How's your gut?

60 to 70 million people are affected by digestive diseases in the United States, that is, twenty percent of the population.  This means about 7 million skiers are affected.  However, that statistic is a measure of the number of people who seek medical help.  It does not include the countless millions and millions who burp and pass gas from gastrointestinal distress on a daily basis.  National Institutes of Health, U.S. Department of Health and Human Services. Opportunities and Challenges in Digestive Diseases Research: Recommendations of the National Commission on Digestive Diseases. Bethesda, MD: National Institutes of Health; 2009. NIH Publication 08–6514.  https://www.niddk.nih.gov/about-niddk/strategic-plans-reports/opportunities-challenges-digestive-diseases-research-recommendations-national-commission

The easiest way to think about your digestive tract is to picture it as a tube that runs through your body, from your mouth to your anus, about nine meters in length.  What is typically referred to as the gastrointestinal tract includes the regions of the digestive tract between the esophagus, the tubular organ that connects the mouth to the stomach, and the anus. 

You take food into your mouth and chew it to produce a ball of chewed food, a bolus.  Chewing causes saliva to be secreted from your salivary glands into your mouth, which lubricates the bolus and starts to break down starch and fats to simpler sugars and less-complex fats.  The simpler fats, sugars, proteins, and undigestible carbohydrates pass into the stomach.  Valdez, I. and P. Fox, “Interactions of the salivary and gastrointestinal systems. I. The role of saliva in digestion,” Dig. Dis. 9(3):125-32 (1991).  https://doi.org/10.1159/000171298

Your stomach is essentially a short-term storage reservoir for food.  The acidity of the stomach serves three main roles: aiding in the digestion of food particles; protecting from potentially dangerous foreign microbes (“bad bugs”); and aiding in the digestion of proteins.  What leaves the stomach into the small intestine is chyme, a thick, semi-liquid mass of partially digested food.

The small intestine is a long, winding tube about 3 meters (9.8 feet) long and 2–3 cm (3/4-1 inch) in diameter.  Secretions from various body organs continue the breakdown of digestible carbohydrates into simple sugars, and proteins into their constituent amino acids.  The surface area of the small intestine is large compared with its length and is covered with thousands of finger-like projections, intestinal villi, that collect nutrients and pass them into the bloodstream; up to 95 percent of absorption of nutrients occurs in the small intestine.

After the small intestine, the large intestine serves as the main site of microbial fermentation of dietary substrates that escape digestion in the upper gastrointestinal tract.  In other words, what does not digested in the small intestine continues to be digested in the large intestine.  It also processes water and waste material prior to the expulsion of feces from the body (defecation).

Enough anatomy.  The reality is the “good bugs,” the beneficial bacteria, viruses, fungi and other microscopic living things in your gut microbiome, your entire intestinal tract from mouth to anus, do the eating for you.  That is, the “good bugs” capture the micronutrients passing through your digestive system, process them, and deliver them into the bloodstream.  We want more “good bugs” than “bad bugs” in our body.  Proper gut function occurs when the gut is balanced with approximately 80 percent good bacteria, “good bugs,” and 20 percent bad bacteria, “bad bugs.”  When you eat processed foods your gut flora risks becoming imbalanced with too many bad bugs.

If you are living with a chronic condition, for example, heart disease, high blood pressure, obesity, diabetes, and the list goes on, you may be living with chronic inflammation.  Even without any preexisting chronic condition, eating processed foods (you know, all those you find in the center isles of the grocery store) that are filled with sugar, bad fats, preservatives and genetically modified ingredients can cause inflammation and have a detrimental impact on your immune system and gut health.  Eating processed foods can trigger an immune response of powerful antibodies meant to fight invaders, which can damage the body's cells.  Further, an abundance of processed foods can become fertilizer for bad bacteria and yeast.  If the gut is not balanced with enough good bacteria, overall health can suffer.

Got the anatomy, understand the problem.  Now what?  Go see a gastroenterologist and get a pill; “we have a pill for that.”  No thanks.  There are plenty of conditions for which you should seek medical intervention; abdominal wall hernia, gallstones, gastroesophageal reflux disease, gastrointestinal infections, inflammatory bowel disease, pancreatitis, peptic ulcers, hepatitis C, to name a few.  Fortunately, gut health is a condition ripe for self-help.

First step, stop eating Frankenfood; stay out of the center aisles.  The ultimate goal is to eliminate processed foods altogether.  While it is unrealistic and virtually impossible to totally quit processed foods today, making changes in your diet will have demonstrable effects.  Swap out as many processed foods as you can with non-GMO organic fruits, vegetables and nuts.  Buy and eat only 100 percent grass-fed beef, lamb, and pork, and free-range chicken.  Sound like the constant refrain here?

