EP.315/ How can probiotic and fermented foods raise SCFA production and support endo healing?
We’ve been talking a lot about the benefits of short chain fatty acids lately, and today, I want to give you another way to raise them.
But first, let’s do a very quick recap. SCFAs are produced by beneficial bacteria in our large intestine. When these bacteria eat fibre, a process known as fermentation, they produce short chain fatty acids. The main ones being acetate, butyrate and propionate. These guys work to lower inflammation in the gut and body, they help heal the gut lining, they re-establish a healthy gut microbiome and inhibit pathogenic (a.k.a bad) bacteria and they can also improve IBS symptoms. But why does this matter to endo? Because research indicates:
People with endo have lower levels of SCFA, lower levels of beneficial bacteria and higher levels of pathogenic bacteria.
This creates an inflammatory environment in the gut, but the lowered levels of SCFA can also affect inflammation levels in the body. We know endo is an inflammatory disease, and so keeping inflammation levels normal and healthy, is one of the key ways of managing endo.
Pathogenic bacteria release a type of toxin called lipopolysaccharides. Lipopolysaccharides have been found to be higher in people with endo, and play a key role in endo development. Butyrate in particular can inhibit the effects of LPS, and by stabilising the microbiome and inhibiting bad bacteria, we can reduce our LPS load.
A weakened intestinal lining is one of the main ways that lipopolysaccharides can leak out of the gut and into the surrounding areas, where they has been found in people with endo. Healing the gut lining through increasing butyrate levels, helps to prevent their translocation (which basically means movement).
If you want to learn more about SCFAs, I’ve linked to some episodes in the show notes. But now let’s look at probiotic foods and how they can raise SCFA.
Probiotic foods are cultured and fermented foods which have live beneficial bacteria in them. When we eat these foods, we ingest this bacteria, which then become part of our gut microbiome and improve our levels of beneficial bacteria.
Many of these beneficial bacterial strains directly increase SCFA levels, but some of them indirectly support SCFA production by creating an environment that helps other SCFA producing bacteria to thrive, or by feeding specific bacteria that in turn, produce SCFAs. This is known as cross-feeding.
So, which probiotic foods might be helpful for us in particular?
Yoghurt:
Yoghurt typically contains lactobacillus and streptococcus thermophilus. These bacteria can help raise acetate and butyrate levels.
While streptococcus thermophilus mainly produces lactic acid, the lactic acid it produces can lower gut pH, which supports the growth of other SCFA-producing bacteria and actually creates a pH environment that inhibits pathogenic bacteria, so another win.
Lactobacillus species on the other hand, directly create acetate and propionate during fermentation, and these are then used by other bacteria, in the process I mentioned earlier called cross-feeding, to produce our endo super star, butyrate.
When choosing a yoghurt, look for ‘live’ cultures to ensure it actually has bacteria in which will reach your gut alive. If you’re going for a dairy version, look for organic to avoid added hormones, and you may find you do better on sheep or goat’s dairy, or lactose free. To understand that more, I’ve linked to my recent vanilla ice cream recipe, where I break down the varying positive and negative effects of dairy and how to choose if it’s right for you, which types, and how much to consume.
I have my own lactose free goat’s yoghurt recipe, that’s also SIBO friendly, which I am thinking to share with you soon!
Kefir:
Next up is kefir. Kefir typically is more probiotic rich and diverse than yoghurt, and contains bifidobacterium and lactobacillus, which directly produce acetate and lactate, and in turn, through cross-feeding, boost butyrate.
Again, when choosing kefir, if you’re going for a dairy type, consider the points I raised earlier and also check for live cultures.
You can also get water kefir, and make your own dairy and water kefir as well.
Sauerkraut:
Now we have sauerkraut, which typically is fermented cabbage, but may often contain other veggies too, like beetroot. The simplest recipe is literally salt and cabbage, left in a jar, for naturally occurring microbes to start chemically altering the cabbage to create that tangy taste, but also, provides us with lots of live and beneficial bacteria.
Sauerkraut is generally high in lactobacillus plantarum, another lactobacillus species that can produce acetate and may indirectly raise butyrate through cross-feeding.
Kimchi:
Now let’s look at kimchi. Kimchi is similar to sauerkraut as they both contain cabbage and various other veggies, but kimchi is flavoured with distinct spices, herbs, etc.
Like sauerkraut, kimchi also contains lactobacillus plantarum, alongside several other lactobacillus species - even one called lactobacillus kimchii, which is specific to kimchi.
The bonus with both kimchi and sauerkraut is that they of course contain fibre from the vegetables, which provides bacteria with food to eat/ferment. In fact, research shows that the SCFA boosting effects of probiotics are enhanced from also adding prebiotic foods.
Tempeh and miso:
The last two I want to mention (they’re a bit of a two in one) are the fermented soy foods; tempeh and miso. These two contain a range of bacteria and even beneficial moulds, but specifically, bacillus and lactobacillus, which both increase SCFA, and some strains of bacillus also directly raise butyrate.
Now, if you’re wondering whether soy is safe for endo, I do cover this with my clients and course students, and I also cover it in my Nutrition masterclass, but in short, the phytoestrogens in soy are in theory, weaker than real oestrogen, and therefore, can be beneficial for people with oestrogen conditions and symptoms. However, it really just depends on your body, and you may find you can eat a few portions a week without any negative impact, whereas some of you may start to get symptoms of oestrogen dominance like sore breasts, or worsening PMS. It’s very individual, however, in general, it should be safe for endo and shouldn’t cause oestrogen dominance unless you’re relying on it heavily in your diet.
