Putting Out the Fire: Gut Flora and the Inflammatory Cycle
It’s funny. Once you realize the relationship between nutrition, disease, health, and metabolism is complicated, complex, and completely interdependent, things somehow get a bit simpler. Everything is connected to everything else. Chronic stress begets chronic inflammation, which chronically elevates cortisol, which induces insulin resistance and belly fat accumulation. Celiacs are usually intolerant of casein, too. Diabetics get heart disease more and have higher cancer mortality rates. Diabetics are often insulin resistant and usually overweight. Celiacs are often Type 1 diabetics. The overweight sleep less, work more, and get less sun than leaner folks.
Now, it’d be difficult to map out the precise relationships between myriad maladies and their nutritional triggers or risk factors. To do so definitively would produce a mostly unreadable mess. What we do instead is speculate. Make good guesses based on clinical, anecdotal, even anthropologic evidence. We look at what those people with chronic inflammation, obesity, autoimmune disease, diabetes, and celiac are eating, sleeping, and exercising, and we go from there. The precise physiological mechanisms behind some of these relationships have yet to be fully teased out, but the relationships exist and that’s usually enough to get results. Hence, simplicity.
Okay, maybe relative simplicity is a better descriptor. My point is this: the human body is incredibly complex, its every process multi-factorial. As soon as we decipher cause-and-effect, we’re beset with more questions. There are intermediary steps along the way. What’s causing the “cause” to have the “effect”? What’s it like on the cellular level? How many steps, how many mechanisms are at play between cause and effect? It’s almost like there’s an infinite regression of steps simply because there are so many things going on at the cellular level to make basic physiological processes go.
We do know that inflammation, especially chronic, systemic inflammation seems to be involved in nearly every disease under the sun. Obesity, cancer, heart disease, autoimmune disease – if it’s killing people, increasing health care costs, and reducing quality of life, inflammation is bound to be involved at some level. That makes things easier, in my opinion, because we have a good idea how to avoid chronic inflammation, and that should take care of half the battle.
Avoid sugars, grains, legumes, and processed vegetable oils.
Eat lots of healthy animals and their fat, along with vegetables, and fruits and nuts on occasion.
Get plenty of sleep.
Get regular exercise – but not too much, and keep the Chronic Cardio to a minimum.
Get regular sun.
Don’t stress.
Now there’s a new (ancient) wrinkle to consider in the fight against chronic inflammation: the gut flora. Understanding our own bodies is difficult enough, but now we’ve also got to make sense of how the droves of foreign (but symbiotic) microbes living in our guts interact with our health. We know a fair amount already.
Our relationship to gut flora is confusing and rather precarious. If the right conditions are met, we exist in harmony. If good bacteria is stable, breaking down fiber (like pectin and inulin) into short chain fatty acids (like butyrate), and working harmoniously with the body, gut inflammation is suppressed, intestinal permeability is reduced, and multiple health biomarkers (lipids, insulin) improve. But we must remember – gut flora doesn’t exist for our benefit. Even if gut flora species were sentient, they’d only be acting out of self-interest. They wouldn’t “care” about us. They’re just trying to survive. It just so happens that keeping us happy by mediating immune responses and tight junction function, helping identify harmful intruders, and producing short chain fatty acids like butyrate puts the flora in good standing with our immune systems. They scratch our back, we provide room and board and don’t dispatch antibodies to destroy them.
Gut flora influences the human immune response (provides a blockade against damaging bacteria; gives a “safe word” to avoid the immune system wasting resources on attacking; influences size of the thymus). Mice without gut flora have a severely truncated immune response, for example.
Now what is the primary immune response to damaging stimuli? Inflammation. In correct doses, inflammation is a boon, necessary for healing and protection from foreign invaders. But in excess, inflammation is at the heart of many diseases. Gut inflammation especially is associated with a number of autoimmune diseases. Leaky gut, or intestinal permeability, for example, is associated with inflammation of the gut, and with small intestinal bacterial overgrowth.
