Up to 1/3 of people with suspected IBS actually have fructose intolerance

Up to 20% of people in the US have IBS. But with appropriate workup, about 1/3 have been reported to actually have fructose intolerance. Fructose is a sugar that can cause a lot of digestive problems. It is a monosaccharide carbohydrate that is NOT easily absorbed in the gut.  This intolerance leads to abdominal pain, bloating, gas, flatulence, distension, nausea and diarrhea. Sounds like symptoms that may mimic many other diseases, like IBS, SIBO etc, right? Well that’s why many of these patients undergo a whole slew of tests like endoscopy, CT scans, blood and stool tests and when these tests come back negative, then they often mislabeled as functional dyspepsia or bloating or irritable bowel syndrome (IBS) and sent on their way. Infrequently do doctors actually think of fructose malabsorption. 

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  Choi et al. AJG 2003

Choi et al. AJG 2003

Absorption of fructose is an active, energy dependent process and therefore our bodies are limited in digesting and absorbing it. Malabsorption means the fructose stays in the gut lumen and generates an osmotic force which moves water into the lumen to help move the fructose down to the colon, where it is fermented by bacteria, making a whole lot of gas. This gas and excess fermentation leads to abdominal pain, excessive gas and bloating... especially in patients with visceral hypersensitivity.

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     Ebert et al. Molecular and Cellular Pediatrics 2016

Ebert et al. Molecular and Cellular Pediatrics 2016

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Why is this so important to discuss? Because fructose is hiding in so many foods. It is naturally present in a variety of foods but also produced enzymatically from corn as high fructose corn syrup (HFCS), commonly found in things like soda and snuck into all sorts of foods. According to the USDA, HFCS consumption has increased for more than 1000% in the past and this rise in fructose consumption may have resulted in a rise in fructose malabsorption

 

So do YOU have fructose malabsorption? To diagnose this condition, you can either take a fructose breath test for a formal diagnosis or just commit to a trial of fructose dietary elimination and see how you feel!

 

The FRUCTOSE elimination diet:

Examples of high fructose corn syrup (HFCS)-containing foods

Examples of high fructose corn syrup (HFCS)-containing foods

1. First and foremost: Ditch ANY product with high fructose corn syrup

- Sauces & condiments like BBQ sauces, Heinz® Ketchup, jams/jellies, salad dressings

- Flavored dairy: chocolate milks, ice cream, yogurts, coffee creamer

- Sweetened juice, energy/sports drinks, soda

- Baked goods & snacks: breads, cake, donuts, granola bars, breakfast cereal, cereal bars, chips, cookies, crackers, nutrition bars

- Frozen food (TV dinners, pizzas)

2. Read the label! "fructose" or "crystalline fructose" finds its way into tons of foods.

3. Avoid sweeteners! It may sound tough but once your palate gets used to unsweetened food, you won't miss it! AND you'll shed a ton of weight.

  • Honey
  • Agave syrup
  • Invert sugar
  • Maple-flavored syrup
  • Molasses
  • Palm or coconut sugar
  • Sorghum

#feedyourgut #eatrealfood #gutlove

 

 

IBS: A real disease with real treatment options

Screen Shot 2017-04-02 at 4.24.46 PM.png

Irritable bowel syndrome is a real disease. Too often I’ve had patients tell me they had debilitating abdominal pain with a change in bowel habits, had a couple tests done, and then were dismissed by their doctor since no obvious source was found. Don't let that happen to you!  IBS is a complex, multifactorial disorder that confuses people and doctors.. Factors that increase the risk of developing IBS include genetic, environmental, and psychosocial factors. Factors that trigger the onset or exacerbation of IBS include a previous GI infection, food intolerances, chronic stress, diverticulitis, and surgery. This results in altered GI motility, increased response in your gut to pain, increased intestinal permeability, immune activation, altered microbiome and disturbances in brain gut function.

Here is what needs to happen in the workup and management of IBS:

1. Make sure it is IBS and not anything else

First, go see your doctor and don't try to manage this on your own. You need to make sure that there is no other disease contributing to abdominal pain and altered bowel habits such as Inflammatory Bowel Disease (Crohn's disease; ulcerative colitis), Celiac disease, lactose and fructose intolerance, and microscopic colitis to name a few. You will need a GI doc to evaluate the need for an endoscopy/colonoscopy.

Once other diseases are ruled out, then IBS is made by fulfilling the following: IBS is an functional bowel disorder with recurrent abdominal pain at least 1 day per week in the last 3 months associated with 2 or more of the following criteria:

1. Related to bowel habits (constipation, diarrhea or both)

2. Associated with a change in stool frequency

3. Associated with a change in stool form/appearance (Bristol stool scale)

 

2. Determine the types of IBS you have

The Bristol Stool Form Scale. Type 1 &2 = slow transit, constipation. Type 6&7= fast transit, diarrhea      Adapted from Lacy et al. Gastro 2016

The Bristol Stool Form Scale. Type 1 &2 = slow transit, constipation. Type 6&7= fast transit, diarrhea

Adapted from Lacy et al. Gastro 2016

IBS-C: mostly constipation: > 25% bowel movements are Bristol types 1 or 2 and < 25% are Bristol types 6 or 7.

IBS-D: mostly diarrhea: > 25% bowel movements are Bristol types 6 or 7 and <25% bowel movements are Bristol types 1 or 2.

IBS-M: mixed bowel habits: > 25% bowel movements are Bristol types 1 or 2 and > 25% bowel movements are Bristol types 6 or 7

IBS-U: unclassified: if you meet diagnostic criteria for IBS but cant categorize your bowel habits into 1 of the 3 groups

 

3. Treatment for all types of IBS

- increase exercise!

- reduce stress! Cognitive behavioral therapy, hypnosis, and various relaxation methods reduce muscle tension and autonomic arousal that are involved in IBS symptoms

- improve your sleep habits

- increase/supplement dietary fiber (specifically SOLUBLE fiber)

- DIET! eat a low gluten, low FODMAP diet (FODMAPS are highly fermented, gas-producing foods) see the #feedyourgutdiet page! 

 

4. Specific treatment for IBS subtypes

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Many patients don’t like the idea of starting an antidepressant for IBS and believe that they are getting labeled as having a psychologic issue instead. The truth is, antidepressants are extremely effective medications for chronic abdominal pain in IBS. Although antidepressants were developed for depression, at lower doses they were found to be great pain relievers (also used in migraines, neuropathy, fibromyalgia). They work at the level of the brain and spinal cord to block pain messages between the GI tract and the brain, thereby reducing visceral hypersensitivity and normalizing the brain-gut function.

The jury is still out on probiotics, folks.

#gutlove: Feed it, clean it, inspect it, respect it.

ACID REFLUX or GERD: what is it and how to avoid taking meds!

Lifestyle changes. I’m sure you’ve heard your doctor suggest lifestyle changes if you’ve spoken to them about acid reflux. But what exactly does that mean?? Everyone may know not to lay down right after eating as you could just imagine the acid and partially digested food forcing its way past your lower esophageal sphincter (LES), irritating your esophagus, and sometimes even ending up in your mouth! No the best feeling. So many people medicate with anti-acid medications like Nexium. But now we’re learning that staying on these medications long term is not good and associated with increased risk of infections like C. difficile diarrhea, malabsorption of key nutrients and minerals like magnesium, possible increased risk of fractures and even dementia and kidney disease. So lets try to avoid them!

