The media have declared that there is a revolution – and that is not too strong a word – happening right now in the nutrition world. Recent discoveries from leading researchers have shown that the state of our gut is central to our weight and health. So if we want to look and feel good for the long term, we need a diet that creates a high-performance digestive system. We have entered the gut-health era of diet and nutrition, and it will be here for a long time indeed. The science is simply too persuasive to suggest otherwise.
So, back to basics. The digestive tract is huge and tightly packed within the body. Running from mouth to anus, if it were laid out straight it would be around 23–30 feet long. Our intestines, especially our large intestine, contain masses of bacteria – weighing on average 3½ pounds in each individual – and these are instrumental to our well-being.
The collection of bacteria living on and in our body has been dubbed the “microbiome” (see here) and consists of about 100 trillion bacterial cells. This may be up to ten times more numerous than the human cells in the body, which means we may only be 10 percent human; the rest of us is all this stuff that is living in and on us.
The highest concentration of bacteria is to be found in our gut. Having a wide diversity of these bugs in our intestines is now understood to be essential to life. In 2014 a landmark review paper on the microbiome published in the Journal of Clinical Investigation from New York University said: “The composition of the microbiome and its activities are involved in most, if not all, of the biological processes that constitute the human health and disease, as we proceed through our own life cycle.” You could think of the microbiome as the control center of human health.
Until recently our gut health has been totally underestimated, but we now know that it is essential to take care of it from cradle to old age. It amazes me that it has taken so long for the idea of gut health to have a revolution. When Hippocrates (circa 460–375 BC) said “bad digestion is the root of all evil” he was certainly on to something all those centuries ago.
Good gut health has an important impact on many aspects of your health, some of which might not have occurred to you:
•There is a growing body of research showing that not all calories are created equal. Junk food, sugar, artificial sweeteners, alcohol, and meat reared on antibiotics may change the balance of bacteria in the gut and actually make us extract more calories from them than unprocessed foods – even if the calorie counts are the same.
•The digestive system has now been dubbed “the second brain” – with signals passing from gut to brain, not just the other way round as originally thought. This may mean an unhealthy gut playing a role in a low mood, and a healthy gut doing the same for a better mood.
•A disturbed gut lining can lead to undigested particles of food, or toxins, getting into our bloodstream, leading to irritated skin, allergy-style symptoms, and a confused immune system.
•A healthy microbiome has been linked with a healthy immune system. The microbiome is in contact with a large pool of the immune system – around 70 percent of immune cells live in the gut.
The great news is there is a lot you can do to cultivate a healthy gut. The biggest influence you can have on the state of your gut lining, and a healthy microbiome, is your diet – which you control.
So what does this mean for us in practice? Simply, it means that we need to adopt a diet which stimulates the flourishing of as many different and varied species of gut bugs as possible, and which makes the beneficial bugs bloom and thrive. We also need to put foods into our diet daily that we know will help us to build a strong gut lining. Both of these concepts have recently been shown to be key to controlling weight, maintaining beautiful skin, improving mood, and developing a strong immune system. A good gut may also protect us from developing autoimmune disorders, which are currently at near-epidemic levels in developed countries.
This book will explain how to eat to achieve great gut health, even in your busy life. It will set you on the path to strengthening your gut lining and reseeding the bugs in your intestines to give you vibrant health and achieve a body weight that suits you.
How the Makeover Works
The book centers around a four-week plan that I have designed based on the latest research on the microbiome and impaired intestinal permeability (also known as leaky gut; see here). It is not a diet in the popular sense of the word; it is a restoration program. It’s a whole health overhaul.
For four weeks we are going to take out of your everyday diet the foods that could be irritating your gut lining or skewing the balance and impacting the diversity of that 3½ pounds of bacteria in your intestines, and replace them with foods that will help. Think of it as a personal makeover working from the inside out: using good food to restore your bacteria, to create a beneficial impact on your weight, skin, mood, and immune system.
The four-week plan pays a nod to the diets of indigenous hunter-gatherers in South America and Africa, who have diverse species of bacteria in their guts supported by eating many vegetables, supplemented with quality meats and fish, eggs, nuts, and seeds, and from time to time a little dairy. The plan involves eating an array of delicious, unprocessed foods that won’t leave you hungry.
Once we have built your gut up to a state of bacterial diversity and abundance on the four-week makeover, we will transition to the maintenance part of this program, which is a gut-friendly version of the real Mediterranean diet, based on the diet from the pre-1960s in Greece. This consisted of a high intake of plants – vegetables, seasonal fruits, and wild herbs – supplemented with fish, nuts and grains, extra virgin olive oil, artisan, slow-matured cheeses teeming with friendly bacteria, and moderate amounts of quality meat. This Mediterranean diet is the best way to support a healthy gut. It’s also an enjoyable way to eat for the long term.
By following this plan you will implement a set of habits that you can incorporate into your diet every day. Once you have a strong gut lining and a flourishing, healthy pond of beneficial bacteria, you will go forward with a set of principles to keep it that way. The recommendations in these pages are simple and implementable, so you can attain and maintain a tip-top-condition gut, and enjoy good health and weight even after the four weeks are up. You may from time to time come back to the four-week plan. It isn’t a roller coaster of feast and famine, self-denial, and rebound hunger, it’s simply a hit of the reset button.
The Gut Makeover is enjoyable and easy to follow, and its recipes accessible and filling, but if you need a little convincing to carry on with the plan, all the way through I will provide you with explanations of the groundbreaking research behind it. I will share with you the latest digestive health science, coupled with my clinical experience based on it, to help you improve your weight and general health. This is a massive area of research, expanding by the day, with the biggest advances having occurred within the past three years (1,389 research papers on “gut microbiome” were published on the PubMed database in the first seven months of 2015, compared with 389 in 2010 and 55 in 2005). Many of the findings are discussed behind closed doors at medical conferences and in peer-reviewed scientific literature; applying it to real life is my job and my passion. I have assessed this research and designed a style of eating for one month that will help you build a strong gut lining and reseed the bugs in your intestines for vibrant health. So, let’s grab hold of this revolutionary gut science and adopt an eating pattern to improve your health today.
Buzzword Bugbears
I’d like to mention my two language irritations around healthy eating: the phrase “going on a diet” and the word “clean.” Let’s start with “going on a diet.” For me, this phrase spells misery, depravation, and starvation. It also spells short-termism. In my experience, and the experience of many people I have met, it often carries connotations of failure. That is why I like to talk about having a “plan” or “eating strategy” rather than “being on a diet.”
The second buzzword that grates is eating “clean.” This is the new term you see a lot on websites and spoken among evangelical communities who are doing something I do agree with – shunning processed food and eating natural, unprocessed food instead. Brilliant! But if you call that clean, does that mean when you’re not eating that way you’re eating dirty? And how does that make you feel – a failure? As you’ll find out later in this book, I don’t want you to eat processed food, as you are unlikely to reach your goals with it. While I agree with the idea behind eating “clean” (avoiding processed foods) I have not adopted this word as I find it judgemental and confusing. So you won’t see the word “clean” in this book, but you will hear me encouraging you to choose unprocessed foods wherever possible.
To call the Gut Makeover a diet – a word most people associate with slimming – would acknowledge just one small part of the benefits you are likely to see from undergoing this makeover for a month. On this plan your gut undergoes a restoration program along with the rest of your health. You may find you experience fewer niggly ailments, too.
