So Simple, But Does the Paleo Diet Make You Feel Better?

Does the Paleo diet, basically, eating lean meats, nuts, fresh fruits and vegetables – foods our Stone Age, hunter-gatherer ancestors could have eaten – really make you feel better?

If it does, then why?  And how, exactly? 

What happens to the microbiome – the countless bacteria that live inside the gut – when you stop eating dairy, processed sugars and carbs?

paleo diet foodsThis is what doctors at the Amos Center for Food, Body & Mind at Johns Hopkins Bayview Medical Center want to know.  Some of their patients who have irritable bowel syndrome (characterized by constipation, diarrhea, and nausea, it also can include anxiety or depression) have reported that they have been doing better after changing to a Paleo diet. 

To help find out why, Kimberly Harer, M.D., gastroenterology fellow at the Center, designed a short-term study.  I recently interviewed Harer and her colleague, epidemiologist Noel Mueller, Ph.D., for Breakthrough, a publication of the Center for Innovative Medicine at Johns Hopkins. 

For two weeks, she says, 40 patients with IBS will be randomly assigned to eat either a Paleo diet or a standard, healthful diet.  Harer and Mueller will be looking at many things in these study participants, including “how the diet affects their GI symptoms, their quality of life, their vitality,” says Harer.  In people who have been experiencing anxiety or depression, the investigators will look for changes in these symptoms, as well.  They will study blood samples and patient responses to questionnaires about their health, and then, looking at the bacteria in stool specimens, the scientists will analyze the gut “microbiome” before and after. 

Let’s just take a moment to reflect on the concept – still fairly new in research – of a microbiome: It’s a small ecosystem made up of bacteria; this is more complex than it sounds.  Just as the earth has its own ecosystems – tundra, tropical rainforests, grasslands – your body has them, too.  Except instead of plants, these microbiomes are populated by bacteria: dozens of them, picky little cliques that only thrive in one particular spot. For example, the bacteria on the inside of your elbow are different from the bacteria on your face – and even on your face, the bacteria on the bridge of your nose are different from the bacteria between your nose and mouth; and those bacteria are different from bacteria on your chin. 

But the gut takes it to another level; it is the microbial mother lode.  In numbers alone, it’s intimidating.  “There are trillions of microbiota (tiny habitats) in the gut,” says Mueller.  And get this:  All of those bacteria in all those micro-habitats have their own genes and their own genomes, which scientists now know how to sequence.  “There are 100 to one more microbial genes than in your own human genome.”

 paleo diet pancakeThis is why scientists at the Amos Center are convinced that the microbiome has an important influence on our health.  It’s not just numbers, it’s sheer mass:  All those bacteria that live inside our gut, if you somehow got them all together in one lump, would weigh and take up about as much space as your brain – three or four pounds.  Trying to get a handle on that would be overwhelming without sophisticated computers and software, sequencing technology, and bioinformatics tools that allow scientists to recognize patterns and identify gene signatures.

Because the study of the gut’s microbiome is still so new, nobody is sure what it’s supposed to look like, and how the gut flora relates to symptoms.  “Maybe we won’t ever be able to define what is the normal gut microbiome,” says Mueller.  “Normal might be different for everybody.”

Even in identical twins, Mueller continues, the bacteria in the gut can be very different.  It is not unheard of for one twin to have a normal weight, and one to be obese. 

Already, at many hospitals gut doctors are waging war with bacteria, successfully treating patients who suffer debilitating diarrhea from recurrent Clostridium difficile (C.diff) colitis with fecal microbiota transplants.  Basically, uninfected fecal material from a relative with healthy gut bacteria is inserted into the patient’s colon, the good bacteria overwhelm the bad bacteria and the C.diff. is conquered. 

In mice, Mueller notes, scientists have found that if they take the microbiota from the fecal sample of an obese individual and inject it into a germ-free mouse, that germ-free mouse will start to become overweight, too.  “The phenotype of obesity can be replicated just through the sharing of bacteria,” he says.  There is a lot of evidence to suggest that gut bacteria play a huge role in diseases of the metabolism – which also suggests that if these bacteria can be changed, there is great potential to improve someone’s health.

