What are Biofilms and Why Should You Care?

I have been getting a lot of questions about biofilms lately.  So what is a biofilm, and should it be an issue in a functional medicine practice?

A biofilm is any group of microorganisms in which cells stick to each other on a surface.  Microbes form a biofilm in response to many factors, not the least of which is nutritional cues.  The questions I have been getting are usually in regard to the pathogenic kind and their impact on the gut microbiota, because biofilms, like any microorganism, can be both beneficial to human health or harmful, depending on the nature of the microorganism.  

Here's some basic facts about biofilms:

• ALL bacteria live in a biofilm.
• Good bacteria themselves – regardless of strain – produce a healthy biofilm.
• All good bacteria produce various bacteriocins – such as the strains used in Ultra Flora Women's and Ultra Flora Integrity and Ultra Flora Acute Care, etc – to aid in restoring microbial balance.
• Bad biofilms are due to the bad bacteria themselves. To reduce pathogenic biofilm focus less on specific probiotic strains and more on overall good biosis (i.e. 5R Gastrointestinal restoration program).

Since biofilms are colonies of organisms, most all intestinal organisms, including good flora, reside in a biofilm. These biofilms also allow organisms to attach to the intestinal wall. Enzyme type oral ‘biofilm’ disruptors are often suggested as a counter to pathogenic biofilm formation. Along these lines, Spectrazyme Complete is a broad spectrum enzyme formula that could be useful as a pathogenic biofilm disrupter. Of course, Spectrazyme Complete is not labeled for biofilms, but the effectiveness of this type of ‘biofilm buster’ is a strong possibility, albeit a bit more theoretical (Petri dish). 

Petri dishes are often like Las Vegas. At times what happens in a Petri dish stays in a Petri dish and is not necessarily applicable in the complex human digestive tract.  That being said, there may be merit nevertheless in using enzymes for helping to support healthy GI microbiota.  

If desiring a comprehensive approach, consider that a biofilm is more driven by dysbiosis itself (is produced by the dysbiotic organisms themselves). A 5R program utilizing GI-active herbals such as the berberine complex in CandiBactin BR or bacteriocin production products like Ultra Flora Restore or Ultra Flora Women's, and/or prescriptive antimicrobials followed by the remainder of the program seems applicable. Colostrum-like support (whey immunoglobulins and prebiotics -- think Probioplex Intensive Care) can further support proper biosis by decreasing the adherence of these pathogenic organisms to the GI wall (lactoferrin, lactoperoxidase). Also, part of 5R includes the use of enzymes mainly to support proper digestion.

Of particular interest is the evidence showing that those more susceptible to pathogenic biofilm colonization had reduced numbers of probiotic strains in the gut.   

“...Biofilms are communities of [established] microorganisms residing within a self-produced matrix of exopolymers. Microbes prefer living within biofilms, which protect them from dislodgement, predation, host immune responses, and antimicrobial agents...Macfarlane noted that microbes inhabiting biofilm are more efficient at fermenting long-chain polysaccharides than are free-living luminal bacteria, which appear to chiefly ferment oligosaccharides. Microorganisms within biofilms in the mucus layer overlying the intestinal mucosa are more likely to interact with the host's immune system, and these interactions may be healthful or harmful depending on the organisms involved. She noted data showing that microbial gastrointestinal biofilm communities in patients with ulcerative colitis contain significantly fewer bifidobacteria and higher numbers of anaerobic gram-positive cocci, peptostreptococci, enterococci, and enterobacteria. Macfarlane reviewed both in vivo and in vitro evidence that the prebiotic inulin [FOS] can significantly increase intestinal biofilm bifidobacterial populations while simultaneously decreasing biofilm populations of Clostridium, Bacteroides, Fusobacterium, and Enterobacteraceae species, and at the same time inhibit pathogen activity and reduce C. difficile toxin concentrations...” http://www.townsendletter.com/FebMarch2009/probiotic0209.htm

While the use of the term "biofilm" seems novel and cutting edge, actually, it is simply another way of describing dysbiosis.  The approaches that experienced functional medicine and nutritionally-based holistic practitioners have been using for healthy GI microbiota all along are effective in establishing a GI environment that is antagonistic to unhealthy biofilms and encouraging of the healthy biofilms, because at the end of the day it's still about good bugs vs. bad bugs.  

Turmeric: Surprising Benefits for Brain Health

The common spice, turmeric, has been used in various types of treatments for dementia and traumatic brain injury.  Research is also showing surprisingly powerful effects of turmeric on Alzheimer's disease (AD)1.

