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TPV Episode 39 Show Notes: Gut Health

May 17, 2013 in Podcast, Show Notes

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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The Science and Art of Paleofying—Part 4 Sugars

December 8, 2012 in Baking Ingredients, Cooking Tips

Creating paleo adaptations of our favorite recipes (a.k.a. paleofying) helps us stay on board with paleo through the holidays (and many other times of the year), help us feel like we can still celebrate and partake in all of the fun and food luxury of the season.  I know that many of you are pulling out your old favorite recipes and wondering what to do with them (I’ve had many questions lately about rules of thumb for flour substitutions, and alternatives for those with nut or egg allergies).  I am too.  I have several family favorite recipes that I am tackling this year.

Paleofying is as much an art as it is a science.  I vaguely remember a time when I did not have extremely well-honed cooking instincts (I think that was back in middle school).  But even starting out as a fairly good cook, there was still a learning curve to all of these new ingredients and to baking without gluten.  After a year of paleo baking (and blogging!), I have a much better understanding of how to adapt conventional recipes now and thought it was high time I share some of this knowledge and experience with you, in addition to my perfected recipes.

This is the fourth in a 6-part post series to help you start the process of adapting your recipes (did I call this a 4-part series before?  Yes, I have realized I needed two extra parts and I reserve the right to expand this to a 7-part series if needed!).  In the first post, I discussed paleo flours and other ingredients that add bulk to a recipe.  In the second post, I discussed binders (ingredients that hold baking together).  In third post, I discussed leavening agents and fats.  In this part, I will discuss sugar.  Part 5 will discuss liquid ingredients and wet-to-dry ratios.  Part 6 will discuss some strategies for doing iterations and troubleshooting your recipes.  You may also be interested in some of my posts that reference paleo baking ingredients:  Important Pantry Items for The Paleo Baker, Paleo Flour Substitutes, Sugar vs. Sweeteners, and Is Sugar Paleo?).

I’ve written about sugar in a couple of posts (see Sugar vs. Sweeteners, and Is Sugar Paleo?).  I don’t want to get into the merit of different sugars in terms of health in this post, partly because I’ve already covered that and partly because this isn’t about which sugar is less bad for you.  We’ve already agreed that we are making a special treat, which means we’ve already decided a little sugar is okay.  This post is just about the chemistry of different sweeteners in your recipes.

Granulated sugar:

Most of the recipes you will be adapting will call for granulated sugar, typically white, light brown or dark brown.  It would be a completely valid choice to just use refined sugar in your recipe (see Is Sugar Paleo?), but really, I know that most of us feel better if we can use healthier options.  So, if your recipe calls for white sugar, the best substitute is Sucanat (also called Evaporated Cane Juice).  This will have a bit of a molasses flavor to it, which you may or may not like in your baking (and depending on what other flavors you have going on, you might not even notice).  Sucanat can be fairly large granules so you might want to pulse a few times in a food processor to replace white sugar in terms of texture too.

Dark Brown sugar can best be replaced by Muscovado Sugar (a.k.a. Barbados Sugar).  This is a rich, dark brown, very molassesy moist sugar that behaves just like dark brown sugar in a recipe (but is unrefined).  I love this stuff.  Light brown sugar is also better replaced by muscovado sugar because of the moisture that it has compared to sucanat, however the molasses flavor is stronger.  You could also replace light brown sugar with sucanat. and a little honey or molasses to replicate the moisture of light brown sugar.  The general rule of thumb is to replace 1 cup of brown sugar with 1 cup of white sugar (or sucanat in this case) + 1 ½ Tbsp molasses (or honey).

