Photobiomics: A look to the future of combined laser and nutrition therapy

An integration of nutritional protocols and laser therapy, photobiomics is opening new avenues for effective patient treatment

In addition to its widely accepted use for treating low-back pain, low-level laser therapy, or photobiomodulation (PBM), can be a valuable adjunctive treatment for metabolic and inflammatory diseases. When PBM modulates the gut microbiome in combination with targeted nutritional therapy — or photobiomics — laser therapy for these diseases becomes even more effective. The value is evident in treating gut issues, low vagal tone and autoimmunity.

Recent research strongly suggests that photobiomodulation of the microbiome can help sharply improve the gut’s microbial diversity. Maintaining diversity in the gut microbiota is key to sustaining healthy production of the numerous vital metabolites, such as butyrate, that these bacteria produce. It’s also crucial for keeping pathogens from gaining a foothold in the gut; diversity helps crowd out harmful bacteria. Using laser therapy to rebalance the gut microbiome has significant therapeutic potential.[1]

How PBM works in the gut

Photobiomodulation through low-level laser therapy affects the gut microbiome both indirectly and directly. A significant indirect effect occurs when the laser light mimics the circadian clock that regulates the gut microbiota and their production of bacterial metabolites.

Specifically, the beneficial bacteria responsible for gut barrier integrity can decrease when the gut circadian rhythm is disrupted through poor sleep, night shift work or travel across time zones. This can lead to systemic inflammation when increased toxic lipopolysaccharides (LPS) pass through the gut wall.[2] When combined with improved sleep and a healthier diet, PBM can help overcome the effects on the microbiome of prolonged circadian rhythm disruption.

Disruptions in the circadian rhythm also decrease the overall bacterial diversity in the gut. An excellent example of how reduced diversity has indirect impacts on overall health is vitamin D metabolism. The greater the diversity of the gut microbiome — particularly those that produce the short-chain fatty acid butyrate — the better vitamin D can be metabolized into the active form and absorbed through the numerous vitamin D receptors that line the gastrointestinal tract. When the gut bacteria are imbalanced, vitamin D absorption is impaired.

Decreased ability to absorb vitamin D because of gut dysbiosis may explain why taking supplemental vitamin D doesn’t always have the expected benefits. Restoring a better bacterial balance through laser therapy may help increase levels of available vitamin D with downstream improvements in immunity and bone health.[3]

Improving immunity through mitochondria

Photobiomodulation works by stimulating the mitochondria within cells to function better. Light from the laser causes increased ATP synthesis, leading to less fatigue. It also modulates the reactive oxygen species produced within the mitochondria, leading to less free radical damage and inflammation.[4]

While we think of the hundreds or even thousands of mitochondria in every cell primarily as the source of cellular energy, they also play a complex role in intracellular signaling. Among other functions, they act as platforms to transmit signals for activating the innate immune system and coordinating immune cell activity with the rest of the cells in the body. When the mitochondria are stressed, however, they don’t function as well. Stressed mitochondria don’t produce as much energy, create more damaging free radicals, and don’t efficiently transmit signals between the immune system and the rest of the body.[5]

Stressed mitochondria become dysfunctional because they produce excess nitric oxide (NO), which competes with oxygen for space on the cytochrome c oxidase enzyme in the mitochondrial membrane. When NO displaces oxygen, mitochondrial dysfunction and oxidative stress result; this triggers the inflammatory NF-κB pathway and causes inflammation and even cell death.

At a wavelength of 635 nm, laser light is absorbed by cytochrome c oxidase, forcing the NO out of the membrane and allowing replacement with oxygen. This restores ATP synthesis and reduces oxidative stress. Normal mitochondrial function — including immune system signaling — returns and cell metabolism improves.[6]

Combining nutritional therapy with PBM can help accelerate improvements in energy and immunity. For patients with “long COVID,” B vitamins, CoQ10, carnitine, alpha-lipoic acid (ALA), liposomal glutathione, zinc, selenium, vitamin C and vitamin E should all be considered as adjuncts. Immune activation can be improved with extracts of medicinal mushrooms, including reishi, maitake, lion’s mane, chaga and shiitake.[7]

Improving low vagal tone

The vagus nerve is part of the autonomic nervous system, which governs essential survival functions such as respiration rate and heartbeat. The vagus nerve is ordinarily highly responsive; its ability to transmit nerve impulses quickly and efficiently is called vagal tone.

A higher vagal tone lets the body return to normal after a stressful event quickly. For example, the vagus nerve makes the heart beat faster during exercise; when the vagal tone is high, the heartbeat returns to its normal resting rate soon after exercise stops. The vagus nerve also monitors the condition of the gut microbiome through chemoreceptors on the afferent (to the brain) fibers that sense the presence of metabolites, such as butyrate, produced by gut bacteria. Overall, low vagal tone is associated with poorer health, including a greater risk of autoimmune disease.

An essential function of the vagus nerve is reducing systemic inflammation by keeping the gut immune system from responding inappropriately. However, when the vagal tone is low, the messages to stay calm may not get through as well; the gut immune system may react inappropriately by increasing inflammation.

PBM therapy is highly effective for raising low vagal tone and reducing inflammation. Higher vagal tone improves blood flow to the intestines and attenuates the disruption of intestinal tight junctions, which reduces LPS-induced inflammation.[8]

The vagus nerve monitors butyrate production in the colon. When the vagus senses that gut bacteria produce enough butyrate, that message is transmitted to the brain. Normal levels of butyrate production signal that enterocytes in the gut wall are getting good nourishment and keeping the gut wall strong and leak-free. The return message along the vagus is to calm inflammation.

