Repairing the Gut

February 18, 2012 in Categories: by

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Whether you’ve recently recovered from an infection requiring antibiotics, are healing after treatment for a parasite, or are battling against anxiety and depression, repairing your gut and supporting healthy gut microflora is not only important, it’s essential.  And depending on your health, your diet, and your life circumstances, you might be fighting an uphill battle.  Here are eight key points for optimizing gut health:

Follow a Strict Paleo Diet.  If you are trying to encourage diverse, healthy gut microflora, avoiding all foods that potentially irritate the gut  is critical.  For at least a while, do not allow yourself cheats.  Initially, you may also want to avoid nightshades, nuts, egg whites, and alcohol (these are the same foods that are restricted on the AIP- Auto Immune Protocol).  It’s also very helpful to keep your carbohydrate content on the moderate side since too many sugars can cause inflammation and encourages growth of bad yeast and bacteria (but too few can cause increased cortisol, hinder thyroid function, and if you’re eating too little fiber, you may not be able to support growth of probiotic bacteria).  Eating plenty of vegetables (starchy vegetables in moderation) and some fruit can have a very beneficial corrective influence on gut bacteria.

Keep Your Omega-3 Intake High.  Aim for a 1:1 ratio of omega-3 to omega-6 fatty acid intake in your diet.  This helps reduce overall inflammation and heal the gut and is one of the most important .  There are several ways of doing this:  you can make sure that all of the meat in your diet is exclusively from grass-fed animals (beef, bison or lamb); you can eat plenty of wild-caught seafood; and/or you can supplement with a good quality fish oil (eating fresh seafood is far superior than fish oil due to the fragility of polyunsaturated fats once isolated).

Eat Coconut Fat and Grass-Fed Butter:  Antimicrobial short- and medium-chain saturated fats help to reduce overgrowth of bad yeast, fungus and bacteria in the small intestine.  They can also help tighten the junctions between the cells that line the small intestine (reducing leaky gut).  The best sources of these special saturated fats are coconut oil, palm oil and butter from grass-fed dairy cattle.  Coconut oil is anti-viral, and contains lauric, capric and caprylic acids–recommended to combat yeast.  Grass-fed butter also contains anti-microbial fatty acids including butyric acid, which has strong anti-fungal effects.  Coconut oil and grass-fed butter are not only anti-microbial, but they also help heal the lining of the gut.

Work on Stomach Acid:  Low stomach acid is a common side effect of stress and can create a host of digestive problems, including Small Intestinal Bacterial Overgrowth which puts pressure on the upper digestive tract, causing acid reflux, indigestion, gas and bloating.  Yes, too little stomach acid ends up feeling like too much.  A great, easy way to help is to drink lemon juice or raw apple cider vinegar 10-20 minutes before a meal (about 1-2Tbsp, which you can dilute in or chase with an ounce or two of water to make more palatable).  It’s also very helpful to take time to chew your food thoroughly (I have to constantly remind myself to do this because my default is to wolf everything down).  Eating plenty of ginger (as tea for or as part of your meals) can be very helpful here too for increasing stomach acid production and gut motility.  Eating homemade sauerkraut has also been shown to help regulate stomach acid production.

Eat Fermented Foods:  This is your greatest source of probiotics for replenishing your gut microflora.  Kombucha is a fermented tea rich in probiotics and good yeast, which also helps increase stomach acid levels.  It is relatively easy to find at alternative grocery stores (like Whole Foods), but is also fairly straight forward to make at home (you need to buy a Kombucha Starter/Scoby).  Homemade, unpasteurized sauerkraut is delicious and quite easy to make (this is my favorite how-to sauerkraut website, but also check out Balanced Bites’ recipe).  You can similarly ferment a variety of other vegetables, including cucumbers, beets, and kale.  Kefir is similar to yogurt, but you don’t need to use cow’s milk.  Goat milk kefir is fairly easy to find in alternative grocery stores.  You can also purchase Kefir Grains to make your own coconut milk kefir at home (see Mark’s Daily Apple for great directions).  I do all of the above.  My kitchen counter is covered in glass bottles of various fermented mixtures (imagine a wicked cackle). See my review of the book Fermented by Jill Ciciarelli, a great resource for fermenting foods at home. If none of these foods appeal to you, you can also supplement with probiotics.