The other thing of course is that soy is a common allergen, so it may be that it irritates you and raises inflammation in that respect, so again, it’s about tailoring to you.
I’ve linked to a few resources on this topic in the show notes.
So, I’m going to wrap up my examples there, but remember there are so many other fermented foods out there that are beneficial, including apple cider vinegar (with the mother), pickled vegetables, kombucha, unpasteurised cheese and natto to name a few. So do some research and see which ones you like.
How many probiotics foods should you eat per day?
So how much of these foods should you be eating, and are they suitable for every endo person?
Well, here’s the thing.
Fermented foods are typically high histamine, and many people with endo have histamine issues including over active mast cells that may further endo pain and development (mast cells are the cells that release histamine).
However, this mast cell and histamine dysregulation is coming from immune dysfunction we see with endo (rather than being caused by eating lots of histamine foods) and can often be worsened by gut conditions like leaky gut, SIBO, and dysbiosis.; and a struggling liver, amongst other things. So whilst a low histamine diet or avoiding specific high histamine foods that trigger you, can help in the short term with symptoms, the ideal solution is we improve gut health, liver function and immune balance so that the immune system calms down, and as a result, mast cells stop being so sensitive. It’s also worth noting that a 2021 study showed that those who ate a diet rich in fermented foods, reduced 19 inflammatory markers, specifically cytokines, and many of which are involved in endometriosis development, such as IL-6 and IL-10.
Having said that, if you’re deep in histamine issues right now, with hives, allergies, dizziness and so on, bringing in probiotic foods is probably not going to help right now. Ideally, work with someone who can support you to calm your histamine flares, whilst also working on the long-term root causes, so that in time, you can tolerate some of these foods which can be so beneficial for endo and for our endo belly/gut health.
If and when you do start introducing histamine foods, try taking DAO with them, which is the enzyme that breaks down histamine in the gut, that many people with histamine problems are low in.
Another consideration is for people with interstitial cystitis, which is extremely common with endo. Some of these foods contain vinegar, spices and acids, and for others, the bacterial strains can cause irritation in the bladder (this was me with yoghurt several years back). Histamine can additionally trigger bladder pain too. So again, it’s about working out which ones you can and can’t tolerate. Several years ago, all fermented foods were off limits, but now it’s typically the ones with spice or vinegar added to them that I struggle with, though sauerkraut can be hit or miss for me.
If you’re not someone with those kind of histamine symptoms, it’s still wise to be cautious with probiotic foods, because a rapid increase in them can trigger gas and bloating, because you’re suddenly introducing new bacteria in your gut, and that bacteria will be fermenting your food and creating gas. This is especially true for those of us with SIBO - some people with SIBO can’t tolerate fermented foods at all, others can do just a little and some don’t have a problem with them. When it comes to SIBO diets, it’s all about tolerance.
You need to give your gut some time to adjust, so try taking it slow with one type of fermented food and trying a small amount, like a tablespoon or so, and slowly building up if you feel you tolerate it. Then, once you’re confident you’ve found your sweet spot on that fermented food, try layering in another.
Now, in terms of how much we should be aiming for, the research shows significant reductions in inflammatory markers with consistently eating six small portions of fermented foods per day. I know, it’s a lot - I agree, I don’t think I could stomach that much either! But it’s about starting where you can and building up to a place that feels enjoyable and sustainable, and doesn’t worsen endo belly symptoms or histamine issues, etc. And the portions don’t need to be big either, it can be a dessertspoon or two of sauerkraut or a tablespoon of apple cider vinegar in a dressing.
Now, before we wrap up, remember that there are other ways to boost SCFA and lower inflammation, so don’t freak out if you know you can’t tolerate fermented foods. Just head to the episodes in my short notes where I list several ways to boost levels, and if you do want to begin bringing these in, remember to start low and slow.
See you next week!
Show notes
SCFA resources
https://www.theendobellycoach.com/podcast/endometriosis-short-chain-fatty-acids
https://www.theendobellycoach.com/podcast/endometriosis-butyrate
https://www.theendobellycoach.com/podcast/endometriosis-propionate-acetate
https://www.theendobellycoach.com/podcast/endometriosis-ibs-psyllium-husk
https://www.theendobellycoach.com/podcast/phgg-endo-belly-sibo-ibs
Probiotic research
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10180739/
https://www.researchgate.net/publication/5647158_Short_chain_fatty_acids_and_colonic_health
https://www.sciencedirect.com/science/article/abs/pii/S175646461630175
https://www.sciencedirect.com/science/article/pii/S0717345820300282
https://www.researchgate.net/publication/272339114_Enhancement_of_Short_Chain_Fatty_Acid_Production_from_Millet_Fibres_by_Pure_Cultures_of_Probiotic_Fermentation
https://apjcn.nhri.org.tw/server/apjcn/5/1/15.pdf
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0047212
https://aspenjournals.onlinelibrary.wiley.com/doi/abs/10.1177/0115426506021004351
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230973/
https://pubmed.ncbi.nlm.nih.gov/11034488/
https://www.mdpi.com/1422-0067/21/8/2890
https://www.sciencedirect.com/science/article/pii/S0002916523065000
Fermented food examples
https://zoe.com/learn/top-fermented-foods
Inflammation and fermented foods study
https://www.cell.com/cell/fulltext/S0092-8674(21)00754-6
Mast cells and endo
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9396281/
https://www.sciencedirect.com/science/article/pii/S0015028206014373
https://www.emjreviews.com/reproductive-health/article/targeting-mast-cells-as-a-viable-therapeutic-option-in-endometriosis/
Soy
https://www.larabriden.com/how-soy-affects-hormones/
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Produced by Chris Robson