GUT MICROBIOME NUTRITION & BEHAVIOR

CASE STUDY OUTLINE

Student’s Name: Heather Strait

CASE STUDY DATA: JANE DOE (20 YEAR OLD FEMALE)

PRIMARY COMPLAINTS: ABDOMINAL PAIN, ABDOMINAL BLOATING AFTER EATING, NAUSEA,

FREQUENT LOOSE STOOLS, AND ANXIETY.

PLEASE REVIEW THE PROVIDED EXAMPLE COMPREHENSIVE GASTROINTESTINAL PANEL:

AND DEVELOP YOUR OWN INTERVENTION PROTOCOL TO HELP THIS INDIVIDUAL.
PROPOSED INTERVENTION OUTLINE

WITH THE LAB DATA PROVIDED, PLEASE DETERMINE THE FOLLOWING APPROPRIATE INTERVENTIONS:

DIETARY INTERVENTIONS

· GAPS diet
· Increase intake of fermented foods such as organic, grass-fed kefir, butter, cheese, natto, kimchi, and
sauerkraut
· Eliminate/reduce alcohol and desserts

SUPPLEMENT INTERVENTIONS (BE SURE TO INDICATE WHAT CHEMICAL FORM IS APPROPRIATE)

· Broad-spectrum antibiotic and antiparasitic herbal blends and extracts in capsule and liquid tincture
form given in treatment cycles
· Saccharomyces boulardii capsules
· Liquid digestive bitters before meals to prevent future bacterial or parasitic infection (e.g. gentian,
goldenseal, Oregon grape root, bitter orange, angelica, and yellowdock)
 · Carminative herbal tea after meals to ease digestive discomfort
· Botanicals to restore the gut lining

LIFESTYLE & INTEGRATIVE HEALTH INTERVENTIONS

· Avoid drinking or swimming in rivers or lakes where these parasites are known to live
· Take precautions when traveling in countries with untreated water (i.e. boil water, take anti parasitic
herbals with meals)
· Acupuncture for anxiety and for immune support

OTHER RECOMMENDATIONS/LAB WORK/CLINICAL REFERRALS

· Follow up fecal test in 3-6 months following last treatment, depending on presence/absence of
symptoms

· If follow-up testing showing absence of parasites but continued elevated levels of calprotectin and
eosinophil protein X, then a methane breath test to rule out small intestine bacterial overgrowth and a
referral to a gastroenterologist is warranted

PLEASE WRITE 2 - 4 PAGES DEFENDING WHY YOU CHOSE THE ABOVE INTERVENTION PLAN UTILIZING A
MINIMUM OF 10 PEER-REVIEWED SOURCES:

Diet Recommendations

The GAPS (Gut and Psychology Syndrome) diet is an effective way to heal the gut and includes foods

like bone broth, which is full of glutathione and collagen that work to repair the intestinal lining. Although there

aren’t peer-reviewed studies validating the efficacy of the GAPS diet, there are many clinicians who have used

it to successfully restore gut function in their clients and patients. Incorporating fermented foods such as kefir,

sauerkraut, kimchi, and natto will provide the necessary beneficial bacteria to promote gut health i.e. keep

pathogens like Candida spp. and Blastocystic spp. in check so that they do not cause symptoms. Sugar and

alcohol are major causes of inflammation and promote growth of Candida (Mohammed et al., 2021), so they

should be eliminated from the diet or drastically reduced.

Supplement recommendations

Based on the lab confirmation of Dientamoeba fragilis, Blastocystis hominis, and Candida species,

elevated calprotectin, eosinophil protein X, and slightly elevated secretory IgA, and the client’s symptoms
(Norberg et al., 2003; Wawrzyniak et al., 2013), this seems like a straightforward parasitic and fungal infection

that once cleared will eliminate the client’s symptoms. The priority is clearing these parasites and fungi from

the intestine and restoring gut eubiosis, however, the Klebsiella pneumoniae also needs to be addressed. The D.

fragilis is present in higher numbers (moderate detected) compared to the B. hominis (rare detected) and may be

the actual cause of symptoms since B. spp. often seem to be commensal and a normal part of a healthy gut

microbiome (Deng et al., 2021). Because B. spp. is one of the most difficult parasites to completely eradicate

from the human intestine, treatment will be considered successful if the client becomes and remains

asymptomatic. Candida spp. also cause the specified gastric symptoms (i.e. abdominal pain, bloating after

eating, frequent loose stools, and nausea) (Knapp & Flynn, 2009).

