1 Whole 30 Week #2

Hi Everyone-

I hope those that are doing the Whole30 program with me this month are doing well! So far so good here…my main issue this week was #1 forgetting my homemade salad dressing one day and #2 I haven’t been exactly making sure that the bacon I eat isn’t cured with sugar. We know bacon doesn’t have any after the cooking process for the most part but sometimes remains a bit sweet. I feel like for a busy working mom who was on the road this weekend, I succeeded!

My conference has been fun. I have enjoyed chatting with other practitioners and dietitians about functional medicine approaches to prediabetes and diabetes. I’ll be speaking at the ASHP Midyear Clinical Meeting about this too with two other pharmacists. Blog posts on diabetes are coming soon!

Seriously if you have a family and haven’t stayed at a Residence’s Inn by Marriott…you are missing out. Full kitchen = better food choices and most of the time the same price or cheaper than area hotels. We packed leftovers, so I was able to eat a yummy butternut squash hash yesterday morning and today a sweet potato with some shredded pork. The one where we are staying at in Indianapolis is just down the street from the convention center and near this awesome cafe called Patachou where I got a whole30 compliant salad yesterday! I just got oil/vinegar instead of green goddess dressing. Another great Indy breakfast find was LePeep. The hash dishes are Whole30 if you say no cheese. If we were staying longer, I certainly would have just headed to the grocery store and cooked here!

We also visited some friends from college last night at their home just north of town. Their kiddos are just a bit younger than ours. They were so sweet and made a wonderful dinner with grilled chicken and farmer’s market veggies. It was delicious! I couldn’t get over how sweet the cherry tomatoes were. Goal this week is to try to find some Farmer’s Market veggies. I think the 2nd street market in Dayton is open on Sundays now, might have to check it out on our way home or find a local one here on our way out. Their little boy and Princess K played together well and even took a dip in the neighbor’s hot tub!

Whole 30 Week #2 Menu

Last week I left off after Monday’s dinner. So here is this week’s meal plan for your enjoyment! If you did cook a whole chicken on Sunday..leftovers are perfect for breakfast or lunch this week!

Tuesday August 8th: Sheet Pan Roast Chicken Dinner Tuesday’s are busy for us with me working the bulk of my clinic time between Monday and Tuesday so we need something simple and easy to do! You can pretty much roast any veggie and chicken thighs (and we like boneless ones for easier eating) this way and it’s amazing. Toddler approved too! I don’t often find parsnips so ours ends up being sweet potatoes and carrots.

Wednesday August 10th: Chive Pesto Shrimp (or chicken) with Zoodles We have lots of yummy chives growing in our garden along with zucchini. This dish is super light and tasty. Feel free to do any protein with it. Chicken, turkey, or pork, with or without the shrimp might have more staying power! Nutritional yeast will have to be used instead of parmesan or omitted.

Thursday August 11th: Salmon and Roasted Veggies. Cook this however you like, we have found grilling on a cedar plank is delicious. We often end up doing this recipe and broiling because it’s yummy and quick. Roast some potatoes, broccoli, or brussel sprouts; really any veggie you like for the side!

Friday August 12th: Roasted Strawberry-Rhubarb Salsa Chicken Tonight we will be at my in-laws and want to share this dish with them. We made it during the last week of July and loved it. Honestly I haven’t tried anything from this blog that I haven’t liked!

Saturday August 13th: Slow Cooker Al Pastor Loaded Taco Salad. We are having a Pool Party with Dustin’s cousin’s family as well as two of their good friends from high school. We are excited for all the kids to play together. We are getting shredded pork for salads for us and sandwiches for others. If you are at home this weekend, definitely try this recipe. So yummy and no need for the tortilla just put it over a baked potato, sweet potato, or salad!

Sunday August 14th: Lettuce Wrapped Hamburgers with Roasted Veggies (leave out the honey). Again I hope this is inspiration…you can roast whatever veggies you would like!

Monday August 15th: Slow Cooker Spicy Stuffed Cabbage Casserole  Again starting the week is often busy for us and I’m sure many of you, so find those go-to slow cooker recipes that you can even prep on Sunday night!

If you haven’t been using ghee on your Whole30 plan you are missing out. My favorite is this brown butter ghee. Other yummy options are over at Thrive Market. If you haven’t signed up check it out and you can get free coconut aminos with your first order! We have saved a lot of money on paleo pantry staples here.

I hope something here inspires your week of clean eating.  If you are interested in checking out SunBasket next week. For the week of August 14th, the Turkish lamb köfte with tahini sauce and smashed cucumber salad, Southeast Asian chicken salad with sesame-lime dressing, and Chinese five-spice steak stir-fry with cauliflower “rice” are all good options to put on your order and Whole30 compliant!

How is your Whole30 or cleaning eating going this week? What have been your go-to meals?

2 Whole 30 Week #1

Hi Everyone-

If you have been following me on Instagram and Facebook, you have seen that in August I will be doing Whole30. This is essentially a reset plan, despite the fact that I should have been watching what I eat more while growing a little human being, somehow it got me off track. And the the ravenous hunger while nourishing my “little” baby (he’s 18 lbs at 4 months!) during the first few months also led to eating some things that weren’t as nourishing. So in an effort to get back on track, I’m heading into 30 days of whole real food!

You can find the “rules” here. Essentially it’s similar to a paleo plan; no grains, no dairy, no added sugar, no alcohol, no legumes, or processed additives. The main difference between this and paleo is not trying to recreate baked goods, or treats with approved ingredients. The goal is to change the way you view and consume food. Also the plan includes not stepping on the scale for 30 days!

I love the tough love found on their site. My favorite is “This is not hard. Don’t you dare tell us this is hard. Beating cancer is hard. Birthing a baby is hard. Losing a parent is hard. Drinking your coffee black. Is. Not. Hard. You’ve done harder things than this, and you have no excuse not to complete the program as written. It’s only thirty days, and it’s for the most important health cause on earth—the only physical body you will ever have in this lifetime.”  Amen to that!

