Did you know that even occasional use of antibiotics, hand sanitizers, and other germ-killers can wreak havoc on your long-term health? This week, we’re here with Dr. Robynne Chutkan, a leading expert in the world of gut health.

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definitive guide to collagen

For decades, the health community had written off collagen as a “useless” protein. It wasn’t essential, in that it contained no amino acids you couldn’t make yourself. It didn’t contribute directly to muscle protein synthesis, so the bodybuilders weren’t interested. In all my years running marathons and then competing in triathlon at an elite level, no one talked about collagen. It was completely ignored, especially after the rash of collagen-based “liquid diets” ended up with a lot of people dead or in the hospital.If you’re on a high-fat ketogenic diet and running on a fat-based metabolism, you need access to fat. Some of it comes from your own body, but not all. A good portion of your body’s fuel will come from dietary fat, or the fat you eat. Especially if you are eating more fat than you’re accustomed to, you need to be able to absorb and then digest the fat you eat and turn it into useable energy. If  you aren’t digesting fats, you may be in for some discomfort.

What are the signs and symptoms of poor fat digestion?

Signs You Aren’t Digesting Fats: What Does Fat Malabsorption Look Like?

Running a fat-based metabolism just doesn’t work if you can’t digest fats. Here’s what it looks and feels like:

Abdominal Pain and Discomfort After Fat-rich Meals

What happens to fat—or anything, really—that goes down the “wrong pipe”? When you consume fat but aren’t able to effectively digest it, that fat has to go somewhere. That fat goes where it isn’t supposed to be, and sometimes that causes pain and pressure.

Greasy Stool

Some misbegotten fat loss plans involve the active inhibition of fat digestion, either by consuming artificial fat-like substances that feel and taste like fat without providing any calories or taking lipase inhibitors which deactivate the intestinal enzymes that digest and absorb dietary fat. In both cases, the fat or “fat” is excreted when you go to the bathroom. Yeah. That’s not a good look, but it is a sure sign that you aren’t digesting fats.


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Floating Stool

Fat is buoyant. If your poop is festooned with the fat you ate but didn’t digest, it will float more readily.

“Leakage”

Passive leakage into your underwear is another common sign you aren’t digesting your fat. One of the most infamous processed “food” disasters was a line of “WOW” branded snacks that contained an indigestible fat substitute, which caused people to leak stool without warning. Same mechanism.

Productive Flatulence

Apologies for the visual, but there’s no easy way to say it. People with poor fat digestion will often produce tangible, lasting results when they fart.

Unexpected Weight Loss

Not absorbing or digesting dietary fat will reduce your calorie absorption, and it may very well cause weight loss. But if you don’t have weight to lose, or if the weight loss comes with unwanted side effects (one study found that Orlistat users indeed lost weight, but they also lost more lean mass), you may want to pay attention.

Low Energy Levels

Trying to run on fat without actually being able to access dietary fat is a miserable exercise in futility. The boundless energy, the steady even keel, the ability to go for hours without eating or crashing—all the promises of fat-adaptation will elude you if you can’t digest the fat you eat.

Oxalate Accumulation

Orlistat users are at an increased risk of oxalate-induced kidney damage.https://www.ncbi.nlm.nih.gov/pubmed/10757623‘>2

But it’s a real issue. You absorb fat-soluble vitamins alongside the dietary fat you eat. If you’re not absorbing the fat, you’re missing out on the nutrients. All those studies which find that eating fat-soluble vitamins like vitamin E and vitamin K2 alongside dietary fat improves nutrient bioavailability assumes that you’re able to digest the fat. If you can’t digest the fat very well, you’re missing out on the rest of the stuff you eat.

Not all of these are individual markers of poor fat digestion. It’s normal to have some floaty stool now and again. You aren’t always going to digest every bit of fat you consume. Everyone can name a time they felt bloated and had a stomach ache after eating. There are many other reasons why you could be losing weight without trying. But if they are co-incident, you might be dealing with poor fat digestion.

And you should probably do something about it.

How to Improve Your Fat Digestion

Okay, so any, some, or all of those symptoms are signs of poor fat absorption and digestion. It’s always a good idea to rule out larger health problems with your doctor. Until then, what can you do about it?

Chew your Food Thoroughly

Most fat digestion occurs in the GI tract, but it starts in the mouth with something called lingual lipase, the oral form of the major fat-digesting enzyme. To produce lingual lipase, however, you have to chew. The simple presence of fat in the mouth isn’t enough—you have to get those teeth and that tongue going. In one study, eating almonds and coconut triggered the release of lingual lipase, while eating almond butter (the same amount of fat) did not.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4446506/’>4 It doesn’t have to be some arcane bitter herb mix; even an espresso after a meal—that classic Italian custom—can improve fat digestion by increasing gastric acid production.https://www.ncbi.nlm.nih.gov/pubmed/31468384‘>6 Luckily, it’s an easy fix. Take a taurine supplement or eat more meat, especially hearts. Chicken, beef, lamb, turkey hearts are all great sources of taurine.

There you have it, folks. 9 signs and symptoms of poor fat digestion and 9 potential solutions to address the issue.

Do you have any problems digesting fat? Have you tried any of these recommendations? Do you have any recommendations of your own that weren’t listed here?

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best-foods-gut-healthWhen the ancient Greek father of medicine, Hippocrates, said “All disease begins in the gut,” he was probably right. Poor gut health has been linked to a broad range of diseases and health conditions, from depression to diabetes, cancer to obesity, and autism to autoimmune disease. Search the medical literature and you’ll probably find links between the gut and any illness you can imagine.

So—all the world’s health issues solved, right? Not exactly.

