Chronic Disease And Why I Care So Much About Gut Flora: An Opinion Piece for an Industrial Age, by Sarabeth
(To be clear: I am presenting a _summary_ of my recent health and nutrition research. I am not providing sufficient evidence/data to prove to anyone that my opinions are valid. If you're curious about or skeptical of the basis for my conclusions, please read the books and websites I recommend. Then, let me know what _you_ decide.)
Six months ago, my family and I radically changed our diet. Many people think we're nuts: why did we--a health-conscious, eco-minded young family--cease our vegetarian ways, stop eating all carbs except for non-starchy vegetables, and begin favoring great greasy gobs of saturated animal fat??
First: my husband and two small sons and I were experiencing a number of moderate to severe health issues. Between the four of us, our symptoms ran the gamut: chronic fatigue, chronic diarrhea, depression, hormonal imbalances, autoimmune disorders, weightloss, autism-spectrum and other explosive behaviors, food allergies, skin problems, and much, much more.
Then, we heard about this crazy theory, which purported to largely explain most (if not all) of our issues. The theory goes like this (the following four paragraphs are a combination of quotes and adaptations from an article by Tom Cowan, M.D. http://www.sustainlane.com/reviews/the-gaps-diet-the-mother-of-all-diet… ):
1. Each of us has millions of intestinal villi, which are tiny finger-like hairs projecting into the small intestine. These villi dramatically increase the surface area of the intestinal lining, making it a more effective semi-permeable barrier (meaning that unwanted things stay out of the bloodstream while nutrients can flow right through).
2. In order to do their job, the villi require a protective layer of mucus which in turn nourishes “good” microbial flora--some estimate a total of 5-7 pounds of millions of different bacteria, viruses, yeast, and other microbes--which reside in the human gut. These healthy bacteria are essential for a healthy human existence. They make vitamins, they digest food, they make antibiotic substances to keep down pathogens, and they function as our immune system.
3. These intestinal villi are the sole site in the body where production of an enzyme called disaccharidase occurs. Just as lipases digest lipids (fats) and proteases digest proteins, these disaccharidases digest disaccharides. When the microbial flora balance is tipped in favor of pathogenic microbes, the protective layer of mucus in the small intestine gets eroded. The villi become blunted, they lose the ability to make this important enzyme, and we lose the ability to digest disaccharides. When we keep eating foods with disaccharides and can't digest them, they become perfect food for the pathogens that always reside in our gut, particularly species of candida. We then continue to produce an overgrowth of candida, other yeasts, clostridia and other potent pathogens - and these often make unhealthy proteins instead of the B vitamins made by our healthy gut flora.
4. Due to all this irritating activity in the small intestine, it becomes more permeable and “leaky,” allowing foreign proteins into the bloodstream. This leaky gut causes either direct poisoning of our nervous system (the proteins essentially act like neurotoxins, as in autism) or creates antibody formation in reaction to these abnormal proteins (which is the process of auto-immune illness). Diseases which are the direct result of this process include not only intestinal diseases such as IBS (Irritable Bowel Syndrome), ulcerative colitis and Crohn's disease, but all the auto-immune problems such as eczema, asthma, rheumatoid arthritis, etc. Thus, the majority of human illness starts in, and must be treated by healing, the gut.
Now: why would a person's microbial flora get imbalanced? you might be wondering. Or, you might instead be thinking: This lady's whacked!
I will politely address both the question and the theory. But first: some more thoughts on carbohydrate consumption which, I hope, will prove edifying, scintillating...or at least, not boring.
For thirty years, I believed that Meat and Saturated Fats Are Bad; A Low Fat and Whole-Grain-Based Diet Is Good. I thought that vegetarianism could save the world, and I didn't take my head out of the sand for a quick look-see until suddenly last April. And it turned out that I'd been ignoring an elephant that had been in the living room since well before my time, despite an enormous amount of data indicating that animal protein and fats and dietary cholesterol are not, and have never been, The Problem (except when they are removed from the human diet, which causes all sorts of other problems).