The biggest thing is planning ahead which is why I’m staying up late to get my  dinner meal plan in your hands in prep for next week if you are joining me in this adventure. For me, breakfast will likely be leftovers from dinner because I don’t tolerate eggs very well. If you tolerate eggs, scramble them, make breakfast hash with whatever veggies you have, make omelets, frittatas, the options are endless. For lunch will likely be salad with some protein (beef/chicken/tuna) and homemade dressing. Lately I’ve just been mixing Apple Cider Vinegar with Olive Oil and Italian Seasoning. I’m going to have to bake lots of sweet potatoes and yams to get some carbs for nourishing little man. Whole 30 is not necessarily a low carb plan, but you can easily make it low-carb if you have diabetes or metabolic syndrome.

Whole 30 Week 1 Dinner Menu

  • Tuesday August 1st: Taco Salads
    • You could do this a variety of ways, shredded pork like fajitas or just taco meat which your own seasoning overtop your favorite lettuce blend with lots of veggies (avocado, tomato, peppers, onions, etc!) Homemade Salsa and Guac for bonus!
    • We have a garden producing a TON of zucchini so likely we’ll have grilled zucchini or roasted zucchini with some olive oil/salt as well. Zucchini + Olive Oil + Trader Joes Everything Bagel Seasoning is really good!
    • Add roasted potatoes if you need more carbs! If you have diabetes, leave them alone.
  • Wednesday August 2nd: Moroccan lamb merguez patties with warm carrot salad.
    • We are trying another round of SunBasket this week. I’m so excited to try this again, for a full review check out this page. Note: if you place your order by tomorrow (7-27) at 3pm EST you can still have SunBasket do your shopping and prep for you. If not you an purchase the ingredients on your own and follow the recipe!
  • Thursday August 3rd: Chicken and new potato lettuce cups with tarragon-mustard dressing
    • This is also a SunBasket meal. Again if you know your planning time will be limited to start sign up and try it out or add the ingredients to your shopping list!
  • Friday August 4th: Vietnamese shaking beef with lime-pepper dipping sauce 
    • This is the last Sunbasket meal of the week. I decided to cook them all in a row so nothing goes bad!
  • Saturday August 5th: Strawberry Turkey Burgers and your choice of veggies/salad.
  • Sunday August 6th: Roast a Whole Chicken.
    • Here are a few options. Lemon Dill or this is pretty simple just use Ghee instead of butter for Whole30. Add carrots and veggies!
  • Monday August 7th: Balsamic Beef Roast and Veggies
    • Mondays are busy in our house so I typically try to at least prep our dinner Sunday night but crockpot meals are always a go to at the begining of the week for us because I’m at the office 7-5 both Monday and Tuesday. Always plan ahead for those busy days to make sure you stay on track!

I am actually traveling on the weekend, I’m headed to the American Association of Diabetes Educators Conference (AADE) but I added some ideas if you are cooking at home. I will likely be packing some sweet potatoes, ghee, (follow the link for the best ghee ever!) grilled chicken, and some hamburgers to heat up at our Residence Inn. It’s not too hard to eat Whole 30 eating out if you pick somewhere you can get grilled chicken/fish/steak with veggies and a starch.

For snacks have some nuts or nut butter (ingredients nuts +salt) on hand or raw veggies/fruit.  You can get great deals on nuts at Nuts.com or Thrive Market!

*this post contains affiliate links to products I recommend. Thanks for supporting the blog, remember 10% goes to support various ministries! Check out My Favorite Things for more details.

Alternatives to Proton Pump Inhibitors

I was going to address allergy supplements next, but because of the recent press on the increased risks of death with Proton Pump Inhibitors (PPI), I’m going to tackle this next!

Most likely you or someone you know has taken a PPI at some point in their life. I have (I wish I hadn’t), but as a college student in a traditional pharmacy program, I had no idea the implications it might have down the road. Currently proton pump inhibitors account for over $10 billion dollars in annual healthcare cost and are consistently within the top ten most prescribed medications. Common names for PPIs are below.

 

Prilosec® (Omeprazole)

Nexium® (Esomeprazole)

Prevacid® (Lansoprazole)

Protonix® (Pantoprazole)

Dexilant® (Dexlansoprazole)

Aciphex® (Rabeprazole)

 

What is a PPI? They are medications that reduce the secretion of acid in the stomach. And in many cases they may be needed to heal conditions such as erosive esophagitis (a condition where the lining of the throat is worn away) or peptic ulcers (small holes in the intestinal lining) and they may be needed long term for Barrett’s esophagus. Other conditions may be able to be treated with PPIs short term and then other methods likely can be used after healing has occurred.

The challenge with this is that our bodies are designed to have secretion of acid start the steps needed for proper digestion. So when we stop the initial acid trigger, we decrease production of digestive enzymes and other processes down the line. Then large food particles are undigested leading to a “leaky gut” which I will have another post on very soon by a guest (another pharmacist blogger!) Since we now know gut health is such an important underlying piece to a variety of health conditions, this may be why we see issues with the use of PPIs.

The most recent study8 was a longitudinal observational study in a Veterans Affairs population. The follow-up time frame was on average 5.71 years. Researchers compared patients on PPIs to patients on histamine H2 receptor antagonists (most commonly used drugs in this category are as Zantac (raniditine) and Pepcid (famotidine)), and patients without either medication. The results suggest excess risk of death among PPI users; risk is also increased among those without gastrointestinal conditions and with extended duration of use. The authors suggested limiting PPI use and duration to instances where it is medically indicated may be warranted. Other risks associated with PPIs are in the table below.

