First slide of Microbiome Awareness PowerPoint
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Microbiome Awareness Conversation from Seminar

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Last Updated on February 15, 2017 by Patricia Carter

SUMMARY:  Sharing more Microbiome Awareness conversation from the May 26 seminar, so that all can benefit, even those unable to attend!  Learn great microbiome support tips!  Amaze yourself with how much you actually learned and know!  Comment if I don’t touch on your thoughts; lets continue the conversation! 

Background and more on our bio

Dana Grau and I spoke at the Microbiome Awareness Seminar.  We explained what the microbiome is and included discussion of diet and lifestyle impact to the microbiome which affects its health.  70+ percent our immunity resides in the health of the microbiome and that microbial community then plays a key role in determining your health:

The crucial position of the gastrointestinal system is testified by the huge amount of immune cells that reside within it. Gut-associated lymphoid tissue (GALT) is the prominent part of mucosal-associated lymphoid tissue (MALT) and represents almost 70% of the entire immune system; moreover, about 80% of plasma cells [mainly immunoglobulin A (IgA)-bearing cells] reside there.  GALT interacts strictly with gastrointestinal functions in a dynamic manner; for instance, by increasing intestinal permeability in replay to particular stimulations, or orientating the immune response towards luminal content, allowing either tolerance or elimination/degradation of luminal antigens, or sometimes provoking damage to the intestinal mucosa, such as in coeliac disease or food allergy. – Allergy and the gastrointestinal system

Inflammation can lead to a permeable gut, thereby allowing metabolites produced by gut inhabitants (and even the inhabitants themselves, or fragments of them) to leak into the bloodstream (56, 57), and some metabolites can even pass the blood/brain barrier (58).   – Towards large-cohort comparative studies to define the factors influencing the gut microbial community structure of ASD patients

 About 60 to 70 percent of your immune system lies right under the one-cell-layer-thick lining of our gut. If this surface breaks down, your immune system will get activated and start reacting to foods, toxins, and bugs in your gut [luminal contents]. The easiest way to begin healing your gut involves eating a whole food, anti-inflammatory diet and removing gluten and other food sensitivities.  – 9 Lifestyle Changes I Always Recommend To Patients With Autoimmune Diseases, by  Dr. Mark Hyman, Director of Cleveland Clinic Center for Functional Medicine.

Microbiome information is cutting edge;  Both of us use diet and lifestyle modulation of the microbiome for management of autoimmunity; I’ve used this strategy since 2010 and remain in remission medication-free.  My website  began as a repository of my research;  I am an attorney and engineer, and I liaison with researchers, scientists, doctors, and experts to blog microbiome. My website is cited and referenced in Harvard Medical School,  An Introduction to the Microbiome Webinar – Dec 11, 2014, and I have worked with Dr. Rob Knight on ferment gut consumer profiling for upcoming microbiome studies.  My health public policy advocacy actually began back in 2006 leading via grassroots the global recall of contact lens disinfection solutions (for bacterial, fungal, and parasite breakthrough) along with two other women.  You can read more at my About page. 

Dana is the Founder of TADA Fitness & Nutrition, LLC.  Beachbody Coach.  She is an ACE Certified Fitness Instructor, AASDN Nutrition Specialist, Commercial Realtor, and a mom who learned in a chance meeting from me, about diet modulation of the gut microbiome and consequent health ramifications.  Dana now walks the walk and is implementing healing diet tenets for diet modulation of the gut microbiome for her own family.

The incredibly diverse seminar audience included medical and lay, some already far up the microbiome curve as well as others who had never before heard the word ‘microbiome’.  With our  home-team Pittsburgh Penguins and the Tampa Bay Lightning meeting in a deciding Game 7 of the NHL Eastern Conference Finals this evening, turnout for the seminar was still phenomenal.  Thank you!

Up Next!  We Heard You!!!

