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First published by Hudson Street Press, a member of Penguin Group (USA) LLC, 2014
Copyright © 2014 by Kathie Madonna Swift and Joseph Hooper
Foreword copyright © 2014 by Mark Hyman
Illustrations by Donna Mehalko
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FOREWORD
Ten years ago, Kathie Swift, our nurse partner Nina Silver and I holed up in my red-shingled house in western Massachusetts and together became the UltraWellness Center. For those first few months, I was working in my office upstairs, Nina was in the living room and Kathie, as befitting my head of nutrition, was in the dining room, just off the kitchen. Today, the functional medicine center that Kathie, Nina and I built employs a staff of thirty working out of a well-equipped building set against the Berkshires woods. Kathie, of course, played an important role in that growth and success. In fact it was she who first pointed me toward what we now call functional medicine, an approach that seeks to uncover the root causes of disease, always with the emphasis on healthy diet and lifestyle.
When we were both working at the Canyon Ranch spa in the Berkshires in the nineties, Kathie introduced cutting-edge nutritional medicine concepts to the doctors and nutritionists there. And she introduced me to Dr. Jeffrey Bland, the father of functional medicine, who became a mentor to so many of us. At Canyon Ranch, where I was co–medical director and Kathie the nutrition director, we were able develop and apply these functional medicine ideas in a clinical setting. Although I was that rare doctor who had actually studied nutrition in a serious way, it was Kathie who really taught me to think rigorously about the role of nutrition in health. In contrast to the “pill for every ill” mentality that almost every doctor absorbs in medical training, with Kathie’s help I came to see how food itself could be powerful medicine with which to treat and actually reverse disease. She was so open and enthusiastic about partnering with me at the Ranch, and together we refined an approach that was effective for thousands of clients there. When I left Canyon Ranch, to build the UltraWellness Center, she was the first person I called to join me. Since then, she’s helped me with several of my books, including UltraMetabolism, to which she contributed the recipes. (As you’ll see in The Swift Diet, Kathie is an accomplished and creative home cook.)
It’s no accident that Kathie and I share this quest to push beyond conventional medical wisdom. We both had to figure out how to heal ourselves before we could fully help our patients. I’ve written about my struggle with chronic fatigue and mercury poisoning in a number of my books. Here in The Swift Diet, Kathie opens up for the first time about her battle with chronic fatigue syndrome brought on by an undiagnosed sensitivity to gluten. Her success in healing herself with a high-fiber, mostly plant-based diet fuels her passion to find the right answers for clients and readers with gut and weight issues. And she never stops. She has the ability to synthesize enormous amounts of data in order to connect the dots, to create meaning where there was none. In The Swift Diet she draws on the latest research on the role of gut bacteria to distill a practical step-by-step guide to health and healthy weight loss.
I think the microbiome is an enormously important emerging story. We’re seeing that the bacteria that live in the gut help regulate the interlocking systems in the body, including the immune system and insulin metabolism. I’ve seen it in the research literature and I’ve seen it in clinical practice: different diets can have different effects on weight, even though they may contain the same number of calories, because of how they affect the gut bacteria. Kathie has been at the forefront of this field, giving talks around the country to general audiences and to her professional peers. She’s been the driving force behind the Dietitians in Integrative and Functional Medicine within the Academy of Nutrition and Dietetics, she’s a founding member of the Institute for Functional Medicine’s nutrition advisory board and, for the past decade, she’s organized an influential annual conference on health and nutrition, Food As Medicine, sponsored by the Center for Mind-Body Medicine in Washington, DC, where I’ve been honored to serve on the faculty and board of directors. Kathie has become something close to a one-woman bridge between the worlds of functional medicine and mainstream nutrition.
She’s also adept at making the connection between body and spirit. Over the past seven years, as she’s developed and led workshops on weight loss, digestion and detox at the Kripalu Center in the Berkshires, she’s integrated mind-body techniques into her nutrition work, addressing the stress piece of the health and weight-loss puzzle. Just as I started out my career as a yoga instructor, Kathie is now a certified qigong teacher!
My friend and colleague Kathie Swift is one of the leading innovators in nutrition in this country. She has devoted her life to discovering how we can heal ourselves through food, and she’s inspired a host of others to do the same. If you’ve bought The Swift Diet, you’re about to join that select but growing group.
—Mark Hyman, MD
Chapter 1
SCIENCE, WISDOM AND STORY
SELF-INQUIRY BOX
1. Have you noticed that when you’re having digestive problems, it’s difficult to manage your weight? That there is a connection between “Irritable Bowel” and “Irritable Weight”?
2. Have you noticed that a week of high stress can have a similar effect on your belly as a course of antibiotics? That both can seem to throw your entire digestive system off?
3. Have you noticed that when you’re eating more vegetables and fruits, and less meat and processed foods, you feel lighter and more energetic?
If you’ve picked up this book, there’s an excellent chance that you’re frustrated with your weight. Maybe you’re carrying around an extra ten or twenty or fifty pounds that you can’t seem to keep off. Odds are you’ve gone on diets before and you may have had success, for a while, but you couldn’t handle the feeling of deprivation, of being hungry over the long haul, and the unwanted weight came back. Or the diet was one of those complicated multiphase productions and after a while you lost the patience or the will to precisely track your calorie intake or the ratio of carbs/fats/protein you were supposed to be eating in any given week.
But there’s an easier and a better way. It happens to be supported by what has become very possibly the most significant and compelling scientific story to unfold in this century—the impact of the bacteria that live in our gut on most every facet of our lives: our weight, our digestive health, our immune system response, our emotions, virtually every aspect of our being. For instance, these gut bacteria can produce toxins that leak into the bloodstream, creating a system-wide inflammation that pushes the body to store calories as fat rather than burning them as energy, and it can drive food cravings. (Researchers now recognize this “metabolic endotoxemia,” literally a poisoning from within, as a likely under-the-radar driver of obesity in this country.) Amazingly, these same bacteria can influence the production of gut hormones that speak directly to the brain, signaling either fullness or hunger. The good news is that by paying attention to what you eat and how you live—chronic stress causes major dysfunction in the gut—you can exert control over the process. Take care of your gut bacteria and they’ll take care of you!
But we’re getting ahead of ourselves. Let’s return to weight gain, which for many women is the most distressing sign that all is not right with the belly and the body.
The Belly Blues
The weight of the average American woman has gone up twenty pounds since the early seventies. Today, 33 percent of American adults are considered overweight (a body mass index of 25 to 30) and 35 percent obese (a BMI over 30). Over the past twenty years, the obese group has increased in number by 60 percent, giving us a new label, the “obesity epidemic,” and fears about crushing rates of heart disease and type 2 diabetes in the future. What hasn’t been talked about as much is that during this same period of time, the nation has experienced a second epidemic, one that has been taking place, out of sight, but not out of mind, in the bellies of American women.
Consider: While men and women have suffered that weight gain in roughly equal measure, women are twice as likely as men to have the chronic, low-grade digestive complaints that get lumped together as irritable bowel syndrome, affecting an estimated 30 percent of American women. Digestive problems are compounded by food allergies and sensitivities, especially to the family of proteins found in gluten-containing grains like wheat, rye and barley. Conservatively estimated, 1 percent of the American population is afflicted with celiac disease, a severe intolerance to gluten. Six times that number have a less severe sensitivity to gluten, which can still result in serious digestive problems as well as all-over fatigue and depression. (Again, a conservative estimate. I, and many nutritionists, find that many of our female clients feel better without gluten.) And it doesn’t stop there. Clinical evidence is piling up that huge swaths of the population are suffering from gut-disturbing, and likely weight-frustrating, sensitivities to common dietary elements like lactose in dairy products, fructose in high-fructose corn syrup and related compounds found in some legumes and vegetables.
The belly of the American woman has become the proverbial canary in the coal mine. It’s letting us know that something has gone very wrong.
As a clinical nutritionist, over the past three decades I’ve worked with thousands of clients, mostly women, to effectively manage both their weight and their digestive issues. But it wasn’t until 2011, when I cowrote The Inside Tract: Your Good Gut Guide to Digestive Health with Johns Hopkins gastroenterologist Gerard Mullin, that the connection between digestion and healthy weight became crystal clear to me. That book brought a parade of women with digestive issues to my private nutrition practice, most of whom had been trying unsuccessfully for years to drop those stubborn pounds. Sometimes it was the unruly gut that was their biggest complaint, typically, a not-so-merry-go-round of constipation, diarrhea, gas, and bloating given the all-purpose label of irritable bowel syndrome. (You can take an IBS self-diagnosis test offered by the American College of Gastroenterology at http://gi.org/acg-institute/ibs-test/.) Sometimes it was just the weight. What was staring me in the face was that Irritable Bowel and what I now call Irritable Weight were usually two faces of the same underlying problem. With some of these clients, I’m working to overcome a serious chronic condition. But for most of them, and for probably the majority of people reading this book, the digestive symptoms come and go. They’re a hassle, to be sure, but they’re also telling us, screaming at us sometimes, that the body is not being properly nourished by the right foods in the right ways. Your digestion and your weight are coconspirators, chipping away at your wellness.
SWIFT DIET DICTIONARY
Microbiome: The total collection of genes belonging to the bacteria that live inside our bodies and on our skin. These single-cell bacteria are at least ten times as numerous as human cells and most of them reside in the human gut.
