Testing, Supplements and Actions

In this section we will cover what are the test you should be considering but also layout of actionable steps to follow to improve your gut health. This steps are to be built on top of the ten protocol steps provided.

Table of Contents

15-Actionable Micro-Strategies

Actionable non-specific steps  to follow every day which that will help to keep your gut healthy. These are on top of the main lifestyle choices addressed previously ( Stress management, Exercise, No Smoking, No Alcohol, No Processed foods)

Llist below is in a prioritized order.

  1.  Drink plenty of water (around 2lt / day)
  2. Limit your intake of caffeine (e.g. up to 1 cup of coffee in the morning).
  3. Take ACV before every meal (or Hydrochloric acid and pepsin)
  4. Bone broth (or collagen) on a daily basis which includes lots of glycine amino acid, which is important for the gut surface.
  5. Increase saturated fat which will help to heal the gut epithelial cells.
  6. Take L-glutamine + zinc which heals the gut epithelial cells ( e.g Rezcue). (5–10 grams 2–3 times per day)
  7. Eat Omega-3 fatty acids (for the Vitamins A, D and E) and to improve the regeneration of mucous membranes. 
  8. Use as a baseline amount of fiber around 20-30g/day and try to increase/decrease the amount depending on how you feel.
  9. Supplement with magnesium citrate to improve the movements of the digestive tract. It is an important mineral for the intestinal epithelium.
  10. Ensure you get plenty of Vitamin B12 and folate from food (or nutritional yeast) on a daily basis.
  11. Drink a soothing tea (e.g chamomile)
  12. Use turmeric and ginger
  13. Eat 1/2cup of Berries (especially blueberries/bilberries)
  14. Take Digestive enzymes
  15. Take activated charcoal before going to bed (without any other supplements)

If you follow the above for 4-6 weeks together with the gut supporting protocols and you do not see improvement you should consider doing detailed testing.

Testing for gut issues

Identifying and pin pointing gut issues can be very difficult, so in some cases it is recommended to do some tests which will help you act faster.

SIBO

  • Do a breath test for hydrogen [H2] and methane [CH4].
  • Evaluate the level of gastric hydrochloric acid production (e.g. Gastropanel lab test and self-produced gastric hydrochloric acid test).

Gut analysis

  • Microbiological analysis of the gut (including yeast cultivation and extensive species identification and sensitivity to various drugs and natural products). Good example is Genova Diagnostics
  • Stool cultivation for yeast. Identifies Candida as a species but no other species
  • Intestinal permeability measurement (again Genova Diagnostics)
  • Blood antibody testing (IgG and IgA antibodies) may be performed if a yeast infection is suspected.
  • Differential diagnosis test: the possibility of small intestinal bacterial overgrowth (SIBO)

HydroChloric acid balance

 

Many laboratories today offer GastroPanel test, the largest complete laboratory test to determine the functional and inflammatory state of the stomach. This examination will also be able to identify situations in which the subject needs further gastroscopy.

The study investigates the following markers in the blood

  • Pepsinogen I (gastric body function – moderately correlated with hydrochloric acid production)
  • Pepsinogen II (structure and function of the entire gastric mucosa – correlates with gastric inflammatory status)
  • Gastrin-17 (Function of gastric fundus – correlates with gastric acid production)

Digestive Enzyme Levels

  • Fecal chymotrypsin test 
  • Putrefactive short-chain fatty acids (measures protein absorption; as part of CDSA)
  • Various fatty acids in stool (measures fat absorption; as part of CDSA)
  • Fecal pH (low level indicates carbohydrate malabsorption)

Bile acid secretion

  • Secondary bile acids in stool (as part of CDSA)
  • Determination of fat in stool (triglycerides, long chain fatty acids and phospholipids; also stool total fat) -> as part of the CDSA and GI Effects Comprehensive Profile tests

