Fixing Crohn’s and Colitis

Excerpts from my podcast “The Perfect Stool: Understanding and Healing the Gut Microbiome“. Edited for readability. L=Lindsey; I=Inna.

L: How did you get into this work on Crohn’s and colitis?
I: That was my long journey to healing. I got sick with Crohn’s in early 2000. I was originally diagnosed with colitis, and then properly diagnosed with Crohn’s. I tried all kinds of medications, and it didn’t bring me much relief. Being a pharmacist myself, I was also skeptical and worried about the side effects, which doesn’t help at all when you know them all. And I tried different methods. I went for different modalities of healing, and my nutrition was not at the point where it is now. But I tried changes and I did succeed to a degree, until I finally found functional medicine, which really brought me to a whole different level. That’s how I started the practice, because [functional medicine] helped me.

L: Were you already a PharmD at the time when all this started?
I: I was an RP, a registered pharmacist, at the time. The reason I [got a PharmD degree in 2017] is because I wanted to dig deeper into the studies and learn way more about evidence-based stuff. I was a pharmacist, then I took a lot of education and learned about functional medicine, integrative solutions. And then I decided, here’s the time to do my doctorate to be able to really extrapolate all the details and learn about the evidence-based studies.

L: What year were you diagnosed with?
I: –colitis, originally colitis, in 2000. And then, in 2003, I was diagnosed with Crohn’s disease, the final diagnosis.

L: When you see a Crohn’s or colitis patient in your practice, what is your first step in working with them?
I: I take them on a really long consultation, we discuss their history, we go all the way back, I listen to them, I need to hear their goals, I need to understand their gut story. And by the end of the session, I am more or less on top of what functional diagnostics they should run and what route they should take in order to heal.

L: Do you typically have to do some more testing with them or is a diagnosis of Crohn’s or colitis sufficient to start working with them?
I: For most of my clients, I recommend functional diagnostics. They really can open up and show us a whole different picture, especially the stool test with PCR technology right now—even other toxicity-related testing that doctors at this point don’t have an option or don’t have the education to dig for. That could be the root cause. And it’s great. It’s great to find out.

L: So what do you use for diagnosing toxicity?
I: Well, it’s really not diagnosing – I try to steer away from that term. But to recognize and to see and to get a lab check, I really love. First I would do an Organic Acids Test for a client. And sometimes just from that lab alone, we could see we have to dig in and see if there is metal toxicity. Then we’re going to do more extensive testing, for example, for metals, or for mold toxicity or other toxins.

L: Whose testing do you use for metals?
I: I love the Great Plains Laboratory. They’re great. I’ve just had really great success with that lab.

L: What kind of test do you use for mold?
I: Also, I love to use GPL for their mold testing.

L: And what’s that one called?
I: Multi-tox screen. I believe a full tox screen and then the Organic Acids Test.

L: Do you also do that through Great Plains?
I: Yes. For around 10 years. I’ve seen hundreds of these tests.

L: So what made you choose the Great Plains over the other labs?
I: I met the rep at an integrative healthcare symposium. They were very compatible to Genova. Genova at that point changed from Methometrix and a pharmacist’s license was no longer okay to order. And that was a perfect choice for me. GPL.

L: What kind of information will you see on an Organic Acids Test that will lead you to believe that it’s perhaps a metal toxicity issue?
I: It could be a combination of things. It could be the fact that we see that there’s a lot of issues with liver detoxification, a symptomatic presentation, along with a combination of things, plus the liver, plus the look of a client. It’s really at least a few different ways you could see and then go for metal testing. [A client with metal toxicity might have a “look”] that’s often a grayish skin, black under their eyes. They’re often feeling cold, cold sensations in the hands. Sometimes they have a metallic taste in their mouth – that’s the liver, unable to process. Again, if the bile ducts are congested, they usually have that color.

L: And would these be people who have had some knowledge that they were exposed to heavy metals, or people who were just sort of, “Oh, I have no idea how that happened?”
I: I often have someone that says, “Oh my goodness, I had no idea. I have so much lead. I have so much aluminum.” But I did have a client that was completely positive they had mercury poisoning. He goes “I went through so much sushi in the past couple months. Maybe I have mercury toxicity.” And here we go. There it was. That can happen.

L: And that I assume is primarily from fish like tuna?
I: Yeah, yeah, large fish. Again, some companies are very, very responsible and they can grab the fish before it reaches a certain weight. So there’s much less mercury in the tuna like Vital Choice. Yeah, it is BPA free and very, very sustainable and organic, very clean company.

L: Good to know. So we were talking a little bit about the mold. What kind of signs and symptoms might lead you to that or things on the Organic Acids Testing that might lead to you to suspect mold?
I: With my clients, it gets a little harder, because my clients usually are Crohn’s and colitis, and they’re very sick to begin with. So the symptoms can kind of mix in all together. So mold I will mostly recognize from the Organic Acids Test. And that’s like, right in the beginning of the test, we will get Aspergillus being high, the different Furan markers, or Tartaric or 5-Hydroxymethyl-2-furoic. If they’re really high numbers, we will really go straight for mold testing.

L: Okay. And then how often do you find that people with Crohn’s and colitis, the root cause is some gut stuff like Candida or bacterial overgrowth?
I: Super often. Very often. Many, many of my clients have candida overgrowth, many.

L: Have you begun to form theories about what the most common root causes are for Crohn’s and colitis?
I: That’s a question I’ve been asked recently a lot. A common root cause would you believe that it’s the personality? My common thing in my Crohn’s clients is type A personality. They push themselves. It’s a combination of course; it’s a multifactorial situation. There’s so much involved. Type A personalities; very common in Crohn’s patients. And they really push themselves – they’re one of those go getters that go without slowing down, and that can really get them in trouble. It’s a root cause for Crohn’s. It’s a multifactorial base, except that being in overdrive and not letting yourself relax enough and not remembering yourself and not prioritizing your health often is an issue.

L: Tell me how that relates to gut issues. What’s the physiological process there? I assume we’re talking about stress.
I: Sure, it’s adrenal imbalance. It’s the fact that, you know, the gut microbiome, this is something interesting, many people probably don’t know, if you haven’t got a perfectly balanced gut microbiome or as close as perfect as you could get. Probably no one is perfect, but as diverse because we want it to be very diverse, to be to be healthy, as diverse as possible. And overnight, there’s some kind of severe stress, a fire, major fights, something really horrible happening. The next day, if you tested that microbiome, it would show someone super sick; a really, really different microbiome. So the gut microbiome, of course, plays a major role. And so presumably, the stress releases cortisol, and then how do you think that impacts the gut microbiome? Stress, releasing cortisol, we don’t have the exact connection to how it affects the microbiome. When your cortisol is constantly high, you will have some kind of other hormone imbalance, sex hormone imbalance, that leads to possibly blood sugar instability. Now [you get] the release of insulin, now you’ll have the cravings that you’re not going to eat properly. It’s a chain reaction, and then you get indirectly to the gut microbiome imbalance.

L: When you work with clients, do you also test their adrenals?
I: I do. It’s part of fixing the entire body. I really appreciate that from the Kalish course from way over 10 years ago. I know there’s a lot of controversy with the adrenal fatigue diagnosis. Of course, I do not diagnose. But fixing, correcting things, is really helpful for those that have chronic conditions.

L: Tell me what kinds of things you’ll find when you test the adrenals.
I: All kinds of things. High cortisol for someone, super low cortisol for another one. If they’ve really been in severe chronic situations, DHEA falls down. For women sometimes, it affects their sex hormone health, like they’re symptomatic for low progesterone because of pregnenolone steal.

L: Pregnenalone steal?
I: Steal, yes, it’s a term with adrenal health. It’s what happens when you have that low cortisol for too long, when it reaches that point, when it really can’t go back high enough, because it’s exhausted, the adrenals, you cause a situation called pregnenolone steal. And from there you’re going to have trouble making a sufficient amount of sex hormones. And that creates other symptoms. A lot of my Crohn’s patients, for example, have low progesterone, young and old, at any age point, and therefore with low progesterone, it is harder to maintain pregnancy. So no wonder now they’re confused why they’re having miscarriages – low progesterone often leads to miscarriages.

L: I know all about that. That’s exactly what happened to me. So what do you recommend for that? And are you an herbalist type with the drops? Or do you get people to use the pills or?
I: I often mix but my favorite one right now is Adaptocrine from Apex Energetics. I’ve seen great results with it.

L: So is that a mix of different adaptogens?
I: Yes, mix of great adaptogens. But again, it’s a blanket adaptogenic herb combo, but if there is a need for more of plant-derived bioidentical hormone for just a short term, DHEA, pregnenolone, they work well.

L: I know that the adaptogens help both with low and with high cortisol, do you use the same thing in that case or something different?
I: Very often I do yes, more often with low cortisol activity. And if I see them overreact to them and if I see this is just a very recent case, and they’ll be able to fix it with a quick fix. But most likely it would be for both cases.

Q. Is there something different between Crohn’s and colitis in your treatment approach or in typical protocols?
I: It’s a very good question. I understand what you’re asking me. Not one of my protocols has been the same for the past good three or four years. Everything is so individualized for every single person. Like no Crohn’s patient is the same; more probably Crohn’s patients than colitis patients but not one wellness plan that I create looks the same as the other.

L: Do you typically use herbal products in helping people?
I: Herbal and neutraceutical supplements.

L: What kind of diet changes do you recommend for people?
I: Anti-inflammatory. That’s where I really focus on. As long as the diet is very anti-inflammatory and favorable for macro and micronutrients balance. I don’t restrict completely. The SCD (specific carbohydrate diet) diet. SCD can work for a short period of time for sure. Except completely without carbohydrates – usually, weak patients, Crohn’s patients in flares, they really need some carbs to flourish. I create for my clients usually a mix of a Paleo, with a little bit of carbs. I focus on properly-balanced plates, from macros to microbes. All thought out and colorful plates to get the most out of your nutrition, like not having them repeat meals all the time. Very important to rotate.

L: What grains do you recommend to people?
I: I concentrate on gluten-free grains like buckwheat. Many of my clients love buckwheat; actually, they haven’t used it before we speak. So that works.

L: That’s funny because I remember as a child being offered buckwheat pancakes and the first time I tasted them I’m like “this is the most vile thing I’ve ever had, what is this stuff?” And I eat gluten free but when I bake, I make a mix. I usually use sorghum and millet and cassava and tapioca starch as my starch or arrowroot. Sometimes tiger nut or coconut flour.
I: Those are all perfect; all in my pantry. I even managed to be able to make crepes; really, really thin pancakes. Yeah, it takes time. But yeah, you learn.

L: Almond flour of course, that’s my go to flour.
I: And the key is to rotate obviously, you don’t want to be stuck on one. Because then you might create another problem. You might create another food intolerance for yourself.

L: I think I probably live like 50% on almonds. What about elemental diets? Do you use those at all or semi elemental?
I: I try to steer away. Unless there’s a specific rare case. I would recommend that for really short term just to kind of calm everything down, but not for too long. Maybe a week or two.