The people who have tried the Gut Makeover have seen a large number of benefits, including increased energy, better moods and fewer mood swings, less anxiety, less bloating and tummy fat, better sleep, fewer aches and pains, disappearance of swollen ankles, reduction or disappearance of menopausal symptoms such as hot flashes, improvement in constipation, disappearance of heartburn, improvement in asthma and hay fever, disappearance of acne and mouth ulcers, and complete subsidence of food cravings – and that’s all before even losing weight!
Weight Loss
Benefit: Most people will lose 6 to 13 pounds in the first month, but if the key principles are maintained longer this can continue gradually in the months afterward, with weight stabilization going forward.
Why? Research shows that if our microbiome has a low bacteria count and certain friendly species are not dominating we may extract more calories from our diet – whatever that may be. We may also feel hungrier. Many of us have a depleted microbiome because antibiotics have wiped out some of the beneficial bacteria and we are eating a poor diet. One course of antibiotics can leave the microbiome weaker for up to four years, leading to increased calorie extraction and appetite changes. However, rebuilding the numbers of different species of bacteria in our gut with the right food could reverse this. The microbiome can be recalibrated in days to weeks through your Gut Makeover.
Better Mental Health
Benefit: Most people experience a better mood and a reduction in mood swings, anxiety, fear, nervousness, aggressiveness, irritability, anger, and depression.
Why? The gut has been dubbed “the second brain” and it has more than 100 million neurons embedded in its walls. We all know how our mood can impact our gut – for instance, experiencing butterflies when we are nervous. But it is now understood that hormonal and neural signals pass from the gut to the brain, which means that if the bacteria in our gut is out of balance, or the number of species is low, our mood and thinking may be affected. Your Gut Makeover will put foods into your diet to help friendly gut bacteria flourish and increase the breadth of bacterial species.
Improved Immune System
Benefit: People experience improvements in gut complaints and immune disorders, such as reduced bloating, heartburn, constipation, loose stools as well as less pain and symptoms connected with autoimmunity, such as rheumatoid arthritis, psoriatic arthritis, and psoriasis.
Why? Our gut bacteria send messages to our immune cells, so having a diverse range of bacterial species can support the immune system and prevent us catching every cough and cold going. Supporting our gut bacteria, and therefore our immune system, through the Gut Makeover can also reduce our risk of autoimmune disorders, currently at near epidemic levels – with more than 80 known at time of writing.
Better Skin
Benefit: Many find an improvement in acne, hives, eczema, rashes, and rosacea.
Why? To have beautiful skin we need to support our microbiome. A healthy microbiome has been linked with healthy skin.
For decades we’ve all been counting calories – in, out, in, out, shake it all about. Be honest now, how many calorie-controlled diets have you been on in your lifetime? Me? More than I care to remember! The first was in the 1980s, when I was 18. I looked in a mirror and thought that if I was thinner I’d look better and people might like me more. At the time I was very influenced by all the chitter-chatter among my peers about weight loss and perfectionism. So I bought a little yellow book listing calorie counts and became such an expert that I could calculate the numbers of every meal without even looking at it any more.
Over a few months I became thinner and thinner. At 5 feet, 7 inches, I went from a healthy 132 pounds to about 112 pounds. Then one day I woke up and suddenly had the most insatiable hunger of my life. I couldn’t stop eating and started craving junk foods I had never eaten before. I remember being on the upstairs of a bus and turning my head to see a McDonald’s; I immediately had to break my journey, get off, and go in and have a big binge. I would buy a loaf of sliced white bread, a pot of jam, and some margarine, saying to myself I’d have just one slice, but then I’d sit by the toaster preparing each one till the entire loaf was gone in one sitting.
I gained 48 pounds and rocketed to 160 pounds – the heaviest I have ever been before or after that time. Instead of being thin, I was now officially overweight for my height. I felt permanently depressed, my skin was a mess, I caught several colds a year, and my figure was destroyed – along with any tiny piece of confidence I’d ever harbored. My thighs rubbed together painfully when I walked and I lived in a long black sweater dress to hide my shape.
It took me another four years of misery-bingeing and crash dieting, counting calories then giving up, and punishing exercise routines before I managed to break the cycle. That was when I finally gave up calorie counting once and for all. The main person behind this change was my mother, who kept pushing me to “eat properly,” as she put it. And you know what? I got my weight back in balance. For four months I ate three balanced meals a day consisting of meat, fish, and a large variety of vegetables – many from my dad’s garden. I also bravely went back to eating butter rather than avoiding fats, had a boiled egg for breakfast, and ate live yogurts at the same time each day. I also walked a dog every day for an hour. I never went hungry. Soon I dropped back to my 18-year-old weight of 132 pounds that I’d been before all this misery and distress began. Why did it work, without counting calories? At the time I had no idea, but when we see what is emerging about the microbiome today I realize that it is probably what holds the answer.
I have to admit I didn’t totally learn my lesson. During a period of chronic stress and self-neglect while I was working on national newspapers sixteen years later in the early 2000s, I did put on weight – but not in the same proportions. Back then I was eating lunch at my desk, grabbing sandwiches from a trolley that parked behind me several times a day. For breakfast I’d guzzle coffee while shoving a croissant into my mouth on a crowded station platform. After a while, in desperation, I resorted to calorie counting again. Spurred on by popular nutrition mantras of the time, I started replacing full-fat items with reduced-fat ones in the belief this would make me thinner. This was the science at that time: calories in, calories out, replace full-fat with low-fat and high-calorie foods with artificial sweeteners and you’ll be thin. But it was always a short-term fix followed by rebound hunger and weight gain. I found myself struggling with my weight, skin, mood, and immune system, catching every cough and cold going. When I left journalism nine years ago I gave up dieting, and with it poor health. My motivation was a mixture of failing health and a personal crusade for the truth about food, which then drove me to study nutrition.
Since that epiphany I have discovered that it is impossible to ever know the whole truth about food – research will continue to open this field decade after decade with more and more new discoveries and breakthroughs. But often one area of research is better put into context by the next chunk of research, like putting a puzzle together.
My late mother was a big influence on my moving into nutrition. I was teased relentlessly in the 1970s at school about my rather alternative background, and deeply embarrassed about it at the time. My mother would stand at the school gates in Lewisham, southeast London, with her henna-dyed hair, sporting a Native American striped poncho – the insults I got for that! We ate artisan brown bread at a time when white sliced really was the next big thing, and we always had “live” yogurt, though I didn’t know why. Dinners were nut and lentil bakes and pick-your-own vegetables that we gathered from the Kent countryside in our stuttery, dark green VW Beetle at various times of the year. Later, homegrown vegetables were a big part of family life. For many years I refused to eat anything homegrown because I hated being “different.” Why couldn’t we have white bread and buy food in packages like “normal” families?
In adult life, however, when I was eating on the station platform and grabbing junk food from the lunch wagon – and feeling below par – I knew that, although my mother hadn’t had a science degree, she certainly knew a lot about the common-sense diet and how to get nutrient-dense food into her family. I now know that brown bread hasn’t had the best part – the B vitamins – stripped out of it, and that we need those B vitamins for good mental health and to make energy in the body. These important B vitamins are also manufactured in the gut by our gut bacteria, and live yogurt and lots of vegetables certainly help that to happen.
