Bowel Health Extras
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Learn the Essentials
Just removing grains from your diet is, all by itself, a powerful strategy for recovering gastrointestinal health. But, just as an alcoholic who stops drinking two fifths of bourbon on Tuesday will not be in perfect health by Wednesday, so we must track a path back to health, too, after the health destruction of grains has been removed from your life. Too many people with celiac disease, for instance, have been told to avoid gluten with no further efforts advised to achieve a full recovery of intestinal health. Countless people with Crohn’s disease or ulcerative colitis have been subjected to drugs and surgery, experience incomplete responses with persistent or recurrent pain, diarrhea, malabsorption, risk for cancer and autoimmune diseases, with no effort made to address any residual issues. This is a big mistake.
We begin with the complete removal of all grains, gluten-containing and otherwise. While wheat is the worst, followed by its closest grass relatives rye, barley, triticale, and bulgur, other grasses such as corn, oats, and rice are also too closely related, thereby sharing overlapping genetics and protein structures, and can serve to re-ignite abnormal immune and other reactions. So we eliminate all of them and remove all uncertainty.
After you have accomplished the complete removal of bowel disrupting grains, the path that stacks the odds in favor of full recovery of gastrointestinal health include some or all of the following.
Strategies to Optimize Digestive Health
Follow the Cureality Guide to Healthy Bowel Flora
The care and feeding of bowel flora begins your path back to recovering normal gastrointestinal function once all grains have been removed from your diet. This involves both an initial probiotic strategy to repopulate with healthy bacterial species, followed by a prebiotic program to nourish microorganisms that yield healthy byproducts, such as butyrate, that protect and heal the gastrointestinal tract. After grain elimination, a probiotic and prebiotic bowel flora management program is the cornerstone of your bowel health program. If you suspect, however, that you are experiencing low stomach acid, or hypochlorhydria (see below: Consider an assessment for residual digestive dysfunction), this situation should be addressed prior to beginning efforts to correct bowel flora. Click Here to read the report or Click Here to complete the associated Health Track on the subject.
Correct nutrient deficiencies
Iron, zinc, vitamin B12, and magnesium are commonly deficient due to intestinal inflammation and nutrient-blocking phytates in grains. Blood tests for each of these are easy to obtain and widely available. If blood testing is unavailable, zinc can be safely taken as a daily supplement in doses of 15-25 mg per day; B12 as 500 to 5000 mcg per day or similar doses as the preferred methyl-B12 form; magnesium, preferably as the malate form, 1200 mg (total weight) two or three times per day. Iron should not be supplemented without an assessment (CBC, serum iron level, ferritin), as iron overload can occur.
Eliminate prescription drugs and cigarettes
The list of drugs that disrupt bowel function is long and includes agents such as anti-inflammatory drugs including naproxen (Aleve), ibuprofen, Vioxx, and aspirin; antibiotics; acid-suppressing medication such as Pepcid, Prilosec, and Protonix, as well as antacids; steroids such as prednisone; birth control pills; pain medication; and cigarette smoking. Have a discussion with your healthcare provider (or identify a healthcare provider who understands what you are trying to accomplish) over whether the prescription drugs you are taking can be stopped or replaced. Unfortunately, the bowel flora and other gastrointestinal implications of many drugs have never been explored; for this reason and others, we try to minimize the use of any prescription agent. Disrupted bowel flora is just one more reason to never smoke a cigarette again.
Correct vitamin D deficiency
Restoration of vitamin D is a powerful strategy for anyone with any form of inflammatory bowel diseases (Ananthakrisnan 2013). Vitamin D deficiency is common and, because it plays such a critical role in modulating inflammation, allows autoimmune and inflammatory diseases to emerge or to persist. Vitamin D deficiency can be worsened when bowels are inflamed and impair absorption of the modest quantities of vitamin D in foods.
After grain removal and bowel flora management, restoration of vitamin D makes a major contribution to reversal of autoimmune and inflammatory injury. In Cureality, we aim to achieve a 25-hydroxy vitamin D level of 60 to 70 ng/ml, typically achieved by supplementing with 6000 units per day in gelcap form. Doses required to achieve this level may be higher in the presence of Crohn’s or celiac disease, due to impaired absorption in the small intestine, needs that can be assessed via monitoring of blood levels of 25-hydroxy vitamin D. (Note that any change in dose requires at least 2 months to be fully reflected in blood levels.) As the gastrointestinal tract heals, vitamin D needs may change, usually dropping over the months and years; occasional monitoring of 25-hydroxy vitamin D levels, e.g., every 6 months, is therefore a good practice.
