18 Gut Brain and Pandas Pans

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The Gut-Brain Connection

and PANDAS/PANS
Generation Rescue Conference Dubai
Feb 2018
Anjum Iona Usman Singh, MD, FAAFP, ABIHM, FMAPS

True Health Medical Center
Naperville, Illinois
Disclaimer
•Information is for educational purposes only

•The alternative view presented has not been
established as standard care or practice
•Clinical trials have not yet been conducted
•Not to be taken as specific medical advice
•All medical decisions regarding your child’s health
issues should be discussed with your health care
provider
•Dr. Usman is owner of True Health Medical Center
and Pure Compounding Pharmacy
•© True Health Medical
Center

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Nature Reviews Neuroscience 2012
• There is a growing body of scientific evidence that the

health of the microbiome (the trillions of microbes that
inhabit the human host) plays an important role in
maintaining the health of the host and that disruptions in
the microbiome may play a role in certain disease
processes.
• An increasing number of research studies have provided

evidence that the composition of the gut (enteric)
microbiome (GM) in at least a subset of individuals with
autism spectrum disorder (ASD) deviates from what is
usually observed in typically developing individuals.
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• There are several lines of research that suggest that specific

changes in the GM could be causative or highly associated with
driving core and associated ASD symptoms, pathology, and
comorbidities which include gastrointestinal symptoms
• If the Gut Microbiome truly plays a causative role in ASD, then
the manipulation of the GM could potentially be leveraged as a
therapeutic approach to improve ASD symptoms and/or
comorbidities, including gastrointestinal symptoms.
• One approach to investigating this possibility in greater detail
includes a highly controlled clinical trial in which the GM is
systematically manipulated to determine its significance in
individuals with ASD.

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Human Microbiome Project
• 5yr/ $140 million effort to study and explore how the trillions of
microscopic organisms in our bodies affect our health.
• Total microbial cells found in association with humans may exceed
the total number of cells making up the human body by a factor of
10:1.
• The total number of genes associated with the human microbiome
could exceed the total number of human genes by a factor of
100:1. Organisms found include bacteria, yeast, protozoa,
parasites, viruses and bacteriophages

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100 trillion bacteria
Atleast 1,000 different

Gut Microbiota
species
Early disruption of gut flora

affects later immune
function causing potential
allergies and autoimmunity
Early disruption affects

neurodevelopment
Good flora protects us from

pathogens
Good flora aids with

digestion of carbohydrates
and fiber to form SCFA
which in turn fuels
enterocytes (gut lining)
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Factors in style
Fetal Microbiome Disruption
• Maternal Autoimmunity
• Maternal Viral infection and/or Fever
• Prematurity, Small for Gestational Age
• C-section vs Vaginal Delivery
• Dietary Factors- formula vs breast-fed, fiber
intake (plant based vs animal based)
• Early antibiotic exposure
• Early toxin exposure (glyphosate, lead)
• Early maternal seperation and childhood trauma
• Stress (vagus nerve)
• Food Sensitivities/Allergies (gluten and dairy)
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Mice, Microbes and Antibiotics
• Dr. Vincent Young, University of Michigan (2009)
•“the gut ecosystem needs to be preserved

and that changing the ecosystem through
stresses such as antibiotics could
irreversibly change the ecosystem, with
deleterious effects.”
• He found that mice when given particularly strong antibiotics
completely wiped out all their normal gut microbes.
• Even more striking, Clostridium species and fungal species are then
able to overgrow without the good bacteria there to fend them off.
• Once the bad bugs take hold in our GI tract they may be extremely
difficult to eradicate.
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• Mice exhibiting autism-like behaviors enjoyed a reduction in

their symptoms when treated with a human gut microbe.
• The microbe also eased the mice’s gastrointestinal problems,

which had previously linked to autism in humans.
• Patterson found that the “autistic” mice harbored lower levels

of Bacteroides fragilis in their guts.
• And when B. fragilis was added to the animals’ diets, they

seemed to get better—both in terms of their behavior and their
gastrointestinal health. • © True Health Medical
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2013, 15 , 1416-1463;
Probiotics as Psychotropics
• Emerging literature is showing the beneficial

effect of oral probiotics on mood and anxiety
symptoms.
• In a double blind, placebo-controlled randomized

parallel group study, daily use of probiotics
reduced psychological distress. (Messaoudi, 2010)
• A number of studies have shown the anti-anxiety

effects of probiotic use in patients with medical
conditions.
(Silk, 2009; Sullivan 2009; Patel, 2008; O’Brien, 2004)
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Ingestion
ClickoftoLactobacillus Strain
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Emotional Behavior and Central GABA Receptor
Expression in a Mouse Via the Vagus Nerve
Bravo. Aug 2011

