Related to this video, a recent research article on mice with IBD on a fasting mimicking diet. The study showed that calorie restriction can decrease intestinal inflammation and promote repair of the intestines. This is interesting because it shows how research is showing intermittent fasting has potential benefit for IBD. 

Research:
Here is the link to the abstract of the study.  https://doi.org/10.1016/j.jnutbio.2021.108785. 

Why is Vitamin B12 so important?

Vitamin B12, also known as cobalamin, is an important B vitamin and the one most people supplement with. So, what is so special about vitamin B12 that causes people to take supplements or get vitamin B12 shots? 

Vitamin B12 is a water-soluble vitamin found primarily in animal foods, meat, poultry, seafood, eggs, and dairy products, but people can also obtain it from fortified cereals and nutritional yeast. Vitamin B12 supports the normal function of nerve cells and the formation of red blood cells and DNA synthesis. It supports bone health, improves energy and mood, and protects against heart disease. Finally, studies show vitamin B12 helps prevent cognitive impairment and dementia. 

Humans cannot make vitamin B12 and can only acquire it from their diet. On the other hand, animals obtain vitamin B12 from soil ingested while eating and grazing. Ruminant animals such as cows and sheep synthesize vitamin B12 from the bacteria in multiple compartments of their stomachs. The richest sources of vitamin B12 are from organ meats. Marketers state fermented soy products such as tempeh and miso are good plant sources of vitamin B12, but they contain compounds like vitamin B12 that do not function as B12 in the body. Since vegans obtain little B12 in their diets, they need to pay special attention of getting enough through fortified cereals (although not usually absorbed as well as animal sources) and nutritional yeast, and health care providers usually advise supplementation.

The recommended dietary allowance of vitamin B12 for adults is 2.4 µg/day and in the United States intake from the diet typically exceeds this amount. Adults who are healthy absorb about 50% of B12 from the foods they eat although the absorption of B12 is complex. First B12 binds to the protein in food and then hydrochloric acid (HCL) and gastric juices of the stomach release B12 from the proteins. The freed vitamin B12 then binds to intrinsic factor in the stomach which enhances its absorption. 

Symptoms of deficiency are hard to detect but include chronic fatigue, muscle aches and weakness, joint pain, poor memory, mood changes, poor dental health, poor concentration, and digestive disorders such as nausea, diarrhea, or cramping.

So, what causes a person to become deficient in vitamin B12 and what are the consequences? There are specific reasons why a person may become deficient. First following a long-term vegan or vegetarian diet can lead to a deficiency. Another reason is limited production of HCL in the stomach often occurring in 10-30% of older adults. Gastric bypass surgery, the drug Metformin to treat type 2 diabetes, and medications that block stomach acid production can cause limited HCL production leading to improper absorption of B12. 

An autoimmune disease called pernicious anemia causes malabsorption of vitamin B12 due to improper production of intrinsic factor in the stomach. Finally, studies show that people with IBD are more prone to vitamin B12 deficiencies and need to play close attention to their intake of this important nutrient. 

There are consequences of vitamin B12 deficiency. If the deficiency is severe enough causing a reduction in red blood cell formation, anemia (Macrocytic) can occur leading to symptoms of fatigue, loss appetite, shortness of breath, tingling of the hands and feet. When there is poor intake of vitamin B12, folate, and vitamin B6 this can lead to high homocysteine (an amino acid found in the blood) levels which is a risk factor for heart disease, stroke, cognitive dysfunction, and fractures caused by osteoporosis. Research studies have not consistently shown supplementation with vitamin B12, B6, and folate to reduce the risk of heart disease, though homocysteine levels went down, but consuming sufficient vitamin B12, vitamin B6, and folate are necessary for good health and normal functioning of the body. Eating goods sources of vitamin B12 is important since even when a deficiency is not severe, often seen in older Americans, neurological problems and elevated blood homocysteine levels can occur. 

As mentioned before, those with a vitamin B12 absorption problem either from surgery, IBD, medications, or pernicious anemia, should consider vitamin B12 supplementation, but always check with your medical provider first. The best sources of vitamin B12 are beef liver, sardines, Atlantic mackerel, lamb, wild-caught salmon, nutritional yeast, feta cheese, grass-fed beef, cottage cheese, and eggs. 

For those requiring supplementation, there are three options. First, monthly injections of vitamin B12 to bypass the GI tract, vitamin B12 nasal gel, or extremely high oral doses (1-2 mg per day) in which the body absorbs a small amount without the need of intrinsic factor. 

For those who begin following a vegetarian or vegan diet, deficiency may not occur immediately since the liver stores vitamin B12 but need to pay special attention to obtaining proper vitamin B12 in their diet. Vegetarians can consume dairy products, eggs, and foods fortified with vitamin B12 along with supplementation. Vegans should also take a vitamin B12 supplement, consume fortified foods, and nutritional yeast. If you have IBD, ensuring you are getting enough vitamin B12 is essential, and this is where we can help!

References
https://draxe.com/nutrition/vitamin-b12-benefits/
Byrd-Bredbenner C, Moe G, Berning J. Perspectives in Nutrition. Eleventh edition. McGraw Hill. 2019.
 