Don’t sweat the fiber
Cellulose fibers, such as those contained in bran cereals, are not protective and may even increase intestinal irritation. Instead, obtain fibers from vegetables and fruits, as well as prebiotic fibers, that yield anti-inflammatory benefits.
Reduce inflammatory fats
Excessive quantities of omega-6 fatty acids, along with inadequate consumption of omega-3s—a situation that essentially defines the modern diet—cultivate intestinal inflammation. Correcting these imbalances reduces inflammation (Tjonneland 2009). Minimize use of omega-6 oils, such as corn, mixed vegetable, safflower, sunflower, and grapeseed oils, and supplement with 3,600 mg of omega-3 fatty acids, EPA and DHA, per day, divided into two doses (the dose that achieves a healthy percentage of omega-3 fatty acids in red blood cells and elsewhere in the body). For enhanced absorption, liquid forms of fish oil are superior. Note that omega-6s, specifically linoleic acid, should not be completely eliminated, as it is an essential fatty acid, but most people obtain sufficient quantities just by consuming meats, nuts, and seeds.
Consider an assessment for residual digestive dysfunction
Hypochlorhydria and achlorhydria (inadequate or absent stomach acid), inadequate bile acid release, and pancreatic dysfunction, singly or in combination, are three conditions that can persist after grain elimination and bowel flora management. Any one results in incomplete digestion of food that causes heartburn, bloating, excessive gas, bowel urgency, even dysbiosis, that, in turn, can trigger or worsen body-wide inflammation, such as in autoimmune conditions.
Hypochlorhydria is suggested by difficulty digesting meats, or bloating and gas that begins soon after eating; it can be diagnosed by an assessment of stomach pH or examination of stool for incomplete protein digestion. Should a complete investigation not be possible, many people succeed with empiric treatment by: - Chewing food thoroughly and eating more frequent but smaller meals
- Taking 1-3 teaspoons of apple cider vinegar diluted in water at the beginning of a meal (start with the least quantity and build up over weeks), or
- Betaine HCL—500 mg tablets (preparations that include the stomach enzyme, pepsin, provide even better relief) and increase as symptoms recede (but never higher than 3000 mg unless under supervision)
If symptoms worsen with either apple cider vinegar or betaine HCL, stop, as hypochlorhydria may be not be the issue for you.
Inadequate bile acid release from the gallbladder (or from the liver and biliary system if the gallbladder has been removed) can occur. One likely explanation is failed response of the CCK receptor due to many years of exposure to the lectin proteins of grains, wheat germ agglutinin, that does not recover with grain removal. It means that bile release from the gallbladder, often coupled with failed release of pancreatic enzymes (see below), can persist and impair fat emulsification and digestion. Inadequate bile acids can even potentiate infection, since bile acids normally help disable bacterial toxins, such as lipopolysaccharide (Bertok 2004). Strategies that can improve bile acid status or minimize struggles include: - Coffee or other caffeine source—Caffeine stimulates the gallbladder to release its bile. (This does not work if you’ve had your gallbladder removed.)
- Coconut oil—Because nearly half the fatty acids in coconut oil are lauric acid, a medium-chain fatty acid that does not require bile acid emulsification for absorption, coconut oil used as the preferred oil in your diet can reduce the need for bile.
- Bile acids—Bile acid supplements, also called “ox bile” or “bovine bile,” since it is sourced from the gallbladders of these animals, typically contain the bile acids taurocholate and glycocholate. Doses generally start at 100 mg prior to meals and up to 500 mg until relief from symptoms occur. Doses can be adjusted depending on the fat composition of a meal, with higher doses required for greater fat intake.
Pancreatic dysfunction, i.e., impaired release of enzymes to digest proteins, fats, and carbohydrates, is suggested by incomplete fat digestion with stools that float or show an oily residue, fragments of undigested meat in bowel movements on examination of a stool specimen, and excessive gas and bloating after meals. Because pancreatic enzyme release is just reduced, but not completely impaired, in the post-grain setting, the need for supplemental enzymes varies, with some people just needing a modest quantity of supplementation, while others require more. (This should be distinguished from more severe medical conditions, such as pancreatic damage from pancreatitis, pancreatic surgery, cystic fibrosis, or autoimmune pancreatitis, in which pancreatic destruction can be complete and higher doses of enzyme supplementation, along with insulin, are required. The degree of pancreatic enzyme dysfunction that applies to most people that can persist after elimination of grains is less severe.)
