As we all think about social distancing, face masks, sterilization, hand washing and the like, I just wanted to make sure you don’t forget the basics of protecting your health and keeping your immune system functioning well.
Drink at least 1/2 your body weight in ounces of water a day (3/4 even better).
Eat a healthy diet. For most of us this means decreasing grain-based carbs (bread, pasta, desserts, white potatoes, rice) significantly and replacing them with healthy sources of protein (beans, legumes, grassfed and pastured meat and eggs) and fat (avocado oil, olive oil, coconut oil, avocados, olives). Eat 5-9 servings of a moving variety of fruits and vegetables a day. See my breakfast photo for how you can amp up your breakfast and start the day right: that’s sauteed spinach, sauteed avocado slices, hash browns made with grated purple sweet potato, sauteed zucchini. See how many colors you can get on a plate. Use fruit or dark chocolate (70%+) as your after dinner sweet. Get lots of fiber from root vegetables, lentils, beans, wild rice, quinoa and other whole grains (preferably not ground into flour). But think of the grain or starch portion of your meal as the side dish – it should only cover 1/8 of your plate (for women that’s like 1/2 cup; men 1 cup), non-starchy fruits and veggies should cover 3/8 to 1/2, Protein 1/4, healthy fats 1/4 (not in size but in terms of servings/calories). Use almond flour for baking instead of white or whole wheat flour. If you can’t give up your sources of white grains, you can greatly reduce their impact by cooling and reheating (potatoes, rice, pasta). This creates resistant starch that your body can’t digest but your good gut bacteria can.
Get 7-8 hours of sleep a night.
Get 20-30 minutes of sunshine unprotected by sunscreen (but protect your face with a hat).
Get regular, daily movement (it’s never been a better time for a walk around the neighborhood). Look for online workout videos. I keep an aerobic step in my living room and do my exercise there while watching TV.
It’s never been a better time to quit smoking.
Continue positive social interaction in whatever way is possible. We’ve done 6-ft. happy hours with our neighbors, we’re planning a zoom happy hour with distant friends and family, you can still take walks/hikes with friends unless you’re in one of the most vulnerable groups (then maybe just keep more distant).
Engage in some type of calming or meditative practice, especially if you are feeling anxious. Possibilities include contemplative prayer, EFT, yoga, tai chi, meditation, yoga nidra and many more.
Keep your bowels moving regularly. Add fiber to your diet (Sun Fiber, psyllium husk or other natural source) and/or magnesium citrate until you’re going at least once a day with ease.
I’m sure that you’ve all heard about the gut-brain axis and how your gut health impacts your mental health. A 2017 review of the peer-reviewed medical literature on this axis by Clapp et al. concluded: “This review demonstrates the importance of a healthy microbiome, particularly the gut microbiota, for patients suffering from anxiety and depression, as dysbiosis and inflammation in the CNS [Central Nervous System] have been linked as potential causes of mental illness. Of note, studies have shown that probiotics effectively mitigated anxiety and depressive symptoms similar to conventional prescription medications.”
In my practice, I have often noted that clients with gut infections and dysbiosis (abnormal overgrowth of certain bacteria or fungi) also have diagnoses of anxiety and depression. While I agree that probiotics can be helpful, it’s important to heal gut infections before wasting money on probiotics.
In my latest podcast episode, I interviewed Mary, a mom from California who sought out FMT or fecal microbiota transplants (aka poop transplants) for her children’s urgent health problems at a clinic in Australia (because it’s not legal here for their conditions). Her daughter had severe social anxiety and auditory and tactile hallucinations diagnosed as something called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcus) and her son had autism and lifelong diarrhea. By the end of 3 weeks of transplants, the clinic determined through testing that her third child was a safe donor to continue the transplants once home.
That’s where it gets interesting on the topic of anxiety and depression. Mary had been suffering with both her entire life, and the anxiety had become quite severe to the point where she was having panic attacks every time she contemplated driving, which was a daily necessity. So Mary gave herself 10 fecal transplants over the course of 15 days using her daughter’s stool. Her symptoms of anxiety and depression were gone after the first two fecal transplants, and haven’t returned since. And her daughter’s condition was also gone after two weeks of transplants plus supplemental FMTs after returning, as well as her son’s diarrhea.
Mary’s story is amazing but not shocking given that we know that gut bacteria produce and/or consume a wide range of our neurotransmitters, including dopamine, norepinephrine, serotonin and gamma-aminobutyric acid (GABA). In fact, 95% of the body’s serotonin is found in the bowels. While Mary’s solution may be a bit extreme for most people (not to mention costly given the testing and the trip to Australia that gave her the confidence to try FMT at home), testing and correction of gut health issues is a much more mundane way to treat mental illness.
Various functional lab tests that consumers can order themselves can shed light on what’s going on in your gut that may be affecting your brain. These include the Organic Acids Test, which includes over 70 metabolic markers of gut health, vitamin levels, neurotransmitters, mitochondrial function and much more and Onegevity’s Gutbio test, which is a complete metagenomic sequencing of your gut microbiome down to the strain level, including parasites, bacteria, archaea, fungi and viruses. Stocked with this information, I educate my clients on protocols recommended by MDs and PharmDs to heal/treat the dysbiosis (usually through herbal antimicrobials + probiotics), which can help correct neurotransmitter issues impacting mental health.
If you’ve only sought out allopathic (aka traditional) doctors or therapists to help with your mental health issues without relief, it may be a gut problem! I encourage you to listen to Mary’s family’s amazing healing story! (Or if you’re not podcast-listening savvy just find it here on my web site.)
If you didn’t have time to listen to my latest podcast episode with Dr. Raphael D’Angelo, MD, who is a retired holistic medical doctor who provides thorough parasite testing through his business ParaWellness Research, here are some of the key takeaways.
What are parasites and which types are most common?
