Wednesday, October 19, 2011

PREBIOTICS: Food for Healthy Gut Flora

Prebiotics are the dietary soluble fibers that the good gut bacteria ferment into short chain fatty acids (SCFA) which have many beneficial effects in the human body, including reducing inflammation. They create conditions that favor healthy gut flora, especially probiotic bacteria from the bifidobacteria and lactobacillus genus.  To be clear, prEbiotics feed prObiotics.

Munching your bowl of Raisin Bran, you may think you are getting your daily fiber, but the scant amount of fiber in our diets is mostly insoluble fiber or roughage which is not nearly as beneficial as soluble fiber. The average American eats only 3-4 grams a day of soluble fiber. Most sources recommend at least 5-10 grams of soluble fiber a day with a warning to slowly build the amount of fiber in the diet as it might cause uncomfortable gas and/or diarrhea if you eat too much before your system adjusts. This seems like a paltry amount in view of the latest findings about our Paleolithic ancestors. Archeological finds in the desserts along today’s Texas-Mexican border reveal that prehistoric man ate an estimated 135 grams a day of prebiotic soluble fiber. Could our drastically reduced consumption of dietary soluble fiber in modern times explain the current epidemic of chronic diseases like obesity, diabetes, heart disease and cancer?  Let's look at the known benefits of soluble fiber:

Benefits of Prebiotic Soluble Fiber
  1. Promotes the growth of beneficial probiotic bacteria and discourages the overgrowth of pathogenic bacteria.
  2. Slows absorption of glucose and reduces insulin resistance improving blood sugar control. May prevent diabetes and other metabolic disorders.
  3. Improves lipid profile lowering LDL cholesterol and triglycerides while raising HDL cholesterol which may reduce the risk of heart disease.
  4. Prevents inflammation of the intestinal lining and leaky gut syndrome. May prevent or improve chronic inflammation.
  5. Helps regulate the immune system preventing infections and autoimmune disorders like allergies, asthma and eczema, and serious autoimmune diseases.
  6. Stimulates intestinal fermentation of soluble fiber into short-chain fatty acids, like butyrate, which may be the root cause of the above mentioned benefits.
You may recall my story of the lab rats which were shown to convert soluble fiber into short chain fatty acids (SCFA), especially butyrate. Higher levels of butyrate measured in human feces are the main indicator of good gut health. As the healthy bacteria flourish in the intestine, they occupy the forest of hair-like protrusions called villi that line the intestine, and keep the bad bugs out of the neighborhood. By producing butyrate, the probiotic micro-organisms signal the immune system that all is well and restore balance preventing any autoimmune attacks that might lead to chronic inflammation in a confused and unbalanced gut environment.

So, how does modern man get more soluble fiber into our diet to get our gut flora back to Eden?

Normal Dietary Sources of Soluble Fiber
As previously stated, the standard American diet (SAD) does not contain much soluble fiber. Among the common foods, the best sources of soluble fiber are: beans, peas, lentils, barley, oat bran, sweet potatoes, onions, garlic, broccoli, citrus fruit, pears and apples. Frankly, it would be hard to get more than five grams a day of soluble fiber eating these foods. For a diabetic, many of these foods contain too much carbohydrate that might adversely affect one’s blood glucose levels. If you are concerned about good gut health, consider adding specialized soluble fibers known to be concentrated sources of prebiotic fiber.

The two prebiotics that are most commonly used as supplements are FOS (fructo-oligosaccharides) and inulin which is usually extracted from chicory root or Jerusalem artichoke. These are powerful prebiotics, so I would not attempt any prehistoric doses at the onset. I read that a therapeutic dose could be over 20 grams/day, but one should start much lower. So, I took 2 grams the first day and 20 grams on the second day. Wow! Talk about a gut feeling. My relationship with my wife was less than harmonious as she was serenaded all night by the wind section.

Some bacteria also makes hydrogen and methane when they ferment soluble fiber and some bacteria consume hydrogen and methane. It takes awhile for the trillions of bacteria in our gut to adapt to their new roles. I recommend starting by adding just 1 gram of FOS and/or inulin to your dailly coffee, tea or favorite beverage ... and gradually ramping up. FOS and inulin are slightly sweet and water soluble. They are often blended with artificial sweeteners to provide a more balanced sweetness and better mouth feel.

