Heal Your Gut, Reduce Chronic Inflammation

This blog is about chronic inflammation which we are now finding can be improved by developing healthy gut flora. I write as a Type 2 Diabetic, but chronic inflammation is a factor in many chronic diseases.  I have found that addressing gut health dramatically helps children who suffer allergies, eczema and asthma.  For adults, it is a critical factor in obesity, heart disease, chronic fatigue, depression, fibromyalgia, lupus, arthritis, Celiac, Crohn's, IBS and many other disorders.


1. People with chronic disease (including T2s) generally have poor gut health. The mucosal lining of their small intestine is inflamed.

2. People with chronic disease (including obese people) have different gut flora than healthy people. The imbalance of the intestinal microbial community is clear and can be easily demonstrated. While we can see the differences in gut flora, our understanding of the hundreds of species and thousands of subspecies of the 10-100 trillion microbes in our gut is still very rudimentary at this point.  My blog explores emerging understanding.

3. People with an inflamed lining of their small intestine have an impaired gut barrier and the inflammation spreads.  We suffer chronic inflammation as measured by C-reactive protein and other markers of inflammation.

4. Chronic inflammation is associated with insulin resistance and obesity. Obesity is both a result of inflammation and insulin resistance and a cause of further inflammation and insulin resistance. Vicious cycle.

5. Incretins involved in insulin signaling are produced in the intestinal lining. In T2 diabetics, an inflamed gut leads to disturbed incretin signalling and a weak or nonexistent First Phase Insulin Response.


6. Other hormonal signaling is disturbed by chronic inflammation.  Beside insulin resistance, inflammation will impair the response to leptin (the hunger hormone) and result in increased obesity.


7. Five measures are known to improve the composition of the gut flora and reduce inflammation: 
-   (a) consuming more probiotic organisms.
-   (b) consuming more prebiotic soluble fiber that favors the growth of healthy bacteria.
-   (c) consuming more phytonutrients that discourage the growth of unhealthy bacteria and yeast.
-   (d) limiting the consumption of simple carbohydrates (especially fructose) which encourage the growth of unhealthy bacteria and yeast in the gut. 
-   (e) improving the body's omega-3 to omega-6 ratio by eating healthy fats and oils.

Rather than battling disease by killing and cutting, I am more interested in realizing health and wellness by achieving balance. I am pleased that many people are looking for gentler ways to achieve health through lifestyle changes and relying less on radical drugs and surgery.

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.

My Wheat-free, Probiotic, High Fiber, Low Carb, Omega-3, Non-Inflammatory Birthday

A great birthday needs the right cake. My wife wanted to buy me a cake, but I insisted on making the cake for my son, my wife and the birthday boy. Deliciously healthy!

The cakes were made with flaxseed meal, coconut flour, whey protein, eggs, cream and flavored with sugar-free raspberry jello. I baked them in the shape of a stars. Red stars are big here. The cakes were topped with yogurt cheese flavored with sugar-free lemon jello and a fresh strawberry each. My son gives it a five star rating ... though, regrettably, I only baked three stars.

Here's the recipe:

Cake:

3 small eggs (equivalent to 2 large eggs)
1/4 cup of heavy cream
1/2 cup of flaxseed meal
1/4 cup of defatted coconut flour (I used Swanson brand)
1/4 cup of vanilla flavored whey protein powder
One small packet of sugar-free raspberry jello
1/2 teaspoon of baking soda
Dash of salt

Grease silicone star baking pans with coconut oil or butter. Bake for about 20 minutes at 175 degrees C or 350 degrees F. Let cool on a rack.

Topping:

1 pint of homemade yogurt made from whole milk and probiotic yogurt starter.
1/2 of a small packet of sugar-free lemon jello
3 fresh strawberries

Ferment the yogurt for a full 24 hours to maximize the probiotic micro-organisms and reduce the lactose to the minimum. I explain how to do it here. Drip the yogurt over night in the refrigerator through a coffee filter to make about 2/3 cup of yogurt cheese. About the same consistency as ricotta cheese. Stir in the lemon jello. Carefully spoon on the lemon topping and arrange in a star pattern. Top with the most beautiful strawberry you can find. One is enough.

This dessert is very low in carb, but extremely high in protein. Fully fermented yogurt made with probiotic strains is so healthy it is nearly therapeutic. The flax and coconut are very rich in fiber. Flax is the richest source of ALA omega-3.

