TPV Episode 39 Show Notes: Gut Health

May 17, 2013 in Categories: , , by

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Our thirty-ninth show!
Ep. 39: Gut Health

In this episode, Stacy and Sarah discuss gut health, food allergies vs. intolerances, small intestinal bacterial overgrowth treatment, the various forms of elimination dieting to aid in gut recovery, and H. pylori.

On Sunday, May 12. The Paleo View launched their first ever bonus episode – The Mother’s Day show! Download the first bonus show by clicking here! And be on the lookout for our monthly, pay bonus podcast!

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The Paleo View (TPV), Episode 39: Gut Health

 

  • 0:00 – Introduction
  • 1:19 – News & Views
    • Coming off the Beyond Bacon chaos, Stacy returned to Crossfit and is overall working towards recovery from the stress load
    • Stacy had a great Mother’s Day, complete with Urban Poser’s Samoa Donuts – experienced a refreshing awareness where her sweet tooth was easily satisfied and she didn’t feel the need to go over board
    • Sarah had a great couple of days and is very close to being done with part two of the book and then she will work on the cookbook section, which she is really excited to shift gears to
    • The Paleo Approach is roughly 210,000 words right now, the book is an information dense book and people are getting a tremendous deal
    • Sarah has made the science in the book incredibly approachable, just like it is on her blog, and it is truly a complete guide
    • Part two of the book is all about the practical implementation – what lifestyle factors to focus on
    • The book is a beast, with the nickname the encyclopedia – Sarah feels like she is racing for the finish line, but feels like she is going to make it and is looking forward to her three days off before editing work comes
    • On Mother’s Day Sarah and her family hung out at home and played outside – it was a nice day
    • The special bonus episode went live on Mother’s Day (May 12) and is available on iTunes, but you have to look for it under a song and not a podcast

