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.

Oligosaccharides
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.

Mucilage
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.

Pectin
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.

Gums
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.

Beta-glucan
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.

Glucomannan
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.

Glutamine: Reduces Inflammation and Improves Gut Health

L-glutamine is the most abundant amino acid in the human body.  Because we can make it endogenously, it is traditionally called a “non-essential amino acid”, but lately the literature seems to refer to it as a “conditionally essential amino acid” because we have learned that some people, particularly when we are under stress, require more glutamine than our bodies can produce.

Many animal studies and human clinical trials have shown that glutamine can reduce inflammation.  It seems to be especially effective at healing the mucosal lining of the intestine and restoring the hair-like villi which can be severely damage by an inflamed intestinal lining.  It is theorized that glutamine works by restoring the gut barrier and preventing the “leaky gut” syndrome which may result in chronic inflammation spreading throughout the body.

Glutamine is a very safe supplement at doses of <40 grams per day.  A normal therapeutic dose is 5-20 grams a day taken between meals in divided doses.  I generally take 5-10 grams at mid-morning and 5-10 grams at bedtime.  It is available as a capsule or powder.  At the required doses, a powder is probably more convenient and economical.  It is a fine white powder with a slightly sweet taste that is water soluble.  I mix it with water and drink it.

Glutamine is used medically to promote post surgery healing.  It is a popular sports supplement as it promotes the healing of overly stressed muscles and, taken at night on an empty stomach, can stimulate the normal pre-dawn release of human growth hormone.  Some claim that it helps with blood glucose management, but I have seen no research supporting this claim.  Presumably, reducing chronic inflammation should improve many conditions.

Making Super Yogurt – More Probiotics, Less Carb

Is yogurt a healthy diabetic food? Maybe not if you buy it at the supermarket. The tutti-fruity yogurt being marketed as a healthy treat can easily have more carb than a candy bar. Even the “plain” commercial yogurt has 11-13 grams of lactose (milk sugar) per cup. Commercial yogurt has too much carb for diabetics or people trying to lose weight, and all this carb is in the form of highly allergenic lactose which is not for people with autoimmune issues. I strongly encourage you to make your own yogurt that is healthy, low-carb, truly probiotic ... and much tastier!

Commercial yogurt is inferior in five ways:

Additives – Obviously, adding high fructose corn syrup can render any food unhealthy, but even the unsweetened plain yogurts have added carbs. Starches are sometimes used to make a thicker more pudding-like yogurt. Most commercial yogurts have added “milk solids” which increase the amount of lactose. Real yogurt is only made from milk, cream and live bacteria.

Little real probiotic organisms – Popular commercial yogurts usually just contain two yogurt strains that are not true probiotics. Although many yogurts are advertised as having live cultures, the number of live organisms is relatively low. Some commercial yogurts are pasteurized with zero live organisms.
Not fully fermented – Commercial yogurts use an abbreviated lower cost fermentation process (usually just 4-5 hours) that results in less probiotic organisms, more lactose and a less tart insipid taste. 

Not dripped – Most commercial yogurts are not dripped or strained. Only a few specialty Greek style yogurts use some straining. Dripping yogurt further reduces the lactose and makes it thicker.
Not fresh – Yogurt should be eaten within days of being made as most of the live organisms will die within a week even when properly stored in refrigerated conditions.  Yogurt sold in the supermarket is usually several weeks old.

MAKING SUPER YOGURT

1. I use an electric yogurt maker which has a one liter (1.06 quart) glass bowl. After sterilizing the bowl with boiling water to make sure there are no stray bacteria which may taint the fermentation process. I add about ½ cup (125ml) of heavy cream and then fill with whole milk. You can add more or less cream depending on how rich you want your yogurt.

2. Using a microwave oven and a food thermometer, warm the milk to about 85-95° C (180-200° F) to sterilize it. It should be warmer than 82° C (180° F) but no hotter than 93° C (200° F). A layer of scum will form on top which many people skim off believing it will give the finished product a better consistency. I prefer to stir it in so as to not lose any of the milk fat.  Set aside the bowl of hot milk covered by a clean towel until it cools to 108-112° F (42-44° C). 

