Aging is associated with chronic low-grade inflammation, sarcopenia and functional decline. The loss of muscle mass between the ages of 40 and 80 is approximately between 30% and 60% and is associated with disability, illness, and death. Age-related musculoskeletal decline is a significant risk for falls in the elderly.

Exercise and nutritional supplementation are currently recommended as preventative against the loss of muscle and muscle strength, however, most of the nutritional studies have focused on protein supplementation. Since sarcopenia is associated with increased inflammation and impaired glucose homeostasis, omega-3-fatty have also been investigated.

According to a new article published earlier this month in Nutrients, researchers investigated the role of gut dysbiosis and the development of sarcopenia.

This was a case-control study investigating the gut microbiome composition in 50 cases in elderly women between 65 and 75 years of age with sarcopenia and 50 healthy controls. A food frequency questionnaire was obtained for the average food intake over the previous 3 months. A physical exam was performed, and assessments included height, weight, grip strength, and body composition.

As a result, grip strength, body weight, body mass index (BMI), skeletal muscle mass, energy intake, and high-quality protein intake were lower in cases than in controls. The gut microbiome testing demonstrated that the Bacteroides was significantly reduced in the case group compared to the Prevotella which was more abundant. Elderly women with sarcopenia had significantly different gut microbiota compositions than healthy individuals. Bifidobacterium longum was significantly higher in the controls. Animal and human studies have showed improved muscle function such as grip strength and muscle endurance as well as recovery from muscle atrophy. Probiotics such as Bifidobacterium longum contribute to the absorption and utilization of vitamin D and minerals and provides a protective factor for sarcopenia. There was also an increase in the Firmicutes to Bacteriodetes in the case group. Prebiotics such as xylo-oligosaccharides (XOS) can increase Bifidobacterium and improve this ratio as well. Prebiotics and probiotics have been shown to reduce low grade inflammation seen in those with sarcopenia.

These findings demonstrate a role of the microbiome and sarcopenia. Other nutrients to consider besides prebiotics and probiotics include vitamin D, magnesium, vitamin C, collagen, BCAAs, HMB, protein supplementation, and tocotrienols.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Wang Z, Deji Y, et al. Bifidobacterium as a Potential Biomarker of Sarcopenia in Elderly Women. Nutrients. 2023 Mar 3;15(5):1266.

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There has been a significant increase in the incidence of autoimmune disorders over the past several decades. Most individuals have a less-than-perfect diet and over the years Americans have lost much of the diversity in their diet which plays an essential role in the gut microbiome and a contributing factor in the epidemic of autoimmune disorders. More and more research demonstrates that the food one eats affects what bacteria populations are in their gut.

A significant environmental trigger in autoimmune disease is the diet. Dietary approaches provide the most effective means to returning balance and dysfunction with the gastrointestinal system. 

According to a new review published 3 days ago in the Journal of Autoimmunity, researchers investigated the the role of the gut microbiome in pre-clinical rheumatoid arthritis.

Studies published over the past several years have demonstrated the correlation between gut microbiome and pre-clinical RA. The research on the microbiome in patients with RA suggests the presence of alterations in the gut microbiota and a potential link between RA development and intestinal dysbiosis. Recent clinical studies of pre-clinical RA individuals (including those with autoantibodies or genetic risk factors) showed that the dysbiosis occurs before the onset of RA.

The function of the intestinal barrier also plays a significant role in autoimmunity. An impaired intestinal barrier can increase intestinal permeability leading to a leaky gut. The disruption of intestinal barrier function and increased intestinal permeability were reported in RA patients, especially those with higher disease activity.

The most used approaches to treat RA include glucocorticoids, NSAIDs, and TNF-a inhibitors but these carry significant side effects.

Dietary supplements and prebiotics are commonly used by functional medicine practitioners and nutritionists for the support of RA by rebalancing the gut microbiota composition. Prophylactic treatment with dietary supplements and prebiotics can regulate T cell polarization, improve Treg and Th1/Th17 levels, reduce pro-inflammatory cytokine levels, and reduce the risk of RA. Probiotic supplementation can competitively inhibit the colonization of pathogenic Prevotella and suppress autoantibody production.