Pharmaceutical antibiotics can be used to treat B. hominis infections, however, the success rate of any

one antibiotic or a cocktail of antibiotics can be quite low due to antibiotic resistance by the parasites

(Rajamanikam et al., 2019). D. fragilis can be successfully treated using the antibiotic Paromomycin (Burgaña

et al., 2019). Treating parasitic infections with antibiotics causes gut dysbiosis by killing beneficial gut bacteria

along with the pathogenic parasites (Yoon & Yoon, 2018), therefore herbal antibiotics should be the first line of

defense against parasites and fungi.

The broad-spectrum herbal antibiotics that have proven efficacy in treating parasitic, bacterial, and/or

fungal infections include (but are not limited to) wormwood (Krishna et al., 20018; Loo et al., 2017), sweet

wormwood (Krishna et al., 2008 ; Loo et al., 2017), walnut hull (Juglans nigra), goldenseal (Berberine, 2000),

myrrh (Nikolic et al., 2016), oregano oil and leaf (Soltani et al., 2021; Teles et al., 2019), garlic (Tesfaye, 2021),

olive leaf (El-Sayed et al., 2017), Chinese goldthread (Niu et al., 2019), clove bud/clove bud oil (Shahina et al.,

2022), cinnamon (Shaina et al., 2022), barberry (Berberine, 2000), Oregon grape (Berberine, 2000), tea tree oil

(Mertas et al., 2015), turmeric (Teles et al., 2019), and echinacea (Canlas et al., 2010; Moghtaderi et al.,

2021), especially when used in combination due to the synergistic and amplifying effects of one herb on the

other herbs (Pezzani et al., 2019). These herbs will be given in cycles beginning with six weeks on treatment
followed by two weeks without treatment, and then another six weeks of treatment, then reassess after two

weeks off the treatment as to whether another course of treatment is necessary.

Saccharomyces boulardii will also combat candida infection due to the capric and caprylic acid it

produces (Suchodolski et al., 2021). S. boulardii also helps to restore gut eubiosis (Kelesidis & Pothoulakis,

2012). Gastric acid (i.e. hydrochloric acid) is the first line of defense against pathogens entering the digestive

tract (Beasley et al., 2015; Tennant et al., 2008) therefore if stomach acid is low taking digestive bitters before a

meal will help to increase stomach acid and prevent future infections.

The probiotics and prebiotics in kefir and other fermented foods will help to rebalance levels of short

chain fatty acids (SCFA). Though still within normal range, this client has a slight imbalance of propionate

compared to butyrate and acetate (Rebalance short-chain fatty acids to correct ratio (den Besten et al., 2013;

Shimizu et al., 2019). Following treatment for fungus, parasites, and bacteria, her SCFA ratios may naturally

return to the optimal ratios.

Blastocystis (Defaye et al., 2020) and candida (Markey et al., 2020) are causes of anxiety, so reducing

the numbers of candida to normal levels should eliminate this client’s anxiety. In the meantime, anxiolytic

supplements like ashwagandha, melatonin, and GABA may help to alleviate some of the client’s symptoms of

anxiety and promote restful sleep.

Lifestyle and Integrative Health Interventions

Acupuncture is able to regulate and normalize immune function (Liang et al., 2015) and reduce anxiety

(Yang et al., 2021).

 References

Beasley, D. E., Koltz, A. M., Lambert, J. E., Fierer, N., & Dunn, R. R. (2015). The evolution of stomach acidity
and its relevance to the human microbiome. PloS One, 10(7), e0134116.
https://doi.org/10.1371/journal.pone.0134116

Berberine. (2000). Alternative Medicine Review: A journal of Clinical Therapeutic, 5(2), 175–177.

Canlas, J., Hudson, J. B., Sharma, M., & Nandan, D. (2010). Echinacea and trypanasomatid parasite
interactions: growth-inhibitory and anti-inflammatory effects of Echinacea. Pharmaceutical
Biology, 48(9), 1047–1052. https://doi.org/10.3109/13880200903483468

den Besten, G., van Eunen, K., Groen, A. K., Venema, K., Reijngoud, D. J., & Bakker, B. M. (2013). The role
of short-chain fatty acids in the interplay between diet, gut microbiota, and host energy
metabolism. Journal of Lipid Research, 54(9), 2325–2340. https://doi.org/10.1194/jlr.R036012

Defaye, M., Nourrisson, C., Baudu, E., Lashermes, A., Meynier, M., Meleine, M., Wawrzyniak, I., Bonnin, V.,
Barbier, J., Chassaing, B., Godfraind, C., Gelot, A., Barnich, N., Ardid, D., Bonnet, M., Delbac, F.,
Carvalho, F. A., & Poirier, P. (2020). Fecal dysbiosis associated with colonic hypersensitivity and
behavioral alterations in chronically Blastocystis-infected rats. Scientific reports, 10(1), 9146.
https://doi.org/10.1038/s41598-020-66156-w

