Omj microbiotagutbrain article

Oriental Medicine Journal

®

Wood/Spring 2014 • Vol. 22, No. 3

The Microbiota-Gut-Brain Axis Joan Rothchild Hardin, PhD

|1

Vol. 22, No. 3

wood/spring 2014

3

6

Contributors

The Microbiota-Gut-Brain Axis

By Joan Rothchild Hardin, PhD

5 Editorial

|3

wood/spring 2014

Joan Rothchild Hardin, PhD, is a Clinical Psychologist in private practice in New York City. A main focus in her clinical practice is to help people become aware of mind/body interactions, especially their “gut feelings” and other physical manifestations of their emotions, to be able to become their true selves.

In an earlier phase of her life she was engaged in social science research projects at the Department of Medical Genetics, New York State Psychiatric Institute; Massachusetts Mental Health Center, Harvard University Medical School; The Medical Foundation (Boston); the Center for International Affairs, Massachusetts Institute of Technology; and the Stanford Research Institute.

She was Project Director for the Youth Leadership in Smoking Control Project under a National Interagency Council on Smoking and Health grant to the Lung Association of Mid-Maryland.

Her earlier article, Successful Holistic Treatment of Clostridium Difficile Gut Infection: Case Study, appeared in the 2011, 19:4 issue of OMJ.

Hardin has a website called Allergies And Your Gut, http://allergiesand yourgut.com/ She can be reached at jrhn-allergiesandyourgut@usa.net.

|5

wood/spring 2014

notes from the editor’s desk

T

he more we learn about life on this planet, the more we discover that is strange and wonderful.

It used to be, for example, that we only encountered “symbiotes” in comic books or science fiction, where aliens invaded the bodies of humans and used them for their own benefit, sometimes turning

the human into a zombie and sometimes giving the human added powers. As it turns out, truth is

stranger than fiction. As we learn in this issue of Oriental Medicine Journal, humans not only are involved in symbiotic relationships with other species, but many of these relationships are mutual and obligate, meaning that neither species involved can survive without the other. If we did not have bacteria living in our digestive tracts, we could not digest our food; nor can those bacteria survive outside our digestive tracts.

In this issue, psychologist Joan Hardin takes us on a journey through our guts to learn about our mutual symbiotic relationships (both parties benefit), commensal relationships (one party benefits and the other is not significantly harmed or helped), and parasitic relationships (one party benefits while the other is harmed). Anyone who has had food poisoning will have some idea what it feels like to share a body with a parasitic symbiote. But you will be surprised and amazed to learn how much we depend on the mutual and commensal relationships. e human microbiome, i.e., all our colonies of symbiotes, has a profound effect on our very existence. Not only is a healthy microbiome absolutely necessary for our survival, but it even affects our decision making and our psychological state.

What is even more incredible is the fact that our ancestors in the practice of our medicine somehow knew these things. ey assigned the role of e General, the decision-maker, to the Gall Bladder, which functions as a part of our digestive system. Hardin explains how our gut and our brain are in constant communication, so much so that some of our decisions are made by our guts . . . as in “gut reaction.” It is a real thing, and scientific findings are now beginning to be able to explain just how it happens.

Just as a well-balanced and fully functioning microbiome is essential to life, dysbiosis is the root cause of much of our ill health, whether it manifests in the body, the mind, or the spirit. Hardin helps us understand how the microbiome can become out of balance, what the consequences are, and how to restore it to health.

Prepare to embark on an incredible journey!

Mary J. Rogel, PhD, LAc

6|oriental medicine journal If you do not change direction, you may end up where you are heading. — Lao-tsu

By Joan Rothchild Hardin, PhD

|7

wood/spring 2014

As someone who suffered through a nasty Clostridium difficile infection in my colon and then its rather unpleasant aftermath and lived to tell about it – and who is also a psychotherapist – my primary interest in the Gut-Brain Axis is in the former, the gut (the seat of our feelings). The brain is certainly interesting in its own right, but the gut is closer to my heart, so to speak. If the psychotherapist-gut connection is not clear to you at the outset, it will become so as we work our way through this vast topic told from my biased perspective.

1978 A patient was working hard in psychotherapy with me, but her depression remained immovable. Finally she mentioned she had a digestive problem that interfered with the absorption of nutrients from food passing through her intestines – and I wondered if that was the source of her mood imbalance as well as the reason there had been no improvement. No one I asked knew anything about that.

How I Became Interested in this Topic

2010 I was enjoying myself on vacation in Paris when I started having episodes of diarrhea every morning.

They became increasingly intense and frequent after my return home, often leaving me feeling weak and decidedly unwell.

Tests revealed a Clostridium difficile infection, along with a few other bacterial infections, a parasite, and low gut immunity. I learned that years of being given antibiotics prophylactically for dental cleanings and for infections had seriously diminished the healthy flora in my gut, allowing the sturdy C. difficile bacteria to take hold.

The accepted treatment of C. diff was then (and largely still is) massive doses of more antibiotics. That made little sense to me. I also learned that C. diff infections treated with antibiotics have a 25% chance of recurring – often with a vengeance. Once the antibiotic has cleared the gut, spores containing C. diff re-emerge from the colon walls where they have burrowed in, break open, find few healthy digestive bacteria left, and easily populate the gut again.

So I enlisted the aid of my trusted holistic health care providers and, working together, we found a way to vanquish this nasty infection without pharmaceuticals.

You can read more about Clostridium difficile and how I treated my infection in my article published in this journal. (Hardin, 2011) 2011 A new psychotherapy patient was sleeping either way too much or too little; had brain fog, chronic upper respiratory allergy symptoms, constipation, and horrible PMS symptoms followed by debilitating menstrual periods; and became virtually incapacitated by even moderate amounts of alcohol – for days.

Psychiatrists over the years, noticing her depression, had put her on a great variety of psychotropic medications. Nothing had helped much. Some made her feel worse.

She agreed to taper off the pharmaceuticals and began working with a holistic health care provider who understood that her gut flora was seriously out of balance, so gave her appropriate probiotics. We talked about the gut flora and food sensitivities, and she gradually gave up gluten and cheese, mostly avoided alcohol, and added kefir to her diet. She is now making excellent progress in her psychotherapy.

2012 After my recently-gained understanding of how the antibiotics I had been given (mostly unnecessarily) by physicians as well as consumed unknowingly in my food over many years, I read Martin Blaser’s article warning that prolonged antibiotics use leads to long-term damage to our beneficial gut flora, seriously reducing our ancient microbial defenses against a wide range of diseases and medical conditions. This struck a chord of recognition in me. (Blaser, 2011) Shortly after that, an article in e Economist called “Microbes maketh man,” with its catchy cover graphic, opened my eyes even further to the vital interaction between our guts and every other bodily function. We need balance in the large population of bacteria and other organisms living in our guts in order to keep our immune systems strong so we can achieve and maintain good health. (e Economist, 2012) It was a long time coming, but I finally got the message: Good gut health is central to our overall well-being. (continued on the next page)

8|oriental medicine journal

The Gut-Brain Axis e Gut-Brain Axis refers to the

Gut-Brain Axis, has become an exciting

healthy and how we can fix ourselves

continuous feedback loop between

new frontier of neuroscience, offering

when we fail.

sensory neurons in our gastrointestinal

great promise for how we can stay

(GI) tracts (from lips to rectum) and motor responses generated in our central nervous systems. is constant two-way communication has a profound influence on almost every aspect of our beings – from how the brain develops and functions, to GI disorders, how well our immune systems work, whether we develop conditions like heart disease or diabetes, what and how much we choose to eat, how sensitive we are to pain, whether we become depressed or anxious, … and much more. anks to recent methodological advances in genetics which have opened doors to detailed research into the ways the gut and brain interact, the field of neuro-gastroenterology, study of the

The Gut-Brain Axis

|9

wood/spring 2014

Intriguing Fact

•

On average, the human brain contains 86 billion neurons (the building blocks of the nervous system) engaged in transmitting information to and from the body. (Randerson, 2012) e brain is the seat of all our thinking. e human enteric nervous system (the gut) contains 100 million neurons – about 1000th the number in the human brain and about equal to the number in the human spinal cord. (Boron & Boulpaep, 2005)

From a Western medical perspec-

Pharmaceutical companies have lost

into normal gut bacteria, making them

tive, this is just in the nick of time. As

interest in trying to develop new, more

antibiotic resistant and turning them

an increasing number of bacteria are

powerful antibiotics which will be taken

into superbugs. Studies have shown

becoming resistant to antibiotics and

for only 7-14 days. eir profits are in

that GMOs can activate and deactivate

turning into superbugs, the antibiotics

more expensive drugs that are taken

hundreds, perhaps thousands, of genes.

era, which began with the commercial

indefinitely.

is sounds serious but has not been

production of penicillin during World War II, is coming to an end.

e main culprit in the overuse of

studied yet. e US has embraced

antibiotics is the agricultural industry,

genetically modified crops. New

which gives 24.6 million pounds of

Zealand and many European countries

produced bacteria containing mutations

antibiotics each year to livestock for

have banned them.

that give them antibiotic immunity.

non-medical purposes.

Extensive use of antibiotics has

ose bacteria with mutations that contain the NDM-1 gene can transfer their antibiotic immunity to their offspring, turning ordinary bacteria

en there is the genetic engineer-

Add that to many physicians’ over- and inappropriately prescribing

ing of our foods. Many believe that

antibiotics to their patients, and you see

genetically modified organisms (GMOs)

how we got ourselves to this place.

in our food transfer genetic material

(Mercola, 11/9/2013)

into superbugs.