Lets start with the basics:

What is GERD?

Gastroesophageal reflux disease (GERD) is movement of gastric juice from the stomach up into the esophagus. There is an antireflux barrier which is made up of the LES and diaghragm at the gastro-esophageal junction to prevent this from happening but it can be compromised in the following ways:

  1. Occasional relaxation of the LES
  2. Anatomic disruption like a hiatal hernia
  3. Obesity
  4. Pregnancy hormone changes
  5. Low pressure of the LES       
  • This includes strain-induced reflux when the LES is overcome and "blown open" by an abrupt increase of intra-abdominal pressure, i.e. lying down after eating
  • Tobacco, chocolate, carbonated beverages, and right lateral decubitus position directly lower LES pressure 

What are the symptoms?

10-20% of the Western world have GERD so know what to look out for! Heartburn, regurgitation, chest pain, trouble swallowing, chronic cough, asthma, laryngitis, sometimes abdominal pain, nausea, vomiting, bloating and belching…even waking up during the night gasping for air and having a choking sensation!

How do I get diagnosed?

See your doctor to make sure it actually IS GERD!  Be sure to bring a food/drink diary to see how your symptoms correlate with mealtimes and certain foods. Your doc may recommend lifestyle changes and/or try you on an acid suppressant and see how you respond and if you respond well, its clear. If not- you may need an endoscopy, esophageal pH monitoring or other testing.

Now to those LIFESTYLE CHANGES!

1.     WEIGHT LOSS! WEIGHT LOSS! WEIGHT LOSS! Probably your MOST EFFECTIVE option. Extra weight increases intraabdominal pressure so that gastric contents break past the LES and into the esophagus. Bariatric treatment like surgical gastric bypass has been demonstrated to be effective in reducing GERD. Losing ~ 10–15lbs decreases the occurrence of frequent heartburn by approximately 40%.

2.     STOP TOBACCO AND ALCOHOL. They loosen tension of the upper esophageal sphincter and cause hoarseness, postnasal drip and shortness of breath by irritating the mouth, larynx and trachea

3.     ELEVATE THE HEAD OF THE BED 6-8in- especially if you have nocturnal or laryngeal symptoms (cough, hoarseness, throat clearing). Use blocks or foam wedges under your mattress.

4.     FOOD RULES:

  • DO NOT LAY DOWN OR EXERCISE UNTIL 3 HOURS AFTER A MEAL
  • NO LATE NIGHT MEALS: Eat at least 3 hours before you go to bed
  • NO SUPERSIZED MEALS: Try eating 5-6 small meals a day instead of 3 big ones!
  • NO FAKE FOOD! Many commercially produced foods and drinks are treated with acid-containing substances to enhance flavor and shelf life (see the #feedyourgut tab!!!)
  • AVOID TRIGGER FOODS! The usual culprits are: caffeine, coffee, chocolate, spicy foods, carbonated drinks, raw onion, garlic highly acidic foods such as citrus/oranges and tomatoes, peppermint, and fatty foods (they take the longest to digest).
  •   EAT HIGH FIBER FOOD- Fiber enhances digestion, reducing pressure on the LES and can aid in weight loss. (see the #feedyourgut tab!!!)

If you DO need a Rx don’t forget there are plenty to chose from!

1.     Antacid (Tums)

  •  For on-demand symptom relief
  • Onset of action: 5 minutes
  • How do they work? Neutralize gastric pH, decreasing exposure of esophageal mucosa to gastric acid during reflux.

2.     Surface agent (sucralfate/Carafate)

  • Onset of action: 1-2hrs
  • How do they work? Adheres to mucosal surface, promotes healing, and protects from peptic injury
  • Short duration of action & limited efficacy
  • Safe to use so usually used in pregnancy
Screen Shot 2017-03-26 at 2.03.23 PM.png

3.     Alginate (Gaviscon)

  • Onset of action: 3-4min
  •  How do they work? It’s a polysaccharide derived from seaweed that forms a viscous gum that floats within the stomach and reduces the aftereating acid pocket in proximal stomach. Good for mild reflux.

4.     Histamine 2 receptor blockers (famotidine /Pepcid)

  • Onset of action: 2.5hrs
  • Usually only work up to 6 weeks
  • How do they work? Block acid secretion by blocking H2 receptors on the parietal cell

5.     Proton pump inhibitors (esomeprazole/Nexium)

  • Onset of action: 1-2 hrs
  • How does it work? Blocks gastric acid secretion by inhibition of the H+/K+-ATPase in the parietal cell
  • Its the STRONGEST anti acid medication but with the most side effects.
  • Usually only used when the above options fail. Take it at the lowest dose available for the shortest time available and make sure to take it correctly—on an empty stomach 30min before breakfast!

Why are we talking about this? Because chronic acid reflux leads to Barrett’s esophagus which puts you at higher risk for esophageal cancer. So manage your GERD early to prevent cancer later!

The resources referenced above:

ACG GERD guidelines

AGA GERD guidelines

NYTimes

Uptodate.com

Gastroenterology & Hepatology: Advances in GERD

 

Spring cleaning… for your gut! Take a 2 week breather from sugar, dairy, meat & processed foods but do NOT juice or take a multivitamin

It’s the first day of spring and I am seriously ready to come out of hibernation. I don’t know about you, but particularly the last weeks of winter are tough and I am often blowing off my diet or exercise routine, feeling like.. I deserve it! It’s awful outside! Well now we can all breathe a sigh of relief. Spring is here and sunshine is just around the corner. And what better way to greet the good weather than cleaning out your gut!

I’m only asking for 2 week. I think you’ll be hooked and keep at it but at LEAST give it 2 weeks to flush you out. Follow this high-fiber, microbiome-diversifying, poop-perfecting, cancer-preventing, low-FODMAP food lifestyle to keep your gut happy & healthy for life!

 

What do you do?

Follow the #feedyourgut diet plan for 2 weeks.

In a nutshell- cut out sugar, dairy, meat, and processed foods and BULK UP on fiber!

Check out the philosophy here: https://www.gutlove.com/the-diet/

Check out the grocery list here: https://www.gutlove.com/shopping-cart/

And follow the other tabs to great recipes!
 

What do you NOT do?

1.     DO NOT Spend a million dollars on a juice cleanse. I hate to break it to you but juice cleanses are not all they’re made out to be. They are actually INFERIOR to eating WHOLE FOODS! Here are the details:

·      Juices won’t fill you up. Without any fiber, they’ll pass right through you.

·      Extra calories. Since you won’t feel satiated, you’ll end up drinking all the juice calories PLUS whatever else you want to eat.

·      Many vitamins & nutrients are lost in the juicing process. Antioxidants + fiber are usually found in the pulp or skin of whole fruits therefore thrown out with the juicing scraps.

·      High glycemic index (GI)! Juice is a super fast, high sugar load. This means that your blood sugar will quickly spike high and then fall without the buffer of fiber. Cranberry juice has a GI of 68 while a grapefruit has a GI of 25. Look for LOWER GLYCEMIC INDEX foods to stabilize your blood sugar whether you are diabetic or not! See a list of foods & their GI from Harvard here. FYI: Several prospective studies have associated diets high in glycemic index with risk of developing type 2 diabetes mellitus, coronary heart disease, and some cancers (uptodate).

