Saturday, April 23, 2011

Fermented Asian Food and Gut Dysbiosis 101

Flexibility = Adaptability

This gentleman was kind enough to let me take his photo by the West Lake in Huangzhou. His pose lasted longer than the time we had to hang out! I especially loved his timeless smile and ageless grace.

Fermented Foods of China

Quest for Fermented Food

In our first leg of our vacation in China, my husband and I had dinner with fellow blogger and fermentation fan Seth Roberts at his choice, a Yunnan restaurant which specialized in regional dishes. Wasn't difficult to track down dishes with fermented condiments or fermented flavors. Most traditional ethnicities incorporate fermented foods in daily meals from dawn to twilight no matter where you are on planet earth. (everywhere except the land of McDonalds, Velveeta doesn't count!)

From top to bottom:
-- roasted duck with fermented bean paste (I think, I can't recall now!)
--deep fried insects (grub have microbiota which ferment but *ugggh* the veggie oils)
--fish with fermented black bean sauce
--yak milk yogurt, fermented sweeten rice wine dessert w/tapioca balls, tea with milk (tea leaves fermented)
--(not shown) B-E-E-R, fermented grains (it aint that bad, no?)


Exploring the Benefits of Fermentation

Our gut microbiome is primarily responsible for fermenting our undigested food. Under pathologic circumstances, fermentation happens where it is not supposed to, e.g. the stomach, small bowel or in our blood stream.

Below Jiménez describes the benefits and distinct role our gut microbiome plays in our health, longevity and maintenance. Some experts even propose that our gut microbiome fucntions as an neuro-endocrine organ. I would strongly concur. It is transplantable like any other organ and is so indisposable that we cannot live without it. When it goes awry in function, like any other organ, a host of chronic illnesses and disorders ensue -- obesity, autoimmune diseases, cancer, mental conditions/crankiness, infertility, heart disease, etc.

Table IV Primary Functions of Intestinal Microflora (per Jiménez) (free PDF)
I. Planktonic microflora --> METABOLIC

(a) To ferment indigestible substrates (fiber, extruded cells and endogenous mucus)

(b) To favor the growth of beneficial intestinal microflora
----(i) Improves lactose digestion----(ii) Modulates intsetinal gas production
----(iii) Increases genesis of short-chain fatty acids --> intraluminal acidication --> increases intestinal transit
----(iv) Increases the absorption of Ca, Fe, and Mg----(v) Synthesizes vitamins: K, folic acid, biotin, B12

II. Mucosa-associated microbiota (MAM)

(a) Protective
----(i) Barrier effect + bacteriocin synthesis --> prevention of invasion by exogenous pathogens
----(ii) Maintenance of intestinal permeability --> prevents bacterial translocation and systemic infection (e.g. PREVENTION OF POOP IN THE BLOOD STREAM)

(b) Trophic
----(i) Controls epithelial cell proliferation and differentiation of intestinal mucosa
----(ii) Maintains new cell growth in intestinal epithelial crypts
----(iii) Of the intestinal immune system: cells and serum (immunoglobulins)


Rev Esp Enferm Dig. 2009 Aug;101(8):553-64.
Treatment of irritable bowel syndrome with probiotics. An etiopathogenic approach at last?
Bixquert Jiménez M.
Irritable bowel syndrome (IBS) is the most common functional digestive disorder, and may affect 11-20% of the adult population in industrialized countries. In accordance with Rome III criteria (2006) IBS involves abdominal pain and bowel habit disturbance, which are not explained by structural or biochemical abnormalities. Several hypotheses attempt to account for the pathophysiology of IBS, but the etiology still remains uncertain or obscure, perhaps multifactorial. Abnormalities in colonic microflora have recently been suggested in such patients, as has abnormal small-intestine bacterial overgrowth (SIBO), or in particular a significant reduction in the amount of intraluminal Bifidobacteria or Lactobacilli, with consequences like the production of colonic gas, and motility or sensitivity disturbances of the intestinal tract. The disorder is difficult to treat, and the wide spectrum of non-drug and drug treatments shows our ignorance about the cause of the condition. Newer drugs, both pro- and anti-serotonin, have failed to show long-term efficacy or have been withdrawn due to concerns about harmful effects. Recent research has provided increasing support for the idea that disturbances of intestinal microbiota occur in patients with IBS, and that such abnormalities may contribute to IBS symptoms. Studies in Scandinavian countries in the last ten years emphasize the role of probiotics in the modulation of intestinal microbiota, and as a consequence in the regulation of the motility and hypersensitivity of the digestive tract. Although results between studies are difficult to compare because of differences in study design, probiotic dose, strain, and duration of therapy, some studies show symptom improvement. Lactobacilli are found among the normal bacterial flora of the gastrointestinal tract, and Lactobacillus plantarum (Lp) is one of the species frequently isolated from the human mucosa, which is capable of surviving the low pH of the stomach and duodenum, resisting the effect of bile acids in the upper small intestine when ingested, and temporarily colonizing the gastrointestinal tract by binding to the intestinal and colonic mucosa. Concurrent with colonization by Lp there is a decrease in bacterial groups with gas-producing ability, such as Veillonella spp. and Clostridia spp. Evidence has now accumulated to suggest the efficacy of certain probiotics like Lp299v, which may be capable of bringing about a significant reduction in pain, abdominal distension and flatulence, while increasing health-related quality of life in IBS.

