My Gut Microbiome Adventure
Update January 2019: Completely off hormones. Check my medication diary to follow my elimination of supplements. My gut health has been remarkably stable given my horrible eating habits since July 2018. I haven’t given up though. I will get back on a diet without sugar soon.
Probiotics
Currently trying Jarrow Bifidus Balance, one per day even though the bottle says dosage is 3/day. Align works for me but can make me constipated.
What will I try next?
- When I am fully healed from surgery I will stop estrogen & progesterone-I’m not looking forward to going through the side effects of menopause again.
- Then I plan to dig deeper into the supplements that I take and stop as many of those as I can. I would like to be able to maintain a healthy gut by eating the proper foods without taking any supplements!
- I still need to address my low stomach acid before I can rely on my food 100%.
Now for the Adventure-A Healthy Gut Microbiome in my 50’s
I am the healthiest I have been in my entire life and it is because my gut microbiome is the healthiest it has been in my life. And the good news is that I expect it to get even better if I continue to work on my diet. I thought I had this great childhood, but I have always eaten too much sugar & starch & I have never been able to digest it well. I’m a little jealous of those that can discover this earlier in their life but I’m also doing this blog for the next generation of my own family.
How do I know my gut is healthy?
I rarely “hear” my digestion process. Nor do I “feel” my digestion process. It is happening silently, without making a spectacle of itself. I also rarely “smell” the byproducts of my digestion process. I had no idea that was even possible, but when my gut is doing its job effectively, I have consistent bowel movements every morning, almost no gas and I don’t stink!
How did I get to this place?
It took me about 3 years of stumbling, but I think you can get here much sooner. To fully understand how I got here, you’ll want to read through some of my other posts. The family history and progression of my symptoms throughout my life will help you to see if we have similar gut issues, so you can decide if you should try my psoriatic arthritis diet and elimination protocol or adapt it for your health concerns. I have detailed logs of the foods, supplements, symptoms, and changes experienced over time.
Gut health during surgery year
Even though I have done significant work this year to get my gut healthier, you will see in the post about surgery and inflammation that I am not completely confident that I can take credit for my healthier gut. I believe my body is completely distracted and focused on growing bones and healing from surgery. When that is done, it may be looking for something else to attack and start going after my healthy joints again.
Food First
If you are serious about getting your gut healthy, the first thing to adjust is your diet. It is not possible to get a healthy gut microbiome eating burgers, pizzas & pasta. It will not happen. That doesn’t mean you can never have those foods again, but you will need to get rid of starches and sugars at a minimum for at least a month (gluten causes inflammation in EVERYONE). Following an elimination protocol will help you discover if you also struggle with dairy, eggs, nuts, etc. The fast food can never be your primary source of calories, but if you can get your gut healthy, you might be able to ask it to process a burger occasionally without throwing your entire system into an inflammatory response.
I have kept a detailed food & symptom log since early 2017 (there are a few gaps) and even started noting my BM health since diarrhea is my main symptom. That diary is now on this blog if you want to check on my status. Everything I eat is written down, even when I break my own rules. It is the only way for me to connect the dots & eliminate the foods and behaviors that cause me distress. The patterns and connections of food to symptoms are only visible when I look back through my food and symptoms across a month or more. I am still working out how to share my full food diary going back to 2017 and may need to scan/email it to people that are interested.
There are a few things don’t fit neatly in either food or supplement. I started taking collagen in a powder form with breakfast after reading the Keystone Approach, and I have resumed L-glutamine while healing from my 2nd surgery. I also try to drink bone broth as often as possible (collagen), and even though Keystone Approach recommends against fermented foods, I have quite a few in my fridge and will eat them until they are gone. Then I’ll reassess whether I should eliminate or not.
Supplements Second
I turned to medications and supplements long before I changed my diet, but I strongly recommend you do it the other way around! I was so sick for so long that my body was depleted of nutrients that are essential to the proper functioning of my cells and my gut microbiome. Supplements helped to jump start my healing. My next journey will be to eliminate as many supplements as possible while getting all my nutrients from my food.