•Chronic treatment with L. rhamnosus (JB-1) induced
region-dependent alterations in GABA(B1b) mRNA in the
brain
• L. rhamnosus (JB-1) reduced GABA(Aα2) mRNA
expression in the prefrontal cortex and amygdala, but
increased GABA(Aα2) in the hippocampus.
•L. rhamnosus (JB-1) reduced stress-induced
corticosterone and anxiety- and depression-related
behavior.
•The neurochemical and behavioral effects were not
found in vagotomized mice.
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Vagus Nerve Cools Gut Inflammation
• Mice exposed to sodium dextran

sulfate to simulate inflammatory bowel
disease.
• Mice with intact vagus nerve exhibit

less inflammation in the gut.
• Mice with vagus nerve cut produced

heightened inflammation in the gut.
• The vagus nerve by releasing

Acetylcholine stimulates T regulatory
cells that lower inflammation.
O'Mahony C. Loss of vagal anti-inflammatory effect in-vivo visualization and adoptive transfer. Am J
Physiol Regul Integr Comp Physiol. Aug 12 2009. •© True Health Medical
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Peptides of Maternal Nurture in
Development and Brain- Gut Function
Dr. Martha Welch, MD- Columbia University
–Hypotheses
• Inflammation is encoded by the brain early in life
• Inflammation causes the individual to maladapt
• Peptides will be effective treatment for dysregulated brain states
–Assumptions
• The brain and gut form a single physiologic circuit
• The gut-brain axis is the crossroads of conditioning via interaction
with mother
• The gut is critical to conditioning reactions to stress in the early
post natal period
•23 Medical
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Combined Administration of Secretin and
Oxytocin Inhibits Chronic Colitis and
Associated Activation of Forebrain Neurons
Welch: Journal of Neurogastroenterology and Motility 2010
• Secretin is expressed in the colon at a lower

level than in the intestines
• S/OT decreased TNF alpha and IFN gamma in
the colon
• S/OT combo reduced inflammation
• S/OT decreased ulcers
• S/OT decreased IL-6 in amygdala
• S/OT may act in synchrony
• “Mother nature knows best”
•24 •© True Health Medical
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Oxytocin
Oxytocin improves “mind-reading” in humans. Domes G, Heinrichs

M, Michel A, Berger C, Herpertz SC. Biol Psychiatry. 2007;61:731–733.
Oxytocin modulates neural circuitry for social cognition and
fear in humans. J Kirsch P, et al Neurosci. 2005;25:11489–11493. Petrovic
P, Kalisch R, Singer T, Dolan RJ.
Oxytocin attenuates affective evalu-ations of conditioned
faces and amygdala activity. J Neurosci. 2008;28:6607–6615.
Oxytocin infusion reduces repetitive behaviors in adults with
autistic and Asperger’s disorders. Hollander E, et al.
Neuropsychopharmacology. 2003;28:193–198.
Oxytocin increases retention of social cognition in autism.
Hollander E, et al. Biol Psychiatry.2007;61:498–503.
•25 Medical
•© True Health
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Leaky Gut and Gluten style
• Gluten causes leaky gut by releasing zonulin

• Zonulin release causes cytokine and chemokine activation
(CXCR-3 , ligands CXCL 9, 10, 11) and migration of
pathological Th1 cells
• Gluten cause wbc (neutrophil) recruitment
• An impaired intestinal barrier is involved in
INFLAMMATION
• MS, strokes, asthma, cardiomyopathy, IDDM, thyroiditis,
celiec disease, rheumatoid arthritis, inflammatory bowel
disease and Autism
• Anti-zonulin Therapy is being studied
•26 Medical
•© True Health
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HumanClick to edita Master
Zonulin titleModulator
Potential style of
Intestinal Tight Junctions Fasano
•Mechanisms of Disease: the role of intestinal barrier function in the pathogenesis of gastrointestinal autoimmune diseases
•Nature Clinical Practice Gastroenterology & Hepatology (2005) 2, 416-422 •27 Medical
•© True Health
•Alessio Fasano Center
What is happening in the gut
of ASD patients?