Next, add fermented foods to your diet.  Fermented foods are foods that have been prepared so that the bacteria naturally found within them starts to ferment.  Fermentation is a chemical process in which microorganisms, such as bacteria and yeasts, and their enzymes break down starches and sugars within the foods, making them easier to digest.  The end result is a food that is filled with helpful organisms and enzymes, “good bugs.”  This process of fermentation is a natural preservative, which means that fermented foods can last a long time.

Fermented foods boost your immune system, enhance nutrient absorption, reduce inflammation, and can improve lactose intolerance.  They reduce sugar craving and help control the hormones that make you feel hungry or full, making it easier for you to maintain healthy body weight (without feeling like you’re on a diet).  Perhaps last, but not least, fermented food is just plain delicious!  This does not sound like much of a health benefit, but it is still important because if the healthy food does not taste good, then you will not continue to eat it for the long term.

Here is a list of some of the best fermented foods to include in your diet:

Kefir, which means “feeling good,” is a fermented milk product made from cow, goat or sheep’s milk that tastes like a drinkable yogurt.  It provides high levels of vitamin B12, calcium, magnesium, vitamin K2, biotin, folate, enzymes and probiotics.

Kombucha is a fermented drink made of black tea and sugar; the best forms of sugar are honey, fruit and cane sugar.  It contains a colony of bacteria and yeast that is responsible for initiating the fermentation process once combined with sugar.

Sauerkraut, which means “sour cabbage” in German, is made from fermented green or red cabbage.  It is high in fiber, vitamin A, vitamin C, vitamin K, B vitamins, and is a great source of minerals like iron, copper, calcium, sodium, manganese and magnesium.  Store-bought processed and canned sauerkraut does not deliver the benefits from traditional, fermented sauerkraut, which is usually stored in glass jars found in the refrigerated section and says “fermented” on its label.  The best sauerkraut is made from organic cabbage.

Fermented pickles contain a ton vitamins and minerals, plus antioxidants and gut-friendly probiotic bacteria.  Unfortunately, most store-bought pickles are made with cucumbers and vinegar that makes the pickles taste sour but does not lead to natural fermentation.  Fermented pickles should be made with cucumbers and brine (salt + water).  Look for “lactic acid fermented pickles” made from organic cucumbers and brine in the refrigerated section.  Check that the label says that the pickles have been fermented.  Often times a local fermenter, such as found at a farmers market, produces some of the best probiotics for your health.  Better yet, make your own pickles at home.

Miso is created by fermenting soybeans, barley or brown rice with koji, a type of fungus.  It’s a traditional Japanese ingredient in recipes including miso soup.  You can find miso-based recipes

Tempeh is made by combining soybeans with a tempeh starter, a mix of live mold.  It becomes dense and cake-like after sitting for a day or two; it contains both probiotics and a significant amount of protein too.  Tempeh is similar to tofu but not as spongy and more “grainy.”

Natto consists of fermented soybeans that after fermentation develops a strong smell, deep flavor and sticky, slimy texture that not everyone who is new to natto appreciates.  It is sometimes even eaten for breakfast in Japan and commonly combined with soy sauce, karashi mustard and Japanese bunching onion.

Kimchi is a traditional fermented Korean dish that is made from vegetables, mostly cabbage, plus spices like ginger, garlic, pepper and other seasoning.  It is often added to Korean recipes like rice bowls, ramen or bibimbap.

Raw cheeses are made with milk that has not been pasteurized (unpasteurized milk is almost impossible to find outside of local farms).  These soft cheeses are particularly high in probiotics, including thermophillus, bifidus, bulgaricus and acidophilus.  Read the ingredient label, which should indicate that the cheese is raw and has been aged for six months or more.

Yogurt is fermented milk.  Look for yogurt that is made from 100 percent grass fed animals, sheep, goat or cow (hard to find in the store but easy to make at home).  Yogurt is most consumed fermented dairy product in the United States and many other nations.

You can search for truly fermented foods in your grocery store; you can find more of a selection in some specialty food stores.  However, they are easy to make at home.  Fermented vegetables are created by shredding or cutting the vegetable into small pieces, and packing them into an airtight container (absolutely need to keep the air out) with some brine (water and salt).  Doing it yourself allows you to choose organic non-GMO vegetables.

