Page 1

I S S U E 4 • 2019

IDENTIFYING THE ROOT CAUSE TO RESOLVE INFLAMMATION Functional insights into constipation with MetaBiome™ testing

The Metagenics probiotics advantage

Measuring the microbiome Is it time to rebrand? How do you know and how do you do it?

Meaty issues in the Australian diet How strong is the cancer link? • EXCITING NEW PRODUCTS • LABEL CHANGES: A CLEAR FOCUS ON PATIENT SAFETY•


14

4 18

16

Contents Every issue

On the cover

10 FAQs

4 Identifying the root cause to 14 Is it time to rebrand?

Frequently asked questions of our Clinical Support Team.

11 In the news Label changes: A clear focus on patient safety.

12 Clinical resources

CIRS and biotoxin questionnaire, Healthy Home Health family - Is where you live, affecting your health?

13 Product announcements

Exciting new products and recent changes.

resolve inflammation

And why providing symptomatic relief is part of a comprehensive treatment approach.

8 Functional insights

into constipation with MetaBiome™ testing How the MetaBiome™ Microbiome Sampling Kit can provide comprehensive, functional insight into a patient's gastrointestinal symptoms.

How do you know and how do you do it?

16 Measuring the microbiome The advantages of metagenomic sequencing as a method of measuring the microbiome in clinical practice.

18 Meaty issues in the Australian diet

How strong is the cancer link?

7 The Metagenics

probiotic advantage The probiotics leader for over 30 years.

Find us on Social Media

2


NEXT GENERATION CANCER CARE

PERSONALISED INTEGRATIVE ONCOLOGY The 2020 Metagenics International Congress on Natural Medicine will provide clarity and confidence to integrative oncology, allowing better outcomes in the management of patients living with cancer as a chronic disease, as well as the palliative care of cancer patients.

PRESENTER LINE-UP

PROF. DONALD ABRAMS USA

DR JILL CARNAHAN USA

PROF. THOMAS SEYFRIED USA

DR GREG POTTER UK

Your Investment: $880.00 incl. GST each per person. Same price applies in New Zealand. More speakers to be announced! Join the Metagenics Facebook Practitioner group for future speaker announcements!

DR TIM CROWE AUS

PROF. MOSHE SZYF

DR WAFAA ABDEL-HADI

Call Customer Service on 1800 777 648 (Australia) or 0508 227 744 (New Zealand) to book. For more information: metagenicscongress.com.au

Be part of a brighter future and book in for Congress 2020 today!


SEMINAR REVIEW

Identifying the root cause to resolve inflammation And why providing symptomatic relief is part of a comprehensive treatment approach.

Written by NATHAN ROSE Clinical Education Manager

Pain and inflammation are two of the most frequent complaints presented to healthcare Practitioners. Patients are often in desperate need of relief, as ongoing pain and inflammation significantly influence quality of life. The holistic principles in Natural Medicine of providing symptomatic relief in combination with addressing the root cause, is a life changing strategy for inflamed patients. As good as these principles sound, the challenge is in the execution. Not only do Practitioners require powerful symptomatic pain relief protocols, they also need objective insights to pinpoint the often nebulous driver of inflammation. In the previous edition of the Update, cutting-edge strategies to manage physiological inflammation that promote resolution were discussed (Figure 1). The below discussion explores how to identify and remove common triggers of inflammation to create a rounded treatment approach.

The Natural Medicine price is right There are seemingly endless potential triggers of inflammation making it challenging to determine which of these may be affecting your patient. Additionally, human nature shows us that we are often attracted to the new and novel, which may bias our perspectives and heuristics. With a flood of new ideas entering Natural Medicine, we can be swept up by what is exciting, putting us in danger of overlooking foundational components of clinical practice. To help integrate new ideas with well-established principles to better manage inflammation, a priority system may be of benefit. Decision making in clinical practice can be likened to the old TV game show The Price is Right. In the program, the contestant is desperately trying to weigh up the value of the items to create a hierarchy; all the while, the crowd is frantically cheering them on trying to influence their decision making. In parallel, clinicians can feel the pressure to prioritise the value of different pieces of information, often with less than perfect data, to provide relief to their patients. The clinician is also hearing outside, often best-intentioned, noise from patients, other clinicians, key opinion

4

leaders, and online influencers etc., all of which can sway their decision on the therapeutic direction. A tough task. Before implementing a treatment protocol, there is a need to create order out of the seeming chaos. This can help the Practitioner choose the most appropriate therapy first and allow them to move onto the next most logical candidate if the response to the first approach is less than ideal. This is akin to putting 'The Price is Right' items in monetary order. There is a common expression of “if you hear hoof steps, think horses, not zebras”. This notion suggests to think of the most obvious, common or logical explanation before suspecting the exotic. For example, rather than suspecting a patient’s arthritis is due to a Borellia infection, first look at more common causes. This principle can be applied to determine drivers of inflammation. Here is a hierarchy of most common to least common inflammatory drivers: • Tier 1: Micronutrient deficiencies, macronutrient excess, circadian rhythm disruption • Tier 2: HPA dysfunction, hypothyroidism, dysbiosis • Tier 3: Biotoxin illness from water-damaged buildings(CIRS), MCAS • Tier 4: Stealth infections, environmental toxicity, EMF/EHS

Entry level inflammogens The first line of inflammatory suspects are essentially dietary and lifestyle-based triggers. Micronutrient deficiencies, such as magnesium, omega-3 and vitamin D insufficiency is quite common and each are linked to elevated levels of inflammatory cytokines and chronic inflammatory diseases.1,2 In contrast, whilst many people have inadequate micronutrient intake, data shows people living in industrialised societies are consuming excessive macronutrients (i.e. calories from macronutrients, particularly carbohydrates and fats).3 Excessive calories do not just drive excessive fat gain that some people consider a cosmetic issue. Instead, the research is clear that it carries a myriad of health risks, including increased inflammatory load.4 The good news is that weight loss is a powerful anti-inflammatory treatment in overweight and obese individuals and the benefits are seen clinically in conditions such as osteoarthritis.5,6 Similar to general weight loss strategies, the current data shows that there is no superior diet for reducing inflammation in overweight patients. For example, a study showed that isocaloric low fat or low carbohydrate diets achieve impressive, yet equal, reductions in inflammatory markers.7 The benefits of dieting appears to be the caloric reduction achieved by limiting a macronutrient – it doesn’t

Physiological Inflammation

Trigger Non-self

Resolution and/or

Phagocytosis Antimicrobial Tissue repair

Innate immunity M1 Macrophage

M1 Macrophage

M2 Macrophage

Inflammatory Cascade

Receptor

Dendritic cell

Mast cell

Neutrophil Signalling

Quasi-self

Transcription Factors

Chronic inflammation

Adaptive immunity

Damaged self

Cardinal Signs T helper cell

B Cell

T reg cell Redness

Swelling

Heat

Pain

White blood cell infiltration Unsuccesful healing Tissue damage

Loss of Function

Meta Mag® - Magnesium Bisglycinate, Corydalis and California Poppy for Pain

Specialised Pro-Resolving Mediators

High Purity, Low Reflux, Concentrated Fish Oil

Figure 1: Strategies such as herbal anti-inflammatories and magnesium can assist in managing physiological inflammation, while fish oil and/or specialised pro-resolving mediators (SPMs) [depending on omega-3 levels] promote the resolution phase of inflammation. For a comprehensive treatment approach, Practitioners need the tools to identify and remove the inflammatory trigger.


SEMINAR REVIEW

typically matter whether its carbohydrate or fat restriction. Thus, Practitioners are recommended to work with patients to determine which weight loss diet the patient feels will be the most sustainable.