Microbiota: The name given to the population of bacteria that live in the human gut, mostly in the colon or large intestine. In the past twenty or so years, we’ve discovered that the microbiota plays a major role in digestion, gut health and overall health, including weight control.
Gut Flora or Microflora: Same meaning as “microbiota” above. In the outside world, “flora” refers to plant life. Inside our gut, it refers to our resident gut bacteria.
Dysbiosis: A change in the composition of the gut bacteria that harms digestion or overall health. It might be brought on by a bad diet, a stressful lifestyle, an infection or a food allergy or sensitivity. Common gut symptoms of dysbiosis include bloating, excess gas, constipation and diarrhea.
The Swift Diet is the fruit of my work at three landmark centers of health and wellness in the Berkshires foothills of western Massachusetts. First, as the former director of nutrition at the famous Canyon Ranch health resort, then at my friend and colleague Dr. Mark Hyman’s UltraWellness Center and more recently at the Kripalu Center for Yoga and Health, I’ve refined an approach that emphasizes delicious whole foods. It’s “flexitarian,” mostly veggies with both plant and lean animal protein and a limited amount of whole grains, fruit and anti-inflammatory fats and oils. Over and over again, I’ve seen a laundry list of debilitating symptoms cleared up—bloated bellies, constipated bellies, joint pain, troublesome skin—and my clients lose the weight. Weight gain and weight loss are influenced by a number of factors—all of which I’ll discuss in this book—but what I’ve learned, and what I incorporate into the Swift Diet, is that when we eat to heal the gut, and we make some basic gut-friendly lifestyle and stress-reduction adjustments, we address virtually all of them. The road to healing runs through the gut. Heal the gut, lose the weight—that’s been my experience and my credo for a long time. Only now, thanks to the research biologists, we have the scientific insights that allow us to better understand what’s going on at the microscopic level.
The Microbiome Revolution
The scientific world has undergone a revolution in the way it understands the gastrointestinal tract, specifically the role played by the bacteria that live there. They’re called either the “microbiome,” referring to their total package of genes, or the “microbiota” (in plain English, “small life”), referring to the organisms themselves. We’ve known for about twenty years that the bacteria living in our colon break down the fiber that we get from plant sources—vegetables, fruits, legumes, nuts, seeds—which would otherwise be indigestible. What we’ve only just recently appreciated is that if the microbiota are not being properly attended to—if they’re not being fed enough plant fiber or if they’re being indiscriminately wiped out by the overuse of antibiotics or if they’re damaged over time by excessive amounts of stress hormones—a Pandora’s box of bad things gets opened up. Weight, digestion and the workings of the immune system can go haywire.
One of the nation’s most eminent microbiologists, Dr. Martin Blaser, believes that the nation’s damaged microbiota is likely a major factor driving the rise of obesity and autoimmune disorders over the past several decades, and his lab at New York University is hard at work amassing the experimental evidence to prove the hypothesis. Just this year, he’s laid out his case to a general audience in his Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues.
In the past few years, the research has moved from cells under the microscope and mouse studies to real-live humans struggling with their weight. In a landmark 2013 study published in the prestigious journal Nature, a French team tracked two groups of subjects, 169 obese people and 123 leans ones.
The lean group, it turned out, had more bacteria at work in their guts and more different strains than their heavier counterparts. They were less likely to gain weight over the nine years of the study and less likely to develop the most common chronic diseases, such as heart disease and type 2 diabetes. Well, you might say, the lean group was just born lucky. But in a second study published in the same issue of Nature by some of the same researchers, 49 subjects who were overweight were put on a lower-calorie, higher-fiber diet for six weeks. “We really wanted to have this fiber enrichment so the study subjects ate a good amount of vegetables and fruits,” says Professor Karine Clément, one of the study coauthors and the director of ICAN, the Institute of Cardiometabolism and Nutrition in Paris.
Not only did the participants lose weight, but the community of bacteria in their guts became richer and more diverse; in other words, it more closely resembled the bacteria in the people who were naturally lean. Their metabolism and digestion had shifted to support their weight-loss efforts.
Think about that. We all know that some people seem more prone to gaining weight than others. (Believe me, I know. I struggled with my weight for years, and even now I still have to be conscious of how and what I eat to maintain my comfort weight zone.) And we’ve learned that our genetic inheritance plays a role here—over fifty genes have been identified that are associated with obesity. All of which sounds depressing—we can’t change our genes, so if we’ve been dealt a bad genetic hand, we’re simply out of luck. What the revolution in microbiology is telling us is that we can change the genes in our microbiome, and that will have an enormous effect on how we look and feel. Because the life cycle of single-celled bacteria is fantastically speeded up compared to the human one, making some straightforward adjustments to your diet and lifestyle will cause the helpful bacteria to increase in number and diversity, and the harmful ones to recede, in a very short period of time. (The biologists call this “exerting selective evolutionary pressure.”)
While upgrading diet and lifestyle choices will always be the surest, most sustainable way to lose weight, there looks to be another way of leveraging the power of the microbiome, this one involving probiotics. Probiotics are friendly bacteria from the outside world that we consume, either in the form of fermented foods (we’ll get to that in Chapter 4) or supplements (in Chapter 5). In a study published in December 2013 in the British Journal of Nutrition, Canadian researchers first put 150 overweight men and women on a diet and then on a weight-maintenance program. Half the study subjects also took two daily probiotic capsules of a bacterial strain similar to one found in yogurt; half did not. The women (but not the men) taking the probiotics lost considerably more weight than their counterparts who didn’t, 9.7 pounds compared to 5.7 pounds. The women on the probiotics continued to lose weight during the maintenance phase, for a total weight loss that was twice as much as that of the other women. These are early days in trying to figure how to engineer probiotics to reliably get these kinds of effects, but the potential, for women anyway, is breathtaking!
The 4-week Swift Plan
The Canadian researchers got those results with a 12-week diet and 12-week maintenance phase. The French researchers measured important changes in the gut bacteria after a 6-week diet. In my clinical experience, I’ve found that four weeks is plenty of time to reap the initial benefits of eating and living in tune with your gut. And so, in the coming chapters, I’ll take you through the principles of a microbiotically aligned diet and lifestyle, then guide you through the 4-week Swift Plan, the template for a healthy and pleasurable lifetime journey.
And no matter how sophisticated the underlying biology, the diet guidelines couldn’t be simpler: take out the fattening and toxic foods in your diet that wreak havoc on your microbiota and put in the delicious, nutritious foods that support it. The path has got to be simple when you intend to stay on it forever. That’s why the current vogue for complicated multiphase diets has never made any sense to me. I’d say that about 90 percent of the women I see in my practice are refugees from these diets.
But they’re undaunted. They’re willing to commit one more time. By the time they, and the readers of The Swift Diet, have completed the 4-week Plan, they will have learned how to tune in to their own “nutritional wisdom.” Was the food they ate today mostly whole foods (veggies, fruits, beans, nuts, fish and lean animal protein), with little or no processed foods? Did most of it come from plants, not animals? Were the fruits and vegetables “color-coded,” that is, did they come in a range of colors? Did the dishes they prepare have tasty and health-protecting herbs and spices? Did they have a fermented food dish? (More on all of this in Chapter 4.)
What happens when you embrace this approach? Let me briefly run down the list. Weight loss—yes. How much and how fast will depend on your unique metabolism and where you begin the journey—your current weight and your eating and exercise (or lack thereof) habits. I’ve worked with clients who’ve lost fifteen pounds in four weeks and those who’ve lost five pounds. I honor both because each person is metabolically unique and I know they’ll reach their goals at their own pace. How about the bloat? The excess fluid that your system is carrying, especially around the waist, shrinks or disappears. Those annoying and sometimes absolutely enervating symptoms of digestive upset subside. Energy and mood lift. Those seemingly uncontrollable food cravings, especially for the sweet stuff, become manageable or sometimes barely noticeable. Skin clears up. Muscle and joint aches and pains subside. I’ve seen it all, on a regular basis, and not only in my private nutrition clients who commit to the four weeks. Over the past seven years, I’ve developed and led workshops on digestive health, detoxification and “integrative” weight loss at Kripalu in Stockbridge, Massachusetts, the nation’s largest residential yoga and health center. The clients there commit to an “immersion” experience but they’re free to eat and exercise as much or as little as they want. And I’ve seen the kinds of results I’ve just described begin to take hold over the course of a single workshop—that’s five days!
Don’t get me wrong. I’m disturbed by inflated or frankly bogus health or weight-loss claims (or, as I like to call it, “cure-isma”). I’m a research maven. When I’m not working with clients, I’m likely to be surfing academic journals, tracking the latest research online. For more than a decade, I’ve organized an annual Food As Medicine conference, which brings together doctors, nutritionists and other health care professionals from all over the country to discuss and disseminate the latest nutritional breakthroughs. But as strongly as I’m committed to what’s called “evidence-based medicine,” I also recognize that there is such a thing as “practice-based evidence.” Another way of putting it is “clinical wisdom.”