2b. If you have access to UHT milk, it is safe to use an unopened carton of room temperature UHT milk poured directly into the sterilized bowl without further sterilizing the milk.  This saves  much time

3. Stir in a freeze dried probiotic yogurt starter. I strongly recommend an "ABC" probiotic starter.  What I refer to as "ABC" probiotic starters contain the two normal yogurt strains (L. bulgaricus and S. thermophillus) as well as the truly probiotic strains (A)  L. acidophillus, (B) some strain(s) of Bifidobacterium and (C) L. casei.  In China, there are many probiotic yogurt startes, but in the US, the dominant brand is the Yogourmet Casei Bifidos Acidophillus yogurt starter. These truly probiotic strains have the potential to colonize the gut with healthy gut flora and greatly improve one's health.

4. Ferment the yogurt for a full 24 hours. Traditionally, yogurt is only fermented for 8-10 hours. This longer fermenting time will ferment away most of the lactose. The lactose is fermented into lactic acid which gives yogurt is tart tastes. This Super Yogurt is also super tart, a taste that I like, but others might need to get used to it. The longer fermentation also results in a higher probiotic bacteria count.

5. Drip the yogurt for 1-2 hours to make thick Greek style yogurt or 12-18 hours in the refrigerator to get yogurt cheese with the same consistency as cream cheese. Traditionally, yogurt is dripped through two layers of cheese cloth placed in a colander. I prefer to use two large reusable nylon coffee filters placed in similarly sized containers to catch the liquid that drips off. Throw away the liquid and enjoy the remaining delightfully thick yogurt. By dripping the yogurt, you also further reduce the lactose (carb) and reduce the lactic acid (less sour). Dripping yogurt reduces the volume about 25% for Greek style yogurt and 50-75% for yogurt cheese.

                           

I have not measured the carbohydrate of this yogurt in the lab, but believe it is about 2-3 grams per cup compared to 8-13 grams of carb for plain commercial yogurt.  This 24 hour fermented Super Yogurt is estimated to have an average concentration of 3 billion cfu/ml of live organisms which works out to 750 billion probiotic micro-organisms per cup!

While common yogurt is a healthy food, only yogurt made with truly probiotic starters will greatly improve gut ecology and reduce chronic inflammation.  A fully fermented yogurt made with an "ABC" probiotic starter has the potential to colonize the gut with healthy gut flora.  No comparison with commercial yogurt.  

Grow the Garden

Gut flora sounds so much nicer than intestinal bacteria, don't you think? So many people think of the intestine as a sewer system when in fact it is an amazing garden of diverse micro-organisms and the center of a healthy life.

Like growing a garden, cultivating healthy gut flora can be a slow process. And, yet, bad diet, illness or medicines of mass destruction can destroy it as quickly as the aerial spraying of Agent Orange can wipe out an ancient forest.

Most depictions of the small intestine and the large instestine look like coiled sausages and support the misconception that it is just a bunch of yucky looking plumbing full of waste. Let's take a look inside this much misunderstood miracle.

The lining of the intestine is carpeted in a growth of finger-like protusions called villi. Think a luxuriant and diverse habitat as rich as an Amazonian rain forest ... or, if you want to dive deeper into a metaphor, maybe a vibrant tropical coral reef teaming with life. This is the prime residential real estate in the gut ... garden view ... and where all the bacteria prefer to live. When the bad bacteria or thug bugs take over the neighborhood, things get out of balance and often a confused immune system will destroy the delicate villi in a failed effort to attack the source of the problem. Autoimmune inflammatory bowel diseases are a case of the forest being slashed and burned in a failed action to bring balance to a serious messed up gut environment.

Let's back up and look at what's in the gut besides the villi. People who think the intestine is just full of ... well, you know ... probably are full of it. In a person cultivating good gut health, maybe 75% of the contents of the gut are diverse micro-organisms. In an unhealthy person, maybe only 25%. The human gut contains 10-100 trillion micro-organisms which is a lot more than the total number of human cells in the body. In the words of microbiologist Dr. Jeffrey Gordon, "We are more microbe than man." Hundreds of species, thousands of sub-species, far weightier than the human mind ... we have only just begun to understand the microbial complexity of the human gut.

So, when the doctor prescribes broad spectrum antibiotics to kill the bad bugs and suggests you eat yogurt to minimize the effect of Antibiotic Associated Diarrhea (AAD), here's a good question to ask -- Doesn't most yogurt just have two kinds of bacteria? What about the other 998 species of bacteria we will be killing?

Let's speak in generalities -- good and bad bugs. Your state of health is clearly reflected in the microbial composition of your gut, your gut ecology. Obese people have very different bugs than thin people, and people who suffer chronic disease with the associated chronic inflammation have very different gut flora than healthy people. Allow me to tell a simple tale of good and bad.