NUTRITIONAL INFORMATION:

Raspberry Jello Flax-Coconut-Whey Cake: (6 servings)

Calories: 840
Net Carb: 13 grams
Total Carb: 36 grams
Fiber: 23 grams
Protein: 52 grams
Fat: 55 grams

Lemon Yogurt Cheese Topping: (6 servings)

Calories: 250
Net Carb: 4 grams
Total Carb: 4 grams (assumes fully fermented low lactose yogurt per my recipe)
Fiber: 0 grams
Protein: 18 grams
Fat: 16 grams

As much as my son loved his star cake, his two year-old stomach could not quite finish it. Good thing. Dad had a wonderful snack in the last hour of his birthday before he retired. Dreaming of a very healthy 58.

Be well.

-denny

Making Healthy Probiotic Yogurt

Sometimes being healthy requires an arduous discipline, but making and eating fresh homemade yogurt is one of the fun parts about good health. Below are the materials I use to make yogurt.

I prefer using an electric yogurt maker, but it is possible to make yogurt without one as many cultures have for centuries. The main ingredient is fresh milk. Organic whole milk is best if you can get it, but any milk will do that does not have antibiotics in it which can kill the organisms. Even UHT milk or powdered milk can work. I prefer to add about 1/2 cup of cream (125mL) to one quart (1 liter) of milk to make it richer, but the amount of milk fat is personal preference.

Yogurt makers can have one large bowl or several individual one serving size containers. I prefer one that has a large glass bowl, but stainless steel or plastic will also work. For best results, I sterilize the bowl with boiling water. Then, I fill it with the milk and cream mixture and place it the microwave. Through trial and error and use of a food thermometer, bring the milk to about 180-200° F (92-95° C). This serves two functions, it sterilizes the milk so there are no unwanted bacteria giving it an off taste, and it slightly modifies the milk so it is smoother when it ferments and does not curdle.

Using a food thermometer, let the milk cool to 108-112° F (42-44° C). Usually, a skin will form on the surface. Many people skim this off. It is milk protein and I prefer to blend it back in with a little battery powered hand blender. At this point, you may add one packet of probiotic yogurt starter. I picture the Yógourmet brand probiotic yogurt starter above which has five strains including the two normal yogurt strains and three probiotic strains. You can read about it here. There are several good probiotic yogurt starters in China but they are formulated to make a thinner drinking yogurt. I use two packets of the Chinese yogurt starters to get a thicker yogurt.

As you can see from the above chart, the length of the fermentation will affect (1) the amount of carbohydrate in the form of lactose (milk sugar), (2) the sourness of the yogurt determined by the amount of lactic acid, and (3) the amount of live micro-organisms. Commerical yogurt is only fermented for 4-5 hours. Most people ferment home yogurt for 8-10 hours. The Specific Carbohydrate Diet for people with autoimmune diseases recommends fermenting yogurt for a full 24 hours and then straining it to get the lowest possible lactose content as lactose is a potent allergen for many people. I generally ferment my yogurt for 20-24 hours to get the most probiotic organisms and the lowest carbohydrate. I like the tarter taste of a fully fermented yogurt, but some may prefer a more mild taste.

Dripping or straining yogurt will make it thicker and change the composition. Traditionally, cheese cloth is used to strain it, but I prefer to use a simple paper coffee filter or a reusable nylon coffee filter which I place in a cylindrical container to catch the liquid which drips off. The liquid portion that drips off will contain water, lactic acid and some residual lactose. Very little micro-organisms, protein or fat will drip through. A dripped yogurt will be slightly less sour, much thicker, lower carb (less lactose), higher protein and have more concentrated probiotic organisms.

If you drip the yogurt for about an hour, you will reduce the volume about 25% and get thicker Greek style yogurt. If you drip the yogurt over night in the refrigerator, you will reduce the volume over 50% and you will get thick yogurt cheese, which is almost like cream cheese in taste and usage.

Remember that yogurt is a live food and be sure to eat it fresh. Even when stored in the refrigerator, it can lose more than half of the live organisms within a week. And it tastes great fresh!

Probiotics: Wanted Dead or Alive?

Probiotics, the beneficial micro-organisms, are not very beneficial if they are dead on arrival. It can be a treacherous path from production of probiotic supplements and live probiotic yogurt to the creation of actual communities of beneficial micro-organisms improving gut ecolology. How do you protect and support the good guys in your gut?

