Originally posted by Dr. Davis on 2015-03-28
on the Wheat Belly Blog, sourced from and currently found at: Infinite Health Blog.
PCM forum Index of WB Blog articles.

The ABCs of your post-grain experience

Wheat/grain elimination is an exceptionally powerful tool for restoring health, reducing inflammation, returning metabolic distortions such as high blood sugar and blood pressure back to normal, and for losing weight. But many of the adverse health effects of years of grain consumption do not fully reverse with their elimination. Specific efforts may therefore need to be undertaken to accelerate your return to full health. Taking these extra steps stacks the odds heavily in your favor that you will enjoy full recovery from abnormal health conditions.

Among the strategies to consider are:

Cultivate and nourish healthy bowel flora
I like to think of bowel flora, the thousand or so species of microorganisms that inhabit the human gastrointestinal tract, as a garden. Probiotics, i.e., anything that provides microorganisms believed to be among the desired inhabitants such as the various Lactobacillus or Bifidobacteria species, are like planting seeds for peppers and zucchini in your garden in spring time.

But what if you planted your seeds, then neglected to water and fertilize your garden? If you’re lucky, you might have a few peppers and zucchini after a few weeks, but you’re more likely to have a few stunted vegetables or nothing except a few shriveled vines. A successful garden requires water and fertilizer.

So it goes with bowel flora. You eliminate the extraordinary bowel-disruptive effects of grains–gliadin, gliadin-derived peptides, wheat germ agglutinin, indigestible D-amino acids, trypsin inhibitors, and others–then “plant” some desired species from a probiotic preparation or fermented food, but then fail to nourish them. It means that desired species may not proliferate, they may not outnumber and overpower unhealthy species such as E. coli, Staphylococcus aureus, Clostridium difficile, and Firmicutes. Unhealthy species are allowed to proliferate, thereby increasing intestinal permeability and resulting in higher blood levels of the bacterial byproduct, lipopolysaccharide, that is highly inflammatory. It also means that healthy bacteria fail to produce fatty acids, especially propionate and butyrate, that are required by intestinal cells for normal metabolism, heal “tight junctions” between cells (disrupted in conditions such as ulcerative colitis), and reduce potential for colon cancer. It also means that metabolic benefits, such as reduced insulin and blood sugar levels, reduced triglycerides, reduced blood pressure, and reduced visceral fat do not result–all because desirable bowel flora were not “fertilized.”

So what acts as water and fertilizer to bowel flora? What feeds them, allows them to proliferate and yield factors such as butyrate? Fibers. But not all fibers.

In a fascinating tale of symbiosis, the coexistence of microorganisms and Homo sapiens, a specific class of fibers, i.e., polysaccharides or polymeric sugars, that are indigestible to the human digestive apparatus but digestible via the enzymes expressed by specific bacterial species, allow all these beneficial health effects to occur. It means that food, chewed, swallowed, bathed in stomach acid, emulsified by bile, broken down into constituents by pancreatic enzymes, exposed to 20-some feet of small intestine, finally reaching the colon where most microorganisms dwell, contains little remaining nutrients to nourish bacteria. The desirable species that thrive in this unique environment are those that can digest the undigested remains of your meal–fibers. But not cellulose fibers, i.e., wood fiber, of the sort that dominates in grains and is found in bran cereals. Cellulose is essentially indigestible by both our own digestive apparatus, as well as the bacteria that humans are capable of carrying. (It is digestible by ruminants.)

The proper care and feeding of bowel flora therefore causes proliferation of healthy Bacterioidetes, Lactobacillus, and Bifidobacteria that produce bacteriocins that suppress growth of unhealthy species, metabolize fibers to butyrate that yields metabolic benefits, even improves bowel habits and allows you to have normal, healthy bowel movements without “crutches” like the bulk of cellulose fibers, laxatives, or enemas.

Is this evolutionarily appropriate? Is there precedent in human adaptation on this planet for such unique fibers? I ask this question because this is my litmus test for the suitability of any dietary strategy we consider. Recall, for instance, that grains were added 300 generations ago, or 0.4% of our time on earth, a mere moment in time ago. They are inappropriate for human consumption, now made worse by the genetic fiddlings of agribusiness. (I have to concede that grains do indeed have some fibers that have health benefits, such as arabinoxylan in wheat and beta glucan in oats, but they come with such undesirable other components that it is simply not worth it.) Yes, consuming such fibers is evolutionarily appropriate, as it dates back well over 8000 generations of human existence, predating even the appearance of the Homo species, even predating carnivory, as it was practiced by pre-Homo hominids, Australopithecus (especially “robust” strains). It is therefore deeply instilled (I almost said “ingrained”–acchhh!) into the adaptive physiology of our species.