Gut health is one of those topics that gets more complicated the deeper you go. The more you read about gut bacteria, the less you realize you know and the less you realize anyone knows, even the researchers. It’s infinite onions, all the way down. The layers never stop, and exposing them eventually makes you want to cry. (Speaking of which, onions are actually a very good food for gut health).

All that said, the scientific community is honing in on the signs and symptoms of an unhealthy gut. We know how to heal an unhealthy gut, or at least improve gut health. An incredible amount of research has determined the best foods for gut health, and we know the worst foods for gut health. We understand that gut health comes down to supporting healthy gut bacteria and avoiding leaky gut. Top-down micromanagement might not work yet, but big-picture, bottom-up intervention does.

Gut Inflammation: Signs of an Unhealthy Gut

Some of the signs are obvious. Others are more pernicious. Not all of these will apply to someone with unhealthy gut bacteria or leaky gut, but some will.

Chronic Constipation, Bloating, and/or Diarrhea

Everyone gets a little constipated now and then. We’ve all had the runs, and we’ve all felt bloated after a particularly large meal. As long as these conditions are acute—as long as they’re brief and transient—they don’t indicate any serious gut inflammation. It’s when constipation or diarrhea or bloating endure and become chronic conditions that you should pay close attention. Chronic constipation, bloating, and diarrhea are signs of an unhealthy gut biome.

Obesity or Overweight

Although the connection hasn’t been established as causal, there is a consistent and significant association between obesity/overweight and poor gut health. If you are obese, you very likely have room to improve the health and function of your gut.

Food Intolerances and Allergies

If the integrity of your gut is compromised due to excessive gut inflammation or missing gut bacteria, undigested components of the foods we eat can slip past the intestinal barrier and into our bodies where they trigger an allergic reaction. This appears to be a necessary step in the development of a food allergy, and a 2011 review concluded that an overly leaky gut facilitates this transportation and leads to the inducement of allergy.

Depression and Anxiety

Researchers have long puzzled over observations that mental health conditions like depression and anxiety often present with common gastrointestinal complaints like constipation and diarrhea. It’s not just circumstantial: gut bacteria produce large amounts of neurotransmitters like serotonin, interact with neural pathways involved in anxiety and depression, and help form the gut-brain axis.

Animal studies show that replacing the gut bacteria of anxious mice with gut bacteria from fearless mice makes the anxious mice more brave, while giving bold mice bacteria from anxious mice makes them more anxious. In human subjects, a probiotic supplement (containing L. helveticus R0052 and Bifidobacterium longum R0175) reduces measures of anxiety and depression, and by some accounts, 35% of depressed patients have leaky gut.

Skin Problems (Eczema, Psoriasis)

In the last section, I told you about the gut-brain axis. There’s also a gut-skin axis: a constant interplay between the health of your gut and the health of your skin. People who have eczema are also likely to have leaky gut, while psoriasis patients show clear signs of unbalanced gut bacteria.

Autoimmune Disease

One of the world’s premier autoimmune disease researchers, Dr. Alessio Fasano, considers poor gut health a necessary pre-condition for all autoimmune diseases. It’s a similar situation to the allergy/intolerance issue: a leaky, inflamed gut allows outside proteins and other food components into the body, the immune system mounts an immune response to deal with the invaders, and this response gets out of hand and redirected toward the body’s own tissues.

Okay, so how does it all happen? Apart from food, which I’ll get to later on…

What Causes an Unhealthy Gut?

There are many potential causes of poor gut health.

Stress

Stress can directly induce leaky gut (PDF) and stress can take many forms, as we all know. Bad finances, marital strife, unemployment, too much exercise, lack of sleep, extended combat training, and chronic under-eating all qualify as significant stressors with the potential to cause leaky gut, especially chronically and in concert with one another.

Poor Sleep

Sleep is restorative, and restorative sleep means you’re lowering stress and improving gut health. If your circadian rhythm starts to shift, starts getting a little dysfunctional, your gut health soon follows.

Inadequate Dirt Exposure

Too sterile an environment causes too sterile a gut. We are made to spend time in nature, feet and hands getting dirty, exposed directly to the natural soil teeming with trillions of bacteria. We’re meant to eat produce directly from the ground, and nature didn’t intend for us to always wash it. (That said, if you didn’t grow it yourself, it’s best to wash your produce.) Exposure to healthy soil may even bestow upon us anti-anxiety gut bacteria—gut microbes that actually make us less anxious.

Not Enough Exercise (or Too Much)

Exercise has been shown to directly improve gut function, increasing the production of beneficial short cain fatty acids by gut bacteria. When you stop training, the gut benefits cease.

Just don’t do too much. An acute bout of intense training causes a transient rise in leaky gut that subsides and even improves several hours after the session. This is fine. This is normal. This is adaptive. But if you start stringing together intense training sessions without adequate rest, the exercise becomes a chronic stressor and the transient rise in leaky gut starts looking more permanent.

Too Many Antibiotics

Antibiotics are great at killing pathogenic bacteria attacking you, but they also tend to be indiscriminate. They do not distinguish between friendly bactieria and harmful bacteria in your gut biome. The broad spectrum antibiotics we commonly take also wipe out the bacteria living in our guts, leading to gut bacteria imbalances and poor gut function.

After addressing the major causes of poor gut health, is there anything you should avoid eating? Are there foods you should focus on eating to improve your gut health?

What Are the Worst Foods for Gut Health?

The worst foods for gut health are no surprise to regular readers of this site, but that doesn’t make them any less important to avoid.

