Dr. Kyle: Diet Do’s and Don’ts for 2019

 

Looking to start a new diet in 2019? Here are a few tips on what to avoid and what to incorporate into your nutritional regime this year.

FATS ARE GOOD

The human body is designed to process and burn fats as one of its primary energy sources. Fat enhances food digestion and nutrient absorption. Accompany sides of vegetables with a fat source to increase nutrient bioavailability.

Try cooking with animal fats, organic grass-fed butter and coconut oil. Avoid trans fats and poly-unsaturated vegetable oils like canola oil.

Add some wild-caught salmon into your diet to balance out the ratio of omega-3’s to omega-6’s. The typical western diet has an abundance of omega-6’s so eating salmon 1-2 per week will boost your levels of anti-inflammatory omega-3’s.

DON’T SHY AWAY FROM CHOLESTEROL

Cholesterol is vital for the synthesis of hormones and vitamin D. It also helps form cell membranes and other structural components.

Eat whole foods and at least 1 yolk with your egg whites. This will give you a better nutrient profile and a healthy dose of cholesterol.

RED MEATS

Red meats have almost everything you need to not only survive but thrive. They are one of the most micronutrient dense fuel sources on the planet. Red meats are high in b-vitamins, iron, zinc, magnesium, and creatine.

Red meat also includes Lamb! It is an excellent source of heme-iron as well.

GET YOUR PROTEIN

It is most commonly recommended that daily intake should be 1g of protein per pound. Older athletes will need more due to less efficient protein absorption.

Keep in mind that dietary needs will fluctuate based on physical demands and training goals. Athletes trying to put on mass should eat 40g before bed to maintain protein synthesis throughout the night.

20g per meal will provide 90% of muscle protein synthesis. 40g will provide 100%.

Carbohydrates

Some carbs are better then other! So, we want to pick the right ones.

Avoid refined sugars (obviously). Include variation and eat 2 forms of carbs at a time for faster absorption. I recommend sweet potatoes, spinach, red peppers and carrots. These foods have plenty of micronutrients and produce low levels of gas.

Add a side of white rice to your meat and vegetable dish. White rice is easy to digest, and can help supplement your macronutrient intake. Oats on the other hand can be hard to digest – soak them in warm water overnight or add yogurt.

Remember, carbohydrates are used to fuel workouts! Getting adequate carbs to sustain your athletic performance will protect against muscle tissue breakdown.

As always, ask a healthcare professional for dietary recommendations that best suit you. Some foods that work well for others may not sit well for you. Listen to your body.

Stay healthy and good luck achieving all your health and wellness goals for 2019!

Dr. Kyle: Debunking the Salt Myth

Do you pay attention to how much sodium you take in?

Maybe you should!

It turns out that sodium may not be as bad as we previously thought. In fact, sodium is essential for many metabolic processes. Sodium is responsible for regulating blood pressure, maintaining blood volume and is required for neuron function and signal transduction.

Many believe that high (or adequate) salt intake will lead to high blood pressure. Most cases of hypertension are actually a result of genetics or stress. A small percentage of the people who are sodium sensitive may experience an increase in blood pressure, but an overwhelming benefit for the rest of the population cannot be ignored.

Sodium has several benefits including:

• Increased performance
• Increased stamina / endurance
• Increased blood volume
• Increased recovery

During high intensity exercise, the body actually responds better to a higher blood volume. This improves delivery of oxygen and nutrients to the working cells of the body. High blood volumes are also optimal for kidney filtration and removal of toxins and metabolic waste products.

Low dietary sodium and elimination diets can have detrimental effects for high performance athletes. Low salt intake will decrease overall blood volume, making the blood thicker. This can cause muscle weakness, cramps and lethargy.

What Type of Salt?

I recommend iodized salt. Iodine helps with thyroid function and regulates metabolism. Unbleached, pure Himalayan salt is also a good option.