I just read the Magnesium Miracle by Carolyn Dean and it is fascinating for me to connect the very first outward signs of my disease to magnesium deficiency. No one caught that 20 years ago and even when I stumbled across the recommendation to take magnesium for my muscle twitches, none of my doctors connected diarrhea to the magnesium supplements. I didn’t even know that I could take magnesium in a form that did not cause diarrhea! Had someone pointed me to proper magnesium supplements 20 years ago, would I be healthier now? Given that I have been deficient in magnesium for 20 plus years, I may need to continue to take it my entire life. It will take me years to figure that out.
NSAIDs
Be very careful with all NSAIDs. It will be the first thing a doctor will prescribe for arthritis. The doctor’s goal is to stop inflammation and NSAIDs are very effective at doing it. There are also tons of products on the market now that supposedly protect your stomach. But none of them address the fact that NSAIDs are very bad for a healthy gut microbiome balance and long-term gut health
Avoid antibiotics
Avoid antibiotics as much as possible but be smart about it. If you have a cold, you probably don’t need antibiotics. One of my incisions got mildly infected after my last surgery—a good time to take antibiotics. It would have been horrible if the infection settled into my bones. In Follow Your Gut by Rob Knight, he points out that our current practice at the birth of a baby is to immediately give the baby antibiotic drops in the eyes to guard against gonorrhea, (most married couples know they do not have gonorrhea). The mother also may automatically get antibiotics while delivering the baby. His point is that antibiotics are administered without any special specific consent from the patient or parent. We have become ambivalent about antibiotics, but hypersensitive to vaccinations. Parents should be involved in both decisions but there is hard science supporting vaccinations and documenting the negative side effects of antibiotics (including killing good gut bacteria). Only take antibiotics when you must and there may be some that are still effective for your great-grandchildren.
The Gut Health Protocol
While recovering from my first foot surgery I implemented a protocol that I adapted from the Gut Health Protocol. This book is a wealth of information but could benefit from some organization. There are so many resources that it is a bit overwhelming. It is more like a list of possibilities. I picked out some of the supplements that seemed appropriate for my symptoms, planned a path for myself, and began that protocol. I added one supplement per week, kept a detailed log of my symptoms, maintained the protocol for about a month, and then removed one supplement per week. It had a profound impact on my gut and I believe reset my gut microbiome.
Fasting & gut microbiome health
I implemented intermittent fasting for about a month in early 2018. My system was to not eat on Mondays until mid-afternoon, so my fast was for about 16-18 hours. It was easier for me to implement than I anticipated. There is significant research that supports the benefits of fasting. The general concept is that when fasting, our digestive system can rest and recover and can tame our overactive autoimmune systems. If you have not tried it, I highly recommend it. My mother was at her lowest point, had been diagnosed with Crohn’s and was on a very limited diet. She fasted for her diagnostic colonoscopy and was amazed at how much better she felt afterward. The 24-hour fast purged her gut of whatever bacteria was causing her problems and somehow reset itself when she started eating again. Fasting also helps us learn to control our cravings and realize that we can pass by the bad foods and be just fine!
Gut health before my diet changes
Perspective changes everything. Keeping logs helps me to go back and see a month or more at a time and notice the symptoms (or lack of symptoms). I can look back and see steady improvements from one year to the next. For example, a year ago, I was having a pretty bad diarrhea flare (month rather than days long) as I wrapped up the excesses of summer. This year, I’ve had a few bad days and I can almost always link it to excesses of the day before. I adjust my diet and my BMs return to normal within a day or two. Before my first elimination diet, diarrhea was so normal that I didn’t think of it as a symptom.