·      Juice does NOT cleanse the body of toxins! Companies love to write “detox” on every juice bottle but what does that mean exactly? No one knows!  The liver & kidney do most of the detox work in the body and juices don’t necessarily assist them. What’s the benefit from “resting” your digestive tract and creating less stool? There IS no benefit. You need healthy stool for a healthy microbiome! Great article from NYTimes here

2.     DO NOT Buy an expensive bottle of vitamins. I’m sure we were all there once. Standing in the vitamin aisle and staring down a $50 bottle of vitamins.. in awe of all the potential health benefits you may reap. Well the news flash is that there is really NO reason to take a multivitamin and if you are experiencing any certain symptoms then see your doctor, they can test you for a vitamin deficiency, and you can take a replacement pill if you NEED it! Here’s the data:

Annals of Internal Medicine, 2005

Annals of Internal Medicine, 2005

·      There is NO clear evidence of a beneficial effect of supplements on cognitive performance, memory, all-cause mortality, cardiovascular disease …and definitely not cancer!

·      In fact, clinical trials shows that β-carotene, vitamin E, and possibly high doses of vitamin A supplements increase mortality

from Sleisenger and Fordtran textbook on Gastroenterology

from Sleisenger and Fordtran textbook on Gastroenterology

·       A multivitamin does NOT WORK—some of the vitamins you are hoping to get need fat to be absorbed and many of the minerals compete for the same transporter for absorption! For example, one transport mediates absorption of iron, zinc, manganese, and copper. So if you multivitamin contains both iron and zinc, they both compete for the same transporter and therefore you DON’T ABSORB one of the two minerals!

 

Spring cleaning for your gut does NOT mean a million dollar juice cleanse & vitamin splurge. Save money AND save your gut. #happyspring

LAXATIVES 101: Your guide to pooping when you're not

So you’ve mastered your pooping ritual and are going like a boss every morning after breakfast. THEN IT HAPPENS. Maybe you had to travel and switch time zones, maybe you had to take an exam and have been stressed out, maybe you changed your diet, maybe you just forgot to drink water all day. Suddenly, you’re bloated, gassy, your head hurts. Yup, you’re constipated. I’m going to help get you through it. Here is absolutely everything you need to know to get back in the poop groove.

1st cover your bases

  • Make sure you’re following the pooping ritual described on the “poop” section of this website and make time to poop in the AM after meals when colonic motor activity is highest.
  • Optimize your water & fiber intake (wheat bran, beans/hummus, citrus, apples, broccoli)! And don’t forget about prunes!
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Next, add a Bulk-forming fiber supplement

  • Ex. Benefiber (wheat dextrin) 1 tbsp 1-2x/day with a huge glass of water. Or Metamucil
  • How does it work? The fiber absorbs water to form a liquid that promotes peristalsis and reduces transit time in colon
  • How fast does it work? 12-72hrs
  • Side effects are mild but worse if you don’t drink enough water. Some bloating and gas, especially in the beginning. Go slow.
  • This is your rock. Consider taking this regularly to ensure perfect poops.

Need backup… for your backup? Next try Miralax (Polyethylene Glycol 3350).

Screen Shot 2017-03-14 at 6.11.03 PM.png
  • Start with 17 g powder dissolved in big glass of water once a day and increase up to a maximum of 34 g daily or decrease as necessary
  • How does it work? It’s an osmotic agent that absorbs water to increase colon distension and stimulate peristalsis. Also increases poop mass.
  • How fast does it work? 24-96hrs
  • Side effects are mild but can include bloating and gas.
  • You can take this on a regular basis and know it’s safe. I mean, we use it in mega doses for colon prep before colonoscopy.

 

OK, it’s been 1-2 days & that didn’t work. I need to go NOW.

If you need to go NOW like TODAY, then try one of these:

1. Stimulant laxatives: Bisacodyl (dulcolax), Senna (Senokot)

Screen Shot 2017-03-14 at 6.12.19 PM.png
  • How does it work? Alters water and electrolyte transport in the colon wall and directly increase intestinal motor activity and peristalsis by irritating the smooth muscle and nerves of the intestine
  • How fast does it work? 6-12hours
  • Side effects: Diarrhea and abdominal pain even with a couple doses.
  • Do NOT take these long term—they lead to dangerous electrolyte abnormalities, salt overload, and even colonic INERTIA—a scary term that means your colon motility slows down to the point that it STOPS. Its surgical management at that point.
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2. Milk of magnesia or Magnesium citrate

  • How does it work? It’s an osmotic agent that absorbs water to increase colon distension and stimulate peristalsis. Also increases poop mass.
  • How fast does it work? 30minutes – 6hrs
  • Do NOT take if you have kidney problems!
Screen Shot 2017-03-14 at 6.11.56 PM.png

If you need to go NOW like this MINUTE, then try a Suppository

  • Glycerin or bisacodyl, either one works. Keep it in your rectum for a good 15 minutes if you can.
  • How does it work? Glycerin an osmotic agent that absorbs water to increase colon distension and stimulate peristalsis. Also increases poop mass.
  • How fast does it work? 15-60min
  • Side effects minimal if used infrequently. Abdominal cramps, rectal irritation, feeling of incomplete evacuation

 

If it’s been DAYS & you may just die of constipation then an enema is just the thing you need.

  • Enemas should only be used to prevent fecal impaction if you have several days of constipation and are miserable.
  • If that’s the case buy a mineral oil enema or use tap water
  • How fast does it work? 2-15 minutes
  • Side effects: abdominal cramps, diarrhea, rectal leakage

 

Don’t waste your time:

  • Colace (docusate sodium): this is a STOOL SOFTENER. It’s not for constipation per se, but to prevent straining while pooping and help with hard, dry stools in a very weak way. This is for HEMORRHOIDS.
    • How does it work? Lowers surface tension of stool, allowing water to enter more easily
    • How fast does it work? 12-72hrs
  • Lactulose (synthetic sugar): Although effective, this med just comes with tons of side effects, tons of  bloating and gas
    • How does it work? Its an undigested sugar that keeps water and electrolytes in the gut lumen
    • How fast does it work? 24-48hrs

 

Last, but not least at all. Actually super important:

If your constipation becomes more frequent or severe, see you doctor! There are plenty of diseases that cause constipation. There are also more powerful drugs your doctor can give you once you make sure nothing else is going on. 

 

Bariatric surgery works for weight loss & diabetes. But what’s really behind the success? Gut hormones.

Bariatric surgery is making headlines- just the other day the New York Times ran a story called Why Weight Loss Surgery Works When Diets Don’t, where someone said “Bariatric surgery is probably the most effective intervention we have in health care.” And indeed, it has proven it to be so. No one can deny the physical results- extreme, durable weight loss- up to 40% reduction in body weight after bypass. Then there are the metabolic improvements- normalizing blood sugar and putting type 2 diabetes into remission—which happened in 84% of patient’s after bypass in one study. And lets not forget about normalizing blood pressure and cholesterol, fatty liver, heart problems, acid reflux, arthritis, infertility, stress incontinence, and curing sleep apnea. And finally the mental benefits- post-bariatric surgery, people rated themselves healthier, less likely to report problems with mobility, pain, daily activities, social interactions and feelings of depression and anxiety. 

