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Kao, Levytam | The Role of the ‘Eubiotic’ Diet
The Role of the ‘Eubiotic’ Diet in
Intestinal Dysbiosis and Hypertension
Chih-Hsien (Bruce) Kao, BEng, ND (Cand.) and Shimon Levytam, MD, ND
Abstract
A 69-year-old female patient presented
with chief concerns of hypertension,
hypercholesterolemia, low immunity, and
osteoarthritis in June 2006. It was hypothesized
that the patient was suffering from dysbiosis
based on her presenting symptoms and past
medical history. The patient was treated with
dietary interventions – specifically, the Eubiotic
diet – in order to repair her gut tissues and
function, and restore beneficial intestinal
flora. After approximately six months on
the diet, her symptoms of dysbiosis such as
sinus congestion, bitter taste in the mouth,
hypochondriac pain, and feeling gassy and
bloated, all disappeared and her blood pressure
stabilized, resulting in a dramatic reduction in
prescription blood pressure medication use. The
Shimon Levytam, MD, ND
Clinic Supervisor
Robert Schad Naturopathic Clinic
The Canadian College of Naturopathic Medicine
1255 Sheppard Ave East
Toronto, ON Canada M2K 1E2
email: [email protected]
Keywords:
naturopathic medicine, CAM, nutrition, complementary and alternative
medicine, hypertension
IntJNM 4(1): 2009
following report discusses how a naturopathic
approach employing the Eubiotic diet is
case reportS
Correspondence to:
Chih-Hsien (Bruce) Kao, BEng, ND (Cand.)
3807 Arbutus Street
Vancouver, B.C
Canada, V6J 3Z9
email: [email protected]
hypothesized to be the major intervention
responsible for improving the patient’s
hypertension. In this report, the potential
physiological mechanisms and rationale are
discussed with respect to this novel approach
of care with an emphasis given to issues of
gastrointestinal health and terrain.
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The Role of the ‘Eubiotic’ Diet | Kao, Levytam
case reportS
T
he term “dysbiosis” was first introduced by Dr.
Elie Metchnikoff, a Russian scientist, to describe
altered pathogenic bacteria in the gut.1 Intestinal
flora consists of the microorganisms normally living in
the digestive tract, which serve many necessary functions,
such as providing energy, synthesis of vitamins (B group
and K), enhancement of gastrointestinal (GI) tract motility
and function, stimulation of the immune system, digestion
and absorption of food, metabolism of plant compounds
and drugs, production of short-chain fatty acids and
polyamines, and inhibition of growth of exogenous and
harmful bacteria within the host.2 The GI tract contains
approximately 100 trillion viable bacteria.3 About 99% of
the bacteria come from 30 to 40 species.4 Concentrated in
the mucosa are 60-90% of all measured immune parameters,
such as mast cells, dendritic cells and macrophages.5 When
the host is healthy and the intestinal microbial population
is in a state of balance there is a symbiotic relationship
established between the intestinal flora and the host to
optimize intestinal and immune function. However, when
there is an overgrowth of harmful pathogens, such as
Clostridium perfringens and E. coli in the intestines, and
decreased concentrations of Bifidobacteria species,6 ratios
activities of the bowel flora can be altered, resulting in
dysbiosis. This is often the result of poor diet and lifestyle,
antibiotic use, psychological, physical, environmental and
emotional stressors, radiation, change in GI peristalsis,
surgical trauma, hypochlorhydria, and decreased mucosal
immunity.2,7 It is believed that the growth of these
harmful bacteria in the intestine can produce harmful
substances that may play a role in chronic diseases, such as
hypertension in this case.
Based on available research and clinical data, it is
believed there are four common causes of intestinal dysbiosis:
putrefaction, fermentation, deficiency, and sensitization.8
1) Putrefaction dysbiosis is the result of diets high in fat and
animal flesh and with a low intake of insoluble fiber. It
often occurs when one consumes animal proteins without
enough chewing, or with achlorhydria. When animal
proteins are not decomposed, fermentation occurs and
amines may be produced, resulting in putrid odor.2
2) Fermentationdysbiosisresultsfrominefficienthostdigestion
of dietary starch or sugar leading to an accumulation of
short-chain fatty acids (i.e. acetate, propionate, butyrate and
valerate),9 lactic acids, and ethanol.8 This form of dysbiosis
usually causes carbohydrate intolerance and fatigue due to
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Table 1: Baseline medication and supplementation use
Table 2: Significant finding - Blood pressure as measured by stethoscope and
sphygmomanometer.
an overgrowth of bacteria or fungi in the stomach, small
intestine and the ascending colon.2
3) Deficiency dysbiosis is often caused by antibiotic exposure
or a low soluble-fiber diet, which leads to a deficiency of
normal intestinal flora.