So when my health started stalling as an adult, and I started trying to work out how to be healthy, I became frustrated. I wanted to get to the truth about food, to be able to critique first-hand scientific research for myself and interpret it into practice. This led me to doing a four-year BSC degree in nutritional therapy at the University of Westminster, and, after graduating in 2012, entering nutritional therapy private practice and writing on nutrition. This book is the culmination of the last nine years of my work.
One thing I’ve learned on my own weight-management journey is that putting good eating into practice every day is something you have to keep focused on – not just the week before a holiday, or in January after Christmas. Self-care is ongoing, and if you’re doing it right, you get better and better at it, adding new techniques here and using new knowledge and better tools there.
To put my ideas into context, let’s have a quick tour of your digestive system. The tube that runs continuously from mouth to anus is a major highway passing through the body. It is finally beginning to be acknowledged that much of our health is dependent on this highway performing optimally. A problem near the beginning of the journey, such as the mouth or stomach, can have a big impact on the gut lining and bacteria balance further down. This becomes clearer when we see what happens when it is operating well.
The Mouth
The first stage of digestion happens in the mouth itself. This is where the mechanical breakdown of food occurs, as we grind and chew it with our teeth. Digestion is also aided by the release of enzymes; these are like chemical scissors, snipping food into smaller molecules that can be absorbed into our bloodstream farther down the line. Some of these enzymes are released in our saliva. We often start producing saliva when we smell good food, or see attractive food, which is why both cooking food and eating it slowly can help our digestion – rather than just throwing it in a microwave for a minute and eating it out of a container at our desk when answering urgent emails.
The Stomach
Once the food has been broken down by the teeth and mixed with saliva, it goes down the chute (the esophagus) to the stomach, which is like a stretchy balloon sitting behind our ribs. The stomach is a dynamic organ that can stretch in size to accommodate larger quantities of food. It produces hydrochloric acid and more enzymes, which work to further break down the arriving food, spontaneously tossing the food around in a churning action so it gets really well mixed with the acid and the enzymes – rather like a washing machine. The mashed-up food is then pumped through to the next chamber gradually. By now it’s pretty sludgy.
It usually takes about 4 to 4½ hours for a meal to leave the stomach. When our stomach is empty, it produces a hunger hormone called ghrelin, which lets the brain know it is time to eat again. When the stomach is stretched and full, the secretion of ghrelin stops, giving us that sensation of feeling full.
The Small Intestine
I can never get my head around why the small intestine is called small when it is so long – on average it is 20–23 feet long (or as tall as a two-story building). When the food enters your small intestine it should now be sludge – as long as you chew properly and your digestive enzyme and acid production are working well. This sludge is now known as “chyme.” At this point, bile and more digestive enzymes join the chyme to help break it down into smaller and smaller particles. The food takes three to six hours to pass through this tube, and this is where the big, important action of absorption happens. This is how all the fuel and nutrients get into our bloodstream. The sludge is squeezed along by automatic contractions called peristalsis; these are very important because if they slow down, for example in the days after a general anaesthetic, we can become constipated.
The sludge has quite a way to go. The texture of the inside of this long tube looks like a shag-pile carpet: each strand is dotted with microvilli, which look like the bristles on a brush and are, unsurprisingly, known as the brush border. The shag pile and brush hairs have been designed to provide an enormous surface area for ease of absorption. If all the strands of shag pile (villi) and brush border (microvilli) were stretched out flat, the small intestine would have the surface area of a tennis court.
Our shag-pile carpet gets a huge amount of traffic every day, so it can wear out quickly, but when we are healthy, cells turn over quickly and good-quality replacements are constantly being built. The inside of this tube is also covered in slimy mucus, which is produced from goblet cells. This helps protect the carpet and keep potentially pathogenic bacteria from passing through into the bloodstream. Of course, we can’t see the texture and health of our inner small intestine (without a medical procedure), but if it isn’t functioning right – if the shag pile and brush texture get worn down, the junctions between the shags come loose or torn, or if there is less mucus than normal – our absorption, and consequently our whole health, can be compromised.
After the enzymes and bile have all done their work and the sludge has been completely broken down to the lowest common denominator, the nutrients go through the little junctions between the blades of the brush border and shag piles into our bloodstream to fuel us, and the leftovers are transferred to the large intestine.
The Large Intestine – and the Microbiome
The large intestine (or colon) is the final stop after the small intestine. This long tube is shorter and fatter than the small intestine, and is where any water is absorbed. The residues – think of vegetables with particularly hard-to-break-down strands and material – provide food for the trillions of microbes. These leftovers spend up to two days in this department before they are excreted from the body.
In science, the colon used to be a forgotten and dismissed part of the digestive system, until the microbiome came along. Of course, this pond of bacteria had always been there, it just hadn’t had much recognition before. Scientists are now calling the microbiome “the forgotten organ.” For decades, bacteria in the gut were considered benign or fairly insignificant, but between 2008 and 2012 scientists across the United States participated in large-scale research, The Human Microbiome Project, to examine and identify much of this bacteria in healthy people. Bacteria run through the whole digestive system, but the majority of them – about 3½ to 4½ pounds per person – lives here in the colon.
So what do these microbes do?
•They ferment indigestible fibers from plants such as vegetables to release short-chain fatty acids. The short-chain fatty acid you will hear most about is called “butyrate.” This is a fuel needed to build the mucus that lines the gut. This mucus protects the gut lining, which is vital for a healthy immune system, mental health, and good skin. So if you don’t eat enough vegetables you won’t have enough fuel to build a healthy mucus layer – and without enough mucus, you are more likely to develop a leaky gut (see here) and suffer from ill health.
•They may determine how aggressively calories are extracted from the food we eat.
•They interact with our hormones – particularly the ones that tell us we are full or hungry.
•They manufacture B vitamins, which are needed for good mental health and make us feel energized.
•They make vitamin K, which is needed to clot our blood if we have an accident, a cut, or a scratch.
•They interact with our immune cells.
•They interact with our nervous system.
The Microbiome
•The microbiome is now considered a whole organ in its own right.
•Officially, there are two terms – “microbiome” and “microbiota” – the gut microbiota being a community of microbes and the gut microbiome being the bacteria and their associated genes together – however, researchers tend to use the two terms interchangeably.
•Between 1,000 and 1,150 species of bacteria are able to live in the human gut, containing more than 3 million genes (150 times more than human genes). The bacterial genes are thought to interact with our human genes to switch them on or silence them. It is early days in this research, but if this is found to be true, it must therefore be essential to cultivate a healthy microbiome through our diet.
•Each person harbors at least 160 species of bacteria and the make-up of bacteria are personalized like fingerprints. The abundance and diversity of the flora is highly influenced by diet.
•What appears to be significant to weight management and health is bacterial diversity: the greater the numbers of different species living in your gut, and consequently the greater your array of bacterial genes, the better. We need to aim for a high number of bacterial species and consequently high gene count. The best way to achieve this is through a wide and varied diet that includes many vegetables.
So we know what the digestive system looks like when the structure is all in good working order and is functioning well. But what does it look like when things go wrong? Below we discuss the main digestive system problems.
IBS
Irritable bowel syndrome (IBS) is a catchall term used by the medical profession to diagnose digestive problems where the cause is unknown.