What drives these fabulous results? None of the published articles revealed the real reason these surgeries are working. The answer is— the gut-brain connection & gut hormones. 

Weight loss efforts are often defeated by the body’s thermostat that regulates body weight. Everyone has a genetically influenced level of fat that is defended by this control system and changes in body fat stores trigger changes in appetite and energy expenditure to resist weight change. This evolved to defend us against malnutrition and starvation.. but now is working against us. Because of this thermostat-- diet, exercise and medications only are successful at losing 5-10% of body weight… and re-gain is almost always expected. But with bariatric surgery you lose 40%! Bariatrics works despite this regulation—because it gets to a more basic principle-- altering gut hormones.

appetite regulation.jpg

Back to that ‘gut-brain axis’ again. Many hormones are secreted from the GI tract and contributes to regulation of energy balance and glucose homeostasis through interaction with the nervous system. The main players are peptide YY (PYY), glucagon-like peptide-1 (GLP-1) and ghrelin.


-  PYY &  GLP-1 are released after food intake and decrease appetite, increase satiety, slow gut motility and improve insulin sensitivity.

- GHRELIN is suppressed after a meal but when active, stimulates appetite, increases food intake and gut motility and decreases insulin sensitivity. When you purely calorie restrict, levels of ghrelin go WAY up.

What do we want? Tons of PYY & GLP-1 to decrease appetite and for GHRELIN to stay quiet. What does gastric bypass do? Increase PYY & GLP-1 and decreases GHRELIN.

No wonder it works!

Conclusion: It’s not the surgery per se that’s causing all of these fabulous weight loss and metabolic outcomes—it’s the gut hormones. And the good news is that you don’t have to undergo surgery to manipulate these hormones!  There are endoscopic GI procedures for weight loss and metabolic management available as well as medications such as GLP-1 agonists (Liraglutide, Exenatide, etc). 

 

There's a fungus among us! Candida overgrowth, SIFO & the Mycobiome

It’s time to start focusing on the other important players in your gut- fungi and viruses. Although all the headlines are showcasing the bacterial microbiome and its importance, more and more research is spotlighting the fungal MYCObiome and the viral intestinal virome. I’ve gotten a lot of questions about candida overgrowth in the GI tract so let’s dig into the mycobiome.

Adapted from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708484/#R42

Adapted from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708484/#R42

Nobody is fungus-free. Candida albicans is actually part of the normal inhabitants of the human GI tract and lives on the mucosal surface, enjoying a symbiotic relationship with the human host and bacterial microbiome. More often than not, Candida doesn’t cause any problems. But in the right circumstances, it can become pathologic, grow out of control and cause symptoms. These situations include antibiotic use, inflammation, physical/chemical damage, weakened immune systems (HIV/AIDS, cancer/chemotherapy, steroid/immunosuppressant use), diabetes, anti acid use that disrupts the protective acidic environment of the stomach and even occasionally in healthy people. Have you heard of SIBO (small intestinal bacterial overgrowth)? Well, meet SIFO (small intestinal fungal overgrowth).

The overgrowth and outgrowth of Candida can lead to infection and invasion of tissues. I am sure many ladies reading this blog have experienced vaginal candidiasis after using antibiotics.  Well- what happens in the gut?

A spectacular study published in Gut showed that GI Candida colonization impairs the GI mucosal barrier and leads to the phenomenon of “leaky gut” (due to activation of mast cells). This means that things in your gut (food antigens) have a greater chance of getting past your mucosal barrier and into your gut wall and introduced to your immune system, which then turns on and creates antibodies like IgE. This promotes sensitization against food antigens and increases the risk of food allergy. This type of IgE reaction has been linked to the activation of the inflammatory skin disease atopic dermatitis.

In addition to leaky gut, the overgrowth and colonization of fungi in the intestine (SIFO) can lead to similar symptoms as SIBO (diarrhea, abdominal pain, bloating, gas).  Two recent studies showed that 26 % and 25.3 % of a series of patients with unexplained GI symptoms had SIFO. The most common symptoms observed in these patients were belching, bloating, indigestion, nausea, diarrhea, and gas. Research is ongoing looking into the association of fungal overgrowth with delayed healing of peptic ulcers, Crohn’s disease/Ulcerative Colitis, IBS, GI cancers, and more.

What can I do to protect myself???

- Don’t disturb your happy myco/microbiome homeostasis—avoid antibiotics unless clinically indicated!

- Control your blood sugar levels by avoiding sugar & processed sweets, artificial sweeteners, and carb-loading!

- Don’t take anti-acids like Nexium or Prilosec unless deemed clinically indicated by your doctor and if so, only take for a specified time period- they’re NOT meant to be taken forever and have side effects!

- Talk to your doctor about taking a course of anti-fungal therapy and utility of an anti-fungal diet.

#respectyourgut #cleanyourgut #feedyourgut

 

Forest Bathing

Spending this weekend in Hudson Valley immersing myself in the woods and snow. Feeling a million miles away from the day-to-day stress of my favorite megacity, New York, and a busy, sleep-depriving job. Out here in the wilderness, I’ve slept better, pooped better, and just feel like I’ve shed a skin of anxiety and worry. Turns out, the practice of forest bathing, or  “Shinrin-yoku” has been studied for years in Japan and means “taking in the forest atmosphere through all of our senses.” It’s nature therapy… and it’s necessary for all of us!

 

adapted from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997467/

adapted from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997467/

Most of us are familiar with a daily state of stress. Psycholgical stress is compounded by "technostress", where forms of technologies that expose us to more artificial elements contribute to the exacerbation of our stress levels.  These stressors induce neurohormonal changes in our body and create a hyperactive sympathethic nervous system overdrive. This stress response wreaks havoc on the body, including the most awful consequence of altering bowel habits and causing gut distress. To combat all that badness, exposure to stimuli from natural sources induces a state of hyperactivity and hyperawareness of the parasympathetic nervous system that renders a person in a state of relaxation.

 

Forest bathing has been studied since the 1990s when it was found that spending time in a forest environment reduced salivary cortisol levels, the “stress hormone”. Subsequently many more studies have shown that forest immersion causes the following physiologic changes:

- decreases heart rate

- decreases blood pressure

- decreases urine adrenaline

- decreases blood glucose levels

- increases NK-cell activity

 

Take away: forest bathing will boost your immune system, fight metabolic syndrome, and normalize your sympathetic system overdrive, ensuring gut happiness. So get out into the woods, turn off that sympathetic overdrive, and get back to good bowel habits!--- REST & DIGEST! 

 

 

Got gas? Bloating? Abdominal pain? Go low FODMAP!

from American Chemical Society https://www.acs.org/

from American Chemical Society https://www.acs.org/

OK, so the name may sound a little strange…  but the low FODMAP diet is an elimination strategy that makes a ton of sense! A diet low in FODMAPs means a diet low in fermentable oligo-, di-, and monosaccharides and polyols (“FODMAPs”) which is a very fancy way of saying gas-producing foods. The idea is to avoid these short-chain carbohydrates that are not really absorbed by your gut and therefore hang out in your intestines where they are rapidly broken down and fermented resulting in abdominal pain, bloating, and gas. In IBS in particular, there is an underlying gut hypersensitivity and therefore an exaggerated discomfort experienced after eating foods that produce a lot of gas. So before picking up a new Rx to help your symptoms-- change your diet!

