Susan
Susan is a professional photographer and a single mom who for most of her adult life had suffered from IBS-type symptoms—bloating, diarrhea, constipation—as well as reflux/heartburn. Hard-to-shed extra weight was an issue as well. When she moved to the Berkshires region two years ago and began to pay more attention to her diet, taking advantage of the fresh produce and fruit in the warmer months, she figured she’d start seeing and feeling some positive results. Instead, she got worse. In addition to her old problems, she felt continually dragged out, with no energy to spare, and she would break out in nasty eczema rashes on a regular basis. She often felt anxious, which was strange since she always had thought of herself as an adventurous, artistic sort of person. Finally, an Internet search of her symptoms turned up a clue, a possible sensitivity to gluten. A lightbulb went on in her head. Since moving to the area, she’d discovered a local bakery and its fresh whole-wheat bread, which she thought was healthy as long as she didn’t overindulge. But Susan’s self-diagnosis was tossed out the window by her local physician when she didn’t test positive for celiac disease, the severe form of gluten intolerance. (He gave her an ointment for the eczema and suggested an antidepressant for her low energy and anxiety.) Thankfully, Susan came across my book on digestive health, The Inside Tract, in a local bookstore and sought me out. Together, we came up with a weight-loss and digestive-health “elimination diet” that excluded gluten and most dairy products. (It was identical to Weeks 1 and 2 of the Swift Plan in Chapter 7.) After a month, we carefully reintroduced these foods and discovered that, yes, indeed, her reaction to gluten had caused the inflammation that was at the root of her problems. Without the gluten, her whole foods–based diet produced the positive changes in her weight and digestion that she’d expected all along. The skin, energy and anxiety issues all resolved over time. Even the reflux improved. She felt like herself again.
I’m not a naysayer by temperament. If I had a choice, I’d much rather talk about the fabulous things that the right foods can do for your health and weight than what the wrong ones can do to derail it. But as a nutritionist, I appreciate that diet is a two-part proposition. You need to eliminate, or aggressively cut back, the problem foods to give your metabolism and your digestion the window they need to recover. That is the E, for “eliminate,” in MENDS. At the same time, you introduce or increase the foods that build up your resilience and protect against disease while fueling a leaner, cleaner metabolism. That’s a story for the next chapter, “N: Nourish the Body, and the Belly.”
Susan’s story illustrates one way the wrong food can make the gut, and life, miserable. She has a sensitivity to a food component, a protein compound called gluten, found in wheat and most of the grain products we commonly eat. As you may remember from the first chapter, the microbiome serves as the immune system’s first line of defense in the gut. If the bacteria don’t recognize a food compound passing through the gut as a friend, they signal to the immune cells embedded in the gut wall to respond to this foreigner. The result is, you guessed it, inflammation, which can disturb the gut (Susan’s IBS-type symptoms) and create problems virtually anywhere in the body (her fatigue and skin issues).
The solution to Susan’s case, and to the cases of hundreds if not thousands of my clients, is to identify the food that’s triggering the problem and get rid of it. In this chapter, I’ve pulled together a master list of potentially troubling foods that can upset digestion and weight control that, one way or another, work through the gut and the bacteria that live there—the MicroMenaces.
But as you’ll also remember from Chapter 1, the microbiome can set in motion digestion and weight problems in another, more under-the-radar way. (There was nothing subtle about Susan’s reaction to gluten—she was wiped out.) We’re not dealing with specific gut irritants here but rather with an overall imbalance in the foods we choose and the quantities in which we eat them. If we eat the wrong foods in the wrong amounts, we’ll wind up feeding the bacteria that can do us harm at the expense of the bacteria that help us. This is a different pathway than the food sensitivity that plagued Susan, but it leads to the same result—chronic, low-grade systemic inflammation that promotes an unhappy gut, weight gain and, again, symptoms that can show up anywhere in the body.
How does a food choice turn into a MicroMenace? As we go down the list, three big, and overlapping, reasons will jump out:
1. Not enough fiber to properly feed the microbiome.
2. Too many nutrient-poor calories, promoting inflammatory weight gain.
3. A specific food or food ingredient, like gluten, that upsets the digestive system or triggers systemic inflammation or both.
MicroMenaces
#1 “Dense” Carbs
For years, nutritionists and popular diet books have been chasing the holy grail of the perfect diet, that just-right ratio of carbs to protein to fat. But finally there is a scientific consensus that dovetails with what I’ve always practiced—the exact percentages of calories are much less important than the quality of those calories. And yes, the total number of calories you are consuming does matter. (If you’re eating plant-based foods in the portions I recommend, you don’t have to count calories. It’s what some nutritionists call a “non-diet approach to eating.”) In fact, when medical anthropologists looked at the diets of indigenous peoples around the globe, they discovered that some had a diet high in carbs (root vegetables and fruit), some had a diet high in fats (nuts and some meat) and it didn’t seem to make any difference. What these traditional peoples had in common was that they weren’t overweight and they didn’t suffer from the diet-related diseases of aging that ultimately drag most of us down—heart disease, type 2 diabetes, obesity.
So what are today’s remaining hunter-gatherers, and our Paleo ancestors, doing right that we’ve got so wrong? As Ian Spreadbury, a brilliant scientist at Canada’s Queen’s University, pointed out in a recent influential paper, the biggest difference looks to be that the hunter-gatherers consume their carbs, the body’s primary energy source, in the form of seeds and plants and fruits. We moderns grind up the seeds into grain flour and create concentrated sugars from what’s naturally found in sugarcane, beets and corn. In the process, we’ve lost most of the fiber and concentrated the calories in fast-digesting food bombs.
Spreadbury calls these carbs “acellular” because the cell walls of the plants have been broken down by this processing before we cook it or eat it. As a result, they are quickly digested and absorbed by the body, driving up blood sugar and insulin, which, as we discussed in the first chapter, can fuel systemic inflammation and weight gain. Spreadbury has captured this idea in a measure he calls “carbohydrate density,” similar to “glycemic load,” which you may have heard of (see the sidebar below.)
Let’s bring this down to earth. The brown-rice cake seems so virtuous because it only has 70 calories, but most of those calories are carbohydrate, so the carb density is actually pretty high. A medium-sized sweet potato is about 100 calories and it too is carb-rich, but because it’s loaded with fiber and water, the carb density is considerably lower. Low carb density is better—it will take longer to break down to sugar in the bloodstream. Some popular diets ban fruit because it contains a fair amount of sugar. But even pineapple, the poster child for high-glycemic fruit, has a lower carb density than a brown-rice cake because it’s packed with fiber and water.
