# Bring on the FODMAPS, I'm eating Kraut!



## Nojokeibs (Apr 14, 2014)

I learned something while I was away.. the executive summary is that I started eating sauerkraut, really it was because I love sauerkraut and it was an experiment when I saw it was for sale at Whole Foods. But it was the probiotic kind that, thanks to the "raw foods" movement, is mainstream enough to get a spot on a shelf in a major supermarket chain. It was worth a try, and it was delicious. But it also caused a reorg of my gut flora which resulted in my eating onions again!! YEY!! I had eliminated those with all the other FODMAPS ages ago. I've experimented with other FODMAP foods now and woo-ha! they are digestible without threat of nuclear war in my gut!! I haven't gone back to eating grains though. That's more risky in my book.

I wrote a long BLOG post about it, but I'll post it here, for the clicking impaired 

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How have I been lately? Better. I found something that works for me. If it helps you too, then great. When I was here last, I was making vegetable shakes and pastes because I was not absorbing vitamins from fruits and vegetables. Someone here suggested we weren't made to digest cellulose and I should "chew better". That struck me as illogical since we're obviously meant to eat veggies. But I had nothing to say to that, nothing concrete except a feeling that it was wrong. I'm not much for just throwing my voice at someone, so I didn't say anything. There wasn't anything to say. Now there is. Who the person was is irrelevant. The purpose of posting this blog post is to share what I've learned, and definitely not to shame anyone.

If I know anything, I know that this area of science is in its infancy and we're all on our own to figure out what's best for us if we delve here. Anyone who dares share an opinion in this part of science is taking a risk because there are so many unknowns. In this post I will be talking a lot as if I know things I don't. That's the nature of unfinished research. If uncertainty makes you nervous, don't read. I've also been thinking about this a lot, so maybe I'm sometimes referrig to things that are obvious to me, but confusing to someone who doesn't live in my brain. Feel free to point out where this is happening. Messing with gut flora is at best a journey, at worst a mad science experiment.

*The Ideal Gut Flora would be like this*:

If you have a body bursting with good bacterias, yeasts and those unknown things called arcahaea, then you've probably healthy. These started coming to visit and taking up residence right after you were born and each new community taught your immune system how to react to invaders, and how to tolerate non-invaders (the probiotics). The word probiotic just means it's something that isn't a pathogen to YOU... RIGHT NOW, and that it IS HELPING YOU DIGEST SOMETHING, usually some kind of carbohydrate, including most types of fiber.

OR... it is a bacteria/yeast/whatever, that is protecting you from pathogens such as vaginal bacteria protecting you from man-cooties, dirty toilet seats, and those mornings when you miss and step on your underwear before putting it on. The function of probiotics is to protect you, and in the gut, it's also to digest your food for you.

Some people would have you believe that fiber can't be digested. It must be chewed up. Not true. You can find articles like this in Pubmed, but honestly it's not a subject that is much studied:

http://gut.bmj.com/content/25/8/805.full.pdf

Cellulose can be and is broken down in the gut. But only if you have the right probiotics ideally already living inside you and they're living happy and well fed by prebiotics... The idea that only cows can digest cellulose is myth and one that fits nicely into the marketing plans of diets like Paleo/Primal. The truth is that we can digest cellulose just fine, if we have the right bacteria to help us. It makes no sense to suggest eating greens and then say that we can't digest cellulose. It leads to people making veggie shakes (which is what I was doing before I figured all this out).

