The best microbiome diet and ideal personalized plan for chiropractic patients
WE’RE LARGELY FLYING BLIND when it comes to recommending diets to our patients. There are a great many approaches when searching for the best microbiome diet that have helped a lot of people, but what about food sensitivity tests that provide key immune information as to how the body is responding to foods, or all of the data supporting a ketogenic diet? What about the FODMAP diet (the acronym for fermentable short-chain carbohydrates, which are more difficult for people to digest)?
All of these are effective approaches under certain circumstances. But surely an anti-inflammatory diet, or Mediterranean diet, is ideal for most, if not all patients, anytime, right? Maybe, but both of those diets do lack critical information, which, it turns out, is easily attainable.
A personalized baseline diet plan
There is a plethora of other diets that really smart people have developed, written books about, and researched extensively. All of them are great, but they all lack something I think is key to personalization and being able to effectively apply “food as medicine.” They lack the insight into a person’s microbiome biochemical individuality and the needs specific to that person. I’m not saying in any way that I wouldn’t recommend any of the diets that I just mentioned — in fact, there is a time and a place for each. But the fact is, with the technology we now have access to, we can provide a truly personalized baseline diet plan designed to nourish the body and modulate the microbiome, and has been clinically proven to reduce a patient’s symptoms — and that other diets, if needed, can be layered on top of.
After seeing what is possible clinically and how far we’ve come in terms of artificial intelligence, the future of dietary recommendations resides in the microbiome.
The vast impact of the microbiome
The importance of the microbiome is well-established, as is its connection to every other vital system in the human body. Microbiome imbalance, as defined by initiatives devoted to microbiome research such as the American Gut Project, the Human Microbiome Project, and the Flemish Gut Flora Project, have been contributing factors to major chronic diseases outside of the gut including heart disease, stroke and diabetes, as well as neurological diseases such as Parkinson’s and Alzheimer’s.
Obviously, there is direct involvement in conditions such as IBS, Crohn’s, chronic constipation and inflammatory bowel disease. As a result of this intensive and expansive involvement in physiology, the microbiome is an area that should be used as a blueprint to achieving better health.
Now we have technology that provides insight we’ve not previously had access to in clinical practice that not only reveals a person’s microbiome blueprint, but also deciphers the blueprint’s information and translates it into actionable steps for modulation, symptom relief and long-term wellness to construct the best microbiome diet.
The best microbiome diet and joint dysfunction and pain
Before we explore the technology, let’s quickly go through the connection between the microbiome and joint health, and why using the microbiome to determine a personalized diet plan could very well be the answer to every chiropractic patient’s question as to what type of diet they should be on.
As we know, the gut is seen as the second brain, lending to the concept of the gut-brain axis. This axis includes cross talk between the intestines and central and enteric nervous system. These bidirectional pathways influence the neural, endocrine and immune activities as well as joints themselves.
Many studies have drawn a direct link between imbalance in the gut microbiome and arthritis and joint pain. Data pulled from the Rotterdam Study found that out of a cohort of 1,427, a total of 124 individuals had radiographic knee osteoarthritis (OA), while 285 participants reported knee OA pain (WOMAC pain score > 0). Incidentally, the majority of participants reporting knee pain were female (n = 206) as the average WOMAC pain score was also significantly higher in females compared to males. To gain as much insight as possible, correction for a variety of possible cofounders was implemented (smoking and alcohol consumption); adjusting for age, sex and technical covariates, there were four microbiome abundancies, all from the streptococcus genus.1
Consistently it is found in many studies that anti-inflammatory bacterial groups, such as Bifidobacterium, Lactobacillus, Clostridium and Enterococcus faecium are lacking in people suffering from joint dysfunction and/or pain.2
While the data is robust on this topic and worth looking into further for a greater understanding, however, the idea that there is gut imbalance and subsequent joint involvement leads to the conclusion that a microbiome-based diet could be an ideal fit for any chiropractic patient.
The A.I.-driven microbiome diet
So how do we gain access to such information? New companies have taken the testing that you see in the market to the next level. They’ve done so with 16S DNA sequencing on a simple stool sample and the application of microbiome bioinformatics (the application of tools of computation and analysis to the capture and interpretation of biological data).
With this combination we now have access to exactly what a person needs in terms of foods to nourish and balance their gut bacteria. Companies have developed microbiome specific bioinformatics, or artificial intelligence, using the open source microbiome data as well as microbiome data of more than 45,000 people, including a Microorganism Nutrient Interaction Database. This database is based on an extensive meta-analysis of 3,000+ scientific publications, with priority given to in-vivo trials, and datasets determining the food components modulating the gut microbiome at specific bacteria resolution.