Eat Bone Broth:  Stock and soups made from the bones of chicken, turkey, duck, beef, lamb and fish are anti-microbial, anti-inflammatory, and contain nutrients which help build the integrity of the digestive tract.  Most importantly, they are rich in proline and glycine which help regulate digestion, reduce inflammation, and heal the body (see The Health Benefits of Bone Broth and my recipe for bone broth for more information).

Get Lots of Sleep:  Getting 8-9 hours of quality sleep every night gives your body time to heal and also is essential for regulating many hormones, including the stress hormone cortisol.  Make sure that sleep is high up on your priority list.

Manage Stress:  If you read my blog post about the Gut-Brain Connection, then you realize just how important this is.  This is also the most individual of all of these recommendations.  Whatever you need to do to manage stress, do it.  Maybe it’s going for a walk, going to a yoga class, or taking a few moments to consciously relax, breathe deeply or meditate.  Maybe it’s making sure you have time for something fun.  Maybe it’s asking for help so you can take a few things off your plate.  Maybe it’s finding a way to divest yourself emotionally/mentally from the things that usually cause you stress.  There are two herbal products that I find very helpful for days when I just can’t seem to relax:  Bach’s Rescue Remedy and Hyland’s Calms Forte.  These are aids to your other efforts though, and not sufficient to manage stress on their own.  I also find chamomile tea to be a great relaxant.

Comments

how long can broth stay in the refrigerator after its made? also, i recently made scd yogurt for the first time, the timer went off after 8 hours, but i didnt know it til the morning, i know its suppose to ferment for 24, but is it bad if it potentially sat at room temp for 10 hours?

My rule of thumb for any cooked protein (including broth and soups made with broth) is 4 days (if it’s something I’m going to reheat well, I often push it to 5). As for the yogurt, if it had a lid on it and was brought up to 180F as the first step in making the yogurt, and it doesn’t have any discoloration (dark or pink spots), and it smells and tastes okay, I would eat it, if it were me. I also like to follow the adage “better safe than sorry”.

Great info. Thanks for being here. I am starting a strict Paleo up until I have a gastroenterologist appt mid July. Hoping I won’t need him then. :)
I just wanted to touch base and say hi as I found after a few weeks of research on Paleo your site is better than all. Have a fantabulous healthy day!
-Bonnie

hi sarah- wow! 120 lbs! u look great! ;) Just found your site. I have RA (AI disease) and seemingly increasing issues, have been doing the GAPS diet, but need more support/instruction. I was laughing at your intro at the top as I too have the skeptical hubs (who also suffers from IBS and psoriasis), and kids who think i eat weird ;) If I can show them the “science” behind my diet, that might help!
How does the palao diet differ from GAPS?

I think paleo is a bit more whole picture than GAPS, but I recommend doing a combination of both for people with severe gastrointestinal issues. Here are some good posts to start with:
http://www.thepaleomom.com/2012/05/modifying-paleo-for-autoimmune.html
http://www.thepaleomom.com/2012/07/modifying-paleo-small-intestinal.html
http://www.thepaleomom.com/2012/03/what-is-leaky-gut-and-how-can-it-cause.html
Feel free to email or post on facebook if you have any more questions. :)

Great article Sarah!

I was wondering how long it usually takes for one’s gut/gut bacteria to heal. How long should I eliminate eggs, nuts, nightshades, etc for?

I have a case of acne. Is it possible that this could go away upon healing my gut? If my acne heals, would I know that my gut has as well?

I have not been diagnosed with any gut problems, just the normal wear and tear from eating SAD for the last 18 years.