The beauty of the Swift Diet is that the white-coat lab research perfectly dovetails with the results I get with my clients. It’s a “diet,” not in the sense of temporary calorie deprivation (the “white-knuckle” approach usually just leads to yo-yo weight loss and regain), but in the sense of aligning the way you eat and live with how your gut actually functions. And it’s “Swift” because, well, that’s my name and, more fundamentally, because the microbiota respond so swiftly to positive changes in diet and lifestyle, wasting no time delivering those benefits in weight, digestive health and overall well-being. Those bacteria do move incredibly quickly. In another 2014 Nature study, the composition of the gut microbiome changed dramatically within four days of the subjects switching from all-animal-products diet to a vegetarian one, and vice versa.
Do Calories Count?
Before I introduce you to my five-step MENDS program that is, forgive the expression, the guts of the Swift Diet and this book, let me clear up a fundamental confusion about diet and weight loss. Especially if you’re a veteran of calorie-counting diets in the past, you may be asking, “Kathie, are you saying that as long as I’m eating the right kind of gut-friendly foods, I can eat as much as I want, that calories don’t matter?” It’s a big question. On one side, you have experts, especially coming from the alternative medicine world, who are now saying exactly that, that it’s all about the quality of the calories and how they interact with the microbiome, indeed with all of the genes in our body, bacterial and human. The quantity of calories is no big deal. On the other side, a lot of mainstream doctors and nutritionists still hold to the traditional view that weight gain and loss are simply a numbers game, so-called calories in/calories out. Consume more calories than you burn, through physical activity and just being alive, and the excess gets stored as fat. The inevitable prescription: “Eat less, exercise more.”
Guess what? It’s both—both the quality and the quantity of the calories you eat count. But I’ll go further than that. The number of calories and the nutritional value of those calories are, in a practical sense, two ways of looking at the same thing. The vegetables that constitute the bulk of the Swift Diet are low in calories, so you don’t have to count calories when you follow my meal plans and recipes. Caloric restriction is built into the ingredients and portion sizes, as is the nourishment, for you and your microbiome! The single element that glues together these two conceptions of food is fiber. The Swift Diet is “holistic,” integrating all of the important aspects of weight loss and digestive health, including lifestyle and stress-reducing mind-body exercises. I like to say, healthy weight loss is about learning to better digest your life. But if you had to pin me down on the single most important nutritional element, it would be dietary fiber.
When we consume plant-based foods, the fiber in these foods is high-volume—it helps trigger a feeling of fullness, or satiety, simply by taking up more room in our stomachs. The bacteria that break down the fiber in the gut produce a compound, acetate, that sends the brain a similar fullness message. As well, fiber slows down the process of digestion. That means, the body breaks down the carbohydrates into fuel that it can use, glucose, more slowly. When our blood sugar levels are more stable, our bodies don’t have to produce as much of the hormone insulin to escort the glucose into our muscle and liver cells. The net result: we stay full longer and avoid those spikes in blood sugar and insulin that cause “boom-bust” hunger—we eat a high-carb meal and then a big shot of insulin rapidly clears the sugar so one minute we’re full and the next we’re hungry. Put another way, the quality of the calories helps us limit the quantity.
When a client tells me after a few days on the program, “I can’t believe it, Kathie; I’m not hungry anymore!” I know a fundamental metabolic shift has taken place. The fiber is doing its job: directly, by promoting fullness, and indirectly, by replacing a lot of the quick-digesting carbs and simple sugars that overstimulate insulin production and promote weight gain. Over time, chronic overproduction of insulin leads to insulin resistance—the pancreas makes more and more insulin and the muscle and liver cells pay less and less attention to it—which leads to more weight gain and, ultimately, to type 2 diabetes. In some people, these sugar-rush carbs activate pleasure circuits in the brain that invite food addiction. (I’ll talk more about that in Chapter 3.)
Under the Microscope
But there’s another dimension to the fiber story, and that returns us to the scientific frontier of the microbiome. Let’s go under the microscope. For starters, the single-cell bacteria in our bodies outnumber our human cells more than 10 to 1, leading some biologists to suggest that we’re not really human at all, not exactly, but rather a superorganism, a collection of species that add up to a communal whole. (You could think of your body as a coral reef!) Nowhere are the bacteria more numerous or more important than in the gut, congregated mostly in the last station in the digestive tract, the colon or large intestine.
The dietary fiber we consume in vegetables, fruits, legumes, nuts and seeds can’t be digested by our own human cells. In the colon, the bacteria break it down for their own energy needs via fermentation, similar to the way bacteria ferment milk into yogurt. It’s a bargain for both parties—we give the bacteria a place to live and a free lunch, and they in return create the friendly fermentation by-products that actually feed the cells of our colon and keep it healthy. They also produce important vitamins like B12, biotin and vitamin K.
What happens if we don’t feed the colon with a fiber-rich whole-foods diet? The good bacteria that feed on fiber—the bifidobacteria and the lactobacilli, to name two—decline in number and get pushed aside by potentially nasty, opportunistic bugs, unfriendly bacteria and often yeast and parasites, which can team up to cause those distressing digestive symptoms. And with fewer good bacteria handling fermentation duties, fewer by-products are being created to feed the cells that line the wall of the colon. The wall that separates the gut from the rest of the body grows porous over time, allowing bits and pieces of harmful microorganisms to leak into the bloodstream. We call this “increased intestinal permeability” or “leaky gut syndrome” and it can trigger low-grade inflammation throughout the system, leading to insulin resistance, which means that extra calories get more readily stored as fat, driving weight gain.
What are the consequences of adding these pounds, mostly “visceral fat” that smothers our internal organs and pushes out the belly? The now larger, and possibly more numerous, fat cells send out inflammatory hormones into the bloodstream that drive more weight gain. (Biologists now regard our adipose tissue as the largest endocrine, that is, hormone-producing, gland in the body.) And the extra weight further unsettles the gut. Overweight people seem more likely to carry the bacterial species that are linked with leaky gut. (It wasn’t a surprise when the French researchers found that lean and overweight people had very different-looking microbiomes.) So this is a vicious circle if there ever was one! I call it Irritable Weight. One of the world’s leading microbiome scientists, Patrice Cani, at the Université Catholique de Louvain in Belgium, calls it “MicroObesity.”
Researchers like Cani filled in a crucial part of the weight gain/weight loss puzzle. In the past, everyone locked into the idea that it was all about burning more calories. We had to keep the “fire” of metabolism burning brightly! Well, “calories out” is an important consideration—exercise, for instance, which I’ll discuss in Chapter 6. But in my opinion, getting too caught up with “revving up the metabolism” has led to gimmicks like “belly-blasting” potions and creams, most of which are of dubious value, and “metabolic-boosting” supplements, some of which can be downright unsafe. Now, thanks to the microbiome scientists, we can appreciate that just as important as raising the fire of metabolism is lowering the fire of inflammation that affects the hormones, insulin first among them, that control how many of the calories we take in get burned for energy and how many get stored as fat.
Your Immune System: Good Gut Gone Wrong?
There’s another important way that food impacts the gut bacteria, upsets digestion and can lead to weight gain. That’s via the immune system and that’s a story unto itself.
About 70 percent of the activity of the immune system takes place in the gut. The microbiome plays a crucial role, “tuning” the human immune system to distinguish friend from foe. Why would nature outsource such a big job, helping the body defend itself against external threat, to roughly one hundred trillion resident bacteria who aren’t even remotely human? As with real estate (and we’re dealing with digestive real estate here), the answer is, “Location, location, location.” The digestive tract is the body’s primary entry point for the outside world, in the form of food, with its collection of foreign proteins and germs, good, bad and indifferent. So that’s where our “bugs” are: the gut contains somewhere between five hundred and one thousand different strains of bacteria that make up our microbiota. You can think of the entire digestive tract, from the mouth to the stomach to the small intestine to the large intestine or colon to the anus, as a single thirty-feet tube designed to bring the outside world into us, right through the very center of us. In this way, we can extract the nutrition we need under reasonably safe and controlled conditions, with all of the digesting, absorbing and, finally, excreting taking place in connecting chambers walled off from the rest of the body by a mucous lining. And our resident bacteria, because they are so numerous and they turn over so quickly—a population of gut bacteria can double their numbers in about twenty minutes—are uniquely well suited to form the immune system’s rapid response team.
And sometimes things go wrong. Sometimes the human immune system, ill-served by a microbiome that’s lacking in number and diversity, overreacts, which is what happens to people with a gluten sensitivity. The body treats one of the proteins in gluten like a foreign invader and mounts an inflammatory response. The upset is often felt in the gut, but because the gut and the brain are constantly sending chemical messages back and forth, symptoms like fatigue, “brain fog” and anxiety are common as well. The more unhappy and out-of-balance the gut bacteria—dysbiosis is the technical term—the more likely you’ll suffer from these sometimes disabling food intolerances.
