Earn up to 14.5
Laboratory, Endocrine, & Neurotransmitter Symposium
February 7-9, 2020
Las Vegas, NV
Gain additional clinical insight and treatment considerations to evaluate some of the most prevalent and challenging conditions that patients present with, including depression, anxiety, altered mental focus and stamina, sexual dysfunction, sleep disturbances, addictions and dependencies, weight management, and chronic disease. Register today!
Advanced Neuroendocrine Primer: Considerations for achieving the best outcomes in your patients
By: Lylen Ferris ND
November 6th, 2019
Join Labrix clinical staff and special guests on the first Wednesday of every month at 9:30 AM and 12:00 PM PST. This free, live webinar series will cover a variety of neuroendocrine topics that will enhance your knowledge, with clinically applicable testing and treatment considerations. 1 CE credit available from the OBNM.
October 18-20, 2019
Ruth Hobson ND from Labrix will be speaking on Saturday, October 19 at the IWHIM Conference on the topic of "Mental, Emotional Aspects of Chronic Pelvic Pain in Women." Stop by our booth and learn more about testing with Doctor's Data and Labrix.
October 22, 2019
Lylen Ferris ND from Labrix will be speaking on Tuesday, October 22 at NUNM for the monthly OANP MedTalk Series on the topic of "Childhood Stress can Affect Adult Disease." Attendees can attend live or via webinar.
Irritable Bowel Syndrome: Microbial Profiling and Fecal Microbiota Transplantation
By David Quig, PhD | October 16, 2019
Irritable bowel syndrome (IBS) affects up to 20% of adults and is associated with life-disruptive symptomatology. The multifactorial pathogenesis of IBS includes gastrointestinal dysbiosis, altered microbial metabolism, intestinal barrier dysfunction and dietary intolerance; especially to soluble fiber. Intervention with a traditional IBS diet or a low FODMAP diet may not be sufficient for amelioration of immoderately disrupted gut microbiota and metabolism, and recent efforts indicate that fecal microbial transplantation may provide an effective option.
Microbial-host crosstalk between key gut bacteria and the mucosa is essential for intestinal barrier functions, inclusive of surveillance, protection and selection of the microbial ecosystem. Disruption of a healthy microbiome, and/or insufficient consumption of soluble fiber (SF), blunts desirable production of short chain fatty acids (SCFA) and stymies communication with specialized cells in the mucosa. Diminished regulation of mucosal metabolism subsequently perpetuates dysbiosis, and causes low-grade mucosal inflammation and breaches of the barrier system. Low levels of fecal SCFA are common for IBS patients.
Extensive research has culminated in a novel PCR-based microbiota profiling approach that targets the most clinically relevant bacteria to identify dysbiosis in IBS patients (classified by Rome III criteria). From that model a dysbiosis index (DI) was algorithmically derived; DI>2 (maximum 5) indicates the extent to which a microbiota profile deviates from that of a healthy reference population (n=500). Dysbiosis was evident across subtypes in 73% of IBS patients (n=297) with a significant percentage of DI values >4 (severe dysbiosis). Predominant bacteria contributing to IBS dysbiosis were Proteobacteria (Shigella/ Escherichia), Bacilli, Acintobacteria and Ruminococcus gnavus.
Formal studies indicate that the “traditional” and low FODMAPs diets variably alleviate symptoms for some IBS patients, but in many cases the gut dysbiosis appears to be irreparable with reasonable dietary intervention. Long-term adherence to a strict low FODMAPs diet has adverse effects on gut microbiota and intestinal barrier integrity; the clinical ramifications are under deliberation. A short-term study (4 weeks) of IBS patients consuming a low FODMAP diet indicated higher than baseline DI despite some symptom improvement; many patients did not respond favorably at all.
Fecal microbiota transplantation (FMT) may be an effective alternative option for long-standing immoderate dysbiosis. FMT is widely accepted as the treatment of choice for C. difficile enterocolitis. The efficacy and kinetics of FMT was studied in IBS patients and healthy donors (n=16). The targeted PCR-based microbiota profiling method was used to follow both donor and FMT recipients before and at intervals up to 28 weeks after a single FMT. At baseline IBS patients had significantly higher DI than donors (4±0.5 and 2.6±0.2, respectively). Patient DI decreased steadily over 12 weeks (2.9±0.20, mild), but trended up after 7 months. At that time the microbiota profiles for patients and donors were very similar. The most significant changes in bacteria were Bifiodobacteria (increase), and Proteobacteria and Shigella/Escherichia (decrease). Symptoms improved rapidly and markedly.
Application of a novel PCR-based targeted microbiota profiling method of analysis, along with symptom improvement, provides evidence that FMT may be an effective means to restore microbial balance for IBS patients with long-standing dysbiosis. Follow up studies should evaluate appropriate “feeding” in addition to microbiota “seeding” towards increased staying power of FMT.
Coming soon, the new GI360TM profile by Doctor's Data. The GI360TM is a comprehensive GI test for profiling the specifics of your patients' individual microbiome, with the added feature of comparing results to published normobiotic reference populations. Watch for details!
Cani P. Human gut microbiome: hopes, threats and promises. Gut (2018)67:1716-1725.
Casen C, Vebo HC, Sekelja M et al. Deviations in human gut microbiota: a novel diagnostic test for determining dysbiosis in patients with IBS or IBD. Aliment Pharmacol Ther (2015) doi: 10.1111/apt.13236
Bennet SMP, Bohn L, Storsrud S et al. Mutivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs. Gut (2017)0:1-10. doi: 10.1136/gutjnl-2016-313128
Mazzawi T, Lied GA, Sanges DA et al. The kinetics of gut microbial community composition in patients with irritable bowel syndrome following fecal microbiota transplantation. PLos ONE (2018)13 doi: 10.1371/journalpone.0194904