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Five ways to improve your microbiome alongside drugs and bugs.


At my medical school commencement, the dean said, "Doctors, keep observing. Keep learning. By the time you are at my stage of your career, half of what you learned during the past four years will be disproven. Your job is to figure out which half." Twenty years later, my dean's prediction appears to be on track.

Several of the tautologies of the 1990s were built around great expectations for the human genome project. Emerging science reveals that some unmet expectations of the human genome are conferred by microbial genetic material. Now treatments include a burgeoning array of probiotics and antibiotics. Presented here are simple evidence-based steps to cultivating a more healthful microbiome alongside or sans drug and bug therapies.

A Daily Dose of Polyols

"If you chew it, they will come." This could be the subtitle of Scandinavian-led research on how chewing gum sweetened with the sugar alcohol xylitol favorably changes the human microbiome. Thinking of xylitol as a sugar substitute is accurate but not the primary reason to chew it. Xylitol gum's association with reduction in otitis media, dental caries, and various newborn conditions links to a direct effect on oral flora. For newborn health, the chewing gum is given to the mother during pregnancy and lactation.

Sugar alcohols, also called polyols, are among the components of fruit that make it sweet. Polyols tend to be removed from plant-derived foods during processing and represent a smaller component of sweetness in the modern diet than in diets past. Polyols are not usually part of the sweetness blend of foods for several reasons. In concentrated amounts, they cause bloating and diarrhea. Polyols break down with heat and lose their sweetness. But added to one stick of chewing gum a day, xylitol is tolerated by the gastrointestinal tract and the taste is enjoyable to most palates, young and old. A number of companies purvey xylitol gum. At NutriBee, we use a brand called XyliChew.

Up Close on Short-Chain Fatty Acids

Get a whiff of butyrate without being forewarned of its odor, and the container is sure to land in the trash. That's because butyrate is a short-chain saturated fatty acid that is produced by anaerobic bacteria during fermentation and it is produced in the human gut. In other words, putrid is how it smells because putrid is what it is. Putrid doesn't mean it is unhealthful. Butyrate is one of many important bacterial byproducts on which human health depends.

Here's the challenge. Modern diets and diseases interfere with butyrate-synthesizing bacteria in the colon. Raising butyrate levels is being studied as a treatment for colon cancer and inflammatory bowel disease, among other conditions. Butyrate is available in capsule form as a dietary supplement, if you can get it past your nose. The prescription medication is Buphenyl, which is sodium phenylbutyrate.

It's also possible to increase butyrate levels in the colon through daily diet. Dietary fiber and other prebiotics promote colonization (note the word colon in colonization) of butyrate-producing bacteria. Eating foods containing butyrate also raises butyrate levels. Clarified butter, known as ghee in South Asia, is a concentrated dietary source of butyrate. Unrefined saturated fats from plants such as coconut, macadamia, and red palm can be metabolized into butyrate. All of these fats are intended to be consumed in small proportions as part of the daily diet.

Cultivating Benevolent Skin Microbes

"Find victory in d'feet," I advise my patients with fungal nails, athlete's foot, psoriatic or scaly skin, or lingering wounds. These are outside evidence of an imbalance of microbes that can be corrected. In addition to the usual recommendations, I suggest that patients soak feet in Epsom salts baths and regularly apply essential oils. Oils that are fragrant and contribute to microbial management are lemongrass, neroli, cardamom, tamanu, frankincense, lavender, and juniper.

Incorporating Stool Softeners and Motility Agents into the Daily Diet

Long before the Internet age, studies of the country mouse and the city mouse showed that the country mouse had bigger and more frequent bowel movements. Then the same study was conducted on people, comparing bowel habits in a traditionally rural plant-based diet with a Western diet. The findings aren't surprising. Bowel movements less than daily are less than sufficient for good health. An infrequently moving bowel could be compared to the river stone that is not rolling and therefore gathers moss. Here moss is a colony of unwanted microbes.

Improving bowel habits is easier than commonly portrayed and doesn't need to involve discomfort. My dietary recommendations usually include vitamin C + magnesium + cutting all artificial sweeteners and trans fats + adding a few extra vegetables and/or kelp.

Making Waves

Ambient energy wavelengths select some microbes over others. There are two immediately relevant considerations for clinical practice. First are the effects of ultraviolet light on skin microbes, and second are the unknown effects of electromagnetic waves on the human microbiome. Studies in these areas would influence my clinical practice. Until there are answers, I reason that direct UV light confers more than vitamin D synthesis, possibly regulation of some microbes. I also reason that EMFs may alter microbes and stress them into releasing toxins.

In Summary

In the course of our daily lives, we can indeed change the DNA that is a part of us--inside and out.

I introduced this topic with a story about the evolving nature of medical science and would like to conclude with another such story. I took an 8-week intensive course on tropical medicine. On the last day of lectures, a senior professor told the class that the microscopy, biochemistry, medical treatment, and parasite life cycles could all be summarized in one slide. The slide looked something like this:

Don't get bit;

Don't breathe spit;

Don't get lit; and

Don't eat ****.

Today's research has turned the last truism on its head. Hand washing and bottled water are still recommended while traveling abroad. However, the most detrimental tropical gastrointestinal infections are being successfully treated with fecal implants or microbial denizens of the human colon.

by Ingrid Kohlstadt MD, MPH

Ingrid Kohlstadt, MD, MPH, FACN, FACPM, is the founder of INGRIDients Inc., where she has edited Advancing Medicine with Food and Nutrients, 2nd edition (CRC Press; 2012). On the faculty of Johns Hopkins Bloomberg School of Public Health, Dr. Kohlstadt is researching an approach to leverage nutrition more fully in disease prevention.
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Title Annotation:Optimizing Metabolism
Author:Kohlstadt, Ingrid
Publication:Townsend Letter
Date:Jan 1, 2014
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