In this study, says Harer, “we will look at the microbiome at three different time points.  First, the baseline, before the diet changes; then, after the Paleo or study diet.”  And then one more time: after participants go back to eating whatever they used to eat for four weeks.  Blood samples will be taken after that four-week period, as well, and patients will fill out questionnaires to report any change in their symptoms.

  “If there are differences in the blood and the stool samples, it will be interesting to see if those correlate with changes in their symptoms,” says Harer.  “And we are very interested to see whether reverting back to their old diet causes the former symptoms to come back, or whether there are lasting changes.” 

Certain families of bacteria thrive on a diet full of macaroni and cheese, soda, and ham sandwiches.  Entirely different bacteria could show up if that diet changes to lean meat, nuts, berries, and veggies.  Which raises another question: If someone gets better with the Paleo diet, “what part is the beneficial part?  Is it the lower carbs?  Is it the increase in plants, or in protein content?  Is it cutting out gluten?”  Or is it some new, beneficial bacteria that have taken precedence in the gut?

paleo diet meatIt’s important to remember that “the microbiome is just part of the study,” Harer continues.  “The question is, does this diet improve symptoms in IBS patients?  Unfortunately, there is a huge unmet need in these patients, because there are few effective treatments.”   

Many people who have IBS are not treated very thoughtfully; they get laxatives for constipation, medicine for diarrhea, and often the symptoms don’t go away because the underlying cause is still there.  The Amos Center takes a team approach with gastroenterologists, allergists and immunologists, psychiatrists, nutritionists, and scientists.  Sometimes, Harer says, people who come to the Center are “frustrated, at the end of their rope sometimes when they come to see us.  We use everyone’s input to treat them holistically, and also to try new things.”

One of these new things is a diet so simple that – as the commercials put it – “a caveman could do it.”  If the Paleo diet does indeed help make people with IBS feel better, understanding why it works at gut level is something we’re only beginning to have the scientific knowledge and tools to decipher.

©Janet Farrar Worthington

Regular disclaimer: This is a blog. It is not an encyclopedia article or a research paper published in a peer-reviewed journal. If a relevant publication is involved in the story, I mention it. Otherwise, don’t look for a lot of citations, especially if I’m quoting from a medical professional.

,

Can Your Gut Bacteria Make You Depressed?

Mr. Rogers' Neighborhood

Gene J. Puskar/Associated Press

If you’re old enough to remember Mr. Rogers, you might remember him singing the happy little song, “So, who are the people in your neighborhood, in your neighborhood, in your neighborhood… they’re the people that you meet when you’re walking down the street.  They’re the people that you meet each day.”

This isn’t Mr. Rogers’ neighborhood.  It’s a lot smaller, but there are some interesting characters here.  They are bacteria, also called gut flora, or microflora.

The microflora in the gut are way more important than anyone realized even a few years ago.  This microbiome is made up of communities of bacteria and other organisms.  Tiny changes here can have big effects — not only on our digestive tract, but on our emotions.

Cynthia Sears, M.D., professor of medicine at Johns Hopkins Medical Institutions, is the director of the Scientific Advisory Board of the new Johns Hopkins Food, Body & Mind Center.  (I wrote about some of the research going on at this center in a recent post.)  In addition to finding links between diet and disease, scientists at the Center, particularly Sears, are studying the role of good and bad bacteria in making us sick and keeping us healthy.

Sears has focused on the many interactions between the gut’s microflora – the little ecosystems of bacteria that live and die down there in without our ever knowing about it – and our health.  I recently interviewed her for Breakthrough, the magazine for the Johns Hopkins Center for Innovative Medicine.  Rapidly expanding evidence, she told me, suggests “that the complex communities that we carry with us, which are on every surface of the body, are essential to health.  But they’re also associated with disease” — both right there in the gut, and distantly.  “They influence liver function, the function of the deep tissues, the enteric nervous system.”  They may also contribute to heart disease, pancreatic conditions, and be linked to our mood and to psychiatric disorders, as well as our weight.  “This concept is amazing,” she says, “particularly the idea that they can influence our mood and how we function in life.”