So if you are hitting a wall during your workout it may be due to sodium depletion. Bottom line, make sure you are drinking plenty of water, eating sufficient carbs for your training needs, getting a balance of micronutrients from a variety of whole foods, and don’t be afraid to sprinkle a little salt on your meals every once in a while!

Dr. Kyle: Sport Injury Rehabilitation

 

There are many factors to consider before clearing an athlete to return to sport. Time since injury, improvements in range of motion and increases in joint stability are all good metrics to evaluate before giving an athlete the green light.

Many rehabilitation programs focus primarily on enhancing maximal muscle strength. Current research suggests that Rate of Force Development (RFD) may actually be a better predictive factor in determining whether an athlete is ready for sport.

Common athletic maneuvers such as pivoting, jumping and stop-and-starts require rapid stabilization of the joints in the lower limb. This requires almost instantaneous muscle activation to prevent joint displacement and avoid re-injury. Factors such as neural activation, fiber composition and muscle contractile properties influence RFD and the body’s ability to absorb load on the joint. Therefore, it may not matter how strong the muscle is, but rather how fast the muscle can fire.

So how might this change rehabilitation programs?

Most physical rehabilitation protocols help build strength but fail to include an explosive component. Because athletic demands are often variable and unpredictable, it is important for the muscles to be able to react to any situation. Incorporating explosive plyometric exercises and a variation of sport specific drills will improve RFD and prevent future injury.

Take home points for sport-injury rehab:

• Allow sufficient time to for healing process to occur
• Recover full range of motion and flexibility
• Progressively overload the muscle to build strength
• Explosive training to enhance ability of muscle to generate force rapidly.
• Incorporate plyometric and sport specific drills to complement athletic demands.

As always, the best way to stay in the game is to avoid injury in the first place. So don’t wait for the pain to start before implementing an effective strength AND conditioning program.

If you or someone you know is suffering from a sport injury, call and book an appointment today for a complete musculoskeletal assessment!

 

Reference:
Buckthorpe, M., & Roi, G. S. (2018). The time has come to incorporate a greater focus on rate of force development training in the sports injury rehabilitation process. Muscles, ligaments and tendons journal, 7(3), 435-441. doi:10.11138/mltj/2017.7.3.435

Dr. Laura on Detoxification

Detoxification is a continual process. This happens at a cellular level throughout the body especially in the liver, kidney, lungs, skin, gastrointestinal tract and emotions.

Cellular toxins

When a cell encounters a toxin, be it too much sugar or alcohol, pesticides, BPA, lead, mercury, cadmium, arsenic, nickel, chemical flame retardants, phthalates, viruses, bacteria, fungi or parasites it mounts a cell danger response (CDR).  This load triggers a series of protective reactions that slows the transport of   goods across the cellular membrane. The membrane walls thicken just like our ancestors ravaged in war, built their walled cities for protection. This response to cellular danger is a fundamental component of innate immunity and can be helpful in times of distress.

Seasonal influence on detoxification

There comes a time when things must come and go from this walled city.  Seasonal influence provide an important basis for organ focus. For example, in the height of summer, the emotions, digestive and energy movement are most active. Autumn is more a time for the lungs and large intestine.  Winter brings the kidney and bladder centre stage. Finally in spring the liver and gallbladder are most ready to clear out the build up from the cold winter months.

Long term effects of toxic exposure

Long term toxic exposure with little support leads to chronic disease. This is when the cells continually want to keep their walls of protection. This is not healthy. Garbage builds up, and the inward flow of nutrients slow down. We also get this feeling after the long, cold winter months as we have hibernated inside, put the heat on and slowed our movement in and out of the house. It is always interesting what tends to happen at human levels of behaviour are also reflected at levels of cellular behaviour.

With this in mind, it might be proactive to think about more outside activities to keep your cells and energy from becoming too stagnant. The kidneys and urinary bladder are likely more open to accept attention in the winter time.  The urinary bladder is pretty straight forward in its function; eliminating water soluble waste that has been prepared by the supporting organs in the body. The kidneys themselves are responsible for blood filtration, mineral and acid base balance. They decide what gets filtered out and what gets recycled back into the body. In Chinese Medicine, the kidneys include the adrenals, our body’s organs that help us adapt to stress.  It is important through the winter months to also ensure the adrenal glands are well supported.