In addition to an anti-inflammatory or Mediterranean diet, other nutrients to consider include vitamin D, fish oil, resveratrol, curcumin, and probiotics.

Autoimmunity can occur a few different ways. It is also important to look at any environmental triggers such as food sensitivities, nutrient status, toxins, and gut health. Each person’s biochemical individuality exerts a major influence on his or her health. The level of nutrient intake, lifestyle choices and environmental exposures filtered through genetic predisposition are major factors in the expression of disease, and a successful treatment approach must investigate these factors.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Lin Liyan, Zhang K, et al. Gut microbiota in pre-clinical rheumatoid arthritis: From pathogenesis to preventing progression. J Autoimmun. 2023 Mar 15;103001. doi: 10.1016/j.jaut.2023.103001.

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Pain is a complex experience that many times is difficult to manage, which can significantly impact one’s quality of life. Traditional approaches include medications such as opioids and non-steroidal anti-inflammatory drugs (NSAIDs), but have side effects and can lead to addiction and dependence. In addition, many older adults cannot take them due to the other medications they are prescribed. As a result, many individuals seek alternative therapies to manage their pain. One consideration is Palmitoylethanolamide (PEA), which a naturally occurring fatty acid that has been shown to have anti-inflammatory and analgesic properties.

PEA is an endogenous compound produced by the body in response to inflammation and injury and is found in various foods such as egg yolk, soybeans, and peanuts. It is also available in supplement form and has been studied extensively for its pain-relieving properties.

According to a review published last month in Nutrients, researchers examined the efficacy of PEA in the treatment of chronic pain.

This review consists of 11 double-blinded randomized controlled trials including 774 patients using PEA supplementation for chronic pain. The primary outcome was pain intensity scores with secondary outcomes including quality of life, sleep quality, functional status, and side effects. The dosage of PEA varied quite a bit between the studies ranging from 300 mg to 1200 mg per day in single or divided dosing and a duration in treatment between 8 to 12 weeks. PEA was found to reduce pain scores with additional benefits of improving quality of life and functional status with no major side effects.

This review demonstrates that PEA supplementation is an effective nutritional therapeutic for chronic pain. It is also good to use a micronized form for optimal bioavailability.

Research has shown that PEA is effective in managing various types of pain, including chronic pain, neuropathic pain, and inflammatory pain. In one study, patients with chronic lower back pain were given PEA for eight weeks. The results demonstrated a significant reduction in pain intensity and an improvement in quality of life. Another study showed that PEA supplementation was effective in reducing neuropathic pain in patients with multiple sclerosis.

In addition to its pain-relieving properties, PEA has also been shown to have anti-inflammatory effects and plays a role in the immune response. There is also additional on sports performance and sleep with PEA.

Other nutrients to consider include omega-3 fatty acids, phyocannabinoids, curcumin, and vitamin D.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Lang-lllievich, K, Klivinyi C, et al. Palmitoylethanolamide in the Treatment of Chronic Pain: A Systematic Review and Meta-Analysis of Double-Blind Randomized Controlled Trials. Nutrients 2023, 15(6), 1350.

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There are only a few natural products that have demonstrated the wide range of protective properties as curcumin. Turmeric has three main bioactive components which are curcumin, desmethoxycurcumin and bisdemethoxycurcumin. These curcuminoids have many biological effects including anti-inflammatory, antioxidant, antitumor, antibacterial, and antiviral properties.

According to a new study published yesterday in Lupus, researchers investigated the efficacy of curcumin on systemic lupus erythematosus (SLE) disease activity.

This review consisted of three double-blind, placebo-controlled, randomized clinical trials, three human in vitro studies, and seven mouse-model studies. In human trials, curcumin decreased 24-h and spot proteinuria. In these studies, the trials were small ranging from 14 to 39 patients with varied curcumin doses and different study durations ranging from one to three months. On average, patients took three capsules a day, but the total constituent curcumin dose ranged from 60 mg to 150 mg a dose. There was no change in C3, dsDNA, or the Systemic Lupus Erythematosus Disease Activity (SLEDAI) scores. The mouse-model trials and human trial data demonstrated that it requires at least an average of 12-16 weeks of curcumin use to have an immunological effect. In addition, I would expect a greater and possibly sooner effect with a higher dose of curcumin.

