Leaky Gut, Probiotics, Winter Survival
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Image by Lindsay Crowder @lec101

February Health News

Michelle Crowder, ND - Licensed Naturopathic Physician

Click here to view the last newsletter from January 2014.

Being as most of my wonderful subscribers (now over 300 of you!) are located in Michigan, I thought you might enjoy a respite from winter imagery. The above image was taken by my sister at Ocean Beach, California. See the end of this newsletter for more ideas to help you make it through the next few weeks until we start seeing crocuses and tree buds. (One of them being movement, which is even better if you can do it on a magnificent beach at sunset.)
I just started a Pinterest page to organize web-based resources for healthy living, including many of my favorite recipes.  I will be adding new pins regularly, so please feel free to follow me!

Earlier this month, I had the honor to speak to the Pre-Med Club at the International Academy in Bloomfield Hills. It was fun and inspiring to share my story and discuss Naturopathic Medicine with such bright and curious students. I know they will go on to do great things in the world.  
For regular updates on pertinent medical news and research, see my Twitter page. To share this newsletter with friends and family, you may forward it from your email, or use this web link.

En salud,

75 Barclay Circle, Suite 225
Rochester Hills MI 48307

Leaky Gut // Increased Intestinal Permeability (IP)

What is up with this uncomfortable-sounding term?  Is it a real thing?

"Leaky gut" is a term commonly seen in alternative health publications.  Despite the funny name, leaky gut is a real phenomenon supported by a growing body of research, and recognized in the conventional medical community.  The technical term is “increased intestinal permeability,” sometimes abbreviated as IP. 

What is it?
The intestinal wall is made of up cells called enterocytes that regulate the passage of nutrients and other particles from the intestines into our bodies.  In a healthy person, the junctions between the cells should be tight, so that nutrients can be absorbed, but larger particles such as bacteria and their toxins, food particles, and other proteins cannot.  In the setting of inflammation and compromised digestive health, the tight junctions between cells become more “leaky,” allowing some of these particles to pass into our bodies, where they come into contact with immune cells.  In an effort to rid the body of these “invaders,” our immune system is activated.  This sustained inflammatory response is thought to be at the root of conditions such as allergies and autoimmune disease (1, 2), and characterizes "leaky gut syndrome".
What causes it?
Scientists and clinicians are still not sure, but several culprits are suspected: poor upper digestive function (low stomach acid and pancreatic enzymes) (1), food sensitivities (1, 2), stress (1, 2), non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen (1), alcohol (1, 2, 3), and intestinal infections (1, 2).  We know through research that the signaling protein zonulin, which is activated by gluten in vitro (1, 2, 3), leads to leakiness of intestinal tight junctions (1, 2, 3). Thus, consuming gluten (wheat, rye, barley) most likely contributes to IP, whether you are sensitive to it or not. 

What are the symptoms?
Many are possible, but the most common signs, symptoms, and co-morbidities of lP include digestive upset and IBS-like symptoms; food sensitivities; rashes, psoriasis, and eczema; depression; chronic fatigue; and autoimmune conditions such as Crohn’s Disease, Ulcerative Colitis, Celiac Disease, and inflammatory arthritis.  IP can be induced by alcoholism and chemotherapy treatment.

How do you test for it?
IP is often diagnosed clinically, based on symptoms. The standard diagnostic test is Lactulose-Mannitol, in which a solution of these two sugars is consumed, and urine is collected after 6 hours. In healthy people, mannitol will be absorbed and show up in urine, but lactulose will not. If IP is present, both mannitol and lactulose will be absorbed and show up in urine. Low urine recovery of both sugars indicates general malabsorption. As a naturopathic doctor, I search for the cause of illness, so I might order testing to elucidate possible contributing factors – this may include stool testing to look for parasites, a breath test to look for bacterial overgrowth of the small bowel, or food sensitivity testing.

How is it treated?
Treatment depends on the cause.  We might promote healthy function of stomach, pancreas and liver, treat intestinal infections, remove aggravating foods and alcohol, or focus on adrenal function and stress management. A nutrient-dense, whole foods eating style low in refined carbohydrates will be the foundation. Nutrients with general application to IP include: L-glutamine, N-Acetyl Glucosamine (NAG), Zinc, botanical demulcents such as Marshmallow root and Slippery elm bark, and probiotics. Sauerkraut is a particularly therapeutic food in IP, due to its high glutamine and natural probiotic content.

Featured Therapy: Probiotics

We are covered with microbes. Over 500 species reside in our gut alone. It is estimated that microbial cells in and on our bodies outnumber human cells by an average of 10 to 1. These microbes protect us from infection, help us communicate with and tolerate our environment, and harness important nutrients and energy from the food we eat. The use of probiotic supplements in human health is a growing field, with evidence to support their use in treating conditions ranging from digestive upset to eczema to depression. 