I now consume at least 10 grams a day of FOS and 15 grams a day of inulin.  FOS ferments relatively fast in the upper portion of your intestine while inulin ferments more slowly in the lower sections of your intestine.  Combining these two powerful prebiotics distributes the benefits throughout your gut ... and I feel great!  Despite my conscious effort to consume more prebiotic soluble fiber, my experiments have shown that if I attempt to eat paleolithic levels of soluble fiber (>100 grams/day), I will still suffer flatulence and diarrhea.  It appears that some of the super probiotic bugs that inhabited our paleolithic ancestors' guts may now be extinct.  Again, gradualism and moderation is the way to approach prebiotics.  I also believe in a diverse source of soluble fiber in the diet.

Psyllium seed husk is the premier source of the soluble fiber mucilage. It is 71 percent mucilage and nine percent insoluble fiber. It is sold as the popular bulking agent Metamucil which is used principally as a laxative. Some of the best food sources of mucilage are flax seed and chia seed which can both be ground as a flour and used as a wheat flour substitute for low net carb and high fiber baked goods. Very tasty. Okra, called Lady Fingers in parts of Asia, is a vegetable that is high in mucilage. Several cacti are rich sources including aloe vera and agave. Fenugreek, a seed used as a seasoning in Indian food, is another good source. Kelp consumed as a sea vegetable has lots of mucilage as well as iodine and carrageen is another seaweed source derived from Irish Moss. Slippery elm bark, which is an herbal remedy for many gastrointestinal disorders, has mucilage as its primary active ingredient.

This prebiotic fiber can be found in small amounts in some fruits and vegetables. Commercial pectin is derived from citrus peel which is about 30% pectin and the pomace that is left after apples are pressed for juice or cider. Pectin is used as a gelling agent in jams and jellies and as a thickener in many processed foods. Pectin sold for making jams and jellies often has added sugar, but it can also be found in its pure form as a nutritional supplement.

Many gums are used by the food processing industry as jelling agents and thickeners. The most common are guar gum, gum Arabic (acacia senegal gum) and xanthan gum. They are also sold as gluten substitutes for people who have gluten intolerance to use in baked goods.  Some Celiacs, however, cannot tolerate these gums. People with sensitive guts sometimes find these vegetable gums irritating, so I no longer recommend them.

The prebiotic fiber beta-glucan is regarded as very effective for modulating immune response. Extracts derived from bakers’ yeast and some medicinal mushrooms are marketed as nutritional supplements. Reshi, Maitake and Shiitake mushrooms are Asian culinary delicacies especially high in beta-glucan that are noted for their medicinal effects. Oat bran and barley are a more common source of beta-glucan but also contain a large amount of starch which quickly converts to glucose in the body.

The soluble fiber gluccomannan comes from the konjac root, a yam-like tuber. Its flour is used to make noodles and fruit jellies in Asia. Because of its ability to quickly absorb lots of water, it is sometimes used as a weight loss supplement that gives one a feeling of fullness. This same characteristic has resulted in some rare instances of capsules of glucomannan expanding too quickly in the body resulting in dangerous blockages. It is best consumed as the traditional Asian translucent noodle called "shirataki" in Japan and "mo yu" in China which is available at most Asian grocers.

Other Non-Starch Polysaccharides
Agar agar is a polysaccharide extracted from red algae that is used as gelling agent (vegetarian gelatin). It is best known as the medium used in petri dishes to grow cultures in labs. It gels liquids at a lower temperature than gelatin and is much firmer. It makes a really great aspic.

Resistant Starches
The principal source of soluble fiber in most Western diets is resistant starch from sources like beans, barley and oats, and to a a lessor extent, whole grains.  These are starches that are not fully digested in the upper intestine and are fermented in the lower intestine.  One problem ... RS is always accompanied by other starches which are quickly metabolized into glucose.  All the above legumes and grains also contain phytic acid which is an anti-nutrient that blocks the absorption of many beneficial nutrients.  Healthy people can eat moderate amounts of legumes and grains, but I know of no resistant starch source which I can recommend to those suffering from obesity, diabetes or any metabolic disorder.

As you cultivate healthy gut flora, think of probiotics and probiotic yogurt as the seed of your emerging health, and prebiotic soluble fiber as the fertilizer to help the good bacteria thrive.  Remember that the opposite of prebiotics is fructose and other simple carbs which are unhealthy nutrients that feed bad bacteria and yeasts.  Unless you are living like a prehistoric hunter-gather in the Chihuahuan Dessert dining on the local cacti, you will be doing very well if you can consume 20+ grams a day of soluble fiber.