Digestive enzyme supplements therefore contain lipase to digest fats, proteases to digest proteins, and amylases to digest carbohydrates. (In the Cureality lifestyle in which we eliminate the amylopectins that come from grains, amylase is the least important.) Enzyme preparations obtained from pig or cow pancreas have been largely replaced by vegetarian/vegan preparations sourced from fungi and yeasts (e.g., ReNew Life DigestMore Ultra, NOW Digest Ultimate, Jarrow Jarro Zymes Plus); preparations sourced from pineapple and papaya are less effective and useful only for the most modest degrees of pancreatic dysfunction. Capsules are best taken just prior or during meals, with dosing adjusted to individual symptoms.
Supplement the amino acid glutamine: The cells lining the intestine (enterocytes), preferentially metabolize glutamine when it’s available. Glutamine, in doses of 25 to 50 grams per day, thereby accelerate healing after injury (Nambu 1992; Buchman 2001).
Anti-inflammatory supplementation: Aloe vera gel, 100 ml orally twice per day, has been shown to relieve symptoms and heal tissue damage (Langmead 2004). Curcumin, from the spice turmeric, provides modest anti-inflammatory effects in inflammatory bowel disease, especially ulcerative colitis. One gram (1,000 mg) of curcumin, twice per day, reduces relapses of inflammatory bowel conditions (Hanai 2006). Likewise, taking 900 mg of boswellia (a component of the spice frankincense), three times per day has been associated with increased likelihood of remission of both ulcerative colitis and Crohn’s disease (Langmead 2006).
Explore other food intolerances: Intolerance to dairy is common and, if present, can allow inflammation to persist, even prevent healthy changes in bowel flora from developing. Fructose intolerance and allergies to other foods may also play a role. Elimination of the suspect food for a period of at least 4 weeks and assessing for symptoms relief is one approach to identify such intolerances. There are also various methods of testing available, such as skin testing, ALCAT lymphocyte testing, and stool testing.
A Word About Bowel Regularity
What goes up must come down. And what goes in your mouth, if not absorbed, must come out the other end. But the timing and form are subject to variation.
Eat an avocado and a few eggs for breakfast, for instance, and the remains should pass later that day or the next. And it should pass easily, with minimal effort. Much more than this amount of time, or passing dry, hard stools, is abnormal and can add to changes in bowel flora, not to mention hemorrhoids and colon cancer risk.
Constipation is no more about “lazy bowels” than weight is a product of “calories in, calories out.” Irregular, infrequent, or hard stools are a signal that something is wrong with the normal digestive process. Laxatives and stool softeners are poor remedies, and should only be regarded as last resorts when bowel habits get out of hand. People often express concern that, upon eliminating grains, they will experience a lack of fiber and constipation. Actually, the opposite generally occurs: bowel habits are improved with grain elimination, provided bowel flora has been addressed with full probiotic and prebiotic strategies. Even the most extreme form of constipation, obstipation, in which bowel movements can occur ever few weeks, can dramatically reverse with grain elimination.
Beyond bowel flora, hydration is a key factor because it causes water absorption out of the colon, resulting in dry, hard stools. The solution is simply to purposefully and consistently hydrate with water (not juices, drinks, or flavored waters).
Magnesium supplementation is a natural and benign means of increasing stool hydration. If you’re taking magnesium just to correct or prevent magnesium deficiency, then highly absorbable forms, such as malate or glycinate, are preferred. However, if taken to encourage bowel regularity, 400 mg of magnesium citrate twice or three times per day is the preferred form. When constipation gets out of control, rather than a laxative, 800 to 1,200 mg of the citrate form all at once, or 250 to 500 mg of magnesium oxide, act as osmotic agents, pulling water into the colon to expel its contents. (This is different from irritative laxatives, such as phenolphthalein and/or sennosides in popular products such as ExLax and Sennokot, which can result in habituation with repetitive use.)
Fiber supplementation is rarely necessary with the improved bowel function unique to grain-free people and once a full bowel flora management program has been instituted. However, if you desire more fiber than you’re obtaining from vegetables, fruits, nuts, and seeds, try psyllium seed, ground flaxseed, or chia seeds, all of which can be helpful. Be sure to hydrate well, though or else constipation can worsen, rather than improve. Note: Refer to the Cureality Program Guide to review the citations for the references listed above.
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