I hope by now you’ve lost some weight, your skin is glowing, and you’re feeling brighter all round. Your Gut Makeover is complete! And now you’re wondering how you can maintain your happy digestive system and continue to look and feel good for the long term.
That is what this chapter is about.
This plan is nutrient-dense, anti-inflammatory, and easy to follow going forward. Keep eating in this style and you shouldn’t suffer a sugar, alcohol, or gluten craving! You’ll also get your calcium from an abundance of green leafy vegetables, some nuts and seeds, and the kefir and Roquefort, if you tolerate those OK. Carbohydrates are contained in vegetables and fruits, so you can get energy from plants rather than traditional grains.
If you have a large amount of weight to lose and you’re in the full swing of the plan – enjoying the benefits of a healthier gut, not feeling hungry and relishing having plenty of energy while the weight is dropping off, probably a pound a week – then you can carry on until you reach your target weight. Look in your diary and plan another month, then review it again if you continue, or decide to carry on eating this way after that.
If you do decide to go on longer, the rest of this chapter may be more relevant when you are ready to move on to the maintenance stage and want to design your diet to the individual you are and what suits your personal gut best. Either way, this is a good moment to complete another questionnaire, fill in your measurements, and acknowledge how far you’ve come in four weeks.
It is best to come to this totally fresh and fill in the questionnaire without referring back to the one you filled out a month ago, nearer the beginning of this book. Add up your score for today, then compare it with the overall scores and those of specific areas (e.g., emotions, weight, digestive, immune, etc.), and see how you’ve fared. Having reached your goals, you can now learn how to transition from this point to eating healthily everyday in a style personalized for you. Please see here for advice on reintroducing foods to your diet to find out which ones are worth including or excluding longer term to keep you healthy and to manage your weight. Your gut lining should now be in good shape, and your microbiome should be teeming with a wide range of bacteria and blooming with friendly species to provide resilience in the future. So let’s get our measuring tools out again.
The Gut Makeover Questionnaire
Date: __________ |
Rate the following symptoms on a scale of
0–5, with 0 being not present at all and
5 being a major symptom:
Emotions Mood swings __________ Anxiety __________ Overeating __________ Feeling down __________ Trouble falling asleep, early dawn waking, or sleeping too much __________ |
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Total __________ |
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Weight Binging (foods or drink) __________ Compulsive eating __________ Cravings __________ |
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Total __________ |
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Digestive Bloating __________ Acid reflux (heartburn) __________ Loose stools __________ Constipation (less than one stool movement a day) __________ |
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Total __________ |
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Skin Eczema __________ Psoriasis __________ Acne __________ |
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Total __________ |
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Immune System Hay fever __________ Asthma __________ Hives __________ Sneezing attacks __________ Stuffy nose __________ Sinus problems __________ Joint aches and pains __________ |
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Total __________ |
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Energy Fatigue __________ Difficulty getting up in the morning __________ Hyperactivity __________ Lethargy __________ Poor memory __________ Poor concentration __________ |
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Total __________ |
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For Women Premenstrual symptoms __________ Menopausal symptoms __________ |
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Total __________ |
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OVERALL TOTAL SCORE __________
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Enter your weight and the date
Weight: ________________ Date: ________________
Enter your waist measurement here: ________________
Gut Makeover is a bit like a one-month makeover of a slightly shabby house where you live without paying much attention to the finer details, but then you decide to make a change. Imagine you have the builders in for a month: you get the structure improved, the cracks in the walls filled in, and the plasterers do a beautiful job finishing the walls so they are smooth. The paintwork is immaculate. You’ve had new floors put in. The doors glide open, all the screws in the handles are tightened, and the squeaking hinges are silent. (This is the REPAIR stage.) You’ve restored some of the existing furniture and added some new bits, too, so you have a much wider range of furniture, making best use of the space in the rooms. Then you’ve added the soft furnishings, beautiful rugs, and cushions and plants, and you’ve put ornaments on the mantelpieces. (This is the REINOCULATION stage.)
But are you living in this house post its one-month renovation in the same way you lived in the old wreck before? Probably not.
Imagine that at the end of your house makeover you invite your friends around to celebrate. This may be done with much more ceremony than when you were living in the old version and with much more concern about red wine ending up on your new carpets!
You probably have every intention of enjoying your house to the full, but in reality you may be a bit more measured in your entertaining and spend more time on maintenance than when you lived in the old wreck. Perhaps you invest more energy in your house than before, but the enjoyment you get from living there more than makes up for the effort.
I hope that after your Gut Makeover you will look after your newly refurbished digestive system and enjoy the benefits in a similar way. This might involve taking more notice of what you eat and how much you drink: with focus, the benefits (being able to better manage your weight, feeling in a better mood, having clearer skin and falling sick less often) may well outweigh the cost in terms of effort.