      • The Paleo View will be offered for free, but the The Paleo View Bonus Shows are offered at a minimal cost to recoup some of the costs that have gone into the show
      • It is $0.99 per episode on the CD Baby site, but we don’t know what iTunes will charge.
      • The show is an expanded ‘News and Views’ format of The Paleo View and is a personal, intimate discussion
      • Despite what Sarah and Stacy anticipated, we are experiencing technical difficulties getting iTunes set-up for the bonus show, please use CD Baby until we resolve these issues
    • Sarah hasn’t yet had a chance to listen to the Bonus Show because of book work
    • Stacy was kind of taken back by the level of intimacy that the discussion took, and feels like mothers and daughters will in particular take a lot away on relationship development
    • Stacy’s treadmill desk broke, so is now working from a standing desk
    • Sarah spends a decent amount of time standing at her treadmill desk, especially when reading fine print or after eating a meal – is overall feeling so much better sitting less
    • Stacy wants a standing desk for work, but is worried about being the weird one and how to handle the days where she doesn’t wear flats
    • Stacy tells the world to go check out whatshouldwecallpaleolife.tumblr.com – it is great when you need a laugh!
    • Reminder, please leave your reviews on both The Paleo View and Bonus Show on iTunes!
    • Welcome new listeners! Happy belated Mother’s Day!
    • Episode 38 is a science-y show about gut health, h pylori, small intestinal bacteria overgrowth, and gut repair
  • 24:53 – Science with Sarah: Why do people react more violently to a food after eliminating it? When you stop reacting to food, is that an indicator that your gut has healed?
    • In every gut there are cells that sample the environment inside the gut and present what they find to the immune system, essentially patrolling
    • If you have a leaky gut, a lot more of what is in the gut leaks out and is presented to the immune system
    • Food intolerances and food allergies are both different kinds of antibodies
    • The cells that produce these antibodies are part of the immune system and are there to develop immunity towards certain things
    • There are a number of cells in the immune system – protectors, therapists to calm, directors
    • When you get to the end of an infection it is the director cells that divide and conquer and makes sure that the immune system doesn’t attack the wrong things and that it deactivates once the threat is gone
    • With a food intolerance and food allergy, the middle management cells are directing antibodies
    • In a normal person you achieve immune tolerance towards the food, which is an equal balance between the middle management cells and the suppressing cells – thus having no symptoms
    • If you have a food allergy or intolerance the system is out of balance
    • When you start any elimination diet you can experience exaggerated responses to small exposures for a number of reasons
    • As your immune system regulates and your body heals, eventually you will end up at a point where both the cells that respond to food are at low levels
    • You could eventually reach the point where exposures to food intolerances will not cause dramatic responses – it is a sign that your system has regulated
    • How long it takes to get there is dependent on a number of factors, including genetics, stress level, sleep quality, nutrient density in diet, hormone regulation
    • During the Cavekids PaleoFX panel, Chris Kresser mentioned that health isn’t having a violent reaction to bad food, that is the process to healing – health is when your body knows how to recover from the exposure to bad food (The Paleo View episode where gut health recovery was discussed with Diane Sanfilippo)
    • Stacy notes that people on a paleo diet will heal their gut in time, that there is another side to the intense negative reactions to an exposure where you body will better handle the minor exposures
    • Thanks to Russ from The Domestic Man for chatting about this topic with Stacy, which sparked the suggestion for this podcast topic
  • 36:57 – Q&A
    • Brittany: Our current Functional Medicine Doctor thinks my family has SIBO (small intestinal bacterial overgrowth) and wants us on FODMAP free diet. With all our other food issues, I am concerned that we won’t get the nutrition needed, that my breastmilk will suffer along with my children’s sleep. What is the difference between FODMAPS, GAPS and SCD?
      • Stacy recommends that they look into a GAPS diet and a very structured approach to healing their gut
      • It can be difficult to put kids on a limited diet, but Stacy has seen and heard amazing success stories from people who take a serious approach to healing their gut
      • Sarah notes that GAPS and SCD are very similar
      • GAPS is more of an inclusive system and includes some detoxification elements
      • The general concept behind both GAPS and SCD is that you starve the bacteria in the gut
      • GAPS places an emphasis on gut healing foods, and both highlight digestive enzyme supplements
      • FODMAPS are fermentable sugars, and are sugars and fibers that are rich in fructose, but also includes sugar alcohols and long fiber chains rich in fructose – they are difficult for the body to digest and absorb, and ferment easy – making it easy for the bacteria to eat
      • These are known as the gassy foods, and in someone with FODMAP sensitivity this is called fructose malabsorption, which means your body is having a hard time digesting and absorbing these sugars so there is more to feed the bacteria
      • The autoimmune protocol combines some of those things, but focuses on the inclusion of foods that normalize gut bacteria
      • Omega 3 fatty acids and fiber are the two foods known to have the most profound impact on the composition of your gut
      • Even though there is a large amount of evidence, there are no scientific studies to back up the impact of a GAPS and SCD diet, the low FODMAP diet has a high amount of scientific research to back it up
      • One of the issues that people face when they adopt a GAPS or SCD diet is that eventually the low crab intake starves the overgrowth, but also starves the good bacteria and you need to introduce prebiotics
      • Which means eating more vegetables, starchy vegetables, fruit
      • Stacy notes that if you are new to a paleo diet, focus on cutting out the junk first, and as you get further into it find ways to maximize the nutrient density of the foods you eat and to ultimately improve your gut health
      • Sometimes you have to eat the things you eat because your body needs it (bone broth, organ meat, sardines, etc.)
      • No matter which of these paths you select, autoimmune, GAPS, SCD, etc. take the nutrient dense road and focus on the foods you can eat, not on the foods you can’t eat, and what lifestyle factors you can change to heal your body
    • (55:45) Heather: Looking for help on how to manage a severe case of small intestine bacterial overgrowth (SIBO).
      • Stacy notes that there is a time and a place for antibiotics, because sometimes food alone cannot solve problems
      • In this case, Stacy suggests probiotic foods to help with the re-balancing of her gut
      • Sarah suggests combining the antibiotics with a nutrient dense, gut friendly diet like what was outlined in question 1
      • There have been case reports of SIBO where doctors have combined two or three different kinds of antibiotics, or even pair with anti-fungals, to manage the bacteria
      • Here are other drugs that have shown effectiveness: rifaximin (brand name is Xifaxan), vancomycin, neomycin, tetracycline, metronidazole, levofloxacin and fluconazole
      • Clinical trials where they have combined antibiotic therapy with probiotics and/or prebiotics have shown even better outcomes
      • (Note, consult a doctor first) The common prebiotic typically used in these studies is VSL-3
      • (Note, consult a doctor first) There are also some good studies on treating with prescript assist, which is soil based organisms, but specifically with irritable bowel syndrome
      • (Note, consult a doctor first) There are also a variety of herbs that can be used as antimicrobials: monolaurin, cat’s claw, wormwood, goldenseal (caution: goldenseal stimulates immune system), pau d’arco, olive leaf extract, garlic, barberry, Oregon grape, oregano oil, extra virgin coconut oil, lactoferrin, DGL
      • A b-vitamin complex is a good idea
      • Digestive support supplements can also go a long way to help restore the gut
      • Turn to primaldocs.com and paleophysiciansnetwork.com
    • (1:08:51) Dana: When an infection is not active, should I still be treating it, beyond what I already do for leaky gut?
      • The standard treatment for h. pylori is the same as the base treatment for SIBO, including herbal supplements, under the supervision of a qualified professional
      • H. pylori is a gram negative bacteria that lives in the upper gastro track and is in 50% of the world’s population, prominent in developing countries
      • 80% of cases are asystematic
      • When they are systematic people experience chronic inflammation of the stomach and small intestine, which causes a lot of misleading symptoms
      • H. pylori causes ulcers, and increases your risk of stomach cancer
      • If you get H. pylori early in life it can protect you from immune related conditions, if you get it later in life it can cause immune related conditions
      • One of the best treatments is a nutrient rich diet – the AIP is a great place to start
      • Talk to your doctor about whether or not you need to treat it and what your options and preferences are
    • Don’t forget to check out the bonus show, leave reviews on iTunes, and we will be back next week!
  • 1:22:54 – Outro