A parasite is anything that derives its life, substance or ability to reproduce from some other organism. Most parasites in the human gut are either worms like roundworms, flatworms and flukes, or protozoa. Protozoa are the most numerous parasites throughout the environment, especially in water, but can also be carried by insects, like malaria. In Dr. d’Angelo’s testing, about nine out of ten patients have a protozoan, and one out of ten has a protozoan and a worm.
Can you have a parasite and no gut issues?
While Dr. d’Angelo generally tests people who are suffering from gut symptoms, he also noted that we would probably find one or two types of protozoa in healthy people who are not having any gut problems. These protozoa may be transient and just reside in the gut for a short time.
Why do typical labs fail to find parasites most of the time?
While Dr. d’Angelo’s parasite testing (at ParaWellness Research) is very thorough and involves many different tools, Dr. d’Angelo explained why parasite testing through typical labs covered by insurance usually finds nothing. Those labs conduct a wide range of tests, including bacterial testing, virus testing, fungus testing, and more. Because there’s a perception that parasites are not a real problem in the United States, parasite testing receives the lowest priority in assigning lab personnel, with newer and less experienced technicians assigned to parasite testing. Insufficient time is spent looking for parasites because they’re rarely found, and parasites change form, making it difficult to detect them under a microscope some of the time. As a result, little effort is given to detecting parasites with a foregone conclusion that they won’t be found. So if you’ve been given an ova and parasites test through your doctor’s office and it came up empty, but you think you may have a parasite, you may want to consider additional testing.
What is Blastocystis Hominis?
The most common protozoan
parasite worldwide other than malaria is called blastocystis hominis. It can
come from contaminated food or water or can be transmitted from person to
person with poor hygiene habits. Symptoms include diarrhea and abdominal
cramping and occasionally, nausea. Often people with a diagnosis of Irritable Bowel
Syndrome (IBS) have blastocystis hominis. Occasionally it can be found in swelling
around arthritic joints when fluid is extracted. For many years it was not
believed to be a parasite, but over the last 25-30 years, it’s been shown that
it can invade some tissues.
hominis is known to be difficult to eradicate, Dr. d’Angelo has had success
treating it with a silver type preparation mixed with essential oils, sometimes
including liquid preparations of herbs.
While treating parasites
with antibiotics is also possible and can take less time (1-2 weeks), those who
wish to avoid antibiotics can choose natural treatments. Dr. d’Angelo
recommends these treatments be taken over the course of three months, for 20
days from when the moon is half full to a full moon and then from the full moon
until the half moon for three moon cycles, giving the body a 10 day rest in
between. The moon’s pull on bodies of water also applies to parasites, and
their most active metabolic period is during this time, allowing smaller
amounts of the medicines to be used. Dr. d’Angelo learned this method of treatment
from colleagues in other countries who treat parasites routinely.
The pull of the moon points
can be an additional help in diagnosing parasites – during the fuller moon
phases, people will complain of more diarrhea and cramps.
What is Cryptosporidium?
Another common protozoan
is cryptosporidium, which is found in contaminated water as a result of animal
or bird droppings. This can often follow on flooding in an area, where drinking
water becomes polluted. Water filtration systems are generally not fine enough
to be able to completely filter out parasites, so when their numbers increase,
enough get through that they can overwhelm our immune systems. In addition,
during the cleaning of the filters, water systems backflow their filters, which
opens up the opportunity for parasites to enter the water flow. If your area
has had flooding, one way to protect yourself is to boil your water one minute
for every 1000 feet of elevation above sea level. Another good way to protect
yourself on an ongoing basis is to use a reverse osmosis filter that you can
put under your sink. Pitcher-type filters are generally not fine enough to protect
you from protozoa (which require a one or two micron filter), although some
units do boast this level of filtration.
A large amount of diarrhea
is almost always present with cryptosporidium. They are very difficult to find
on lab tests because they tend to live in upper part of the small intestine,
but they can be located using a specialized
antibody test. For a
normal healthy person who gets cryptosporidium, they may have a big bout of
diarrhea for two-three weeks, then it tapers off and they get better. However,
in an immunocompromised person, with something like diabetes or cancer, it may
cause a chronic, ongoing problem.
What is Giardia?
Another common parasite
found in humans in the U.S. is giardia. It’s almost universally present in wild
animal populations and in soil and water, so it gets into our drinking water reservoirs.
Symptoms include mushy bowel movements with a sulfurous smell and a rumbly
stomach and intestines on and off throughout the day. It can be treated through
10 days of prescription antibiotics if it’s causing problems, although many people
may have just a few giardia that their immune system keeps in check, causing no
What is Cyclospora Cayetanensis?
Another parasite that was
a problem relatively recently in the U.S. is cyclospora cayetanensis, which
came in through a cilantro farm in Mexico that had contamination from animal
waste. This also causes profuse diarrhea and can be treated with antibiotics or
three months of Dr. d’Angelo’s remedy.
What are examples of some types of parasites that typical labs
will not identify as pathogenic but that may cause problems?
Other protozoan parasites
that the CDC may not classify as pathogenic but that Dr. d’Angelo recommends
treating include dientamoeba fragilis, endolimax nana and iodamoeba buetschlii.
Dientamoeba fragilis can enter through contaminated food and water and also piggybacks
onto roundworms. Endolimax nana and iodamoeba buetschlii are very common and
can be found in almost any water source. In some people these protozoa may be numerous
enough to block nutrient absorption. These are typical of parasites that a
traditional lab will not identify.
What are the most common parasitic worms found in the U.S.?
Worms are also pretty
common in the U.S., but in nowhere near the amounts that Dr. d’Angelo would
find in samples from Vietnamese people, where he received his original training
through the U.S. army during the Vietmam war. A typical Vietnamese worker on
their base might have had five or six different types of worms and four or five
types of protozoa and have no digestive issues at all, because their immune
systems were well adapted to keeping these populations in check.