Following your successful makeover, here are the 12 principles for maintaining a healthy gut lining and microbiome – and all the benefits that come with it – for the long term.
1.Implement a 12-Hour Fast Habitually
After a whole month of doing this plan, you should be able to follow it literally with your eyes closed. This is a really easy practice to maintain, and can have good implications for the microbiome and consequently for metabolism and weight. Overnight, your microbiome can change – certain species come out when you are fasting and create a healthier gut lining, which in turn means less gut permeability and inflammation. An overnight fast is a convenient way of giving your gut the chance to regenerate without the inconvenience of long periods of hunger during the day, when you may be expected to perform well or don’t want to risk falling into a state of “hanger” (hunger plus anger).
2.Keep Chewing, Keep Counting
A month of practicing chewing your food properly means this may now begin to be your default eating habit. So there’s no need to turn back here on this point, just keep doing what you’re doing. Your gut lining and flora (and consequently your overall health) will be happy about this. It costs nothing, and it should make you better able to recognize when you are full so you will stop eating more than you really need to.
3.Say Adios to Snacks
Now that you understand the importance of including protein at each meal along with piles of fiber-rich vegetables, both of which help us to feel full, do you really need snacks? Many Gut Makeover participants say their cravings for snacks are massively reduced on this plan, especially after the first week, and some found that they saved money each week by avoiding them. They also realized that when they manage the balance of each meal well, they no longer need snacks.
Often, a lot of sugar comes with snacking – even healthy snacks like fruit juices and dried fruit and nut bars – so ditching snacking is a really powerful way to keep the sugar content of your diet in check and your gut lining and microbiome in good shape. High-sugar and high-fat eating without enough fiber and color from plants in the diet to counterbalance them can skew your gut flora, and snacks can be the culprit for this. So if you remain conscious of maintaining your protein intake and fiber-rich vegetables at main meals, you shouldn’t need to top yourself up with unnecessary food in between.
4.Keep up Your 7 a Day
Forget 5 a day, you’re now expert in 7 a day! I hope that after a month on 7 a day, you’ll see how easy it is to eat as wide a variety as possible of vegetables, herbs, and fruit as you can once you’re in the swing of it.
Narrow your eyes and look at your shopping cart as you push it toward the checkout – it should be an explosion of fresh foods teeming with bright, vibrant colors. If it looks rather more beige in tone, whip around the store again and add more color, and more fresh food. On the Gut Makeover we aimed for 20–30 varieties of plants a week – one recent Gut Makeover participant revealed a food diary, which more than doubled that in one week, while others were well over 40 after a couple of weeks. And they didn’t have to move to the countryside or join a remote Amazonian tribe to achieve it!
Wherever you live, try to access a wide variety of different fruits and vegetables. It’s important to avoid slipping into eating beige foods and to stay focused on consuming a large range of multi-colored foods. Your microbiome cries out for color and variety. Feed it well.
5.Go Easy on Pasta and Grain, and Choose Sourdough Breads
So this is where we come to the beige tone that can dominate much of the Western diet. If your gut lining and flora are in good shape, eating pasta and grains such as rice may not be a problem for you, but with the amount and domination of them in the diet they can sometimes become an issue and lead to digestive problems. We now know that the number of people who need to go gluten-free out of medical necessity is much higher than just the numbers of those who are diagnosed as celiac, and having a resilient microbiome is key to being able to tolerate gluten. It has been observed that you are four times more likely to develop celiac disease if you were born by C-section than if you were born vaginally. When a baby is born via the birth canal, its digestive tract is exposed (via the mouth) to bacteria from the mother’s vagina. This means you start life ahead of the game with a stronger microbiome, which in turn means a stronger immune system, fewer food intolerances, and less susceptibility to autoimmune disorders such as celiac disease. After a Gut Makeover, your microbiome, and therefore your immune system, should be functioning better than before.
So now you may be wondering whether to go back to gluten. Later in this chapter I’ll explain how you can reintroduce individual foods into your diet in stages, allowing you to observe any potential symptoms and assess if they are a problem for you. This will give you powerful personalized dietary information to help you decide if gluten is for you or not, and to weigh the cost versus benefit to you of having it and whether to include or exclude it long term.
The majority of people (at least 70 percent) doing the Gut Makeover should be OK to go back to gluten after the month without it. If you can tolerate gluten, here are some tips:
Choose sourdough breads whenever you can. Sourdough breads should be easier to digest because they contain lots of friendly bacteria. Foods that are fermented are partially digested already, so can be easier on the gut.
