Fermenting gut - the Full Monty

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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

Starve them

The mainstay of treatment is the ketogenic diet 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. Please see Ketogenic diet - the practical details.

See also:

Kill them

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. Avoid prescription drugs which symptom suppress and do not address the root causes.

Take vitamin C to bowel tolerance - ascorbic acid is ideal -- start with 1-2 grams in your daily water bottle and drink little and often through the day -- build up to bowel tolerance which for most is 7-10 grams daily

Take Lugol's iodine 15% 2-3 drops at night. Iodine is one of my favourite multi-tasking tools and has many other benefits

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.

Monitoring blood sugar and Vitamin C

Bear in mind that the DIY home tests for blood sugar rely on a test that employs glucose oxidase. Vitamin C cross-reacts – so if you are taking vitamin C to bowel tolerance your blood will be saturated with vitamin C and this may give false highs. My experience is that this may be 2-3mmols/l higher than the actual blood glucose. That is to say an apparent reading of 7-8mols/l equates to a real reading of 4-5mmol of glucose.

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. 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. Make sure you are still in ketosis by testing.

Practical ideas for smoothies

An essential tool is a food processor or juicer which reduces foods to tiny particle such as Juice Master or Nutribullet at Amazon.co.uk.

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

Faecal bacteriotherapy

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!

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