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Click to PEDIATRICS
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Vol. 125 Supplement January 2010
Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in
Individuals With ASDs: A Consensus Report
Timothy Buie, MD, et al…
…The consensus expert opinion of the panel was

that individuals with ASDs deserve the same
thoroughness and standard of care in the
diagnostic workup and treatment of
gastrointestinal concerns as should occur for
patients without ASDs. Care providers should be
aware that problem behavior in patients with ASDs
may be the primary or sole symptom of the
underlying medical condition, including some
gastrointestinal disorders…
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Gastrointestinal Dysfunction (literature)
Maldigestion
• Decreased activity of digestive enzymes (Horvath,1999. Buie, 2004)
• High levels of opioid peptides found in urine of autistics. (Reichelt, 1997)
Malabsorption
Dysbiosis/Microbiome Disruption
• Dysbiosis or altered bowel flora (Rossenau, 2004)
• Clostridial overgrowth (Sandler, 2002, Finegold, Kang)
• Abnormal Microbiome (Finegold, Kushak,Parracho, Adams)
Immune Dysregulation (allergy, autoimmunity, inflammation, deficiency)
• Enterocolitis, Lymphoid Hyperplasia (Wakefield, Krigsman, Balzola)
• Increased intestinal permeability leading to food sensitivities
and autoimmunity (Vodjani, 2002/ Fasano 2011)
• Increased pro-inflammatory cytokines – LPS, TNF alpha, IFN gamma
(Ashwood, 2004)
• Proinflammatory response to dietary proteins (Jyonuchi, 2004)
• Low Secretory IgA (Gupta, 1996)
Motility •© True Health Medical
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• Gastroesophageal Reflux associated with aggressive behavior(Buie)

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Dysbiosis in ASD title style
• Dysbiosis or altered bowel flora (Rossenau, 2004, Adams 2013,

Finegold 2013)
• Clostridial overgrowth (Sandler, 2002)

• Overgrowth of spore-forming anaerobes
microaerophilic bacteria ei. Clostridia spp. (Finegold 2002)
• Clostridia species produce propionic acid, which has
neuroinflammatory effects on the CNS of rats (McFabe
2007)
• Increased incidence of Mycoplasma spp. infections

compared to controls (Nicholson 2007)
• Elevated HPHPA in ASD, associated with Clostridia sp.
(Shaw 2013) •© True Health Medical
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Infections Associated with ASD
• Babesia
• H H V -6
• Mycoplasma, multiple
• Bartonella species
• Blastocystis • Plasmodium
• Borrelia burgdorferi • Taenia solium
• Chlamydia pneumoniae • Toxoplasma gondii
• CMV • Treponema pallidum
• Ehrlichia
• HSV
Preventable cases of autism: relationship between chronic infectious diseases
and neurological outcome. Pediatric Health (2009) 3(2), 125-140. Center
PANDAS/PITANDS/PANS
Pediatric Autoimmune Neuropsychiatric Disorder Triggered by
Streptococcus or Other Infections
• Presence of obsessive-compulsive disorder and/or a tic disorder or
acute behavioral changes
• Pediatric onset of symptoms
• Episodic course of symptom severity, roller coaster
• Association with group A Beta-hemolytic streptococcal infection (a
positive throat culture for Strep or history of Scarlet Fever)
• Triggered by other infections (Lyme, Bartonella, Mycoplasma,
Viruses…)
• Association with neurological abnormalities (motoric hyperactivity, or
adventitious movements, such as choreiform movements)
• Acute change in behavior, skills (handwriting), bladder control
• Elevated CAM kinase and tyrosine hydroxylase, dopamine
upregulation, and autoimmunity (M. Cunningham, Univ of Oklahoma)
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From Research
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edit to Clinical
Master title style
Syndrome: Modifying the PANDAS
Criteria to Describe PANS (Pediatric
Acute-onset Neuropsychiatric
Syndrome)
Susan E. Swedo. NIH 2013