L: And why is that?
I: Again, I won’t find an evidence-based study on this. Strictly from my experience with so many clients – when the stomach is empty for the first few days it feels great, though there’s no pain. When your gut is inflamed, what happens? Food passes, it creates pain. So food is associated now with pain; people are afraid to eat. This is common with Crohn’s and colitis patients. When you restrict them on chunky food, you will now decrease the pain so they feel better. For a couple of days to a week, things are great. What happens afterwards is that the microbiome cannot be really sustained and be really well-balanced without the chunky meal, or at least the smoothie. You need to feed the intestinal lining. You need to feed the gut microbiome. And, unfortunately, elemental diets won’t provide that in my opinion. With a decade of experience, people start to feel gassy. They will start losing natural probiotics in the gut flora. And they start to feel worse later, in pain. So yes, it’s very short term in my practice only. I’m not putting anybody’s practice down if they have success.

L: What about fiber?
I: Fiber again, very carefully, but it’s a must to reseed that flora. You can’t avoid fiber, but you’re going to have to be very careful and do a proper job putting down the fiber. I’ve learned that if there’s overgrowth of bad bacteria, no good probiotics and you give them fiber, they hurt. That’s gas, that’s pain. And in the beginning, it took me a while to understand how to gently, gradually put it back in.

L: When they’re flaring do you use fiber? Or do you wait until the flare stops?
I: Depends on the flare. If it’s a real flare, then yes, I would wait a little bit until they’re better.

L: And how do you gently introduce fiber?
I: Small amounts, little by little, pinches in the beginning only, and then we grow.

L: And then probiotics. Which probiotics do you use?
I: I really use a lot. I use probiotics depending on the results that I see on the GI map and other labs. I love Garden of Life original professional formulas and Multiprobiotic their soil-based I love. S. boulardii, depending only if there is a need. I love Probiomed from Designs for Health. I am very choosy. And I pick and choose for every case.

L: Will you typically have people do multiple kinds of probiotics, like the spore-based and the lacto-bifido and the S. boulardii?
I: It depends. Most of the cases I do not combine. Most of the cases I don’t. I’ve had a few where I had to, there was a need.

L: And so this is basically based on what you see on the GI map, you’ll decide what they’re most lacking in?
I: Yes, exactly. What they’re lacking in, what they would benefit from, for example, Megasporebiotic by Microbiome Labs for certain cases. But if there’s Bacilli overgrowing, of course, I won’t give that to our clients. So it has to be review and then recommend.

Listen to the entire podcast episode with Dr. Lukyanovsky.

And if you’re struggling with a gut issue, autoimmune disease or a mystery health issue, please feel free to set up a free, 30-minute breakthrough session with Lindsey to talk about what’s been going on and hear about how health coaching could help.

Gluten-free Blueberry Muffins

gluten-free blueberry muffins

Preheat oven to 350 degrees F. Mix all of the following in a bowl:

1½ cups almond flour
½ cup gluten-free flour (I use a mix of 2/3 sweet sorghum and millet flour, 1/3 tapioca or arrowroot starch)
½ cup sugar or xylitol (if you want a safe sugar-free alternative)
½ tsp baking soda
½ tsp salt
½ cup full fat coconut milk (for dairy-free), sour cream or full-fat yogurt
½ cup avocado oil or coconut oil
1½ tbsp apple cider vinegar
2 eggs
2 tsp real vanilla

Add 1 cup fresh blueberries, mix in.

Bake in greased muffin tins for 20 minutes. To keep blueberries from sinking to the bottom, you can also mix in ½ of them then take the pan out after 5 minutes in the oven and add ½ of them to the tops of the muffins.

Optional: you can also sprinkle chia seeds on the tops of the muffins before baking for some extra fiber and omega 3 fatty acids.

Upper Digestive Issues: Gastritis, Ulcers, GERD and Low Stomach Acid

Upper Digestive Issues: Gastritis, Ulcers, GERD and Low Stomach Acid

Gastritis
The problems I address in this article happen north of the intestines in the stomach or in the first part of the small intestine, called the duodenum. While some of these are dealt with effectively using traditional medical care, others will be missed by your traditional doctor, or will become advanced and require a functional medicine approach because they’ve been left so long unattended that they’ve provoked problems in your gut microbial balance or because their origins are bacterial gut infections that traditional doctors don’t know how to look for or treat.

Let’s start with gastritis. This is a first line problem where your stomach is bothering you. It can be asymptomatic or can have symptoms such as

• Indigestion
• Nausea or recurrent upset stomach
• bloating, pain, vomiting, including vomiting of blood or material that looks like coffee grounds
• Burning or gnawing feeling in the stomach between meals or at night
• Hiccups
• A low appetite, or
• Black, tarry stools, indicative of blood in your stool

All this means that you have inflammation, irritation and/or erosion of the lining of the stomach. And you can have an acute or sudden case of gastritis or it can come on gradually and last a while, which would be considered chronic. But either way is, if you catch it early, gastritis can be dealt with pretty easily. However, left untreated, it can lead to a severe loss of blood and may increase your risk of stomach cancer.

A lot of people will just figure out they have gastritis from the pain and do something about it without seeing a doctor. But if you have a chronic case and taking antacids isn’t doing the trick, you may see a doctor, who may do an upper endoscopy, and likely blood tests, such as checking your red blood cell count for anemia, or possibly check your B12 levels to see if you have pernicious anemia or a B12 deficiency, which can result from low stomach acid, which can give you some of the same symptoms as gastritis. And if you have evidence of blood in your stools like the black, tarry stools I mentioned, your doctor may do a fecal occult blood stool test. And if your doctor is on the ball, he or she will also check for H. Pylori or helicobacter pylori, which is a bacteria that can cause these symptoms. I’ll touch more on that later. However, your doctor’s test could miss H. Pylori, so often people will end up needing better testing to verify that their problem was H. Pylori all along.

Some of the causes of gastritis are within your control, so if you are using alcohol excessively, stopping or reducing your use is one treatment. If you have an eating disorder, chronic vomiting will also cause gastritis, so you may need to get professional help with that. And of course our old friend stress can also cause gastritis, so either eliminating your sources of stress or mitigating them may help. And taking NSAIDs or non-steroidal anti-inflammatory drugs, including acetylsalicylic acid, which is the drug in medicines like Aspirin, ibuprofen (which is in Advil and Motrin), diclofenac (which is a topical pain cream and is found in a product called Voltaren) and naproxen sodium, found in Aleve, is another way to end up with gastritis, so if you can stop those or reduce your use, that may help. You can take Acetominaphin without these negative side effects, although I’m well aware that it doesn’t take care of the same problems.
The last possible causes of gastritis that will require professional help are H. Pylori or other bacterial or viral infections, and bile reflux, which is a backflow of bile into the stomach from the bile tract (which connects to the liver and gallbladder).

If you are diagnosed with gastritis, one treatment you’ll likely be offered by your doctor is to take either antacids and other drugs (such as proton pump inhibitors, also known as PPIs or H-2 blockers) to reduce stomach acid. Some examples of these are Nexium, Protonix, Aciphex, Omeprazole, Prilosec and Prevacid, and these are offered over the counter, which makes them look innocent, but let me warn you, as someone who took them continuously for like 15 years, they are not innocent. These drugs will reduce your stomach acid by up to 99% and the end result of that can be the development of even worse gut bugs, maldigestion of protein, B12 anemia, leaky gut, and ultimately, autoimmune disease, all of which I believe I developed after long-term PPI use. The only one that wasn’t definitely diagnosed for me was the maldigestion of protein, but I had all the rest. If you have to take a PPI, my recommendation is to follow the instructions on the package that says not to take for more than 14 days. If your problem doesn’t resolve in those 14 days, you may need to look harder for your root cause. In my case, my root cause of bloating and an incessant cough that was coming from stomach acid in my esophagus, was an intolerance to dairy. I thought I was only lactose intolerant and dutifully took my lactose digestant tablets when I ate dairy, but it turns out I was also intolerant to casein. When I completely cut out dairy, my 15 years of acid reflux disappeared. It was a sad day, but as my French friend said to me about a year earlier, “if you have to take a pill to eat something, do you think you should be eating it?” Those words rolled around in my head for about a year before I was willing to face the loss of my beloved dairy, but I haven’t looked back and have learned to replace the creamy, salty, umami of dairy with avocado or just make different dishes that don’t require dairy. And I occasionally cheat and take many pills to digest gluten and dairy for Neopolitan pizza or burrata cheese, but that’s about it.

Back to treatments your doctor may recommend for gastritis, this could include recommending you avoid hot and spicy foods, eliminate gluten and/or dairy, which are two of the most likely dietary culprits for these kinds of issues, or if your issue if pernicious anemia, vitamin B12 shots or like I take, sublingual tablets. And finally, if your root cause is H. Pylori, and a traditional doctor finds, it, you’ll likely end up on a cocktail of several antibiotics plus PPIs, which may mess up your gut microbiome even more and cause you long-term problems, so I wouldn’t recommend that approach. And I’ll address the best way to deal with H. Pylori under the topic of ulcers.

Some more functional medicine type treatments for gastritis include taking DGL* or Deglycyrrhizinated Licorice before meals, which helps with the mucus production in your stomach and intestines and helps coat and protect them. And the probiotic Lactobacillus rhamnosus GG, which is found in Culturelle* and other probiotics, has also been found to help with gastritis.

But the good news is that most people with gastritis improve quickly once treatment has begun, so the moral of the story is, don’t ignore your body’s early signals that something is amiss in your gut because it can get worse.

Ulcers
Left unchecked, some gastritis, depending on its root cause, can turn into an ulcer, which is an open sore on the inside of your stomach (aka a gastric ulcer), or an open sore on the inside of the upper portion of your small intestine, or your duodenum, (aka a duodenal ulcer). Together, both of these are referred to as peptic ulcers. The main causes of these, like with gastritis, are H. pylori and long-term use of NSAIDs and/or taking other medications along with NSAIDs, such as steroids, anticoagulants, SSRIs (or selective serotonin reuptake inhibitors, which are prescribed for anxiety or depression), or the drugs Fosamax or Actonel.

Symptoms of ulcers include:

• Burning stomach pain
• Feeling of fullness, bloating or burping
• Intolerance to fatty foods
• Heartburn
• Nausea

And some more severe but less common symptoms are:

• Vomiting or vomiting blood — which may appear red or black
• Dark blood in stools, or stools that are black or tarry
• Trouble breathing
• Feeling faint
• Unexplained weight loss
• Appetite changes

You may not be old enough to remember this, but I do. They actually used to believe that spicy foods and stress caused ulcers, which we have since learned isn’t exactly true. Drs. Barry J. Marshall and J. Robin Warren, Australian researchers, discovered in 1982 that H. Pylori was in fact the root cause of more than 90% of duodenal ulcers and up to 80% of gastric ulcers, for which they were awarded a Nobel Price for Physiology or Medicine in 2005, after being ridiculed and ignored by the mainstream medical establishment.

