Protiotics and Prebiotics

Many years ago I found a book called Wild Fermentation by Sandor Katz. He wrote about how he healed his body and got healthy after a chronic illness by eating fermented foods. He didn’t just ferment cabbage, but just about every food he could. He fermented vegetables, meat, fruits, grains, and I am not sure what else. This book had an impact on me. I was inspired to start fermenting and recommending fermented foods to my patients. I already had a garden at this point, and lots of extra vegetables. One year I weighed my produce from my garden and had over 750 pounds. So I took some of those extra vegetables and fruits, got out Sandor’s recipes and started fermenting.

Around this time there were more and more fermented foods finding their way into the health food stores. And kombucha had become popular. When kombucha first came onto the shelves in the health food store, I remembered back to my first year in medical school, when I had a kombucha mama living on top of my refrigerator, making me the vinegary drink. Kombucha, kimchi, sauerkraut, sourdough bread, yogurt, kefir. What do these foods have in common? They are all fermented.

Why do we want to eat fermented foods. Well according to Sandor Katz, these fermented foods help us stay healthy. And it is not just Sandor Katz who supports eating fermented foods. Since the Human Microbiome Project (HMP), there is now evidence that eating these foods have a beneficial effect on our bodies. The HMP was a study done by the National Institutes of Health to understand the association between the human microbiome in health and disease.

The microbiome is a combination of bacteria, viruses, protozoa and fungi that live in our body. Different areas of our body have different types of organisms that live in a balance. The microbiome help us digest our food, protect against infection, help with detoxification, and produce vitamins. There are common bacterial strains that have been found in different areas of the body. Some of these bacteria can lead to infection in certain areas of the body, but are “normal” parts of the microbiome in other areas. For health, it is important to have a healthy microbial balance in all areas of the body. Research shows that a healthy microbiome can help with fertility, prevent infection and may even prevent cancer.

There are things that we put in our body that help us to create a healthy microbiome and things that negatively effect our microbiome. The current information shows that the gastrointestinal microbiome can be altered by diet, probiotic and prebiotic intake, prescription medication, including antibiotics, cortisosteroids and H-2 blockers. These may effect the microbiome of other areas of the body as well.

There are two ways to get probiotics and prebiotics into your body, food and supplements. Foods high in probiotics include saurkraut, pickled vegetables, kombucha, tempeh, sourdough bread, miso, yogurt and kefir. I suggest everyone make their own fermented vegetables and sourdough bread if possible.

Prebiotics are plant fibers that stimulate the good bacteria in the gut. Prebiotics are not digested by your body, so they pass through the digestive system to become food for the probiotics. Without prebiotics the microbiome will not have what it needs to nourish and cultivate a healthy balance. All bacteria, good and bad, feed on different things. What you feed your microbiome has a big impact on how healthy it is. Prebiotics are found in chicory root, Jerusalem artichoke, flax seeds, oats, garlic, onions, apples, and many other foods.

You are not alone on your journey to health. There are thousands of bacteria living in your body who can support you in getting healthy. But if you don’t feed them, you may have some that work against you. The best way to feed your microbiome is by eating a wide variety of Whole Foods, including various fruits, vegetables, grains, seeds and nuts containing both probiotics and probiotics. With a varied diet, you will be able to diversify the healthy bacteria, and diversity in the gut microbiome is associated with overall health.

Testing for Chronic UTI and Interstitial Cystitis

Many women come to me with a diagnosis of chronic UTIs and Interstitial Cystitis. If you have chronic bladder pain and frequent urination, it is likely effecting every aspect of your life. You probably feel frustrated because standard laboratory testing shows no cause for your pain and discomfort. You might have sleep disruption and anxiety because you know there is a reason for your symptoms and the medication you were given does not help.

There is a test available that looks at a DNA analysis of the urine and is finding infections in women who on standard laboratory testing show no infection. With this test, you will find the cause for your urinary symptoms. You will also be given proper treatment specific to your infection, support to maintain your microbiome and biofilm treatment to break through the layers of bacteria.

With this treatment and proper support, you will be able to get off the pain medications. You will be able to travel in a car without having to worry about using the bathroom, your sleep will improve and you will have the freedom back to live a full and happy life.

A patient recently came to me after four years of recurrent UTIs. She had been to multiple doctors to find the cause. She was told she had Interstitial Cystitis and was given psychiatric and pain medication. She did not feel depressed, but was told that the problem she had was not treatable and she needed to be on medication to ease her symptoms and help her deal with the fact that she will never get better. I got her the proper testing, found the 5 bacteria that had been thriving in her bladder and treated them. After treatment, she was able to go back to living the life she had before the UTIs began.