Leaky Gut

  • Intestinal Permeability Measurement
  • Measure the permeability of the intestinal epithelial cells and those between.
  • Intestinal Permeability and Absorption Test
  • Measure nutrient absorption and malabsorption, intestinal permeability, and intestinal damage in various in parts of the intestine.
  • Extensive digestive analysis (e.g. CDSA, which also tests for potentially harmful bacteria, fungi,and parasites)
  • Measurement of zonulin protein in stool and circulation

Food Allergies

  • Skin prick test
  • IgE antibody tests (for example Genova Diagnostics IgE Food Antibodies)
  • lgG antibody tests (for example Genova Diagnostics IgG Food Antibodies)
  • IgG4 antibody tests (for example Genova Diagnostics Allergix IgG4 Food Antibodies 90 Profile)

Testing for Histamine

  • Daily urine methylhistamine (NMHIN)
  • Histamine DAO test (DNA test)

Calcium

Measure your blood calcium levels (both free and ionized) and make a bone density measurement (DXA scan).

Strategies for specific issues

Below you can find an actionable list for specific issues

Constipation

  • Drink enough water (the recommendation is about 40 ml / kg body weight including water from food)
  • Try immediately after waking up drinking a glass of water with 1 teaspoon of salt, as well as fresh squeezed lemon juice. This significantly increases bowel movements.
  • A light morning exercise can improve bowel emptying (5–10 minutes after waking up) – also, many rotation movements present in yoga will help.
  • The use of magnesium citrate increases bowel movements and the amount of water in the stool
  • Increase fiber intake especially in the morning and evening (good fiber products later on). Do not use cereal products
  • Experiment with the so-called ”salt flush” to effectively boost intestinal emptying. Put 1 to 2 tablespoons of salt in warm water (approx. 1 liter) and allow it to soak, and then you drink it quite rapidly. This should within 20–40 minutes accelerate intestinal emptying quite a bit.
  • Optimize defecation position (squatting is the optimal posture). A good tool for this is Squatty Potty.
  • Check the possibility of hypothyroidism.

Diarrhea

  • Try a grain-free, dairy-free, and legume-free diet
  • Remove all sweeteners and excess sugars from your diet
  • Reduce coffee and alcohol use (replace with tea)
  • Increase use of fermented foods (sauerkraut, kefir, kombucha; fermented dairy products, if you tolerate them) – these are not for everyone, especially for people suffering from SIBO
  • Check your diet for insoluble and soluble fiber
  • Bentonite clay and activated charcoal can improve the excretion of toxins from the intestines and ease
  • Try  probiotic  (Saccharomyces boulardii, Boulardii)
  • Try Traditional probiotics (containing Lactobacillus and Bifidobacterium strains) 
  • Consider FODMAP restriction diet

Leaky Gut approach

1. Diet (grain-free, dairy-free, legume-free; no processed foods, oils, and sugars)

2. Adequate intake of vitamins A and D, and fixing deficiencies

3. Adequate intake of long-chain omega-3 fatty acids, and fixing deficiencies

4. Regular stress management (Meditation and breathing exercises)

5. Probiotics 

6. L-Glutamine (5–20 g/day)

7. Lactoferrin 250–500 mg/day

8. Colostrum (Recommended: Symbiotics Colostrum Plus Powder/2 servings daily)

9. High-quality fish or liver oil packaged in a dark glass bottle (omega-3 fatty acids)

10. If necessary, select one of the following:

– Biotics IPS (Intestinal Nutrition Supplement), Thorne Research Perma-Clear, GI-Revive (formerly GI Renew), 

11. Use of digestive enzymes with food

12. Intestinal toxin removal and absorption:

– Activated charcoal (1–2 capsules 1–2 times a day; taken separately from pharmaceuticals and supplements just before bedtime)

– Bentonite clay (for toxin removal)

– Chlorella (purifies heavy metals from the intestines and reduces inflammation)

– Calcium-D-Glucarate 500 mg (1 capsule 3 times daily; removes excess toxins)

Other Topics

Fiber

Fiber is not necessary strictly speaking however many people many benefit from it so this is very individual. We suggest getting 20grams of fiber per day and then adjust depedning on how you feel.