A large amount of data support the theory that the following diseases owe their existence either largely or entirely to consumption of excessive carbohydrates, especially added sugars and improperly prepared and refined grains, and especially in the context of a low-fat diet (Useful/necessary reading: “Good Calories, Bad Calories” by Gary Taubes.):
--Type II Diabetes
--Coronary Heart Disease
--Tooth decay/Abnormal jaw development requiring orthodontia
--High Blood Pressure
--Most types of Cancer
--Metabolic Syndrome ( a “constellation of symptoms” (Wikipedia) such as Fasting hyperglycemia (“diabetes mellitus type 2 or impaired fasting glucose, impaired glucose tolerance, or insulin resistance”), High blood pressure, Central obesity (“also known as visceral, male-pattern or apple-shaped adiposity”), Decreased HDL cholesterol, and Elevated triglycerides. “Associated diseases and signs are: hyperuricemia, fatty liver...progressing to non-alcoholic fatty liver disease, polycystic ovarian syndrome (in women),” gout, arthritis, etc.)
--Many hormonal irregularities, including infertility
For better or for worse, arteriosclerosis doesn't develop overnight. High blood pressure doesn't generally spike one day when a person turns forty-three. Before people become fully-blown diabetics, they get “pre-diabetes.” Dietary choices accumulate over a lifetime, in every person's uniquely individual bodies--which means that when it comes to health, everyone is on a spectrum. One Twinkie every twenty years is not going to kill me. But I'm certain that obtaining nourishment predominantly from grains and sugars would likely, over a lifetime, make me very, very sick.
That the most deadly diseases have a nearly-invisible onset is not good from a public health perspective; most people are generally terrible at making decisions that involve delayed feedback. It would be easier if the message could be simpler: “Stay away from Johnny when he sneezes, and you'll cut your risk of catching cancer!” It is _really_ hard for the human animal to recognize, at, say, age fifteen, the logic in a more realistic warning like: “Habitually consuming sweets and refined flour products is setting the stage for diabetes and heart disease twenty years from now, not to mention increasing the odds that your future offspring will be diabetic or overweight...”
The problem is, I'm convinced that this epidemic of “The Diseases of Affluence” is going to get worse well before food industry practices, governmental policies, _or_ conventional wisdom start helping us get healthy.
In 1873, Edmund La Croix patented his “middlings purifier,” which propelled white flour to a staggering level of popularity--refined grain for the masses, and cheap, too! This bit of progress, along with the growing availability of cheap refined sweeteners, changed the average human diet in completely unprecedented ways.
While doomsday hasn't completely arrived in the last decade and a half, many people are finding that their health concerns are not either satisfactorily explained or addressed by doctors, USDA food pyramids, or popularly accepted or “alternative” advice concerning diet and disease.
And habitual consumption of refined carbohydrates isn't just a problem for humans. It can be very problematic for the symbiotic organisms that humans depend on for survival.
Any good dairy farmer knows something about her/his cows that many people have yet to recognize about their own bodies. Farmers know that if they provide feed that is not suited to the cows' particular digestion, which involves a fermentative process that occurs in their rumens, milk production will quickly plummet and the cows' general health will, too. Cows are meant to eat grass; unsuitable feed might consist of improperly fermented (or rations containing a disproportionate amount of) grain.
Once a cow's milk production goes downhill, it takes a long time to ramp back up again. Beneficial microbes in the rumen are responsible for maintaining an exquisite balance between probiotic flora and pathogenic microbes. If the Good Bugs are thrown off by the cow's consumption of unsuitable food, a cascading situation can occur when the cow is given antibiotics to kill the overgrowing Bad Bugs, which also destroys good flora and creates a positive feedback loop where more and more invasive treatments are required to keep the cow alive and its rumen functional at all. Moral of the story is, The best cure is prevention: let cows eat food that cows (and the microbial ecosystems contained in their rumens) have evolved to digest. Then, nobody will have to struggle to fix problems after they've already started.
I know that humans aren't cows, we don't have rumens, and our best digestion does not occur via fermentative processes. But our own digestive systems absolutely cannot function without many billions of beneficial microbes which have evolved, just like the cows' have, to thrive when we're eating certain types of foods. And as far as I can tell, there are no human populations anywhere who thrive on refined carbohydrates.
