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Integrative Psychiatry

Gut Assessment and Treatment Planning by Pierre Brunschwig, MD

Why does the gut matter?
Did you know that the gut can be a source of distress physically and psychologically?
Come join us as Dr. Pierre Brunschwig talks about Gut Assessment and Treatment Planning.

FULL TRANSCRIPT

It’s interesting that we are literally swimming around in a microbiome soup. And what we are struggling as clinicians, researchers and people who are interested in this, is how do we make this change and this paradigm shift from this idea that the gut should be studied in isolation? Maybe it should be studied in relationship with the rest of the organs. And the same thing in terms of our ecological sense of who we are, and how our gut functions.

Why the gut matters: The gut can be a source of distress physically and psychologically.

The brain is quite dependent on the gut for the absorption of the nutrients that it needs to do its normal functions.

Malabsorption syndromes and other kinds of gut disturbances that result in nutritional deficiencies will affect the gut. The gut, also, when it’s not healthy is the source of inflammatory cytokines. These cytokines can travel broadly and increase inflammation in the brain. For people who have chronic gut disorders, the gut is a source of psychological and physical distress.

Lower GI Relevant History: Parasite, Foreign Travel, Diarrhea Disease, Food Allergies and more.

Likewise, ask about relevant gut history and stressors in their past. Extensive foreign travel, history of parasites, frequent antibiotics, inflammatory bowel disease, like Crohn’s disease and ulcerative colitis and IBS. Terrible diagnosis, IBS. C. difficile, a terrible stressor on guts, many people who had C. difficile feel their guts are still not right, either because of the damage from C. diff., or the dysbiosis that follows because they’re on antibiotics.

And frequent antibiotics for any other reasons or a history of food allergies, feel comfortable with referring to a gastroenterologist. You might put your toe right in the kiddie end of the pool here and order a poop test on somebody and find something that’s a little distressing.

Don’t be shy about just saying, you know what, I think this is outside my wheelhouse. This looks more serious than I think I can handle. We have a faculty, and we all have emails. And so, if you find something like that on a poop test, and you’re concerned about it, and give us a call or send us an email, we can help you understand whether or not what you have found right is not appropriate to be treating in your office and needs the attention of a gastroenterologist. But don’t go down the path with patients who have uncontrolled gastrointestinal chronic disease.

Key findings in maldigestion 

On stool testing, the most common way that we see this is with human pancreatic elastase as a marker for the production of pancreatic enzymes. Not a foolproof test, but very useful. Chymotrypsin is still used in some comprehensive stool testing. And then we see other forms of maldigestion in the form of protein. This is also somewhat reliable, but it’s helpful when it’s elevated, because then you know, the proteins aren’t getting digested and that gives you a hint as to what the patient would need.

The five “R” Treatment Protocol: Remove, Replace, Reinoculate, Repair and Rebalance

This is the five “R” treatment protocol and this is super helpful in staying oriented if you’re ordering comprehensive stool testing. And why is that? Because the gut is complicated; however, you can keep your feet underneath you if you remember, remove the bad guys. Replace the things that are missing when we’re talking about digestive acids, pancreatic enzymes, bile acids and such. Reinoculate with prebiotics and probiotics. Give repair, support and rebalance. Make sure the patient is doing their self-care because if they eat at Taco Bell and drink a six pack of beer, they’re going to undo your work.

Sara Reed, MS, LMFT

Sara Reed is a Licensed Marriage and Family Therapist and CEO of Mind’s iHealth Solutions, a digital health company that provides evidence based and culturally responsible mental health services for underserved groups. As a mental health futurist and clinical researcher, Sara examines the ways culture informs the way we diagnose and treat mental illness. Sara’s prior research work includes participation as a study therapist in psychedelic therapy research at Yale University and the University of Connecticut’s Health Center. Sara was the first Black therapist to provide MDMA-assisted psychotherapy in a clinical trial and continues to engage in ongoing advocacy work around health equity in psychedelic medicine.