Probiotics (the good bugs) are sticky. They love living in the luxuriant villi that line the wall of the intestine and literally stick around this area of the gut. When they establish residence here, there is little available space in the neighborhood for bad bugs like E. coli, Salmonella, Clostridium, Candida yeast, etc. Probiotic organisms also produce substances that create an unfavorable environment for bad bugs and encourage the growth of more good bugs. Finally, the good bugs ferment soluble fiber into the short chain fatty acid (SCFA) butyrate which has many beneficial effects in the gut. It signals the immune system that peace and harmony reigns in the gut and prevents any autoimmune attacks that may lead to chronic inflammation.

The prebiotic fibers that I previously wrote of are like fine dining in the gut environment that only encourage the best of bugs to take up residence. Think of fructose and other simple carbohydrates as the equivalent of crystal meth being distributed in the neighborhood. An evil substance that supports the thug bugs and makes things quickly deteriorate. Probiotics are the outstanding bacteria that you want to daily invite into your body knowing they will bring out the best in your gut's microbial community.

Obviously, the above is a gross simplification, but I hope it gets you thinking about what you need to be doing to grow your garden and be healthy.

Tale of Two Rats – How Fiber Can Make You Beautiful and Healthy

Not an epic novel, my story concerns two rats – a fat rat and a thin rat. Some bored scientists analyze their fecal content and discover they are distinctly different. The gut flora in the fat rat has more of a bacteria called firmicutes (think F for fat) and the thin rat has more bacteriodes (think B for beautiful). Said scientists decide to amuse themselves by performing a fecal transplant. The unsuspecting thin rat gets the fecal content of the fat rat. It’s a tragic story. With no change in diet, the thin rat whose gut flora is now dominated by firmicutes gets fat.

Another two rats, another story. Two thin rats and each has more bacteriodes in the gut flora. The sadistic scientists put one of the healthy rats on a high fructose diet. Predictably, thin rat develops a new gut ecology with dominant firmicutes … and gets fat.

Final story. Some kind hearted scientists observe that bacteriodes are able to produce a short-chain fatty acid called butyric acid which seems to improve the gut ecology with many benefits. Being better scientists than cooks, rather than feed the rats some tasty food naturally high in fiber, they add 5% sodium butyrate to their laboratory rat chow. The rats that are supplemented with sodium butyrate do not get fat like their buddies on the same highly fattening diet. Check out the graph below:

Actually, the last story has a really happy ending. Not only do these rats not get fat, their post prandial blood glucose levels are much better with the butyrate and their insulin resistance improves as measured by HOMA-IR.

Moral of the story? Nope, I am not recommending fecal transplants for all my chubby T2 friends and I am not suggesting you use sodium butyrate as a condiment in all your favorite foods. Let me tell you how the same healthy gut environment can be achieved in the human species.

The way bacteriodes are supposed to work in people is that they ferment fiber to produce butyrate. Nope, I am not talking about your raisin bran cereal. The sugar in it will feed the evil firmicutes and hasten your demise while the insoluble fiber from the wheat bran going through your gut like sawdust will likely providing more irritation than health. But isn’t fiber supposed to help diabetics? As it turns it, only soluble fiber is the diabetic’s friend.

Soluble fibers from rich sources like low carb veggies, flax meal, chia seeds and supplements like pectin, beta-glucan, FOS, inulin, etc. are the healthy nutrients that the good bacteria love. The bacteriodes will thrive on this stuff and you will look and feel great.

While you are are savoring your broccoli and enjoying a flax meal muffin, don’t forget the bad guys. Do not feed the firmicutes! NO FRUCTOSE! If you dare consume any unhealthy quantities of sugar, HFCS or fruit juices (and any quantity is unhealthy) please contact me immediately to learn how you can schedule that fecal transplant.

OK, most of my readers already know that I am no doctor or scientist … and certainly not a pillar of virture. Seems I succumbed to temptation only this morning when my wife offered me a piece of nice dark chocolate. Should perfection elude you, too, please refer to my earlier posting and eat lots of low carb, probiotic yogurt daily. Having more probiotic bacteria in the neighborhood will help keep out the bad guys.

Breaking News -- According to an article in ScienceNews, my Venti-sized Americano coffee may have as much as 2 grams of that soluble fiber that is so beloved by bacteroides. Discussion continues at the Da Mu Zhi Guangchang Starbucks.