RiskRationale
Impaired Nutrient Absorption 9,10The long-term use of PPIs may impair the absorption of calcium, magnesium, iron, and vitamin B12 among other nutrients. These effects usually do not appear to be clinically relevant; however, there is speculation that some of these effects contribute to some of the other risks of PPIs.
Osteoporosis 11-14
PPIs have been linked to increased risk of fracture in several observational studies. This may be due to impaired calcium absorption; however, the exact mechanism has not been well-established.
Kidney Disease 15,16
PPIs have been implicated in both acute and chronic kidney disease. Again this is mostly observational data, but dose-response relationships have been demonstrated. PPIs appear to increase the risk of kidney disease; however, the mechanism for this is not well understood. There are some case reports of PPIs inducing acute interstitial nephritis, which may contribute.
Dementia and Functional Decline 17-19PPIs have been associated with increased risk of functional decline and loss of activities of daily living. PPIs have also been associated with an increased risk of dementia including Alzheimer’s disease. Both of these links are difficult to prove, and the evidence out there has bias and limitations. Still, studies have shown that patients using a PPI before diagnosis were 40% more likely to be diagnosed with dementia.
Pneumonia 20Observational evidence has shown a 50% increase in risk of developing community acquired pneumonia in patients taking a PPI. This risk may not be relevant after controlling for cofactors.
Clostridium Difficile 21,22There is evidence that PPIs may increase C Diff risk by 74%. This increases to 96% when PPIs are given along with antibiotics. H2RAs have been shown to have a lower risk compared to PPIs. There is also some evidence in mice that PPI use aggravates inflammation associated with C Diff infections.
Heart Attack 23PPI use has been shown to be associated with a 15% increase in risk of heart attack. This was observational data, and there is some argument that this increase in risk may be related to physicians mistaking dyspepsia for an MI.
Stroke 24A recent abstract from the American Heart Association’s 2016 meeting demonstrated a 21% increased risk in ischemic stroke for patients taking PPIs. The abstract also notes a dose-response relationship.

So the question is, I don’t have erosive disease, I’m just on this medication for heartburn/acid reflux.. how do I get off?

When patients discontinue a PPI, they may experience some rebound acid reflux. PPIs increase a hormone called gastrin, which would normally signal the production of acid; however, while patients are taking the PPI this effect is suppressed. Following the withdrawal of the PPI, the elevated gastrin can cause a rebound increased in acid secretion. The effects tend to last for one to two weeks.25,26

When discontinuing a PPI…

  • Talk with your healthcare provider to consider titrating it down; in other words slowly decreasing it.
  • Recognize that heartburn may return for the first week or two.
  • You could consider using OTC Antacids (like Tums) or H2RAs (like Ranitidine or Famotidine) for 1-2 weeks to help with the rebound effect.
  • Consider supplements and alternative options.

Alternative Options

ProductDirectionsRationale
Apple Cider Vinegar 27Take 1-2 teaspoons in a glass of water before meals. (drink with a straw to avoid erosion to teeth)Some theories for how heartburn develops suggest that heartburn can happen as a result of not having enough stomach acid to properly digest food. Adding a small amount of the acidic apple cider vinegar may help reduce symptoms.
Probiotics 27Aim for at least 10 to 20 billion CFUs per day.Heartburn symptoms could be due to an imbalance of GI bacteria. Probiotics can help restore the balance of GI flora and improve digestion. Various bacteria play different roles in digestion.
Digestive Enzymes 28Take 1 capsule with meals.Poor digestion may make heartburn symptoms worse. Adding digestive enzymes can aid digestion and prevent symptoms.
DGL 29-31Take 1 capsule once daily with a meal.Soothes gut lining, stimulates proper digestion.
GI Revive 29-35
(Contains DGL and other ingredients)
Take 7 capsules daily; These can be spaced out however the patient tolerates them. It may be beneficial to take them with meals.GI Revive can help heal the gut if damage or “leaky gut” is suspected. The theory is that since most of the immune system lies in the gut, if there is damage and large inflammatory particles get through, patients will experience inflammation and GI symptoms.
DGL by OrthoMolecular 29-31, 36-401-2 tablets per daySoothes gut lining, stimulates proper digestion. Marshmallow root has a long history of providing a soothing property to mucous membranes. Slippery elm bark also helps protect the GI tract and promotes a healthy cycle of inflammation. Aloe Vera has studies that show it helps balance gastric acid secretion and at low doses protects the membranes from excess acid.
Heartburn Essentials 29-31, 36-371 capsule with each mealHas DGL, marshmallow root, slippery elm, artichoke, and turmeric plus digestive enzymes.

In our practice we typically use GI Revive for patients with suspected leaky gut and inflammation in the gut because it has good nutrients for helping to restore tissues such as zinc carnosine, l-glutamine, and N-Acetyl Glucosamine. As well as some anti-inflammatory supplements like MSM and Quercetin. Then it also has some of the similar ingredients to other products above such as DGL, slippery elm, and marshmallow root, etc. I typically do it for 1-2 months then move on to something a bit less expensive for maintenance if needed. Again this is for patients with inflammation present and you may not know that unless you work with a provider who can do some functional medicine testing.

For most patients with occasional heart burn and reflux without other symptoms of “leaky gut” starting with DGL may be enough. I like the Orthomolecular product that also includes slippery elm bark, marshmallow root, and aloe vera. There is a similar product called Heartburn Essentials by Pure Encapsulations noted in the table as well.

If you aren’t taking the GI Revive, it may be worth considering adding Zinc Carnosine.  It is a great nutrient for helping re-build the mucosal lining. It also has anti-ulcerative properties.

In summary for most patients trying to get off a PPI (without evidence of erosive disease)

I would recommend discussing the following with your health-care provider.

  1. A quality probiotic like OrthoBiotic from OrthoMolecular (I like that this doesn’t need to be in the fridge and includes Saccharomyces Boulardii) or Ther-Biotic Complete Klaire Labs
  2. Digestive Enzymes take your pick of products, I have some of my favorites listed in my Full Script store. If you have symptoms that include a “burning sensation” at this time, you likely want to avoid a product with HCL until soothing nutrients have allowed the mucous membranes to heal.
  3. Deglycyrrhizinated licorice (DGL) (The Orthomolecular product or plain DGL) OR the Heartburn Essentials (Pure Encapsulations).