We begin to cook. Bring your Ninja (if you own one) and glass containers for “Meet the Fats” WorkShop. You’ll make and take home microbiome supporting, easy, practical, and company worthy salad dressings, toppings, and dip creations all the while learning about monounsaturates, polyunsaturates, carotenoid absorption, unadulterated EVOO sourcing, herbs (part of your 30 vegetables), proper preparation of plant sourced protein (qunioa/lentils/nuts/seeds), some TMAO, how to add true microbiome supporting salad components. and so much more putting science into practice!  Hint, it isn’t red peppers, carrots, cucumbers and greens.  And if you are low FODMAP, you’ll learn how to still infuse the flavors of garlic and onion!  Best, you’ll understand those slides that I could only summarily address at the seminar! Look soon (possibly later today) for sign-up for the “Meet the Fats” workshop!

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Dietary Diversity = Microbiome Diversity = Better Health
Now for Microbiome Awareness Conversation from the Seminar!

Read through some interesting dialogue and benefit even if you were not able to attend the seminar!

Microbiome Awareness TMAO

TMAO was addressed last week in this post and is included here for completion. In summary, I suggested until the dust settles and studies confirm human dietary modulation of the microbiome that mitigates TMA and TMAO production, 

Consider consuming condiment size red meat (and up to 2 eggs a day if desired) regardless of quality (pastured or confined feed lot operations) as described in the Pegan diet (detailed below) crafted by Dr. Mark Hyman, Director of Cleveland Clinic Center for Functional Medicine.

Further, consider integrating meat prep using these TMAO mitigation strategies (shown in recent mice studies, April 2016 and Dec 2015).  Read all details in the post, Microbiome Awareness TMAO Conversation.

Restricted Diet Thoughts — restrictive diets are not so restrictive after-all.  Why?!?

It is disease that takes away freedom of life.  Dietary modulation of the microbiome gives back freedom of life.

Those with chronic disease, or watching a loved one deal with such, totally gets that concept.  Those realizing the power of the microbiome for preventative aggressive medicine, do so too.

Salt and a Whole Foods Diet

Make sure you consume sufficient sea salt and iodine if you eat a whole foods diet (it is low in processed, prepared, and restaurant foods).  The post, WHOLE FOODS & SALT: HOW MUCH, AUTOIMMUNITY, & IODINE?  discussed these concerns and provided tons of resource links.  In summary, recent studies find that the safest sodium limits actually are within a U shaped bell curve having the range of 2,645 — 4,945 mg/day.  Key excerpts from the post are:

Deaths increased when daily consumption was less than 2,645mg or above 4,945 mg.  

Between 2,645 and 4,945 mg of salt a day had little or no variation in death.

FODMAPS and Monash Unviersity Prebiotic Chart listing some Prebiotic Foods

Why do we want to consume FODMAPS?  Many of the high FODMAP food substrates( fructans and galacto-oligosachairdes (GOS)) are actually prebiotics which stimulates growth of the kind of microbiome bacteria that is associated with good digestive health. FODMAP foods are hard to digest and for many they cause digestive symptoms. But eating a low FODMAP diet adversely alters the microbiome.  “Altering [reducing] the dietary intake of FODMAPs alter gastrointestinal microbiota [58] and a significant decrease in the concentration of probiotic bifidobacteria after four weeks of a low FODMAP diet has been reported [52].”  – Lactose Intolerance in Adults: Biological Mechanism and Dietary Management. 

What are FODMAPs?  FODMAPs are food substrates that are poorly absorbed and therefore fermentable by the gut microbiota. The acronym stands for Fermentable Oligo-, di-, Monosaccharides And Polyols. FODMAP substrates are ubiquitous in the diet, they are additive, and when in excess for your unique physiology, can cause digestive  symptoms.  The diet is not intended to be long-term therapy. Monash guidelines are that a low FODMAP diet is consumed for 2 to 6 weeks.  After symptom resolution, patients are guided by a FODMAP dietitian on how to systematically and gradually re-introduce foods high in fermentable carbohydrates to determine individual tolerance to specific FODMAPs. 12–14

The FODMAP diet successfully manages over 86% of IBS/IBD patients, having partial (54%) or full (32%) efficacy.  From the study: Satisfaction with dietary management was seen in 83 (70%) IBS patients and 24 (55%) IBD patients. Eighty-four percent of patients lived on a modified low FODMAP diet (LFD), where some foods rich in FODMAPs were reintroduced, and 16% followed the LFD by the book without deviations. Wheat, dairy products, and onions were the foods most often not reintroduced by patients.

