Moodle at CCNM

The liver synthesizes and secretes hydrophilic primary bile acids, processed in the small and large bowel by the microbiota. These enter the enterohepatic circulation and join the bile acid pool. These bile acids are hormones that regulate their own synthesis and transport as well as regulating lipid, glucose, lipoprotein and energy metabolism as well as inflammation. Dr. Sandberg-Lewis reviews the biochemistry and physiology of these processes and discuss the use of botanicals, nutrition and prescription medication to aid the activity of this essential “endocrine organ”.

Symptomatic relief is an important part of Small Intestine Bacterial Overgrowth management. There are many at home and over the counter treatment options to relieve SIBO symptoms. This lecture will describe supplements, as well as some food and lifestyle factors for SIBO symptom relief, by symptom (bloating, constipation, diarrhea, pain, acid reflux, nausea…), along with precautions and warnings for the treatments.

The 5 Laws of Metabolism are explained and strategies to combat a stalled metabolism are explored. The metabolic toggles of EMEL (eat less, exercise less=couch potato, ELEM (the dieter), ELEL (eat less, exercise less), and EMEM (eat more, exercise more) are introduced as methods that allow the changeable metabolism to react. His popular catchphrase has been derived from this model using your own biochemistry to check in with your individual metabolism: Become your own "metabolic detective." "Is your HEC (hungry, energy, cravings) in check." It is a "structured flexibility" that allows an individual to build their own program. This talk leaves the audience with the tools to begin a completely individual health regime and gives all the reasons why it will work.

This course explores the Broad based Benefits of Bile Acids.

This 2-part presentation covers the way that IBD and IBS interact and the underlying causes of IBS that present in IBD and why. The first part of the presentation looks in depth at SIBO, fistula’s, fissures, and bacterial changes of the GI. Part 2 is a look at a majority of functional GI testing and if there is any scientific validity to those tests.

In the last decade, the understanding of clinical breath testing in the evaluation of SIBO has evolved. We have come to know that methane on breath testing is highly associated with constipation and requires a different approach to treatment. Hydrogen on the other hand is not related to any specific symptom. The missing gas has been hydrogen sulfide and this gas is of great importance to the symptom diarrhea. Not having this gas in the breath test profile leaves a missing piece of the puzzle out. In this presentation we will examine the interaction of all three gases and the importance they play in the evolving microbiome story of SIBO. Rifaximin will be discussed which is FDA approved, neomycin a drug not yet approved for SIBO and SYN-010 which is not yet approved by FDA for methane.

Integrative medicine providers, including naturopathic physicians, routinely employ new and emerging science to inform their clinical practice. This practice of early adoption, along with growing interest from the public, has contributed to the explosion in affordable gastrointestinal (GI) microbiome testing marketed to integrative medical practices. These tests are often described as clinically useful tools that can be used to inform treatment of chronic medical conditions, as well as strategies for optimizing general wellness. While these interventions can often be of great benefit to patients, their implementation is not always informed by a nuanced understanding of the limitations of this testing. Commercial microbiome testing in its current form cannot truly nor completely describe an individuals GI microbiome health, except possibly when identifying specific infectious pathogens, nor inform specific interventions (probiotics, prebiotics, etc.) with the accuracy often claimed by the tests themselves, or the physicians employing them. As early adopters, it is our responsibility to not only understand the usefulness of GI microbiome testing, but also its limitations, and ensure that our care is informed by this knowledge. This presentation will review the technology employed in current commercially available microbiome testing and what practitioners should know regarding the limitations of utilizing this technology in clinical practice.NOTE: This talk is not intended to dissuade providers from using GI microbiome tests, but rather encourage thoughtfulness and transparency when utilizing these technologies. I believe that highlighting this discussion in a separate talk (vs combining with a more in-depth review of the technology) will help participants better retain information essential to their PARQ discussions.

The tongue is very important. How it sits in your mouth, how it moves, how much it is used, and its size and shape can have an impact on a variety of health conditions. From EENT disorders to dysbiosis, and from GERD to apnea, examining your patient’s tongue will give you a much greater picture of their GI health as well as how likely they are to have or develop EENT conditions and sleep apnea. Evaluating and treating weak or large tongues in children can help doctors and parents understand the importance of proper dietary hygiene and can reduce patient’s future risk for sleep apnea and EENT conditions. Food introduction and suckling habits in infants can help to mold a patient’s risk for tongue influenced pathologies and starting young with important habits may add years to a child’s life. Our current dietary habits are causing pathology in both young and old and its vitally important to improve muscle tone of the tongue to help ward off future health pathologies.

This is a discussion of the connection between how both SIBO and parasitic infections affect the Microbiome and how one is often misdiagnosed as another. This will be a deeper look on how we currently understand how parasitic infections change the microbiome presentation and how patients will often suffer from and be diagnosed with one but the underlying cause is the other one.  Alinia is briefly discussed as a use for treatment of parasitic infections.

You are more bacteria than you are human with 10 trillion human cells outnumbered by over 100 trillion bacteria cells in and on your body. The human genome contributes just 1% genetic material to daily metabolic function compared to the 99% that is contributed by the microbiome. An often-overlooked role of the microbiome is to prevent post-prandial endotoxemia and the inflammatory devastation that follows. This lecture will illustrate the danger of having post-prandial endotoxemia and why this condition is being called the number one cause of mortality worldwide as it sets up the body for virtually every chronic disease. This condition is caused by eating and a failure of the microbiome to protect its host from this response. You simply cannot completely correct any chronic condition without addressing post-prandial endotoxemia.

There are many causes of Small Intestine Bacterial Overgrowth. This lecture explains both the physiologic underlying causes as well as the many risk factors. Physiologic underlying causes primarily encompass failure of protective mechanisms such as the migrating motor complex and anatomic alterations. Risk factors encompass diseases, injuries (including surgery), medications and other lifestyle factors as well as genetics. A clinical checklist of risk factors is discussed along with testing and treatment.

There is an important link between gastrointestinal function, brain, hormones, and health. Why do some women feel bloated or have stool changes with fluctuations in their menstrual cycle? What about PMS, including symptoms such as anxiety and depression, all coinciding with gastrointestinal health? In the past decade, there have been huge advancements in the research on this topic. Now we see a relationship between the gut microbiome, our mood, and our memory. We see a higher percentage of people with IBS or other bowel problems suffering from depression and anxiety. We see gut inflammation impacting a whole range of issues from pain, sleep, and libido to mental health. We see probiotic therapy used in place of some anti-depressants with equal success. We've found evidence of direct communication from gut to brain, a type of neural superhighway. This presentation attempts to connect some of these dots in order to shed light on how this intersection may impact our approach to case management.

Visceral hypersensitivity occurs in up to a third of patients with IBS and Functional Dyspepsia, two of the most common functional gastrointestinal disorders presenting to naturopathic practices. This condition is often overlooked and rarely discussed in clinical context, yet can complicate presentation and often leaves patients with continued symptoms despite "normal" work-up. This presentation reviews the proposed causes of visceral hypersensitivity, its relationship to IBS and FGID, and various treatment approaches, including review of research on pharmaceutical, botanical, manual, and psychological interventions. Review of pharmaceuticals to include classes of SSRI, TCA, 5HT3 antagonists, 5HT4 agonists, GABAnergic agents, as well as Ketotifen & Naltrexone (low dose).

Presenters respond to questions from the audience regarding food fear and SIBO. A mixture of data, clinical experiences and outcomes and case examples are covered.