Bifidobacterium – Have You Lost Your Birthright?

One of the most precious gifts your mother gave you was the first bacteria that inhabited your gut. The trillions of micro-organisms in our intestine form a community that begins the day we are born. You were born empty with no organisms in your gut. In a normal vaginal birth, a baby will pick up a healthy dose of its mother’s micro-flora. In birth by C-section, however, the babies will slowly be influenced by many environmental factors and it may be months before their gut ecology is firmly established.

As advocates of breastfeeding know, breastmilk is a rich source of probiotic bacteria, specifically, the species Bifidobacterium or bifidus. A child develops the most healthy gut ecology at its mother’s breast. In a breastfed child, about 80-90 percent of the bacteria in their intestine are Bifidobacterium, and that’s why breastfed kids are healthier. Unfortunately, the proportion of our gut flora that are this Bifidobacteria begins to diminish as we grow older, and, by the time we become an adult, may virtually vanish … if not by the ravages of time, than by overused antibiotics.

So, you may ask, why should you care about the bacterial zoo in your gut? About 70 percent of cells involved with immunity are in the lining of the intestine. A healthy gut is the key to overall good health. If the lining of your intestine becomes inflamed, it may become more permeable allowing the inflammation to leak out into other parts of the body. This can lead to the chronic inflammation condition that is present in most chronic diseases. I believe that gut inflammation is one of the root causes of Type 2 diabetes and its complications.

Since I have just been writing on making your own yogurt, you might guess that I am going to tell you that yogurt is the best way to replenish the healthy probiotic bacteria in your gut. Well, yes and no. It is possible to make yogurt that contains Bifidobacterium, but 99.9 percent of commercial yogurt does not have it and very few yogurt starters contain it. Commercial yogurt usually just has L. Bulgaricus in it for a nice consistency and S. thermophilus to ferment the milk to a pleasant tartness. The S. thermophilus will not survive your stomach acid. The L. bulgaricus will make it to your gut where it will discourage the growth of some harmful bacteria for a short time, but it passes through without colonizing the gut or making any long-term improvement.

Bifidobacterium is a colony forming bacteria. It improves the neighborhood so the thugs of bacteria world like E. coli and salmonella do not take over and any Helicobacter pylori that are still around are better behaved. Your gut will be very happy with Bifidobacterium back on the block. So, how to restore it if time and antibiotics have vanquished your old childhood friend?

Maybe you can pop some pills. There are many varieties of Bifidobacterium that can be found in commercial probiotic supplements. Remember, however, that these are live organisms and life in a gelatin capsule in a bottle stored in a warehouse, store shelf or medicine cabinet for months may not be that hospitable. Probiotics deteriorate rapidly in less than perfect conditions. What was an excellent product when it was produced may have few if any live organisms in it when you take it. Any remaining Bifodobacterium will need to run the gauntlet from mouth to intestine. Some can survive harsh stomach acid, but they do much better if there is food present to lower the pH of the stomach acid a little. Which brings me back to my favorite food.

Yes, you can make yogurt that contains Bifidobacterium. You still use the standard two yogurt making strains, but you can find specialized cultures that have some Bifidobacteria and other probiotic strains. Usually, they will also add some Lactobaccillus strains, too, especially L. acidophilus. The Yógourmet line of home yogurt making cultures has one specialized product with three added probiotic strains.

You can find Yógourmet probiotic starter here.

Personally, I like the taste of yogurt fermented with a little bifidus added to the culture. It seems to have a slightly more cheese-like flavor. In the interest of full disclosure, however, I must say that consistency is not quite like the "swirly goodness" of the Pinkberry Frozen Yogurt store. It can be a little slimy. If you drip it to make a Greek style yogurt, it improves the unusual viscosity and I find it quite OK. More importantly, my family’s main yogurt aficionado, my two-year-old son, greatly prefers Daddy’s yogurt to Dannon’s or Yoplait’s. And, my son’s impeccable taste is only exceeded by his radiant health.

Are Your Dining Companions Making You Sick?

“You never dine alone,” according to biologist Jeff Gordon of the Human Gut Microbiome Initiative (HGMI). About 10-100 trillion gut microbes join you every time you eat. The reaction of your dinner guests greatly affects your health which depends not just on what you eat but also on how your intestinal microflora react to it.