The guts of the problem The second tier, and thus second most frequent, drivers of inflammation include intestinal dysbiosis and disturbances in homeostatic mechanisms such as hypothalamus-pituitary-adrenal (HPA) axis dysfunction and hypothyroidism. With the exponential growth in microbiome research, the focus on second tier drivers will centre on dysbiosis. Dating back to Hippocrates’ era, Traditional Medicine had recognised that gastrointestinal health can drive systemic disease such as chronic inflammation. Likewise, modern science has now elucidated the molecular pathways through which the gut influences systemic inflammatory tone. Most notably, research has identified hair-like fragments on the outer surface of gram negative bacteria from the microbiome, known as lipopolysacchirades (LPS) or endotoxin, which are potent inducers of inflammation.8 For example, osteoarthritis sufferers were found to contain significantly greater LPS in their affected joints compared to healthy controls.9

The inflammation is in the detail Interestingly LPS occurs in two different forms - an extremely subtle difference with dramatically different inflammatory ramifications. At one end of the LPS molecule is a collection of fatty acid tails, termed lipid A.10 There are two types of lipid A – pentaacetylated endotoxin and hexa-acetylated endotoxin. The penta-acetylated endotoxin contains five fatty acid tails and barely initiates an inflammatory response when absorbed into systemic circulation. In contrast, hexaacetylated endotoxin possess a single extra fatty acid that remarkably, causes it to be 100 fold more pro-inflammatory when it interacts with toll like receptors (TLRs) on immune cells than penta-acetylated endotoxin.11 From a clinical perspective, the next generation microbiome sequencing technique, known as metagenomic sequencing, can measure the amount of hexa-LPS genes a patient's microbiome possess as a marker of their microbiome’s inflammatory potential.

Don’t let LPS live up to its potential LPS generation, absorption and ability to induce inflammation appears to be modified

by dietary and lifestyle behaviours. Post prandial LPS, i.e. a sharp increase in serum LPS after a meal, which is the largest contributor to systemic LPS, can vary widely depending on the type of food ingested. High calorie, high fat, especially high saturated fat meals act as a chaperone to transport LPS into the circulation and drive systemic inflammation.12,13 In contrast, a low fat diet, or better yet, a low fat diet supplemented with 1.2 g/day of fish oil, has been shown to reduce post prandial LPS below baseline levels.14 The generation of LPS from dietary fat is not the only consideration in this discussion. Data shows that several other factors can affect whether a person absorbs LPS from a meal, or if they do absorb appreciable levels, the degree to which it will induce an inflammatory response. For example, it appears that body composition and physical activity influence LPS. In one study, despite consuming the same high-fat meal, overweight individuals experienced heightened LPS absorption and inflammatory response compared to healthy weight individuals.15 Similarly, obese women completing a 12 week resistance training program showed a significantly reduced post prandial LPS profile compared to sedentary controls.16 Finally, phytochemicals can reduce the inflammatory response to LPS absorption. For example, sulforaphane was found to completely blunt the typical pro-inflammatory cytokine secretion from macrophages when stimulated by LPS; possibly, by sulforaphane's ability to upregulate the cells own protective antioxidant response.17

Taken together, the data suggests that it would be wise for patients to eat a low saturated fat diet, ensure adequate EPA/ DHA intake, undertake regular exercise, and consume a phytochemical rich diet to reduce the likelihood of the microbiome possessing high levels of LPS; mitigating the inflammatory response to absorbed LPS.18

Not just a sore knee The more complex drivers in tier three and four can be suspected when patients present with widespread symptoms and/or have not responded adequately to diet and lifestyle interventions or first-line anti-inflammatory protocols. Tier three drivers include chronic inflammatory response syndrome (CIRS) from water-damaged buildings (WDB) and mast cell activation syndrome (MCAS). These conditions are considered tier three because while they require a complex set of events to trigger their manifestation, they are still reasonably common conditions. For example, research shows that around 24% of the population possess the HLA genotype that make them susceptible to biotoxins.19 Couple this statistic with the claims that around half of Australian homes and offices are susceptible to water damage, it is not unreasonable to think that a significant portion of the population are exposed to and sensitive to water-damaged buildings. Likewise, studies suggest up to 17% of the population suffer to some degree of MCAS.20 This condition is known to run in families, yet no genetic defect has been discovered to date.21 Instead, research has found epigenetic

5


SEMINAR REVIEW

Table 1: Clinical features and work up of CIRS and MCAS. CIRS Common signs and symptoms

Fatigue, aches, sinus issues, headaches, memory and concentration complaints, neurological symptoms

Fatigue, fibromyalgia, syncope, headache, urticaria, paraesthesia, nausea, vomiting, and migratory oedema

Triggers

Biotoxins from WDB

Allergens, pressure, heat, sex hormone imbalance, gut dysbiosis, insomnia

Screening questionnaire

CIRS and Biotoxins Questionnaire

Mast Cell Activation Syndrome (MCAS) Screening Questionnaire

First line testing (recommended)

Visual contrast sensitivity (VCS) HLA haplotype

Chromagranin A Therapeutic trial of anti-histamines

Second line testing (optional)

Blood biomarkers - Leptin, vasoactive intestinal polypeptide (VIP), melanocyte stimulating hormone (MSH), anti-diuretic Hormone (ADH), osmolality MARCoNS NeuroQuant™

Urinary 1-methyl histamine Tryptase Heparin

Clinical priorities

Identify and remove source of biotoxin Bind toxin in GI Correction of abnormal biomakers

Identify and remove triggers Stabilise mast cells Low histamine diet

differences between MCAS patients and controls, thus explaining the high degree of heritability of MCAS.22 The major tip off that a patient has either CIRS or MCAS is typically the presence of a long list of co-morbidities alongside their inflammation. CIRS patients can often suffer a ‘multi-system, multi-symptom illness’ with fatigue, aches, sinus issues, headaches, memory and concentration complaints, and neurological symptoms, such as numbness and tingling.23 A similar complex clinical picture is seen in MCAS with fatigue, fibromyalgia, syncope, headache, urticaria, paraesthesia, nausea, vomiting, and migratory oedema, as the most common symptoms.24

Which acronym is it? The above symptom picture between CIRS and MCAS shows considerable overlap making diagnosis based purely off symptoms essentially impossible. Therefore, more objective and specific data from testing is necessary. Fortunately, there is ample testing that can be performed to screen for both conditions. An excellent place to start is with the screening questionnaires as both conditions have researched and validated questionnaires.25,26 The CIRS and Biotoxins Questionnaire and Mast Cell Activation Syndrome (MCAS) Screening Questionnaire can be downloaded from the Metagenics Practitioner login website under the Clinic Tools tab. Both conditions have recognised biomarkers to consider measuring to further rule in or out as a working diagnosis (Table 1). For further clarification on working through a suspected case of CIRS or MCAS please call Clinical Support on 1800 777 648 within Australia or 0508 227 744 within New Zealand.

Time to look for zebras The final tier includes drivers that are less often suffered by patients. However, Practitioners still need to be mindful that these could occur in patients and be ‘alert but not alarmed’. Similar to the tier three candidates, the drivers

6

MCAS

Table 2: Clinical features and work up of stealth infection, EHS and environmental toxicity. Stealth infection

EHS

Environmental toxicity

Common signs and symptoms

Fatigue, fever, aches, swollen lymph nodes

Headache, insomnia, neurological issues, tinnitus, dizziness

Fatigue, brain fog, arthritis, GI symptoms

Triggers

Tick bite, mosquito bite, overseas travel

Mobile phone use, Wi-Fi, Bluetooth, LCD screens

Occupational exposure

Screening questionnaire

Horowitz Lyme-MSIDS Questionnaire

Environmental Exposure Decision Tree

Environmental Exposure Decision Tree

First line testing (recommended)

IgG/IgM antibodies Borrelia - Immunology (EliSpot) test

Therapeutic trial of EMF avoidance 6OH melatonin: creatinine ratio

Heavy metals Pesticides Serum GGT

Clinical priorities

Antimicrobials Immune support Energy support

Avoidance of EMF Nutraceauticals to build resilience

Detoxification Nutraceauticals to build resilience

in tier four – stealth infection, environmental toxicity and electromagnetic hypersensitivity syndrome (EHS) – are known to present in patients as clusters of signs and symptoms, not simply a single presentation of inflammation. Again, similar to tier three pathologies, a Practitioner is cautioned on basing a working diagnosis off signs and symptoms alone and it is suggested to do further testing, with the exception of EHS, as a therapeutic trial of EMF avoidance is recommended (Table 2).

Dual approach Treating the root cause as a principle in Natural Medicine is a noble endeavour and sounds wonderful philosophically. However, in reality, when it comes to identifying the root cause of inflammation, it can be challenging to say the least. Therefore, employing symptomatic relief should not be seen as ineffective or band aid solution, but a necessity in patients afflicted with pain and inflammation. In contrast, Practitioners shouldn’t be disillusioned that the triggers of inflammation are near impossible to identify. By demonstrating patience and taking a step-wise approach, employing testing where indicated, clinicians should more often than not uncover the drivers. This dual pronged approach of providing symptomatic relief and removing true triggers can be life changing for many inflamed patients.