Our Second Brain - The Gut Mind During vertebrate embryonic development a single clump of fetal tissue divides to grow into the gut and the brain. One section becomes the central nervous system (the brain and spinal nerves) while another migrates lower in the body to create the enteric nervous system embedded in the sheaths of tissue lining the esophagus, stomach, small intestine, and colon. e two separate nervous systems connect via the vagus nerve running from the brain stem into the abdomen. is major trunk line is one of the longest nerves in the body. e gut and the brain are constantly signaling each other, back and forth, along the vagus nerve and also via chemicals released by the gut and transported to the brain. ough the means of transportation is not entirely understood yet, when one brain gets upset, the other becomes upset too. ey work in conjunction with each other along the Gut-Brain Axis, each heavily influencing the other. (Champeau, 2013; Gershon, 1998; Foster, 2013) At birth there are about one million brain cells in our guts. We now know that the neurotransmitter serotonin enables growth of new neurons in this second brain – even in adulthood. is knowledge suggests we will learn how to repair a damaged or congenitally defective enteric nervous system one day without resorting to invasive procedures. (Paddock, 2009) (continued on the next page)

10|oriental medicine journal

e information on this second brain of ours is truly mind boggling.

In 1683 in Delft, when the Dutch haberdasher turned lens maker, Anton van Leeuwenhoek, peered through one of his primitive microscopes at scrapings he had taken from his own teeth and became the first person to observe what he termed “animalcules” living in the tartar, he unknowingly launched the fascinating field of microbiology. But he surely had no idea what would be discovered with high power equipment in our own age.

Gastro-intestinal Tract

wood/spring 2014

|11

Intriguing Fact

•

e digestive system is a complex chemical processing machine, breaking down food, absorbing nutrients, and moving waste via muscular contraction down towards the anus for expulsion. e autonomous nervous system of the gut allows it to work independently of the brain. When the vagus nerve connecting the brain and the gut is surgically interrupted, the gut runs the bowels all on its own. (Gershon, 1998)

The Gut Microbiome - Our Second Genome e long held view has been that our

first dose of bacteria as we pass through

balance for up to six months after birth.

bodies consist of 10 trillion cells, the

the birth canal out into the world. en

ese babies do acquire some of their

products of the 23,000 genes found in

we acquire additional bacteria from our

mothers’ microflora, but their initial

the human genome. Recent research

nutritional intake, the environment, and

exposure is mostly from the environ-

into the composition and role of the

other humans via suckling and being

ment (the air, nursing staff, other

human microbiota or microbiome has

caressed and kissed. At about a month

infants). Amazingly, as adults, we each

revealed that we are home to consider-

after birth, the primary intestinal

have approximately 2-5 pounds of

ably more cells dwelling inside us,

microflora of vaginally born infants

mutually beneficial tiny organisms

mostly in our guts.

has become well established.

living inside our guts – they help us,

e GI tracts of babies in the womb are sterile. We pick up an important

In contrast, the primary gut flora in babies born by C-section may be out of

while we provide them a cozy home.

(Wikipedia, 2013)

is collection of 100 trillion cells living inside us consists of several hundred species of non-human genes – at least 1,800 genera and up to 40,000 species of bacteria, together possessing 100 times the number of genes in the human genome. (Forsythe & Kunze, 2013) is vast amount of gut-dwelling organisms is not even manufactured by our own bodies! e majority of them are various bacteria, but there are also fungi, protozoa, viruses, yeasts, and Archaea (single celled organisms characterized by their ability to tolerate extremes in temperature and acidity – Archaea are primitive life forms that appeared on earth billions of years ago but were only identified by scientists in the late 1970’s). (Wikipedia, 2013; American Society for Microbiology, 2012) And, most shocking of all, it turns out we need these little aliens inside us and could not thrive – or even survive – without them. (Cryan & Dinan, 2012; Forsythe & Kunze, 2013) So, as a result of fairly recent advances in science, we now are aware that humans are not really single organisms at all. We are actually complex eco-sysInfant Receiving Gut Microbiota

tems made up of a multitude of smaller, alien organisms working together among themselves and with our bodies to make us who we are. (Cryan & Dinan, 2012) (continued on the next page)

12|oriental medicine journal

pathways as well as immune and Approximate Size of Human Gut Microbiome versus Human Genome

endocrine mechanisms. e vagus nerve is also an important pathway used by the bacteria in our guts for sending signals to our central nervous systems. e exact ways the gut microbiome communicates with the brain are not yet fully known – possibly via a combination of neural, endocrine, and immune pathways. (Cryan & Dinan, 2012) Researchers are understandably eager to solve the puzzle of what is sometimes called our second genome

To put this illustration another way,

or immune relationships takes place,

so they can develop microbial-based

we are only about 10 percent human.

leading eventually to a disease state.

therapeutic strategies to correct mood

Our other 90 percent is made up of

(Cryan & O’Mahony, 2011)

disorders and any number of other

microbial organisms. Not exactly how we have been viewing ourselves, is it? ese alien components of our

e gastrointestinal (GI) tract is an important hub of interaction between the body’s largest concentration of

health problems. (Forsythe & Kunze, 2013) We will make a return visit to the

microbiomes interact with their hosts –

immune cells, a network of 500 million

relationship between gut and mental

us – to try to achieve a health-produc-

neurons in there, and the gut micro-

health in a bit.

ing homeostasis. When the microbiota

biota.

is diminished or unbalanced, deterioration in gastrointestinal, neuroendocrine,

We know that the gut and brain communicate with each other via neural

wood/spring 2014

|13

Intriguing Fact

•

in fact, our guts make more independent decisions for us than any other part of the body. e gut’s endocrine signaling to the entire body is quite elaborate. Communication from our gut-dwelling microbes to the anterior cingulate, orbitofrontal cortex, and amygdala up in the brain affects our emotions, motivation, cognition, memory, and behavior. (lieff, 2012)

An Artist’s Vision of the Human Body with Its Microbiota Credit: The Economist/ Jon Berkeley

e topic of the gut microbiome is

scientists cannot even assign them to

topics researchers are studying now, this

so new that many of the bacteria

a specific bacterial genome. is is

article would turn into a thick tome,

discovered in new research studies

truly an exciting new frontier with

which it has been threatening to do

are still unnamed and are without

vast implications … some of which

from the outset.)

descriptions or sequenced genomes.

I will explore below. (If I were to give

For some microbiome bacteria,

descriptions of all the microbiome

The Vagus Nerve e vagus nerve, our 10th cranial nerve, runs from the hypothalamus in the brain to all the body organs shown in the diagram on p. 14, terminating in the gut. It wraps around the heart and core area of the gut, delivering the healing, calming neurotransmitter, acetylcholine, all along its route. e body responds by becoming inflamed when it experiences stress. Acetylcholine acts as a brake on inflammation. Acetylcholine is also responsible for learning and memory.

(continued on the next page)

14|oriental medicine journal

A key function of the vagus nerve is to act as a reset button after your internal alarm system goes off in response to some type of real or perceived threat. Once you feel safe again, the nerve delivers the news to the rest of your body that it can return to normal healing mode.

Your breathing and heart rate can calm down. Stress hormones stop being produced.

If you live in a perpetually overstressed state (in a war zone; have PTSD, OCD, insomnia, a stressful job …) the body is unable to calm down and heal itself – and your body becomes increasingly inflamed. As we all know, chronic stress creates a whole variety of negative effects, including depression, anxiety, sleep disturbances, and interference with thinking and attention. e best way to activate the vagus nerve and your relaxation response is to breathe. Slow, deep breaths relax and expand your diaphragm, restarting the vagus system, lowering your cortisol level, and letting your brain heal.

(Leiff, 2012; Papas, 2012) All kinds of good things happen when the mind The Vagus Nerve

is quiet.

wood/spring 2014

|15

Intriguing Facts

•

Just like our primary brain, our gut brain is also able to learn and remember. (Gershon, 1998)

•

human intestines measure about ten times the length of the body in which they reside.

Symbiosis Versus Dysbiosis When the body and those pounds of non-human microbes living inside our guts, the gut microbiome, are in harmony, we are in Symbiosis: a balanced, mutually beneficial relationship between us and those several hundred species of alien bugs. e gut, brain, and the rest of the body are in balance – in health, free from disease.

In return for a pleasant home, these friendly organisms in our guts (often called “our old friends”) allow us to thrive.

Symbiosis How friendly organisms in the gut help us thrive: • Help absorb and assimilate nutrients from the foods we eat • Produce important biological chemicals like serotonin and dopamine (needed for brain function) • Synthesize vitamins • Produce energy • Protect us from carcinogenic and otherwise harmful chemicals • Detoxify the body • Inhibit and kill off harmful bacteria and other nasty bugs • Maintain a healthy immune system • Provide a protective coating on the bowel walls • Promote normal peristaltic action in the bowel to keep us regular • And much more But when, as happens too often, the harmonious relationship between the body and the large colony of bacteria, yeasts, viruses, parasites, etc., living in our guts becomes out of balance, we are in DYSBiOSiS: A disruption or skewing of the constant two-way communication between gut and body. Pathogenic bacteria, fungi, or parasites can then easily proliferate, throwing the system out of balance.

When the imbalance crosses a threshold, the body initiates disease (dis-ease) conditions.