Thanks,
Jay

Great site! I’ve been reading here for about 2 hours already! However I have a comment/question about coconut oil… have you ever heard of someone reacting to it? I have had a bad reaction to it twice already, I was taking it for Candida/yeast which a biological terrain test found.. anyway both times I had been taking it I reacted after a couple of weeks with extreme racing heartbeat, and I do mean racing! By the time I was able to schedule a Holter monitor test I had realized it was the coconut oil and cut it out but it still took over a week to get rid of the symptom. The first time I took caprylic acid, reacted, but didn’t put 2 and 2 together, then I thought ‘use the whole food it came from’ and it happened again! (Holter monitor test came back fine) My naturopath said that coconut oil/caprylic acid interferes with calcium absorption – I cannot remember whether he said it makes you absorb more, or less! But anyway my point is that it may not be for everyone! You must listen to your body and if you start to have any alarming symptoms STOP all supplements then add them one by one to see what you reacted to. I will never ingest coconut oil ever again after how badly I reacted to it (using the rest of the jar in my hair;) Again, great site, off to go check out your recipes! ~Tanya

Yes, I have heard of people having food sensitivities to coconut (even coconut oil). And some people have issues with whole coconut products because the fiber in coconut can be a difficult for some people to digest. Racing heartbeat is interesting though! That almost sounds like a metabolic reaction. I definitely think avoiding it is a good choice! :) Whole coconut has some phytic acid which can interfere with calcium absorption, but I’m not sure why coconut oil would do that. I’ll have to look into it. :)

So glad I found this blog! I need my own Paleo Mom! Too late I’m afraid being 50 yrs old. Suffering from Crohns last 10 years and still no relief. Recently became interested in Paleo. I am determined to kick this thing in the behind. Thanks for the wonderful information contained in this blog.

[...] Healing the gut becomes very important.  I highly recommend consuming bone broth, organ meat, oily fish, and coconut oil on a fairly routine basis as well as making sure that you are getting adequate vitamin D, whether you are taking a supplement, food sources like liver and fish, or spending lots of time outside. Note that coconut oil does not contain the phytic acid or inulin fiber (both gut irritants) that other coconut products contains (a little coconut is typically tolerated, but I urge caution).  Stress management is very important and I highly recommend doing at least one of the following: go for daily walks, take up yoga or tai chi, take a class on meditation, or make time for an activity/hobby that you absolutely love.  And I cannot emphasize enough the importance of getting lots of good quality sleep.  Aim for 8-10 hours of sleep in a cool, pitch-black room, preferably waking up without the use of an alarm.  It may help both stress hormone regulation and improve sleep quality to drastically reduce your caffeine intake.  Aim for no caffeine if you can.  It is also very helpful to drink plenty of water and to make sure you are consuming enough food.  The body is not very efficient at healing itself when you are running a caloric deficit (you shouldn’t have to gain weight to heal, but losing weight may be a competing goal for now). [...]

Most people can handle egg whites, but for those with with severe inflammation, severely leaky guts, and autoimmune disease, they can definitely be contributors. It’s worth playing with leaving them out of your diet for a few weeks and then reintroducing them. Prof. Cordain recommended limiting to 6 per week in his first book, but I don’t think he suggested limiting them in his second book.

I see all these posts about healing leaky gut by eating fermented foods, like sauerkraut. I have a goiter and cabbage is a goitrogenic food. What other alternatives are available to eat? I am so confused by all this pale/whole30/GAPS/SCD because while each relatively says the same thing, there are enough variations to leave me totally clueless as to how to eat to benefit my health having Hashimotos AND a goiter! Please help.

I’m actually going to start pulling back on my recommendations for eating fermented foods because they contain some yeast and yeast is a potential cross-rector to gluten (meaning if you are gluten-intolerant, there’s a good chance you will also react to yeast). My recommendation is to find a good soil-based probiotic supplement.

Generally, where these diets tend to agree is where the science to back it up is stronger. Where they disagree is either where the science is new or just hasn’t been done yet. But definitely, sauerkraut isn’t a good food for hashimotos.

When healing leaking gut, my practitioner recommend purified water enemas to hydrate and mineralize the colon. Have you ever heard of this and is it generally accepted as beneficial? Thank you

Does that mean no sweet potato as well?
Also, I have a Greek yoghurt with no gluten, sugars, preservatives, low lactose, no gelatine, it’s basically 100% natural and pot set (brand is Jalna Greek). Also is high is several good bacteria. I have Crohn’s disease and when I have an episode I find that eating a lot of this youghurt helps settle things down, by a lot I mean 2 serves a day. Would you still recommend that I give this up too to follow the autoimmune protocol?

Sweet potatoes are not nightshades, but they are very starchy and high FODMAP, so I don’t typically recommend them. Yes’ I do recommend giving up the Greek yogurt but do also think that finding a very potent probiotic would be a good idea. You could take it in conjunction with coconut oil if you think the fat is helpful too.

