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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.


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.

Frederick Barrett is a cognitive neuroscientist with training in behavioral pharmacology, and the Associate Director of the Johns Hopkins Center for Psychedelic and Consciousness Research. Dr. Barrett has been conducting psychedelic research at Johns Hopkins University since 2013, and his research in healthy participants and in patients with mood and substance use disorders focuses on the psychological and neurological mechanisms underlying the enduring therapeutic and other effects of psychedelic drugs. In 2017, he received an NIH “R03” grant as Principal Investigator to investigate biological mechanisms of psilocybin effects, the first federally funded research since the 1970s administering a classic psychedelic to people with psychedelic effects as the primary focus. He has developed measures of subjective effects of psychedelic drugs, and has also published first-in-human studies characterizing the acute and enduring effects of psilocybin on the brain. He is currently leading clinical trials to investigate the use of psilocybin to treat patients with major depressive disorder and co-occurring alcohol use disorder, and he is leading a number of ongoing studies aimed at better understanding the psychological, biological, and neural mechanisms underlying therapeutic efficacy of psychedelic drugs.

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.