Thursday, September 8, 2011

Are You a Wheat Head with a Wheat Belly?

Wheat Belly: Lose the Wheat, Lose the Weight, and Find Your Path Back to HealthIt's been over a year since I first wrote about wheat, and, regrettably, I still am a "wheat head" with a "wheat belly."  Still haven't completely kicked the habit, but the newly published book by cardiologist, Dr. William Davis has inspired me to once again repent of wheat. The good Doc has become even more confident in his anti-wheat crusade. Wheat Belly makes a great case against demonic wheat ... and it's a fun read.

If you doubt that the "staff of life" is the origin of every malady in your life, this will definitely be an engaging read.  I still struggle with the realization that today's hybrid wheat has been transformed into a Frankenfood with the potential to reek havoc with my health.  Mom's fresh baked wholegrain bread right out of the oven ... how could it be bad?

Let's start where we can all agree. The whole world has not turned Celiac. Celiac is an extreme allergic reaction to the gluten in wheat. A friend who was recently diagnosed with Celiac explains that the smallest amounts of gluten can result in severe gut pain, high blood sugar and bad diarrhea if you are truly Celiac. The intestine is lined with fine hair-like protusions called villi which work with the diverse gut flora to extract nutrients from food passing through the intestine. In a Celiac, gluten can completely destroy the gut ecology and flatten the villi like slash and burn agriculture in a delicate Amazonian rain forest. When the lining of your intestine becomes damaged, you develop leaky gut and the inflammation spreads throughout your body creating a state of permanent chronic inflammation which, among other things, will greatly worsen insulin resistance.

Dr. Dawn Motyka explains in her NPR talk show that Celiac is an end-stage gluten sensitivity disease that does not inflict that many people. Not everybody with some degree of gluten sensitivity is Celiac. It can only be conclusively diagnosed by biopsying the small instestine where you will see structural damage. The presence of the antigens associated with gluten sensitivity can only suggest the possibility of Celiac or less serious gluten sensitivity. But even if you are negative for the gluten antigens, you can still have wheat intolerance issues as wheat contains many other allergens.

By the time full-blown Celiac is diagnosed, people have already suffered irreparable intestinal damage. Dr. Kenneth Fine has pioneered new more sensitive tests to detect early stage wheat intolerance.  Initial testing has revealed how shockingly widespread the problem is.  According to Dr. Fine, "Recent research in our laboratory indicates that immune sensitivity to gluten is exceedingly common, present in 30-40% of all Americans. Although these reactions can cause malnutrition, growth failure in children, osteoporosis, many autoimmune diseases (including colitis, diabetes, arthritis, and many others), most of the affected individuals are unaware they have it because there have been no sensitive tests capable of diagnosis."

How do you know if wheat is an issue for you? Like Dr. Davis, I am a Type II Diabetic who can see wheat register on my glucometer every time I consume it.  Nonetheless, Dr. Davis concedes in his Heart Scan Blog that "not everybody needs to go wheat-free. 20-30% of people can include wheat in their diet and suffer little more than weight gain, some not at all."  If any of the following are an issue for you, however, consider wheat as a possible culprit.
  • High blood glucose spike after eating any wheat product
  • Elevated triglycerides
  • Low HDL
  • High C-reactive protein
  • Abdominal obesity (wheat belly?)
  • Alternate bouts of diarrhea and constipation
  • Chronic fatigue, depression and/or mood swings
  • Any other inflammatory disease like rheumatoid arthritis, colitis, lupus, fibromyalgia, pancreatic destruction, etc.
    The elimination diet is the best way to assess a possible wheat intolerance. Don't eat any wheat for 2-3 weeks and see how you feel. There is a problem with doing this. If you have wheat intolerance, the smallest amounts may affect you ... and wheat is everywhere. I remember one Celiac friend trying so hard and finding that his Celiac flared up when he took his wife out for a healthy steak and salad. The cook had dusted the steak with flour before grilling it.

    Wheat products can be very seductive. Dr. B. Gan of the Animal Pharm blog suggests wheat is as addictive as crack cocaine. She claims it actually contains some opioid peptides. Now, I have never smoked wheat or injected it into my veins, but I did find myself sneaking a piece of my three year-old son's pretzel the other day. Then, obviously in a wheat induced delirium, I stole a couple of slices of my wife's bread and made a sandwich. Ahhhhh!