Often laboratory tests, X-rays, and biopsies have come back negative. IBS patients often have constipation, or loose stools, or alternate between the two. There is thought to be a stress and emotional component involved and sometimes this can indeed be an underlying factor. However, in my clinical practice I’ve often seen that what has been labelled IBS is actually impaired intestinal permeability or dysbiosis. In my experience, removing the root cause – poor diet or foods an individual may be intolerant to – and implementing a gut-friendly diet (Gut Makeover style) often leads to a vast reduction in IBS symptoms.
I’ve described the microbiome as a teeming pond of life, with different communities and species of bacteria living in it. When we eat a gut-friendly diet this pond will be in a happy balance. This is an eco-system of life. We want this system to be in balance, with all friendly bacteria blooming and proliferating. When this happens, it means the friendly bacteria (“commensal bacteria”) are likely to be dominant and the unfriendly bacteria (“pathogens”), the lurgies, are kept in the background. If the lurgies become dominant we often run into health problems.
When the baddies are getting the upper hand, this picture is called “dysbiosis.” One of the first things a person may notice with dysbiosis is their abdomen might bloat, and they may experience more wind than usual. Others might find they start catching colds because their immune system is affected, or they might feel emotionally low. Dysbiosis has been linked with low mood and anxiety. It used to be thought that mood disorders were solely to do with imbalances in the brain but recent research indicates they can be connected with disharmony in the gut. It is now known that the brain picks up on dysfunction in the gut – this is believed to be via the vagus nerve, which connects the brain and gut – another consequence of dysbiosis is skin complaints, such as breaking out in spots or a worsening of eczema. Dysbiosis is also thought to result in greater numbers of calories being extracted from the food we eat.
Not chewing our food properly can also lead to undigested particles of food reaching the colon, where the non-beneficial bacteria feed on the undigested food (which isn’t supposed to be there) and proliferate. Also if the stomach doesn’t produce as much acid as it should do, the breakdown of food is compromised and the chance of undigested food reaching the colon and causing dysbiosis is increased. An indication of low stomach acid can be heartburn.
Heartburn is often assumed to be the result of high stomach acid, but this is not necessarily always the case. Heartburn, or acid reflux, is where acid from the stomach pops up through the sphincter (plug hole) to your esophagus and creates a burning sensation. It can happen when stomach acid production is low and proteins stay in the stomach longer than normal because there isn’t enough acid to break them down properly. What little acid is there causes digestive discomfort and the burning sensation in the esophagus.
You can stimulate and improve the production of stomach acid by chewing your food thoroughly and putting certain foods in your diet at the start of a meal – habits you’ll be practicing in the four-week plan (see here and here).
Another cause of heartburn can be a sensitivity to gluten, which can develop at any stage of life. If gluten really is your particular trigger for heartburn, you may see an end to the discomfort in a matter of days after going completely gluten-free (see here for more on this).
Low Numbers of Different Species
Obese individuals have been shown to have a lower number of different species living in their guts than non-obese individuals. Why are we concerned about this? Because a large diversity of different species of bacteria living in the gut has been linked with healthy weight. Eating a diet that incorporates a wide range of plants every day will create a wide diversity of bacteria species to flourish and call your colon home. Around 10 percent of U.S. residents eat the 2–3 cups of vegetables daily as recommended by government guidelines and 13 percent eat the recommended 1½ cups of fruit. During the Gut Makeover we will massively increase your plant intake to 7 cupfuls (5 as vegetables, 2 as fruit) to boost the diversity of your bacteria and create an abundance of friendly gut bacteria – consequently modulating your weight.
The connection between weight and gut bacteria is a rapidly expanding area of research, and the links with weight are alarming. Bear with me for the rest of this paragraph – it isn’t exactly conversation fodder for dinner parties, but the science is extraordinary. For some years, scientists have known that when they insert the feces of slim mice, which are teeming with the bacteria from the colon, into obese mice, the obese mice become slim. When they insert the feces of the obese mice into the slim mice’s guts, the slim mice become obese. This procedure is called a fecal transplant, and has been shown in humans to be more than 90 percent effective at curing the chronic diarrheal infection Clostridium difficile, which is usually caused by overuse of antibiotics. One unexpected side effect, though, can be an impact on weight. A recent case study saw a woman of normal weight become obese after undergoing a fecal transplant from her obese daughter. Gut bacteria are clearly powerful stuff. The woman’s C. difficile was cured, but her weight went out of control. Doctors have since been advised not to use obese donors for such transplants.
Old Age and Species Diversity
Our microbiome diversity peaks in adulthood and declines as we enter old age. If you want to counteract the loss of diversity in the gut and the subsequent weakening of your immune system as you age, you need to eat a gut-supporting diet – starting with the ideas suggested in The Gut Makeover.
Leaky Gut (Impaired Intestinal Permeability)
For years “leaky gut,” or – to give it the correct medical term – “impaired intestinal permeability,” was considered an invention of alternative medicine. However, there is now a large body of research that explains the mechanisms behind it. The latest review paper from Germany in 2014 references 265 research papers related to the subject.
So what is leaky gut? In our tour of the digestive system I described the inside lining of the small intestine as being like a shag-pile carpet. When we’re healthy (and chew our food properly) our food should break down to the lowest common denominator of particles and then go through the shag-pile carpet, through minuscule gaps called tight junctions. However, these gaps can become wider, or ripped. If this happens, undigested particles of food, or toxins, can seep through the shag pile into our bloodstream, which causes our immune system to go into a state of alarm.
The rips or gaps can occur for a number of reasons. Perhaps we haven’t chewed well, or our stomach isn’t producing enough stomach acid at the moment. It could be that we are stressed or drink a lot of alcohol. We may be continuing to eat foods that our body can no longer tolerate – for some this might be food containing wheat or other grains, or particular dairy products. Then there are the foods that haven’t been broken down properly, the ten pints of lager we drank last night, or our high-wheat diet of toast, pasta, and pizza we’ve had for breakfast, lunch, and dinner that can become potential irritants to the gut lining.
So let’s say you had a cream cake instead of lunch and the superhighway of your digestive system isn’t operating as it should. The cream will reach your small intestine with the proteins still not broken down to the lowest common denominator of single-block amino acids. Your shag pile is ripped and so proteins, and/or peptides from the cream, will pass through the rips into your bloodstream. Suddenly your immune system goes into overdrive. Proteins? You’re not supposed to be here! Invader alert! Suddenly immune cells start charging into action to fight the invader that they sense is a foreign body that shouldn’t be here. They get out their weapons and start attacking the unwanted visitor. This may display itself to you as violent sneezing, a worsening of asthma, or itchy skin, chronic acne, or chronic inflammation of many kinds – from obesity to depression. (For more on inflammation see the box below.)
A healthy microbiome has been shown to help prevent leaky gut and reverse it. By following the Gut Makeover, you will remove potential gut-lining irritants to give the villi and microvilli time to repair. Instead you will eat foods that will help with the restoration of the gut-lining cells and beneficial bacteria in the colon.
