Wheat Belly (Revised and Expanded Edition)

by William Davis

  To help get your arms around these issues, let’s view bowel flora as a backyard garden. Just as you prepare soil and plant seeds in the springtime, then water and fertilize your garden throughout the growing season in order to enjoy a rich yield of juicy tomatoes and asparagus, we take a similar approach in cultivating our “garden” of bowel flora.

  Fail in this symbiotic relationship or allow it to be disrupted and all manner of peculiar things can develop in the body. Just as humans have managed to wipe out grasshoppers that used to fill open fields and to pollute lakes and rivers, killing off wildlife and allowing intruders to proliferate (ever witness an algal bloom?), we have likewise fouled our intestinal tracts. It is becoming clearer every day that the consequences of disrupted bowel flora are enormous. The list of diseases that originate or are worsened include those of the intestinal tract itself, such as irritable bowel syndrome, constipation, ulcerative colitis, and colon cancer, as well as conditions outside of the intestines such as fibromyalgia, rheumatoid arthritis, depression, anxiety, Parkinson’s disease, restless leg syndrome, even dementia.

  We’ve also gone from a life of butchering animals by hand and consuming their intestines, walking on dirt floors, and bathing whenever the seasonal opportunity arose, to a life of showering with hot running chlorinated water and bath soap and shampoo, using toiletries for every surface and orifice, and keeping cleaners and handwipes for every occasion. We reach for hand sanitizers, mouthwash, toothpaste, deodorants, and anti-perspirants to conceal human body odors and stay “clean.” But it was the day-to-day dirtiness of human life that populated our bodies with organisms needed for health. Encounter someone from the past and you would likely be repulsed by the smell, dirt, and eagerness with which they consumed the organs and meats of the animals they killed, sometimes raw. Yet that is how human life was lived until modern conveniences like washing machines, mouthwash, and body wash came along.

  No matter how much you shampoo your hair, scrub with soap, or wipe sinks down with disinfectant, your body is still populated by trillions of microorganisms. Modern efforts to sterilize our surroundings have not eliminated microorganisms but have changed the varieties dwelling in and on our bodies, causing benign or healthy organisms to be replaced with harmful intruders, Staphylococcus aureus, for instance, associated with skin infections and eczema instead of benign Staphylococcus epidermidis.37 Distortions of the microbiome begin at birth if a child is delivered by C-section, rather than through the vagina, depriving the newborn of essential microbes, as does feeding an infant formula in lieu of breast milk. Throw in the occasional exposure to antibiotics for, say, an earache or urinary tract infection, that temporarily wipes out microorganisms, or the effects of chlorinated and fluoridated drinking water, and modern humans now have an entirely different collection of microorganisms compared to “dirty” primitive people.

  I’m not suggesting that you give up showering, or reject the use of toothpaste or toilet paper (although you should consider using as little soap as possible and shampooing only occasionally). Because we are exposed to hordes of humans (unlike primitive humans exposed to only a few dozen other people), we are potentially exposed to pathogenic species of Staphylococcus aureus from skin and E. coli from the bowels and other harmful organisms. A London School of Hygiene study found fecal organisms on the hands of 44 percent of people who touched public doorknobs, provoking a collective “ewwwww.”38 The cleanliness of our age is, to some degree, a necessity arising from the modern populated world, but we’ve taken it too far in trying to wipe clean the rich and diverse landscape of microbes that should find home on your skin and in your mouth, sinuses, airway, vagina, and bowels.

  On top of our modern obsession with cleanliness are countless other factors disrupting our microbiome: antibiotic residues in meat and dairy, industrial chemicals in food, GMO-containing foods with Bt toxin and glyphosate, prescription drugs. Just like the grasshoppers, fireflies, and hummingbirds that used to fill backyards and woods but are now nearly gone, so many microorganisms that were supposed to populate our bodies are long gone in modern people, replaced by a collection of unfriendly newcomers.