A growing body of evidence indicates that oxidative stress, free radicals, beta-amyloid plaque, metal toxicity, and abnormal inflammatory reactions contribute to AD pathology.  Due to the various effects of turmeric, including antioxidant, anti-inflammatory, and lipophilic (an affinity for fats) properties, decreased amyloid plaque, metal-chelation, and decreased microglia formation, the overall memory in AD patients using turmeric in studies has improved.

In one 2013 study in particular2, older rats experienced a "remarkable restoration" of brain function when given turmeric, especially the ability of vessels in the brain to relax and allow blood to flow freely.  The treated rats also experienced a reduction in reactive oxygen species (ROS), which is associated with decreased oxidative stress and cell damage.

The effects of turmeric on AD were also demonstrated in a 2012 case study3 on three patients with "very severe" manifestations of the disease: irritability, agitation, anxiety, apathy, incontinence, and wonderings.  The patients were given 764 of turmeric every day for 12 weeks.  The results were that "behavioral symptoms improved remarkably as a result of the turmeric treatment."  In two of the tree patients, "they came to recognize their family within 1 year treatment."  

Turmeric is a common spice that can be added to food.  However, therapeutic levels such as the ones used in the studies are easier to obtain via turmeric-containing food supplements.  Additional good news is that even higher levels in supplement form are not usually expensive.

1. Ann Indian Acad Neurol. 2008 Jan-Mar; 11(1): 13–19.
2.  Cell Physiol Biochem. 2013;32(5):1167-77. doi: 10.1159/000354516. Epub 2013 Nov 11.
3.  Ayu. 2012 Oct-Dec; 33(4): 499–504
  

Fraudulent Labeling Common in Supplement Industry

Today the New York Times reported that the New York state's attorney general's office investigated over-the-counter supplement lines sold at GNC, Walgreen's, Walmart, and Target, and found that nearly all of them were fraudulent.  

Tests showed that products labeled as medicinal herbs did not actually contain ANY of the herb, but instead cheap fillers like powdered rice and house plants!  

As part of its investigation, the attorney general’s office bought up 78 bottles of the leading brands of herbal supplements from a dozen Walmart, Target, Walgreens and GNC locations across New York State. Then the agency analyzed the products using a type of genetic fingerprinting known as DNA bar coding that the agency has used to root out labeling fraud in the seafood industry.

Unfortunately, the problem of fraud and tainted and/or outright contaminated products is not terribly uncommon in the supplement industry.  In 2013, for example, an outbreak of hepatitis that affected at least 72 people in 16 states was traced to a tainted supplement. Three people required liver transplants, and one woman died.

Hospitals have been affected as well. In December 2014, an infant at a Connecticut hospital died when doctors gave the child a popular over-the-counter probiotic supplement that was later found to be contaminated with yeast. After the child’s death, the FDA issued a warning to the public that reiterated its limited control over supplements.

While the FDA's limited control over supplements is a good thing in that it prevents consumers from having to obtain a prescription to get high-potency vitamin C, for example, the downside is that all kinds of shlocky supplement manufacturers are selling fraudulent products to consumers because there is no accountability in the industry. 

This is a wake-up call to be very scrutinizing in what supplements to buy and from whom.  Here, then, is a very brief checklist of things to ask about and look for when buying supplements.

1.  GMP Certification:  GMP stands for Good Manufacturing Practices, and it is one of the most important standards of elite quality supplements.  GMP represents the stamp of approval of 1 of 3 independent entities: Natural Products Association (NPA), Therapeutic Good Association (TGA), and the National Sanitation Foundation (NSF).  These organizations are reliable third-party sources of gold standard analysis on the quality of supplement manufacturing.  While many companies claim to be operating at or above the quality standards of GMP, the only way to know for sure is if the company has been audited at random by one or all of these organizations and have been passed and certified to be operating according to GMP standards.  Similar to how a doctor must acquire a license in order to claim to be a health professional, elite quality supplement manufacturers must be willing to have their feet held to the fire by having their quality control standards analyzed and scrutinized by GMP organizations before they can honestly claim to be in the health business.

2.  Assays and Bioactive Profiles:  An assay is a laboratory analysis of finished products and their individual ingredients.  Bioactive profiles analyze the DNA and chemical structure of plant extracts to determine if the actives are still present in the raw material and to what level.  Most companies do not perform these delicate analyses because they are not required by the FDA and they are very expensive.  But these tests are the only way to determine if a batch of raw material is fit for human consumption, both in the way of validating label claim of herbs and other active ingredients, but also in the way of screening for contamination with molds, fungus, heavy metals, pharmaceutical agents, or other foreign materials.   Many companies that do perform assays do them randomly, perhaps one batch out of every 10 or 20 at best.  However, responsible quality control demands that assays be performed on EVERY BATCH because purity is not guaranteed with every batch of raw material, as actives and contamination can change radically from batch to batch.