Int J Mol Sci. 2009 Aug 27;10(9):3755-75. Free PDFThe improvement of hypertension by probiotics: effects on cholesterol, diabetes, renin, and phytoestrogens.
Lye HS, Kuan CY, Ewe JA, Fung WY, Liong MT.
Probiotics are live organisms that are primarily used to improve gastrointestinal disorders such as diarrhea, irritable bowel syndrome, constipation, lactose intolerance, and to inhibit the excessive proliferation of pathogenic intestinal bacteria. However, recent studies have suggested that probiotics could have beneficial effects beyond gastrointestinal health, as they were found to improve certain metabolic disorders such as hypertension. Hypertension is caused by various factors and the predominant causes include an increase in cholesterol levels, incidence of diabetes, inconsistent modulation of renin and imbalanced sexual hormones. This review discusses the antihypertensive roles of probiotics via the improvement and/or treatment of lipid profiles, modulation of insulin resistance and sensitivity, the modulation of renin levels and also the conversion of bioactive phytoestrogens as an alternative replacement of sexual hormones such as estrogen and progesterone.


Calvin said...

Hey G, Best wishes for a funtastic vacation. The food posts look so yummy :)

Dr. B G said...


Happy Easter/Passover/Earth day! I highly recommend visiting Asia but you'll gain wt -- the food is SPECTACULAR *ha*


Peter said...

Wow, the flexible gentleman.....

Food looks fantastic too


Anonymous said...

Can you tell us what you specifically recommend, diet-wise?

Dr. B G said...


Indeed! I think adaptability (mind/body) = S*XXXXINESS *wink*


Dr. B G said...

Diet-wise I think I have really evolved so what I advise is actually now very customized to a particular person and their respective current metabolic state and their stated health goals.

The questions one should consider:
--Are they adrenally competent (b/c this requires some carbs 4-5 x daily)? Normalizing cortisol by eating carbs, protein, and fats at regularly paced intervals is essential to recover.
--Are they gonadally competent? Fasting is great but this will raise cortisol and lower testosterone too much if the adrenals are not in place.
--Fertility goals? Again all the above should be optimal but if they are difficient, for epigenetic purposes, all nutrient levels should be good and dandy otherwise the next generation will be affected. B-vitamin status (again folic acid and B12 are highest in meat/organ meats not veggies), cholesterol (eat yolks and animal fats), vitamin A and other fat-soluble vitamins nutrients like phosphatidylcholine/serine (yolks, animal fats, organ meats), omega-3 (wild game/fowl, avoid fish and seafood (even farmed) due to PCBs and methylmercury so $$$$ supplementation is best), minerals mag ca zinc selenium etc incl iodine... etc... until replete.
--Health goals? Gain lean muscle and strength? Lose belly fat? Lose subcutaneous fat? Lower leptin resistance? etc

It's more complicated.

Dr. B G said...


BTW you can tell Squiggs we ate the bugs ;) (well. my hubby didn't but Seth and i went for it)

Delish and crunchy w/salt!!

Dan said...

Your dinner looks yummy. Too bad I don't eat much at Chinese restaurants, even good ones because almost everything is fried in soy oil or smothered in high fructose/sugar sauces.

I love my fermented grains too. Things like beer and naturally brewed soy sauce are some of my favorites. Do you know any evidences or studies that were done on their impacts on our health?