Near the end of one season and the beginning of another, during equinox, the need for the organs shift. So in late winter, early spring, the stage prepares for the kidneys, adrenals and bladder to fade and the liver and gallbladder begin to take centre stage. If the flow of energy through these organs is not smooth, it generally results in a lack of creativity and feelings of irritability and nagging frustration.

Organ System Screening

Electro dermal screening (EDS) can provide insight into the health of your detoxification organs. Much like an EKG on the heart or EEG on the brain, nervous system conductance related to each organ may be captured at peripheral points of the nervous system on the hands and feet. The onsite EDS equipment at Forward Health is German engineered, precise and needle free. 

Detoxification Plan

Together with sensitive body biofeedback from the EDS equipment and understanding what’s bothering you, Dr. Laura M. Brown, ND can create a clear detoxification plan to help you relax those walls you and your cells have built, and get the river of life flowing smoothly once again.

Resources:
Teeguarden, Ron. 1984. Chinese Tonic Herbs. Japan Publications New York.
Naviaux, Robert. 2013. Metabolic Features of the Cell Danger Response. Mitochondrion Volume 16, May 2014, Pages 7-17 https://doi.org/10.1016/j.mito.2013.08.006.

 

Tips for Snow Shovelling

 

Don’t Let the Snow Get You Down

Winter weather can pack a punch and, with the season’s heavy snowfalls, injuries often result. Improper snow shovelling is often to blame.

But shovelling out after a storm doesn’t have to leave you stiff and sore. With a little know-how, you can clear your driveway without the all-too-common back, neck and shoulder pain cramping your style. Here’s how:

Before You Start:

  • Drink plenty of water. Dehydration is just as big an issue in the winter months as it is in the summer.
  • Dress in several layers so you can remove a layer as you get warm.
  • Wear proper footwear. Shoes and boots with solid treads on the soles can help to minimize the risk of slips and falls.
  • Pick the right shovel. Use a lightweight, non-stick, push-style shovel. A smaller blade will require you to lift less snow, putting less strain on your body. An ergonomically correct model (curved handle) will help prevent injury and fatigue. Also, if you spray the blade with a silicone-based lubricant, the snow will slide off more easily.
  • Before beginning any snow removal, warm up for five to 10 minutes to get your joints moving and increase blood circulation. A brisk walk will do it.

All Set to Go

PUSH, DON’T THROW.

Push the snow to one side and avoid throwing it. If you must throw it, avoid twisting and turning — position yourself to throw straight at the snow pile.

BEND YOUR KNEES.

Use your knees, leg and arm muscles to do the pushing and lifting while keeping your back straight.

WATCH FOR ICE.

Be careful on icy walkways and slippery surfaces. Intermittent thaws and subsequent freezing can lead to ice building up underfoot, resulting in nasty slips and falls. Throw down some salt or sand to ensure you have a good footing.
Once you’ve mastered safe snow shovelling techniques, you’ll be free to have fun and stay fit all winter.

 

Call and book an initial assessment with Dr. Kyle Aram today!

 

Dr. Laura: Cough and Cold Relief, Naturally.

Naturopathic medicine offers much in line with cough and cold relief. The common cold and sinusitis are classic respiratory tract illnesses.

Respiratory Tract

The respiratory tract can be affected by many different cold viruses which  cause coughs due to inflammation, pain, and irritating mucous. The typical respiratory virus lasts 7-10 days.

Prevention

  • wash hands
  • avoid cross contamination
  • strengthen immune

First line is prevention. Washing hands regularly with soap and water is key. Also keep unwashed hands away from common sites of viral and bacterial entry: the nose, eyes, ears and mouth. Medicinal mushrooms, herbal formulas geared to the immune system, garlic, vitamin C may all be used to help strengthen the immune system.