But as I mentioned, one other primary cause of ulcers is prolonged use of NSAIDs, like Ibuprophen. I recently had the misfortune of experiencing this during my ongoing bout of sciatica because I can’t survive without some type of pain relief. I was taking 2 Ibuprofen every 4 hours (which was what my doctor described as the maximum safe dose, without any warning about ulcers, although of course I knew better). First it felt like an acidy feeling in my chest, then it felt like a burning or slight discomfort in a particular place in my stomach after taking Ibuprofen. I was so desperate for pain relief I kept taking Ibuprofen for at least 7-10 days after this sensation started, but eventually knew I had to stop or I’d end up with a bleeding ulcer. I have since had to switch to Acetominaphin, even though it’s not as good for my type of pain, but I really had no choice. Now I reserve the Ibuprofen for only my worst days. And the good news is that I was able to reverse this problem relatively quickly by taking a PPI, Omeprazole, for about 10 days along with the probiotic Culturelle, which is also recommended for ulcer prevention, and my symptoms resolved quickly. The bad news is, I’m on another drug to help relax my muscles called Tizanadine, which is starting to cause an acidy stomach, so I may have to dip back into the PPIs, or stop the Tizanadine, so I’ve got a bit of a dilemma, as I imagine many of you have when faced when you’re faced with the choice of taking your needed drug or having digestive issues, which was something I was a bit more flippant about when it wasn’t my body, and which I can now totally appreciate, as I try to control my pain while trying to resolve the root cause of my sciatica.

Getting back to our old friend, H. Pylori, which is the primary cause of ulcers, the dilemma is that it doesn’t always cause ulcers, and many healthy people have it in their systems with no problem. In fact, in developing countries, H. Pylori is found in over 80% of people, and about 20-50% have it in developed countries, but only 10-15% of people who have H. Pylori will develop peptic ulcers. Some strains of H. Pylori cause gastric cancer, but not all, so if you have it, it’s important to find out which strain you have and if it’s a problematic one, which you can find out through the GI Map Test, which costs about $400, and is used by functional medicine practitioners. Unfortunately, it’s not covered by insurance, but the information you get on it is worth its weight in gold. You can order it yourself online too, and I usually recommend it for my clients with upper GI issues, because it will tell you not only if you have H. Pylori, but if you have what’s called virulence factors, or the really bad strains of H. Pylori, and whether your amount of H. Pylori is abnormal, and will also test for all other known gut pathogens as well as signs of gut dysfunction originating in your digestive organs.

The way that H. pylori causes peptic ulcers is by attaching itself to the protective mucous coating of the stomach and duodenum, and weakening it, allowing acid to reach the sensitive lining beneath it, causing an ulcer to form. Left untreated, it can lead to stomach perforation and bleeding. Ironically, some studies show H. Pylori can be protective as well against gastro-oesophageal reflux (aka GERD) and oesophageal carcincoma, and the former is documented in fascinating detail in Martin Blaser’s book “Missing Microbes” that made me want to go out and get H. Pylori, because of the GERD that plagued me for years. Dr. Blaser, who had H. Pylori but was asymptomatic, cleared it out with antibiotics, then found himself with GERD, then reinoculated himself with it. It turns out that certain strains of H Pylori (cagA+ ones) can reduce the acidity of the stomach (thereby raising its pH) which can prevent GERD, Barrett’s oesophagus and adenocarcinoma (a kind of cancer) of the oesophagus.

However, what I have seen in clients with H. Pylori is a sequence of events that leads to problems. First you see a decrease in stomach acid. This is caused by the release of an enzyme from H. Pylori called urease, which breaks down in the stomach into carbon dioxide and ammonia, causing burping and bad breath that are commonly associated with H. Pylori, and which neutralizes stomach acid or hydrochloric acid, or HCl. HCL prompts the release of bile, which helps metabolize fat in the small intestine, so you can get fat maldigestion, which can lead to nutrient deficiencies. If your stool is pale or floating, that may be because you don’t have enough bile production.

As a result of low stomach acid, you get a rise in pathogenic bacteria or overgrowths of commensal or beneficial bacteria that are not killed off in an acidic stomach, such as Escherichia, including certain pathogenic strains of E Coli, Clostridia, including Clostridia Difficile, which you often see people getting after hospital stays and which causes explosive and frequent diarrhea, Enterococcus, including Enterococcus faecalis and faecium, streptococcus, and overgrowths of yeast such as candida albicans, candida glabrata or other fungi and a high ratio of the phylum firmicutes to bacteroidetes or other more pathogenic strains of H. Pylori. Eventually this can turn into an increase in stomach acid, which will also cause symptoms of acid reflux, bloating, gas, etc.

Low Stomach Acid
Now I want to stop for a minute to make sure you understand that low stomach acid can cause the same symptoms as too much stomach acid, but traditional doctors will almost always assume that your symptoms are coming from too much stomach acid, diagnose you will GERD and prescribe PPIs. The normal pH of a stomach for healthy protein digestion is 1.5-2.2. And that proper pH is a trigger for contraction of the lower esophageal sphincter, which is just above the stomach. This protects the soft, delicate tissue of the esophagus from the harsh acids in the stomach. If your stomach acid is too low, the sphincter may remain open, letting acid up into your esophagus, causing GERD symptoms like burning or an incessant cough, which often prompts people to take antacids or PPIs. These medications can exacerbate the problem by preventing proper digestion of foods, especially protein, which you need HCl to digest, and stressing the enzymatic system of the pancreas and other digestive organs, which are prompted to secrete enzymes in response to stomach acid levels. This can lead to calcium deficiencies, iron deficiencies, B12 deficiency, Vitamin A deficiency (which leads to increased inflammation and gut damage), and protein deficiency, all of which lead to other problems in the body.

When you have a low stomach acid situation brought on by H. Pylori or other reasons, like aging, you will often then see low pancreatic elastase 1 on the GI Map test, which is a digestive enzyme secreted by the pancreas. You can also see this decrease in pancreatic elastase 1 for other reasons, such as gallstones and a vegetarian or vegan diet.

Now back to the question of whether stress is a potential cause of ulcers. The reality is that it probably is, but indirectly. While H. Pylori may be ultimate culprit, given that so many people have H. Pylori and no ulcers, the question is, “why do some people get them?”. So here is the route that this commonly follows. First, our bodies’ first line of defense in the mucous membranes, segretory Immunoglobulin A or SIgA decreases in response to chronic stress. As a result, our gut defense systems are down, allowing the overgrowth of pathogenic or opportunistic bacteria like H. Pylori, which can lead to an ulcer. Or it can lead to decreased stomach acid and other overgrowths as I mentioned before.

So the better way to deal with H. Pylori, rather than taking antibiotics, is to take mastic gum* which is quite effective in treating H. Pylori, along with probiotics of various types, DGL*, and slippery elm*, to help coat your stomach. And if you can tolerate it and it appears you have low stomach acid, it helps to supplement with Betaine HCl*, or stomach acid, using a Betaine HCl challenge test approach, which I’ll describe in just a minute.
GERD

Okay, finally let’s finish up the topic of GERD or gastro-oesophageal reflux, which again is when the lower esophageal sphincter lets acid up into the esophagus. We’ve already touched on some possible causes, including low stomach acid and H. Pylori, so other possible causes are a hiatal hernia, pregnancy, scleroderma, which is an autoimmune disease, obesity, smoking, alcohol usage and certain prescription drugs. So it may be that you have excess stomach acid and not low stomach acid, in which case a short-term (meaning no more than 14 day) course of PPIs may be called for, but you should really only use them when necessary and symptomatic, and then start to try to figure out the root cause of your excess stomach acid and address it. So if you have no other possible root cause as I just mentioned and are negative for H. Pylori, you can start by trying the Betaine HCl challenge to see if you have low stomach acid. The way you do that is to start with one capsule per meal with animal protein (they typically are sold in the 500-750 mg range) then increase your dosage by 1 capsule/meal every 2 days until you feel heartburn or a warmth in your stomach (going up to as many as 5 capsules), then back down to previous dose. If you immediately feel a burning, then it may be you have excess stomach acid or perhaps a hiatal hernia or some other issue. You can take an antacid or some baking soda to neutralize the acid if it’s bothering you. But there are some contraindications for using Betaine HCl, which include Barrett’s esophagus, diagnosed malformation of the lower esophageal sphincter, a history of stomach ulcers, any diagnosed disease or pathology of the pancreas, or if you’re taking NSAIDs or have a diagnosed blood-clotting disorder. One alternative to taking Betaine HCl is to have 1-2 tbsp. of apple cider vinegar or lemon juice mixed in water 10-15 minutes before meals. But again, if you have a diagnosis of Barrett’s esophagus, esophageal strictures, or reflux esophagitis, you shouldn’t use these either. In that case, your best bet is just to try digestive enzymes* that don’t include Betaine HCl, but if you do want to try the Betaine HCl* approach, it’s best to find one with pepsin, which is an enzyme normally secreted by the cells in your stomach.

If you’re struggling with these issues or other gut health issues and need some help, that’s what I do for my clients. I offer a free, 1-hr. breakthrough session to talk about your issues and to see if gut health coaching might help you resolve them.

This information isn’t intended to diagnose or treat disease but is for educational purposes only. Please consult with your health care professional before acting on any of this information.

*As an Amazon Associate I earn from qualifying purchases. Thanks for your support in using my links!

Medicinal Mushrooms: Immunological Adaptogens and Gut Health Helpers

Medicinal Mushrooms: Immunological Adaptogens and Gut Health Helpers

Mushrooms have been eaten by humans for thousands of years. There are tens of thousands of different mushrooms species, of which six are cultivated for food in North America. There are about ten “choice edibles,” wild mushrooms for which people forage because they’re especially tasty. In Asia, they cultivate approximately twenty different mushrooms. At any time, you might see at least a dozen of those in an Asian market.

Jeff Chilton, co-author of The Mushroom Cultivator*, founder of NAMMEX (North American Medical Mushrooms Extracts), and my most recent guest on The Perfect Stool podcast, introduced medicinal mushrooms to the supplement market in the United States in 1990. He started NAMMEX in 1989, at a time when no U.S. company offered mushroom-based supplements, even though mushrooms have been used in traditional Chinese medicine for thousands of years. This is partly due to the high cost of cultivating mushrooms in the United States. Developing mushroom supplements is even more expensive. For example, while fresh mushrooms may sell for $5 a pound, once they’re dried, it’s $50 per pound because the process of drying is more involved. Mushrooms, like a lot of vegetables, are 90% water. So the economics of mushrooms as supplements do not work in the United States. For this reason, no mushrooms are grown the United States for supplement use; NAMMEX grows all of its mushrooms in China.

The most important attribute for medicinal mushrooms is their ability to modulate the immune system. Mushrooms contain compounds called beta-glucans. In fact, their cell walls are made up of approximately 50 percent of these beta-glucans. A large body of scientific research has demonstrated that beta-glucans express immunological activity. Mushrooms are often working in the background – so when your immunity is low and you get frequent colds, that’s when mushrooms can stimulate the production of immune cells, including macrophages, NK cells, or T killer cells. The key takeaway is that mushrooms modulate our immunity, which means they help potentiate and strengthen our immunity when we need it; but if our immunity is fine, they don’t do anything.

