Well-Timed Inspiration

“True health is not found in the medicine cabinet or at the end of my scope at Georgetown. It’s found in the little things. I encourage you to embrace this concept of do-it-yourself medicine.” — Robynne Chutkan, M.D., FASGE

“All disease is born in the gut.” — Hippocrates

I spent much of Friday whining to myself about how difficult the Paleo AIP diet is and wondering if it was time to throw in the towel. Yes, I have seen some improvements, but am I feeling incredible yet? No. (Yes, I know, healing a compromised gut and an over-excited immune system takes more than three weeks, but I am just being honest — that was where my head-space was). Furthermore, I find not eating packaged anything quite a hassle. Therefore, the timing of a lecture I heard by integrative gastroenterologist, Dr. Robynne Chutkan, could not have been better timed.

Chutkan spoke about the integral role that the gut plays in mediating all disease, but especially autoimmune disorders (for an excellent primer in this, see Dr. Sarah Ballantyne’s article). I had a good understanding of this after reading “The Paleo Approach” cover to cover, but it was news to me that how we come into the world and our earliest days can either set us up for a lifetime of gut health or potential trouble, according to Chutkan. She stressed that unnecessary c-section births and western culture’s reliance on infant formula are extremely deleterious to gut health. Passing through a vagina on our way into the planet apparently is very advantageous; in her book, Gutbliss, Chutkan cites a study that shows that babies born vaginally have guts primarily colonized by good bacteria, whereas c-section babies (like my daughter and Chutkan’s daughter, incidentally, born via c-section for the same exact reason) have guts primarily colonized by more common, “bad” hospital bacteria.

After a very, very rough start with breastfeeding, where my daughter’s pediatrician and my OB both encouraged me to stop nursing, I am still breastfeeding my toddler with no plans to wean her. Chutkan warmed my heart by loudly championing breastfeeding to build gut health in children for a lifetime. She acknowledged that a small percentage of women actually can’t breastfeed, but that does not account for the abysmal rates of breastfeeding in the United States. “This idea that [formula feeding] is fine, and it’s equivalent, and that formula is as ok as breast milk is incorrect,” Chutkan said, adding that the third ingredient in breast milk, human milk oligosaccharides, is non-digestible and is there solely to nourish the baby’s gut.

All of this matters greatly because scientific research is proving that once the microbiome is disrupted, it’s very hard to get it all back, so starting strong is important. For example, Chutkan cited a statistic that a five-day course of a broad-spectrum antibiotic wipes out about one-third of the microbiome and that most of those don’t come back. Good bacteria is especially vulnerable to probiotics, and it is especially hard for kids to repopulate their guts, she said. Futhermore, the evidence pointing to a relationship between gut health and overall health is strong and getting stronger: Chutkan cited a study that said the biggest factor that determined whether people with Crohn’s Disease in their families ever manifest the disease was repeated pediatric antibiotic use.

Chutkan also emphasized the following to maintain gut health:

1. DO be judicious about antibiotic use, especially in children. Chutkan reminded the audience that usually the doctor’s decision of whether to prescribe an antibiotic is not black and white, and cited a statistic that pediatricians prescribe antibiotics seven percent of the time when parents do not want their children to take one and 67 percent of the time that parents do. She encouraged the audience to always ask their doctor, “What would happen if I didn’t take this?” if antibiotics are on the table. (Note: Before you go ballistic, please note that the doctor said that like some c-sections, antibiotics are life-saving in the right circumstances. We just need to be careful about misusing them.)

2. DO NOT use hand sanitizers and antibacterial hand soaps.

3. DO let your kids play in the dirt. Seriously, it builds up the microbiome.

4. DO get a pet, which also builds the immune system.

5. DO take a high-quality, refrigerated probiotic, such as VSL#3, the only one FDA-approved to repopulate the gut.

6. DO work with a qualified health care provider to discuss the possibility of reducing or eliminating medications that disrupt the microbiome, such as proton pump inhibitors, antibiotics, steroids, and hormonal contraceptives  (see Chutkan’s and Ballantyne’s books for a full discussion of this).

7. DO eat pre-biotic foods that nourish good gut bacteria. All vegetables help, but those containing indigestible plant fiber such as leeks, asparagus, Jerusalem artichokes, bananas, and green leafy veggies are the most beneficial.

8. DO spend money on high-quality, natural meat raised without antibiotics, since meat is a huge source of antibiotic intake.

All of these points made me feel really good about sticking with the Paleo AIP diet, since Ballantyne emphasizes all of the points that Dr. Chutkan made. I actually raised my hand and said that I was a good example of what not to do to a microbiome: I was born via c-section, formula-fed from day one, and I took years of oral and intravenous antibiotics to cure a stubborn Lyme Disease infection. I told Chutkan that I was following the Paleo Approach, and she said “It sounds like you’re on the right track.” Yay!

