Your gut is your gateway to wellness and your gateway to inflammation and disease. Dysfunction in the gut can lead to a huge array of issues in the body, including diabetes, obesity, depression, asthma, autoimmune diseases, chronic fatigue syndrome, eczema, arthritis – you name it. Always consider gut issues as a root cause of ANY disease or illness.*

Gut Flora and the Gut Barrier

There are two closely related factors or variables that determine our gut health: the microbes in our gut, or gut bacteria, and the lining of our gut, or gut barrier. Our gut bacteria help us digest our food, regulate our immune system, protect against other bacteria that cause disease, and produce vitamins. Ideally you want a diverse group of bacteria comprised of about 85% good bacteria.

The lining of our GI tract, which is only one cell thick, is where 2/3 of our immune system is housed. This gut lining is critical for separating the good (nutrients) from the bad (toxins and foreign invaders).

An imbalance in our gut bacteria (microbial imbalance) and/or damage to the lining of our gut (known as intestinal permeability or leaky gut) will lead to inflammation and disease. If you have a leaky gut, you probably have bad gut bacteria, and vice versa.

Causes

Leaky gut and microbial imbalance are common because of our modern lifestyle. Several features directly contribute to these conditions, including:

• poor diet
• medications (antibiotics, NSAIDs, birth control pills, steroids, antacids, etc.)
• infections
• stress
• hormone imbalances
• nutrient deficiencies.

Antibiotics are particularly harmful to the gut flora. And while leaky gut and bad gut flora may manifest as digestive trouble, in many people it does not. Instead it shows up as problems as diverse as heart failure, depression, brain fog, eczema/psoriasis and other skin conditions, metabolic problems like obesity and diabetes and allergies, asthma, and other autoimmune diseases.

To adequately address these conditions, you must rebuild healthy gut flora and restore the integrity of your intestinal lining. This is especially true if you have any kind of autoimmune disease, whether you experience digestive issues or not.

How to Restore a Healthy Gut

Steps you can take to restore and maintain a healthy gut include:

• Improve your diet – eat plenty of plant foods and stay away from highly refined processed foods.
• Eat organic (chemicals in food damage the intestinal lining)
• Eat fermented foods such as yogurt (if you don’t have a dairy sensitivity or intolerance), sauerkraut, kimchi, etc. and/or take a high-quality multi-strain probiotic
• Treat any intestinal pathogens (such as parasites) that may be present
• Avoid medications
• Take a Vitamin D3 supplement (low Vitamin D can contribute to intestinal permeability)
• Address any hormonal imbalances
• Address any food sensitivities
• Take steps to manage your stress.

Heal your gut and the rest will follow…

* You always want to think of the gut as a likely source of chronic mood/neurological issues. Over 90% of our body’s serotonin is made in the GI tract, so gut health is key to producing enough serotonin – a neurotransmitter responsible for controlling mood, sleep, and appetite regulation, among other things. Fifty percent of our body’s dopamine is made in the gut. Dopamine is another neurotransmitter which manages our ability to focus, learn new habits, control our muscles, and have good memory. Inflammation in the gut can inflame tissue in the small intestines and affect whether or not our body makes serotonin and dopamine effectively.

“But given the stress of our modern life, the poor quality of our food supply, and the high load of toxins on our brains and bodies, most of us need a basic daily supply of the key, raw materials for all our enzymes and biochemistry to run as designed.” – Dr. Mark Hyman

Nutrient Drain

There is a nutrient drain going on in our society – compared to 35/40 years ago, our food has much less nutrition* (for many different reasons, including modern farming practices). We have plenty of calories, but not enough nutrients. The result is we are becoming obese, but malnourished. And on top of that, our bodies demand more nutrients now because of the highly toxic environment in which we live. Did you know that there are more than 3800 new chemicals being introduced into commercial use every single year! Our body’s demand for detoxification is huge.

So the answer to the question, food vs. supplements isn’t one or the other – it’s both. Food and supplements are needed for optimal health. Supplements can and should be used 2 ways: 1) as a targeted solution to address a known insufficiency, and 2) as an insurance policy to make sure the body gets sufficient daily support (given the environment I’ve just described).