Now we can make sense of an important 2011 Harvard study that found that high levels of consumption of certain types of food, like potato chips and French fries, was an excellent predictor of weight gain over time. The junk-food crowd was gorging on the “dense carbs” and it showed on their waistlines.
So when I place dense carbs number 1 on my MicroMenace list, I’m not demonizing all carbohydrates. As I’ll detail in the next chapter, the non-starchy vegetables that are the cornerstone of the Swift Diet are made up of fiber-rich carbohydrate (that and a lot of water). It’s the processed-food dense carbs, the quick-to-digest carbs, that we need to eliminate. I think most of us have accepted the fact that a cookie, or refined-grain cereals with a ton of added sugar, is not the acme of healthy eating, for the microbiome or for any other system in the body. But what about whole-wheat grains, let’s say the tasty multigrain bread you buy at the supermarket or the health food store? True, the fibrous plant germ (the plant embryo) and the bran (the seed coat) are added to the flour so it’s a better choice than a loaf of fluffy white Wonder Bread. But the flour itself is, to use Spreadbury’s language, “acellular”; these dense carbs are quick to be digested and absorbed by the body.
The Insulin Connection
Of the three macronutrients that make up our diet—carbs, fat, protein—only carbohydrate significantly stimulates the body’s production of insulin, the hormone that escorts the sugar from the blood into the cells of the body, to be burned for energy or stored as fat. Both protein and fat can be burned for energy, but they have different primary jobs. The body uses protein to build the cells that provide structure (organs, muscle, bones) and the cells (enzymes, hormones and so on) that direct the whole show. Fat is the raw material for cell membranes and certain types of hormones.
For most people, the single biggest “bang for the buck” they get when they reform their diet is replacing dense carbs with smart carbs. Another way of putting this is: replacing processed, refined carbs with the fiber-rich, unrefined version. In one fell swoop, they decrease the calories that they’re taking in and reduce the amount of insulin the body has to produce to convert those calories into energy. The net result: a more effective calorie burn with fewer calories going into the fat storage locker. One Harvard study analyzed the diets of nearly two thousand Costa Ricans and found that merely substituting one serving of beans for one serving of white rice a day dropped the risk of developing metabolic syndrome (prediabetes) by 35 percent.
Remember the traditional explanation for weight gain: more calories coming into the system than being burned (calories in/calories out). It turns out that dense carbs promote weight gain by affecting how efficiently we burn calories as well (calories out). In 2012, my friend Dr. David Ludwig, at Boston Children’s Hospital, published an elegant study in The Journal of the American Medical Association that looked at three groups of people after they’d lost 10 to 15 percent of their body weight in the first part of the study. He rotated the groups through three different diets that all had the same number of calories. The group that ate the conventionally healthy diet, with lots of whole-grain carbs, burned fewer calories a day than either the group whose low-glycemic carbs came mostly from legumes and veggies, or the group on the low-carb diet with lots of protein and fat. (The last group actually had the best numbers, but Dr. Ludwig had health concerns about going so low on the carbs, which in practice means a lot more protein and fat in the diet. I’ll delve into that shortly.) These results suggest that people who rely on grains as a dietary mainstay, even whole grains, are at greater risk for regaining the pounds after they’ve lost weight, which, sad to say, is what happens to most people.
The public health establishment is slowly getting the message. The USDA’s 2011 My Plate dietary advice recommends a daily diet of over 30 percent grains, still too high if you’re striving for healthy gut and weight. But compare that to the government’s 1992 Food Pyramid. The bottom, largest block of the pyramid was grains, any kind of grains, with a recommendation of six to eleven servings of bread, cereal, pasta and rice a day!
(Microscopic) Gut Check
Let’s check in on what’s going on at the microscopic level. When we eat a diet heavy with dense carbs, we’re overfeeding the small intestine, where the sugars are broken down and absorbed into the bloodstream through the wall of the small intestine. Too much sugar, too fast and, as we said, we’re setting the table for insulin surges, supersized sweet cravings and weight gain. But that’s only half the story. The other half is what we’re not eating, the fiber-rich plant foods that feed the bacteria in the colon. “It’s starvation in the midst of plenty,” is how University of Pittsburgh gastroenterologist Stephen O’Keefe puts it. As we mentioned in the first chapter, if our friends in the gut, the bifidobacteria and lactobacilli, don’t get enough to eat, they decline in number and can’t ferment enough organic acids to properly maintain the lining of the gut that keeps the messy business of digestion walled off from the rest of the body. (One leading microbiome researcher, Justin Sonnenburg, at Stanford, discovered that the friendly bacteria can get so hungry, they’ll resort to eating the gut lining itself!) Because less organic acid is being produced, the pH balance of the gut changes and becomes more hospitable to opportunistic troublemakers such as unfriendly bacteria and fungi. Bits and pieces of them slip through the now depleted gut wall into the bloodstream and provoke a system-wide inflammation. This can cause insulin resistance and weight gain as well as enervating symptoms like fatigue and brain fog.
Leaky gut is probably the best-studied type of MicroObesity, but scientists are looking at a number of ways that gut bacteria can influence weight. It’s been discovered, for instance, that certain types of bacteria can extract more calories more efficiently from a given amount of food. People who harbor greater numbers of these bugs are thought to be vulnerable to becoming overweight.
Paleo Perspective
Researchers like Leach and Sonnenburg are telling us that the more energy we can get from bacteria breaking down fiber in the colon and fermenting it, the more our gut will resemble that of today’s hunter-gatherers (and yesterday’s Paleo Woman) and the better off we’ll be. Paleo scientists estimate that our ancestors ate at least 70 grams of fiber a day, significantly more than the current government dietary recommendation, and got about 30 percent of their calories from fermentation in the gut. And we know from studies of surviving hunter-gatherer tribes that their digestive systems aren’t generating the kind of inflammation, and health and weight problems, that accompany today’s highly refined convenience-driven diet. Take your pick, SAD (Standard American Diet) or MAD (Modern American Diet)! To take one example from the research literature, Dr. O’Keefe authored a study that linked the rich diversity of gut bacteria in subjects from rural Africa, where colon cancer is relatively rare, with the lower bacterial diversity in a matched group of African Americans with much higher colon cancer rates.