Research

Bites

Mending menorrhagia with boswellia and ginger. Monthly menstrual visits need not come with code red warnings of heavy bleeding. New research involving 102 patients investigated the use of boswellia and ginger for treatment of heavy menstrual bleeding (80 mL/cycle or lasting more than seven days). In addition to nonsteroidal anti-inflammatory medication, patients were randomly assigned to receive either 300 mg of boswellia, 300 mg of ginger or placebo three times daily from day one to seven of their menstrual cycle, for two consecutive cycles. Compared with placebo, the duration of menstrual bleeding decreased in both boswellia (p=0.003) and ginger groups (p=0.001), with additional improvements in quality of life scores (p<0.001). The potent antiinflammatory effects of boswellia and ginger could be the secret weapon your female patients need in their period artillery.


The Metagenics probiotic advantage The probiotics leader for over 30 years.

T

he benefits of probiotics come directly from the selection of probiotic strains and doses that are specific to an individual’s needs. Metagenics is proud of its history of providing effective, well-researched probiotics; those that are clinically trialed, with researched mechanisms and at researched strengths.

Multistrain probiotic formulas Recent developments in the understanding of the human microbiome have led some to question the ability of probiotics with one or two strains to influence the microbiome and interest has increased in multistrain probiotics, in the hope that they may have a greater influence on the microbiome. Combining multiple proven strains can provide different, complementary actions in the body, providing multiple health benefits for an individual. Judicious combinations can also provide additive or synergistic benefits, where one probiotic strain can enhance the adhesion or growth of another, through creating favourable alterations in the luminal environment or through direct support such as crossfeeding.1 On the other hand, antagonistic interactions between probiotic strains are also possible, such as competitive growth inhibition, or conflicting therapeutic actions, which reduce the benefit of individual strains.2 While early evidence is revealing probiotic strains do not compete in the capsule or gut, and that overall, antagonistic effects are unlikely, this can only be guaranteed by quality manufacturing processes and extensive testing.

When to choose a multistrain Overall, there is a greater level of evidence for single and simple combinations of probiotics than there is for high strain number probiotic combinations. Metagenics recommends the use of condition-specific single or simple probiotic combinations that have been researched to support the strain and dose used to achieve condition specific clinical effects. Where microbiome restoration is desired, simple probiotic combinations of strains proven to influence composition and diversity are recommended, over attempting to supplement with as many strains as possible. Where multiple therapeutic targets exist and generic gut flora support is desired, a multistrain probiotic that combines a higher number of clinically proven strains at clinically trialed doses is therapeutically valuable.

Beyond industry standard Metagenics can confirm the strain combinations found in our probiotic formulas do not negatively interact due to the absence of moisture and heat in the capsule or powder. Metagenics’ raw materials are freeze dried and stored at -20˚C and employ unique technology to ensure that our probiotics are not exposed to moisture. This ensures our strains are not interacting in formula. Testing of strains before blending, as well as testing bacterial quantities immediately after encapsulation, and at the end of the product shelf life, gives Metagenics absolute confidence in the quality and potency of our probiotic formulas.

Research

Bites

Healthy gums for a healthy mind. Keeping your gums healthy offers more than a dazzling smile, it may help you maintain a sharp mind as well. Researchers compared brain samples of people with and without Alzheimer’s disease (AD), discovering higher concentrations of Porphyromonas gingivalis, a bacterial organism involved in chronic periodontitis, in the brains and cerebrospinal fluid of AD patients.5 Additionally, toxic proteases from the bacterium (known as gingipains) were also identified, suggesting that that P.gingivalis may play a role in the pathogenesis of AD. Dental hygiene habits may be key for a bright mind in the golden years.

7


C ASE STUDY

Functional insights into constipation with MetaBiome™ testing How the MetaBiome™ Microbiome Sampling Kit can provide comprehensive, functional insight into a patient's gastrointestinal symptoms.

A

33-year-old female presented to the Metagenics MetaBiome™ Research Clinic in early 2019 with constipation dominant irritable bowel syndrome (IBS-C), which she had been struggling with for the past 25 years. “I often wonder where all my food goes, I eat a lot, but the stools I pass are so small - sometimes the stool builds up so much that when I do go, I can fill up the whole bowl”. The patient was passing small, hard lumps two to four times per week. “I strain and struggle to get the tiniest bits out”. She suffered from daily bloating, rated as 7 to 8/10, and experienced noticeable foul smelling flatulence four times per week. Concomitant symptoms included mild acne around her chin and neck that flared periodically.

A window into gastrointestinal health To understand how the patient’s microbiome was contributing to her symptoms, a swab of her stool was taken using the non-invasive MetaBiome™ Test Kit, which utilises metagenomic sequencing to gain compositional and functional insight into the microbiome. Relevant parameters from the patient’s reports are described below, with specific microbiome changes detailed in Table 1. MetaBiome™ Score: An indication of overall gut health based on the eleven categories (promoters/reducers of health) within the MetaBiome™ report.

Markers with the potential to reduce health: Hexa-acylated Lipopolysaccharide (hexa LPS): Lipopolysaccharides (LPS) are an important component of the cell wall of many bacteria, but when these bacteria die, the LPS is released into the gut where it can be proinflammatory, particularly hexa LPS. Hydrogen sulphide production: High levels of hydrogen sulphide can disrupt the gut mucus barrier. This gas is also responsible for the rotten egg smell of flatulence. B. fragilis toxin production: This toxin can cause symptoms such as diarrhoea, while other

people can remain symptom free. This toxin may also cause intestinal inflammation. Methane: Produced by enteric bacteria, methane slows intestinal transit and augments small intestinal contractile activity. This can be associated with IBS, in particular with constipation-predominant individuals. Excessive gas retention causes functional symptoms such as belching, flatulence, bloating, and pain. Escherichia coli: The harmful strains can produce pro-inflammatory compounds (particularly hexa LPS) and toxins that cause infection and diarrhoea.

Table 1: Key MetaBiome™ results from baseline and post-treatment samples. Reference Range

Baseline Score

Post Treatment Score

100

70

90

Improvement of overall microbiome health.

0% - 0.73%

1.1%

0%

Reduction of B.fragilis and E.coli therefore reduction in hexa LPS. Overall reduction of gut inflammation.

Escherichia coli

0.00%-0.33%

1.10%

0%

Not detected in final report due to antimicrobial treatment.

Hydrogen sulphide production

1.03%-5.55%

8.9%

6.5%

Reduction of inflammation and improved mucosal integrity. Improvement in flatulence. Not detected in final report due to antimicrobial treatment.

Key Markers MetaBiome™ Score Hexa-acylated Lipopolysaccharide

8

Interpretation

B. fragilis

0%-0.16%

0.1%

0%

Methane

0%-0.15%

0.27%

0.33%

Longer treatment is required to improve this marker due to long standing constipation.

Methanobrevibacter_A smithii

0%-0.19%

0.27%

0.25%

Reduction in methane producing bacteria, with subsequent improvement in constipation.


Short interventions can make a big difference!

MetaBiome™ testing provides compositional, but more importantly, functional insight into how the microbiome is contributing to patient symptoms.

Methanobrevibacter_A smithii: Elevated levels have been observed with constipationpredominant IBS, diverticulosis, and multiple sclerosis.

Markers with the potential to promote health: Butyrate production: Butyrate is the main fuel source for gut cells and helps to keep the gut cell barrier intact, reduce inflammation, control appetite, and stimulate the production of serotonin from gut cells. Fibre degradation: Fibre-consuming bacteria are responsible for producing important by-products such as short chain fatty acids. Microbial diversity: The different type and amounts of species in a sample. High microbial diversity is associated with good health. Akkermansia muciniphila: Mucus turnover is a normal part of gut function, with this species playing an important role in regulating mucus turnover. By living in the mucus layer, it prevents potentially harmful bacteria from colonising this space through competition.

At the conclusion of just four weeks of treatment of the Metagenics Gut Pathogen Elimination Detoxification Program, “it is much easier to pass a stool now, and I am not straining as much - I notice that my stools are bigger”. Her stool was less compact and had increased in size. Bloating frequency reduced from four days per week to two days per week, with severity reducing from 7 to 8/10 to 4/10. Her flatulence was also less offensive due to the reduction in hydrogen sulphide production. Additionally, she saw some improvement in her acne, due to an improvement in overall digestive health. The MetaBiome™ results indicate a reduction in pathogens resulting in an overall improvement in gastrointestinal inflammation and mucosal integrity, with subsequent reduction in her symptoms. There were no significant changes to her beneficial markers post treatment, demonstrating the Gut Pathogen Elimination Program targets unwanted pathogens, while supporting changes towards a healthy microbiome.