Supplements Not a Substitute for Food

Keep in mind that supplements can be valuable, but they’re never a substitute for food. Food still has many advantages over supplements. First, food (whole foods, not processed) is usually more nutrient dense than a supplement. For example, a typical multivitamin has at most about 30 vitamins and minerals, while a typical stalk of broccoli has over 500 nutrients (many of them phytonutrients).

Second, food often offers combinations of nutrients that support the absorption of one another, while supplements often feature only one form of a nutrient. There is a natural synergy in food that can’t be made up for or duplicated with supplements. Our bodies use nutrients in symphony, in a cascade supporting one another, not in isolation.

And finally, many cheap supplements are made from synthetic nutrient forms that can’t be well digested and/or absorbed in the body. This is why it’s so important to take a high quality supplement in the right form (see below for a list of recommended brands). Read your supplement labels! Be aware of artificial, chemical ingredients in supplements. The supplement form really matters. The order for best absorption is as follows: liquids, powders, capsules, tablets (tablets usually comes with binders and fillers which impair nutrient absorption).

To recap: High quality supplements should be used as a targeted solution to a known deficiency or as a general insurance policy. But food needs to be where we get the vast majority of our nutrition. Proper nutrition is a symphony in which nutrients act in concert with one another.

Maintenance Protocol

Given the daily toxic burden we face, as well as the diminished quality of our food supply, I recommend the following daily maintenance supplements for all adults. This protocol does not address specific issues; rather it helps you to maintain optimal health.

• Multivitamin/mineral with B vitamins (Metagenics PhytoMulti or Garden of Life Vitamin Code)
• Essential Fatty Acids Supplement (Metagenics EFA Combination or Green Pasture’s Blue Ice Fermented Cod Liver Oil)
• Probiotic (Market America’s NutriClean or Renew Life adult variety)
• Vitamin D3 (2000+ IUs Pure Encapsulations liquid)
• Antioxidant – the huge amount of chemicals that our body has to manage causes inflammation and oxidative stress; thus, increasing our need for antioxidants. (Pure Synergy Superfood, Market America’s Isotonix OPC-3)

Recommended Brands

Some high quality brands of supplements that I recommend include:

• Pure Encapsulations
• Thorne
• Metagenics
• Designs for Health
• Jarrow
• Market America
• New Chapter
• Synergy
• Garden of Life
• Renew Life
• Nordic Naturals
• Green Pasture

Jarrow, Garden of Life, New Chapter, Renew Life, and Nordic Naturals brands are available at Whole Foods. Most of the other brands can be ordered online via Amazon or found at local health food stores and holistic pharmacies.

Brands to Avoid

Here is a list of low quality brands of supplements that you want to avoid. They are full of chemical additives, flavorings, artificial colors, etc.

• One-A-Day
• Centrum
• Kirkland (Costo brand)
• Spring Valley (Walmart brand)
• Nature Made
• Equate
• Berkley & Jensen (BJ’s Stores brand)
• Viactiv
• Adora

*Nutrient Drain

Compared to 1975:

• Apples have 41% less Vitamin A
• Bell peppers have 31% less Vitamin C
• Watercress has 88% less iron
• Broccoli has 50% less Vitamin C and 50% less calcium
• Collard greens have 60% less potassium and 85% less magnesium
• Cauliflower has 48% less Vitamin B1 and 47% less Vitamin B2.

Too Much Calcium Can Be Dangerous

You might think…I’m going to take a calcium supplement anyway, just to be safe. What’s the harm in that? Well, it’s actually quite harmful. Too much calcium can be dangerous. It can end up in the wrong place and wreak havoc. Our bodies have a hard time absorbing calcium into bone tissue all at once, so it ends up calcifying other tissue in the body, such as our kidneys (and we end up with kidney stones) and our arteries (and we end up with arterial plaque). Up to 40% of most arterial plaque is made up of calcium. This can include plaque in the brain (think Alzheimer’s). And kidney stones are mostly made of calcium. So getting calcium through food is safe, but getting calcium via a supplement, particularly without all of the other supportive nutrients, can be harmful. The single most important point about calcium is – it’s not how much is going in your mouth, it’s how much your body can absorb and use. And Vitamin D and other nutrients such as magnesium, zinc, copper, Vitamin K…the list goes on – play a critical role in how your body absorbs and uses calcium.

Where Should I Get My Calcium?