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Moleculera Cunningham Panel
PANS Mechanism
Group A Streptococcus (GAS) Infection

• TH17 opens the Blood Brain Barrier (BBB)
(Agalliu, Columbia Univ)
• Auto-antibodies cross-react with antigens in the brain in basal

ganglia
(Cunningham, Univ of OK)
• Lymphatic channels link the immune system and the brain

(Kipnis, Univ of VA)
•Agalliu, et al. Group A Streptococcus intranasal infection promotes CNS infiltration by streptococcal-specific Th17 cells. J Clinical
Investigation. 2016;126 (1)303-17

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PANS Mechanism
GAS Ab cross the BBB
• Th17 in Nasal Associated Lymphoid Tissue (NALT)

(animal model)
• Migration Th17 cell from NALT to brain
• BBB breakdown
• Serum IgG deposition
• Microglial activation
• Loss of excitatory synaptic proteins with no viable bacteria in
CNS
• CD4+T cell predominantly in olfactory bulb (OB)
• GAS-specific Th17 in tonsils of humans
•Agalliu, et al. Group A Streptococcus intranasal infection promotes CNS infiltration by streptococcal-specific Th17 cells. J
Clinical Investigation. 2016;126 (1)303-17

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PANS Mechanism
•Agalliu, et al. Group A Streptococcus intranasal infection promotes CNS infiltration by streptococcal-specific Th17 cells. J Clinical Investestigation. 2016;126 (1)303-17

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Inflammation, Infections,
Click to edit Master title Stress
style and
the BBB
The blood-barrier can be

compromised by
inflammation, infections,
stress, histamine, and
hormones allowing antibodies
to enter and affect certain
parts of the brain.
Infectious moods: Bugs that cause

bizarre behavior
12 January 2011 by Linda Geddes The blood-brain barrier (green)
turns out to be leaky

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PANs update Aug 2016
Sue Swedo, MD, (Head of NIH Autism Research)
• General Symptoms: OCD, tics (25%), need for

symmetry, fear of contamination, body image
distortion, depression, suicidality, usually occurs
after 4th untreated infection (from an
asymptomatic sibling)
• Type 1: Post Infectious – Strep, Chicken Pox,
Mycoplasma, Influenza, Virus, Lyme
• Type 2: Abrupt, lightening like onset of OCD,
eating disorder, anorexia

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Physical Exam
Infectious etiology
• Skin findings (warts, ringworm, molluscum)
• Thrush
• Strawberry tongue
• Tonsils/Adenoids
• Red Anal Ring
• Peeling fingers/feet
• Joint pain/swelling
• Mouth sores/ulcers
• Viral exanthams
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Testing Evidence

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Additional Testing to Consider
• Anti DNase B Antibody

• Throat Culture, Anal Culture
• Sinus Xray to r/o Sinusitis
• Inflammatory markers- CRP, ESR
• Check for allergic triggers (inhalant, foods, chemicals,
mold)
• Immune (other)
• Total Immunoglobulins
• Total Ig E
• CD 57 (natural killer cells)
• Zinc (plasma)
• Vit D 25 OH

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Treatment title style
Modalities
(see PANDAS Physicians Network)
1.Treat the SOURCE of infections with antibiotics and/or antivirals
2. SYMPTOM relief. Make patients comfortable by treating mood and

anxiety symptoms, consider CBT (cognitive behavioral therapy)
3. Modulate the IMMUNE SYSTEM response to infections with steroids,

high dose IVIG (dose 1.5 g- 2.0 gm/kg), and/or Plasmapheresis (severe
cases)

