Happy new year to you too @Naveed Aslam

Hey @Sara,

Thank you so much! Happy New Year to you too! And thank you for sharing the love! The love goes both ways 🙂 We are very happy with this place where like-minded people can find each other! And thank you for all of your questions this year. It creates educational value for everyone

Back to your questions:

1. Heart of Palm Rice: The ingredient list looks pretty simple. Sliced heart of palms, water, sea salt and citric acid. This product fits in a low-carb no-grain diet.

Blue Dragon Spring rolls: Here the ingredient list looks simple as well. Rice Flour, Tapioca Flour, Water, Salt. Depending on where you are in the healing process of rebalancing your blood sugars, you might want to avoid it or eat it only occasionally. The spring rolls are a source of carbs that are also relatively fast digestible. White rice is a fast digestible source of carbs and can raise blood sugar quickly. Tapioca, which is a root, is even more quickly digested then potatoes. Because we aren’t talking about whole foods, but about very fine powdered flour, as a rule of thumb, the body doesn’t need to break down the whole foods and it is even easier for the body to absorb.

Do you have certain lab values that could indicate how well you are balancing your blood sugars? For example, do you know your fasting glucose? Did you measure your HbA1c? Or even better: did you measure your fasting insulin? Just to give us a feeling of how well your body is balancing blood sugars?

When you are trying to heal from leaky gut, avoiding grains can be part of the solution. Some healthcare professionals will ask you to avoid gluten containing grains like wheat, barley and rye. Some will ask you for certain reasons to avoid all grains for a while. Rice is a gluten-free grain, but it is still a grain. I’m just mentioning this since I don’t know what recommendations you had. Just be aware.

Since you mentioned you eat oats: although oats are from themselves gluten-free, often oat products are contaminated with gluten. When you eat oats, always make sure you choose gluten-free oat products.

Have you seen this video about gut healing strategies? You might find it interesting. Supplements like Zinc l-carnosine, quercetine, L-glutamine and Deglycyrrhizinated licorice root have been shown to help heal leaky gut.

Another tip is to make sure your serum vitamin D levels are in the ideal range (50-60 ng/ml). Vitamin D is necessary to keep the ‘tight junctions’(reed ‘doors’) between the cells of the gut lining closed.

Have a beautiful last day of the year and best wishes for you in 2024!

Hey @Sara,

Great questions! Let’s dive into them!

1. Is Nutritional Yeast okay for someone who is gluten-free and dairy-free?

The short answer is: yes and yes! Nutritional yeast is a species of yeast known as Saccharomyces cerevisiae. It’s the same type of yeast that’s used to bake bread and brew beer, but it is an inactivated version. It wouldn’t work well if you would try to bake bread of it. It might be used for baking bread, but it doesn’t contain gluten and it is made dairy-free.

I wouldn’t know any brands in the UAE. On iHerb (here in The Netherlands) they sell organic nutritional yeast from the brand Simply Organic. I like it because it’s packed in a glass container (and not in plastic).

2) what is a good miso paste to use that is not processed?

Miso is a fermented soy product. Miso paste contains probiotics. It is however a soy product and could therefore be Genetically Modified. If you like your products GMO-free, choose an organic version or at least a product that has the label GMO-free on it. Do I recommend it? It depends on your personal health. Soy is a common food allergen and some people are sensitive to soy. For those people, I recommend avoiding soy products.

Women who are low in estrogen because of menopause can benefit greatly by adding estrogenic foods like organic soy and flaxseed.

Some people have trouble with digesting soy, for a variety of reasons. Soybeans contain phytates that can bind to minerals (like iron, zinc and calcium) in foods, which prevents those minerals from absorption. The benefit of Miso is that it is fermented, and contains much fewer phytates than soybeans.

3) Do you recommend rice wraps or are they under the “UnJUNK” foods?

I didn’t write UnJUNK and might not be the best person to answer this question. @Bernadette Abraham might want to add her vision, but this is mine. The answer is: it depends:

The less processed the wraps are, the better. The ingredient list can guide you. As a rule of thumb: again, the fewer ingredients, the better. It is also a good sign when the ingredient list contains the names of foods. For example, rice is a food name. Rice extract is not a food name.

If your diet contains a lot of processed foods, minimally processed rice wraps might be a step in the right direction. If your diet is mainly made of homemade fresh vegetables and meats, minimally processed rice wraps might not be a concern, but it moves your food choices in the direction of ‘more processed’.