Also consider

  1. Zinc carnosine  if not taking GI Revive
  2. Ox Bile if your heartburn is worse after fatty meals and you have trouble digesting those, you could add  Ox bile 125 mg with fatty meals. The OrthoDigestzyme product has this in it already but also has HCL.

You can find these in my FullScript Supplement store under the “GastroIntestinal Health” category.

Additional things to consider would be acupuncture, chiropractic care, or osteopathic manipulation with a DO physician. The human body never ceases to amaze me, that God created each part of us to work together, to balance our bodies. If one area is out of whack, it often affects other processes in the body. I have found all three to be helpful at different points in my life. Lastly in the list below, there are some other ideas that are non-medication or non-supplement related steps reducing heartburn as well.

Next steps…. if no improvement you may want to consider doing a stool test with Genova Diagnostics. This will discover if you have inflammation in the gut, an imbalance in bacteria, yeast or an invader like a parasite contributing to symptoms. It also shows you if you have undigested proteins and fats in the stool.  You can find providers in your area at this site. Or come find me in Enon/Fairborn, Ohio! You can also search for functional medicine providers in your area here.

I hope you find this helpful! A HUGE thank you to a past student of mine Dr. Trevor Stump for compiling a lot of this information. He shared with our team of local providers earlier this year.

Dr. Hartzler

Non-Pharmacological Recommendations for Heartburn

  • Weight Loss
  • Smoking Cessation (Quitting Smoking)
  • Avoiding Spicy or Fatty Foods
  • Eating Smaller Meals
  • Avoiding Tight Clothing
  • Elevating the Head of the Bed at Night
  • Avoiding Meals within 3 Hours of Bedtime
  • Yoga or Meditation (Stress Relief)
  • Eating More Slowly

*this post contains affiliate links to products I recommend, all the supplements recommended in this post can be found in my FullScript Store You do have to set-up a quick account to use.  Thanks for supporting the blog, remember 10% goes to support various ministries! Check out My Favorite Things for more details. Reminder that this information is general and personal specific health decisions should be made between you and your medical provider. Remember supplements can interact with certain medications, so make sure to include a pharmacist knowledgeable in this area in your decisions as well.

References:

