Tummy Troubles = Autoimmune Disease?

Well, not exactly "tummy," if by "tummy" you're thinking, "stomach." What I really mean is your small intestine, specifically the upper part of your small intestine, know as the duodenum. I've written about small intestine bacterial overgrowth (SIBO) before, but I think it's worth delving back into for a minute to give you options for dealing with it.

Before telling you how to manage SIBO, let's review why it should be eradicated in the first place. It basically goes like this: bacteria from your colon have overpopulated their home, so they move up the plumbing. If they get far enough up, they make it to the duodenum, where about 75% of the absorption of what you eat takes place. If you have increased gut permeability from too many lectins in your diet (which are found in high concentrations in all grains, as well as legumes), that bacteria can get into your bloodstream. The literature is starting to lean heavily on the idea that most auto-immune diseases start in the gut.

Common symptoms for SIBO are everything from reflux to diarrhea, and it has been implicated in Crohn's disease, ulcerative colitis, and rheumatoid arthritis, and some are even connecting it to lupus. Go to Pubmed.gov and start searching. It will blow you away. I have one paper on my hard drive at home where 100% of the fibromyalgia patients and and 84% of the IBS patients tested had SIBO. When fibromyalgia patients walk through the door here, we go hard core anti-inflammatory, otherwise we're just chasing symptoms.

To overcome the SIBO, you have to do two things: starve it and kill it. This is a war for your health, after all, so you can't be nice to the bugs. The prescription for starving SIBO is fairly straight forward--get off the grains. The indigestible carbs in grains are what feeds the bacteria. This is one of the major ways that grain consumption is so inflammatory. Uncontrolled inflammation leads to a whole host of the diseases of the west. Want to know what you're genetically susceptible to getting? What's your family history? Heart disease? Cancer? There's your answer. For me it's heart disease (dad's side), and dementia (mom's side). Both of those diseases are caused, in part, by uncontrolled inflammation. I think I'll do my best to pass.

As far as killing SIBO, my recommendation is to try 600 mg a day of oil or oregano for six weeks. Oil of Oregano (OoO) should be in an emulsified form that will help it make it to the bad bugs. OoO is also a potent anti-inflammatory in it's own right, so it's something that I dance with on occasion. If I even have an inkling that there's some gastro intestinal upset in the works I throw some down the hatch. If I had any kind of auto immune disease I would treat with OoO just to see what happens. There are no contraindications that I'm aware of, so the worst case scenario is that nothing happens and you're out a few bucks, but the potential benefits are huge. So, why not?

There are drug therapies for SIBO, too, most notably an antibiotic called rifaximin, which targets the specific area of the gut where SIBO does the most damage. Either way you go, the rub is that it will come back, even after a good killin', if you don't change the habits that started the whole process in the first place. So join me in the grain free challenge. People who did just that in January reported losing weight (some were dropping a pound a day for a couple of weeks straight), and less joint pain (which is something I ask people about all day long, since that's why they're here in the first place).

If OoO interests you, let it be known that I sell some here, and the brand I sell was recommended to me by the guy who wrote Integrative Rheumatology, which is a textbook that I regularly review when I write this kind of stuff.

Biscuits!

I thought I'd show you guys some love, since I've been beating you all down with my no grains talk since January. I stand by all that I've said, but I also want to give you some great ways to get around the whole no grains thing. There are basically two food groups that people miss the most when avoiding grains: crunchy, and biscuits. Today we'll cover biscuits, and we'll get to some crunchy soon, too.

First, you need to me my friend: almond flour. We prefer this brand, but I' sure there are others. We've started buying it in the 25 pound bags because we use so much. The recipe for biscuits I'm about to throw your way is from this book. I think we've (and by "we," I mean, "Cara") improved a little on the original recipe. We've also made the pancakes, which I don't like that much more than pancakes made from coconut flour, but it is a nice variation.

What you need:
2.5 cups of almond flour
.5 tsp of baking soda
.5 tsp of salt (or a whole tsp of kosher, which is my preference)
1 tsp of lemon juice
2 eggs
1/8 cup of maple syrup (the original calls for agave nectar, which I would advise against because of the super high fructose level. I'll write something about the reason for that soon.)
1/4 cup of melted butter (unsalted), or coconut oil (we use butter)
(Decimals! Fractions! I'll use them all!)

350 oven. 15 to 20 minutes on a Silpat or parchment paper (or just lube up a cookie sheet with oil)--divided into 8 servings.