Many folks are lactose (a high FODMAP substrate) intolerant.  The majority of healthy individuals with lactase deficiency can tolerate up to 20 g lactose without difficulty.  For IBS patients, half need to go beyond just lactose reduction and many find they  actually have intolerance to a GROUP of other food substrates that go by the acronym FODMAPs.   Similarly, intolerance thought to be due to the protein gluten (wheat is a high FODMAP substrate), also found intolerances to other FODMAP substrates.

What is fortunate about doing a FODMAP elimination with re-challenge is you learn once and for all what and how much you tolerate for the varying FODMAP substrate categories as the gut fermentation symptomology is additive.  You could learn it may not be the lactose or gluten you believe you cannot tolerate, but in addition to or instead of, it may be other FODMAP substrates that you need to learn tolerance levels for.

caution sign3Dr. Gibson, the creator of the FODMAP diet, estimates that overall ~10% of the population may be FODMAP-sensitive

The book, The Complete Low-FODMAP Diet: A Revolutionary Plan for Managing IBS and Other Digestive Disorders, by Drs. Sue Shepherd and Peter Gibson is a reference guide and road map for the low-FODMAP diet.

What food substrates actually are FODMAPs?  Here they are (not inclusively):

  • oligosaccharide includes fructans/fructo-oligosaccharides found in grains and vegetables and galactans/galacto-oligosaccharides found in legumes,
  • disaccharide includes lactose found in milk,
  • monosaccharides  inlcudes fructose found in fruit, and
  • polyols includes sorbitol found in sweetened products.

Google for a Convenient FODMAP Food Chart such as these:

or use this Convenient Food list:

  • High-FODMAPs protein: Legumes

Low-FODMAPs protein: Meat, fish, chicken, tofu

  • High-FODMAPs vegetables : Garlic, onions, asparagus, artichokes, sugar snap peas, celery, sweet corn

Low-FODMAPs vegetables: Green beans, carrots, cucumbers, lettuce, tomatoes, zucchini

  • High-FODMAPs fruit and nuts : Apples, mangoes, pears, peaches, plums, watermelon, cashews, pistachios

Low-FODMAPs fruit and nuts: Bananas, oranges, grapes, almonds

  • High-FODMAPs cereals, grains, breads, pastas : Wheat products, barley, rye

Low-FODMAPs cereals, grains, breads and pastas : Gluten-free bread and pastas, oats, rice, quinoa

  • High-FODMAPs dairy products: Soft cheeses, cow’s milk, cream, ice cream, yogurt

Low-FODMAPs dairy products: Lactose-free milk and yogurt, hard cheese

If you find you can not tolerate any FODMAPs, then additional testing is needed.  It is possible there are chemical intolerances (histamine, salicylate, amines, glutamates, suplhites), SIBO, gluten sensitivities or other conditions present.