(Epidemic Answers, 2013; Byron Body & Soul, 2009) Happy Gut

Dysbiosis A sampling of symptoms dysbiosis causes or has a role in (Diagnose-me.com, 2013; Morris, 2011; Wikipedia, 2013): • Digestive issues, including irritable bowel syndrome or disease (IBS and IBD), Crohn’s disease, celiac disease, gut strictures, bloating, belching, constipation, diarrhea, heartburn, bad breath, abdominal pain, indigestion, colic, lactose intolerance, GERD • Gum disease and tooth decay • Cardiovascular (heart) disease and stroke • Obesity • Joint pain • Food and other allergies • Sinus infections and headaches • All autoimmune and autoimmune-related disorders – over 80 of them - including asthma, Addison’s disease, celiac disease, dermatomyositis, Graves disease, Hashimoto’s thyroiditis, multiple sclerosis, pernicious anemia, rheumatoid arthritis, sprue, systemic lupus, Lou Gehrig’s disease (ALS), Crohn’s disease, Parkinson’s disease, fibromyalgia, chronic fatigue, multiple chemical sensitivity, and type I diabetes • Yeast infections, local and systemic (eg, Candida albicans) • Urinary tract infections • Low libido • Impaired mental functioning/brain fog • Sugar cravings (including alcohol) • Carbohydrate intolerance • Skin conditions, such as acne, psoriasis, eczema, erythema (pathological redness of the skin), allergic dermatitis (skin inflammation), and hives • Hormonal imbalances • Nail fungus • Neurological diseases • ADD & ADHD • Mental disorders, such as depression and anxiety; conditions along the autistic spectrum, including autism and Asperger syndrome; schizophrenia and bipolar disorder • Pulmonary diseases • Alzheimer’s • Cancers (continued on the next page)

16|oriental medicine journal

Causes of Dysbiosis Dysbiosis can result from many causes, (Hawrelak & Myers, 2004) including: • Antibiotics – medications as well as antibiotics fed to animals we eat • A poor, nutrient deficient diet • Genetically modified organisms (GMOs) and genetically engineered (GE) foods • The body’s pH becoming too acidic • Infants born via C section birth • Infant formula instead of breast milk • Prolonged stress • Chronic illness • Birth control pills/hormone replacement therapy • Chemotherapy • Other pharmaceuticals • Carcinogens in foods, the environment, cosmetics

Gut Dysbiosis

wood/spring 2014

|17

Intriguing Facts

•

in the lowest, most primitive part of our brains, a neural network called the basal ganglia is constantly evaluating the outcomes of our every behavior and extracting decision rules: When i said that, it worked out well. When i did this, bad things happened. And so on, like a tireless experimental scientist tasked with guiding us wisely through our lives. e basal ganglia store our accumulated life wisdom.

But when we are faced with a decision, it is our verbal cortex that delivers our thoughts about it, often drowning out the wisdom accumulated inside the basal ganglia’s storehouse. e most interesting part: e basal ganglia area is so primitive that it has no connection to the verbal cortex, so it cannot share its knowledge in words - but its connections to the gut are plentiful. e basal ganglia area tells us what is right or wrong for us as a gut feeling. So trust your gut, your felt sense, your intuition – not what comes to you in words from your brain! (Goleman, 2011)

Imflammation When the immune system detects a

or antibiotics. Under conditions of

threat from toxins, germs, environmen-

chronic inflammation, instead of heal-

other grains has long been known to be

tal pollutants, injury, and stress, it sends

ing itself, the body becomes chronically

a cause of intestinal inflammation and

troops to fight the battle; and inflamma-

out of balance. It is not yet known how

damage. e inflammation may even

tion results. e same is true when the

chronic inflammation is produced.

be there for many years before overt

immune system has become overly

Many mechanisms are involved,

symptoms are noticed or a recognized

reactive and launches attacks against

including mast cells, chemicals that get

illness makes itself known. Since we

perceived threat, as happens in people

produced, organs that become involved,

know the gut and brain are intimately

with allergies and autoimmune condi-

and more; but it all starts with imbal-

connected, it is not a big leap to learn

tions. Inflammation is the body's effort

ance in the gut microbiome that wreaks

that gluten has adverse effects on the

to heal itself, but the inflammatory

havoc on our bodies in a wide variety of

central nervous system as well.

process can go awry and become

ways. (Bested, 2013; Brogan, 2013)

chronic.

For many of us, chronic inflamma-

e presence of chronic inflamma-

e gluten found in wheat and some

GreenMedInfo (a well-respected, open access, evidence-based resource

tion has been noted in people with

supporting natural and integrative

tion is the result of consuming multiple

cardiovascular disease, Type 2 diabetes,

modalities) published the results of a

pharmaceuticals and a Western diet of

obesity, and cancers – the combination

search of the biomedical literature in

nutrient-poor foods that have been

is called Metabolic Syndrome. Chronic

the National Library of Medicine,

genetically modified or overly processed

inflammation is also found in people

reporting over 200 documented

and altered with preservatives, emulsi-

suffering from the whole variety

adverse health effects linked to

fiers, artificial food dyes, other FDA-

of unpleasant conditions in the gut

gluten-containing grains.

approved additives, growth hormones,

dysbiosis list in the side bar on p. 15.

(continued on the next page)

18|oriental medicine journal

Neurotoxicity appeared at the top of the list of 21 distinct modes of toxicity stemming from gluten, which also included neuropathy, ataxia, autism, acute manic states, and schizophrenia.

(Ji, 2013) Gluten is Latin for "glue" and refers to the doughy complex of proteins inside the wheat plant. Because wheat is the by-product of three separate ancestral plants that became one, it has six sets of chromosomes and 6.5 times as many genes as are found in the human genome! Gluten is made up of over 23,788 different proteins, many of them pharmacologically psychoactive and having adverse neurological and cognitive consequences.

(Ji, 2013)

strongly glued together) with the same sturdy sulfur-based bonds found in human hair and vulcanized rubber in other words, not possible for our guts to break down fully. e result is a cycle of autoimmunity and systemic inflammation.

Given the recombinatorial potential of 23,788 distinct proteins, some of them have become nearly identical in

When the gut's immune system identifies any one of these wheat proteins as “other” (because it is indigestible), it launches an attack, producing inflammation to vanquish the enemy. Some of these 23,788 wheat proteins are disulfide-bonded (i.e., Chronic Inflammation

structure and configuration to both opiates and virulent components of immune-system activating microbes.

(Ji, 2012) No wonder we so often crave wheatcontaining baked goods!

See the Addictions section on p. 27 for further discussion of wheat addiction.

wood/spring 2014

|19

Intriguing Facts

•

i have noticed as a psychotherapist that people’s voices relax and become lower pitched when they are speaking their gut truths and get tense and higher pitched when they are saying what they think.

•

Nearly every brain-regulating chemical found in our skull brains has also been found in our gut brains. is includes major neurotransmitters (serotonin, dopamine, glutamate, norepinephrine, and nitric oxide), brain proteins called neuropeptides, major immune system cells, a class of the body’s natural opiates (enkephalins), and even benzodiazepines (the family of psychoactive chemicals found in drugs such as Valium and Xanax). (Gershon, 1998)

Thermal Imaging of Inflammation If you are interested in seeing actual images of the inflammation in your own body, you may want to have non-invasive, thermal imaging done.

A medical thermography camera, about the size of a camcorder, measures the infrared radiation emitted by the body to produce a thermogram showing temperature variations in the body. The color-coded images make it clear if and where a disease process is developing. A healthy body produces thermally symmetrical images. An asymmetrical image may indicate a problem brewing.

Thermography measures the infrared radiation from our bodies so is safer than mammography, which exposes us to relatively high levels of radiation. Since it is a way of measuring inflammation, thermography is an excellent tool for those of us who are interested in prevention rather than waiting for something serious to develop.

When my GI tract was very inflamed by the activity of highly overactive mast cells, I could see the resulting inflammation clearly on the color images in my thermography report. And when I had succeeded in calming those mast cells down, I could see that clearly too.

Here are two examples of thermal imaging of the gut:

From my Allergies and Your Gut site: Above are thermograms of a woman medically diagnosed with irritable bowel syndrome (IBS). e image on the left, taken during her initial examination, clearly shows the circular inflammatory pattern indicating IBS. e image on the right was taken 45 days following treatment with acupuncture and Chinese herbs. Much of the red circular, spotted pattern (indicating inflammation) is gone and is being replaced by the increased green area, demonstrating a return to a healthier, cooler thermal pattern. (Louiselle, 2013) Louiselle, M. (2013). Screening Inflammation to Better Monitor Women’s Health: What are your body’s heat patterns saying about inflammation and our health? See http://www.cimwellness.com/screening-inflammation-to-better-monitor-womens-health/

(continued on page 21)

wood/spring 2014

|21

Intriguing Facts

•

e gut has opiate receptors much like the brain. Drugs like morphine and heroin attach to opiate receptors in the brain and also in the gut, causing constipation. Both brains can be addicted to opiates. (loes, 2003)

•

Our emotions are greatly influenced by chemicals and nerves inside the gut. Most of us know Prozac as a best selling anti-depressant pharmaceutical. in 1971, when Eli lilly was developing the drug, they expected it would become a treatment for high blood pressure or obesity. Prozac (fluoxetine hydrochloride) works by increasing brain levels of serotonin, a neurotransmitter that produces feelings of well-being. Serotonin also affects sleep, appetite, and aggression.