Early signs

At early signs of throat tickles or glandular reactions, there are homoepathics and essential oils, mineral and botanical sprays that can nip things before they take off. Wet socks can also be helpful to boost white blood cells.

Naturopathic Treatments for Cough and Cold

Relieve blocked sinuses

There are acupuncture points to help balance heat and cold in the body, as well as ones that activate and release the sinuses. Even a single treatment can provide significant relief. At home hydrotherapy is always useful. A nasal saline rinse, wet socks or steam inhalation can all help you breath and sleep better at night and breathe better through the day. Steam inhalation with essential oils of thyme, lavender or eucalyptus allows antimicrobials to come in direct contact with the respiratory tract mucosa and the heat will help loosen the mucous. Herbal remedies blended to suit the symptoms of the cold and cough are very helpful to reduce the severity and duration. They offer antimicrobial factors, reduce inflammation and soothe irritated tissues. Mucolytics are neutracueticals which help break up mucous. Dr. Laura will work with you to find the best combination of remedies for you.

Relieve cough

  • Herbal remedies to soothe and reduce inflammation of mucous membranes
  • Homeopathic remedies prescribed for the specific nature

As mentioned above, custom blended herbal and homeopathic remedies can reduce the intensity and duration of the respiratory virus. Often, in upper respiratory tract infections, it is the post nasal drip of mucous from the sinuses that produces the cough. In lower respiratory tract infections, there is also irritating mucous involved. In both cases, it is important to treat the mucous congestion as mentioned above and soothe the tissues.

Treat lingering cough

  • Nebulized Glutathione

Nebulized or inhaled glutathione may be helpful to nourish and restore respiratory tract tissue. It is useful in any trauma to respiratory tract including smoke and fume inhalation and treatment can reduce and even avoid the post viral cough. Glutathione offers antioxidant protection and immune support while avoiding influence on plasma levels.

Alterations in the levels of glutathione in the lung and alveoli are widely recognized in many inflammatory lung diseases. Glutathione in the lining fluid of the lower respiratory tract is the first line of defence against oxidative stress.

 

Dr. Laura M. Brown ND

 

References:

The treatment of pulmonary diseases and respiratory-related conditions with inhaled (nebulized or aerosolized) glutathione. Evid Based Complement Alternat Med. 2007;5(1):27-35.

https://ndnr.com/bacterialviral-infections/post-viral-cough-clinical-considerations/

Dr. Laura: How does your thyroid function?

Feeling tired, loosing hair, bring fog, brittle nails, constipated,  periods heavy and cholesterol rising? Perhaps your thyroid is to blame.

What does thyroid hormone do?

Thyroid hormone keeps:

  • our metabolism humming
  • hair and skin smooth and silky
  • muscles and tendons well lubricated
  • mood bright
  • digestion moving along
  • brain firing on al cylinders
  • LDL cholesterol at healthy levels

How do you measure thyroid function?

General practitioners assess Thyroid Stimulating Hormone (TSH), and if it is out of range, T4 and T3 is measured. Sometimes an ultrasound is done to visualize the size and health of the gland, to assess nodules or help diagnose thyroid cancer.  Naturopathic doctors, functional medicine doctors and endocrinologists will be more likely the ones to run a full thyroid panel (freeT4, freeT3, TSH, TPO, Anti-Thyroglobulin and reverse T3).

How does the body naturally balance thyroid hormone?

T3 is the active hormone in the body and is made from T4. Although the T4 is made in the thyroid, conversion to T3 happens mostly in the liver and the gastrointestinal tract.   A normal functioning thyroid gland works with the hypothalamus in the brain using a negative feedback system to indicate when there is enough active thyroid hormone in the system.

How does the medical doctor balance thyroid?

Traditionally synthroid or levothyroxine is prescribed to treat inadequate levels of thyroid hormone and treatment is geared to reach a desired TSH level. Direct T3 therapy (Cytomel) is rarely prescribed due to lack of research and clinical experience. Typically the family doctor will  treat to normalize the TSH, but recent research, and numerous patient complaints may indicate that this is not enough.