Following the low FODMAP diet strictly is not easy as it includes very ubiquitous foods (try to eat flavorful meals omitting all garlic & onion!) but I've broken it down below to make it easier to start and follow. The goal is to initially eliminate ALL of the food groups below high in FODMAPs for 6-8 weeks and then after you start feeling so much better, you can gradually reintroduce one of the groups at a time to determine what your intolerance is it.

Oligosaccharides= fructans, galacto-oligosaccharides= ex. Wheat

Does this mean going gluten-free? Yes! Even in the absence of celiac disease, the identification of nonceliac gluten sensitivity has emerged as an entity that can alter bowel barrier function and motility causing diarrhea.  But don’t forget you can still eat all sorts of breads and pasts made from rice, spelt, buckwheat and other whole grains (see previous post).

Gluten-free crepes, spicy hot cocoa made with almond milk, and an acai bowl from  Little Choc Apothecary in Brooklyn, NY  http://www.chocny.com

Gluten-free crepes, spicy hot cocoa made with almond milk, and an acai bowl from Little Choc Apothecary in Brooklyn, NY http://www.chocny.com

Disaccharides= lactose= ex. Milk, ice cream, and yogurt

Does this mean going dairy-free? Yes! Even in the absence of a formal lactose intolerance diagnosis, individuals have been found to be intolerant to milk components such as the cow milk protein. Don’t forget you can still drink and eat all sorts of plant-based, dairy-free milks, yogurts, and ice creams!

Monosaccharides= Fructose= ex. High-fructose corn syrup (HFCS)

This stuff is EVERYWHERE! Read your nutrition labels folks. This can be found in soda, juice drinks, breakfast cereal, yogurt, salad dressing, baked good, bread, candy, and even fiber bars that may have misleading "healthy" labels. HFCS has been found to cause more weight gain, more abdominal body fat, and higher triglycerides... and that's compared to natural sugar! Just avoid it. 

Polyols= Sorbitol, mannitol, maltitol, and xylitol= ex.  artificially sweetened chewing gum and sweets

Pretty self explanatory. Just eat real food and if you want something sweet, eat real plant-based honey, agave, or maple syrup-sweetened sweets.

Just remember the diet is “LOW” FODMAP, not “NO” FODMAP!  

Now go #feedyourgut!! Visit https://www.gutlove.com/shopping-cart/ for a list of delish low fodmap foods to stock your pantry with... as well as plenty of amazing recipes!

“The whiter the bread, the sooner you’re dead”

I’ll admit it’s a little morbid, but it drives the point home. Processed food including white bread, white rice, white pasta, processed breakfast cereals, and the like ….  is not good for you. But why then, do only 60% of Americans eat a whole-grain food at least once in 2 weeks? Turns out, we've been totally deceived by "Big Food."

What’s better than freshly baked crusty bread dipped in olive oil?? Absolutely nothing- as long as the bread is whole grain! Brown, dark bread is whole-wheat bread which is made from the whole natural grain — bran, germ and endosperm. The whole natural grain then gets milled and ground into the flour that bread is made with . Whole grain contains plenty of nutrients and fiber-- which is what your gutbugs need to thrive and create a healthy, strong microbiome. In addition, eating at least 3 servings of whole grains per day is associated with lower risk of death from cancers, heart disease, and stroke.

Now let’s talk about the so-called “wonder” bread? Imagine that beautiful natural whole grain and imagine it getting bleached and stripped of everything that made it good for you-- the bran and germ, leaving just the starchy white endosperm.  The refinement process robs grain of its fiber and nutrients. And although factories attempt to “enrich” grains (“nutritional window dressing”) after stripping them of all nutritional value, they may not have the same composition as whole grains and therefore don't have the same benefit. Synthetic vitamins and minerals are cheap and  easy to add to food and let's not forget they are often made through a chemical process using coal-tar derivatives. Add in even MORE chemicals to prevent the bread from drying out and extending its shelf life, and voila! The fake bread that takes over the supermarket shelfs. And to add insult to injury, this fake bread is incredibly cheap to buy because the government has subsidized and supported industry in this refining process.

http://wholegrainscouncil.org

http://wholegrainscouncil.org

OK, now that you understand the difference between whole grain and refined white bread, lets break down the science about what refined grains will do to you:

- WEIGHT GAIN! Consumption of refined grains is less satiating, increasing hunger signals and total caloric intake, as compared with calories obtained from less processed, higher-fiber foods. Consumption of processed foods high in refined grains increase weight gain. Specifically, expect at least an extra 0.6 pounds every four years.

- INCREASED RISK OF DIABETES, INSULIN RESISTANCE, and METABOLIC SYNDROME! Refined grains are rich in rapidly digested carbohydrates with a  high glycemic index and glycemic load meaning fast spikes in blood sugar and insulin after eating that can lead to insulin dysregulation and insulin resistance, part of the metabolic syndrome. Diets with a high glycemic indexand/or high glycemic load like refined grains increase the risk of chronic lifestyle-related disease, especially type 2 diabetes and gallbladder disease.

- INCREASED RISK OF HEART DISEASE! Speaking of glycemic index, metabolic studies have shown that refined grains with higher glycemic index scores  are associated with coronary risk factors, such as higher fasting triglycerides and lower high-density lipoprotein cholesterol levels.

I think you're beginning to understand why I titled this post...

But lets end on a positive note. There are so many breads you can still enjoy!  Look for the ingredient “100% whole grain”. Here are some keepers:

- Food For Life Ezekiel 4:9 Bread, Sprouted Whole Grain - Sprouted 100% whole grain bread. Flourless. Low glycemic.

- Mestemacher Bread, Whole grain Rye bread- whole rye kernels, wheat-free!

- Rudi's Organic 100% Whole Wheat Bread

- check out some other options in the “grocery cart” section of the #feedyourgut diet tab

Sourdough Starter (click for NYT Cooking recipe!)

Sourdough Starter (click for NYT Cooking recipe!)

….or make your own!

Sourdough No-Knead Bread (click for NYT Cooking recipe!)

Sourdough No-Knead Bread (click for NYT Cooking recipe!)

One last thing. One bread that may look white but is surprisingly good for you is sourdough. Fermented sourdough is perfect for your gutbugs.  As per Michael Pollan, “[The] tradition of fermenting flour with sourdough breaks down the peptides in gluten that give people trouble." Sourdough bread has been reported to improve glucose metabolism in both healthy subjects and those with impaired glucose tolerance. subjects with impaired glucose tolerance had lower glycemic responses after the consumption of sourdough bread than after the bread leavened with baker yeast. This effect is likely due to the lactic acid produced during dough leavening as well as the reduced availability of simple carbohydrates. A pilot study has even found that Gluten-free sourdough wheat baked goods appear safe for celiac patients as the gluten is completely degraded in the fermentation process. If you have been diagnosed with celiac disease—just ask your doctor before trying it!

Now go #feedyourgut!

You've heard all about PRObiotics... but what about PREbiotics?

First, let's start with some definitions:

adapted from http://fitandawesome.com

adapted from http://fitandawesome.com

PREbiotics= FIBER! Non-digestible (poorly-absorbed) fermentable carbohydrates that stimulate the growth/activity of beneficial colonic bacteria. All prebiotics are fiber but not all fiber is prebiotic. 

