As I mentioned in my previous post, Chris Kresser outlines three steps for getting rid of acid reflux, GERD, and many other digestive problems. Step 1 is to "reduce the factors that promote bacterial overgrowth and low stomach acid." This is achieved by a basically low-carb and low fiber diet. The Specific Carbohydrate Diet and its offshoot the GAPS Diet are not really low carb, but they are very helpful for people with digestive problems who need help switching to low-carb. Many people think the changes that the GAPS diet makes to the original SCD are very beneficial, like going easy on dairy in the beginning. I myself started with the SCD six years ago and started tweaking it to a lower carb diet almost from the start. Too much honey! And too much dairy!
After about a year, I found the Eades's Protein Power diet. Their book, The Protein Power Lifeplan is still the first book I recommend to friends and family because again they give very good advice on making the transition from a standard American diet (SAD) to a low-carb diet. Also, between them, the Eades have treated thousands of people and have seen the results of their diet suggestions. They are not just theorists. Along with the Eades, I found and read a lot about the Paleo Diet and incorporated some of their tenets into my nutrition plan. All of this I have blogged about before, so let's move on to Step 2.
Step 2 is to "replace stomach acid, enzymes and nutrients that aid digestion and are necessary for health." This was the stumbling block for me because, as I related in my previous post, I was afraid to try the HCl with Pepsin. Once I did, I had immediate and complete relief of my symptoms of cramping, heart-pounding, and palpitations after a meal. I have also been taking enzymes towards the end of a meal and they seem to help stop the bloating and gas.
So that leaves Step 3, "restore beneficial bacteria and a healthy mucosal lining in the gut." And here again I have had problems. Even though one enlightened doctor I saw recently told me that you can't overdo the probiotics (he was talking in relation to re-populating the gut with good bacteria after taking a round of antibiotics), I have found that I need to be careful. Sometimes when I have used probiotics, my symptoms would get worse and I couldn't tell if it was the probiotic that was causing the trouble or not.
Most everyone, when you say probiotics, thinks yogurt. And yogurt, especially a good Greek-style yogurt or one that is made from raw milk (and of course, we're talking about plain, unflavored yogurt) or better yet one you make yourself and let sit for 24 hours, is an excellent source of lactobacilli. But as I recently discovered, those bacteria live in the small intestines and they do nothing to promote the growth of friendly bacteria in the colon. Other suggestions include fermented foods such as pickles, sauerkraut, kombucha, kefir, even aged cheeses, as well as probiotics in pill form.
Dr. Art Ayres on his blog, Cooling Inflammation, has a wealth of material on the subject of gut flora with some rather enterprising ideas on how to establish friendy bacteria (fecal transplants?) Every time I go to his site, one thing leads to another and I end up spending hours reading his posts and especially the comments. (I'm having trouble getting this post written because I keep getting side-tracked!) His anti-inflammatory diet is low-carb and he includes other things that can reduce inflammation (which he thinks is the basic cause of many diseases) like exercise (cardiovascular and muscle building), dental hygiene, and vagal nerve stimulation (more on this below). In a post on Constipation, Gut Flora and Health, actually down in the comments, he gives this recipe for restoring gut flora:
So, assuming that you have corrected any vit.D deficiency (check serum levels before and after supplements) start with probiotics (you can probably also tolerate live yogurt with full fat), lactulose, pectin (apples, tomatoes, etc.), inulin (leeks, etc.). I would stick to a high fat/low carb diet. That means no vegetable oil (only olive oil, butter, coconut oil), most of your calories from saturated fat in meat/dairy/fish/eggs, and lots of diverse leafy vegetables. Veggies fresh from the garden or farmers market are preferred, because then you won't over wash or cook them to remove too many of the bacteria that you need to reconstitute your gut flora.
You are going to have to be patient with your gut, because you need to accumulate more than a hundred different species of bacteria to have a healthy gut flora that can digest all of the vegetable polysaccharides in a healthy diet.
You probably couldn't tolerate dairy previously, because you eliminated the bacteria that can metabolize lactose. Get used to live yogurt first and then slowly add more milk to increase your gut flora's ability to digest lactose. It takes about two weeks.
I found the reference to pectin and inulin interesting. Those are considered pre-biotics. Dr. Ayres has this to say about inulin:
I neglected to discuss inulin, which is a fructan. Normally, I would resist eating fructose-containing carbs, because fructose is a metabolic problem. Also, sucrose can be used by bacteria as an activated intermediate in the production of fructan polysaccharides for biofilms, e.g. dental plaque.
Inulin is a different category, because it is not hydrolyzed by human enzymes and thus moves on to the lower GI tract, where it is food for gut flora. It would seem that inulin would be a nice accompaniment to pectin for increasing gut flora in the case of constipation. One would expect some traditional remedies and perhaps meal combinations to include, for example leeks and apples.
Again this information is buried in the comments. It would seem that Dr. Ayres has so much information to share, that it just overflows everywhere. So while most probiotics help to populate the small intestine, pectin and inulin are ways to feed the good bacteria in the colon. My friend Yvetta recommended that I eat half an apple every night before going to bed to keep my gut happy. Another quote from Dr. Ayers comments:
Note that most probiotics are only useful in providing a limited number of bacteria that usually grow at the end of the small intestine. Inulin, pectin and lactulose are more effective in promoting the other hundred species that are anaerobes. Most of those will have to be recruited from other environmental sources.
Just one note. The fermented foods focus just on bacteria that may act as probiotics for the upper part of the digestive tract. That is less than 10% of the gut flora.
To feed the rest of the gut flora that also influence the immune system (even though that resides in lining of the small intestines) apparently other plant polysaccharides are needed. This is another good reason to feed a variety of veggies.
This may be one instance where it is not good to be too low-carb.
In another comments section accompanying his post on how to cure inflammatory diseases, Dr. Ayers talks about (of all things) oil pulling! This is with respect to that vagus nerve stimulation he recommends as part of an anti-inflammatory lifestyle. His post on how the vagus nerve is involved in inflammation and controls gut inflammation has links to other vagus nerve stimulating exercises that I will give here and here. Now both of these maneuvers are pure Buteyko! (See my previous posts here and here.)
See what I mean? One thing just leads to another. Dr. Ayres is a research biologist. He got his PhD in Molecular, Cellular and Developmental Biology at the U. Colo. Boulder. I really think that the answer to our most vexing nutritional questions will come from microbiology. Humans are too complex and the variables way too many for studies to show positive proof that any one food or one macronutrient will do this or that. So I like to rely on evidence like the Eades have collected, a certain diet with real people that shows positive results, and what the microbiologists are discovering, what is happening on the level of our cells.