Diet selects for the bacteria that grow in the GI track and control the development of the immune system. Diet-based inflammation produces aging symptoms.
Returning to the Subject of AgingI want to return to the subject of aging. A year and a half ago I wrote, “You don’t wear out, you flame out.” I still think that is true, but I need to update that idea of inflammation and aging to include diet, gut flora and immune system development. So here is my old article with a new focus on the gut.
Wearing Out Only Happens with Inflammation
I don’t think that aging happens -- most symptoms associated with aging are just medically mismanaged chronic inflammation. The major observations are that older people have more degenerative/autoimmune diseases and they suffer from fewer infectious diseases. The typical explanation is that the bodies of older people have figured out infections with an experienced immune system and that mechanical damage takes its toll over time -- joints wear out. I think that there may be a minor amount of truth in this cultural perspective, but there is something more profound at work, sarcopenia combined with a compromised gut flora.
Replacing Muscle with Visceral Fat Is Inflammatory
Sarcopenia (muscle loss) is the gradual loss of muscle and replacement by fat. Thus, by age fifty most people are physically less active and even if they appear to have the same weight and shape as in their active youth, the muscle of their abdomens and limbs has been partially replaced with fat. This fat, as in those who are obese, releases inflammatory cytokines into the circulation and the body reacts as if it has a low grade infection.
Chronic Inflammation Taxes Immune System
Senior citizens are constantly expending energy and taxing their immune system by chronic inflammation. As a result they get fewer infections, but the chronic inflammation provides the foundation for cancer and autoimmune diseases. Their bodies aren’t mechanically wearing out, but they are wearing out by over use of the immune system.
Aging Symptoms Are Inflammation Symptoms
Those seniors who are physically active and eat an anti-inflammatory diet, do not appear to age as fast as those who are sedentary, obese and display the typical symptoms of chronic inflammation, the metabolic syndrome. Most of the characteristics associated with advancing years are merely symptoms of poorly managed chronic inflammation that can be reversed by an anti-inflammatory diet and exercise.
Diet Determines Gut Flora
Diet also contributes to aging, because diet controls development of gut flora and gut flora control development of the immune system. The gut flora of an individual reflect the bacteria that have entered the GI tract, nutrients available to the bacteria in previous meals, bacterial growth regulators released by the gut, exposure to antibiotics, exposure to phytochemicals and gut transit time.
Gut Flora Is Diverse and Adaptable
Gut flora appears to be amazingly diverse from individual to individual with thousands of bacterial species inhabiting humans worldwide and about 150 species in each individual. The same species remain in an individual for long periods of time regardless of diet. The dominance of particular species depends on recent diet. Major changes can result from antibiotics or gut diseases, e.g. Crohn’s.
Constipation Means Dysfunctional Gut Flora
Bowel stools are made up predominantly of bacteria and not undigested plant parts, i.e. fiber. Fiber is made up of plant polysaccharides that are not digested by salivary, stomach or pancreatic enzymes, e.g. proteases and amylases that degrade proteins and starch. Fiber polysaccharides pass into the colon where they are digested by gut flora. People with constipation usually have disrupted gut flora, e.g. wiped out by antibiotics, and so the minimal volume of remaining undigested fiber is all that passes out in compact, dehydrated lumps. If gut flora have been exposed to a particular type of fiber and bacteria having the needed enzymes have been brought into the gut previously, then the fiber is digested to sugars that feed the gut bacteria. The increased population of bacteria is what makes up normal, hydrated bowel stools.
Gut Flora Changes Slowly to New Foods (Polysaccharides)
Bacteria grow quickly and with ample nutrients gut bacteria can double in number in about an hour. Bacterial species are usually defined by the ability to utilize various carbohydrates or polysaccharides as nutrients. Depending on the food eaten, nutrients favor the growth of particular bacterial species and the gut flora population changes dynamically. New species are incorporated into the gut flora only if they find their way into the gut on food, e.g. riding on fresh, uncooked vegetables, and food provides nutrients that can permit the new bacteria to grow. It will take several meals for new bacteria to reach appreciable numbers. In the mean time the new fiber may be partially degraded and produce chemicals that disrupt other gut flora and cause bloating symptoms of food intolerance. This is not an allergic reaction of the immune system. It just takes time and persistence to permit the gut flora to adapt. Most people systematically make themselves intolerant to particular foods by over-reacting to initial maladaption of their gut flora to the new food. If they persisted with progressive exposure to diverse foods, their gut flora would adapt.
Simplified Aging Gut Flora Contributes to Inflammation
People of increasing age who maintain a diverse, anti-inflammatory diet and maintain muscle mass by weight-bearing exercise, avoid age-related inflammation and disease, i.e. they age more slowly. Conversely, those who simplify their diets by eating processed foods high in starch and vegetable oils, show symptoms normally associated with advanced age, even when young. The aging diet is inflammatory and it also produces a gut flora which is different from the youthful.
Aging Gut Flora Contributes to Disease
Constipation is an extreme example of dysfunctional gut flora and since gut bacteria are needed for the normal development of the immune system that is located in the lining of the small intestines, constipation is also an indicator of a compromised immune system. Aging is frequently accompanied by digestive problems with one extreme being constipation. It should not be surprising that individuals with compromised immune systems also develop numerous degenerative diseases indicative of a lack in the immunological tolerance systems that develop in the gut in response to normal gut flora. Constipation and digestive problems are not normal signs of aging.
Eliminate Symptoms of Aging by Cultivating Gut Flora
A healthy diet, healthy gut flora, and a competent immune system are all tightly connected. The typical symptoms of aging merely reflect an unhealthy diet and lifestyle that leads to chronic inflammation, a compromised immune system and disease. The process of aging can be slowed by attention to the next meal. Most people who fail to be healthy and active well into their 80’s are simply victims of bad choices (or of bad medical advice.)
136 comments:
Great Post ! Absolutley loved it , maintaining a anti inflammitory diet, and resistance training allows to prevent the aging process and should be the focus. But I do have a question, over the years I created a milk and dairy allergy, from supplmenting with whey protein, now I seem to bloat about 30 % above normal and have extreme cases of dierhea , is there anything I can do to fix this?
Nicholas,
Are you sure that it is a dairy allergy? It could be just lactose intolerance. If so, it can be eliminated by adjusting your gut flora using live yogurt. You just build up your tolerance by increasing the amount eaten over two weeks.
If it is an actual allergy, in which you are producing antibodies to dairy proteins, then you have to avoid the dairy proteins and get your gut functioning properly. The allergy should fade with time.
Allergies are a lot harder to handle, because you have to develop immunological tolerance. That means you have to find out why your gut flora-based immune system is malfunctioning.
I hope this helps. Thanks for the comments.
Dr. Ayers,
Thank you for so much for generous, groundbreaking work .
During a recent conversation with a friend that is familiar with raw dairy, he commented that raw milk products are populated with bacteria from manure. Even under the most exacting hygiene standards there has to be some contact between the milk and its physical environment.
Could there be an advantage for humans to ingest bacteria that been predigested by cows? Is dairy a more efficient delivery system when compared to raw vegetables?
As much as I believe and accept your advice, I’m looking for a more palatable substitution to fecal transplants.
Actually Ive gone back and forth what it possibly could be, Good question, I know I get those symptoms when I take any form of whey protein and milk. Cheeses and of course good old yummmy greek yogurt, gives me no problems at all. I keep a journal of nutrition and over the years Ive observed that I always tended to only cycle proteins one or twice every 6 months, not good ! So I felt it might be a dairy allergy, but good points I guess this is gonna take good old fashion guess and check : I will follow your guideline for increasing yogurt, and if it is a allergy, I figured it might be that my Gut is inflamed, but I have been off of whey substances for about 4 months and will need to try again to see if I have issues.
But If it is lactose intolerance, could it just appear? I have never had this issue in the past?
Thank your for answering my comment, much appreciated P.s I have been using Glutamine 20-30 grams with my Post workout intakes and Probiotics which I hope it helped.
Anonymous,
I don't understand the paranoia about bacteria. I used to teach microbiology and the message that I got from slogging through the compendium of bacterial pathogens was that they can't kill you unless you immune system is compromised. It is a lot easier to be healthy than to keep sterile.
I used to do a lab experiment in which I got some raw milk and inoculated it with a lab strain of E. coli. The students then measured the number of living E. coli over time. Surprise, the milk killed the E. coli. Raw milk is anti-microbial.
When I was in Singapore, I watched a fire walking ceremony in a Hindu temple. After walking the coals, the devotee stepped into an anti-microbial solution of ... milk. Severe burns were treated with turmeric.
Raw milk from reasonable sources is safer than pasteurized, homogenized milk. I think that the processing actually makes the milk more allergenic.
You will think that you were just being silly when fecal exchange parties become mainstream.
We are simply too clean for our own health.
Thanks for watching.
Nicholas,
Your prior use of probiotics should have maintained your lactose metabolizing capability, since most of those bacteria use lactose. Unfortunately, those bacteria don't tend to stick around in most guts and you probably didn't keep maintaining those bacteria by supplying enough lactose in your diet.
Let me know what happens with your experiments.
Thank you for all of your hard work and taking the time to share your insights.
Aside from my own issues, I'm concerned about my 8yo daughter... she had/has kidney reflux and used to get uti's a lot, which were of course treated with antibiotics. Then she was on a daily antibiotic for a long time... maybe 18 months? 2 years? Then she had that deflux procedure which took care of most of the kidney reflux and has only had 2 uti's since then. She was also having some holding issues/constipation, which I'm gathering was probably due to all of the antibiotics.
I want to do everything I can to optimize her gut flora - I'm concerned that this will cause all sorts of problems down the road for her. She's a good eater, but I can't get her to eat anything too different... i.e. saurkraut, kim chee (sp?), and don't want to give her soy. I can try to get her to do some greek yogurt with whole fruit.
We have probiotic powder, but haven't been quite sure how to get it into her if she's not having shakes, yogurt, milk, cereal, etc. And I saw it mentioned that sometimes the non-encapsulated probiotics don't make it down far enough into the gut... is that correct? And the capsules are still too big for her to swallow.
Besides the greek yogurt, maybe she can try some kefir, and the powdered probiotics, do you have other suggestions to repopulate her gut? Any ideas you have would be greatly appreciated.
She was breastfed until she weaned herself by the age of 3, but I worry that all of those antibiotics may have ruined all of that.
"riding on fresh, uncooked vegetables"
- so, what if all vegs i eat are cooked?
Dear Dr. Ayers,
great post. Thanks a lot for your very useful insights. I´m sure you´ve heard from the Crownalife projekt:
http://jn.nutrition.org/cgi/content/full/137/11/2590S
I wonder if not even younger people look very much older because of a damaged gut flora.
Anonymous with 8 yr old,
Somebody knew what they were doing getting her to breastfeed for 3 yrs. That is a superb start. The heavy antibiotics mean that she will have to start from scratch and rebuild her gut flora.
She needs to share food with other healthy kids her age and eat plenty of raw vegetables. I think that you need to bite the bullet and clean out your kitchen and have the whole family go on a healthy food binge for a couple of years. You need many sources of healthy bacteria and a broad diversity of plant polysaccharides (raw or minimally cooked).
My three daughters (youngest six at the time) would head out in all directions of the food hawker centers in Singapore and buy their own favorites. They ate everything, because they didn't want to miss out on the goodies that everyone else was enjoying. That was the way the six-year-old learned to swim in the reefs in Bali -- she didn't want to be left behind by her older sisters and miss the extraordinary fish the others were shouting about.
At any time it is possible to regenerate gut flora. It just takes persistence, sources of bacteria and the full spectrum of plant fiber/polysaccharides, e.g. pectin, inulin.
Thanks for the comments and let me know how it works out.
Anonymous,
Cooking vegetables is great for making their nutrients more available, but it isn't going to provide any new bacteria for your gut.
So if you have a well trained gut flora already, cooked vegetables are great. If you have a compromised gut flora, then you need new recruits that fresh veggies from the garden can provide.
Thanks for the comment.
Byron,
Thanks for the lead on a bunch of articles on the impact of inulin.
Note that most probiotics are only useful in providing a limited number of bacteria that usually grow at the end of the small intestine. Inulin, pectin and lactulose are more effective in promoting the other hundred species that are anaerobes. Most of those will have to be recruited from other environmental sources.
Yes, I agree that many young people look much older than there years, because of poor diets and the gut flora of the elderly.
Thanks for the comments.
Thank you Dr. Ayers.