Now at this point you may be wondering about the Paleo Diet, which, in its various incarnations, has generated a lot of interest and book sales. The Paleo Diet has yet to be rigorously researched, but in a few small clinical studies it’s yielded some nice results, dropping waist circumference and lowering heart disease risk. In theory, I’m all for it. But in practice, a lot of modern Paleo proponents recommend mega meat portions. Because today’s Paleos tend not to be as creative foragers as their ancient forebearers, they often rely on a lot of animal protein to make up the caloric shortfall that comes with eliminating grains. A few years ago, two leading researchers who had helped put the Paleo Diet on the map revised their thinking and concluded that a true Paleo pyramid would be built on a foundation of vegetables and fruit, not meat. And as I’ll discuss in a minute, too much meat can contribute to gut and overall health problems. The Swift Diet takes a flexitarian approach: plenty of plant foods with limited amounts of animal protein and whole grains like quinoa and buckwheat, providing a nice variety in taste, texture and nutrition. You might be interested to know that the most recent anthropological detective work has uncovered the fact that the original Paleo people did themselves eat a limited amount of legumes and grains. They ground up wild grasses mortar-and-pestle style.
A Matter of Timing
When you get down to it, the problem with dense carbs is timing. Our grain-based agriculture is only about ten thousand years old. That’s not an issue for the microbiota, which adapts to whatever it’s being fed in a matter of days. It is a problem for our human metabolism, which evolved over hundreds of thousands of years on a fiber-rich diet without developing the systems to handle the fallout from whole-wheat bagels and Lean Cuisines. Maybe in another ten thousand years it will. In the meantime, we need to make some dietary changes to protect our health and shed the excess weight, starting with cutting out the highly processed dense carbs.
#2 Sugar: The Not-So-Sweet Truth
Sugar is the ultimate dense carb. It’s a pure hit of food energy to the system, quickly absorbed by the body, unlike more complex starches that are broken down more slowly before they can be absorbed. The result is metabolic chaos:
And the stuff is ubiquitous. Sugar, both ordinary table sugar (sucrose) and a supersweet industrial version, high-fructose corn syrup, finds its way into almost every morsel of processed food in this country, which, per person, breaks down to forty-seven pounds of fructose consumed annually, forty pounds of table sugar. We eat, on average, twenty-two teaspoons of added sugar a day! And clearly, added sugar must be undermining metabolism in a number of ways. It’s been linked to high blood pressure, increase in fats in the blood and insulin resistance. In a February 2014 study published in JAMA Internal Medicine, Harvard researchers calculated that people who consumed more than 21 percent of their daily calories from added sugar doubled the risk of dying from heart disease compared to those who got less than 10 percent of their calories that way. And yet, as a society, we keep gorging. That same study estimated that Americans as a group get 15 percent of their daily calories from added sugar.
The Sweet Rush
These sour statistics on national sugar consumption highlight a mega-problem with this MicroMenace. It really can be highly addictive. Do you think that language is overblown? My friend Kelly Brownell, recently appointed a dean of public policy at Duke University, doesn’t. He developed the well-known Yale Food Addiction Scale and compares an addiction to highly processed food to other potentially pathological attractions like sex and gambling (yaleruddcenter.org/resources/upload/docs/what/addiction/foodaddictionscale09.pdf). Dr. Robert Lustig, a University of California, San Francisco, endocrinologist who researches sugar’s effect on the gut and the brain, says the government should regulate sugar the same way it does alcohol and tobacco. Both alcohol and sugar activate the same reward centers in the brain. In both cases, excess can be a disaster.
Whether it’s the clients I work with privately or the students I teach in my workshops, the single biggest stumbling block is their craving for sweets. And yet I have plenty of clients who have fought a hard battle against weight their entire adult lives and after a week—a week—of clean eating and no added sugar, the craving loosens its grip. If you stop eating sugar-laden foods, the cravings will subside.
To get a better handle on the physiological reasons why people eat in ways that clearly don’t serve their best interests, Dr. David Ludwig conducted an ingenious experiment, published in 2013. He fed milk shakes to a group of a dozen volunteers on two separate occasions using two different milk shake formulations. The study subjects thought they liked the milk shakes about the same, but their brains told a different story. Their brain scans showed more activation in the brain centers that regulate cravings and reward after drinking the milk shake with the higher-glycemic sweetener. This is in line with earlier studies that showed that the pleasure center in the brain lights up more brightly when a subject is presented with a slice of chocolate cake than when the food on offer is a plate of vegetables. This “sweet rush” tended to be greater in people who were overweight. And not surprisingly, the sweeter milk shake packed a metabolic wallop as well. Four hours after drinking it, the subjects’ blood sugar levels had plummeted and they were hungrier than when they had drunk the lower-glycemic-index shake.
None of this should be surprising. For hundreds of thousands of years, we evolved as a species to seek out the relatively few sources of unprocessed sugar in nature—fruits, root vegetables and honey—as a nutritional hedge against starvation. Evolution has hardwired our sweet tooth. As the former FDA commissioner Dr. David Kessler described in The End of Overeating, and Pulitzer Prize–winning reporter Michael Moss amplified in Salt Sugar Fat, the food industry has exploited that vulnerability to sell us billions of dollars’ worth of sucrose- and fructose-laden drinks, cookies and crackers.
Fructose and Sucrose: The Bitter Facts
Sugar in the form of fructose is found in some of the healthiest foods that nature provides: fruits, root vegetables, honey. In the body, fructose behaves differently than the other major sugar, glucose. When it’s digested, it heads straight to the liver, without stimulating the production of insulin, usually a good thing. Really, the problem with fructose in nature is that it has the potential to upset the sensitive gut. Fructose is a card-carrying member of a group of carbohydrates that can feed the bacteria in our guts too well—we’ll discuss this in detail later in this chapter. In the plant world, fructose is always partnered with glucose in fruits. But certain fruits, such as figs, apples and pears, are very high in fructose and relatively low in glucose. These are the ones that can over-ferment in the gut and aggravate IBS-type symptoms. We call this fructose intolerance or malabsorption.
But the major ugliness emerges when the fructose in corn is industrially converted to high-fructose corn syrup, or HFCS, and added to processed foods and drinks. In this concentrated, high-calorie form, stripped of the fiber that slows down digestion and the nutrients that enhance health, fructose does its dirty business. In the liver, it mostly gets converted into fat, raising cholesterol and triglyceride levels in the blood, a process scientists call lipogenesis. For some seventy million Americans, this hit to the liver contributes to fatty liver disease. In one small clinical study, the subjects who consumed the HFCS gained more belly fat than their counterparts who consumed the same amount of calories as glucose.