Paleo AIP Nine Days In

I have been 100% Paleo AIP compliant for nine days now. I have some random thoughts and reflections to share:

The Good

1. The first thing I noticed was that my brain fog has begun to lift. For years, I have felt mentally sluggish and very foggy. That feeling is dissipating rapidly. When I asked Dr. G why he said, “Brain fog is a symptom of inflammation, of a brain on fire.” He then gave an eloquent explanation of how the brain is supposed to work as a symphony, but because of my central sensitization syndrome, it has been discordant. Now that the inflammation is starting to subside, the notes are starting to be played properly.

2. I thought that coming off the sugary, starchy diet I’d fallen into would leave me with intense cravings, as it had in the past. Subsisting on totally healthful, unprocessed, non-allergenic foods has blessedly left me with no food cravings.

3. I have a long way to go to calm my systemic inflammation. My C4A (complement factor 4A, a marker of inflammation when read by a reliable lab) is around 20,000, when it should be under 2830. However, I can tell that my body likes this way of eating. I do feel a little bit better, and Dr. G and I suspect that this trend will continue as my gut heals and my inflammation goes down.

4. My tummy is happier. I will not go into the details of how I know this.

5. To my surprise, I had an easy time eating out at a restaurant after I first checked the menu online. I enjoyed a large salad with avocado (of course!), topped with grilled fish and an olive oil and vinegar dressing. Yum! I am convinced we cavepeople are keeping the avocado industry thriving.

6. I am getting satisfied on much less food than before, probably because I am eating only real food for the first time since I was a baby.

7. My energy level is better than before, even without coffee. I have a long way to go before I’m even close to the energy level of a person my age without my health problems, but every little bit helps.

The Rough

1. I am shocked at how much time I am spending grocery shopping and in the kitchen, although I shouldn’t be; my husband correctly noted that I am only eating foods that my great-grandparents would have eaten. I hope that as I get more used to this style of cooking and not relying on processed foods and easy grains, that I will find my rhythm and can cook less often. Part of this is me being me. If I were content with simpler foods, I could cook less often. I am trying to strike a balance between some days of very simple meals and some days of yummy, more energy-intensive ones.

2. It is very hard doing this with a partner who isn’t Paleo. I don’t believe in forcing my diets on my loved ones (ok, honestly, I kinda do, but am restraining myself). My husband eats what I cook for dinner, but his breakfasts and mine are polar opposites. He still grooves on cereal and milk, while I am eating huge salads and a side of grass-fed, free-range, home-made beef patties.

3. I made the very amateur mistake of weighing myself one week into this. First of all, I should only be weighing myself once a month. Secondly, Dr. Ballantyne warns in “The Paleo Approach” that people often will initially gain weight as their bodies adjust to this new way of eating, yet I fell into the trap. Luckily, my Paleo AIP Facebook group was there to pull me out of the funk, although some people still offered some dumbass advice. Yes, it’s still the Internet. Ironically, today I put on my jeans and they were a lot looser, so go figure. I have committed to going back to only weighing myself once a month.

Bumps aside, my body and brain feel good, so on I go.

Organic, free-range bone broth and my new staple, avocado.

Missing My Fun-Size Boddhisattva

“And I know of the pain that you feel the same as me, and I dream of the rain as it falls upon the leaves. And the cracks in our lives like the cracks upon the ground, they are sealed and now washed away.” — Iron Maiden, “Rainmaker”

“I decided like a bird that’s trapped inside a gilded cage, it’s right to set it free, hurts to watch it fly away. Letting go of you was so hard to do. And I thought that it would kill me, but I made it through somehow, and I’m so much stronger now.” — Warrant, “Stronger Now”

One of the things that I like about the Paleo Approach program is that it is truly holistic, with a major emphasis on stress management. In that vein, I need to talk about one of the most stressful, and certainly one of the most painful events in my life. April 15 was the 12th birthday of my (ex) beloved dog, Kacy. Kacy is a beautiful, spunky Norwich Terrier, who sadly no longer could live with us after she began attacking our daughter.

Kacy had lived with us since she was nine months old. She was meant to be a show dog, and indeed was a repeat breeding of a champion stud and champion bitch. Alas, she was too small to compete in conformation shows, so her breeders sold her to us. We had a rough start after we learned a few months later that Kacy needed liver surgery to fix a shunt that was the reason that she was small. After that, Kacy lived a life of luxury with us in D.C. and quickly became spoiled. Like most problems with dogs, this was owner error, not hers. When she would bark incessantly for food, I would always think of that Pop Evil song “Monster You Made” (“I’m only the monster you made me.”) Kacy had 11 years of getting her way when Roya was born. We did everything we read in the “prepare your dog for baby” books and Web sites, and implemented all of our veterinarian’s suggestions. None of them made a bit of a difference. Kacy was hostile from the get-go, even getting food aggressive toward my breast milk, which was most certainly not for her!