In the U.S., some of the
most common worms are pinworms and a large roundworm called ascaris
lumbricoides. With pinworms, which are common in young children, symptoms
include restlessness at night and itching of the anus. If you press a piece of
scotch tape to your child’s bottom before they get out of bed in the morning
and look at that under the microscope, you can see the eggs of the pinworm.
Ascaris lumbricoides usually
comes through swallowing an egg from contaminated food, mainly meats. That’s
why Dr. d’Angelo recommends wearing disposable
gloves when you’re handling fresh, slaughtered game meat like deer, and cleaning
the meat under running water. Sometimes it’s possible to find an egg in a
parasite test, but often it’s only discovered when the worm is passed in stool.
For many people, ascaris
lumbricoides will cause no problems while residing in your gut for six to nine
months and will pass out without incident. Some people may have no symptoms but
others may have a sense of fullness or of movement. However, in other people,
the worm may find its way to a spot in the upper part of the small intestine, where
it can block the outflow of pancreatic juices or bile into the small intestine
for digestion. Symptoms of this include pain in the upper right quadrant of the
abdomen. If given an x-ray, the worm may be visible on it.
Can parasites cause food sensitivities?
When there are
disruptions of the integrity of the lining of the intestinal tract, parasites
can contribute to food sensitivities. Blastocystis hominis, for example, eats
good bacteria and can strip an area of the intestinal lining of commensal or
beneficial bacteria that would normally protect it. As a result, the mucus
layer is stripped and partially digested food particles can escape, causing an
immune response and the production of an antibody against that food, which
leads to a sensitivity.
In addition, parasites take
in nutrients and put out toxic waste products, which can also deteriorate the
lining of the intestinal tract, causing the immune system to react as it tries
to clean up the problem, creating an allergic reaction involving foods that are
also in the area.
If you are found to have
a parasite that you believe created a food sensitivity, you should wait about a
month after clearing it before trying to eat that food again.
Should your sexual partner be treated for parasites when you are?
If there is some chance
that there’s been shared stool, urine or other bodily fluids, it’s wise to test
both members of a couple so that you don’t pass things back and forth.
What is mimosa pudica seed and can it be used to treat parasites?
Dr. d’Angelo finds it
very helpful for resistant parasites and something called rope worm. Symptoms
of rope worm include a rumbly tummy, and the frequent passing of long, rope-like
or stick-like, mucus-covered items in the stool. The mimosa plant has been used
for centuries by the indigenous healers for parasites, and so it’s a very good
anti-parasitic for many different kinds of parasites that would also work in
place of the essential oil/silver/herbal preparations that Dr. d’Angelo uses.
However, his preparation also treats pathogenic bacteria and candida.
Does Dr. d’Angelo also test for yeast/candida?
In Dr. d’Angelo’s
testing, he also looks for excess yeast in the stool and in the urine. Forty
percent of patients have excess yeast, which is why he includes silver in his
treatment, as it is effective against candida.
How much is testing through ParaWellness Research and can I order
An initial test, including a $10 membership fee to his research program and shipping is $316.95. Patients can order tests themselves at parawellnessresearch.com.
So the short answer is, yes, you probably should. At minimum, most people need to start dealing with gut issues by trying an elimination diet, and gluten is the primary thing to eliminate. Dairy, soy, added sugar, corn, alcohol, processed seed oils and processed foods with many ingredients (which are pretty much out if you’re already eliminating corn and soy) are other really common problem foods. So that’s a good place to start.
So let’s talk a little bit about what gluten is. Briefly, it is the protein found in wheat, barley, rye, spelt and triticale, which is a cross between wheat and rye. And because of cross contamination, it can also often be found in oats.
Alpha gliadin is the protein fragment that most research focuses on as the main culprit in gluten sensitivity or celiac disease. But all grains contain proteins that are similar to gluten and may also cause problems. So a heads up that if you have already eliminated gluten and other problem foods, and you’re still having problems, there is a whole school of thought led in part by Peter Osborne who wrote “No Grain, No Pain”, that all grains need to be eliminated. In that case, because you may be having problems or cross-reactivity with other grains, you may want to get a test through Cyrex labs of 24 other foods that have typical cross-reactivity with gluten. One surprising cross-reactive food is instant coffee because there’s a high rate of contamination with gluten.
It’s also possible that what you think is just a sensitivity to gluten may be undiagnosed celiac disease. Celiac is an autoimmune disease in which the villi in your small intestine are actually destroyed by eating gluten. That impairs nutrient absorption, which leads to intestinal symptoms, typically diarrhea, but also fatigue and many other things. So the gold standard for testing for celiac is an intestinal biopsy, but there are also blood tests for Immunoglobulin A (IgA) antibodies, which will be found in about 80% of people with celiac disease. Cyrex lab can also test blood more extensively to catch false negatives for IgA. The problem with the testing for celiac is that you have to eat gluten about twice a day for four weeks prior to the test. Nevertheless, there is real value in actually getting a diagnosis. Imagine you have accidentally discovered that you don’t do well with gluten, but you’re kind of cheating, eating gluten every week or every couple of weeks, and you’re just not really taking it seriously because you don’t have an official celiac diagnosis. You could really be putting your health in danger. Getting that celiac diagnosis is going to lead to a lot better compliance because you’re going to realize what the stakes are for eating gluten. People with celiac disease have increased chances of other autoimmune diseases and the sooner it’s discovered and a very strict gluten-free diet is followed, the better.
I actually had a client who had suffered from extreme fatigue his entire life, but up until more recently, he hadn’t had the gastrointestinal symptoms. At the age of 60, he finally got his celiac diagnosis. So the fatigue comes from a lack of nutrient absorption. You’re basically running on nothing because your villi normally absorb nutrients but they’re getting progressively more destroyed.
It’s estimated that about 1% of people have celiac disease in the U.S. and it is hereditary. If you have a first degree relative with celiac disease, you have a one in 10 risk of having it as well. So if you find out that someone in your family has celiac, or if you find out that you have celiac, you should encourage your relatives to get tested. If you are diagnosed over the age of 20, there’s a 34% risk of another autoimmune disorder. Celiacs do have to eat a strict gluten-free diet for the rest their lives.