Neither us nor our microbes are built to tick along healthfully, decade after decade, eating Food-Like Products made from corn and wheat and sugar. In some cases, and especially if an individual's health is already compromised, consuming even whole grains and beans and fruit can constitute a damaging diet for an already less-than-robust digestive system.
Here comes my public service announcement. When we eat too many carbohydrates, our bodies start breaking down, and we are very likely to develop some or many symptoms of chronic disease. When our microbial ecosystem becomes additionally weakened, then we can get really, _really_ screwed. And the big question becomes: IS IT REALLY WORTH IT??
The following list comprises a host of symptoms that might be rightly grouped under the umbrella of Digestive Disorders:
-Autoimmune disorders, including asthma
-Autism Spectrum behaviors
-Neuro-psychological symptoms including hyperactive, defiant, oppositional, aggressive, obsessive, and/or compulsive behaviors
-Chronic back pain
-ADHD (Attention Deficit Hyperactivity Disorder)
-"Failure To Thrive" (in babies)
-Eating disorders, including anorexia and bulimia
-IBS (Irritable Bowel Syndrome)
-OCD (Obsessive-Compulsive Disorder)
-PMS and many hormonal disorders
-Painful or irregular menstruation accompanied by migraines
-Underweight with the inability to put weight on
-For a more complete list of disorders that can be addressed using a gut-healing protocol, click here: http://gapsguide.com/about/conditions-addressed-by-gaps/
For some people, simply reducing or eliminating refined carbohydrates, and moving toward a more traditional (fat-rich and nutrient-dense) diet that also includes properly prepared (fermented or sprouted) grains and beans, can improve gut flora, along with the offending symptoms listed above.
But by the time someone is suffering from complaints like these, his or her body and gut flora can be too far gone to respond to moderate positive changes. In this case, a protocol like the Specific Carbohydrate Diet may be necessary: temporarily cutting consumption of nearly all carbohydrates (especially double-chain polysaccharides, found in grains, most beans, potatoes, sugar, maple syrup, etc.). The main goals: reducing consumption of foods that in turn easily feed an overgrowth of unhealthy, fermentative microbes, which produce toxins and cause the “leaky gut”; and encouraging the re-establishment of Good Gut Bugs that help us digest and absorb our food, provide for the basic functioning of our immune system, and keep stray proteins and other nasties from leaking out of our small intestines.
I know this hypothesis--that imbalances in our gut flora is the basis for so many modern afflictions--may seem counter intuitive at best, and like a Wacked-Out New-Age Non-Theory at worst. I mean, didn't I just invent a laundry list of seemingly unrelated diseases, and blame them on one underlying cause that sounds like it comes straight out of a science-fiction movie?
I used to think so. After all, if something so basic as our digestive system were at the basis of so many different diseases, wouldn't we and our doctors have heard about it already?? The thing is, Modern Western Medical Treatment (as well as media interpretation of complex medical research) focuses almost exclusively on Symptoms. These are catalogued obsessively, patterns are duly noted, and sometimes it's easy to forget that our reams of syndrome documentation do _not_ often prove the actual _cause_ of the problem in the first place. (Please do let me know if I've missed some causal science out there relating to any of the listed disorders.)
Along these lines, we can treat our (for example) chronic depression, Irritable Bowel, and our Asthma with three different drugs. These drugs often have striking effects, and sometimes treat certain symptoms very effectively. But we come again to the questions: are low serotonin levels the _cause_ of depression, or are serotonin levels thrown off, along with a person's emotional state, as an _effect_ of something entirely different? This might seem like a really simple-minded question, but often it never gets asked. Does the fact that Prozac helps relieve some folks' depression, prove that the existence of depression is due to an absence of Prozac? Trying to interpret scientific data into a useful format for decision-making is surprisingly messy and confusing.
But healing an underlying Gut Dysbiosis doesn't necessitate identifying each individual protein that leaks through a leaky gut wall (way too many to quantify), or understanding each individual's genetic predisposition to express their Dysbiosis in their own individual way. Instead, I am proposing that treating chronic illness doesn't require much specialization at all--just a much clearer understanding of scientific research, and the ways that we interpret Cause vs. Effect.