4) Sensitization dysbiosis is the result of abnormal
immune responses caused by an alteration of the normal
intestinal flora.
With the four types of dysbiosis in mind, we describe
the following diet that has been called the Eubiotic diet.
Eu- is a prefix meaning “good”, –biotic is a suffix meaning
“life”,10 Thus, Eubiotic = ‘good life’. The purpose of the
Eubiotic diet is to achieve an ideal terrain in the GI that
will limit the overgrowth of pathogenic microbes and
optimize conditions for the beneficial bacteria. Following
the Eubiotic diet is intended to minimize the occurrence of
putrefaction, fermentation, deficiency, and sensitization.
Although many clinical studies have associated intestinal
dysbiosis with inflammatory bowel disease,11,12 irritable
bowel syndrome,13,14 eczema,15 asthma,16 arthritis, and
IntJNM 4(1): 2009
Kao, Levytam | The Role of the ‘Eubiotic’ Diet
Table 3: Current medication and supplementation use.
Case Description
PB is a 69-year-old Caribbean female who presented with
hypertension, post-nasal drip, sinus congestion, a bitter
taste in her mouth, hypochondriac pain, dry throat and
mouth, and increased thirst. PB’s past medical history
includes chronic stomach pain, gastritis, hematuria,
gingivitis, atherosclerosis, and prior appendectomy and
cholecystectomy. Her hypertension was controlled with
enalapril (5mg bid) and aspirin (81mg qd). Table 1 details the
IntJNM 4(1): 2009
medication and supplements the patient was taking at the
time of her first visit.
Recent
medical
history
included
dysbiotic
syndrome, such as sinus congestion, bitter taste in the
mouth, hypochondriac pain, gassy and bloated feeling,
hypertension, and atherosclerosis. Naturopathic treatment
commenced with the addition of the Eubiotic diet,
nutritional supplementation, nebulized glutathione,
exercise, constitutional hydrotherapy, homeopathic
treatment, and lifestyle counselling. The Eubiotic diet
in combination with nutritional supplementation was
designed to improve the gastrointestinal flora, whereas the
exercise, hydrotherapy, nebulized glutathione, and lifestyle
counselling were initiated to improve the overall health
and well-being of the patient.
The patient began the Eubiotic diet on Aug 31 2006. She
continued to experience her negative dysbiotic symptoms
mentioned above after four weeks, and a constitutional
homeopathic remedy, Dioscorea villosa 200C (one dose,
3 pellets), was prescribed to address the symptoms of
hypochondriac pain, bitter taste in the mouth, and ear-nosethroat problems. The remedy was taken on day 29 of the diet
(Sept 28 ‘06) and a week later the patient reported resolution
of her hypochondriac pain.
By day 36, Oct 5 ‘06, PB had regained some of her
energy and was carrying out daily living activities without
difficulty (determined by using energy scales during the
regular visits). It was noted that her blood pressure (BP)
was lower by a 10 point drop in systolic pressure and an
18 point drop in diastolic pressure when compared to Aug
4 ’06, even though her medication use had not changed.
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case reportS
ankylosing spondylitis,17,18 no studies have investigated its
possible relationship to hypertension.
The Eubiotic diet is a specific dietary program initiated to
achieve microfloral balance through an increase of insoluble
fiber and a decrease of saturated fat, animal flesh, starchy
vegetables, and sugar consumption. Following this kind of
diet has been shown to lead to a lowering of GI Bacteroides
levels and a concomitant increase in the levels of lactic acidproducing bacteria like Bifidobacteria, Lactobacillus, and
beneficial lactic acid Streptococcus.19 In addition, fruits and
starchy vegetables are not recommended due to their high
sugar content. The basic premise behind the diet is to stop
feeding harmful bacteria and instead feed the beneficial
intestinal flora. A brief food guideline for the Eubiotic diet is
shown in Appendix 1.
