“All disease begins in the gut”– Hippocrates

The gut microbiome is set to be all the rage in 2016. Large scale research studies are in effect, dietitians are pulling their focus to a diet that encourages a diverse intestinal environment, and scientists now actually consider gut microbiota an organ, an acquired one, but an organ nonetheless. As humans, we are covered and filled with tiny microbes on our skin, in our nose and mouth, and throughout our intestinal tract, living in a symbiotic and, mostly, harmonious relationship. These microbes outnumber our human DNA 10-fold, and the number of genes in all of those microbes’ genomes is roughly 100 times greater than the number in our human cell genome. Whoa. According to the group “Gut Microbiota for Health,”

“Our gut microbiota contains tens of trillions of microorganisms, including at least 1000 different species of known bacteria with more than 3 million genes (150 times more than human genes). Microbiota can, in total, weigh up to 2 kg. One third of our gut microbiota is common to most people, while two thirds are specific to each one of us. In other words, the microbiota in your intestine is like an individual identity card.”

What this means, in essence, is that while any two people in the world, no matter age, sex, location, will share %99.9 of the same DNA, only about %30 of their gut microbiota is the same. Two-thirds of your gut microbiota is as unique as a fingerprint! You can see why scientists are so excited about this.

I first learned about the gut microbiome in 2012. My brother-in-law has a rare disease called Primary Sclerosing Cholangitis (PSC), which causes inflammation and fibrosis of bile ducts inside and/or outside the liver. 75% of individuals with PSC also suffer from a form of irritable bowel disease, mostly ulcerative colitis. He was winding up in the hospital approximately every 6 months with complications from colitis, and Monica desperately wanted to take him off one of the medicines she thought was causing this. Having just returned home from a recent hospitalization, Moni was especially on top of her research game and called to tell me she had a plan: “It’s called fecal transplant. I’m going to give him my poop.” I pulled my car off the freeway and sat slack jawed while she explained the process, mostly responding with highly intelligent comments like, “oh my god,” “ewwwww,” and, “huh.” You know what, though? She nailed it. They went through this process before the FDA decided to take it over, and it worked. He’s had very few flare-ups of ulcerative colitis since then, and when he did a couple of years ago, she just gave him her excellent bacteria again. Now that the FDA has stepped in, fecal transplant with a known donor is regulated and difficult to access unless it’s treating c-dif, but that’s a story for another time.

A few short years ago, it was the commonly held belief that infants were born sterile, with no exposure to bacteria, fungi, or other microorganisms, but recent research has indicated that the amniotic fluid surrounding the fetus may have bacteria present that are important in establishing the early immune response. For sure, during vaginal birth, the infants microbiome is colonized by skin bacteria from the birth canal and from the colon of the mother, and from there it’s off to the races. Your gut microbiome is a direct indication of the environment you were raised in (country, city, suburbs), the food you ate (McDonald’s, home cooked, processed, organic), and whether vaginal birth vs. c-section/breast feeding vs. formula.

Why, you might be tempted to ask, does this matter to me? I became interested because they have linked response to chemotherapy to intestinal microbiota, and I have a minty fresh colon that I want to really treat right this time around. Here’s what they say about the chemo thing:

• “Researchers have shown that the efficacy of one of the molecules most often used in chemotherapy relies to an extent on its capacity to mobilise certain bacteria from the intestinal microbiota toward the bloodstream and lymph nodes. Once inside the lymph nodes, these bacteria stimulate fresh immune defences which then enhance the body’s ability to fight the malignant tumour” Gut Microbiota for Health

This could be a game changer for people receiving chemo. My response to chemo was impressive, and I’m set on developing a super microbiome in the off chance I ever have to do it again. Now, why does the gut microbiome matter to you? Because, we are absolutely, positively products of our environment and diet, and guess what? You really are what you eat, and for that matter, what you eat off the floor. Oh no or yay, depending on who is reading this, but your diet and environment matter. Recent studies have linked certain bacteria and/or lack of diversity in the gut microbiome to obesity, diabetes, rheumatoid arthritis, multiple sclerosis, muscular dystrophy, fibromyalgia, other auto immune diseases, and some cancers. As well, variations in the gut microbiota are linked to anxiety, depression, bipolar disorder, and other stress related psychiatric disorders. Do you get where I’m going with this? 80% of your immune response is in your microbiome. Your helpful, lovely, dynamic gut microbiota help you to digest your food,  in the production of certain vitamins, to combat the aggression of other microorganisms, and to modulate inflammation related with numerous disease processes. As you can see, they are busy, and they are important. It is suggested that a future is imminent where “microbiota typing” will become a standard of medical care. Analysis of the urine and feces would reveal the unique make up of an individuals microbial community, which might indicate why an individual was sick and what may make them well. Researchers are seeking pathways to develop antibiotics that are targeted rather than global to decrease disruption of the gut microbiome, and someday we might be able to deliver drug therapy’s that are geared to your unique intestinal environment.