In addition to that, for about 8% of celiacs, even gluten-free oats are problematic and cross-reactive. Let me also mention that dairy is also frequently problematic to people who have celiac because it is digested with the top of the villi. But once you go off the gluten and the villi start to heal, which can actually happen relatively rapidly, possibly in a matter of months, then you may regain your ability to digest dairy. So you may want to retest dairy after some time has passed.
Symptoms of celiac disease are unexplained iron deficiency, anemia, fatigue, bone or joint pain, arthritis, osteoporosis, or osteopenia, liver and biliary tract disorders, depression or anxiety, peripheral neuropathy, which is tingling or numbness or pain in your hands and feet, seizures or migraines, amenorrhea (loss of your period), infertility, canker sores, and an itchy skin rash.
Non-Celiac Gluten Sensitivity
Now, let’s talk a bit about non-celiac gluten sensitivity (NCGS), because a lot of people think that if you’re not celiac, then the rest is just kind of made up. That is not true. It is a real diagnosis. In the U.S., somewhere between 0.6% and 6% of people are gluten sensitive. But I have seen in at least one article that as many as 33% of Americans are currently trying to avoid gluten (so restaurant owners, how about more gluten-free options?) One study in Italy of about 12,000 people found that there is about a rate of 3% of gluten sensitivity.
The official way to diagnose NCGS is to test negative for celiac, but have both gastrointestinal and non-gastrointestinal symptoms. The gastrointestinal symptoms would be the kind of symptoms you’d see with IBS, like cramping, bloating, diarrhea, stomach rumbling, constipation and foul-smelling stool. The non-gastrointestinal symptoms are brain fog, trouble concentrating, memory problems, frequent headaches, mood-related changes like anxiety and depression, low energy, chronic fatigue, muscle and joint pains, numbness and tingling in the arms and legs, reproductive problems and infertility, skin issues like dermatitis, eczema, rosacea and rashes, nutrient deficiencies including anemia, and just generally increased inflammation in the body. Having non-celiac gluten sensitivity also puts you at a higher risk of autism, ADHD, Alzheimer’s, dementia, neurological and psychiatric diseases and leads to autoimmune disease.
SIBO and Low FODMAPs
Now, let me also mention that for some people, gluten sensitivity is not in fact sensitivity to gluten, but an intolerance to FODMAPs, which are fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are a component of gluten-containing grains. So if you are reacting to foods like onion and garlic as well, it may be that what you need is a low FODMAP diet, not just a gluten-free diet. FODMAPs are in a lot of foods, including lots of fruits and vegetables, and of course in gluten and in dairy. If you do well on a low FODMAPs diet, then that is probably indicative of the fact that you have SIBO or Small Intestine Bacterial Overgrowth, a primary cause of Irritable Bowel Syndrome (IBS).
One of the potential origins of SIBO is an autoimmune attack on the villi in your small intestine, which can come from an episode of food poisoning. And now there’s a test called the IBS Smart Test that is starting to be covered by some insurance and by Medicare and Medicaid, although your doctor may not have heard of it. It can test you for the antibodies that could be hurting your villi, which damages your migrating motor complex (MMC), the movement of your intestines that pushes food through. If you have the autoimmune type of SIBO, you’ll need to get treated for SIBO, but also go on a prokinetic, or something that helps your MMC do its job of peristalsis, or moving food through the intestines. So if you are reacting to onions and garlic, it may be SIBO. Look in that direction for healing rather than just eliminating gluten.
Let me also mention that just going on a low FODMAPs diet will not be sufficient to heal your SIBO. It will help you with the symptoms, but it’s not a good, long-term diet because it is deficient in a lot of nutrients and fiber that are important for your gut microbiome. So you want to get the diagnosis, heal the SIBO (which can be through a prescription drug called Rifaximin or herbal anti-microbials), then you might need to go on a prokinetic to get that small intestine moving again in order to keep the gut motility up and your MMC functioning in the long-term. So you need to see someone (like me) who can help you get the testing and educate you on antimicrobial options.
Why Gluten is Problematic in General
Now let’s talk a bit about why gluten is problematic in general. Gluten, for all people, triggers the release of a chemical called zonulin. And zonulin opens up the tight junctions in your intestines, causing what is known as intestinal permeability or in lay parlance, leaky gut. And the thing is, when those tight junctions open, gluten is a large, hard-to-digest protein that can then slip out those cracks and cause an immune response. So what they have found is that in celiac disease, the opening time for zonulin is much longer, so a good bit of undigested food, toxins and bacteria can slip out.
For people who have NCGS, there may be two things at play. One may be that the barrier is held open for a longer period of time, and then you’ll have increased leakage of undigested proteins and the immune response. But the second is that there may be changes in the gut microbiome that lead to gut dysbiosis, which then leads to increased intestinal permeability, gut symptoms and systemic inflammation, which is your immune immune response.
Gluten and Autoimmune Disease
In both celiac and NCGS, the real danger is molecular mimicry, which means that when that gluten escapes, the gluten protein looks like your own cells. When your immune system sees your own cells that look the same, it attacks those as well, which is one of the origins of autoimmune disease. That’s why Hashimoto’s thyroiditis is so common: the cells in your thyroid resemble the gluten protein. At this point, they say that one in five of American women will have Hashimoto’s or another thyroid disorder in their lifetime. Other autoimmune diseases besides Hashimoto’s that are most frequently mentioned in conjunction with non-celiac gluten sensitivity are dermatitis herpetiformis, psoriasis and rheumatologic diseases like rheumatoid arthritis, which is another one of the very common autoimmune diseases.
So to have that autoimmune reaction, you basically have to have three factors at play. Number one, you have to be genetically predisposed to gluten sensitivity or celiac, you have to have an environmental factor that’s the instigator of the immune response (in this case, gluten), and then at the same time, you have to have that breach of the intestinal barrier so that the genetic predisposition to the food sensitivity can interplay with the protein from that food entering the body.