This report describes how following a specific diet, the
Eubiotic diet, was associated with a clinically significant
reduction in blood pressure. We hypothesize that this
benefit is a result of adherence to the Eubiotic diet and a
concomitant improvement in the patient’s gastrointestinal
flora and associated dysbiosis.
The Role of the ‘Eubiotic’ Diet | Kao, Levytam
case reportS
Figure 1: Mean Systolic and Diastolic Blood Pressure (mmHg)
The patient began to report frequent dizziness at the same
time, especially when her BP fell below 120/60mmHg.
The patient was referred to her family doctor to discuss
the possibility of adjusting the dosage of enalapril. Table
2 and Figures 1-3 illustrate the patient’s blood pressure
changes over time.
Patient’s weight was measured and body mass index
(BMI), body fat, and lean body mass were determined by
using a body fat analyzer and reference charts from Dr.
Barry Sear’s Zone Diet at each visit. Data for these outcomes
is not included as there was no significant change over time
in any of these endpoints.
Based on the linear regression lines in Figures 2
and 3, the patient’s average BP over the past 217 days
was about 121/69mmHg. If we are to assume that the
regression line provides an effective measure of change
over time, then based on this assumption the patient’s
starting BP is calculated to be 124/70mmHg and her final
BP 118/68mmHg. This change corresponds to a 6 point
drop in systolic BP and nearly a 2 point drop in diastolic
BP. These changes are further magnified if we assume that
the initial blood pressure value of 134/83mmHg is a more
accurate reflection of the patient’s hypertensive status to
begin with. Although there is a trend towards decrease
being witnessed, no test for statistical significance was
conducted on the changes observed.
On day 106 (Dec 14 ‘06), PB decreased her blood
pressure medication from 10mg of enalapril daily to 7.5mg.
She continued to feel dizzy and weak upon waking and on her
own volition decided to stop taking daily aspirin (81mg). PB
began to take greater responsibility for her own health and
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would titrate her medication based on self-monitoring her
blood pressure three times per day. From January until April
2007, she had not taken any aspirin, but would occasionally
take hawthorn (as needed) or enalapril (averaging 2.5mg/
wk). Her decision to take enalapril or hawthorn depended
mostly on her level of anxiety.
At this point, her current working diagnoses continued to
be dysbiosis, controlled hypertension, and atherosclerosis. Her
current medication and supplements are listed in Table 3.
Discussion
The result of most importance with respect to this report
is the control achieved in the patient’s blood pressure. The
absolute changes in the diastolic and systolic blood pressure
numbers are not of great clinical significance. What is most
relevant, however, is that the drug previously used to control
the blood pressure was dramatically reduced over the course
of treatment. This, of course, is of clinical and personal
significance to the patient.
The goal of the treatment plan was to use the Eubiotic
diet to repair her intestinal flora, reduce toxic amines
produced by bacterial putrefaction of food, lower her blood
pressure, increase immunity, improve energy levels and
enhance overall health. We hypothesize that her high blood
pressure was partially caused by dysbiosis. Based on the data
and outcomes realized, we hypothesize that the Eubiotic diet
not only improved the patient’s overall health, but lowered
her blood pressure as well.
According to clinical studies, diets high in protein
and sulfates (primarily derived from food additives) have
been shown to play a role in the production of potentially
IntJNM 4(1): 2009
Kao, Levytam | The Role of the ‘Eubiotic’ Diet
Figure 2: Mean Systolic Blood Pressure (mmHg)
IntJNM 4(1): 2009
detoxification function, in turn decreasing perfusion of
the kidneys’ juxtaglomerular apparatus resulting in an
increased release of the enzyme renin.24 Once renin is
released, it converts angiotensinogen to angiotensin I
that is then converted to angiotensin II by angiotensinconverting enzyme (ACE), found in the lung capillaries,
and causes vasoconstriction and eventually increases
blood pressure.24 Thus as kidney perfusion decreases and
renin is increased, a rise in BP would follow.
When the harmful metabolites are in the bloodstream,
the kidneys become the only real route of elimination and
detoxification. As the interference of the kidneys’ normal
function occurs, such as regulation of fluids and minerals,
fluid retention may result.24 This may also explain why our
patient has woken up with swollen ankles and pitting edema
on her legs in the past.