If you want to have freedom from UTIs and Interstitial Cystitis, please call my office.

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The Truth about Chronic or Recurrent Urinary Tract Infection (UTIs)?

Have you had multiple UTIs? Have you been waking all night long to go to the bathroom? Is it hard to drive any distance or get on an airplane because you need to use the restroom yet again? You may have a chronic UTI! I can help you figure this out. If this article is helpful, please share it with others. You can also leave questions on my Facebook Page https://www.facebook.com/drdeannaberman/

What is a UTI?

A UTI is an infection in any part of the urinary tract, including the urethra, bladder, ureters and kidneys. In the bladder, a UTI is called infectious cystitis. In the urethra, urethritis. In the kidneys, pyelonephritis.

Most infections occur in the lower urinary tract - the bladder and urethra. If untreated, the infection can move into the kidneys. A UTI occurs because bacteria that do not belong in the urinary tract enter through the urethra and get into the bladder.

Now, it is important to understand that it is natural to have bacteria in the bladder. This is called the “bladder microbiome” or “urinary microbiome”. This microbiome is comprised of various strains of bacteria and plays a protective role for most individuals.

Originally it was believed that the urinary tract was a sterile environment, meaning there were “no” bacteria in the urinary tract. Since the Human Microbiome Project (HMP), we understand that many bacteria live in a healthy urinary tract. The difference between the “healthy” bacteria and those that cause an infection is that the healthy bacteria live in a balance with other bacteria and do not cause symptoms for the individual. The bacteria that cause a UTI are considered “pathogenic” bacteria. Pathogenic bacteria cause symptoms.

There are many different strains of bacteria and some strains of the same bacteria can be pathogenic, while others are not. The most common cause of a UTI is Escherichia coli (E. Coli), a bacteria that is part of the healthy gastrointestinal tract microbiome. E. colidoes not cause any symptoms in the gastrointestinal tract, but causes symptoms in the urinary tract. There are many other bacteria found to cause symptoms in the urinary tract, including Staphylococcus saprophytic, Proteus mirabilis, Klebsiella pneumonia, and more. There are too many to list here.

Acute vs Recurrent UTI?

If you get a UTI, it will usually come on strong. You will have bladder pain and urgency and it can be severe. You cannot think about anything else. This is a standard acute UTI.

When we talk about recurrent or chronic UTI, it is less clear.

After that first infection a few things could happen:

  1. You get treatment and your symptoms go away and do not come back. This would indicate a acute cystitis and complete elimination of the pathogenic bacteria, resulting in a cure.

  2. You get treatment and your symptoms do not go away. This would indicated that the infection is still present. This is called Chronic Cystitis.

  3. You get treatment and your symptoms go away but then come back within a short time. This is called Recurrent or Persistent Cystitis.

Who gets UTIs?

UTIs are a very common infection, affecting 8-10 million people a year. Women are more likely to get UTIs than men. Most women will experience at least one UTI over the course of their lives. Men can get UTIs, but it is less common. Children get UTIs as well. Up to 8% of girls and 2% of boys will get a UTI by age 5.

What increases your risk for UTI?

  1. Being female - Women have a shorter urethra than men, shortening the distance bacteria must travel leading to increased risk of UTI.

  2. Pregnancy - The uterus sits over the bladder and as it grows, the weight can block the drainage of urine from the bladder causing an infection.

  3. Menopause - The decrease in estrogen causes changes to the vaginal wall that increase the risk of UTIs.

  4. Certain types of birth control - The use of a diaphragm or other internal device or spermicide can increase the risk.

  5. Sexual activity - Women who are sexually active tend to have more UTIs. Having a new sexual partner or multiple sexual partners can increase the risk. Having an STI, such as chlamydia or gardnarella

  6. Urinary Track abnormalities - Babies born with urinary track abnormalities may have increased risk

  7. Blockages in the urinary track - These can be caused by any physical blockage to the flow of urine, including kidney stones or enlarged prostate.

  8. A suppressed immune system - Chronic infections, diabetes, and other diseases that effect the immune system may leave an individual susceptible to a UTI.

  9. Aging - Women over 65 years old have an increased risk of UTI. As women get older, the risk continues to increase. Men over the age of 65 also have an increased risk, but the risk significantly increases for both men and women over 85 years old.

Dementia / Memory / Alzheimer's

Cognitive decline or dementia is a major concern in the aging population.  The effects of cognitive decline are not only for the patient, but also for the families and employers.  When my mother first developed cognitive decline, we did not know what was going on.  She was living in Florida and I would hear her say things that did not make sense.  She was in her early 60s, with no family history of cognitive issues, so I just brushed off her comments and continued with my life.  As the months went by, my mother would say more things that seemed irrelevant to our conversation.  Eventually I realized that something was wrong.  It is scary to realize that you or someone you love may be forgetting things or saying things that don’t make sense.  