We (and again, "we"="Cara") often add frozen blueberries, which is super awesome. A cup and a half of frozen blueberries adds about 15 minutes to the cook time. They should be golden on top, and a toothpick inserted into the biscuits will come out clean. Raisins and cinnamon go well in them too. Play with it. With our strawberry shortcake  a few days ago there was half a lemon's worth of zest in the batter. They were served with some fresh strawberries and  some whipped, unsweetened coconut cream. Delicious.

See? Who loves you?

Who's Been Eating Beans?

I made a comment on Facebook about peas being an irritant to the gut recently, and although I was referring to the Black Eyed Peas and their horrendous half time "song," the fact is that peas, which fall under the broader category of legumes, really can irritate the GI tract in the same ways that grains can. For some of you, this means you may be better off skipping the beans.

Legumes do have some redeeming qualities, though. Unlike grains, the protein in beans is fairy easy for your body to absorb when they're cooked well. A long soak helps beans become more gut friendly. Still, beans are full of fiber that we can't digest on our own. That fiber, however, gives the bugs in your gut a bean buffet to feast on, which can lead to, among other things, funny jokes about beans. If you know what I mean.

Some legumes have higher amounts of protein than others--lentils come to mind. They're no grass fed steak, but they do have some redeeming qualities. Some legumes are more starchy, like my personal favorites, lima beans. I generally try to avoid excess consumption of all legumes, but I'll happily eat some refried beans at a Mexican restaurant on the occasions when I eat out. Just being real with you. Some of the more hard core "paleo" crowd out there won't touch them, and I do understand the motivation, I'm just more of a moderation kind of guy when it comes to legumes.

Legumes do contain a high amount of lectins, which I wrote about in the above linked grains post a few weeks back. Lectins increase gut permeability, and can lead to some pretty nasty auto-immune disorders. But compared to wheat, legumes are a distant second, and not bad enough for me to shun entirely. If I had any of the signs of inflammatory or auto immune disorders, I would be a little more strict with myself.

In the end, I consider legumes a cheat food that I like, but not as much as other cheat foods like cheese or heavy cream. The carbs will add up with beans, and for my money, I'll take the carbs in the form of dark chocolate.

Even More Good News

Funny thing--people are still reading the bad news post about 2 to 1 to the good news post. To catch us all up I decided to give you a little more good news, and this time I'm going to try my best not to spoil it with anything negative. I'm sure I'll fail, but now you know my intentions at least.

Most of the bad news had to do with certain foods causing inflammation. Today's good news will be focused on all the delicious foods, spices, and seasonings that modulate inflammation. And by "modulate" I mean "make not as bad." Which is good. See? Good news!

I'm going to give you a list of these anti-inflammatory tasty treats first, and then, if you want to geek out on the why you can keep reading. And the list, my friends, is long. You see, most of the culinary traditions of the world have in their respective arsenals a virtual menagerie of inflammation fighters. They also have their bad news fare, so the strategy is to delve into the good, and leave the bad behind, or at least eat less of the bad.

Let's get on on with it: spices are where the party is. This is good, because there are practically unlimited combinations of  flavors that can be derived from the spice pantries of the world. Take ginger for instance. It's prevalent in many Asian and Indian dishes, but it's also known to pop up in plenty of other culinary hot spots. It's also one of your new go to modulators of inflammation. Speaking of Indian--many of the spices that frequently show up in Indian dishes are potent anti-inflammatories. turmeric (which gives many Indian dishes and yellow mustard their characteristic yellow tint) and garlic, which frequently show up in curries, are on my list of things to eat as often as you can. Meet you at the buffet.

Cinnamon is also one of the most important spices to add to your flavor enhancement repertoire. Cinnamon, by the way, goes great in meat dishes. Find yourself a Greek cookbook and start exploring. The Greeks figured that last one out a long time ago, and if it weren't for some valuable time I spent teaching at Annunciation Orthodox School in Houston, I may not have ever figured this out. So thanks, AOS!

The reality is, we're just getting warmed up. Other common ingredients from the herb section of the store that pack a healthy punch are basil, mint, rosemary, and thyme. And all of you Tex-Mex/Indian food lovers should be happy to hear that cilantro makes the list as well. The best part is the fact that not only do these spices greatly enhance flavor, they are also virtually calorie free as well as low carb. What's not to love?

Another class of foods that control inflammation are the flavanoids.  You know them as the compounds that give many foods their colors. Examples of flavanoid rich foods are berries, dark chocolate, green tea, dark beer, and red wine. How's that for a list? See? it's not all gloom and doom around here!

