All people seem to be talking about lately is guts. Specifically, the idea that our gut may be the solution to and source of many of our health problems. Probiotics, the things usually recommended awkwardly by Jamie Lee Curtis in yoghurt ads to promote more “regular” digestion, are now being hailed as an elixir that could help us prevent or combat more serious illnesses including autoimmune diseases, cancer and mental conditions like ADHD. Why? In short, the theory goes that the standard American gut doesn’t contain enough “good” bacteria to combat the inflammation caused by “bad” bacteria. The inflammation, allegedly, can build on itself and possibly lead to conditions like rheumatoid arthritis, type 2 diabetes, celiac disease, cancer, and even mental health conditions like OCD and depression. (I’m oversimplifying the current research; see below for links to a few great pieces of journalism, which I’ll also be discussing further.) What condition you get — or hopefully don’t get — would depend on many factors, of course, including your genetic makeup.
The connection between our guts and our mental health is probably the newest link to come to light. Last week, the website The Verge published an article citing the case of a young woman with ADHD and OCD who was suffering until her doctor came up with the idea of treating her with probiotics (in addition to psychotherapy and medication). He “came up with” the idea after asking his patient and her parents plenty of questions, which most doctors don’t do enough of. The woman was nothing short of cured of the conditions after one year, the article alleges, and her doctor and parents largely credit the probiotics. To the annoyance of some commenters, the article doesn’t actually cite any of the probiotic studies it mentions, but includes several that suggest a connection — at least in mice — between psychological behavior and what we eat and drink. In the words of this woman’s doctor, “There are more neurons in the GI tract than anywhere else except the brain.”
As usual, the author and food activist Michael Pollan should probably be credited with bringing the issue of our guts to the forefront of health news. At least, it seems that since Pollan published his story on the “microbiome,” collectively the bacteria that make up our bodies, in a May issue of the New York Times Magazine, the amount of general hubbub over the microbiome and its connection to a vast number of health problems has increased. In that article, Pollan, the author of The Omnivore’s Dilemma, cautioned that research on the microbiome is still in its early stages, with much about our guts remaining a mystery. But he touted natural probiotics such as yoghurt and kimchee (fermented cabbage) and pointed to research suggesting that a gut with a more diverse makeup of good bacteria results in a healthier person.
Also last week, the New Yorker published a piece by author Meghan O’Rourke called “What’s Wrong With Me?” about her struggle with an autoimmune disease, thyroiditis, which began to display symptoms after the death of her mother in 2009 (I also have this disease). Essentially, O’Rourke’s relatable, stress-inducing, yet funny piece is an argument against the kind of health care that routinely leaves autoimmune disease sufferers with more questions than answers (the same problems could be said to apply to those with mental health conditions, though she does not discuss this). She argues that most American doctors aren’t adequately trained to really treat patients with chronic conditions, to help them feel more than “eighty percent” healthy at any given time. Autoimmune specialists like endocrinologists and gastroenterologists are, generally speaking, obsessed with lab work, and often lack the time, in O’Rourke’s experience and in mine, to look at the bigger picture of a patient’s health.
But the doctor who treated the young OCD and ADHD sufferer with probiotics was looking at the big picture. He wasn’t focusing on the numbers, having this woman come in for repeat labs every few months and looking at what was happening in her body on a micro level. Unfortunately, he’s a rare breed. In the recent ebook The Upstream Doctors, Rishi Manchanda, a California-based doctor, takes a long hard look at what US health care would look like if more doctors were like hers. The book was adapted from a TED talk and is an inspiring look at how things could be if doctors simply asked more questions.