We started vegetable gardening last year and the kids would eat stuff right out of the garden (no chemicals). Last year I was grinding my own wheat and baking bread thinking it was healthy, but we've stopped that. We've greatly reduced our grain intake (the kids get an occasional sandwich... like once a week) and we're also trying to eliminate the o6 oils and isolated fructose (i.e. non-fruit). Her little brother, now almost 5, breastfed until almost age 4, and they do share foods and such, so hopefully that has helped her as well.
They both love apples, oranges and carrots (pectin) so that's good. And they like jicama (when I can get it) and asparagus. I'm going to see about growing some jerusalem artichokes... they seem versatile too.
They both like salads and vegetables (cooked and uncooked) so that shouldn't be too much of a problem there.
This year we've also been using mostly pastured dairy (butter, cream, milk) and pastured eggs. We can't always get the pastured meats, but do when we can.
They also both take omega 3s and some vitamin d, though now the sun is out and we're outside more so we're backing off of the d a bit.
They still get more sugar than I'd like, but not nearly as much as most kids do.
So maybe we're already doing a lot of the right things but just need a tweak a bit. I was thinking that the probiotic was critical.
Thanks again!
Fascinating post Dr. Ayers.
I have recently posted on longevity and blood glucose levels. It seems that blood glucose control before age 55 may significantly increase your chances of living beyond 90:
http://healthcorrelator.blogspot.com/2010/04/blood-glucose-control-before-age-55-may.html
I guess the connection with gut flora is related to the intake of refined high glycemic load foods, which stimulates the formation of a particularly set of gut microorganisms.
Does that make sense?
Of course blood glucose levels may also reflect an increase in fat mass, decreased adiponectin, and other factors. So the relationship with gut health may be more complex.
Coincidentally, I have just seen this on Nephropal, which appears to get to the heart of my question:
http://nephropal.blogspot.com/2010/04/colonic-flora-and-diabetes.html
Anonymous with 8 yo,
My 11 yo son doesn't like sauerkraut, either (yet), but he does like dill pickles, so I include a generous spoonful of lacto-fermented pickle relish when I make egg/tuna/chicken salad, etc. Or I serve a slice of a LF dill pickle with his meals now and then. I also make salad dressing with a splash of LF sauerkraut juice for part of the vinegar. I have found Bubbies brand of lacto-fermented dill pickles/relish and sauerkraut in the chilled pickle area in several markets in my area (So Cal), including two major supermarkets (Ralphs & Stater Bros). Ask your store managers (or go to the Bubbies website for store listings).
I also recommend Sandor Katz's fantastic book, Wild Fermentation, which contains great recipes, tips, and technique descriptions for a wide range of lacto-fermented foods you can make at home.
Japanese grocery stores (or online retailers) sell inexpensive pickle makers that have a screw-down perforated plate in the lid that hold the veggies under the brine to ensure anaerobic bacteria growth instead of molds.
Good info. I didn't realize that only raw or lightly cooked vegetables provide the right substrate for beneficial bacteria.
What do you think of legumes, soaked oatmeal, and sweet potatoes as sources of soluble fiber for bacteria? I'd assumed these were helping the situation, but not so?
What about fruits?
Helen,
The point I was trying to make was based on an observation about the fiber-digesting enzymes of the gut flora of Japanese who ate kelp. Those Japanese gut flora had genes derived from marine bacteria that normally lived on kelp in the sea.
If you want to have a stable, healthy gut flora that stimulates a healthy, tolerant immune system, then you need access to the bacteria that grow on the plants you want to eat. Those plant-eating bacteria will be found in and around the plants, but will be removed by cleaning and cooking.
To have healthy gut flora, you need both the original bacteria from the plants and you need to select for those bacteria in the gut, by continuing to eat those plants. That means a diet complex in plants and a constant supply of fresh, raw veggies.
Cooked veggies are a fine way to feed established gut bacteria, but won't provide a source of new bacteria.
Thanks for the questions.
Anna - thank you for that info! They do like pickles so those suggestions would work great. And I'll check out that book as well... sounds like it will have lots of great recipes and ideas.
We seem to keep having the same few meals over and over, which is fine, b/c they're good and everyone likes them, but I think we need to start branching out a bit.
Thanks again!
Anonymous,
Just one note. The fermented foods focus just on bacteria that may act as probiotics for the upper part of the digestive tract. That is less than 10% of the gut flora.
To feed the rest of the gut flora that also influence the immune system (even though that resides in lining of the small intestines) apparently other plant polysaccharides are needed. This is another good reason to feed a variety of veggies.
Ned,
As you point out, glucose from the diet has complex impacts on health. An interesting aspect of the small intestine is that it is designed not to take up small nutrients, e.g. amino acids or glucose, directly from food. Hence the body does not secrete enzymes to degrade proteins to amino acids or starch to glucose, but rather the enzymes secreted produce fragments of protein, i.e. peptides, and of starch, i.e. oligosaccharides, that bind to other enzymes on the surface of the intestinal epithelial cells. Amino acids and sugars are then released from the food polymers and immediately bind to receptors on the surface that transport them into the intestinal cells.
This means that amino acids and sugars in the diet are used more by what should be few bacteria in the upper intestines. Does this change the gut flora. I expect that it does. This is in addition to the utilization of starch oligosaccharides that are available in typical hyperglycemic meals. This shift in gut flora may have dramatic impact on the immune system in the intestines.
Thanks for the papers and comments.
Dr. Ayers,
What are your thoughts on the probiotic yeast Saccharomyces boulardii? I know you aren't a big fan of probiotic supplements, favoring food sources instead, but Sacc boulardii has some good data behind it and may be a helpful measure for the GI tract during antibiotic usage. And thanks again for all your efforts.
Garry,
I am only familiar with Saccharomyces boulardii in infants. And there it was used successfully to suppress adult bacteria and promote normal baby bifidobacteria. It is supposed to produce polyamines that aid gut maturation.
I don't think that one component of the gut flora out of the hundreds of species of bacteria will make a huge difference, but no one knows much about the field of gut microbiology. Maybe there are keystone species that are needed for dozens of other species.
Thanks for your comments.
Dr. Ayres, Thanks for your work. Really enjoy this cutting edge effort.
Saw This
http://www.cell.com/abstract/S0092-8674%2809%2901248-3
Summary
The gastrointestinal tract of mammals is inhabited by hundreds of distinct species of commensal microorganisms that exist in a mutualistic relationship with the host. How commensal microbiota influence the host immune system is poorly understood. We show here that colonization of the small intestine of mice with a single commensal microbe, segmented filamentous bacterium (SFB), is sufficient to induce the appearance of CD4+ T helper cells that produce IL-17 and IL-22 (Th17 cells) in the lamina propria. SFB adhere tightly to the surface of epithelial cells in the terminal ileum of mice with Th17 cells but are absent from mice that have few Th17 cells. Colonization with SFB was correlated with increased expression of genes associated with inflammation and antimicrobial defenses and resulted in enhanced resistance to the intestinal pathogen Citrobacter rodentium. Thus, manipulation of this commensal-regulated pathway may provide new opportunities for enhancing mucosal immunity and treating autoimmune disease.
Interesting post.
Lots of people don't have the lactase enzyme. But are you saying that we really don't need the lactase enzyme? It should be sufficient to just get some lactose-degrading bacteria? Do you suggest that 100% (or close) of the population should be able to learn to tolerate diary?
Does casein have to enter the blood stream through a compromized gut lining in order to be problematic, or could the casein cause problems even without a leaky gut? For instance, if mucus is produced when one drinks dairy, does that mean that casein has entered the blood stream or could it happen anyway?
Dr Ayers,
I’m curious about something. I was suspicious of bacteria before ever finding your blog, mainly due to the fact that so many people with fructose malabsorption tend to react to different foods. Some are bad for everyone but others can tolerate different things which led me to wonder if the particular bacteria prefer specific foods. What also tipped me off was reading about colic in babies (I had it bad) and how klebsiella was found in large quantities in sufferers and has been found to set people up for gut troubles when they’re older. As a child I, beyond the colic, didn’t have too much gut trouble, which I credit my upbringing with, as my mother didn’t believe in hyper-hygiene. We had a good sized garden, I was encouraged to spend a lot of time outdoors, getting muddy, catching crawdads, climbing trees, you couldn’t get shoes on me in the summer. On occasion my mother made my sisters and me strip on the back porch so she could hose us off before letting us in the house. And I’d eat anything that didn’t eat me first, as my mother tells it. I’m fairly certain I would have gotten a lot sicker a lot sooner had I not had this kind of upbringing. Which brings me to something puzzling me. Aside from the constipation, which is improving my the way, symptoms I get when eating things that don’t agree with me, chills, achy joints, tendonitis and what feels like neuralgia and gives off heat, a burning sensation mostly in my Achilles tendons and across the top of my feet around the ankle joint, etc . . . I’m wondering what’s going on here. I’ve read a bit about a herxheimer reaction, although most of the literature deals with an antibiotic cause. Can the bacteria fighting it out be causing this? I’m going to ask my doctor to run more blood tests this week, check for deficiencies, look for anything out of the ordinary, so if there’s something more serious at work it should turn up.
Hi Art,
Love the blog. I'm currently conducting research on an inflamatory diet, insulin resistance in the midbrain, and compensatory behavior that cause insulin resistance in the periphery. Good to find a scientific source for more info on "Cooling Inflamation."
A question for you. A recurring problem I have had is that everytime I start Vitamin D therapy (my last levels were 30). I suffer from bad constipation. Constipation has intermittently been a problem in my life, perhaps becuase of indiscriminate antibiotic use from about ages 7-14 (lots of Strep and doctor parents who didn't know better). Things usually return to "normal" after stopping therapy, although I've never stuck it out for more than two weeks to see if I can adjust. I don't think its a problem with hypercalcamia, and added magnesium doesn't help. I was wondering if perhaps you could share some insight. Perhaps it is causing a die off of whatever bacteria were causing regularity through its antiinflamatory effects, and these need to be replaced with agressive pre-biotic therapy.
Best,
Simon
Hi Doctor,
So, are you saying that going to Whole Foods, and buying, then eating raw veggies should give us diverse bacterial exposure?
Do you think there is anything (beneficial bacteria) lost in the transition from 'wild' veg (however a grocer obtains the plant)to store-bought veg?
What do you think about primarily meat-eating tribes like the traditional masai, inuit, etc. that don't seem to consume much plant food, but probably are fairly healthy?
What you say is interesting, I just wonder how often our ancestors would have sought low-calorie plant food.
Maybe their flora is generally pretty stable throughout their life simply consuming natural food?
Thanks if you can get to any of these! (great blog btw)
Simon
If you are taking Magnesium oxide,
only 5% is absorbed. I have been
taking Magnesium sulfate (Epsom salts). This is much stronger
and very cheap. Other chelated
products cost 50 times more.
Not sure of any downside.
A bit off topic--does cooking herbs and spices (turmeric, cayenne pepper, garlic, etc.) reduce their anti-inflammatory effect?
John,
I don't think that in most cases that cooking alters the anti-inflammatory properties of herbs and spices.
Up to boiling water temps., e.g. boiling or sautéing, all that is altered is hydrogen bonds between molecules. Frying and baking temps are high enough to alter covalent bonds and produce new molecules, but even under those circumstances, most of the active compounds are pretty stable.
Cooking does, however, produce some inflammatory compounds. I don't think that most of the rearrangements of carbs, e.g. caramelization, that produce browning and new flavors, are a problem, but browning proteins with carbs, e.g. grilling, results in glycation. The glycation of proteins with high blood sugar is what causes the dangerous symptoms of diabetes.
Most of the activity of the anti-inflammatory spices is lost in the gut as detoxifying enzymes "protect" us. Turmeric is inactivated this way. That is why most cuisines that use turmeric also add black pepper, which temporarily inactivates the P450 enzymes and increases the amount of turmeric that gets into the blood stream.
Thanks for the comment.
Anonymous,
I commented on IL-17 production and gut flora in a previous article on rosacea. I think that this is just the first of many examples of modification of the immune system by gut flora. Another example is the development of Tregs by H. pylori.
Thanks for sending articles my way.
Tim,
Lactase is obviously produced by everyone to use the only readily available sugar in breast milk. It then gets shut off and is only produced by some people as adults.
Those people who are intolerant of milk as adults, don't have enough bacteria able to hydrolyze lactose in the end of their small intestines. Examples of those bacteria are typical probiotics or dairy fermenting bacteria in yogurt. I think that anyone can overcome lactose intolerance by building up lactose digesting bacteria by continually eating food with lactose. Most will become more intolerant when they stop eating lactose or lactose-digesting bacteria.
More exposure of casein to the immune system will occur with a leaky gut, but I think that the immune system also checks out food through the intact gut lining. My own thinking is that allergies only reflect past histories of inflammation and damage to gut flora and can be reversed by eliminating sources of inflammation and improving gut flora to regain immunological tolerance.