Deng, L., Wojciech, L., Gascoigne, N. R. J., Peng, G., & Tan, K. S. W. (2021). New insights into the
interactions between Blastocystis, the gut microbiota, and host immunity. PLoS Pathogens, 17(2),
e1009253. https://doi.org/10.1371/journal.ppat.1009253

El-Sayed, S. H., Amer, N., Ismail,S., Ali,I., Rizk, E., Magdy, M., & El-Badry, A. A.-M. (2017). In vitro and in
vivo anti-Blastocystis efficacy of olive leaf extract and bee pollen compound. Research Journal of
Parasitology, 12, 33-44. https://scialert.net/abstract/?doi=jp.2017.33.44

Hacioglu, M., Oyardi, O., & Kirinti, A. (2021). Oregano essential oil inhibits Candida spp. biofilms. Zeitschrift
fur Naturforschung. C, Journal of Biosciences, 76(11-12), 443–450. https://doi.org/10.1515/znc-2021-
0002

Kelesidis, T., & Pothoulakis, C. (2012). Efficacy and safety of the probiotic Saccharomyces boulardii for the
prevention and therapy of gastrointestinal disorders. Therapeutic Advances in Gastroenterology, 5(2),
111–125. https://doi.org/10.1177/1756283X11428502

Knapp, K. M. & Flynn, P. M. (2009). CHAPTER 212 – CANDIDIASIS. In R. D. Feigin, J. D. Cherry, G. J.

Demmler-Harrison, & S. L. Kaplan (Eds.). Feigin and Cherry's Textbook of Pediatric Infectious
Diseases (6th ed), 2741-2751. W.B. Saunders. https://doi.org/10.1016/B978-1-4160-4044-6.50217-X.

Krishna, S., Bustamante, L., Haynes, R. K., & Staines, H. M. (2008). Artemisinins: their growing importance in
medicine. Trends in Pharmacological Sciences, 29(10), 520–527.
https://doi.org/10.1016/j.tips.2008.07.004
Liang, F., Cooper, E. L., Wang, H., Jing, X., Quispe-Cabanillas, J. G., & Kondo, T. (2015). Acupuncture and
Immunity. Evidence-based complementary and alternative medicine : eCAM, 2015, 260620.
https://doi.org/10.1155/2015/260620

Loo, C. S., Lam, N. S., Yu, D., Su, X. Z., & Lu, F. (2017). Artemisinin and its derivatives in treating protozoan
infections beyond malaria. Pharmacological Research, 117, 192–217.
https://doi.org/10.1016/j.phrs.2016.11.012

Markey, L., Hooper, A., Melon, L. C., Baglot, S., Hill, M. N., Maguire, J., & Kumamoto, C. A. (2020).
Colonization with the commensal fungus Candida albicans perturbs the gut-brain axis through
dysregulation of endocannabinoid signaling. Psychoneuroendocrinology, 121, 104808.
https://doi.org/10.1016/j.psyneuen.2020.104808

Mertas, A., Garbusińska, A., Szliszka, E., Jureczko, A., Kowalska, M., & Król, W. (2015). The influence of tea
tree oil (Melaleuca alternifolia) on fluconazole activity against fluconazole-resistant Candida albicans
strains. BioMed Research International, 2015, 590470. https://doi.org/10.1155/2015/590470

Moghtaderi, M., Mirzaie, A., Zabet, N., Moammeri, A., Mansoori-Kermani, A., Akbarzadeh, I., Eshrati
Yeganeh, F., Chitgarzadeh, A., Bagheri Kashtali, A., & Ren, Q. (2021). Enhanced Antibacterial Activity
of Echinacea angustifolia Extract against Multidrug-Resistant Klebsiella pneumoniae through Niosome
Encapsulation. Nanomaterials (Basel, Switzerland), 11(6), 1573. https://doi.org/10.3390/nano11061573

Mohammed, L., Jha, G., Malasevskaia, I., Goud, H. K., & Hassan, A. (2021). The interplay between sugar and
yeast infections: do diabetics have a greater predisposition to develop oral and vulvovaginal
Candidiasis?. Cureus, 13(2), e13407. https://doi.org/10.7759/cureus.13407

Nikolic, M., Smiljkovic, M., Markovic, T., Cirica, A., Glamoclija, J., Markovic, D., & Sokovic, M. (2016).
Sensitivity of clinical isolates of Candida to essential oils from Burseraceae family. EXCLI Journal, 15,
280–289. https://doi.org/10.17179/excli2014-621