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Comments

I love your podcast! I will be that person who listens to them all in the next month too! I do have a silly question. I picked up a bison knuckle at my farmers market, but I’m not sure if I need to cook it first then make broth? Since there appears to be meat on there.. or do you just throw it in the pot frozen? I am a complete noob with this.

What I do when I have meaty bones (but not meat that will be tender enough to eat I if just roast them), is put the whole thing in my pot. After 8-10 hours, when the meat has completely fallen off the bone, I remove the meat and put it in the fridge. I continue to boil the bones for another day. Then I chop the meat and add it back to the pot with some veggies to make a stew (depending in how much broth I have, I might use half the broth for stew and the other half for something else–and sometimes, I just eat the meat straight and use all of the broth for other things).

Sarah and Stacy – you mention some herbal supplements for managing SIBO (as well as antibiotics). Can I ask why the precaution on supplements that are also immune stimulating (e.g. goldenseal)? My ND had/has me on a SIBO treatment with a round of neomycin (already finished) with a combo of oregeno oil (adp) plus berberine complex (i.e. goldenseal). At this point, I honestly don’t think I had/have SIBO since I’ve finished the neomycin and have been on the “natural” microbials/anti-fungals and have noticed zero difference (I DO think I have leaky gut and dysbiosis, along with food intolerances!). I’m about half through a bottle of prescript assist and thinking of adding back in a bifido/acidoph probiotic blend. I’m still trying to figure out what’s causing the chronic constipation and massive hard, pregnant belly by the end of the day (the gas has actually gone away, due to eliminating eggs, which I think were the culprit). I’m basically doing trial and error with different supplements (I already use digestive enzymes) and dietary changes in an effort to heal and also figure out what’s causing the tummy troubles. Sorry for the long comment – any info on extra things to try would be great. Thanks!

I assume you’re paleo. If you aren’t completely dairy free and gluten free, that’s where I would start since both of those sensitivities commonly manifest as constipation.. Have you tried low FODMAP? The reason why I caution against immune stimulating herbs is because of the high co-occurrence rate of SIBO and immune-related disorders (asthma, allergies, autoimmune diseases). But, a qualified healthcare professional who knows you will be a better judge of whether something is right for you or not. That being said, if you don’t feel that it’s working, it might be worth a discussion with your ND. The other things that can correct gut dysbiosis more quickly is high omega-3 intake and eating lots of vegetables, and spacing out your meals (3 meals a day is fine, but it’s worth trying to give up snacking if you are). You might also try increasing your digestive enzyme dose or changing to another brand. Another thing that might be causing constipation are deficiencies in serotonin or melatonin (which eating more fish, organ meat, and glycine-rich foods like bone broth). It would be worth investigating magnesium supplements (the need for magnesium is higher when you are stressed, plus what isn’t absorbed by your body acts as a stool softener) and adding an ox bile supplement (if you aren’t digesting fats well, that could lead to constipation or diarrhea). I hope this helps!