This review demonstrates that curcumin can be a potential therapeutic for the management of SLE.

Autoimmunity can occur a few different ways. First, there can be a mistaken identity and the body attacks itself. This can occur with a virus where there is tissue destruction, and it appears to be foreign to the body. Second, is called molecular mimicry. This occurs when the body makes an antibody (a protein in the body that attacks objects in the body that appear to be foreign) to a specific antigen. These antigens can resemble certain proteins in the body and the antibodies attack our body’s own tissues. Third, is the development of the T cells (the immune system). This can be affected by genetics, stress, and environmental triggers.

Environmental triggers are what integrative doctors mainly work with in functional medicine. These can be food triggers such as gluten or food sensitivities that can trigger inflammation as well as anything coming in with the food such as toxins or molds. In addition, the nutrient status of the person. This can be antioxidant status, vitamins, essential fatty acids, vitamin D, etc. Also, gut health. This includes “leaky gut” and dysbiosis. Finally, there are toxins that can be affect the status of the immune system. These are heavy metals, xenobiotics, as well as the total toxic burden in the body.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Ramessar N, Borad A, Schlesinger N. The impact of curcumin supplementation on systemic lupus erythematosus and lupus nephritis: A systematic review. Lupus. 2023 Mar 3;9612033231161961.

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Healthcare providers know the importance of assessing vitamin D status on their patients. When vitamin D levels are low, supplementation is recommended or the dosage is often increased. More and more research demonstrates the intricate interrelationships with other nutrients. It is important to maintain optimal levels of all the fat soluble vitamins but one cannot forget magnesium either.

According to a new review published last month, researchers investigated the association of vitamin D and magnesium with insulin sensitivity and their influence on glycemic control. Researchers have found that patients with good glycemic control have high magnesium levels. In addition, magnesium is closely related to vitamin D and is required for the transport and activation of vitamin D.

Several studies have reported that vitamin D deficiency is common among patients with type II diabetes, suggesting a possible correlation between low vitamin D levels and pancreatic insulin secretion and action.

Vitamin D is also known to have immunomodulatory and anti-inflammatory effects, which can improve insulin resistance by altering low-grade chronic inflammation involved in insulin resistance. In addition, low vitamin D levels increase parathyroid hormone concentration, resulting in secondary hyperparathyroidism, which can lead to glucose intolerance.

Most studies agree that both vitamin D and magnesium are important regulators of glucose

homeostasis and play an essential role in the management of type II diabetes. Vitamin D and magnesium levels were found to be significantly lower in diabetic patients. This was demonstrated by a study on diabetes patients that showed those with poor glycemic control had significantly lower vitamin D and serum magnesium levels than those with good glycemic control.

Vitamin D and magnesium insufficiency are a common issue among many patients. Over 75% of individuals have calcium to magnesium ratios greater than 2.5 and up to 80% of people do not consume enough magnesium in a day to meet the recommended dietary allowance (RDA) and most of these individuals are also vitamin D deficient.

It is essential to recommend patients consume foods including dark leafy greens, beans, whole grains, dark chocolate, fatty fish such as salmon, nuts and avocados as deficiencies in magnesium and vitamin K can contribute to vascular calcification and supplement with vitamin D accordingly.

The role of vitamin D and magnesium in enhancing insulin sensitivity has been confirmed by previous studies. Vitamin D supplementation increases vitamin D levels and supplementation of magnesium alone in patients with diabetes shows insignificant effects on glycemic control, however, studies have shown the combination of vitamin D and magnesium supplementation improves glycemic control in patients with diabetes.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Wan Nor Fazlia Hafizan Wan Nik, Hani Ajrina Zulkeflee, at el. Association of vitamin D and magnesium with insulin sensitivity and their influence on glycemic control. World J Diabetes. 2023 Jan 15;14(1):26-34.