Dementia is a catchall term for several disorders that cause memory loss, personality changes and impaired reasoning. The leading cause of dementia is Alzheimer’s, which can begin as early as 30 years old, but more commonly in the 60s.   There are many other causes including Lewey Body Dementia, Parkinson’s, Vascular Dementia, Frontotemporal Dementia, and more.  These conditions are said to be “nonreversible”, but there are many studies that indicate dietary supplements, herbal medicine, and lifestyle and dietary changes can help, and even reverse Alzheimer’s and other forms of dementia.  

As a naturopathic physician, I take on the role of medical detective.  I delve into your history and help you find the cause (or causes) of your cognitive issues.  Each person is different and the causes of dementia are often multifaceted.  I try to get as much information about your health and lifestyle to determine the most likely causes for you.  In my experience it is important to not focus on one cause, but to look at all the possible causes and create a program for health and recovery that you will be able to maintain for the rest of your life.  My goal is to help you create a lifestyle for long term health.  

Symptoms: 

  • Memory loss

  • Problems with planning or problem solving

  • Losing track of time

  • Having vision problems

  • Misplacing things

  • Poor decision making

  • Problems with speaking or writing

  • losing track of where you are

  • Changes in mood and personality

Contributing Factors to the development of Dementia / Alzheimer’s Disease:

  • Nutritional Deficiencies

  • Heavy Metal Toxicity 

  • Mold exposure 

  • Medication use

  • Circulatory Issues 

  • Blood sugar imbalances 

Finding the Cause / Laboratory testing

  • Nutritional testing: looking at deficiencies of specific nutrients

  • GI Map: looking at the gut-brain connection; digestion and absorption; food sensitivities and allergies 

  • heavy metals if needed - hx smoking 

  • hormone testing: looking at thyroid and adrenal hormones

  • Neurotransmitter testing: looking at specific neurotransmitters

  • Organic Acid Testing

  • check inflammatory markers 

  • glucose / insulin levels

  • circulation

Possible Treatments: many of which have been researched and clinically tested

  • Nutritional supplements, including B vitamins, vitamin D, E, glutathione

  • melatonin

  • herbal medicine, including Bacopa, Ashwanganda, Rhodiola, and more

  • dietary changes, including low carbohydrate diet and intermittent fasting

  • bio-identical hormone replacement 

  • replacing pharmaceutical medication with natural treatments

It is important to find the specific reasons for your cognitive issues.  The sooner we can find the causes and start addressing them, the sooner we can stop the progression.  

Amenorrhea

When I was 16 years old, I stopped menstruating.  This was a result of over-exercising and not eating enough.  I had not started out with the idea that I would lose my menses.  It all began with my wanting to lose some weight.  I thought I would start exercising and cut back on some of the junk food I was eating.  This spiraled quickly into an unhealthy pattern of losing weight, exercising more, losing more weight and then losing my menses.  I looked in the mirror and did not understand why I had lost my period, because to me, I didn’t look too thin.  I had what psychologists call body dysmorphia.  No matter how much weight I lost, I thought I needed to lose more.  

As this article is not about how I arrived at amenorrhea, I will stop my story here.  The point I wanted to make was that I have been there and I was able to resolve this issue for myself.  The way I did it was simple, I started eating again.  I actually ate quite a bit, allowing myself to eat whatever I wanted, and within a couple of months, my menses returned.  Now, I am not advising you do the same, but it was effective.  

My experience with anorexia, the clinical term for what I was doing, starving myself, taught me about the relationship between the body and the mind.  It taught me that the mind can be so powerful that even when the body is saying, “hey, there is something wrong,” the mind can continue to tell you otherwise.  This is called self-deception.  We can deceive ourselves for long periods of time, causing more and more damage to our bodies.  

Some time between the age of 10 and 16 years old most young women will start menstruating.  If you have never had your period by the age of 15, you may have primary amenorrhea.   If you have had your period and it has since stopped for at least 3 consecutive months, you have what is called secondary amenorrhea.  If you are not menstruating, then your body is telling you that something is wrong.  There may be some more serious structural issues that need to be ruled out, especially with primary amenorrhea.  And we always want to consider pregnancy.  If you have had sexual intercourse, even once, even if you have never had your period, you can get pregnant.  But once these have been considered, then we want to look deeper into how your diet and lifestyle may be influencing your amenorrhea.  And if you are reading this article, I suspect you want to come to awareness about a better way of living.  And I want to help you find your way back to your womanhood.