The other granulated sugar options that I like in terms of health are is date sugar and maple sugar.  Date sugar can replace either white or brown sugar in your recipe (although again, you may want to add a little molasses or honey for moisture).  Maple sugar has a very strong maple syrup flavor, which may or may not be desired.  No, I don’t like powdered sugar alcohols, stevia, or coconut/palm sugar.  I don’t like palm sugar (a.k.a. coconut sugar) because it is very high in inulin fiber, which is a FODMAP and is not easily digestible by most people.  I don’t like stevia because it has a hormone structure and the longterm effects of regular consumption have not been studied.  I don’t like sugar alcohols because they are gut irritants (with the possible exception of erythritol, but I’m not comfortable enough with its benign-ness to actually recommend it).  Just stick with glucose/sucrose (your body knows what to do with it) and don’t eat too much.

Generally, 1 cup of granulated sugar equals 1 cup packed brown sugar or 1 cup of super-fine sugar.  Really, you can replace granulated sugar cup for cup with any other form of granulated sugar.

One of the biggest things that you will probably consider doing with your recipes is decreasing the overall sugar content.  I typically use as little as a quarter the sugar called for in the original recipe when I’m paleofying.  In this case, it helps to know if sugar is a dry ingredient or a wet ingredient so you can figure out what other adjustments need to be made.  Even though granulated sugar feels dry, it’s really a wet ingredient (although, when it’s creamed with butter, it also adds to the lightness of a recipe and in that respect behaves a little more like a dry ingredient).  It doesn’t contribute that much moisture though, so I’ve been relatively successful drastically reducing the amount of granulated sugar in a recipe without any other adjustments.  However, if you choose to replace sugar with honey, molasses, dried fruit, applesauce etc., you will almost always have to adjust the wet and dry ingredients accordingly.

Liquid sugar:

If a recipe calls for molasses, honey, or maple syrup, then you’re in luck.  If you want to use less that your recipe calls for though, you will have to adjust your wet and dry ingredients, either by adding to your wet ingredients or by reducing your dry ingredients.

If a recipe calls for corn syrup, honey makes a pretty good substitute most of the time.  It doesn’t have quite the thickness or the ability to form long strings (unless you’re making a candy and then it works very well).  You can also replace each 1 cup of corn syrup with 1 cup granulated sugar (like sucanat) plus 1/4 cup whatever liquid is used in the recipe (water, coconut milk, etc.).

If you want to replace granulated sugar with a liquid sugar, then typically adjusting the wet and dry ingredients is necessary.  The exception is if you plan to replace some or all of the flour in a recipe with coconut flour.  In that case, replacing sugar with honey or molasses can actually really help a coconut flour based recipe hold together since coconut flour is such a thirsty flour (it absorbs water like crazy!).

When can you replace granulated sugar with liquid sugar?  This is tricky to do in cookies, but it is possible (see my Orange-Strawberry (Nut-Free) Cut-Out Cookies and Chocolate Cut-Out Cookies (Nut-Free)).  It’s much easier to do with cake and muffin recipes where there’s naturally more wet ingredients.

If you are trying to figure out sweetness levels to gauge how much honey or maple syrup to add, here’s a general guide (this is by sweetness):

3/4 cup sugar = 1 cup unsulphured molasses.
Also, decrease the liquid by 1/4 cup for each cup of molasses, omit any baking powder and add 1/2 teaspoon baking soda instead.

1 1/4 cups sugar = 1 cup honey or maple syrup.  Also, decrease liquid by 1/3 cup.

No, I don’t like agave nectar because it is high in fructose (what’s the point in avoiding high fructose corn syrup if we’re just going to eat agave?).  It might be important to mention that some honey can be high in fructose too.  If you have a FODMAP sensitivity and honey is a problem, there’s a huge variability in the fructose content from batch to batch and brand to brand, so simply trying another brand may be better tolerated.  Honey also has the highest quantity of monosaccharaides, so often those with SIBO can tolerate honey but no other sugars.

Some flavor tips:  I like the combination of maple syrup and honey to provide a more neutral flavor (neither the honey nor the maple syrup overwhelms) such as in my Best Paleo Pumpkin Pie recipe.  Molasses pairs very beautifully with chocolate and coffee flavors and can actually trick the palate into thinking a chocolate flavor is stronger.