Thanks for the comments.
Rainarana,
I wrote a post about "paradoxical" infections of tissues, and used it as an explanation for some of the symptoms of rosacea that are triggered by diet. This is similar to what you related with inflammation of your tendons and other connective tissue in response to diet.
I think that you are reasonable in invoking Herxheimer, or die off reactions. Release of bacterial wall components, e.g. endotoxin, cause release of inflammatory cytokines that can cause localized inflammation in tissues with increased cytokine receptors.
Thus, disruption of gut flora, e.g. in biofilms as one member of the community is stimulated by fructose, can produce a release of inflammatory cytokines from the gut that enhance existing inflammation in particular tissues. Different people will experience different secondary inflammations depending on pre-existing problems. Lowering overall inflammation will decrease the secondary inflammations.
I think that this type of complex response is most common in people with low vit.D serum levels.
Thanks for the lengthy observations and comments. I think you are headed in the right direction.
Simon,
I think that your gut flora have never recovered from your antibiotic use. What I would recommend is that you work for a couple of weeks on an anti-inflammatory diet (lots of raw, fresh veggies from gardens with minimal cleaning) and building up your gut flora with probiotics/live yogurt, then start adding pectin (apples, tomatoes, etc.) and inulin (leeks, etc.) and then slowly add lactulose. You should have normal bowel movements.
At that point you can start to increase your vit.D3 supplements. Go slowly and maintain your normal bowel movements. When you are up to 5000 IU of D3 per day, check you serum vit.D. If it is still low, you may need to have your doc give you some larger doses to overcome some other source of inflammation, but your gut should be in much better shape.
Also make sure that you don't have dental infections.
Good luck and tell me how you progress.
This post was just the nudge I needed to eat more veggies in a raw state (I'm not going all-raw & vegan, mind you).
I regularly eat salads of lettuce, arugula, cabbage, and so on with my evening meal, but not always not earlier in the day (most days I eat only two meals - a late breakfast/brunch of eggs cooked in butter (sometimes with some breakfast sausage or bacon & sauteed onions), a raw egg & cream eggnog of sorts if I'm in a hurry/need to take it with me, or reheated leftovers from a previous dinner. I don't skip lunch most days for any particular reason other than it seems to suit my appetite. I think the higher fat content of my two meals makes 2 meals possible. Back when I ate a lot of carbs at every meal (and a lot less fat) I had hunger I couldn't ignore very quickly after eating.
This weekend I experimented with veggie smoothies as a way to increase raw greens consumption, as well as use up more of the produce we receive in our weekly CSA subscription box (we are the pickup location hosts, so the complimentary weekly box we receive is sometimes a bit too much for our small family of three, so I give some of it away).
I found that greens (I used chard, parsley, & green cabbage this time), don't actually contribute much flavor at all when blended with some fruit ( a handful of whole strawberries - green top and all, a whole cut up blood orange - peel sliced off, and half a *really* ripe banana) - in the 40 or so oz blender pitcher that took all day to drink up (in 5 oz glasses, by two adults).
But the greens do make the smoothie very green no matter what color fruit is added, which tricks the eyes & tastebuds (I'm going to have to blindfold my kid the next time because he was suspicious of the color and not interested in participating a taste test). I'll cut back on the fruit on the next batch, I think, though I didn't add so much fruit as to screw up my BG (I checked before and 1 hour after).
I didn't make the smoothie low-fat, either. I added a couple Tbl heavy 40% butterfat cream and perhaps 1/4-1/3 cup whole milk plain yogurt and two whole eggs. If relying on this for a mini-meal instead of a snack or beverage, I'd definitely add some additional eggs or egg yolks for more protein.
Anna,
I would recommend your suggestions of veggie smoothies to change the American Diet (see my idea about the Barack's Breakfast Blog.) If our humble pres. talked about eating a veggie smoothie before his next press conference, imagine how many people would be on the right path to better bowels!
Thanks for the input.
Ryan,
I think that our supermarkets are too clean for our health, i.e. the veggies lack healthy bacteria splashed up off of healthy soil. This simplifies our gut flora and prevents us from adapting to foods.
I think that foraging humans will eat anything that has nutritional value. My impression is that anywhere in the world where there is population pressure, the local sea shore is picked clean and so are the forests. I think that people have always browsed, because it makes the gut more efficient and exploits more nutrients. At the same time, the veggies are a major source of antimicrobial compounds that reduce spoilage of meat. That is the point of herbs and spices.
I think that there are some people who have subsisted on animals alone, but that is because of scarcity. People can adapt to life without plants, but it is harder.
Thanks for your comments.
I think this is a large part of what causes aging. On a related note what's interesting to me is why, for example, ingesting some chicken collagen helps arthritis even though there's no way that what's happening is simply eating collagen replaces the collagen in the degraded arthritic joints. I speculate that it must be something to do with resetting the immune system to stop attacking the collagen in the joints rather than helping the body repair the collagen in the joints.
If this is indeed the case I speculate that consuming samples of the various auto-allergens might work to turn off the destructive auto-immune attacks in other auto-immune diseases...
Would, for example, consuming supplemental myelin stop multiple sclerosis in it's tracks?
I also speculate that maybe aging is inevitable (unless corrected artificially) because there are so many pathogens and foreign bodies out in the environment that over the course of a human lifetime it's almost inevitable that one or more of these will be consumed or the body will have some exposure. Then since the foreign bodies have similar chemical structures to self, the immune system from then on is primed to attack your own body. Maybe it's inevitable.
I hold hope, however, that since the chicken collagen works, then my theory might have some grains of truth to it and we have at least one option available to us to age more healthily.
Anyways, I rambled a bit.
Thanks Doc for your ever insightful posts.
Hey Art,
Thanks for the advice, sounds like a plan. I have a couple of questions, mainly stemming out of curiosity. You mentioned lactulose, which I had never heard of before. It seems like it is actually indicated for constipation and has a beneficial effect on the microflora, its so bizzare I've never heard of that before. All the other options are so bad. I assume I need a prescription from my doctor for that? Also, what might the mechanism be for Vitamin D causing the constipation in this instance, I mean, we know the gut flora is probably not entirely recovered, but why would Vitamin D have an effect? Finally, do you reccomend a multivitamin (I know your not a doctor, but I am always curious what people who have studied the matter are doing)
Best,
Simon
I meant to say not a physician by the way. :-)
DB,
You bring up many interesting points. The immune system focused on the ileum of the small intestines, which features the unique Peyer's Patches, are part of the mucosal immune system. A major role of this system is to provide tolerance for common antigens and bacteria.
I previously studied the ability of fed antigens to provide tolerance, i.e. immunological non-responsiveness to subsequent injection of antigens. I used it to produce a selective antibody response to a modified part of a protein, by feeding the normal protein and then injecting modified protein. Only antibodies to the modified part of the protein would be produced.
In the same way, in a normal, by which I mean non-inflamed gut, feeding an autoantigen (self antigen) should reduce production of an immune response to the autoantigen and thereby neutralize an autoimmune disease based on the autoantigen. The problem is that if there is inflammation in the gut, the opposite response will occur and the fed autoantigen will stimulate an immune response.
I don't think that autoimmune diseases and allergies are more common in advanced age, because of chance exposure to cross-reacting microbial antigens. I think that inflammation is the basis for autoimmunity and allergy, and aging people are permitted to develop symptoms of advance inflammation without treatment.
Old people are expected to develop immune system dysfunction, so no one bothers to feed them anti-inflammatory diets that will eliminate the symptoms and stop the development of the diseases.
Thanks for your comments. I think that you are on the right track.
Simon,
Depending on where you live, lactulose may be more or less readily available. Lactulose usually acts as a laxative, because it is disruptive to existing bacterial communities in the colon. As bacteria adjust, it becomes just another nutrient for the gut flora. In this way it is similar to fiber, which are polysaccharides that are initially indigestible by gut flora, but later your gut flora adapt and digest it.
After you gut adjusts to the lactulose, you won't have to keep taking it, because you are just using it to help adjust the diversity of your gut flora.
I think that the vit.D caused constipation because it disrupted another interaction that was causing irritation and diarrhea. In other word, what you thoughts was normal was actually diarrhea+constipation.
Just a thought. I think working for a healthy gut and normal bowel movements should be uniformly helpful.
Let me know how it goes.
Dr Ayers,
Thank you for the response. I had a feeling that that's what was going on. I haven't read that post yet but will soon. Still catching up after my short holiday. And the heads up on the lemon zest. I've cut way back on it. I am feeling better overall so far with minor flare-ups of inflammation here and there but nothing major. I find this all very fascinating, as I have ADHD as well (focus is much better low carb), and the relationship there with carbs and fats, how its all interconnected. I really appreciate your advice and this blog. It's given me incredible insight.
Rainarana,
Just a note on ADHD and omega-3 fatty acids. There have been hundreds of studies on fish oil and behavior. A survey of over 250 studies showed that essentially all of them were messed up because the investigators treated omega-3 fatty acids like vitamins and ignored the interactions between omega-3 and omega-6 fatty acids. In almost all cases, the omega-6 levels were not controlled.
ADHD has been associated with deficiency of omega-3 fatty acids in blood cell membranes. This kind of pattern is what I usually find with symptoms that are based on inflammation. The bottom line, is that you should see a decrease in ADHD symptoms with the anti-inflammatory diet that I suggest. Remember to eliminate vegetable oils, because the omega-6 fatty acids should be problematical for ADHD. You should also be able to see good results by slowly increasing fish oil supplements.
Thanks for your observations.
Dr. Ayers, I had of course heard about the connection with omega 3 and ADHD but only just learned about the interaction with omega 6. I saw a huge difference when I eliminated gluten. I have the predominantly inattentive type without the outward hyperactivity. Suddenly I had much more energy, my mood was better, actually motivated to exercise and eat better, not as overwhelmed by assorted stimuli. Focus can still be a problem, although not as much as before, and I'm hoping as I get my gut in better shape I'll see more improvement.
Hi Dr.Ayers,
in your Anti-Inflammatory Diet post you've stated:
"Saturated fats appear to be problematical primarily if chronic inflammation is established. Saturated fats are healthy in the absence of inflammation."
Why is it?
Suffering from IBS I'm a bit uncertain whether I should keep on having most of my calories from butter or not.
Just bought Micheal Eades new book, I'll give his diet a try.
Marco
p.s. - Coffee is really terrible for my IBS, just a small cup and loose stools in minutes.
Doc,
Thanks so much for your clarification. Now the light bulb goes on!
So the steps are this:
1. Control Inflammation
2. Heal the Gut
3. Desensitize the immune system by introduction of auto-allergen via gut
It's interesting that ingestion of the autoallergen while the gut is inflammed would be BAD!
I wonder if the development of auto-antibodies could occur initially by a healthy inflammatory response to some pathogen combined with the concurrent ingestion of some food that is similar in chemical composition to self.
Anyways, very interesting. Thanks.
Re: Lactulose
Again, there is a journal letter describing an anecdote with n=1.
http://www.springerlink.com/content/nm230774614mr210/fulltext.pdf?page=1
In this case, symptoms of diarrhea returned when the lactulose consumption stopped.
I suppose this is one of those things that you have to test on yourself and see what works.
This post & your answers to the comments has provided again very much useful information, thanks Art!
I try to explain here with few words what I had in mind when I was asking about LPS tolerance. Feel free to comment.
If I try to increase and sustain the diversity of my gut microflora I have to start eating those microbes with the stuff that garden and forest nearby offers.
If you compare market foods and food stuff grown outside in the nature there is a big difference in the content and diversity of microbes. Clean river or lake water for example contains extremely more microbial activity than tap water.
What happens when a person starts to eat and/or drink fresh food and water from the nature?
Increasing amount of dietary microbes will also increase the amount of microbial components that enters in our digestive system.
This should also lead to increased innate immunity activity.
Dietary LPS for example get free ride from the gut with the chylomicrons which are transported to the circulation through very controlled lymphatic system.
Are we getting sicker if we eat immunesystem activating proinflammatory food? No, but we are getting healthier. Why's that?
I think tolerance to the dietary microbial burden could explain that.
Innate immunity activation through TLRs leads to th1 responce and also increased Treg activity. This could be something that we see as an enhanced resistance towards pathogens and decreased chronic inflammation. Chronic inflammation is overactivity of our own immune cells like Kupffer cells in the liver.
Some researchers are claiming that modern environment has become proinflammatory and that is why people get sick. I'd rather say that we have lost the proinflammatory tolerance building environment contact and that is why we get sick.
