HPN 24: GI Stool Tests vs. Endoscopy/Colonoscopy, PPI Risks, Sports Nutrition for IBD/Colitis, and New Study Shows Eggs With Yolk Out Perform Egg Whites Only

January 1, 2021
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Welcome to episode 24 of Holistic Performance Nutrition (HPN) featuring Tawnee Gibson, MS, CSCS, CISSN, and Julie McCloskey, a certified holistic nutrition coach who you can find over at wildandwell.fit.

On this episode:

Introduction

  • New study: Randomized control trail – “Whole Egg Vs. Egg White Ingestion During 12 weeks of Resistance Training in Trained Young Males”
    • Purpose: Compare the effects between whole eggs and egg white ingestion during 12 weeks of resistance training on body composition, muscular strength, and anaerobic power in resistance-trained young males. A secondary purpose was to examine systemic hormonal responses.
    • Motivation: Whey and casein are routinely used in exercise nutritional studies; however, it is relatively unknown what effects protein-based whole food products have on the physiological adaptations from RT. Whole eggs (containing yolk) are considered a high-quality protein food source because of their amino acid profile and their digestibility.
    • Sample size:
      • 15 resistance-trained young males were randomly assigned to one of 2 groups
      • Group 1 – ate 3 whole eggs immediately after a resistance training session
      • Group 2 – ate 6 egg whites immediately after a resistance training session
      • 12 weeks of whole-body undulating periodized resistance training 3 sessions per week
    • Tested: Knee extensor muscle mass, lean body mass and body fat percentage, muscular strength (knee extension, handgrip strength), Wingate (cycle ergometer), and serum concentrations of hormones were assessed.
    • Conclusion: Postexercise whole egg ingestion increases knee extension and handgrip strength, testosterone, and reduces body fat percentage compared with postexercise egg white ingestion, despite no group differences in muscle mass, in resistance-trained young males. Therefore, whole egg ingestion may be preferable if increasing muscular strength or improving body fat percentage is the focus during a RT program.
    • Why they think this was the conclusion: Calories, cholesterol, and micronutrients! Egg yolks contain various nonprotein components that may modulate the anabolic response, such as vitamins, minerals, phosphatidic acid, palmitic acid, DHA, and micro RNAs. Other nutrients ingested with protein will influence the nitrogen utilization of the protein intake.  On a whole-body level in resting subjects, incorporation of dietary nitrogen into peripheral proteins was highest when fat was ingested concurrently. Dietary cholesterol, independent of total daily protein intake, was positively associated with RT gains in muscle performance. Potentially, the higher cholesterol and saturated fatty acid intake (in the egg yolk) may have modulated the serum testosterone concentration changes.

Kat B. asks:

Paleo-based endurance nutrition

Hi Tawnee and Julie,

Thank you so much for all of the work the two of you do as well as the entire Endurance Planet Team.  Over a year ago I was diagnosed with a GI based autoimmune disease (ulcerative colitis) and I have been working with a functional medicine doctor to get to the root cause and am finally back to feeling like myself and almost symptom free.  Given the craziness of 2020 I was furloughed from my job, and headed out to CA to spend some time with my parents.  I took my bike with me but left my HR monitor at home (by accident). I focused on listening to my body, riding when it felt right, I took the time to enjoy rides with friends and ditch my competitive nature most days.  My rides were based more on time than mileage, and it really helped me to find my love of cycling again.  Due to my IBD I currently follow a paleo based diet, and find that grains and high sugars cause me to flare up and I feel sluggish for a few days.  I want to get back to riding longer distances, as well as returning to Ironman training but I seem to be hitting a bit of a wall with the nutrition component.  I know that nutrition has always been my weak point.  I was in RED-S after my ironman, my periods were almost gone, I had an ankle fracture 6 months after finishing, my IBD was getting worse and most of the doctors I saw just wrote me off (that’s a whole other story).  I really want to work back in a smart way, but I am finding it difficult to navigate the world of portable nutrition that is not overly packed with sugar or grains.  As of right now I tend to eat RX bars or lara bars when on the bike or trails, but on some of my longer rides I end up with sugar fatigue, and feel supper foggy the next day.  Just wondering if you have any suggestions for good nutrition sources when riding or running for a paleo based athlete.

Thank you again for all of your help and great advice!

