Presented by Julia Malkowski, ND, DC | November 4, 2026 at 12 PM Pacific

Gut microbial aging, intestinal barrier dysfunction, and chronic low-grade inflammation (inflammaging) are increasingly recognized as modifiable contributors to cognitive and functional decline. This session reviews how the gut microbiome changes with age, including loss of diversity and butyrate-producing taxa, and how these shifts weaken the mucosal barrier and increase zonulin and LPS translocation. It then follows the resulting inflammatory signal to the brain, where blood-brain barrier changes and neuroinflammation affect the hippocampus.

Attendees will learn which objective measures are available today (stool microbiome diversity and dysbiosis profiles, zonulin, hs-CRP) and how to incorporate these into practice. They will also learn how to apply evidence-based dietary, nutraceutical, and medication-review strategies in a rational sequence, with dosing limits and reassessment.

Learning Objectives:

• Describe age-associated changes in gut microbiome composition and diversity, including loss of butyrate producers, and how they relate to biological age.
• Explain how intestinal barrier dysfunction, zonulin, and LPS translocation contribute to inflammaging, neuroinflammation, and cognitive decline.
• Interpret stool microbiome diversity and dysbiosis profiles, zonulin, and hs-CRP in a patient with cognitive or functional decline and recognize the limits of these tests.
• Apply evidence-based dietary, nutraceutical, and medication-review strategies to restore microbial diversity and barrier integrity, including sequencing, dosing limits, and reassessment.