3.  Human Evaluations on Finished Products for Determining Safety and Efficacy:   Research on finished products is almost never done in the supplement industry. I know of only one company performing human trials on finished products in a real clinical setting.  Seriously.  One company.  It's just too expensive for all other companies to do human trials.  And since the FDA does not require human research on finished nutritional products, nearly all companies opt to not do them, but to simply rely on borrowed research on individual ingredients.  But it's vitally important that there be a system in place that provides human safety and efficacy studies on the finished product to be able to provide a high level of predictability.  This is, after all, the standards that the FDA holds pharmaceutical companies to because in the drug world consumers want nothing left to chance.  And while the world of supplements may not appear to pose the kinds of health threats that contaminated drugs would, we are beginning to see that that may not always be the case.  In a world where we now see herbal supplements tainted with drugs or contaminated with yeast, molds, funguses, heavy metals, etc, which can have, in some cases, devastating effects on one's health and even lead to death, consumers should be as concerned about the herbs and vitamins that they put into their bodies as the drugs they take.  

The list you have just read is a very partial one.  The previous three points represent a much longer list of standards too lengthy to discuss here.  But you get the point.  Elite quality safety and efficacy standards are rare in the supplement industry.  Very rare!  And consumers would be well advised to buy supplements only from practitioners who actually practice holistic and integrative medicine in their clinics and who rely on products created for the clinical setting and that are created by companies that adhere to these standards.  

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For a more protracted discussion on quality control standards in elite supplement manufacturing, see Determining Quality in Supplements, right here at Quantum Health.    

Who to Trust in the Age of Media Marketing

This past September, a guest on the Dr. Oz show claiming that green coffee bean caused rapid and dramatic weight loss without diet or exercise was ordered to pay out $9 million for false claims. As you'll see in this news article, Dr. Oz’s guest, Lindsay Duncan, and his two companies were manufacturers of said products.  

On the one hand, the FTC’s witch hunt doesn’t always discriminate against those in the industry who are doing things right and those who aren’t.  They are, after all, a government entity closely related to the FDA, and the FDA is partially funded by drug companies.  However, in this case, I think they got it right.  

Unfortunately, many patients and lay people are trusting online marketers and media darlings for their health information, not realizing that media personalities are entertainers mostly, even the ones whose titles are "doctor."  They have shows to do and audiences to attract.  And not only do they get paid handsomely for hosting those shows, but they also sometimes get kickbacks on the products they promote (not necessarily referring to Dr. Oz).  

These marketeers and media personalities do the same thing as the entire media and news industry does, which is promote hype in order to sell a program and/or a product.

If you don't believe that statement, let me share a statement that a news anchor shared with me once.  I was at dinner with her and her husband, and I asked her a pointed question.  I said, "Why is it that the news is mostly bad news?"  She answered in surprisingly honest fashion: "Because we have a saying in our industry: Bad news is good news, and good news is no news."  Translation?  The media can hype bad news and make it sell.  But good news can't be sensationalized like bad news, so it's usually ignored.  (Not to mention the strong and obvious worldview slant of most of the news media, but that's a subject for another day.)

So then, can we trust the media with reporting responsibly about health-related issues?  Probably not.  And can we trust media superstars who are being paid to sell programs that sell?  Same answer.  

The embarrassing Dr. Oz incident with his guest, Lindsay Duncan, is a glaring example of the truth of my statements above.  People with significant health challenges will self-diagnose based upon misleading and questionable statements made on these programs and are disappointed and disillusioned when the claims don't pan out, or, worse yet, worsen their problems.  

Any physician reading this post would do well to educate their patients on the danger of trusting the media, Hollywood, and online resources with their health.  That's what doctors are for. (Holistic and complementary medicine practitioners, which would include chiropractors, medical doctors, nurse practitioners, naturopaths, osteopaths, and some compounding pharmacists, etc, would be my recommendation here.) Doctors do an examination, provide a report-of-findings, and then prescribe products or protocols that are in keeping with the personalized needs of each patient.  

Lastly on this subject, it was determined by the FTC that the "research" cited by Lindsay Duncan on green coffee bean extract to promote rapid and effortless weight loss was flawed.  Again, no surprise, as this goes on all the time in our industry and in the drug world.  I will remind my readers that any product manufacturer can make all kinds of impressive claims and create all kinds of impressive-looking marketing material and product packaging.  But that does not equate to real science.  