More research is required to support T4 and T3 combination therapy, whether it is levothyroxine plus cytomel or natural desiccated thyroid, alone or in combination.

Research finds TSH monitoring is not enough to determine adequate thyroid functioning and some medical doctors agree a 4:1 ratio of T4:T3 predicts patient satisfaction and better health.

What does the naturopathic doctor do to balance the thyroid?

Naturopathic doctors seek to support the thyroid in making T4 and the body’s ability to convert the T4 to the active form of thyroid known as T3.   A naturopathic doctor offers support to people on pharmaceuticals like synthroid or levothyroxine, and is also able to additionally or solely prescribe advice for nutraceutical  support and natural desiccated thyroid.

A naturopathic doctor will:

  • look at the full thyroid panel
  • adrenal health
  • cholesterol panel
  • sex hormone health
  • the function of the liver
  • health of gastrointestinal tract,
  • nutrient balance of things like selenium, zinc, iron and iodine

How is cholesterol linked to thyroid function?

T3 levels are also inversely linked to LDL Cholesterol. When thyroid levels are low, LDL cellular reception is reduced, leaving more LDL in the blood stream.  Emerging research finds treatment with T4 alone (synthroid, levothyroxine) does not always correct the high levels of cholesterol induced by poor thyroid function. Rising levels of LDL cholesterol in peri-menopausal women with symptoms of fatigue should trigger an investigation into the balance of T4 and T3, not just TSH.

What drives T3 levels down?

  • Body shuttles T3 to reverse T3 in times of starvation and stress
  • Poor feedback function in the hypothalamus
  • Thyroiditis
  • High levels of natural and environmental estrogens
  • Epstein Barr Virus

T3 levels are increasingly challenged as xenoestrogens (environmental contaminants) rise in developed countries.  Peri-menopausal women also experience challenges. This is because estrogen (unopposed by progesterone as ovulation slows down), or estrogen mimickers like xenoestrogens (from plastics, pesticides and insecticides) have the ability to bind up Thyroid Binding Globulin and somehow affect the T4 to T3 conversion ratio. Some research points to Epstein Barr Virus impacting the genome and ultimately the function of the thyroid.

For more help optimizing your thyroid function, book an appointment with Dr. Laura M. Brown, ND.

 

Improving Cognitive Function in Older Adults

The prevalence of Alzheimer’s and various forms of dementia are on the rise in western society and scientists and doctors alike are looking for ways to prevent and combat these horrible diseases . Luckily, recent studies have found promising strategies to reduce the rate of cognitive decline as we age. For many years research has shown that regular exercise leads to improved physiological and cognitive function. As the general population becomes more sedentary at home and in the work place, the role of exercise for improved health has become increasingly important.

The current hypothesis to explain the positive cognitive effect of exercise is that physical activity induces neural and vascular adaptation that promotes neurogenesis. In other words, maintaining exercise in your daily life will help increase the brains ability to produce new neurons. Physical activity will also decrease systemic inflammation and reduce cellular damage caused by oxidative free radical. As a result, older adults who engage in moderate amounts of physical activity maintain a higher level of cognitive functioning

 

The results of this meta-analysis demonstrated that both aerobic and resistance training exercise were beneficial in improving cognitive outcomes in people over the age of 50. It is recommended that training sessions should be 45-60 minutes in lengths and performed at a moderate to vigorous intensity. These results are not surprising and will hopefully provide aging adults with a starting point in preventing age-related dementia.

For some, it may be a challenge to create a workout plan that suits their specific physical capacity. I recommend seeing a health care practitioner with proper training in therapeutic exercise and rehabilitation to at least get you started! Taking on a training program can be overwhelming for beginners and having a helping hand and some extra motivation will go along way. Many chiropractors will be able to get you started and guide you on your journey to healthier and more rewarding life!

Northey JM, Cherbuin N, Pumpa KL, Smee DJ, Rattray B. Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. Br J Sports Med. 2017 Mar 30:bjsports-2016.