Best fiber choices are vegetables (Cucumber, lettuce), berries, low-sugar fruits and high-quality fiber such as psyllium, acacia fiber, and sensitive oat fiber.

Others options

• Fresh carrot juice (supports intestinal mucous membranes)

• Celery juice (promotes intestinal movements and alleviates constipation)

• Carminatives reduce gas in the intestine: Orange, fennel, ginger, cinnamon, cilantro, oregano, parsley, peppermint oil, rosemary, sage, dill, thyme, garlic

• Bitters stimulate the production of stomach acids and digestive enzymes:Jerusalem artichoke 

• Silica and silicic acid-carmellose gel: Protects the mucous membrane of the stomach

• Lactoferrin, Lowers the inflammation on gut surface and reduces/fixes gut permeability

Probiotics

Probiotics refer to living microbes that have positive effects on health. The official definition for a probiotic is: ”Live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.” Probiotic bacteria are those that

1. Microbes must be alive in an adequate number when administered.

2. Strains must be identified genetically, classified using the latest terminology, and designated by numbers, letters, or names.

3.Appropriately sized and designed studies must be performed to designate a strain as probiotic and using the strain(s) on the host to which the probiotics are intended (human, livestock, companion animal, etc.)

4. Strains shown to confer a benefit for one condition may not be probiotic for another application.

5. Strains that are probiotic for humans but are being used in animal studies should be clearly designated as human probiotics under experimental testing.

Fermented foods, prebiotics, fecal microbiota transplants, and microbial strains of the same genus or species as documented probiotic strains but have not undergone appropriate testing on the target host should not be considered as probiotics based on adherence to the scientific definition. The benefits of probiotics become apparent through the balancing of the microbiota (microbiological ecosystem) and microbiome (microbiological genome) in the digestive tract.

Bacterial strains producing hitamine (use less)

• Lactobacillus casei (many probiotic preparations contain this but usually in very small amounts)

• Lactobacillus bulgaricus (most yogurts), Lactobacillus helveticus, Lactobacillus delbrueckii, Streptococcus thermophilus, Bacillus coagulans SL5

Neutral bacterial strains for histamine

• Lactobacillus acidophilus, Lactobacillus lactis, Lactococcus lactis, Saccharomyces boulardii, Lactobacillus reuteri (this causes the conversion of histidine to histamine, but the overall effect is anti-inflammatory via its effect on cAMP)

Histamine-degrading bacterial strains

• Lactobacillus rhamnosus (especially GG; reduces histamine receptors & anti-inflammatory effect)

• Bifidobacterium infantis (also, for example, in breast milk), Bifidobacterium longum, Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus plantarum

• Lactobacillus gasseri, SBO (soil-based organism) probiotics

Resistant starch

Resistant starch (RS) differs from conventional starch in that it is not absorbed by the digestive tract. Thus, the term resistant refers to this fact. Resistant starch is a good food for intestinal bacteria, meaning its role in nutrition is similar to that of oligosaccharides and soluble fibers.

The dietary recommendation is a minimum of 6 grams of resistant starch per meal recommended for health benefits.167 The energy produced by resistant starch is 2.5 kcal / g (cf. starch 4 kcal / g). Resistance starch is found in bananas, cooked and cooled white rice and potatoes, broad beans

and some other legumes, and to some extent, whole grains. Potato starch also has high levels of resistant starch that can be used to feed intestinal bacterial strains.

Resistant starch is classified into five different categories:

RS1 (physically inaccessible starch)

• Starch that is resistant to digestion due to its physical density or physical protective structure

• Starch from seeds, whole grains, and pulses

• Grinding and careful chewing releases at least some of the resistant starch to the digestive tract.

