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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 and oatmeal. Gluten-free grains, seeds, flours and starches include millet, sorghum, rice, buckwheat, quinoa, cassava, chickpea or garbanzo bean flour, coconut flour, tapioca starch, arrowroot starch, tigernut flour (not a nut), chestnut flour, almond flour, green banana flour, teff, amaranth, corn and oats and oatmeal (if marked gluten-free). There may be small amounts of proteins that bother some individuals even in gluten-free grains, but for most people, these other options will be fine. If you want to go completely grain-free, cassava, coconut flour, tapioca starch, arrowroot starch, tigernut flour, chestnut flour, almond flour and green banana flour will be your best bets.

Alpha gliadin is the protein fragment that most research focuses on as the main culprit in gluten intolerance/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.

Celiac Disease

It’s also possible that what you think is just a sensitivity or intolerance 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 of gluten sensitivity 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’re wondering how you’ll make it without all those foods, especially sugar, for 30 days, don’t worry, I’ve got a great recipe for gluten-free banana chocolate chip muffins that can be made almost completely sugar-free (except the chocolate chips) and I have a gluten-free blueberry muffin recipe that is completely free of all those ingredients. And you’ll find tons of recipes for gluten-free desserts that can easily be turned into sugar-free using xylitol in a 1:1 ratio instead of sugar or dairy-free by using coconut milk or cream instead of cream (and most people can get away with using ghee or clarified butter, which has no casein or lactose, instead of butter).

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.

(To hear more about loss of oral tolerance, listen to the second part of my podcast on this topic: “Should I give up gluten to help my gut issues?”)

Gluten-Free Forever?

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 couple months 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 questions on gut health, do join my Gut Healing Facebook group.

And I do one-hour consultations as well as longer-term health coaching programs (starting with a free, 1-hour breakthrough session) to help with gut issues, autoimmune disease reversal and weight loss, so don’t hesitate to sign up for a Breakthrough Session.

Happy gut healing!

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.

To hear more details about this exciting new technique and much more, listen to my latest episode of my podcast The Perfect Stool: Understanding and Healing the Gut Microbiome.

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. To find out more, you can set up a free, 30-minute Breakthrough Session with me (Lindsey) to share what you’ve been going through and decide whether a multi-session health coaching program is a good fit for you. Individual 1-hour consultations may be scheduled directly here.

Check out my recent article in the Raytheon Magazine: “Learning to Eat Fat Again” (double click to zoom in on article).

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)

For more sugar-free and healthy recipes, invitations to talks in Tucson on “How and Why to Kick the Sugar Habit” and “Reversing Autoimmunity” and healthy living tips, sign up for my newsletter.

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 or Lakanto monk fruit sweetener
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 (I use a combo of 2/3 sweet sorghum and millet flours, 1/3 tapioca starch)
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.

Last updated 5/10/24

There is a rich amount of peer-reviewed, published data supporting the many positive effects of taking probiotics. However, not every product is perfect for every condition. Here is a brief summary of the strains that help with each type of condition, with links to some products that contain as many of those strains as I could find. As an Amazon Associate I earn from qualifying purchases, so when you use the affiliate links to Amazon and the manufacturers you support the time and effort I put into doing this research for you! Thanks for using my links!

You can also find most of these products in my Fullscript Dispensary. Check prices there before deciding where to buy. It’s easy to set up an account!

Probiotics for Babies Born via C. Section

Bifidobacterium (B.) longum subsp. infantis, Bifidobacterium (B.) infantis EVC001

Baby’s Jarro-Dophilus Drops – Amazon
Evivo (15% off using this link)

Probiotics for Constipation

B. lactis (in children), B. longum, S. Boulardii, Equilibrium (115-strain probiotic), L reuteri ATCC PTA 6475 + L reuteri DSM 17938 and a combo of Lactobacillus (L.) acidophilus, L. reuteri, L. plantarum, L. rhamnosus and B. animalis (B. animalis lactis was formerly called B. infantis), spore- or soil-based strains (Bacillus)

For kids:
Douglas Labs Multi-Probiotic Kids Powder – Amazon
For adults:
Equilibrium – Equilibrium Store (15% off with code HDH15OFF)
Biogaia Gastrus – iHerb Amazon
Jarrow Formulas S. Boulardii – Fullscript
Microbiome Plus+ – Microbiome Plus web site
Greens First Women’s Health Probiotic – Amazon
Kirkman Pro-Bio Defense – Amazon
Syntol AMD (also yeast cleansing formula) – Amazon
Megasporebiotic – Fullscript
justthrive Probiotic – justthrive Store

