Category Archives: Gastrointestinal problems

Insane Medicine – Akkermansia muciniphila and the Gut biome

  • The bacteria in your gut create a huge ecosystem or biome that has major effects on your overall health. More and more studies are demonstrating this, including the one below.
  • The gut microbiota diversity and function plays a role in the development of obesity and metabolic ailments.
  • Akkermansia muciniphila is a mucin-degrading bacteria found in the mucus layer of the intestine that has been found to help improve your metabolic status by increasing insulin sensitivity and glucose regulation.
  • Obese individuals and those with Type 2 diabetes differ from leaner individuals in the constitution of their gut micobiome and the microbial gene richness. It has been found in mice that higher levels of  mucin-degrading bacteria (Akkermansia muciniphila) are inversely associated with body fat and glucose intolerance. In other words, these bacteria help improve glucose metabolism and improve overall metabolic health.
  • The article below demonstrated that Akkermansia muciniphila, when increased in the gut, resulted in healthier metabolic status in obese people. This was accomplished by caloric restriction, which then resulted in increased microbial gene richness ( a good thing) and improved glucose homeostasis and blood lipids. Following a FODMAP diet also increased Akkermansia muciniphila in the gut.
  • The higher the Akkermansia muciniphila bacteria levels are in the gut, it seems that you will have better glucose metabolism, better waist-to-hip ratios, lower fasting glucose levels, better triglyceride levels,  and better fat distribution.
  • Increasing amounts of fat in the form of fat hypertrophy is a proinflammatory condition and is associated with bad cardiometabolic risk. This inflammatory risk is measured through insulin levels, interleukin-6, lipopolysaccharide levels, and C reactive protein levels in the blood stream. Caloric restriction leads to increased Akkermansia muciniphila and other healthy bacteria, which increases the overall microbial gene richness. These bacteria lower the inflammatory markers through their metabolic activity. This results in better metabolic outcomes.
  • How does this all occur? Akkermansia muciniphila ferments waste products into other items that other beneficial bacteria species can feed on. Short chained fatty acids are one of those items as well as acetate, which becomes an anorectant when absorbed in the body. In other words, you eat less.
  • The key here is that the gut biome plays a tremendous role in our overall health, and caloric restriction results in a  boosting of the healthy richness of our gut biome, which is probably a key part of overall health!

KEY study in GUT :



Dao M, Everard A, et al. Akkermansia muciniphilaand improved metabolic health during a dietary intervention in obesity: relationship with gut microbiome richness and ecology. Gut.2015. 

Gut Bacteria and Food Allergies:

  • Gut bacteria also seem to play an integral role in other aspects of our health including food allergies. The presence of Clostridia in our gut appears to be protective against food allergies by causing the release of Interleukin-22 from gut cells, thereby decreasing permeability of the gut to allergens, which cause allergic reaction. Without gut permeability, the antigens cannot create an allergic immune response. Food allergies have been increasing in recent times due  to modern dietary and hygienic practices, which disturb our natural gut biome.High fat diets, antibiotics,  and formula feeding have all affected our gut bacteria, some of which protect us against food allergies. In a study, it was shown that germ-free mice and mice treated with antibiotics both reacted to peanuts, however, when clostridia was introduced, the reaction went away! This demonstrates how Clostridia decreases food allergies.  The study, “Commensal bacteria protect against food allergen sensitization,” was the source of this information.
  • Clostridia protects against Food Allergies

Insane Medicine – Wheat products, Grains, Gluten, celiac disease, and your body.

