Approach

Thirty years ago, the most common way to treat gut bacterial overgrowths was with broad-spectrum antibiotics.  However, it is now shown that antibiotics can lead to dysbiosis, by wiping out the bacterial diversity that exists in the gut.  In fact, sometimes, pathogenic bacteria such as Clostridium Difficile can come back stronger after antibiotics because there are no longer so many species competing for food [13].  Clostridium Difficile, along with all spore-producing bacteria, can survive outside the body for weeks in the form of spores, and repopulate the gut after antibiotics are completed.  Some bacteria can also survive antibiotics by producing biofilms, or biochemical “houses” that a colony of  bacteria build to protect themselves [15].

Today, reconstruction of the microbiome with dysbiosis or antibiotic use is a hot topic of research. The new theory is generally to accept that the microbiome will always contain some pathogenic bacteria.  In a healthy gut, there are not enough of these pathogenic bacteria to cause any disease.  Also in a healthy gut, the “good” bacteria are balanced and there is not an overabundance of any bacteria crowding out other important bacteria.  This balance is controlled by a combination of genetics, diet, the immune system, the brain, toxins, and the gut itself, when it is healthy.  Also, herbicides or pesticides from foods or other exposures can act like antibiotics, altering the microbiome.

My research shows that the microbiome can be difficult to reconstruct from dysbiosis, and keep it from eventually reverting back to where it started. It is important to get professional help and testing, and to understand the importance of things like diet. 

Professional Help

 I got help from two naturopathic doctors (NDs), but you can also look for help from functional medicine, integrative, or holistic MDs.   There are also some nutritionists and MDs who have written books about healthy diets for the mind, autism spectrum disorder, and ADHD, which can be relatively inexpensive ways to learn more.  The genetics and dysbiosis common in ASD, CD, and PD can have a relationship in dopamine production and metabolism, metals retention, and oxidative stress pathways.  In fact, many children with ASD also have dysbiosis [22] and dystonic movement patterns.

Tools Providers Often Use to Fight Dysbiosis 

Testing: Testing options for the microbiome and dysbiosis have greatly increased in the past few years.  Testing can include testing for bacterial overgrowths, bacterial genetic capabilities (metabolomics), levels of important chemicals, and susceptibility of detected bacterial overgrowths to both antibiotics and herbal formulations.   Tests from reputable, established labs in the US include:

• https://www.doctorsdata.com/gi-360/
• https://www.greatplainslaboratory.com/comprehensive-stool-analysis

Antibacterials: These are substances, often herbal, that can help reduce growth of certain bacteria, to help bring the microbiome back in balance.  These are typically less powerful than antibiotics, and also less disruptive.  It is important to work with your practitioner on these for proper effect and to minimize side effects.

Probiotics: Probiotics are beneficial bacteria to repopulate the gut, especially with antibacterial or after antibiotic usage.  There are many studies showing that even probiotics with a small number of species can help modify the microbiome, reduce inflammation, reduce PD symptoms, and help improve mood (even in healthy individuals) [16].  

Note there are two basic categories of probiotics.  The probiotics which contain only “soil based” or “spore-producing” bacteria generally do not require refrigeration and survive stomach acids easily.  Other probiotics generally require refrigeration for a decent shelf life.   If a product does not state whether it requires refrigeration or not, I usually avoid it. 

My NDs asked me to take a variety of probiotics, often recommending specific brands.  There can be quality issues with probiotics [17] so I generally stuck to manufacturers which they had vetted in the past.  I ordered all my refrigeration-required products through Wellevate, or other providers that offered express shipping with ice packs.  

Fermented Foods: Fermented foods like yogurt, cheese, and pickled foods also can contain naturally occuring probiotics.  However, some people may have inflammatory reactions to the histamines in fermented foods, so it’s important to discuss with your healthcare provider.

Prebiotics: Prebiotics are various types of foods for beneficial bacteria.  Resistant starch made from potato fiber has been shown to increase colonic butyrate SCFA production [27], often found short in PD, and possibly in some cases of CD.  My ND prescribed Paleofiber RS, a combination of fiber and resistant starch. 

Diet: The diet can have a significant influence on gut microbiota in PD, and diets such as the Mediterranean diet may be beneficial [18]. Diet is such a large subject I will cover it in another article.  However, I will say here that reducing heavy metals in the diet (contaminated fish, brown rice grown in certain areas, etc.) is important in all neurologic disease.   Also, it is important to limit sugars, especially if they cause excessive burping or gas, which can be a sign of small intestine bacterial overgrowth (SIBO).

Vitamin D: Vitamin D (VitD) is involved in immune cell differentiation, gut microbiota modulation, gene transcription, and intestinal wall barrier integrity, and deficiency can be associated with reduced butyrate production [19]. It is not surprising vitamin D deficiency is common in PD and almost all systemic disease.  

NAC: NAC (and vitamin C) are supplements that can help break down dysbiosis biofilms [20].  NAC is also an antioxidant and a precursor to glutathione, so it can convey a variety of benefits in systemic disease, when properly used.