Probiotics for Infectious Diarrhea

L. rhamnosus GG, L. acidophilus and L. bulgaricus

Culturelle – Amazon
Klaire Labs – Ther-Biotic Complete – Fullscript

Probiotics for Antibiotic-Associated Diarrhea

S. boulardii, a mixture of Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R and Lactobacillus rhamnosus CLR2

Jarrow Formulas S. Boulardii – Fullscript
Florastor – Amazon
Bio-K+ (contains dairy) – Amazon

Probiotics for IBS-Related Diarrhea

Bacilis coagulans, S. boulardii, Clostridium butyricum, and a combination of several Lactobacillus and Bifidobacteria strains

Pendulum Butyricum (30% off first purchase with code GoParsons30) or Fullscript
Jarrow Formulas S. Boulardii – Fullscript
Douglas Labs Multi-Probiotic 40 Billion – Fullscript
DrFormulas Nexabiotic Advanced Multi-Probiotic – Amazon

Probiotics for Breakdown of Digestive Plaques Associated with Crohn’s Disease

L. acidophilus, S. Boulardii, B. breve, L. rhamnosus + Amylase (digestive enzyme)

BIOHM – BIOHM store (use my affiliate code HDH for a discount)

Probiotics for Leaky Gut

Bacillus indicus (HU36), Bacillus subtilis (HU58), Bacillus coagulans, and Bacillus licheniformis, and Bacillus clausii

Megasporebiotic – Fullscript
justthrive Probiotic – justthrive Store

Probiotics for Pain and IBS Symptoms

Bifidobacterium infantis 35624

Align – Amazon

Probiotics for Gas and Bloating

L. plantarum 299v

Jarrow Formulas Ideal Bowel Support – Fullscript

Probiotics for Heart Health/Decrease in Bad Cholesterol, Increase in Good/Reduction of Triglycerides

L. acidophilus, B. longum and L. reuteri, spore- or soil-based strains (Bacillus)

Microbiome Plus+ – Microbiome Plus web site
trunature Advanced Digestive Probiotic – Amazon
Nature’s Way Primodophilus Reuteri pearls – Amazon
justthrive Probiotic – justthrive Store

Probiotics for Inflammatory Bowel Disease, Ulcerative Colitis

S. Boulardii, L. rhamnosus GG, L. plantarum 299v, VSL#3 (combo of many lactobaccili and bifidobacteria)

Jarrow Formulas S. Boulardii – Fullscript
Culturelle – Amazon
Jarrow Formulas Ideal Bowel Support – Fullscript
Visbiome (originally called VSL#3) – Amazon or VSL#3 (made by different manufacturer than original VSL#3) – Fullscript

Probiotics for H. Pylori Infections

L reuteri DSMZ 17648 (Pylopass™)

Life Extension Gastro-ease – Fullscript
H. Pylori Fight – Amazon
Pyloguard – from Microbiome Labs (you need to set up an account to order) or Fullscript

Probiotics for Weight Loss and Metabolic Health

A. muciniphila, L. gasseri, L. rhamnosus, a combo of L. rhamnosus and B. lactis (B. animalis lactis, previously known as B. infantis) and Equilibrium (115-strain probiotic)

Pendulum Akkermansia 500 Pro on Fullscript or Akkermansia 100 Pro on Fullscript
Pendulum Glucose Control – Fullscript or Metabolic Daily Pro – Fullscript
Douglas Labs Multi-Probiotic 40 Billion – Fullscript
Equilibrium – Equilibrium Store (15% off with code HDH15OFF)
Bifido Maximus from The Gut Institute – The Gut Institute

Probiotics for Mental Health

B. longum, B. breve, B. infantis, L. helveticus and L. rhamnosus, L. acidophilus, L. casei and B. bifidum, Bacillus indicus (HU36), Bacillus subtilis (HU58), Bacillus coagulans, and Bacillus licheniformis, and Bacillus clausii

Dr. Ohhira’s Probiotic Professional Formula – Amazon
justthrive Probiotic – justthrive Store

Probiotics for General Health, Increase of Short Chain Fatty Acids/Butyrate

B. bifidum, A. muciniphila, Clostridium butyricum

Bifido Maximus from The Gut Institute – The Gut Institute
Seeking Health – ProBiota HistaminX – Fullscript
Douglas Labs Multi-Probiotic 40 Billion – Fullscript
Lifted Naturals Bifidus Mood Boost – Amazon
Pendulum Akkermansia 500 Pro on Fullscript or Akkermansia 100 Pro on Fullscript
Pendulum Glucose Control – Fullscript or Metabolic Daily Pro – Fullscript
Pendulum Butyricum (30% off first purchase with code GoParsons30) or Fullscript