I should also mention that casein, one of proteins in dairy, also looks like gluten to the body, and about 50% of the people who are sensitive to gluten are also sensitive to dairy. So that’s a big one. I’ve heard clients say to me, well, I went off gluten for X amount of time and didn’t get better. Well, you may be deep into it. First of all, it may take more than a month or two of elimination. But also, you may not be eliminating all the foods that you need to eliminate to really get at the root of your problem. And if you’ve not done that, then you’re still going to have the symptoms.
Elimination Diets and the AIP
So let’s talk about an elimination diet. The ideal elimination diet is going to last at least 30 days and eliminate gluten, dairy, soy, added sugar, alcohol and processed foods, at minimum. Six weeks would be even better. Then you should reintroduce each food individually for a week at a time, eating it a couple of times a day so you can really gauge the effects. It’s important to leave enough time to make sure that food is really non-reactive, then remove that food again as you test something else and then slowly add the non-reactive foods back in at the end.
Now if you are dealing with an autoimmune disease and not just gut symptoms, the autoimmune protocol (AIP) is a much more strict elimination diet that you could try. That also eliminates nightshades, which are tomatoes, peppers, potatoes and eggplant, legumes, eggs, coffee, all grains, nuts and seeds, seed spices, every spice in the pepper family, and chocolate! Tragic, I know. But I wanted to caution you that if you are going to go that route, there’s something that can happen when you go on elimination diets like the AIP. You may end up eating the same things every day and reducing your diet to so few foods that you get to the point where you can basically eat nothing without getting sick. So a word of warning, if you’re just starting to plan to go on the AIP, it is essential to eat a variety of foods, especially fresh produce and the starchy vegetables that are allowed on it, to keep up the diversity of your gut bacteria during that time. Otherwise, you may risk losing oral tolerance for many foods, which is what I hear from a lot of people who have gone on strict elimination diets and kept them going for too long.
So I know that the big question for a lot of people who are considering going off gluten is, “Does this mean no more pizza for life? Will I always have to be gluten-free?” So if you’re celiac, of course you will always have to be gluten-free. For those who have non-celiac gluten sensitivity, the research at this point is not conclusive. For now, the expert recommendation is that you should follow a gluten-free diet for one to two years and then retest by eating gluten. In my experience, I have had autoimmune conditions (which I described in my January podcast episode: “How I Reversed My Autoimmune Diseases and Got Interested in Gut Health”). During the 5-year process of bringing my antibodies to normal through among other things, staying off of the foods I’m sensitive to (gluten, dairy and soy), I have been able to cheat with gluten about four to six times a year without really throwing myself off track. However, autoimmune experts warn that even eating it once every 6 months could be problematic. That has not been my personal experience.
And there’s no question that I’m gluten sensitive because my stomach bloats up with a food baby every time I eat it, among other problems. But I can still get away with it by taking gluten and dairy digestants and lactose pills. And yet I have been able to continue to reduce my antibodies. Of course I’ll be a little bloated the next day, and I’ll have a sore throat, mostly from the dairy, but I make it worth it. If I’m going to cheat, I’m not having a couple of saltines or frozen pizza. I’m going out for Neapolitan pizza and a chunk of fresh mozzarella or burrata and a nice tiramisu. I’m making the most of it. So I would say that if you’re going to cheat, be purposeful and make the most of it. Don’t just cheat on something stupid because it’s sitting there at some church potluck.
I’ve been thinking that when my Thyroglobulin antibodies for Hashimoto’s are normal (which is under 0.9; mine were last 2.4 ) I may try eating gluten more frequently and see if I can get away with it. But honestly, bread has always made me feel bloated and gross, and it takes up stomach space and calories that really could be filled with more nutrient-dense foods, and it leads to weight gain. (Update 6/3/20: my antibodies were completely normal at my last lab tests in April and I have begun having pizza again every 3 weeks or so with no obvious ill effects. I haven’t retested my antibodies but I’ll update you when I get that chance.)
So in general, I’m not really trying to find more ways to include gluten in my diet, because I don’t think that ultimately it’s the food I most want to reintroduce and take up space with. I have to say that being gluten sensitive has given me a lot of freedom and ease in limiting sugar. I was such a sugar addict before, and the vast majority of desserts out there that you don’t make yourself are going to have gluten in them. So that just means they’re off limits. So it’s really given me the freedom to say “no” to so many foods without even being tempted because they’re just on the no fly list. They’re just never going to be a possibility for me. So I feel like giving up gluten has led to a healthier life overall. So I don’t actually really want to go back on gluten for good. Gluten-free has been a pro in my life.
So if you are struggling with gut issues and haven’t yet taken the plunge and gotten off gluten, this may be the time.
If you have been struggling with an issue like SIBO, candida, IBS, IBD or an eating disorder that is not resolving with traditional or alternative treatments, you may be dealing with an electrical problem in your gut, brain or the connection between the two. In my last podcast episode: The Gut-Brain Connection: A Deep Dive with Corey Deacon, DNM, CFMP, we talked about an amazing new tool that he is using, the electrogastrogram (EGG), to help resolve these issues and retrain the brain and gut.
EGGs record the electrical activity of the gut through sensors on the outside of your body. Every cell in your body needs an electric current to function, and your gut cells are no different. The EGG is similar to an EKG you would have on your heart, just on a different part of your body. EGGs can run through an app on your phone and are then synched with a diary of times you eat, have a bowel movement, etc. In Dr. Deacon’s work, he has found that people with IBS, IBD, GERD, SIBO, chronic parasites or fungal problems, the EGG isn’t smooth and the gut isn’t moving things in the proper rhythm, which is normally 0.05 Hertz. In many people, the migratory motor complex, which controls the movement of food through the intestines, is moving food too slowly, which is known as dysmotility. In other cases, there are little areas within the intestines that are firing improperly, and sometimes firing in the wrong direction. A common example of this is GERD, where acid comes back up the esophagus. While it’s obvious when this happens in the esophagus, it’s much harder to diagnose throughout the rest of the gut as the symptoms are more subtle. But the result of this firing in the wrong direction is a buildup of dysbiotic bacteria that release lipopolysaccharides (LPS). LPS, also known as endotoxins, stimulate a strong immune response, leading to inflammation.
