scientific about it as possible. I can't help myself. And so with these cases, I was like, we're just going to add stress release or we're just going to add this because then I want to see what happens. Because then you know. And then they know, because otherwise they'll say, oh, it's because I took a fish oil. And you're like, no, I think there's more to it. Awesome. Thank you, everybody. So appreciate it.