(Bellis, 2013)

The Role of Mast Cells Mast cells, located in our skin and

released by mast cells gathered there to

We require mast cells in order to

mucosa, are an essential part of our

promote healing. It is also believed that

survive. Without them we would be

immune defenses. ese unique cells

mast cells have a role in angiogenesis,

defenseless against pathogenic invaders.

are tasked with activating our immune

the growth of new blood vessels.

No person without any mast cells has

systems to defend us from harmful

(MastCellAware.com, 2012-2013)

ever been found.

invaders. Mast cells commonly reside at the body’s various borders, where they act as goalies to defend us against pathogens trying to gain entry.

Mast cells also live in the linings of our stomachs and intestines, in connective tissues, including the skin, where they promote wound healing, and elsewhere in our bodies.

Inside the mast cells are tiny granules containing a variety of chemicals called mediators that activate our immune systems to defend us from harmful invaders. An example, when

e mast cells’ mediator chemicals are divided into three major groups.

You will probably have heard of some of these neurochemicals before: Preformed mediators: Histamine, serotonin, proteoglycans, tryptases, and other proteases Newly synthesized lipid mediators: Prostaglandins, cysteinyl leukotrienes, platelet activating factor

mast cells perceive a breach in the skin, they sound the alarm, releasing histamine to send troops to the wound site. e itching you feel around a healing scab is probably caused by histamine

Cytokines and chemokines:

Mast Cell at Work

Interleukin-4, interleukin-5, TNF-alpha, TGF-beta, chemokines (Gurish & Castells, 2013)

(continued on the next page)

22|oriental medicine journal

perfumes or other odors, medications,

finding they also play a key role in the

cells get activated at the same time or

insect stings, and foods. (American

early phases of the various autoimmune

they proliferate wildly, unpleasant

Academy of Allergy, Asthma and

diseases – such as rheumatoid arthritis.

symptoms and disorders result.

Immunology, 2013; Mastocytosis

(Benoist & Mathis, 2002)

However, if too many of these nifty

An extreme form of mast cell

Society, 2011)

Anaphylaxis: Anaphylaxis is a

dis-regulation is Systemic Mastocytosis

Even when mast cells are not so

systemic overreaction to things like

(in which the body over-produces mast

wildly out of control, their over-activa-

nuts, bee stings, shellfish, latex, and

cells in multiple organs, including bone

tion can cause much misery. ey have

some drugs. Mast cells begin degranu-

marrow) and a serious condition called

historically been considered useful first

lating (releasing their contents) when

Mast Cell Activation Syndrome (in

responders in microbial infections.

an allergen is detected. An anaphylactic

which a trigger activates even a normal

eir role as potent contributors to

reaction can begin immediately on

number of mast cells to release their

allergic reactions has also been known.

exposure and rapidly progress to

mediators too easily).

Continuing research into mast cells is

airway constriction, skin and intestinal

revealing that mast cell involvement can

irritation, and altered heart rhythms.

worsen some conditions, disorders, and

Severe anaphylaxis can result in a

diseases.

complete inability to breathe, shock,

In Systemic Mastocytosis, these mediators can cause a range of symptoms in children and adults, including shortness of breath, low blood

Allergic Reactions and Autoim-

and death. (Mayo Clinic, 2013)

pressure, hives and swelling, itching,

mune Diseases: Mast cells are the

Reproductive Disorders: Mast cells

nausea and vomiting, diarrhea, fainting,

primary responders to minute amounts

exist within the endometrium, with

headache, uterine cramps and bleeding,

of otherwise harmless substances the

increased activation and release of

skin rashes, flushing, abdominal pain,

immune system regards as allergens.

mediators in endometriosis. In males,

bloating, musculoskeletal pain and

e ensuing battle results in various

mast cells are present in the testes and

lesions, and anaphylaxis. ese

allergic reactions – such as asthma,

are increased in oligo- and azoosper-

symptoms can be triggered by heat,

eczema, itching, allergic rhinitis, and

mia, with mast cell mediators directly

cold, physical or emotional stress,

allergic conjunctivitis. Researchers are

suppressing sperm motility.

wood/spring 2014

|23

Intriguing Facts

•

90 percent of the body’s serotonin is located in the gut, where it regulates intestinal movements. Only 10 percent is synthesized in the central nervous system, where it serves many functions including mood regulation, appetite, sleep, and the cognitive functions of memory and learning. (Berger, Gray & Roth, 2009; King, 1996-2013)

•

Known side effects of Prozac, one of the antidepressants in the selective serotonin reuptake inhibitor (SSRi) class, include nausea, diarrhea, insomnia, and a lowered sex drive – clear evidence of a gut-brain interaction. (Bellis, 2013)

•

People with bowel problems also tend to have disturbances in their REM (dream cycle) sleep causing fatigue in the morning even after what felt like a sound sleep. (Alternative Medicine Angel, 2013)

Mast Cell Tumors: In the less serious form of Mastocytosis, prolifera-

Mast cell tumors can also grow on hu-

heart failure, brain inflammation, mixed

mans. (MastCellAware.com, 2012-2013)

organic brain syndrome, multiple

tion of mast cells in the skin, mast cell

ere is a long list of other condi-

sclerosis, multiple myeloma, postural

tumors are produced. ey are often

tions and diseases where mast cells also

orthostatic tachycardia syndrome

seen in elderly dogs and cats and can

appear to play a significant role: Autism,

(POTS), and more.

become quite large. ough often not

breast cancer, fibromyalgia, interstitial

(MastCellAware.com, 2012-2013)

malignant, they have the potential to be.

cystitis, Crohn’s disease, dysautonomia,

My Own Struggle with Mast Cells Gone Wild e mast cells in my gut gave me a lot of grief about a year after I had vanquished my Clostridium difficile infection and was back to eating more or less normally – the new normal, trying to eat gluten free but not entirely succeeding.

Dining on a lovely vegetable lasagna I had made with an indulgent amount of cow’s milk cheese gave me acute diarrhea that clearly was not a return of the C. diff. (Diarrhea caused by a C. diff infection has a distinct odor to it.) A GI test panel confirmed this but did not identify the cause.

So again I began suffering with chronic diarrhea that went on for about nine months until, fortuitously (though it did not seem so at the time), I became sea sick while on vacation and, in desperation, took Dramamine. Much to my amazement, it not only stopped the mal de mer but also gave me a whole day with a well-knit-together gut.

Doing some research on returning home, I learned that Dramamine is an anti-histamine. So I continued taking it and did some more research on why an anti-histamine would be effective on gut hypermotility – and learned about mast cells.

From the day after I had enjoyed that cheesy vegetable lasagna, I felt as if a switch had been turned on in my gut. I would eat or drink something – anything – and my gut reacted as if a horde of Huns was at the gate and a full-scale defense needed to be launched to expel the invaders. (continued on the next page)

24|oriental medicine journal

A colonoscopy showed beautifully clean colon walls but the tissue biopsies I requested found a vast over-production of mast cells, just as I had expected.

Again I was desperate to feel better so reluctantly agreed to take a steroid to try to turn the switch off. A course and a half of generic Entocort, a corticosteroid used to treat severe Crohn’s disease, allergies, arthritis, asthma, and skin conditions, did the trick. ermography images confirmed a huge reduction in inflammation inside my gut and chest areas.

I am assiduously gluten free now.

I also stopped eating all milk products,

refined sugar, and artificial food dyes as much as possible, while continuing to take high quality probiotics and other helpful nutritional supplements. In recent months, I have been able to add plain yogurt, goat and raw milk cheeses, and kefir back into my diet with good results.

Two other interesting discoveries during this time: • My main health care provider noticed an imbalance and asked if I had consumed any artificial food dyes.

I said I did not think so, as I try to avoid even those approved by the FDA. e next morning, as I was about to take my daily steroid dose,

I saw that the gel cap was colored fluorescent pink.

• I learned, the hard way, that food products marked “Certified GF” are not necessarily without gluten; they may contain very low levels of gluten proteins, so are considered safe for people with celiac disease, which is a t-cell mediated reaction to gluten. A gluten allergy, like mine, involves an IgE-mediated reaction to the wheat proteins’ albumin and globulin fractions and also sometimes an IgG-mediated reaction. Hence my “being hit over the head with a shovel” reaction to snacking on some quite tasty “Certified GF” granola.

A Return Visit to Gut Symbiosis and Dysbiosis We return now to the topic of gut symbiosis and dysbiosis.

Pre- and Post-Natal Development As mentioned above, the guts of babies developing in the womb are sterile. ey start acquiring their gut microbiota at birth. ere is evidence that the mother’s gut health during pregnancy affects both her and her developing child’s health. For example, a Finnish study found that mothers given probiotics during pregnancy (Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12) had a lower incidence of gestational diabetes mellitus. (Luoto et al, 2010) Another Finnish study found that abnormal development of gut bacteria in C-section babies can continue well beyond infancy. e authors recommend ongoing dietary interventions for these children to improve their health. (Salminen et al, 2004)

wood/spring 2014

|25

Intriguing Facts

•

Alzheimer's and Parkinson's disease patients often report being constipated. We think of these diseases as central nervous system problems yet our guts also play an important role. (Alternative Medicine Angel, 2013)

•

it is well known that factory farmed and processed foods are more likely to cause illness than organically grown, unprocessed foods.