(Geeks only from here on out...)
You may remember medications known as "select COX-2 inhibitors," some of which were taken off the market because people were having some serious side effects. Celebrex and Vioxx are two that come immediately to mind (Celebrex is still available, but not Vioxx, just to be clear). COX, short for cyclooxygenase, is an enzyme that turns some of the fatty acids in your cellular membrane into either pro or anti inflammatory mediators.

When we eat too much of the wrong types of fats we make it far more likely that COX is going to be working on that type of fat, and consequently produce the pro inflammatory results we'd all prefer to avoid. All of the above mentioned items keep COX from working so hard to sabotage our biochemistry. The bonus comes with the fact that all that stuff tastes good, too. 

The Good Stuff: Magnesium

 I'm frequently asked which supplements I take--it's a fair question since the person asking is usually someone I just suggested take this or that. My answer: not much of anything, but what I take gives the most bang for the buck. Today I want to spread the love for a supplemental underdog, our old friend magnesium.

Magnesium is found naturally in green leafy vegetables of which we both know you're not eating enough. It's also found in nuts, legumes, and sea food. A quick list of the punch this mineral packs: glucose metabolism, cellular energy transport, calcium transport, nerve signal conduction, over 300 enzymatic reactions. Lack of magnesium in the diet is known for contributing to the following list of stuff I'd rather avoid:

• Muscle weakness, tremor, or spasm
• Heart arrhythmia, irregular contraction, or increased heart rate
• Softening and weakening of bone
• Imbalanced blood sugar levels
• Headaches
• Elevated blood pressure
• Insomnia
• Muscle Cramps
• Panic Attacks
• Hyperactivity

I've written about C-reactive protein (CRP) before, but to review, it's a blood test that measures a marker for systemic inflammation. It is often used to determine one's risk for a coronary "incident." A recent paper, however, shows that elevated CRP means you're at risk for all the inflammatory diseases of the west: cancer, heart disease, and so on. Another recent paper shows a correlation with inadequate dietary magnesium and elevated CRP. One of the diseases that shows up in my family history, and is at least in part a disease of uncontrolled inflammation, is dementia. And I don't want that. Therefore--I take magnesium.

Another important factoid on magnesium supplementation: it helps prevent, and even reverse, bone loss in post menopausal women. Along with that fact, you should know that calcium supplementation doesn't appear to do squat for bone loss. See the abstract here. That paper discusses women on hormone therapy, but my inclination is to think that magnesium, not calcium, is the way to go if you're at risk of developing osteoporosis. Mrs. Green supplements, too.

Another paper I reviewed while writing this post makes a strong case that many of us are deficient, and had this to say about the consequences of that deficiency:

"Patients with so-called exclusion diagnoses (as for example,
attention deficit hyperactivity disorder (ADHD) or chronic
fatigue syndrome (CFS) would have their symptoms improved
through Mg therapy.—Similarly, patients with diagnoses of
depression, epilepsy, diabetes mellitus, tremor, Parkinsonism,
arrhythmias, circulatory disturbances (stroke, cardiac infarction,
arteriosclerosis), hypertension, migraine, cluster headache,
cramps, neuro-vegetative disorders, abdominal pain, osteoporosis,
asthma, stress dependent disorders, tinnitus, ataxia,
confusion, preeclampsia, weakness, might also be consequences
of the magnesium deficiency syndrome."

Yikes!

I routinely recommend magnesium supplementation for headache sufferers with great results. It's also in my arsenal for hypertension control (along with CoQ10, which I'll address soon), and the final icing on the (gluten free) cake: it helps you sleep better. And good sleep alone can do quite a bit for a tired soul. This article in the Huffington Post calls magnesium a "chill pill" and describes how it helps you deal with stress.

I'll get into some more of the supplements I take in the days to come. It's a short list, and I've already written about vitamin D, which is my favorite supplement, here and here. Magnesium, though, is a close second. They both have anti-inflammatory functions, and of course we sell them both here at Green Chiropractic. As an aside. it may be worth reviewing my post on supplement quality before you run off to your local mega-mart to buy any of this stuff...

But What About Potatoes?

With the whole no grain challenge I've been getting the same question thrown at me repeatedly: can I eat taters? And of course, the answer is far more than a simple yes or no. Let's have a look at the good, the bad, and the tasty when it comes to these tempting tubers.

Like usual, let's get the bad news out of the way first: potatoes will definitely spike your insulin levels, which is one of the same reasons I advocate avoiding grains. If you're trying to lose weight and get healthy, keeping your insulin levels low and your sensitivity to insulin high is the order of the day. Like I said in the grain post, you only have so much storage capacity for glucose (stored as glycogen in your muscles and liver), and when those cells are full the remaining is shuttled off to your fat tissue. One of the big problems with extra fat is that excess adipose tissue is full of cells that essentially pump out inflammation at an alarming rate, and many of the diseases of the West are diseases of inflammation that's gone unchecked for too long. Even the main stream media is finally getting the message that fat doesn't make you fat.