Prebiotics are those things listed in the FODMAPS list, but also cellulose and other fibers. This is why you can swallow a bit of lettuce whole and it doesn't come out whole again at the "other end" - at least not if you have the right gut bacteria. It should be a warning sign if it does. Your helpful flora should be breaking down the cellulose so you can access the vitamins inside the plant cell walls (made of cellulose). This causes gas, but it should again ideally NOT BE ENOUGH TO HURT. Ideally you should have methanogens, sulphate reducers and acetobacters to help reduce the initial gas down to a smaller volume of gas. The proof for this from the research of the Monash university itself (the originators of the Low FODMAP diet itself):

http://www.med.monash.edu.au/ehcs/docs/benefitsofh2testingafterlactulose.pdf

In the introduction they describe what would be "normal" for the gut to do with hydrogen, that's what I'm referring to. But there is much more research into sulphate-reducing bacteria, some of it even claims that H2S is harmful, but I've read in many places that people say that if their ahem.. doodoo doesn't stink, they feel worse... hydrogen sulfide is what causes the rotten egg odor of gas and poop. My own theory is that if the poo smells, it means I'm not in pain because there is less gas, I can put up with smelly gas as long as it leads to good digestion and it's painless.

You don't have to take my word for this. There is a fellow with Crohn's who runs a science show on youtube who sums it up pretty well here:






... and the current status of our knowledge of all the helpful germs that live in us is cataloged in the Human Microbiome Project here:

http://commonfund.nih.gov/hmp/index

That's my summary of what we know about what is the ideal way our flora SHOULD operate. Or at least what I understand of it so far.

*What if it's not Ideal right now?*

Obviously in this post I'm going to push probiotics. But I'm going farther than saying "pick one that works for you" I'm going to try and explain my rationale for why sauerkraut worked so well for me. For years, literally decades, I'd been drinking kefir and/or eating yogurt, and/or taking probiotics and it helped, sure. But it wasn't a total revolution like sauerkraut was. I think the milk-based probiotics are good for preventing intestinal infection, or even recovering from it, but what I really needed were the exact bacteria that break down vegetable matter and fiber.

Think about it: What causes gas, bloating, pain, and most of the IBS symptoms? Those things that are classed "fiber" (inulin, FOS, cellulose...) and carbohydrates (especially grains, in fact Monash U. was using wheat in the early days of their research as their surefire FODMAP until they realized it could be a confounder because people could be intolerant of wheat). So why are we suggesting using milk based probiotics to solve this? Just ferment some veggies and go!

Not that probiotics from yogurt don't help. But they have to learn to use the carbs from fiber and veggies/fruits before they can help us. They can teach themselves new tricks, that's what bacteria do. But they aren't instantly adapted to doing it, like the probiotics in sauerkraut and/or other fermented vegetables or fruits. I'd also extend that to soudough bread, but I'm honestly too scared yet to try it.

Maybe after some months have gone by and my gut is very happy, I will make my own homemade gluten free sourdough bread, perhaps a sourdough version of Ezekiel that is also wheat free... but right now, I'm too cautious yet. It is, however, my goal to be capable of fully digesting EVERYTHING someday. Even wheat. I will recover my body, or die trying. I hate being paranoid that I'll eat something and get sick. I'm doing this to recover my normalcy.

Sources of vegetable and fruit based germs: grapes have a community of funguses and bacterias as long as they have not been irradiated, sauerkraut (fermented, live, raw, may be purchased from Whole Foods in the USA, though other places may also have it), for those more adventurous and not gluten intolerant there are recipes for "rejuvelac" on the Internet which is a fermented grain mash made with wheat or rye, Homemade kombucha is another option - the store kind is full of not yet fermented sugar - it should be like vinegar if it's "done" not sweet.

And the GAPS diet, although I do not follow it, is an excellent source for recipes of homemade fermented vegetables and foods of all kinds. Youtube has some videos for making various kinds of fermented foods, but I'd warn that I've found some videos to be very shallow on instructions, and food safety is important when you're fermenting something.

Generally, you should always cover your fermenting food with a terry towel to allow for gas to escape and yet exclude any gnats that may be flying around. I personally don't make fermented food in the kitchen because I think it is too close to the sink drain (an area I can't really clean). The best fermentations I've done were in the living room, though it means putting up with a small amount of odor whenever you open it to check.