Small intestinal bacterial overgrowth, or SIBO, occurs when the gut flora is compromised. Remember, normal gut flora acts as a physical barrier to foreign flora; they are stubborn tenants, old ornery relics of the neighborhood who refuse to leave and who dissuade pathogenic flora from settling in. If the good gut flora is gone or disrupted, pathogenic bacteria can populate the gut at will. The result is SIBO, and it leads to gut inflammation and intestinal hyper permeability.
Barriers called tight junctions guard the pathways between intestinal epithelial cells. Tight junctions, and their governing toll-like receptors, rely on cooperative gut flora in order to know which proteins and which molecules are to be barred entry; compromised gut flora and leaky tight junctions allow proteins and other molecules to enter the blood stream haphazardly. If damaging proteins (like lectins from grains and legumes, for example, or gluten) slip into the blood stream, they are recognized and the immune system responds as it normally would to foreign, damaging intruders: with inflammation.
In correct doses, inflammation is a boon, necessary for healing and protection from foreign invaders…
See where I’m going with this?
It’s all a vicious cycle. Inflammation leads to disturbed gut flora (or maybe it’s the other way around – the classic chicken and the egg dilemma), SIBO, malfunctioning toll-like receptors, and leaky gut, allowing proteins to enter the body and provoke an inflammatory response by the immune system. More inflammation, more bacterial overgrowth, maybe a bout of antibiotics thrown in for good measure which wipes out the bacteria, leaving a clean slate and prompting another mad dash by microbes to fill the vacancies, and the result is – potentially – a permanently altered/disrupted distribution of gut flora both supporting and supported by chronic systemic inflammation. Where does it end? How do we fix it?
Common tactics don’t seem to work too well. Excessive antibiotic usage negatively impacts the population of gut flora, destroying the good with the bad. Think indiscriminate carpet-bombing. Living a sterile, bacteria-less early existence (dirt avoidance, lack of breastfeeding, C-section) has a similar effect by limiting the variety and the amount of gut flora from the very start. Whether you had it and lost it or never had it at all, the effect is the same: suboptimum levels of intestinal bacteria. Neither avoiding nor eradicating bacteria is the solution.
So what is the solution, beyond traveling back in time to populate your infant gut with probiotics?
I mentioned Dr. Art Ayer’s Cooling Inflammation blog last week, and I’m going to do so again. First, Art suggests adopting an anti-inflammatory diet. His dietary recommendations are essentially identical to mine – high SFA, moderate animal protein, low O-6, O-3 supplementation, leafy greens, some fruit and nuts. He also suggests probiotic usage, either in supplement or whole food form (yogurt, kefir, sauerkraut), to repopulate the gut with good flora. The next one is the most interesting: eating fibrous vegetables fresh from the garden, unwashed, in order to feed your new flora as well as introduce new bacteria and new digestive enzymes to diversify your gut’s digestive skill set (similar to how seaweed-borne bacterial enzymes taught Japanese gut flora to break down seaweed). Foods like jicama, onions, garlic, and Jerusalem artichokes provide the prebiotic inulin (a type of fiber) which gut flora consume and convert to helpful short chain fatty acids.
It seems like a solid, familiar plan. The basic Primal Blueprint diet is already anti-inflammatory, and we promote the consumption of fermented foods and probiotics, but perhaps a greater focus on feeding flora prebiotics is in order, too. It makes sense.
If there’s anything I’ve learned as a married father of two, it’s that keeping the organisms living under your roof happy and well-fed is absolutely essential if you intend to live a low-stress, anti-inflammatory life.
Thanks for reading and Grok on!
Get Free Health Tips, Recipes and Workouts Delivered to Your Inbox
Posted By: Mark Sisson
(
This is really great. I love it when people cite their sources and elaborate, that way we all learn much more and don’t feel like we’re lost in the dark. It’s not enough to just “be like Grok” and assume the “paleo” diet, but to make use of every single bit of contemporary science and knowledge to be the healthiest one can be. That’s why you’re king of the jungle, Mark.
What an excellent post! Much food for thought here.
The relationship between nutrition, disease, health, and metabolism is indeed a classic “which came first” scenario. As a newbie to the Apple, I can say somewhat definitively that diet is the conerstone of the process. When you get that right, like a domino effect, everything else follows.