It's not all bad in tater town, though. Potatoes have a decent omega 6 to 3 ratio of about 4:1. Grains, for example are almost all omega 6, and an imbalance of fatty acids is one of the main culprits in producing a pro inflammatory body chemistry. When I give nutrition lectures I speak of the "three legged stool of healthy eating." Leg one: eat to control inflammation. One of the main ways to do that is to maintain a balance of omega fatty acids, and  since potatoes have a decent ratio they satisfy that leg of the stool.

Leg two is keeping your acid/base balance in check. Your blood Ph is slightly alkaline, and when you eat too much acidic foods like pretty much all protein sources, alcohol, caffeine, dairy, and especially grains, your body has to buffer the load back to alkaline. Fruits and veggies are, for the most part, alkaline, so the idea is that you should eat some protein (acid), and buffer with vegetation. And potatoes, my friends, are alkaline. For those keeping count, that satisfies two legs of the three legged stool. Foods that get this far are cheat foods in my book, and if you time an intense workout and a tater eatin' session just right you can even use the higher glycemic index of potatoes to your advantage.

Leg three, by the way, is keeping your insulin levels in check, which we've already discussed. Sneaky, huh?

When I eat potatoes I try to make it on days when I've worked out hard doing something intense like sprints. Other examples are lifting heavy weights or even your own body weight. The key is to burn the glycogen stores out of your muscles first, so the insulin surge you get when you eat a starchy carb will actually get it's job done without resorting to putting more fat in storage. High intensity exercise on a regular basis will also make your cells more sensitive to insulin so your pancreas won't need to work so hard in the first place. Check back in the near future for a series on exercise...

If I haven't done much working out on a tater eatin' night I try to eat small portion of potatoes in combination with a much larger amount of vegetables of the green variety, which can help modulate the overall glycemic impact. Sweet potatoes, by the way, are lower on the glycemic index than regular potatoes, which I find odd, since they contain the word "sweet" in their name.

So, potatoes. A two-legs-of-the-stool cheat food, and a post high-intensity workout food, too.

See? It's not all bad news around here! And if you have neck or back pain, give us a call at Green Chiropractic!

The Good News

Well now. That last post sure did generate some controversy! In one day it received more hits than my previous number one (the fish oil article) by more than double, and it's still climbing. Much of the feedback has been positive, actually--there are plenty of people out there who have cut grains out in the past, but then let them sneak back into their lives. Their stories are replete with anecdotes about how few and far between illness visited their households, how much better they felt in general, and, once they got into the groove, how easy it was (for a time) to maintain the grain free lifestyle. I had some detractors as well (as expected), many of whom don't take the post seriously (although seriously enough to respond) because I didn't cite the references I used.

So, before the good news, I suppose I should respond to that charge. First off, I write this blog between patients at my office, and, fortunately, there is getting to be less time  between. As this is a blog rather than a scientific journal like, say, Spine, I don't worry too much about the references. I have had plenty of people email me and ask for more information, in which case I give references and so forth.

I love talking about this kind of thing, but in clinical practice I have to focus on the one or two points I can try to get across before the patient tunes me out. I write these kinds of articles as a resource that people can read at their leisure. I always welcome comments and questions, and almost always mention that all my contact information is on the Green Chiropractic website. So don't hold back--ask! Also, it's worth mentioning that these posts shouldn't serve as an official diagnosis or treatment--you have to come to the office to get that.

People have a hard time letting go of grains in part because they're somewhat addictive, as is the nature of carbs. The insulin surges that come with their intake create a day in, day out rollercoaster effect, and  can lead to mood swings and irritability. And like I said in the previous post, filling up your muscle cells with glucose doesn't take too long--the rest is then stored as fat. Walking around with an extra 20 or more pounds of fat isn't all that great for one's psychological status either. The inflammation excess grain consumption causes often manifests clinically as low back pain, joint pain, and even depression. I have one paper (a case study) that details symptoms of schizophrenia related to gluten in the diet.

