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Digestive Difficulty's

Some clinical if basic information from Chris that you maybe interested in doing Part one
Clinician’s Guide to Digestive Disorders
As practitioners, we face numerous digestive diseases in our patients every day, ranging from irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD) to ulcerative colitis and diverticulosis. Some conditions—such as constipation—are relatively benign (although very uncomfortable), while others—such as inflammatory bowel disease—can be life threatening. Like most chronic diseases, digestive disorders are complex and have multiple causes that may vary from person to person.
Luckily for the practitioner, almost all digestive disorders share one or more of the following underlying mechanisms:
An overgrowth of bacteria in the small intestine
An imbalance between “good” and “bad” microbes in the gut
A permeable gut barrier (leaky gut)
Chronic bacterial, parasitic, or fungal infections (such as pylori, Blastocystis hominis, Candida albicans)
Low stomach acid or digestive enzyme production
Sensitivity, allergy, or intolerance to certain foods
Impaired communication between the gut and the brain
In this e-book, I’m going to review the essential dietary, lifestyle, and supplement recommendations that target the underlying mechanisms of digestive disorders. These tried
and true techniques have helped my patients make tremendous improvements and can bring
relief to your patients with chronic gut symptoms. In my ADAPT course on functional and
ancestral medicine, I go into more detail on the underlying mechanisms of disease, diagnosis,
and treatment plans.
Diet
Paleo Diet
The first thing I do with all of my patients is start them on a customized Paleo diet. I individualize a patient’s diet with a three-step program that I outlined in The Paleo Cure. It begins with a 30-day Reset Diet that allows high-quality, natural animal meats, bone broths, eggs, starchy and non-starchy vegetables, fermented vegetables, traditional fats, sea salt, and spices. During this reset period, the following foods are completely off-limits: dairy, grains, sweeteners, sodas, legumes, processed foods, alcohol, and industrial seed and vegetable oils. See the “Paleo 30-Day Reset” handout* for a more detailed description of this diet to use with your patients.
In Step 2, Rebuild, I have the patient reintroduce foods that were eliminated in Step 1. By testing gray-area foods one by one, the patient can see which foods are safe to incorporate into her diet and which ones need to be removed for the foreseeable future. Step 3, or Revive, is when we fine-tune the patient’s diet to figure out what is the best balance of proteins, carbohydrates, and fats for her. Does she do best with three meals a day, six meals a day, or intermittent fasting?
After they have adopted a customized Paleo diet, most of my patients experience dramatic improvement. However, if your patient is still struggling with stubborn gut symptoms after working on the diet in these ways, there may be an underlying gut infection or unchecked chronic stress.
If your patient has an irritated, inflamed gut, certain non-starchy vegetables may be aggravating the situation.
Non-Starchy Vegetables
Vegetables are one of the few foods that every diet philosophy agrees are healthy. That said, vegetables (particularly non-starchy vegetables) tend to be high in insoluble fiber, which can irritate an inflamed gut. Patients with irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or other digestive disorders may benefit from reducing their intake of vegetables that are high in insoluble fiber.
These include:
Greens (spinach, lettuce, kale, mesclun, collards, arugula, watercress, and so on)
Whole peas, snow peas, snap peas, pea pods
Green beans
Kernel corn
Bell peppers
Eggplant
Celery
Onions, shallots, leeks, scallions, garlic
Cabbage, bok choy, Brussels sprouts
Broccoli
Cauliflower
Note that I’m not suggesting complete avoidance of vegetables that are high in insoluble fiber; I’m just suggesting that they should be limited in certain patients. Moreover, preparation, cooking, or fermentation can make these foods more digestible and less likely to irritate the gut.
These food preparation steps can make non-starchy vegetables easier on the digestive system:
Always eat insoluble-fiber foods with other foods that contain soluble fiber. Never eat insoluble-fiber foods on an empty stomach.
Remove the stems and peels (i.e., from broccoli, cauliflower, and winter greens) from veggies (and fruits) high in insoluble fiber.
Dice, mash, chop, grate, or blend high-insoluble-fiber foods to make them easier to
break down.
Eat well-cooked insoluble-fiber foods: steamed thoroughly, boiled in soup, braised, etc.; avoid consuming them in stir-fries, and if you do eat them raw, prepare them as described in #3 above.
Fermented Vegetables
Fermented vegetables like sauerkraut, kimchi, sauerruben, and cortido are excellent alternatives for people who don’t do well with certain vegetables. First, the fermentation process “pre-digests” the vegetables and makes them easier to absorb. Second, fermented veggies contain probiotic microorganisms that help heal the gut.
Although sauerkraut and kimchi contain cabbage, which is high in insoluble fiber, I’ve found that many patients with gut problems can tolerate it quite well. Fermenting vegetables can also make FODMAPs easier to digest (coming up in the next section).
You can make fermented vegetables at home, as can your patients. Take a look at this page for a great primer. It’s really quite easy—and cheap. You can also have your patients buy fermented vegetables at a health food store. Fermented vegetables should say “raw” on the jar, and they should be in the refrigerated section. The sauerkraut in the condiments section has been pasteurized and won’t have the same beneficial effect.