Icing/Confectioners sugar:

Icing sugar (a.k.a. confectioners’ sugar) contains corn starch and is not paleo.  You can make a very fine powder by wizzing sucanat in your food processor or blender for a minute (careful when you take off the lid because it does that same powder in the air thing that icing sugar does).  If you need the drying effects of the corn starch in icing sugar (which you may if you’re making a frosting or icing to pipe onto cookies), try adding some arrowroot powder, perhaps as little as 1-2 Tbsp per cup of sugar.  As a general place to start, replace

1 ¾ cups icing sugar = 1 cup ground granulated sugar + ¾ cups arrowroot powder.

Other Ways to Get Sweetness into Your Baking:

Depending on how long you’ve been paleo (and exactly what version of paleo you follow), your sweet tooth will have adapted quite dramatically.  You might even find that your baking is sweet enough with the inclusion of some fruit ingredients and that you don’t need sugar or honey at all.  Here are some other ingredients that add sweetness to baking.

Fresh or Stewed Pureed Fruit—This is anything like mashed banana, applesauce, pearsauce, reconstituted dates, etc.  You might be using this as a binder, but remember that is also adds sweetness to your recipe.

Dried Fruit—dates are magical, but they aren’t the only dried fruit around.  Raisins, dried cranberries (typically sweetened), dried apricots, dried papaya, dried pineapple, dried blueberries, dried strawberries, dried cherries, dried figs and dates all add sweetness and a lovely chew to a recipe.  If a recipe calls for raisins, try replacing with a mix of dried fruit for a different flavor.  Blended, these dried fruit can also help bind a recipe.

Chocolate—unless you are using 100% cocoa dark/baking chocolate or cocoa powder, you are adding sugar to your recipe.  I have had great success with some recipes using only semisweet chocolate as a sweetener (see my Decadent Double Chocolate Cookies (Nut-free, Coconut-free, Egg-free) and Chocolate Cupcakes with Ganache Frosting (nut-free) recipes).

A note on candy making:  it’s very challenging to reduce the amount of sugar when making confections because heating the sugar and making long strings of sugar molecules is the whole reason why you can achieve the desired result (whether a chewy toffee or crunchy brittle).  While changing the total amount of sugar doesn’t typically work, you can often change the type of sugar (replace granulated sugar and water with honey for example).  You can also reduce the total sweetness with other tricks, like adding more nuts to a brittle.

I hope this will get you started on your paleofying adventures.  As you play more and more with these ingredients and get to understand their properties better, it will be easier to intuit what will work in any particular recipe.  But, I still have recipes that take me many iterations to get right.  And of course, if you adapt a recipe that is absolutely awesome, you are welcome to e-mail it to me to share on the blog:  thepaleomommy@gmail.com

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Guest Post by Dr. Kellie Ferguson: Naturopathic Medicine for Autoimmune Disease

July 14, 2012 in Alternative Therapies

Allow me to introduce Dr. Kellie Ferguson, N.D., a Naturopathic Physician in British Columbia, Canada.  Kellie is actually a very old friend of mine–we went to high school together!  But don’t worry; neither one of us remembers high school so no embarrassing stories can be told.  I asked Kellie to give a quick overview of Naturopathic Medicine and how it relates to autoimmune conditions and how she’d approach their treatment.  Also, you can read more about Kellie’s practice at her website www.koruhealth.com and her blog www.koruhealth.blogspot.ca. 