As discussed above, p
robiotics are an important aspect of treating "leaky gut" or IP, as they help to improve intestinal barrier function (123)Probiotics also have immunomodulatory effects, meaning that they can both calm an overactive immune system, reducing inflammation, and stimulate an underactive immune system, preventing infection

Additional evidence-based benefits of probiotics include:
  • Improved Digestive Function. In people with Irritable Bowel Syndrome (IBS), 4 weeks on a mixed probiotic led to significant symptom relief, improved stool consistency, and change in microbiota (1, 2). Lactobacillus reuteri helped to prevent colic, regurgitation, and constipation during the first 3 months of life. 
  • Reduction of Allergies and Eczema. When given from birth until 2 years old, Lactobacillus rhamnosus reduced the prevalence of eczema at 2 and 4 years by 50%. The overall incidence of allergies was also reduced among children taking L. rhamnosus, including food allergies. Supplementing with a mixed probiotic during pregnancy and breastfeeding helped to prevent eczema in the infant.
  • Prevention and Treatment of Infections. Lactobacillus reuteri and a mixed probiotic have reduced duration and severity of acute gastroenteritis in children. L. reuteri increased effectiveness of antibiotic treatment against Helicobacter pylori, improved symptoms, and reduced side effects. L. reuteri and rhamnosus seem to be effective at preventing urinary tract infections in women. A mixed probiotic may help prevent necrotizing colitis in preterm newborns. L. reuteri reduced inflammation in people with chronic periodontitis.
  • Mental Health Benefits. In mice, L. rhamnosus was comparable to Prozac in managing obsessive-compulsive behaviors. 
  • Blood Sugar Regulation. In people with type 2 diabetes, taking a multi-species probiotic prevented a rise in fasting blood sugar, reduced inflammatory markers, and increased antioxidant levels in the blood.

How To
In general, I recommend a refrigerated, multi-species probiotic with at least 10 billion organisms per day. Quality and viability of probiotic supplements vary widely, so I stick to a few tried and true brands. Specific recommendations will vary by individual. For example, I may recommend high doses for a short period of time after antibiotic treatment. It is important to find the right formula for your needs. Many probiotic supplements contain undigestible starches such as inulin, chicory root, and FOS (fructo-oligosaccharides) to feed bacteria; however, these compounds can worsen certain presentations, such as Small Intestine Bacterial Overgrowth (SIBO). 
Fermented Foods
Eat them! Fermented foods are a wonderful way to get probiotics and other nutrients, and I recommend eating them on a regular basis. Some of my favorites include sauerkraut, kim chee, kombucha, kefir, yogurt, and miso. Making fermented foods at home is fun and fairly simple. Wild Fermentation by Sandor Katz is a wonderful reference to get started.

How to Survive Until Spring

Spring is less than a month away, and the days are getting longer, but these last few weeks of winter are difficult for many people. The beauty and excitement of snow has worn off, and we are ready to spend more time outdoors. Here are some steps you can take to promote health of body, mind, and spirit as we approach the vernal equinox:

Many studies have shown a benefit of aerobic exercise on mood and symptoms of depression (123). Exercise may be as effective as antidepressants in treating depression, and be better at preventing relapse. Aim for a brisk walk for about 35 minutes a day five times a week, or 60 minutes a day three times a week. Endorphins released during a "runner's high" stimulate the same brain regions as are activated when in love or listening to beautiful music. The minimum effective dose seems to be running for at least 10 minutes at 9 min/mile.

Eat Colorful, Real Food
  • Eat a Combination of Raw and Cooked Vegetables.  Raw green leafy vegetables like spinach, romaine, and arugula contain active folate and other B vitamins that are needed for synthesis of mood-stabilizing neurotransmitters such as serotonin and dopamine. Cooked leafy greens including kale and swiss chard contain more easily-digested minerals such as magnesium, zinc, and copper that also participate in neurotransmitter synthesis.
  • Eat Good ProteinAmino acids, which come from dietary protein, are the raw material for making our neurotransmitters - dopamine, serotonin, epinephrine, norepinephrine, and GABA. Eat plenty of nuts and seeds, especially almonds, walnuts, pecans, pumpkin seeds, and sesame seeds, and moderate amounts of  wild, cold water fish such as salmon and sardines, pasture-raised eggs, turkey, bison, beef, and lamb.
  • Avoid Processed Foods, fast food, and refined grains, as they are associated with increased feelings of depression and anxiety (1, 2). Stick to the outside perimeter of the grocery store when shopping, where the real food is found – vegetables, fruits, high-quality fish, eggs, and meat, legumes, nuts and seeds.
  • Eat Cocoa. Consuming this antioxidant-rich powder for 30 days led to greater feelings of calm and contentment. Check out this recipe for cocoa energy bars.