Key clinical take-homes: • MetaBiome™ testing provides compositional, but more importantly, functional insight into how the microbiome is contributing to patient symptoms. • Significant improvement in digestive symptomology can be seen within a relatively short period of time (four weeks). • In this case, methanogens are likely a driving factor underlying this patient’s long-standing constipation, ongoing treatment is required to see a reduction in methane producing species as archaea species are harder to eradicate.

Caring for the world’s oldest living culture $2000 worth of supplements donated to reawakening the Yolngu way of life through Action Learning: A lived experience of what it means to have a healthy body. Metagenics proudly support Hope For Health in their mission to help transform Indigenous Health, one retreat at a time. 9


FA Q

FAQ Frequently asked questions of our Clinical Support Team.

Q: What contaminants are Metagenics fish oils tested for?

Heavy Metal Contaminant Levels

0.8

materials, which includes omega-3 raw materials for the EFAs range.

Q: Are Metagenics products non-GMO?

Sum of Dioxins, Furans, Dioxinlike, PCBs (200+ Different Forms)

None Detected

0.01

25 20 15 10 5 0

<0.5

Milliequivalents per Kilogram

4 0.63

Pictograms per Gram

6

0

A: Metagenics standards mean we will not accept irradiated raw

Arsenic

30

8

2

Cadmium

Oxidation Freshness Indicators

10

A: During manufacture and bottling, the Metagenics team of experts

Q: Are Metagenics products tested for radiation?

Lead

Environmental Contaminants

Q: How does Metagenics minimise oxidation?

carefully handle the fish oil in our temperature-controlled facility. The oil is processed in a time critical manner to minimise exposure to environmental factors such as air, heat and light. For added protection, the oil is transported in nitrogen flushed vats and stored in nitrogen flushed bottles (twice-nitrogen flushed), a process whereby nitrogen is used to displace oxygen that may cause the oil to oxidise over time.

Mercury

None Detected

0

0.02

0.2

0.005

0.4

None Detected

0.6

0.02

represent the highest technology in purified fish oil. Our omega-3 fatty acids undergo an additional purification process known as molecular distillation to remove contaminants. Heavy metals and other environmental contaminants including persistent organic pollutants (POPs) such as dioxins, furans and dioxin-like PCBs, are all screened for and removed from Metagenics omega-3 fatty acids. Our purification processes ensure our omega-3 oils are not affected by contaminants such as phthalates, as well as over 200 pesticides. Metagenics omega-3 fatty acids surpass Australian standards for acceptable levels of contaminants (Figure 1), so you can be confident your patients are receiving the purest omega-3 fatty acids on the market.

Parts per Million

1

A: The Metagenics range of concentrated omega-3 fatty acid formulas

Anisidine

Peroxide

Australian Standard

A: Metagenics ingredients are not derived from GMO materials. We will

Metagenics Manufacturing Standard

not accept GMO raw materials.

Metagenics Batch Testing Results 2019 Figure 1: 2019 Batch test results for High Purity, Low Reflux, Concentrated Fish Oil.

TOTOX - is a calculation of the anisidine and peroxide vaules as tested in Metagenics fish oils Purification of 200+ pesticides Purified to remove plasticisers (phthalates)

Research

Bites

Resveratrol reverses uterine fibroid growth. Making headlines in womenâ&#x20AC;&#x2122;s health is the revolutionary compound, resveratrol, which has been shown to shrink uterine fibroids. In an animal study, researchers examined the effects of resveratrol on fibroid size, at a dose of 10 mg/kg twice weekly (equivalent to 700 mg twice weekly in a 70 kg human). After four weeks of treatment, a significant reduction in fibroid size and volume was observed in the treatment group, compared to controls.1 In addition to reducing fibroid growth, resveratrol effectively reduced proliferation markers - indicative of the shrinkage of the benign uterine tumours. Reaffirming the effects of powerful polyphenols in abnormal tissue growth, resveratrol steps in the fight against female fibroids.

10


In the news

Parex contains herbs to help maintain healthy intestinal microbial balance, and help rid the body of parasites and intestinal worms, as used in traditional Western herbal and Traditional Chinese Medicine. Parex includes carminatives, as used in traditional Western herbal medicine, to help decrease the symptoms of dyspepsia and indigestion. Store below 30°C. Do not use if cap and/or bottle seals are missing or broken.

?

• Herbal preparations: The herbal input amount (weight of herbal material used to make the extract) is now also required to complement the herbal extract amount e.g. Juglans nigra (Black walnut), fruit hull dry extract 100 mg, equiv. to fresh hull 1.0 g (Figures 1 and 2). • Minerals: The active ingredients and amount of elemental mineral will be clearly stated. • Change in how dosages are expressed: ‘Per tablet’ rather than ‘Each tablet contains’. • Pregnancy warnings for certain ingredients. • Vitamin A and its derivatives will be expressed in terms of microgram retinol equivalents (microgram RE). • The definition of ‘allergen’ has been broadened to include fish, crustaceans, egg, soya bean/products, and residual antibiotics, amongst others. • Labels will clearly indicate if medicine is a homeopathic medicine. Updating labels is yet another way that Metagenics is meeting appropriate standards of quality, safety and efficacy, and supporting the quality use of medicines. These actions help maintain a responsible and viable Natural Medicine industry to the benefit of Practitioners and patients alike.

?

Each tablet contains: Extracts equivalent to: Punica granatum, fruit peel dry (Pomegranate) Artemisia annua, herb dry (Sweet wormwood) Juglans nigra, fruit hull fresh (Black walnut) Nigella sativa, seed dry (Nigella) Commiphora myrrha, gum oleoresin dry (Myrrh) Peppermint oil

Parex

Antiparasitic, Antimicrobial and Anthelmintic Herbs for Dysbiosis.

?

3.3 g 2.0 g 1.0 g 1.0 g 1.0 g 25 mg

Directions for use: Adults: Take 1 tablet three times daily with food, or as directed by your healthcare professional. If symptoms persist consult your healthcare professional.

50 Tablets Dietary Supplement 9315771010723

AUST L 298288

Metagenics Australia 741 Nudgee Road, Northgate, QLD 4013 Australia metagenics.com.au

0001

Following the philosophy of continuous improvement, the Therapeutic Goods Administration (TGA) has once again prompted change – this time focussing on product labels. With the implementation of Therapeutic Goods Order No. 92 (TGO 92), this will affect labels of non-prescription medicines including Metagenics listed products. Registered medicine labels don’t miss out either, and these too will be subject to change, with the ultimate purpose to facilitate the quality use of medicines by health professionals and consumers. By making it easier to identify important information about the product and its active ingredients, new labelling will improve safety and effectiveness of product use, minimising the risk of prescribing errors and enhancing patient safety (e.g. by avoiding confusion or inappropriate use of medicines). As all labels must conform to TGO 92 from 1st September 2020, you will soon begin to notice the newly formatted labels, which will look subtly different, though content will be very similar to current labels. Here are some of the differences you can expect to see: • The brand and product name on the label will clearly match that registered on the Australian Register of Therapeutic Goods. • In products with single ingredients, the product name and active ingredient will appear together on the main label; any key words describing the product will be listed below.

?

L-1408/0218

Label changes: A clear focus on patient safety

?

PRACTITIONER ONLY

Store below 30°C. Do not use if cap and/or bottle seals are missing or broken.

Each tablet contains: Peppermint oil 25 mg Dry herbal extracts: Punica granatum (Pomegranate), fruit peel 66.7 mg Derived from dry fruit peel 3.3 g Artemisia annua (Chinese wormwood), herb 100 mg Derived from dry herb 2.0 g

Parex Antiparasitic, Antimicrobial and Anthelmintic Herbs for Dysbiosis.

Juglans nigra (Black walnut), fruit hull 100 mg Derived from fresh hull 1.0 g Nigella sativa (Nigella), seed 66.7 mg Derived from dry seed 1.0 g Commiphora myrrha (Myrrh), gum oleoresin 100 mg Derived from dry gum oleoresin 1.0 g

Directions for use: Adults: Take 1 tablet three times daily with food, or as directed by your healthcare professional. If symptoms persist consult your healthcare professional.