Park YF, Park SJ, Park JJ, et al. Incidence and risk factors of micronutrient deficiency in patients with IBD and intestinal Behçet’s disease: folate, vitamin B12, 25-OH-vitamin D, and ferritin. BMC Gastroenterol. 2021; 21(32). https://doi.org/10.1186/s12876-021-01609-8.

Health Belief Model Video

Watch Sara discuss the use of health beliefs in helping us change our ideas on diet and compliance. 

Probiotics: what do they do?

Today, probiotic supplements are marketed to support many ailments and you may be asking why and if they are worth the money. Before discussing the benefits of probiotics, the gut microbiome needs to be explained. Bacteria make up 10 percent of our body weight and there are 10 times more bacteria in our gut then the cells of our body. This bacterium is our microbiota and we have about 500-1000 different types of bacteria in our digestive system. There are billions of microbes in the mouth and small intestine and trillions in the large intestine. The microbiota acts like an organ and is a major component of the immune system. A healthy microbiome protects us from disease, allows us to maintain a normal weight, and keeps our overall health in check.  No two people have the exact microbiome, but our microbiome is different from our ancestors due to medications, climate, breast-feeding versus bottle-feeding, stress, C-sections, lack of exercise, and more processed foods in the diet. These factors cause disease producing bacteria to build up leading to symptoms such as diarrhea, bloating and gas, and is a major cause of irritable bowel syndrome, and are the basis for the SCD diet to treat IBD, which promotes rebalance of the gut microbes. The bacteria in the gut communicate with each other and our genes to help regulate metabolism and the immune system. If there is a microbial imbalance or too few microbes in general, then some existing bacteria mix may become harmful. Bacteria from the Bacteroides and Firmicutes families make up about 80-90 percent of the bacteria found in our gut. The next most common bacteria are Actinobacteria such as Bifidobacteria and Proteobacteria such as H Pylori and E Coli. Humans have lived in harmony with these normal strains of bacteria by consuming fermented foods, being born vaginally, and putting fingers in our mouth (commonly seen among children). The bacteria that cause chronic disease are usually found in small quantities but when given the opportunity will begin to thrive and cause illness.

So, the next question to answer is how does probiotic bacteria help us? First, a probiotic is a specific type of bacteria or yeast, and each type has a specific effect on the human body. The benefits are numerous including improved digestion reducing intestinal inflammation, regulating peristalsis which improves diarrhea, constipation, and IBS, and balancing intestinal pH.  Probiotics have been found to improve lactose intolerance, increase absorption of minerals, decease symptoms of allergies, asthma, and eczema, and protect against auto-immune illnesses. Finally, probiotics can help regulate metabolism, normalize cholesterol levels, and support healthy blood pressure. 

Now that we know the benefits, what is the best way to obtain these beneficial bacteria? The two most beneficial bacteria to our intestinal flora are the lactobacilli, found in the small intestine and bifidobacteria found in the colon. Both bacteria need to be consumed daily since they are not naturally found in the digestive tract and only live in us for 12 days. These bacteria secrete acetic, formic acid, and lactic acid making the intestinal environment unfriendly to invading microbes. Lactobacillus also produces antibiotics effective against bacteria such as strep and staph.  The regular consumption of cultured dairy products and other fermented foods is important for those who are healthy, but supplements may be necessary to rebalance the intestinal flora once disease producing microbes have established themselves in the gut. To obtain these healthy probiotics from food think cottage cheese and yogurt versus milk, sauerkraut versus cabbage, and tofu or tempeh versus soybeans. For example, traditional sauerkraut has been eaten by Europeans to help with ulcers and other digestive problems and lactose intolerant people worldwide have consumed cultured dairy products such as cottage cheese, yogurt, and kefir. Asian cultures eat pickled daikon radish and kimchi. Other probiotic rich food and drink include miso, olives, raw vinegar, traditionally made sourdough bread, wine, chocolate, coffee, black tea, kombucha, brine cured pickles, and fermented vegetables. It’s also important to consume foods with prebiotics since they play an important role in maintaining good health and stimulating the growth of beneficial bacteria, lactobacilli and bifidobacteria. They also acidify the intestinal flora which allows for better absorption of minerals. Foods high in prebiotics include asparagus, bananas, fruit, garlic, honey, legumes, onions, peas, yogurt, oats, bran, Jerusalem artichokes, and leeks. 

