In part two of Matt’s interview with Kim Celmer, they explore practical strategies for gut health, covering topics like the "four R's" of gut restoration, prebiotics vs. probiotics, microbiome testing, and nutritional recommendations. They also discuss healing peptides, insulin-degrading enzymes, SIBO testing, and the FODMAP diet, offering actionable insights for improving digestion and overall wellness.

Kim Celmer, ND, is a naturopathic doctor specializing in primary care. After earning her doctorate from Bastyr University, she completed a residency in naturopathic medicine at the Institute of Complementary Medicine in Seattle, focusing on integrative approaches to hormone health, digestive wellness, and chronic disease management.

Check out the links below for further information and/or reading about some of the things we discussed in this podcast episode. Note that we do not necessarily endorse or agree with the content of these readings, but present them as supplementary material that may deepen your understanding of the topic after you listen to our podcast. This list is in no way exhaustive, but it’s a good start!

Translating microbiota analysis for clinical applications | Nature Reviews Bioengineering

Matt and Kim discuss the strengths, challenges, and actionable insights gained from the clinical application of gut microbiome analysis. They conclude that while it's a useful supportive tool for disease diagnosis, it's most effective when used alongside comprehensive health analysis.

This article explores the crucial characteristics of microbiota analysis systems, their clinical applications, and the challenges inherent in high-throughput sequencing technologies used for analyzing microbial DNA composition.

Key challenges include:

1. Lack of functional insights: Microbiome composition often doesn't indicate functional roles, as bacteria can have various functions depending on physiological context, gut localization, and the surrounding microbial ecosystem (biofilm).
   
   

2. Inability to detect microbial location: Certain microbes may promote health in the large intestine but play a pathological role in the small intestine, making spatial tracking crucial.
   
   

3. Difficulty distinguishing live from dead bacteria: This limitation can skew interpretation of microbial presence and activity.
   
   

The authors emphasize that microbial composition analysis should ideally be performed alongside multi-omics and functional analysis to better understand how microbes influence host physiology through their postbiotic secretions.

The gut microbiome as a modulator of healthy ageing | Nature Reviews Gastroenterology & Hepatology

This review explores targeted studies of the gut microbiome in aging individuals across geographically distinct populations, evaluating how changes in microbial composition and function correlate with age-related diseases and adverse health outcomes.

Analysis of both composition and function of the gut microbiome across age reveals a loss of microbial diversity and overlapping, yet distinct functional changes. These changes are involved in the secretion of factors associated with chronic inflammation, metabolic dysfunction, and dysfunctional intercellular signaling.

The authors highlight that age-related alterations in the gut microbiome are influenced by a complex array of factors, including:

Genetics:

1. Environment
   
   

2. Progressive physiological deterioration (e.g., gut barrier function and anatomy)
   
   

3. Lifestyle-linked factors such as diet, medication, and reduced social contact.
   
   

The study concludes by suggesting that while a single universal healthy microbiome configuration does not exist, specific gene expression and metabolomics profiles are strongly associated with healthy aging outcomes. Furthermore, gut microbiome-based therapeutics for aging individuals will require combinatorial approaches, including dietary intervention and restoration of lost strains through supplementation or fecal matter transplant.

Platelet-Rich Plasma Applications, The Past 5 Years: A Review Article - European Medical Journal

Matt and Kim discuss the current application potential and unknowns of platelet-rich plasma (PRP) therapy, with a focus on gut health and regeneration following injuries. This review article summarizes PRP applications in randomized controlled trials over the past five years for diverse conditions, including dermatology, wound healing, orthopedics, and pain management. The authors find the results inconclusive, with outcomes ranging from positive to no effect compared to placebo. Several key limitations exist:

●      Small sample sizes

●      Short follow-up durations

●      Lack of standardization in PRP preparation methods

This article also discusses classification systems for different types of PRP and underscores the need for controlled studies and standardized protocols, including optimal preparation and administration methods. Future studies are needed to better understand the components of PRP (e.g., growth factor composition) that influence clinical outcomes for its various applications.

Brain-gut Axis and Pentadecapeptide BPC 157: Theoretical and Practical Implications - PMC

This paper reviews preclinical evidence on the effects of BPC 157 for various conditions including gastrointestinal disease, periodontitis, liver and pancreatic lesions, and healing of various tissues and wounds. Notably, the authors propose that BPC 157 may also have neuroprotective effects including nerve regeneration in response to traumatic brain injury. Interestingly, based on various studies evaluating its mechanism of action, the authors suggest that BPC-157 may be exerting its effects through modulating signaling at the gut-brain axis.  At present, BPC 157 is being studied in clinical trials of inflammatory bowel disease and multiple sclerosis. Initial studies suggest it is safe, but more studies are needed to validate both safety and efficacy for the diverse range of age-related conditions it demonstrates potential to address in animal models.

Critical appraisal of the SIBO hypothesis and breath testing: A clinical practice update endorsed by the European society of neurogastroenterology and motility (ESNM) and the American neurogastroenterology and motility society (ANMS) - Kashyap - 2024 - Neurogastroenterology & Motility - Wiley Online Library

Matt and Kim discuss the utility of the lactulose breath test (LBT) for diagnosing SIBO and its clinical implications in treating chronic GI conditions. They conclude that while the breath test can provide useful information, it should be used selectively after considering its limitations and other comprehensive gut health measures (e.g., stool tests, functional tests, and imaging) which may provide more information for disease diagnosis. This review provides an overview of the history of SIBO diagnosis, possible overuse of antibiotics due to the overdiagnosis of SIBO, and the importance of assessing microbial composition and function as opposed to overgrowth alone. The authors explain how the LBT works for SIBO diagnosis and highlight challenges in using it as a surrogate for localization of bacteria, primarily due to variable lactulose transit times between individuals. Consequently, they propose that LBT has relatively low sensitivity and specificity for diagnosing SIBO. The authors conclude that further studies are needed to better understand the impact of bacterial communities, their metabolites, and diet-host interactions to move away from diagnostic criteria for SIBO that solely focus on absolute numbers of microbes.