So how do we obtain such indigestible fibers that nourish healthy bowel flora, so-called “prebiotics” or “resistant starches”? Well, do what a member of the Hadza of sub-Saharan Africa or Yanomamo of the Brazilian rainforest would do and grab a stick, stone, or bone fragment and dig in a field or forest for the underground tubers of plants. If you don’t want to do that, you can incorporate foods available in modern grocery stores that mimic such practices. Among the foods that yield such fibers:

• Green unripe bananas or plantains–with around 27 grams prebiotic fibers per medium sized banana
   
• Raw peeled potato–with around 20 grams per 3½-inch medium
   
• Inulin powder–with 5 grams per teaspoon
   
• Bob’s Red Mill raw unmodified potato starch–8 grams per tablespoon
   
• Legumes, lentils, chickpeas, hummus–Around 3 grams per ¼-cup. But we have to be careful here, as any more than this quantity and blood sugars start to climb to unhealthy levels.

These are the most efficient sources, with lesser quantities in other below-ground vegetables. I pick one of the above foods and include them in a smoothie every morning along with, for instance, a cup of unsweetened coconut milk, some blueberries or other berries, a few drops of stevia, etc. If you choose the banana, peel it like an apple or chop off the ends and slit the skin, as it is very tough to skin when green. Chop both banana and potato coarsely before putting in the blender; a blender with a strong motor is advised. Rely on NO MORE than 2 level tablespoons of the potato starch, as more will raise blood sugar; use other choices to amp up your intake.

The science that examines bowel flora composition tells us that 20 grams of such fibers yield substantial effects. While the average grain-consuming human obtains around 3 or 4 grams per day, us grain-deniers can fall below this and experience undesirable bowel and metabolic effects. Benefits begin around 8 or 9 grams per day, with maximal benefit likely around 20 grams. (Interestingly, there is anthropological evidence of intakes as high as 135 grams per day.) When new to this experience, start with no more than 10 grams fiber per day; more and abdominal pain and bloating can occur; build up over days to weeks. Full benefits, such as reductions in blood pressure and blood sugar, require 4 to 8 weeks to show themselves, likely due to the shifts in bowel flora species.

Vitamin D
I rank correction of vitamin D deficiency as second only to wheat and grain elimination as the two most powerful strategies for overall health I have ever seen in my 20+ years of medical practice.

Vitamin D deficiency is rampant, given life in northern climates, wearing clothes year-round, working indoors, and the gradual loss of the ability to activate vitamin D in the skin as we age. It means that having a favorable vitamin D level in the body is uncommon outside of tropical climates or during summer months with plenty of skin surface area exposure in young people.

Among the benefits of restoring vitamin D are: improved mood and freedom from seasonal mood fluctuations; rise in HDL, drop in triglycerides; reduction in insulin and blood sugar; reduction in blood pressure; improved bone and joint health, including increased bone density; reduction in coronary disease risk and cancer; reduction in potential for dementia. And you just feel so much better.

The ideal approach to restoring vitamin D is to take a dose that raises 25-hydroxy vitamin D blood levels to 60-70 ng/ml (150-180 nmol/L). While dose needs vary from individual to individual because of body weight, relative proportion of body fat, time of year, age, and genetics, most people require 4000-8000 units per day in gelcap or droplet form (not tablets: very poorly absorbed, sometimes not at all). Note that, if you are following blood levels, it requires 3 months for levels to stabilize after initiating supplementation or any change in dose.

Iron, zinc, magnesium
Absorption of positively-charged minerals, especially iron, zinc, and magnesium, is blocked by the phytates of grains. The second most common worldwide cause for iron deficiency anemia, for instance, is grain consumption, second only to blood loss (e.g., menstrual cycles). The phytate content of a bagel or two slices of whole wheat bread is enough to block iron absorption by 90%. Iron deficiency results in fatigue, lightheadedness, feelings of being cold, poor physical performance. Zinc deficiency most commonly results in skin rashes, itchiness, impaired growth in children, learning impairment, and gastrointestinal distress. Magnesium deficiency shows up as muscle cramps/”charlie horses,” higher blood pressure and blood sugar, loss of bone density, and heart rhythm disorders.