This is why many people would call mushrooms adaptogens. Adaptogens are non-specific: they sit in the background, available to help when needed. That’s why it’s so important to either include mushrooms in your diet or supplement regularly to enjoy their benefits. It’s not recommended that you supplement with mushrooms for a week or two, stop for a week or two and then start again. Rather, Jeff Chilton recommends that before considering supplementation, everyone include mushrooms in their regular diet as a very healthy food.

There has not been a lot of specific research about gut health issues with medicinal mushrooms. However, chaga mushrooms have been used traditionally for gut issues. Chaga is interesting because it doesn’t even look like a mushroom. It is not cultivated, but wild-crafted. It comes about very irregularly from what is called a canker that grows off of trees when a fungus has attacked a tree. Jeff Chilton suggests chaga as potentially helpful for Irritable Bowel Syndrome or Crohn’s disease, for example. Mushrooms also have a very high level of fiber, which directly feeds the microbiome. Some species are so high in fiber that scientists have suggested they should be processed and sold as a fiber supplement. So that’s a key way in which they help the gut microbiome.

Information in this article was adapted from my interview with Jeff Chilton on episode 33 of my podcast: The Perfect Stool: Understanding and Healing the Gut Microbiome.

*As an Amazon Associate I earn from qualifying purchases. Thanks for your support in using my links!

Seven Lessons My Sciatica Taught Me about Gut Health

Seven Lessons Sciatica Taught Me about Gut Health

Excerpted from episode 32 of The Perfect Stool podcast, “What My Sciatica Has Taught Me about Gut Health.”

So by way of history, I’ve been going through a pretty awful bout of sciatica over the last 5 months, which had been, up until about a week ago, what felt like a slow and inexorable slide into disability. With each passing day, despite all my best efforts, I could see a little bit of loss of function over the previous day. And by the end of August, 2020, I was even finding it challenging to sit up straight, I couldn’t walk more than three steps without having to stop to stretch, so that my muscle spasms would let up, and my nights were spent writhing in pain until I could feed myself enough Ibuprofen, pharmaceuticals and melatonin to finally knock me out, only to wake up two hours later when my hip got sore from only sleeping on my right side. Then I’d have to spend an hour on the floor doing stretches to stop the muscle spasms and kill time, because there was no other comfortable position I could lie in. You’ll be glad to hear that things have finally started turning a corner, and I can now sit up easily and walk a bit but I’m still taking it easy as I heal. But during this time, I did a lot of thinking about gut health and how my journey with sciatica related to it. So here are some lessons I learned that I think may be useful to those of you who are struggling with a gut health, autoimmune or other mystery health issue.

  1. Don’t wait too long to see a professional.

When I first started having back pain, I assumed that if I just kept doing the right stretches and used good posture, that my back pain would eventually go away as it had before. But the reality was, I was two years into pretty consistent back pain. If I could say something to the Lindsey of December 2019, or even July 2019, I would have said: “Go see your doctor! Get a referral for physical therapy! Take care of this before it gets worse!” I had no idea how bad it could get.

Similarly, if you’re having gut health problems and you’ve been trying to take care of it on your own, or only seeing traditional MDs, while you’ve been doing that your problem may be going from what Dr. Daniel Kalish calls a stage 1 gut problem involving some loss of gut diversity, to a stage 2 gut problem with compromised organ function that could impact your hydrochloric acid, enzyme or bile production and consequent damage to your gut lining and gut immunity, to a stage 3 problem in which you’ve acquired or your system has allowed the overgrowth of a pathogen because of the weakness of compromised organ function and lowered gut immunity. Left even longer, this can lead to autoimmune disease, increasing food intolerances, and Mast Cell Activation Syndrome, in which you quickly have what appears to be an allergic reaction to a whole slew of inputs, including many foods. The longer you wait, the harder, more expensive and the longer it will take for you to solve your problem, and honestly, the more you’ll suffer. Whatever concern I had in July or December of 2019 regarding spending the time or money to solve my problem, it pales in comparison to the amount of lost time, suffering that I could never have imagined, and money I have now spent on many modalities to try to solve my problem. Not to mention the opportunity cost of not spending time on my business while I’ve been trying to get well.

  1. Don’t reject traditional modalities if they can bring you relief while you search for the root cause.

With my sciatica, I held out hope that the right kind of physical therapy with consistent follow-through, eating a super low inflammatory diet, taking the right supplements, and staying active would help me recover. However, my decline just continued. I waited way too long to see a doctor, and when I heard that the next likely step would be a hydrocortisone injection, I purposely delayed following up in hopes that things would get better and I could avoid the shot. As a result, I probably spent an additional 5 weeks of sleepless nights writhing in pain and got much worse before I finally had my first injection, which I don’t regret at all, no matter the potential side effects. I also tried for so long to avoid taking NSAIDS (Non-steroidal anti-inflammatory drugs) for pain, but finally realized that I was suffering a lot unnecessarily, and am now up to the maximum dose of ibuprofen each day, while protecting my stomach with DGL and shilijat. I sometimes hear from clients that they have refused certain treatments from their doctors (especially around autoimmune disease and biologic drugs) that might bring them relief. While I’m a strong advocate of finding and addressing the root cause of any problem, if you’re really suffering or your health is in serious danger, it’s okay to try traditional treatments for a time while looking for the root cause.

  1. Don’t let the medical-industrial complex put you off from finding solutions.

One of the biggest roadblocks in getting to the root of my problem was my insurance wanting me to do at least a month of physical therapy before I got an MRI. But it was clear from almost the beginning of physical therapy that I was in too much pain to do most of the exercises I was being given, nothing was helping and I was going downhill. I finally resolved to just pay for the MRI myself because I felt it was important to have some insight into what was going on inside of me and they were clearly trying to make me jump through 1000 hoops to approve it. I didn’t want to have to pay for the test, but in the end, testing can give you real insight into root causes.

So if you’re hesitating to spend the money on gut testing that isn’t covered by your insurance and that your doctor doesn’t know about or won’t order, I’d urge you to reconsider. For gut health, there are two tests that I recommend to clients. They are the Organic Acids Test, which is $325, you can order it online yourself and it can enlighten you as to yeast and fungal overgrowths, bacterial overgrowth and dysbiosis, problems with carbohydrate, fatty acid and amino acid metabolism, detoxification issues, energy production issues and neurotransmitter problems. The other test I recommend, if problems are mostly confined to the gut, is a thorough gut health test like the Diagnostic Solutions GI Map or Doctor’s Data GI 360, which each run around $399, and you can order them yourself online. These tests will alert you to problems in your digestive system like a lack of hydrochloric acid, pancreatic enzymes or bile, indicating problems with fat metabolism, as well as test for specific pathogens, including pathogenic bacteria and parasites. It will also tell you how certain medications will work against those pathogens. It’s a rare insurance that would pay for these, although HSAs or FSAs might, but they’re worth their weight in gold for the information they will give you so that you’re not shooting in the dark. If that’s not financially possible, a less expensive option is doing a metagenomic sequencing of your gut through Sun Genomics. That’s only $147 if you go through my affiliate link, and if you look at the raw data, it will tell you everything that’s in your gut, if you know how to interpret that. So if you’re hesitating on testing, just think about how over time, you can waste a lot of money buying every supplement you hear someone recommending on a podcast or in a health summit, while building up a lovely supplement graveyard and getting no closer to a solution. Better to go around the medical-industrial complexes rules, order your own tests and get a functional medicine provider to help you understand the results.

  1. Listen to anyone’s and everyone’s advice – you never know where your solution may come from.

As things got worse and even the checkout clerks at the grocery store knew about my sciatica, I started getting advice from them and everyone else who heard my story. I also joined a Facebook group on sciatica and frequently popped in there to commiserate and find advice. Some of the advice didn’t work out, but some was useful. And some of the most useful stuff was about the mental game. I had been working myself into a giant pity party in which I was focusing so many hours a day on my pain and helplessness that my mind was feeding into my problem rather than helping solve it. Someone in my sciatica Facebook group said she would meditate and picture her nerves flowing freely through her spine. This image has helped me go to sleep so many nights, as I used my mind to help calm my muscle spasms. And it was a health summit on toxic mold where I heard about a special modality of physical therapy and a machine that helps reduce inflammation that may be one of the key elements of my healing, in addition to the injections. Even my plumber showed me a stretch no one else had shown me that helped him with his sciatica. So don’t reject advice because of the source – give everything a good listen and if you’re not ready to try it, put it in your back pocket for later.

  1. Don’t be afraid to ask for help.

As I was falling into disability, I realized that the more I was up and around, trying to cook, clean and do the things of everyday life, the more it was hurting me. The moment I had to tell my family that I really needed them to step up and help make my food and do my dishes, I couldn’t hold back the tears. I never considered myself one of those self-sacrificial people who always did for others and never asked for anything herself, but this was one of the hardest things I’ve ever done. But of course my husband stepped up and started filling in and got our boys to do more, and his kindness in this has really brought us closer. If you’re really suffering, let people help you. Don’t do things that will make you worse. It truly brings others joy to help, even if it forces us to humble ourselves, but there is growth in that humility. And also, don’t be afraid to reschedule or cancel things. People will understand. People have been very understanding with me when I’ve been honest with them. When you’re well again, you can pay it backward to those who helped you or forward to someone else who’s suffering.

  1. Don’t keep it all inside. 

Chronic pain and illness is not just physically debilitating, it’s mentally debilitating. And sometimes you can feel very alone in your pain and suffering. I had moments in the middle of the night where I had spent over an hour trying to get the agonizing muscle spasm in my glutes to let up through stretches, exercises and using a massage wand. One night, after an hour, I was still in agony, lying on the floor and sobbing because I felt so sorry for myself. That night, I finally woke my husband up and asked for help. He told me that from then on, he didn’t want me suffering alone, but that I should wake him up. After I stopped worrying about waking him and started relying on his help, my nighttime suffering quickly decreased and he was able to help me settle back down to sleep sooner, and also started asking if I needed anything when he woke up at his usual 5 a.m. That helped me go back to sleep for several more hours. Even if you’re single, there is probably someone in your life you can lean on more if you’re suffering. Someone who would be happy to help you research treatments or doctors, someone who you can share your fear or tears with, someone who will make you a meal if you’re not up to it. Or friends who’d be willing to contribute to help fund your care. There’s actually a charity called efundyourhealth that matches up to $250 for functional medicine care if you can raise the rest. New campaigns are currently on hold while they’re updating their web site, but they’re still soliciting donors, so hopefully they’ll be up and running again soon. But back to the original message, don’t suffer alone. 

  1. Find the gift in your pain and suffering.

When you’re deep in the midst of pain or suffering, it may be hard to find the positive, but doing so will leave you with a gift of wisdom that may help carry you through. For me, one of the biggest gifts will be the empathy I now have for people in chronic pain. I confess that before going through this, I assumed that anyone who had chronic back pain must have a terrible diet, or they didn’t exercise, use good posture, or try the right kind of physical therapy (speaking of which, if you’re dealing with chronic back pain, I’d highly recommend seeing a Mackenzie method practitioner). I looked down on people who got addicted to opiates because of their pain. After spending a desperate night in pain and like a crazy person rummaging through our medicine cabinet to find the two oxycodone’s left over from my husband’s dental surgery and washing one down without hesitation, I finally understood firsthand what drives people to desperation and addiction. I also know now how much a kind word helps. It may drive someone to tears, but it means so much to hear someone say “I’m so sorry about how much you’re suffering.” So if you’re the loved one of someone dealing with chronic pain or illness, you can’t ask how they’re doing or express your empathy enough. It’s like a balm on our wounds. So look for the good in your experience, the learning, the opportunity to grow as a person and then help others. It will make your situation just that much more bearable.