They definitely work in coconut milk. I think they’d be okay in other non-dairy milks. They like high fat. And they need the occasional break in cow or goat diary (or I guess other dairy like sheep or camel). I would suggest a round in dairy every 1-2 weeks or so.

I thought I read on another page of yours that you are sensitive to yeast so can’t do the ferments. You mentioned here you make plenty. Thanks for clarity.

I only went through about a month with no ferments, and have now successfully added them back in. I think I was actually sensitive to some other things I was eating, since I now include a huge pile of sauerkraut at breakfast, other fermented veggies and kombucha most days too.

Also I saw somewhere you like fermented cod liver oil and I like to try what you do but I’m afraid to spend the money not knowing if I will react as I think yeast brothers me. Is carlsons brand OK as I have some in the frige afraid to take as I’m trying to identify food allergies first. I want to heal my gut but think coconut oil gets me(darn!) Watch out everyone about yeast and oxalates. Yeast is in my Garden of Life vitamins and I did not know for months causing big setbacks.

I use Green Pasture (but I eat so much fermented foods and organ meat, that I really only take it if I feel like I’m fighting a cold). Carlson’s has a good reputation.

One more thing as I value your knowledge! I have candida too and GAPS says I can have fruit and raw honey but Body Ecology says no way those sugars feed yeast too. Which is right!! I’m so starving reacting to so many foods. One serving of quinoa a day is really going to hurt?

Neither the GAPS diet nor the candida diet have been validated in the scientific literature. So, I’m afraid neither! But, what I know about gut dysbiosis and overgrowths is that the two most important corrective diet factors are fiber content (from vegetables and fruit) and high omega-3 intake. I would watch fructose intake (and keep below 20g per day), eat lots of fish and veggies. I’m not a fan of quinoa and would rather see you get carbs from starchy vegetables.

Thank you for this information! I have many food allergies and I need to start healing my gut. I have been taking probiotics, enzymes and avoiding food I am allergic to but I know I am developing more allergies. I am not sure if I can follow the diet exactly due to allergies but I am motivated to try.

Do digestive enzymes destroy our beneficial bacteria we are all so desperately trying to repopulate? I cannot find any research but wonder. Would it make sense to take probiotics seperate? I need help repopulating as my tests came back no growth and I have been taking high priced ones for months! What all could kill our flora that we are not aware of?

Can you please clarify an issue that came up for me with digestive enzymes (that was embarrassingly pointed out by my 9th grade brother, meanwhile I’m in a medical graduate school program)? He always makes fun of me for my Paleo diet and all the supplements I take, but he pointed out that the enzymes like lipase in my NOW Superenzymes won’t be able to make it past the stomach acid. How do these digestive enzymes work (if they do at all) when they contain both enzymes that should be present in the stomach and those that should be present in the duodenum (like lipase, ox bile, etc.)? If the capsule is meant to break down in the stomach to release the HCl and pepsin, won’t the others get destroyed in the stomach acid? Thanks!

In the meantime, my answer to him continues to be, “I can discuss it at your funeral.” (He would eat nothing but chocolate croissants, chocolate milk shakes, Snapple, and steak if my parents would let him)

Many enzymes are acid-stable. I can’t speak for the specific enzymes in NOW Superenzymes, but my understanding is that the enzymes used in digestive support formulas in general are specifically chosen for their ability to survive the stomach. Pancreatic enzyme supplements are typically used in a tablet designed to release into the small intestine.

Sarah – I want to tell you what a LEGEND you are! My deal is HS, MTHFR, Pyrrole, periodontal issues, hormones out of whack and a Blasto’ infection – and that’s what I know about! Your book arrived safely (in Australia) and – despite some serious reading over the past 18 months, has become my bible. Two weeks into AIP and going strong. It’s an interesting journey, this owning your health!

Thank you!