Qi Dai, Xiangzhu Zhu, JoAnn E Manson, Yiqing Song, Xingnan Li, Adrian A Franke, Rebecca B Costello, Andrea Rosanoff, Hui Nian, Lei Fan, Harvey Murff, Reid M Ness, Douglas L Seidner, Chang Yu, Martha J Shrubsole. Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial. The American Journal of Clinical Nutrition, 2018; 108 (6): 1249 DOI: 10.1093/ajcn/nqy274

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Inflammatory bowel disease (IBD) is an autoimmune condition where in most cases there are multiple triggers chronically stimulating the immune system over a long period of time in multiple ways and the immune system gets into overloaded, overwhelmed state and loses its ability to function leading to chronic inflammation causes symptoms such as diarrhea, abdominal pain, and other debilitating symptoms and anemia.

According to a new review published last month in Frontiers in Immunology, researchers investigated the role of Akkermansia muciniphila in patients with IBD.

Although previous research has shown differences in the gut microbiome in IBD patients, this review investigates how changes in the microbiome can contribute to an inflammatory response.

This review has demonstrated the potential protective effect of A.muciniphila in the process and development of intestinal inflammation. An abnormal decrease in the abundance of A.

muciniphila maybe a hallmark of IBD, which is associated with dysbiosis, decreased intestinal barrier function, and altered immune response.

It is important to note that the role of commensal A. muciniphila in IBD is still controversial as in too high of levels it can contribute to intestinal inflammation, which might be due to difference in genotypes and strain specificity of A. muciniphila.

Therefore, we should always hold a reasonable dose of expectation and skepticism in terms of the overwhelming “good effects” of A. muciniphila in health and disease states.

A. muciniphila therapies are now considered a valuable therapeutic approach to treat IBD patients. There is an A. muciniphila probiotic that has recently become available. In addition, A. muciniphila can also be increased with an increased intake of foods rich in polyphenols or supplementation with polyphenols including blueberry, cranberry, pomegranate, and quercetin.

It is important to know what bacteria are present and how these bacteria shift as the patient’s symptoms exacerbate or improve.

Previous research has identified that in healthy people, the gut microbiome was much more stable than those with IBD. Patients with IBD have dramatic shifts in their microbiomes with some bacteria disappearing almost completely at times.

Medication to treat IBD can also affect the microbiome. Individuals who take steroids for part of their treatment have more fluctuations in their microbiome and those who were experiencing a flare-up in their symptoms are more likely to have dramatic fluctuations in their microbiome.

These results further support the functional medicine approach to assess the microbiome regularly in these patients so one can take an individualized approach to manipulate the microbiome and keep IBD patients in remission, especially if medications like corticosteroids can be shift the microbiome leading to an exacerbation of the disease.

Probiotics, fish oil, glutamine, polyphenols, and mucilaginous botanicals are helpful in immunomodulation and for their anti-inflammatory properties. Other common deficiencies include magnesium, vitamin D, and iron. A low FODMAP diet or elimination diet can improve gastrointestinal function and decease disease activity.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Zheng M, Han R, et al. The role of Akkermansia muciniphila in inflammatory bowel disease: Current knowledge and perspectives. Front Immunol. 2023. Jan 6;13:1089600.

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Type II diabetes affects more than 30 million individuals and the youth account for 20% to 50% of new onset diabetes cases.

Previous research has demonstrated low levels of vitamin D are associated with an increased risk of type II diabetes. Vitamin D has been shown to play a role in reducing inflammation and inhibiting β-cell destruction. 

According to a new review this week in BMC Endocrine Disorders, researchers investigated the effect of vitamin D supplementation on the glycemic control of type 2 diabetes patients.

This review consisted of 46 randomized controlled trials (RCTs) consisting of 2,164 patients that had vitamin D supplementation and 2,149 placebo patients. The pooled analyses for HbA1c showed a significant change between the intervention and placebo group. In addition, there was a significant reduction in fasting blood glucose and significant change in HOMA-IR after vitamin D supplementation. The subgroup analyses showed the most efficacy in a higher dose (>2000 IU daily) and short intervention period (<12 weeks) and in individuals with a vitamin D deficiency.

This study demonstrates the benefits of vitamin D supplementation. It is essential to take a vitamin D supplement containing vitamin K or taking a vitamin K supplement in addition to vitamin D to optimize the level of each vitamin and prevent against arterial calcification. It is important to maintain optimal levels of all the fat-soluble vitamins as more and more research demonstrates their intricate interrelationships with other nutrients.