You feel better losing some weight initially, then you notice allergy problems going away. Because you seem to feel so much better you become more active and get more sun & exercise. As you start focusing on more and more of the details, you can’t seem to quit improving in each of these aspects. You drive on and overall health keeps getting better as the body rebuilds itself internally.
The Primal Blueprint isn’t a diet. It’s truly amazing process that starts with diet. Thanks.
I am really enjoying the recent articles on gut flora, probiotics, fermented foods, etc. I have never been the one to consciously consume probiotic foods, but I am about to start. I am reading more and more about it and it just makes sense to start immediately.
I do not eat much dairy, so yogurt is out of the question. But, if I find raw yogurt from grass fed cows then I may give it a go.
Maybe I should just try your probiotic supplement Mark, ya?
My thoughts exactly. I made sauerkraut last week (its still fermenting) and bought some pro-biotics. What I don’t understand is how people I tell about my lifestyle and blogs like this one don’t believe or refuse to believe the truth about health. They think I’m crazy! My friend and I say it’s like living in the Matrix….we took the right pill.
You can make raw milk yogurt by ordering cultures from somewhere like http://www.culturesforhealth.com/
Thank you for informative post! I am on a mission to cure my 2-year-old daughter from Leaky Gut Syndrome. Your gut flora posts have been extremely valuable.
Very nice, Mark.
One concrete example of applying these principles: I have found that cooking onions and mushrooms in cultured butter and some meat makes my digestive system feel tremendous. This combination of prebiotics (inulin in onions, for instance), probiotics (cultured butter), and healthy lipids (butter and animal fat) nurtures my gut flora and is anti-inflammatory.
I can Grok to that!
Seth Roberts commented about the interconnectedness of physiological inputs today as well:
http://www.blog.sethroberts.net/2010/05/04/positive-side-effects/
Add back the letter “K” to your keyboard and a lot of misspelled words go away in unison. Good analogy.
See Seth’s previous post for more credit to Mark’s awesome work and it’s influence on my life:
http://www.blog.sethroberts.net/2010/05/03/brent-pottenger-and-the-benefits-of-an-ancestral-diet/
There should be another post tomorrow with more follow up comments on cultured butter and Meta-Rules. I’m eating a lot of the former, and I’m self-experimenting with the formation of the latter.
Cheers,
Brent
@Brent Do you think that the probiotic properties of cultured butter survives the cooking process?
NotSoFast – you are right on! I have experienced the same wonderful things.
Dr. Ayers writes: “Saturated fats appear to be problematical primarily if chronic inflammation is established. Saturated fats are healthy in the absence of inflammation.” No bacon and eggs if an inflammatory condition is present? Mark, can you help make sense of this?
Inflammation is reduced when you follow all the PB laws- no chronic cardio, sleep, good nutrition, no grains, and getting sun.
This is why many of the studies on the health effects of saturated fats are flawed. They analyze the impact on coronary health, etc… of a typical diet(containing copious grains and other refined carbohydrates) versus a typical diet PLUS saturated fats.
Kefir is a great source of good gut flora.
How often and how much Kefir do you consume?
8oz a day or so is a pretty good starter. I usually drank about quart or so a day.
I definitely agree that we need to view our body in a holistic way as everything is connected.
You eat poorly, you feel bad, it disrupts your sleep. You go to the doctor and they treat you the best they can by writing out a prescription.
I’m a firm believer that healing starts with good primal food- the way we were meant to eat.
Suppose someone wanted to do a complete flush of their gut bacteria- wipe out everything, good or bad, and repopulate the digestive system. What would that person need to do to ensure a healthy and diverse population of “good” bacteria gets established while minimizing the presence of “bad” bacteria?
A complete flush of gut bacteria is bad news.
One treatment for a lack of bacteria from incredibly severe diarrhea is actually a fecal transplant from a family member.
Great information!
Home brewed probiotics (Kefir/Kraut mostly) made a huge difference in my gut health after coming off the grains.
NOW Super Enzymes
seem to help quite a bit too. I’m taking them right now to help me digest all this plant matter
let them eat dirt! love it.
