Fermenting gut - the Full Monty
The upper fermenting gut is a major problem for which I have a lot more good questions than answers! The upper gut (stomach, duodenum and small intestine) should be a near sterile, digesting gut and the lower gut should be fermenting vegetable fibre with friendly anaerobic bacteroides, producing short chain fatty acids. The principles of treatment of upper fermenting gut are to starve the little wretches and also to kill them. See Fermentation in the gut and CFS
The mainstay of treatment is a low carbohydrate, high fat diet. Fat is a perfect fuel because no microbes can ferment it. Microbes in the upper gut are as hungry for B vitamins and minerals as human cells, so these nutrients should be given transdermally, if possible. High dose live fermenting probiotics are very helpful by competing with bad bugs for space and for substrate.
Restoring normal digestion is very helpful. The stomach should be acidic because acid kills all microbes. Hypochlorhydria (see Hypochlorhydria) is a major risk factor for upper fermenting gut. Pancreatic enzymes also kill microbes as do bile salts. There are many botanicals which have antimicrobial activity, such as uva ursi, plant tannins, grapefruit seed extract, berberine, oregano complex, clove oil and many others. Very often prescription drugs are additionally needed.
The business of digesting food is demanding of energy. This is in short supply in my severe ME patients so there is an obvious vicious cycle that can occur here.
Smoothies and juicing
I have seen a handful of patients who have done extremely well using juices and smoothies made up of vegetables, small amounts of nuts and seeds together with coconut oil and lecithin as an emulsifier. This makes perfect sense – no energy is expended in chewing. There are enzymes naturally present in vegetables and fruit for their own digestion and these are released by juicing. There are naturally occurring antimicrobials present in smoothies which again are released by juicing. Fats are reduced to very tiny globules called micelles, which makes them much easier to digest and absorb. Importantly, smoothies and juices are rapidly digested and absorbed so that the stomach remains empty for most of the time. This is essential to allow the normal acidity of the upper gut to be restored between meals because that is an essential part of sterilising the upper gut.
One has to be careful with fruits because the sugar in them can be fermented. However, it seems that some fruit is tolerated when presented in this form.
Practical ideas for smoothies
The idea is that different combinations of vegetables, oils, nuts and seeds can be used according to the following principles:
- Vegetables – avocado, raw green vegetables, raw carrot, beetroot, salad.
- Oils – nut, seed, vegetable, fish, butter (if not allergic to), egg.
- Emulsifying agent, lecithin, to allow the above to mix – lecithin 1-2 teaspoonfuls.
- if the mix is too runny, then add dry ingredients (such as nuts and seeds) – these absorb water to thicken the mix;
- if the mix is too thick, then add wet ingredients (such as Kefir, water or fruit in modest amounts) to thin the mix.
- Add in any required digestive aids – e.g. betaine HCl, pancreatic enzymes, bile salts/lecithin (to emulsify oils);
- Add in any additional nutrients eg vitamins, minerals, essential fatty acids;
- Add in any antimicrobials – e.g. probiotics, vitamin C, botanicals (grapefruit seed extract, garlic, oregano, curcurmin etc) according to test results and clinical picture.
Jason Vale offers useful recipes and demonstrations, which can be seen at Jason Vale's Juicing recipes and smoothies
Coffee enemas and/or colonic irrigation
The overall idea, of course, is to reduce the toxic load of the gut and reduce the energy required and raw materials required to digest and absorb food. A few patients have combined the above juicing technique with coffee enemas and/or colonic irrigation with further improvements. I am a great fan of easy do-it-yourself techniques and coffee enemas given on a regular basis should have such an effect.
Do have a look at Michael McEvoy’s suggestions at Coffee enemas - benefits and guidelines
It may be that the above regimes which tackle gut problems from the top and the bottom are sufficient. However, if this were not the case then the next logical step would be faecal bacteriotherapy. See Faecal bacteriotherapy
This is now available at The Taymount Clinic – it has a good record of results but is expensive.
I welcome feedback from people trying these combinations as I too am on a steep learning curve!
And a whole lot of great recipes to cook for a Stone Age diet and problems with a fermenting gut!
One of my patients, Sally Phillippe, has produced a fantastic collection of recipes for the Stone Age diet and for anyone with a fermenting gut. Enjoy!
More often I now prescribe the ketogenic diet - please see Ketogenic diet - the practical details and My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds
- Fermentation in the gut and CFS
- Faecal bacteriotherapy
- Recipes for the Stone Age diet and fermenting gut diet
- Ketogenic diet - the practical details
- My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds
- Juice Master
- Nutribullet at Amazon.co.uk
- Jason Vale's Juicing recipes and smoothies
- Coffee enemas - benefits and guidelines
- The Taymount Clinic
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