Most of us think of diabetes as having a genetic component. Could it be that the genetic makeup of the microbes that have come to inhabit our gut affects us as much or more than our own DNA?

We are born with no microbes in our gut. They are all acquired after birth from our mothers, families, friends and communities. What we eat can radically alter the balance of our microbial communities, sometimes in ways that are very difficult to change. There are over 500 varieties of bacteria in our intestines, but their different attributes are not still fully understood. Science is just beginning to map the genetic code of our intestinal bacteria.

Already, a clear link has been established between obesity and our gut microflora. Fat people have very different gut microbes. Why? It seems to be a function of the bacteria we have been exposed to, what we eat and our degree of obesity. Some of the foods that I rant about in my blog can radically change your gut ecology in a rather short period of time. These changes are not easily reversed. We do know that the gut microflora changes some when people lose weight, so there is hope for improving our gut health and overall health.

Some intestinal bacteria are associated with inflammation and autoimmune disease, including diabetes. Because the role of gut bacteria in disease is complex and our understanding is still incomplete, most scientists caution against attempts to radically change gut ecology by using powerful antibiotics to eliminate intestinal bacteria and then attempting to re-colonize our guts with a healthier microbiological environment. Let me give an example of a man-made disease where tampering with the intestinal environment my lead to more serious risks.

Asthma has become much more prevalent in recent decades. After WW II, our overuse of antibiotics destroyed the common bacterium Helicobacter pylori in the guts of many people. People without H. pylori are much more likely to have asthma, allergies, and acid reflux. Writing on the ecology of human disease, one scientist has postulated that the destruction of this ancient microbe may also be a factor in the post-modern Type II diabetes and obesity epidemics. So, why not reintroduce H. pylori into our GI tracts? As it turns out, this microbe can also lead to ulcers and stomach cancer if it becomes too dominant. Tipping the scale to the other side might be even more damaging. Modern medicine’s weapons of mass microbial destruction are hardly adequate to preserve delicate balances.

Wholistic medicine has suggested that probiotics and prebiotics might help bring GI tracts ravaged by processed foods and modern drugs back into balance. Maybe, but do we really know which probiotic organisms and probiotic substances our bodies need?

Probiotics are micro-organisms which are believed to be beneficial to the human body. Yogurt with its lacto acidophilus and other live cultures has long been believed to strengthen immunity and improve health in general. Many other probiotics have been developed as nutritional supplements but our knowledge about the specific benefits of the hundreds of varieties of bacteria in our gut is currently at best partial. Anyway, yogurt tastes great and makes me feel good.

Prebiotics like fructo-oligosaccharides (FOS), inulin, and beta-glucan are believed to feed the good bacteria in the gut and improve gut health. They can be found in infant formula, nutritional supplements and some foods. I have tried them and found the short-term effects to be more embarrassing than life changing. As they ferment in your intestine, you can become quite pneumatic. One can only hope that these are the sounds of beneficial bacteria feeding well. Prebiotics, however, are not without critics. Some believe that they may also support some strains of harmful bacteria in your gut.

Here’s what we know for sure. High carbohydrate consumption, especially fructose, feed the bad bacteria and can seriously damage your gut ecology. We can also assume that healthy, fresh foods with abundant nutrients and natural fiber will improve the balance of the gut microflora.

Gut Feeling About Diabetes

I have a gut feeling about the pathology of Type 2 Diabetes (T2). A radical new treatment, gastric bypass surgery, suggests we might have had it all wrong. Maybe it is not just about visceral fat and a burnt out pancreas. Can surgery cure diabetes? As the medical establishment stands scalpel in hand preparing to separate us from our small intestine … and $15-35,000 … I hope you do not think me too impertinent for asking, “So, what’s wrong with the small intestine they want to cut out?”

I was told that the disease that plagues me was caused by the genes from my parents and my own gluttony and sloth. We all know it is principally a disease of insulin resistance associated with upper body obesity, right? So, I lost weight and greatly reduced the carb load in my insulin resistant body. I was pretty happy and healthy as I drifted along in the flow of conventional wisdom, but then some troublesome contradictions began to ripple the surface of my understanding of D. As I dove into some of the latest research, I have found myself struggling to keep my head above water in confounding cross currents of new ideas.

Maybe my family lacks intestinal fortitude. My cousin had serious problems related to morbid obesity, and diabetes was one of them. Just short of her 60^th birthday, she had gastric bypass surgery. Conventional wisdom holds that fat people are insulin resistant and would predict that massive weight-loss would greatly improve diabetes, but that’s not my cousin’s story. Apparently, her diabetes was reversed shortly after her surgery before she had lost any significant weight.