PRObiotics= Live microorganisms that benefit the host. 

SYNbiotics= PREbiotics + PRObiotics

Now that we got that out of the way, let's get to the point- in the end, probiotics and prebiotics work together to achieve the same goal-- a diverse population of beneficial colonic bacteria. Prebiotics have been ignored and forgotten about when in fact, they are JUST as important as probiotics! The key is to incorporate naturally-occurring prebiotics and probiotics found in food to strengthen and fortify your microbiome!

   Short-chain fatty acids are in control of body weight &amp; insulin sensitivity. Adapted from  Nature Reviews Endocrinology, 2015

 

Short-chain fatty acids are in control of body weight & insulin sensitivity. Adapted from Nature Reviews Endocrinology, 2015

More on prebiotics: Prebiotics selectively stimulate the growth and/or activity of beneficial members of the gut microbiota. Lactosucrose, fructo-oligosaccharides, inulin, bran, psyllium, and germinated barley extracts foster the growth of Lactobacillus and Bifidobacterium species and stimulate production of short chain fatty acids (SCFAs), especially butyratewhich achieves the following:

- Restores a healthy balance of beneficial vs. harmful gut bacterial species 

- Stimulate protective lactic acid bacilli, which suppress harmful bugs by decreasing the gut pH and secretes substances that kill bad bacteria. 

- Gut bugs ferment prebiotics to SCFAs that have direct anti-inflammatory effects 

- SCFAs promote intestinal integrity through effects on epithelial cell proliferation and differentiation which may combat leaky gut and even possibly inflammatory bowel disease 

 

How exactly will YOU benefit from PREbiotics?

-       WEIGHT LOSS! Prebiotic treatments appears to be a promising “pharmaco-nutritional” approach to reversing the host metabolic alterations linked to the dysbiosis observed in obesity. 

Adapted from  dietspotlight.com

Adapted from dietspotlight.com

-       INCREASING IMMUNITY! Taking prebiotics has even been shown to prevent infections before liver transplant, and that is a very ill, infection-prone patient population.

-       BETTER POOPING! Have you heard of lactulose? That sweet suryp is a synthetic prebiotic that works wonders to make your bowels move, specifically by increasing stool water content and accelerating colonic transit and increasing stool frequency. Better yet, avoid the icky flavor and cramping and use a wheat dextrin powder, which is the active ingredient in BENEFIBER!

Jerusalem artichoke, a root vegetable. Adapted from &nbsp;   Bon Appetite &nbsp;magazine

Jerusalem artichoke, a root vegetable. Adapted from Bon Appetite magazine

-       IMPROVING LACTOSE INTOLERANCE! The prebiotic RP-G28 increases lactose-fermenting bacteria and therefore has been associated with symptom improvements(abdominal pain, bloating, diarrhea, cramping or flatulence).

 

OK so prebiotics are amazing and JUST as important as probiotics. So what foods should you eat??? Enjoy the following (disclaimer- some of these foods are high in FODMAPS!):

adapted from http://www.med.monash.edu.au

adapted from http://www.med.monash.edu.au

Ditch dairy. Your gut will thank you.

Eating dairy after infancy is actually not natural. Our bodies weren’t made to digest milk products after breastfeeding. But we still do it, cause yeah, it tastes amazing… but then we feel awful! Well, quitting dairy was the best thing I did for my gut and I promise your gut will thank you too! Here’s the evidence:

1. Lactose Intolerance: Did you know that 65% of the human population has a reduced ability to digest lactose after infancy? Lactose intolerance (LI) in adults is caused by gradually decreasing activity of the LCT gene that provides instructions for making lactase, an enzyme to digest lactose which is the sugar found in milk/dairy. Less activity of the LCT gene means less lactase after infancy and less ability to digest lactose. And this occurs in most humans.  Lactase persistence is thought to be related to the domestication of dairy cattle during the last 10,000 years…which means that we have evolved genes to tolerate lactose due to advances in agriculture. But this is not naturally what your body should be doing! Your body was meant to digest breastmilk, and NO dairy afterwards! So return to your body’s natural state, and don’t force it to digest lactose. You can visit your GI and get diagnosed officially with a hydrogen breath test, or just cut out dairy and see how much better you feel!

2. Cow milk allergy: Maybe you've been suffering with stomach issues because you're allergic to cow's milk! In one meta-analysis, they found that self-reported prevalence of food allergy was up to 17% for cow’s milk. A cow milk allergy may manifest as nausea, abdominal pain, vomiting, diarrhea, difficulty swallowing, and even rashes and skin issues. You can visit your GI and have him order a lab test to confirm your diagnosis (cow's milk-specific IgE)… or you can just quit milk and heal your gut!

3.  Dairy is high in FODMAPs! FODMAPS are fermentable oligo-, di-, and monosaccharides and polyols. These short-chain carbohydrates are poorly absorbed and osmotically active in the gut where they are rapidly fermented, resulting in abdominal pain and bloating. You know that feeling when you're so bloated you look pregnant and are gassy and miserable? Yup, that may be dairy's fault.

4. Acne: We’ll step away from GI for a quick second and talk about something else extremely important to our well-being, our skin. Milk may be causing you to breakout. A study of 47,355 women in the Nurses' Health Study that used retrospective data collection to determine diet found an association between acne and milk intake. Two subsequent large prospective cohort studies also reported an association of milk ingestion and acne. The reason is that the hormones and other bioactive molecules in milk can exacerbate acne. Not to mention all the antibiotics they feed the cows now may lead to antibiotic resistance and so many other personal and public health problems! And lets not forget about the inhumane way they treat cows

5.  Animal cruelty : OK, this doesn't have to do with GI either, but your conscience and moral values are pretty important. I'll leave the explanation to the most dedicated and brilliant food journalist there is who knows firsthand about the brutality of CAFO, the concentrated animal feeding operation: Michael Pollan.

So can you ditch dairy and still enjoy life? YES. Let me introduce you to some of the best dairy-substitutes out there, and these are not just “good for vegan” good, they’re good, PERIOD.

adapted from  vanleeuwenicecream.com

adapted from vanleeuwenicecream.com

Van Leeuwen Artisan Ice Cream. The BEST: Vegan chocolate (but all their vegan flavors are fabulous!) Ultra rich and creamy, Van Leeuwen gets their chocolate from a small family-run French company that doesn’t use soy lecithin and grows cocoa on  biodynamic and organic plantations. Sprinkle a little sea salt on for fun. It’s a MUST HAVE.

Ingredients: coconut cream, cashews, coconut oil, cocoa butter, organic cane sugar, michel cluizel chocolate (cocoa butter, cocoa liquor, vanilla bean, ginger), michel cluizel cocoa powder, organic carob bean, salt

adapted from  eatbychloe.com

adapted from eatbychloe.com

  2. bychloe’s vegan cupcakes. Everything at bychloe’s is good but her raspberry tiramisu cupcake? Heaven. Fun fact- Chloe Coscarelli won the Food Network’s reality-competition series "Cupcake Wars", and was the first vegan chef to do so!

Her winning Raspberry Tiramisu Cupcake is a  moist vanilla cake soaked with espresso and amaretto, stuffed with a fresh raspberry filling, ground chocolate, and topped with fluffy tiramisu buttercream. “Totally vegan and totally delicious!” Try it at home!