  1. Gawron AJ, Feinglass J, Pandolfino JE, Tan BK, Bove MJ, Shintani-smith S. Brand name and generic proton pump inhibitor prescriptions in the United States: insights from the national ambulatory medical care survey (2006-2010). Gastroenterol Res Pract. 2015;2015:689531.
  2. Forgacs I, Loganayagam A. Overprescribing proton pump inhibitors. BMJ. 2008;336(7634):2-3.
  3. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308-28.
  4. Heidelbaugh JJ, Kim AH, Chang R, Walker PC. Overutilization of proton-pump inhibitors: what the clinician needs to know. Therap Adv Gastroenterol. 2012;5(4):219-32.
  5. Masclee GM, Sturkenboom MC, Kuipers EJ. A benefit-risk assessment of the use of proton pump inhibitors in the elderly. Drugs Aging. 2014;31(4):263-82.
  6. Scarpignato C, Gatta L, Zullo A, Blandizzi C. Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression. BMC Med. 2016;14(1):179.
  7. Benmassaoud A, Mcdonald EG, Lee TC. Potential harms of proton pump inhibitor therapy: rare adverse effects of commonly used drugs. CMAJ. 2016;188(9):657-62.
  8. Xie Y, Bowe B, Li T, et al Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States veterans BMJ Open 2017;7:e015735. doi: 10.1136/bmjopen-2016-015735
  9. Aronson JK. Inhibiting the proton pump: mechanisms, benefits, harms, and questions. BMC Med. 2016;14(1):172.
  10. Jung SB, Nagaraja V, Kapur A, Eslick GD. Association between vitamin B12 deficiency and long-term use of acid-lowering agents: a systematic review and meta-analysis. Intern Med J. 2015;45(4):409-16.
  11. Zhou B, Huang Y, Li H, Sun W, Liu J. Proton-pump inhibitors and risk of fractures: an update meta-analysis. Osteoporos Int. 2016;27(1):339-47.
  12. Thaler HW, Sterke CS, Van der cammen TJ. Association of Proton Pump Inhibitor Use with Recurrent Falls and Risk of Fractures in Older Women: A Study of Medication Use in Older Fallers. J Nutr Health Aging. 2016;20(1):77-81.
  13. Yang YX, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 2006;296:2947-53.
  14. Corley, D.A., Kubo, A., Zhao, W., Quesenberry, C., Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients, Gastroenterology (2009), doi:10.1053/j.gastro.2010.03.055.
  15. Lazarus B, Chen Y, Wilson FP, et al. Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease. JAMA Intern Med. 2016;176(2):238-46.
  16. Arora P, Gupta A, Golzy M, et al. Proton pump inhibitors are associated with increased risk of development of chronic kidney disease. BMC Nephrol. 2016;17(1):112.
  17. Haenisch B, Von holt K, Wiese B, et al. Risk of dementia in elderly patients with the use of proton pump inhibitors. Eur Arch Psychiatry Clin Neurosci. 2015;265(5):419-28.
  18. Batchelor R, Gilmartin JF, Kemp W, Hopper I, Liew D. Dementia, cognitive impairment and proton pump inhibitor therapy – a systematic review. J Gastroenterol Hepatol. 2017; e-pub ahead of print.
  19. Corsonello A, Maggio M, Fusco S, et al. Proton pump inhibitors and functional decline in older adults discharged from acute care hospitals. J Am Geriatr Soc. 2014;62(6):1110-5.
  20. Lambert AA, Lam JO, Paik JJ, Ugarte-gil C, Drummond MB, Crowell TA. Risk of community-acquired pneumonia with outpatient proton-pump inhibitor therapy: a systematic review and meta-analysis. PLoS ONE. 2015;10(6):e0128004.
  21. Kwok CS, Arthur AK, Anibueze CI, Singh S, Cavallazzi R, Loke YK. Risk of Clostridium difficile infection with acid suppressing drugs and antibiotics: meta-analysis. Am J Gastroenterol. 2012;107(7):1011-9.
  22. Hung YP, Ko WC, Chou PH, et al. Proton-Pump Inhibitor Exposure Aggravates Clostridium difficile-Associated Colitis: Evidence From a Mouse Model. J Infect Dis. 2015;212(4):654-63.
  23. Shah NH, Lependu P, Bauer-mehren A, et al. Proton Pump Inhibitor Usage and the Risk of Myocardial Infarction in the General Population. PLoS ONE. 2015;10(6):e0124653.
  24. Sehested TSG, Fosbol EL, Hansen PW, Charlot MG, Torp-Pedersen C, Gislason GH. Abstract 765. Proton pump inhibitor use increases the associated risk of first-time ischemic stroke. A nationwide cohort study. Presented at: the 2016 American Heart Association Scientific Sessions. November 12-16, 2016; New Orleans, LA.
  25. Reimer C, Søndergaard B, Hilsted L, Bytzer P. Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy. Gastroenterology. 2009;137(1):80-7, 87.e1.
  26. Niklasson A, Lindström L, Simrén M, Lindberg G, Björnsson E. Dyspeptic symptom development after discontinuation of a proton pump inhibitor: a double-blind placebo-controlled trial. Am J Gastroenterol. 2010;105(7):1531-7.
  27. Kines K, Krupczak T. Nutritional Interventions for Gastroesophageal Reflux, Irritable Bowel Syndrome, and Hypochlorhydria: A Case Report. Integr Med (Encinitas). 2016;15(4):49-53.
  28. National Enzyme Company, TNO Nutrition and Food Research. The First Quantitative Evidence Proving The Efficacy Of Supplemental Enzymes. National Enzyme Company. 2004. http://www.enzymeessentials.com/TNO_Research_Web.pdf.
  29. Aly AM, Al-alousi L, Salem HA. Licorice: a possible anti-inflammatory and anti-ulcer drug. AAPS PharmSciTech. 2005;6(1):E74-82.
  30. Momeni A, Rahimian G, Kiasi A, Amiri M, Kheiri S. Effect of licorice versus bismuth on eradication of Helicobacter pylori in patients with peptic ulcer disease. Pharmacognosy Res. 2014;6(4):341-4.
  31. Brogden RN, Speight TM, Avery GS. Deglycyrrhizinised liquorice: a report of its pharmacological properties and therapeutic efficacy in peptic ulcer. Drugs. 1974;8(5):330-9.
  32. Mahmood A, Fitzgerald AJ, Marchbank T, et al. Zinc carnosine, a health food supplement that stabilises small bowel integrity and stimulates gut repair processes. Gut. 2007;56(2):168-75.
  33. Klimberg, V. Suzanne, M.D., et al. Prophylactic Glutamine protects the intestinal mucosa from radiation injury. Cancer 1990, July 1;66(1):62-68.
  34. Hickson R, et al. Glutamine prevents downregulation of myosin heavy chain synthesis and muscle atrophy from glucocorticoids. Am J Physiol 1995 Apr;268(4 Pt 1):E730-E734.
  35. Noyer CM, Simon D, Borczuk A, Brandt LJ, Lee MJ, Nehra V. A double-blind placebo-controlled pilot study of glutamine therapy for abnormal intestinal permeability in patients with AIDS. Am J Gastroenterol 1998;93(6):972-5.
  36. Engels, G. Marshmallow. HerbalGram. 2007;(75):1-5.
  37. From: https://umm.edu/health/medical/altmed/herb/slippery-elm. Accessed 3-3-14. (Slippery Elm reference)
  38. Blitz, J.J., Smith, J.W. et al. Aloe vera gel in peptic ulcer therapy: preliminary report. J Am Osteopath Assoc. 1963;62:731-735.
  39. Rajendran A, Sobiya G et al. Study on the Effective Supplemenation of Aloe vera Gel Antacid to Peptic Ulcer Res J Medicine & Med Sci. 2008; 3(2):132-134.
  40. Gawron-Gzella, A., Witkowska-Banaszczak, E. et al. [Herbs and herbal preparations applied in the treatment of gastric hyperacidity, gastric and duodenal ulcer in cigarette smokers]. Przegl Lek. 2005; 62(10):1185-1187.

 

Allergic Rhinitis & The Gut..Is it time for Probiotics?

Despite summer being in full swing here in Ohio, there are a lot of people here and across the country are who are still suffering from seasonal allergies and what the medical community refers to as allergic rhinitis (AR). AR is one of the most common diseases that effects nearly 1 in every 6 Americans. AR is an inflammatory condition often leading to symptoms such as congestion, runny nose, sneezing, nasal itching, and watery/itching eyes.