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PANDAS: THMCtitle style
Integrative Approach
• Probiotics
• Commensals/helminths
• Xylitol
• Antibacterial Herbs/Biofilm Protocols
• Goldenseal
• Berberine
• Neem
• Enzymes
• Immune modulators
• Zinc, Vit D, Vit A, Vit C
• Low Dose Naltrexone
• Transfer Factors
• Immunotherapy
• Adrenal Support
• Address Allergies/Histamine Intolerance
• Balance Glutamate/GABA
• Natural Anti-inflammatories
• Homeopathics •© True Health Medical
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• Essential Oils
Excitotoxins - Glutamate
• Glutamates • Anti- Glutamates

• Monosodium Glutamate (MSG) • Pycnogenol
• Hydrolyzed Protein • Rosemary, Lemon Balm
• Modified Food Starch • Skull Cap, Chamomile
• Natural Flavors • Magnesium
• Peas, Mushrooms, Tomatoes • Taurine
• Parmesan Cheese • GABA
• Protein • L- Theanine
• Vitamin K
• Lithium
• Namenda (drug)
• Minocycline (antibiotic)
Excitotoxins = Substances that cause an excess of excitatory
neurotransmission in the brain. If inhibitory neurotransmission is lacking, the
excess excitation may lead to neuronal death. Neuronal death leads•© toTrue Health Medical
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microglial activation and chronic inflammation in the brain.
Never, Never, Never Give Up…
-Winston Churchill
Basic Biomedical Strategy
• History and Physical Examination

• Laboratory Testing
• Clean Up
• Environment
• Diet
• GUT!!!!!!!!!!!!!!!!!!!
• Foundational Nutrients (Omega 3, Vit D, Zinc…)
• Support Detoxification Pathways, esp. Methylation,
Glutathione and Sulfation
• Address Mitochondrial Dysfunction
• Support Endocrine System (Adrenal, Thyroid)
• Heavy Metal/Chemical Detoxification
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Gastrointestinal title style
• History of Colic, Reflux

• Frequent or Early Antibiotics
• Dairy Intolerance, Sugar Cravings
• Frequent Otitis Media or Sinusitis
• History of Thrush, Severe Diaper Rash
• Poorly Formed Stools, Odd Color, Consistency, Odor,
Mucus, “Soft Serve”
• Undigested Food in Stools, Floating Stools
• Constipation, Chronic Diarrhea, Both
• Abdominal Distention, Gassiness
• Abnormal Posturing
• Self Injurious Behavior, Aggression
• Poor Sleeping Habits
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Physical Exam
• Skin rash, sand paper skin, eczema

• Dilated pupils
• Lack of eye contact, divergent gaze
• Poor visual tracking
• Allergic shiners
• Nails – spots, ridges
• Coated tongue or thrush
• Lymphadenopathy
• Spleen tenderness
• Abdominal bloating and tenderness
• Hypotonia
• Ligamentous laxity (double jointed)
• Signs of precocious puberty
•52 Medical
•© True Health
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Lab Options for Gut Issues
• Urine Organic Acids Test (OATS, MAP)

• Stool Microbiology
• Stool Mycology
• Stool Parasitology
• IgG/IgE Food/Mold Antibody Panel
• Celiac Panel, Carnitine level, Vit D25 OH, retinol
• Ammonia - blood,urine
• Fecal Fat
• Breath Test for Fructose Malabsorption
• Breath Test for SIBO
• Inflammatory Markers (ESR, CRP, histamine,
calprotectin,lysozyme, sIgA…)
• IBD Serology (prometheus testing)
• Endoscopy, Colonoscopy if necessary
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Clean Up the Gut
• Address Maldigestion
• Digestive Enzymes
• Address Malabsorption
• Probiotics and Prebiotics, Essential Fats, Biotin
• Lipase
• Give Fat Soluble Vitamins (A, D, E, K) and cholesterol
• Gall bladder support, Bile Acids, taurine, glycine
• Address Dysbiosis and pathogenic Biofilms
• Address Food Allergies and Hypersensitivities
• Address Oxalates/Calcium dysregulation
• Address Motility/Constipation
• Castor Oil packs •© True Health Medical
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Digestive Enzymes
• Enzyme activity is dependent on specific cofactors and

coenzymes(vitamins/minerals)
• Enzyme activity can be inhibited by toxins, fungi, oxidative stress, and
malnutrition
• Enzyme activity can be optimized with proper nutrition and elimination
of toxins
• Ex. DDP4 enzyme activity inhibited by Hg
•Saccharidase breaks down sugars