Niu, H. X., Duan, Q. J., Shi, G. X., Wu, D. Q., Shao, J., Wang, T. M., & Wang, C. Z. (2019). Zhongguo Zhong
Yao Za Zhi = Zhongguo Zhongyao Zazhi = China Journal Of Chinese Materia Medica, 44(1), 125–130.
https://doi.org/10.19540/j.cnki.cjcmm.20180912.004

Norberg, A., Nord, C. E., & Evengård, B. (2003). Dientamoeba fragilis--a protozoal infection which may cause
severe bowel distress. Clinical Microbiology and Infection: The Official Publication of the European
Society of Clinical Microbiology and Infectious Diseases, 9(1), 65–68. https://doi.org/10.1046/j.1469-
0691.2003.00459.x

Pezzani, R., Salehi, B., Vitalini, S., Iriti, M., Zuñiga, F. A., Sharifi-Rad, J., Martorell, M., & Martins, N. (2019).
Synergistic effects of plant derivatives and conventional chemotherapeutic agents: An update on the
cancer perspective. Medicina (Kaunas, Lithuania), 55(4), 110.
https://doi.org/10.3390/medicina55040110
Rajamanikam, A., Hooi, H. S., Kudva, M., Samudi, C., & Kumar, S. (2019). Resistance towards metronidazole
in Blastocystis sp.: A pathogenic consequence. PloS One, 14(2), e0212542.
https://doi.org/10.1371/journal.pone.0212542

Shahina, Z., Molaeitabari, A., Sultana, T., & Dahms, T. E. S. (2022). Cinnamon Leaf and Clove Essential Oils
Are Potent Inhibitors of Candida albicans Virulence Traits. Microorganisms, 10(10), 1989.
https://doi.org/10.3390/microorganisms10101989

Shimizu, H., Masujima, Y., Ushiroda, C., Mizushima, R., Taira, S., Ohue-Kitano, R., & Kimura, I. (2019).
Dietary short-chain fatty acid intake improves the hepatic metabolic condition via FFAR3. Scientific
Reports, 9(1), 16574. https://doi.org/10.1038/s41598-019-53242-x

Soltani, S., Shakeri, A., Iranshahi, M., & Boozari, M. (2021). A Review of the Phytochemistry and
Antimicrobial Properties of Origanum vulgare L. and Subspecies. Iranian Journal of Pharmaceutical
Research: IJPR, 20(2), 268–285. https://doi.org/10.22037/ijpr.2020.113874.14539

Suchodolski, J., Derkacz, D., Bernat, P., & Krasowska, A. (2021). Capric acid secreted by Saccharomyces
boulardii influences the susceptibility of Candida albicans to fluconazole and amphotericin B. Scientific
Reports, 11(1), 6519. https://doi.org/10.1038/s41598-021-86012-9

Teles, A. M., Rosa, T. D. D. S., Mouchrek, A. N., Abreu-Silva, A. L., Calabrese, K. D. S., & Almeida-Souza, F.
(2019). Cinnamomum zeylanicum, Origanum vulgare, and Curcuma longa Essential Oils: Chemical
Composition, Antimicrobial and Antileishmanial Activity. Evidence-Based Complementary and
Alternative Medicine : eCAM, 2019, 2421695. https://doi.org/10.1155/2019/2421695

Tennant, S. M., Hartland, E. L., Phumoonna, T., Lyras, D., Rood, J. I., Robins-Browne, R. M., & van Driel, I.
R. (2008). Influence of gastric acid on susceptibility to infection with ingested bacterial
pathogens. Infection and Immunity, 76(2), 639–645. https://doi.org/10.1128/IAI.01138-07

Tesfaye, A. (2021). Revealing the therapeutic uses of garlic (Allium sativum) and its potential for drug
discovery. The Scientific World Journal, 2021, 8817288. https://doi.org/10.1155/2021/8817288

Wawrzyniak, I., Poirier, P., Viscogliosi, E., Dionigia, M., Texier, C., Delbac, F., & Alaoui, H. E. (2013).
Blastocystis, an unrecognized parasite: an overview of pathogenesis and diagnosis. Therapeutic
Advances in Infectious Disease, 1(5), 167–178. https://doi.org/10.1177/2049936113504754

Yang, X. Y., Yang, N. B., Huang, F. F., Ren, S., & Li, Z. J. (2021). Effectiveness of acupuncture on anxiety
disorder: a systematic review and meta-analysis of randomised controlled trials. Annals of general
psychiatry, 20(1), 9. https://doi.org/10.1186/s12991-021-00327-5

Yoon, M. Y., & Yoon, S. S. (2018). Disruption of the gut ecosystem by antibiotics. Yonsei Medical
Journal, 59(1), 4–12. https://doi.org/10.3349/ymj.2018.59.1.4