RS2 (granular starch with the B- or C-polymorph)

• Resistant to digestion due to physical density and the dry nature of starch

• From the outside these may not look dry (e.g. raw potatoes and bananas)

• Cooking releases starch resistant to digestion.

RS3 (retrograded starch)

• The most resistant starch

• Amylose becomes resistant when heated and then cooled. For example, boiled and refrigerated potatoes or cooked and cooled rice

RS4 (chemically-modified starches)

• Industrially-modified starch used as an additive in the food industry

RS5 (amylose-lipid complex)

• Stearic acid-complex high-amylose starch

• Amylose-lipid complex formation is an instant reaction and the complex can reform after cooking.

Type V resistant starch (RSV) is considered thermally stable. Resistant starch may not be suitable for sensitive stomachs (IBS), as it is fermented in the same way as FODMAP carbohydrates.

Supplements

Supplementation is a key area for supporting your gut in case of issues and until you are completely healed and have pinpointed the root cause.

Hydrochloric acid

Get hydrochloric acid tablets or capsules (called Betaine-HCL) The strength of the capsule may vary from 300 to 600 mg. However, it is a good idea to take a so-called hydrochloric acid test at home, which gives an indication of how well your stomach’s hydrochloric acid level is.

Bile

  • Apple cider vinegar (ACV)
  • Vitamin C may prevent the formation of gallstones. 
  • Melatonin may also be used to prevent the formation of gallstones and possibly even treat cholelithiasis.
  • Bile Salts
  • Artichoke juice due to Phenolic compounds
  • Turmeric
  • Oranges
  • Soluble fiber (for example, from oats; do not use if you are on a grain-free diet)
  • Dandelion 

Enzymes

  • Bioptimizers HCL breakthrough (includes digestive enzymes)
  • All Enzymedica products: Digest Gold ATPro, Digest Basic, Digest Spectrum (great for food intolerances)
  • Now Foods Super Enzymes
  • Thorne Research Bio-Gest (Contains hydrochloric acid, pepsin, pancreatin and bile)
  • Life Extension Enhanced Super Digestive Enzymes

Probiotics

These are high-quality, clinically researched products 

• Seed Synbiotic

• Vivomixx (contains up to 450 billion living bacteria -> particularly effective in balancing the gut from major dysbiotic states; scientifically well studied and documented)

• Saccharomyces boulardii (for example: Thorne Research Sacro-B Probiotic)

• Living Nutrition Your Flora-probiotics (Symbiotic probiotics)

• Advanced Orthomolecular Research Probiotic 

• Life Extension Florassist Balance

• Primal Probiotics

• Garden of Life Primal Defense ULTRA

• Enzymedica Pro-Bio Potency Probiotic

Prebiotics

Prebiotics refer to non-digestible fiber compounds, such as oligo- or polysaccharides, used by thebacterial strain of the intestines as growth media. T

he use of prebiotics increases the growth of good quality probiotic bacteria such as bifidobacteria and lactic acid bacteria in the intestines. 

Prebiotic intake can have positive effects, among other things, in the absorption of trace elements, immunity, blood pressure Prebiotics (inulin and oligofructose) are the most abundant in weight in, artichokes, dandelion leaves, garlic, leek and asparagus. 

If you have a problem with IBS or SIBO, do not use these foods or any fiber-containing fructo-oligosaccharides or inulin, as they will make symptoms worse due to  excess fermentation. Prebiotics are also abundant in potato starch, which in recent years has been used as a dietary supplement to support the intestinal bacterial balance. Potato starch is rich in so-called resistant starch, which can be used by the bacterial strain of the gut. In addition to the general health benefits of prebiotics, resistant starch has been shown to have beneficial effects on insulin sensitivity and obesity and on hunger control.

Dyspepsia and Gerd

  • Ginger and artichoke extract
  • Apple cider vinegar (ACV)
  • Magnesium
  •  Chamomile tea and ginger
  • Hydrochloric acid supplementation and digestive enzymes
  • Carnosine and zinc