Unfortunately, the norm in this country is still for doctors to be brusque and overly technical, and for probiotics and other dietary wisdom to be touted only in ways that can be fit into the space of a 20-second television advertisement. Activia yoghurt “promotes regularity.” Cheerios are “heart-healthy” (never mind that they’re made with genetically modified grains grown on industrial-sized farms). Our doctors are often just as brief as the TV advertisements. My gastroenterologist once shoved a prescription for an acid reflux medication called Prilosec at me when I complained about indigestion, instead of asking me a single question about my diet (I decided to cut down on coffee and threw the Prilosec away unopened). We — and our doctors — need to appreciate health on a macro level if we’re going to get anywhere in tackling the mysterious rash of diseases affecting tens of millions of us. In the current healthcare landscape, chronic disease patients feel that they can only say things like this, O’Rourke’s final analysis:
You can’t muscle your way through the enervation and malaise of autoimmunity–if you could, I would have. The real coming to terms with autoimmune disease is recognizing that you are sick, that the sickness will come and go, and that it is often not the kind of sick you can conquer.
But it should be the kind of sick you can conquer. I only say this because I know people — and I’m one of them — who have been relieved of nearly all of the symptoms of their autoimmune diseases through a change in diet. But many of us had to do a lot of the work on our own. I also benefited from the wisdom of others who have autoimmune diseases. When O’Rourke began to tackle her myriad symptoms through a change in diet, she was initially left considerably more stressed and uptight than she’d been in the first place. She was eventually able to make some permanent and very beneficial dietary changes (she avoids gluten, among other things), but she felt adrift as she experimented. No doctor was going to guide her. Going to a nutritionist helped, but not dramatically.
So maybe the best we can do for now is help each other. I imagine some kind of alliance of the chronically and mysteriously sick sharing best dietary practices somewhere on the Internet. I can safely say that in my experience probiotics — and I mean a refrigerated, fairly pricey version like Udo’s Choice Super 8 High Potency Probiotic from Flora — do work for me. They provided the foundation of regimen that ended the near-constant appearance of strange symptoms associated with thyroiditis. But first I had to learn the hard way that I had a second autoimmune disease, celiac. Once I learned this and went on a strict gluten-free diet (back in 2008), the thyroid problem nearly went away. It tended to come back at these times: if I was under stress, if I drank too much, if I ate too much rich or processed food, if I wasn’t eating enough vegetables and fiber, or if I ran out of probiotics and was too lazy to get more. Again, unfortunately the triggers of my thyroiditis were learned by trial and error at home, not in a doctor’s office.
As many perfectly healthy Americans are deciding now, going gluten-free is only part of my self-prescription. I also started to stay away from high-glycemic carbohydrates like corn and gluten-free breads packed with too many gluten-mimicking fillers. I began avoiding products that had a good chance of being genetically modified, like cereal and tofu. I stopped drinking juice, and cut down on fruits high in acid. I started to eat far more leafy greens, blending them into a smoothie if I didn’t feel like cooking them. I continued to eat meat, trying to stick with the grass-fed, organic and antibiotic-free versions whenever possible. On the advice of a friend with RA, who on a Paleo-like diet has been utterly free of flare-ups and has gone off painkillers for the first time in about seven years, I started to put Kerry Gold, butter from grass-fed cows, in my coffee in the morning, a ritual he swears by. This friend also avoids vegetables classified as nightshades (e.g. peppers and tomatoes) and basically all grains. On the advice of a doctor, he takes a cocktail of supplements including vitamins and minerals and a couple of amino acids.
All that is hard to implement, and some of his regimen is of course specific to his condition and his body. But for those suffering from mysterious ailments, mental or physical, I would argue that, in consultation with a doctor (lab tests and professional opinions are still important, because each of our bodies brings unique issues to the table), it’s worth throwing all of this on the wall and seeing what sticks. We can’t go to such extremes that we end up harried and paranoid about what we put in our mouths, as O’Rourke for a time was. We know that no one food or supplement is going to make us healthy and keep us healthy. But opening up the discussion about our guts means that more of us are looking at the bigger picture of our health and experimenting with diet. It’s a relatively easy way to improve our health — perhaps the easiest of all.
“Some of My Best Friends Are Germs,” Michael Pollan, The New York Times Magazine
“Gut Feelings: The Future of Psychiatry May Be Inside Your Stomach,” Carrie Arnold, The Verge
“What’s Wrong With Me?,” Meghan O’Rourke, The New Yorker (behind the paywall)
“Who Has the Guts for Gluten?,” Moises Velasquez-Manoff, The New York Times