Some reasons why so many have problems digesting FODMAPs

  1.  75.6%, 37.8% and 13.3% of [IBS] patients have fructose malabsorption, lactose malabsorption, or small intestinal bacterial overgrowth, respectively. The FODMAPs diet eliminates these food substrates and then learns tolerance levels at the re-introduction phase. – The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study and see Clinical Ramifications of Malabsorption of Fructose & Other Short-chain Carbohydrates  
  2. Not surprising, the health of your microbiome plays an important role in your ability to tolerate FODMAP substrates.  My guess, it centers on REDUCED MICROBIOME RICHNESS   and DIVERSITY  since less diversity can result in increased bacterial strains that cause inflammation representative of obesity, Type2 Diabetes and cardiovascular disease.   The study “Richness of human gut microbiome correlates with metabolic markers,” found one in four have 40% less gut bacteria than average.  And Dr. Maria Gloria Dominguez-Bello estimated that 1/3 of the population has reduced microbiome as seen on this interview for the film “Microbirth.”
  3. FODMAPs are prebiotics, which are difficult to digest for most all.  Dieters begin eating a low FODMAP diet and then re-introduce FODMAPs to learn tolerance levels.  From Monash University (the creator of the Low FODMAP diet):  A low FODMAP diet will reduce the intake of foods high in fibre and natural prebiotics, which in turn may impact of the growth of certain bacteria in the gut.  This is why we advise against following a strict low FODMAP diet  unnecessarily.  Typically consume low FODMAP 2-6 weeks, then re-introduce FODMAPs in a deliberate process to learn tolerance levels using a FODMAP knowledgeable professional.  Source: Monash University, Dietary Fibre and natural prebiotics for gut health: FAQs.   The below chart lists some prebiotics which beneficially feed the microbiome.
Medications may be necessary at times to reduce inflammation.  Adding healing diet tenets helps since diet modulates the microbiome increasing diversity.

Dr. David Suskind discusses this in NIMBAL (Nutrition in Immune Balance) Therapy for IBD and notes that weaning off drugs with concomitant use of SCD can be possible for many once inflammation is under control.  This Stanford SCD clinical trial uses this strategy for IBD. Remember, SCD increases microbiome diversity (see the below slides for the many studies, and SCD also increased F. prausnitzii (read the post here) an important microbiome and gut lining supporting short chain butyrate producer.  The studies find mucosal healing and reduced disease indices with the end result that SCD can maintain and/or induce remission allowing patients to reduce and even eliminate meds.

SCD is used for conditions other than IBD.  There are many posts on dietary modulation of the microbiome for other conditions; just drop down the bar in the right sidebar to search.

 

Healthy and ill gut slides

The room was too bright the night of our talk for you to see the full implications of these two slides:  the healthy vs ill gut.  Here they are!  Note especially the mucosal linings.  Recall that if you aren’t eating to nourish the microbiome, the microbiome will consume the glycans in the mucosal lining.  Additionally, recall that emulsifiers, ubiquitous in the food system, cause gram negative LPS producing bacteria to penetrate and degrade the mucosal lining.  LPS can cross the blood brain barrier and is associated with many neurological conditions.  The emulsifier researchers have personally eliminated them from their diet.  Nuff said!

Just to clarify information on the two page handout:
  1. Exercise outdoors is better than indoors as microbiome diversity increases with outdoor exposure.
  2. ADD sauerkraut to the UMass IBD-AID plate prebiotic listing.  UMass IBD-AID is a  more lax version of the Specific Carbohydrate Diet (SCD).  SCD is a healing diet that is used for IBD and lots of other conditions.  IBD-AID differs from SCD in that it increases food substrate that better supports the microbiome.  IBD-AID is not as well studied as SCD, but UMass is currently looking at microbiome pre/post IBD-AID in ~250 patient cohort study.  These results I eagerly await since  IBD-AID has been shown to be successful in other studies to date.  IBD-AID has 5 basic components: (1) the modification of specific carbohydrates (eg, refined or processed complex carbohydrates and lactose); (2) emphasis on restoring the intestinal flora balance through ingestion of prebiotics and probiotics in the form of soluble fiber such as leek, onion, and fermented foods; (3) focus on decreasing total and saturated fats, eliminating hydrogenated oils, and encouraging the increase in food sources rich in omega-3 fatty acids; (4) review of the overall dietary pattern, identification of food triggers and intolerances, and detection of missing nutrients; and (5) food texture modification to enhance absorption and reduce intact fiber.  Read more at,  Diet and Inflammatory Bowel Disease, August, 2015.
Teeth Cleaning:  Coconut Oil or Hydrogen Peroxide

Some talked about oral health care.  Here’s my take:

  1. Fluoride is tough on your gut.  Many physicians suggest GI patients ditch fluoride toothpaste.
  2. The oral cavity is supposed to have a microbiome.  Things that nuke that environment like coconut oil and hydrogen peroxide (antimicrobial) may not be helpful for preservation of the oral microbiome.
  3. Perhaps consider swishing probiotics a few times to encourage a healthy oral microbiome?  I do!
  4. Coconut oil pulling and extending concern #2. I have read that coconut oil pulling with mercury fillings is NOT a good idea as it moves the mercury out of the fillings.  Also, I wonder what it does for composite filling materials.  Last, you don’t want to spit the oil down your drain as it can clog pipes solidifying as it cools.
How To Feed A Happy, Healthy Gut is a great article that nicely summarizes some of what we discussed at the seminar.  

