digestion

In news from stupid-land: The FDA cautions against high dosages or prolonged use of acid inhibitors.

It's kind of criminal that these medicines are still in use, given that the latest studies published in journals show that the cause of GERD is not too much acid. So while proton pump inhibitors might mask the symptoms, they get rid of stomach acid, which we kind of evolved for a reason- to help digest food and to protect against pathogens.

The agency said it would order revised labeling on packages of the drugs to reflect the fact that they have been associated with an increased risk of fractures of the hip, wrist and spine…The drugs have previously been linked to an increased risk of contracting pneumonia and the troublesome bacterium Clostridium difficile, as well as to an increased risk of dementia. A recent study found that the drugs increase the risk of bone fractures by about a quarter. It is not clear what the mechanism of the increased fractures is. Most researchers believe it is due to decreased absorption of calcium from the diet because of the reduced stomach acid, but it is possible that the drugs interfere with bone maintenance.

I am particularly incensed because last year my younger sister started having problems with GERD. She is only 19 and the doctor's recommended Prilosec. Instead she is now paleo and her symptoms have resolved. It's lucky that she knew that the paleo diet could treat GERD and she didn't get on the PPI wagon of dooooom like I did. Here is what I can remember:

It started when I was 18 or so. I was overweight and had terrible stomach problems. My internist gave me Zantec but my mom thought it was unnecessary and I never took it. Over the next two years I lost some weight on a vegetarian and then vegan diet, but the heartburn just got worse and worse. I couldn't sleep or concentrate on my school work. My school doctor finally convinced me to get on Prilosec. The spiel for these pills is that you take them for a month and it helps heal your esophagus, but of course it never works. I try to go off them after a month and the heartburn returns with a vengeance.

So I stay on them, but my IBS just gets worse. My allergist, who is treating me for severe asthma gives me an anti-spasmodic for my IBS and tells me not to worry about the PPIs. He says I'll probably be on them for the rest of my life, but not to worry since they are mostly harmless. At least I can eat pizza as much as I want now...

At some point I get really really sick. My doctor at school thinks it's just my IBS, but when I collapse and end up in the E.R. I finally get diagnosed with chronic salmonella. What should have been a one day bout of food poisoning decided to settle down in my weak digestive system. I take heavy antibiotics and recover...sort of. Now pretty much EVERYTHING upsets my stomach and even worse....I get chronic burping "attacks" all the time. I'm sickly in general- I get yeast, urinary tract, and sinus infections constantly. I get tested for all sorts of things like celiac and Crohns, but no dice. I do some research and find that PPIs might be causing some of my problems. Through looking at Pubmed I find out about a small study that effectively treated GERD with a low-carb diet. I try that for awhile, but using foods at the dorm cafeteria. I just end up feeling crappy... and no wonder with the factory farmed meat and gluten-laced sauces.

When I encounter Art De Vany's site through Marginal Revolution, I am intrigued by a more vegetable-heavy version of low-carb. I try it and it helps my IBS, but I'm still on the PPIs. When I try to go off I feel really terrible. I find a site where people tout apple cider vinegar as a cure. I start eating mostly paleo and taking apple cider vinegar diluted in water after every meal. I start eating a wide variety of vegetables and trying fish for the first time. It's not perfect, but I'm finally at the point where I can at least function without PPIs. I do an egg fast for a week. It takes about six months, mostly very low carb, but eventually I find myself...not taking any medicines at all. 

A journey to get rid of heartburn fixed much more than that. At my worst I was on thirteen different medications and dependent on antibiotics every month. I haven't taken antibiotics in two years now...nor had to go to the doctor for IBS, GERD, or asthma. PPIs are hard to kick, but it was worth it.

My sister and my father have been sucessful with this approach as well, though they were lucky that they never took PPIs. PPIs alter your digestive system and it can be hard to get it in working order again.

Last weekend the fridge at work was left ajar, which was overall a complete disaster. But I did notice that a jug of apple cider was bulging. Aha! A sign of fermentation. I poured it into a glass. It was fizzy and smelled kind of alcoholic. I took a swig. It was fairly tasty, though later I realized I didn't need the alcohol at 11 AM. 

A few years ago I would have been aghast at eating "spoiled" food like that, but since becoming intimate with fermentation, I am much more daring. The fridge is a recent invention and our ancestors might not have had the luxury to turn up their noses at food that's a little...um...off? But "off" sort of implies the food is bad, when  actually in many cases it's good. 

The status of fermentation in the paleo diet is controversial. Many paleo books do not mention it and Cordain's Paleo Diet newsletter recently knocked kombucha for containing acetic acid and yeast (they also said it causes metabolic acidosis...of which there is one case in the medical literature and the person in question also had other serious problems).  

That's nonsense. Our our bodies are full of yeast and acetic-acid producing bacteria and our natural environment would have also been rich in these. Think about the life of a hunter-gatherer. From birth to death they are surrounded by dirt. Of course this is bad when you have a wound that gets infected, but this immersion in dirty nature probably means their bodies are more biodiverse than ours. 

Contrast that with my birth, which was a C-section done in a clean environment. Science shows that C-sections alter gut bacteria, which is bad news, because largely the species established when you are young are the ones that stay with you for the rest of your life. There is plenty of science supporting the Hygiene Hypothesis, which posits that children growing up in clean environments have higher incidences of allergies, asthma, and other diseases of civilization. There is emerging evidence that gut bacteria plays a role in metabolic syndrome as well.

There is no question in my mind that our modern gut biodiversity caused by our divorce from dirt is a bad thing. 

Having a history of stomach problems, managing my gut bacteria is important to me. I do it two ways: not eating foods that seem to encourage the proliferation of misery-causing bacteria and then balancing my bacteria with probiotic foods. "Cleansing" is a bad idea because it gets rid of both bad and good bacteria and irritates the gut...and an irritated gut can't be a good habitat. 