How's that sound?
Marco,
You ask about saturated fats. I think that the biomedical literature clearly shows that saturated fats are healthy and the actual problem is the omega-6-rich vegetable oils. The medical advisers and nutritionists didn't look critically at the data and came to the wrong conclusion, with disastrous results for public health. Most of the focus on controlling serum cholesterol is also inappropriate.
It turns out that butter, eggs and coconut oil are far healthier and cause less obesity than grains, corn oil and margarine.
Gut diseases, such as IBS, as you are very aware, are not at all straightforward in treatment, since the gut and gut flora control so many parts of the immune system and physiology in general. That is why there are so many unique triggers for diarrhea. That is also why there are paradoxical responses to foods that would normally be anti-inflammatory, e.g. fish oil, vit.D3, saturated fats, etc. I also suspect that the blanket diagnosis of IBS actually includes many different diseases at different stages of development, which means different responses to various treatments and food.
This underlying complexity is why I just suggest that people try to normalize their gut flora with an anti-inflammatory diet to simplify the disease.
Coffee sensitivity with a very rapid response, presumably to the caffeine? is difficult for me to explain. It probably says something about the nerve-based components of the disease.
Let me know how you do.
DB,
I don't think that autoimmunity develops from foreign antigens that look to the immune system like self or autoantigens. I have looked and the amino acid sequences of dozens of allergens and autoantigens. All of them have a sequence of three basic amino acids that provide a predisposition to being internalized and presented to the immune system as antigen fragments for antibody/T-cell receptor recognition.
By my thinking, the problem of autoimmunity is production of a chronic inflamed system that skews antigen presentation to include molecules to which the immune system is normally tolerant. Autoimmunity also is built on gut flora dysfunction that compromises normal tolerance.
So, this means that presentation of antigens in the gut enhances the suppression of responses to mundane antigens and produces tolerance.
Thanks for the comments.
Westie,
I don't think that ingesting more bacteria necessarily means that more bacterial components enter the blood. I think that LPS in the lacteals is inflammatory and brings recruitment of lymphocytes, etc. This may be a component of the swelling of the bowel lining that can occur in bloating.
Controlled release of LPS and TLR signaling may be a normal part of stimulation of the gut-associated lymphatic tissue and that is essential for general immunological tolerance, e.g. to normal gut flora. I don't think that there is any tolerance of LPS.
Thanks for the stimulating conversation.
Art,
I agree that ingesting more bacteria does not necessarily mean that more bacterial components enter the blood. But if you digest more bacteria with chylomicron forming fatty acids that will be the case (according to pubmed). A fatty meal could lead to after meal low grade inflammation.
Here in Europe a lot of work is done with probiotics. Cani et al. have noticed that Kupffer cells has critical role in diet-induced diabetes and obesity. They claim also that Kupffer cell activation is a causal factor for hepatic insulin resistance.
On the other hand there is evidence that human proinflammatory phenotype is related to increased CRP (due to increased IL-6) and increased LPS-stimulated whole blood TNF-{alpha} and IL-1ß levels.
I have to disagree with you still about the existence of LPS or endotoxin tolerance since it really does exist. The big question is how closely it is connected these things you are discussing here in your blog.
LPS tolerant animal has attenuated LPS-stimulated cytokine response and at the same time LPS tolerance is associated with enhanced resistance to Gram-negative infections and that this effect is mainly mediated by improved effector functions of the innate immune system.
And it seems like that liver macrophages, Kupffer cells, has a major role in the development of LPS tolerance:
http://www.ncbi.nlm.nih.gov/pubmed/7757516
Could this all be just a coincidence?
Could be but I don't think so; atleast not yet.
Westie,
I agree that the liver shows reduced response to subsequent challenges with LPS, after an initial challenge. This is part of the system that handles bacteria escaping to the liver after alcohol exposure and can result in fatty liver.
I was reserving the term tolerance for the immunological tolerance produced through the exposure of the gut-associated lympatic tissue to antigens. I was saying that I didn't think that LPS caused this type of active suppression of a response to LPS. Your example shows that LPS does not produce immunological tolerance, but rather alters the TLR-based response of phagocytic cells to LPS as part of the innate immune system.
Some bacteria, e.g. H. pylori and filamentous bacteria, and helminths do specifically alter the adaptive immune system and that is the type of response that I am pursuing through alterations of the gut flora.
Thanks for your input.
Thank you Art for your patience! :)
I used the word tolerance because it is widely used in the literature but I understand your point.
just wanted to check back... i have added kefir, strained goat yogurt, sauerkraut and random pickles into my foods daily. it has helped my digestion amazingly. i use the sauerkraut juice as a base with oil in salad dressing as well...is there any benefit to that?
Hi Malpaz,
It's nice to hear from you. I see that you are making some progress on your gut flora. The fermenting bacteria that you are eating are the typical probiotics and they are the biggest help in getting your gut flora going.
There are about 150 different species of bacteria in the gut of the typical human. The probiotics that are used and present in fermented food may contain 10-20% of the gut bacteria that you need. The probiotic bacteria inhabit the region between the end of the small intestine and the beginning of the colon and a normally functioning appendix may contribute a "starter culture" of bacteria in this region.
To get the rest of the bacteria you need, add some pectin and inulin, polysaccharide fiber, that those bacteria use as food. Fruits and vegetables, e.g. apples and leeks, provide those polysaccharides and that is the major reason to have them in your diet. Until the new bacteria grow, most of the fiber will just pass through. It takes months to acquire and grow healthy bacteria to provide normal digestion and eliminate intolerances.
Most food intolerances are not genetic or immunological, they just indicate the absence of necessary, normal gut bacteria.
The sauerkraut sounds tasty and should provide some nutrients for you and your gut flora. Browse lots of different veggies and be persistent. It takes time to adjust.
Thanks for the update, keep me posted.
Dr. Ayers,
My question:
You just wrote, "It takes months to acquire and grow healthy bacteria to provide normal digestion and eliminate intolerances."
In your initial blog post you wrote, "Bacteria grow quickly and with ample nutrients gut bacteria can double in number in about an hour."
I am familiar with both of these ideas, since I've been exposed to them prior to reading your article.
But I find it difficult to hold both of these thoughts simultaneously in my not-very-large head. What would happen to the different populations of bacteria in months, that doesn't happen in days? Three days would mean that a single strain of bacterium could multiply by 2^72 times. Isn't that enough? What would another 30 days do that 3 days couldn't?
Thanks again for your informative work.
Moises,
It takes time to assemble all of the species that you need, because some only grow after others are established. It is like assembling any kind of community that has many different specialties.
In some cases, e.g. after antibiotics, the normal gut flora will not return, because food intolerances stop people from eating diverse foods needed to develop the lost bacterial species. Some of the old bacteria are simply not introduced into the gut again.
So gut flora development takes time and persistence.
Thanks for the questions and comments.
What's your opinionon blood type and food choices? I recently read D' Adamo's book, Eat Right for Your Type and it is very compelling...
thanks so much, very interesting as always.
Claire
Claire,
Is there a relationship between blood type, gut flora and diet? There doesn't seem to be a direct relationship. Blood type is determined by genes that code for enzymes that add alternative sugars to the ends of oligosaccharides found on glycolipids of red blood cells and attached to some serum proteins.
These same sugars are also found on the surface of some bacterial cells. The reason you produce antibodies to the blood type you don't have, is because you produce antibodies to bacteria with the other sugar antigen. You don't produce antibodies to your own antigens, so you tend to have bacteria with antigens similar to your own, because the other antigens lead to antibody binding and phagocytosis.
If the blood antigens are important to the existence of bacteria that are important to our health, then blood type may control gut flora type, which could alter the immune system. Diet that favors different gut bacteria may have a different impact on people with different blood types.
This would be a long shot and has not been found to be significant in medicine, but that alone doesn't prove anything.
Major histocompatibility antigens have been associated with predisposition to a variety of diseases. So there is a vague precedent.
To summarize, I doubt that blood type matters for health and diet, but if a mechanism is established, I could be convinced.
Thanks for the comment/question.
Going to find some leeks today as I have never had a leek…or seen one? I think they kinda look like bok choy though? Im not sure exactly what inulin and polysaccharide fiber are but ill Wikipedia it and figure it out. Thanks for the help- this all means a LOT to me. I need to expand my vegetable selection as I usually stick to lots of variety greens and mushrooms, onions, and garlic usually cooked in cultured butter or coconut oil
Digesting protein is extremely hard on the liver, for those already suffering from auto-immune diseases.
Dr Cordain (Paleo fame) and many others advise against nightshade vegetables and eggs.
Of course eliminating grains, sugar, dairy, gluten is going to make one healthier. But it's no so straightforward as what I've read here.
Dr. Ayers,
Thanks for explaining why it takes more than a few hours for gut microbe populations to reach some kind of equilibrium.
I have often experienced that fact that it can take weeks and months, and it's always nice to have a theoretical structure to help me understand my experience.
Doc,
It looks like your ideas are being investigated more by the mainstream.
Check out this post on what CalTech are doing at sciencedaily:
"The bacteria appear to have struck a deal with their host," Mazmanian says. They keep their own numbers low so they don't overwhelm the immune system, and in return, the immune system leaves them alone. "The bacteria need the secretion system to put the host in 'don't attack' mode." In return, the presence of the bacteria does not induce inflammation, as would be the case with a pathogen that has not evolved a similar "agreement."
http://www.sciencedaily.com/releases/2010/04/100426092803.htm
Dr Ayers,
Firstly, youre work is amazing!
and secondly,
how does this relate to the occurance of digestive leukocytosis that raw vegans claim to be proof that cooked meats are harmful to us?
Steve,
My understanding is that the increase in white blood cells that was reported in the 1920's in response to cooked food has not been replicated since. It is probably of no consequence.
So raw is probably good for recruiting new bacteria, but it hasn't been examined. Cooked meat and veggies have many more nutrients available and that is why food has been cooked for the last couple of thousand years by most cultures.
Thanks for the comments/questions.
Crapartist,
I don't know what you mean by digesting protein being hard on the liver. Do you mean utilizing amino acids as energy sources?
I think that any change in diet is difficult. Some people have a very hard time changing their habits and food can have intense psychological significance for some people. That said, for most people, all it takes is suffering with a diet change for three weeks and then new habits are formed. It may have looked impossible at the beginning, but three weeks later it is no big deal.
I think the habit of eating lots of carbs is easier to break if there is a dramatic shift to low carb, because then the hunger cycle is eliminated. If you don't start the day with a glucose spike, then there is much less hunger for carbs during the day.
I found it interesting that Dr. Sears in his Zone books identifies hunger between meals as an indicator of a meal that was too high in carbs.
The Six Week Cure diet of Drs. Eades, gets around carb lust by using a two week diet of protein shakes. That breaks the high carb hunger cycle and makes food selection more rational.
As you say, the low carb diet is healthier and it is worth the improvement in lifestyle to get there.
Thanks for your comments.
Annonymous,
The Sciencedaily article is great, because it talks about the intricate interactions between gut and flora. I find it particularly interesting, because in the early 1970s I was examining the same phenomena in plant pathogens.
The only difficulty I have with the article was the supposition that the bacteria optimize their strategy to avoid triggering host responses. I think that mutants that lead to increased virulence and use of host nutrients are always at an initial selective advantage, but are eliminated by the host response. That is slightly different, but is similar to the observation that viruses always evolve in hosts toward increased virulence, but are eliminated when they are counter-selected by poor transmission to new hosts. There are always pairs of opposing selection pressures in these host-pathogen interaction systems.
Thanks for the paper and comments.
Steve, I've found a good rule to be that any time a vegan/vegetarian makes a nutritional claim it's best to do some research before believing them. I usually just smile and nod and dismiss everything they've just told me. One of my favorites is the one about undigested meat in the colon, especially when they invoke Elvis, as some think he had 60 lbs of meat in his guts when he died. Or when they use Kellogg as a reference, the man who invented cornflakes as an anaphrodisiac and even had the army convinced to the point of using cornflake suppositories on the soldiers.
I recently had a discussion with a couple of vegans who claimed that you could get all of your aminos through a plant based diet. I was curious as to how that would be possible so did a bit of searching. This is a recommended meal plan to accomplish that: http://www.vrg.org/nutrition/protein.htm That's an awful lot of food, (not to mention really carb heavy) especially considering that you then need to eat a wide variety of vegetables to meet other nutritional needs.
Dr. Ayers,
I have no "carb lust" and followed an organic, Paleolithic diet for 20 years. Before it was even called anything. I've also been a Naturopathic med student(and now work for many plus MDs interested in). It's well known protein puts enormous stress on the kidneys and liver (digestion).