  Disrupted bowel flora, “dysbiosis,” is now the rule, not the exception. For instance, up to 85 percent of people with the common and “benign” condition of irritable bowel syndrome have dysbiosis.39 Prescription drugs, such acid-blocking drugs and narcotics (that slow bowel function), alter bowel flora to the point of causing new health problems just from this effect. If you are overweight or have an autoimmune condition, prediabetes, diabetes, constipation, or any number of other common health problems, it is virtually guaranteed that you have dysbiosis sufficient to impact health in many ways.

  Just how far adrift we are becomes clear when our “poopulation” is compared to that of primitive people who have never been exposed to antibiotics, Mr. Clean, or a Quarter Pounder with Cheese. Even though primitive populations living on different continents have very similar bowel flora to one another, it is strikingly different from our modern “poopulations.”40, 41

  Working to cultivate a healthy garden of bowel flora can therefore yield impressive health benefits. The benefits that have been demonstrated in our own species include:42, 43

  Reduction in symptoms of irritable bowel syndrome

  Reduction in childhood infections and infant colic

  Reduction in atopic dermatitis (eczema)

  Reduction in appetite mediated through hormones such as GLP-1, ghrelin, an oxytocin

  Reduction in blood sugar and insulin, reduction in insulin resistance

  Increased absorption of calcium and improved bone health

  Reduced triglycerides, total and LDL cholesterol

  Relief from fibromyalgia

  Deeper sleep, reduced daytime anxiety

  Reduction in stress via reduced cortisol

  Reduction in blood pressure

  Improved bowel regularity, reduction in factors leading to colorectal cancer

  Reduction in urinary oxalate levels that otherwise lead to calcium oxalate kidney stones

  Accelerated skin healing and increased dermal collagen (i.e., reduction in wrinkles)

  These creatures may live mostly in your colon, but their impact extends far and wide, including immunity and bone, lung, stomach, skin, and even brain health. You can also appreciate that, in modern healthcare, nobody works to restore healthy bowel flora but instead they prescribe countless drugs to “correct” many of the phenomena attributable to dysbiosis.

  But we can surely do better and allow a little dirtiness back into our lives.

  We can therefore break down our efforts to grow your garden into three steps:

  1) Prepare the “soil”

  2) Plant the “seeds”

  3) “Water” and “fertilize” the garden

  How do we prepare the soil if there are no rocks and weeds to clear? We start by removing wheat, grains, and sugary foods, since unhealthy bacteria thrive on these things, even causing them to ascend up the small intestine, duodenum, and stomach (creating a condition called small intestinal bacterial overgrowth [SIBO]; see “SIBO: Uncontrolled ‘Poopulation’ Growth” box, this page). Removing wheat and sugars also eliminates many genetically modified foods containing dysbiosis-cultivating Bt toxin and glyphosate. (Soy is nearly all genetically modified, and we therefore minimize our exposure to soy products as well.) Several additional efforts keep wily varmints out of your garden:

  Filter drinking water—Chlorine and fluoride are antibacterial, thereby altering the composition of bowel flora, just as it kills off soil flora when used to water plants. Drink water filtered via the reverse-osmosis process and/or carbon filters to remove chlorine and fluoride. Filtered water is also less likely to contain residues of prescr
iption drugs, which are making their way into the water supply.

  Avoid unnecessary antibiotics—There will be times when antibiotics are necessary. But avoid them for questionable indications, such as a viral illness “just in case” it converts to a bacterial infection. Also, dairy products and meats and poultry can, despite FDA policy, occasionally contain antibiotic residues. Choose organic products whenever possible.

  Minimize or avoid prescription drugs—Acid reflux drugs and anti-inflammatory NSAIDs are among the drugs that alter bowel flora.44 Probably plenty of other prescription drugs also change bowel flora, but this is almost never explored during drug development, nor will your doctor be aware.