First, become aware of what led you here.  The awareness can help you to not repeat the cycle.  Have you been eating enough?  Have you been exercising too much?  Are you using laxatives?  Are you under a lot of stress? What are the underlying emotional issues?  Are there hormonal issues?  Just because you read somewhere that a specific diet or exercise routine was good, does not mean it is good for you.

You can talk to a counselor who is educated in disordered eating or eating disorders.  Many athletes do not have a defined eating disorder, but have some level of disordered eating.  The difference is that an eating disorder has a very specific definition.  Many young women do not meet the defined guidelines for these diagnosis.  Disordered eating is more about not meeting your bodies nutritional needs.  Many young women follow a food plan based on something they read or some ideals, like being a vegan because you don’t believe in killing animals.  These ideals may not allow you to give your body what it needs nutritionally.  There is something called Orthorexia, a disordered eating pattern where the person is addicted to “healthy eating”.  This is a very common issue.  

Second, get some lab testing.  There are places where they will do metabolic testing.  This testing uses a machine to assess your utilization or deficiencies of fat, carbohydrate and protein.  Other testing that can be useful are hormonal testing, such as TSH, Free T3, Free T4, FSH/LH, prolactin, estradiol, progesterone, testosterone, DHEA-sulfate, androstenedione, cortisol (both saliva and blood).  Some doctors utilize these tests for diagnosing conditions such as hypothyroid, PCOS (polycystic ovarian syndrome), or low adrenal function.  I like to use this tests to look for imbalances in hormones.  I use a test called a DUTCH hormone test that gives me a good picture of what is going on hormonally for women.   I don’t need to see elevations or deficiencies in hormones that clearly fit the parameters for a specific diagnostic criteria.  If a patient is having symptoms, such as amenorrhea and they have a relative imbalance in their hormones, I can utilize nutritional supplements and herbs to try to re-balance their hormones.  

Some tools to help your menses return: 

- Nutrition:  As stated above, you will need to get enough fat, calories, and protein to make the hormones necessary for menstruation. Women need fat!  

- Seed Cycling:  Seed cycling is a very simple naturopathic therapy where you use specific seeds in order to simulate a natural menstrual cycle. This is very gentle.  If you do not have enough calories, fat, and protein in your diet to make hormones, seed cycling will not be enough to return you to menstruation.  The seeds are rotated based on the follicular and luteal phases. The follicular phase of your cycle starts with “Day 1,” which is  the first day of your menstrual cycle and the day that you begin to bleed. The luteal phase is from ovulation, or about day 14 or 15, to day 28.  If you are not menstruating, then you will use the moon cycle to “create” a menstrual cycle.  You will make Day 1 of your cycle on the new moon and day 14 will be on the full moon.  Day 14 would be when you ovulate, and when you are most fertile.  

Follicular Phase: Day 1 (new moon) to Day 13, or until ovulation: 1 tablespoon each freshly ground raw flax seeds and pumpkin seeds daily.

Luteal Phase: From Day 14 (full moon) to 28, or until menses: 1 tablespoon each freshly ground raw sunflower and sesame seeds daily.

- Biphasic herbal tincture:  A biphasic tincture uses phyto-estrogen herbs and  phyto-progesteronic herbs in order to simulate a menstrual cycle.  You use the phyto-estrogenic herbs during the first half of the menstrual cycle from day 1 to day 14, or starting on the new moon,  and phyto-progesteronic herbs during days 14 to 28, or starting on the full moon.  There are various phyto-estrogenic and phyto-progesteronic herbal tinctures on the market.  Or you can work with a naturopathic doctor who will create a formulation specific to your needs.  Again you will need to have enough fat, protein and calories in your diet in order to begin menstruation

- Nutritional Supplements: Depending on the lab values I see, I will use various nutritional supplements to support the body to initiate or re-establish menstruation.  Some of these include, mayo-inositol, NAC (N-acetyl-cysteine), lipoic acid, chromium, vitamin D, magnesium, iron, omega-3 fatty acids and others. 

- Bio-Identical Hormones: These will need to be prescribed by a naturopathic physician or another physician.  Once you have done hormonal testing and established a deficiency,  you can use bio-identical hormones in the same way your body would use it’s own hormones.  You can adjust dosing of estrogen and progesterone to create a cycle.  This would help your body to recognize what it needs to do.  

- Prescription Medications: It is always my goal to support the body to return to a normal menstrual cycle.  At times, I need to use things like Metformin or other prescription medications to help in this process.