But Dr. Deacon and his colleagues have found that some of the time, the improper firing or gut dysmotility has its origin in the brain, for example following a traumatic brain injury. So when you have both an EGG and an electroencephalogram (EEG), which tracks your brain waves, you can figure out the directionality of your gut problems. One surprise that the practitioners of this technique discovered was that with eating disorders, 70% of the time, it was in fact the gut taking control of the brain and causing the behavior, not the contrary. Using these neuro and biofeedback technique techniques to retrain the brain and gut, Dr. Deacon and others have had success in helping people resolve their eating disorders.
Brain and gut retraining is done through a technique called operant conditioning, which is accomplished by providing audio and visual feedback cues that the brain likes when it’s behaving correctly. This is done by hooking sensors up to the gut and brain and playing a game, movie, music or animation for the patient when the gut or brain is facilitating a proper rhythm. In the brain, the superior and inferior colliculi respond to audio and visual information, and send a message to the limbic system, which then sends a message to the reward system. The limbic system likes stimulus (as opposed to nothing), like how we love our cell phones and can’t stay off them. So when the stimulus is removed, the brain is unhappy. Over time, the brain figures out how to get the stimulus by facilitating the proper gut rhythm, and through the neuroplasticity of the brain, extinguishes old pathways and creates new, healthy pathways to facilitate proper gut movement.
Training sessions last 45 minutes to a hour 2-3 times/week, with 16-24 retraining sessions in total to correct problems in mild to moderate cases. Then patients will do a maintenance session every 1-4 weeks to correct for mental or emotional stress or physiological stress on the gut through toxins, etc. In the next 2-3 years, they’re hoping to develop an at-home system for gut retraining that could be accessed via a cell phone app.
Antibiotics are dramatically overprescribed in our current medical system, and this takes the form of prescribing them when they aren’t necessary, prescribing wider-spectrum antibiotics than necessary, and prescribing longer courses than necessary. I was once prescribed 10 days of Cipro twice in rapid succession for urinary tract infections that I later learned only warranted a 3-day course. All of my autoimmune conditions were diagnosed in the following year. This makes me quite suspicious!
During the cold and flu season this winter, your doctor may prescribe you antibiotics for conditions that are caused by viruses, like cold and flu, or for sinus infections, which are much more likely to be fungal, not bacterial or viral. So if you’re offered an antibiotic for one of these conditions, you should definitely ask your doctor, first of all, is this really necessary? Now admittedly, there are some bacterial infections like strep throat that can be secondary to a viral infection, and those legitimately do need to be treated with antibiotics or herbal antimicrobials. If you go that route, you can see a naturopath for herbal medicines or instructions on which herbal products to use and when to seek out antibiotics if they aren’t working.
If you do have to go on antibiotics, one of the best things that you can do is to take probiotics both during the time you’re taking the antibiotics and then afterwards, to make sure that you protect and rebuild your gut. Note that most probiotics are just transitory and will not colonize your gut, but will protect you from pathogenic bacteria taking root (like C. Difficile) while you’re on antibiotics, will help select for healthier strains in your gut and will protect you from intestinal permeability or leaky gut, where the gut opens up and allows food particles, bacteria and toxins to escape.
So the first probiotic that I always recommend is S. Boulardii, (officially Saccharomyces Cerevisiae subspecies Boulardii), which is not actually a bacteria. It is a beneficial yeast. I like the Jarrow brand (5 billion CFU in 1 capsule; also available from my Fullscript Dispensary) because you can get a nice big bottle for a reasonable price. I would take those at least two or three times a day during the time you’re on antibiotics. As a yeast, the antibiotics won’t kill it. The nice thing about S. Boulardii is that it stops the reproduction of candida, which is also a yeast normally present in your gut. When you are killing off bacteria, the balance between the bacteria and the candida can get off, which can lead to an overgrowth of candida. I take S. Boulardii on a daily basis even when I’m not on antibiotics.
Then another type of probiotic you will want to consider are soil-based or spore-based probiotics, of which I’d take one serving/day. Some of the big names in spore-based are Megasporebiotic (also on Fullscript); likely the most expensive, most diverse and highest dosage one with 4 billion CFU and 5 strains in 2 capsules). Then there’s justthrive (3 billion and 4 strains in 1 capsule) and ProFlora 4R (on Fullscript; 3 billion CFU, 3 strains + Querticin, Aloe Vera and Marshmallow Root). And then there’s also a brand called Restorflora (on Fullscript) that has both 5 billion CFU of S. Boulardii and 2 billion CFU of 2 strains of spore-based probiotics. So I’d either go with the S. Boulardii plus a separate spore-based probiotic, or I would go with the combined one. But you may want to double up on RestorFlora to get as many of the spore-based as you would with another brand that was only spore-based strains. But of course, it’s not an exact science.
Another probiotic that I recommend as well is Equilibrium, which is really unique in the field of probiotics because it’s a human-derived probiotic with 115 strains. So these are strains that actually live in your gut. Again, I would go with maybe two or three of these a day during the time you’re on antibiotics or one/day starting right after you’re done, and keep that up until you’ve finished out 1-2 bottles. You could also go with Equilibrium Boost, which is basically 2 capsules of 10 Equilibrium combined into one, and then follow that by a regular bottle of Equilibrium right after you finish with the antibiotics. (You can use discount code HDH15OFF to get 15% off Equilibrium either at at the link above or on Amazon).