Probiotics for Histamine Intolerance

B. infantis, L. gasseri, B. breve, B. bifidum, L. salivarius, L. rhamnosus (especially GG), B. longum, B. lactis, L. plantarum


Bifido Maximus from The Gut Institute (also D-Lactate-free) – The Gut Institute
Seeking Health – ProBiota HistaminX – Fullscript
Vitanica – Flora Symmetry – Amazon
Lifted Naturals Bifidus Mood Boost (also D-Lactate-free) – Amazon

First Probiotics Post-SIBO Treatment

Bifidobacterium strains
Bacillus clausii

justthrive Probiotic – justthrive Store
Renew Life Adult 50+ Probiotic – Amazon
RestorFlora – only available from Fullscript
Seeking Health Probiota Bifido – Amazon
Lifted Naturals Bifidus Mood Boost (also D-Lactate-free) – Amazon

Probiotics post Binge-Drinking to Prevent Hangovers

Genetically engineering B. subtilis

Zbiotics – 10% off your first order using that link or code PERFECTSTOOL

Probiotics for Heavy Metal Detox

Lactiplantibacillus plantarum DSM 33464

MegaMetalliQ – from Microbiome Labs (you need to set up an account to order)

Most Diverse Probiotic (Highest Number of Strains)

Equilibrium – Equilibrium Store (15% off with code HDH15OFF)

Probiotics for Oral Care (Probiotics for Teeth, Gums and Breath)

Lactobacillus reuteri (LRE-15), Lactobacillus salivarius (LS-33), Bifidobacterium lactis (HN019), Streptococcus uberis KJ2, Stretococcus oralis KJ3, Streptococcus rattus JH145

Probiora – from Amazon
Researched Nutritionals Oramax – from Pine Street Clinic

If all this was too confusing and you feel like you need some help and guidance in choosing a probiotic or solving your gut, autoimmune or other health issues, you can set up a free, 30-minute Breakthrough Session with me (Lindsey) to share what you’ve been going through and decide whether my 5-appointment gut health coaching program or a longer program for autoimmunity or weight loss is a good fit for you. Individual 1-hour consultations may be scheduled directly here.

Sources:

• How to Choose the Best Probiotic Supplement
• Intervention strategies for cesarean section–induced alterations in the microbiota-gut-brain axis
• 200 Person Double-Blinded Placebo-Controlled Study of Equilibrium Brand Probiotic
• Effects of a Novel Probiotic Combination on Pathogenic Bacterial-Fungal Polymicrobial Biofilms
• Histamine Intolerance and Probiotics? Careful.
• Oral spore-based probiotic supplementation was associated with reduced incidence of post-prandial dietary endotoxin, triglycerides, and disease risk biomarkers
• Probiotics for Histamine Intolerance: What You Need to Know
• Probiotics for Irritable Bowel Syndrome
• Strain-Specificity and Disease-Specificity of Probiotic Efficacy: A Systematic Review and Meta-Analysis
• Therapeutic modulation of gut microbiota: current clinical applications and future perspectives

If you’ve never tried lemon grass from the tubes of paste that you can find at Safeway in the produce section, you’re in for a treat!

Chicken with Lemon Grass Recipe

Ingredients
1 package (1 lb.) chicken thighs or breasts
3 tbsp. lemon grass paste or 3 stalks of lemon grass, outer leaves removed and edible parts blended
3 spring onions
¼ tsp. salt
¼ tsp. ground black pepper
2 tbsp. avocado or coconut oil
2 cups cut up vegetables of your choice (broccoli, bok choi, Chinese broccoli, peppers, carrots, kale, chard, etc. are all good choices)
1-2 fresh red chilies, seeded and chopped (or a squirt of sriracha)
4 tsp. sugar or xylitol
Extra black pepper to taste
½ cup roasted peanuts, finely chopped
1-2 tbsp. fish sauce to taste
fresh cilantro, washed and leaves removed

Cut the chicken up into bite sized pieces and remove fat. Finely slice the spring onions, including green leaves. Mix the chicken pieces with the salt, pepper, 2 tbsp. of the lemon grass paste and spring onions and set aside for 30 minutes.

Heat a wok to medium high, add oil and when oil is hot, add the chicken mixture and stir fry for 5-7 minutes until all chicken is mostly cooked through. Remove from pan. Add the chilies and vegetables and cook until crisp and bright but cooked through. Add last tablespoon of lemon grass paste, put chicken back in, and add sugar (or xylitol), extra black pepper and fish sauce and mix. Sprinkle chopped peanuts and cilantro on dishes to serve.

Serve over rice, rice noodles or shirataki noodles if grain-free.