I don't disagree with your statements necessarily but the inflammation diet you promote while great in ways-- is not the answer for many with auto-immune diseases (nor is high carb).
Crapartist,
I don't think that the anti-inflammatory diet is the whole answer to autoimmune diseases, but it does begin to address diet-based inflammation and dysfunctional gut flora/mucosal immune system/immunotolerance that I think are the basis for autoimmunity.
Is there another diet that you think is more appropriate in the treatment of autoimmune diseases?
I still don't understand why protein is considered hard to digest. Amino acids/peptides are produced spontaneously by the action of gut enzymes on proteins. Do you mean that it takes energy to produce the proteases or are you talking about excretion of nitrogen when using amino acids for energy when carbs/fats are not available?
Thanks for your comments.
malpaz,
Leeks are not really like bok choy (cabbage family), but rather are a mild-tasting member of the onion family. Leeks look like "scallions on steroids"; despite their large size, they are much milder tasting.
Generally, the tough dark green tops are cut off and discarded or chopped small and cooked a long time if they are to be eaten (I trim, wash, & dry the dark green tops tops and save them in the freezer for flavoring long simmered bone broths, later straining them out).
Sand and dirt can become trapped in between the leek leaves at the junction of the white and green area, which needs to be rinsed out (unless you like sandy grit).
I try to buy leeks that have a lot of white area compared to dark leaves, as they generally are sold by the pound, though the condition of the green leaves can indicate how fresh or old the leeks are in the store. Leeks do not keep as long as "storage" onions, and will quickly dry out and go limp unless wrapped in a damp cloth towel or in a plastic bag. I store leeks in my refrigerator for a week or two, but a root cellar or similar cool area should also work, too, if you are fortunate enough to have such a place.
The white mild-tasting lower portion of leeks is the part most typically eaten as a vegetable (either as a flavoring ingredient or as a starring role).
I'm not aware of leeks being consumed raw, but when cooked long and slow (low heat) in water based liquid (braised) or in natural fat, leeks become sweet, tender, and very delicious. I love to cook sliced leeks in ghee or butter (grassfed, of course), gratinéed in the oven with cream and a good raw milk grating cheese, in a vegetable frittata, or puréed in bone broth soup.
Enjoy your leeks!
Hi Anna,
Thanks for the kitchen guidance. I know that a lot of readers enjoy/need this kind of seasoned advice and I am weak in this area.
Thanks for the constant attention and input.
What do you think about for instance cat allergy. Is that totally determined by genetics or is that also caused by leaky gut or bad gut flora? If I get my gut fixed, how long does it take for the body or immune system to get that the protein from cat is not dangerous? It's probably a tough questions, but maybe you have some testamonials?
If a cat licks on my fingers and I for some reason touch my eyes, the eyes immediately starts to itch. Does the protein from the cat enter the bloodstream through the eyes somehow or can there be a reaction anyway?
If the cat protein can get to the blood stream other ways than the gut (e.g. the eyes) and if cat allergy is not something you unconditionally have from birth, then your "chronic inflamed system that skews antigen presentation" theory sounds interesting. Cat allergy can't be a mimicry problem, because then everyone would be affected.
What's your theory about unlearning the skewed antigen presentation? Can it be done? How long could it take?
Tim,
Some allergies have minor genetic components, but basically they are a specific disruption of the immune system. Allergies indicate that your immune system is unable to suppress antibody production against common protein antigens, e.g. the major cat allergen, a glycoprotein secreted in cat saliva.
You produce IgE antibodies against the cat allergen, those antibodies move through the blood and bind to mast cell receptors distributed through the body. Rubbing the cat allergen in your eyes, results in binding of the cat allergen to the anti-cat IgE on the eye mast cells. The activated mast cells release granules containing histamine, proteases and heparin. This causes your symptoms.
I think that your initial exposure to cat allergen (or a related protein from mice for example) resulted in antibodies because it occurred when the exposed tissue was inflamed and your gut production of suppressing T-cells was compromised. The result was an aberrant presentation of cat allergen to your system and IgE production.
To eliminate the allergy, you need to fix your gut flora to repair your immune system to make it tolerant of the cat allergen. You also need to eliminate diet-based chronic inflammation, because this is the most common source of inflammation. The anti-inflammatory diet I recommend should do the trick. It will be a slow process (months to years), because you have to change your gut flora and then wait for the turnover of IgE that has already been produced.
Fortunately, the same diet will help you to avoid other allergies, autoimmune diseases, etc.
Thanks for the questions.
Drinking Raw (farm fresh as I call it) Milk has been nothing short of a miracle food. If you can buy it- try it. If you do, please support the peoples right to drink it. The other commercial pasteurized white liquid is NOT milk.
pjnoir,
You are right about the transformation of milk caused by pasteurization and homogenization. I think that those process, in addition to decreasing the effectiveness of the antimicrobial properties of milk also modify the interaction of milk proteins/fats/carbs with the drinker's immune system.
I think that as a consequence the treated milk becomes unusually immunogenic and makes milk allergies possible.
Raw milk is great stuff.
Thanks for the comment.
Dr. Ayers -
I have a few questions. I have suffered from two "conditions" throughout my life, allergies and poor digestion (mostly constipation -- relatively regular BM but often hard stools; gassiness, bloating). My only known food allergies are to nuts, but I have an array of allergies to grass, pollen, dust, cats, etc. It may be obvious that I've experienced no relationship between my digestive ails and my allergies.
Recently, I've delved into a low-carb eating style (and have eliminated wheat and 0-6s, due to the allergy risk; I sometimes wonder if I should do the same for dairy, not because of any obvious symptoms, but because casein so often seems to bother allergic people), but have experienced no consistent results. Some suggest the addition of fiber for digestive issues; other suggest avoidance, particularly for IBS. I'm not aware if I have umbrella "IBS" or any of its related issues, but certainly something appears to work improperly. I've noted that a very high fat diet helps soften stools, but doesn't seem to resolve the fundamental discomfort. Further, almost everything I eat now seems to cause some digestive difficulty.
To the questions, then. How does a person with many allergies determine what are food allergies, food sensitivities, or symptoms of other kinds of inflammation, etc.? The "anti-inflammatory" diet sounds helpful, but I'm confused about the necessity of vegetables in human diets (thanks to Eades, Taubes, Paleonu, etc.).
Developing a strategy has been quite difficult, considering the range of erudite folks writing on the same topic. I'm clear on certain things -- no wheat, no 0-6s, very low sugar -- but how I should structure my diet remains elusive.
I appreciate any insight you can offer.
I can relate to this. Many autistics are plagued by constipation. Autistics are also most likely to be born to mothers with autoimmune disease. My son is plagued by constipation. He came out of autism (now only mild PDD) three weeks into a diet disigned to reestablish proper gut flora, the Specific Carbohydrate Diet. I feel better on it as well and it turns out I have Celiacs and Crohns (I happen to feel better on his food so his gi recommended I get checked). So I have been fascinated by this topic ever since. Do you ever study the role of yeast intolerance?
Medjoub,
It seems to me that all of your symptoms point back to lacking gut bacteria, dysbiosis. It was likely that it all started with antibiotic treatment and you never regained the needed gut bacteria.
Allergies are usually caused by diet-based chronic inflammation aggravated by some local inflammation in the gut or elsewhere that presents an antigen to the immune system without proper tolerance provided by gut-based regulatory T-cells.
The constipation shows that your gut flora is damaged and your allergies show that your immune system is damaged. Both can be fixed by restoring your gut flora with a normal, anti-inflammatory diet.
Your chronic inflammation compromised your vitamin D levels as well, so start by restoring your vitamin D: get tested for serum vit.D, supplement with vit.D3 until retests give >70 ng/ml. Don't just rely on supplements, but test to make sure that they give the adequate serum level.
You are probably low on saturated fats, so increase your meat/eggs/full-fat live yogurt. Get most of your calories from fat and not carbs. Cut back on carbs/sugar/grains/starch. Eat plenty of fresh veggies. Note that most of the bacteria that you are lacking must be introduced on the surface of the veggies. Those bacteria will then adjust to the new environment of your gut and about 150 different species of bacteria are needed for health and to eliminate your symptoms.
Eliminate vegetable oils from your kitchen. They are contributing to your chronic inflammation. Use olive oil, butter and coconut oil instead. Fish oil will help your symptoms, but only in the absence of omega-6 vegetable oils.
To help build up your gut flora, eat probiotics and live yogurt, along with veggies containing pectin and inulin. Lactulose may help too.
The veggies supply minerals, vitamins, phytochemicals and fiber to feed your lower gut flora. The bacteria are what make up the bulk of normal stools. You are constipated, because you lack lower gut bacteria and don't provide the fiber to feed those bacteria. These bacteria also trigger the development of the part of your immune system needed to stop allergies.
Any inability that you have to handle food is the result of lacking appropriate gut bacteria. The point is not to avoid the food, but to cultivate the bacteria needed to digest that food. Most food allergies are actually food intolerances, deficiencies in gut flora.
Meals are simple. Just realize that most diet plans have been developed to sell processed foods. Just keep it simple and eat from the outer isles at the grocery store: meat/fish/eggs/dairy/vegetables/whole fruits
(skip the bread, pasta, cereal, etc.)
Let me know how it works out.
Mrs. Ed,
I wrote an article on changing problem gut flora, based on a website that used that approach to treat autism. They swept away the existing gut flora and biofilms with a total bowel irrigation and then rebuilt the gut flora.
Your son's chronic constipation speaks to a simplified gut flora that could be repaired with probiotics, prebiotics and soluble fiber.
The response to omega-3s suggests some source of inflammation. That could be the gut, but vit.D deficiency, dental infections, etc. could also contribute.
The yeast connection is very complex. Normally fungi are not much of an issue in humans, but if the immune system is compromised (as it would be in people who have constipation) then yeasts are found colonizing parts of the gut. This causes all sorts of problems.
The Specific Carbohydrate Diet was recently tested in a clinical trial and found to be ineffective. This means that some parts of the diet were probably useful, but it was not uniformly effective. Personally, I think that the rationale for the diet doesn't make much sense, but excluding starch/grain/sugars is useful. Excluding some of the fiber that binds phytate and adsorbs minerals, is good, but soluble fibers/plant polysaccharides (pectin, inulin) are very beneficial in building gut flora and should be eaten.
I think that you are on the right track with your diet changes and fixing the constipation should provide more benefits.
Let me know how your family progresses.
Rainarana, Lightcan, Anna, others,
Thanks for all of your help is providing detailed help to other readers.
I really appreciate your careful reading and also rely on you to help me when I make mistakes.
Dr. Ayers -
Thanks for your detailed reply -- I have been following a diet close to the one you describe, sans much fruit and little pectin/inulin containing vegetables. Should these vegetables be prepared in any particular way? You've recommended eating raw vegetables for the bacteria, but the fiber remains unaffected by cooking, correct?
One final question -- some bloggers/doctors whose work i follow suggest that it possible, maybe even preferable, to eat only meat (or close to it). Can you speak to that suggestion, or shed any light on how a gut-bacterial population would survive on such a diet?
Medjoub,
I think that more nutrients are extracted from veggies that are cooked and/or eaten with oil/fat, but of course any treatment that kills adhering bacteria will decrease that source of potential gut flora. For an established gut flora, eating cooked veggies is an advantage and all of the fiber polysaccharides will be more available too.
For those with autoimmune disease or allergies or other indications of a compromised immune system, then introducing new bacteria and expanding the diversity of gut flora, should be a top priority.
For most people, a mix of raw and cooked veggies would be most interesting and desirable.
My justifications for eating meat and veggies are:
Veggies alone lead to common deficiencies and focus to heavily on carbs for calories.
Meat alone simplifies the gut flora and decreases the cross-talk between gut and bacteria needed for a fully functional immune system.
Veggies also supply numerous phytochemicals, abundant in herbs and spices, that control gut flora and also contribute to health.
Increasing grassland for grass-fed beef and replacing corn/soy is one of the few reasonable solutions for reducing atmospheric carbon dioxide.
I see no advantage to a meat only diet. It should just lead to constipation unless too much meat is eaten at one time to be digested. I don't know what happens to undigested meat in the colon, but it would seem to be putrification. From my perspective, the colon bacteria metabolize fiber and the bacteria provide the hydrated bulk of normal stools.
Thanks for your questions.
Dr. Ayers,
To another commenter you said, "The yeast connection is very complex. Normally fungi are not much of an issue in humans, but if the immune system is compromised (as it would be in people who have constipation) then yeasts are found colonizing parts of the gut. This causes all sorts of problems."
That reminding me of something I've been meaning to ask you.