If you follow the major health stories in the media over the past few years, you know that, increasingly, inflammation is suspected as being a villain behind the most serious “diseases of aging”: heart disease, type 2 diabetes, Alzheimer’s and even cancer. It’s paradoxical. Inflammation is the body’s effort to respond to injury or infection by cordoning off the area and sending in specialized cells to clean up the damage. We couldn’t survive without this biological response. However, while the body is quick to call out the troops, it’s often not so good at calling them back. Considering how bound up the gut bacteria are in so many areas of our health, and the inflammatory processes that undermine them, some researchers are beginning to wonder whether, as the influential food writer Michael Pollan framed it in a New York Times Magazine cover story, “medical science may be on the trail of a Grand Unified Theory of Chronic Disease, at the very heart of which we will find the gut microbiome.” The tools of microbiology and genomic sequencing seem to have brought us back to a place that the ancients might recognize. To the Indian sages who centuries ago codified Ayurveda, the Indian philosophy of medicine, agni, “the digestive fire,” was the all-important measure of health. Hippocrates, the Greek father of Western medicine, famously said, “Let food be thy medicine, thy medicine shall be thy food.”
Kathie’s Story
These aren’t just clinical or philosophical issues with me. I’ve lived it. When it comes to the microbiota and gut/weight health, you could say I was born with three strikes against me. I was a Caesarean preemie, bottle-fed and, as a sickly little kid, I spent a good chunk of my early years on antibiotics.
We don’t come into the world with a developed microbiota, far from it. We live largely germ-free in the womb and then we acquire a bacterial starter kit as we pass through the birth canal when we’re born, the basis for our gut’s immune system. Then, as babies, if we’re lucky, we consume breast milk. It’s the perfect infant food to nourish the microbiota that will be needed when that baby grows into a toddler eating solid food.
None of this applied to me, a bottle-fed Caesarean, just as many of you will have missed out on the advantages of being breast-fed or being brought into this world via vaginal delivery, the best inoculation possible for a healthy start in life. Adding insult to injury were the medications I was prescribed for my problematic digestion, the antacids and the proton pump inhibitors (PPIs) that actually interfered with normal gut function. Worse still, the multiple courses of antibiotics I was given in my early years further depleted my gut bacteria, which probably contributed to the health issues I always seemed to be struggling with as a child: chronic ear infections, headaches and a very irritable bowel.
Work by microbiome pioneers like Dr. Blaser and anthropologist Jeff Leach, the cofounder of the American Gut Project, has established that the overuse of antibiotics—by some expert estimates, half of the antibiotics we consume are unnecessary or useless—is one of the prime causes of the depletion of the helpful bacteria in the American gut. Leach likens it to bombing your backyard with toxic chemicals: “You spray everything and it’s the invading, opportunistic species that come back first.” Dr. Blaser is currently doing research studying how a human microbiome, deprived of certain bacteria by antibiotics or simple lack of exposure to the bugs in the natural world, can throw off the communication between the gut and the hormones that regulate hunger. Some of us may be overeating because our brain isn’t getting the message that we’re full!
In any event, I survived my childhood. I was always outdoors, fairly athletic and I enjoyed OK health until I hit my early thirties when, as a busy wife and mother of two young children, I battled chronic fatigue syndrome. My husband, Dan, was at the time a U.S. Air Force pilot and when he was transferred to an air base in southern England, we were excited to be having a family adventure. The day before we left for the UK, I got hit by some sort of stomach bug and after that passed, I was laid low by an exhaustion that just wouldn’t lift. I’d want so desperately to go on a bike ride with the kids that I would make myself do it and then wind up back in bed, totally wiped out. And since I couldn’t exercise, my weight began to steadily creep up.
The military doctors diagnosed me with an autoimmune disease and wanted to send me back to the States for more advanced tests, but I was determined to figure things out for myself. It turned out the major culprit was all of the wheat-based foods I was eating, specifically the gluten protein that’s in many grains and most definitely in the muesli I ate every morning with the kids, the whole-wheat sandwich I ate for lunch, the pasta I cooked for the family at dinner. It certainly was in those delicious scones that seemed to be everywhere I turned. I was feeding a sensitivity to gluten that in all likelihood was triggered by that stomach bug. Today, researchers understand that a bout of bacterial food poisoning or a stomach virus will often trigger a latent food sensitivity. But this was the eighties and almost no one had ever heard of gluten sensitivities. Eventually, with the help of intellectual mentors like Dr. Jeffrey Bland, the biochemist father of the “functional medicine” movement in the United States, I slowly figured things out. In a strange way, those early struggles were a gift. I have spent a career searching for—and then finding and developing—solutions for people burdened with weight and digestive problems.
In 1991, when my family and I moved to the Berkshires, the northwestern corner of Massachusetts, I became the director of nutrition at Canyon Ranch, the famous Tucson resort that had opened a new, luxurious spa in the town of Lenox. At the Ranch, I learned and then taught the importance of a whole life—including natural weight loss as a result of healthy, delicious meals as well as eating, moving and sleeping on a regular schedule.
I believed in the power of the right foods to heal and to manage weight. This was reflected in my own life, as I steadily cut back on the amount of animal protein my family and I ate and increased the amount of vegetables and completely switched over to gluten-free grains. Meals now are moderate portions, high in fiber and loaded with vitamins and minerals. And, unlike many diets that separate the dieter from her family, this way of eating made the whole family healthier and brought us together for delicious meals we all enjoyed. I was able to eat my way back to health and a healthy weight, helped by daily exercise once I had my normal energy back.
When I saw the results in my life and in my clients’ lives, I became unstoppable. I helped persuade the food development team at the Ranch to jettison their signature “60/20/20” formula (that is, carbs, fats, proteins) to embrace something we called “nutritional intelligence.” While everyone’s metabolism is unique, every woman can exercise her nutritional intelligence to lose weight by becoming mindful of portion size and building diets around lower-calorie, fiber-and-nutrient-dense food, especially veggies.
I formed a kind of “brain trust” with the medical directors at Canyon Ranch, health pioneers and authors Dr. Mark Liponis and Dr. Mark Hyman. Our medical/nutritional team spearheaded an “ultra-preventative” approach to health and vitality that was ahead of its time. Years later, when Dr. Hyman started up his own clinic in Lenox, the UltraWellness Center, I followed as the head of the nutrition department. We embraced a “food is medicine” philosophy, fine-tuning meal plans to help heal a range of health problems, like type 2 diabetes and IBS, with which conventional medicine had had little success.
While I continue to work with Mark at the UltraWellness Center, for the past six years I’ve devoted most of my time, outside my own private nutritional practice, to the workshops I lead at the Kripalu Center and around the country. It’s a two-way street. I teach my students about the microbiome and how they can leverage it to reach their healthy-living goals. And, in turn, I’m routinely blown away by the transformations I’ve seen in them that can take place in a few short days, how mind-body practices like yoga and qigong can calm their stress levels and strengthen their resolve. I strongly believe, and a raft of studies backs me up, that these movement therapies are a kind of invitation to my students to enter into a different relationship with their bodies. A body in need of balance needn’t be the enemy but more like a dear old friend—accepted and capable of surprising you in positive ways. Compassion and nonjudgment are such beautiful antidotes to the self-blame that so often undercuts the commitment to healthy weight.
In addition to my workshops, I do nutritional consulting for a local financial company in the Berkshires. Currently, the small group of women I’m working with there have formed their own weight and lifestyle-reboot group. These are overweight middle-aged women who work hard at their office jobs to help support their families. They’ve embraced the whole foods, mostly plant-based diet, and I’ve got them doing a modicum of exercise and a few basic qigong practices, which they love. As of this writing, they have been on the program for eight months and between them they’ve lost more than one hundred pounds. They feel fantastic. And so do I. I eat and exercise and make use of stress-reducing techniques the same way my clients do, the same way I trust my readers will. And at sixty, this is the best I’ve ever felt in my entire life. I feel blessed to have grown into this knowledge about the healing power of food and for the chance to share it with others.
The MENDS Approach
I’ve integrated my clinical and my personal experiences with the latest microbiome research to create MENDS, the five-step program that is the backbone of the Swift Diet. There is nothing here that is intrinsically difficult or complex. But we all recognize that changing old habits can feel daunting—“Where do I begin? What do I have to change first?” With that in mind, I’m devoting one chapter, Chapter 7, to a 4-week Swift Plan that takes readers by the hand into this new world of delicious whole foods, day by day, meal by meal. The message here couldn’t be more empowering. With some straightforward modifications to the way we eat, and some smart lifestyle tweaks, we can change the composition of the microbial community inside us. Beginning that first month, MENDS and the Swift Diet will pay out weight and health dividends over the course of your entire life.
M—Mind Your Digestion
Digestion actually begins in the mind. That is why I start my program here. The hungry brain sends out messages to orchestrate the production of enzymes and acids that the body will use to process the food. Our GI (gastrointestinal) tract is packed with neurotransmitters like serotonin and dopamine—“the second brain.” Too much stress can upset the balance of bacteria in our gut, which contributes to the IBS-type problems that many of us are familiar with when we feel like we’re under the gun. And when cortisol, our primary stress hormone, goes into overdrive, that actually promotes fat gain around the middle, the last thing we want. Daily, it seems, researchers are making breakthroughs to unravel the brain-belly connection.
If a stressed-out brain can make life miserable for the belly by upsetting digestion and adding on pounds, the mind can heal the damage and take off the weight. In this first M section of my program, I introduce you to the basics of eating mindfully, including: giving the “cephalic” (from the Greek, “in the head”) digestion system the time it needs to properly digest food without irritation or inflammation; engaging with your body’s inner sense of satiety or fullness; and spacing meals so that the gut has time to cleanse itself and prepare for the next intake of food (no more “grazing” throughout the day!).