  Minimize exposure to emulsifying agents—Emulsifiers have the potential to disrupt the mucous lining of the intestinal tract, thereby altering the microbial composition of bowel flora. Total avoidance is, however, not practical, as there are natural emulsifiers in otherwise healthy foods, such as eggs (lecithin) and mustard. We therefore work to minimize exposure to synthetic emulsifiers such as carboxymethyl cellulose, polysorbate-80, sodium stearoyl lactylate, and carrageenan.45

  Avoid the artificial sweeteners aspartame, saccharin, and sucralose—These artificial sweeteners modify bowel flora, increase the potential for diabetes, and help explain why sugar-free soda drinkers are more overweight than sugared soda drinkers and are at a greater risk for type 2 diabetes.46 Choose natural and benign sweeteners instead, such as monk fruit, stevia, inulin, allulose, and erythritol.

  Now that we’ve taken steps to prepare the soil, let’s plant the seeds: supplements and foods that provide various species of bacteria.

  Probiotics, such as Lactobacillus rhamnosus and Bifidobacterium lactis, are collections of bacteria that have been demonstrated to be beneficial. Given current knowledge, the best probiotic nutritional supplements contain multiple species, preferably at least a dozen, since species diversity has proven, over and over again, to be associated with good health, decreased diversity with poor health. A good probiotic should also contain substantial numbers of organisms, or colony-forming units (CFUs), preferably fifty billion (billion with a b) or more in order to exert an effect, not the few million contained in many products. My top choices for healthy probiotic preparations you can purchase are listed in the “Preferred Probiotics” box (this page).

  Nobody knows just how long you should take probiotics. Some considerations: Taking a probiotic “seeds” the intestines with the species contained in the probiotic preparation for only a few weeks (i.e., colonization is only temporary for most species). However, probiotic studies were performed without the combined and synergistic effects of fermented foods that contain many of the same species. And, of course, primitive people with vastly different and healthy bowel flora don’t have probiotic supplements, but they consume fermented foods and the intestines of animals while not worrying about the kids washing their hands or wiping the sink down with Fantastik. My practical solution until better evidence is available: Take probiotics for six to eight weeks while also consuming fermented foods at least once per day, including prebiotic fibers (discussion to come). If any symptoms recur on stopping the probiotic, or if you have a pre-existing bowel condition, such as irritable bowel syndrome, ulcerative colitis, Crohn’s disease, or celiac disease, or have any other autoimmune condition, consider taking the probiotic for a longer period of, say, a year or more.

  SIBO: UNCONTROLLED “POOPULATION” GROWTH

  There is a peculiar modern and, until recently, underappreciated condition called small intestinal bacterial overgrowth (or SIBO). Although it was previously thought to be uncommon, emerging evidence suggests that tens of millions of Americans have this condition, undiagnosed by doctors who still believe that bowel health ends at a prescription for Prilosec, laxatives, or a bowl of bran cereal or that, if you can’t see it with a scope, it must not be important. In fact, SIBO is proving to be an epidemic on a scale that matches type 2 diabetes and obesity—big, nasty reflections of how far we have strayed in health and diet.

  Bowel microorganisms should be confined to the colon, with sharply diminishing numbers ascending up into the ileum, jejunum, and higher. But, like tossing bread crumbs to entice ducks, consuming wheat and sugar causes bowel microorganisms to ascend. Throw in factors such as emulsifiers from processed food, synthetic sweeteners like aspartame, GMOs, failure to consume fermented foods, prolonged emotional stress, and unhealthy Enterobacteriaceae species such as E. coli, and Klebsiella ascend up twenty-some feet of small intestine, duodenum, and stomach, creating a virtual full-length intestinal infection.