Some experience seasonal allergies that are temporary due to triggers being pollens that come and go depending on the season. Others experience year-round or perennial allergies due to dust mites and continued triggers. Some patients could experience what is referred to as episodic allergies from triggers they encounter outside of their typical environment such as family members’ pets.1

Guidelines recommend avoiding allergic triggers as a first step in treatment such as removal of pets, using air filtration systems, and bed covers (to avoid dust mites). 1 Nasal saline rinses can be very helpful to clear out the pollens from the nasal passage before sleeping, this is my favorite one that is easy to use! Washing your hair before sleeping can also help reduce the pollens that attach to our hair follicles. From a western medicine standpoint, during serious allergy flare ups, I need to use a topical nasal steroid such as fluticasone. 1 The great part is they are now available over the counter. This can help calm down the inflammation short term as you consider other ways to address allergies more naturally. Budesonide  is the nasal steroid of choice for pregnant women, using the lowest effective dose and duration is recommended.2,3

An interesting discussion recently has been the connection between the gut and the lack of diverse healthy microbes to the development of allergies. Multiple studies indicate that the increased incidence of autoimmune and allergic diseases in developed countries may be associated with reduced diversity in bacteria exposure and changes of bacteria in various body tissue. AR and atopic eczema have been shown to be related to changes in gut microbial composition.4

“Leaky gut” is a term for an impaired intestinal barrier or an increase in gut permeability, which may also play a role in the development of asthma and allergies. The intestine should play a role as the gatekeeper of immunity and when this is broken the body can start to have a reaction to typical proteins called antigens it would not normally react to. This can include food reactions, or reactions in the nasal passageways or lungs. AR is considered by some to be an early form of an autoimmune disease.4

Thus an important part of treating seasonal allergies is making sure the gut is healthy, this is a whole post in itself that will be coming soon, but for now starting with a high quality probiotic and avoiding allergic triggers including foods that further trigger allergy symptoms is a start. For me I have a reaction to ragweed in the fall and I have found that sunflower seeds trigger my allergic rhinitis because they are similar plants. Paying attention to food triggers can be very helpful! In regards to probiotics, Vliagoftis et al performed a meta-analysis of 16 clinical trials on the treatment of AR and Asthma and found that 9 of 12 studies that elevated clinical outcomes of AR showed improvement due to the use of probiotics. They determined that probiotics may have a beneficial effect by reducing symptom severity and medication use. Most of these studies reported used some form of Lactobacillus species such as Lactobacillus casei, Lactobacillus acidophilus, Lactobacillus paracasei, Lactobacillus rhamnosus, some included a combination with Bifidobacterium strains.5

My favorite probiotic for adults right now is OrthoBiotic from OrthoMolecular. This is a high quality mix of the strains discussed above.  It also includes Saccharomyces boulardii which is a beneficial non-pathogenic yeast that works to balance intestinal flora.  The only patients who should not take Saccharomyces would be those with compromised immune systems. Each OrthoBiotic capsule provides seven proven probiotic strains chosen for their ability to withstand the harsh gastrointestinal (GI) environment and adhere to the intestinal tract. The specific strains found in this product have be shown to increase Secretory IgA which provides enhanced gut Immunity.

Bifidobacterium lactis (B. lactis), one of the probiotics in the above formula, is predominantly found in the colon. A double-blind, randomized placebo-controlled trial on subjects receiving B. lactis or placebo for eight weeks found that B. lactis supported a balanced immune response in individuals hypersensitive to environmental allergens.Flora Boost can be a great option for toddlers and kiddos that don’t swallow pills yet.

Ther-Biotic Complete is another great probiotic I recommend by Klaire Labs. They also have a Women’s Formula as well that supports healthy colonization in the vaginal tract as well as provides the probiotic strains above shown to be beneficial in allergic conditions. Klaire Labs formulas do need to be refrigerated upon arrival.

You can find all of these high quality probiotics in my Supplement Store on FullScript. If you have questions, feel free to reach out! Don’t forget to contact me & sign up for blog updates if you want 15% off your first order.

Stayed tuned for my next post which will discuss my favorite supplements (Quercetin, Stinging Nettles) and nutrients (Vitamin C, Bromelain, N-Acetyl-L-Cysteine) and their useful role in supporting allergic conditions. And if you need recommendations for probiotics for babies, head over to this post.

 

References:

  1. Seidman et al. Clinical Practice Guideline: Allergic Rhinitis. Otolaryngology–Head and Neck Surgery 2015, Vol. 152(1S) S1–S43.
  2. Wallace DV, Dykewicz MS, Bernstein DI, et al, “The Diagnosis and Management of Rhinitis: An Updated Practice Parameter,”J Allergy Clin Immunol, 2008, 122(2 Suppl):1-84.[PubMed 18662584]
  3. NAEPP Working Group Report on “Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment,” National Institutes of Health, National Heart, Lung, and Blood Institute, NIH Publication No. 05-5236, March 2005. Available athttp://www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg/astpreg_full.pdf
  4. Hormannsperger G, et al. Gut matters: Microbe-host interactions in allergic diseases. J Allergy Clin Immunol 2012;129:1452-9.
  5. Vliagoftis et al. Probiotics for the treatment of allergic rhinitis and asthma: systematic review of randomized controlled trials. Ann Allergy Asthma Immunol. 2008;101:570–579
  6. Singh A, Hacini-Rachinel F, Gosoniu ML, Bourdeau T, Holvoet S, Doucet-Ladeveze R, Beaumont M, Mercenier A, Nutten S. Immune-modulatory effect of probiotic Bifidobacterium lactis NCC2818 in individuals suffering from seasonal allergic rhinitis to grass pollen: an exploratory, randomized, placebo-controlled clinical trial. Eur J Clin Nut. 2013 Feb;67(2):161-7.

5 Babies and Probiotics

Over recent years the connection between the gut microbiome (the bacteria in our gut, also know as our gut flora!) and chronic diseases has been stronger than ever.  There are a large number of publications linking less diverse flora to a myriad of conditions especially those in the asthma, allergy, and autoimmune realm.

The bacteria in our gut play several roles including:1

  • Critical role in regulation of the immune system
  • Provide protection against pathogen (bad bugs!) overgrowth
  • Influence host-cell growth and blood vessel growth
  • Regulate intestinal endocrine functions, neurologic signaling, and bone density
  • Provide a source of energy (5 to 10% of daily host energy requirements);
  • Biosynthesize vitamins, neurotransmitters, and multiple other compounds
  • Metabolize bile salts
  • React to or modify specific drugs
  • Eliminate exogenous toxins

Currently researchers are even studying how to implant drug peptides into the bacteria in our gut for certain conditions. One particularly interesting one is for the treatment of inflammatory Bowel disease, which often severe cases come with injectable agents that weaken the immune system all over. Wouldn’t it be great if we had targeted therapy just in the gut!