I stumbled on the article from Dr. Elisabeth Bik (one of my fav microbiome researchers.) We went much farther in the seminar and talked  about where the microbiome originates from, C-section microbiome risks and swabbing, microbiome diversity, richness, and community functions, Dr. Sonnenburg generational microbiota concerns, Dr. Gerwirtz emulsifiers, TMAO and PUFA, MUFA, carotenoid absorption, antibiotics, Dr. Knight American Gut findings, Drs. Gibson and Sue Sheperd FODMAPs, nutrient sufficiency, vegetable intake and short chain fatty acid production, toxin loads, and more. But still, read through the excerpts and see how much you actually learned about microbiome support! Key excerpts are:

  • The relationship between food and the microbiota is a two-way street: The food we eat affects the composition of our microbiota, and the composition of our microbiota affects how we digest and absorb our food. One layer of cells is all that separates your immune system from the contents of your gut
  • A healthy, balanced gut microbiota promotes a strong immune system and lower levels of chronic inflammation. An unhealthy microbiota has been linked to obesity, asthma, allergies and autoimmune disorders such as celiac disease, Type 1 diabetes, inflammatory bowel disease and rheumatoid arthritis. Increasingly, chronic inflammation is also thought to be a root cause of cardiovascular disease, Type 2 diabetes and some forms of cancer.
  • Prebiotics: Your microbiota adapts to its environment, and if that environment doesn’t provide the fiber it needs, your microbes will instead dine on the thin layer of mucus that protects your intestinal lining, potentially leading to a “leaky gut” and all number of health problems. So nurture a stable and diverse community of intestinal critters by offering them a fiber smorgasbord from a diet rich in vegetables, fruits, whole grains and pulses (beans and lentils). These foods are rich in “prebiotic” fiber, or dietary fiber that escapes digestion in the small intestine but is fermented by the types of bacteria you want to have hanging around in your colon.
  • Eating prebiotic fiber promotes the growth of bacteria that break down plant starches and fibers into short-chain fatty acids (SCFAs). Some SCFAs [butyrate] may protect against inflammation and cancer, while others help us absorb essential minerals from our food, including calcium, magnesium and iron.
  • Good food for your microbiota also comes from resistant starch, which is found in whole grains as well as in cooked and cooled pasta, rice and potatoes. Some people find that it’s easier to boost intake of resistant starch than fiber. [Those are NOT food substrate included in the healing diet tenets for those using dietary modulation of the microbiome like SCD, GAPS, PALEO.]
  • Probiotics: Properly fermented foods are teeming with beneficial, health-promoting microbes, or probiotics. When you eat these live foods regularly, they may help maintain or improve the population of good microbes in your gut. Eat probiotics in the form of fermented dairy products such as unsweetened yogurt and kefir (fermented milk), fermented soy foods such as tempeh and miso, or fermented vegetables such as sauerkraut, pickles and kimchi.
  • Individuals who consistently eat plant-based diets, such as vegan, vegetarian or Mediterranean diets, tend to have higher levels of SCFAs. This suggests that the AMOUNT OF FERMENTABLE FIBER matters more than the diet itself. Because not all fiber is the same, when you eat a VARIETY of whole plant foods you nourish the microbes that can break down that fiber and encourage a more diverse and robust gut ecosystem overall.

We are totally happy to hear the great feedback from the seminar and that many of you want to learn more about How-To practically implement microbiome support!

 Look soon for “Meet the Fats” signup!

Best in health through awareness,

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