  Conditions associated with a high likelihood of SIBO include irritable bowel syndrome (IBS), fibromyalgia, autoimmune conditions, restless leg syndrome, and psoriasis. IBS and fibromyalgia, in particular, are proving to be virtually synonymous with SIBO, though a disturbing 20 to 40 percent of people with no symptoms at all can also have it.47, 48 Telltale signs that you are among the many who have this condition, in addition to associated conditions, include diarrhea or constipation, bloating, seeing an oily film in the toilet or floating stools, intolerance to various foods, and unexplained skin rashes, especially eczema. The Wheat Belly lifestyle, in which we purposefully amp up prebiotic fiber intake, can unmask SIBO with excessive bloating, gas, and diarrhea. If you experience such symptoms within the first hour of consuming prebiotic fibers, it is virtually certain that you have SIBO.

  If you have reason to believe that you have SIBO, sometimes just adhering to the entire collection of Wheat Belly strategies may reverse it, although it may take a prolonged course of probiotics and fermented foods while omitting prebiotic fibers. A challenge with reintroduction of prebiotic fibers can tell you whether or not you have reversed SIBO. If you remain intolerant, then it’s time to either undergo a hydrogen/methane breath test to diagnose the condition, or simply to treat it empirically (i.e., based on judgment) with antibiotics. We have been using the herbal antibiotics CandiBactin-AR/BR or FC-Cidal with Dysbiocide with success, with recurrences blocked by enthusiastic consumption of fermented foods, probiotics, and prebiotic fibers.49

  Fermented foods really need to become part of your daily habits, a practice that harkens back hundreds of thousands, perhaps millions, of years before refrigeration became available and food fermented, then rotted, shortly after it was found or killed. Fermentation is simple and adds little to no cost to your grocery bill, but it provides a natural means of further supplementing beneficial probiotic species. By allowing foods to ferment, you are increasing the microbial flora that ferments sugars into lactate, giving vegetables and fruits that characteristic tangy sensation and unique flavors, while adding health benefits from consuming the bacteria themselves. You may even find that you and your family begin to love the added unique flavors of, say, sliced or spiral-cut fermented beets, or caraway seed–and rosemary-infused fermented radishes added to salads. (Fermentation is not the same as pickling; most dill pickles and store-bought sauerkraut are not probiotic sources and have no beneficial microbial species.)

  PREFERRED PROBIOTICS

  We look for probiotics that have bacterial counts sufficient to have a rapid impact (i.e., fifty billion or more CFUs [colony-forming units] per day) and a variety of species (i.e., a dozen or more Lactobacilli, Bifidobacteria, and other species). Recall that this serves to “seed” your garden of bowel flora, and species diversity is a consistent marker of health.

  There is plenty more to learn about choosing an effective probiotic. For instance, most products do not specify the precise strains of species contained, a major oversight, as strain specificity is crucial. This issue will hopefully clarify in coming years, helping us better choose the best probiotic preparations. Also, note that some probiotics can be used to make yogurt; just be sure to choose a brand—e.g., RenewLife—that does not contain any fungal strains such as Saccharomyces, else you will have alcohol in your yogurt. I
also list a probiotic that provides the fungus Saccharomyces boulardii, which possesses the unique property of helping healthy bacterial species proliferate.

  RenewLife Ultimate Flora

  Garden of Life RAW

  Dr. Mercola Complete Probiotics

  Jarrow Saccharomyces Boulardii + MOS

  The basic methods to ferment foods in your kitchen are outlined in appendix B. I’ve also included recipes that incorporate fermented vegetables into dishes. If you find it too much to handle, you can buy a growing number of delicious fermented foods, such as fermented carrots, Bubbies fermented Kosher pickles or sauerkraut, kimchi, kombucha, kefir, and yogurt with live cultures. Eat them, toss them in salads or other dishes, drink their juices, even rub them onto your skin and you will be impressed with the effects.

  Once you’ve seeded your garden with probiotics and fermented foods, what are the “water” and “fertilizer” that nourish them? These are prebiotic fibers, fibers that you ingest but cannot digest, leaving them for the microorganisms in your intestines to consume. Getting prebiotic fibers is crucial to health and the success of your diet.