Research done by Dr. Lustig and Dr. Richard Johnson at the University of Colorado suggests that HFCS contributes to weight gain in another way. It gets in the way of leptin, a satiety hormone produced by our fat cells that tells our brain when we’ve had enough to eat. Other researchers argue that table sugar is just as good at confusing our hunger signals. Cold comfort. What is indisputable is that added sugars, fructose or sucrose, deliver a double whammy in soft drinks, sports drinks, and sweetened teas. Not only does the sugar promote leptin resistance, which blunts our ability to feel full, but liquid calories in any form aren’t registered by the body as accurately as the calories in solid food. We don’t compensate for them as effectively when it comes time to eat our next meal. And fruit juice, while it’s more nutritious than a soft drink or a bottle of sweet tea, delivers a similar sugar hit. When fiber is removed from fruit to make fruit juice, you’re left with a MicroMenace, so if you’re going to drink fruit juice, I recommend a “nano-serving,” not more than a couple of ounces, preferably diluted with water or seltzer. Take a look at the numbers. Between 1965 and 2002, when the percentage of Americans who were overweight and obese was skyrocketing, the percentage of daily calories we took in from beverages, mostly sugar-sweetened, almost doubled, from 11.8 percent to 21 percent.
I’m not asking you to be ashamed of your sweet tooth. It’s how our ancestors survived. Honor it; build a shrine to it. But you can’t negotiate with it. As you’ll see, on the Swift Plan, processed foods with added sugars are out. They stimulate the appetite for more of the same and they coarsen our taste for naturally sweet foods. And so, for that matter, do low-calorie or no-calorie artificial sweeteners. First off, there is little good evidence that these fake-sugar compounds help with weight loss. In one 2013 study rats fed yogurt with either saccharin or aspartame gained more weight than their rodent counterparts who took their yogurt with simple table sugar.
The fact that the number of Americans consuming artificial sweeteners more than doubled from 1987 to 2000, the same period of time when the national waistline was dramatically expanding, does not fill me with confidence that tricking the taste buds through chemistry is a good weight-loss strategy. Safety is probably the bigger issue. In one 2013 study, coauthored by a National Institutes of Health researcher, the popular artificial sweetener Splenda (sucralose) was found to release compounds that when heated are related to the infamous carcinogen dioxin! In rats, the stuff reduced the helpful bacteria in the gut, adding insult to injury!
The reeducation of the palette begins with what I call a Sweet Sabbatical. We replace the white menace with strong flavors provided by fruits and by herbs and spices, whether they’re savory like rosemary and thyme or sweet tasting (but with precious few calories) like cinnamon and vanilla. Spiced Indian tea, chai, with no added sugar also makes for a soothing sweet alternative.
#3 Fats: Unfriendly and Too Much
The dietary fats story has changed radically since the days when doctors and diet gurus knew that dietary fat was the villain responsible for weight gain and heart disease. Yesterday’s public enemy number one, saturated fat, has been rehabilitated, at least partially. And mass-produced vegetable oils like canola oil and corn oil, which until recently were considered healthy alternatives to saturated-fat-laden butter, are coming under increasing scrutiny.
The Fat Family
Let’s rewind. Fatty acids, the building blocks of the fats we eat, come in three main types: monounsaturated, polyunsaturated and saturated. These terms refer to their chemical structure, how hydrogen is connected to the carbon chain in the fatty acid. But let’s not get bogged down in biochemistry. For now, let’s focus on when an oil change is in order; in the next chapter you will learn more about nourishment when it comes to the matter of fat!
Your Belly on (Saturated) Fat
The takeaway from the new microbiome research just confirms an older nutritional truism: all things in moderation. Yes, we can celebrate healthy fats like the omega-3s and monounsaturated fats—and I’ll do just that in the next chapter. But in microbiome study after study, dietary fat, especially animal fat, was found to be the nutrient that most reliably promoted leaky gut syndrome. Here’s what happens. The fat feeds some potentially unfriendly bacteria that live in the small intestine. These mostly “gram-negative” bacteria have an outer membrane that contains some very nasty molecules, or endotoxins (meaning toxins produced within the body itself). If these bacteria become numerous enough, in other words, well fed enough from bad fats and dense carbs, fragments of this membrane leak through the wall of the small intestine into the bloodstream and provoke an inflammatory response that can promote insulin resistance and weight gain.
Research has shown that people who consume a lot of saturated fat in their diet, as well as people who are obese, have gut microbiomes made up mostly of these gram-negative bacteria that produce these inflammatory endotoxins. In one study, the ingestion of 300 calories of cream, about six times the amount of cream in a cup of coffee, was able to cause the levels of these bacterial endotoxins in the blood to shoot up. This does not mean that some saturated fat in your diet is bad; in fact, some is necessary for cell membrane integrity. It’s the excess that fuels a toxic gut.
Some researchers now suspect that diet may affect heart disease risk most tellingly by how it affects the composition of the microbes in our gut. This year, a group of Italian scientists suggested, “the way to a healthy heart may be through a healthy gut microbiota.” As for the conventional argument that saturated fat causes heart disease by raising “bad” cholesterol levels in the blood, a lot of the older research has been reexamined, and there really is no consensus now about how much either saturated fat or LDL cholesterol contribute to heart disease. No matter what the final verdict is, your fat portfolio is in good shape with the Swift Diet, which is low in animal saturated fats and balanced in the healthy fats that I’ll discuss more in the next chapter.
Mass-Produced Vegetable Oils
Just as human civilization learned to concentrate the calories of wild grasses in grain flour, it also figured out how to squeeze the fat in plants into oil form. We’re probably aware of the olive oil we put on our salads, but we’re often oblivious to the rivers of mass-produced vegetable oils, mostly soybean oil and corn oil, that run through our processed foods—in this country, totaling about twenty-eight billion pounds a year. For all the energy that the public health establishment has lavished on warning us about the dangers of saturated animal fats, it’s likely the vegetable oils—especially soybean oil and corn oil—that are the bigger threat to health.
The problem is the disturbed balance between omega-6, which we consume in huge quantities in these oils, and omega-3, found most abundantly in cold-water fish, wild game and some nuts and seeds. Today, we eat far more omega-6 and far less omega-3 than our Paleo ancestors. As usual, when our diet strays too far from the way humans ate for millennia, the result is inflammation. Nature designed these two types of fats to keep each other in check. In excess, the omega-6 fatty acids get converted to pro-inflammatory hormones that can unsettle the gut and promote weight gain.
It gets worse. To keep the omega-6-heavy oils from going rancid over time, whether in the bottle or in processed foods like chips and commercial baked goods, the food industry pumps hydrogen into them, creating trans-fatty acids, or trans fats for short. They are bad news. They can “arm” the excess LDL cholesterol in your blood, making it more prone to turn into artery-clogging plaque. Unlike with saturated fat, our bodies haven’t evolved to deal with trans fats—the process of partially hydrogenating these oils was introduced in the early 1900s. And the evidence suggests it can disturb a broad swath of human physiology. If we haven’t pinned down the exact cause and effect, the consumption of trans fats tracks closely with increased disease. In the well-regarded Nurses’ Health Study, a 2 percent increase in trans-fat consumption increased heart disease risk by a startling 93 percent.
