(using excerpts from the book, "The Good Gut")
There are more microorganisms (or microbes) on your hand than there are people in the world! The microbiome in our body has been considered by some as another organ as it performs functions and produces chemicals necessary for the body. It is effected by diet, exercise, weight, overall health status, antibiotics, probiotic use, medications, geographical location, stress, age and sex. Microbes produce substances that regulate inflammation, mood, weight just to name a few. As one scientist put it, man is a product of his/her bacterial population.
Consider how the microbiome effects the immune system. The immune system wants to enforce a safe distance between our human cells and our microbes. The microbes, on the other hand, want to hang out in our gut without fear of being forced out. This tension can change in intensity depending upon what food we've eaten, if we've introduced a food-borne pathogen, stress and many other factors. If a "pushy," and everyone has a different tolerance for different more aggressive types of microbes, comes into dominance, the immune system is put on heightened alert resulting in a more sensitive immune system ready to jump into action at the slightest insult. The immune system is then more likely to overreact to threats that are not real resulting in something as minor as an allergy or more severe like an ulcerated colon. One solution, get dirty or better yet, be less clean. Skip the antibacterial soap, play in the dirt, let your pets lick you, hand wash your dishes. There is theory that the rise of autoimmune diseases appear to be more closely tied to our increase in cleanliness. The majority of the microbes we encounter do not cause disease, but do mildly trip the immune system in different ways to keep it active, but not in hyperdrive. It is part of maintaining a healthy immune system.
Do you or someone you know suffer from urinary tract infections? Try this effective, natural treatment. Take a probiotic capsule and push it up into the vaginal cavity just like a tampon. Use one/day for at least 2 days, possibly 3. There should be improvement by the second day. If there is no improvement by the second day, you may want to see your physician. You will want to wear a light day pad. As the capsule dissolves, some of the dissovled particles will leak out. The following is a list of bacterial strains that are suggested for vaginal health: lactobacillus rhamnousus GR-1, lactobacillus reuteri RC-14, lactobacillus acidophilus KS400, and lactobacillus casei rhamnosus Lcr35. I have used the brand that we had on hand that had 12 different strains and 20 billion CFUs (colony forming units). Make sure you buy one that contains at least 6 different strains and at least 1 billion CFUs
The brain is physically and chemcially wired to the gut and our microbiota is a factory dispensing pharmaceuticals and toxic waste. These substances can find their way to our brain. Our liver and kidneys are responsible for clearing the toxic waste from the blood. If kidneys are not working adequately, these toxic waste can build up and result in cognitive dysfunction. I have witnessed this in my dialysis clinic. A normally cooperative, pleasant patient started acting odd. He was very agitated, tried to pull out his needles and was talking nonsense. 911 was called and the patient was sent to the hospital. The diagnosis--severe constipation. The patient was cleaned out and prescribed a laxative. The patient returned to his usual pleasant self and has been stable since.
Researchers found that microbiota transplants can cause personality changes. Microbes affect the levels of brain-derived neurotripic factor (BDNF) which has been linked to diseases such as depression, schizophrenia and obsessive compulisve disorder. Celiac disease is a disease where certain proteins we eat such as gluten are toxic to the lining of the small instestine. This damaged lining can become porous and allow intestinal contents to leak into the bloodstream and cross the blood brain barrier(a poorly functioning microbiota can also cause this). It has been suggested that celiac disease can lead to schizophrenia. I have a friend who is also a dietitian whose husband had suffered from constipation since childhood. At some point late in his adult life, this very competent, sweet and gentle man started exhibiting strange, disturbing behavior. He became paranoid and started hallucinating, not allowing the television to be turned on saying that his employer was watching him through it and that his fellow employees were conspiring against him. He lost several pounds from his already very tall, lean frame. My friend became extremely alarmed and had him see a psychologist only to become more frustrated because the psychologist wouldn't diagnose him with paranoia or any condition that would give her something to work with. After many frustrating and tortuous months, he was diagnosed with Celiac's disease. He was put on a gluten-free diet and soon reverted back to his former sensible, reliable, sweet self. I also know of a man whose sister has Celiac's disease which is genetic and whose son is a ward of the state due to his schizophrenia. So is it the microbiome causing gut motility issues such as constipation that causes toxins to build up in the blood and cross the blood brain barrier or is it the undigested food stuffs that leak from the damaged intestine into the bloodstream and across the blood brain barrier or is it a combination? Either way, with the rise in mental disorders and our lack of effective, safe and cost effective treatments for them and our nutrient poor diets, it's worth exploring.