Try an Uplifting Tea or Tincture
Botanicals that benefit mood include Lemon balm (Melissa officials), Oats (Avena sativa), California poppy (Eschscholzia californica; does not contain narcotic constituents), Holy basil (Ocimum sanctum; Tulsi), Rhodiola rosea, and Skullcap (Scutellaria lateriflora). Green tea is also wonderful.
Center yourself  
Try this breathing technique to balance the energy from both sides of your body, including the two branches of your autonomic nervous system: the sympathetic “fight or flight” and the parasympathetic “rest and digest” responses. While you’re at it, make sure you get enough sleep: Loss of sleep reduces emotional resilience and constructive thinking, and may trigger aggressive behavior.
Express gratitude
From Martin Seligman, founding father of positive psychology. The "What-Went-Well Exercise,” also known as “Three Blessings:”
  • Every night for the next week, set aside ten minutes before you go to sleep. Write down three things that went well today and why they went well. You may use a journal or your computer to write about the events, but it is important that you have a physical record of what you wrote. The three things need not be earthshaking in importance (“My partner picked up my favorite ice cream for dessert on the way home from work today”), but they can be important (“My sister just gave birth to a healthy baby boy”).
  • Next to each positive event, answer the question “Why did this happen?” For example, if you wrote that your partner picked up ice cream, write “because my partner is really thoughtful sometimes” or “because I remembered to call him from work and remind him to stop by the grocery store.” Or if you wrote, “My sister just gave birth to a healthy baby boy,” you might pick as the cause … “She did everything right during her pregnancy.”
  • Writing about why the positive events in your life happened may seem awkward at first, but please stick with it for one week. It will get easier.
Do something nice for someone else, without expecting anything in return. MRI studies show that when we perform an act of kindness for someone else, our brain's pleasure centers are activated, improving mood. 

Take a vacation 
Can you? Please take at least 2 weeks off each year, and do not work during this time. In the winter, consider going somewhere sunny and warm, where you can soak in a mineral-rich sea, eat whole, fresh foods, and spend time with loved ones.  Perhaps to the island where people forget to die

What is Naturopathic Medicine?

In short, Naturopathic Medicine combines the best of conventional and alternative medicine into an individualized, whole-person approach to primary health care. NDs are trained as primary care providers with an emphasis on natural and common sense approaches including clinical nutrition, lifestyle counseling, and botanical medicine.

What to Expect from Your Visit

I work with my clients to identify the root causes of disease, taking into account the various factors that influence health, including lifestyle, genetics, physiology, and mental-emotional state. First visits are 90 minutes and include a thorough health history, followed by discussion of my preliminary assessment and recommendations. I may order conventional or specialty lab work to aid in my understanding of your condition. We work together to devise a plan that will meet your health goals.

Follow-up visits generally last 30-45 minutes and are important so that I can better get to know your unique physiology, track your progress, and refine my recommendations. I can consult with your other health providers and make referrals as necessary.

Integrative Medicine

I am fortunate to work in an integrative primary care practice, alongside a D.O. (Doctor of Osteopathy), N.P. (Nurse Practitioner), and P.A. (Physician's Assistant).  We share patients and regularly consult with each other to coordinate care. 

I believe this approach benefits patients by offering them the best of both worlds - conventional and natural.  These two worlds are not mutually exclusive; in fact, many health concerns are best addressed by a multifaceted approach.  The power of Integrative Medicine is backed by research, especially for chronic conditions such as heart disease.
I am now offering Gift Certificates for my services. They are available for a 90 minute New Patient appointment, 1 hour Follow-Up, and 30 minute Follow-Up.  Please call my office with questions, or to order one for a friend or family member.

FYI: Licensing and Regulation of Naturopathic Medicine

Licensed Naturopathic Physicians attend a 4-year post-graduate medical school accredited by the Council on Naturopathic Medical Education and recognized by the U.S. Department of Education. They must pass basic science and clinical licensing exams administered by the North American Board of Naturopathic Examiners. Currently, 16 states license Naturopathic doctors as primary care providers. National and state legislative efforts are organized by the American Association of Naturopathic Physicians.  Because NDs are not currently licensed in Michigan, they function as complementary providers.

For more information about the active legislative efforts to license Naturopathic Medicine in Michigan, visit the Michigan Association of Naturopathic Physicians.


About Michelle Crowder, ND

Michelle Crowder, ND is a licensed Naturopathic Physician with a focus in holistic and preventative primary care.  She works with people of all ages to identify and treat the root causes of disease, empowering her clients with the tools they need to understand and take control of their own health. Areas of special interest include digestive health, hormone imbalance, and immune dysfunction, including thyroid disease.

National College of Natural Medicine, Doctorate of Naturopathic Medicine, High honors
University of Vermont, Master of Science in Botany
University of Michigan, Bachelor of Science in Biology, Summa Cum Laude
Copyright © 2014 Michelle C Davila, ND, All rights reserved.
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