The problems with soybean oil and corn oil begin long before the plants are processed in the food factory. The vast majority of these crops have been genetically modified (GM) to withstand what otherwise would be impossibly toxic amounts of pesticides. We’re now routinely consuming plants containing certain proteins that the human system had never been exposed to before industrial agriculture got into the business of “improving” nature. Just how big a health hazard GM crops poses is a matter of intense scientific debate. For health and for weight and really for every reason I can think of, my prescription is to skip the processed foods and avoid GM food in general. Here is link to a non-GM shopping guide that is downloadable to your smartphone: http://www.nongmoshopping guide.com.
#4 Problematic Proteins
Digesting protein takes more metabolic energy than digesting fat or carbs, so diets higher in protein often do better in short-term head-to-head comparison of different weight-loss diets. Dr. Ludwig has found that the body’s metabolism stays elevated on a higher-protein diet even after an individual meal has been digested, for reasons at this point we can only guess at. So I’m all for increasing people’s protein intake from plant sources—legumes, for instance—if they can handle the digestive challenges. (We’ll get to those in a moment.)
Historically, high-protein diets were thought to overburden the kidneys, but the current thinking is that this is only a serious problem if someone already has impaired kidney function. Protein from a serving or two a day of high-quality poultry or fish is fine. Fatty red meat, however, presents us with some health issues, and here the microbiome is deeply involved.
Meat: Metabolic Mayhem?
The research literature is stuffed with studies that analyze the dietary histories and medical records of large numbers of people and arrive at the unsettling conclusion that people who eat a lot of red meat are more likely to die before people who eat only a little. Keep in mind these studies are correlational—they establish that a behavior and a condition happen over the same period of time, but that doesn’t mean one causes the other. And the meat they were looking at was the usual feedlot, industrially processed stuff. The results might have been different had it been higher-quality meat. Still, scientists have succeeded in identifying some potentially toxic ingredients in red meat that, taken together, explain why it may behave differently, and worse, in the body than poultry or fish and, specifically, why it may contribute to an increased risk for colon cancer. For one, the gut bacteria that feed on meat convert the nitrites in processed meats into potentially carcinogenic compounds. It turns out, they can create noxious N-nitroso compounds from non-processed meats as well.
Hot and Bothered
The invention of cooking meat, fish and poultry has on balance been a good thing for humankind, contributing to an increase in our brain size and saving us from countless pernicious bugs and parasites. But it too comes at a cost. When we cook animal flesh at very high temperatures, we’re subjecting ourselves to some vile chemistry experiments. Especially when we grill or broil, we’re creating a potentially carcinogenic family of compounds called heterocyclic amines (HCAs). We’re also creating another class of molecules, AGEs or advanced glycation end products, formed when compounds in the meat bind with protein and fat. It’s a natural process that occurs in us and in the animals we eat: when you leave a cut of meat out, it will “brown” over time, thanks to the accumulation of AGEs. The joint stiffness that we experience as we get older is another example. Our connective tissue is literally getting mucked up with AGE. And when we consume meat, especially meat cooked at higher temperatures, we increase AGE levels in our own body, increasing our susceptibility to heart disease, dementia and type 2 diabetes, in effect speeding up our own aging process! (Red meat has higher AGE levels than poultry, which has higher levels than fish—and bacon is the worst offender.)
The solution to the problems posed by both HCAs and AGEs is simple: Substitute fish for meat as often as you can and turn down the heat. Lower the temperature and increase the cooking time slightly when you grill, broil, roast, bake and stir-fry. Using a marinade when grilling can decrease HCA formation by up to 96 percent. And adding acidic ingredients like lemon or vinegar to your meat marinade will slow down the formation of AGEs. Cooking methods that make use of water, such as steaming and poaching, are safer yet. Culinary medicine to the rescue!
Microbial Mischief
In 2012 the gut bacteria made headlines when researchers at the Cleveland Clinic discovered a brand-new risk factor for heart disease. The bacteria ferment two nutrients, carnitine and choline, that are found in red meat and, in lesser quantities, in dairy and fish, and turn it into a toxic compound, TMAO (trimethylamine-N-oxide). High levels of TMAO in the body may “arm” the LDL cholesterol in the blood and make it more likely to do damage to the heart vessels.
Ammonia is one of the most common breakdown products of protein in the gut, and too much ammonia is suspected of damaging those all-important cells that line the wall of the colon. It may help account for the high rates of colon cancer in the West and the lower rates in parts of the world where people consume a greater range of plant fiber and less meat. In a real sense, the microbiome doesn’t care what we eat. It will respond to whatever digestive challenge we send its way. But when we feed the wrong bugs with the wrong foods, we suffer the consequences. In fact, a brand-new study showed promising early results treating type 2 diabetes with a vegan diet, or what the Italian researchers described as a no-animal-protein macrobiotic diet. The researchers speculate that the improvements they saw are the result of the prebiotic fiber in the diet improving the balance of microbes in the gut.
Livestock Antibiotics
For some of us, the most harmful thing we ingest with our hamburger has nothing to do with the protein and everything to do with the way livestock are industrially processed. Eighty percent of the antibiotics in the United States are being fed and injected into animals, which may contribute—how much, no one knows—to a growing crisis of human antibiotic-resistant diseases. In the Unites States, according to the Centers for Disease Control and Prevention, some twenty-three thousand people die annually from illnesses related to antibiotic-resistant bacteria. The meat producers consider the routine use of antibiotics a cheap way to ensure that cattle, pigs and poultry don’t get ill when they’re jammed together in feedlots eating grain contaminated with their own feces. The industry term for this is CAFO (concentrated animal feeding operation). These regular low doses of antibiotics also promote weight gain in cattle, which should give you pause if you’re reaching for an antibiotic at the first sign of the flu. There’s even some interesting research suggesting that the stress hormones produced during these animals’ short, unhappy lives can affect the humans who eat them. Remember, in some sense, we are what the animal ate and how it was raised!
Vote with Your Fork
Besides being a pressing public health issue, the way most animals are raised and slaughtered in this country is an ecological and moral disaster. The majority of crops in this country are grown to feed the animals we eat, most of it GM corn and soy. The methane produced by the livestock, and their collected waste, is a major contributor to climate change. Meanwhile the forests that act as “carbon sinks” to absorb greenhouse gases and counteract climate change are routinely cut down to make room for livestock pasture or for the farms to grow the food to feed the animals. You can educate yourself on these environmental and health issues on the Web sites for the Center for Food Safety (centerforfoodsafety.org) and Natural Resources Defense Council (nrdc.org).