Heavy alcohol use in mid-life
My gut health symptoms peaked when I was about 47. The diarrhea was daily & severe. I finally sought help when I realized I was dreading a camping trip with my kids—I couldn’t be without facilities! The Small Intestine Bacterial Overgrowth (SIBO) diagnosis was completely new to me and so easy to fix with antibiotics. The diarrhea stopped immediately, but my diet, environment, and drinking had not changed. My gut was still sick. I remember eating the requisite lunch at meetings and I would be so embarrassed with the sounds my body made digesting my meal. It was LOUD! I didn’t toot…it was just my intestines! I believe there are many things that affect our gut microbiome, including the brain connection that is currently getting some research. A stressful marriage and home life, conflict with kids, and no fulfilling outlets in my life all contributed to a very unhealthy mental state. And there was the drinking. Back then I would stay up late at night and watch TV shows with a glass of wine (that often became a bottle). This type of behavior probably went on for about 5 years. It was very unhealthy, and I wish someone would have intervened!
Young Adult Gut
The one thing I want younger people to know is that if you have persistent digestive distress of any type, then you need to work on these things. Your whole life will get better! Like most young adults, my 20’s and 30’s were filled with education, travel, then working and family. I would often skip meals or eat heavy meals out. I didn’t drink as much during this phase (less money). But I was always VERY gassy. I hated having to use the work bathroom because I could not take care of business without noise. I also woke up gassy every morning. My sister and I would joke about this, so on some level, I thought we were “normal”. I even remember struggling with gassiness as a kid. Clearly, my body was never digesting some types of food. It has been in an inflammatory mode since I was born!
My notes on Gut Bacteria
We have 10 times more bacteria cells than all the rest of the cells in our body. Our microbiome weighs 5 pounds, almost twice as much as our brain. If you laid out the surface of our microvilli, it would be the size of a tennis court. Seventy percent of our immune system is in our gut, the microbiome is the majority of our immune system! The microbiome is the most important piece and we are just starting to discover it. I will constantly update this list of bacteria as I learn about their relationship to food, disease, and behavior.
Firmicutes vs Bacteroidetes
Get familiar with these two words as they are the 2 primary groups of bacteria in our gut microbiome. Research shows that people with a higher ratio of Firmicutes to Bacteroidetes are more obese. There are also studies that show some populations have different ratios, depending on their primary diet.
Good Bacteria
Akkermansia muciniphila Foods rich in polyphenols, like cranberries and concord grapes, somehow help our gut maintain a healthy number of this bacteria. We don’t know why yet, but it is linked to lower inflammation and even a better response to cancer treatment.
Bifidobacteria genus of bacteria is very important to gut health. It restores intestinal barrier function, inhibits the growth of harmful bacteria, modulates local and systemic immune response, increases regulatory T cells, reduces inflammatory mediators among other things. B. Longum and B. Breve have proven particularly effective with Psoriatic Arthritis.
Clostridia A Firmicute that includes the Genus Clostridium (some bad bacteria), is important to our gut microbiome. If I understand correctly, it helps in the production of butyrate and boosts regulatory immune cells.
Lactobacilli Also a Firmicute and the most common bacteria added to yogurts. You aren’t going to get rid of it in your system, but it might be best if you avoid products with added Lactobacilli because it has shown little benefit to arthritis and L. casei & L. bulgaricus strains can produce histamines, which can perpetuate inflammation.
Fermentum-Not effective for SIBO
Saccharomyces boulardii-Not effective for SIBO
VSL#3: L. Plantarum, L. Acidophilus, L. Casei—Used for IBS, Ulcerative Colitis, and SIBO, but I will avoid because they are all Lactobacilli bacteria.
Bad Bacteria
Escherichia Coli specifically adherent-invasive E. Coli is present in people with spondyloarthritis and there is a potential association with starch in foods. Discussed in Keystone Approach book
Salmonella
Prevotella-present in people with rheumatoid arthritis
Collinsella-present in people with rheumatoid arthritis
Klebsiella-present in people with ankylosing spondylitis and other spondyloarthropathies. Also the suspected bacterial culprit in the Specific Carbohydrate Diet targeted at Crohn’s Disease.
H. Pylori-this article has a fascinating pie chart at the beginning that shows the breakdown of the gut microbiome with & without an H. Pylori infection. The study is about cancer, but the chart is very informative to see how significantly our gut microbiome can change.