•Lipase breaks down lipids/fats
•Protease breaks down protein
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Enzyme Supplements
• Bromelain- Papaya and Pineapple breaks down

protein
• Plant Based Enzymes – Aspergillus derived
• Lumbrokinase- earth worm
• Nattokinase- soy
• Serrapeptase- silk worm
• Carnivora- venus fly trap
• Pancreatic glandular
• Prescription enzymes- Pancrealipase
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Probiotics
• Remain viable and stable after culture,

manipulation, and storage
• Survive gastric, biliary and pancreatic digestion
• Able to induce a host response once they enter
the intestinal microbial ecosystem
• Transiently colonize or occupy the gut
• Not all viable ingested bacteria in the food supply
are probiotics.
Live microorganisms which when administered in adequate
amounts confer a health benefit on the host
-WHO 2001 •
© True Health Medical
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Probiotics – beneficial bacteria
• Bifidobacterium (breve, longum, infantis)

• Lactobacillus (acidophilus, casei, paracasei,
johnsonii, lactis, plantarum, reuteri, rhamnosus,
salivarius, gasseri, rheuteri, bulgaricus )
• Escherichia coli
• Enterococcus
• Streptococcus thermophilus
• Bacillus Coagulans (spore forming)
• Sacchyromyces Boulardii (good yeast)
• D- Lactic Acid Free •© True Health Medical
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Success of Probiotics
• Safety
• Adhere to intestinal mucosa for transient colonization
• Proven health benefit
• Antimicrobial (lactic acid bacteria)
• Anticarcinogenic (1,2 dimethylhydrazine tumors)
• Survival in the product
• Needs a food source (prebiotic stimulation)
• Using compatible bacteria together (lactobacillus plantarum not
compatible with bifido)
• Dosing 108 – 109 cfu, overdosing not possible
• Probiotics may be an issue in patients with inflammatory bowel
disease and in patients with SIBO
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Lactobacillus and Bifidiobacteria
L. casei, bulgaricus, and acidophilus increase

macrophage and enhance phagocytosis
Decrease gut permeability
Exert antimicrobial activities
Secrete antimicrobial proteins (activate mucin, MUC2
and MUC3 genes)
Increase T helper cells, Th2
Decrease Th1, and allergic response
Increase IL 10, TGFbeta
Bifidio lowers proinflammatory cytokines
Lactobacillus is highly populated in the small
intestines,
Bifido is highly populated in the large intestines •
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Prebiotics
Fibers (non-digestible) that are a food source for

good bacteria
Bifidobacteria ferment this to make short chain
fatty acids(SCFA)
SCFA help feed and fuel the cells of the colon,
prevent dysbiosis and inflammation in the gut
Probiotics, prebiotics, and synbiotics De Vrese. 2008

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Prebiotic Health Benefits
Enhance absorption of minerals such as calcium,

magnesium and iron
Promote bowel motility and regularity
Inhibit growth of cancerous lesions in the GI tract
Improve immune function
Lower blood cholesterol
Slow digestion of carbohydrates/sugar
Goal: 5-15 grams/day
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Sources of Prebiotics
Food Sources:
Artichokes, garlic, onions, leeks, asparagus, chives
legumes, soybeans, peas, chicory root, oatmeal, flax,
bananas
Supplements:
Inulin
Fructooligosaccharides, galacto-oligosaccharides
Larch arabinogalactan
Guar gum
Polydextrose
Maltodextrin
Lactulose •
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Improve Motility
If it takes greater than 24 hrs