The best way to get your calcium is through your food. You can find it in dark leafy greens (especially spinach, collard greens, kale, bok choy), nuts (particularly almonds), legumes, and sesame seeds (tahini is actually very high in calcium)  – all of these foods are loaded with highly absorbable calcium, along with other important nutrients. Contrary to what the dairy lobby claims, you do not need to consume dairy products to get sufficient calcium. In fact, studies show that countries with the highest milk consumption also have the highest osteoporosis rates. Have you ever wondered where elephants, giraffes and horses, some of the biggest-boned mammals in existence, get their calcium? They’re not sitting around drinking cow’s milk! They eat plant foods all day long. Which is exactly what we humans should be doing. And parents – if you’re still thinking you have to feed your kids milk… a study published in the American Journal of Clinical Nutrition shows that higher intakes of fruits and vegetables throughout the teen years improve bone density in adulthood. And it’s because all of those amazing nutrients that I’ve been mentioning that are so important for bone health are found abundantly in fruits, vegetables, and other plant foods.

When do I need a supplement?

There’s no need to be taking calcium supplements unless you have osteopenia or osteoporosis. If you do take a calcium supplement, the type of calcium is very important. You want to avoid carbonate or ascorbate forms of calcium – they are very hard to absorb. The best forms are citrate, phosphate, malate, and other multi-chelate forms.  A newer supplement from some high quality companies called MCHC (micro-crystalline calcium hydroxy-apatite complex) is derived from whole animal bone and is particularly easy to absorb into our bones. You want to avoid cheap, low-quality brands such as Viactiv (whose first ingredient is corn syrup!). Make sure you choose a high-quality brand – look at the ingredients. For maximum bone density retention and function, a blend of calcium, magnesium, Vitamin D, Vitamin K, and other supportive minerals is best. For people with osteopenia, Jarrow’s ‘Ultra Bone Up’ (at half the recommended dosage) is a good option. For those with osteoporosis, Garden of Life’s ‘Grow Bone’ is a good blend of bone-strengthening minerals. And always take minerals on a full stomach.

Dr. Walter Willet, from Harvard University’s School of Public Health and one of the most respected nutritionists in the world, recommends no more than 700mg total calcium per day for healthy adults. And since part of this comes from food, most healthy adults don’t need to supplement more than 500mg, depending on your diet.

Stomach acid also provides our first defense against food poisoning, H. pylori, Candida, parasitic and other gut infections. Without adequate acid, we leave ourselves open to decreased immune resistance.

As we age, our internal production of stomach acid declines (half of people over the age of 60 and 80% of people over 85 have hypochlorhydria, or low stomach acid). Low stomach acid can cause:

• Poor protein digestion and absorption
• Nutrient deficiencies – including magnesium, iron, zinc, calcium, Vitamin B12, etc.
• Discomfort, bloating, and belching
• Acid reflux.

If our supply of stomach acid is low and can’t digest proteins properly, food can hang around in your stomach longer than it should and ferment. Gas builds up, causing belching and bloating, and blows open your esophageal sphincter. This in turn causes your digestive juices to bubble up into your esophagus, giving you acid reflux.

In the center of your chest, there is a small, muscular tunnel that separates the end of your esophagus from your stomach. It’s called your lower esophageal sphincter (LES). When you’re eating, the sphincter should be open and loose, so food can travel to your stomach. But at all other times, the sphincter should be tightly closed. This prevents all food and digestive fluids from traveling upward. Acid reflux is just having a loose sphincter when it should be tight.  It does not mean that there is too much acid. It means that the acid is in the wrong place – in your esophagus. Unlike your stomach, the lining of your esophagus is not coated with mucus to protect it from digestive juices, so when the LES is loose and these juices bubble upward, it hurts.

In addition to low stomach acid, there may be many causes of acid reflux, including magnesium deficiency, eating in a rushed or stressed state, drinking too much liquid during meals, etc.

Here are some of my go to solutions for acid reflux:

1) Slow Down and Chew. The average American chews each bite of food only a few times before swallowing it down hard, often with a gulp of water as a chaser. Try to chew your food until it’s liquid. This significantly reduces the work of your stomach. I know this seems simple, but sometimes the simplest remedies have the most profound effects. Just by chewing your food 20-30 times per bite and not drinking much liquid with meals (see below), you may resolve your acid reflux.