3. CocoWhip! So delicious coconut whipped cream.

I literally eat it by the spoon-full. They actually have a 21 day dairy-free challenge you can sign up for- try it today

adapted from  sodeliciousdairyfree.com

adapted from sodeliciousdairyfree.com

adapted from  wholefoods.com

adapted from wholefoods.com

4. Organic unsweetened almond milk by 365. You’ll forget all about cow’s milk once you try this. Perfect for coffee, smoothies, cereal… you name it! Another staple to always have in the fridge.

Ingredients:  Organic almondmilk (filtered water, organic almonds), tricalcium phosphate, sea salt, xanthan gum, potassium citrate, sunflower lecithin, vitamin a palmitate, ergocalciferol (vitamin d2), dl-alpha tocopherol acetate (vitamin e).

Challenge yourself!! Check out the 21-day dairy free challenge sponsored by So Delicious-- sign up today! http://sodeliciousdairyfree.com/dairyfreechallenge

All cancer death rates are dropping… except liver cancer. Meet the culprits: hepatitis C, alcohol, fatty liver

For just a minute, we're going to move away from poop habits and talk about protecting your liver. This is especially relevant as I am currently at Mount Sinai Hospital in NYC working on the liver transplant service. Rounding on the transplant hepatology floor, I am shocked by how many patients are admitted with decompensated cirrhosis and liver cancer, some of whom are hopeful and eligible for a liver transplant… and many of whom are not. The scary thing is how many of these patients are only in their 50s and 60s and with young children. The reason most of these patients developed liver disease was due to drinking alcohol, not treating (or knowing they have) hepatitis B or C, or the newest and scariest reason- fatty liver. Hepatitis C is the most common reason for liver transplant in the US, and a 2015 article showed that fatty liver is the second.  Then just this year, it was announced that fatty liver surpassed hepatitis C as the top reason for liver transplant in people under 50 years old.

2017 American Cancer Society statistics just published that liver cancer is the ONLY cancer with an increasing death rate. The scariest thing is, liver cancer is not an easy cancer to treat, especially if diagnosed at a later stage. In fact, the 5-year survival is 17.5%. 

Therefore PREVENTION is KEY! #protectyourself with these tips:

EMBRACE:

Love Stumptown. Image from http://sf.funcheap.com/

Love Stumptown. Image from http://sf.funcheap.com/

- DRINK COFFEE! Enjoy your daily cup of coffee a day! Coffee protects you from cancer in many ways: blocking the formation of new blood vessels (angiogenesis) that tumors need to survive, improving insulin sensitivity and reducing the risk of diabetes which is associated with an increased risk of liver cancer, reduces inflammation, and reduces DNA damage that may lead to mutations and cancer. Make sure to drink it black (NO SUGAR, NO DAIRY!) to avoid extra calories and negating the positive effects!

- LOSE WEIGHT! Higher BMI has been linked to liver cancer.  Extra fat directly affects hormones such as insulin, insulin- like growth factors and estrogens, creating an environment that promotes cancer. Fat tissue stimulates inflammation. Obesity is also a risk factor for fatty liver which may progress to cirrhosis and cancer. Check out my #feedyourgut eating tips to lose weight. 

Visit NYC health for more

Visit NYC health for more

- IF YOU HAVE VIRAL HEPATITIS, GET TREATED! Hepatitis C is curable with oral medication. And hepatitis B is controllable. And if you don't know, get tested! Everyone born between 1945-1965 should be screened for hepatitis C and cured.

Try Arctic Char! Click above for a recipe from the NYTimes

Try Arctic Char! Click above for a recipe from the NYTimes

- EAT FISH! Higher fish consumption may decrease risk of liver cancer, perhaps due to n-3 fatty acid intake as the long-chain polyunsaturated fatty acids (PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) present in fatty fish and fish oils, inhibit carcinogenesis.

- EXERCISE! Higher levels of physical activity may decrease the risk of liver cancer due to the beneficial effect on insulin sensitivity, weight loss, and decreasing inflammation. Check out the move section and get moving! Hello, yoga!

FORGET IT:

- EXCESSIVE ALCOHOL. Moderation is key. 3 drinks a day has been proven to have a clear relationship with cancer.  If you have cirrhosis, then avoid alcohol entirely.  FYI: Alcohol consumption is graded by the International Agency for Research on Cancer (IARC) as carcinogenic to humans. Alcohol is also associated with increased fat in the body and especially in your liver (fatty liver) that also leads to cancer.

Quit now.

Quit now.

- SMOKING. Especially if you have Hepatitis B and/or C or drink alcohol. But seriously, smoking is GROSS.

- AFLATOXINS. A product of the Aspergillus fungus and a common contaminant of cereals (grains) and peanuts in Africa/Asia is a cause of liver cancer. Conclusion: don't move to Asia and live off grains and peanuts.

From the   World Cancer Research Fund

From the World Cancer Research Fund

#gutpeace: De-stress your gut in 2017

When you’re happy, your gut is happy. When your gut is happy, you’re happy.

But when you’re stressed, your gut is also stressed. And when your gut is stressed, you feel stressed.

How are they so intricately related, you may ask? Well its because your gut has its own nervous system (enteric nervous system) that communicates directly with your brain (central nervous system). In embryology, one neural tube differentiates into the brain in your head and the brain in your gut. Both are richly innervated with cells and nerves that communicate with neurotransmitters and hormones and provide the basis for the Brain-Gut Axis. This bidirectional system translates feelings, thoughts and memories from your brain into neurotransmitters that are released and affect your gut motor, immune, and inflammatory function and vice versa.

So, what exactly does STRESS do to the GUT?

·      Increases pain

o   Being upset/distressed à abdominal discomfort, change in bowel function

o   Stress lowers the pain threshold so it takes less stimulus to cause pain, especially in IBS

·      Messes up your pooping ritual

o   Anger, intense pleasure, or aggressive behavior à more blood flow to gut, diarrhea, especially in setting of functional GI disorders

o   Fear or depression, withdrawal (giving-up), or disengagement à less blood flow to gut, constipation

·      Causes massive inflammation

o   Stress increases proinflammatory cytokines

o   Acute stress triggers the hypothalamic-pituitary axis, leading to increased cortisol and activates the autonomic nervous system, with increases in proinflammatory cytokines

·      Causes leaky gut

o   Stress leads to mucosal permeability due to weakening of tight junctions, with an increase in bacterial translocation into the intestinal wall

·      Destroys your microbiome

o   Stress can lead to a change in intestinal microflora, with a shift from “good” to “bad” bacteria

And how does your GUT affect your MIND and STRESS?

·      Gut infection (gastritis, colitis) causes stress-induced memory problems  

with decreased neuronal activation in the hippocampus

o   Memory impairment persists after bacterial clearance

o   Probiotics prevent stress-induced memory deficits, normalizing the hypothalamic-pituitary-adrenal axis and colon injury.

Schematic for microbiota regulation of   neuroinflammation   and HPA axis activity.&nbsp;

Schematic for microbiota regulation of neuroinflammation and HPA axis activity. 