Yet 90 percent of the American food budget is spent on processed and fast foods. (Schlosser, 2001)

It is well known that breast milk is

likely to develop autoimmune disorders

and continued breastfeeding up to

loaded with antibodies and other

later in life. (Jackson & Nazar, 2006)

the age of two years, about 220,000

protective factors that provide the

e World health Organization

child lives would be saved every

newborn with an immunological

reports:

year. Globally, less than 40% of

umbrella. Infants who were not breastfed or whose nursing was prematurely discontinued are more

If every child was breastfed within an hour of birth, given only breast milk for their first six months of life,

infants under six months of age are exclusively breastfed. (World Health Organization, 2013)

The Gut and Mental Health It is likely that the future of psychotropic medicine will be microbes like probiotics, not pharmaceuticals. We are learning that what is inside our guts strongly influences our mental health.

Some intriguing examples: • A Boston-area psychiatrist successfully treated a teenage girl’s severe OCD and ADHD by adding probiotics to her diet. Within six months her symptoms were greatly reduced. At the end of a year, she was symptom free – including free of the digestive problems that had also plagued her. (Arnold, 2013) • When anxious laboratory mice who were afraid of water were given the probiotic Lactobacillus rhamnosus (JB-1), they showed lower anxiety levels, decreased stress hormone production, and an increase in brain receptors for a neurotransmitter (GABA) that is responsible for curbing worry, anxiety, and fear. ey even began spending time in water, apparently enjoying themselves. e researchers commented that their findings “highlight the important role of bacteria in the bidirectional communication of the gut-brain axis and suggest that certain organisms may prove to be useful therapeutic adjuncts in stress-related disorders such as anxiety and depression.” (Arnold, 2013) • An article in a major psychiatric journal makes the case that life in modern, sanitary environments triggers inflammatory responses that lead to depression. e rate of major depression seen in younger people has steadily outpaced the rate in older populations. e authors believe this is due to a loss of contact with “our old friends,” the good bacteria on which our immune systems came to rely over the centuries to keep inflammation at bay. ey point out that depressed people have high levels of gut inflammation, as high as people with allergies, irritable bowel syndrome (IBS) and irritable bowel disease (IBD), Crohn’s disease, ulcerative colitis, asthma, hay fever, Type 1 diabetes, multiple sclerosis, cancers, and all autoimmune diseases. (Raison et al, 2010)

(continued on the next page)

26|oriental medicine journal

• Autoimmune conditions have been found in chronic stress and in a number of psychiatric disorders, including psychotic disorders. An example of connection between the gut and severe psychiatric symptoms is being studied by researchers at Johns Hopkins University. People with schizophrenia and bipolar

disorder are known to have elevated levels of inflammation in their blood and nervous systems from a heightened sensitivity to gluten proteins. is sensitivity produces elevated antibodies against gluten. e antibodies leak outside the GI tract, enter the bloodstream, and invade the central nervous system, generating

an immune reaction causing inflammation.

Leaky gut can occur when a parasitic organism called Toxoplasma gondii, found in raw meat, water, fruits, and vegetables contaminated by feces from infected animals, is consumed.

(Severance, 2013)

Weight and Food Intake Regulation • e gut-brain axis is heavily involved in the processes of satiety, food intake, regulation of glucose and fat metabolism, insulin secretion and sensitivity, and bone metabolism. (Romijn, 2008) • Altered gut microbiota, inflammation, and gut barrier disruption are characteristics of both obesity and type-2 diabetes. A higher amount of a beneficial gut bacterium (Akkermansia muciniphila) has been found in thin mice than in overweight mice. ese bacteria have been used to reverse obesity and type-2 diabetes in animal studies. e bacteria are thought to change the gut’s lining and the way food gets absorbed. (Gallagher, 2013) • Researchers took gut bacteria from mice who had undergone gastric bypass surgery and implanted it into obese mice. e obese mice started to grow more healthy bacteria in their guts and lost weight. (Ramlagan, 2013)

Happy Belly

wood/spring 2014

|27

Intriguing Facts

•

A genetically engineered (GE) food is a plant or meat product that has had its DNA artificially altered in a laboratory with genes from other plants, animals, viruses, or bacteria in order to produce foreign compounds in that food. An example is sweet corn that has been engineered to produce a pesticide (Bt toxin) in its own tissue and be herbicide resistant (to Monsanto’s weed killer, Roundup).

Genetically Modified (GMO) corn is regulated by the Environmental Protection Agency (EPA) as an insecticide but is sold in the US unlabeled. if you eat products containing high fructose corn syrup and many other corn-containing substances, you are consuming this pesticide. ere have been no long term studies to determine the safety of GE and GMO foods. Many countries, containing over 40 percent of the world’s population, already label GE & GMO foods; nevertheless, the US Food and Drug Administration (FDA) does not. Even China labels GE foods, as do all the European Union countries. (label GMOs.org, 2013)

Addictions ere are many addictions besides those to drugs like tobacco, alcohol, and narcotics. ey all involve the gut-brain axis, for example, wheat addiction.

Substances called polypeptides, produced during the digestion of wheat, are able to penetrate the blood-brain barrier separating the bloodstream from the brain. Once inside the brain, wheat polypeptides bind to the brain’s morphine receptors, the very same ones used by opiate drugs.

In a World Health Organization study of 32 wheat-consuming schizophrenics with active auditory hallucinations, the opiate-antagonist naloxone was found to reduce their hallucinations, alerting researchers to the mind-altering effects of wheat.

It has been shown in laboratory animals that administrating the opiate-blocking drug naloxone also blocks gluten-derived exorphins from binding to the opiate receptors in the brain.

Furthermore, in two separate studies, opiate-blocking drugs administered to non-opiate-using, non-psychotic, wheat-eating humans with uncontrollable appetite have been shown to reduce both calorie intake and cravings – and the effect seems specific to wheat-containing products.

Do you ever crave bread or cookies when you feel anxious or upset, and nothing else will do? Eating what you crave makes you feel better, but you need to keep dosing yourself at regular intervals. is is symptomatic of addiction. During the many years I consumed wheat, I would often find myself feeling sleepy and foggybrained after meals. With wheat eliminated from my diet, this no longer happens.

Wheat is clearly a food with potent central nervous system effects. It can alter mood, induce pleasurable effects related to those of alcohol and narcotics, and produce a withdrawal syndrome when removed from the diet. (Davis, 2011) e gluten in wheat products produces considerable inflammation in the body. Kelly Brogan’s excellent article, is Is Your Gut (and Brain) on Wheat, lays out a clear explanation of what happens in the body when it is fed wheat. (Brogan, 2013) (continued on the next page)

28|oriental medicine journal

Adding refined processed sugar (such as high fructose corn syrup) and trans fats to wheat augments the addiction process. A study showed that Oreos are just as addictive as opiate

drugs. e research was investigating the potential addictiveness of high fat/high sugar junk foods. It found that eating Oreos activated more neurons in the pleasure centers of lab rats’ brains

than exposure to cocaine and morphine did. (Mercola, 10/23/2013) at yummy filling in Oreos is basically sugar flavored Crisco. It is hard to feel satisfied with just one.

Skin Conditions Skin conditions are influenced by the health of the gut biome – perhaps even caused by an overgrowth or lack of something in the gut flora. People suffering with acne are at higher risk for mood disorders such as depression and anxiety, as well as gastrointestinal problems such as constipation, gastric reflux, bloating, and halitosis. (Bowe & Logan, 2011) eir common connection is to the health of the gut’s microflora a gut-brain-skin triangle.

A large number of people with acne produce inadequate stomach acid, allowing bacteria from the colon to migrate into the small intestine, producing an imbalanced gut microflora and a compromised intestinal lining (leaky gut).

Parodi (2008) found small intestine bacterial overgrowth (SIBO), a condition with inappropriate growth of bacteria in the small intestine, 10 times more frequently in people with acne rosacea than in healthy controls; correcting the imbalance markedly improved their skin condition. Fourteen percent of patients with ulcerative colitis and 24 percent of patients with Crohn’s disease have skin problems. Patients with celiac disease are also likely to have skin conditions, such as dermatitis herpetiformis, oral mucosal lesions, alopecia, and vitiligo.

Pimple

Probiotics have been proven effective for preventing eczema (atopic dermatitis) in infants.

A 2003 study of over 100 children from families with a history of eczema found probiotic supplementation beneficial. (Rosenveldt, et al., 2003) A 2011 study concluded that daily supplements of probiotic foods may reduce the risk of childhood eczema by 58%. (Ritz, 2011) is is good news since the presence of eczema on the skin also indicates something is out of balance in the gut's immune defenses. According to the Mayo Clinic, about three quarters of children who have eczema as newborns and into childhood develop asthma or hay fever later on in their lives. (Mercola, 2010)

wood/spring 2014

|29

Intriguing Facts

•

e Standard American diet (aptly abbreviated as SAD) is common in developed countries like the US. it is characterized by high intake of sweets, animal products, cooking oils, and high-fat and processed foods. People living on SAD have a higher incidence of heart disease and cancers. (Fuhrman, 2011)

•

Since we now know that broad spectrum antibiotics kill the beneficial bacteria in our guts along with the infection-causing ones, here is an alarming piece of information: Children in the US and other developed countries have received 10-20 courses of antibiotics by the age of 18. (Blaser, 2011)

e fix for most skin conditions is

Oral probiotic supplements have

kefir. (Bowe & Logan, 2011; Kresser,

not to apply prescription ointments or

been shown to improve intestinal bar-

swallow pharmaceutics, but to add

rier function and reduce inflammation.

more friendly bacteria to the gut and

Especially helpful are the various Lacto-

on p. 30 for more on the benefits of

consume omega-3 fatty acids.

bacillus and Bifidobacteria, both found

kefir.