I see your point on eating fermented food. The traditional paleo diet do not emphasis enough the health benefits of fermented food in our diet. What is your opinion on the effects of fiber on our intestinal health?

By the way, one of my professor thinks that an obese person have a different intestinal flora than a slim person. According to him, the type of microflore in the obese person intestine can extract calories, nutrients and fatty acids from food more efficiently than the ones in a slim person. If I am not mistaken it must be the fermentation of a the indigestible fiber.

Dr. B G said...


Thanks for our comment and links, esp the first to the informal THINCer and Barry Groves enlightening comments.

Lactic acid is a problem when probiotics are given to someone with EXTREME SIBO (small intestinal bowel overgrowth) esp when the predominant microbes are in the lactobacillus family. This was brought up when I was learning about the comprehensive stool analyses and one of the leads at Metametrix pointed out the potential contraindication you are discussing here. In real life, I don't know if fermented yogurt would pose a problem but I can think of a few problems until the SIBO is controlled and effectively eradicated. Unless the yogurt is fully fermented for 24hrs or greater, the lactose in the yogurt may fuel the fire in SIBO. If the person is engaging in HIIT and endurance sports and athletics without being conditioned, the amount of lactic acid in the blood after exercise may also be significant. Also if acidosis is already occuring with lactate-producing microbes (bacterial, yeasts) and the problem is extreme, coupled with the other factors maybe problematic. There is a reason why the Chinese prefer 'alkaline' blood/body fluid states for longevity! A book called 'The Acid Alkaline food guide' By Dr. Susan Brown and Larry Triveiri uses the principles culled from nephrologist (and paleo MD) Dr. Lynda Frasetto MD from UCSF to adjust pH by alkaline producing foods (veggies, nuts) and avoiding acid-producing foods (sugar, grains/seeds except gluten-free ones like rice, quinoa). The states that yogurt, kefir and other fermented products are only mildly-acid producing and thus IMHO are fine. Meat is acid-producing however I think Cordain has extinguished the idea that is fails to confirm to optimal health. It's the balance and the key is keeping the gut happy and healthy. The first link talks about the HCl-feeding of dogs. Acid will degrade the gut lining of dogs. Naturally atherosclerotic plaque will occur! I'm not sure if the acid/base question is answered by that study.

Lactic acid should not normally be a problem -- dietary or endogenously produced -- when all metabolic engines are 'go'. We effectively take care of it by clearing it from the blood stream (hence less sore muscles) unless certain circumstances overload the rate of clearance...

One of the your links mentioned the drugs that predispose a metabolic acidosis state -- drugs, not dietary lactic acid, are far more powerful in causing mortality related to acidosis. Phenformin (no longer available in the US but as a contaminant in Chinese produced 'herbals' or 'drugs' is a big issue) killed people before it was taken off the market for inducing acidosis. Metformin has a rare warning for lactic acidosis which is fatal under certain conditions which predispose to drug induced acidosis or where the drug accumulates secondary to poor kidney function (heart failure stage III or IV, kidney dysfunction SCr > 1.4-1.5, dehydration, acute alcohol ingestion, chronic high dose alcohol, liver failure, etc).


Dr. B G said...

Hey Dan, Mr.Hokkien/Hakka HOTNESS :)

That is great you can read Wuxia!! I'm thoroughly jealous. Maybe when I retire I'll learn Chinese proficiently enough to read them...

MDA and Nikoley are awesome and accesible. It's wonderful that you found them! Personally like you I avoid the Chinese restaurants too!! Too much omega-6 pufas! The secret to even the 'healthiest' purported restaurants is that the DEEP FRY everything in transfats. In Calif, like NYC, they've banned transfats but I personally doubt the Chinese restaurants will significantly change... Yeah vanity is a great motivator *wink* hence we stay paleo despite its challenges in the nealethal word. Not being a FANATIC is the key, I'd agree stringently after losing MANY BATTLES! *haa* My kids sneak it in the school cafeteria but they will tell me many times when they want to make me happy (yeah, I'm easy) they had *this food or that food* which didn't have gluten (like teriyaki chicken v. corndogs/burgers). The ones who miss gluten/wheat are the ones who are the most negatively affected.


Anonymous said...

Hi, Dr. BG - thanks for commenting. I have found that the lactic acid issue is a bit more complex than expected...

Dr. B G said...

Me too! Wish life were simple however it emulates networks... like we are all connected together, so are the biochemistry and energy, no matter how distant they appear.