So the question is if our gut is so important, how do we help our children start out on the right track with solid gut flora.  The answer….you guessed it..probiotics!  Probiotics are “Live microbes that confer health benefits when administered in adequate amounts in the host.”1The key with infants though is to get them probiotics early in the first few days when their gut is designed to multiply those good bugs! The in utero environment was once considered sterile. However recently, DNA studies of the micro biome have found bacterial species in the placentas of healthy mothers, in amniotic fluid of preterm infants, and in meconium.1

Ideally babies born vaginally shouldn’t need this right, they swallow fluid during delivery through the vaginal canal that should seed their gut? While that is true, most of us Mommas have taken antibiotics in our lifetime, if not multiple courses, been under stress (which has been proven to change gut flora!)2, and often times are eating or have eaten a diet previously that was not friendly towards growing and multiplying good bacteria.  We also live in an environment where traces of antibiotics are in our water supply and food chain. So I recommend every baby whether born vaginally or c-section get probiotics during the first week of life. I also recommend Mommas take probiotics throughout their pregnancy.

Another way to help the flora grow is with breastmilk. Studies3,4 have shown that the guts of breast fed babies vs formula fed babies are different compositions of bacteria. Breastfed babies have more beneficial bifidobacteriam species.  Exclusive and partial formula-feeding have been shown to alter the gut bacteria toward adult patterns, increase pro-inflammatory bacterial species, increase gut permeability (leaky gut) and result in lower concentrations of fecal short-chain fatty acids compared with exclusive breastfeeding.4 While I realize this isn’t possible for every women, from my experience it’s hard, especially during those first few months.  Believe me lots of tears were shed in the process of making it work for us with my first child. Then of course pumping if you are working out of the home is hard too. But I promise it’s worth the attempt at least. The IGG in the breastmilk also helps seal the gut lining which makes your babies less susceptible to gut damage and autoimmune conditions such as type 1 diabetes5, and allergies, asthma, and airway disease.6

Studies have shown infant gut flora diversity and healthy guts have been linked to less risk of asthma/wheezing, food allergies, and many other autoimmune conditions.5-9 Some data is even suggesting good flora can modulate behavioral and neurodevelopmental disorders.10

Ther-Biotic Women’s Formula

Ther-Biotic for Infants

It’s pretty simple, babies don’t need a large amount of probiotics just a little bit to get their gut started and if you get it early, you don’t may not have to supplement daily later on. Most functional medicine providers and myself recommend either using a Women’s Formula like Ther-biotic® Women’s Formula  by Klaire Labs or their Ther-biotic® Infant Powder.  With the capsules, you can open the capsule and place a small amount of the powder on the breast or the tongue of the infant before feeding, then mom can close the capsule and swallow the rest.

After a few days of that you can also use the infant powder or continue to share yours. They are similar formulas.  The Women’s formula is designed to be the flora that are found in the vaginal canal so it’s just want baby should have swallowed in an ideal world. If baby becomes too gassy after a week or so of the powders, you can start to decrease the dose to 1-2 times per week.

UltraFlora® Baby

OrthoMolecular Saccaromyces product

Metagenics also makes an infant drop called UltraFlora® Baby  that has been easily to use with my son.  If gas becomes an issue with the baby again only give a few times a week after that initial week and consider using a strain called Saccaromyces Boulardii which is a healthy yeast that balances the gut flora and is well known for it’s beneficial effects in acute and chronic GI conditions.11  I is not a gas producing organism.I personally like the OrthoMolecular Saccaromyces product that doesn’t have to be stored in the fridge but Klaire Labs makes one too. There have been case reports of Saccharomyces Boulardii blood stream infections in immunocompromised patients, so I would not recommend use for those patients or premature infants.11

I wish I would have known to give probiotics earlier with my daughter, we started them at about 5 weeks after she was colicky and had reflux. Along with an elimination diet for me, she was lots better!  So it’s not too late even if you are reading this and your child is older they may benefit from replacing gut flora, depending on age, they may need a different formula. Our daughter was allergic to tree nuts, eggs, and a few other things early on, verified by skin prick testing, after a few years of vitamin D and probiotics and eating a gut friendly diet for the most part. The most recent skin test was negative for everything tested! Praise the Lord! She enjoyed splitting a Cashew LaraBar with mom today no problems! Feel free to reach out if you need specific recommendations on probiotics for you or your loved one!

More on gut healing in adults and kiddos to come! Also a post to come on metabolic disease and the gut, early life exposure to antibiotics can influence risk of diabetes and other metabolic conditions like obesity and allergies!12,13

*this post contains affiliate links to products I recommend, all the probiotics recommended in this post can be found in my FullScript Store You do have to set-up a quick account to use. Thanks for supporting the blog, remember 10% goes to support various ministries! Check out My Favorite Things for more details.