Vit C and Magnesium to pass charcoal or beets,
5HTP consider a motility issue!
Acetyl L Carnitine
Iberogast Check a KUB
Cholinergic Agents
Phosphatidyl Choline Remember constipation may
mask as intermittent diarrhea
Urecholine
Triphala, Aloe, Senna
Address Oxalates- Consider B6, Biotin, Mb, Calcium
citrate
Address Metal Burden especially Lead (Pb) and
Aluminum (Al)
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Natural Anti-inflammatory Agents
• Herbs
• Boswellia, Green Tea, Nettles, Slippery Elm, Cat’s Claw,
DGLicorice, Aloe, Ginger, Garlic, Echinacea, Ginseng, …
• Bioflavinoids (carotenoids, catechins)
• Curcumin, Hesperidin, Pycnogenol, Quercetin Rutin,
Chamomile
• Antioxidant rich fruits, veggies, phytonutrients
• Nrf2 inducers – sulfurophane(broccoli seed extract), triphala
• Omega 3 and Omega 6(DGLA) EFAs
• Cholinergic agonists
• Phosphatidyl Choline, Phosphatidyl Serine
Aggarwal, B.B. and K.B. Harikumar, Potential therapeutic effects of curcumin, the anti-inflammatory agent, •© True against
Health Medical
neurodegenerative, cardiovascular, pulmonary, metabolic, autoimmune and neoplastic diseases. Int J Biochem Cell Biol, 2009. 41(1): p. 40-59. Center
Address Excessive Oxalates
Susan Owen BS
• When the gut is inflamed or becomes permeable excess oxalate from

foods can be absorbed and stored
• When present in high amounts, can lead to oxidative damage, depletion
of glutathione, and inflammation
• Excess oxalates form crystals after binding with calcium
• Symptoms include: Pain, Burning, Frequent Urination, Eye Poking,
Family history of Kidney Stones, Vulvodynia
• Avoid High Oxalate Foods
• Spinach, Greens, Nuts, Soy, Beets
• Avoid High Doses of Vitamin C
• Avoid Collagen/Gelatin
• Supplements: Biotin, Vit B6, Mg/Cal citrate, Mb, Vit D, electrolytes, Vit K2
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Treatment For Dysbosis
• Usually long term, 3-6 month courses

• Antibiotics may cause further imbalance of gut
microbiota.
• Antimicrobial Herbals can be very effective
• Consider HBOT, oxidative strategies
• Biofilm strategies
• Restoring good flora
• Prebiotics
• Probiotics
• Fermented foods
• Low sugar diet •© True Health Medical
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Clostridia Issues
Symptoms Treatment Options

• Aggressive • Probiotics, High Potency single
• OCD strain
• Temper • Sacchromyces Boulardii
• Agitation • Antibiotics
• Irritable • Vancomycin
• Very foul stools • Metronidazole (Flagyl)
• Mucus in stools • Herbals(Bayleaf, Thyme)
• Severe diarrhea following • Immune modulators
antibiotic use • HBOT
• L. Carnitine
• Oxidative Therapies
• Fecal Transplants
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Yeast Issues
Treatment Options
Symptoms • Limit carbs, sugar, yeast
• Spacey • Probiotics
• Foggy thinking • Sacchromyces Boulardii
• Inappropriate laughter • Zinc, Molybdenum, Biotin
• Antifungals
• Sugar cravings • Drugs
• Poor sleep • Nystatin, Ampho B
• Fluconazole
• Frequent diaper rash
• Itraconazole
• Frequent urination • Ketoconazole
• History of frequent • Herbals
• Grapefruit Seed Extract
antibiotics • Oil of Oregano, Pau dʼArco
• Garlic, Samento, …
• Enzymes •© True Health Medical
Center
• Homeopathics
Bacterial Issues
Symptoms Treatment Options

• Probiotics
• Ritualistic
• Xylitol
• Repetitive
• Antibacterial Herbs
• Verbal tics
• Goldenseal
• Obsessive • Neem
• Compulsive • Berberine
• Verbal stims • Immune modulators
• Oral Immunoglobulins
• Transfer Factors
• Colostrum
• Mushroom Extracts
• Beta Glycans
• Drugs
• Penicillins, Cephalosporins
• Zithromax
• Homeopathics Center
Parasites
Symptoms Treatment
• Bizarre Behavior • Probiotics
• Insatiable Appetite • Antiparasitic Drugs
• Aggressive • Flagyl
• Worse at full moon • Paromomycin
• Picking, biting, licking, • Mebendazole, Pyrantel
itching, grinding • Alinia
• Fecal smearing • Natural Remedies
• Restlessness • Wormwood(artemesia)
• Black Walnut
• Pumpkin Seeds
• Clove Oil •
• Homeopathics Center
Binding Agents
• Fiber, insoluble/soluble (prebiotics)

