Fire and Battle in the Gut – the immune response and your long list of foods that cause reactions

It seems like every year around this time, I find myself in a phase of asking myself, “what food am I reacting to?”. After half a decade or more of asking this question annually, and over the years slowly pin-pointing it down, I’ve gotten a little wiser.

William and I have grown a fairly substantial garden every year since 2016, and I’ve had some version of one in community garden plots, on balconies or patios, college rental backyards, and even dorm room windowsills since I left home as a teenager. Even before that, my mom has always grown a large garden, so having super-fresh summer produce has literally been a happening my whole life. My mom’s favorite thing to grow, from my perspective anyway, has always been heirloom tomatoes, so all the big, fat, juicy tomatoes have also been a long-time staple of summer and early fall. Yum.

But for the last several years, it has become apparent that I may like tomatoes, but they don’t quite like me—in the amounts that any tomato-growing person would need to consume them anyway.

So each year I’ve slowly reduced how many tomato plants I’ve grown. This year, instead of pulling the plants after two solid months of heavy tomato production, the thick smoke and hazardous air days earlier this month had me pulling the one plant we grew early. So there was only one month of tomato production, and I gave a bunch away just to keep up.

And yet still, by the time I pulled the plant and sent it to the compost, every time I had a tomato-based meal I was getting itchy ears and hot, flushing of my face within minutes. At the point where these symptoms were the worst, we were also in extremely hazardous air quality—likely even with the blessed indoor air purifiers—and I had been eating other nightshades regularly too; we also grow a few peppers, eggplant, and this year, potatoes—William’s pride and joy.

And while the itchy ears and facial flushing are classic allergic reactions, every year before this, I react later, after many more weeks of eating tomatoes and other nightshades, and with my more consistent go-to digestive symptom: a dully, achy, distracting pain.

Why am I sharing all this? Well, because I know many of you can relate to having various food sensitivities or allergies and not always knowing what you’re reacting to or how to deal with it—and because let’s be clear, eliminating one food after another until you’re down to a handful of “safe” foods is not the best long-term answer.  

For anyone that read my last digestion-focused article, you’ll remember part of the nervous system traverses through the gut. You may have also read that about 70 percent of our immune system is located in or around the digestive system. This is why when our digestive barriers or defenses are worn down, the immune system, whose very job is to determine what is you and what is not—and to attack what’s not—begins to take on substances that ordinarily it shouldn’t, like foods or substances from the environment.

The reason for this is partly because the lining of the gut is only one cell thick. If that sounds especially thin, it is. Just below the gut lining lies a part of the immune system called the gut-associated lymphoid tissue (GALT), whose job is to help absorb nutrients. We also have a part of the immune system called the mucous-associated lymphoid tissue (MALT) which resides in the mucosal lining, as well as in other mucousy tissues (nose, bronchia, etc.). When the gut and mucous-associated lymphoid tissues’ membranes are structurally strong, then we have more ability to withstand ‘stressors,’ both actual stress and substances that might stress the body internally. When these lymphoid tissues are structurally compromised, then bacteria, food particles that cause a negative reaction, and other inappropriate pathogenic molecules get into our blood. And the cellular version of battle ensues.

Cue reactions to tomatoes, other nightshades, wheat and gluten, dairy, corn, peanuts, soy, and on and on. The immune system turns on against otherwise harmless foods.

One more thing to know before I get into what we can control about this immune response:

There are layers to the immune system with first line defense, second, what follows, etc. Likewise, when we do blood or skin tests for food sensitivities and allergies, there are different substances to test for.
Secretory IgA (sIgA), is the main way that the mucous-associated lymphoid tissue gives the message to the immune system to initiate battle. Secretory IgA are antibodies in the gut mucosa that are on constant alert for foreign substances—think of them as guards for the castle walls of your mucous-immune tissue. They initiate a non-specific response. When the secretory IgA antibodies aren’t showing up to the job or are overwhelmed, the IgG antibodies next kick in. They are what we’ll call a second line of defense and cause reactions to specific foods or substances, but perhaps not immediately. That’s why in the past, I could eat tomatoes for weeks before having any reactions and when those reactions occurred, they were hours or even days after the ‘enemy’ tomato made its appearance at the castle walls.

When IgG antibodies get overwhelmed, it is time for the IgE antibodies. These are what we consider true allergies. That’s the classic itchy throat, swelling, mucous and nasal drip, hives, itchy ears and/or eyes, flushing, and anaphylaxis symptoms. Not what any of us want to experience.

Of what we currently know of the immune system, people don’t develop true IgE allergies until all the other systems have broken down—and when food sensitivities are cleared up—that’s the IgG response—the true IgE allergy response can either partially or fully resolve. Good news when I want to eat a tomato symptom-free, or when you want to go back to enjoying any of the various foods you’ve thought you’d have to avoid forever.

So going back to factors that we can control and/or play a role. They include:

– Genetics. Many conditions such as celiac, inflammatory bowel diseases (crohn’s, ulcerative colitis, etc.), and most other autoimmune conditions have a genetic component. While that can seem discouraging, we are learning more about how to modify gene expression through what’s known as epigenetics—using food, nutrients, and environment (like stress reduction), to help us overcome otherwise ‘risky’ genetics.