2012) See the section on Super immunity

in abundance in the fermented drink

Sleep Disturbances As we all are painfully aware when we are not getting enough of it, sleep is essential to our health. Sleep deprivation compromises our immune systems just as illness and physical and emotional stress do. ough we are not aware of it, helpful bodily processes are taking place as we sleep. e most important is the removal of potentially neurotoxic waste from the central nervous system. e brain has its own waste management system, called the glymphatic system, which is similar to the body’s lymphatic system. is system pumps cerebral spinal fluid through the brain’s tissues, flushing waste into the body’s circulatory system and from there into the liver, where it is eliminated.

In aid of this flushing process, the sleeping brain’s cells shrink about 60 percent, allowing for more efficient waste removal and helping ensure metabolic homeostasis. Perhaps we feel restored and can think more clearly after a good night’s sleep because toxic waste products, built up while we are awake, have been removed from our central nervous systems. (Xie, 2013) Lack of adequate sleep is also known to have a worsening effect on chronic diseases such as Alzheimer’s, Multiple Sclerosis, and Parkinson’s (all autoimmune neurodegenerative diseases), gastrointestinal tract disorders, kidney disease, childhood behavioral problems, and many others.

A clue to the important relationship between sleep and disease: Amyloid-beta proteins, the ones that create the plaque typically seen in Alzheimer’s patients’ brains, get removed in significantly greater amounts during sleep. An implication of this finding is that treatments for Alzheimer’s might be more helpful if given before bedtime. (Xie, 2013) When the gut is inflamed, infected, or suffering from dysbiosis in some other way, major stress gets put on the adrenals – tiny but powerful endocrine glands that sit atop the kidneys. ey manufacture and secrete hormones such as steroids, cortisol, cortisone, estrogen, progesterone, and testosterone as well as chemicals such as adrenaline (epinephrine), norepinephrine, and dopamine. (continued on the next page)

30|oriental medicine journal

e ever-alert adrenals are in constant, sensitive communication with the gut flora, so an imbalance in one will affect the other. e adrenals have a regulating effect on every organ, gland, tissue, and cell in the body as they work to maintain homeostasis. eir main purpose is to allow the body to deal with stress of any kind. ey even

influence the way we think and feel.

If stress becomes chronic, the adrenals can become overworked, eventually exhausting the immune system.

Stress – from any cause – is the most common reason for poor sleep.

When cortisol levels rise and fall erratically, especially when combined with a

nutrient-poor diet, the adrenals become fatigued – they can actually wear out.

In adrenal fatigue, cortisol levels are too high at night (preventing sleep) and not high enough in the morning to keep us functioning well through the day.

(AdrenalFatigue.org, 2013)

Super Immunity Catching whatever viral or bacterial thing is going around? Suffering from a skin condition, poor sleep, allergies, acid reflux, an autoimmune disease, chronic sinus congestion, frequent tooth decay, gum disease, constipation, diarrhea, frequent UTI’s, a mood disorder, or nail fungus? Work on restoring the friendly bacteria in your gut flora and see if your health does not improve. Depending on where you are starting, this may take a while. It will also help to improve your diet – eating nutritious foods while reducing nutritient-poor ones. e idea is not to avoid contact with all the bad bugs out there but to build up your gut immune system with good ones, our traditional “old friends,” so they can deal efficiently with the bad guys. Building super immunity means shifting the emphasis to PREVENTiNG illness rather trying to CURE it after we have become ill. is approach not only reduces suffering; it is an enormous money saver.

Prebiotics and Probiotics Probiotics are living microorganisms that stimulate the growth of beneficial microorganisms in the gut. ey are found in fermented foods such as kefir, live-culture yogurt, sauerkraut, kimchi, and real pickles (not ones made with vinegar). Often we need to take probiotics as supplements to restore an already out-of-balance gut flora.

wood/spring 2014

|31

Intriguing Facts

•

e existence of the enteric nervous system was first detected by a scientist named Auerbach, working in Germany with a primitive optical microscope in the mid 1800’s, while America was embroiled in our Civil War. (Gershon, 1998)

•

e traditions of Chinese medicine, Ayurvedic medicine, and hatha Yoga have been aware of this communicating dual-brain system for centuries. e colon cleansing process of Ayurveda and Nauli, a digestive cleaning exercise practiced in classical hatha Yoga, help cleanse the gut and increase feelings of wellness. in Mayur Asana (Peacock Pose) the body is balanced on the navel. e pressure stimulates the vagus nerve, helping improve the brain-gut connection. (Rajvanshi, 2011)

Prebiotics are foods that are indigestible by humans but promote the growth of probiotics, the beneficial bacteria in our guts. We get prebiotics from fruits, vegetables, and whole grains, or from supplements.

Before we had refrigeration, canning, or freezing, foods were often preserved by fermentation. In eating and drinking those fermented foods, we regularly ingested probiotics to keep our gut flora balanced and happy.

See Chapter 11 in Bacteria for Breakfast (Karpa, 2006) for a discussion of which probiotics are most effective for treating which health issues. I highly recommend the rest of the book too. It is easy to read and full of helpful information.

For a wealth of useful information on the functions of probiotics in general as well as specific probiotics, I recommend a visit to accomplished nutritionist Jo Pankoy’s website, Power of Probiotics. (Panyko, 2012-2013) Kefir Kefir, one of the oldest cultured milk products in existence, is regarded by many (including me) as a super food.

It is a fermented, yogurt-like drink made from cow, goat, or sheep’s milk, containing probiotic yeasts along with ten strains of beneficial bacteria.

Centuries ago, shepherds in the Caucasus Mountains running between the Black and Caspian Seas discovered that fresh milk carried in leather pouches sometimes fermented into a tart, effervescent beverage with amazing health benefits. It is consumed regularly for its medicinal benefits in eastern Turkey, Georgia, Chechnya, Armenia, and Azerbaijan.

Kefir balances the body’s ecosystem, supports digestive health and immunity, reduces inflammation, moderates the body’s allergic response, and has anti-fungal and antibacterial properties. It is also a good source of calcium, protein, many vitamins, essential amino acids, and minerals. Because the fermentation process digests most of the lactose in the milk, it is 99% lactose free so does not produce the sinus congestion common after eating dairy products.

In addition, it tastes good – clean, tart, and clearly a living food. e Turkish word keif means “feeling good.”

Kefir is one of the most potent probiotic foods available. (Kresser, 2012)

(continued on the next page)

32|oriental medicine journal

You will find bottles of kefir in the dairy case of your grocery store, probably near the selection of yogurts.

My preference is for the low-fat, plain type. e flavored ones have some sugar added to them. I pour it over my breakfast cereal in the morning, over fruit for dessert, and add water to it just to sip during the day. You can also make smoothies out of it. It is safe to give to babies – and so good for stopping colic and creating a healthy gut flora to help them thrive.

A caveat on kefir: It is a fermented food, so it contains some tyramine. If you are taking an MAO inhibitor, you should avoid kefir unless your physician has told you it is safe for you. Some kefir samples have been found to contain just a trace of tyramine, but some have been found to contain more. (Ozdestan & Uren, 2010) Donna Schwenk’s blog (culturedfoodlife.com) and book (Cultured Food for Life) are excellent sources of information and recipes for both making kefir and using it in cooking. You can brew your own kefir from various types of milk (cow, goat, sheep) and also from nut milks (almond, walnut), young coconut water, green tea, or just plain filtered water.

Saccharomyces boulardii I also sing the praises of Saccharomyces boulardii. is probiotic yeast, along with dietary changes and probiotics, helped restore my health from the Clostridium difficile infection, when my mast cells went wild, and most recently when I had a Morganella infection and needed to take antibiotics for it. S. boulardii is a yeast with digestive benefits that support the immune system by nourishing the cells in the intestinal walls, which are a front-line defense against invaders.

It works in several ways including as an antitoxin, an anti-microbial, and an anti-inflammatory. It is highly useful for adults and children in the prevention and treatment of acute and chronic gastrointestinal disorders with a predominant inflammatory component – including antibiotic-associated diarrhea, C. difficile and Helicobacter pylori infections, traveler’s diarrhea, enteral nutrition-related diarrhea, Crohn’s disease, ulcerative colitis, IBS, parasitic infections, and HIV-related diarrhea.

No adverse reactions have been seen in clinical trials with S. boulardii, but increased risk of complications from probiotic products have been noted in some immunocompromised subjects and patients with severe general or intestinal disease who have indwelling catheters. (Kelesidis & Pothoulakis, 2012)

wood/spring 2014

|33

Intriguing Facts

•

e belly has been seen as a center of energy and consciousness throughout the world's healing and mystical traditions. e huge paunches depicted on many of india’s deities indicate that these gods are full of prana (life force or qi). (Alternative Medicine Angel, 2013)

•

e gentle art of tai chi emphasizes the lower abdomen as a reservoir for energy. it teaches strengthening of the abdominals by learning how to compact prana into the belly. From the Chinese viewpoint, the belly is considered the dan tian, the body’s energy center. e dan tian is an important focal point for meditation and exercise techniques such as qigong and martial arts – and also in traditional Chinese medicine. (Cohen, 1999)

I take S. boulardii regularly as a supplement (Jarrow’s Saccharomyces boulardii+MOS). It occurs naturally in the tasty, fermented drink kombucha, which also provides folic acid, various antioxidants, and organic acids, plus an assortment of B vitamins (which have the added benefits of nourishing your adrenals and controlling your mood). (Schwenk, 8/24/2013) Another very helpful thing to know about S. boulardii is that it is a yeast, not a bacterium, so it is not targeted by antibiotics. Should you get an infection that truly requires a pharmaceutical antibiotic, S. boulardii will help your gut flora stay strong through the 7-14 days you are taking the drug.