If you are trying to work on your blood sugar balance, you might want to avoid a certain amount of carbs for the time being. Rice wraps might not be the best product for you.

In short: the answer depends on what is written on the label of your rice wrap product, it depends on where your current diet is at and it depends on your current health. Although I didn’t give you a direct answer to your question, I hope I have provided you with some guidelines.

4) What’s your opinion on Hearts of Palm products like “hearts of palm rice or hearts of palm pasta?”

Again, like the previous question, I will answer with some guidelines. I don’t believe Hearts of Palms products are all bad or all good, but it depends on what is written on the label and your personal health.

As a rule of thumb: again, the fewer ingredients, the better. It is also a good sign when the ingredient list contains the names of foods (see above)

Heart of Palms is also high in fiber. For people who are avoiding grain, this can be a good source of fiber. If you are choosing Heart of Palm products because of their high fiber content, be aware that products like Heart of Palm rice and pasta may contain less fiber, especially if the Heart of Palm was made into a paste first.

It is also considered a product that is low in FODMAP (This is short for fermentable oligosaccharides, disaccharides, monosaccharides and polyols). and is therefore suited (in moderate amounts) for people with a Small Intestinal Bacterial Overgrowth (or SIBO for short).

5) What is a good health “grain-free cereal” other than steel-cut oats? What would not cause inflammation and is 0 sugar?

Many cereal variations can be made at home. Ingredients you can use for example coconut flakes, sliced and chopped nuts like almonds, walnuts and pecans, chia seeds, flaxseeds, pumpkin and sunflower seeds. I personally never buy cereals from a shop since I’m never happy with the content. I prepare a big batch myself once in a while.

Although all these ingredients are healthy, people who are sensitive to one of those ingredients (or have allergic reactions to one of these ingredients), these foods will cause inflammation. it is therefore good to try these foods and see how your body responds.

Are you choosing grain-free for a certain reason? For example, are you working on your blood sugar balance?

Hey ,

It’s always hard to assess skin from a picture. It could be Vitiligo, but it is best assessed by a professional who can see the skin closely like a dermatologist.

If there is an autoimmune component to your skin condition, we do have handouts that provide you with some guidance. Many of these tips will sound familiar. You can find the handout right here.

To your personal situation: the gut plays often a factor in autoimmune diseases. Although your last test didn’t show evidence of SIBO, other things can play in the gut (for example mold that has been colonised and candida overgrowth as a way to protect the body from mercury toxicity by amalgam fillings for example)

Digestive fluids like stomach acid influence the gut microbiome as well. Digestive fluids are an important part of the environment that influences the diversity and the balance between species in the microbiome. Other components of that environment are the immune system and of course, the foods you eat.

The foods you eat can change the microbiome quite quickly! Lots of species divide really fast. Some species reproduce even 10-15 minutes! And this quick change is necessary since the microbiome continuously needs to adapt to what you eat.

Unfortunately, some of these microbes can create cravings for foods they need. That’s why I asked you in your previous post how you’re doing at your basics. If you’re making great choices during the day, but in the evening you’re giving in to sugar cravings, you’re going to feed certain species that can cause some havoc in the gut. And also these choices can influence the microbiome quite quickly!

The damage in the gut can cause a cascade of other stuff symptoms in the body. The inflammation in the gut can reduce your ability to deal with dietary histamine, make the immune system hypervigilant to invaders to which it is frequently exposed to, which can lead to autoimmune conditions.

I can only imagine the struggle which you have been through and I empathize greatly! From the labs you’ve been showing us you have done an amazing job and we have seen great improvements. But that’s just labs. Symptoms are what it’s all about of course. This is where autoimmune diseases become a bit confusing as well.

Even if you’re on the right way, with autoimmune diseases we still expect symptoms to flare up once in a while.

This can sometimes create feelings of discouragement which can lead to letting go of the basics, while you might have been on the right track! But these basics are really important for creating balance:
• provide your immune system support
Focus on vitamin D, vitamin A, vitamin C, zinc and B vitamins
• provide your body with the right nutrition
Try to avoid giving in to sugar cravings. Try to add in fibre-rich foods that you can handle well. Make sure your environment is as mold-free possible as you can get.
• reduce stress
Stress influences the microbiome and reduces digestive fluids.