Dr. Laura: Long Term Effects of Cortisol and Stress

Cortisol is released in a daily rhythm, but also in response to stress. Ever wonder what are the long term effects of cortisol (stress) in the body?

picture from  philosophytalk.org

Long term danger can be perceived in the form of anything that takes away our freedom, feeling unloved, feelings of insecurity, projecting into the future something that is not true, as if it were and  fear-based memories for future survival so as to avoid any repeat of traumatic events.

Cortisol is not all bad, it has some daily and life-saving functions. The problems lies when the body gets stuck in fear gear, cannot return to its natural state of homeostasis and subsequently has difficult with rest and digestion.

Normal Cortisol Function

Cortisol hormone produced by the adrenal glands. It is released twice a day with blood levels peaking in the morning, and rising slightly again in mid afternoon.

Throughout the day, cortisol:

  • Helps provide energy; maintains blood glucose
  • Suppresses nonvital organ systems to provide energy to the brain, nerves and muscles
  • Is a potent anti-inflammatory hormone
  • Prevents widespread tissue and nerve damage associated with inflammation

Short Term Stress Response

In response to a moment of physical or emotional shock or trauma, the body releases three main chemicals: epinephrine, norepinephrine and cortisol. In the short term, these chemicals trigger a series of events in the body to promote survival including anti-inflammatory actions and activation of energy to flee from the danger. Short term response has a clear purpose to better outcome (safety, life).

Once the epinephrine, norepinephrine and cortisol are released into the blood flow,

  • heart rate increases
  • blood pressure increases
  • respiration rate increases
  • arteries vasoconstrictor & release sweat.
  • pupils dilate
  • Pro inflammatory response so as to destroy antigens, pathogens, or foreign invaders; adrenoreceptor antagonists have been shown to inhibit stress-induced inflammation and cytokine production by blocking the proinflammatory effects of norepinephrine.

Long Term Cortisol Danger

Body’s release

When the brain feels you are in danger on an ongoing basis, cortisol release goes into overdrive. This can be things that threaten our survival like financial concerns, relationship problems, too many commitments, feelings of bitterness towards others, anger, resentment, being unhappy with yourself, lack of faith, hope, love, fear of loosing something you treasure… the list can go on.

Basically the body gets stuck in some type of survival mode. It is then difficult to re-establish to its natural balance.

Medications

Long term medications that end on “-sone” are often producing similar effects to cortisol in the body. These are drugs that suppress the immune system like prednisone, hydrocortisone.

Cortisone type drugs are used to treat pain, allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders.

Be sure to also be aware of information on cortisone drug side effects. 

  • Osteoporosis
  • Muscle wasting
  • Hypertension
  • Hyperglycemia
  • Hyper irritability
  • Depression
  • Weakness
  • Vascular fragility including easy bruising
  • Striae or redish stripes over the lower abdomen (thinning of the skin structures)
  • Suppressed immune system, make it easier to get infections
  • Central obesity

If you feel like you are “always on” , have difficulty digesting food or feel “tired and wired”, chances are you are running the meter up on cortisol. As you can see the long term effects are not favourable for good health.

Have Hope

Don’t give up hope, however. The first step is to recognize what is stressing you out. This is more than relationships, it can be pain, inflammation, poor diet, lack of sleep, poor coping mechanisms or genetic wrinkles.

Resolution doesn’t happen overnight but can be improved on a steady course of treatment over time.  Treatment will look at things like sleep hygiene, a healthy diet, the right amount and type of exercise,  and new perspectives on managing yourself in relationships with yourself and others.

The Last “Peace”

Need more peace in your life?  Join me at Goodness Me! on Sept 19th in a presentation on Anxiety Antidotes.

 

References:

Constanzo LS. 2011. BRS Physiology Fifth Edition. Walters Kluwer|Lippincott Williams & Wilkins. Philadelphia.

Hannibal KE, Bishop MD. Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation. Physical Therapy. 2014;94(12):1816-1825. doi:10.2522/ptj.20130597.