Dysbiosis and Leaky Gut Have Been Connected With:
•Obesity
•Eczema
•Asthma
•Acne
•Depression
•Anxiety
•Insomnia
•Type 2 diabetes and insulin resistance
•Inflammatory bowel diseases such as Crohn’s and ulcerative colitis
•Irritable bowel syndrome
•Autism
•Autoimmune disorders – including multiple sclerosis, celiac disease, psoriasis, rheumatoid arthritis, type 1 diabetes
•Parkinson’s
•Alzheimer’s
•Colorectal cancer
•Esophageal cancer
•Cardiovascular disease
For references and further reading on these, see here.
Food Intolerances
We can develop problems digesting certain food types when we are overexposed to them, particularly if we have a genetic predisposition (e.g., celiac disease or non-celiac gluten sensitivity; see here). This can cause an array of nasty symptoms such as gas, bloating, and indigestion. Food intolerances can also lead to other gut problems such as leaky gut, which can in turn lead to dysbiosis.
A common problem food group is dairy. For example, it is estimated that up to 80 percent of individuals of Asian heritage have difficulties digesting the natural sugar in milk called lactose. The genes of many cultures in Europe have adapted to tolerating dairy foods over the last 10,000 years, and lactase persistence (the production of the enzyme to break down lactose beyond infancy when it is needed to digest breast milk) has become common. In many Asian and African cultures, where dairy farming was less adopted, genes have not adapted so frequently to persistently produce lactase into adulthood.
The Gut Makeover removes common triggers of digestive discomfort such as gluten and all other grains for one month. Milk products are removed for the first two weeks and put back into the diet in prescriptive amounts in the second two weeks. At the end of the month, common allergens such as gluten and other grains are gradually reintroduced to help you identify if any particular ones are a problem for you. The aim is to find a tailor-made diet that fits your particular physiology in the long term.
What is Inflammation and Why Should I Care?
Inflammation can be a protective response in the body. For example, you fall down and break your arm, and it immediately balloons into a swollen, red, painful, stiff, immovable state. Inflammatory immune cells come to take care of the mess and fight off any foreigners (such as dirt or infectious bacteria) that might have entered the injury and chemicals called cytokines signal pain so you don’t move your arm and instead allow healing to take place.
Acute inflammation can be a helpful and useful service, but if the body keeps thinking it is injured, or that foreigners may be in its territory, this can trigger long-term inflammation that’s detectable in your bloodstream called “systemic inflammation.” Your immune system could, for instance, start mounting an immune reaction every time you eat a food you might be sensitive to (such as gluten) or if undigested particles of food are entering the bloodstream because you have leaky gut. Dysbiosis can also lead to systemic inflammation. When the gut bacteria are in balance it is thought to promote anti-inflammatory signalling to the immune system.
Systemic inflammation is implicated in autoimmune disorders. When the immune system becomes confused, immune cells start to attack cells in your own body, rather than foreign ones – for instance in psoriasis, when your immune cells start attacking your own skin, or multiple sclerosis, where immune cells attack the myelin sheaths on your nerves, which prevents proper nerve signalling.
Systemic inflammation has also been linked with heart disease, and a mounting body of evidence indicates that inflammation is more dangerous than total cholesterol levels themselves. There are doctors talking loudly about this in the mainstream and in literature right now. Pioneering cardiologist Dr. Aseem Malhotra was the bravest, starting the debate in the U.K. with his article in the British Medical Journal in 2013, which began: “Saturated fat is not the major issue.” This made the front covers of several national newspapers that day.
As nutritionists we’d been watching the research on this coming out for several years, but no cardiologist seemed brave enough to collate and shout about it publicly in the U.K. In fact, 75 percent of patients in the U.K. who are admitted to hospital with a heart attack have completely normal total cholesterol levels. It is becoming apparent that what is much more dangerous than total cholesterol levels is if your arteries are inflamed – which means certain types of small particle-size cholesterol (as opposed to the fluffy, big type) stick to them.
Expect to hear much more about systemic inflammation in coming years. Government advice follows scientific research, not the other way around, and it can sometimes take several decades for new findings to become adopted and accepted in mainstream medicine and translated into public health advice. Especially when it involves having to admit previous advice wasn’t spot on. If I was a stock-buying kind of person (which I’m not) I’d be investing in extra virgin olive oil, which has been shown to be anti-inflammatory, and probiotic foods like kefir (which have also been shown to reduce inflammation) above pharmaceutical company stocks any day!
In the last few decades we have lost many gut-supportive habits and foods. Traditional staples such as slow-cooked stews and cheap cuts of meat such as organ meats have become scarce, as have the habits of eating meat (or fish) and two vegetables, regularly eating greens, eating fish on Fridays, making chicken stock from leftover bones, drinking live yogurts or fermented foods, and eating slow-produced quality breads such as sourdoughs and smelly cheeses. Instead a typical modern Western diet is based around convenience foods and packaged items.
Here are some of the food and drink items that are most commonly found in our diets:
1.Refined carbohydrates – such as white bread, pasta, rice, and breakfast cereals. These are quickly broken down into sugar in the body.
2.Sugar – from white sugar in cookies, cakes, and breakfast cereals to high-fructose corn syrup in fizzy drinks. You’ll even find sugar in high doses in “healthy” granola bars. High-sugar diets have been linked with an impoverished microbiome.
3.Trans fats – these fats can be found in some commercial and highly processed cakes, cinnamon rolls, cookies, muffins, salad dressings, coffee creamer, microwave popcorn, etc., and in some margarines and low-fat spreads. They make food last longer, and create a desirable texture. Trans fats are also used in some fast food outlets in the oil for deep-frying so that it can be reused over and over. Trans fats come under names such as “partially hydrogenated fat,” “partially hydrogenated vegetable oil,” or, “vegetable shortening,” and can sometimes be hard to spot, particularly if you are buying from an open display without packaging such as a muffin, say, in a coffee shop. Trans fats are the ones that cause most concern in connection to heart disease and brain function; the specific chemical structure of them makes it difficult for the body to deal with them and are the fats most likely to increase the dangerous small dense particles of cholesterol mentioned earlier. Trans fats have been shown to raise inflammation markers, and, as mentioned here, systemic inflammation has now been linked with heart disease and depression. However, although trans fats are the most dangerous, any type of fat dolloped into the diet in too large amounts may not be compatible with a healthy microbiome if not accompanied by enough plant fiber. High-fat diets in conjunction with low vegetable/fiber intake have been linked with lower bacterial species in the gut, and for optimum health we want a high bacterial count. This means we should choose our fats carefully. We should look for quality and purity, selecting natural fats such as pure extra virgin olive oil, real butter, and coconut oil, as opposed to chemically manufactured trans fats and eat lots of fiber.
4.Artificial sweeteners – from aspartame to saccharin and sucralose. We think we are only consuming them when we have diet colas and fizzy drinks, but they are creeping into our other foods in the most unexpected places. Having heard that sugar is the spawn of the devil, we now head toward the “reduced-sugar” ketchup, only to find it may have been spiked with artificial sweeteners.
5.Alcohol – this can irritate the gut lining, zap our gut flora, and cause dysbiosis.
Here is what a busy New York office worker who is watching their weight might eat in one day. This food diary incorporates common patterns and trends that I have noticed when working with corporations and their staff.
Breakfast (on the way to work): large café latte made with skimmed milk.
Lunch: pesto and pasta salad.
Mid-afternoon: three rice cakes and a diet cola.