Better to trust product lines who are pioneering real research on finished products with real people in a real clinic and publishing reliable scientific papers in trusted publications.  I only know of one product line doing that.  :-)

(Go here for more on determining quality in supplements.)

New Advances in Support for Joint Pain

Arthritis effects 43 million Americans.  It is estimated that by the time the average person reaches age 70 nearly 100% will have developed some form of arthritis.  

For years the nutritional industry has touted the use of glucosamine and chondroition for joint support.  And while many do indeed experience some relief from these two compounds, the results are inconsistent.  Some people do very well with glucosamine and chondroiton, and some experience no appreciable results.  Others cannot use glucosamine-based products at all because of sulfur and shellfish allergies.  Since glucosamine has a sulfur component and is derived from shellfish, allergies to glucosamine are a significant concern for some.

With the above in mind, alternatives to glucosamine and chondroiton are being explored in the scientific literature with some promising results.  

Enter, then, undenatured type-II collagen (UC-II).  

UC-II is not sulfur based and is not derived from shellfish, so the potential for allergies are significantly lower.  UC-II is derived from chicken collagen, and actually seems to work better than glucosamine and chondroiton for joint pain by nourishing and supporting chondrocytes (cartilage cells).

In a trial comparing the results of UC-II against a glucosamine/chondroiton (G/C) mix, UC-II outperformed G/C by more than double in terms of pain relief at 90 days (see figure 1 below).  While the G/C produced some pain relief in the first 30 days, the progress leveled off at that point and did not continue to improve past 30 days, whereas the UC-II continued to produce pain relief that progressed to 90 days and beyond.

UC-II also improved joint flexibility and enabled the test subjects to undergo strenuous exercise for longer periods of time compared to placebo.  

Most subjects in these trials began experiencing relief in as little as two weeks, with the most significant pain relief and joint function improvement being seen at 90 days.  No liver, kidney, GI, or cardiovascular toxicity was observed.  

Furthermore, all but three of the test subject were able to discontinue pain medications after 90 days, and the three who remained on the medications were able to reduce the dosage.  Since nearly all pain relief medications carry significant side effects, including GI bleeding and risk of death due to heart attacks, discontinuing or reducing these medications is an important health benefit. 

Some studies have shown that UC-II is also effective support for those suffering from autoimmune-related rheumatoid arthritis.   

Since there is more than one type of supplemental collagen on the market, it must be emphasized that the Undenatured Type-II collagen is the kind used in these studies.  Denatured collagen or Type-I collagen would likely not produce the same results.

Also of note in the battle against joint pain is a natural anti-inflammatory compound from hops called, tetra-hydro iso-alpha acids (THIAA).  THIAA may also improve joint function and provide a different mechanism of pain relief by reducing inflammatory chemicals, thereby possibly accelerating the pain relief process when combined with UC-II.     

Soy and Fructose: Spawns of Satan?

Because, in part, of a well-known doctor who makes his living selling products from his internet site, two questions still come up that I find myself addressing from time to time.  In the mind of this well-known internet marketer, Satan has two spawns: soy and fructose.  

The concerns regarding soy and fructose are common because of some of the widespread misunderstanding about these natural compounds.  But let's examine these two compounds from a different perspective.

Spawn #1: Soy

The misunderstanding here stems from compounds in soy known as phytoestrogens, which is an unfortunate name because soy contains no estrogen.  These compounds are estrogen mimics, yes, but unlike xenoestrogens (toxic chemicals that mimic estrogen), phytoestrogens are weak estrogen mimics, whereas xenoestrogens are strong estrogen mimics.  The result is that xenoestrogens increase the estrogen pool, whereas phytoestrogens lower the estrogen pool and have beneficial effects on the endocrine system.  Granted, there are allergies to soy, just like there are allergies to strawberries, eggs, and everything else under the sun, but allergies do not necessarily equate to an unhealthy food.  It is unfortunate that soy has been so misunderstood, and it should interest the reader that some of the "research" pertaining to the "dangers" in soy was funded by…..guess who….the DAIRY industry!  Hmmm.  

Anyway, if the concerns around soy are referring to GMOs, then that's different.  GMOs should be avoided.  

Spawn #2:  Fructose

Regarding fructose, that again is a very misunderstood ingredient.  It is not the same as High Fructose Corn Syrup (HFCS).  They are not the same at all.  HFCS does indeed lead to metabolic syndrome and many other maladies.  But fructose in its purest form is simply a fruit sugar and the body responds to it completely differently than HFCS.   Fructose is simply a carbohydrate, and a beneficial one at that.   You cannot eat fruit without getting fructose.  