Insane Medicine - Gluten and Gluten free glutenprobs

  • Gluten is a substance present in rye, wheat, and barley. In some individuals, the body gets sensitized to this substance in the form of an autoimmune disease that results in damage of the gastrointestinal tract lining.
  • First we will discuss basic information about cereal grains and grasses. The cereal grains form part of the Gramineae (Poaceae) family and have four subfamilies.
  1. Pooideae – which is subdivided into the Triticeae/Hordeae family (wheat, barley, rye) and Aveneae family (oats)
  2. Ehrhartoideae (rice) subfamily
  3. Chloridoideae (ragi and teff)
  4. Panicoideae: which includes millets, corn, and sorghum
  • Non-cereal grains are grains from families other than the Gramineae family:
  • Amaranth from the Amaranthaceae family
  • Quinoa from the Chenopodiaceae family
  • Buckwheat from the Polygonaceae family
  • A grain is an individual fruit that contains a single seed in which the fruit wall and seed coat are fused and cannot be separated. Wheat, rye, barley, oats, rice, and corn are grains.
  • Seeds can have their coat separated from the fruit
  • Corn originated from the Americas and is the major world grain produces, while wheat originated from the Near East/Ethiopea and is consumed in pasta, wheat noodles, breads, bulgur, and couscous as examples. It is the second most produced grain. Rice originated from China and can be ground into flour and made into rice milk among other uses. Millet is the 6th most produced grain in the world and is grown in the African/Indian subcontinent for bird and cattle feed primarily. Amaranth is consumed in India as a cereal and also is ground into flour or popped into popcorn. Buckwheat (is not related to wheat) is used to make a dark flour in Asiatic and European dishes in the form of crepes, pancakes, bread, and bagels. Quinoa has it’s origin from the Andean regions of Bolivia and Peru.
  • Allergy to wheat is fairly common and is IgE mediated (common from of allergy pathway) to different components in the wheat. In childres, a reaction to the omega-5-gliadin component is the most common cause of allery. In Baker’s asthma, its the alpha-amylase inhibitor that is the wheat component causing the reaction. However, the most common allergen in wheat is the Lipid transfer protein (LTP). Allergies caused by these generaly are in the form of rashes, hives,  respiratory reactions such as wheezing, abdominal pain., nausea, vomiting, and anaphylaxis symptoms. These are more common in childres. It is possible to have reactions to cooking vapors as the grain proteins are volatalized into the atmosphere. Hives can result from toucing certain grain proteins in susceptible individuals.
  • IgE-type reactions have been found to occur in all cereal grains except for sorghum. Wheat is the most common IgE mediated allergen causing food-dependent exercise -induced anaphylaxis at its extreme (where a person gets anaphylaxis upon execising after exposure to wheat) and also Baker’s asthma, in which wheezing occurs during the baking of wheat-containgin items.
  • Rice can also caause IgE mediated reactions in some individuals, especially on exposure to rice dust or from boiling rice.
  • Eczema can result from or be worsened by food alleries. Eggs and milk are the most common culprits, but wheat is the third most common cause of worsening eczema and atopic dermatitis in children.
  • Milk products and wheat products can cause an allergic eosinophilic esophagitis allergic phenomena that causes chronic reflux symptoms (GERD), vomiting, abdominal pain, weight loss, and food impactions.
  • Grains (oats and rice), wheat, and barley can cause a Food Protein Induced Enterocolitis (FPIES) that results in nausea, vomiting, and diarrhea two to four hours after eating products with these grains in them. it can result in dehydration and shock in some. Chronically, a perason can get chronic nausea, vomiting, and diarrhea, with low blood albumin levels.
  • Celiac disease is the most famous process that results form wheat exposure and is the focus of this segment. It is an immune mediated small intestine inflammatory process caused by dietary gluten. The sources of gluten are:
  1. Wheat (breads, baked goods, soup,  pasta, cereals, sauces, salad dressings, and roux)
  2. Barley ( malt, food coloring, soups,  malt vinegar, beer)
  3. Rye ( rye bread,  rye beer, cereals)
  4. Triticale ( a newer source of gluten used in breads, pasta, and cereals)

In summary : Gluten sources include: wheat (durum, emmer, spelt, farina, farro, KAMUT® khorasan wheat and einkorn), rye, barley and triticale.

  • A wide variety of foods and food products may have gluten mixed in the product. Croutons and flour-cereal and brown rice syrup are gluten sources. Imitation seafood, bacon, pasta, and processed lunch meat have gluten, as does self-basting poultry, soupd, stuffing, salad dressing, and communion wafers. Also, play-dough and crayons may have glutenin them as well.

