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Integrative Psychiatry

Leaky Gut and Malabsorption by Pierre Brunschwig, MD

Did you know that having healthy tight junctions are key to protecting the brain and gut? Watch this video as Dr. Pierre Brunschwig talks about the Leaky Gut and Malabsorption.

FULL TRANSCRIPT

Now I spoke to you about gluten related disease, Candida related complex and malabsorption. And how that interplays with our tight junction structures in both the gut and the brain, and we’re going to develop some further concepts about that. But in particular, today we’re going to talk about how to clean out the riffraff.

Restoring the biofilm and removing the tight junction inflammation

Healthy tight junctions are key to protecting the brain and gut.

We talk about cleaning out abnormal organisms in the biofilm, we’re really adding to our ability to remove inflammation and protect the tight junctions and the intestinal line. Because as you may recall that as we protect those tight junctions, we are also protecting the tight junctions in the blood-brain barrier. Healthy tight junctions are key to protecting our gut and our brain. So, gluten related disease, dysbiosis and other tight junction disruptors are important to identify as we want to work with the psychological and cognitive function of our patients.

And remember, we’re in a sea change regarding our understanding of the gut. And we’re moving away from the notion of pathogenics and moving into more the ecology and ecological approach to restoring gut balance.

Tight Junctions: Leaky Gut = Leaky Brain

On the left here, we see an image or a schematic of tight junction complexes, forming a system of basically spot welds that connect the adjacent cells to each other to form a permeable or somewhat permeable, connection between the cells. These tight junctions operate just below the brush border and the biofilm. And on the right, you’ll see all of the different protein elements that would, in some, create these tight junctions.

Zonulin increases permeability of the BBB

We talked about zonulin and its ability to increase permeability in the gut lining. It turns out zonulin has the same effect at the blood-brain barrier. This is a reference indicating that zonulin and inflammatory cytokines can increase the permeability of the blood-brain barrier. Zonulin release by a way of reminding you can be stimulated by enteric infections, and hypoxemia and insulin resistance. Circulating zonulin has the same effect, if you will, in the intestinal lining and the blood-brain barrier.

Tight Junction leak: Three Ways

Autoimmunity tends to aggravate and cause leaking of these tight junctions in two specific ways.

  1. One, it can stimulate inflammatory cytokines, and it may provoke the production of autoimmune antibodies that target proteins and the tight junction.
  2. And these create a second level of inflammatory response that causes the tight junctions to leak.

When to Deworm

Don’t wait for a positive stool test because you’ll wait a long time. So worms remain very difficult to find under the microscope and until we have PCR testing or something comparable, we’re going to be thinking about treating presumptively. So, this is common in tropical countries, where deworming is not unusually done every year, or with the onset of a diarrheal disease. If you’re going to do presumptive treatment for worms, consider it for people who’ve had either extensive third world travel, or frequent third world travel, or ill while traveling in a third world country.

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.