·      A diverse healthy microbiome protects you from stress and immune-related dysfunction

o   Lab animals raised in a sterile environment with a germ-free gut had an exaggerated hypothalamic-pituitary-adrenal axis activity with elevated cortisol and anxiety in response to stress

o   Colonization with bacteria (ex. Bifidobacterium) and probiotics reduced the stress-induced increase in cortisol and anxiety

o   Lactobacillus reduced stress-induced cortisol levels, an effect that was abolished with vagotomy, suggesting that a functional neural relay from gut to brain is necessary for governing stress response

·      Intestinal inflammation leads to depression/psychiatric disorders via cytokines

o   Chronic inflammatory diseases such as IBD (Crohns, Ulcerative colitis) are associated with fatigue, anorexia, depression and “sickness behavior”, due to peripheral cytokine activation that produces central effects

o   Depressed patients with increased inflammatory biomarkers are less likely to respond to treatment

o   Inhibiting proinflammatory cytokines may improve depression and increase treatment response

What can you do?

1. Eat a lot of fiber and a gut-healthy diet to diversify your microbiome

2. Build a large, strong social-support network full of family, friends, co-workers, etc.

3. Know how to cope with stress! See a therapist, do a ton of yoga, meditate, exercise

4. Read Robert M. Sapolsky’s incredible book, “Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping”

 

[gut facts adapted from Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 10th edition]

 

#poopgoals: Wake up, coffee+fiber+eat, poop, REPEAT.

Your body wants you to have a routine. And you cant blame it, because your body knows it will work best with a daily schedule so that it can work in harmony with your sleep-wake cycle, eating habits, metabolic function, etc. Case in point: lack of sleep is associated with a dysregulation of the neuroendocrine control of appetite leading to increased hunger and altered glucose tolerance leading to an increased risk of diabetes. We all know it can be hard to control and perfect your sleep habits. So what can we control? Pooping. We all need to make time for pooping and maintain a daily pooping routine. A daily AM poop may just be what you need to put that pep in your step for the rest of the day, every day. Here’s the evidence from the textbook on colon motility:

1. Colon motor activity slows down during sleep & increases significantly upon waking up in the AM.

adapted from The New Yorker

adapted from The New Yorker

2. Eating a meal enhances colonic motility for ~2 hours, especially in the AM when the sigmoid colon and rectum are full.

3. Giant migrating contractions (GMCs) in the colon produce mass movement of stool. These are GMC stimulators:

- Long-chain oleic acid—a common dietary constituent found in olive oil

- Short-chain fatty acids, the end products of dietary fiber fermentation

- Excessive absorbable or nonabsorbable fluids in the colon

- Strenuous exercise after a meal

 

How does all that scientific evidence translate to an AM routine? Here it is:

1. Wake up

2. Eat: Breakfast + olive oil, i.e. avocado toast drizzled with olive oil, yogurt with olive oil +pistachios, Ezekiel cinnamon raisin sprouted whole grain toast with olive oil butter , etc.

3. Drink: Coffee or green tea + teaspoon or tablespoon of Benefiber (titrate your dose to daily bowel habits)

4. Sacred toilet time: Grab your squatty potty, prop your feet up to straighten out that anorectal angle, and lock yourself in the bathroom for 10 minutes of quiet time with a crossword puzzle or other light reading.

**in case you’re ambitious enough to squeeze exercise into your AM routine as well, it also definitely help stimulate GMCs and move everything out**

 

Final words: Do NOT strain, push or force it. If it doesn’t happen, it doesn’t happen. That’s poop zen. But once this becomes your schedule everyday, it WILL happen eventually and you will be able to go on and enjoy the rest of your day with a smile on your face knowing you’ve gotten rid of all that poop (for more, including Bristol scale #poopgoals, see the poop section).

What is a D.O. (Doctor of Osteopathic Medicine) and how can visceral osteopathy help you achieve digestive wellness?

I chose to pursue my medical training in the osteopathic tradition because I consider it an “MD+”. D.O.s learn everything a traditional allopath (MD) does—and then some. In addition to the countless lecture hours, clinical clerkships and anatomy labs, we also learned the skill of hands-on osteopathic manipulation and the interconnectedness of the body. Osteopathy emphasizes a whole-person approach to treatment, valuing the health of body, mind, and spirit. It focuses on prevention and understanding how a patient’s lifestyle and environment can impact their well-being. One key aspect of osteopathy particularly useful in the stressful world we live in is the emphasis on balancing your sympathetic and parasympathetic nervous systems (“fight or flight” systems). And although osteopaths are board-certified, licensed physicians that can prescribe medications, they do so only when absolutely needed and believe in pursuing integrative solutions to health problems.

For example, constipation may be due to slow transit, IBS, dyssynergic defecation, medications, sedentary lifestyle and many other reasons. In addition to evaluating those etiologies with colonoscopy, motility studies, etc, an osteopath also considers an increased parasympathetic tone leading to increased peristalsis,  an increased sympathetic tone leading to decreased bowel movements and pelvic diaphragm dysfunction. Keeping those in mind, an osteopath can manipulate key contributors such as the vagus nerve to affect colonic motility. Another manipulation commonly utilized is the mesenteric lift. 

adapted from  http://www.cappinophysio.ca

adapted from http://www.cappinophysio.ca

Visceral osteopathy assists functional and structural imbalances throughout the body including digestive dysfunction. Here are some more evidence-based uses for visceral osteopathy in GI disease: 

1. IBS: visceral osteopathy improves short-term and long-term abdominal distension, diarrhea and pain, and also decreases rectal sensitivity. Studies have down that it improves the severity of IBS symptoms and improves quality of life scores.

3. CROHN'S: there was an increase in quality of life and a decrease in the severity of fatigue in patients receiving osteopathy 

3. GERD: osteopathic intervention of the diaphragmatic muscle increased lower esophageal sphincter (LES) pressure that may lead to symptom improvement

 

 

Having a dog may be way more beneficial than any probiotic!

People who own dogs are happier, less-stressed, and even less likely to die of heart disease... but did you have any idea your dog may be influencing your microbiome?

Studies show that exposure to dogs in early infancy has been show to reduce the risk of childhood asthma and allergies, and dog ownership is associated with a distinct house dust microbial exposure, specifically a lot more Lactobacillus johnsonii. Turns out, L. johnsonii is a pivotal species in the GI tract capable of influencing adaptive immunity at mucosal surfaces in a way that is protective against respiratory insults.

Just another reason to adopt a dog today

 

adapted from  uBiome

adapted from uBiome

Overnight oats: the vegan power breakfast you've been looking for

Who wants to wake up even earlier to make breakfast these days?? Not me. But I also don't want to grab one of those processed food bars-to-go thats packed with 5 types of sugar.

So you can imagine how excited I was to find out about overnight oats. It may be the most simple & healthy breakfast idea out there. The night before eating, simply grab a mason jar and fill it about 1/4-1/2 full of raw oats. Then let your creative juices flow- add a tablespoon of almond butter and half a banana, or opt for fresh strawberries & coconut shavings (not sweetened of course!) Basically, add whatever delicious toppings you want. Finally add enough non-dairy milk to cover the oats completely. I like soy or almond milk. 

And voila! Wake up the next morning and grab it as you rush out the door. And enjoy your zzzs.

If forest bathing, consider picking up one of patagonia's Provisions Breakfast Grains and enjoy outdoors-style.

vegan. raw. no extra sugar. and the high fiber content is guaranteed to get you that bristol 3/4 you need to start your morning right.