2) Drink as little liquid as possible with your meals. Ingrained in our dining culture is the practice of drinking beverages with our meals. But this habit is actually causing us harm. When we drink a lot of water or other beverages during meals, we are diluting our stomach acid. This makes it less potent, leading to belching, bloating, and acid reflux. Ideally we should hydrate 20 – 30 minutes before a meal and wait 1 ½ to 2 hours after a meal to drink. In between meals is by far the best time to hydrate. Have only a small glass handy during meals to help clear your palate (e.g. 4 oz).

3) Eat less at one time. Sometimes our LES gets blown open by the sheer volume of food we try to cram into our bellies. This is especially true when we eat at restaurants. Yes, the stomach will stretch, but only so far. Try to stop eating when you are 80% full. You have to leave room (literally) for digestion to take place.

4) Fix magnesium deficiency.  This is a widespread issue in the US. The USDA estimates up to 90% of Americans don’t get enough magnesium. Low magnesium can cause your muscles to be too tight or to spasm erratically. This includes the LES. If you also struggle with any regular constipation, headaches, irritability, or tight muscles, try taking a magnesium supplement (start with 400mg magnesium citrate).

5) Stop eating foods that cause your LES to spasm. So here’s the solution to acid reflux that you didn’t want to hear. Unfortunately, we tend to love the foods that are most irritating to the LES. I know it’s hard to give up some of the foods we love, but continuing to eat them and just pop a pill to ignore the pain is likely to turn into a serious illness or disease some day. The most powerful food triggers include: cooked tomato sauce, citrus juices, coffee, soda, alcohol (especially wine), peppery or spicy foods, fried food, chocolate, and things with mint in them (e.g. gum, mints, toothpaste, tea).

6) Don’t eat or drink anything 2-3 hours before bedtime. Reflux can often be worst at night. This is when all of our muscles relax at least a little bit, including our LES. If you put food in your stomach and then go to bed before it’s fully digested, reflux is much more likely. The goal is to eat throughout the day such that you just go to bed with an empty stomach – but not hungry. Not eating a full 3 hours before bed is also an excellent way to improve the quality of your sleep.

7) Experiment with acid replacement. If you suspect that low stomach acid is the cause of your reflux, try taking 2 teaspoons of apple cider vinegar in the middle of a meal (mixed in 1 -2 oz. of water). The idea is to put something more acidic into the stomach at the right time.

And finally, a few words about acid reflux medications. Antacid medications such as Tums are only treating the symptoms – they do nothing to remedy the root cause. And long-term use makes acid reflux worse. If you’re taking a Proton Pump Inhibitor (PPI) such as Prilosec or Nexium for your acid reflux, it’s important for you to be aware that long-term use of PPI medications (more than a couple of months at the most) is dangerous! PPIs act by reducing the body’s production of acid (remember acid reflux is often a result of too little stomach acid, not too much!). PPIs prevent the absorption of critical protein and minerals that, over years, can be the true root cause of ailments such as osteoporosis, arthritis, depression, heart disease, and diabetes. If you are taking a PPI and want to stop, do not stop cold turkey; that can actually do more harm than good.  Slowly wean off the medication over a month’s time.

What it is

Why it’s dangerous

How to cure it

The average American is chronically constipated. If you don’t have regular bowel movements, it’s only a matter of time before you’ll get sick. And on top of that, it can be really uncomfortable.

Everyone should have at least one bowel movement per day. If our food takes too long to move through our system, then toxins will remain pent up in our body and there’s a greater risk that they’ll be reabsorbed back up into the body and/or damage your colon due to toxicity.  Toxic build-up from constipation can be the trigger for many autoimmune diseases and other organ and gland dysfunction. Ideal transit time is between 12 and 24 hours.

Constipation is a symptom of gut dysfunction – it is not an illness in and of itself. Underlying causes of constipation include:

• Hypothyroidism
• Medications (particularly opioid painkillers)
• Dehydration
• Magnesium deficiency
• Food sensitivities
• Insufficient fat or fiber in the diet
• Microbial imbalance (too much bad bacteria in the gut)
• Lack of exercise/minimal activity

Key Lifestyle Changes that will get your bowels moving:

1)    Take a Magnesium Citrate supplement. Magnesium is what your body naturally uses to move stool along. Most Americans are magnesium deficient and often times chronic constipation is really chronic magnesium deficiency. Magnesium can be found in foods such as almonds, cashews, spinach, and seaweed. Take 400-800 mg of good quality magnesium citrate (e.g. Thorne, Metagenics) every night after dinner. If you don’t like to take pills, you can take 1 -2 tsp. magnesium powder (Natural Calm) before bed and dissolve it in water.