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First published by Hudson Street Press, a member of Penguin Group (USA) LLC, 2014
Copyright © 2014 by Kathie Madonna Swift and Joseph Hooper
Foreword copyright © 2014 by Mark Hyman
Illustrations by Donna Mehalko
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FOREWORD
Ten years ago, Kathie Swift, our nurse partner Nina Silver and I holed up in my red-shingled house in western Massachusetts and together became the UltraWellness Center. For those first few months, I was working in my office upstairs, Nina was in the living room and Kathie, as befitting my head of nutrition, was in the dining room, just off the kitchen. Today, the functional medicine center that Kathie, Nina and I built employs a staff of thirty working out of a well-equipped building set against the Berkshires woods. Kathie, of course, played an important role in that growth and success. In fact it was she who first pointed me toward what we now call functional medicine, an approach that seeks to uncover the root causes of disease, always with the emphasis on healthy diet and lifestyle.
When we were both working at the Canyon Ranch spa in the Berkshires in the nineties, Kathie introduced cutting-edge nutritional medicine concepts to the doctors and nutritionists there. And she introduced me to Dr. Jeffrey Bland, the father of functional medicine, who became a mentor to so many of us. At Canyon Ranch, where I was co–medical director and Kathie the nutrition director, we were able develop and apply these functional medicine ideas in a clinical setting. Although I was that rare doctor who had actually studied nutrition in a serious way, it was Kathie who really taught me to think rigorously about the role of nutrition in health. In contrast to the “pill for every ill” mentality that almost every doctor absorbs in medical training, with Kathie’s help I came to see how food itself could be powerful medicine with which to treat and actually reverse disease. She was so open and enthusiastic about partnering with me at the Ranch, and together we refined an approach that was effective for thousands of clients there. When I left Canyon Ranch, to build the UltraWellness Center, she was the first person I called to join me. Since then, she’s helped me with several of my books, including UltraMetabolism, to which she contributed the recipes. (As you’ll see in The Swift Diet, Kathie is an accomplished and creative home cook.)
It’s no accident that Kathie and I share this quest to push beyond conventional medical wisdom. We both had to figure out how to heal ourselves before we could fully help our patients. I’ve written about my struggle with chronic fatigue and mercury poisoning in a number of my books. Here in The Swift Diet, Kathie opens up for the first time about her battle with chronic fatigue syndrome brought on by an undiagnosed sensitivity to gluten. Her success in healing herself with a high-fiber, mostly plant-based diet fuels her passion to find the right answers for clients and readers with gut and weight issues. And she never stops. She has the ability to synthesize enormous amounts of data in order to connect the dots, to create meaning where there was none. In The Swift Diet she draws on the latest research on the role of gut bacteria to distill a practical step-by-step guide to health and healthy weight loss.
I think the microbiome is an enormously important emerging story. We’re seeing that the bacteria that live in the gut help regulate the interlocking systems in the body, including the immune system and insulin metabolism. I’ve seen it in the research literature and I’ve seen it in clinical practice: different diets can have different effects on weight, even though they may contain the same number of calories, because of how they affect the gut bacteria. Kathie has been at the forefront of this field, giving talks around the country to general audiences and to her professional peers. She’s been the driving force behind the Dietitians in Integrative and Functional Medicine within the Academy of Nutrition and Dietetics, she’s a founding member of the Institute for Functional Medicine’s nutrition advisory board and, for the past decade, she’s organized an influential annual conference on health and nutrition, Food As Medicine, sponsored by the Center for Mind-Body Medicine in Washington, DC, where I’ve been honored to serve on the faculty and board of directors. Kathie has become something close to a one-woman bridge between the worlds of functional medicine and mainstream nutrition.
She’s also adept at making the connection between body and spirit. Over the past seven years, as she’s developed and led workshops on weight loss, digestion and detox at the Kripalu Center in the Berkshires, she’s integrated mind-body techniques into her nutrition work, addressing the stress piece of the health and weight-loss puzzle. Just as I started out my career as a yoga instructor, Kathie is now a certified qigong teacher!
My friend and colleague Kathie Swift is one of the leading innovators in nutrition in this country. She has devoted her life to discovering how we can heal ourselves through food, and she’s inspired a host of others to do the same. If you’ve bought The Swift Diet, you’re about to join that select but growing group.
—Mark Hyman, MD
Chapter 1
SCIENCE, WISDOM AND STORY
SELF-INQUIRY BOX
1. Have you noticed that when you’re having digestive problems, it’s difficult to manage your weight? That there is a connection between “Irritable Bowel” and “Irritable Weight”?
2. Have you noticed that a week of high stress can have a similar effect on your belly as a course of antibiotics? That both can seem to throw your entire digestive system off?
3. Have you noticed that when you’re eating more vegetables and fruits, and less meat and processed foods, you feel lighter and more energetic?
If you’ve picked up this book, there’s an excellent chance that you’re frustrated with your weight. Maybe you’re carrying around an extra ten or twenty or fifty pounds that you can’t seem to keep off. Odds are you’ve gone on diets before and you may have had success, for a while, but you couldn’t handle the feeling of deprivation, of being hungry over the long haul, and the unwanted weight came back. Or the diet was one of those complicated multiphase productions and after a while you lost the patience or the will to precisely track your calorie intake or the ratio of carbs/fats/protein you were supposed to be eating in any given week.
But there’s an easier and a better way. It happens to be supported by what has become very possibly the most significant and compelling scientific story to unfold in this century—the impact of the bacteria that live in our gut on most every facet of our lives: our weight, our digestive health, our immune system response, our emotions, virtually every aspect of our being. For instance, these gut bacteria can produce toxins that leak into the bloodstream, creating a system-wide inflammation that pushes the body to store calories as fat rather than burning them as energy, and it can drive food cravings. (Researchers now recognize this “metabolic endotoxemia,” literally a poisoning from within, as a likely under-the-radar driver of obesity in this country.) Amazingly, these same bacteria can influence the production of gut hormones that speak directly to the brain, signaling either fullness or hunger. The good news is that by paying attention to what you eat and how you live—chronic stress causes major dysfunction in the gut—you can exert control over the process. Take care of your gut bacteria and they’ll take care of you!
But we’re getting ahead of ourselves. Let’s return to weight gain, which for many women is the most distressing sign that all is not right with the belly and the body.
The Belly Blues
The weight of the average American woman has gone up twenty pounds since the early seventies. Today, 33 percent of American adults are considered overweight (a body mass index of 25 to 30) and 35 percent obese (a BMI over 30). Over the past twenty years, the obese group has increased in number by 60 percent, giving us a new label, the “obesity epidemic,” and fears about crushing rates of heart disease and type 2 diabetes in the future. What hasn’t been talked about as much is that during this same period of time, the nation has experienced a second epidemic, one that has been taking place, out of sight, but not out of mind, in the bellies of American women.
Consider: While men and women have suffered that weight gain in roughly equal measure, women are twice as likely as men to have the chronic, low-grade digestive complaints that get lumped together as irritable bowel syndrome, affecting an estimated 30 percent of American women. Digestive problems are compounded by food allergies and sensitivities, especially to the family of proteins found in gluten-containing grains like wheat, rye and barley. Conservatively estimated, 1 percent of the American population is afflicted with celiac disease, a severe intolerance to gluten. Six times that number have a less severe sensitivity to gluten, which can still result in serious digestive problems as well as all-over fatigue and depression. (Again, a conservative estimate. I, and many nutritionists, find that many of our female clients feel better without gluten.) And it doesn’t stop there. Clinical evidence is piling up that huge swaths of the population are suffering from gut-disturbing, and likely weight-frustrating, sensitivities to common dietary elements like lactose in dairy products, fructose in high-fructose corn syrup and related compounds found in some legumes and vegetables.
The belly of the American woman has become the proverbial canary in the coal mine. It’s letting us know that something has gone very wrong.
As a clinical nutritionist, over the past three decades I’ve worked with thousands of clients, mostly women, to effectively manage both their weight and their digestive issues. But it wasn’t until 2011, when I cowrote The Inside Tract: Your Good Gut Guide to Digestive Health with Johns Hopkins gastroenterologist Gerard Mullin, that the connection between digestion and healthy weight became crystal clear to me. That book brought a parade of women with digestive issues to my private nutrition practice, most of whom had been trying unsuccessfully for years to drop those stubborn pounds. Sometimes it was the unruly gut that was their biggest complaint, typically, a not-so-merry-go-round of constipation, diarrhea, gas, and bloating given the all-purpose label of irritable bowel syndrome. (You can take an IBS self-diagnosis test offered by the American College of Gastroenterology at http://gi.org/acg-institute/ibs-test/.) Sometimes it was just the weight. What was staring me in the face was that Irritable Bowel and what I now call Irritable Weight were usually two faces of the same underlying problem. With some of these clients, I’m working to overcome a serious chronic condition. But for most of them, and for probably the majority of people reading this book, the digestive symptoms come and go. They’re a hassle, to be sure, but they’re also telling us, screaming at us sometimes, that the body is not being properly nourished by the right foods in the right ways. Your digestion and your weight are coconspirators, chipping away at your wellness.
SWIFT DIET DICTIONARY
Microbiome: The total collection of genes belonging to the bacteria that live inside our bodies and on our skin. These single-cell bacteria are at least ten times as numerous as human cells and most of them reside in the human gut.