Rotate your grains continually. Avoid a mono-grain diet. If you eat bread, choose different varieties of grain (e.g., rye or spelt). Although these both contain gluten, it is not necessarily in the same quantities as the regular dwarf wheat used in many mass-production breads. Regarding other grains, such as oats, rice, and quinoa, make sure you have variety every day – it not only makes life more interesting, but it also means your gut has less chance of becoming irritated by overexposure to one particular type of grain. In clinic, I’ve noticed that people who are sensitive to gluten are sometimes also sensitive to other grains. This can be rather irritating – and not just to the gut! For instance, someone goes gluten-free because of a problem with wheat, then starts consuming lots of “gluten-free” alternatives (e.g., gluten-free beers), only to find out later that the GF beer they are drinking is made using a grain called sorghum, and they have an intolerance to sorghum, too. This is why if you have a concert of grain intolerances it may be better for your gut and health to stick to the principle of replacing grains on the plate with vegetables. Try eating a burger without a bun and instead wrapped in a couple of big lettuce leaves, or a canapé filling carried on a chicory leaf, or spiralized zucchini instead of pasta.
Go for a quality experience, rather than quantity. I recently met Dr. Alessio Fasano during the coffee break of a microbiome conference in London, where he was a headline speaker. He’s a leading gastroenterologist based in the United States, a pioneer of research into impaired intestinal permeability. He and his team established the first distinguishable marker of a permeable gut, a protein called zonulin. As you may have guessed from his name, he is Italian. So I asked him what kind of diet he eats, and if he eats pasta. He said he lives on a Mediterranean diet, which includes an abundance of brightly colored plants, fish, some meat (if of good provenance), extra virgin olive oil, nuts, seeds, and some red wine – which we’ll come back to shortly – and one bowl of pasta a week. I liked his approach, and it makes sense. If you don’t have a known intolerance and would like to include pasta in your diet, eat a good plate of it each week and really enjoy it, but don’t bombard your gut with pasta or you might risk your gut losing tolerance to it. You’ll also leave more room in your diet for brightly colored vegetables this way.
6.Invest in the Least Processed, Most Natural Foods You Can
I hope that after your Gut Makeover you’ll have become a more savvy shopper and will now be used to reading the labels of all the foods you buy. Pick items with short ingredients lists and foods that sound like real foods, not food-like substances. I also hope you’ll be more aware of sugar in all its different guises now, and that you will have developed a palate that demands less of it. Many Gut Makeover subjects report that after completing the plan they need far fewer sugary treats, such as cakes or cookies, to get a sugar hit. If you do go for cake, go for quality over quantity – something baked with real, recognizable ingredients. If you bake yourself, you will have much more control over the amount of sugar, honey, or maple syrup that you include. Do keep your radar alert for artificial sweeteners, and avoid those altogether if you can.
7.Include Fermented Food and Drinks Daily
Foods that are naturally fermented usually contain high numbers of friendly bacteria. The higher the numbers, the more chance they have of reaching the colon and doing you good. That is why I’m a fan of kefir-fermented milk, so if you can tolerate this try to include it in your diet daily somehow. You could use it as a replacement for live plain yogurt in your foods (which probably still contains bacteria but the counts may not be as high), or desserts with fruit.
Fermented pickles and sauerkraut are attracting a lot of attention among foodies and nutritionists right now. However, a lot of those sold in the supermarkets have not been slowly fermented and their labels are not clear about the length of time involved in the process or of the numbers of bacteria they contain. So if you want to obtain fermented pickles with high bacterial numbers, go to the fridge section of your health food store (the best place to find true fermented pickles these days). These should contain high numbers of bacteria; when you open the jar, it should almost burst open like a fizzy drink.
Continue to include fermented miso (bought from a refrigerated compartment) and tempeh too if you have enjoyed them on this plan. These foods have masses of friendly bacteria and can be regularly embedded in your microbiome to keep your gut healthy.
8.Use Caffeine with Caution
So can I go back to my beloved morning coffee, you may ask? Caffeine is a stimulant and can produce a stress response in the body, which manifests as an increase in stress hormones such as cortisol and adrenaline. When these hormones are high, our sympathetic nervous system is turned on. As explained earlier in this book, we need the other nervous system, the parasympathetic nervous system, the “rest-and-digest” one, to be dominating when we are eating in order to digest our food well. I hope that, after a month, your rest-and-digest system has had a chance to get more into action, your digestion and absorption have improved so that food is broken down better, and dysbiosis has gone and consequently your microbiome serves you better.
So by all means enjoy caffeine, but I recommend limiting it to one really great cup of coffee daily. Coffee does contain some polyphenols, which can increase friendly bacteria, but if you have too much coffee you may risk your sympathetic nervous system becoming revved up, which means you may not digest your food so well overall and there is a danger of your digestive health suffering. Better to get your polyphenols from dark-colored plants such as blackcurrants, blueberries, black grapes, olives, red chicory, plums, cherries, raspberries, red onions, pomegranates, or nuts and seeds such as pecans or flax seeds, or tempeh, without caffeine attached. Remember, even decaffeinated coffees and teas contain small amounts of caffeine.