2)    Take a daily Probiotic. Our guts are full of good and bad bacteria, or microbes. Sometimes we get constipated as a result of poor digestion or inflammation in the intestines. Good or beneficial bacteria help to calm inflammation and get things moving. Take a good multi-strain probiotic after dinner that has at least 1/3 (1/2 is better) of Bifidobacterium units (the large intestines are overwhelmingly populated by this type of bacteria).

3)    Eat a lot of Healthy Fats. After being wrongly vilified for decades, fat is making a come back. And that’s because fat is actually good for you. It is good for your heart and helpful for body fat loss, among other things. The best lubrication for your GI tract is grease, not water. Fat helps to move stool along. Add healthy fats to your daily diet such as avocados, olive oil, coconut oil, salmon, walnuts, almonds, pumpkin seeds, eggs, etc.

4)    Eat more Plant Foods. Fiber is only found in plants. There is no good substitute for food-based fiber in our diets. Insoluble fiber, such as flaxseed and leafy greens, moves your stool along for easy exit.

5)    Drink more Water. You knew this one was coming! It’s important to drink plenty of water if you want to have regular bowel movements. Fiber helps form stool, but water allows soluble fiber to bulk up your stool. Ideally, you want to sip water throughout the day (rather than gulping it down occasionally). Drink water first thing in the morning – this is the time when we are most dehydrated. Then sip water throughout the day between meals.

Ingredients:

• 1 cup organic raw cashews, soaked for 2 hours*, rinsed, and drained
• 1/2-inch piece ginger, peeled
• 1 teaspoon cinnamon
• 1/4 teaspoon cardamom
• 1/4 teaspoon salt
• 2 to 3 tablespoons maple syrup
• 3 1/4 cups water

Directions:

1.  In a high-speed blender, blend all ingredients until smooth and creamy.

*Note: you can soak cashews anywhere from 2 – 6 hours. If you want to make this drink in the morning, soak the cashews for 2 hours the night before, drain, rinse and store in the fridge in a glass container.

Adapted from Kris Carr’s Crazy Sexy Juice.

But genes are not our fate. Read what Dr. Craig Venter, the scientist who first mapped the human genome, has to say about it…

“Everybody talks about the genes that they received from their mother and father, for this trait or the other. But in reality, those genes have very little impact on life outcomes. Our biology is way too complicated for that and deals with hundreds of thousands of independent factors. Genes are absolutely not our fate. They can give us useful information about the increased risk of a disease. But in most cases they will not determine the actual cause of the disease or the actual incidence of somebody getting it. Most biology will come from the complex interaction of all the proteins and cells working with environmental factors, not driven directly by the genetic code.”

A gene must be turned on in order to have an affect. And genes are turned on or off by our aggregate experiences – what we eat, drink, do, think, feel, etc. Everything we do, every experience we have, changes what genes are expressed at any given time in our lives.  Your body is responding to your environment at every moment.

Remember the age-old nature vs. nurture debate? That argument has swung sharply in favor of nurture – that is, our life experience is based much more on nurture than it is on nature. Our choices have everything to do with how the nature is expressed. Choices do matter! We inherit tendencies, but we behave our way in and out of what gets expressed. We are not what we inherit, we are what we express. Our genes are not a fixed code – they are a flexible and changing set of instructions. We need to get away from this notion that we are doomed to inherit our parents’ diseases.

Did you know that it is estimated that the risk of cancer is based only 5-10% on inherited genes and 90-95% on lifestyle? So if your genes have to be activated in order to have an impact, why not choose to behave in a way that fosters health and avoids disease?

Yield: 4 small cups/ramekins

Ingredients:

• 2 large, overripe bananas
• 2 Tbsp maple syrup
• 1/4 cup organic cacao powder
• 1/3 cup almond butter
• 1/4 to 1/3 cup almond milk
• pinch of sea salt

Directions:

1. Combine all ingredients in a high-powered blender and blend until smooth, adding more almond milk if needed.
2. Transfer to 4 small ramekins and chill for at least one hour before eating.