Macronutrients and Micronutrients e body needs various macronutrients found in fats, carbohydrates, and proteins to get its required supply of calories for energy, growth, and normal functioning. Micronutrients, including minerals, vitamins, and phytochemicals, are also required in small quantities to serve various bodily needs. (Fuhrman, 2011) e Standard American Diet is woefully low in both macronutrients and micronutrients while frighteningly high in empty calories and chemical additives. laughter and Meditation Laughter, especially a good belly laugh, is one of the best ways we have to relieve stress and turn a bad mood into a good one. Meditation has been shown to promote antiviral activity and reduce inflammation. Both aid digestion, boost our immune systems, and return us to our centers where we feel connected and whole.

An early adherent of “the science of happiness” was Norman Cousins, a former magazine editor, who was diagnosed with ankylosing spondylitis, a life-threatening autoimmune disease, in 1964 and given little chance for recovery. He created his own laughter therapy program, akin to today’s Laughter Yoga, to mobilize his body’s natural healing resources; and he made a good recovery.

Cousins went on to establish the Cousins Center for Psychoneuroimmunology in Los Angeles and wrote a book called Anatomy of an Illness. He also served as Adjunct Professor of Medical Humanities for the School of Medicine at the UCLA, where he did research on the biochemistry of human emotions, which he believed were the key to human beings’ ability to prevent and fight illness. (Mercola, 12/12/2013) (continued on the next page)

34|oriental medicine journal

The American Gut Project Under the auspices of the Human Food Project, the American Gut Project is analyzing 10,000 samples of gut bacteria (along with oral, skin, and vaginal bacteria) from 6,000 people around the world. It is the largest open-source science project to understand the microbial diversity of people around the world.

You can participate. Send a $99 donation to the project, and they will send you a home sampling kit.

In return for your samples, they will sequence your bacteria and send you a list of the bacteria in your samples and their relative abundance. You will see how your own microbiome compares to that of others who have participated in the project and how your diet and lifestyle may be shaping your gut flora, which in turn American Gut Project

influences almost every aspect of your health. e project scientists rightly describe the study as the “Anthropology of Microbes.” e importance of the project is clear. With this global information, we will learn more about the relationships among health, diet, and environment. It might also be possible to develop biomarkers to predict aspects of our gut health based on a saliva sample or a swab from a palm. For example, it is known that arterial plaque has microbes in common with the mouth but not with the gut. Perhaps dental plaque in the future will be used to look at our heart health.

You can read more about the American Gut Project and join it at http://americangut.org/.

wood/spring 2014

|35

Non-Allergenic Cats?

Allergies are abnormal reactions of the immune system occurring in response to usually harmless substances. e overly-sensitive immune system of a person allergic to cats reacts to one or more glycoproteins produced in cats’ saliva, sebaceous glands, urine, and dander as if they were dangerous invaders requiring the launch of a full-blown histamine defense. Your eyes water and itch, your Contented Cat sinuses clog up, maybe you sneeze – the 10 percent of you with a cat allergy know the symptoms well. You might even have an asthma attack.

However, the problem may lie not just in your own impaired gut biota but also in allergic reactions the cat itself is having. Properly balancing the cat’s gut bacteria may help both you and the cat.

As someone who was highly allergic to cats for years, I managed to boost my gut immunity to the point where I was able to have a series of cats in my home even though I still had a mild allergic reaction to them when especially stressed. I fed them what I thought was high quality food, but they all developed serious digestive issues requiring frequent veterinary visits and sometimes GI surgeries. While sitting in vet clinic waiting rooms, I heard person after person being told their dog or cat had similar problems and needed to be put on an elimination diet.

When I got my current girl, rescued off the streets of New York barefoot and pregnant, I decided to look into the diet issue so she would not suffer like previous cats and learned that cats in the wild do not eat grains. We know that grains cause inflammation in humans. is cat has been getting a mixture of probiotics designed for cats and dogs and eating only grain-free wet and dry foods over the four years she has shared my home. Neither I nor anyone else with a cat allergy or asthma has ever produced so much as a single sneeze in her presence. And she has produced only one hairball on this diet.

Makes me wonder.

Conclusions e clear implication of all this for me is that there is a powerful relationship between the well-being of our gut biomes and the health of all our various systems and parts. Keeping our gut flora well balanced for the particular environments they encounter will vastly improve overall health in a wide variety of ways.

Michael Pollan states it well in his New York Times Magazine article “Some of My Best Friends Are Germs,” (a link to the article is included in the Reference list): Human health should now ‘be thought of as a collective property of the human-associated microbiota,’ as one group of researchers recently concluded in a landmark review article on microbial ecology — that is, as a function of the community, not the individual. (continued on the next page)

36|oriental medicine journal

Such a paradigm shift comes not a moment too soon, because as a civilization, we’ve just spent the better part of a century doing our unwitting best to wreck the human-associated microbiota with a multifronted war on bacteria and a diet notably detrimental to its well-being. Researchers now speak of an impoverished ‘Westernized microbiome’ and ask whether the time has come to embark on a project of ‘restoration ecology’ — not in the rain forest or on the prairie but right here at home, in the human gut. (Pollan, 2013) Jordan Rubin, who figured out how to heal himself when he was wasting away from terminal Crohn’s disease, put it more succinctly, “You’re not what you eat, but what you digest.” (Rubin, 2003) A concluding appreciation for our clever and invaluable guts: Our gut’s knowledge, its constant evaluation of sensations we experience inside our bodies, along with information coming in from the outside world, is worth heeding. While the brain in our skull, which quickly gets well programmed with behavioral and moral shoulds, speaks to us in words and images and easily censors information; our gut communicates to us only in feelings and physical sensations so is incapable of self-deception.

If you want to know where you stand on something – such as whether you genuinely enjoy someone’s company, want to accept that new job offer, have found a home that is perfect for your needs, think you want to spend the rest of your life with someone – ask your gut, not your head. Your gut knows you well. Read those gut feelings, then send that information up to your head for it to tell you whether your desires are feasible. Rely only on the brain in your skull, and you will often find yourself making decisions that are not

•

good for you.

A digital version of this article with additional material can be found on my website http://allergiesandyourgut.com

wood/spring 2014

|37

References AdrenalFatigue.org (2013). Adrenal function. See http://www.adrenalfatigue.org/adrenal-function Alternative Medicine Angel. (2013). See http://altmedangel.com/braingutconnection.htm American Academy of Allergy, Asthma and Immunology. (2013). Systemic Mastocytosis. See http://www.aaaai.org/conditions-and-treatments/related-conditions/systemicmastocytosis.aspx American Gut Project. (2013). See http://americangut.org/.

American Society for Microbiology. (2012). Microbe Beta World, Archaea. See http://www.microbeworld.org/types-of-microbes/archaea Arnold, C. (2013). Gut feelings: the future of psychiatry may be inside your stomach. See http://www.theverge.com/2013/8/21/4595712/gut-feelings-the-future-of-psychiatry-may-be-insideyour-stomach Bellis, M. (2013). Prozac: e making of a miracle cure? – e history of Prozac.

See http://inventors.about.com/library/weekly/aa980225.htm Benoist, C. & Mathis, D. (2002). Mast cells in autoimmune disease. Nature, 420, 875-878.

Berger, M., Gray, J.A., & Roth, B.L. (2009). e expanded biology of serotonin.

Annual Review of Medicine, 60, 355–66.

Bested, A. et al. (2013). Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: Part II – contemporary contextual research. Gut Pathogens, 5: 3.

See http://dash.harvard.edu/bitstream/handle/1/10609763/3601973.pdf?sequence=1 Blaser, M. (2011). Stop the killing of beneficial bacteria: Concerns about antibiotics focus on bacterial resistance — but permanent changes to our protective flora could have more serious consequences. Nature, 476, 393-4.

Boron, W.F. & Boulpaep, E.L. (2005). Medical Physiology, 883.

Bowe, W.P. & Logan, A.C. (2011). Acne vulgaris, probiotics and the gut-brain-skin axis - back to the future? Gut Pathogens, 2011, 3:1.

Brogan, K. (2013). is Is Your Body (and Brain) on Gluten.

See http://www.greenmedinfo.com/blog/your-body-and-brain-gluten Byron Body & Soul. (2009). Symbiosis or Dysbiosis? See http://www.byronbodyandsoul.com/top/ regular-columms/naturopathy-with-sue-kira/symbiosis-or-dysbiosis/p/123 Champeau, R. (2013) Changing gut bacteria through diet affects brain function, UCLA study shows.

See http://newsroom.ucla.edu/portal/ucla/ changing-gut-bacteria-through-245617.aspx Cohen, K.S. (1999). e Way of Qigong: e Art and Science of Chinese Energy Healing.

Cryan, J.F. & Dinan, T.G. (2012). Mind-altering microorganisms: e impact of the gut microbiota on brain and behaviour. Nature Reviews Neuroscience, 13:10, 701-712.

Cryan, J.F. & O’Mahony, S.M. (2011). e microbiome-gut-brain axis: From bowel to behavior.

Neurogastroenterology & Motility, 23:3, 187-192.

Davis, W. (2011). Wheat Belly: Lose the wheat, lose the weight, and find your path back to health. 48-51.