 For those that may not know Naturopathic Medical trainingis very comprehensive and similar to conventional Medical training.  Licensed Naturopathic physicians must complete a 4 yr undergraduate degree as well as a 4 year Naturopathic Medical postgraduate degree from a regulated and fully accredited school.  That degree includes classroom and clinical rotations and is followed by North American licensing exams.  There are two big differences between conventional and Naturopathic medicine:  our primary treatment therapies use botanical medicine, diet and nutrient therapies, counselling and homeopathy and using pharmaceutical medicine only if absolutely necessary.   Conventional medicine also focuses is on the diagnosis of disease then using the pharmaceutical or surgical treatments indicated for that disease.  In Naturopathic Medicine, the goal is to treat the underlying cause and triggering factors affecting that disease process and optimizing overall health and normal body functioning.   It is very important to note that Naturopathic Physicians are not licensed in all Provinces and States, therefore in many places there is no regulation on who can call themselves a Naturopathic Doctor.  To make sure you find a practitioner with the appropriate training and who has passed all the regulatory exams have a look at these two websites: CAND for Canada and AANPfor Naturopathic Physicians in the US.

So let’s start with the basics of how an autoimmune process does its thing.  Basically, the immune system is triggered (sometimes by a virus, sometimes by bacteria or foods in the gut) and that starts things going.  This pathway triggers inflammation and causes the immune system to be on high alert to the original trigger.  Unfortunately, in an autoimmune process the immune system confuses (cross-reacts) our own body tissues with the original trigger.  So when these immune cells come in contact with those normal tissues it attacks and reinitiates the inflammation turning it into a bit of a runaway train.  Conventional treatment is to suppress the immune system trying to tamp down the reaction.  This is usually effective but just manages the symptoms.  The Naturopathic approach is to find and eliminate the original trigger and help the body to restore appropriate control of the immune system.  Sometimes both approaches are needed, especially initially if the system is pretty aggravated, but in the long run people tend to get much better success with addressing the underlying issue rather than just suppressing  symptoms.

In Sarah’s post about the Autoimmune Protocol she talks about the importance of addressing the gut.  While it may sound so strange to address the belly when we’re talking about eczema or rheumatoid arthritis, the gut plays an enormous role in managing the immune system.  There are huge patches of immune cells lining the gut protecting us from bacteria or parasites in our foods.  The healthy bacteria (or probiotics) living within the gut act as schooling grounds, training our body to be less allergic by triggering for different chemicals to be released.  You can imagine that if there are any food sensitivities or unhealthy bacteria or fungi present, then all that immune tissue is going to react and cause inflammation and lots of potential for cross reactions.   If you don’t have enough good healthy bacteria (normal flora), then they won’t be able to help the immune system to regulate itself.  If the gut becomes damaged enough (because of ongoing food sensitivities or some medications) then it allows undigested proteins to get into the body whole, which increases the potential for food sensitivities and cross reactions to occur. 

As I mentioned above, the first step to modulating the immune system is to find and address the gut immune triggers, whether they are food sensitivities or abnormal flora.  Sarah’s asked me to do another post later to discuss food sensitivity testing so check back later for that.  Once they are identified, we can limit or avoid those foods to allow the immune system to settle down.  Occasionally, we need to look at testing to identify if there are any harmful bacteria or fungi present and we can address those with diet (Paleo and SCD are ideal) and often with herbal or prescription antibacterials/antifungals.  Probiotics serve double duty by preventing harmful bacteria and fungi from taking up residence in the gut and also by stimulating normal immune regulation by releasing regulatory chemicals called cytokines.   It’s always wise to research probiotics or consult a Naturopath first as there are lots available over the counter but purity, potency and freshness are significant issues.

Even once the triggers have been identified and eliminated, many people need to heal their gut in order to prevent new food sensitivities from developing.  There are lots of protocols for doing this and the SCD or Specific Carbohydrate Diet was specifically designed to do this.  I often do a multi-step process with probiotics, digestive enzymes, fiber, omega 3 fatty acids and a product for intestinal healing.  This can be accomplished with diet rather than supplementation by increasing bone broths, coconut oils, cabbage and fiber, lots of fish and nuts and seeds.  But I have occasionally found that the gut is too compromised at the outset to be able to properly digest these foods without supplemental support.