50 Tablets Dietary Supplement 9315771010723

Figure 2: New product label – Parex.

PRACTITIONER ONLY

AUST L 298288

Metagenics Australia 741 Nudgee Road, Northgate, QLD 4013 Australia metagenics.com.au

L-1408/0719

Parex contains herbs to help maintain healthy intestinal microbial balance, and help rid the body of parasites and intestinal worms, as used in traditional Western herbal and Traditional Chinese Medicine. Parex includes carminatives, as used in traditional Western herbal medicine, to help decrease the symptoms of dyspepsia and indigestion.

00000001

Figure 1: Current product label – Parex.


CLINICAL RESOURCES

Clinical resources CIRS and biotoxin questionnaire Chronic inflammatory response syndrome (CIRS) is a progressive, multisystem, multi-symptom illness caused by an aberrant immune response to certain biotoxins. The most common source of biotoxin exposure are moulds from water damaged buildings (WDB). This is particularly concerning given that an estimated 40% of Australian residential buildings are water affected, and the notorious ‘leaky homes crisis’ in New Zealand still affects tens of thousands of buildings nationwide. While fatigue and muscle aches are the most frequently experienced symptoms, CIRS typically impacts multiple systems; it is not uncommon for patients to experience respiratory, gastrointestinal, neurological and musculoskeletal involvement. Approximately 24% of the population carry genes which make them susceptible to developing CIRS, so it pays to be vigilant of this condition when assessing complex cases. However, due to its heterogeneous, multisystem presentation, CIRS can be difficult to identify and differentiate from other conditions with similar symptom pictures. The Metagenics CIRS and Biotoxins Questionnaire is a free, validated tool which uses symptom clusters to give Practitioners a sensitive and accurate assessment of whether a patient has been affected by biotoxins. This questionnaire can be used to screen patients before testing biomarkers and their home, work, or school for mould contamination.

Where to download: log onto metagenics.com.au > Clinic Tools > Downloads > Questionnaires > CIRS and Biotoxin Questionnaire

Healthy Home Healthy Family – Is where you live, affecting your health? Could your home or workplace be making you sick? Healthy Home Healthy Family highlights the impact of health hazards in the built environment and other modern-day exposure risks. Author, Nicole Bijlsma, an expert on environmental health, has packaged over 15 years of research into one informative resource. Delving into various topics, such as the impact of allergens (mould), chemicals (toxicants), electromagnetic fields (EMFs), building/renovations, and drinking water on health. Nicole explains why we need to act now to create a healthier environment, and provides simple, practical solutions and checklists to assess your home and reduce exposure. Nicole sold 100 books in 30 minutes at the Metagenics 2019 International Congress on Natural Medicine, “providing clinicians with the knowledge and skills to diagnose and treat patients with environmental sensitivities”. This book is a must read and an excellent resource for both you and your patients. Healthy Home Healthy Family can be purchased from Nicole Bijlsma's website: www.bulidingbiology.com.au

Electromagnetic Fields (EMFs): Noxious or Nocebo? With Nicole Bijlsma In this podcast, Nicole joins Nathan Rose, Metagenics Clinical Education Manager, to discuss the sometimes controversial subject of electromagnetic field exposure. What are the greatest sources of EMFs? How do they affect our physiology? How can we help to minimise EMF exposure and build resilience?

12Access the Metagenics Clinical Podcast on the

Metagenics website, iTunes or Spotify

12


PRODUCT ANNOUNCEMENTS

Product announcements Pregnancy Care Advanced Specialised Nutrition for Preconception, Pregnancy and Lactation. Contents: 60 capsules (30 days) Order Code: PCA Wholesale: $22.40 excl. GST (AUS) / $25.80 excl. GST (NZ) Directions: Take 1 capsule twice daily with food for at least one month before conception, during pregnancy and lactation.

Each vegan capsule contains: Choline bitartrate Equivalent Choline Lutein Potassium iodide Equivalent Iodine

1 Cap 167 mg 69 mg 1 mg 195.5 μg 149.5 μg

2 Caps 334 mg 138 mg 2 mg 391 μg 299 μg

For the full list of ingredients, contact Clinical Support on 1800 777 648 (Australia) or 0508 227 744 (New Zealand) or visit metagenics.com.au or metagenics.co.nz

Ultra Flora Baby Care Digestive System Health and Beneficial Intestinal Flora. Contents: 50 g oral powder (17-35 days) Order Code: UFBC Wholesale: $26.05 excl. GST (AUS) / $29.95 excl. GST (NZ) Directions: Infants (from birth) and children to 12 years: Take ½ metric teaspoon (1.4 g) once daily. To restore gut flora: Take ½ metric teaspoon (1.4 g) twice daily.

Each dose (1.4 g) contains: Lactobacillus rhamnosus (LGG®) 6 billion CFU (organisms) Bifidobacterium animalis ssp lactis (BB-12®) 5 billion CFU (organisms) Bifidobacterium longum (BB536) 2.5 billion CFU (organisms) Bifidobacterium breve (M-16v) 2.5 billion CFU (organisms)

MetaPure Algal Oil High Purity, Sustainably Sourced, Vegan DHA and EPA. Contents: 60 tapioca-based softgel capsules (30 days) Order Code: ALG60 Wholesale: $35.45 excl. GST (AUS) / $40.80 excl. GST (NZ) Directions: Take 1 capsule twice daily with food.

Each capsule contains: DHA/EPA rich Schizochytrium algal oil Equivalent Docosahexaenoic acid (DHA) Equivalent Eicosapentaenoic acid (EPA)

962.7 mg 300 mg 150 mg

MetaCholine Vegan Choline for Healthy Pregnancy, Brain Function and Liver Health. Contents: 90 capsules (VegeCaps) (30-45 days) Each capsule contains: Order Code: CHOL90 Choline bitartrate (VitaCholine™) Wholesale: $15.45 excl. GST (AUS) / Equivalent Choline $17.80 excl. GST (NZ) Directions: Adults: For pregnancy support and foetal brain development: Take 2 to 3 capsules daily. For brain function, cognition and liver support: Take 3 capsules daily.

548 mg 225 mg

For more information on the above announcements, please contact our Clinical Support Team on 1800 777 648 (Australia) or 0508 227 744 (New Zealand).

13


BEST PRAC TICE

Is it time to rebrand? How do you know and how do you do it?

H

ave you ever considered rebranding your business? Why would you want to rebrand? What is involved? What are the benefits? What are the risks? These are all important questions to ask yourself if you are considering a rebrand. In this article, we explore all of these questions to help you make the important decisions when it comes to the future of your business face and message.

A brand is more than a logo. A brand is the way in which a company, organisation, or individual is perceived by those who experience it. Because it’s intangible, a brand isn’t easily defined. Brands live in people’s minds. They live in the minds of everyone who experiences them: employees, investors, the media, and, perhaps most importantly, consumers. Simply put, brands are perceptions.1 What is the goal of rebranding and how do I know if I need to rebrand? Greg Liberman, Chairman and CEO of Spark Networks states the goal of rebranding is “…to strengthen your brand’s message and allow it to evolve”. Although rebranding can do many things, Liberman emphasises “…it should support your core message while connecting with your audience in a new, authentic way.” Think about it, at various times in our lives we rebrand ourselves with a wardrobe change, a new hairstyle or colour, new furniture, or a new car. We improve our diet, take on a new exercise regimen and read new books for our own personal growth. This seems natural and necessary. We get a freshen up, a new look that expresses our identity and sends an outward message of who we are, our values and the type of tribe we belong to and wish to attract. Do you think then, perhaps, it is time your business went through a similar process to grow and flourish? If you are not sure, here are four signs that it is time for a rebrand.

