Local practitioners embrace the gut microbiome

Something very small was wrong with Jaydee Sedmak. A combination of fasting and colon hydrotherapy, she says, had disrupted the balance of microorganisms in her digestive system, leading to a condition called small intestinal bacterial overgrowth. Each individual bug was just a couple of millionths of a meter in length, but her problems were anything but tiny.

“I had lost a lot of weight, I had extreme fatigue, my hormones were extremely out of whack,” Sedmak recalls of her health at the end of 2016. Having lost her normal complement of beneficial microorganisms and gained an excess of unhelpful ones, she says, her digestive and endocrine systems “started to come unraveled.”

Trips to several “more mainstream” practices, Sedmak says, resulted only in doctors confused about SIBO and recommendations for gas and heartburn medicine. Even a visit to a natural health center in Oregon failed to yield a successful treatment plan. She reports that her symptoms only began to lift after she started seeing Dr. Cynthia Libert, an Asheville-based functional medicine practitioner, and got to the gut of the problem.

Through a combination of thyroid hormones, supplements and dietary changes, Libert helped Sedmak clear up her SIBO and re-establish a healthy gut microbiome: the complex ecosystem of bacteria, fungi and other microorganisms that lives in a mutual relationship with the human body. She regained weight, restored her normal hormone balance — and gave birth to a healthy baby boy in 2018.  

Libert is among the growing number of local health professionals who believe that a focus on the microbiome can transform medicine in general as radically as it transformed Sedmak’s health. New research, she says, has hinted at the gut’s surprising influence in matters far beyond digestion.

“We’re just learning that the microbiome has a central role in many of our chronic degenerative diseases, autoimmune conditions and mental illnesses,” Libert says. “It’s certainly early in the process in terms of exactly how to manipulate the microbiome, to have therapeutic interventions when those conditions develop, but I think there’s a ton of evidence showing that we need to be much more proactive about protecting it.”

Small but significant

In a healthy gut microbiome, Libert explains, microorganisms produce compounds that promote the health of their human hosts as well. Bacteria in the colon, for example, break down dietary fiber into a chemical called butyrate, which in turn feeds human colon cells and protects them against inflammation and cancer.

Other microorganisms make substances that serve as signals for healthy brain functioning. Libert says that when the normal microbiome balance gets thrown off, the brain can react with inflammation as if it had been injured. That response, she says, can contribute to Alzheimer’s disease and cognitive decline.

“As people age, the microbiome tends to undergo a marked shift and decrease in diversity, especially in nursing homes,” Libert says. “When you have that decrease, you can also get what we call dysbiosis, where there’s an imbalance of the healthy and unfriendly bacteria.”

Even heart disease may be related to the balance of bacteria, suggests Dr. Doreen Saltiel of Genova Diagnostics, an Asheville-based company that offers clinical microbiome testing. Inflammation of artery walls, she says, is associated with coronary events — and recent research has found ties between that inflammation and signals from the gut.

“The functional medicine community takes the approach that the gut is the lens through which you should view health and disease, because 70 to 80 percent of the immune system lives in the gut,” Saltiel says. “Altering the gut microbiome probably plays a huge role in disease manifestation.”

All for one

Due to the complexity of the microbiome, with hundreds of bacterial species identified in the human gut, health practitioners are increasingly taking a holistic approach to its improvement. Todd Stone, an integrated natural medicine practitioner in Arden, contrasts this strategy with the use of probiotic pills containing specific strains of microbes.

“I think popular media, and even functional medicine culture, tells people that you need to be constantly replenishing [microbes], you need to be taking a probiotic,” Stone says. But people with chronic health problems, he continues, should examine what’s inside rather than rely on external support.

“I use the crack house analogy: If you send families into the neighborhood and they all die, you’ve got to think about the neighborhood,” Stone explains. “You’ve got to clean up the crack houses and make it a nice neighborhood, and then they will live and thrive naturally.”

Libert agrees, albeit in less colorful terms. “The vast majority of what I do is lifestyle medicine interventions that are just going to cultivate a healthy environment for the friendly bacteria to thrive,” she explains. “That just goes back to the basics in terms of diet: not eating processed foods, getting plenty of fiber, getting a lot of diversity with different types of fruits and vegetables,” she explains.

Both Stone and Libert are also wary of using pharmaceutical antibiotics to treat their patients. Although these drugs kill harmful microorganisms, they can wipe out much of the beneficial microbiome at the same time, making it more difficult for the body to return to a healthy bacterial composition.

Instead, the practitioners more often turn to natural medicines that they say help the body naturally fight bacterial imbalances. Libert favors a beneficial yeast, Saccharomyces boulardii, in treating Clostridium difficile infection, while Stone says he’s successfully used Chinese goldthread and cayenne pepper to combat ulcerative colitis.

“This isn’t mainstream yet; it isn’t in the textbook that you read in medical school, but it’s kind of pieced together from the emerging literature and the training that I’m getting from the Institute of Functional Medicine,” Libert explains. “I’m just trying to really apply the latest [research], in terms of looking at studies and not waiting 20 years for it to trickle down into practice.”

Down the road

Saltiel acknowledges that members of the conventional medical community have been slower than their alternative counterparts to embrace the microbiome as a lens for health. While the basic research has been promising, she says, few outcomes studies — experiments that compare results for similar patients under different treatments — have been conducted for microbiome interventions.

The American Gastroenterological Association, wrote Dr. Gail Hecht of the professional body’s Center for Gut Microbiome Research and Education in a 2014 review article, agrees that “manipulation of the gut microbiome is quite likely to have a major influence on the treatment of several diseases in the future as the involvement and related mechanisms are further defined.” However, the organization advises practitioners to “exercise patience” when it comes to addressing disease through the gut.

“We must proceed with caution when considering altering the microbiome in humans; it is possible that decades in the future, we will realize that other currently unforeseen problems have been created as a result,” Hecht wrote. “Recognizing these potential pitfalls in the face of the major preventative and therapeutic power of the gut microbiome, the AGA has made this area an important priority for the organization.”

Genova has tried to bring greater rigor to the microbiome, Saltiel says, by analyzing data from over 177,000 of its stool profiles. By establishing associations between microbial species, metabolic biomarkers and different health conditions, she explains, the company can help health practitioners determine the significance of irregularities.

“When you tie the microbiome to digestion and inflammation, you start to tell a story of how the cross-talk between hormones, signaling and the gut systemically controls or maintains homeostasis,” Saltiel says. “Every clinician should be thinking about the gut microbiome when they see any kind of patient.”

Sedmak, who attributes her health turnaround to the recovery of her gut, says her own approach to well-being has shifted in light of what she learned about the microbiome. Instead of “pushing the limits” of her health through measures like fasting and colon therapy, she’s learned to practice intuitive eating and give her gut what it needs to take care of itself.

“I was doing those things out of a concept of what I thought I should do to be healthy, instead of really checking in with my own body and what was healthy for me,” Sedmak explains. “I realized that trying to meet these idols of drinking my green smoothie every day and doing yoga and eating only organic food was actually harming me, because I was so disconnected from what my body really needed.”