To me, it is key that healing the human gut can _affect_ (“cure”) every symptom on these lists. (A rudimentary understanding of the complexity of our digestive microbial ecosystems, as well as the Specific Carbohydrate Diet protocol, has existed since the 1940s.) Also, there is another type of evidence that can be Good Enough when trying to determine the best way to treat disease. In this case, I'm talking about “Clinical Effectiveness”: “the extent to which specific clinical interventions do what they are intended to do, i.e maintain and improve the health of patients securing the greatest possible health gain from the available resources.”
In other words: if a doctor's practice employs a healing method like GAPS that works exceptionally well, works repeatedly with hundreds of different patients, and continues to work over time with few or no side effects (except for improved overall well being), then I pay attention.
Right now, the science of our human microbial ecosystems is in its infancy. Clinical proof-of-effectiveness is not the same as evidence generated by large-scale epidemiological or double-blind placebo-controlled studies. But many of us don't have the several lifetimes that it may take to prove or disprove everything necessary for widespread acceptance that human gut health might be the most basic requirement for good health. (Useful/necessary reading: “Breaking the Vicious Cycle,” by Elaine Gottschall; and “Gut and Psychology Syndrome,” by Natasha Campbell-McBride.)
“But!” everyone says. (There are LOTS of Buts.) “How can you say these are _all_ digestive disorders? But...what about environmental pollution? But...what about vaccinations? But...not everyone is as sick as your family! But...I thought that low-carb diets are unhealthy and people can't stay on them, anyway. But...all my health issues started recently, and I'm not eating anything different than I used to. But...some people recover from these conditions without GAPS. But...high-fat diets cause heart disease! But...some people--lots of them--aren't sick at all. And lots of kids with way worse diets than yours' aren't nearly as anxious and don't exhibit autism-spectrum behaviors and...”
Here are some thoughts:
#1. Genetic disorders don't skyrocket the way Diseases of Civilization are skyrocketing (i.e. enormous increases in just one decade, for example). Genes do not work like this. Therefore: autism et al cannot be correctly attributed to Bad Genetics.
#2. My parents' generation was the first to grow up using Antibiotics As Magic Bullets. My generation was raised on antibiotics too, with only lip service paid to the fact that anything that Kills Microbes will kill the good along with the bad. All this time, over several generations, widespread use of these non-discriminatory drugs has been steadily affecting the state of the average woman's gut flora. And this complement of flora, good _and_ bad, is bequeathed unto a woman's babies the moment they come through the birth canal. My kids' generation is suffering from what may be an epidemic of messed-up microbes, and so it seems especially important to refrain from using antibiotics unless it's extremely, absolutely necessary.
#3. Environmental pollution, childhood vaccinations, and many other factors are certainly affecting our health; yet each factor alone does not significantly explain what underlies the epidemic-style health crisis facing industrialized populations right now (nor does the elimination of any of these individual factors offer substantial possibilities for curing what ails us).
#4. It's true that some people recover from lots of different conditions without using a gut-healing dietary protocol. In some cases, positive visualization, western medicine, yoga, meditation, alternative therapies, and/or “waiting and seeing” can be effective and lead you to be as healthy as you desire. If that is the case, then great! You don't need a Specific Carbohydrate Diet at all. But when these alternative measures fail or cause major side effects or are not attractive options for various reasons, I resoundingly believe that it is best to “let food be thy medicine and medicine be thy food.”
#5 Surprisingly, there is no good evidence that high-fat diets increase the risk of heart disease of any kind. You won't hear this from the mainstream media, because the low-fat gospel has reached just about every educated, health-conscious person around. Your doctor probably tells you that fat (at least saturated fat) is nearly deadly. And yet, I'm convinced that daily consumption of dry wheat toast will raise your risk of heart disease (as well as almost every chronic disease) far more than subsisting simply on fatty platefuls of red meat. (Again, Gary Taube's “Good Calories, Bad Calories” is essential reading.)