This groundbreaking meta-analysis was conducted to evaluate the studies examining the effects of macronutrients, vitamins, minerals and phytonutrients on the microbiota. This combination of DNA sequencing and A.I. application lays out exactly which foods a patient should eat. Those foods are broken down into three categories:
- Foods that should be consumed in greater quantities
- Foods that should be moderately included in your diet
- Foods that should be eaten minimally
This diet makes no assumptions; the foods included are not inherently good or bad, and there are no foods that are always recommended. If a microbiome profile indicates that a certain bacteria is abundantly present and it is negatively impacting the balance in the gut, and apples feed that bacteria, it will be recommended that apples not be consumed daily or even every other day.
A baseline that avoids blanked recommendations
When you look at any of the diets mentioned at the outset, you see that they routinely make blanket food recommendations.
The keto diet recommendations always including fats such as coconut oil, proteins like eggs, and carbs in the form of spinach. However, if a person’s microbiome profile indicates that a specific bacteria is found in abundance and it happens to thrive on coconut oil, eggs and spinach, it’s possible that the keto diet recommendations alone, without the microbiome data, could be contributing to an imbalance and making the inflammatory response worse throughout the body.
And I know, I’ll get all sorts of grief from the keto community for what I’m about to say … I’m not downing keto; I’m simply citing data that indicates that layering a microbiome-based diet with keto is more ideal. In sticking with the keto example, it’s well-established that only applying a keto diet long-term decreases the anti-inflammatory bifidobacterium, increases inflammatory E. coli, and decreases bacterial abundance overall and diversity. Now, it’s not to say that a patient won’t lose weight, regulate their blood sugar and have more energy. But long-term, because of the impact on the microbiome, it may be more beneficial to use the microbiome diet as a baseline so as to retain that gut balance and achieve all of those outcomes.
Clinically proven for IBS and constipation
Obviously, you can see how this level of personalization hasn’t really been achieved using other dietary approaches; if food sensitivity tests come to mind, they measure the immune response to certain foods and ultimately reveal what foods should be avoided. They lack the insight to inform which foods should be eaten for nourishment for the best microbiome diet.
Regardless, this idea of an A.I.-driven microbiome diet is great in theory. In fact, when I explain to doctors what it is, they all say, “That’s great, but does it actually work?” The answer to that is, yes, it actually does. While some microbiome companies have put together nice marketing materials, none have conducted the full-scale clinical trials that are now being released, and certainly not on the application in circumstances of disease states or clinical conditions. Two of these trials have been completed to date, one on IBS patients and the other on chronic constipation. Both yielded unprecedented results. The IBS trial not only demonstrated a statistically significant increase in anti-inflammatory bacteria, but also resulted in the change (delta) values in IBS-SSS scores (before-after) being significantly higher in the 82% of intervention group than the control. In this 82%, there was a marked shift from severe symptoms to moderate to low. And anyone who struggles with IBS or treats patients with IBS will understand that is a life-changing shift. Additionally, participants also reported a 42% decrease in their sleep disorders, a 63% increase in their energy levels, and there was an overall average of 15.6-lb. weight loss. Again, the reach of the microbiome is vast and implications of balance reflect that.
As for the 50-cohort randomized constipation study, results revealed the customized diet developed for subjects on the study arm resulted in a 2.5-fold increase in CBMpW (complete bowel movements per week) after six weeks (1.7 vs. 4.3). The proportion of the study group patients with CBMpW>3 was 83% at the end of the study and the satisfaction score was increased four-fold from the baseline (3.1 to 10.7 points). More than 50% improvement in PAC-QoL scores was observed in 88% of the study cohort compared to 40% in the control group (p: 0.001). These two studies are in the process of being published and this data has fueled additional studies that are currently underway. But the bottom line is, the A.I.-driven microbiome is clinically proven.
Don’t fly blind with dietary recommendations
Comfort and confidence in anything you give to your patients is key. The knowledge that you have access to a food plan based on a patient’s own microbiome blueprint using the latest technology and artificial intelligence, and has been proven to work, lends itself to instilling the highest levels of both comfort and confidence, and keeps you from flying blind when it comes to dietary recommendations.
ADAM KILLPARTRICK, DC, CNS, DACBN, graduated from Palmer College of Chiropractic in 2005. In addition to maintaining a private functional medicine practice for the majority of time since graduating, he has also attained multiple nutritional certifications and has served for over a decade as an executive and key figure in R&D and product development within the dietary supplement industry. Most recently, he has focused his career on fields of nutritional genomics, epigenetics and microbiome assessment. He can be reached at firstname.lastname@example.org, or learn more at enbiosis.com.