And if you’re struggling with a gut issue, autoimmune disease or a mystery health issue, please feel free to set up a free, 1-hour breakthrough session with me to talk about what’s been going on and hear about how health coaching could help.

Is FMT a Panacea for All That Ails You?

Over the course of my podcast (The Perfect Stool: Understanding and Healing the Gut Microbiome), I have done seven interviews with people who have had fecal microbiota transplants (FMT), some in clinics overseas, some self-administered, and I’ve also shared about my own ill-conceived  experience with DIY FMT. I also covered the research being done on a purified form of FMT for children with autism. As a result, I often hear from potential clients who are interested in trying FMT to heal their gut issues. Consequently, I decided to summarize the kinds of results that have been discussed in my interviews, and share my perspective on whether FMT is a good fit for various conditions and the practicalities of doing it, both in clinics and on your own.

One of my most striking FMT stories was episode 23: “PANDAs, Autism, Anxiety and Depression: One Family’s Miraculous FMT Healing Story”, in which Mary talked about using FMT from a clinic in Australia to treat her daughter’s auditory and tactile hallucinations, her son’s autism symptoms, and her own anxiety and depression. About FMT in general, Mary shared, “This is like the golden elixir of life. If you have a very sick child, you are going to get over the ick factor very quickly because it’s just a miracle that we have such a beautiful, natural solution all along.” About changes to her daughter’s affect, Mary said, “[Before FMT], she just had a darkness pulling in, she had a fearfulness on her face, and a lack of affect, [and after FMT]… she’s off and running, she’s just doing beautifully.” About changes to her son’s affect, Mary said, “Whatever the interferences that autism causes, [after FMT] he’s just present, he’s looking you right in the eye, he’s listening to what you’re saying, he’s calm in his body, he wants to be part of the group instead of hiding from the group… He’s more friendly. He goes up to people and introduces himself… His desire for independence has just exploded.”

In episode 10 ““Designer Sh*t” – Coming Soon to a Theater Near You:
One Filmmaker’s Story of Overcoming Colitis”, I interviewed Saffron Cassady, a filmmaker in the process of making a film about FMT, including her own personal story of healing from colitis thanks to repeated FMTs from her boyfriend.

In episode 5, “DIY Fecal Transplants for Irritable Bowel Syndrome (IBS): One Patient’s 9 Experiences and the Urgent Need for High Quality Stool Donors” Michael described his nine experiences with DIY FMT to address IBS, irregular heartbeats and severe fatigue, the benefits and drawbacks of each experience, and the urgent need for healthy donors, which led him to collaborate on the formation of a donor/recipient connection tool, Microbioma.org. He also shared numerous resources including a sample donor questionnaire.

My very first episode “SIBO Recovery and Fecal Microbiota Transplantation (FMT)” was with Amy Hollencamp, a now-dietitian whose microbiome was decimated by antibiotics and an extended restricted diet used to treat SIBO, resulting in unwanted weight loss and continuing bowel issues. She chose the Taymount Clinic in the Bahamas for her FMT. After the procedure, she reported “better gut function mainly . . . less bloating . . . I felt like my bowel movements were a lot better.”

On my most recent episode (31), “How FMT Helped One Woman Read Emotions and Normalized Sound and Touch Sensitivities,” I interviewed Amanda, who sought out FMT at a clinic in Argentina for gut issues and psoriasis and benefitted from other unexpected benefits:  “[My constipation and diarrhea] got a lot better. My skin didn’t change at all. It completely did not change, which was weird. But everything else got way better: the social awkwardness got better, the sound sensitivity got way better, my energy level got better, my ability to connect words in my head got better… I could remember things from pop culture, I could remember the plot of a TV show and I could not do that before… Yeah, I mean everything except my skin, ironically, got better.”

In episode 12, “Healing Autism via Microbiota Transfer Therapy with Dr. James Adams” (whose title I realized subsequently was not the best choice and was offensive to many in the adult autism community), we learned about the amazing research using purified FMTs on children that Dr. Adams and his collaborators had conducted, resulting in a 47% decrease in symptoms of Autism Specturm Disorder three years post-FMT. The results were published in the prestigious journal Nature.

And finally, in episode 19, “How I Reversed My Autoimmune Diseases and Got Interested in Gut Health”, I shared my own health journey, my ill-conceived DIY FMT and some of my continuing personal opinions about FMT: “I definitely think there are a lot of mental health issues and things like autism, where fecal transplants can clearly help… To be perfectly honest, if I were a parent of a child with autism, I would not hesitate to try and give my child a fecal transplant because it’s going to jump start their development.” I also shared about FMT’s success in treating C. Difficile, “I think there are some conditions that we’re seeing, obviously C. Difficile, there’s a 92 percent success rate in some studies with the fecal transplant and it’s a shame, frankly, that [FMT] is still only essentially approved for C. Difficile that is recurrent and resistant to antibiotics, given that the antibiotic success rate is only in the 30 percent [range]. That’s the only use that you can get [FMT] for officially from a doctor in the U.S.”

So if you are you considering a fecal transplant, all these success stories might make you anxious to try it, but there are a lot of drawbacks. First of all, if you’re in the U.S. and can’t afford the ~$10,000 fee of doing it at a crapsulesclinic overseas, you’ll need to find a donor and have the donor thoroughly tested. Of course you’ll have to have complete faith that the donor is honest in their questionnaire or well-known to you, as testing won’t reveal inactive viruses, such as Human Papillomavirus or Herpes Simplex Virus. If you don’t have your donor tested, you also risk catching a nasty bug from your donor that may not have caused them problems but will cause you problems if your microbiome is unstable and dysbiotic (like C. Difficile or H. Pylori). And if you’re lucky enough to find a potential donor who’s willing to give you 5- 10 samples (typical sequences of FMTs in a clinic run over the course of 5 days for C Diff and 10 days for conditions like IBS or colitis), thorough testing could be very expensive and most tests won’t be covered by anyone’s insurance. But at minimum to cover the microbiome end, you should run either a metagenomic sequencing of their gut microbiome and examine the raw data or do a test like the GI Map or Doctor’s Data GI 360. And clinics typically put patients on strong antibiotics like vancomycin for two weeks prior to FMT, so you’d need to get access to the same or use longer herbal protocols to properly prepare the terrain to receive new residents. The Power of Poop website is a great resource for all your FMT questions and lists other tests that should be done for a donor.  It includes instructions about How to Safely do a Fecal Transplant at Home and comprehensive information about Donor Registry Requirements.

But before you get your heart set on FMT, you should realize that FMT is not likely the quickest, easiest or least expensive way to solve your gut or other health issues. Most gut issues have at their root dysbiosis of some sort, be it an overgrowth of the wrong type of bacteria or an overgrowth of candida or other fungi, many of which take place in the small intestine, making it unlikely that FMT would reach the problem, unless you take it in crapsule format. However, herbal interventions following testing to determine the root cause of your problems, coinciding with dietary interventions and probiotics, followed by prebiotics, are likely to bring about substantial relief for most gut issues. And of course there are more complex interventions for more complex issues, like mold exposure, histamine intolerance or Mast Cell Activation Syndrome, that a good practitioner can guide you through.

So I’d encourage my listeners who are thinking of FMT as a first-line treatment to investigate other possibilities before taking the risk of using a donor who is not properly screened and a DIY fecal transplant. But if you are determined to move forward, please take as many precautions as you can afford in terms of donor selection and testing.

And if you’re struggling with gut issues, food intolerances, skin problems, mental health or other issues that you believe could have their origin in your gut, please feel free to set up a free, 1-hour breakthrough session with me to talk about what’s been going on and hear about how health coaching could help.

Food for Thought: Mental Health and the Gut

Food for Thought: Mental Health and the Gut

Excerpts from episode 30 (“Food for Thought: Mental Health and the Gut”) of my podcast, The Perfect Stool: Understanding and Healing the Gut Microbiome, edited for readability.

Relationship between Brain Activity and Gut Inflammation

One example of gut-brain dysfunction can begin with decreased brain activity. This could come from a brain injury, concussion or stress. Decreased activity can lead to a decrease in the activation of the vagus nerve, which is the main component of the parasympathetic nervous system (which is one arm of the enteric nervous system, or the two thin layers of more than 100 million nerve cells lining the gastrointestinal tract from the esophagus to the rectum, the other branch being the sympathetic nervous system, which controls the fight or flight response to a stressor). The parasympathetic nervous system oversees many crucial bodily functions, like digestion, control of mood, immune response and heart rate, specifically undoing the work of the sympathetic nervous system after a stressful situation and bringing your body into the rest and digest mode by decreasing respiration and heart rate and increasing digestion when you’re resting, relaxing or eating.

Returning to the vagus nerve – the vagus nerve connects the brain and the gastrointestinal tract and sends information about the state of the inner organs to the brain via fibers. Decreased activation of the vagus nerve then suppresses the intestinal immune system and decreases intestinal blood flow. This slows digestion and can cause increased growth in pathogenic yeast and bacteria, which then cause intestinal permeability or leaky gut. Leaky gut causes a state of chronic low grade inflammation. And then the inflammatory cytokines or chemical messengers produced in the gut travel through the blood and cross the blood-brain barrier, which activates the microglial cells, which are the immune cells of the brain, and the brain gets inflamed. That inflammation creates a leaky blood-brain barrier, also known as leaky brain. The blood-brain barrier is a single-layered lattice of cells joined by tight junctions that regulates which substances are allowed into the brain, not dissimilar to the way that the intestinal epithelial cells regulate what’s let in and out of the intestines. Generally, it keeps out toxins like heavy metals, pesticides and damaging proteins, while allowing in oxygen, hormones and nutrients. So this brain inflammation decreases nerve conductance, which in turn can cause depression and reduced activity of the vagus nerve, which controls mood, and we’re back where we began: caught in a vicious cycle, in which reduced activity in the brain causes gut inflammation, which inflames the brain, which leads to reduced brain activity.

It’s important to recognize that when gut symptoms persist even in the context of a healthy diet and lifestyle, this could be an indication of a gut-brain axis problem.

And likewise, the problem can also originate in the gut, with a poor diet lacking in fiber and high in sugar, simple carbohydrates, gluten, dairy or other common food allergens creating intestinal permeability, which then sets off the same series of events terminating in mental health issues.