For several years (since preschool), my nearly 12 yo son has had recurrent patches of what appear to be a mild skin fungal infection on his cheeks (pale areas that look a bit dry and slightly rougher than the rest of his skin). They slowly come and go and appear in various places on his cheeks. At first it seemed to appear in the summer, but that's probably an illusion as the patches don't tan with sun exposure, so they lack color contrast with his regular skin tone in winter. He isn't bothered by the patches, and in fact, named them Tim and joked about the patches being his friends. I haven't made much issue with him over these, but intermittently I've been quietly trying to figure out what is going on. I suspect in his teens he won't be so unconcerned about his facial skin appearance ;-).
I suspect tinea versicolor. I haven't pointed it out yet to the new family medicine doctor my son now sees (his visits so far have only been for injuries). The pediatrician he saw from birth to age 10 (when the Dr suddenly unexpectedly passed away) was very blasé about the patches when I pointed them out on several occasions over the years and simply said to use anti-fungal cream (you know how it goes - suppress the symptoms and don't bother to understand why a little kid gets a chronic fungal infection on this face that more often shows up on adolescent or adult males on their oily torso skin, unless there is some underlying immune issue - sigh).
I just can't figure this one out. His diet is pretty anti-inflammatory overall, esp at home (I sometimes relax on things like french fries on the not-so-frequent occasions we dine out, and he's happy to drink water or carbonated mineral water) though his diet is somewhat more relaxed than mine. He could be eating his friends' junk food at school, says he isn't, though I know he gets candy at friends houses (wrappers in his pockets) and probably spends his pocket money on Slurpees as the neighborhood 7-Eleven. He does try to eat GF, and mentions any symptoms like canker sores that show up and what he might have unwittingly consumed with gluten (red licorice was the canker sore culprit). But I'm sure there is some incidental gluten exposure here and there when eating away from home, despite our efforts to choose wisely (we don't make requests for diff cutting boards, knives, etc.).
Any thoughts on his skin patches and what might be going on there?
iHi Anna,
Tim sounds like Tinia sp. to me too, and as I said before, the human immune system has innate receptors for fungal wall polysaccharides, so normally the fungi can only attack where there is a compromised immune system and poor blood flow. I think that is why people get superficial fungal infections in dead layers of skin, e.g. athlete's foot.
Gluten intolerance attacks the small intestines and the hind end of the small intestines is the residence for the gut-associated immune system that generates immunological tolerance to food, common bacteria, etc. and also avoids allergies and autoimmunity. Thus, gluten intolerance typically leads to autoimmune diseases, such as Hashimoto's thyroiditis, and food allergies. Vitiligo is a comorbidity as an autoimmune disease attacking melanocytes.
The face is very peculiar in its plumbing and enervation. That's why it has its own inflammatory diseases called collectively, rosacea. I don't think that Tim could survive in the presence of a high level of inflammation, because the increased circulation should kill it off. So Tim might be the result of the opposite of rosacea.
I think that Tim comes and goes, because of changes in circulation and sun exposure. I think if your sun took up cross country running, he would seldom see Tim.
Have you tried Vick's? It is very effective against fungal infections. What about hot springs or hot showers?
I would expect that any treatment that starts to kill Tim will result in inflammation of the infected area.
I would avoid any treatment that produces lasting inflammation. Permit the face to recover.
I don't understand gluten intolerance well enough to cure it. I think that some bifidobacteria species reverse the condition at least in part by producing proteases that digest the active part of gliadin. It may be that the answer is in human milk oligosaccharides. Maybe I will write an article on HMOs.
Thanks for the questions.
Dr.
I greatly appreciate your blog and come to it often for insight. I have a question that has been bothering me for a few years and has cost me alot of stress both financially and emotionally. What do you think the cause of morphea is? From reading comments and your blog it seems to be some sort of reaction to gluten. What are your thoughts.
Thank you
Dom,
Morphea is localized scleroderma, a thickening of the skin. It is an autoimmune disease with many of the typical autoantibodies against nuclear proteins that are inappropriately presented to immune cells. All of the proteins have regions with basic amino acids that result in them being internalized into cells during inflammation.
The major support for morphea as an autoimmune disease is chronic inflammation and dysfunction of the gut-associated immune system caused by dysfunction of gut flora. Both of these sources of problems can be attacked by the Anti-inflammatory Diet that I outline at the top of this blog. Change your diet, make your gut flora healthy and your morphea should dissipate.
Have you tried applying Vick's Vaporub (menthol) or castor oil?
Let me know how you do.
I have another question pertaining to reintroducing gut flora in an elderly, somewhat frail woman after endoscopy and colonoscopy.
My 82 yo MIL in London was recently found to be "anemic". We don't have many details on how this was determined. My MIL and SIL - they live together again the past 3 yrs - neglected to ask for copies of pertinent lab reports (or they don't want to rock the God's, I mean specialist's boat), but it was noted by my MIL's GP that her "counts" on two recent tests dropped within a short time frame, and long story short, the decision has been made by the consulting GI to do an endoscopy and colonoscopy on Wed. "They" are all satisfied that less invasive testing is complete, etc., and that these invasive GI tests are warranted. OK, so be it. She also has a lot of reflux, so I wouldn't be surprised if gluten is an issue, but who knows if that is even being considered. You know how that goes. I seriously doubt they'd consider gluten elimination unless their doctor recommended it, and he probably won't unless something shows up on the endoscopy (not sure if they are even considering or looking celiac disease).
Not sure if it's related, but my MIL was recently taken off Atenolol (old HT med) after 30 years. My husband and I have noted that there is a "Black Box" warning about sudden cessation of this drug, but nonetheless, she wasn't weaned off it or told about this warning. As far as I can determine, going off Atenolol wouldn't cause the sudden anemia. Neither my MIL nor SIL report noticing any anemia symptoms, but frankly, in recent years it doesn't take much to wear her out.
Her resistance is quite low (lots of lingering coughs and colds despite little exposure to many people) so I'm sure she isn't starting out from a strong gut flora position going into the tests. I've been able to get her Vit D level checked once about a year ago and while low, it was better than I expected at 31 ng/mL, nonetheless, she takes the 5000iU Bio-Tech D3 I mail (I was more concerned about my night-shift working SIL whose 25 (OH)D was only 9!). It definitely is time for a re-test for both of them, but one can only nudge so much with this anemia stuff going on...
Anyway, my question is about restoring my MIL's gut flora after the tests on Wed. What can she eat or take as supplements to get healthy gut flora established. I know what I'd do for myself, but she's elderly, frail, and has other issues like reflux and IBS. She's had dental troubles for years, then had an even worse time chewing food after she got dentures two years ago, so she can only eat the softest of foods. And she has a powerful sweet tooth...
My SIL knows about probiotic supplements and will get some, but she doesn't know much about the fermentable soluble fiber and its role in establishing and maintaining bacteria in the colon colon. She has acquired a blender, so perhaps some raw green smoothies in addition to cooked veggies? My MIL can't chew raw greens at all (even the cooked ones need to be really, really overcooked or pureed. They buy their produce from local small green grocer shops mostly (not usually packaged much), not at supermarkets, so probably the produce isn't entirely sterile (and generally is stored out at room temp as the fridge is tiny).
Inulin powder supplements? Anything else you can think of? I'll have to order and mail anything really specialized as their budget is limited and some supplement items are hard to source in the UK. Additionally my SIL already has a lot on her plate with work and care for her mother and another elderly friend of the family (she's a nurses' aid in the geriatric ward in a London NHS hospital - she's really found her calling, huh?).
Thanks for all your helpful insights.
Anna...I am betting that they are doing the GI tests because they think she has celiacs/is bleeding from the intestines. My coworkers mother ended up in the hospital and diagnosed severely anemic. They barely got started with the first scope and saw enough to stop and put her on gluten free diet. She had no digestive symptoms nor anemia symptoms until she 'crashed'.
Tanya,
Yes, I think you are right. They are looking for an ulcer or other source of internal bleeding.
My SIL couldn't say if the GI doc had considered celiac disease a possibility (my husband and I have to tread very carefully when asking questions, because she's quite defensive when it comes to the NHS, past medical decisions, who is "in charge of Mom's care" and so forth). Sigh...families.
Given my MIL's decades of "IBS" as a mature woman, appendicitis when she was a young woman, yo-yo dieting much of her adult life, and frequent reflux of late, I wouldn't be at all surprised if she has flattened villi and a fairly damaged GI track.
I can say this, though, she won't like the idea of going on a GF diet. I remember discussing GF eating with her when my son and I went off all gluten.
Dr. Ayers
Thank you for your response. The website on Autism and Gut Flora, is it still up?
As for the SCD, I feel amazingly better on it myself. (great energy and no fibro pain) Same with the Omega-3. My son and I both had ELISA IgG food panels done and they were elevated on most things, but for me yeasts scores were double what was considered "severe". As I said the SCD has worked wonders, but I do feel there is more we can do. My brother is autistic and my mom is also ASD, so anything goes is the gi flora department. I'm beginning to suspect normal flora was just never there. So the next question would be, how does one get a decent flora if there's a possibility of never having been colonized correctly in the first place?
You'll have to excuse me, I have no science backgound and spend my breaks digging in PubMed. So I may be way off here. Could MBL defficiency be a possiblility? I do have Crohn's and Celiacs and have seen several articles on MBL and those. I want to understand more but have no one to bounce ideas off of. In my neck of the woods Poptarts, Nerds and Dr. Pepper are considered a healthy normal diet, even amongst the medical community(and especially so).
Tracee
Dr. Ayers,
One more question. You have me very curious. What is it about the Specific Carbohydrate Diet that does not make sense? If you don't mind me asking. We don't eat grains and the real starchy veggies, but there's a whole slew of fruits and veggies, such as apples, leaks, greens, cauliflower, squashes, etc where one can get pectins and other goodies naturally. (although getting my son to eat these has been difficult, which may be our problem). Have you ever read the books "Breaking the Vicious Cycle" by Elaine Gottshall or "Gut and Psychology Syndrome" by Dr. Natasha Campbell-Mcbride? I'll send you a copy of the former if you're interested.
FYI: Your comment section is just as interesting as your posts!!
Hi Anna,
I was trying to spend more time with a daughter home, briefly, from college and was only answering the posts I could do in a couple of minutes.
I think that you are correct in being concerned about gut flora reconstruction in an older relative showing signs of chronic inflammation. Since she lacks an appendix, which is the source of bacteria to reconstruct gut flora following diarrhea, she is particularly at risk.
I think that the probiotics and other fermented foods would be the first priority and then follow with purried soups that include pectin and inulin. From my perspective, I think that veggie diversity is important and people tend to narrow their dietary range as they age. I think that this narrowing of diet and associated simplification of gut flora is responsible in part for aging.
If you look at Jack Lalane (95), it is certainly possible to be agile at eighty. It is also unfortunate that your MIL didn't persist and get her dentures properly fitted. She may also be less interested in eating because of declining taste and smell sensitivity. That actually provides an opportunity to put more herbs and spices into her food, but it is probably a problem for your SIL.
I think that it is important to note that the hospital is not a place your MIL should linger after her tests, because she is at risk for Clostridium and other problems that increase with length of exposure to the hospital environment.
Good luck and I hope that you have some impact on the diet of your relatives. Let me know how it turns out.
Tracee,
The autism and gut biofilms web site is still there:
http://www.scribd.com/doc/18583142/Gut-Recovery-Program-A-New-Approach-To-Treating-Chronic-Gastrointestinal-Infections
I find it interesting in looking through that site again, that it mentions lactoferrin as an iron chelator for biofilm destabilization.
I doubt that you could survive with MBL defective. MBL could be involved in antigen presentation.
It is also interesting that ASD in some cases is completely reversed temporarily by fevers. That suggests that the basic wiring is intact.
I think that it makes sense to eliminate obvious gut antagonists, such as grain. On the anti-inflammatory diet that I recommend, it isn't such a big deal to exclude grain. Low carb is much easier than high carb without grains. It is also much easier if you stay away from processed foods and feed off of the outer isles at the supermarket. The saturated fat in addition to being healthier is also very satisfying.
I am familiar with the SCD as it is presented on the related websites and in Wikipedia. The actual food in the diet is consistent with the anti-inflammatory diet that I recommend. The biggest area of difference is in the rationales for the diet.
The SCD claims that disaccharides and polysaccharides must be degraded before they can be absorbed. That is mostly true, but I would contend that soluble fiber polysaccharides are degraded by gut flora and converted to other products, including short chain fatty acids, some of which are absorbed and used by colon cells.