9.Use Extra Virgin Olive Oil As Your Default Oil Long Term
Extra virgin olive oil has been shown to make us live and look better longer, and subjects on a Mediterranean diet with this at its base (and a wide range of vegetables and fruit) have shorter telomeres – markers of aging. Telomeres look like strings inside our cells and shorten as we get older. However, those who use olive oil see slower shortening of these telomeres. You could call it the perfect anti-aging food. Even when extra virgin olive oil is cooked (rather than consumed raw) in the diet, the benefits to healthy aging and a healthy heart have been shown to shine through. In the (now famous) 2013 New England Journal of Medicine PREDIMED study, more than 7,000 Spaniards who were at high risk of heart attack were put on a Mediterranean diet, which included 4 tablespoons of extra virgin olive oil or nuts (⅓ cup of mixed walnuts, almonds, and hazelnuts) every day. The results were then compared with those of a low-fat diet group. The Mediterranean diet groups encountered up to a third less heart disease compared with the low-fat diet group, running along the same timescale (the study was halted at just under five years). The Med diet was deemed so much more effective than the low-fat one that the ethics committee cut short the study. As for your microbiome, extra virgin olive oil contains polyphenols even when heated, which can help the friendly bacteria flourish.
10.Get Dirty
In our society there is great emphasis on good hygiene – avoiding dirt, vigorous hand sanitizing every second that we can. It is now thought that we have become too clean, and the hygiene hypothesis suggests that not getting dirty enough is triggering a generation of atopic children. Atopic allergies are those such as eczema, asthma, and hay fever. When we stroke cats, play in mud, or live as part of a big family, we are exposed to lots of germs, and our immune system is trained well and knows how to fight when something really dangerous comes along. However, nowadays our children often play indoors on computer screens and don’t get dirty, and as a result they don’t have strong immune systems to protect them from pollen, or gluten, which a robust immune system could do. A diet rich in plant diversity can help increase bacterial diversity in the gut, which primes the immune system to work well. But being less zealous with the hand sanitizer, owning a pet, mixing with lots of people, and becoming a gardener handling rotting vegetation and mud may also help.
11.Be Cautious About Antibiotic Use
As mentioned before, antibiotics can be lifesavers, but chronic use of them for the small fry could be contributing to obesity and lowering our immune resilience. When we take antibiotics they kill the friendly bacteria in the gut as well as the pathogenic bacteria causing that ear infection, leaving us more vulnerable to getting ill again. If you do have to take antibiotics, make sure you’re keeping your vegetable and fruit count at seven cups a day, that you’re concentrating on lots of variety and color, and add in kefir, Roquefort, fermented miso or tempeh for a few days to help get the friendly bacteria in the gut flourishing again. You can do this while taking antibiotics, but it is recommended that you have these foods a couple of hours away from the time when you take your medicine, so the bacteria have a chance to embed.
12.Identify a Few Days a Week When You Don’t Drink Alcohol – Especially If You are Female
Many participants on The Gut Makeover said they didn’t miss alcohol after a few days, and that at the end of the month they drank less in quantity, and less frequently, than they used to. They reported that cravings for alcohol reduced, and some said they felt they didn’t actually need it any more to have a good time. Many found enjoyable alternatives when socializing – e.g., Virgin Mary cocktails, sparkling mineral water dressed up in a champagne flute, coconut water, or even pure watermelon juice.
It’s worth remembering your gut health when and if you go back to drinking alcohol. Too much can lead to an irritated gut lining and act like weed killer on your gut bacteria, which could lower your resilience. The month spent doing the Gut Makeover has allowed your gut lining (which may have been irritated by chronic drinking) to heal and repopulate your microbiome.
So the big question is, how much is too much? No one knows exactly, and every one of us is different, but if you drink enough that you wake up a little dehydrated and below par the next morning, the chances are your gut may have taken a pounding too.
There is much controversy around so-called “healthy” drinking, and current government guidelines are no more than an educated guess at what is supposedly all right. The liver needs a rest from drinking at least two to three days in a row each week to have time to repair itself. A healthy liver is essential for balancing our hormones and filtering out toxins so we don’t develop cancer.
The microbiome has only recently been identified as an organ in its own right in the human body. I believe it is only a matter of time before drinking advice will go beyond just talking about the liver and will start to discuss protecting the microbiome too.
Meanwhile, in 2015 a couple of hair-raising big studies added further weight to the idea that daily drinking is not a good idea. The BMJ paper on 136,000 people studied over 30 years showed that low to moderate alcohol intake (i.e., one glass of wine a day) increases a woman’s cancer risk (predominantly breast cancer) by 13 percent. In an accompanying editorial, one of the authors wrote: “All people, whatever their medical history, are recommended to take a break from drinking a few days a week.” All the exact mechanisms behind the cancer link and alcohol aren’t fully understood, but alcohol may lead to increased levels of the hormone estrogen and could be damaging DNA in our cells.