Depression and the Microbiota

In a study published in the journal Nature Microbiology in 2019, researchers in Belgium sequenced the gut microbiome in 1,054 individuals, correlating their findings with measurements of both quality of life indicators and depression status of the participants. They found that those with lower levels of Bacteriodes enterotype 2 displayed lower measurements of quality of life and a higher prevalence of depression while those with higher quality of life indicators were consistently correlated with higher levels of Faecalibacterium and Coprococcus, which produce the short-chain fatty acid butyrate, which feeds gut epithelial cells and helps maintain a healthy gut barrier. They also found that a lack of Dialister and Coprococcus species also correlated with higher levels of depression. The researchers also looked at the genetics of these particular organisms and their role in manufacturing the neurotransmitters dopamine and GABA, which led to the suspicion that this may be another role that the microbiome is playing in mental illness. So overall, while we can’t say that precisely those organisms cause depression, what we do know for sure is that a healthy gut microbiome decreases inflammation, and the inverse, an unhealthy one increases it, and this has an impact on depression, which is at its core an inflammatory disorder.

Another study, which was a systematic review of studies on major depressive disorder and the gut microbiome, found that nine genera were higher in major depressive disorder (Anaerostipes, Blautia, Clostridium, Klebsiella, Lachnospiraceae incertae sedis, Parabacteroides, Parasutterella, Phascolarctobacterium and Streptococcus), six were lower (Bifidobacterium, Dialister, Escherichia/Shigella, Faecalibacterium and Ruminococcus), and six were divergent, meaning different results in different studies. What they suggested is that studying microbial functioning, or the function that any genera of microbes may play, may be more productive than a purely taxonomic approach, or singling out specific families, genera, phyla, etc. of bacteria to understanding the gut microbiome in depression.

Going into a bit more detail on the role of specific gut bacteria in creating neurotransmitters, studies have shown that Lactobacillus and Bifidobacterium, typically genera in multistrain probiotics, synthesize GABA from monosodium glutamate which is notable because it’s hypothesized that depression may be caused by a deficit in GABA. Escherichia coli (aka E. coli), Bacillus and Saccharomyces produce norepinephrine (which you may know also as noradrenaline), whose general function is to mobilize the brain and body for action. Candida (a yeast, not a bacteria), Streptococcus, Escherichia and Enterococcus produce serotonin, which is the key hormone that stabilizes our mood, feelings of well-being and happiness and helps with sleeping, eating and digestion. And Bacillus and Serratia produce dopamine, which plays a role in how we feel pleasure. This is leading to research on a new class of drugs called “psychomicrobiotics” for the treatment of psychiatric disorders.

Another study that sheds some light on the mechanism by which the gut microbiome can cause depression was a controlled clinical trial on patients with major depressive disorders that helped validated the existence of an immune response to LPS or lipopolysaccharide, which is a component of the cell walls of gram negative bacteria. LPS is believed to also play a role in depression, along with inflammatory cytokines. The study looked at concentrations of the immune cells IgM and IgA against the LPS of 6 gram negative bacteria from the family Enterobacteria, which would indicate an immune response in the blood to bacteria. They found that the prevalence and median values for serum IgM and IgA against LPS of enterobacteria are significantly greater in patients with major depressive disorder than in normal volunteers, which led them to conclude that “. . . the results show that intestinal mucosal dysfunction characterized by an increased translocation of gram-negative bacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression.” That means that the blood-based immune response indicates that this LPS is escaping the intestines and creating this immune response. They go on to suggest that patients with major depressive disorder should be checked for leaky gut by means of the IgM and IgA panel used in the study and be treated for it if found.

The Gut-Brain Axis and Anxiety

If you’ve ever had an experience that made you “feel nauseous” or had “butterflies” in your stomach before a public speaking event, you are probably clued into how your gut responds to anxiety-producing situations. Conversely, conditions in your gut can trigger various emotional responses in your brain, like anxiety, which studies have shown may affect up to a third of people at some point in their life. The enteric nervous system doesn’t just send messages to regulate the digestive system, it also receives information from the digestive system, creating thoughts in your brain. For a long time, researchers and clinicians thought that anxiety and depression contributed to conditions like IBS and other problems like constipation, diarrhea, bloating, pain and upset stomach. However, new research suggests the reverse is true too: that people suffering from IBS and other functional bowl problems are at much higher risk of developing depression and anxiety. As a result, you may find your gastroenterologist suggesting antidepressants to treat your IBS, not because they think the problem is in your head, but because these medications can calm symptoms by acting on nerve cells in the gut, as can cognitive brain training or other psychotherapies.

Looking at the research evidence on gut-based interventions for anxiety, a systematic review of 21 studies with 1503 people from 2019, examined the evidence from observational studies to support improvement of anxiety symptoms by regulating the intestinal microbiota. Of the 21 studies, 14 had probiotics as interventions to regulate the microbiota and 7 had non-probiotic interventions, like diet adjustments. Overall, 11 of the 21 studies showed a positive effect on anxiety symptoms by regulating gut microbes. Of the 14 studies that used probiotics, more than a third found them to be helpful in reducing anxiety symptoms, while 6 out of the 7 remaining studies that used others means found those to be effective. The researchers concluded that more studies are needed to clarify the conclusion that non-probiotic interventions are more effective that probiotic interventions in reducing anxiety, but overall, they did affirm that regulating intestinal flora is effective in alleviating anxiety symptoms.  

Episode 30 show notes

Food and Supplements to Aid with Weight Loss: Beyond the Obvious

If you’re struggling to lose weight or successfully doing so but want a little boost or some help getting beyond a weight loss plateau, there are a number of foods and supplements that have good evidence behind them for supporting weight loss. In my experience, the number one issue for weight loss is reducing your carbohydrate intake, but we’ll focus on some more advanced strategies here.

Protein: When you’re trying to lose weight, you want to lose fat and preserve or increase muscle mass. In order to favor that balance, it’s important to eat sufficient protein, ideally spread throughout the day rather than primarily at dinner. In addition, protein requires more calories to digest it (20-30% of its calories) than fats (0-3%) and carbohydrates (5-10%), the other macronutrients. As a result, the net calories that you absorb from the protein you’re eating will be less than other foods. Megan Hall, Scientific Director at Nourish Balance Thrive recommends eating 1.8-2.2 grams of protein daily per kilogram of body weight if you’re trying to lose weight. This is probably a lot more meat than you’re used to eating: a 150 pound person would need to eat 123-150 grams of protein a day (FYI – 6 ounces of meat is around 50 grams of protein). Of course you can get your protein from non-meat sources as well like nuts, beans and legumes, but you will end up eating a really large (and complex and healthy) amount of carbohydrates at the same time. Vegetarians and vegans would likely benefit from the addition of protein powders to their dieting toolbox. For vegetarian food options, tofu is a good choice for a high protein to carb ratio.

Turmeric/Curcumin: Well known for its anti-inflammatory properties, curcumin (the active compound derived from turmeric), has been shown in mouse and human studies to enhance weight loss and increase body fat reduction. For the humans, the weight reduction of curcumin plus a weight loss program in 30 days (over just a weight loss program alone) went from 1.88% to 4.91%, while the increase in body fat reduction went from 0.70% to 8.43%.

Apple Cider Vinegar: Consumer Labs affirms that apple cider vinegar (ACV) may reduce or slow the rise in blood sugar after eating and may modestly help with weight loss. They recommend taking 1 tsp. to 1 tbsp. diluted in 1.5-8 ounces warm water before meals. They also recommend that you not let the vinegar linger in your mouth and to rinse afterwards, as it can erode tooth enamel. Note that they did not find ACV powder and pills to be an equally effective form for weight loss. They also caution against using ACV for diabetics without adequate blood sugar surveillance because of its alteration of blood sugar levels.

Probiotics: There is some evidence that probiotics may be helpful in weight loss due to their impact on the gut microbiome. In a placebo-controlled, double blind, 7-day study of Equilibrium Probiotic, 72% of participants reported a reduction in food cravings and mild weight loss.

Berberine: Used for centuries in Chinese medicine, this powerful compound found in many plants and known to help blood sugar regulation (perhaps even as well as Metformin), has been shown in several studies to help with weight loss. In one 2012 study, participants consuming 500 mg of Berberine three times a day lost an average of 5 pounds, while simultaneously improving their triglyceride and cholesterol levels. In another 2012 study, participants lost an average of 4 kilograms over those who consumed a placebo.

Fiber: While losing weight, it’s also important to consume foods with plenty of fiber, or supplement with additional fiber. Toxins are stored in fat cells, and if you have a higher toxic burden you may find yourself feeling unwell while losing weight unless you consume sufficient fiber to flush it out. One of my favorites fibers is psyllium husk, which can be mixed with a full glass of water or mixed in smoothies, ideally 1-2 tablespoons a day. It thickens up quickly so drink it down right after mixing if possible.

If you need help meeting your weight loss goals, I specialize in helping clients lose weight without cutting calories or eliminating any food groups. You can set up a free, 1-hour Healthy and Sustainable Weight Loss Breakthrough Session anytime to talk about what’s been keeping you from meeting your weight loss goals and hear about how health coaching can help.

Note: Some of the links on this page are affiliate links and I receive a small commission if you click on them. Thanks for your support!

The Cancer Cocktail: Gut Dysbiosis, Inflammation, and Poor Immune Function

Excerpts from episode 29 of my podcast The Perfect Stool: Understanding and Healing the Gut Microbiome with Dr. Nasha Winters, ND

LP: Lindsey Parsons, NW: Nasha Winters

LP: Do you still consider yourself a cancer patient? Or do you feel fully recovered and not in danger?

NW: That’s a really good question. I personally don’t believe that there is a cure for cancer. I believe cancer is in all of us and the studies and research support that fact. I believe that we have the ability to turn the signaling and those pathways off, or to keep them quiet and dormant, or we have the ability to set them on fire and turn them on wildly. So, I feel where I am today, per Western medical standards, I am not cancer free. However, per my standards, especially since about mid 2010, I’ve stopped “cancer-ing,” if that makes sense. Everything is stabilized, and my body is completely in harmony and balance with all of this. And I know how to check under the hood: to test, assess, and address my process. That’s what I’ve learned for myself, what I’ve taught other patients and now what I’m teaching other physicians: is exactly how to manage this disease process and really understand where it’s come from, why it’s so individualized, and how to best support the person through the process. One of the coolest key foundations for getting better outcomes is based on the health and diversity of the microbiome.

LP: Well, that’s exactly where I was heading. So let’s talk more about that.

NW: First of all, one of the things I love—and you being the poo goddess, microbiome diva that you are, I’m probably not saying anything that you are not aware of—but I love how we consider the microbiome today the “Forgotten Organ.” Let me explain. We’ve known since Ayurvedic medicine, which is the sort of great grandmother of medicine that we know of today—so we’re talking anywhere from 3000 to 5000 years old information—saying that our health is based on the health of our gut. We didn’t quite know what that exactly meant, but we know today, when we started really looking at studies in 2005, and really started placing more emphasis on our GI tract, we certainly were validating thousands of year-old ideology and theory. So that’s the one thing that even as a naturopathic doctor, since my medical school training in the mid 90s, we were like, “the gut, the gut, the gut,” and everyone just basically said, “you’re crazy,” and “standard of care.” Yet today, we’re investing so many of our resources for research and treatment. Until they could monetize [research on the gut microbiome], it didn’t mean anything. But once they were able to really monetize it, now we’re paying attention. That’s unfortunately the way it happens a lot in our medical system. But I just think this is really a powerful thing to think about: the Forgotten Organ always been there, we’ve always known it played a role, and now we are paying for the research to really explain why. The other cool thing specific to cancer and the microbiome is that it is estimated at 20 percent of all tumors worldwide are microbially-driven. Let that sink in.