About 99 percent of commercial yogurt is made with just two bacteria – S. thermophilus and L. bulgaricus. These two organisms are excellent for quickly fermenting the lactose in milk and thickening the milk. Once in the human body, however, they are not exactly probiotic superstars. Most are killed by the gastric acid in the stomach and the few that reach the gut are not able to multiply and colonize the gut. They quickly pass through with little lasting positive effect. These wimpy bacteria are also short lived in commercial yogurt. The live organisms in yogurt rapidly degrade and completely die off within three weeks of production. Another reason that fresh homemade yogurt is so much healthier.

There are several strains of Lactobacillus and Bifidobacterium micro-organisms that can live in yogurt and can survive in the gut to colonize with healthy bacteria. Why are these healthier probiotic bacteria not routinely used in yogurt? Unfortunately, they do not add much to the taste or texture of commercial yogurt, so commercial yogurt companies rarely incur the additional cost of adding them. They can only be found in a few specialty probiotic yogurts and probiotic yogurt starters. While probiotic strains flourish in the human gut, they are not as hardy as the commercial yogurt strains during the production process. If you attempt to make probiotic yogurt using an old batch for a starter, you will find that the commercial yogurt starters grow faster and will quickly crowd out the healthier bacteria in successive batches. To make probiotic yogurts, you must add fresh probiotic organisms to each batch.

Bifidobacterium, the bacteria that dominates in the gut of a breastfed baby, should always be added to probiotic yogurt. There are several popular strains with B. bifidum being most common. Other popular strains found in healthy human guts include B. infantis, B. adolescentis, B. longum and B. breve. While Bifido can live in both the small and large intestine, my Chinese microbiologist friends tell me they are most helpful in the large intestine where they promote good GI health.

Lactobacillus bacteria probably play a more important role in the small intestine where they seem to improve the immune function and help people who suffer inflammatory autoimmune diseases. L. acidophilus is the most common Lactobacillus probiotic organism which can colonize the gut. L. casei is transient micro-organism but some studies have shown it can assist the propagation of acidophilus. L. reuteri and L. rhamonous have been shown to be especially effective in preventing and lessening symptoms of eczema, asthma, allergies and other autoimmune diseases. I have postulated that improving the health of the small intestine may mediate any possible disturbance of the production of incretins produced in the lining of the small intestine, a condition which can impair first phase insulin response in Type 2 diabetics. Both Bifidobacterium and Lactobacillus promote healthy mucosal lining which will prevent leaky gut syndrome that can lead to chronic inflammation and result in increased insulin resistance.

I love my yogurt, but there are other reasons I prefer getting my probiotics from fresh yogurt rather than probiotic supplements. The live organisms in probiotic supplements are usually freeze dried. If kept in a cool, dry environment, they might maintain most of their efficacy for six months to a year, but they are extremely sensitive. Humidity is the main problem. Probioitcs sold in a bottle began rapidly degrading as soon as the bottle is opened. If you want to use probiotic supplements, be sure to only buy probiotics that are sealed in individually in blisterpack packaging and manufactured very recently. They are best stored in a freezer until they are used. Please be careful of condensation when cold probiotics are first removed from the freezer. Wait until the package is at room temperature before you open them.

Some probiotic supplements are enteric coated to help the micro-organisms survive the gastric acid and make it to the gut. Most manufacturers of probiotic supplements admit that they deteriorate rapidly after production and more than 80 percent of the remaining organisms will be killed in the body before they reach the gut. The survival rate of probiotic organisms in yogurt passing through the stomach is believed to be higher.

Like probiotic supplements, probiotic yogurt starters are fragile. They must be fresh, packaged in individual sealed packets, kept dry and not exposed to heat. It is still difficult to find good probiotic yogurt starters. Frankly, it is rare for commercial yogurt starters to contain more than 1-3 of the probiotic strains that I mention above. I have worked with Chinese microbiologists trying to develop yogurt starters that contain L. reuteri and L. rhamonous because I have not been able to find them commercially. Unfortunately, L. reuteri and L. rhamonous appear to not be stable in yogurt medium and not commercially viable.  They still must be consumed as expensive supplements like Culturelle and BioGaia.  The Yogourmet probiotic starter mentioned in my previous post on yogurt does contain L. acidophilus, L. casei and a strain of Bifidobacterium.

Homemade yogurt stored in the fridge is still a live food which is quite perishable. The half-life of the probiotic organisms is probably less than a week, so I recommend eating your homemade yogurt within a couple of days. This is no problem for my family. How wonderful that good gut health can be so tasty!

And remember – consuming lots of healthy probiotics will do you little good if you are eating bad food. Avoid simple carbohydrates, especially fructose, which feeds the bad gut bacteria and be sure to eat lots of soluble fiber to feed the good bacteria.

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.