The other study weighing in on this subject was in The Lancet, which involved 115,000 people in 12 countries and showed that any potential benefits to heart health from wine are outweighed by the increase in the risk of cancer from alcohol consumption. The risk for cancer was 38 percent higher in wine drinkers than those who never drank alcohol, and 20 percent higher in beer drinkers. The bottom line: if you’re drinking wine for heart health, there is no net benefit when you add in the increased cancer risk.
Red wine contains polyphenols which – wait for it – could actually be supportive of the microbiome. Why haven’t I been drinking that for the last month, you may be asking? Well, the idea behind this plan was to give your gut lining a chance to completely recover from habitual onslaught of alcohol, and to give your gut flora an uninterrupted chance to really bloom. Polyphenols are the antioxidants found in foods like extra virgin olive oil and a multitude of vegetables and fruit, as mentioned above, but you can easily and very quickly outdo any of the benefits of the polyphenols from wine with the alcohol that is also in the wine. So if you do decide to go back to wine and want to protect your microbiome and keep your cancer risk low, my advice would be to drink one drink when you do drink, and not on consecutive days – so give your gut and liver a rest several days a week.
These numbers are way below many government guidelines, but I think they are more in line with the latest research on cancer risks. According to Cancer Research U.K., one in two people born after 1960 will be diagnosed with cancer at some point in their life. Prevention is always better than cure, I say, and reviewing one’s drinking is a good place to start.
Of course, after a month off you may decide not to go back to drinking at all. Before they started the program, many Gut Makeover participants were concerned that not drinking might exclude them from social groups, but just one week into it many had already rejected this idea. They were able to see their family and friends as usual, and adapted to enjoying other drinks while socializing. One said she felt very smug waking up the next day without a hangover and bounding with energy, while her partner was a bit worse for wear.
If you are having a drink, I recommend doing so with a meal or some aperitif nibbles to cushion the impact of the alcohol on your gut lining and avoid irritation.
While on the subject of aperitifs, a tip – one small aperitif now and again could be helpful for some people’s digestive systems. As I said before, we are all different, and what works for one person may not for another. But for some, particularly those who may suffer bloating after a meal, the occasional strategically positioned aperitif may actually help. This is another example of a cultural practice with a benefit and explains why traditional aperitif drinks are usually bitter concoctions by default. As I explained earlier in this book, bitter-leaf salads and lemony vinaigrettes can stimulate production of stomach acid so we break down our food better. Food that has been broken down well is less likely to cause bloating farther down the digestive tract, or cause dysbiosis. Drinking a small, bitter aperitif can also stimulate production of stomach acid and lead to better digestion and less bloating in some people. The odd bitter Campari with soda and ice, or a gin and tonic as an aperitif washed down with a few olives (or fermented pickles), or even a nice glass of chilled dry champagne may help you out. The combination of these drinks and nibbles mean you aren’t drinking on a totally empty stomach; they are also quite bitter, and if the pickles are fermented they could help your gut flora. But remember, this is beneficial in the big picture if you only drink aperitifs now and again, and not on consecutive days.
If you do end up having a few too many one evening, do some gut repair and flora help the next day. Get your chicken stock out of the freezer, heat it up with a little sea salt, and sip it gently. It contains lots of electrolytes to replace those that you may have lost by drinking and the collagen helps restore your gut lining. A few sips of kefir could help, too, by planting friendly bacteria back into your microbiome.
So seven plants a day, as many different varieties and colors as possible, lots of fish, some meat – particularly wild or game, nuts and seeds, pulses (lentils, chickpeas, etc. – now your gut has repaired we can reintroduce these), sourdough bread (if you can tolerate it), extra virgin olive oil, a little red wine, a little dairy in the form of artisan-produced fermented cheeses from goats or sheep. Sounds good, doesn’t it? And it would support a healthy digestive system very well, too.
That is essentially what the Mediterranean diet is, and it is easy to transition to after your Gut Makeover. If you follow the 12 principles above, your diet shouldn’t be dissimilar to a real Med diet.
Some of us may not want to keep a hunter-gatherer-style diet going forever, and with just a few tweaks could benefit and enjoy a Mediterranean-style diet for the long term.
Some Gut Makeover participants reported that they hadn’t realized how far from a natural diet their usual diet had been until their Gut Makeover, which encouraged them to shine a spotlight on their usual habits. It can be surprising to discover that diet colas containing artificial sweeteners, sugary drinks and cakes, bread or pasta with most meals (meaning little rotation with other grains), highly processed tofu and soya, and processed meats containing nitrates and other preservatives and additives, all washed down with lots of caffeine, have comprised more of your original diet than you may have realized.