We hypothesize that the Eubiotic diet provides
optimal conditions for the growth of beneficial intestinal
flora and at the same time reduces toxic amines produced
by bacterial putrefaction of food. The Eubiotic diet may
then help to keep the liver, stomach, kidneys and other
body systems from becoming overwhelmed. When organ
systems work more efficiently, energy and immunity
are improved. Blood pressure may thus be reduced by
decreased arteriolar resistance (especially renal) and
through increased cardiac output. One provocative
hypothetical possibility is that ‘essential’ hypertension, of
generally unknown cause, may in fact be due in part to
dysbiosis and imbalances within the intestinal flora.
Although intestinal flora could contribute to PB’s high
blood pressure, her family history of renal disease plays
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case reportS
toxic products in the gut.20 The production and absorption
of toxic metabolites, referred to as bowel toxemia,21 may
have contributed to the patient’s pathology. The patient’s
previous diet was high in animal protein, animal fat, simple
carbohydrates, sugar, and low in insoluble fiber. The patient’s
typical diet may have resulted in bowel toxemia and the
production of irritant toxic amines. As a result, chronic
exposure to these metabolites may have made her digestive
system hypersensitive and caused it to react to antigens it
normally would not react to, such as carbohydrates, animal
proteins, sweets, fruits, juices, and even spices.
In the case of dysbiosis, vasoactive and neurotoxic
amines, such as histamine, octopamine, tryptamine, and
many others are produced by bacterial putrefaction of food,
or more specifically by bacterial decarboxylation of amino
acids. These toxic amines are absorbed through the portal
circulation and deaminated in the liver.21 The pathway
is detailed in Figure 4. The symptoms of hypochondriac
pain, stomach irritation, food intolerance, bitter taste, and
intestinal activity are believed to be closely associated with
the patient’s dysbiosis and ‘bowel toxemia’.
Regarding the cause of hypertension, it is believed that
the production of potentially harmful bacterial metabolites
could be an important etiologic agent. The accumulation
of ammonia, amines, phenols, sulfide, and indoles could
lead to a reduction in metabolic efficiency and an increased
production of reactive metabolites,2 such as increased
production of histamine, octopamine, or tryptamine.23
It is hypothesized that this harmful accumulation could
lead to hypertension through the following process.
Primarily, the toxic amines could overwhelm the liver’s
The Role of the ‘Eubiotic’ Diet | Kao, Levytam
Figure 3: Mean Diastolic Blood Pressure (mmHg)
an important role as well. It is interesting to note that the
Eubiotic diet may also have improved her kidney function.
In the past, her urinalysis results often showed hematuria,
but her recent urinalysis results were normal. These changes
correlated with the changed diet as well as other naturopathic
recommendations. Unfortunately her urinary pH was not
measured at each visit; otherwise urinary pH may have been a
good method of monitoring her progress on the Eubiotic diet
since it is believed that the reduction in amine production
would correct to a shift in urinary pH.
Conclusion
case reportS
Given other recommendations for care, the holistic
treatment approach used with PB does not allow a
perfectly clear picture of exactly what treatment produced
what results. This, in addition to the fact that ours is an
observational report without comparator or means for
replication, imposes some strict limitations with respect to
the conclusions that can be drawn. That said, the clinicians
in charge of the patient’s care, BK and SL, are confident that
the Eubiotic diet was responsible for the improvements
exhibited by PB.
Although the patient’s hypertension was partially
controlled by medications, her blood pressure often
exceeded the normal range. We believe that the Eubiotic
diet was the core component of our naturopathic
treatment, and was most responsible for helping control
this patient’s high blood pressure. We also believe that
dysbiosis was the root cause of the condition and treated
accordingly. This unique case helps elucidate potential
connections between systemic dysbiosis, kidney damage,
and high blood pressure. The case highlights a generally
unrecognized treatment approach for hypertension and
emphasizes the need for scientific and clinical exploration.
Further research should include an appropriate comparator
group and be conducted to explore the benefits of this diet
for high blood pressure specifically.
Figure 4: Harmful Substances Produced by the Intestinal Microflora - figure
adapted from Mitsuoka. Science and Technology in Japan. March 1976.22
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Kao, Levytam | The Role of the ‘Eubiotic’ Diet
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The Role of the ‘Eubiotic’ Diet | Kao, Levytam
Appendix 1: Food Guidelines for Eubiotic Diet
49
IntJNM 4(1): 2009