14

1. The direction of your business has changed. In the Natural Healthcare industry, the majority of us start out in practice as generalists. We can, and do, manage everything from the top of the head to the tips of the toes. We brand ourselves accordingly (though, often unwittingly). After several years of experience we start to identify what we like and what we are good at. We may tell people that this is our niche, we may ask for referrals and write blogs on the topics, but does your brand reflect your niche? If you really want to focus on your favourite areas of health, but are constrained by being known as a generalist, it is time to rebrand so your speciality is clearly associated with you. 2. You are attracting the wrong kind of clientele. When your brand is strong, clear and directed, it sends a message to the type of patients you want to attract. Your brand tells a story, sending a message to your ideal patient that you are there for them. Your brand will attract both the demographic and psychographic (the way people think and feel) you want to attract to your practice. You also need to rebrand if you are not attracting your ideal patient. For instance, you want to attract tired, stressed professional females juggling families and work, but you find you are attracting scattered university students who don’t have the means to pay you and can’t afford the foods you recommend for their health. Look at the wording you are using in your messaging, the look and feel of your marketing and social media. Speak to who you want to attract in their words. 3. Your brand is outdated. Vintage clothing is fashionable and antiques are collectables, but this does not apply in business. Businesses, especially since the rise of the internet and online platforms, must stay contemporary in their look, their message and the way they do business. It is expected. People are now conditioned to have a short attention span and will move on to the next Practitioner if you don’t satisfy their need for variety. You may not need to do a full rebrand; a refresh may suffice. Either way, a change is needed so you look contemporary, current and up to date with market needs and expectations. 4. Your brand no longer services your patients. Yes, you are there to service your patients, but the numbers seem to be dropping off and the repeat business isn’t what it used to be. Are your appointments too long? Not long enough? Do you take too long to get back to them? Are you not available outside 9 am to 5 pm hours? Do they want to book in online and this is not available? What modern conveniences do you offer? Do you expect too much change in a short time? Do your clients need more hand-holding than you are willing to give? What we do and how we do it, the services we offer and the support we provide are all part of our brand story. So, is it time to rebrand?

Your brand tells a story Do you remember being told stories as a child? We love stories. They are a major way that we learn and relate. Your brand tells a story about you and how you can help. What story is your brand currently telling? To illustrate this point, consider the movies. There are many genres of film. Romantic comedies, scary movies, documentaries, action movies, suspense thrillers, dramas, period movies, marvel comic, sci-fi and so on. Each tells a story of their own and each movie, with its different story, fits into its specific genre. Each of us has our own favourite genre of film. We also choose the films we watch by how we are feeling and what our needs are at the time.

Our brand is like a film genre that will appeal to and attract certain people. As a Practitioner, our brand tells a story that helps attract the patients who need what we offer, who will be satisfied by our story. You may think of your brand like the movie trailer that reaches out and gives an insight to those who view it. If it is what they are seeking, they will go see the movie. If your brand is what your patients are seeking, they will come see you.


BEST PRAC TICE

Not to be taken lightly If you have decided your business needs a rebrand, be mindful it takes careful consideration and meticulous work to get right. It is not as simple as a change of clinic and business card colours or a new logo. But don’t let this put you off! Getting your rebrand right can have innumerable benefits to your business growth. The first step is to put yourself in your clients’ shoes. How do they think? How do they act in line with your brand? How do you service them?

Rebrand in a professional way Clarify your brand’s message The first step is to get clarity about who you are and what your business offers. You will need to research and brainstorm who you are as a brand and how you want to translate this to your clients. What is your niche? What do you do and not do? Who is your ideal patient? What will you do to change their lives? Once the brainstorming is done, get specific. How can you drill this down? You may need to come back to this several times. Each time with fresh eyes. Write down keywords that describe your business so you can compare who you are now to who you were before. This will help you see the changes you need to make with your clients. If you were your own patient what would you want out of your business? What would you want to gain? Identify your ideal patient The next step is to identify how your ideal patient thinks so you can attract them by building your brand around the qualities they are looking for. When you are working on creating your new brand identity, don’t use anything your clients can’t relate to, as it may distort the services you offer and relay the wrong brand message. All brand design should be based on your ideal patient and their tastes. Note their tastes, not yours. Therefore it is vital to identify the psychographics of your ideal patient. Who do you want to work with? How will your ideal patient benefit? How can you differentiate who they are? Identify how your patient thinks and feels. As an example: “I don’t have enough time in the week to eat healthily and exercise. I don’t have the energy to do this anyway and I don’t even know what healthy really is. I am over not sleeping properly and can’t lose this weight!” Now, write a few simple sentences that define your brand and what you do to solve your ideal patients’ problems. Write them in a clear

People don’t want what you offer; they want a better version of themselves. Show them how you will benefit their lives through the movie trailer that is your brand.

way, avoiding the use of confusing, ambiguous words; just let it flow. At this stage, go on to your website and social media platforms and do an audit. What needs to be updated? How can you represent who you are and what you do through your content, words, tagline, logo, site heading, and the descriptions on your social media platforms? Hone your services The third step is to make your services distinct. Consider the following: do you offer packages for each service you provide? How do your consultations run? What do you offer? Break down exactly what it is you offer and use short phrases with relevant branded imagery. When your services are accurately conveyed, your existing and potential clients will feel comfortable and engage with you. They are also more likely to refer your services to others. Engage your clients Tell your story that serves to engage your ideal patient and/or conveys a clear message of how you are the best Practitioner for their needs. You may consider how you became a Practitioner; why you are interested in your area of speciality; your experience; how you live your life in alignment with your healthy values. Be relatable and try to portray your brand in a candid and personable way that will draw your audience in and, at the same time, keep a professional, modest front. Reshape your brand’s face In marketing, the saying ‘you can’t judge a book by its cover’ doesn’t have legs. If you don’t like the cover, you are not going to buy

it. As an artist changes perspective by painting close into the canvas and then stepping back to see the whole – you also need to consider every single thing that your ideal patients will rest their eyes upon. This is the fun part, this is the where you get to design your logo and colours; the design aesthetic of your brand. Are you reaching and engaging your ideal patient? When looking at all aspects of your brand; your website, clinic, social media and so on, ask yourself these questions. Does my brand identity clearly illustrate: • My brand’s message and ethos? • My ideal patient and clientele? • The services I offer?

Go forth and rebrand When you have planned your rebrand, don’t forget to communicate your rebrand in a launch process. You will need to let your current customer base and your community know about your rebrand so they can recognise the new you and are engaged. This can be a great opportunity to reconnect with your past patients and re-ignite interest in your practice. Your brand tells your story, so make sure you’re sending the right message to attract your ideal clients! Now, go make it happen!


KEY CLINICAL CONCEPTS

Measuring the microbiome The advantages of metagenomic sequencing as a method of measuring the microbiome in clinical practice.

Written by LAURENCE KATSARAS Clinical Resources Manager

A new lense helps us see more clearly Ever since Hippocrates claimed that the gut is the origin of disease, Naturopaths and Functional Medicine Practitioners have been supporting the influence the gut has on systemic health. Although these gut-health interactions may have been well accepted by Practitioners, science was slow to accept the connection. As research of the microbiome began to emerge it was hoped that by identifying the microbial communities, we would at last be able to demonstrate how the gut impacts health. However, initial research struggled to find specific correlations between microbial composition and systemic pathology. Thanks to accumulating evidence and developments in technology, we have begun to understand the cross-over effects of certain species and the greater importance of the functional output from microbes as they are more influential on different states of health and disease. Research now shows that the function of metabolites produced by the microbiome can directly affect immune, cardiometabolic, neurological and bone health, as well as supporting basic physiological

processes such as digestion and energy harvest from food, nutrient production, drug metabolism and tissue repair (Figure 1). By utilising the latest technologies, we are able to evaluate the microbiome’s functional metabolites as well as the composition. This emerging frontier provides more accurate insights into our patient’s microbiome and gut health, which can help refine our clinical interventions to enhance patient outcomes.

It’s not what you’ve got, it’s how you use it One of the earliest learnings from the Human Microbiome Project was that there is no ideal composition and that the accumulation of microbes within each person’s digestive tract is as unique as they are. However, while varied in composition, everyone’s microbiome should produce the same health promoting functions. This phenomenon known as ‘functional redundancy’ has shown that despite vast differences between compositions, similar functions can be performed by the microbiome as the same metabolites are produced by several species of microbes. For instance, a key function of the microbiome is the fermentation of short chain fatty acids (SCFAs), which serve to fuel and maintain gut barrier integrity, stabilise pH, detoxify LPS endotoxin, regulate energy and liver

Modulation of bone-mass density Protection against epithelial injury

Promotion of fat storage

Resistence to pathogens

Promotion of angiogenesis

BACTERIA Development and training of the immune system

Breaking down food compounds K

Modification of the nervous system

B12

Metabolism of therapeutics Figure 1: The role of gut microbes on systemic physiology.3

16

Biosynthesis of vitamins and amino acids

metabolism, and set systemic inflammatory tone.1 Therefore, the presence of SCFAs, especially butyrate, is critically important for gut and immune health, however there are numerous species of bacteria that have been noted to produce SCFAs. Thus, knowing an individual’s microbiome composition may act as a proxy marker for SCFA levels, but measuring their genetic metabolites provides us with a more specific assessment of their SCFA status. It is these metabolites that are of particular interest when assessing an individual’s microbiome. Focus should be placed on the functions the microbiome performs, compared to what microbes it is composed of, in order to determine how healthy a microbiome is and how it may contribute to health or disease.