Research indicates that the human gut microbiome has been drastically altered by our addiction to processed foods, antibiotics, and an increased number of elective c-sections. City living doesn’t help much either. People born in rural areas, in the vicinity of livestock, appear to have a more diverse and healthy bacterial load. We are basically sanitizing ourselves into ill health. The good news is that our microbiome is affected with each meal, and that a recent Harvard study showed that the gut microbiome can be drastically altered in a few days with a significant alteration in diet. We actually have control over the bodies first line of immune defense through diet and a discretionary use of antibiotics. That is phenomenally exciting news! With the myriad life events I have minimal ability to impact, I love to embrace the things I can actually affect, and after my year of living cancerously, I am all about impacting my healthy positively on every level.

So now that you know that you are much more inorganic than organic material, what in the world do you do? Get down and dirty with your diet, darling. As per usual, it all comes down to what you stick in your mouth. Seriously, don’t forget that we have a skin microbiome, too. Haha. Sorry. Moving on:

• Fermented foods: plain yogurt with active cultures, kimchi, sauerkraut
• High fiber foods: especially the fructan and cellulose fibers. The rough fibers. The parts you don’t usually eat. Stalks of broccoli, the tough end of asparagus, leeks, the parts that get stuck in your teeth.
• Foods that are low in sugar and unprocessed
• Farm to table: get your food with bacteria on it! Buy your food as close to the source as you can. Austin is rich with urban farms and farmer’s markets serviced by numerous local vendors. Utilize these resources here or in your own community.

There you have it. My new obsession, and the good news is, you can get involved in all of this exciting research! From the creators of the Human Genome Project comes the Human Microbiome Project. You can add your unique gut bacterial composition to that of thousands of others in America and around the world and get results of your data sent back to you. Find all this info at The Human Food Project.

P.S. 1 year ago today I was diagnosed with cancer. Wow, just wow.

P.P.S. 3 years ago today my uncle George died from complications from multiple myeloma. I miss him.

 

“Dearly beloved, we are gathered here today to get through this thing called life.” This post isn’t a tribute to Prince, but a tribute to the final step in the most challenging year of my existence, so far. Prince is also dancing around in my brain almost constantly after news of his death last week, therefore it would be impossible not to bring a little of him into this.

On April 14th I arrived at the hospital with my parents and sister in tow for my final operation. Having the ileostomy reversed is much less harrowing than the first surgery, and I’ve been poked and prodded so often this year that an IV or two and a few extra shots don’t actually stress me out anymore. This time they gave me the option of an epidural or an Exparel shot for the post-op pain, and because I think it’s always better not to have something injected into my spinal cord, I chose the Exparel. What’s Exparel? It’s a nerve block that they inject directly into the surgical site to numb the area for about 4 days. How do I remember the name so well? It was on a wrist band I wore in the hospital. Very rock ‘n roll. In theory this is an easy surgery, cut out the part of my small intestine that was my darling stoma, sew the two ends back together, and drop it back down through the astoundingly taut and toned layers of my abdominal musculature. My words, obviously. And it was easy. Everything went beautifully. Except the fact that for some reason the Exparel didn’t kick in until about 4 hours after I woke-up.

I now know what it feels like to be in so much pain that it makes you want to vomit. Yay, more lessons from that barbarous teacher named cancer. The last thing they want you to do after abdominal surgery is puke, and I was nauseous and in pain, but when they would ask about my pain levels all I could say was “maybe a 6 or 7? “Why in the world am I such an idiot? I have no clue. All I can think is that in my incapacitated state I thought that if I didn’t say it, it wasn’t so. I do love some good delusion, but thankfully my sister, who knows me pretty well, pulled the recovery nurse out into the hall and told her that if I was saying 6 or 7, it was probably a proper 10. She also said I looked like I might die. I love her so much. From there they kicked into action. In under 1 hour I got 2 IV doses of phenergan, a dose of emend (both strong anti-nausea meds), 2 IV doses of dilaudid and a bump of morphine. I was flying for the next 24 hours, AND, because MD Anderson is the best place ever in the history of everdom, they continued to give me IV Dilaudid every 6 hours with hydrocodone and tramadol thrown into the mix in-between to keep me comfortable. Oh la la, I was very, very, very comfortable. I didn’t know my name, actually didn’t care, but I was very comfortable.