So, if you chose to take a probiotic supplement consult with your medical provider and the following tips should be considered.  Many supplements on the market look similar but can vary greatly in their effectiveness. It’s important to consume well-researched probiotics that have been shown to be useful in the clinical setting, always look for a batch number and date, and when possible, purchase them from a health professional or someone who has done the research for you. Typically, the best probiotic supplement is a combination of lactobacillus and bifidobacterial strains. You may also choose to purchase a dairy-free probiotic. The most effective test is to try out several different ones and see which one your body likes best. The number of organisms per dose does not necessarily give an indication of effectiveness, but whether the probiotic contains living viable organisms which can adhere to the gut lining, although research has shown that even dead probiotics can be beneficial to the immune system. Be aware that some microbes are inactivated by stomach acid and are essentially useless. Look for enteric coated capsules when taking probiotic supplements. Finally chose a probiotic that is refrigerated to ensure the life span and potency and a probiotic that contains a prebiotic such as FOS and inulin which provides nourishment for the bacteria. For dosing consider taking 1 billion to 25 billion organisms daily depending on the severity of your condition. Begin taking them at a low level and increase the dose slowly. If you experience worsening symptoms such as gas, bloating, and diarrhea, stop taking them. When the disease producing bacteria and fungus are killed off, they release chemicals that can cause worsening symptoms. Once symptoms have resolved, begin taking them again in small amounts and symptoms should subside. If symptoms continue, consult your medical provider.

It’s important to remember that probiotic supplements can be helpful but are not a magic cure and are expensive. Getting your probiotics from fermented foods; cheese, yogurt, pickles, kefir, miso… and always eating your probiotic with prebiotic fiber: oats, asparagus, onions, garlic, honey, bananas is the best way to rebalance your microbiome. It’s always best to consume a diet of minimally processed whole foods which contain natural probiotics and prebiotics, exercise daily, participate in stress reducing modalities such as yoga and deep breathing, and make following a healthy lifestyle one of your top priorities. 

Lipinski E. Digestive Wellness. Strengthen the Immune System and Prevent Disease Through Healthy Digestion, 4^th Edition. McGraw Publishing. 2012.

Why treat disease with a whole food diet over medication?

In western medicine, medications are commonly the first line of treatment for disease. For example, steroids and immunosuppressive drugs are prescribed to calm inflammation seen in many auto-immune diseases such as ulcerative colitis, lupus, and fibromyalgia. While these medications are effective, but lose efficacy with prolonged use, they come with many side effects. Chronic steroid use can lead to bone loss, high blood sugar, weight gain, and increased risk for infection. Other immunosuppressive drugs lower the immune systems response to infection and increase the risk of cancer. Another class of drugs commonly prescribed for heartburn and GERD are proton pump inhibitors, or PPIs. This group of medication, initially developed to be taken for only two weeks, blocks acid production in the stomach preventing heartburn and GERD, but like immunosuppressives, lose efficacy with prolonged use. Many users are unaware of the side effects of PPIs such as preventing the absorption of vital vitamins and minerals (calcium and magnesium to name a few) which require acid for proper absorption. Studies have shown that long-term use of PPIs leads to an increased risk of developing kidney disease and dementia.

Before discussing the side effects of a whole foods diet, let’s discuss what this means. A whole foods diet consists of minimally processed foods such as fresh fruits and vegetables, high quality protein from lean meats, fish, and eggs, fermented foods such as plain Greek yogurt, nuts, legumes, olive oil, and whole grains. The whole foods diet is also very low in refined sugar. When switching from the highly processed western diet to a minimally processed diet, think Mediterranean Diet, there will be side effects, but not the one’s commonly seen with medications. These positive side effects include improved digestion, decreased chronic inflammation, better glucose control (important for Type 2 Diabetics), increased energy, better sleep, improved mood, weight loss, and reduction in cholesterol and blood pressure. So, with the many positive side effects why don’t we see the whole food diet prescribed before medications? The possible answer to this question is many. First, most physicians receive little to no nutrition education in medical school and only know how to treat patients with medications. Second, we live in society that would rather take a pill than make lifestyle changes. For many taking medication is the only answer.  Finally low socioeconomic groups may experience food insecurity and live in food desserts in which access to minimally processed foods aren’t readily available.

So, the next question is what can physicians treating the multitude of diseases present in our society do before prescribing medications or treat patients with the fewest number of medications and at the lowest dosages? Intake forms prior to the patient’s appointment should include a 24-hour dietary recall including an assessment of food insecurity and access to high quality, nutrient dense food. During the appointment the 24-hour dietary recall should be reviewed, a handout with a variety of minimally processed whole foods should be given to the patient along with discussing the government's My Plate nutrition guide which shows what a balanced diet looks like focusing on high consumption of fruits and vegetables. In certain circumstances referrals to registered dietitians should be made along with social workers if food insecurity is identified. Then, before the next appointment a 3-day dietary recall should be completed by the patient and reviewed to determine compliance and where modifications can be made. This approach empowers the patient to take control of their health without relying solely on medications.

Unfortunately, physicians do not have the training or time to discuss nutrition with their patients, but that does not mean that looking for alternatives to medication is impossible. If you are diagnosed with a medical problem such as GERD, high blood pressure, or high cholesterol due your own research. Ask your doctor if you can try a whole foods diet before going on medication. If medication is initially required, eat a whole food diet in conjunction with taking medication and a consequence may be the medicine is no longer needed, or the dosage may be reduced. Not only should you improve your diet, but get daily exercise, adequate sleep, and engage in stress reduction modalities such as deep breathing and yoga. Show your physician the effects a whole food diet has on improving health. Now is the time to change our way of treating illness from a reactive mentality to being proactive.

https://www.verywellhealth.com/side-effects-of-proton-pump-inhibitors-1742874