– Gut bacteria and dysbiosis. Both “good” gut bacteria in the wrong place, and an imbalance between the amount of beneficial and disease-producing microbes are factors we can control. Examples include bacterial, fungal, and parasitic infections. They are far more common than most of us think.

– What we eat on a daily basis. The diet of most individuals is high in refined carbohydrates and poor-quality fats and meats, and too low in fiber, vegetables, whole-grains, beans and legumes, fruit, and nuts and seeds—the very foods that are rich in anti-inflammatory nutrients and feed good gut bacteria.

– Leaky gut. When we get “holes” in that one-cell-thick gut lining, we’re going to experience increased inflammation and breakdowns/battle in the immune system. Stress, of all causes, plays a huge role in this.

Now that you know a little more about the immune system, let me know if you have questions, or if this helped clarify why with healing the gut and turning off the immune system response, you might be able to eat some of the foods you’ve thought you’d have to always avoid.

The immune response and subsequent inflammation is one of the five primary categories of digestive imbalances I look for when working with individuals clinically. Often when we’re experiencing chronic GI distress, there will be imbalances in several categories, and we begin working on the areas that appear most pertinent. I shared about the nervous system’s role here, and I’ll explain the other three categories of digestive imbalance in future articles.

And If you’re tired of dealing with your wonky GI, I invite you to reach out to me for more personalized support.

References:
1: Lipski, L. (2012). Digestive Wellness (4th ed.). New York, NY: McGraw Hill.

roasted zucchini and crookneck squash with pumpkin seeds, oregano, and olives

I went out to harvest in the garden this morning and after using up about 20 crookneck squash in the last couple days, I harvested a dozen more. And a dozen cucumbers and three tomatoes. I trimmed the tomato plant back a bit so I can see several others are nearly ready, and William on corn duty tells me there are six or more ears that need to be used now. They’ll be as many or more of everything tomorrow.

I somewhat jokingly wrote in an instagram post several weeks back that I’ve found the best way to eat more vegetables is to grow a lot of vegetables. No jokes anymore since at this point in the season, it’s an incredible fact. For me anyways, this goes particularly because even though the romanticism of growing our own has long since worn off, there’s a huge sense of obligation to not waste what we’ve watched growing all season, to not waste the many hours William has spent watering and sifting compost, pulling weeds, and turning over beds.

Me? I mostly just harvest and cook and then take the glory. As is true for most gardeners and farmers, we tend to plant extra of everything because inevitably one or more crops fail– and people who grow things are slightly addicted to growing more things. (A slight problem when the backyard is producing so much). This year so far, nothing has failed. Literally nothing except a slow start and replanting of beets which thankfully won’t be ready until the summer squash, cucumbers, and corn are about done.

Anyhow, one thing I’ve been thinking about all summer is how very little has been stated publicly, in the mainstream US news anyway, about lifestyle factors that can help us through this pandemic season. Eating more vegetables, filling ourselves up on all the colors, nutrients, phytonutrients, and generally eating more whole, looks-like-it-came-directly-from-the-earth, foods can go a long way. I was asked to write a little more in-depth about this topic recently for Territory Run Co., so if you’d like more details on specific foods, nutrients, or lifestyle factors to help through this season (like mindfulness for stress relief), you can find the article here.

Meanwhile, I’ll be trying to figure out how to gift a few harvest extras this week, and chop, roast, sauté, etc. my way through the others. A little Italian flavor inspired, this combination of roasting zucchini and crookneck squash, and topping it with an herby, olive, garlic, and pumpkin seed topping is just one way to add some pizazz to eating your vegetables. If you have a grill basket and would like to take the cooking outside, grilling the squash instead of roasting will be a nice shift in methods.

Roasted Zucchini + Crookneck Squash with Pumpkin Seeds, Oregano, and Olives, serves 4 as a side
Use any type of summer squash you have available. The smaller, less seedy ones have the best texture.

4-8 small to medium summer squash, chopped (enough to fit a sheet pan or baking tray)
1 clove garlic
1/4 cup pumpkin seeds, toasted
1/4 tsp. salt
20 fresh oregano leaves, finely minced (about two large sprigs)
15 small black olives (about 1/4 cup), rinsed, drained and sliced

  • Preheat your oven to 425 F. Line a baking pan with parchment and then spread the chopped squash evenly, so it’s mostly a single layer. Sprinkle with a little salt and roast until soft and borderline mushy, about 30-40 minutes.
  • Meanwhile, lightly toast the pumpkin seeds in a pan on the stovetop, and then remove them to a cutting board. Chop them until they’re in medium-small pieces, small enough to not be able to tell they’re pumpkin seeds, but not super-fine.
  • Mince the garlic and add it to a small dish, along with the pumpkin seeds, salt, minced oregano and olives.
  • When the squash is done roasting, slide it into a serving bowl, and then stir the herby pumpkin seed mixture throughout and serve.