I know this is a pretty long answer to your question ‘What is this skin condition? Is it autoimmune?’. And to summarize: I don’t know.

But I’m convinced it is all connected.

Hey ,

I’m so sorry to hear your struggles. From your reply, I think there are things you can try. Pick things you are comfortable doing. You don’t need to address it all at once.

Lifestyle factors you can explore.
It’s great that you are standing. But with moving your body I mean exactly that. From personal experience leg exercises and movement in the core area are more effective. When you explore this option, don’t immediately go from standing to a full workout, but gradually add movement (or workout intensity) to see how your body reacts.

Vegetables contain fibre, but vegetables as the only source of fibre won’t provide you the amount you’ll need daily. Oats are a great source of fibre. If you discover your fibre intake is low, you can play with the amounts of oats.

Your medications & constipation
I can only educate you on the side effects of your medications. Almost all of them, besides Prucalopride, can contribute to constipation through different mechanisms of action.

Prucalopride was meant to counter constipation. Does the Prucalopride have an effect? This medication works by activating serotonin receptors in the gut.

H2 blockers, like Famotidine, interfere with digestion. Even if it helps you with the heartburn, it can cause side effects like constipation.

The Sucralafate can have a constipating effect (look here). It is also a source of aluminium. Although it is advertised as safe, I’m not the biggest fan of getting any form of aluminium sources in the body. Aluminium can cause damage to nerves. When taken on a regular base, the accumulative effect of aluminium exposure on long-term health is hard to study. The gut is also, just like the brain, extremely rich in nerves. One of the functions of the gut nerves is to create coordinated muscle contractions to cause a bowel movement.

If you and your doctor decide that this is for now the best strategy for dealing with your heartburn, focus on the lifestyle factors first. If you’re going to try different medications, don’t switch them all at once. You won’t be able to tell which medication has the biggest impact.

I hope you can find some relief with these tips!

Hey ,

With my questions, I am actually trying to find out whether the pain you mean is caused by the intestines or by something around the intestines. However, I realize this is better done by a doctor or other healthcare professional sitting opposite you.

After all this time, taking a fresh look at basic habits is also good!

For example: for a good colon transit time you need sufficient exercise. So if you sit a lot, there is a lot of profit to be made.

If you eat a lot of sugar, this can affect the composition of the bacteria in your intestine.

Do you know how many grams of fibre you eat? A lack of SCFA in the feces may be due to insufficient types of bacteria that produce SCFAs, but the test shows that there are strains present that produce SCFA. The SCFAs may be absorbed by the body due to the long transit time. But it may also be that in the days before the GI Effects test you hadn’t consumed enough fibre.

Being sufficient in magnesium, eating the right types of fats, being sufficiently hydrated and consuming enough food are other basics that influence transit time. Are there things on the list you can feel you can improve on?

Medications (such as antidepressants) can also contribute to constipation. Have any of your doctors looked at all the side effects of your current medications?

Hey ,

Well, the first step is determining if the pain is really caused by the gut. Unfortunately that’s hard to assess from here. I’m assuming a healthcare professional helped you find out, but if it’s just an assumption, you might want to ask someone first!

Besides the awful pain and the bloated feeling, can you tell me more about what you (don’t) feel?
• Are you gassy?
• How often per day do you poop currently?
• How do you score on the Bristol stool chart? (You’ll find good pictures on google)
• What color is your stool? And is it light or dark?
• Do you also feel pain in the groin?  (see pictures attached)[groin.jpg]

Hey ,

It’s amazing he wants to work on his health and he and that he gets such great support from you!

I think, if he eats meat, it’s easier for him to get in his proteins and because most people who train do not consume enough protein, it is good not to rely solely on shakes for the recovery of their muscles.

I usually recommend my clients consume 1.8 – 2.2 grams of protein per kg of body weight. That’s about 1 gram per pound of bodyweight. So for someone weighing 200 lbs that is about 200 grams.

A shake often contains about 30 grams. So getting him to eat more is important.

I like PurePaleo from Designs for Health. It comes unflavoured (yugh!… but with an excellent recipe it will make a nice smoothy) and it comes in chocolate and vanilla. There is also a vegan version. My guess is you’ll love this product better. The product is called Phytotein and it’s composed of organic pea protein with additional protein from organic sunflower, pumpkin seed, sacha inchi, and rice sources.