• Pectin, guar gum, ground flaxseeds, psyllium
husks
• Activated Charcoal if needed for severe die
off
• Alginates, Brown Algae, Clay
• Modified Citrus Pectin
• Slippery Elm, Yucca
• Burbur
• Chlorella, Cilantro/Chinese Parsley
• Very important step
• Helps prevent symptoms of die off and detox
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Rebuilding/ Nourishingtitle style
the Gut Lining
Probiotics Fermented Foods
Prebiotics -Kefir
Probiotic/Prebiotic Rich
-Cabbage
Foods
Healing, nutritious, non- Supportive Supplements
toxic foods -Comfrey
-Ghee -Chamomile
-Aloe -Colostrum
-Ginger
-Okra
-Bone broths/Collagen
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Rebuilding/ Nourishing
the Gut Lining
• Probiotics • Fermented Foods

• Prebiotics • Kefir
• Probiotic/Prebiotic Rich • Cabbage
Foods • Supportive Supplements-
• Healing, nutritious, non-
• Comfrey
toxic foods-
• Chamomile
• Ghee
• Aloe • Colostrum
• Ginger
• Okra
• Bone broths/Collagen

Center
Remember to stop and smell the roses!!!!

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18 Gut Brain and Pandas Pans

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The Gut-Brain Connection

Anjum Iona Usman Singh, MD, FAAFP, ABIHM, FMAPS

•Information is for educational purposes only

•© True Health Medical

•© True Health Medical

• There is a growing body of scientific evidence that the

• An increasing number of research studies have provided

• There are several lines of research that suggest that specific

•© True Health Medical

•© True Health Medical

Atleast 1,000 different

Early disruption of gut flora

Early disruption affects

Good flora protects us from

Good flora aids with

• Dr. Vincent Young, University of Michigan (2009)

•“the gut ecosystem needs to be preserved

• Mice exhibiting autism-like behaviors enjoyed a reduction in

• The microbe also eased the mice’s gastrointestinal problems,

• Patterson found that the “autistic” mice harbored lower levels

• And when B. fragilis was added to the animals’ diets, they

•© True Health Medical

• Emerging literature is showing the beneficial

• In a double blind, placebo-controlled randomized

• A number of studies have shown the anti-anxiety

Bravo. Aug 2011

• Mice exposed to sodium dextran

• Mice with intact vagus nerve exhibit

• Mice with vagus nerve cut produced

• The vagus nerve by releasing

Dr. Martha Welch, MD- Columbia University

• Secretin is expressed in the colon at a lower

Oxytocin improves “mind-reading” in humans. Domes G, Heinrichs

• Gluten causes leaky gut by releasing zonulin

•© True Health Medical

…The consensus expert opinion of the panel was

• Gastroesophageal Reflux associated with aggressive behavior(Buie)

• Dysbiosis or altered bowel flora (Rossenau, 2004, Adams 2013,

• Clostridial overgrowth (Sandler, 2002)

• Increased incidence of Mycoplasma spp. infections

•© True Health Medical

Group A Streptococcus (GAS) Infection

• Auto-antibodies cross-react with antigens in the brain in basal

• Lymphatic channels link the immune system and the brain

•© True Health Medical

• Th17 in Nasal Associated Lymphoid Tissue (NALT)

•© True Health Medical

•© True Health Medical

The blood-barrier can be

Infectious moods: Bugs that cause

•© True Health Medical

• General Symptoms: OCD, tics (25%), need for

•© True Health Medical

•© True Health Medical

• Anti DNase B Antibody

•© True Health Medical

1.Treat the SOURCE of infections with antibiotics and/or antivirals

2. SYMPTOM relief. Make patients comfortable by treating mood and

3. Modulate the IMMUNE SYSTEM response to infections with steroids,

•© True Health Medical

• Glutamates • Anti- Glutamates

• History and Physical Examination

• History of Colic, Reflux

L. casei, bulgaricus, and acidophilus increase

Fibers (non-digestible) that are a food source for

Enhance absorption of minerals such as calcium,