Dentistry for Health – Medical ermography. See http://www.dentistryforhealthny.com/breastthermographyny.html Diagnose-me.com. (Nov. 1 2013). Bacterial Dysbiosis. See http://www.diagnose-me.com/symptomsof/bacterial-dysbiosis.html e Economist Science and Technology Editors (2012).

Microbes maketh man: People are not just people. ey are an awful lot of microbes, too, August 18, 9. e Economist Science and Technology Editors (2012). Me, myself, us: e human microbiome. e Economist, e Economist, August 18, 69-70.

Epidemic Answers. (2013). Gut Dysbiosis. See http://www.epidemicanswers.org/epidemic/biologicaldysfunction/gut-dysbiosis/ Forsythe, P. & & Kunze, W.A. (2013). Voices from within: gut microbes and the CNS. Cellular and Molecular Life Sciences, 70:1, 55-69.

Foster, J. (2013). Gut Feelings: Bacteria and the Brain. e Dana Foundation.

See https://www.dana.org/Cerebrum/Default.aspx?id=39496 Fuhrman, J. (2011). Super Immunity: e essential nutrition guide for boosting your body’s defenses to live longer, stronger, and disease free.

Gallagher, J. (2013). Weight loss gut bacterium found. BBC News Health.

See http://www.bbc.co.uk/news/health-22458428 Gershon, M.D. (1998). e Second Brain: A groundbreaking new understanding of nervous disorders of the stomach and intestine.

Goleman, D. (2011). e Brain and Emotional Intelligence: New Insights (Kindle eBook).

Gurish, M. & Castells, M.C. (2013). UpToDate, Mast cell derived mediators.

See http://www.uptodate.com/contents/mast-cell-derived-mediators Hardin, J.R. (2011). Successful holistic treatment of Clostridium difficile gut infection: Case study.

Oriental Medicine Journal, 19:4, 24-37.

Hawrelak, J.A. & Myers, S.P. (2004). e causes of intestinal dysbiosis: A review. Alternative Medicine Review, 9:2.

Jackson, K.M. & Nazar, A.M. (2006). Breastfeeding, the immune response, and long term health.

Journal of the American Osteopathic Association, 106:4, 203-7.

Ji, S. (2012). Wheat contains not one, but 23K potentially harmful proteins. GreenMedInfo.com.

See http://www.greenmedinfo.com/blog/ wheat-contains-not-one-23k-potentially-harmful-proteins Ji, S. (2013). e grain that damages the human brain. GreenMedInfo.com.

See http://www.greenmedinfo.com/blog/grain-damages-human-brain Karpa, K.D. (2006). Bacteria for breakfast: Probiotics for good health.

Kelesidis, T. & Pothoulakis, C. (2012). Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of gastrointestinal disorders. erapeutic Advances in Gastroenterology, 5:2, 111-125.

King, M.W. (1996-2013). Serotonin. e Medical Biochemistry Page. Indiana University School of Medicine. See http://themedicalbiochemistrypage.org/nerves.php#5ht

Kresser, C. (2012). Kefir: the not-quite Paleo superfood.

See http://chriskresser.com/kefir-the-not-quite-paleo-superfood Labelgmos.org. (2013). See http://www.labelgmos.org/the_science_genetically_modified_foods_gmo Lieff, J. (2012). Searching for the Mind with Jon Lieff, M.D. Blog post 11/19/2012. Gut Feelings: e Brain-Gut-Microbe Axis. See http://jonlieffmd.com/blog/gut-feelings-the-brain-gut-microbe-axis Loes, M.W. (2003). e Healing Response.

Louiselle, M. (2013). Screening Inflammation to Better Monitor Women’s Health: What are your body’s heat patterns saying about inflammation and your health? See http://www.cimwellness.com/screeninginflammation-to-better-monitor-womens-health/ Luoto, R. et al. (2010). Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: A double-blind, placebo-controlled study. British Journal of Nutrition, 103, 1792-1799.

MastCellAware.com. (2012-2013). e Good, e Bad & e Ugly: What are mast cells and why should we care about them? See http://www.mastcellaware.com/about.html e Mastocytosis Society, Inc. (2011). See http://www.tmsforacure.org/welcome.php Mayo Clinic. (2013). Anaphylaxis. See http://www.mayoclinic.com/health/anaphylaxis/DS00009 Mercola, R. (11/11/2010). Probiotics Send Signals from Your Gut to Your Skin. See http://articles.mercola.com/sites/articles/archive/2010/11/11/probiotics-send-signals-from-your-gut-to-your-skin.aspx Mercola, R. (10/23/2013). As the EU Launches Shocking Fructose Health Claim Label, Oreos Are Found to Be as Addictive as Cocaine. See http://articles.mercola.com/sites/articles/archive/2013/10/30/ oreos-fructose-consumption.aspx?e_cid= 20131030Z1_DNL_art_1&utm_source=dnl&utm_ medium= email&utm_content=art1&utm_campaign=20131030Z1 Mercola, R. (11/9/2013). e Age of Antibiotics is Coming to an End, as Wider Variety of Bacteria are Now Impervious. See http://articles.mercola.com/sites/articles/archive/2013/11/09/antibioticdrugs.aspx?e_cid=20131109Z1_DNL_art_1&utm_source=dnl&utm_medium=email&utm_content=art 1&utm_campaign=20131109Z1&et_cid=DM33171&et_rid=331501235 Mercola, R. (12/12/2013). Happiness and Laughter Are Natural Immune Boosters. See http://articles.mercola.com/sites/articles/archive/2013/12/12/happiness-laughter-immuneboosters.aspx?e_cid=20131205Z1A_DNL_artTest_B5&utm_source=dnl&utm_medium=email&utm_c ontent=artTest_B5&utm_campaign=20131205Z1A&et_cid=DM34485&et_rid=358522925 Morris, M. (2011). e Root of Health, Dysbiosis. See http://www.therootofhealth.com/dysbiosis/ Ozdenstan, O. & Uren, A. (2010). Biogenic amine content of kefir: A fermented dairy product.

European Food Research and Technology, 231:1, 101-107.

Paddock, C. (2009, August 5). "Not Only Does Our Gut Have Brain Cells It Can Also Grow New Ones, Study." Medical News Today. See http://www.medicalnewstoday.com/articles/159914 Panyko, J. (2012-2013). Power of Probiotics. See http://www.powerofprobiotics.com/JoPanyko.html Papas, H. (2012). Insightful Nutrition: Orthomolecular Health and Nutrition, e Vagus Nerve – its many roles and functions.

See http://helenpapas.wordpress.com/2012/11/21/the-vagus-nerve-its-many-roles-and-functions/ Parodi, A. (2008.). Small Intestinal Bacterial Overgrowth in Rosacea: Clinical Effectiveness of Its Eradication. Clinical Gastroenterology and Hepatology, 6, 759 –764. See http://www.metsol.com/ wp-content/uploads/2011/02/Rosacea-SIBO.pdf Pollan, M. 2013). Some of My Best Friends Are Germs. New York Times Magazine, May 15 2013. See http://www.nytimes.com/2013/05/19/magazine/say-hello-to-the-100-trillion-bacteria-that-make-upyour-microbiome.html?_r=0 Raison, C.L. et al. (2010). Inflammation, sanitation, and consternation. Archives of General Psychiatry, 67:12, 1211-1224.

Rajvanshi, A. K. (2011). Brain, heart and gut minds. e Times of India, July 10. See http://articles.time sofindia.indiatimes.com/2011-07-10/science-of-spirituality/29755632_1_gut-brain-vagus-nerve Ramlagan, N. (2013) Gastric bypass surgery alters gut microbes. Science Translational Medicine.

See http://www.aaas.org/news/releases/2013/0327_gastric_bypass.shtml Randerson, J. (2012). How many neurons make a human brain? Billions fewer than we thought. e Guardian.com, February 28. See http://www.theguardian.com/science/blog/2012/feb/28/ how-many-neurons-human-brain Ritz, B W. (2011). Probiotics for the Prevention of Childhood Eczema: A review of the literature. See http://www.naturalmedicinejournal.com/article_content.asp?edition=1&section=2&article=158 Romijn, J.A. et al. (2008). Gut-Brain Axis. Current Opinion in Clinical Nutrition and Metabolic Care, 11:4, 518-521.

Rosenfeldt, V et al. (2003) Effect of probiotic Lactobacillus strains in children with atopic dermatitis.

Journal of Allergy and Clinical Immunology. 111:2, 389-95.

See http://www.ncbi.nlm.nih.gov/pubmed/12589361 Rubin, J.S. (2003). Patient Heal yself.

Salminen, S. et al. (2004). Influence of mode of delivery on gut microbiota composition in seven year old children, Gut, 53:9, 1388–1389.

Schlosser, E. (2001). Fast Food Nation: e dark side of the all-American meal.

Schwenk, D. (2013). Cultured Food for Life.

Schwenk, D. (August 24 2013). Is Happiness in Your Gut? See http://www.culturedfoodlife.com/is-happiness-in-your-gut/ Severance, E.G. (July 5 2013). Schizophrenia, Inflammation & Bacteria, Brain & Behavior Research Foundation. See http://bbrfoundation.org/brain-matters-discoveries/brain-behavior-research-foundation-funded-study-links-schizophrenia Wikipedia. (November 16 2013). Gut Flora. See http://en.wikipedia.org/wiki/Gut_flora World Health Organization (July 2013). 10 facts on breastfeeding.

See http://www.who.int/features/factfiles/breastfeeding/en/ Xie, L. et al. (2013). Sleep drives metabolite clearance from the adult brain, Science, 342:6156, 373-377.