Wright H. 2009. A More Excellent Way. Whitaker House. Pennsylvania.

Dr. Laura Shares: GUT Viruses Implicated in Parkinson’s Disease

This article on the link between viruses found in the gastrointestinal tract and Parkinson’s Disease is from www.medscape.com

Gut Viruses a Potential Trigger for Parkinson’s Disease?

Pauline Anderson

July 19, 2018

Shifts in gut bacteriophages, viruses that infect and replicate within bacteria, are implicated in the pathogenesis of Parkinson’s disease (PD), new research suggests.

“Most likely, bacteriophages are previously overlooked triggers for the development of Parkinson disease in some patient populations,” lead author George Tetz, MD, PhD, head of R&D at the Human Microbiology Institute, a not-for-profit scientific research organization in New York City, and of the Tetz Laboratories, told Medscape Medical News.

Dr George Tetz

Although the results need to be confirmed, they open the door for discussing bacteriophages as a novel therapeutic target and diagnostic tool for patients with PD, said Tetz.

The study was published online July 17 in Scientific Reports.

Incidence Rising

The incidence of PD is on the rise in the Western world, with a higher prevalence among white men.

PD symptoms of tremors and motor symptoms are mainly related to depletion of dopamine in the striatum. The hallmark pathological signs of PD are Lewy bodies, which have a main component of α-synuclein protein.

While genetic risk factors contribute to PD, about 90% of PD cases are attributed to environmental factors. Up to 75% of patients have gastrointestinal (GI) abnormalities that can precede motor symptoms by many years.

Given the influence of gut bacteria on human health and the early involvement of GI microbiota in PD, the concept that the microbiota-gut-brain axis plays a role in PD has recently emerged.

The human GI tract houses bacteria, archaea, fungi, and viruses, including bacteriophages, which outnumber other viral and bacterial species.

How bacteriophages negatively affect health has recently gained scientific interest.

“These bacterial viruses can lead to the death of bacterial populations,” said Tetz.

He and his team previously showed that bacteriophage administration can cause shifts in mammalian microbiota, leading to increased intestinal permeability and triggering chronic inflammation.

Gut bacteria may be implicated in PD through several pathways. One such pathway outlined by the authors involves the enteric nervous system (ENS), which  that is in constant direct communication with the brain through the vagus nerve.

Vagus Nerve a Disease Pathway?

According to the model of gut-originating, inflammation-driven PD pathogenesis, PD starts in the ENS and spreads through the vagus nerve to the central nervous system.

This concept is confirmed by the presence of α-synuclein aggregates in myenteric neurons of the ENS before the onset of PD motor symptoms, the authors note.

An unrelated 2016 study, reported by Medscape Medical News, showed that truncal vagotomy, or removal of the vagus nerve, was associated with a reduced risk for PD.

The authors of that study concluded that this finding suggests Parkinson’s pathology may ascend from the gut to the brain via the vagus nerve.

In the new study, Tetz and colleagues note that changes in the composition of gut microbiota may cause alterations in the intestinal barrier function and permeability, affecting both the immune system and the ENS.

The new analysis was based on another study that included 31 patients, mean age about 65 years, with early-stage PD and 28 sex- and age-matched people without PD.

The patients with PD had not yet been treated with L-dopa. This, said Tetz, is very important.

“It’s well-known that the administration of dopamine in Parkinson’s disease patients leads to a significant shift of the microbiome.”

Patients with chronic and inflammatory GI diseases and those using laxatives, immune suppressants, or antibiotics in the past 3 months were excluded from the study.

To analyze the study participants’ fecal samples, researchers used metagenomics analysis and a unique algorithm developed by the authors to quantify bacterial and phage content. They also examined the phage/bacteria ratio.

Environmental Origin?

Under normal circumstances, this ratio is 1, which means one bacterium has one bacteriophage inserted in its genome, said Tetz.