On getting home: packet of chips and large glass of white wine while cooking a goat’s cheese pizza (marketed as under 500 calories).
This food diary reveals a number of disordered eating patterns that have been fueled by the messages delivered by popular media on current nutrition trends and outdated science.
•First, the entire food diary contains only small traces of vegetables – the basil in the pesto and a smear of tomatoes and red onions on the pizza. Low levels of vegetables can lead to a low diversity of gut flora and all the problems that go with that – one being difficulty in managing weight. This person may be trying to manage their calories but they are likely to continue to be overweight as well as being tired and in a low mood, catching colds, and suffering from poor skin condition in the process, not to mention feeling constantly hungry.
•Many people drink skimmed milk because we have been told it is “healthier” for us. We are told that having 2 percent fat instead of 4 percent is healthier, however, once the natural fat is extracted from milk it actually becomes a higher-density sugar drink – there is less fat but a higher concentration of lactose from the natural sugar in milk to digest.
•Pasta is often seen as a “low-fat” meal, but the carbohydrate in pasta turns to sugar quickly when broken down by the digestive system. Many of us eat too much wheat – contributing to a monotonous narrow range of foods in our diet, which can lead to a lack of diversity in the gut flora. It can also irritate some people’s gut lining causing dysbiosis and inflammation in the body. This office worker is eating wheat for lunch and dinner. Wheat also spikes our fat-storage hormone, insulin, and may lead to a more aggressive calorie-extracting microbiome.
•The pizza marketed with a crumble of goat cheese is rather tasty but still represents an unbalanced meal because 90 percent of the meal is the base, which is refined flour and so turns to sugar and does all of the above.
•The diet cola contains artificial sweeteners, which have been shown to alter gut flora. The rice cakes are broken down to sugar quickly. The chips may contain trans fats. The alcohol may not help your microbiome and could cause dysbiosis.
Where the Western Diet Goes Wrong
Microbiome scientists have been examining the gut bacteria of hunter-gatherers in parts of Africa and South America. Hunter-gatherers are fascinating for microbiome researchers because their diets are thought to have many elements in common with our ancestors. The view is that these people are eating what we are genetically designed to eat rather than the Western, modern diet that most of us eat, which is dominated by farmed foods such as grains and dairy, which only started to become a large part of our diet with the advent of farming just 10,000 years ago. For millions of years before that, we were hunting our own wild meat and fish and picking our own wild fruit and vegetables, nuts, and seeds.
Hunter-gatherer tribes’ guts teem with an enormously wide variety of bacterial species. Meanwhile those on the Western diet – dominated by one main grain, wheat (rather than a broader range), with a small amount and variety of plant matter, and high in processed fats, factory-farmed meats and fish, and alcohol – have been shown to have a narrower range of gut flora and a set of non-communicable diseases to go with it. Even rural farming populations in Africa and South America today that eat a broad variety of vegetables and are breast-fed as babies have been shown to have a much better gut bacterial profile than Westerners on the diet described above. So we don’t have to turn into full-blown hunter-gatherers to improve our health – we just need to make some significant Gut Makeover tweaks to get there.
Here are some of the key areas where our Western diet is currently going wrong.
Low Vegetable Intake
Only 10 percent of U.S. residents eat the 2–3 cups of vegetables daily as recommended by government guidelines and just 13 percent eat the recommended 1½ cups of fruit. The guidelines are troubling, too – myriad other sources indicate that we should be eating at least 7 portions a day, if not more.
Lack of Diversity
How many different plants have you eaten this week? If it’s just a handful, the range of your gut flora species could be quite limited, and your health too. The more diverse your intake of plants and wider range of flora, the better your health and weight. If we want a beautiful microbiome, we need to eat a rainbow of colors and a wide spectrum of varieties. In a recent interview, Jeff Leach, lead researcher of the American Gut project, said he tries to eat 20–30 different plants (vegetables and fruit) per week for a healthy gut microbiome. The greater the diversity of the diet, the greater the diversity of bacteria, and therefore the better your health.
Another concern is that overexposure to particular foods (such as when we are following monotonous diets) can actually lead to us becoming intolerant of those foods, which can lead to further health problems.
We also need to make sure that some of the vegetables and fruit we eat contain prebiotic fibers. This type of fiber is a superfeeder of bacteria in our gut and makes that gut bacteria flourish and bloom. I’ll be covering where to find prebiotic fibers in Part 2.
Too Much Sugar
A high-sugar diet can be detrimental to our microbiome. The reason is that bacteria love sugar, and the non-beneficial ones are likely to get more dense and powerful if we feed them sugar all day, leading to dysbiosis. However, if the rest of your digestion is working well, 85 percent of sugar should have been absorbed before the food reaches the colon.
Too Much Caffeine
Many of us rely on caffeine from coffee, tea, sports drinks, colas, and even green tea to get through the day. We like the quick boost to alertness and energy they seem to give us. There are also antioxidants in coffees and teas that can offer some benefits to the gut, but a digestive system constantly assaulted with the caffeine accompanying them is unlikely to be operating at its best. This happens because caffeine is a stimulant and can trigger the release of the stress hormones adrenaline and cortisol to get us going. When stress hormones are high, the sympathetic nervous system, known as the “fight or flight” system, is dominating. This means the parasympathetic nervous system – “the rest-and-digest” nervous system, which needs to be switched on to ensure our digestion is working well – may be operating at half capacity while the body diverts energy to the more pressing stress situation.
Caffeine also can lead to sugar being tipped from the liver, where it is stored, into the bloodstream. So when you have that first coffee of the morning it doesn’t just give you an adrenaline surge but a sugar rush too. To get your digestion in optimal running order during your Gut Makeover it is important to take a break from caffeine.
Overexposure to Antibiotics
Antibiotics may kill the bacteria causing you that earache, but they aren’t selective about which other bacteria they kill in the body. This means that when you take a course of antibiotics, it is also likely to kill friendly bacteria in your gut. So if the friendly ones take a beating, as well as the ones in your ear, you may be left with dysbiosis and a smaller diversity of species in there. Antibiotics have been shown to reduce diversity of the bacteria in the gut in three to four days, with the impact lasting for up to four years after treatment if you’re maintaining a typical Western diet.
In addition to any antibiotics we take, we may also be being subjected to residues of antibiotics on a low level by consuming farmed fish, meats, and dairy, as farmers routinely give prophylactic antibiotics to their livestock.
We have known about the link between antibiotics and weight gain for decades through the observation of farm animals, when farmers noticed that feeding their animals antibiotics had the additional, profit-driving effect of making livestock fatter. But what is good for their bottom line isn’t helping our waistlines.
I’m not saying never take antibiotics – they can, of course, be life-saving. I’m simply saying there is a time and a place for them, and that overexposure could be making us fatter, as well as leading to antibiotic resistance, meaning their ability to save lives is in danger too. So you need to weigh up the pros and cons carefully, and if you do need a course of antibiotics, the Gut Makeover is the perfect way to kick-start your microbiome afterward.
Nutrition is a notoriously confusing and contradictory subject, and many of the health beliefs we have been brought up with are now being challenged by new research. Here we explore the changing nutrition landscape in the early 21st century.
The Calorie Myth
We now know that the quality of the calories we eat is more important than the numbers; this is because not all calories were created equal. For instance, if you take in 500 calories from drinking cola, it will have a totally different impact on fat deposition than eating the same number of calories from a portion of asparagus and a piece of chicken.