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Jeffrey Guss, MD is a psychiatrist, psychoanalyst, and researcher with specializations in psychoanalytic therapy and the treatment of substance use disorders. He was Co-Principal Investigator and Director of Psychedelic Therapy Training for the NYU School of Medicine’s study on psychedelic-assisted psychotherapy in the treatment of cancer-related existential distress, which was published in Journal of Psychopharmacology, 2016. He currently is a study therapist in the NYU study on Psychedelic-Assisted therapy in the treatment of Alcoholism, a collaborator with Yale University’s study on psychedelic-assisted therapy for Major Depressive Disorder and a study therapist with the MAPS (Multidisciplinary Association for Psychedelic Studies) study on treatment of Post Traumatic Stress Disorder with Psychedelic-Assisted Psychotherapy. 

Dr. Guss is interested in the integration of psychedelic therapies with contemporary psychoanalytic theory and has published in Studies in Gender and Sexuality and Psychoanalysis, Culture and Society. He has published (with Elizabeth Nielson, PhD) a paper on “the influence of therapists’ first had experience with psychedelics on psychedelic-assisted psychotherapy research and therapist training” in The Journal of Psychedelic Studies, August, 2018. He is an Instructor and Mentor with the California Institute of Integral Studies’ Center for Psychedelic Therapies and Supervisor in NYU’s Fellowship in Addiction Psychiatry. 

Dr. Guss maintains a private practice in New York City.

Will Van Derveer, MD

Will Van Derveer, MD is Co-Founder of Integrative Psychiatry Institute and Integrative Psychiatry Centers. Dr. Van Derveer was co-investigator on a phase 2 MAPS study of Psychedelic-assisted psychotherapy for treatment-resistant PTSD, and co-authored the publication of this study in 2018. He has also provided Psychedelic-assisted psychotherapy in two MAPS training studies. An active provider of KAP at his clinic in Boulder, CO, he has been teaching others KAP therapy for several years. Dr. Van Derveer contributed a chapter on mescaline in the 2021 "Handbook of Medical Hallucinogens" (edited by Charles Grob and Jim Grigsby). He is co-host of the Higher Practice Podcast.

Dr. Van Derveer regards unresolved emotional trauma as the most significant under-recognized root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass.


Scott has been a student of consciousness since his honors thesis on that topic at the University of Arizona in the 1970s under the tutelage of Dr. Andrew Weil. Following medical school, Scott studied Jungian therapy and acupuncture while working as a primary care physician in a rural area for four years. Psychedelic-assisted psychotherapy became a facet of his practice before this medicine was scheduled in 1985. He then completed a psychiatry residency at Columbia program in New York. Scott studied cross-cultural psychiatry and completed a child/adolescent psychiatry fellowship at the University of New Mexico.

In 2010 he founded Wholeness Center in Fort Collins. This innovative clinic provides cross-disciplinary evaluation and care for all mental health concerns. Scott serves as a site Principal Investigator and therapist for the Phase III trial of psychedelic-assisted psychotherapy for PTSD sponsored by (MAPS). He has also published numerous articles about his research on (CBD) in mental health. Currently, Scott works extensively with psychedelic-assisted-psychotherapy. He lectures all over the world to professional groups interested in a deeper look at mental health issues, safer tools, and a paradigm-shifting perspective about transformative care.

Will Van Derveer, MD is co-founder of Integrative Psychiatry Institute (IPI), along with friend and colleague Keith Kurlander, MA. He co-created IPI as an expression of what he stands for. First, that anyone can heal, and second that we medical providers must embrace our own healing journeys in order to fully command our potency as healers.

Dr. Van Derveer spent the last 20 years innovating and testing a comprehensive approach to addressing psychiatric challenges which transcends the conventional model he learned in medical school at Vanderbilt University and residency at University of Colorado, while deeply engaging his own healing path.

He founded the Integrative Psychiatric Healing Center in in 2001 in Boulder, CO, where he currently practices. Dr. Van Derveer regards unresolved emotional trauma as the most significant root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass. In addition to his clinical work and teaching, he was co-investigator in 2016 a Phase II randomized clinical trial, sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). He continues to support this protocol, now in a Phase III clinical trial under break-through designation by FDA.

Dr. Van Derveer is a diplomate of the American Board of Integrative and Holistic Medicine (ABoIHM) since 2013, and he was board certified in the first wave of diplomates of the new American Board of Integrative Medicine (ABIM) in 2016.