Since your husband likes to work on his health, he might like this handout as well. It talks about the root causes of high (and low) blood pressure and what you can do about it!

Let me know if you’ve got any further questions!

,

I was just making an example, there can be other contributing factors to slow transit time besides SIBO.  I just wanted to raise the awareness that the slow transit time could have other root causes.

Direct SCFA markers are more accurate. Especially if they are more recent. I would give more weight to the stool test since SIBO comes in different varieties.
 
The results of the smart pill are from 2021. I wouldn’t give too much weight to the results of these tests anymore. The microbiome changes with how you eat and you applied quite a few changes in those 2 years I believe.

Even if you still have SIBO (read carefully: I’m not saying you have SIBO right now!), the composition of the bacteria could have changed!

Hey ,

In this test, they didn’t measure SCFA. What they mentioned in the results they mention that a low caecal pH is suggestive for increased production of SCFA produced by gut bacteria. But they only measured the pH.

The low pH could be indicative of SIBO.

Basically what they say is: it could be you had more bacteria and therefore more SCFA production.

The delayed colonic transit could be caused by other factors as well. If the medication wasn’t working, it would be more likely that other factors might be at play as well. For example, a slow thyroid can also cause a delayed colonic transit time. Linaclotide wouldn’t help with that

Hey  ,

Let me answer your questions!

Questions about the recording:
What Dr. Ralph is saying is that Atorvastatin & rosuvastatin have the potential to increase insulin resistance. He is a fan of red yeast rice as a natural alternative to statin medication. Red yeast rice contains chemicals that are similar to prescription statin medications. One of these, called monacolin K, has the same makeup as the drug lovastatin.

Questions related to your husband’s wish to increase protein:
Am I right to assume that the goal of your husband is to lose weight and that he would like to increase protein to decrease muscle loss as much as possible? If so, can you tell me a little more about his health & lifestyle? For example:  
• how are his kidneys functioning? 
• Is he on a plant-based diet? And can you give me an indication of how much protein he is currently having in his diet? 
• How high is his blood pressure with the medication?
• How high would his blood pressure be without the calcium channel blocker he uses?
• What type of workouts is he doing and what benefits would he like to get from his workouts? 

Hey  ,

For some reason, I can’t open the pdf. Perhaps the password you gave isn’t the right one?

,

I totally over focused on the iodine in the lab yesterday, I’m sorry! Low bodyweight, low muscle muscle mass and dietary choices like low protein intake can cause lower creatinine levels. With these values I would adv se you to rule out kidney and liver dysfunction as well. Especially in combination with symptoms of kidney problems!

Hey ,

That’s exciting for both of you! Your son is lucky with such a caring mother! Is there anything in particular you are worried about?

There is a handout called B’s Medicine Cabinet Must Haves in which you can find some general inspiration if you like.

If he is sick regularly, you can also perhaps teach him the importance of nutrients that are needed to build white blood cells like vitamin D, A, zinc and vitamin B12.

Let us know if you are searching for something more specific!

Hey ,

While editing my response I must have by accident deleted the hyperlink to the supplement, I’m sorry! I was referring to this product from Designs for Health: Super Liquid Folate. It contains folate (but in a different form) and a tiny bit of vitamin B12.

I’m saying tiny. But compared to the amount of B12 in food it’s still a lot.

You can use it together with your current B complex. Make sure you combine both supplements with food.

You can use it in 2 ways:

1️⃣ Take it together with the other B complex. If you do it like this it will increase your serum B12, but not a lot. 

2️⃣ Take it away from the other B complex. If you do it like this, it will increase your serum B12 more.
The reason has to do with the 2 different ways in which vitamin B12 gets absorbed. One is very efficient. One is super inefficient. 

The efficient way depends on intrinsic factor (a taxi for B12) produced by the stomach. 

In the first scenario (1️⃣), you’re taking both supplements together. You might get more B12, but since all intrinsic factor is already being taken up, the extra B12 from Super Liquid Folate depends on the super inefficient way to enter the body.

In the second scenario (2️⃣), you’re taking super liquid folate away from the b complex. Now the B12 from super liquid folate doesn’t compete with the other B12 from the B complex for intrinsic factor. Taking the supplements in this way can push your serum B12 harder.

I hope it now makes sense now