So, imagine that you have depression, and a doctor has put you on an antidepressant.  And it’s not really helping that much.  Then imagine that a doctor tells you, “the problem could be in your gut.”  This discussion is still pretty new, Sears says, but “our hope is that we will be able to identify the bacteria that produce the right metabolites, the ones that make you feel better,” to change how the microbiome functions.  “So if the microbiome has bad molecules, that we could modify it or treat it in such a way that you get good molecules and change the balance.”

Good bacteria

Photo Credit: sahilsajjad via Compfight cc

I asked her if this might one day eliminate the need for antidepressants.  Probably not, Sears says.  “But there are a lot of people who probably don’t fit into classic psychiatric criteria, who don’t feel well.  So this idea that we can use food and possibly ‘good’ bacteria to modify function and make someone feel better, and help turn someone’s life around, is very intriguing.”

Fermented Foods and Probiotics

Is there anything you can do to help clean up the neighborhood of bacteria in your gut?  Well, yes:  You can eat fermented foods, which contain probiotics, or you can take supplemental probiotics.  The problem with probiotics is that they are not regulated as drugs by the FDA, and there is a lot of variability in quality and effectiveness.  Similarly, there is a surprising lack of definitive, scientific journal-published research absolutely proving that fermented foods are helpful to your health.  However, that said, there is a lot of anecdotal evidence that they are.  The fermented items listed below, eaten in moderation, are not harmful to your health.  You may want to give them a shot for a couple of weeks, and see if you feel better with them in your diet.

Sauerkraut.  It’s fermented, hip, it’s happenin’ — check out the gourmet varieties (like Wildbrine’s Arame Ginger) of sauerkraut in the refrigerated section at upscale grocery stores — and it’s been around since the 4th century B.C.  First of all, it’s cabbage, and cabbage is already good for you, just raw out of the garden.  It’s in the family of cruciferous vegetables, along with broccoli and cauliflower, which have long been shown to help prevent cancer.  But the fermentation process brings some new chemicals to the table, including: isothiocyanates, which counteract carcinogens and help the body remove them; glucosinolates, which activate the body’s anti-oxidants; and flavenoids, which help protect artery walls.  Sauerkraut has few calories.  However, if you eat too much of it, it can cause diarrhea.  Again, moderation in all things.

Kombucha.  Fermented black tea.  Again, we’re starting with something that is already good for you; tea is rich in antioxidants.  Fermented black tea delivers a load of probiotics to your gut.  In addition to aiding digestion, these beneficial bacteria boost the immune system and can relieve irritable bowel symptoms, yeast infections, and other problems.  In one study, rats given kombucha had higher levels of “good” HDL cholesterol, a finding linked to a lower risk of cardiovascular trouble.   FloraStor, a commercial probiotic that’s used to treat C. difficile colitis, was isolated from kombucha.  A study from India found that a form of kombucha was just as effective as the drug, omeprazole (Prilosec), in healing stomach ulcers.  (Note: If you have an ulcer, I wouldn’t chuck Prilosec and start drinking kombucha.  For one thing, the kind you get might not have the kind of bacteria these scientists studied; also, how much would you need to be drinking every day, and for how long?  Ideally, as fermented foods become more popular, they will be better studied and their benefits will become a lot more clear.)

file5321333011701Yogurt.  Look for the words, “Live and active cultures.”  These are probiotics, and besides increasing the number of good bacteria in your gut, they can help reduce symptoms of irritable bowel syndrome, and also can help improve symptoms of inflammatory bowel diseases, such as Crohn’s and ulcerative colitis.  Greek yogurt has more protein than traditional yogurt; it takes longer to digest and can help you feel full longer — which, in turn, can reduce the need for snacks between meals, so as a bonus, it may help you lose weight.

 

 

©Janet Farrar Worthington

Regular disclaimer:  This is a blog.  It is not an encyclopedia article or a research paper published in a peer-reviewed journal. If a relevant publication is involved in the story, I mention it. Otherwise, don’t look for a lot of citations, especially if I’m quoting from a medical professional.