A few times since starting the paleo diet I've gone off the band wagon. My IBS soon returns with a vengeance. I can tell the wrong bacteria are having a feast at my expense. My strategy for getting it under control borrows a lot from the Specific Carbohydrate Diet, which treats colitis by reducing such fermentation. Last time this problem happened, after a week of staying up late to plan a food event and then eating lots of carby sugary food at the event, I calmed things down by eating zero carb for a week. I particularly enjoyed a tonic of egg yolks cooked in bone broth. 

Soon my stomach was feeling much better, but I don't think zero carb completely solves the situation. I think fermented foods are the missing link, providing valuable bacteria and truly digestible nutrients. 

While the scientific studies show that it's very hard and perhaps impossible to add new species to your gut, probiotics can still have an effect, though it will go away if you discontinue them. Furthermore, fermented foods often are simply easier for your body to digest and contain many beneficial bioavilable nutrients. 

That brings me to Wild Fermentation, which was really a groundbreaking book for me. It taught me to embrace and take advantage of wild crazy bacteria.

 This book is of the post-vegan canon. Sandor was a vegan, but a serious health problem propelled him to become omnivorous. In his case, it was AIDS. 

But Wild Fermentation contains a wide variety of ferments suitable for all diets. The exception is meat ferments, which he does himself, but does not include instructions for in his book. He refers readers to The Indigenous Fermented Food of the Sudan, which apparently tells of how the Sudanese ferment meat nose to tail. Unfortunately that book seems to be unaffordable. 

That's OK with me actually...I'm not sure meat fermentation is something I want to dabble in right now.  The main ferment I consume is lacto-fermented vegetables. It's quite funny because just a few years ago I wouldn't have eaten pickles or sauerkraut if you paid me. I think my tastebuds were to put it lightly, shallow from years of consuming industrial food lacking in complexity. I admittedly had to force myself to eat my first batches of pickled vegetables, but at this point I LOVE them. They are tangy and delicious. The best part is that I now crave sour foods rather than sweet foods.

Pickled ginger carrots vs. Snickers? I'll take the former. The variety of flavors, the spicy and sour ginger with the tart carrots, is just superior. 

An important thing I learned from this book was the distinction between vinegar preservation and lacto-fermentation. You can make pickles by just putting some cucumbers in vinegar, but they will not have the same health-giving or flavor properties as vegetables that have been fermented. 

Sandor particularly praises sauerkraut: he talks about a study that shows that it is much richer in cancer-fighting compounds than plain old cabbage. I personally find that the best sauerkraut is made in a heavy crock with a water seal that allows the cabbage to breath, but doesn't allow mold to get in. Luckily, I have access to one, but if I didn't I would make kimchi, which is just as tasty and more resistant to mold. However, Sandor says not to worry too much about mold, as it seems to be a surface phenomonon that doesn't affect the overall welfare of the cabbage buried beneath the brine. 

One of the joys I experienced when I first ate Korean food was all the delicious pickled vegetables they bring you. I realized after my first Korean meal that you really can pickle almost any robust vegetable. Vegetable fermentation has become trendy in NYC and the local farmer's markets are full of pickled beets, radishes, onions, carrots, peppers, and silky wonderful mushrooms. The most surprising pickle I had recently was pickled beet stems, which is a revelation since I usually throw those away. The pickling process had muted the bitterness, but preserved the crunchiness and added a rhubarb-like tartness. 

Some of the other ferments Sandor addresses are less relevant to the paleo diet, but great if you eat grains to get the full nutrition out of them. Kefir is relevant to everybody since you can make it from ruminant milk, nut milk, and anything that has fermentable sugars like coconut water. 

Overall, my digestion feels better when I consume fermented foods and I have noticed that my seasonal allergies are much better. But of course, the main reason to eat them is that they are delicious and nourishing. 

Occasionally I will hear from someone who does badly on a paleo diet or whose health improved when they gave up meat. It's very interesting to me. I guess I' shouldn't really surprised then by Matt Stone's latest post which is a rant about how paleo kills your sex drive (WTF?????* Lierre's assertion that paleolithic is a diet for a smaller population is about economics, as obviously grains allows us to feed more people) and also a letter from a woman who experienced horrible digestive and other problems on paleo. It's so bizarre because paleo cured the exact same problems for me. 

But then again, I've rarely been 100% paleo. I have this fantasy that if I were I would suddenly become super woman or something, but the errant bowl of grits with butter never has made me feel terrible enough to make me stop having cheat meals. I know people who are 100% and honestly they seem no healthier than people who eat butter or an occasional beer. 

But I also see a pattern in people who don't do well on paleo. I'm not blaming people...it's hard to do a paradigm shift and admittedly my first foray into low carb wasn't so successful either. I think it started working only when I stopped thinking low-carb and started thinking about food quality. Some Purdue chicken beasts and steamed broccoli isn't quality in my opinion. Grass-fed beef, oysters, seaweed, purple yams, blueberries, kale...these sort of things form a nutrient-dense nucleus for my diet. When I'm really craving grits or bacon lentils, I personally don't sweat it. Gluten, vegetable oil, and sugar free + high nutrient density seems to solve most of my own problems, the rest was just tweaking. So my own experiences can't refute Matt's assertions. 

But I just don't buy that low carb is dangerous. Plenty of arctic peoples ate low carb their entire lives and reproduced and didn't keel over and die! I think people should work on removing the worst offenders like sugar from their diet and simply do what works for them. 

*In Robb Wolf's podcasts he talks about many women in his gym getting pregnant while doing paleo, but he has also had some questions from people who lost their period...I would be curious to know the nutrition intake numbers of people who that happens to.