References

  1. Lynch S, Pederson O. The human intestinal microbiome in health and disease. N Engl J Med 2016;375:2369-79.DOI: 10.1056/NEJMra1600266.
  2. Konturek PC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J Physiol Pharmacol. 2011 Dec;62(6):591-9.
  3. Madan JC, Hoen AG, Lundgren SN, Farzan SF, Cottingham KL, Morrison HG, Sogin ML, Li H, Moore JH, Karagas MR. Association of Cesarean Delivery and Formula Supplementation With the Intestinal Microbiome of 6-Week-Old Infants. JAMA Pediatr. 2016;170(3):212-219. doi:10.1001/jamapediatrics.2015.3732
  4. O’Sullivan A, Farver M, Smilowitz JT. The Influence of Early Infant-Feeding Practices on the Intestinal Microbiome and Body Composition in Infants. Nutrition and Metabolic Insights. 2015;8(Suppl 1):1-9. doi:10.4137/NMI.S29530.
  5. Endesfelder D, Engel M, Zu Castell W. Gut Immunity and Type 1 Diabetes: a Mélange of Microbes, Diet, and Host Interactions?. Current Diabetes Reports [serial online]. July 2016;16(7):60. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed February 19, 2017 doi:10.1007/s11892-016-0753-3.
  6. Huang et al. Breastfeeding and timing of first dietary introduction in relation to childhood asthma, allergies, and airway diseases: A cross-sectional study. Journal of Asthma. 2016; Published on-line 07 Sept 2016. P 1-10. http://dx.doi.org/10.1080/02770903.2016.1231203
  7. Uusitalo U, Liu X, Virtanen S, et al. Association of Early Exposure of Probiotics and Islet Autoimmunity in the TEDDY Study. JAMA Pediatrics [serial online]. January 2016;170(1):20-28. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed February 19, 2017.
  8. Arrieta M, Stiemsma L, Finlay B, et al. Early infancy microbial and metabolic alterations affect risk of childhood asthma. Science Translational Medicine [serial online]. September 30, 2015;7(307):307ra152. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed February 19, 2017.
  9. Fujimura K, Sitarik A, Lynch S, et al. Neonatal gut microbiota associates with childhood multisensitized atopy and T cell differentiation. Nature Medicine [serial online]. October 2016;22(10):1187-1191. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed February 19, 2017.
  10. Hsiao E, McBride S, Mazmanian S, et al. Microbiota modulate behavioral and physiological abnormalities associated with neurodevelopmental disorders. Cell [serial online]. December 19, 2013;155(7):1451-1463. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed February 19, 2017.
  11. Kelesidis T, Pothoulakis C. Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of gastrointestinal disorders. Therapeutic Advances in Gastroenterology. 2012;5(2):111-125. doi:10.1177/1756283X11428502
  12. Yallapragada S, Nash C, Robinson D. Early-Life Exposure to Antibiotics, Alterations in the Intestinal Microbiome, and Risk of Metabolic Disease in Children and Adults. Pediatric Annals [serial online]. November 2015;44(11):e265-e269. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed February 19, 2017
  13. Johnson C, Ownby D, Joseph C, et al. Antibiotic exposure in early infancy and risk for childhood atopy. The Journal Of Allergy And Clinical Immunology [serial online]. June 2005;115(6):1218-1224. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed February 19, 2017.

 

 

3 My Journey

My husband Dustin and I welcomed our first child, our daughter (pictured!) in March of 2014. We attempted to go with natural labor route but after 21+ hours of being induced I got an epidural, it was my best chance of pushing her out because I needed rest.  She was a healthy baby, except she was colicky and didn’t sleep well. Through chiropractic care I learned about food intolerances and started to remove foods from my diet that she was reacting to. After a tongue tie and lip tie release procedure, probiotics, and my elimination diet she was a much happier baby!

About six months later I personally started to have awful GI symptoms and when she was 8 months old she had her first allergic reaction to eggs. While it wasn’t the extreme of what it could have been it made me very anxious every time she ate about anything new. Between the already damaged gut (high stress schooling & job, good amount of antibiotics as a child, and poor diet as a teenager), plus now the stress of figuring out what my child could and couldn’t eat, by the time she was about 10-11 months old I had awful pain in my right lower abdomen after literally everything I ate.

I had the full work-up and everything modern medicine was looking for came back negative. I thankfully already knew about the Paleo lifestyle and elimination diets, so I started there but ended up losing a good chuck of weight because I was eating so limited and still breastfeeding. The stress and worry of not knowing what was wrong was also making everything worse.  I had a good friend who had been to a local physician who practiced some functional medicine and got in about a month later with him. After some functional medicine testing including allergy testing ultimately I had “leaky gut” and bacterial overgrowth. And while I didn’t realize it at the time, likely a large deficiency of B vitamins.  I took some natural and conventional approaches to treatment.

Along the way I learned about histamine intolerance, gut healing protocols, the gut’s link to inflammatory diseases, and food allergy testing, while I knew this wasn’t a quick healing process I was frustrated that I didn’t feel too much better even six months later.  I ended up seeking a few other practitioners (including a gastroenterologist), all of whom I’m grateful for their part in my journey. From those providers, I learned about the impact of stress on the symptoms I was having, and natural approaches to balancing stress with both supplement and lifestyle medications. I also learned how even my low hormone levels were impacting my symptoms.

Two years later, after treatment for fungal overgrowth, about six months of acupuncture, and a change in supplements, was when I really started to feel a lot better. At this point, I felt like my body was healthy enough to consider trying for another baby.  Thankfully God was on the same page and after a wonderful 6 weeks in Spain with my family and teaching for a study abroad program, we got home and found out we were expecting!

For my daughter thankfully we have learned a lot for her too. There is a wonderful DO pediatrician nearby that we take her too occasionaly for the natural approaches to allergies and gut health. I’ve learned about how important early introduction of probiotics can be vital for babies (blog post coming soon on that!), how foods effect skin conditions like eczema, natural approaches to constipation and much more.

During the midst of all of this, I spent a lot of time in prayer, often asking for healing, and a purpose for all of this.  Thankfully my prayers were answered. During my second pregnancy I had minimal GI symptoms which has been wonderful for maintaining a well balanced diet. But most importantly all that I have learned along the way has impacted so many people.  After a conversation about all of this with one of my dear friends whose little boy had awful reflux symptoms, she visited the pediatrician mentioned above and learned his symptoms were due to a corn allergy, and with elimination diet and some supplements, he is a new kiddo. His reflux was so severe he was hospitalized during the first year of life.  I hope I can get her to write a guest post on that because she is also a PharmD! The many other people that have been impacted have been friends and family as well as my patients.  My goal for this blog is to continue to share what I have learned and what I am continuing to learn with a broader audience.

I hope you will join me on our family’s continued journey towards wellness!

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