We kept the girls far apart and hoped that things would cool down, which they did until Roya started crawling. At that point, Kacy became an unpredictable lunatic, lunging and biting the baby without provocation. Thankfully, she didn’t really hurt Roya, though it was terrifying for her. We consulted with our vet, Kacy’s previous dog trainer, and even a new specialty trainer with the Dogs and Storks program. Nothing made a difference. Soon, our lives became a hell of baby gates everywhere and constant vigilance trying to keep Kacy and Roya apart. It is no exaggeration to say that the only time that David and I relaxed was when the baby was asleep. It was frustrating to see both Kacy’s and Roya’s worlds getting smaller by the day because of the forced separation. Nobody was happy.

Then, Kacy finally bit Roya on the face, and she bled. We called her vet and said, “We have to re-home this dog.” Knowing how much we love Kacy, the vet urged us to bear with 100 percent separation a little while longer and get a consult with an animal behaviorist, Dr. Katherine Meyer, who might have other suggestions. At worst, the consult with Meyer would mean that if we had to give Kacy away, we would do so knowing we truly had no other choice. That is exactly what happened. Dr. Meyer said did a thorough bite assessment and said to me, “Your daughter is in grave danger if you don’t remove Kacy from your home. Don’t wait.”

I spent the next week soaking through tissues, literally having to pull the car over because I was sobbing so hard; I couldn’t get over the fact that very soon would be the last time I would see Kacy. Given her long and tight history with us, Dr. Meyer strongly advised no contact after we re-homed her. Terrible for me, but good for Kacy, so I’m taking the high road. Kacy was more than a pet to me. She is a registered service dog, so we partnered as hospice volunteers and sat at the beds of many dying patients. We did other volunteer work, too, such as going to college campuses to help students de-stress during exam week, and letting kids read to her at public libraries. We spent countless Sundays at nursing homes visiting patients with a group of other dogs.

More than that, Kacy was my buddy during the darkest days of my Lyme Disease infection. When I couldn’t wash my hair or do anything else, I still had to get her outside during the day. We couldn’t always go far, but I had to always get her out. She was responsible for my contact with the world during my darkest days. I also spent hours crying into her fur after our three miscarriages, consoled that if I couldn’t have a human baby, at least I had the world’s cutest dog.

I was scared that we wouldn’t be able to re-home an older dog who was headed into a time of her life when she would begin to incur higher medical costs. I worked my butt off to find Kacy a deserving home, and luckily, people started to compete for her. After weighing the options and consulting with our vets for their opinions, we decided to give her to my friend’s parents in a neighboring state.

We felt good about her new family, but the day we dropped her off was one of the worst days of my life. I felt like my heart was being ripped out of my chest: I was giving away a family member. Even though I knew I was doing so to protect my very vulnerable human family member, it still hurt like hell. I’m not sure I’ll ever get over it. I will say that I knew she would be just fine in her new home when I saw that they had custom grave markers for their previous two family dogs buried in the back yard. Yesss!

As previously mentioned, Kacy is a healing dog. She just snuggles up next to anyone (uh, except Roya, whom she wanted to tear apart). I have come to see now that the energy couldn’t be contained here, and she really did need to leave our house. Her new mom is facing a terminal illness, so Kacy gets to do what she does best: exude healing love and energy. My friend brilliantly described her as a “fun-sized bodhisattva.” I couldn’t say it better! I am so sad that Kacy’s new mom is so ill, but I am grateful that she and her family have Kacy to help them through that transition.

I don’t think I am someone who tries to see a reason in everything, but in this case it seems very apparent to me that God or the Universe sent Kacy to her new family where she could truly be of service and free from a scary toddler. I will love and miss her forever.

Eat Like A Baby

Something I don’t feel ready to address in this format, but keeps coming up, is the intersection between my decades-long struggle with food addiction and completely overhauling the way I eat. Oh, I’ve overhauled my eating before, but I haven’t liked it. And I’ve never been willing to give up so-called “healthful” foods like low-fat dairy  and the nightshades which I love to eat, but which seem to be eating my gut.

Like everyone else on the planet, I want what I want when I want it. But when you add in the layer of someone with an eating problem, going on any kind of elimination diet is especially challenging.