Refined Carbohydrates

When we eat refined carbs like grains or sugar, glucose is immediately released into the digestive tract, increasing the concentration of carbohydrate available to your gut biome. This concentrated influx of dense carbohydrate into the gut produces an inflammatory microbial population that increases production of bacterial endotoxin and increases leaky gut. Meanwhile, the lack of prebiotic fiber means your beneficial gut bacteria have no food to consume.

Gluten

Gluten, a protein found in wheat, barley, and rye, causes your body to release zonulin—a chemical messenger that tells your intestinal junctions to open up. Many people can handle this increase in zonulin, but if you’re already suffering from poor gut health or are sensitive to gluten, the zonulin response may be strong enough to trigger leaky gut.

What Are the Best Foods for Gut Health?

  • Fermentable fiber
  • Chocolate
  • Berries
  • Red wine
  • Skin, bones, and broth
  • Fermented foods
  • Resistant starch
  • Meat
  • Pistachios
  • Onions, garlic, and leeks

Fermentable fiber

Without food, your gut bacteria suffers. And the best food for your gut bacteria is fermentable fiber, found in many different plants. Asparagus, carrots, Jerusalem artichokes, and alliums like garlic and onions are your best bet.

Chocolate

Besides being delicious, high-cacao dark chocolate is an excellent source of prebiotic fiber (fiber your gut bacteria can consume) and prebiotic polyphenols (plant compounds that also feed your gut bacteria).

Berries

Name a berry and it’s been shown to improve gut health. Strawberries feed the gut biome and improve the gut function of diabetic mice. Blackberries restore gut health and trigger neuroprotective effects. Eating blueberries leads to compositional changes to the gut bacteria linked to improved metabolic health. And black raspberries have been shown to cause “anti-inflammatory” bacterial profiles in the gut.

Red wine

Although too much alcohol can have a detrimental effect on gut health, moderate amounts of red wine polyphenols may have prebiotic effects on the gut bacteria.

Skin, bones, and broth

Skin, bones, and broth offer gut health benefits in a number of ways. First, they provide “animal fiber,” collagenous and gristly substrate that our gut bacteria can digest and prosper on. Next, they offer ample amounts of gelatin, which can help repair damaged gut lining. In a pinch, collagen can fill the gap.

Fermented foods

This is an obvious one, but it’s incredibly important and more complex than you probably think. First of all, fermented foods like yogurt, sauerkraut, pickles, kefir, and dozens of other varieties seed our guts directly with beneficial probiotic bacteria. That has real benefits—though they don’t “form colonies” and you do have to continually eat fermented foods for the full benefit. Some fermented foods also have the ability to “train” your resident bacteria to digest new compounds. One example is fermented milk: in one study it didn’t colonize the gut but led to increased microbial expression of carbohydrate metabolizing enzymes in the existing bacteria.

Resistant starch

Resistant starch isn’t like other starches. Our stomach acid and digestive enzymes cannot break it down, but our gut bacteria can digest it. Multiple studies indicate that resistant starch consumption generally leads to an increase in “beneficial” colonic bacteria and a reduction in “pathogenic” colonic bacteria, including a boost to bifidobacteria and a decrease in firmicutes and a huge boost to butyrate production. The best sources of resistant starch are green (unripe) bananas and raw potato starch.

Meat

Meat usually doesn’t pop up on these lists, but that’s a huge mistake. Red meat especially provides ample B-vitamins required for energy generation and general physiological maintenance, including gut function. It’s a nutrient-dense “safe” food for even damaged guts who need to be careful about the plant foods they eat. And if you’re eating a significant amount of meat, you’ll have less room to eat the refined carbs and refined sugar that really cause gut issues.

Pistachios

Pistachios are the most potent nut for improving gut health. Other nuts like almonds are good too, but pistachios produce  a biome richer in butyrate-secreting bacteria which is extremely beneficial to several body systems.

Onions, garlic, and leeks

Onions, garlic, leeks, and other members of the allium family offer concentrated doses of fructo-oligosaccharides, some of the best-studied and most beneficial fermentable prebiotic fibers in the plant kingdom. Plus, they’re delicious, and humans have been eating them for thousands of years (if not longer).

Some people will react poorly to some of the foods listed in the “Best” section. If your gut health is compromised and your gut bacteria dysfunctional, you may very well have trouble consuming fermentable fiber, resistant starch, berries, and other fibrous foods without bloating, gas, stomach pain, constipation, and diarrhea. Please read my article on FODMAPs to understand how to work around this issue and maintain your gut health.

Thanks for reading, everyone. If you have any questions about gut health or the info contained in this post, let me know down below!