It’s not a pretty picture but you can improve it with your food-purchasing decisions, one meal at a time. To source humanely raised livestock, go to the Humane Farm Animal Care Web site, certifiedhumane .org, and look for the CERTIFIED HUMANE RAISED AND HANDLED label on the meats you buy. Alternately, check out Animal Welfare Approved and its Web site, animalwelfareapproved.org. The meats will be leaner and because the animals feed on grass, not grain, the omega-3 levels will be higher. It’s my personal belief that you can and should eat a mostly plant-based diet, not only for your microbiome and your overall health but also for the health of the planet. At the heart of the concept of “nourish” is expanding outward your circle of concern, from “me” to “us.” Another way of putting that: Vote with your fork.
#5 Gluten (and Other) Glitches
The word gluten comes from the Latin for “glue” and aptly, gluten does provide a familiar chewy texture to grain products. But while the pizza maker couldn’t knead and stretch his dough into a pizza shape without it, it’s hardly indispensable, which is fortunate because it may cause the body, and the belly, a lot of difficulty. According to the (conservative) statistics, 1 percent of Americans have the severe reaction to gluten, celiac disease, and 6 percent have non-celiac gluten sensitivity (NCGS), which suggests that gluten is a major problem. But my experience, shared by numerous colleagues, is that many of our clients feel and look better when gluten is excluded from the diet. With the explosion of gluten-free foods that have come on the marketplace in the past few years, and a growing familiarity with gluten-free whole grains like amaranth, buckwheat and quinoa as well as more familiar standbys like wild rice and (certified gluten-free) oats, excluding wheat, rye and barley is no longer such a big sacrifice to make.
Back in the Day
The gluten story begins, like a lot of dietary detective stories, with the introduction of agriculture about ten thousand years ago. When Paleo Woman began to eat ground-up wheat seeds, or flour, she was ingesting proteins stored in the plant for its own growth in addition to the starchy carbs that contain most of the calories. Because the human gut hadn’t evolved to deal with gluten over the previous 99.9 percent of human prehistory, she couldn’t completely digest it, and ten thousand years later, many of us don’t do well with it either.
Over the past forty years, modern agriculture has selectively bred the traditional wheat plant to arrive at today’s version, shorter, hardier and capable of producing higher yields. The gluten portion has increased either in size or in its capacity to react inside the body. Or both. These issues are still being debated. What is obvious is that our society is consuming more and more wheat, and grains in general, presenting challenges to digestion and overall health. Meanwhile, over this same period of time, the American gut was becoming less resilient because of poor diet, antibiotic use, and indeed for all the reasons I listed as root causes at the end of the first chapter. This mismatch has helped create the current epidemic of celiac disease and related disorders.
Gluten and the Microbiota
Scientists are still fleshing out the details, but it looks like the microbiota plays a crucial role in the gluten-wheat story. In our first years, the gut bacteria help educate our developing gut immune system to distinguish friend from foe. Being born by Caesarean section delivery or not being breast-fed or having a heavy exposure to antibiotics can all conspire to prevent the gut bacteria from becoming plentiful or diverse enough to “tune” the gut immune system so that it doesn’t overreact to things like gluten. (Recall my gluten sensitivity story in the first chapter. I had the bad microbiome trifecta!)
We know there is a genetic component to celiac disease and the related conditions. But genes by themselves aren’t enough. It’s likely that a dysbiotic or out-of-balance microbiota can help turn on the “quiet” genes responsible for responding to gluten at any stage of life. A gut infection can disrupt the digestive ecology. Or, as we’ve already discussed, a processed-food-heavy diet fails to feed the bacteria that nourish the gut wall so that it becomes permeable or leaky, allowing microbes or food proteins into the bloodstream, where they can trigger an inflammatory immune system response.
Celiac Disease and “the Spectrum”
What we do know for sure is that the gluten-wheat epidemic is best seen as a spectrum of related conditions. They include celiac disease, non-celiac gluten sensitivity/intolerance (NCGS) and wheat allergies and sensitivities. Let’s briefly examine them, one by one.
Celiac disease had been named and its symptoms studied going back to ancient times, but it wasn’t until the middle of the past century that doctors figured out that gluten in the diet was in some people causing intestinal distress—constipation, diarrhea, bloating and abdominal pain—and damaging the gut’s ability to absorb nutrients. It turned out that celiac was an autoimmune disorder, like rheumatoid arthritis or type 1 diabetes, in which the immune system, for reasons still not entirely understood, attacks the body itself. In the case of celiac disease, the immune system strongly responds to gluten and related proteins in wheat, rye and barley. It then mounts an immune response, making antibodies that attack not only the offending gluten proteins, but the gut’s own digestive machinery, the microvilli in the small intestine.
Non-Celiac Gluten Sensitivity
But what about my client Susan and others like her? She didn’t test positive for gluten antibodies and an endoscopy didn’t reveal any damage to her microvilli. Was she, as her doctor surmised, simply mistaken that gluten was causing the problem, maybe even deluded? As medical science has only recently concluded, the answer is no. Over the past few years, academic leaders in gastroenterology, like Dr. Alessio Fasano at MassGeneral Hospital for Children and Dr. Umberto Volta at the University of Bologna, have published the research that has filled in our understanding of NCGS.
In the case of both celiac disease and NCGS, gluten enters the system and the gut gets dragged into a war. With celiac disease, the immune system feels so threatened, it calls out the heavy artillery, producing the antibodies that run amok and cause the autoimmune disorder. Not so with NCGS. Here, it’s the immune cells housed within the gut that respond to gluten, and they in turn trigger the release of all-purpose immune cells called cytokines, which circulate in the bloodstream, causing inflammation wherever they go.
The gut is often affected—think of Susan’s IBS-type symptoms—but sometimes digestion is untouched and the symptoms pop up only outside the gut; for instance, joint pain, skin eruptions like eczema, insulin resistance and the common hormonal disorder PCOS (polycystic ovary syndrome). As Dr. Fasano puts it, “The digestive system is not like Las Vegas. What happens in the gut doesn’t stay in the gut.” Considering that insulin resistance is one of the major drivers of weight gain (and PCOS, for that matter), not surprisingly, many of my gluten-sensitive clients come to me wanting to lose weight as well.