While mineral absorption improves dramatically with wheat and grain elimination, iron and magnesium typically need to be supplemented to make up for severe deficiency. Iron is best managed by checking a blood level of ferritin and a complete blood count (CBC), as iron overload can also occur. Magnesium can be safely supplemented on your own by the vast majority of people; I recommend taking the magnesium malate form, 1200 mg twice per day (180 mg “elemental” magnesium twice per day). Zinc can also be safely supplemented, 10-15 mg once per day.

Iodine deficiency—
Most of us have forgotten that, up until the early 20th century, iodine deficiency and goiters (enlarged thyroid glands) were major health problems worldwide, affecting 20% of people in most regions. The addition of iodine to table salt, along with encouragement to use plentiful salt solved the issue of iodine deficiency . . . but then led to adverse effects of overuse of salt in at least some people.

So modern people have been advised to cut back on salt–but everyone forgot about the iodine. Iodine deficiency has numerous health implications. It can take on special significance in the early wheat- and grain-free experience in that it can impair your ability to lose weight and impair full recovery of health.

I therefore urge people to obtain an inexpensive iodine supplement such as iodine drops or kelp tablets (dried seaweed) that provides 500 mcg of iodine per day, what I believe to be the ideal intake of iodine. People with Hashimoto’s disease, Grave’s disease, or history of thyroid nodules or thyroid cancer should work with their doctors on iodine issues (though seek out a healthcare practitioner knowledgeable about this issue–most doctors are not), since iodine restoration needs to be managed carefully in these situations. However, those of us without these conditions can simply supplement iodine, allowing the thyroid gland to operate at full capacity.

Omega-3 fatty acids
The omega-3 fatty acids, EPA and DHA, available only from fish oil in truly healthy quantities (NOT flaxseed, chia seed, nor krill oil) yield considerable health benefits that include accelerated clearance of the byproducts of digestion (that contribute to heart disease), reduced triglycerides, and reduced overall cardiovascular risk and cancer risk.

However, a sufficient dose needs to be taken to achieve such benefits. I therefore advise people to take 3000 mg per day of EPA and DHA, divided in two. This is the level that raises the level of omega-3 fatty acids in blood cells to 10% or greater in most people, the level associated with maximum benefit. The best fish oil is the triglyceride form, i.e., the form that occurs naturally in fish. This is available as liquid fish oil from producers such as Halifax’s Ascenta NutraSea.

No gluten-free junk carbs
This bears repeating, as so many people interpret the Wheat Belly message as a “gluten-free” message, then booby-trap their health with gluten-free foods.

Let me be very clear: I do NOT advocate consumption of gluten-free processed foods made with cornstarch, tapioca starch, potato flour, or rice flour–they raise blood sugar sky-high, cause visceral fat accumulation, inflammation, and increase risk for cataracts, hypertension, diabetes, heart disease, cancer, and dementia.

We therefore replace wheat and grains with healthy choices that do not cause such problems. Don’t replace a problem–wheat and grains–with another problem–gluten-free junk carbohydrates.

Be aware of dairy casein beta A1
There are a number of tricky issues with dairy products, including lactose, potential exposure to antibiotic residues and bovine growth hormone, and estrogens. However, the real problem for many people may be a form of casein dairy protein produced by North American cows called casein beta A1.

Casein beta A1 is an immunogenic (immune system stimulating) form of casein that appeared through a chance mutation in cows around 6000 years ago. It is believed to underlie at least some cases of type 1 diabetes in children, some instances of autoimmune diseases like rheumatoid arthritis, heart disease, even sudden infant death syndrome.

Most dairy products in North America contain the casein beta A1 form, though it is present in small quantities in cheese and butter. Goat and sheep products do not have this form of casein.

That’s it!
Yes, it takes a bit of effort. But if your goal is to stack the odds in favor of full recovery from any condition, or to powerfully prevent such conditions, these strategies are your best, most accessible, inexpensive, yet effective ways to do so.

More discussions like this can be found in Wheat Belly Total Health.