Having said that, anything in excess is not good.  One can die from drinking too much water, as an example.  So fructose in excess added to an already carbohydrate saturated diet can be problematic.  But again, to lump fructose into the category of a man-made sweetener is categorically wrong.  Sucrose (white table sugar) and High Fructose Corn Syrup are both ultra-refined carboydrates that the body reacts to in a strongly negative way.  Fruit sugar (fructose) cannot be categorized like that, because it is not ultra-refined and the body responds to it as an energy source.  Fructose does not spike insulin and effect blood sugar like sucrose and HFCS.  In fact, following is a list of common foods and their glycemic index.  Note where fructose is on the list.

Glucose..............................100 glycemic index score
White bread........................ 100

Baked potatoe.......................95

carrots................................85

sucrose (table sugar)...............75

Beets..................................75

Honey.................................75

Watermelon..........................70

Banana................................60

Baked beans..........................60

Brown rice............................55

Apple .................................40

Ultra Meal medical food..........36

Fructose (from any source).......20

Research Supports the use of Soy and Fructose in Nutriceuticals

Taken together, soy and fructose can provide very beneficial effects on human health when administered in the form of nutriceuticals.  Study after study  on the Metagenics medical food, Ultra Meal, for example, consistently demonstrates profound benefits in metabolic syndrome patients.    Numerous studies also show that soy isoflavones (isolated compounds from soy) improve symptoms related to female hormone balance and cardiovascular disease.

Here are some additional resources to help you better understand the truth about soy and fructose:

1. Link to my blog article highlighting research showing soy improves breast cancer risk: http://www.quantumhealth1.blogspot.com/search/label/Breast%20Cancer%20and%20Soy
2. Dr. David Dahlman's article on soy, perhaps the single best and most definitive article on the subject I have ever seen.  http://www.drdahlman.com/benefits-of-soy.shtml
3. A paper on the benefits of fructose over other sweeteners: http://www.metaproteomicslabs.com/position_papers/MET746_fructose.pdf

The Bottom Line

I hear this phrase a lot among holistic naturalists: "If God made it, it's good.  If man made it, be cautious."  

Generally I agree with this statement.  I believe this is a good rule to live by for the most part.  Of course, I believe this can also be taken to an unreasonable extreme, such as suggesting that you shouldn't take vitamins because they are "man made."  

Why, then, is fructose -- one of God's ingenious creations added to foods from the vine -- so vilified among some of the same people who say that if God made something it is good?  Why then is soy -- a staple in societies all over the world for centuries and one that has been scientifically validated as having many health promoting properties -- gotten a bad rap?  

The negativity surrounding fructose and soy is not in keeping with the if-God-made-it-it's-good philosophy.  

"New" Class of Omega Fatty Acids Shows Promise in Cardiovascular Health

A class of fatty acids known as omegas have been studied since the 1970s.  In particular, the omega-3 fatty acids have become famous for their various health benefits.  

Recently a "new" class of omega fatty acids has emerged in the research as showing promise for cardiovascular health and potentially other health benefits.  A class of omegas known as omega-7s may be as good, and perhaps even better, than omega-3 fatty acids for certain aspects of health.  

It must be first be understood that omega-7 fatty acids have always been part of fish oil, just like omega-3s.  However, they have not been the focus of research until now, and, therefore, no one has bothered to concentrate them and provide them in supplement form until now.  It should also be understood that the research on omega-7 fatty acids is still preliminary.  Compared to the massive amount of data available on omega-3s, the research on omega-7s is still quite small.  Having said that, the research on omega-3s was once small as well.  So far, the available data on omega-7s is quite impressive.

An overview of the data on omega-7 fatty acids shows dramatic improvement on C-Reactive Proteins (CRP), a marker for inflammation.  One study showed a 50% drop in CRPs in 30 days among patients who observed no dietary changes.1  Another similar study showed a drop in CRPs by nearly 64% among patients who did undergo some lifestyle changes.2  Triglycerides, a fat in the bloodstream that is responsible for making the blood sludgy leading to clogging in the arteries, also shows impressive improvement with the addition of omega-7 fatty acids; up to 36% drop in triglycerides in 30 days.  All cholesterol numbers also improve with the administration of omega-7s.  

As data is mounting implicating inflammation as the biggest culprit in heart disease, the early research on omega-7 fatty acids is promising in preventing and perhaps treating certain aspects of cardiovascular disease.  

1. MartinezL.Purifiedomega-7inthereductionofhs-CRP:adouble-blinded,randomized, placebo-controlled study. Proprietary research report, 2013.

2. MartinezL.Lipidandhs-CRPreductionsobservedwiththeadministrationofpurified palmitoleic acid: an open label trial. Proprietary research report, 2013.