So why is chicken and asparagus so much better? Cola contains high quantities of sugar (usually fructose), and high-sugar diets can upset the balance of the bacteria in your gut, which is also being linked with calorie extraction from food – any food – rising and hunger increasing. In comparison, the chicken contains protein, and protein is the hardest and slowest type of food there is for the body to break down. We burn up to one-third of the calories from chicken just by digesting it. That is called the “thermogenic” effect of a food. On top of that, the asparagus, besides being a nutrient powerhouse of good vitamins and minerals, contains a particular type of “prebiotic” fiber that helps beneficial bacteria in your gut proliferate. Helping your flora bloom could mean less extraction of calories and hunger.
Masses of fast-moving pioneering research has been done in this area. The results indicate that the diversity and balance of gut bacteria is closely linked with weight. When the range of species within this 3½ pounds of bacteria are reduced (such as when we eat a lot of sugar, take antibiotics, eat insufficient vegetables, consume foods we are intolerant to, or drink a lot of alcohol), we may extract more calories from the foods that we are eating.
Thankfully this message is now being heard and promoted in mainstream medicine. A group led by the previously mentioned cardiologist Dr. Aseem Malhotra wrote an editorial in the journal Open Heart in 2015: “Shifting the focus away from calories and emphasising a dietary pattern that focuses on food quality rather than quantity will help to rapidly reduce obesity, related diseases, and cardiovascular risk.”
No one warns us about potential insatiable, uncontrollable, rebound hunger when they recommend a calorie-controlled diet, or how depleted we may become in important vitamins and minerals that are needed for good mental health, which means we may crave food – any food – later on. Nor do they tell us about protecting our immune system, our mental health, and the health of our skin.
To those who nowadays embrace eating quality food and appreciate that being a healthy weight is more than just a calories game, this may all seem obvious. However, I do regularly meet women (and some men) in my clinic who are attached to calories and live every day in a battle with them. More often than not, they are women of my age, who, like me, had been conditioned in earlier years to believe this was the right approach. Because it’s not working for them, we work together on new approaches – starting with gut health.
I am often asked about my views on fasting for weight loss and to improve health. More recently, the 5:2 diet of fasting on two days a week (on which you consume just 500 calories if you are a woman and 600 calories if you are a man) has become a popular way to lose weight and improve metabolic markers. This method can be a godsend for some, but it may be a disaster for others who suffer hunger and anger (“hanger”) on the “fast” low-calorie days. I have come across people who experience immense rebound hunger and weight gain when they stop regular two-day-a-week fasting.
We have to remind ourselves that we are all different, with a unique genetic make-up, and for this reason, one person’s meat can be very much another person’s poison. There is no one diet in the world that suits all mankind. Throughout The Gut Makeover I will encourage you to experiment with foods over these weeks to find out what suits you and doesn’t suit you, so you can stay healthy for the long term. Personalized nutrition is an exciting way forward.
The Sugar Crusade
Sugar – the villain that has been on the run for several decades while fat took all the flak – has finally been hunted down and shamed. We’ve had years of nonsense, demonizing all fats and messing around with natural foods to make them supposedly more healthy by extracting their fat content and replacing it with sugar to make them palatable. Reduced-fat yogurts and frozen yogurt are prime examples of this approach.
High-sugar diets in animals have been shown to change the balance of the gut flora, with subsequent declines in mental and physical performance, so it’s not only the impact of sugar on our weight that we need to worry about. Fructose, the type of sugar found in many fizzy drinks and junk foods, has been shown to induce a leaky gut in animals. However, “diet” drinks aren’t any better. Recent research has indicated that the artificial sweeteners that replace sugar can lead to changes in the flora in the microbiome, which may lead to greater extraction of calories eaten, as well as an increase in type 2 diabetes. This was an early study, and more quality research is needed, but, even so, it is a stark warning, and in my opinion means artificial sweeteners such as aspartame, sucralose, and saccharine are best avoided.
Alcohol is also packed with sugar, but as there is no labeling of the ingredients, it is easy to forget that fact.
The Problem with High-Fat Diets
Medium-chain triglyceride (MCT) fat such as coconut oil and saturated fat butter are now being celebrated for their health benefits and their lack of adulteration and stability. You can recognize a saturated fat because it is solid at room temperature.
Fats are an important part of our diet, but high-fat diets accompanied by low vegetable intake have been linked to a reduction in the diversity of gut flora. As we have seen before, diversity is essential to our health and weight. This is why I am wary of those diets where coconut oil is celebrated and slathered on every morsel of food, and dolloped freely into your coffee in the morning (the famous “bulletproof coffees”) without enough emphasis on plants.
The truth is, if you have too much fat – any fat – and not many vegetables – it could skew your gut flora and you could gain weight more easily.
The Gut Makeover does include fats and oils from olives and nuts, including coconuts. Real butter (in the second half of the program) and extra virgin olive oil (throughout the four weeks) are my favorite recommendations. Butter contains butyric acid (the fuel needed to build a healthy gut lining), which can also be made by the bacteria in the gut as they ferment vegetable fibers. Butter also contains vitamin A to support the gut lining. Extra virgin olive oil contains plant chemical polyphenols, which can help protect the oil from damage when it is heated. Polyphenols may also help gut flora proliferate.
The Paleo Diet
Paleo in its true form is a diet of wild proteins (such as meat, fish, eggs, nuts, and seeds) and plants (vegetables and fruits), and is based on an idea of what our ancestors in the Paleolithic period would have eaten millions of years ago. This means, in theory, eating what the human body evolved to eat.
Eating a natural diet without the refined flours, sugar, unhealthy fats, and artificial sweeteners of the Western diet can be enormously beneficial to the microbiome – and consequently your weight and health – and my one-month Gut Makeover does pay a nod to Paleo. My plan also puts into your diet lots of delicious meat, fish, eggs, nuts, seeds, and mountains of vegetables. However, there are two problems with the Paleo diet. One, we are living in a 21st-century industrialized society with very different food access from our ancestors; and two, our protein and plants are, for the most part, not wild, so the nutrient density and quality are far poorer.
In true Paleo diets, all dairy and grains that came into our diet with the advent of farming 10,000 years ago are left out. The argument is that after eating protein and plants for millions of years, our genes have not adapted fast enough over this time frame to digest farmed grains and dairy well. I disagree with the rigidity of the Paleo argument: we now know that our genes are pretty flexible and interact with our environment all the time and are constantly adapting. It has been shown that famines suffered by recent generations can alter genes of children born down the line to help survival in famines, if encountered today. We also know that a healthy microbiome cross talks with our genes, having the potential to switch them on or be silent.
When the Paleo diet is followed using high-quality foods, including wild meats and fish and nutrient-powerhouse organ meats, it can be enormously supportive for some groups of people, in particular those with autoimmune disorders. But I must stress that it is very important to concentrate on the quality aspects of the protein and plants you are eating because in standard Paleo diets the plate is half protein, half vegetables.
The Gut Makeover plan differs from the Paleo in that, while it avoids dairy for part of the program, and gluten, grains, and beans for a month while your gut mends, it does not banish these foods for the long term. This is because you are not a caveman and you live in the 21st century, so we need to give you a caveman’s microbiome but using the food you have access to in the world today.