There is no evidence for an ideal ratio between D and K1 or K2, however, we need to optimize each vitamin. It is also important to note their no toxicity of vitamin K.

All chronic conditions are multifactorial and vitamin D is many times just a small part of the picture. It is important to look deeper and address other common deficiencies such as magnesium, vitamin C, glycine, and essential fatty acids. Other nutrients that can help therapeutically include inositol, lipoic acid, delta and gamma tocotrienols, chromium, zinc, and berberine. Many of these nutrients play a synergist role with one another and it is important to have adequate levels for optimal function.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Farahmand MA, Daneshzad E, et al. What is the impact of vitamin D supplementation on glycemic control in people with type-2 diabetes: a systematic review and meta-analysis of randomized controlled trails. BMC Endocr Disord. 2023 Jan 16;23(1):15.

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Asthma has become more prevalent over the past several decades. Many patients have managed their asthma with medication and avoiding environmental triggers.

According to a new study published last week in Allergy, Asthma & Clinical Immunology, researchers investigated the improvement of clinical asthma symptoms in patients with asthma taking probiotic supplementation.

This study was a randomized, double-blinded, placebo-controlled trial including 40 patients with asthma with a mean age of thirty-eight. Each patient was given probiotic supplementation or placebo for 8 weeks. The supplementation given was a 24 billion CFU multi-species probiotic consisting of L. acidophulus, L. rhamnosus, L. bulgaricus, B. breve, B. longum, and S. thermophilus. Assessments included pulmonary function tests, IL-4 and IFN-γ levels, and expression of microRNAs. These were obtained at baseline and after treatment.

The results demonstrated that the expression of miR-16, miR146-a and IL-4 levels after probiotic supplementation was significantly reduced and miR-133b expression was increased. In addition, the pulmonary function tests demonstrated a significant improvement in Forced Expiratory Volume in 1 s and Forced Vital Capacity after receiving probiotics.

As a result, probiotic supplementation for 8 weeks led to a reduction in Th2 cells-associated IL-4 and improved Forced Expiratory Volume and Forced Vital Capacity. Probiotics should be considered as an adjunct to traditional asthma treatment.

Probiotics exert their effects in a few different ways. They can affect the immune system providing metabolites, cell wall components and DNA. Also, probiotics can systematically affect the function of immune cells by producing short chain fatty acids (SCFAs) and modulate inflammatory responses.

This double-blind, randomized, placebo-controlled trial included 160 children ranging from 6 to 18 years of age with asthma. Each child received either a supplement of Lactobacillus paracasei, Lactobacillus fermentum, a combination of the two, or a placebo for 3 months.

Previous research has also shown a benefit of Lactobacillus probiotics in children with asthma. Compared with the placebo group, the children receiving Lactobacillus containing probiotics all had lower asthma severity and higher C-ACT scores. In addition, the group that received both Lactobacillus strains demonstrated increased peak expiratory flow rates and lower IgE levels.

Other nutrients to consider to relax the airways and provide anti-inflammatory properties include magnesium, vitamin D, vitamin C, and fish oil.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Sadrifar S, Abbasi-Dokht T, et al. Immunomodulatory effects of probiotic supplementation in patients with asthma: a randomized, double‑blind, placebo‑controlled trial. Allergy Asthma Clin Immunol. 2023 Jan 2;19(1):1.

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Infertility effects approximately 7.3 million couples in the US. One of seven couple will experience difficulty conceiving. About 40-50% of these the cause is unknown. It may be related to toxicity, oxidative damage, poor nutritional status or nutritional deficiencies, heavy metal or environmental toxicity, systemic disorders, hormonal imbalances, xenobiotic exposure, age-related decline, or obesity.

According to a recent review published in Nutrients, researchers investigated the efficacy of CoQ10 and melatonin on male fertility.

Coenzyme Q10 is involved in mitochondrial energy production and plays a key role as

an antioxidant. In this review, CoQ10 supplementation as a monotherapy was shown to enhance sperm motility and concentration as well as improve sperm DNA fragmentation in infertile men. In addition, these results also demonstrate that CoQ10 may by itself be effective in improving conception rates. The improvement in semen parameters was followed by a higher frequency of spontaneous pregnancy and better outcomes for assisted reproductive technology (ART). The dose of CoQ10 used as monotherapy was between 200-300 mg per day.