The SCD claims that undigested polysaccharides cause a growth of inflammatory bacteria. I would contend that undigested polysaccharides just ride with the stool bacteria. Polysaccharides that are digested and utilized by bacteria maladapted to the gut environment produce products that upset the gut flora and cause inflammation.
The SCD claims that bacterial overgrowth increases waste and irritation. I contend that bacterial growth is the hydrating component of the stool. Disruption of bacterial signaling with the gut causes inflammation.
I also feel that the SCD accounts for adaptation to new diets without using changes in the hundred plus bacterial species found in the healthy gut.
So, these are somewhat subtle differences in the underlying mechanisms of the interactions between bacteria, food and gut cells, but they produce basically the same recommended diets. The justification of the diets is different.
I hope that you have looks at my articles on celiac and Crohn's diseases.
Thanks for your comments/questions.
Thanks very much for your thoughtful response. I hope you had a nice holiday weekend with your daughter.
I'll pass your recommendations along to my SIL, who just called from the taxi with the test results - nothing at all was discovered which could have caused the anemia, nor were any polyps or other issues reported. So, no idea as to the cause of her anemia, which the nurse at the test facility described as "mild", but of course the GI specialist insisted such invasive tests were necessary.
The worst part, as always, was the bowel prep the day before.
Now to get Granny's "little friends" back in the garden...
Again, thanks very much for your generous attention to my queries and everyone else's, too. Your posts are not to be missed but I also learn much in the comment section.
Dr. Ayers,
I'll check out your articles. I'm no guru here, I think that the SCD was designed for a severly damaged gut. So it's not that the polysaccarides cause the overgrowth, it's that it was already in place, thus the IBD. And that mucus production and lack of digestive enzymes is already happening as well. So the premise comes from the state of the damaged gut, not a healthy one, and is a means to get it under control, so you can go onto a healthier flora balance. The intro diet is also different from the advanced which is more similar to the anti-inflammatory diet.
My son had always had gi issues and was on baby Zantac the first 8 mos of life, but quite the friendly little guy. At 18 mos of age, he had 3 rounds of butt salding antibiotics in one month and lost speech, appetite and ability to sleep at night immediately afterwards. One year later, 3 more bouts of strep throat and anitbiotics, and he had lost play skills, eye contact etc.
He's been on the SCD for over 2 years and anyone who meets him today would never believe he was autistic. We still have some eye contact issues and picky eating but that's it. (now diagnosed as mild PDD)
I suspect there was harmful gi flora that the SCD helped eliminate. Our issues with his constipation seem diferent than two years ago. This time there's no ASD behavior to accompany it. My husband and I have been discussing your ideas on simple gut flora and it really makes sense. We will keep this in mind.
We have really been working on getting him to eat vegetables. (a feeding therapist was unable to help us). I was reading some of your posts, that it's important to introduce bacteria from vegetbles and fruits. It got me thinking, our old "eat your veggie's" strategy was to place a little bite of a veggie on his plate that he had to try before he could leave the table to play.(any more and he gags) Now I put a whole serving of raw veggies, his option is to take one bite or pick up each piece and lick both sides. Perhaps a few bacteria would be introduced (although they will probably starve to death, but it's a start). Although he did take three bites of carrot last night, quite the victory.
I won't take up more of your time, and thank you for your responses. I will definatly be checking out your older posts as well as looking forward to future ones. Thanks again!
Dr Ayers,
I have an allergy to fish, (although not all seafood) which started when I was a child. I had an anaphylatic reaction to cod and almost died. Since then when I have accidently eaten fish, or had it touch my eyes lips I get swelling although I've never had a reaction as bad as the first. I also have allergies to nuts, cats, and horses.
I was recently diagnosed with ITP (idopathic thrombocytopaenia) an autoimmune condition which gives me a low platelet count. I was advised to go on steroids which I haven't done.
Since discovering your blog I have been following your suggestions for an anti inflammatory diet. I've found I'm able to take fish oil capsules too.
Do you think it's possible that I could restore my immune system and get rid of the ITP and not have to have steroids? and is it possible to overcome my allergies, should I ever try eating fish again?
Thank you so much for all the info on your blog,
Marcel
Dr. Ayers,
I am so appreciative of the time you spend on this blog. It has helped me on my healing journey in so many ways!
I have a couple questions as I seek to understand Gut Flora and it's impact on my immune system. I have been on the SCD Diet, which is a simple anti-inflammatory diet, to help my Celiac Disease. It has been amazing, but as I have tried to introduce more variety of fruits and veggies, I faced maldigestion challenges (gas, loose stools). Your posts about the destabilization of gut flora and diet's impact to it helped me to understand that I need to stick with trying a new food for a little while to increase the specific bacteria that digest it (some of these foods I haven't had in over a year!). My question is, how long does it usually take for the gut flora to adapt and be able to handle a new food? Should I start small (like 1/2 cup) of a fruit or veggie and work my way up over time, or is more better? Also, have you ever researched how long it takes for the bacteria to lose volume once you stop eating something (for instance, I try to stay on a four day rotation diet)?
My second part to this is about Probiotic diversity. I have seen some research that might suggest avoiding Bifida bacteria while in the initial healing stages (or cooling stages) so I have been taking a simple lactobacillus acidophilus for about 6 months now. Do you think that I am limiting my healing by not introducing a more diverse probiotic that has more strains?
I would appreciate any thoughts you might have on this. It has been a long journey, but a good one!
Thanks for your time,
Jordan
Jordan,
It is difficult to estimate how long it will take to adjust to new foods, usually new plant polysaccharides. The time needed depends on the gut flora diversity that already exists, production of new bacterial species in the gut and acquisition of new bacteria in food and by exposure to other people/animals.
Thus, one of the side effects of the increasing use of antibacterial soaps, etc. is the narrowing of the diversity of gut flora and enhancing the production of allergies and autoimmune diseases.
I think that probiotics inhabit the GALT (gut associated lymphatic tissue) region of the intestines, which is a low oxygen region near the appendix. The probiotics are temporary residents that can contribute to shift in the gut flora toward normalcy, but are only a handful of the hundreds of species that are needed for health.
I think that a secret to health is to be in intimate contact with other healthy people and animals. You will benefit from their healthy flora. It is also beneficial to not be excessively clean -- you must be optimistic that the bacteria that rub off on you will bring more good than harm. If you are healthy, then pathogens don't matter. If you are immunocompromised, then isolation is needed for survival.
I don't see any benefit from eating a large amount of anything. It will not enhance the rate acquisition of new gut flora and merely shifts the existing flora toward extremes. It is good to entertain diversity and moderation in foods eaten. One of the problems of the high carb, processed foods diet, is the narrowing of nutrients to just starch and vegetable oils. The complex polysaccharides of plants are excluded, because it makes fast food production more difficult. It also eliminates beneficial gut flora candidates.
I suggest browsing, seasonal changes, seasoning with lots of herbs and spices, and local fresh vegetables.
Tell me of your progress.
Hi Dr. Ayers,
In relation to this post and comments, I have a few quick updates and anecdotes for you.
Regarding adapting gut flora in relation to a milk intolerance, I have now adapted a few peaple (myself initially, and a couple of others who were very intolerent of most dairy product) to being able to consume up to 2 cups of milk per day with no problems. This was through an anti-inflammatory diet, diversifying bacteria exposure, and slow introduction of bacteria-carrying dairy such as grass fed greek yoghurt and artesian cheese.
Secondly, especially regarding the fish intolerance comment above, I have been experimenting on a family member who has had a serious shellfish re-action since she was 8 (now 26, accute inflammatory response). After a similar diet process as above and ensuring immune system was not over-stimulated, introduction of a wider wariety of sea-foods and sea-weeds (never had a problem with normal fish), then shellfish (standing around prawns being shelled, contact with tolerant family, touching prawns..). Finally last week she ate 4 whole prawns with only a tingling and slight swelling (percieved, not visable) on the tounge and lips.
This has been a very eye-opening experience, but with your research, seems like such a "well duh" conclusion now. I hope this gives you and other readers another point of view into the practical aplication of your ideas.
Once again, thanks for your tremendous work and time you spend your readers.
Steve
after thought: Each individual had specific supplements to help their situation, mostly fish oil, D3, gut healing herbs/glutamine, High Vit C as an anti-histamine around the shellfish (except the last 'eat some prawns' test)...
(sorry if I double tapped, first post didnt come up..)
Steve,
I feel the same way about all of the stuff that I study. Most of my literature searches pull up articles from the last couple of years, showing that my conclusions are being confirmed by current research. But, if I take the effort to look back in the old literature, the expected observations were there decades or even a hundred years before. The practical applications turn out to be folk wisdom.
I am pleased that my insights have helped. Thanks for your progress report.
Hello Dr Art, my husband has been very ill for 5 years now following lots of antibiotics for a gut infection. He has been on a strict diet for about 12 months eating meat, organic veggies and salads and buckwheat and has been taking soil based organism probiotics for 6 months, he still has lots of gut pain, loose stools, brain fog, breaking into sweats, fatigue. Should we just keep persevering with diet and probiotics or is there something that we are missing. Traci.
Traci,
The history of antibiotic use suggests intestinal yeast and the symptoms are consistent.
I would also suggest blood work to check for vit.D deficiency.
Good gut flora would be reflected in normal stools/no constipation and no food intolerances.
I would also recommend more herbs and spices, along with garlic.
Does your husband's symptoms improve with the total bowel irrigation (by PEG) used to prepare for a colonoscopy?
Let me know if this was helpful (or not.)
Drinking from the birdbath, indeed...
http://www.thecompletepatient.com/journal/2010/8/25/beyond-pathogens-the-question-around-raw-milk-that-few-in-th.html
Anna,
Perhaps the birdbath is the answer, but even I shudder at the pathogen potential. At the same time, my obstreperous dog looks forward to every filling of the bird bath. He has never been sick and self-medicates his arthritis with bee melittin.
Thanks for the mention of Cooling Inflammation.
Well, our birdbath is empty anyway - I like to keep the cat focused on catching the tiny mice she likes for her mid-morning snack, instead of the birds ;-).
On the soluble fiber front, I've been keeping crunchy, inexpensive, and high-in-soluble-fiber jicama around this summer, after forgetting about it the past few years.
http://www.marksdailyapple.com/low-carb-jicama/
Wide slices of jicama stand in well for chips, allowing for big scoops of fresh chunky guacamole, lacto-fermented salsa, Tzatziki, and so on. Thin julienne strips (faster & more uniformly cut with a mandoline julienne slicer) add great crunch and texture to slaws, tossed greens, and chicken/tuna/shrimp salads.
Peeled and cut jicama sticks keep well for several days in a tightly closed container in the fridge (I add a few drops of water to keep the cut surfaces moist) for snacks and quick salad assembly. Most kids seem to like jicama sticks as a snack. Now that school has started, I'm packing jicama sticks wrapped in waxed paper in my son's lunch.
I've also been mindful of your recommendation to consume an abundance of fresh herbs. My CSA has been providing large bunches of herbs most of the summer, including dill, basil, & cilantro, sometimes one of each in our weekly box. It's been a challenge to use so much fresh herbs some weeks, especially the cilantro, which has quite a distinctive assertive flavor that can easily overpower other flavors if used too liberally.
I've not really liked the cilantro pestos I've made in the past that substituted cilantro for basil, but this variation has worked out quite well, as it uses coconut milk to tame cilantro's power, instead of olive oil, parmesan cheese, and nuts. The mixture is easy to blend up in a small food processor with 1-3 cloves garlic, 1 inch peeled fresh ginger (optional), 1/2-1 fresh jalapeño to taste (seeds removed), juice of 1 large lime, and one bunch of cilantro (rinsed & drained well to remove grit, and about half of the stems cut off if they are thick). Sea salt to taste. Then add 1/4-1/2 cup coconut milk to achieve desired consistency (coconut milk will thicken when chilled). Keeps in the fridge at least 3-4 days, perhaps up to a week, though it never lasts that long in my house.
I used this recipe as a template - http://primalbydesign.wordpress.com/2010/02/07/chicken-with-cilantro-lime-pesto/
I've served this cilantro/lime/coconut milk concoction thinned with olive oil as as a salad dressing, poured as a sauce over spicy meats and steamed or stir-fried veggies, and as a thick dip for slices of cukes, jicama, celery, raw green beans & pea pods, carrot sticks, cherry tomatoes, etc. Instead of sour cream, I top chorizo "taco" salad with it (salad consists of torn romaine, chunks of heirloom tomatoes, sliced red onions, warm crumbled Mexican chorizo sausage, grated aged English Coastal cheddar, diced avocado, diced or sliced jicama, & olives). Mmmmm.
Hope that gives your readers some ideas.