Post-Gut Makeover, this is your chance to keep out old habits. In the supermarket, ask yourself:
•Would I put this ingredient in this dish if I were cooking it at home?
•Would a person living in a rural village in Greece pre-1960 have eaten or drunk this?
•Would a hunter-gatherer in the Amazon easily convert to this food and remain fit, active, and healthy?
One aspect of the Gut Makeover has involved excluding for a month certain foods known to be the most troublesome to a happy gut. These include gluten and other grains (e.g., rice, oats, couscous, corn and quinoa), highly processed soy that has not been fermented, sugar and artificial sugars, and for ominvores, pulses (e.g., beans and lentils). In the first half of the program, dairy from milk products was also kept at bay, and in the second half it was limited to kefir and Roquefort, which were added to the diet on a prescription basis. The diet has also been alcohol- and caffeine-free throughout. Pausing these foods and drinks not only removes potential triggers to digestive problems and potential inflammation in the gut itself, or elsewhere in the body, but also gives the digestive system a chance to recover and repair itself without the usual daily assaults it may not have been very happy about. The inside of the intestines, the villi (the shag-pile-carpet-textured area of the gut designed to provide maximum absorption for digested food), is one of the fastest-renewing areas of cells in the body. Depending on how much sensitivity to certain foods has been going on there, your Gut Makeover should have allowed your villi a good bit of R&R (rest and recovery) and, aided by well-digested proteins and collagen-rich stocks in your cooking, an opportunity to repair any collateral damage.
If you have suffered long-standing gut issues and have felt much better over the last month, you may be feeling a little nervous about reintroducing some of the above foods. In this case I would suggest reintroducing foods in a structured manner so that you can monitor any symptoms immediately, or in the hours or days afterward. Many medics consider the process of “elimination and challenge” to be the gold standard for identifying food intolerances. Having done the elimination part during Gut Makeover month, this may now present you with a blank canvas to do the “challenge” detective work, to provide information for managing your health long term.
You may already have a sense of which foods might be most troublesome from your experiences before your Gut Makeover. In this case, make a list of them and decide in which order you will carry out your challenges. So, decide on a food (e.g., gluten), eat it once a day for three days, and monitor your symptoms. For example, have a piece of toast or a bowl of pasta three days in a row. The reason it is better to do each challenge over three days, though it may seem like painstaking work, is that a reaction doesn’t always happen immediately. Some people may bloat in the couple of hours afterward, some not at all. Others see a worsening of a skin condition over the three days, but not immediately. There may be a return of certain immune reactions, such as coughing, asthma, watering eyes, or an itchy scalp or a very bad headache. It may be as simple as bloating, wind, or a change in stool movements (either becoming constipated or having loose stools). If you do get an instant reaction to a food you have your answer already. Wait a couple of days till trying another new food, to let inflammation subside, so that you can notice any reaction coming from another food when you try it.
When you have the information you need, or you think everything is OK, move on to the next grain and try that. You may be OK with gluten but not with rice, for example, or OK with rice and gluten but not quinoa, and so on.
If you identify a food trigger, rejoice. You now have a potential answer to a long-standing problem. If that is the case, consider removing that food from your diet for the long term, and think about how to replace the nutrients you may have received from that food from other sources. For example, the carbohydrates found in gluten and bread are also found in fruit and vegetables, so if you continue to eat 7 portions of plants a day in the long term you will get plenty of carbohydrates for energy. Darker-colored breads can be a source of B vitamins, but if you eat plenty of plants, and therefore have a healthy gut, your colon should manufacture lots of B vitamins to help the body release energy from food and also encourage good mental health. So if you replace the space on your plate with mountains of vegetables, removing gluten from your diet should not leave you in any kind of nutrient deficit.
In the second half of The Gut Makeover, we discussed the issue of monitoring your symptoms with the reintroduction of some milk dairy in the form of fermented milk kefir and Roquefort cheese. Fermented milk products are supposed to be easier for the digestive system to process than other types of dairy because the lactose is already partially digested due to the fermentation process. So if you had any inkling of discomfort when you tried introducing those foods – anything from digestive symptoms to skin issues flaring up again – it may be that you have a sensitivity to either lactose or one of the proteins in milk products such as casein or whey, and dairy is best avoided longer term if your goal is optimum health. If you do decide to remove these foods from your diet for the long term, it is even more important that you load up your plate every single day with mountains of fresh leafy green vegetables and some nuts and seeds, as many of these foods contain decent quantities of calcium needed for healthy bones, which you will need to get from elsewhere if you aren’t having dairy.