I have a 15 month old daughter, Roya, who is an enthusiastic consumer of both breast milk and table food. Since Roya’s birth, I have been in awe at her natural ability to regulate her food intake. Newborns nurse when they are hungry (hint: all the time). As a toddler, she eats on a pretty regular schedule, but she has total control of her intake. My husband and I are big believers of Ellyn Satter’s Division of Responsibility in feeding: we are responsible for what and when we feed Roya, but she is responsible for the amount she eats. Some days, she eats very little. Other days, it seems like I can’t give her enough. One day she’s in the mood for eggplant and grapes. The next day, not so much. Some days she seems to be carbo-loading like a marathoner before the big race; the next day she is all about protein and veggies.

It has been very eye-opening for me to witness this process, but it also leaves me a little bit sad. In Roya and other babies, I can see so clearly how we are all imbued with a gift (from God, I believe) to know: what we are supposed to eat day to day to nurture our bodies and please our palates; how much of it; and how to stop when our stomachs have had enough. This way of nurturing ourselves is our birthright. Yet, look around at all of the disordered eating and the body dysmorphia epidemic in our Western culture: many of us lose touch with these instincts. If I could conclusively figure out why, I’d be writing to you from my private island near Fiji, but here are four ideas off the top of my head:

1. Early in life, many of us get hooked on a processed and sugary diet that changes our palates and perhaps our metabolisms.

2. Life is stressful, even for children, and at some point many of us turn to food as an affordable, legal coping mechanism.

3. Many well-meaning parents, caregivers, and educators foist their ideas about what they think we should eat on us. These ideas may be very outdated (how many of you still think that the cholesterol in eggs is a problem?) or very inappropriate for us, but as young people, we adopt them anyway. Furthermore, if you are raised by a parent with an eating disorder, it is very hard to undo that negative patterning.

4. Food is ubiquitous. If you never go without something in your mouth, the harder it is to go for reasonable periods without something in your mouth.

Babies don’t have any of these issues. Furthermore, it is incredible to see the sheer delight that Roya takes in eating. As my husband, David, says, “I wish I enjoyed eating anything as much as she enjoys eating everything.” Roya has no self-consciousness or shame about what she eats. No, “Is it ok that there is whole milk in my cereal? It has 30 more calories per cup than skim,” or, “I ate red meat for a third time this week!” It’s a beautiful thing. I hope to recapture some of that joy and wisdom in my own eating.

Well Now You’re Here, There’s No Way Back…

“Well now you’re here, there’s no way back.” — Quiet Riot, “Bang Your Head”

“Oh, let’s get back to the cave, for a little while.” — Lita Ford, “Back To The Cave”

This is day one of me following the “The Paleo Approach” diet by Dr. Sarah Ballantyne. I don’t believe in diets. I especially don’t believe in diets that forbid eggplant, tomatoes, eggs, and my very beloved dairy. So how in the hell did I end up here?

I have been having serious medical problems since contracting a very pernicious case of Lyme Disease and co-infections diagnosed in 2007 that left me with permanent nerve damage, weakness, and feeling very fatigued. A good day is one in which I don’t have to nap. At my sickest, I could not brush my own hair, and I could not drive a car for three years because I couldn’t hold my hands up on the steering wheel. I have seen amazing doctors (and a few mediocre ones along the way) who have helped me on my journey to healing, and I am much better than I was. However, the miraculous arrival of our daughter in January 2014 has upped the ante for my personal wellness goals. I want to be as fully functioning as possible to enjoy my very energetic toddler.

This led me to finally decide to break into our savings and pay the substantial sum to join the concierge practice of an amazing doctor (let’s call him Dr. G) in my area who sees last-ditch patients. I borrowed Dr. G’s book from a friend and decided that I needed to see him. I actually whined to my therapist, “I want to keep my savings for a rainy day, not spend it on medical care!” She said, “You’re saving money for a rainy day? It’s raining.”

Dr. G diagnosed me with central sensitization syndrome and a vicious level of mold toxicity from nuts. He prescribed pharmaceutical, dietary supplement, and lifestyle changes, in addition to treating me with traditional osteopathic manipulations (nifty!).  I began to see other complementary medicine caregivers in his office. Still, I wasn’t seeing the improvement I was hoping for. I have long had a nagging feeling that something I am regularly eating is furthering my dis-ease, so I wasn’t surprised — though I was displeased — that he recommended The Paleo Approach, a diet for people with autoimmune disorders which is designed to eliminate almost any foods that would irritate an already amped-up central nervous system, as well as restore integrity to irritated gut linings, which are a given in people with the kind of symptoms I present.

As Quiet Riot said, so now I’m here, there’s no way back. I am treating this as an experiment: I am all in for eight weeks. If I don’t feel better, I plan to celebrate with a pizza with a side of Mediterranean eggplant salad.