Hi Sarah (I’ve left some comments on the AI protocol, SIBO and probiotics posts…). I’m not 100% paleo but am 100% gluten free and 99% dairy free (I do eat ghee from time to time and will occasionally experiment with small doses of dairy, typically yogurt, I also cheat from time to time with some chocolate candy at work which is like m&ms, but usually only if I’m feeling super low blood sugar and woozy). I’ve had chronic constipation for most of my adult life (we’re talking 10-15 years now) WAY before I ever went gluten or dairy free, which I started to experiment with 3-4 years ago. I’m 99% compliant with this way of eating (meaning a small small gluten cheat less than once per years and it’s typically by accident – AND I just get VERY horrible gas and bloating – the poo is never affected). Currently, the main grains in my diet are white rice, sun warrior rice protein powder (I know, not a real food but it’s good for my smoothies), and corn (tortilla chips are my biggest weakness but don’t “seem” to cause gas/bloating, that doesn’t mean I should be eating them…). I will also eat gluten free crackers when traveling/camping/hiking, etc and I just need some fuel and options are limited. I’ve tried cutting out the bulk of grains and use fruits like bananas and berries as carbs, as well as tons of carrots (cooked) and white potatoes, but found many paleo carbs – like sweet potatoes – give me massive bloating. I’m still experimenting with carbs but have some pretty huge hormonal imbalances (amenorrhea with no period for two years now) as well as low T3 and I will feel really weak/woozy by about hour 4 after not eating, so I’m trying to work on my carb/protein/fat in meals. I actually have been taking mag supplements for a while now and try different brands (I rotate between natural calm and mag glycinate pills), different doses, etc but the times I’m actually more “regular” I’m usually on vacation and taking NO supplements at all! The mag definitely helps me sleep but I also wake up every single night (and I mean EVERY night) to go pee. I can’t tell you the last time I actually slept through the night – years ago maybe? I also have been taking digestive enzymes for years (sometimes just HCL, sometimes a full spectrum blend, sometimes a combo of the two). I sip ACV in my water throughout the day, take l-glutamine in the am/pm on an empty tummy and feel like I have tried, and continue to try, EVERYTHING. I know certain foods trigger instant bloating/gas (sweet potatoes and high doses of sugary foods, and raw onions and garlic give me reflux – cooked seem to be fine though – although I still avoid them for the most part). I continue to just do trial and error with certain things. I more recently cut out eggs 100% to see if that made a difference, and while I still have constipation, my problems with gas pretty much vanished completely within a couple of weeks, so I’ve kept them out. Oh, I also have started eating liver regularly (I mix it with grass fed ground beef and cook up) and eat coconut oil every day like no one’s business! I definitely feel like I’m doing the right things, and making teeny tiny amounts of progress, but it’s still very frustrating when I already have such a limited diet (at least compared to everyone around me) and still have issues. Re FODMAP, I have not really tried 100% but I have cut way back on high FODMAP foods (I still eat them but just not in super large quantities and every single day). Basically, I now try to really make sure I rotate foods in my diets – fruits, veggies, nuts/seeds, meats, even grains (I don’t eat rice or corn every day) etc, – and have also cut out most processed foods (except, like I said if I’m traveling and it’s a matter of starving or eating something processed but still “safe”). I’ve even cut out gums and buy coconut milk without gums and no longer buy pre-made nut milk with carageenan. It should come as no surprise that I’ve seen countless doctors (even multiple NDs), some of whom have literally thrown their hands in the air with no answers and referred me elsewhere. I’ve also had food sensitivity testing done (YEARS ago before I ever ate gf) and also a comprehensive stool test (by my latest ND), so I am armed with some information, but I’ve also had a long history of very unhealthy vegetarians eating (from pre-adolescence to late 20′s), was an incredible sick baby with a horrible immune system and allergies (I was on massive doses of antibiotics and highly allergic to cow’s milk), all topped with a few years of disordered eating in my late 20′s for good measure (ironically, the DE was, in large part, a result of the sluggish system – I felt better in many ways by NOT eating at all vs eating and then feeling just bloated, gassy and terrible and never having a BM). Phew! Sorry – this is crazy long…I don’t expect full solutions, but I’m finding that the wealth of info on your site is really helpful and (I hope) moving me in the right direction! I appreciate all of your responses :)

Awesome podcast! I dealt with many digestive problems and, even as a registered dietitian, I had very limited knowledge in how to adapt my diet to control my GI symptoms and heal my gut. From all the information I gathered from my own experience and working with many clients, I just released a book called “Digestive Health with REAL Food”. It’s a Paleo-friendly book that should help anyone interested in gut health:http://bit.ly/14ox3wY. I love what you Stacy and Sarah, thanks for your work!

I would love to know more about this topic ” why we react violently to a food after eliminating it”. Do you have any good readings / articles to recommend Sarah ? Or anyone else? I love the podcast but I am a visual person so I always need to read to make sure I fully understand. I am sure your book will be awesome Sarah and I can t wait to buy it.

Well, I discuss it in my book. I’m not sure I’ve seen anyone else tackle the topic systematically and my information comes from a collection of scientific studies. :(

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