The last step is to directly affect the immune system.  A word of caution:  This is too tricky to do without discussing with a qualified practitioner (I’d recommend a licensed Naturopathic physician) that is knowledgeable about herbal medicine and their interactions with medications.  There are many herbs that modulate the immune system, that is to say help boost it when it’s underfunctional and help to control it if it’s too active, but obviously there is lots to consider before starting any of these.  Some include: Echinacea species, Rehmannia, Albezia, Nettles and Quercitin.  Do not add any of these herbs (no not even Echinacea!) if you have an active autoimmune process without first discussing it with a licensed Naturopathic Physician.

I hope this has been a helpful primer on autoimmune support and keep an eye out here for more information on food sensitivity testing. If you have any questions or comments please feel free to email or post via my blog, where you can also find more tips about current news topics, allergies, Autism and other Naturopathic topics.

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Modifying Paleo for Small Intestinal Bacterial Overgrowth

July 3, 2012 in FAQ, Gut Health, Paleo Modifications

Small Intestinal Bacterial Overgrowth (or SIBO) is a chronic bacterial (and/or yeast) infection of the small intestine, characterized by excessive number and/or abnormal type of bacteria (and yeast) growing in a part of the gastrointestinal tract that normal contains relatively few microorganisms.  These bacteria can cause a variety of problems by interfering with digestion and absorption of nutrients and by damaging the lining of the gut, causing a “leaky gut” (I addressed the many health problems that can arise from a leaky gut in this post). 

The most common symptoms of bacterial overgrowth include abdominal pain, nausea, bloating, gas, belching, flatulence, chronic diarrhea, and chronic constipation.  These symptoms are due to the large volume of bacteria the digestive tract (alive and dead, as they read the end of their lifecycle) and the large amount of gas and metabolic waste that they produce.  Many more symptoms of SIBO are a direct effect of nutrient malabsorption.  This arises either from the bacteria metabolizing those nutrients before we can absorb them or by the bacteria causing enough inflammation in the lining of the gut that it the gut can’t work properly anymore.   For example, the bacteria preferentially consume iron and vitamin B12, causing anemia.  The bacteria decrease fat absorption by deconjugating bile leading to deficiencies of vitamins A & D and causing steatorrhea (fatty stools).  As the gut lining becomes increasingly inflamed and leaky, larger and not fully digested food particles enter the body, causing an immune reaction which leads to food allergies and food sensitivities.  Bacteria themselves can enter the blood stream causing systemic inflammation and immune reactions that can lead to autoantibody formation and autoimmune diseases (for a comprehensive review article see the footnote). 

SIBO was only described in the late 1990s and is still grossly underdiagnosed. This is partly because many patients don’t seek medical attention for their SIBO symptoms, because many doctors aren’t aware of its prevalence and don’t consider it in their differential diagnostics, and because the tests for SIBO still have fairly high false negative rates (where you have the disease but the test says you don’t).  As SIBO becomes more recognized, it is also becoming inextricably linked with many other diseases.  Many physicians and scientists now believe that Irritable Bowel Syndrome (the cause of which has never been properly defined) is actually a group of symptoms caused by SIBO (see the book The New IBS Solution).  SIBO is also often associated with Crohn’s disease, Celiac disease, short bowel disease, various liver diseases, fibromyalgia, some autoimmune diseases (such as scleroderma, diabetes, lymphoma, and chronic lymphocytic leukemia and the aforementioned Crohn’s disease and Celiac Disease) and even rosacea (for a fantastic summary of confirmed related diseases, see http://www.siboinfo.com/associated-diseases.html).  Whether SIBO is a causal factor or a symptom of these diseases remains to be determined.  Given how new all of this science is (and how prevalent SIBO actually is!), I suspect that over the next few years many more health conditions will linked with SIBO.