My current plan is to take in as many of these as I can to repopulate myself. I haven't abandoned the milk-based ones, but I also have no reason to limit myself to just one of these. I happen to like sauerkraut, but if you dislike it, then start with kombucha and work on that until you find something else that helps, and keep expanding it. That is, if you plan to try this yourself. My experience was that sauerkraut gave me stinky gas for about 2 days, and then it went away. Now I can eat things I couldn't eat before like garlic and onions. I can't tell you how much I missed eating onions. I'm so grateful that I can eat them now. I'm trying out new fermented veggies, and thinking about which fermentations I should try next... beans? It would be awesome if I could at least eat lentils again. I love lentils. I dream about them.

Other options for "what if it's not ideal?" are of course available. Some people do use fecal transplant for IBS, and assuming that the person you're getting it from has these bacterias, then you'll recover. If you're not ready for that option, then I used to do probiotic enemas before I stopped doing enemas altogether. I don't exclude the idea that maybe I would do a probiotic one again if I thought it necessary. If I hated the flavor of all fermented foods, I might go that route. But only as a way to start it up. I'd keep working on finding a fermented food I liked. Taking probiotic supplements is helpful too, but they're just so limited. I don't mean that 30 billion bacteria is limited, I mean it's not a complete community of vegetable eating bacterias that you're taking in. It's better than nothing, but for me, it's just a start. And they were probably grown on milk, so I'm not sure how fast they'll start working, and they may not be the type that break down cellulose.

*My "Doctors" soapbox:*

I believe strongly that a regular doctor (the kind you get insurance to cover in the USA) is only part of the story because there is something called "clinical practice" that protects them from malpractice suits. It also keep them in the dark ages, at least 20 years behind science. I consider it self defense to read science and find out what science thinks if I find that doctors aren't helping me, and, on the subject of IBS-C, they've been all thumbs. I do not ignore them, however, I go and see a specialist, discuss what I can with them, and also when my budget allows, see functional medicine doctors or naturopaths depending on what I need at the moment. I might need to know such things as "am I running any vitamin deficiencies?" and most regular doctor won't do a complete test for that. And most insurers would complain if they did. Lately I've noticed concierge services for doctors (pay $1000/yr and we'll give you longer office visits, actually read your medical history, and run any test you ask for). i may try that out. What I'm saying is, see a doctor. But be aware that it's not the last word. The truth is not found in the opinion of any one person... not me, not a doctor, not anyone. Keep your mind engaged and you'll feel better faster. Don't settle for feeling tolerably well. Get well for real. Keep asking, "what if I were completely healthy? What would that be like? What if I didn't have to fear ANY food?"

Three types of doctors:

1. Regular doctor or specialist: Sometimes behind the times, though not always. Extremely good at diagnosing things, but sometimes diagnoses the effects as a disorder. What I mean is, If your gut is a trigger for migraines, they may diagnose the gut as IBS alone. And the migraine as that alone. They will miss the connection, and even if you tell them, they will miss it next time. They don't look at you as a whole person, but a collection of parts. You can become overmedicated and still miserable. I do think they're the first line of defense though, and if you haven't seen a doctor about your problem yet, you should see one. Just don't expect it to be the last word or an instant cure.

2. Naturopath: Sometimes can suggest way too many supplements. Extremely good at looking at the whole picture and can diagnose things that are "maybe problems" which you only much much later figure out. For example, I had one tell me my platelets were "sticky." OK.... so what? He couldn't explain except he told me to be careful about that. OK, how? Nothing specific was offered. Years later I developed a clotting disorder. Aha. Maybe if he'd told me to take fish oil and vitamin E, or daily aspirin, it could've been prevented? I don't know. If you are good at preventing things, they can help you prevent them. They must also be good at knowing what their results mean and what to do about it. This one wasn't, but that was only clear in retrospect. One good thing they always offer is a full test of all vitamin deficiencies. A common one for constipation is magnesium. You might get a regular doctor to test you for Mg or Vitamin D deficiency, but not often will they do a complete one, of everything. A naturopath will. They have ND next to their name, and are often also an MD.