All grains aren't the same, but the wheat, rye, and barely that I mentioned in the previous post are among some of the bigger troublemakers because of the fact that they contain gluten. The others still contain lectins, phytic acid, and are acidic compared to fruits and veggies. That acidity causes your body to use certain minerals as a buffering agent because human blood Ph is naturally slightly alkaline (between 7.35 and 7.45). Anything too acidic, and your body will mobilize various buffering agents to keep things in that small window of alkalinity. Some of the agents used are magnesium, calcium, iodine, and potassium. We're often deficient in one or more of those, and the metabolic consequences can be anything from headaches to muscle cramps. And of course, too little absorption of calcium can be a problem for those dealing with osteoporosis.

The answer? Eat a whole lot of vegetables. A whole lot. Like, a bunch. To lose weight you need a nutrition dense food that is low on calories, and that describes vegetables perfectly. Anything good to be found in grains is found in far greater concentrations in vegetables. And in vegetables there are little to none of the "anti nutrients" found in grains. Nobody ever got small intestine bacterial overgrowth from eating too much grilled zucchini. Another way to get the calories that you need, as well as plenty of the basic building blocks for your cells is to eat more fat. Time for some more controversy. Here goes.


Fat doesn't make you fat. If you're going to cut grains out of your diet you're still going to need a certain amount of calories to give you the energy you need. Most of those calories are going to come from delicious, flavorful fat. Of course, there is always more to the story, and there is with this one, too. The types of fats you eat are either pro or anti-inflammatory depending on where they came from. For example, grain fed beef eat, um, grains, which are high in the omega 6 fatty acids we discussed in the previous post. We are what we eat, and they are too. So eating fatty, grain fed beef, although delicious, can cause some of the same inflammatory diseases that eating grains cause.

I know not everyone reading this is in Texas, and I truly feel sorry for you if you're not, but here in Texas getting grass fed beef is easier now than it ever has been. For everyone not in the Promised Land, you can find sources of the good stuff at Eat Wild. Cows like to eat grass, you see, and when they do they have the bonus of accumulating fatty acid profiles that favor a higher omega 3 ratio. This type of fat packs your cell membranes with anti-inflammatory raw materials that drive tissue healing. These animals don't need tons of drugs pumped into them either, which is typical of feed lot cows that are force fed grains in the last several months of their lives to fatten them (and consequently, us) up. Other sources of omega 3s are cold water fish and wild game, which also all happen to be both delicious and abundant here in The Promised Land.

Other fats that do a body good are two that we keep on hand here at the Green Compound: coconut oil, and ghee. These fats are mostly saturated fats, and (time to get controversial again) are extremely healthy. For coconut oil we get the big ol' plastic tub from Wilderness Family Naturals, and for ghee, well, we make our own.

Saturated fat is much more of a dietary necessity than the food police have been wanting you to believe. A large chunk of your cellular membranes are made from it, and some (especially those found in coconut oil) even have anti-microbial and anti-fungal properties. It's  also much more stable than the omega 3s and 6s because of its structure, and therefore harder to oxidize. Oxidation leads to all the free radicals you've been hearing about for years that can gang up on your DNA and make it turn into mutant DNA, and unfortunately, that won't give you cool super powers like an X-man. Just illness. Sorry. Like a friend of mine says, though, I don't write the mail, I just deliver it.

You may not happen to have a freezer full of grass fed beef. If you're buying meat from the grocery store, I say go for the leanest cuts as they'll have less of the bad omega 6 fats in them. By the way, have I mentioned that bacon is mostly saturated fat? Have I mentioned that bacon wrapped shrimp is consequently a health food? See, it's not all bad news. I can easily give up the wheat flour biscuits for bacon and coconut flour pancakes. (I am excited to say, that my wife is making some kind of biscuit out of almond flour for breakfast, God bless her.) (I'm now happy to say that they were indeed delicious).

So to reiterate, the goal for the next 30 days is to drop the grains from your diet, and add more, much more, vegetables and fruits. If you've gotta have some starchy carbs you can cheat a little with sweet potatoes, and the occasional serving (serving is not a big pile, by the way) of regular potatoes which have a decent fatty acid ratio, and are alkaline, too. Those cheat foods can be used by your body especially after intense exercise, which will be the subject of a future post.

One last thing: I have no vested interest other than your health (and driving prospective patients to my website) when I write this stuff. What I do have is the experience of having had one of the foremost nutrition experts in the world as a mentor for almost a year (click that link and start reading the stuff in the tables. And all the references are at the bottom). If I have a bias, it's to eat crusty bread, tortillas, and pizza, cause I think all that stuff is tasty. Sometimes I do eat that stuff, but for the most part I practice what I preach, and I'm far healthier at 40 than I was at 30 when I didn't know any of this. It's my desire that you get healthier too, and if you have back or neck pain, that you come see me at Green Chiropractic.