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References

Bell DS. Changes seen in gut bacteria content and distribution with obesity: causation or association?. Postgrad Med. 2015;127(8):863-8.
Tordesillas L, Gómez-casado C, Garrido-arandia M, et al. Transport of Pru p 3 across gastrointestinal epithelium – an essential step towards the induction of food allergy?. Clin Exp Allergy. 2013;43(12):1374-83.
Perrier C, Corthésy B. Gut permeability and food allergies. Clin Exp Allergy. 2011;41(1):20-8.
Foster JA, Mcvey neufeld KA. Gut-brain axis: how the microbiome influences anxiety and depression. Trends Neurosci. 2013;36(5):305-12.
Hidalgo-cantabrana C, Gómez J, Delgado S, et al. Gut microbiota dysbiosis in a cohort of patients with psoriasis. Br J Dermatol. 2019;181(6):1287-1295.
Allen JM, Mailing LJ, Niemiro GM, et al. Exercise Alters Gut Microbiota Composition and Function in Lean and Obese Humans. Med Sci Sports Exerc. 2018;50(4):747-757.
Petersen C, Wankhade UD, Bharat D, et al. Dietary supplementation with strawberry induces marked changes in the composition and functional potential of the gut microbiome in diabetic mice. J Nutr Biochem. 2019;66:63-69.
Marques C, Fernandes I, Meireles M, et al. Gut microbiota modulation accounts for the neuroprotective properties of anthocyanins. Sci Rep. 2018;8(1):11341.
Lee S, Keirsey KI, Kirkland R, Grunewald ZI, Fischer JG, De la serre CB. Blueberry Supplementation Influences the Gut Microbiota, Inflammation, and Insulin Resistance in High-Fat-Diet-Fed Rats. J Nutr. 2018;148(2):209-219.
Pan P, Lam V, Salzman N, et al. Black Raspberries and Their Anthocyanin and Fiber Fractions Alter the Composition and Diversity of Gut Microbiota in F-344 Rats. Nutr Cancer. 2017;69(6):943-951.
Mcnulty NP, Yatsunenko T, Hsiao A, et al. The impact of a consortium of fermented milk strains on the gut microbiome of gnotobiotic mice and monozygotic twins. Sci Transl Med. 2011;3(106):106ra106.
Haenen D, Zhang J, Souza da silva C, et al. A diet high in resistant starch modulates microbiota composition, SCFA concentrations, and gene expression in pig intestine. J Nutr. 2013;143(3):274-83.
Martínez I, Kim J, Duffy PR, Schlegel VL, Walter J. Resistant starches types 2 and 4 have differential effects on the composition of the fecal microbiota in human subjects. PLoS ONE. 2010;5(11):e15046.
Liu Z, Lin X, Huang G, Zhang W, Rao P, Ni L. Prebiotic effects of almonds and almond skins on intestinal microbiota in healthy adult humans. Anaerobe. 2014;26:1-6.
Ukhanova M, Wang X, Baer DJ, Novotny JA, Fredborg M, Mai V. Effects of almond and pistachio consumption on gut microbiota composition in a randomised cross-over human feeding study. Br J Nutr. 2014;111(12):2146-52.
Gibson GR. Dietary modulation of the human gut microflora using prebiotics. Br J Nutr. 1998;80(4):S209-12.

 

The post 6 Signs of an Unhealthy Gut, 7 Likely Causes & the Best Foods for Gut Health appeared first on Mark’s Daily Apple.

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For the vast majority of human history (and prehistory), men, women, and children had near-constant contact with the natural world around them. They were walking on the ground. They were playing in the dirt. They were digging for roots and grubs. They were eating with their hands. They were field dressing animals and wiping their hands on the grass. Nothing was sterilized; the tools to sterilize the environment didn’t exist. You could boil water, but that was about it. Bacteria were everywhere, and humans were constantly ingesting it. Even as babies, preindustrial infants nursed for almost four years, so they were getting a steady source of breastmilk-based probiotic bacteria for a good portion of their early lives.

The Agricultural Age: Farms and Fermented Foods

After agriculture and animal husbandry hit the scene, human diets changed, but their environmental exposures didn’t so much. Every day they interacted closely with the soil and/or animals (and their respective bacteria). And they also continued ingesting probiotic bacteria on a regular basis through the use of fermented food—for at least the last 10,000 years. Honey into mead, grains into beer, fruit into wine, alcohol into vinegar.

We know that fermented dairy has been an integral part of any traditional dairy-eating culture because fermentation is the natural result of having milk around without refrigeration. You take raw milk and leave it out for a couple days at room temperature, and it will begin to separate and ferment. Introduce an animal stomach and you can make cheese. Introduce specific strains of bacteria, and you can make yogurt or kefir. But the point is that dairy fermentation—and, thus, the consumption of dairy-based probiotics—was unavoidable in pre-industrial dairy-eating societies.

In areas without (and some with) dairy consumption, they fermented plants. Kimchi, sauerkraut, pickles, chutneys, soy sauce, miso, and natto are just several examples among hundreds.

Modern Diets, Modern Environments

Here’s my point to all this: probiotics in one form or another have been a constant input in the human experience… until today.

Today? We live sterilized lives.

  • We wipe everything down with anti-microbial agents.
  • We wash all our plates and eating utensils with ultra-hot water and powerful soaps.
  • We wear shoes.
  • We don’t touch (or see) dirt for days, weeks at a time.
  • We stay indoors most of the day.
  • We pasteurize our dairy. We render shelf-stable (and thus inert) our sauerkraut and pickles.
  • We sterilize our water.
  • We take antibiotics.
  • We eat processed, refined food that’s been treated with preservatives and anti-microbial additives designed to remove all traces of bacteria.
  • We employ tens of thousands of scientists, bureaucrats, and agents whose primary role is to ensure our food supply is as sterile as possible.

I get all that. There are good reasons for doing all these things, and on the balance I’d of course rather have clean water, clean food, and antibiotics than not, but there are also drawbacks and unintended consequences. We live in a sterile world, and our guts weren’t built for a sterile world. They’re meant to house a diverse array of bacteria.

What Are the Consequences Of Living a Sterile Life?

Hippocrates, the father of medicine, said that “all diseases originate in the gut.” The most obvious example, digestive issues, are some of the most common in the post-industrial world. Constipation, diarrhea, bloating, and general digestive distress affect tens of millions. Food intolerances and allergies, which also have a link to gut health, are rising.

Even conditions that aren’t intuitively linked to gut health, like autism or hay fever or even heart disease, may actually have a connection with the state of our guts or digestion.