You may have discovered a lot of new things about you and your gut on this program, and perhaps now things are a bit better but not completely right. This may be because your gut has further underlying disturbances, causing your gut to leak and your microbiome to be out of balance (e.g., parasites, yeast infections, small intestinal bacterial overgrowth, insufficient enzymes, or extensive food sensitivities – or a mixture of these). In this case I would suggest working with a functional medicine practitioner in North America. Functional testing and personalized and targeted supplementation of specific strains of probiotics may be helpful. They can help identify any underlying imbalance in your physiology that is the root cause of your ill health. This may be dietary, or lifestyle, or a combination of both.
You can find a functional medicine practitioner on this directory here: www.functionalmedicine.org/practitioner
Many have access to, and are trained in interpreting, a wide range of cutting-edge testing – for example, blood tests for testing food intolerance by U.S.-based Cyrex Laboratories and personalized genetic testing using saliva from Nordic Laboratories in Denmark, or comprehensive stool tests that look at the diversity of your microbiome from U.S.-based Genova Diagnostics or Doctor’s Data. These sensitive tests can also pick up a wide variety of parasites and stomach bacterial infections, such as Helicobacter pylori bacteria (symptoms are nausea and chronic acid reflux), which drill holes in your stomach and can lead to stomach ulcers and cancer if left untreated. Comprehensive stool tests can measure specific types of bacteria in the colon and give you an idea if some of the friendly ones are low. They also give an idea as to whether you are producing enough of the right enzymes in the gut to break down food, and if the levels of short-chain fatty acids and butyrate needed for a healthy gut lining are sufficient.
Cyrex Labs offers a blood-based, impaired intestinal permeability test that measures levels of the protein marker zonulin. They also offer advanced gluten testing, but you need to be actively eating gluten for a month for an intolerance to show up on the test. They also now offer a test for intolerances to a wide range of foods including cooked vs. uncooked, food coloring and gums founds in processed meats, and a wide range of nuts and seeds. If you are a complex case and need a more personalized approach, an experienced functional medicine practitioner may be the way forward.
As you’ll have gathered from this book already, there is a strong link between our mind and gut. If you’ve ruled out all of the above issues in relation to the gut and are still having issues, it may be worth considering embarking on a talking therapy for support.
Congratulations on finishing The Gut Makeover! You have made a great investment in your health, and I guarantee that your life is unlikely ever to be the same again. The knowledge you now have about the gut – your gut – will be with you for the long term. If you have reintroduced foods in a staged way, you should have been able to work out the best personalized diet for the individual you are. It may combine elements of hunter-gatherer and Mediterranean, or be more one than the other. Whether it’s pulses, or dairy, processed soy, or gluten, or bolting your food, knowing the root cause of poor gut health can support good health for the long term. Once you have a picture of what works best, try to practice that style of eating long term. However, there may be setbacks and communication is going to be key.
A recent Gut Makeover participant who saw her long-standing gut issues disappear during the one-month plan keeps many elements of the makeover going. She recently visited a relative whom she assumed would remember from her last visit that she is now gluten free. On arrival she was presented with a home-made lasagne, which she felt too embarrassed to not eat. She politely ate it, but told me: “I was on the toilet, had abdominal pain and bloating for days after.” Her advice: “Don’t assume people will remember your dietary needs. You have to be strong about communicating for the sake of your health. My relative may have taken half a day to make the lasagne but I’m sure they wouldn’t have wished me a week of pain.”
Managing Change
I’d like to share with you some of the thoughts that tend to go around in our minds when we make big changes in our lives. Human beings are not designed for overnight change. Change happens gradually, in stages, and I’d like to show you how far you’ve come in just one month.
Few people wake up one morning ready to be convinced to do the Gut Makeover. Yes, some may, but the majority will have had to have heard the new buzz word “gut” a few times, and to have read or heard about the links with our health and weight before coming on board. There are five stages of change – what follows is an example of how it may work when it comes to changing your diet.
Stage One – Denial
You hear about this book: “I eat loads of vegetables every day. I don’t need to increase them!”
Stage Two – Contemplation
You keep hearing about this book: “Seven cups? Seven fists of plants? That sounds mad. I probably have three or four a day.”
You hear about the link between a large variety of plants each day and a healthy gut, and you hear about 7 large portions being better than the standard 5. You hear about the links between the gut and weight, mood, skin, and immune system and start to wonder if your gut isn’t as healthy as you thought – if perhaps, after all, you could ramp up your vegetable intake and widen your variety, and that there might be some major wins by doing so.
Stage Three – Preparation
You buy this book. Hurray! This is the exciting bit. You’re reading the book cover to cover, you’re looking at your calendar to identify the best four weeks to do the plan that will afford you the best chance of success.