Yes, the water and the salt do make a difference.  Virtually all tap water is chlorinated, and chlorination inhibits fermentation.  A common solution for chlorine is to leave the water you intend to use for fermentation out uncovered to allow the chlorine to evaporate, or simply boil the water, or use a filtration system.

Furthermore, a recent study by the US Geological Survey shows that nearly half of the tap water in the US is contaminated with “forever chemicals,” chemicals that have been linked to cancer, obesity, thyroid disease, high cholesterol, decrease fertility, liver damage, and hormone suppression.  Smalling, K., et al., “Per- and polyfluoroalkyl substances (PFAS) in United States tapwater: Comparison of underserved private-well and public-supply exposures and associated health implications,” Environ. Int. 178:108033 (July 5, 2023).  https://doi.org/10.1016/j.envint.2023.108033  A study in 2019 suggested that 98 percent of the US population have PFAS chemicals in their bodies.  Calafat, A., et al., “Legacy and alternative per- and polyfluoroalkyl substances in the U.S. general population: Paired serum-urine data from the 2013-2014 National Health and Nutrition Examination Survey.” Environ. Int. 131:105048 (October 2019).  https://doi.org/10.1016/j.envint.2019.105048

Per- and polyfluorinated substances (PFAS) dissolve in water which means that most traditional drinking water treatment systems are not able to remove them.  Activated carbon, ion exchange, and high-pressure membranes are considered the most effective treatments for removal of PFAS.  There are inexpensive filtration systems on the market that contain these treatment methods.

Common table salt typically contains iodine and anti-caking agents to keep it from clumping.  Even the iodine-free table salt contains anti-caking agents; don’t use it.  Kosher salt is a course salt that contains anti-caking agents; don’t use it. Pickling salts are additive-free, but refined; don’t use them.

Sea Salt is made from evaporated salt water, and contains more trace minerals than table or Kosher salt.  Some Sea Salt is refined, which removes trace minerals; use a mineral-rich, unrefined sea salt.  Mineral rich salt mined from ancient sea beds like pink Himalayan salt from Pakistan contain many beneficial trace minerals; use it.  You will be surprised at the difference between different types of salt if you taste the fermented foods side-by-side.

Virtually any vegetable can be fermented; beets, broccoli, cabbage (sauerkraut), carrots, cauliflower, celery, cucumbers (pickles), daikon, garlic, green beans, hot peppers, napa cabbage, okra, olives, onion, radishes, snap peas, soybeans, turnips.  Create the environment and let the microrganisms work their magic.

There are two “bibles” for fermentation; all of the titles by Sandor Ellix Katz, for example, The Art Of Fermentation(2012), Wild Fermentation: The Flavor, Nutrition, and Craft of Live-Culture Foods, 2nd Edition (2016), and Fermentation Journeys: Recipes, Techniques, and Traditions from around the World (2021) and The Noma Guide to Fermentation (2018) by René Redzepi and David Zilber.  There are also a number of other very good beginner books.

Beginner vegetable fermentation kits are widely available in health food stores and online.  You can also easily make yogurt at home, both traditional and Greek-style, with inexpensive yogurt makers.  Use only milk from 100 percent grass fed animals for the best yogurt.

I had a Chef’s Salad topped with fermented red onions … from expected flavor to exotic, and health benefits to boot!  It turned out the restaurant got its fermented foods for its dishes from its own on-site fermentation research facility … that’s very awesome.

The tour and meeting Stefania, the full-time fermentation researcher, incentivized me started experimenting myself.  I found it especially easy with the Masontops Complete Mason Jar Fermentation Kit.  The kit contains airlock lids for wide-mouth mason jars (to allow fermentation gas to escape but not let oxygen in), glass weights that snugly fit into the wide-mouth mason jars to keep the vegetables submerged in the brine, and a handy wood tamper for tightly packing the jars.  The easiest start is simple brine fermentation; the formula for basic brine is ½ cup salt in 1 gallon of water; cucumber brine somewhat saltier, ¾ cup salt in 1 gallon of water.  This is not vinegar pickling like you find in the stores, this is real fermentation!

Here are my first attempts after about two weeks; the cabbage is definitely on its way to becoming sauerkraut, the taste is there but it needs more time to fully develop; the yellow beets are already delicious; the red onions have turned almost translucent white and their taste is totally different from the raw slices that went into the jar; the cucumbers will definitely take more time, but the aroma of fresh dill and garlic is delightful.  With the onset of summer and the availability of fresh vegetables, now is definitely the time to experiment with fermentation for your gut and your taste buds.  Bon appétit fermenté!