At least since Biblical times (and probably earlier), humans have identified a connection between the gut and our emotions. “I’ve got a gut feeling…” or “I feel it in my gut.” Though it’s usually portrayed as “merely metaphor,” this connection isn’t spurious and can feel quite real. Remember when you held hands with that pretty girl or handsome guy for the first time? You felt those butterflies in your gut. Or how you had to rush to the bathroom before giving that big talk in front of your college class? You felt the nervousness and anxiety in your gut.

Evidence is accumulating that our gut bacteria can manufacture and synthesize neurotransmitters like serotonin and GABA, and even sex hormones like testosterone. We’ve even identified a legitimate physiological pathway running from the gut to the brain and back again. Couple that with the fact that gut health seems to play a role in depression, anxiety, and other related conditions, and it starts looking like our lack of exposure to probiotic bacteria could be triggering (or at least exacerbating) the rise in mental health issues.

Supporting Our Guts In the Age of Sterility

The foundation of gut health has to be diet: 1) Eating fermented foods to provide probiotic bacteria and 2) eating plant and animal foods that provide prebiotic substrate to feed and nourish those bacteria. That’s been the way of humans for tens of thousands of years—from ingesting soil-based and animal-based bacteria on the food we ate as foragers to directly producing and consuming fermented food—and it should remain the primary mode of probiotic procurement.

But there’s also a place for probiotic supplementation. Food alone probably can’t atone for the sterile existence we’ve built for ourselves. Food alone can’t counteract the several years of breastfeeding you didn’t get, the dirt you didn’t play with, the antelope colons you didn’t handle with bare hands, the untreated water you didn’t drink. You may get it now, but what about ten years ago? What about when you were a kid?

Evolutionarily novel circumstances often require evolutionarily novel responses to restore balance.

And probiotics aren’t even that “novel.” We’re clearly designed to consume probiotics in the food we eat, and probiotic supplements utilize the same ingestion pathway, especially if you consume them with food. The dosages may sound high. Primal Probiotics, the one I make (and take), contains 5 billion colony forming units (cfu, a measure of bacteria that are able to survive digestion and establish colonies in the gut) of good bacteria per dose—but that’s right in line with (or even well under) the dose of probiotics found in common fermented foods.

A single milliliter of kefir can have up to 10 billion cfu.

A cup of yogurt can contain up to 500 billion cfu.

A tablespoon of sauerkraut juice can contain 1.5 trillion cfu. Kimchi is probably quite similar.

A single gram of soil can contain almost 10 trillion cfu. A gram of soil is easy to consume if you’re eating foods (and drink water) directly from the earth.

Now, Primal Probiotics isn’t the only option. It may not even be the best option if you have specific conditions that other strains are particularly adept at addressing. (I’ll cover this in a future post.) But the way I designed Primal Probiotics was to be a good general, all-purpose probiotic with particular applications for Primal, keto, and other ancestrally-minded people living their modern lives.

For instance, one of my favorite strains I’ve included is Bacillus subtilis, the very same bacterial strain that’s found in natto, the traditional Japanese fermented soybean. B. subtilis addresses many of the issues we face in the modern world. It helps break down phytase in the gut and turn it into inositol, an important nutrient for brain and mood and stress. It helps convert vitamin K1 (from plants) into vitamin K2 (the more potent animal form of the vitamin). It can even hydrolyze wheat and dairy proteins to make them less allergenic.

There’s also Bacillus clausii, an integral modulator of the innate immune system (PDF)—the part of the immune system that fights off pathogens, toxins, and other invading offenders. Innate immunity is ancient immunity; it’s the same system employed by lower organisms like animals, plants, fungi, and bacteria. It’s the foundation of what we know as the immune response. What’s funny is that B. clausii has such a powerful effect on our innate immunity that one could argue B. clausii is an innate aspect of our gut community.

I’ve also included a small amount of prebiotic substrates in the latest iteration. I use raw potato starch (for resistant starch) and a blend of fructooligosaccharides and galactooligosaccharides. The prebiotic doses are low enough that they shouldn’t exacerbate any gut problems or FODMAPs intolerances and high enough to provide enough food for the probiotics to flourish.

Again, you don’t have to take Primal Probiotics. It’s my opinion that they provide the perfect combination of strains for most people’s needs, especially when combined with regular intakes of fermented veggies like sauerkraut and fermented dairy like yogurt, cheese, and kefir, but the actual strains themselves aren’t proprietary. You can find them elsewhere if you want to get individual probiotics. Hell, you may not even need a probiotic supplement. Depending on your personal health background, the level of sterility in your life history and current life (if you grew up on a farm drinking raw milk, for example), and the amount of fermented foods you currently consume, you may not need supplemental assistance.

But it’s sure nice to have around.

Anyway, that’s it for today.

How do you get your probiotics? Do you find them necessary for optimum health? What kind of benefits have you experienced from taking probiotics, either via food or supplementation?

Thanks for reading, everyone. Take care.

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The post Life In the Sanitized Bubble (Or Why Probiotics Are So Important) appeared first on Mark’s Daily Apple.

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Holly Perkins is a well-respected fitness expert who uses fitness to help her clients improve their emotional well-being. Holly is really into gut health (wait until you hear her research on “fecal transplants!”) and how it correlates with depression and anxiety — and her passion for this topic is personal. After spending much of her life on and off different antidepressants along with therapy, she discovered that she had an allergy to grains and dairy. Turns out, that allergy was exacerbating her depression and anxiety symptoms, and by eliminating those items from her diet, she found herself functioning better than…

The post Podcast Ep 116: Fitness Expert Holly Perkins appeared first on Fit Bottomed Girls.