And then either at the same time or after you’re finished with your antibiotics, I’d also use food-based probiotics, something that has high levels of lactobacilli and bifidobacteria. If you want to go really high end, you can look at the Bifido Maximus, which is sold out of the Gut Institute and has 100 billion CFU per ¼ tsp. serving. Another good one is Renew Life Ultimate Flora that has 50 billion CFU per capsule. Of the food-based, I’d shoot for 100 billion CFU/day.
In terms of timing, all of the probiotics besides the S. Boulardii need to be taken separated in time from antibiotics. Otherwise the antibiotics will just be killing them. So for example, if you’re taking your antibiotics at breakfast and dinner, then take your probiotics at lunch and/or right before you go to bed, or if the antibiotics are three times/day, then take the probiotics between meals and/or at bedtime.
Another substance you might want to look at to help protect your gut is L-glutamine, which is a nonessential amino acid. Normally your body makes enough and it also comes from a lot of different foods like chicken, fish, dairy, tofu, cabbage, spinach, beets, peas, lentils and beans. But it can become deficient due to major infections, trauma, significant stress, radiation and chemotherapy, shock and vigorous exercise. So one way to protect your gut during these times of infections is to have a lot of bone broth, which has both L-glutamine and collagen, which is why of course grandma’s chicken soup was recommended. Note though that if you have histamine intolerance, bone broth is a source of histamine, so you wouldn’t want to go that route. Or you can take supplements of L-glutamine. The maximum dose is 30 grams a day split into five gram portions taken six times a day. But what I’d recommend is that you just start with a powder and work your way up to what seems to be a good dose for you. That helps seal the gut and keep it protected from becoming leaky.
Then you should also make sure you eat probiotic foods. So fermented sauerkraut, kefir, kim chee, etc. And the other thing that’s really important is to avoid sugar and processed carbohydrates during the time you’re on antibiotics and while you’re rebuilding your gut afterwards, because this is a time you’re going to be particularly prone to an overgrowth of candida. The more I see clients and people around me who are sick, the more I believe that a lot of these gut and autoimmune issues are traceable to the destruction of the gut microbiome due to antibiotics. You end up with an imbalance between the bacteria and fungi, including candida. So it’s really important that you get off the sugar and the processed carbs as much as possible. And that includes alcohol.
Then the other important part is to feed the body and its resident bacteria prebiotics and fiber. So just in case there’s any unclarity, probiotics are the bacteria and beneficial yeast, prebiotics are the food for the bacteria. I wouldn’t say it’s necessary to go for a prebiotic supplement, but just eat a lot of fiber from fruits and vegetables, like onion, garlic, beans, lentils and other legumes (the powerhouses of fiber).
And then you can also aim to get good resistant starch, which functions like soluble fiber, as a food for our bacteria. It helps us feel more full and controls blood sugar but we don’t digest it, our bacteria do. Good sources are tiger nut flour (a root vegetable, not a nut), green banana flour and banana skins. If you want to put banana skins into your smoothie, make sure you use organic bananas. You can also get resistant starch from heated and then cooled rice and potatoes. Once you cool them down, you get significantly fewer carbohydrates (or simple carbohydrates if you’re eating white rice) and 2½ to 3 times more resistant starch. Once you cool them, you can heat them back up to eat.
Finally, I did want to mention that if you took antibiotics a long time ago and you’re now dealing with what seems to be gut issues that followed on the antibiotic treatment, you can certainly try probiotics. You can go hard on them and see if it helps. But it may just be putting a bandaid on a bigger problem. So my recommendation is if it’s been a while since you took the antibiotics and you’ve been having gut issues, then you probably want to see what’s going on through testing. It may be parasites, it may be bacterial overgrowth like SIBO, it may be fungi like candida. It’s important to figure out what’s going on so that you can kill the appropriate thing, if there’s something to kill, and then rebuild with the prebiotics and probiotics. I think that’s a better route than trying to just put a bandaid on a dysbiotic gut.
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If you’re suffering from an autoimmune disease, you’re not the only one, but fortunately, there is hope! Over the last 50 years, autoimmunity has increase threefold, with around 50 million Americans current affected (more than cancer or heart disease), 78% of whom are women. In autoimmune diseases, the body produces antibodies that attack its own cells, tissues and organs. The most common autoimmune diseases are Rheumatoid arthritis, Hashimoto’s thyroiditis, Celiac disease, Graves’ disease and Type 1 Diabetes Mellitus, but there are more than 100 autoimmune diseases that are either systemic or attack individual organs.
This affected me personally when I was diagnosed with three autoimmune diseases around 2014 – Hashimoto’s Thyroiditis, ITP (an autoimmune platelet disorder) and B12 anemia. Traditional doctors had nothing to recommend other than monitoring the progression of my conditions and waiting until treatment was necessary (except for the B12 anemia which shots and sublingual supplementation helped). I soon realized that there was a lot more I could do, and thanks to the methods I outline below, I have been able to reverse my autoimmune diseases almost completely. And last week was a special celebration when my lab tests showed my platelet count solidly in the normal range for the first time since 2013! And I have yet to have to go on replacement thyroid hormone for my Hashimoto’s and my antibodies were almost down to normal at my blood tests last year.
So what causes autoimmune disease? While twin studies show that about 25% of the cause may be genetic, the other 75% is environmental, which means that changing those environmental factors can help reverse your autoimmune disease and its symptoms. The main environmental contributing factors are diet, intestinal permeability (aka, leaky gut), environmental and dietary toxins, infections and stress. In fact, many autoimmune sufferers can point to a period of high stress when their condition started.
Pharmacological treatments for autoimmunity include immunosuppressive drugs, NSAIDS (non-steroidal anti-inflammatory drugs), DMARDs (disease-modifying anti-rheumatic drugs), and biologics. Immunosuppressive drugs suppress the immune system, creating vulnerabilities to bacteria, viruses and toxins that your immune system normally can handle, and cause a host of other dangerous side effects. NSAIDs, when used long-term, can cause stomach pain, heartburn, ulcers, headaches, dizziness, liver or kidney problems, high blood pressure, and increased risk of worsening heart failure. Side effects from DMARDs include abdominal pain, anemia, anxiety or depression, easy bruising or bleeding, fatigue, infection, lymphoma, night sweats, skin cancer and tuberculosis. Finally, biologics, which are quite expensive, also have side effects that include cancer, headaches, heart failure, hepatitis B, joint pain, nausea, upper respiratory infections and vision problems.