Microbiota: The name given to the population of bacteria that live in the human gut, mostly in the colon or large intestine. In the past twenty or so years, we’ve discovered that the microbiota plays a major role in digestion, gut health and overall health, including weight control.
Gut Flora or Microflora: Same meaning as “microbiota” above. In the outside world, “flora” refers to plant life. Inside our gut, it refers to our resident gut bacteria.
Dysbiosis: A change in the composition of the gut bacteria that harms digestion or overall health. It might be brought on by a bad diet, a stressful lifestyle, an infection or a food allergy or sensitivity. Common gut symptoms of dysbiosis include bloating, excess gas, constipation and diarrhea.
The Swift Diet is the fruit of my work at three landmark centers of health and wellness in the Berkshires foothills of western Massachusetts. First, as the former director of nutrition at the famous Canyon Ranch health resort, then at my friend and colleague Dr. Mark Hyman’s UltraWellness Center and more recently at the Kripalu Center for Yoga and Health, I’ve refined an approach that emphasizes delicious whole foods. It’s “flexitarian,” mostly veggies with both plant and lean animal protein and a limited amount of whole grains, fruit and anti-inflammatory fats and oils. Over and over again, I’ve seen a laundry list of debilitating symptoms cleared up—bloated bellies, constipated bellies, joint pain, troublesome skin—and my clients lose the weight. Weight gain and weight loss are influenced by a number of factors—all of which I’ll discuss in this book—but what I’ve learned, and what I incorporate into the Swift Diet, is that when we eat to heal the gut, and we make some basic gut-friendly lifestyle and stress-reduction adjustments, we address virtually all of them. The road to healing runs through the gut. Heal the gut, lose the weight—that’s been my experience and my credo for a long time. Only now, thanks to the research biologists, we have the scientific insights that allow us to better understand what’s going on at the microscopic level.
The Microbiome Revolution
The scientific world has undergone a revolution in the way it understands the gastrointestinal tract, specifically the role played by the bacteria that live there. They’re called either the “microbiome,” referring to their total package of genes, or the “microbiota” (in plain English, “small life”), referring to the organisms themselves. We’ve known for about twenty years that the bacteria living in our colon break down the fiber that we get from plant sources—vegetables, fruits, legumes, nuts, seeds—which would otherwise be indigestible. What we’ve only just recently appreciated is that if the microbiota are not being properly attended to—if they’re not being fed enough plant fiber or if they’re being indiscriminately wiped out by the overuse of antibiotics or if they’re damaged over time by excessive amounts of stress hormones—a Pandora’s box of bad things gets opened up. Weight, digestion and the workings of the immune system can go haywire.
One of the nation’s most eminent microbiologists, Dr. Martin Blaser, believes that the nation’s damaged microbiota is likely a major factor driving the rise of obesity and autoimmune disorders over the past several decades, and his lab at New York University is hard at work amassing the experimental evidence to prove the hypothesis. Just this year, he’s laid out his case to a general audience in his Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues.
In the past few years, the research has moved from cells under the microscope and mouse studies to real-live humans struggling with their weight. In a landmark 2013 study published in the prestigious journal Nature, a French team tracked two groups of subjects, 169 obese people and 123 leans ones.
The lean group, it turned out, had more bacteria at work in their guts and more different strains than their heavier counterparts. They were less likely to gain weight over the nine years of the study and less likely to develop the most common chronic diseases, such as heart disease and type 2 diabetes. Well, you might say, the lean group was just born lucky. But in a second study published in the same issue of Nature by some of the same researchers, 49 subjects who were overweight were put on a lower-calorie, higher-fiber diet for six weeks. “We really wanted to have this fiber enrichment so the study subjects ate a good amount of vegetables and fruits,” says Professor Karine Clément, one of the study coauthors and the director of ICAN, the Institute of Cardiometabolism and Nutrition in Paris.
Not only did the participants lose weight, but the community of bacteria in their guts became richer and more diverse; in other words, it more closely resembled the bacteria in the people who were naturally lean. Their metabolism and digestion had shifted to support their weight-loss efforts.
Think about that. We all know that some people seem more prone to gaining weight than others. (Believe me, I know. I struggled with my weight for years, and even now I still have to be conscious of how and what I eat to maintain my comfort weight zone.) And we’ve learned that our genetic inheritance plays a role here—over fifty genes have been identified that are associated with obesity. All of which sounds depressing—we can’t change our genes, so if we’ve been dealt a bad genetic hand, we’re simply out of luck. What the revolution in microbiology is telling us is that we can change the genes in our microbiome, and that will have an enormous effect on how we look and feel. Because the life cycle of single-celled bacteria is fantastically speeded up compared to the human one, making some straightforward adjustments to your diet and lifestyle will cause the helpful bacteria to increase in number and diversity, and the harmful ones to recede, in a very short period of time. (The biologists call this “exerting selective evolutionary pressure.”)
While upgrading diet and lifestyle choices will always be the surest, most sustainable way to lose weight, there looks to be another way of leveraging the power of the microbiome, this one involving probiotics. Probiotics are friendly bacteria from the outside world that we consume, either in the form of fermented foods (we’ll get to that in Chapter 4) or supplements (in Chapter 5). In a study published in December 2013 in the British Journal of Nutrition, Canadian researchers first put 150 overweight men and women on a diet and then on a weight-maintenance program. Half the study subjects also took two daily probiotic capsules of a bacterial strain similar to one found in yogurt; half did not. The women (but not the men) taking the probiotics lost considerably more weight than their counterparts who didn’t, 9.7 pounds compared to 5.7 pounds. The women on the probiotics continued to lose weight during the maintenance phase, for a total weight loss that was twice as much as that of the other women. These are early days in trying to figure how to engineer probiotics to reliably get these kinds of effects, but the potential, for women anyway, is breathtaking!
The 4-week Swift Plan
The Canadian researchers got those results with a 12-week diet and 12-week maintenance phase. The French researchers measured important changes in the gut bacteria after a 6-week diet. In my clinical experience, I’ve found that four weeks is plenty of time to reap the initial benefits of eating and living in tune with your gut. And so, in the coming chapters, I’ll take you through the principles of a microbiotically aligned diet and lifestyle, then guide you through the 4-week Swift Plan, the template for a healthy and pleasurable lifetime journey.
And no matter how sophisticated the underlying biology, the diet guidelines couldn’t be simpler: take out the fattening and toxic foods in your diet that wreak havoc on your microbiota and put in the delicious, nutritious foods that support it. The path has got to be simple when you intend to stay on it forever. That’s why the current vogue for complicated multiphase diets has never made any sense to me. I’d say that about 90 percent of the women I see in my practice are refugees from these diets.
But they’re undaunted. They’re willing to commit one more time. By the time they, and the readers of The Swift Diet, have completed the 4-week Plan, they will have learned how to tune in to their own “nutritional wisdom.” Was the food they ate today mostly whole foods (veggies, fruits, beans, nuts, fish and lean animal protein), with little or no processed foods? Did most of it come from plants, not animals? Were the fruits and vegetables “color-coded,” that is, did they come in a range of colors? Did the dishes they prepare have tasty and health-protecting herbs and spices? Did they have a fermented food dish? (More on all of this in Chapter 4.)
What happens when you embrace this approach? Let me briefly run down the list. Weight loss—yes. How much and how fast will depend on your unique metabolism and where you begin the journey—your current weight and your eating and exercise (or lack thereof) habits. I’ve worked with clients who’ve lost fifteen pounds in four weeks and those who’ve lost five pounds. I honor both because each person is metabolically unique and I know they’ll reach their goals at their own pace. How about the bloat? The excess fluid that your system is carrying, especially around the waist, shrinks or disappears. Those annoying and sometimes absolutely enervating symptoms of digestive upset subside. Energy and mood lift. Those seemingly uncontrollable food cravings, especially for the sweet stuff, become manageable or sometimes barely noticeable. Skin clears up. Muscle and joint aches and pains subside. I’ve seen it all, on a regular basis, and not only in my private nutrition clients who commit to the four weeks. Over the past seven years, I’ve developed and led workshops on digestive health, detoxification and “integrative” weight loss at Kripalu in Stockbridge, Massachusetts, the nation’s largest residential yoga and health center. The clients there commit to an “immersion” experience but they’re free to eat and exercise as much or as little as they want. And I’ve seen the kinds of results I’ve just described begin to take hold over the course of a single workshop—that’s five days!
Don’t get me wrong. I’m disturbed by inflated or frankly bogus health or weight-loss claims (or, as I like to call it, “cure-isma”). I’m a research maven. When I’m not working with clients, I’m likely to be surfing academic journals, tracking the latest research online. For more than a decade, I’ve organized an annual Food As Medicine conference, which brings together doctors, nutritionists and other health care professionals from all over the country to discuss and disseminate the latest nutritional breakthroughs. But as strongly as I’m committed to what’s called “evidence-based medicine,” I also recognize that there is such a thing as “practice-based evidence.” Another way of putting it is “clinical wisdom.”