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For today’s edition of Dear Mark, I’m answering three questions. First up, what can a person do to help their gut recover its barrier function after too many antibiotics? Are there any foods, supplements, or dietary strategies? Second, what can explain rapid fatigue during sprint sessions on a keto diet? Is this simply part of the deal, or are there modifications you can make? And finally, what do I do when I know I’m going to get a bad night’s sleep?

Let’s go:

Mark – any idea how to cure leaky gut caused by overuse of antibiotics. Tried raw dairy for a month to no avail.

First of all, check out my post on leaky gut. Read through it and follow my suggestions for preventing and treating intestinal permeability. It’s a great place to start.

Then, let’s look at some other interventions that have been shown to improve recovery from antibiotic therapy. While most of the studies referenced don’t explicitly describe antibiotic-induced leaky gut, anything that improves gut function and restores healthy gut bacteria will also normalize leaky gut—since it’s the eradication of native gut bacteria that causes antibiotic-induced leaky gut.

Fermented dairy. You tried raw dairy. What about fermented dairy? While raw dairy has its merits, it’s fermented dairy that just works for recovery from antibiotics. Yogurt is a good option to try, although the evidence is a bit inconsistentKefir is probably better; it’s been shown to improve patients’ tolerance to triple antibiotic therapy during treatment for H. pylori infection. This is even worth consuming during antibiotic therapy, as many of the probiotic bacteria found in fermented dairy show resistance to common antibiotics.

Fermented vegetables like sauerkraut are also must-eats. The fermented cabbage contains ample amounts of L. plantarum, a bacteria strain that’s been shown to prevent antibiotic-related diarrhea in piglets (another omnivorous mammal). Good options exist in stores (check the refrigerated section; shelf-stable pickles and kraut aren’t lactofermented), and even more are available in farmer’s markets, but the best way to get the most bacteria-rich vegetable ferments is to make your own.

Supplemental probiotics are fantastic here, too: large doses of the desired microorganisms delivered directly to your gut. Some of the strains used in Primal Probiotics, like B. clausii and S. boulardii, have been shown to be effective against antibiotic-related diarrhea, so that could be a good choice.

Don’t forget the food for your gut bugs: prebiotics. You need to eat fermentable fibers and other prebiotics like resistant starch to support the growth and maintenance of the helpful bacteria that improve gut barrier function. Consider eating cooked and cooled potatoes, unheated potato starch, leeks, garlic, onions, green bananas, apples, pears, berries, and pretty much any fruit or vegetable you can get your hands on. Plenty of them are low-carb enough to work on a keto diet, if that’s your desire. Oh, and dark chocolate is a great source of fiber and polyphenols, which have prebiotic effects in the gut.

Incorporate intermittent fasting. Going without food for a spell gives your gut a break and induces autophagy, which can help with tissue healing.

Get dirty, too, to introduce potentially helpful bacteria. Go out and garden. Go barefoot at the park (do your due/doo diligence, of course) and practice tumbling, or roughhouse with your kids (or friends). Don’t immediately rush to wash your hands all the time (unless you’ve been handling raw meat and/or dog poop).

Whatever you do, don’t stress too much about the antibiotics you had to takeStress is awful for gut health and you’ve already taken the antibiotics—which were probably necessary—so that ship has sailed.

If probiotics with prebiotics aren’t helping (or making things worse), you might want to try going the opposite direction—removing all plant foods and doing a carnivore diet for a few weeks. While I have doubts about the long term viability and safety of eschewing all plant foods, enough people have written to me about their great experiences resolving gut issues with a bout of carnivory that it’s worth trying.

When on a strict keto plan, why do I become so quickly fatigued while attempting a HIT sprint workout?

The first five seconds of a sprint are primarily powered by phosphocreatine (or creatine phosphate), a “quick burst” energy source that burns hot but disappears quickly. This is the stuff used to perform max effort Olympic lifts, short sprints, and other rapid expressions of maximum power. It doesn’t last very long and takes a couple minutes to replenish itself. A keto diet doesn’t affect our creatine phosphate levels. If anything, it should improve them if we’re eating meat.

After five seconds, anaerobic metabolism of muscle glycogen provides the lion’s share of your energy needs. The longer your sprint, the more glycogen you’ll burn. The less glycogen you carry in your muscles, the shorter your sprint. Because once you run out of creatine phosphate and glycogen, you’re left with aerobic metabolism—great for longer distances, not so great for max effort sprints.

Keto dieters tend to walk around with less glycogen in their muscles. If that’s the case, longer sprints will be harder.

If you want to keep sprinting:

Do shorter sprints. Try a 10-second hill sprint rather than a 20-second one. Really go hard. Heck, you can even do 5-second sprints and derive major benefits; just do more of them and make sure to recover in between. There’s no rule saying you have to sprint for 20-30 seconds.

Take longer rest periods. Give your muscles a chance to replenish more creatine phosphate (and take creatine or eat red meat and fish, which are the best sources of dietary creatine).

Eat 20-30 grams of carbs 30 minutes before a sprint session. See if it helps. Alternatively, you can eat the 20-30 grams of carbs after the sprint session to replenish lost glycogen stores (without really impacting your ketone adaptation, by the way).

Most people figure out their sprinting sweet spot while doing keto. They may have to play around with the dosages, durations, and rest periods, but you can usually make it work. Be open to trying new permutations.

If you knew you were going to have a poor nights sleep, what measures would you take to reduce some of the damage?

I would exercise hard that night. Normally, a bad night’s sleep tanks your insulin sensitivity the next day, giving you the insulin resistance and glucose tolerance of a diabetic. A good hard interval session the night before a bad night’s sleep, however, counters the next-day insulin resistance.

I would make the most of it. Don’t dawdle. Don’t beat yourself up because of the impending sleep deprivation. It’s going to happen. You have to accept it, not let it destroy you.