You’ll remember in the preceding chapter how the brain and the gut are intimately linked, engaged in a never-ending two-way communication carried on by hormones and neurotransmitters. The NCGS-driven inflammation can distort that conversation and contribute to abnormalities in brain function that the mind experiences as anxiety or depression. There is some evidence that gluten intolerance may be linked to mental disorders like autism, ADHD, and schizophrenia. And some theorists, like the neurologist David Perlmutter, author of Grain Brain, believe that gluten-driven inflammation fuels age-related cognitive decline and even Alzheimer’s. The evidence isn’t conclusive; these stories are all unfolding.
However that plays out, we now appreciate that the more common gluten sensitivity can’t be considered a form of “Celiac lite.” People with celiac disease certainly may have more severe gut damage and consequently have problems absorbing the nutrients they need. But NCGS can also cause vitamins and minerals to be malabsorbed, which contributes to symptoms that can show up anywhere in or on the body. According to American celiac authority Dr. Tom O’Bryan, a major Swedish study looking at “gluten-related disorders” found that people with NCGS—inflammation only, no visible gut damage and no gluten antibodies—had a 72 percent greater than average chance of dying young, far worse odds than the people with celiac disease! The figures are alarming but the remedy is straightforward—eliminate the gluten.
Wheat Allergies and Sensitivities
But gluten isn’t the whole story! Some researchers now suspect that a significant percentage of people who see their symptoms improve or disappear on a gluten-free diet are reacting not to gluten but to other components of the wheat plant. (Wheat has an estimated ninety-five thousand genes, about five times the number of human genes, so there are plenty of candidates.)
We know that at least a handful of these non-gluten proteins can trigger allergic responses in some people. An allergic response is different from a chronic autoimmune disease like celiac. As I’ll describe in a little more detail later in the chapter, another set of immune cells goes into action, usually much faster, often causing symptoms within seconds or minutes of eating the problem food. Although these symptoms can be dangerous, even life threatening, they usually resolve relatively quickly with the careful elimination of the allergenic food.
A wheat sensitivity can be caused by the body reacting to some other component in the wheat; for instance, fast-fermenting carbohydrates called fructans. Here, the immune system isn’t directly involved. IBS-type symptoms can result from eating foods like wheat that are difficult for a sensitive gut to digest. Again, more on these potentially problematic carbs—fibers like fructans and sugars like lactose—further down the MicroMenace list.
Many Problems, One Solution
As a clinician, I believe my practice is my living laboratory. I have witnessed dramatic improvement of symptoms, even their disappearance, when gluten and gluten-containing grains are eliminated from the diet. Sometimes this unfolds over a number of months; sometimes it’s rapid—a matter of weeks, even days. The meal plans I’ll provide in Chapter 7, “The 4-week Swift Plan,” and the recipes in Chapter 8 should make this transformation as easy as possible.
But always, it comes down to the individual. For the person with celiac disease, the prescription is a meticulous, lifelong gluten-free diet. Someone with a milder sensitivity may want to experiment (that is, once she has completed the 4-week Swift Plan) to see how much gluten her system can tolerate. “Heritage grains,” traditional grain strains with a more manageable gluten load, are becoming an increasingly popular option in the marketplace.
And finally, remember, not only are we limiting or eliminating problem foods in the Swift Diet, but, as we’ll discuss in the next chapter, we’re adding the healthy MicroMender foods that will make us and our guts more resilient and better able to deal with whatever potentially troublesome foods come down the digestive pike.
Wheat: bulgur, couscous, dinkel, durum, einkorn, emmer, farina, farro, graham, kamut, seitan, semolina, spelt, sprouted wheat, wheat berries, wheat bran, wheat germ, wheat gluten, wheatgrass
Rye
Barley and barley malt
Triticale (a crossbreed of wheat and rye)
Amaranth
Buckwheat (kasha)
Corn (maize)
Millet
Montina (Indian rice grass)
Oats (certified gluten-free)
Quinoa
Rice (all types)
Sorghum
Teff
Wild rice
#6 Lactose/Dairy: Sour Milk
The most common food intolerance in the world is to lactose, the sugar in all dairy products coming from cow, goat and sheep. For most people on the planet, including a majority of Asian Americans and African Americans, their bodies produce progressively less lactase, the enzyme needed to digest lactose, once they’re weaned off breast milk. As they grow up, lactose-containing foods will contribute to those now familiar IBS-type symptoms—abdominal pain, excessive gas, constipation and diarrhea.
Undiagnosed sensitivities to lactose, fructose and gluten are the most common causes of the symptoms that send people to the gastroenterologist. In fact, some clinicians suspect that gluten intolerance often sets the stage for the usually less severe sensitivity to lactose and other food elements. It increases the chance that milk sugar compounds pass through the small intestine to the colon, where the bacteria there can ferment it into harmful by-products. These compounds and their by-products (or metabolites) can escape the gut into the bloodstream and cause systemic symptoms such as headaches and brain fog. (And some researchers think it’s the opposite, that gut sensitivity to non-gluten compounds in milk, wheat and a number of fruits and vegetables gets mistaken for gluten intolerance.) For the lactose-intolerant consumer, reading labels on foods, dietary supplements and medications is a must to avoid the lactose in the dairy-based ingredients that could be lurking there!
I eliminate dairy completely in the first two weeks of the Swift Plan but allow for its reintroduction in the following weeks, including fermented milk foods such as yogurt and kefir that over time can increase the gut resiliency. I had to smile when I came across a new journal article from the Nestlé Research Center in Switzerland, which floated the theory that when the first herding tribes in the prehistoric Near East discovered how to ferment milk into cheese and yogurt, they were effectively seeding their guts with the lactic acid–producing bacteria, allowing them to digest the milk more easily.
#7 The FODMAP “Gang”
Now comes the tricky part. Certain high-fiber vegetables and fruits that help us build up gut health can, in some people, cause the very digestive symptoms they were designed to address. Remember the old Mae West line, “Too much of a good thing is wonderful”? Well, not true if your microbiome is in disrepair.
Around 2005, a pair of Australian nutritional scientists came up with an acronym that covered a collection of fibers and sugars that, inside the sensitive gut, can cause digestive distress by fermenting too rapidly and aggressively: FODMAP. (It stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols and yes, it would have been handier if they could have made it FOODMAP.) This bacterial over-fermentation creates an uncomfortable amount of gas and it may interfere with the colon’s ability to maintain the body’s “water table.” It sends either too much water back into the system, creating uncomfortable bloat or, in more severe cases, diarrhea; or too little, causing constipation. So this idea of limiting high-FODMAP foods has become increasingly influential with nutritionists and some gastroenterologists, with good reason. In one major study, over 70 percent of the subjects lessened their IBS symptoms with a low-FODMAP diet. In early 2014, at the Gut Microbiota for Health World Summit in Florida, leading experts declared that the old view of IBS as a mostly psychological-driven disorder had to be replaced with a new understanding that emphasized the role of the gut bacteria.