The beauty of the Swift Diet is that the white-coat lab research perfectly dovetails with the results I get with my clients. It’s a “diet,” not in the sense of temporary calorie deprivation (the “white-knuckle” approach usually just leads to yo-yo weight loss and regain), but in the sense of aligning the way you eat and live with how your gut actually functions. And it’s “Swift” because, well, that’s my name and, more fundamentally, because the microbiota respond so swiftly to positive changes in diet and lifestyle, wasting no time delivering those benefits in weight, digestive health and overall well-being. Those bacteria do move incredibly quickly. In another 2014 Nature study, the composition of the gut microbiome changed dramatically within four days of the subjects switching from all-animal-products diet to a vegetarian one, and vice versa.
Do Calories Count?
Before I introduce you to my five-step MENDS program that is, forgive the expression, the guts of the Swift Diet and this book, let me clear up a fundamental confusion about diet and weight loss. Especially if you’re a veteran of calorie-counting diets in the past, you may be asking, “Kathie, are you saying that as long as I’m eating the right kind of gut-friendly foods, I can eat as much as I want, that calories don’t matter?” It’s a big question. On one side, you have experts, especially coming from the alternative medicine world, who are now saying exactly that, that it’s all about the quality of the calories and how they interact with the microbiome, indeed with all of the genes in our body, bacterial and human. The quantity of calories is no big deal. On the other side, a lot of mainstream doctors and nutritionists still hold to the traditional view that weight gain and loss are simply a numbers game, so-called calories in/calories out. Consume more calories than you burn, through physical activity and just being alive, and the excess gets stored as fat. The inevitable prescription: “Eat less, exercise more.”
Guess what? It’s both—both the quality and the quantity of the calories you eat count. But I’ll go further than that. The number of calories and the nutritional value of those calories are, in a practical sense, two ways of looking at the same thing. The vegetables that constitute the bulk of the Swift Diet are low in calories, so you don’t have to count calories when you follow my meal plans and recipes. Caloric restriction is built into the ingredients and portion sizes, as is the nourishment, for you and your microbiome! The single element that glues together these two conceptions of food is fiber. The Swift Diet is “holistic,” integrating all of the important aspects of weight loss and digestive health, including lifestyle and stress-reducing mind-body exercises. I like to say, healthy weight loss is about learning to better digest your life. But if you had to pin me down on the single most important nutritional element, it would be dietary fiber.
When we consume plant-based foods, the fiber in these foods is high-volume—it helps trigger a feeling of fullness, or satiety, simply by taking up more room in our stomachs. The bacteria that break down the fiber in the gut produce a compound, acetate, that sends the brain a similar fullness message. As well, fiber slows down the process of digestion. That means, the body breaks down the carbohydrates into fuel that it can use, glucose, more slowly. When our blood sugar levels are more stable, our bodies don’t have to produce as much of the hormone insulin to escort the glucose into our muscle and liver cells. The net result: we stay full longer and avoid those spikes in blood sugar and insulin that cause “boom-bust” hunger—we eat a high-carb meal and then a big shot of insulin rapidly clears the sugar so one minute we’re full and the next we’re hungry. Put another way, the quality of the calories helps us limit the quantity.
When a client tells me after a few days on the program, “I can’t believe it, Kathie; I’m not hungry anymore!” I know a fundamental metabolic shift has taken place. The fiber is doing its job: directly, by promoting fullness, and indirectly, by replacing a lot of the quick-digesting carbs and simple sugars that overstimulate insulin production and promote weight gain. Over time, chronic overproduction of insulin leads to insulin resistance—the pancreas makes more and more insulin and the muscle and liver cells pay less and less attention to it—which leads to more weight gain and, ultimately, to type 2 diabetes. In some people, these sugar-rush carbs activate pleasure circuits in the brain that invite food addiction. (I’ll talk more about that in Chapter 3.)
Under the Microscope
But there’s another dimension to the fiber story, and that returns us to the scientific frontier of the microbiome. Let’s go under the microscope. For starters, the single-cell bacteria in our bodies outnumber our human cells more than 10 to 1, leading some biologists to suggest that we’re not really human at all, not exactly, but rather a superorganism, a collection of species that add up to a communal whole. (You could think of your body as a coral reef!) Nowhere are the bacteria more numerous or more important than in the gut, congregated mostly in the last station in the digestive tract, the colon or large intestine.
The dietary fiber we consume in vegetables, fruits, legumes, nuts and seeds can’t be digested by our own human cells. In the colon, the bacteria break it down for their own energy needs via fermentation, similar to the way bacteria ferment milk into yogurt. It’s a bargain for both parties—we give the bacteria a place to live and a free lunch, and they in return create the friendly fermentation by-products that actually feed the cells of our colon and keep it healthy. They also produce important vitamins like B12, biotin and vitamin K.
What happens if we don’t feed the colon with a fiber-rich whole-foods diet? The good bacteria that feed on fiber—the bifidobacteria and the lactobacilli, to name two—decline in number and get pushed aside by potentially nasty, opportunistic bugs, unfriendly bacteria and often yeast and parasites, which can team up to cause those distressing digestive symptoms. And with fewer good bacteria handling fermentation duties, fewer by-products are being created to feed the cells that line the wall of the colon. The wall that separates the gut from the rest of the body grows porous over time, allowing bits and pieces of harmful microorganisms to leak into the bloodstream. We call this “increased intestinal permeability” or “leaky gut syndrome” and it can trigger low-grade inflammation throughout the system, leading to insulin resistance, which means that extra calories get more readily stored as fat, driving weight gain.
What are the consequences of adding these pounds, mostly “visceral fat” that smothers our internal organs and pushes out the belly? The now larger, and possibly more numerous, fat cells send out inflammatory hormones into the bloodstream that drive more weight gain. (Biologists now regard our adipose tissue as the largest endocrine, that is, hormone-producing, gland in the body.) And the extra weight further unsettles the gut. Overweight people seem more likely to carry the bacterial species that are linked with leaky gut. (It wasn’t a surprise when the French researchers found that lean and overweight people had very different-looking microbiomes.) So this is a vicious circle if there ever was one! I call it Irritable Weight. One of the world’s leading microbiome scientists, Patrice Cani, at the Université Catholique de Louvain in Belgium, calls it “MicroObesity.”
Researchers like Cani filled in a crucial part of the weight gain/weight loss puzzle. In the past, everyone locked into the idea that it was all about burning more calories. We had to keep the “fire” of metabolism burning brightly! Well, “calories out” is an important consideration—exercise, for instance, which I’ll discuss in Chapter 6. But in my opinion, getting too caught up with “revving up the metabolism” has led to gimmicks like “belly-blasting” potions and creams, most of which are of dubious value, and “metabolic-boosting” supplements, some of which can be downright unsafe. Now, thanks to the microbiome scientists, we can appreciate that just as important as raising the fire of metabolism is lowering the fire of inflammation that affects the hormones, insulin first among them, that control how many of the calories we take in get burned for energy and how many get stored as fat.
Your Immune System: Good Gut Gone Wrong?
There’s another important way that food impacts the gut bacteria, upsets digestion and can lead to weight gain. That’s via the immune system and that’s a story unto itself.
About 70 percent of the activity of the immune system takes place in the gut. The microbiome plays a crucial role, “tuning” the human immune system to distinguish friend from foe. Why would nature outsource such a big job, helping the body defend itself against external threat, to roughly one hundred trillion resident bacteria who aren’t even remotely human? As with real estate (and we’re dealing with digestive real estate here), the answer is, “Location, location, location.” The digestive tract is the body’s primary entry point for the outside world, in the form of food, with its collection of foreign proteins and germs, good, bad and indifferent. So that’s where our “bugs” are: the gut contains somewhere between five hundred and one thousand different strains of bacteria that make up our microbiota. You can think of the entire digestive tract, from the mouth to the stomach to the small intestine to the large intestine or colon to the anus, as a single thirty-feet tube designed to bring the outside world into us, right through the very center of us. In this way, we can extract the nutrition we need under reasonably safe and controlled conditions, with all of the digesting, absorbing and, finally, excreting taking place in connecting chambers walled off from the rest of the body by a mucous lining. And our resident bacteria, because they are so numerous and they turn over so quickly—a population of gut bacteria can double their numbers in about twenty minutes—are uniquely well suited to form the immune system’s rapid response team.
And sometimes things go wrong. Sometimes the human immune system, ill-served by a microbiome that’s lacking in number and diversity, overreacts, which is what happens to people with a gluten sensitivity. The body treats one of the proteins in gluten like a foreign invader and mounts an inflammatory response. The upset is often felt in the gut, but because the gut and the brain are constantly sending chemical messages back and forth, symptoms like fatigue, “brain fog” and anxiety are common as well. The more unhappy and out-of-balance the gut bacteria—dysbiosis is the technical term—the more likely you’ll suffer from these sometimes disabling food intolerances.