Enjoy it. A little-known acute treatment for depression is sleep deprivation. That’s right: a single night of sleep deprivation has been shown to ameliorate depression in patients with clinical depression. Sometimes the effect lasts up to several weeks. It’s not a long term or sustainable fix for clinical depression, obviously, and you can’t do it every single night—chronic sleep deprivation is a major risk factor for developing depression—but it can improve your mood if you give in to it.

I would set out a jar of cassia cinnamon. I always add cassia cinnamon to my coffee in the morning after bad sleep; cassia cinnamon the day after a bad night’s sleep attenuates the loss of insulin sensitivity and glucose tolerance.

That’s it for today, folks. Thanks for writing in and reading! If you have any input on today’s round of questions, let me know down below.

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References:

De vrese M, Kristen H, Rautenberg P, Laue C, Schrezenmeir J. Probiotic lactobacilli and bifidobacteria in a fermented milk product with added fruit preparation reduce antibiotic associated diarrhea and Helicobacter pylori activity. J Dairy Res. 2011;78(4):396-403.

Bekar O, Yilmaz Y, Gulten M. Kefir improves the efficacy and tolerability of triple therapy in eradicating Helicobacter pylori. J Med Food. 2011;14(4):344-7.

Erginkaya Z, Turhan EU, Tatl? D. Determination of antibiotic resistance of lactic acid bacteria isolated from traditional Turkish fermented dairy products. Iran J Vet Res. 2018;19(1):53-56.

Yang KM, Jiang ZY, Zheng CT, Wang L, Yang XF. Effect of Lactobacillus plantarum on diarrhea and intestinal barrier function of young piglets challenged with enterotoxigenic Escherichia coli K88. J Anim Sci. 2014;92(4):1496-503.

Jitomir J, Willoughby DS. Cassia cinnamon for the attenuation of glucose intolerance and insulin resistance resulting from sleep loss. J Med Food. 2009;12(3):467-72.

The post Dear Mark: Antibiotic Recovery, Sprinting on Keto, Preparing for Bad Sleep appeared first on Mark’s Daily Apple.

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I have a confession to make: I, Mark Sisson, suffer from keto crotch.

It’s embarrassing, really. I thought maybe it was just the change in climate moving from Malibu to Miami—the humidity, the heat, the fact that I’m paddling and swimming more often now. There’s a whole lot of moisture down there. Perpetual steaminess.

But then I met up with my writing partner and good pal Brad Kearns, who’s been working with me on my upcoming book. Brad lives in Northern California, which is far from hot or humid right now. He’s also a staunch keto guy most of the time, and, well, let’s just say I could smell him before I could see him. We met up at a coffee shop and cleared out everyone in a fifteen foot radius. We sampled a new exogenous ketone product he’s been trying and not one, not two, but three separate individuals approached to inquire if we were salmon fishermen.

Okay, let’s get serious. Does “keto crotch” really exist? And, if it does, what can you do to prevent it?

I’m writing this not because of overwhelming demand from loyal followers of the Keto Reset plan. In fact, I hadn’t ever heard of “keto crotch” before last week. There’s a good chance almost no one heard of it before March 2019, if Google Trend data for “keto crotch” searches is any indication. I’m writing this post because the barrage of news articles, Twitter hashtag campaigns, and extremely serious warnings from people with lots of acronyms after their name has led people to ask me if it’s a legitimate phenomenon. A few acquaintances have brought it up in social situations. Our marketing director found herself fielding keto crotch questions at a dinner for Expo West last week.

So, are women following a ketogenic diet experiencing an epidemic of stinky vaginas?

Probably not.

Is Keto Crotch Even Physiologically Plausible?

Vaginal odor does change. It fluctuates naturally, and sometimes it can get worse. The most common cause of unpleasant changes to vaginal odor is bacterial vaginosis, which occurs when something upsets the balance between the beneficial lactobacilli bacteria that normally live in the vagina and pathogenic bacteria. What can upset the balance?

The vagina is supposed to be an acidic environment; that’s how the healthy lactobacilli thrive. If something upsets that pH balance, tilting it toward alkalinity, unhealthy bacteria gain a foothold and become predominant, and begin producing unpleasant-smelling amines like putrescine, tyramine, and cadaverine. This is bacterial vaginosis. As it turns out, the lactobacilli bacteria normally present in the vagina are instrumental in maintaining an acidic pH. They consume glycogen, spit out lactic acid, and exert antimicrobial and antifungal effects that block common vaginal pathogens like candida, e. coli, and gardnerella from taking hold and causing trouble.

The interaction between diet and vaginal biome is understudied. To my knowledge, there exist no direct controlled trials that address the issue. It’d be great to have a study take a cohort of women, split them up into different dietary groups, and follow them for a year,  tracking their vaginal pH and bacterial levels. Alas, we do not.

We do have a study that provides a hint. In 2011, researchers looked for correlations between dietary patterns and bacterial vaginosis in a cohort of nearly 2000 non-pregnant mostly African-American women aged 15-44. While there probably weren’t many keto dieters, and the diets as a whole were of the standard American variety, glycemic load—which basically boils down to carb load—was the strongest predictor of bacterial vaginosis. Other markers of food quality, like a person’s adherence to “healthy eating guidelines,” initially seemed to reduce the chance of bacterial vaginosis, but those relationships were almost abolished after controlling for other factors. Only glycemic load remained highly significant.

This connection between dietary glycemic load and bacterial vaginosis starts looking more causal when you realize that diabetes—a disease where one’s “glycemic load” is perpetually elevated and exaggerated—is another risk factor for bacterial vaginosis.