Foods that help raise vagal tone are those that are rich in phytonutrients and polyphenols. In addition to PBM treatment to raise vagal tone, dietary improvements to increase prebiotic fiber intake are needed. Inulin and xylooligosaccharides (XOS) are complex carbohydrates that pass through the small intestine and arrive in the colon as a preferred food for butyrate-producing gut bacteria. Prebiotic supplements are beneficial, especially for patients who can’t tolerate fiber-rich foods in the diet.

Supplements of omega-3 fatty acids from fish oil are also crucial for improving vagal tone. The omega-3 in fish oil supplements is known to help improve heart rate variability and lower blood pressure. Fish oil also inhibits the action of Toll-like receptor 4 and inhibits the NF-κB pathway. When these receptors are less sensitive, inflammation is reduced and vagal tone improves.

Two probiotic bacteria species also positively affect the vagus nerve: Lactobacillus rhamnosus and Bifidobacterium longum. Studies have shown that B. longum helps reduce inflammation, stabilizes the gut lining, increases levels of BDNF in the brain, and may help reduce anxiety and depression.[9]

1. rhamnosus directly affects neurotransmitters in the central nervous system — it increases GABA by stimulating the vagus. It helps modulate the immune system by preventing the release of inflammatory cytokines. L. rhamnosus may also help with stress-related disorders.

Both bacteria species help improve vagal tone by improving the gut’s overall health and decreasing the impact of LPS-induced inflammation.[10]

PBM for back pain

Low-back pain and sciatica are among the most common conditions sending patients to chiropractic care. Adding PBM to the treatment mix helps improve outcomes; adding nutritional support can improve them even more.

The evidence for the value of PBM in treating back pain is robust. Laser light at the 635-nm wavelength has been shown to provide significant pain relief on nociceptive musculoskeletal pain and reduce the use of opioids and NSAID medication.[11] This wavelength reduces inflammation by inhibiting the NF-κB inflammasome and the production of the inflammatory COX2 enzyme. It also reduces the production of free radicals in the irradiated area and cuts the production of inflammatory cytokines such as interleukin-1 beta (IL-1β) and TNF-alpha.

Nutritional supplements enhance the value of laser therapy for back pain. Recent research suggests that combining the omega-6 fatty acid gamma-linolenic acid (GLA, also called evening primrose oil) and alpha-lipoic acid (ALA) effectively treats low-back pain sciatica.[12] Supplements of curcumin are also valuable for accelerating sciatic nerve repair.[13]

Back pain patients, particularly if they also have diabetes, should be tested for vitamin D levels. Patients with vitamin D deficiency or insufficiency are more than twice as likely to have low-back pain than patients with normal vitamin D levels.[14] Patients with low vitamin D may also have dysbiosis that is interfering with absorption. If levels are low, supplementation with vitamin D3 (cholecalciferol) can help bring them up. At the same time, the possibility of dysbiosis should be explored and treated if needed to help improve vitamin D absorption naturally.

Restoring the balance

When the gut microbiome is unbalanced and lacks sufficient diversity, the whole body is affected. PBM therapy and nutritional supplements can help, but restoring a better balance requires a more significant commitment.

Dietary and lifestyle changes are needed to provide a gut environment where a good range of beneficial bacteria can thrive. The Super 7(R) Action Plan puts patients on the right path for better gut health:

Reset — The first action step is to reset the diet, lifestyle and mindset of patients. The critical dietary component is an anti-inflammatory premise based on the basic Mediterranean diet, supplemented with MCT oil, fiber and magnesium. Stress reduction and regular exercise are additional essential components.

Remove — Remove foods related to individual intolerances, sensitivities and allergies, along with processed foods, sugar, dairy and gluten. Remove pathogens (harmful bacteria, viruses and yeasts) and environmental toxins through the use of nutritional supplements such as berberine, oregano oil and garlic.

Replace — Replenish and replace digestive enzymes, stomach acid and bile.

Regenerate — The damaged intestinal wall needs help to regenerate and become an effective barrier again. A plethora of nutrients is typically suggested to repair the gut barrier and decrease inflammation in the gut region. These include glutamine, zinc carnosine, okra, collagen and others.

Re-inoculate — High-quality prebiotics and probiotics can help improve the balance of beneficial bacteria in the gut. Prebiotic fiber is crucial to this step as support for the bacteria in the probiotic supplement.

Reintroduce — When the symptoms of dysbiosis are reduced or gone, foods removed earlier in the process can be gradually reintroduced.

Retain — Retaining the gains is accomplished by helping patients continue down the road to good gut health and avoiding a return to poor diet, a sedentary lifestyle and high stress levels.

Emerging photobiomics

Our understanding of the microbiome’s role in health and disease is expanding rapidly. The emerging science of photobiomics — the combined effects of light on metabolic factors, the microbiome and the interaction between them — is opening many new avenues for effective patient treatment.

The future will bring us even more ways to combine nutrition with our improving knowledge of the microbiome and our enhanced knowledge of PBM to help optimize our patient outcomes.

ROBERT G. SILVERMAN, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, FAKTR, is a chiropractic doctor, clinical nutritionist, national/international speaker, author of Amazon’s #1 bestseller “Inside-Out Health,” and founder and CEO of Westchester Integrative Health Center. He graduated magna cum laude from the University of Bridgeport College of Chiropractic and has a Master of Science degree in human nutrition. The ACA Sports Council named him “Sports Chiropractor of the Year” in 2015. He is on the advisory board for the Functional Medicine University and is a seasoned health and wellness expert on the speaking circuits and in the media. A frequently published author in peer-reviewed journals and other mainstream publications, he is a thought leader in his field and practice. His new book, “Superhighway to Health,” was published in June 2021. He can be reached at drrobertsilverman.com.

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