Celiac disease results from an autoimmue reaction to the Gluten component of wheat and results in many manifestations:

  • Anemia, dental enamel defects, osteoporosis, arthritis, and elevated liver function tests (transaminasemia) are vague manifestations. SOme people develop neuroapthy in the form of tingling in theri hands and feet. Abdominal pains, nausea, and bulky stools may be present. Growth failure, weight loss, and vitamin D deficiency can occur. there has been an association of migraine headaches, depression, and eppilepsy with celiac disease. Vitamin deficiendies found in celiac disease include Vitamin B1 (thiamine), Vitamin B2 ( riboflavin), Vitamin B3 (niacin), Vitamin B6 (pyridoxine), Vitamin B12, as well as Vitamins A, D, and E. Also copper, zinc, carotene, folate, ferritin, and iron levels may be low. This is due to malabsorption in the gut from the chronic inflammation.
  • With celiac disease, there is mucosal inflammation throughout the small bowel, leading to vllous atrophy (the absorption of the gut is through the villi) and crypt hyperplasis inthe small bowel. This leads to recurrent diarrhea, malabsorption, weight loss, bloating, and lactose intolerance.
  • There is an association of celiac disease with recurrent miscarriages.
  • Other asscoiated conditions include aphthous stomatitis (canker sores), cerebellar ataxia (incoordination), dental enamel loss, osteoporosis and bone mineral density decrement, atrophic glossitis (burning tongue), pancreatitis, myocarditis, menstrual irregularities, and growth delay problems.
  • There is an increase risk of type 1 Diabetes as well.
  • The incidence of celiac disease is 1:100 – 1:250 in whites of European ancestry. It is rare in those of Chinese, Japanese, and sub-saharan African descent.
  • Testing can be performed by serum testing for IgA/G antitissue transglutaminase antibodies, which are elevated in the disease primarily. There are other serological test as well. If there is high suspicion of the disease, an endoscopy to look at the small intestine, with a biopsy, would be indicated. One should be checked for vitamin deficiencies in Vitamins A, D, E, and B vitamins, as well as copper, zinc, carotene, folate, ferritin, and iron levels.
  • A Dual energy Xray Absorptiometry scan (DEXA) scan can be considered in the right populations to check for low bone mineral density and osteoporosis
  • Be certain that your pneumococcal vaccination has been made up to date, because patients with celiac disease may have hyposplenism ( which has an immune function).
  • Gluten-free diets have become more common lately, especially as gluten has been attributed to causing memory loss, arthritis, and weight gain. People who have followed the diet claim to have better digestion, more weight loss, better immune systems, and lower cholesterol..
  • Gluten-free foods do not necessarily have more nutritional value than regular foods, in fact, many gluten-free foods are not enriched or fortified with nutrients such as folate, iron, and other agents. The gluten that is removed in the gluten-free foods removes certain desirable flavors that are then replaced by  extra fat, sugar, and sodium. This may mean that some gluten-free foods may be worse with respect to their nutritional content than regular foods.
  • Gluten not only adds flavor to foods, it may also have beneficial effects on triglycerides and blood pressure. There are fructan starches in wheat that support healthy bacteria in the gut, so less gluten in the diet can result in an altered gut bacteria biome.
  • Another issue with gluten-free foods is that many of the products have rice flour or another form of rice in them. The problem with this is the arsenic content that this adds. Arsenic is carcinogenic. 17 % of the average person’s arsenic load comes from rice products, but this percentage increases in people who follow a gluten-free diet. It is possible that a person on this diet may be consuming 10 times the normal amount of Arsenic.
  • A gluten-free diet is not a weight loss strategy as most gluten-free foods have more calories, sugars, and fat. The best way to  lose weight on this diet is to replace items with foods that have more fiber. For example, eating an apple instead of a sugary dessert.
  • Be certain you still include grains in you gluten-free diet, so you can replace wheat with amaranth, corn, quinoa, millet, teff, and rice. Also, fruit, vegetables, fish, meat and poultry have no gluten content, so include these in your diet, Be certain to watch out for the fat, sugar and sodium content in your gluten-free food.
  • Be careful that gluten isn’t sneakily present in your ‘gluten-free’ foods. For example, some gluten-free chips and energy bars have malt or malt extract or malt syrup, which are made from barley.
  • Per the FDA, gluten-free foods cannot contain an ingredient from a gluten grain unless it was processed to remove the gluten, and not just a measurement of less than 20 ppm gluten in the ingredient.  < celiac disease foundation