There’s also a 2007 study that found “high” intakes of dietary fat, particularly saturated and monounsaturated fat, were a significant predictor of bacterial vaginosis. In this study, “high fat” meant around 39% of energy from fat. That leaves 61% of energy from carbohydrate and protein, the kind of “high-fat, high-carb” Standard American No-Man’s-Land that’s landed the country in the current metabolic predicament. High-fat intakes in the presence of high-carb intakes may very well be bad for your vagina, but it says nothing about the likelihood of keto crotch.

At any rate, neither study was a controlled trial, so we can’t say anything about causality.

What about a yeast infection? The most common offender is candida, which usually favors sugar for fuel, but there’s also evidence that it can metabolize ketones. Could keto make a latent yeast infection worse and lead to smelly “keto crotch”?

Perhaps keto can make candida worse (that’s for another day), but that’s not the cause of “keto crotch.” Candida vagina infections don’t smell very much, if at all, and they certainly don’t smell “fishy.” That’s only caused by bacteria and the aforementioned amines they can produce.

Free glycogen levels in vaginal fluid are a strong predictor of bacterial vaginosis. If ample glycogen is available, the good lactic acid bacteria have plenty of food and produce plenty of lactic acid to maintain the acidic pH conducive to vaginal health. If inadequate glycogen is present, the lactic acid bacteria have less food and produce less lactic acid, increasing the chances of the pH tilting toward alkalinity. An alkaline vagina is a vagina where pathogenic bacteria—the ones that produce stinky amines—can establish themselves.

The question then is if ketogenic diets lower free glycogen in the vaginal fluid. That’s a fair question. I wasn’t able to find any solid answers. I guess “ketosis effect on vaginal glycogen” isn’t the most lucrative avenue of scientific inquiry.

Should I Worry?

Even assuming this is a real phenomenon, it’s a rare one. The vast, vast majority of people following a ketogenic diet aren’t coming down with keto crotch. Other than a few Reddit posts from the past 5 years, I haven’t seen anyone at all in our neck of the woods complain.

Maybe people doing Primal keto are eating more nutrient-dense ketogenic diets than people doing conventional (or caricature) keto. Salads, steaks, eggs, and lots of non-starchy veggies are a great way to stay keto and obtain micronutrients. And there are links between micronutrient status and bacterial vaginosis. The most common relevant deficiencies include vitamin D (correcting the deficiency can cure the vaginosis) and folate. Hard to get adequate folate if your diet is based on salami and cream cheese.

We also know that the health of your skin biome tracks closely with that of your gut, and that eating plenty of non-starchy veggies, fermented foods (yogurt, kefir, sauerkraut, kimchi, etc), and colorful produce can provide prebiotic fiber, prebiotic polyphenols, and probiotic bacteria that nourish your gut biome. If the vaginal biome is also connected to the gut biome (and it is), tending to the latter should also have positive effects on the former.

The Primal brand of keto tends to emphasize micronutrients and gut health a bit more than some other types of keto I see floating around. If—and it’s a very big “if”—keto crotch is legit, that may explain some of the discrepancy.

Finally, be sure to check out this very interesting Twitter thread where the author lays out his suspicions that the whole “keto crotch” phenomenon might be a manufactured stunt designed to vilify the ascendant ketogenic diet. Nothing definitive, but it’s certainly food for thought.

If You’re Concerned…

Okay. Say you’ve recently gone keto and your vagina is smellier than usual. (And you’ve ruled out other, more obvious potential causes like changes in soaps, etc.) It’s hard to ignore, and I wouldn’t want you to. What can you do?

  • Confirm that you have bacterial vaginosis. Seriously, get it checked out.
  • Make sure you’re getting enough folate and vitamin D. Supplement if need be.
  • Eat prebiotics and probiotics. Fermented food and/or a good probiotic supplement.
  • Try a carb refeed. If ketosis depletes vaginal glycogen and increases pH, the occasional carb refeed could restore glycogen by 30-50 grams and should do the trick. Note that this is entirely theoretical; I’m not saying it’s a “problem” on keto.
  • Hang out in the keto zone. I’ve written about the keto zone—that metabolic state where you’ve reached full keto and fat-adaptation and find yourself shifting in and out of ketosis as you please due to increased metabolic flexibility. A few carbs here, a fasting day there, a few more days of keto. Again, if full keto is theoretically depleting vaginal glycogen, maybe relaxing your restrictions will solve the issue while maintaining your fat adaptation. This is actually where I hang out most of the time.

That’s it for today, folks. Do you have “keto crotch”? Do you know anyone who does? Or did your vaginal health improve on keto? I’m curious to hear what everyone’s experiences have been, so don’t be shy.

Take care and be well.

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References:

Thoma ME, Klebanoff MA, Rovner AJ, et al. Bacterial vaginosis is associated with variation in dietary indices. J Nutr. 2011;141(9):1698-704.

Kalra B, Kalra S. Vulvovaginitis and diabetes. J Pak Med Assoc. 2017;67(1):143-145.

Taheri M, Baheiraei A, Foroushani AR, Nikmanesh B, Modarres M. Treatment of vitamin D deficiency is an effective method in the elimination of asymptomatic bacterial vaginosis: A placebo-controlled randomized clinical trial. Indian J Med Res. 2015;141(6):799-806.

Dunlop AL, Taylor RN, Tangpricha V, Fortunato S, Menon R. Maternal vitamin D, folate, and polyunsaturated fatty acid status and bacterial vaginosis during pregnancy. Infect Dis Obstet Gynecol. 2011;2011:216217.

The post The Curious Phenomenon of “Keto Crotch” appeared first on Mark’s Daily Apple.

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