Our microbiota determine how quickly or slowly a drug is excreted from our bodies. Depending on the type of microbiota in our system, a certain dosage of one drug could be toxic for one person, but fine for another. Vincent Van Gogh is thought to have suffered from the toxic effects of digitoxin, one of which is the perception of a pervasive yellow-green tint seen in many of his paintings.
Taking Weight Loss Out of the Equation
Losing weight is hard. Keeping it off is even harder. Getting our patients to succeed with weight loss is time consuming, frustrating, draining and oftentimes fruitless. Could it be that we are setting them up for failure the minute we suggest it? How can we instead set them up for success?
1) Take the focus off the weight. The number on the scale is subject to change despite the best efforts. It’s also intangible. It’s much easier to control things that we can touch such as medications. Another problem is that the weight is simply a symptom of a much bigger problem or at least a cause of poor lifestyle choices. The focus needs to be on the cause of the weight, tie. lifestyle choices, depression, PTSD, etc. Most importantly, a person’s weight comes with a lot of baggage, i.e. the divorce, the poor self image, the death of a loved one, an abusive childhood. This baggage (sometimes even a metaphor for the weight) can be very difficult to unload.
2) Focus on specific, more manageable variables that are devoid of baggage; variables such as energy, blood sugars, triglycerides, alertness. Focus on a variable that the patient chooses. If the patient mentions their weight, explain that you would rather they not worry about their weight that you’re more concerned about them feeling better.
3) Ask them what has worked for them in the past. Then brainstorm with the patient what I call 99.99% doable (something they could do on their craziest, busiest day), user friendly, everyday behaviors that they can engage in to improve the targeted variables. Examples would be moving their body for 1 minute every day or trying one recipe from the cookbook this week or checking their blood sugar daily. A good tool to use to help determine how likely they are to follow through on the actions are the Motivational Interviewing confidence and motivation scales (any search engine will provide information on these). If either their motivation or confidence is less than 7, they need to pick a new goal.
4) Have them choose a non-food related reward for reaching their goal. This can be a massage, a magazine subscription, new clothes, a round of golf, manicure or pedicure, some flowers, a book, etc.
5) Equip them with applicable products/tools that they can take home. They must be very user friendly and practical. Some examples include a glucometer, our cookbook, a pedometer, exercise and/or blood sugar log book, meal replacement products, resistance bands. You can use these products to market yourself by having your logo placed on them.
6) Before they leave, let them know that you will call them or see them in a week to see how they are doing. Ongoing and frequent support is critical to their success.
7) Ask them how they did on their goals. Discuss what was easy about it, hard, enjoyable or unenjoyable about it. If they didn’t achieve their goal, ask them what got in the way.
8) Using the confidence and motivation scales again, see if their confidence and motivation has changed since your last visit. If they don't feel confident about meeting their goals any longer, set new goals. Otherwise, if they are making progress with their goals ask them if they would like to establish a new goal(s) to work toward in addition to the ones they are already working. Again, be sure to apply the motivation/confidence scales every time that you establish new goals.
9) Once they have met their goal(s), no matter how simple, at least once, that is proof that they can in fact do it.
10) Praise them for their efforts and achievements. For example, “great, you were able to put yourself first and as a result you met your goal!”
11) Ask them if their variables have changed since their last visit and if so, how. If they’ve improved, again, praise them for their efforts that allowed for the positive results. If they’ve gotten worse, assess what got in the way and what changes need to be made. Enlist them in the process. Ask them what they think might need to change.
12) If you do all of the above and see no or little progress after a few attempts, consider the possibility of a more complicated medical problem that will require a more comprehensive level of care and/or the presence of a mental illness like depression, anxiety, ADHD. To quote a study, a group of doctors offered a reduction in their premiums to patients if they were able to improve their outcomes by making some lifestyle changes. Some of the patients were able to do this, but a notable number saw their premiums rise. When the doctors looked into this, they found that these patients either had a chronic disease and/or mental illness.
Be an agent of change.