Stage Four – Action
You are actively engaging with this book. You’re reducing your intake of alcohol and caffeine. You’re moving on to week 1 (quite hard), week 2 (amazed at how blunted your hunger has become, and how you are enjoying the new style of eating and trying new recipes), week 3 (this is a whole new way of life!), and week 4 (I’m not sure if I want to go back to my old ways after all this). You may be actively participating on the Facebook Gut Makeover page, sharing experiences, recipes, and achievements and offering peer support.
Stage Five – Maintenance
You’ve had success from this book and now you are looking and feeling great. In your new everyday diet you are eating 7 large portions of plants a day as standard, and when you go to the supermarket you deliberately pick as many different types as possible, and continue to push the frontiers in the veggie department, trying every strange new plant available. You’ve massively cut down on alcohol and coffee (or haven’t had the urge to go back to them); when (and if) you do eat bread, it’s sourdough; and you try to have a fermented food such as kefir each day. You’ve lost the habit of snacking, and only rarely do you crave chocolate. You might have some dark chocolate now and again in a home-made dessert or a cake, but you’re more vigilant about the quality and quantity of what you put in your precious gut.
Identifying and Avoiding Traps
For you to sail along on the maintenance stage for the long term, do rally support from friends, family and colleagues – and perhaps even your employer. Role-modelling healthy eating often creates a better culture around you as groups tend to adopt one another’s habits. You may decide to spend more time with people socially who share your health-conscious values, or have also done a Gut Makeover. Or you may choose to work for an employer who actively supports employees looking after their health – this might be cultivating a culture of not eating at desks, providing tables or a lunch room where people can eat away from the pressures of their work, or making sure employees get proper time to rest and digest with their families when they get home, without being bombarded with emails expecting quick responses after hours.
Be mindful. This is a four-week plan where you will learn a great deal about your gut, so you can work out the right way for you for the long term. Be aware of returning to old, unhelpful habits if they weren’t working for you before. Make a commitment to the new ones that you have found really worked for you. You may even need to repeat your Gut Makeover from time to time for a reset, to make certain habits and food choices stick for the longer term. It’s worth acknowledging that change in any of us isn’t usually overnight and can involve lots of practice, time, effort, and attention. Learning what combination of foods suits your gut and helps you best manage your weight varies from person to person. Once you have your best-case diet established (starting with a happy gut), devote practice to it.
Also bear in mind that support from others can be very helpful to maintenance. This is why doing this plan with other people or with a friend, or having a relative taking an interest in your journey and listening and empathizing, or plugging into a Facebook page with others, can help us reach and maintain our goals and make the whole experience a little more fun.
Another simple tactic to help prevent relapses is to identify your triggers. The next time you crave a bar of chocolate or make a date to meet a crowd you know will insist you binge-drink with them, try to notice what else is going on in your life at that moment. You may find there are particular emotional upsets that trigger a particular food or drink binge or have you phoning the heavy drinkers for a night out.
I’m going to share here my emotional food-eating trigger. It was only when I started studying nutrition and we looked at the functional medicine model that I was alerted to even start thinking about triggers.
Previously, if I ate an entire big packet of Kettle chips in one sitting the voice in my head told me I was a glutton and a sloth with no self-control, and I felt a pretty nasty loathing toward myself. A bit heavy, I know, and seeing it written down here makes me think I wasn’t particularly empathetic or kind to myself.
Then one day I had some upsetting news and, without even thinking about it, I stopped off at a supermarket, dashed round to the snack section and bought a giant bag of Kettle chips. I then walked home stuffing them down at breakneck speed until the entire contents were gone, scraping and licking the salty bits out of each corner of the bag to finish off. It might be obvious to anyone else that me being upset was my trigger for a salt binge, and I’ve since identified that it’s the salt that gives me the kick, rather than the fat content. But I hadn’t made the connection until then. Now if I’m upset, I notice the craving, and make a mental note to actively avoid Kettle chips. I generally don’t have them in the house any more for this reason. But if I am upset and feel the need for salty food, I may buy a packet of sushi instead and shake some tamari sauce on top as a healthier choice. Sushi rice, by the way, is cold and forms resistant starch, which is good for the gut, so on the maintenance part of the program it may satisfy more than just a salt craving if you enjoy it and can tolerate rice.
Take note of what you crave next time you’re upset and see if there is something that might be a better food choice instead. Or maybe it’s the company of a friend who is a good listener over a cup of tea you need, rather than a night downing tequila in a big group. If you need fat and crave nuts, go for it, but an effective way to limit going overboard is to buy, or have in the house, only a small bag rather than the giant packs – even though they are cheaper. Even better is to remember to chew slowly. If it’s chocolate, go for the darker ones with the polyphenols (another good gut nutrient – as long as it doesn’t have too much sugar!). Gosh, there I go again, back to the gut …
Welcome to a new way of life. A healthy gut-centric kind of life.