Well, our birdbath is empty anyway - I like to keep the cat focused on catching the tiny mice she likes for her mid-morning snack, instead of the birds ;-).
On the soluble fiber front, I've been keeping crunchy, inexpensive, and high-in-soluble-fiber jicama around this summer, after forgetting about it the past few years.
http://www.marksdailyapple.com/low-carb-jicama/
Wide slices of jicama stand in well for chips, allowing for big scoops of fresh chunky guacamole, lacto-fermented salsa, Tzatziki, and so on. Thin julienne strips (faster & more uniformly cut with a mandoline julienne slicer) add great crunch and texture to slaws, tossed greens, and chicken/tuna/shrimp salads.
Peeled and cut jicama sticks keep well for several days in a tightly closed container in the fridge (I add a few drops of water to keep the cut surfaces moist) for snacks and quick salad assembly. Most kids seem to like jicama sticks as a snack. Now that school has started, I'm packing jicama sticks wrapped in waxed paper in my son's lunch.
I've also been mindful of your recommendation to consume an abundance of fresh herbs. My CSA has been providing large bunches of herbs most of the summer, including dill, basil, & cilantro, sometimes one of each in our weekly box. It's been a challenge to use so much fresh herbs some weeks, especially the cilantro, which has quite a distinctive assertive flavor that can easily overpower other flavors if used too liberally.
I've not really liked the cilantro pestos I've made in the past that substituted cilantro for basil, but this variation has worked out quite well, as it uses coconut milk to tame cilantro's power, instead of olive oil, parmesan cheese, and nuts. The mixture is easy to blend up in a small food processor with 1-3 cloves garlic, 1 inch peeled fresh ginger (optional), 1/2-1 fresh jalapeño to taste (seeds removed), juice of 1 large lime, and one bunch of cilantro (rinsed & drained well to remove grit, and about half of the stems cut off if they are thick). Sea salt to taste. Then add 1/4-1/2 cup coconut milk to achieve desired consistency (coconut milk will thicken when chilled). Keeps in the fridge at least 3-4 days, perhaps up to a week, though it never lasts that long in my house.
I used this recipe as a template - http://primalbydesign.wordpress.com/2010/02/07/chicken-with-cilantro-lime-pesto/
I've served this cilantro/lime/coconut milk concoction thinned with olive oil as as a salad dressing, poured as a sauce over spicy meats and steamed or stir-fried veggies, and as a thick dip for slices of cukes, jicama, celery, raw green beans & pea pods, carrot sticks, cherry tomatoes, etc. Instead of sour cream, I top chorizo "taco" salad with it (salad consists of torn romaine, chunks of heirloom tomatoes, sliced red onions, warm crumbled Mexican chorizo sausage, grated aged English Coastal cheddar, diced avocado, diced or sliced jicama, & olives). Mmmmm.
Hope that gives your readers some ideas.
First time poster on your blog here (currently working my way through past posts).
I wish to work on building my gut flora. I've read your advice and will increase vegetable variety in my diet and also increase consumption of fermented products (I've already tried kefir--quite good). In the meantime, I'd like to give my gut flora a boost and am considering a probiotic supplement. Is there any concern about the delivery method of the probiotic? Does exposure to the acidic environment likely to kill off all or most of the beneficial bacteria (ie. should I opt for an enteric coated product, if such products are available)?
Also, do I need daily supplementation of these probiotic supplements to get the benefit out of them? I'm assuming that I don't need daily yogurt to draw the benefits of the lactobacillus. My understanding is that once these beneficial bacteria have colonized the gut, it's only a matter of "feeding" them what they eat in order to keep this flora functioning--rather than dumping new bacteria on a regular basis. Could you clarify this? Thank you and thanks for a fascinating blog.
Poisonguy,
My impression of studies on probiotics is that they are all temporary and will be replaced by your own comparable bacteria. Thus, continually taking probiotics just disrupts or has no impact on your gut flora if you already have bacteria in those niches. There are over 150 different species of bacteria (=gut flora) in each healthy human and I think that new species are created continually by genetic rearrangements in the gut -- there is huge horizontal transfer of genes between "species".
Thus, your current gut flora is created by responses of your gut flora community to diet and recruitment of new bacteria on your food. So your gut flora and the immune system that it stimulates, tracks your environment. Hygiene weakens gut flora and promotes disease. I worry less about pathogens on produce and invest in development of my immune system by eating diverse garden fresh/slightly soiled veggies.
In the current egg contamination, about a billion eggs resulted in about a thousand sick people. This means to me that a very select group of people got sick and those people must have been immunocompromised. My take home message is that I don't have to worry about cooking eggs thoroughly as long as I avoid the modern American diet and its associated compromised immune system. The problem is not the food contamination, but the compromising diets.
Thanks for the questions.
Better to build a gut flora based on foods you eat (and therefore can feed the bacteria exactly what they eat--gotta love that symbiosis), rather than colonizing it with species who’s diet you don't know. Makes sense.
Sounds like you aren't too concerned with the acid environment of the stomach. Beneficial bacteria are acid-stable enough to make it into the small intestines. Cool. And Thanks.
Interesting study: "Scientists suggest that cancer is purely man-made"
http://www.manchester.ac.uk/aboutus/news/display/?id=6243
Fascinating study: Dogs detect colon cancer
http://www.stuff.co.nz/life-style/wellbeing/4604996/Dogs-detect-colon-cancer
Hi Dr. Ayers,
Thank you, thank you, thank you for sharing your knowledge. So many of us are plagued with deficiencies in gut flora, and the information you so willingly provide is truly invaluable.
As a child and into adulthood, I suffered terribly from sinus infections and was on antibiotics a couple of times a year. Luckily, about three years ago I happened-upon the neti pot...and it changed my life. No antibiotics since! Of course, I now lack that oh-so precious gut flora:) I began a paleo diet a couple of years ago, but I most often cook my veggies because they are easier to digest for me - I didn't realize that raw veg would be more beneficial for someone like me! I also tend to avoid dairy (i.e. yogurt and kefir), as I try to maintain a strict paleo diet. I am a big fan of coconut oil, though I notice I feel ill when I eat the meat (why might this be?).
Could you clarify a couple of things for me? First, do you recommend NOT washing our veggies, then? What about the presence of pesticide (I know, organic is best, but it's not always possible:)? Do you think my morning cup-o-joe needs to go for now? It's the first thing I have in the a.m., after swallowing my 2 Jarrowdophilus supplements. Also, I feel like I 'pudge out' when I eat sat fats from dairy and meats (even grassfed varieties)...could this be due to lack of digestive enzymes? I would like to add kefir and yogurt, but tend to avoid them because of this (I do use a lot of coconut oil). Chris over at the Healthy Skeptic recommends sweet potatoes, yams, etc. for increasing gut flora - what do you think about this, as they are certainly higher in carb. Lastly, why does the coconut meat give me 'crazy stomach' and a headache?
Again, thank you!
Best,
Jessica
awesome post. thanks.
Dr.Ayers,
I have many questions about biofilms... How are you? Hope you and your daughters and family are doing well. I miss your posts. Enjoying the archives however and the depth of your understanding on obscure topics dear to my heart! *haa ah*
What are you up to? Busy teaching? Writing???
Is the MAM, mucosa-asssociated microbiota a biofilm??
Thank you and kindly,
Grace (aka dr.bg, animal pharm blog)
PS How can I contact you directly?
What about the chances of
a. getting parasitic infections if eating raw unwashed produce in the hope for good bacteria intake?
b. studies have shown that FOS help bifido grow which is good as it is a beneficial bacteria, but what about the bad bacteria that use the FOS too. Kleibesella Pneumonia for example uses FOS to flourish as well.
c. Plants provide a lot of fiber. Fiber feeds bacteria (after all fiber is a carbohydrate) including the bad ones.
d. If someone has a compromised gut flora, what food would you recommend he eat? Should he take probiotics right away with the food you recommend?
e. Also studies have shown that probiotics based good bacteria do not stick to the mucosal lining and once you stop the probiotics, the good bacteria population dwindles (i.e no colonization occured) as there are no good ones in the gut left.
Thanks Doc
What do you recommend as a post workout meal?
Anonymous,
A. Parasites and pathogens
I think that the fear of food-borne disease and hygiene is exaggerated and exploited in affluent societies, to the extent that we are now compromising our health. See my new article on Contagious Health.
B&C. Soluble fiber - FOS is just another soluble fiber and Bifidus is just another member of the complex adult gut flora. I think that the concepts of probiotics and prebiotics are oversold for marketing. A salad fresh from the garden should eliminate the need for probiotics and prebiotics.
D. Gut flora repair - probiotics/live yogurt are OK as a temporary influx of bacteria, but they do not replace a persistent diverse diet and access to environmental bacteria.
E. Gut biofilms support the lateral exchange of genetic material, so genes from transient probiotics are transferred to resident members of the gut flora. That is how lactose intolerance is quickly cured by just eating live yogurt.
Thanks for your questions/comments.
Dr. Ayers,
Thank you so much for this invaluable information.
Please can you advise if drinking vegetable juices such as spinach, lettuce etc is a good way of getting friendly bacteria into the gut?
If so how much juice would you reommended to drink per day?
hello and thanks for you time!
1. how do you feel about lectins and their role in gut health?
2. do you think well water would add beneficial bacteria?
3. why do you tell people to eat spices?
4. if you get bacteria that eats carrots from eating raw carrots, how do you get bacteria that eats grains or meat if you can't eat grains or meat raw?
thanks!
Dear Doctor Ayers,
Would you suggest probiotic (there are different types, which one could I take) capsules for a person suffering from constipation.
I am suffering from constipation since many years and am vegetarian in diet.
Thanks for your nice posts and great work
Thank you once again
Regards
Manoj
Dr. Ayers
Is Colon Cancer connected to Gut Flora. Have a close relative detected with colon cancer and undergoing treatment (2nd stage).
I am a bit concerned and being a vegetarian in diet and consuming regular fruits and vegetables i suffer from constipation. Apart from that I have started eating sauerkraut (alternate day)...but does not help with the constipation.
Would probiotic pills help, if yes, what type of bacteria would be the best suited for constipation and gut flora.
Thanks again Dr. Ayers.
dear manoj, this is not dr. ayers, but i wanted to share with you the only thing that has worked for my years of const. ayurvedic moistening diet - avoid all dry foods (grains*except white rice, beans, nuts, dried fruits, celery, potatoes, corn, apples, pears, lentils.) eat wet foods - cucumbers, melons, zuchinni, oranges, pineapple, yams, juices, broths, milk if you can. take slippery elm or marshmallow root. if you have a problem with acid, all fruits and juices must be soaked in sugar first to neutralize. good luck
Thank you very much
Regards
Manoj
I believe I have seen somewhere (possibly here) that inflammation is also itself protective and so may contribute some protection in older adults.
I've wrestled with constipation since my 20s. In my late 30s I purged my diet of corn oil, canola oil, soybean oil, etc. AND started listening to the idea that maybe bread isn't great for you; in my 40s I stopped eating most wheat and breads; and about age 50 I totally cut out grains. Throughout, I tried various things out when constipation flared up. I exercise, eat and drink healthy, and treat my hypothyroidism.
I've followed (badly, perhaps) the Perfect Health Diet for about a year and a half. I only just started to supplement with Primal Defense probiotics. Previously I'd thought my homemade kefir and yogurt ought to do.
Finally this week, finally finally finally I started paying attention to the Resistant Starch thing you find in both Jaminet's PHD and among his "friend" blogs (especially Free the Animal). I have started with 1/2 tsp potato starch.
So, since the added RS has helped immediately, then my gut flora isn't perhaps so very damaged????
The reason I thought to listen to the resistant starch conversation was that I'd looked back again at stool test results and pondered my very very low n-Butyrate, then went to Jaminet's blog and read about Butyrate, and thought it could be a factor in my stubborn constipation.
You said a salad from the garden ought to be more effective than supplementing with probiotics? My poor grandma, who kept on gardening almost as long as she lived, had one messed up gut, the best I can tell. (But then, white flour and Crisco were her top foods.)
Hi doc...I have a question relating to my severe candidiasis, constipation, bloating and heavy metal toxicity that has its roots in immunosuppression from arthritis drug therapy. My gut is definitely good bacteria deficient...hence the constipation...I am currently chelating metals in order to boost my immune system. In cases of severe candidiasis is the good gut bacteria killed off or are these good soldiers in a temporary state of hiding..away from dominant fungi??
It is great to hear people pursuing their dream and becoming successful.
Bellafill Artefill
it's so refreshing to see a post that talks straight to the point. thanks so much for writing about this it has really helped me with building my experience. thanks a lot
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