Let’s break it down. We’ve already covered two major FODMAP categories: lactose in dairy and fructose in high-fructose corn syrup and in fruits like apples, pears and watermelons, which have an especially high fructose content. Now we come to the fructans, related to fructose, which are found in gluten-containing grains like wheat, barley and rye. No problem there since we’ve already eliminated those grains from the Swift Plan.
But fructans (chains of fructose) also include the prebiotic fibers in vegetables that feed our microbial partners in the gut. Here’s a partial list of these vegetables: artichokes, Brussels sprouts, garlic, onions and peas. The next category, the galactans, includes some more foods that feed our bacterial best friends: legumes such as lentils, black beans and soy. We’ll cover some of these foods in the next chapter, “N: Nourish the Body, and the Belly.” But in the Swift Plan, we’ll go slowly to take into account the vulnerabilities of the sensitive gut. I’ll gradually increase the amount of these healthy prebiotic foods over the course of Weeks 3 and 4, making use of the tastiest, healthiest ingredients in season.
Finally, the last FODMAP category is the polyols—sugar alcohols such as sorbitol and xylitol, which are found in sugar-free gums and candies. Just like the sugar substitutes that we’ve already covered, eliminate them. But sugar alcohols are also naturally found in fruits such as nectarines and plums and vegetables such as cauliflower, snow peas and mushrooms. These whole-food polyols can be introduced into the Swift Plan over time.
#8 Food Additives and Chemicals
About 70 percent of the food Americans eat can be considered highly processed. Food chemists have taken apart actual food, removed some ingredients and cooked up new ones in the lab to put back in their place. Consider the middle aisles of your supermarket or the drive-through window at your local fast-food joint as a giant science experiment. In former New York Times reporter Melanie Warner’s Pandora’s Lunchbox, she can’t help being funny, in a gallows humor sort of way, as she describes the 105 ingredients that go into Subway’s Sweet Onion Chicken Teriyaki sandwich, 55 of which, she writes, are “dry, dusty substances” that include things like disodium guanylate and calcium disodium EDTA. Subway’s tagline? “Eat Fresh!”
Another mystery ingredient is azodicarbonamide, which Subway added to its bread to make it chewier, not surprising since it’s commonly added to everything from shoe rubber to yoga mats to increase elasticity. In early 2014, Vani Hari, the Food Babe blogger (foodbabe.com), marshaled consumer pressure to persuade the company to remove it—it was already banned for human consumption in Europe and Australia because of a suspected link with respiratory problems like asthma.
Disturbing and ghastly as these food additives sound, I’m just as worried about some of the toxic chemicals that are sprayed on our produce or manufactured into our food containers and everyday household products. Triphenyltin (TPT) in pesticides and tribuyltin (TBT) in vinyl products have both been found to make lab rats fat. Bruce Blumberg, who researches these compounds at the University of California, Irvine, calls them “obesogens” and regards them as a hidden factor in the obesity epidemic. Other toxic compounds are even more widespread: bisphenol A (BPA) in plastic bottles and tin cans; perfluorooctanoic acid (PFOA) in Teflon and microwave popcorn bags; phthalates in shampoos. These are the “endocrine disruptors” that disrupt the sex hormones of lab animals. What they’re doing to us is an open question. But public pressure forced the industry to remove BPA from baby bottles and Campbell’s is removing it from their soup cans. Vote with your pocketbook, and with your blogs and tweets!
#9 Alcohol: Salut, Sensibly
Drinking, especially heavy or binge drinking, can increase gut permeability and decrease its ability to keep what’s supposed to be kept inside the digestive tract in. Alcohol consumption also ups the perils for women who are at high risk for breast cancer. And like most of the MicroMenaces, alcohol undermines both digestive health and weight loss. Many of the women I see for healthy weight management cannot afford the empty calories of one or two drinks a day. I think about my client Sharon, a classical musician in the Berkshires, who plateaued twenty pounds shy of the target weight she had set for herself. She was eating and exercising just as we had mapped out, but it was her routine of two glasses of wine at night to unwind, those extra 250 or 300 calories a day, that had impeded her progress. We agreed that she would limit the alcohol, no more than two drinks a week. It worked for her, as it has for a number of my clients, and that’s the limit I’ve built into my Swift Plan in Chapter 7. You can space the drinks out or you could have both of them at a Saturday night dinner with friends.
#10 Suspect Foods
A recent report published in a prestigious journal notes that there has been a stealth-like rise in what are termed “adverse food reactions,” in adults as well as children. These reactions include both food allergies and food intolerances. By now, you can appreciate that an impoverished microbiota is at least partly to blame.
Food allergies can quickly result in serious or even life-threatening situations. The immune system can go into overdrive responding to even tiny amounts of the problem food. Symptoms can occur within seconds to a few hours and affect multiple organ systems. If eating shellfish causes your lips or mouth to swell and you experience breathing problems or anaphylactic shock, you quickly learn to be vigilant about shellfish—and carry an EpiPen in case you are unknowingly exposed to the allergen. Some individuals are so highly allergic that even kissing someone who ate the food or being in the same room where the food is being prepared puts their life in jeopardy. For good reason, schools have strict rules about not serving peanuts to students.
But far more common than food allergies are the subtler food intolerances that are more difficult to pin down, often because the adverse reaction is delayed—for instance, it took me years to get to the bottom of my gluten issues. I admit that the terminology is confusing here. “Food intolerances” and “food sensitivities” are used more or less interchangeably, and experts in the field of allergy and immunology are still sorting out the precise definitions and nuances. But generally speaking, food intolerance is an umbrella term referring to adverse food reactions that have multiple causes, just as we talked about in the case of gluten and lactose intolerance. Food intolerances can be triggered by lots of things, including chronic stress, additives in the food supply such as sulfites or MSG and, of course, a dysbiotic gut flora!
Connecting the Dots
Some of my clients don’t pay enough attention to making the connection between how they eat and how they feel. They risk going through life being made miserable by a food they could remove from their diets. Some of my clients pay too much attention and they suspiciously jettison good foods until they’ve whittled their diet down to a boring short list of “safe” foods. In both instances, the remedy is a healing-foods “elimination diet.” The Swift Plan in Chapter 7 is an all-purpose elimination diet, but you can experiment on your own or with a nutritionist to work on specific dietary vulnerabilities. Remember, do not experiment with any food that you are seriously allergic to, unless you are working closely with an allergist.
Here are the rules to help you identify if a food intolerance is causing troubles. Use these guidelines when you suspect that a certain food or foods may be causing you to feel off.