The goal following an ileostomy reversal is getting your bowels to move, or to pass gas, and they won’t discharge you until one or the other happens. I don’t think I was asked any less than 60 times in those first two days if I had experienced any activity. Everyone is super interested. Even my friends. They asked A LOT. So we walked and walked and walked. My mom and I actually got our 10,000 steps that second day! Which is amazing because I wasn’t moving quickly. Too loopy. I quickly went from a liquid diet (who knew that an Ensure slushy can be delicious) to soft solids, and the astounding feeling of absorbing nutrition after 8 months of absorbing almost none was beyond inspiring. The end result is that I felt much better than I ever anticipated. About a month after finishing chemo, I found myself incredibly perturbed that I still fatigued quickly or couldn’t keep a train of thought. I understand that chemo brain is real because I still have some memory loss, but I didn’t realize how much malnutrition was affecting my ability to think or concentrate. After two Ensure’s (which are gross and chemically…don’t drink them unless you must) that first day in the hospital, I started to perk up immediately. When I began to add other foods I thought I might dance out the front door. The end of the story is that on night two my bowels began to work and they discharged me the next morning. According to everyone, I’m really good at recovering from surgery. It’s a skill.

My mom and I drove home with floods bearing down on Houston, and started trying to figure out what I could eat. The first 5 days were lots and lots of white foods. They call this the low-residue diet and I stuck to it. White bread, eggs, bananas, rice, mashed potatoes, sweet potatoes, blah blah bland bland, but it works. Most people post-ileostomy have uncontrollable diarrhea and can’t be away from a bathroom. Their anal sphincter is unconditioned and weak. Not to toot my own horn or anything, but not me. Toot toot. My stools were firmed up the day after discharge, my bowels tended more toward constipation so I actually needed to add some foods with higher fiber to my diet instead of eliminate them, and because I have diligently been doing my anal kegels since last October, I can actually hold my bowels. Side note: this newfound ability to talk to openly about the state of my bowels is astounding, which is a good thing, because it comes up often. Anyhow, I’m able to drink coffee without upset, thank god, and I am now, 2 weeks post-op, walking for about an hour most days…away from the house! Ta. Dah. The goal is to slowly add foods to my diet, only one new, higher fiber food every couple of days, and find out what affects my stomach and what doesn’t. They say that your sensitivities  will be similar to the ones you had before. Luckily for me, I’ve never had a super sensitive stomach. Except for that time my sister drove me to madness in Barcelona and I bought coffee from a questionable vendor. Who deprives someone of coffee for the first 3 hours of their day? Is the Sagrada Familia really that great? Yes it is, but I still needed my coffee.

The lesson this taught me that I knew before but had forgotten because bbq, tacos, sweetbreads, fried chicken, and old fashioned’s ARE a way of life, is how completely nutrition affects our physical well-being. The way the human brain and body respond to even the most minimal amount of nourishment is awe inspiring, and I am super curious to see what happens if I focus on super nutrition. To that effect, you will see me cooking more, hitting the farmers markets more, and repopulating my gut microbiome with healthy, happy, helpful bacteria. How many people actually have the opportunity to repopulate their gut microbiome? It’s a rare opportunity and I intend to take advantage. By the way, if you haven’t been turned on to the gut microbiome, yet, I suggest you do some research, or read my next post, because all I can think about these days is my gut! So far I find that with a little more fiber in my diet (important for the gut microbiome) I void more at once, which is important because I don’t have much of a rectum left. It’s all about getting my colon back into tip top shape and teaching it to act as a rectum, and I’m well on my way to doing it. I also have to believe that my Pilates practice has had something to do with my success. Maybe it’s the internal massaging the happens during many of the exercises, or keeping the abdomen toned. I don’t know, but according to my doctor I’m experiencing the best possible outcome we could have hoped for, and we’re both thrilled.

Now its time to move on and focus on beginning a new work life, moving forward, taking care of what I now know is an extraordinary machine (seriously, I should have bred when I had the chance because, in general, my genes are super stars), and keeping these lessons with me. What I’ve learned in the last year is that I have an extensive and dedicated support network, how to ask for help, and how to, at times, be weak in front of others. I have learned that even during crisis, I am really good at getting “through this thing called life.”