Given the track record of pharmacological treatments, natural treatments to reverse or improve autoimmune conditions hold great promise for relieving suffering without causing additional problems. Protocols to reverse autoimmunity aim to address the underlying triggers of autoimmunity and heal the root causes. These protocols typically involve 5 steps. They are:
a. Detoxification – A congested liver may be making it hard for your body to remove current toxins, leading to an overload. Gentle supplements that support your body’s own detoxification systems can help clear the backlog of toxins and give your body the chance to reset. Eliminating environmental and food toxins by choosing natural cleaning and personal care products, filtering your water, and eating whole, organic foods will help eliminate a large percentage of toxins entering your system.
b. Identifying food sensitivities – Gluten and other common food sensitivities are often co-factors in autoimmune disease, that when eliminated allow your body to heal. An elimination diet done under the care of a professional will help you identify and replace foods to which your body may be sensitive.
c. Suppressing and/or healing infections – Different infections including small intestine bacterial overgrowth, candida overgrowth in the gut, Epstein-Barre virus (which causes mononucleosis), HSV (Herpes Simplex Virus), and bacteria such as Yersinia and Klebsiella have been implicated in different autoimmune conditions. Testing for and treating underlying bacterial or fungal infections or overgrowths and suppressing viral infections will help heal your autoimmunity.
d. Healing the gut lining – Stress, antibiotics that alter the balance of your gut microbiome, emulsifiers used in foods, environmental toxins, food sensitivities, a diet high in sugar and simple carbohydrates and low of fiber and heavy alcohol use can lead to an unhealthy gut lining with large cracks or holes that allow partially digested food, toxins and bacteria, to enter your body, triggering inflammation and autoimmune reactions. Eliminating those foods and toxins, and identifying and removing triggers, as well as including healthy sources of fiber in your diet and using appropriate probiotics and other supplements will help heal your gut lining. Finding effective ways to remove stressors and manage stress is also essential.
e. Fixing nutrient deficiencies – Deficiencies in key nutrients like vitamin D, omega 3 fatty acids, B vitamins, selenium, zinc and magnesium can also be a factor in autoimmunity. Testing for nutrient deficiencies and supplementing where necessary will give your body the tools it needs to modulate your immune response, fight bacteria and viruses and support an appropriate inflammatory response.
If you’re suffering from an autoimmune disease or know someone who is, the good news is that many people have reversed autoimmune conditions even as serious as Multiple Sclerosis and gone on to lead long, healthy lives. Please share this information with people who need it! I coach clients on reversing autoimmune disease using these natural methods. It just takes an open mind and willing spirit! Set up your complimentary, 1-hr. Autoimmune Health Breakthrough Session ($97 value).
My family and I moved to Tucson, Arizona about a year ago and I really wanted to enjoy some of the native free food (I can never resist free food!) Prickly pears are a local green cactus (like the ones in my logo) that produce oval, red fruit in the summer. The plants are abundant around us, so my son and I only had to go out to the median strip near our house and spend about ½ an hour picking them (we used pliers to avoid getting pricked) to get a huge bucket full.
Once home, I rinsed them with water, then ran them through the juicer my neighbors were kind enough to lend me. Its filter is very fine, which traps all of the tiny, fine needles that would kill you if you swallowed them.
So that got us a full giant crock pot plus a big Tupperware container full of juice.
Some of it I used in a vinaigrette, some we saved for prickly pear margaritas (amazing color, right?), and the rest I cooked down for about 2 hours, to make a tangy, sweet paste. I didn’t really have any prickly pear recipes, so I used some of that paste for these Prickly Pear Muffins I invented, which I was happy to discover turned out spectacular. If you don’t have access to prickly pears, you could substitute any kind of reduced fruit paste (without big seeds) like mango, strawberry or blueberry.
Prickly Pear Muffins (Gluten-free, Dairy-free, and Sugar-free)
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Ingredients 1½ cups almond flour ½ cup gluten-free flour (or whole wheat if not gluten-free) ½ cup xylitol (or sugar if you don’t want sugar-free) ½ tsp. baking soda ½ tsp. salt ½ cup full fat coconut milk or coconut cream ½ cup prickly pear juice reduction ½ cup avocado oil 1½ tbsp. apple cider vinegar 2 eggs 1 tsp. vanilla 1 tbsp. chia seeds
Instructions Preheat oven to 350 degrees F. Use an electric mixer to mix all of the ingredients except chia seeds in a bowl.
Grease muffin tin with avocado oil. Fill muffin slots to about 3/4 full with batter (I use a regular-sized muffin pan so cooking time is based on that). Sprinkle chia seeds on the top. Bake for 18-20 minutes until a knife inserted in the middle comes out clean.
½ cup xylitol ½ cup avocado or coconut oil 2 eggs 2 mashed ripe bananas ½ cup coconut cream or full fat coconut milk 1 tsp vanilla 3/4 cup almond flour 3/4 cup gluten-free flour 1 tsp baking soda ½ tsp salt 1/3 bag Enjoy Life dark chocolate chocolate chips 2 tbsp. chia seeds
Preheat oven to 350 degrees. Grease muffin tin. Beat xylitol and oil. Add eggs, bananas, coconut cream or milk and vanilla and mix with beaters. Mix flours, baking soda, and salt then add. Beat just until dry ingredients are moistened. Stir in chocolate chips. Spray muffin tins with oil, then pour into muffin tins then sprinkle each one with chia seeds and cook for 18-20 minutes or until a toothpick inserted into the center comes out clean.