How do you know if you have SIBO?  If you have digestive symptoms, especially if they persist after adopting a strict paleo diet, SIBO is a possibility.  You can opt to get tested (there are several different test options which can be ordered by your primary care physician), however know that the current testing methods are not 100% reliable.  One of the easiest ways to determine whether you have SIBO is to see if diet modifications aimed at treating it make you feel better. 

How can you fix SIBO?  There are two diets (very similar to each other) that have been developed with the intention of starving the bacteria in the small intestine and healing the damaged lining of the gut.  These are the GAPS (Gut and Psychology Syndrome) diet(see Gut and Psychology Syndrome) and the SCD (SpecificCarbohydrate Diet) diet (see Breaking the Vicious Cycle).  The general approach to these diets is to eliminate any dietary sugars that are not monosaccharides.  Monosaccharides are simple sugars like glucose and fructose and are the most easily absorbed in the digestive tract.  More complex sugar molecules like sucrose (i.e., table sugar which is a disaccharide) and starches have to be broken down into monosaccharides before they can be absorbed.  This means that the sugar takes longer to be digested, which means it travels farther down the digestive tract before being completely absorbed, which means that some of it reaches the abnormal bacteria growing in the small intestine and provides a food source for them.  These diets also focus on consuming healing foods such as bone broth, conjugated linoleic acid found in the fats from grass-fed animals, and coconut oil.  I recommend combining one of these diets with a paleo diet for the most rapid and effective reversal of SIBO.

A standard paleo diet is typically not enough to treat and reverse SIBO.  Attention also needs to be paid to the amount and types of carbohydrates being consumed.  I recommend following a paleo diet with modifications disallowing starchy vegetables and high sugar foods as per the SCD and GAPS diets (see my post Fruits and Starchy Vegetables with SmallIntestinal Bacterial Overgrowth).  Many people may find taking Apple Cider Vinegar before meals (as outlined in TheStomach Acid Connection) is helpful.  For more severe cases digestive supplements may be beneficial (I am not familiar enough with these to recommend a particular brand, type or dose.  Recommendations can be found in The Paleo Solution, It Starts With Food, and this post from Chris Kresser.  If you need personalized recommendations, I suggest contacting Diane Sanfilippo at www.balancedbites.com).  You may also find some good information in my posts Repairing the Gut and What Should You Eat to Heal a Leaky Gut?  I also want to mention that stress management is very important (see my post How Mood and Gut Health Are Linked).  Homemade bone broth and a source of Vitamin D(sunshine, liver, supplement) are particularly important to promote healing.  A source of diverse probiotics (from fermented foods like Sauerkraut,coconut milk kefir, or Kombucha and/or from a high quality supplement) help to restore normal gut microflora (it’s better to keep the dose of these beneficial bacteria on the low side, at least at first, since they can add to the high volume of bacteria and increase symptoms if you’re too aggressive).  In extreme cases, a doctor may recommend a course of potent antibiotics followed by a gut-healing protocol (exactly what is outlined above) and probiotics.  For those with symptoms indicating the early phases of autoimmune conditions (see my post You May Have an Autoimmune Disease But Don’t Know It), following the Autoimmune Protocol for the first 1-3 months may be very beneficial.

Correcting SIBO can take up to 2 years.  However, you should see improvement in your symptoms fairly quickly with gradual and continuous improvement (if you don’t, it’s worthwhile considering a FODMAP sensitivity as a confounding factor, which I will be discussing in my an upcoming post).  Stress, poor sleep, infections and poor diet choices can all create setbacks.  It is always difficult to commit to more restrictive forms of a paleo diet (which can be tough enough as it is!).  I have what I believe is a mild case of SIBO.  Because I follow the Autoimmune Protocol, I rarely have issues now.  However if I slip and eat a high carbohydrate food, I fairly rapidly suffer intense bloating followed by days of gas pains and constipation.  It’s not fun to follow such a restrictive diet, but is it worth it!

Bures J. et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010 June 28; 16(24): 2978–2990.

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