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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.


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.

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.