“Alterations of this ratio represent an increase of bacteriophages, and as a result, lead to a decrease of bacterial populations that are killed by these bacteriophages.”

The investigators found a significant between-group difference in the phage/bacterial ratio for Lactococcus (lactic acid bacteria). There was more than a 10-fold decrease in Lactococcus species  in patients with PD compared with controls.

Lactococcus plays an important role in the metabolism of neurotransmitters, including dopamine. It also regulates intestinal permeability, another factor implicated in PD pathogenesis.

Despite the “striking” depletion of Lactococcus species in patients with PD, the total number of respective Lactococcus phages was about the same between the PD and control groups, the investigators report.

To investigate this discrepancy and a possible role of bacteriophages in the depletion of Lactococcus, the researchers divided Lactococcus phages into two clusters: strictly virulent (lytic), which can lead to the death of bacterial populations, or temperate. They compared the distribution of these two types between patients with PD and controls.

In the control group, the number of the lytic and temperate phages was similar, whereas in the PD group, most lactococcal phages were strictly virulent.

Tetz noted that the increase in these strictly lytic phages was accompanied by a decrease of Lactococcus bacteria. This, he said, suggests that the depletion of Lactococcus in patients with PD could be caused by lytic phages.

It’s not clear why the patients with PD had increased levels of lytic phages — whether, for example, it was from diet or a particular genetic susceptibility. This question must be addressed in further experiments, which are already in the planning stages, said Tetz.

However, he believes that the appearance of these lytic phages is most likely due to some external factor. The fact that these phages are lytic, meaning they enter microbiota, lead to the death of the bacterial population, and don’t persist for long in the gut, “would suggest that it’s something that originates from the environment.”

Dairy to Blame?

He noted that the type of phages that were increased in patients with PD in the study are found in yogurt and other dairy products. But he said it’s too early to conclude that such products play any role in PD.

The investigators believe that boosting Lactococcus bacterial species, or preventing a drop in levels, may prove useful in halting the development of PD.

But he stressed the importance of “diagnosing the death of the Lactococcus population at the appropriate time — before and not after the development of the disease.”

While it’s still unclear whether changes in dairy food consumption, or use of supplements, would change the gut Lactococcus population, fecal transplants are an intervention under active investigation.

However, Tetz believes that to be successful, such transplants would likely need to involve a limited number of bacterial species.

“There are a lot of drawbacks to regular fecal transplants, especially in the elderly population,” said Tetz. “It can lead to unpredictable shifts of the microbiome,” so new methods and new algorithms need to be developed “to make it safer.”
In light of these new results, bacteriophages should be added to the list of possible factors associated with the development of PD, the authors note.

They add that gut phagobiota composition may serve as a diagnostic tool as well as a target for therapeutic intervention.

The research team has also investigated the role of bacteriophages in type 1 diabetes. Tetz said the results “have revealed a striking difference” in children with this autoimmune disease.

Gaining Momentum

Commenting on the findings for Medscape Medical News, Michael S. Okun, MD, professor and chair of neurology, University of Florida, Gainesville, and medical director, Parkinson’s Foundation, said the idea that change in the gut microbiome and bacterial content may be important to PD is “gaining momentum.”

The new study, which is “novel” in that it analyzed the phage/bacteria ratio in study participants, contributes useful information on the topic, said Okun.

“There were possibly important shifts in the phage/bacteria ratio in lactic acid bacteria potentially important to dopamine and to intestinal permeability.”

The depletion in Lactococcus was “intriguing” as previous studies have linked dairy products to development of PD, said Okun.

However, he warned that the new study needs to be interpreted carefully because all the patients with PD were drug naive and there were only 31 of them.

Okun agreed with the authors that it would be “speculative” to use this information “as a direct link” to the cause of or potential treatments for PD.

“Understanding the microbiome in Parkinson may unlock new diets or treatment approaches, or even help current medications and therapies work more effectively, but much more research will be required.”

Tetz and Okun have disclosed no relevant financial relationships.

Sci Rep. Published online July 17, 2018. Full text

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