Insane Medicine – Stool DNA tests for detecting colon cancer

  • The FDA approved Cologuard (Exact Sciences) to screen average risk adults for colorectal cancer. Age must be over 50. This is a DNA-test performed on a stool sample.
  • Options for screening for colon cancer include barium enemas, flexible sigmoidoscopy (the doctor uses an instrument to look in the colon under sedation), CT colonoscopy using a CT scan with contrast, or colonoscopy to look for cancers.
  • Current guidelines recommend that at the age of 50, a colonoscopy be done every 10 years.
  • The stool DNA test can be used for those who refuse a direct visualization of their colon. The DNA test looks for something called KRAS mutations and NDRG4 and BMP3 methylation, as well as hemoglobin to determine if there is a probability of colon cancer.
  • The test detected 92% of the cases of colorectal cancer in people without symptoms. It had a fair amount of false positive tests, meaning that it gave a positive result when, in fact, the patient did not have the disease. Obviously, a colonoscopy must be done if the test is positive to look directly at the colon.
  • The test is done by having the Cologaurd kit sent to your house and providing a stool sample that is shipped back to the company. How convenient!
  • Again, this is another option to screen for colorectal cancer.
Colon cancer
Colon cancer invades the colon wall.

Irritable Bowel Syndrome and new dietary management for it! Zofran for IBS with diarrhea symptoms!

General bowel anatomy
General bowel anatomy
  • Irritable Bowel Syndrome (IBS) affects a lot of people with low abdominal discomfort and bloating, diarrhea, and/or constipation.The disease is chronic and relapsing. It is, in part,  a result of malabsorbed carbohydrates that are fermented by gut bacteria to produce gas.
  • FODMAPS (fermentable oligo-saccharides/disaccharides/monosaccharides/and polyols) are believed to be a major cause of bloating and abdominal cramping symptoms in IBS patients.  FODMAPS are carbohydrates found in our diets.Many people who perceive that they have Gluten intolerance (celiac disease) in fact have FODMAP intolerance.
  • FODMAPS include fructose, lactose, fructans (in wheat), galactans, and polyolo sweeteners.
  • FODMAPS are not absorbed in the small intestine and pass to the large intestine where they get broken down by bacteria in the gut, forming gas.
  • Sugar alcohols (polyols) such as sorbitol, mannitol, xylitol and maltitol are present in many food products and are FODMAPS. They are found in artificial sweeteners, as well as many fruits, such as apples, cherries, peaches, and a wide range of fruit.
  • Galactose  (Galactans) are a oligosaccharides  that are found in beans
  • Fructans (Fructose) are present in wheat, rye, barley, onions, and many other vegetables.
  • A recent study in the journal, Gastroenterology, demonstrated that FODMAPS are the primary cause of abdominal cramping and IBS symptoms, not gluten intolerance. Changing ones diet to avoid FODMAPS helped many patients with IBS symptoms.
  • How does one change to a diet that is low in FODMAPS? There are apps that have dietary recommendations as well as the following site:
  • General information: Animal protein is low in FODMAPS
  • Fats and oils are low in FODMAPS, but remeber that butter, palm and coconut oil are high in saturated fat, so avoid too much of them
  • Cheeses have lactose, a FODMAP, but hard cheeses, such as brie and camembert or feta cheese are lower in lactose than cream cheese or ricotta cheeses.
  • Garlic and onions are high in fructans ( a FODMAP), so avoid too much of them. These are frequently added to oil-based sauces and condiments and increase the FODMAP levels.
  • Some flours have lower amounts of FODMAPS, such as spel or oats, whereas wheat and rye are high.
  • Fruits have variable amounts of FODMAPS, but drying may concentrate them even more.
  • A recent study demonstrated the use of Ondansetron, a 5- hydroxytryptamine-3 receptor antagonist, as being effective for irritable bowel symptoms if the person has diarrhea-type symptoms primarily. Ondansetron is an anti-emetic agent and was found to increase stool consistency, decrease urgency and bloating, and decrease the number of bowel movements in patient with diarrhea caused by IBS.
  • If you are concerned over the glycemic index of the foods that are  low in FODMAPS, consult
  • So, if you suffer from irritable bowel syndrome, consider consulting a dietician and trying a low FODMAP diet, as opposed to a gluten-free, celiac-type diet. You might not have gluten-intolerance!!