LP: And would that be bacteria, fungi, viruses…?

NW: Yes, yes, yes, yes, yes.

LP: …and parasites!

NW: Yes. You’re nailing them all! You hit them all. And there’s a great quote that showed up in a cancer journal back in January 2019. The article was titled “Gut Microbiome and Cancer Immunotherapy.” This simple quote says, “a healthy body is inseparable from an integrated gut epithelium with specific function and gut microbiome, immune cells and mucosal barriers together that maintain epithelial homeostasis.” In short, what that says is that what those crazy Ayurvedic doctors have been saying for 5000 years was spot on: our health comes down to the function and flora of our microbiome. I just think it’s very interesting that it took us until 2019, to really state that fact with much more certainty in the standard of care model.

LP: So let me dig a little bit more into what you were saying about 20 percent of cancers having a microbial origin, is the implication there that the microbe is somehow setting off the tumor process?

NW: Yes, basically what we have learned is that the micro ecology of our microbiome, the changes there, are where—if you’re going in the wrong direction, that’s where we will rapidly proliferate rogue bacteria, or viruses, or parasites, and then those little creatures will then interact with the lining of our gut: the epithelial cells, and these other cells, which hold the structure of our inner world into a sort of matrix or into sort of a scaffolding, known as the stromal cells. What happens when that ecology gets tweaked in any way [is that] the epithelium and stromal cells are altered in their function and their chemical responses. Even more specifically, what’s happening is that rapid shift in the microbiome, and those specific cells result in what’s known as toxic metabolites that trigger off what we call carcinogenesis: new cancer cells that can grow anywhere in the body, not just in the gut. Then that happens even further, causing a cascade of things like inflammation and immunosuppression. In my mind, the trifecta today of cancer is: gut dysbiosis with inflammation and poor immune function. This is the perfect combination for a cancer storm.

LP: Okay, so, now, when you said “toxic metabolites,” is that the same as the endotoxins? Or LPS?

NW: Yes, all of those pieces. So, endotoxins that the individual organism can shed, but also a perforation to the lining, that LPS, that lipopolysaccharide coating that goes across our whole tube—I always tell people, “we’re just a tube with the body wrapped around it”—and so that piece happens. But, then, also we trigger—because you and your listeners obviously know that, depending on who you talk to, about 70 to 80 percent of our immune cells and our immune function is happening at the GI tract level, the microbiome level—we trigger a cascade of cellular responses such as: natural killer cells, cytokines, which are inflammatory molecules. We can create a little cacophony, a little orchestra, of all types of things that are triggered, that not only impact what’s happening at the tube level, but send out all kinds of signals throughout the rest of the body.

LP: And so they’re sending those signals, and as a result a tumor forms? I’m having trouble taking the one part and making it connect to the other part.

NW: Well, so, here’s the thing: your discomfort around really grappling with this is because we have [in Western medicine], frankly, blown smoke up people’s asses for 70 years with regards to what cancer is. So, what I’m talking about blows people’s minds because we sort of think of cancers as exogenous invaders that somehow enter us, from outside of us, and we have to then kill it or fully eradicate it. We’ve given [cancer] unbelievable power, [in believing] that it’s driven by our genetics, that it is a genetic disease, and that we’re sort of powerless and dealing with it. However, what we have learned in the last–well, what we’ve re-learned, let’s put it that way, because we knew this back in the early 1900s, but we took a little different turn when Watson and Crick came along with their focus on genetics and DNA–but what we’ve since learned is that really cancer is a metabolic disease. It’s a disease on the energies that we take into the body. It’s a disease at the mitochondrial level: on the little powerhouse cellular structures that each of our cells carry, the turning on or off energy performance throughout our tissues, throughout our organs, throughout our whole body. But [because cancer is a disease at the mitochondrial level, it is also a disease on] the signaling pathways that tell things to grow. Mitochondria tell things to die, they tell things to stall, to hold off, they tell things to regenerate, they tell things to increase inflammation when you need it, or to decrease inflammation when you need it. So basically, all of these cell pathways start to communicate to each other for the rest of the body, and, then, over time, on average, somewhere between seven and ten years, enough cells start to congregate and clump up, and hang out, based on the inflammation we talked about at the level of those epithelial cells that not only line our gut, but line our vasculature, and line our cells, and line our organs, [and] so, too, at the level of our stromal cells that offer structure–think of them as the sort of jungle gym that cells walk around on, like travel around on to migrate throughout, building and metastasizing. So when you said, “Okay, I’m trying to understand where the bridge comes together–that suddenly you have a tumor from this,” [my response is] it’s a long standing, ongoing process that can take years to solidify to be big enough and loud enough and clumped together in such a way that we recognize it as a tumor, or a cancer diagnosis. What I’m trying to help your listeners understand is that we have the power to turn this around way before it’s big enough and loud enough to capture our attention by changing things down at that cellular level, and preventing things from getting on the move, and congregating and clumping up to make what we know today as a tumor.

[…]

LP: What do you recommend–short of a fecal transplant–to replace that diversity [in the microbiome] as a preventive measure?

NW: I mean, first of all, we eat very differently than we do from our ancestors. We ate so many more diverse foods, and plants for millennia. And as I said, we’ve really mono cropped. So, you, then, have to take it upon yourself to branch out your diet and bring in foods you don’t normally eat. I tell people: start playing with things like Jerusalem artichoke, leeks, plantains, things that you would probably normally eat a little bit of in your diet that bring in the prebiotics and the insulin and the types of fibers that are the food and fuel for your microbiome. Then, diversify your portfolio with your pre-digested soil rich foods. Don’t be too clean with your foods. Grow your own. Eat the dirt off your carrot… And then also, in the West, we’re not really keen on our ferments, but most cultures have some type of ferment: like borscht, like the kvass, you know, in some parts of the world and, and the kimchi in others, or the sauerkraut in others, or pickled vegetables in others. It’s now becoming kind of hipster and cool in the U.S.: thanks to things like Portlandia: “you can pickle that!” But ultimately it’s about encouraging people to eat a fermented food on a daily basis. If you have really terrible things like FODMAPs or Small Intestine Bowel Overgrowth issues, even those foods can backfire. So you have to work with a trained professional to help get the inner garden more ready to accept those foods. So that’s a big one. Another big one is sugar. We’re a bunch of sugar junkies and sugar is really a beast and feeding these little wrong directional microbes and organisms in our gut. They will vie for that fuel and basically starve us of our other nutrients. And then fiber. We tend to have a very low fiber dietary intake in the West. We just don’t do our veggies. You know, we want to be telling our patients to take their 9-15 servings of vegetables in a day, which is what I have my patients do: above the ground, leafy green, low-carbohydrate rich foods, but ultimately, most people can barely get three servings in a day.

Prebiotics and Fiber: Supplemental Treasures or Marketing Ploys?

Pulled from my podcast The Perfect Stool: Understanding and Healing the Gut Microbiome

Prebiotics

Because their names are so similar and because they’re often combined in one supplement, people often confuse the terms probiotics and prebiotics. And you’ve probably heard a lot from me so far about probiotics, as I’m a fan, but today I’m going to be writing about prebiotics.

So the term prebiotic can be used officially as a food ingredient if you can scientifically demonstrate that it
• resists gastric acidity, (meaning your stomach acid doesn’t break it down), hydrolysis by mammalian enzymes (hydrolysis is any chemical reaction in which a molecule of water ruptures one or more chemical bonds), and absorption in the upper gastrointestinal tract;
• is fermented by the intestinal microflora; and
• selectively stimulates the growth and/or activity of intestinal bacteria potentially associated with health and well-being.
In other words, we can’t digest it and our good bacteria can.

The most widely accepted prebiotic supplements are the fermentable oligosaccharides fructoligosacrharides (FOS or fructans), inulin (a form of FOS), galactooliogosaccharides (GOS), xylooligosaccharides (XOS) and lactulose. Besides being found in supplements, these beneficial substances are handily located in something we all could stand to eat more of – fruits and vegetables, in particular legumes, as well as in whole grains, nuts and seeds. So the more of these foods you’re eating, in particular fruits and vegetables, and the greater the variety of them, the more and different types of prebiotics you are getting.

Some examples of particularly good food sources of prebiotics are: onions, leeks, radishes, carrots, coconut meat and coconut flour, flax and chia seeds, tomatoes, bananas, garlic, chicory root, dandelion greens, Jerusalem artichoke, jicama, asparagus, and yams.

Both prebiotics and probiotics nurture the good bacteria required by the digestive tract for proper health beginning in your mouth. And while probiotics are live, active, bacterial cultures capable of multiplying in numbers, prebiotics serve as the food source for the bacteria and do not grow or reproduce. As such, prebiotics are considered functional foods because they provide numerous health benefits and aid in the prevention and treatment of various health conditions and diseases.

Prebiotics have been shown to have many positive effects including:
• increasing the health of the intestinal mucous membrane, which improves digestion and gut health in general
• decreasing blood sugar and insulin levels, and consequently the risk of obesity and weight gain
• decreasing inflammation
• lowering cholesterol and the risk for cardiovascular disease
• lowering the stress response
• helping with hormonal balance
• modulating the immune system and helping manage autoimmune symptoms. In particular, prebiotic foods can result in significant changes in the composition of the gut microbiome that help improve immunity, shown by improvements in biomarkers and activities of the immune system, including reduced levels of certain cancer-promoting enzymes and bacterial metabolites in the gut (the byproducts of bacterial digestion).
• Other benefits include preventing traveler’s diarrhea and aiding in the digestion of lactose in those who are lactose intolerant, in particular with the prebiotic GOS.

So now that we’ve talked about some of the benefits, let’s get to some of the potential concerns, especially if we’re talking about supplementing with prebiotics, as opposed to getting them from food.

First, because you’re giving your gut bacteria a sudden, pure form of food, you’ll likely have some bloating from the gasses that the bacteria produce after eating this food, until the balance of bacteria in your intestines adjusts and more bacteria that consume that gas grow to accommodate it. So start slow and build up – either with a supplement or with a new prebiotic food you don’t normally consume (think gas with that occasional meal with beans – it’s because your system isn’t adjusted to their regular consumption).

In his great tome “Healthy Gut, Healthy You,” Dr. Michael Ruscio summarizes the research on prebiotics for various gut conditions.