Another aspect of leaky gut is the leakage of endotoxin from the gram negative bacteria in your gut (like E. coli) into the bloodstream. Endotoxin is bad news, and stimulates the toll-like receptors like crazy (and the ones on the endothelial cells respond with arterial inflammation leading to atherogenesis). I read a paper once where someone tried to commit suicide by injecting a tiny amount of endotoxin (almost succeeded). So leaky gut is a big deal and should be minimized (though it probably always occurs at some low level).
I would be reluctant to go quite so unwashed with the vegies. I once got a recalcitrant diarrhea from eating unwashed berries. Washing certainly doesn’t remove all bacteria anyway. People’s fear of bacteria is silly- the bacteria wage war amongst themselves, and some of them are really our allies, as you point out.
wash your fruit in water with apple cider vinegar or lemon or salt. that will kill all bacteria
As my family and I take over this lifestyle, my four year old is having some diaherria problems, I keep poking around and have found different responces so I wanted to ask those out there if anyone else has been through this and what could possibly help. I appreciate everything you do Mark to get this info out there, and to the followers you guys make this post feel like your second family. Thanks
The paragraph about eating unwashed veggies made me flash back to the other day when my preschooler and 1 yr old boys were “helping” me in the garden, and eating spinach and lettuce straight from the patch. My 1-yr old in particular seems to like eating dirt (definitely prefers it to the sandbox sand), and I wonder if this is helping re-populate his digestive system after antibiotics treatments for ear infections. I hope so, because he is averse to sour/acidic tastes and won’t go near yogurt or milk kefir.
Interesting post. I would really like to hear more about the development of infants and kids’ digestive systems and gut flora.
“If there’s anything I’ve learned as a married father of two, it’s that keeping the organisms living under your roof happy and well-fed is absolutely essential if you intend to live a low-stress, anti-inflammatory life.”
Amen, brotha!
That bit of the post made me laugh out loud as well!
Boy – a lot to process – I need to reread this but I do want to throw one thing out. I have psoriasis which, from what I am told, is an inflammation reaction where my own immune system is attacking my skin in certain areas. I take creams – tried this and that etc BUT I was hoping to see a reduction in this after following PB but it has remained stubbornly persistent. Which says to me that the inflammation in my system has not disappeared despite the lifestyle I have led over the last few months. I have not ventured into the fermented foods area very often, which may be an issue and I take an over the counter Whole Foods probiotic supplement just because – but no idea if it makes a difference. Any long term PBers out there who have input into auto immune over time on this lifestyle? Mark do you have any specific input / knowledge about conditions like psoriasis and how they are connected re inflammation and possible gut flora?
Thanks
Hey John, I have had severe Eczema since I was 4 months old (according to Mom) I now have relief. My skin is still on the dry side…still working on getting more olive and coconut oil in..and I take Flax oil supplements because I am allergic to fish. (Yes, I know the fish oil supps SHOULD be OK…just havent had the free time to test!)
I have basically eliminated grains in all forms and corn (yes a grain) in all forms..If you are diligent about reading labels, this alone will eliminate most processed food..So I eat Meat and its fat, veggies, some nuts, seeds and fruit. Some full fat Dairy. I am not a regular consumer of fermented foods, although I enjoy some full fat greek yougurt or krout occasionally.
I will take a probiotic supplement if I feel bloated or If I have intentionally tormented myself with poor dietary choices.(and, yes I will experience an eczema flare up just to prove a point!)
Do you also suffer from hay fever or seasonal allergies? I have found these to be greatly reduced…
Not exactly Psoriasis, but an immune response and inflammation just the same…Sorry or the long post, I tend to ramble..(you should see my phone bill!)
My son had the same story–nasty eczema from about 4 mos. old. He’s now 14 and free from it after stopping all soy. His seasonal allergies have improved after eliminating wheat and gluten. He is no longer allergic at all to the cats, who can now sleep in his room. At one point we were advised to get rid of the cats.
I’m no expert, but i saw out of control psoriasis almost completely cured after my friend stopped drinking alcohol, specifically the daily beer habit. I’m sure everybody has different sensitivities though…
I also have psoriasis, on my elbows, and am always looking to hear about possible fixes (damn that ugly red skin
.