It’s not the weight-loss, it’s the rerouting the small intestine that seems to be behind the cure. My second cousin to undergo the weight-loss surgery sent me a University of Minnesota study of 8000 diabetics who had undergone such surgery where most reported a reversal of their diabetes. According to the study, “More than 95 percent of patients reported no diabetes symptoms after a duodenal switch, a more complicated procedure that shrinks the size of the stomach and bypasses the duodenum, or first segment of the small intestine.”

Sensing a new medical opportunity, some doctors are now expanding their gastric bypass surgery practice to include other diabetics, even if they are not morbidly obese. Writing in American Diabetes Association (ADA) publications, Dr. Francesco Rubino has put forward “The Anti-Incretin Theory” to justify surgical interventions. Before we explore the mysteries of the anti-incretin, first a word about incretins.

Incretins are peptides in the human body that signal the pancreas to produce insulin. There are two – GIP, which is produced in the lining of the upper small intestine, and GLP-1, which is produced in the small and large intestine. Both GLP-1 and GIP have a very short half-life in the body because the substance DPP-4 shuts them down shortly after they are produced in the intestine. Please underline intestine as we will be winding back to this point shortly.

Pharmaceutical companies are all over the incretins business now. With billion buck drugs like the statins about ready to go off patent, they need a new hit. Diabetes is booming and drugs to mimic and control incretins to better regulate glucose metabolism could be big. Synthetic GLP-1’s, like Byetta and Victoza, have been developed to have a longer half-life than endogenous GLP-1. Another approach is drugs like Januvia and Galvus which inhibit DPP-4 from deactivating the incretins.

The “anti-incretin” theory put forth by the bariatric surgery club has no relevance to the pharmaceutical industry’s plans which to develop and commercialize more incretin drugs. Unproven theories are not needed to recognize that T2s have virtually zero first phase insulin response and any drug that can stimulate better insulin signaling can be a best seller. These new incretin drugs do not attempt to heal the underlying pathology. Like insulin injections, artificial incretins try to balance the hormonal disorder. The results are mixed. many T2s are helped by incretin drugs, but not most. The side effects have been significant and the results imperfect.

So, back to cutting out the mysterious anti-incretin. After reading Dr. Rubino’s writings, I still do not really understand his “The Anti-incretin Theory.” It seems like the anti-incretin is simply DPP-4 which inactivates incretins and other peptides, but no, it is not that simple. Dr. Rubino has not actually discovered his anti-incretin yet, but he believes “it is reasonable to postulate the existence of a counterregulatory mechanism stimulated by the same passage of nutrients. Such an anti-incretin system would have opposite actions to those of incretins” and Dr. Rubino is convinced it originates in the small intestine. He writes that his “findings suggest that a proximal intestinal bypass could be considered for diabetes treatment and that potentially undiscovered factors from the proximal bowel might contribute to the pathophysiology of type 2 diabetes.” Although these “undiscovered factors” remain elusive, the doctors, now joined by ADA prepare to exorcise the demon “anti-incretin” declaring it to be the source of “insulin resistance, diminished insulin secretion, and β-cell depletion—in other words, type 2 diabetes.”

Excuse me, but before you begin cutting your theoretical anti-incretin out of me and my diabetic buddies, may I ask a question. What’s wrong with my diabetic small intestine anyway? As it turns out, this is a rather impertinent question. There is no good medical research yet explaining what the malfunction is in the small intestine. I feel like I am pulling back the curtain in the presence of the Great and Powerful Oz, and peering beyond the current reach of medical science. So, as long as I am in the realm of non-science, allow me some more uneducated speculation.

We all know that diabetes is often an inflammatory disease as evidenced by high C-reactive protein (CRP) numbers. Where does the inflammation come from? Conventional wisdom again implicates our plump bodies and believes the adipose tissue is the origin of the inflammation. And why are we fat? Genetics and poor lifestyle, right? Maybe, but how does that genetic part work? What is the actual mechanism? Two views: Old view is that we get fat like our relatives which creates inflammation which leads to insulin resistance and eventually burns out our pancreases. Revisionist view is that we suffer inflammation first and then insulin resistance, obesity and the whole parade that leads to diabetes.