Carnival Belly, Running, and a Digestive Health Survey

Lately, William and I have been taking weekend adventure runs, meaning we’ve been getting out of town for a good part of the day to run somewhere new. Often this is followed by a picnic with a very runner-favorite spread: PB&J sandwiches, fruit, and tortilla chips. A couple weekends ago, the route I chose was based on being new and not far to drive, and as such it was on a course that’s designed more for mountain biking. After three miles of steady running upwards amidst the giant forest foxgloves and complete peace that is running away from civilization, we got to our summit and the single-track mountain biking descent. It started out as a really fun, fairly technical terrain with lots of creek rocks, tree roots, twisty trails and garden-gnome spotting. But there were also steady, heavy mountain biking moguls, making every bit of downhill come with nearly the same in little uphill rollers.

By about halfway through the downhill, I had this experiential memory of being on a carnival ride, and I was unsurprised to find my digestive system was feeling jostled in just the same way. By the end of the fourth and final mile of downhill, I realized I’d taken for granted that the norm for runners is to cruise and ‘wheee!’ downhill once the climbing is done. And I’d gladly take that steady climb over the tumbling in my lower GI and the muscle fatigue setting in from all those rollers.

My carnival belly largely went away for the day once I stopped running and had a meal, but it was mildly painful and upset for a day or two afterwards. Relatedly, this week our annual relay team has taken the very different challenge of racing the 2020 relay race virtually, and because this race coincides with the hottest stretches of heat year after year (and no different this year), I had that same mild carnival belly throughout the day yesterday after a hard race effort in the morning heat that was quickly becoming uncomfortable. Similarly to the week before, the discomfort was mostly gone again within a few hours.

So What’s With the Carnival Belly From Exercise, and in Running Particularly?

When we exercise, our body directs blood flow away from the gastrointestinal tract and to the working muscles. This reduction in blood flow, accompanied by an increased release of stress hormones during higher intensity or long exercise efforts, as well as the high impact of running (just visualize the internal organs being jostled up and down as we run), all combine to cause damage to the cheesecloth-thin lining to the gut, leading to all sorts of uncomfortable symptoms, as well as impaired digestion and absorption of food and drinks.

And yes, all of this is fairly normal in small amounts given the nature of doing long or hard exercise bouts. When we are dehydrated (a big topic in itself for another day) and/or exercise in the heat or to an extent that we have a high body temperature, we further reduce blood flow to the GI system, increasing stress hormone release, and develop a higher likelihood of digestive distress. But what might be a small amount of discomfort and upset sometimes should not lead to or be confused with frequently occurring and/or greater than mild GI symptoms.

Despite the serene views, this was taken at the point in the day when the sun was getting hot, the water bottle was running low, and my fun to need-to-be-done ratio was starting to tip directions.

What Can We Do For MILD GI upset?
Rather than grimace and bear it, there are many nutritional and training strategies we can do to minimize GI distress. Primary strategies include being properly hydrated in the 24 hours before / after exercising, especially in the summer heat, as well as training the gut. Just like other aspects of the body, we can train our gut to tolerate different types of foods, fuels, and amounts. Other helpful tactics include avoiding NSAIDS around exercise (as frequent use negatively impacts the gut), and eating and drinking smaller and more frequent amounts during exercise–this method alone helps alot with optimizing absorption and reducing upset.

But what about when that GI ‘offness’ or tummy upset isn’t just mild, and it continues long-term or occurs frequently?

That’s what I’d love to ask about today. Having chronic or frequent digestive symptoms including nausea, GI pain or cramping, reflux, lack of appetite (in general or after exercise), bloating, gas, diarrhea, constipation, loose stools with undigested food, or limited food choices due to reacting to many foods are all big warning signs, kind of like our body’s version of a flashing yellow or red light telling us to proceed with caution, or just plain stop and seek to understand what’s going on.

Rather than address any of those symptoms individually or all together, I’d actually first like to know how common those symptoms are–so I’ve created an anonymous survey for you to tell me about them.

If you’ve followed along here longer term, you’ll know I write about digestion a lot as it’s one of a few factors that finally pushed me into clinical nutrition, and it’s honestly my favorite nutrition topic to help others with–partly due to my own challenges over the years, but also because it can be complicated and I love a good challenge.

So if you’d please, fill out the quick survey for me and I’ll see if I can share about any of those flashing yellow or red symptoms that can cause us distress in or out of exercise in the coming weeks.

Best summer post-exercise treat / summer snacking — all the berries!

References:
Costa, R.J.S., Miall, A., Khoo, A., Rauch, C., Snipe, R.,…and Gibson, P. (2017). Gut Training: The Impact of two weeks repetitive gut-challenge during exercise on gastrointestinal status, glucose availability, fuel kinetics, and running performance.
Costa, R.J.S., Snipe, R., Kitic, C.M., and Gibson, P.R. (2017). Systematic Review: Exercise-induced gastrointestinal syndrome-implications for health and intestinal disease.
Snipe, R. (2018). Exertional heat stress-induced gastrointestinal perturbations: Prevention and management strategies.