Thank you for your informative website and articles and recipes. My daughter is in the middle of this battle with a gastrointestinal problem her gastroenterologists cannot figure out. They have ruled out Crohn’s and Celiac and tumors, cancers, etc. So far they have only prescribed her hyoscyamine for stomach spasms (which she says slows her whole stomach system down too much.) They also recommended a specific probiotic which did not help. She attends Gettysburg college and we live in VT. Difficult to have her so far away but she is home on break and I have been feeding her according to Paleo. She seems to be doing pretty well this week, but it is difficult to know because she has no patience for talking about her condition very much. She is just way beyond sick and tired of it! Also, since an infant she has been lactose intolerant. It’s scary because she is down to about 95 lbs. and that doesn’t seem to concern her physicians. I assume that MD’s may think young women are just anorexic or bulimic. Or maybe gastroenterology is like psychology – there is not enough research/answers for the complexity.

This is a great post. After a few transition days, I started the strict AIP. Digestive issues flared up right away, so I came here looking for ideas. I was afraid that I’d have to eliminate even more foods, but no, all I needed was to try your trick of drinking lemon juice or apple cider vinegar 10-20 minutes before eating. A few days later, I am happy to report that all is well! I’ve also noticed improvement in how I’m feeling overall. I’ve long suspected food sensitivities and gave up many of the biggies long ago (gluten, processed food, etc.), but something still wasn’t “right”. Thank you for putting well-thought and well-researched information out there for us – I was at my wits end before reading your book/blog and buying Mickey Trescott’s book.

Hi Sarah. I have a question: I was diagnosed with GERD and told to take PPIs – terrible advice that I’ve steadfastly ignored. I also have Hashimoto’s and have (so far) been able to manage my condition reasonably well through diet alone. I have been gluten-, soy-, corn-, nightshade, and dairy-free for almost three years, and AIP-friendly for a month or so, while working my way through The Paleo Approach (thank you for an exceptionally well-written and well-researched resource). I am convinced of the gut-thyroid connection, and feel confident that the road to healing starts in my gut. But I’m confused…my only overt, digestion-related symptom is what I would call ‘burning stomach’ (no heartburn, but acid reflux and a narrowing of the esophagus due to scar tissue). I have been operating under the assumption that I have low stomach acid, but when I try things like taking raw apple cider vinegar (or lemon juice) in an ounce or so of water to dilute (as you’ve suggested above), the burning pain in my stomach is almost instantly severe…leading me to question whether high stomach acid could be the culprit. (I am also a single mother and full-time PhD student, so I know stress plays a role in this as well.) Any thoughts?

You might consider trying a stomach acid supplement to see how that affects you. It may simply be that lemon juice and ACV are not potent enough for you, or that you are sensitive to them. Of course, stress will throw all kinds of kinks in the works. – Christina, Sarah’s assistant

Sara, I’m devouring your book and love this post. So well written and lots of info in a short summary. I, like many have been chasing numerous digestive issues for a long time, many practitioners and a sugar free, paleo diet for 2 years now and I was getting worse. Unrelenting fatigue and Dr’s telling me I have Lyme- that all aside I’ve been doing lots of research and am finding that I really fell like the answer to my issue(s) is low (really low) stomach acid. I read your post about lemon water-which I’m religious about and AC vinegar. Which I’ve tired but not for long periods of time. Just this week I started taking 300+mg of HCI w/every meal. I read that you up the dose to 2 x /per meal until you get a warm feeling in your gut. I’m taking 800mg 2 x per day now ( wk 2) I’m finally for the first time in 3 yrs having normal bowel movements, no bloating, no gas, huge improvement in my energy.

Can you comment on this? taking HCI supplement vs. lemon water and or AC vinegar?

Also-relative to another post. I stopped drinking Kombucha 1 yr ago as I heard that the yeasts are unidentifiable-meaning each batch is a batch in it’s own and if you are fighting yeast ( which I am -based on a stool test) that Kombucha ( but not other fermented food) can make yeast/fungus worse.

your thoughts?

thank you,Caren

An HCl supplement does have more therapeautic “oomph” than lemon juice or ACV, so it is a better alternative for those that need a high dose. Sarah recommends a low-FODMAP approach for all cases of SIBO, in conjunction with whatever treatment your doctor prescribes. Food sources of probiotics are still good (kombucha, fermented veggies, water kefir and even coconut milk kefir for some people). – Christina, Sarah’s assistant

Excellent! Thank you. Yes, working on the specific clean eating daily-it’s a way of life for sure! thanks Christina ( and Sarah!)

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