#6. Current mainstream (and even alternative and hippie) thinking essentially says: If You Are Overweight, You Eat Too Much And/Or Exercise Too Little.
We've heard this so many times that most of us think it's true. And if you follow this thinking, and you're someone who wants to lose weight, then you essentially believe that you personally should eat less (except that of _course_ you'd be eating less, if you weren't so hungry), and/or exercise more (except that of _course_ you'd be exercising more, if you felt like it). And if you fail to lose weight despite being hungry and exercising, most conventional advice says: you have to eat even less, and exercise even more, without stopping to ponder: what if the desire to exercise and eat less is actually the _effect_ of weightloss itself, and not the causes at all?
This seems totally simplistic, and not useful if you're trying to understand the psychology of overweight, right? The thing is, if what I'm learning is true, than nearly all overweight is _not_ due to overeating or underexercising, but rather to metabolic malfunctioning, which can be corrected by dealing with the underlying cause: imbalanced insulin levels, due to over-consumption of carbohydrates (particularly refined grains and sugars).
High-fat, low carbohydrate diets, even when unlimited calories are consumed, appear to cause significant, permanent weightloss--and they work fairly quickly, completely independently from exercise levels, and people don't feel hungry while following these diets. At the beginning, switching from a high-carb to a high-fat diet, people can suffer from major withdrawal symptoms (which can be horribly similar to other addictions, like heroin). These cravings can be nearly intolerable, many people can't take the withdrawal, and some studies show that half of all low-carb dieters quickly resume eating carbs.
When people consider the unpleasantness of dieting, I wonder if they often confuse the prospect of _cravings_ (for specific foods, regardless of hunger levels) with _hunger_ (the body's non-ignorable directive to eat, in order to provide energy for celllular function). This confusion must be amplified when you've been told that it's actually normal to feel hungry, and that you lack self-control if you can't eat less, since conventional wisdom says you need to cut calories in order to lose weight.
But what if it's really true, that you _don't have to feel hungry in order to lose weight?_ And that calories really don't matter? (Gary Taube's “Good Calories, Bad Calories” presents an amazingly compelling case.) If this is true, and I think it is, then it could be a huge public service if people seeking to lose weight were actually informed of this simple fact. It could help them deal with the cravings much more effectively, if they didn't also have to feel hungry at the same time. It could be a huge shift of public consciousness, to understand that overweight is NOT a disease caused by “lack of self-control.”
#7. It's true--our human bodies and brains are resilient and elastic, and each one is unique. Many people have strong constitutions that allow them to go for many years, fueled by carbs, without breaking down in any noticeable way. Some people can go a lifetime without suffering any ill-effects from over-consumption of carbohydrates, and without developing gut dysbiosis. Some people's gut dysbiosis manifests as digestive symptoms with no neurological effects; other people have some constipation and are profoundly, non-verbally autistic. In any case, I think that most people would agree that on a _population scale_, the industrialized world is full of sick people. Even if you don't agree, try this little game: go through Lists #1 and #2, and make your own list: name anyone you know who _isn't_ suffering from at least one of these ailments.
I'm very curious how many people you have on your list.
I am NOT denying that there are serious complications involved with the above-listed disorders. In fact, abnormal brain activity, metabolic disturbances, nutritional deficiencies, and more are endemic in anyone with gut dysbiosis. But I am convinced that there is enough clinical evidence to conclude that these symptoms are not generally _underlying causes_. Yes, a person may lack insulin or serotonin, have an excess of leptin and ghrelin, exhibit an irregular quantity of thyroid hormone, or suffer from an overstressed liver. But WHY are these things happening?? Why such a massive breakdown of our basic bodily systems, so relatively recently and suddenly in human evolution?
If medical researchers and doctors and individuals want to make some useful strides in helping us heal, I propose that we all stop examining our collections of symptoms as separate illnesses, confining each to separate realms of research. Let's begin to examine the breakdown of these systems _as a whole_. And ask a question: what if our very real symptoms are not the _causal_ factors we've been led to believe?
Please see this list of references/resources: http://www.lifeisapalindrome.com/articles/gaps-resource-list