Gluten – to Eat or Not to Eat?
Gluten is often spoken as a bad word, but what is it and where do we find it?
Simply put, gluten is a protein found in certain grains, most commonly wheat, as well as in trendy grains like spelt. It’s in the couscous in that delicious roast vegetable couscous salad we just ate. It’s also in the pearl barley enjoyed in that stew at the nice organic cafe, and that semolina pudding in the cafeteria. We’re usually aware that there is gluten in wheat flour, but it’s easy to miss it when we’re enjoying a home-cooked Sunday roast and only later discover a relative has thickened the gravy with flour. For many people gluten isn’t a problem, but increasing numbers of people are finding gluten causes all sorts of issues for their guts.
In the olden days you were either celiac or non-celiac. Celiac disease is a life-threatening autoimmune disorder triggered by eating gluten. Gluten causes a tremendous immune reaction in celiacs, a bit like a fire alarm. A celiac’s immune system does not like gluten and sees it as an invader. After fighting the gluten onslaught for a time, the immune system gives up, gets totally confused and can no longer recognize the difference between gluten and the cells of the small intestine itself. The immune cells then start attacking the gut cells and destroying them. This shag pile carpet becomes mowed down and the surface area for absorption of fuel and nutrients isn’t there any more, or only parts of it are left. This means the body can no longer absorb food properly and the person becomes ill. If a celiac continued to eat gluten in this condition, they would die. This is because they can’t absorb nutrients and fuel from their food. Just one particle of gluten stuck to a French fry that has been cooked in the same oil as the shop’s battered onion rings or tempura could ignite a massive immune reaction in a celiac’s gut, destroying parts of the shag pile. Even the slightest, accidental exposure to gluten can set them back.
You can develop and be diagnosed with celiac disease at any stage of life. It often develops during or shortly after pregnancy, and 20 percent of newly diagnosed cases are in people over 60. It is not something you are necessarily born with, though there may be a genetic predisposition. Around 95 percent of celiacs have either the HLA-DQ2 or HLA-DQ8 genes. If you carry either of these genes you are at risk of developing problems with gluten.
We now know that genes are not, as originally thought, certain fate: we can be born with a particular gene, but it may never get switched on. We also know that our environment can switch on, or silence, particular genes. So for instance, if you are one of the 30 percent of northern Europeans with the HLA-DQ2 or HLA-DQ8 genes, and you eat gluten for years on end for breakfast, lunch, and dinner, washed down with beer made from wheat, your chances of developing celiac disease are higher than someone with the same genes who eats bread and pasta only occasionally. So if you live in North America and are of northern European heritage the possibility of a genetic pre-disposition is something to bear in mind. You can check if you have the HLA-DQ2 or HLA-DQ8 genes on www.23andme.com. The other factor is that the wheat we are most exposed to nowadays is the dwarf variety, which has been bred to yield as many tufts as possible without falling down. However, the content of the protein gluten is greater in these plants than in old-fashioned ones such as einkorn wheat or spelt. This means that our exposure to gluten is higher than ever before.
It is estimated that ½ to 1 percent of European and North American populations have full-blown celiac disease. However, in contemporary scientific literature, it is estimated that 6–10 percent of the population is having problems with gluten but do not fit the criteria to be diagnosed celiac. The term being used to identify and discuss this group is non-celiac gluten sensitivity (NCGS). However, if you have the HLA-DQ2 or HLA-DQ8 genes you could already be experiencing problems connected with gluten without being celiac, and these areas are where many people fall.
The New England Journal of Medicine has linked 55 other disorders with eating gluten. These range from rheumatoid arthritis and thyroid disorders to fatigue, anxiety, depression, joint pain, infertility, miscarriages, skin rashes, and mouth ulcers. For this reason many people are cutting out gluten-containing foods to see if it makes a difference to their health. Some report that their brain fog disappears, others that the chronic joint pain that they have endured for years miraculously clears up. In some, chronic adult acne disappears or their chronic fatigue clears up. By removing a food that is putting their immune system on low-level constant alert, people often feel more energetic than they have in years.
Another point to consider is that it is not always the protein gluten that is causing reactivity. In some people it can be other proteins in the wheat kernel. This is why some individuals swear their well-being improves when they give up their usual wheat bread and feel much better on spelt. There is also the possibility that gluten is irritating the gut lining from overexposure; having a pause for a while gives the gut time to heal and allows the gut flora to repopulate.
However, I’m not advising you to swap your usual treats for junk foods marketed as “gluten-free.” Whole aisles in supermarkets are appearing dedicated to this trend. Just because a cake or bread says “gluten-free” does not make it healthy. Read the ingredients list and make your own decisions. When I looked at one mainstream brand of gluten-free bread I identified 33 ingredients, of which many were probably better described as food-like substances. These products are often highly processed, loaded with sugar, and made from other grains instead of wheat. For example, you often find rice, corn, buckwheat, or soy flour replacing wheat in commercial gluten-free foods. The problem with this is that some people who are sensitive to gluten or wheat may have also lost tolerance of other grains, especially if they are loading their diet with them after quitting gluten.
This is why sometimes celiacs don’t improve on a gluten-free diet – they can be reacting to other grains too so the immune system is constantly being enraged. Before you know it the individual is diagnosed with another autoimmune disorder such as Hashimoto’s (where your immune cells attack your thyroid) or rheumatoid arthritis. Autoimmune disorders, unfortunately, often come in clusters if the immune system isn’t kept in check.
If you find after this plan that you feel much better not eating gluten, don’t turn to commercial gluten-free products. Instead, eat real, homemade foods. You could make a cake with ground almonds instead of flour; you can use a little red leaf lettuce or chicory leaf as the “bread” for a sandwich. You could also spiralize some chopped zucchinis and sauté them in a pan as a replacement for spaghetti with your bolognese. Eating real-food replacements is healthier, much tastier, and prevents you from subjecting yourself to highly processed alternatives.
Another growing misconception is that going gluten-free is better for everyone. It isn’t. Gluten is not the food of the devil. In fact, certain types of bread such as sourdough could be positively good for your gut flora, and, subsequently, your overall health – as long as you are in the 70 percent of the population that is likely OK with gluten and has no genetic predisposition to associated problems with the protein.
The Gut Makeover removes gluten from your diet for one month, even if you don’t have a sensitivity. Here is the rationale: leaving it out in the short term will encourage you to replace it with many more vegetables in your diet, which will aid microbiome restoration. This in turn may lead to weight loss as you may extract fewer calories from the food you eat. At the end of the month you may wish to reintroduce gluten into your diet – eating foods like sourdough bread, which has been fermented, might be helpful for some.
Try to keep a food and symptom diary and note any changes in your health for three days during reintroduction. If gluten is a trigger for poor health, you are likely to notice a reaction – from a change in stool pattern and bloating, to mood, skin reactions, brain fog, or insomnia. By keeping a diary you may find you discover some key information for managing your health in the long term.
So this is the science behind why the Gut Makeover is good for you, and just some of the reasoning as to why certain diet and cooking methods benefit our gut flora and ensure we have a healthy gut lining and good overall health.
In the next part of the book you’ll be putting this theory into practice. I’ll be encouraging you to make specific changes to your diet for the four weeks of your Gut Makeover plan.