I just started PB eating, and also am trying no-dairy no-citrus. I’d be interested to hear how the probiotic thing goes…
Bovine Colostrum is said to be great for healing leaky gut and other gut inflammation issues.
I am currently trying it. It’s too early (barely a week in) to say about results so far but I feel great.
big fan of efir, ogurt, kraut.
any ore info on the cltured btter, mushrooms, onion &meat combo…nojoke I am eating that right now!
Reminds me of a story I read in the New York Times – http://www.nytimes.com/2008/07/01/health/01iht-01prof.14122951.html – apparently some intestinal fauna cut down on systemic inflammation too! (taken in extreme moderation, of course)
A right and balanced nutrition is essential for a healthy life, but I also believe that it must start from a healthy mind.
What about your mental cooking or your mental health? Are you following a recipe that 100% works or are you mixing lots of unwanted things into your mental world to make your life less than tasteful and healthy?
your health reflects what you carry in your mind. By changing your mental world you can make a huge difference in your health.
Take a look at how you feel and examen your thoughts at the same time and you will realize that there is a great connection. There is no way of feeling good if you carry negative thoughts.
I think stress is the worst contributor to inflammation for most people, and what is especially problematic is that being stressed frequently causes us to eat those foods that are worst for us, which compromises our energy levels so that we don’t feel like exercising. I agree with NotSoFast that diet is a place to start, but what seems glaringly evident is the interconnectedness between stress, poor diet, lack of exercise, and lack of sunlight with those who suffer from poor health. Since stress can be the hardest factor to control, at least we can control what we put in our bodies and try to avoid becoming victims to a vicious cycle.
When I realised that all the body is really interdependent at a deep level and that the mind depends on the body the decision to exercise daily became so much easier to make. It was for mental clarity more than anything else.
Now that my got flora became so messed up and I can’t digest anything properly, I have to find stronger alternatives to regular probiotics.
Just eating simple commercial yogurt use to give me strong die off reactions, but now I think things are so much controlled by the bad guys that ingesting huge amounts of probiotics in the form of either supplement or food does very little.
I’m giving a chance to the Primal defense probiotics witch are stronger and are soil based and I’m also starting a regimen of taking cellulose digesting enzymes on an empty stomach morning and night. This is supposed to digest yeast and candida’s cell wall and thus killing the bad guys.
Hope it will make a difference!
FYI: I couldn’t get the link about “inflammation of the gut” to work as is — I kept getting a cookie / session error — and had to use a slightly altered version. Original:
http://www3.interscience.wiley.com/journal/121659818/abstract?CRETRY=1&SRETRY=0
Updated:
http://www3.interscience.wiley.com/journal/121659818/abstract
Though having used the “updated” version, now the original works. YMMV.
Mark,
I agree completely with the importance of “good” gut flora, but I wanted to clarify your definition of SIBO. You said
“Small intestinal bacterial overgrowth, or SIBO, occurs when the gut flora is compromised”, and this is technically not correct. Normally the small intetine has very low levels of flora, whether “good” or “bad”. Occasionally, and for a variety of reasons, the flora from the colon colonize the small intestine and start to use unabsorbed starches/sugars as their food by the fermentation pathway. This leads to gas, inflammation, leaky gut etc. in the small intestine. So SIBO is definitely a problem, but it’s not caused by a compromise of flora, just an error in anatomical location. SIBO can result from decreased “sweeping” peristalsis in the small intestine, and constipation. True that antibiotic therapy and overconsumption of sugars and simple starches can contribute to severity of SIBO.
Thanks for all your great info though…
Helen
I’m curious about the most effective method to of consuming probiotic foods. Like, say I plan to drink 8oz of kefir in a day. Would it be better to drink all at once, half in the morning and half in the evening, or drinking a couple ounces here and there throughout the day?
I take probiotic capsules, and I know those are to be taken in the morning on an empty stomach; I’d guess the same would go for probiotic foods, but not totally sure…
Since drinking Raw Milk for the last three months- all my GI problems have gone away I am Low carb and IF Paleo, more Primal since I now include the Raw Milk. Its anabolic problems are incredible, without any real weight gain, I have increase muscle mass. And I only do a light to modest strength workout. Diabetes still in check.