Methods of measurement Over the years of microbiome research there has been different incarnations of technology that have allowed us to monitor the microbiome. In clinical practice, there are four main methods available. Each provides their own benefits, but for a functional assessment of microbiome and gut health and how this can impact general physiology, metagenomic sequencing offers distinct advantages. Culture-based methods: Use a growth medium that contains nutrients to culture the microbes from the stool sample. The medium used will dictate which microbes are able to be cultured, as different microbes require different nutrients to thrive. As such, culture-based methods are unable to provide an accurate reflection of all microbes present. They are however, able to identify the presence of bacteria even if it is only present in the sample at very small amounts. Although, considering the medium acts as an amplification of the bacteria, culture-based methods are unable to provide a quantitative assessment of the bacteria it detects. PCR-based methods: Polymerase chain reaction (PCR) testing methods extract the DNA from the faecal sample and probe it to identify the tag of a specific bacteria or pathogen. This probing is only carried out for specific microorganisms within the sample and as such cannot provide a complete compositional analysis. Therefore, the spectrum of organisms that can be detected via this method is limited to only a small number of


KEY CLINICAL CONCEPTS

species. However, the method provides high detection sensitivity of specific organisms and if quantitative PCR is used, can also provide a measure of the abundance of detected organisms. PCR 16s-rRNA gene sequencing: 16s ribosomal ribonucleic acid (rRNA) sequences a small portion of a single gene found on bacteria. This acts as a fingerprint to identify known bacterial groups but is very similar amongst species, so can only identify down to the genus level. Considering there may be 100 species within any genera, there is no way to determine the health impact of that genus nor its functional metabolites. Likewise, as the method is screening for identified tags of known bacteria, it is unable to detect unclassified bacteria, or other organisms that can be present in the microbiome such as fungi, protists and viruses. It is also important to consider that different labs will use different regions of the gene portion and as such the method is not reproducible across labs. Metagenomic sequencing: Is the latest technology available and provides the broadest and most detailed picture of all microorganisms within the microbiome. From a faecal sample, metagenomic sequencing takes in all the genetic material of the gut microbiome. It accurately identifies microorganisms down to the species level; rather than the genus level as many tests currently do, and it looks promising to facilitate strain level detection within the next year. This screening technology is not just limited to detecting known bacteria, but is able to sequence undefined bacteria which will provide valuable insights as more is learnt about them. Likewise, it can accurately sequence genes for all microorganisms and detect levels of viruses, fungi, archaea, protists and parasites, which are just as influential as their bacterial counterparts. This methodology extends beyond compositional analysis to also include functional capacity of the microorganisms present and records their produced metabolites. This provides an understanding of the functional health of the microbiome and its potential to influence the patient’s physiology. As such, metagenomic sequencing is the most reproducible, accurate and comprehensive DNA sequencing method of the microbiome that not only provides an assessment of ‘who is there, but also what they are doing’. 2

Clinically directive reporting The MetaBiome™ report is scientifically validated and clinically orientated to help direct therapeutic interventions. Through metagenomic sequencing the test is able to comprehensively analyse the genes from each microbe and the metabolites they produce, capturing the functional capacity

of the microbiome and how it is contributing to an individual’s health. The metabolites and microbial species are grouped according to how they will impact different body systems and each system is scored with a percentage of markers within healthy range. Body systems reported on include, immune function, inflammatory balance, metabolic health, detoxification and gut health; which is further divided into general gut health, gut mucosal health and gut motility. This functional reporting easily prioritises if a system is below optimal health from a microbiome perspective, and if treatment should initially focus on the gut or systemically to improve health.

MetaBiome™ Score: Beyond the assessment of the various body systems, the report also provides an indication of the overall health of the microbiome. Based on 11 of the most scientifically validated microbiome markers that have been shown to promote health, the score provides an easy snapshot of functional capacity of an individual’s microbiome and how this is contributing to their state of health.

Microbial diversity: Recognised as one of the most important markers in microbiome health. Microbial diversity reports on the evenness and richness of the microbiome; the number of different microorganisms and the amount of each of them present in the

microbial composition. Specific high-fibre foods are also suggested to enhance this parameter as a greater diversity has been clearly associated with health. Metabolites: Various metabolites for each body system are included throughout the report. Some key metabolites include butyrate, indolepropionic acid (IPA), hexalipopolysaccharides, trimethylamine, ammonia, hydrogen sulphide, and human DNA, to name a few. Their beneficial or detrimental effects are explained in detail alongside dietary and lifestyle suggestions to bring them into healthy range, as specific metabolites directly impact the health presentation of the patient. Complete microbiome profile: Beyond the systems-based functional approach of the report, the complete microbial composition at the species level is outlined with levels of each species and its function detailed alongside the expected normal range and whether it is high, average or low comparatively. Microbiome fuel: Identifying the absence of health-promoting bacteria is one thing, but thankfully the report also provides prescriptive advice. Foods that are most indicated for the individual, based off which beneficial bacteria were detected below optimal amounts, and lifestyle habits that can help enhance their growth are specified. Furthermore the recommendations are able to be filtered by allergens or intolerances such as FODMAP friendly, gluten-containing foods and peanuts, for ease of dietary customisation for the patient.

Master microbiome testing for better patient outcomes The latest generation of microbiome testing available through MetaBiome™ can provide clinically valuable insights into your patient’s microbiome and help prioritise improvements in gut health to support systemic physiology. For more information, or a sample report, contact the Clinical Support team on 1800 777 648 or 0508 227 744.

17


FOOD FOR THOUGHT

Meaty issues in the Australian diet How strong is the cancer link?

Written by DR TIM CROWE BSc(Hons), MNutrDiet, PhD

In 2015, the World Health Organization released a report into how likely red and processed meats are to cause cancer. The Internet promptly exploded with headlines proclaiming: ‘How your steak is giving you cancer’ and ‘Bacon is as bad for you as smoking’. Taking a step back from the attentiongrabbing headlines, the real substance of the report was much less alarming, especially when put into context of all the positive diet and lifestyle habits that can reduce cancer risk. The meat and cancer report that generated so much public interest was prepared by the International Agency for Research on Cancer (IARC) – a group comprised of 22 experts from 10 different countries.1 The IARC serve to help guide advice on food and health given by the World Health Organization. The IARC concluded that processed meat and likely red meat are a cause of colorectal cancer. Colorectal cancer is the second leading cause of cancer death in Australians, so the findings rightly did garner a lot of media interest.2 Context here is key though. What the IARC was not saying was that if you eat a single sausage you are a candidate for cancer. What they were warning about was that if processed meats were a daily feature of your diet, your risk of bowel cancer would go up. To put the risk in context, for every 50-gram portion of processed meat eaten daily (about two slices of bacon), this increases the risk of bowel cancer over a lifetime by 18 percent. The IARC report though did not exist in a vacuum. For well over 10 years, the link between red meat, especially processed meat, and colorectal cancer has been well described. Peak cancer bodies such as the World Cancer Research Fund and the Cancer Council Australia have recommended people eat less red and processed meats for exactly the same reason.3,4 So the IARC report was more a reframing of evidence rather than a presentation of a new scientific finding.

What is meant by red and processed meat? It may seem obvious what red meat is, but some white meats also count as red meat. Confused? Red meat is considered the muscle flesh that comes from cattle, sheep, pigs and

18

goats. Pork looks white when it is cooked, but it is typically red when raw because of its high haemoglobin content. Fish and poultry though are not part of the red meat family and were not linked to cancer by the IARC. Processed meat, on the other hand, is any type of meat (including poultry) that has undergone salting, curing, fermentation, the addition of additives or smoking to enhance its flavour or improve preservation. Bacon, hotdogs, sausages, ham and salami all belong here.