The research team also investigated the role of melatonin in male infertility; however, the data was limited. Melatonin is a free radical scavenger demonstrating its antioxidant potential.

Animal models have shown that melatonin may contribute to gonadal physiology by modulating androgen production (both centrally and locally) by acting as an immunomodulatory compound and by influencing the progression of germ cells to spermatozoa. Clinical data in men is limited compared to the broader evidence on female fertility from ovarian aging to clinical improvement on in vitro fertilization success rate. In conclusion, preclinical data regarding melatonin show potential in the context of male infertility, but additional clinical studies are needed.

Other nutrients that may be beneficial include vitamin D, fish oil, carnitine, zinc, and inositol.

Also, one must keep in mind that exposure to endocrine-disrupting chemicals (EDCs) including Bisphenol A (BPA), Phthalates, PCBs, PBBs, PBDEs, pesticides, and heavy metals can also contribute to infertility.

It is important to minimize further exposure by eating organic produce, drink filtered water, use household products that are fragrance-free and free of phthalates and BPA, and replace non-stick pans with glass, ceramic, or cast iron.

Nutrients that can support detoxification pathways include n-acetyl-cysteine, glutathione, calcium D-glucurate, milk thistle, and sulforaphane.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Gianpaolo Lucignani, Letzia Maria Ippolita Jannello, et al. Coenzyme Q10 and Melatonin for the Treatment of Male Infertility: A Narrative Review. Nutrients. 2022 Nov 1;14(21):4585.

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Many chronic conditions typically have increased nutrient demands than healthy individuals. These are considered conditionally essential nutrients. There is either a disruption in metabolic processes, underlying inflammation, oxidative stress, or an inability to meet the metabolic demands with the current nutrient reserves.

According to a new study published earlier this month in JAMA Network, researchers investigated whether oral butyrate supplementation is effective in treating pediatric obesity.

This was a randomized, quadruple-blind, parallel-group, placebo-controlled trial including 54 patients with obesity between the ages of 5 and 17 years of age. These individuals had a body mass index (BMI) greater than the 95^th percentile for sex and age. The patients in the butyrate group received sodium butyrate capsules at a dose of 20 mg/kg body weight up to a maximum dose of 800 mg per day for 6 months. The placebo group received cornstarch capsules. Children that were not able to swallow capsules, were allowed to open the capsules and dissolve them in liquid or food. Laboratory assessment included fasting glucose, insulin, and a lipid panel. HOMA-IR was calculated, and ghrelin, IL-6 levels, and gut microbiome analysis were also measured. This clinical trial took place from November 2020 through December 2021.

This was the first randomized clinical trial evaluating the effects of butyrate on pediatric obesity. As a results, the study demonstrated 6 months of supplementation with butyrate can reduce BMI and improve glucose metabolism and inflammation.

The beneficial effects of butyrate supplementation on glucose metabolism were consistent with previous data. The research team found that butyrate supplementation decreased HOMA-IR and fasting insulin levels in children with obesity. In addition, the gut microbiome analysis supported the role of butyrate in glucose metabolism, as suggested by a more positive response in children with a higher abundance of butyrate-producing bacteria at baseline.

Glutamine is also another nutrient to consider due to its benefits on modulating the microbiome and its impact on the intestinal barrier and its role in patients who are overweight or obese. Glutamine may also be altering the microbiome by decreasing the Firmicutes to Bacteroidetes ratio, which is associated with obesity.

Other nutrients that should be considered include vitamin C, fish oil, and tocotrienols.

Obesity is associated with chronic low grade inflammation, so there will be increased vitamin C and antioxidant requirements to mitigate oxidative stress.

Increasing dietary fiber or fiber supplementation should also be considered. Only about 10 percent of Americans meet their daily fiber requirements. Dietary fiber is crucial in supporting the proper microbial balance and optimizing gut health.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Coppola S, Nocerino R, et al. Therapeutic Effects of Butyrate on Pediatric Obesity: A Randomized Clinical Trial. JAMA Netw Open. 2022 Dec 1;5(12):e2244912.

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