3. Functional Medicine MD: This is a new trend. These doctors often do not participate with any insurance company. They look at the whole body interactions between parts on a biochemical level, and they look at what you need biochemically to overcome your particular problem. An example of recovery using Functional Medicine is the Wahl's Protocol. These are regular MD doctors, but they offer many more options than a typical doctor who is often limited by what the insurers will typically allow them to submit in claims. Some of them help you submit your own claims, others do not. I simply plan on paying out of pocket, and if the insurance company pays for some things, hey great, bonus. I call my insurer and explain that they can look at my history and see how many medications I've stopped using, and how much less I am claiming nowadays and that the change is due to my use of these alternatives. That tends to get across better, even if I don't insist on talking to a "nurse." But I don't expect them to pay really, it's just so they're aware that this is helpful and I wish they'd cover it. I want to point out that they're actually saving money and they could be saving it more by supporting therapies that work.


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## tummyrumbles (Aug 14, 2005)

I could have been one of those people saying that we have to be very careful with fibre and to chew properly. It makes no sense to feed bacteria more than you have to so chewing properly makes sense. You absorb more carbohydrates the more you chew, so it fills you up more, and you produce less gas as well, so it's a win-win situation.

It took me a while to get over the "but fibre is good for you" mental block. I kept buying brussel sprouts and all kinds of veges in the belief that nature intended for us to eat veges and nature must be right. Which means what - that IBS is wrong? There's no right or wrong, just what works. And for most of us, we have to be very careful with fibre. Volvulus is an extreme case, but a good example of what can go wrong if you overload on fibre. Volvulus is a knotted, twisted colon and is believed to be caused by too much fibre. It is more common in countries like Africa with a typically high fibre diet where it can cause up to 50% of all colonic obstructions.

http://www.mdguidelines.com/volvulus

"Causation and Known Risk Factors

A vegetarian or high fiber diet with large amounts of coarse vegetables that result in the production of significant intestinal gas or an overload of the sigmoid colon appears to be a risk factor in beginning the twisting process."

So nature can get it wrong. Good, healthy vegetables can cause serious obstruction.

Most of us probably won't get volvulus hopefully, however a few people here have had a twisted colon. I believe that IBS is a progressive disease and we need to reduce inflammation and irritability first as part of the healing process. I'm not sure how long this takes but my condition is steadily improving and I expect to be gas-free for most of the day. My low-fibre, low FODMAP and low starch diet is helping to reduce the gas that causes IBS. Methane can act like a neurotransmitter, causing non-propagating spasms and constipation. It makes sense for me to reduce digestion gas, not to enhance, it so I'm doing my best to reduce the gas that not only is a symptom but also causes the symptoms in the first place. The important thing is to heal the colon first, if possible, then start eating onions, garlic etc. But if people start eating foods like this before they're ready they might make themselves sicker.

I tolerate yoghurt. You tolerate sauerkraut. Someone with IBS-D or inflammatory bowel disease possibly won't tolerate either because their IBS is more advanced than ours. You have to be careful with advice here. I err on the side of caution. Go easy on fibre. Reduce the inflammatory and gas-inducing foods as much as possible. If there is a bacterial overbalance, the idea is to try to reduce that population as much as possible but therein lies another puzzle. Is the overbalance in the colon or the small intestine? If it's in the colon I should feed it with yoghurt, maybe. If it's in the small intestine, then it's not so clear cut. Do I really want to encourage the growth of even good bacteria if they're in the wrong place? What works wonderfully for you might have someone else running to the toilet.


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## Nojokeibs (Apr 14, 2014)

I agree with what you said, tummyrumbles. But none of it is a reason to keep any of my discoveries to myself. If you find something that works, you should share it. That's what I think. If people aren't well yet, they should keep trying new things until they are well. I have no intention of stopping with the sauerkraut experiment. I'm not completely well yet, but I will be. Or I will run out of time while I'm trying and die of old age. My will to be well is 100% complete.


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