How strong is the evidence? More than 800 published research studies that looked at the relationship between meat and cancer informed the IARC conclusion. A summary of the findings is shown in Figure 1. For processed meat, it was classified as Group 1 under the IARC classification scheme meaning it is a cause of cancer. The evidence for red meat was ranked one step lower as ‘probably’ causes cancer.

IARC CARCINOGENIC CLASSIFICATION GROUPS Processes meats have been given Group 1 classification

Group 1

Causes cancer

Group 2A

Probably causes cancer

Group 2B

Possibly causes cancer

Group 3

Not classifiable as a cause of cancer

Group 4

Probably not a cause of cancer

INCLUDES Salami

Bacon Sausages & hot dogs

Red meats have been given Group 2A classification Pork

Beef

(Does not include chicken or fish)

Lamb

These categories represent how likely something is to cause cancer in humans, not how many cancers it causes. Figure 1: The level of evidence linking red and processed meat to cancer. Source: Cancer Research UK.


FOOD FOR THOUGHT

Putting the recommendations into perspective

Did you know? The MetaBiome™ Microbiome Sample Kit assesses the prevalence of TMAO-producing organisms within the gut microbiome as well as directly measuring trimethylamine (TMA) as a functional marker of microbiome health. This tool can give you an indication of your patient's ability to produce TMAO and direct therapeutic interventions. Trimethylamine production 0

0.2

0.32

Smoking and asbestos are also classed as Group 1 carcinogens by the IARC. Putting processed meat in the same carcinogen group as smoking explained the alarming news headlines upon the release of the report which declared: ‘Bacon is as bad for you as smoking’. These types of headlines work great for getting website clicks but are very misleading. Just because something is linked to causing cancer, does not mean all substances are equally dangerous. It all comes down to risk. And the risk of developing lung cancer from smoking is far, far greater than the risk of developing colorectal cancer from eating bacon.

Why is it so? Establishing a link between red and processed meat and colorectal cancer is one thing, but the missing piece of the puzzle is what is the mechanism? Several plausible culprits have been proposed. And the common theme among them is the damage they can do to the cells lining the wall of the large bowel. The first candidate is the pigment that gives red meat its colour: haemoglobin. In the gastrointestinal tract, haemoglobin is broken down to a family of chemicals called N-nitroso compounds (NOCs). These NOCs have been found to damage the cells that line the bowel, causing them to divide and replicate more to repair the damage.5 It is this increased cell replication that increases the chance of errors developing in DNA; errors which can be the first step on the road to cancer. Processed meats can have a double-whammy effect because they contain added preservatives that can also form NOCs.6 An interesting side turn here is that eating lots of green-coloured vegetables may lower colorectal cancer risk. The reason for green vegetables being cancer-protective could be from the green chlorophyll molecule which is central to the process of photosynthesis. Chlorophyll is very similar in structure to the animal haemoglobin molecule. Chlorophyll may compete with haemoglobin or help eliminate it from the body before it has a chance to be converted into NOCs.7 A second culprit could be the actual cooking process of red meat itself, especially

grilling or barbequing at high temperature. The cooking causes char to form, which promotes the formation of heterocyclic amines (HCAs) on the surface of the meat. These HCAs have been shown to increase cancer risk, at least in animals.8 One simple way to reduce the formation of these compounds is to marinate the meat first. Think of it as a protective layer on the meat, but with the added bonus of extra taste. Yet another theory is that the iron in meat, so often promoted for its health benefit, could be a candidate for causing cancer.1 Iron is needed for a host of health reasons, but too much of it can place higher oxidative stress (a process not unlike ‘rusting’) on the body, and damage cells lining the large bowel. And finally, over the past several years, research is looking at a chemical made in the gut by bacteria called trimethylamine N-oxide (TMAO). TMAO is a natural by-product made during digestion derived from nutrients such as the amino acid carnitine and choline that are abundant in red meat. TMAO is linked to a higher risk of heart disease, activation of inflammatory pathways and potentially cancer initiation.9 A high fibre diet may promote a more beneficial gut microbiome that can mitigate metabolism of dietary precursors to TMAO. Table 1: Lifestyle factors that can reduce the risk of cancer.11 Lifestyle factor

Cancer(s) where risk is lowered

Fibre

Colorectal*

Wholegrains

Colorectal*

Non-starchy vegetables

Oral cavity*, oesophagus, breast, lung

Physical activity

Colorectal*, breast, oesophagus, pancreas, liver, endometrial

Lactation

Breast*, ovarian

Dairy foods

Colorectal*, breast

Coffee

Liver, endometrium

Fish

Liver, colorectal

Fruit

Oesophagus, lung

*Cancers bolded are where evidence is considered ‘convincing’ or ‘probable’.

With every media story reporting on a new dietary villain that causes cancer, it can make people throw their arms in the air and declare that ‘everything causes cancer, so why even worry about it?’. The constructive message though is that there are many positive lifestyle habits that can lower the risk of a person developing cancer. Table 1, which was developed by the World Cancer Research Fund and the American Institute for Cancer Research, outlines some of these factors.10 Take note of how several of them are strongly linked to reducing the risk of colorectal cancer. When it comes to diet and cancer, it should be no surprise that fruits, vegetables and wholegrains come out on top as being the best cancer-preventing foods. While some foods may be promoted as being more beneficial, there is no one single ‘superfood’ that can prevent cancer; it is a combination of good eating habits and food variety that gives the greatest benefit. Physical activity is now recognised as a potent ‘cancer-preventing’ habit. Estimates link regular physical activity to a 20 to 40 percent lower risk of colorectal and post-menopausal breast cancer, and a potential benefit in lowering prostate cancer risk too. In addition to its cancer-prevention benefit, physical activity plays a large part in preventing heart disease and diabetes, so the health benefits are multiplied.

In summary If someone chooses to eat red meat, there is no reason to now exclude it from the diet, but it should not be an everyday feature. The Cancer Council recommends eating no more than 455 grams of cooked red meat per week and to limit processed meat. Chicken and fish make excellent alternatives to red meat. Or this just could be the perfect time to get on board the #MeatlessMonday trend and have more vegetarian meals in the diet.

Tim Crowe PhD is an Advanced Accredited Practising Dietitian, nutrition researcher and educator with a special interest in nutrition and cancer, and over 25 years of experience. We are excited to announce that Dr Crowe will be presenting at the Metagenics International Congress of Natural Medicine in June 2020, navigating Practitioners through confusing topics such as dietary carcinogens and the use of antioxidants during and around active cancer treatment. Connect with Tim at: www.thinkingnutrition.com.au

19


Your Comprehensive Bioelectrical Impedance Analysis and Business Success System MetaScan™ Bioelectrical Impedance Analysis Can Assess Your Patient’s:

Hydration Levels

Body Fat %

Nutritional Status

Cellular Health

MetaScan™ is Personalised Medicine Learn how the body’s cellular health and composition can provide important insights into the impact of each patient’s diet and lifestyle choices, nutritional requirements, genetics and environment.

Attend the professional MetaScan™ Practitioner Program and you will learn:  ow to use the Quadscan BIA device H in your practice.

 reate and apply effective natural treatment C solutions to correct imbalances detected.

 ow to use and interpret Quadscan BIA H parameters for each and every patient presentation.

Set up business and marketing success systems. Grow your network with like-minded Practitioners.

 tilise the dedicated MetaScan™ Metascreen 2 U software to generate a personalised report.

20

Melbourne | 8th to 10th November, 2019 To book, contact your Area Sales Manager or Customer Service today on 1800 777 648 (Australia) or 0508 227 744 (New Zealand)

Metagenics Australia

Metagenics New Zealand

20

741 Nudgee Road, Northgate, Queensland 4013. PO Box 675, Virginia BC, Queensland 4014.

Ph: (07) 3117 3300 Fax: (07) 3117 3399 Ph: Country and Interstate 1800 777 648

metagenics.com.au info@metagenics.com.au orders@metagenics.com.au

22B William Pickering Drive, Rosedale, Auckland 0632. PO Box 35383, Browns Bay, Auckland 0753.

Ph: (09) 478 2540 or 0508 227 744 Fax: (09) 478 2740 or 0508 227 733

metagenics.co.nz info@metagenics.co.nz orders@metagenics.co.nz

This paper has been responsibly sourced from a sustainable forest.

MEU1282 - 09/19

Find us on Social Media

The Metagenics Update is produced bimonthly by Metagenics.

Profile for Metagenics

Metagenics Update Issue 4  

Metagenics Update Issue 4