For IBS (Irritable Bowel Syndrome) and SIBO (Small Intestinal Bacterial Overgrowth), the best evidence suggests prebiotics should be avoided and a low-prebiotic diet like the low-FODMAP diet should be adopted. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols and it’s a huge list of foods including many fruits and vegetables, whole grains, dairy products and more. But keep in mind that this is a temporary diet and elimination and reintroduction process, not a permanent diet, until you’ve resolved your SIBO, dysbiosis or IBS. I’ve done the low FODMAPs diet on two different occasions and it’s very limiting – excluding two very common food ingredients – onion and garlic, including their powders – so imagine trying to go to a restaurant and not eating FODMAPs. And I actually had a funny thing happen to me during those two low FODMAP diets, and I’m curious if anyone else has experienced this. When I’m excluding FODMAPs, after a couple of days, everyone’s breath starts to smell like garlic to me, to the point that I can’t even kiss my husband. So it’s interesting how much our bacteria and its die-off (for lack of food) can influence our senses. So if you do try low FODMAPs, keep in mind it’s more about managing symptoms, rather than solving the problem. Typically you also need to take antimicrobials or other supplements to bring a dysbiotic gut or bacterial overgrowth into balance.

For IBD (an umbrella term used to describe disorders that involve chronic inflammation of your digestive tract, such as Crohn’s disease and ulcerative colitis), the best evidence suggests that people should avoid supplemental prebiotics as some trials have shown harm from using prebiotic supplementation in IBD.

While in a flared state, you should adopt a low-prebiotic diet like the low-FODMAPs diet or the Specific Carbohydrate Diet (SCD), which is a diet that eliminates all sources of grains and pseudograins like quinoa, even the white ones, all but long-fermented dairy, processed meats, most processed sugar, artificial sweeteners, sugar alcohols and all processed foods.

In terms of weight loss and gain, while a systematic review of twenty-six clinical trials concluded that prebiotics are effective in lowering blood sugar, many studies show prebiotic supplements have little to no effect on weight loss.

Finally, for celiac disease, there are no studies available, however, indirect evidence suggests avoiding prebiotics may be advisable, especially in those who do not fully respond to a gluten-free diet.

Synbiotics

Now on to another related topic. While I’m talking about prebiotics, I should also mention synbiotics, which are combination products of probiotics and larger amounts of prebiotics than the nominal amounts typically added to a lot of probiotics. One review published in 2014 concluded that the use of synbiotics may promote an increase in the number of bifidobacteria, glycemic (blood sugar) control, stimulation of the immune system, reduction of blood cholesterol and balancing the intestinal flora, which aids in reducing constipation and/or diarrhea and improves intestinal permeability. The study, linked above, has recommendations on dosages of certain prebiotics and probiotics in order to see benefits.

Fiber Supplements

Another related topic is fiber supplements. So while all prebiotics are dietary fibers, not all dietary fibers are prebiotics.

But first, a little bit about what fiber actually is and why it’s important: fiber is the part of plant-based foods—fruits, vegetables, nuts, seeds, legumes—that give the food its structure. There are many types of fiber, but we’ve separated it into two major types: soluble fiber and insoluble fiber. Soluble fiber dissolves in water and gastrointestinal fluids when it enters the stomach and intestines and then is transformed into a gel-like substance, which helps to positively slow absorption of nutrients during digestion. Insoluble fiber passes through the body and becomes the bulking agent to take up and help eliminate any by-products of metabolic processes, such as bacteria that need to be cleared, excess estrogen, and excess waste. Both soluble and insoluble fiber play an important role in digestion and the health of the microbiome. While soluble fiber feeds the bacteria in the gut, insoluble fiber ensures that nothing harmful lingers too long and creates a state of putrefaction or dysbiosis. You can find soluble fiber in supplements like Metamucil (or its simplest form without additives, psyllium husk), Citrucel (which is methylcellulose) and FiberCon, Fiber Lax, Equalactin, and Mitrolan, which are polycarbophil. You can find insoluble fiber in foods like beans, barley, corn, rice, bran, whole wheat, vegetables and apple and pear skins.

Other supplemental fibers you may want to consider include Sunfiber, which is made from the guar plant and is actually a low FODMAP fiber, glucomannan (made from Konjac root), acacia, pectin and inulin. In foods, you’ll find some of these same and other fibers as well, including cellulose, found in legumes, nuts, and bran; inulin, found in bananas, garlic, onions, asparagus, wheat, barley and rye; pectins, found in apples, strawberries, citrus fruits, carrots, and potatoes, and in smaller amounts in legumes and nuts; beta glucans, found in oats, barley, shiitake mushrooms, and reishi mushrooms; and lignin, found in whole grain foods, legumes, green beans, cauliflower, zucchini, avocado, unripe bananas, and nuts and seeds.

So you’ve probably heard that we all need more fiber and you’ve likely heard of the Recommended Daily Allowance of fiber, which is is 30 to 38 grams a day for men, 25 grams a day for women between 18 and 50 years old, and 21 grams a day if a woman is 51 and older. Or generally, you should get 14 grams of fiber for every 1,000 calories in your diet. But it’s important to remember that, while fiber can help some and probably most people feel better, especially if you’re currently eating a standard American diet, it can make others feel worse, especially those with inflammatory bowel disease during a flare. But for anyone considering supplementing with fiber, it’s a great first step in trying to solve lower level bowel issues like constipation, but be sure to do it with a full glass of water or other liquids.

Resistant Starch

Another related topic is resistant starch, which is like fiber, in that it feeds your healthy gut bacteria. It’s called resistant because it resists digestion by us but not by our bacteria. Resistant starch is naturally found in foods like green bananas and their flour; banana skins; cooked and then cooled potatoes, rice and pasta; beans and legumes; raw potato starch; hi-maize flour and oats. And I like to think of resistant starch as free food because the amazing thing is that by cooking and cooling and then optionally reheating to no more than 130 degrees foods like potatoes and rice, you can save yourself many calories but eat the same foods. This is because the starches convert into resistant starches, so we don’t absorb the calories! They also promote feelings of fullness so you end up eating less. One study showed that men who had a meal with resistant starch versus a placebo ate 90 fewer calories. One great trick I learned is that if you buy organic bananas and use them in smoothies, leave the skin on and you’ll get a nice serving of resistant starch and it will fill you up a lot more without adding calories. I also tend to make my rice ahead of time and reheat it throughout the week as I eat it, but of course that’s primarily because no one else in my house will eat any whole grain rice so I have to make it for myself while they make white rice.

Benefits of Fiber

In terms of the research on the benefits of fiber, Michael Ruscio also sums it up in his book. In terms of digestive-tract cancers, the overall impact of supplemental fiber, including resistant starch, on colorectal-cancer risk appears minimal at best. Most of the data shows no positive impact.

For IBD, randomized controlled trials have shown fiber to be helpful for IBD, but again, fiber is best used when IBD is in remission. Low-fiber diets have been shown to be helpful for active or flaring IBD.

For IBS, fiber has been shown to help IBS symptoms, including stool frequency and consistency and quality of life. However, high-fiber intake can be problematic for some IBS patients. You may have heard that something like 80% of IBS is believed to be caused by small intestine bacterial overgrowth (SIBO), so as you can imagine, if your small intestine bacteria is overgrown, adding more fuel to the fire wouldn’t be ideal. As a result, low-fiber diets like low FODMAPs have also been shown to be helpful in IBS, at least until the SIBO is cleared, if that’s your underlying cause. And in general, fiber has the most benefit for those with IBS-C or constipation, although I have to say that I have tended more toward the IBS-D and found that supplementing with psyllium husk gave me much better quality stool as it absorbed some of the excess water in my colon.

For celiac disease, there is no quality data available for supplemental fiber’s impact.

For type 2 diabetes, high-level science shows supplemental fiber can help lower fasting blood glucose by about thirty-five points and hemoglobin A1C by about 1% in patients with type 2 diabetes. But the healthier your blood sugar already is, the less effect supplemental fiber will have.

For heart health, supplemental fiber may cause a small decrease in blood pressure and cholesterol levels. However, there does not appear to be a clear benefit for heart disease from fiber supplementation.

For obesity and weight loss, a review paper showed that the average weight loss from fiber supplementation was around 4.2 pounds. Viscous fibers (gel forming) might be best for weight loss but also may carry the highest risk of digestive side effects. Overall, supplemental fiber does not appear to be hugely effective for weight loss.

Now I’m going to mention a study from 2018 that seems to have gone virtually unnoticed but definitely didn’t escape my notice. Researchers at the University of Toledo found a link between refined dietary fiber, gut bacteria, and liver cancer, at least in mice. The study challenges conventional wisdom that dietary fiber is good no matter how you get it. Chicory root is used as a source of inulin to fortify a lot of processed foods with fiber. In the study, the mice were given chicory root inulin and they developed liver cancer. And the ones that developed liver cancer had altered and elevated gut bacteria, or dysbiosis. Interestingly, the researchers observed no evidence of liver cancer in inulin-fed mice that were treated with broad-spectrum antibiotics to deplete gut bacteria. So given this was on mice and was just one study, probably the biggest takeaway is that fortifying processed foods with refined, soluble fiber may not be safe or advisable for people with SIBO or dysbiosis, whose abnormal fermentation of this fiber could potentially increase their susceptibility to liver cancer.

On the other hand, there are studies supporting the positive effects of fiber, in particular in kidney disease. A 12-week, single-blind study published in 2014 in the Journal of Renal Nutrition found that supplemental inulin was beneficial, in particular with increasing stool frequency. Many people with chronic kidney disease don’t get enough fiber, because many fiber sources are too high in potassium and phosphorus, so if you do have kidney disease and try to get more fiber, be sure to do it carefully and with your doctor’s advice and support.

Speaking of stool frequency, in case you weren’t sure, ideal stool frequency is around 1-2 bowel movements a day, so it’s beneficial to keep the gastrointestinal tract moving. This also helps prevent diverticulosis or pockets inside the colon, which can become diverticulitis when they become inflamed or infected. This is a very painful condition and can lead to bowel surgery, so keeping those bowels moving regularly is very important.

Now you may be asking what to do with all this information if you’re just an average person? Well, my general approach to fiber and prebiotics has been to get it from my diet rather than trying to supplement, although I will say that prior to solving all my bowel issues, I did have success with a tablespoon of psyllium husk in my smoothies, and I now get it in my keto bread. I hear that Jason Hawrelak, a Naturopath, probiotic researcher and university lecturer, recommends aiming for 40 different whole plant foods week. So next time you’re shopping, pick one new fruit or vegetable you’ve never tried, and incorporate it into your diet. Then add another one the following week. Just because you like broccoli and have finally gotten your kids to eat it, don’t just buy broccoli every week – switch it up, get something different, try new recipes. And you can find some of my favorite vegetable recipes at the bottom of my podcast show notes.

If you’re someone with IBD and you’re flaring, switch to a low fiber diet, but once your flare is over, slowly increase your fiber again to protect yourself from future flares.

If you’re considering investing in a prebiotic or synbiotic supplement, look for research to support its effectiveness. But don’t be like these folks I’ve seen in some Facebook groups who are selectively supplementing with certain prebiotics in hopes of increasing specific gut bacteria. We really don’t know enough about individual gut bacteria to be targeting them. Rather, think more about how well your gut is functioning overall.

If you’re struggling with your gut health or want to reverse your autoimmune disease naturally, I offer free, 1-hour breakthrough sessions to talk about what’s going on and hear about how health coaching could help. I also offer individual, single appointments to throw all my knowledge at you, if you want to start that way.

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