If you follow the major health stories in the media over the past few years, you know that, increasingly, inflammation is suspected as being a villain behind the most serious “diseases of aging”: heart disease, type 2 diabetes, Alzheimer’s and even cancer. It’s paradoxical. Inflammation is the body’s effort to respond to injury or infection by cordoning off the area and sending in specialized cells to clean up the damage. We couldn’t survive without this biological response. However, while the body is quick to call out the troops, it’s often not so good at calling them back. Considering how bound up the gut bacteria are in so many areas of our health, and the inflammatory processes that undermine them, some researchers are beginning to wonder whether, as the influential food writer Michael Pollan framed it in a New York Times Magazine cover story, “medical science may be on the trail of a Grand Unified Theory of Chronic Disease, at the very heart of which we will find the gut microbiome.” The tools of microbiology and genomic sequencing seem to have brought us back to a place that the ancients might recognize. To the Indian sages who centuries ago codified Ayurveda, the Indian philosophy of medicine, agni, “the digestive fire,” was the all-important measure of health. Hippocrates, the Greek father of Western medicine, famously said, “Let food be thy medicine, thy medicine shall be thy food.”
Kathie’s Story
These aren’t just clinical or philosophical issues with me. I’ve lived it. When it comes to the microbiota and gut/weight health, you could say I was born with three strikes against me. I was a Caesarean preemie, bottle-fed and, as a sickly little kid, I spent a good chunk of my early years on antibiotics.
We don’t come into the world with a developed microbiota, far from it. We live largely germ-free in the womb and then we acquire a bacterial starter kit as we pass through the birth canal when we’re born, the basis for our gut’s immune system. Then, as babies, if we’re lucky, we consume breast milk. It’s the perfect infant food to nourish the microbiota that will be needed when that baby grows into a toddler eating solid food.
None of this applied to me, a bottle-fed Caesarean, just as many of you will have missed out on the advantages of being breast-fed or being brought into this world via vaginal delivery, the best inoculation possible for a healthy start in life. Adding insult to injury were the medications I was prescribed for my problematic digestion, the antacids and the proton pump inhibitors (PPIs) that actually interfered with normal gut function. Worse still, the multiple courses of antibiotics I was given in my early years further depleted my gut bacteria, which probably contributed to the health issues I always seemed to be struggling with as a child: chronic ear infections, headaches and a very irritable bowel.
Work by microbiome pioneers like Dr. Blaser and anthropologist Jeff Leach, the cofounder of the American Gut Project, has established that the overuse of antibiotics—by some expert estimates, half of the antibiotics we consume are unnecessary or useless—is one of the prime causes of the depletion of the helpful bacteria in the American gut. Leach likens it to bombing your backyard with toxic chemicals: “You spray everything and it’s the invading, opportunistic species that come back first.” Dr. Blaser is currently doing research studying how a human microbiome, deprived of certain bacteria by antibiotics or simple lack of exposure to the bugs in the natural world, can throw off the communication between the gut and the hormones that regulate hunger. Some of us may be overeating because our brain isn’t getting the message that we’re full!
In any event, I survived my childhood. I was always outdoors, fairly athletic and I enjoyed OK health until I hit my early thirties when, as a busy wife and mother of two young children, I battled chronic fatigue syndrome. My husband, Dan, was at the time a U.S. Air Force pilot and when he was transferred to an air base in southern England, we were excited to be having a family adventure. The day before we left for the UK, I got hit by some sort of stomach bug and after that passed, I was laid low by an exhaustion that just wouldn’t lift. I’d want so desperately to go on a bike ride with the kids that I would make myself do it and then wind up back in bed, totally wiped out. And since I couldn’t exercise, my weight began to steadily creep up.
The military doctors diagnosed me with an autoimmune disease and wanted to send me back to the States for more advanced tests, but I was determined to figure things out for myself. It turned out the major culprit was all of the wheat-based foods I was eating, specifically the gluten protein that’s in many grains and most definitely in the muesli I ate every morning with the kids, the whole-wheat sandwich I ate for lunch, the pasta I cooked for the family at dinner. It certainly was in those delicious scones that seemed to be everywhere I turned. I was feeding a sensitivity to gluten that in all likelihood was triggered by that stomach bug. Today, researchers understand that a bout of bacterial food poisoning or a stomach virus will often trigger a latent food sensitivity. But this was the eighties and almost no one had ever heard of gluten sensitivities. Eventually, with the help of intellectual mentors like Dr. Jeffrey Bland, the biochemist father of the “functional medicine” movement in the United States, I slowly figured things out. In a strange way, those early struggles were a gift. I have spent a career searching for—and then finding and developing—solutions for people burdened with weight and digestive problems.
In 1991, when my family and I moved to the Berkshires, the northwestern corner of Massachusetts, I became the director of nutrition at Canyon Ranch, the famous Tucson resort that had opened a new, luxurious spa in the town of Lenox. At the Ranch, I learned and then taught the importance of a whole life—including natural weight loss as a result of healthy, delicious meals as well as eating, moving and sleeping on a regular schedule.
I believed in the power of the right foods to heal and to manage weight. This was reflected in my own life, as I steadily cut back on the amount of animal protein my family and I ate and increased the amount of vegetables and completely switched over to gluten-free grains. Meals now are moderate portions, high in fiber and loaded with vitamins and minerals. And, unlike many diets that separate the dieter from her family, this way of eating made the whole family healthier and brought us together for delicious meals we all enjoyed. I was able to eat my way back to health and a healthy weight, helped by daily exercise once I had my normal energy back.
When I saw the results in my life and in my clients’ lives, I became unstoppable. I helped persuade the food development team at the Ranch to jettison their signature “60/20/20” formula (that is, carbs, fats, proteins) to embrace something we called “nutritional intelligence.” While everyone’s metabolism is unique, every woman can exercise her nutritional intelligence to lose weight by becoming mindful of portion size and building diets around lower-calorie, fiber-and-nutrient-dense food, especially veggies.
I formed a kind of “brain trust” with the medical directors at Canyon Ranch, health pioneers and authors Dr. Mark Liponis and Dr. Mark Hyman. Our medical/nutritional team spearheaded an “ultra-preventative” approach to health and vitality that was ahead of its time. Years later, when Dr. Hyman started up his own clinic in Lenox, the UltraWellness Center, I followed as the head of the nutrition department. We embraced a “food is medicine” philosophy, fine-tuning meal plans to help heal a range of health problems, like type 2 diabetes and IBS, with which conventional medicine had had little success.
While I continue to work with Mark at the UltraWellness Center, for the past six years I’ve devoted most of my time, outside my own private nutritional practice, to the workshops I lead at the Kripalu Center and around the country. It’s a two-way street. I teach my students about the microbiome and how they can leverage it to reach their healthy-living goals. And, in turn, I’m routinely blown away by the transformations I’ve seen in them that can take place in a few short days, how mind-body practices like yoga and qigong can calm their stress levels and strengthen their resolve. I strongly believe, and a raft of studies backs me up, that these movement therapies are a kind of invitation to my students to enter into a different relationship with their bodies. A body in need of balance needn’t be the enemy but more like a dear old friend—accepted and capable of surprising you in positive ways. Compassion and nonjudgment are such beautiful antidotes to the self-blame that so often undercuts the commitment to healthy weight.
In addition to my workshops, I do nutritional consulting for a local financial company in the Berkshires. Currently, the small group of women I’m working with there have formed their own weight and lifestyle-reboot group. These are overweight middle-aged women who work hard at their office jobs to help support their families. They’ve embraced the whole foods, mostly plant-based diet, and I’ve got them doing a modicum of exercise and a few basic qigong practices, which they love. As of this writing, they have been on the program for eight months and between them they’ve lost more than one hundred pounds. They feel fantastic. And so do I. I eat and exercise and make use of stress-reducing techniques the same way my clients do, the same way I trust my readers will. And at sixty, this is the best I’ve ever felt in my entire life. I feel blessed to have grown into this knowledge about the healing power of food and for the chance to share it with others.
The MENDS Approach
I’ve integrated my clinical and my personal experiences with the latest microbiome research to create MENDS, the five-step program that is the backbone of the Swift Diet. There is nothing here that is intrinsically difficult or complex. But we all recognize that changing old habits can feel daunting—“Where do I begin? What do I have to change first?” With that in mind, I’m devoting one chapter, Chapter 7, to a 4-week Swift Plan that takes readers by the hand into this new world of delicious whole foods, day by day, meal by meal. The message here couldn’t be more empowering. With some straightforward modifications to the way we eat, and some smart lifestyle tweaks, we can change the composition of the microbial community inside us. Beginning that first month, MENDS and the Swift Diet will pay out weight and health dividends over the course of your entire life.
M—Mind Your Digestion
Digestion actually begins in the mind. That is why I start my program here. The hungry brain sends out messages to orchestrate the production of enzymes and acids that the body will use to process the food. Our GI (gastrointestinal) tract is packed with neurotransmitters like serotonin and dopamine—“the second brain.” Too much stress can upset the balance of bacteria in our gut, which contributes to the IBS-type problems that many of us are familiar with when we feel like we’re under the gun. And when cortisol, our primary stress hormone, goes into overdrive, that actually promotes fat gain around the middle, the last thing we want. Daily, it seems, researchers are making breakthroughs to unravel the brain-belly connection.
If a stressed-out brain can make life miserable for the belly by upsetting digestion and adding on pounds, the mind can heal the damage and take off the weight. In this first M section of my program, I introduce you to the basics of eating mindfully, including: giving the “cephalic” (from the Greek, “in the head”) digestion system the time it needs to properly digest food without irritation or inflammation; engaging with your body’s inner sense of satiety or fullness; and spacing meals so that the gut has time to cleanse itself and prepare for the next intake of food (no more “grazing” throughout the day!).
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