Optional: garnish with cacao nibs, chopped banana, or toasted almonds

Adapted from Sara Forte’s the Sprouted Kitchen Bowl & Spoon.

Chimichurri is a traditional sauce from Argentina. The main ingredient is parsley. It is very similar to Italian salsa verde. With the help of a mini food processor, it comes together in no time. It pairs beautifully with the smokey quinoa cakes. But no need to stop there. This sauce goes well with almost anything – fish, whole grains, grilled vegetables, etc.

Prep and Cooking Time: 20 minutes if you have already cooked quinoa; 40 – 45 minutes if   cooking quinoa.

Serves: 4

Quinoa Cakes

Ingredients:

• 1 cup uncooked quinoa (or 2 cups cooked and cooled)
• 2 cups water (if cooking quinoa)
• 1/2 tsp. sea salt
• 2 teaspoons smoked paprika
• 1/2 teaspoon ground cumin
• 1/2 teaspoon dried oregano or leaves from a couple stems fresh oregano, minced
• 2 or 3 large eggs, lightly beaten
• olive oil (for pan frying)
• Flaky sea salt (such as Maldon)
• Freshly ground black pepper

1. If using uncooked quinoa, rinse the grain in cold water, then drain in a fine-mesh strainer.
2. In a pot, combine the quinoa with 2 cups water. Bring to a boil, reduce heat to low, cover, and cook until the water is absorbed, 15 to 18 minutes. Allow quinoa to cool. If you are in a hurry, spread the quinoa in a large, shallow dish and place, uncovered, in the refrigerator.
3. Combine the cooled quinoa, salt, paprika, cumin, oregano, and 2 eggs. You should have a “dough” that will form a moist ball. If the mixture is still dry and fluffy, add another egg.
4. Heat your largest skillet or a flat griddle pan over medium-high heat. Lightly oil the skillet or griddle pan. Form 1/4 cup of the quinoa mixture into a ball. Place it in the skillet and use a spatula to flatten it into a pancake about 1/4 inch thick. Repeat to make 7 or so more pancakes, working in batches as necessary.
5. Cook the quinoa cakes until golden brown on one side, 2 to 3 minutes, then flip and brown the other side, about 2 minutes more. Remove from the pan and season with flaky sea salt and pepper. Serve immediately with chimichurri (see below).

You can eat this salad warm or cold, as a main meal or a side dish. I use zucchini, red peppers, and onions, but feel free to add or substitute any vegetables you like (e.g., eggplant, asparagus, etc.)

Yield: 4 main dish servings

Ingredients:

1 1/2 Cups Dried Semi-Pearled Farro

2 Small Zucchini

1 Red Pepper

1 Small Red Onion

1 Cup Cherry or Grape Tomatoes, cut in half

1/2 Cup Fresh Basil Leaves

3 Tablespoons Capers, drained

Olive Oil For Brushing

Dressing:

1/4 Cup White Balsamic Vinegar

1/2 Cup Extra Virgin Olive Oil

1/4 Cup Fresh Parsley, finely chopped

Sea salt & freshly ground pepper

Directions:

1. Cook the farro in lightly salted boiling water (3 cups) until tender to the bite but still just a bit chewy, about 25 minutes.
 (I soak my farro for several hours or overnight before cooking.)
2. Drain the farro and place in a large bowl.
3. Meanwhile, peel the onion and cut into wedges; cut the zucchini into 1 1/2 inch slices; cut the pepper into four pieces after coring and seeding it.
4. Lightly brush the vegetables with olive oil and grill until tender and lightly browned.
 (I use a grilling basket, but if you don’t have one of these, you can put the vegetables right on the grill. Alternatively, you can cook them under a preheated broiler until lightly browned and soft).
5. Remove the skin from the pepper and chop into 2 inch pieces. Cut both the zucchini and the onion into similar sized pieces and place all of the vegetables into the bowl with the farro.
6. Add the halved tomatoes and capers and mix.
7. Tear the basil into small pieces and add to the bowl.
8. Mix the dressing ingredients together in a separate small bowl and pour it over the farro mixture (there will be extra dressing).
9. Toss well and serve.