So, I find myself exploring the inflammation part of the diabetes equation. Where does the inflammation come from? Before, I might look in the mirror and point to my T2 belly, but now the medical establishment is pointing a scalpel at my small intestine. Could gut inflammation be the root cause of much T2 diabetes?

Alternative medicine has long blamed imbalanced diet as the cause of most chronic disease. My blog talks about how foods like simple carbohydrates (especially fructose), bad fats (omega-6, trans-fats, arachidonic acid, etc.) and some allergenic foods (wheat, corn, soy, etc.) might exacerbate inflammation. The Huffington Post’s alternative MD, Dr. Mark Hymann explains the theory.

The typical American diet promotes the growth of bad bugs in the gut. These bugs damage the gut lining and produce toxins that your system absorbs. When your gut is leaky, partially digested food particles can enter your bloodstream, where your immune system reacts, creating inflammation. Inflammation triggers insulin resistance - which makes you gain weight.

When your gut is damaged, it becomes leaky and food particles become exposed to its immune system. The result? A full-body immune response that triggers inflammation, which in turn leads to insulin resistance. And insulin resistance leads to belly fat (and leads to T2).

We often read that T1 diabetes, unlike T2, is an autoimmune disease. While T1 is obviously caused by an autoimmune attack on the beta cells of the pancreas, T2 also has several characteristics of an autoimmune disease with high levels of tissue inflammation being the most obvious. Many T2s also suffer from other autoimmune diseases like hypothyroidism, Celiac, rheumatoid arthritis, fibromyalgia, allergies, asthma, lupus, etc. What if T2 is similar to Crohn’s disease where the lining of the intestine is inflamed? If the lining of the small intestine was inflamed, it would impair our ability to produce incretins resulting in poor insulin signaling, and a leaky gut might spread the inflammation resulting in greater insulin resistance.

So, should we cut it out? Well, maybe we could first explore a kinder and gentler approach. I am appalled at how quickly the medical establishment and the ADA has jumped to the conclusion that gastric bypass surgery is the cure for T2 diabetes. Why don’t we first diagnose the disease and see if we can heal it before we begin cutting. Let’s exhaust all lifestyle interventions before we go to surgery.

Because of the close association between insulin resistance and inflammation, most of things we do to manage our blood glucose (BG) levels will also address the inflammation issue … but not all. Injecting insulin is the clear example of a powerful BG management tool that will not address inflammation as a causal factor. A restricted carbohydrate diet, on the other hand, is an example of a practice that will dramatically lower BG and greatly lower CRP.

If gut inflammation is the root cause of T2, what would happen if the small intestine was completely empty? My most dramatic personal experiment was a seven-day water fast at the end of 2009. From Day 2-7 of my fast, my BGs (tested frequently) were all in the non-diabetic range and my CRP plummeted … and I required no diabetic medications. Specifically, BGs ranged from 74-98 and averaged 86. My CRP dropped from an elevated 8 to a normal 2. Talk about a diabetic cure!

No, I am not advocating the complete cessation of eating, but there is an important lesson. Frankly, fasting is not pleasant. The fasting gurus will tell you that after the initial discomfort, you will feel wonderful. I had a few lucid moments, but generally I felt exhausted, irritable and achy. I believed that this zero carb zero calorie diet would definitely lower BG, but I was sure that, based on how terrible my body was feeling, my CRP would be elevated. My lower back was very sore and my head was throbbing when I went to the lab to get tested. I can only attribute my 75% reduction in general inflammation as measured by CRP to my empty intestine.

In the month of January 2010, I continued my experiment. I did intermittent fasting where I fasted for 24 hour periods every 2-3 days. Results? All my morning BGs were under 100 and my post pradial BGs were also in the non-diabetic range. My morning BGs were good even when I was eating or the mornings after the days I ate. As I lost no significant weight through intermittent fasting, we cannot attribute improved CRP and BGs to weight-loss. Here I must agree with the fasting gurus who say that allowing your intestine periods of healing improves health.

I continue to experiment with lifestyle interventions to reduce inflammation and normalize my BGs including choice of foods, timing and quantities of eating, nutritional supplements and exercise. It’s hard. I understand why doctors are more comfortable with pharmaceuticals and surgery. Lifestyle interventions are extremely difficult to sustain. They only work when discipline can withstand errant hormonal signaling, emotion-based unhealthy behavior, and a whole lot of societal pressure to do the wrong thing. But, when they work, it’s all good.