    It's hard to give up wheat for most of us on the 'spectrum'... kinda like giving up narcotics (opioids). The withdrawal won't kill you like alcohol (seizures, DTs) or benzo withdrawal (seizures), but opioid, tobacco, and caffeine cessation share similar characterics with that of wheat cessation. For one, wheat digestion releases several feel-good chemicals called opioid peptides which provide a temporary sensation of satisfaction and satiation (basically a carb dose-dependent 'high'). Studies demonstrate that wheat can actually deliver equivalent doses of morphine. The wheat chemicals are extremely short-lived and their quick drop in the blood concentrations leads to cravings for more wheat/carbs that can be difficult to control.... in fact they can be downright all-consuming and overwhelming for some (even those who work out like mad creatures).   Dr. B. Gan,

    Sadly, Dr. Gan's hyperbole characterizes my own wheat addiction far too accurately.  Should someone ever form a Wheataholics Anonymous, it may be a tougher discipline than AA.  Wheat is insidious.  It's everywhere.  The perfect croissant that seduces you with its Sirens' song as  you order your morning latte.  Or, how about that stealth wheat that lurks in the soy sauce at your favorite Chinese restaurant.  Sure I can eat a salad instead of a sandwich. No brainer.  But my low-wheat lifestyle keeps falling short of 100% wheat-free.  Save me, Dr. Davis!

    In my current struggle to be 100% wheat free, I'm feeling great, but my practice is still too tenuous for me to be to be canonized as a wheat-free saint.  Don't believe me.  Read the Doc's book.

    Monday, January 10, 2011

    Alcohol is Anti-Inflammatory, but …

    I was trying to be good as I celebrated a friend’s birthday last night.  Didn’t touch the French bread, didn’t succumb to the pasta, and steadfastly resisted the cake, but everybody knows that dry red wines are healthy … and I was feeling very healthy as they began to pour the second bottle.

    The truth is that alcohol is anti-inflammatory and the relationship between alcohol consumption and the tendency to have an elevated C-reactive protein number (a measure of inflammation) is a mildly U-shaped curve.  Those that abstain completely from alcohol tend to have a higher CRP than those who drink lightly or moderately.  It is only when one drinks excessive quantities of alcohol that CRP begins to rise.  This anti-inflammatory effect is believed to be the reason that light to moderate alcohol consumption has been shown statistically to be somewhat cardio-protective.  So, drink up, right?

    Hate to spoil the party, folks, but there is another side to alcohol.  Alcohol is a hepatotoxin that messes with our livers.  Like fructose, ethyl alcohol raises triglycerides, contributes to fatty liver, worsens insulin resistance, and promotes obesity in a dose dependant fashion.  There is probably some threshold below which the liver can safely detoxify it, but for people who are overweight or suffer diabetes or some other metabolic disorder, this threshold may be very low.  As fructose and alcohol have an additive effect, the amount of alcohol one can safely consume is diminished by the consumption of sweet foods which contain fructose.

    So, what is the optimal amount of alcohol to consume?  It takes very little alcohol to get the anti-inflammatory effect.  Three to four fluid ounces (90-120 mL) of dry wine or a shot of distilled spirits is probably all it takes.  Most people can probably safely detoxify this much alcohol without hurting their livers.  Anything beyond this will not significantly improve inflammation but will have the aforementioned ill effects on your liver and your metabolism.

    I love fine wines and really hate to be a killjoy, but I believe that the health recommendation should be to drink lightly, that is, one small serving of alcohol per day.  What most of us think of as moderate drinking may be too much for somebody with a metabolic disorder like obesity or diabetes.

    In my own case, I try to limit my combined daily consumption of fructose and alcohol to less than 20 grams a day.  A four ounce glass of wine has about  15 grams of alcohol, a medium apple has about 9 grams of fructose, a 12 oz. can of Coke has 22 grams of fructose, and a piece of birthday cake has about 12 grams of fructose.  I get about 6 grams a day of fructose from the vegetables I eat.  So, if I have a glass of wine, it has to be a small one to meet my goal and I cannot eat any fruit or sweets.

    I am not as disciplined as this blog might suggest.  On some occasions, I choose hedonistic pleasures over health, but let’s at least be honest about how much drinking is healthy.