What the coaches say:

  • Specific Carbohydrate Diet (SCD) as a resource for “safe” carb sources and other fuel choices. From their website:
    • Avoid anything with these: agave, spirulina, amaranth, arrowroot, barley, buckwheat, most beans/bean products, NO GUM, chocolate, corn, dextrose, sprouted grain breads, FOS (read labels), fructose (as in added fructose in commercial products), guar gum, gums, hemp, inositol, inulin, maple syrup, millet, molasses, oats, Sorbitol, mannitol, xylitol, natural peanut butter, Pectin (check labels on jams, jellies), plantains, whey protein powders, quinoa, rice, seaweed, seed butters/flours, all things soy, sweet potatoes, wheat, xantham gum, yams, yucca,
    • Ok to use: almonds/almond flour+ butter, apples, avocado, bacon, bananas, berries, brazil nuts, butter, butternut suqash, cashews, aged cheese, everything from coconuts, cranberry juice, dates (but not date sugar), eggs, ghee, ginger, grape juice, grapes, homemade SCD yogurt, honey, mac nuts, meats (Epic bar?), melon, homemade orange juice, some aged cheeses in moderation but not processed cheese, peanuts and PB, canned fruit in own juice no sugar added, raisins in moderation, saccharine, walnuts.
  • Danielle Walker’s Against All Grain recipes: https://againstallgrain.com/category/recipes/scd-recipes/ 
  • As much as you can do so, make homemade nutrition! (e.g., Grain-free, sugar-free banana bread.)
  • *UCAN – Being a corn-derived starch fuel source, but also a special unique low glycemic carb to manage blood sugar, Tawnee was curious if there’s any evidence of UCAN either aggravating symptoms or helping IBD athletes. Tawnee reached out to UCAN and received a couple of anecdotal reports:
    • From a young high-level triathlete (just accepted his pro card):
      • UCAN started in 2013 for him. 2011 and 2012 he was diagnosed with ulcerative colitis. Couldn’t find anything that worked for him. Stuff he was using before was really bothering him and making it worse. Tried GU, Hammer, a whole bunch of things. Worked with sports nutritionist – Dr. Krista Austin. UCAN is not the only thing he consumes during workouts, but pretty close to it. The ulcerative colitis is under control now. UCAN before the race, before a long run or long rides. “With colitis, I can’t eat a ton of stuff before.” UCAN does a decent job of being a meal replacement. 
    • Here’s another example from someone who only just recently started using UCAN after we had a conversation about how it might help her with her colitis:
      • “I am loving the UCAN products!!! I have been using the protein drink every morning before my training. I’ve noticed a HUGE difference in my energy levels during the day plus way less stomach issues… overall a massive win so far. In addition, I’ve noticed I’m less grumpy after long days (big win especially for the husband)Also the UCAN carb drink for runs seems to be working really well. My husband and I went hunting over the weekend which included a ton of hiking plus my daily run miles. UCAN made it possible. I couldn’t eat much at hunt camp because of the flare-up but I could rely on UCAN for energy.”
  • You don’t want to push the sugar intake since that is contributing to inflammation. You need to change the way you train now that you have a diagnosis and a way of eating that you know is benefitting your body. Think about the long game, don’t push the sugar and grains just to hit a PR or extend an already long ride — try to find your sweet spot that combines everything you love about ironman and keeping your health solid
  • Hire a health coach or sports nutritionist to help you navigate the complexities.

Bri asks:

Help me figure out the right tests to heal my messed up gut! 

Hi gals,

I have some major gut issues that I suspect might be something related to SIBO, candida, leaky gut, maybe even IBS?—who knows!— but when I talked to my doctor, they wanted to send me straight to a gastroenterologist for an endoscopy and colonoscopy. I hear you often talk about functional stool tests like GI MAP, which I’ve browsed online and what seems to be what functional medicine doctors recommend. However all that looks very expensive and not covered by my insurance unlike the gastro and those tests which will be covered. So can you explain to me if I am wasting my time with an endoscopy and colonoscopy for my issues? Or is there value to these tests in the quest to diagnose gut dysbiosis and figure out a healing plan. What are the differences? Also, second question: I was prescribed a PPI some time ago for reflux, and some of my (amateur) research online is now leading me to believe this may be doing more harm than good for my gut issues. Can you elaborate if I am onto something here?

Background: I am 33 years old, longtime runner now turned ultra runner. I also do some CrossFit on the side. I don’t have an eating disorder, and feel like I have a healthy relationship with food, but I am very stressed with life stuff and more so this year with COVID—and as a result my gut symptoms are a lot worse, which is why I’m reaching out for some expertise. After (sometimes even during) my run workouts I have pretty bad loose stools or diarrhea, undigested. (Sorry TMI!) I also feel bloated a lot of the time especially after eating. I am worried that I stay so lean because I am not digesting food that well (5’6 125lbs) and quite frankly sometimes I feel like I”m wasting money buying high-quality meats and organic produce! I am willing to invest in my health in 2021…. so if you think I do need these stool tests and a functional doctor I am ready to budget for that and get this figured out, because at this point, it’s just making life miserable. 

Thanks for any advice and any directions you can point me in.

What the coaches say:

  • Endo/Colon: Not a bad idea to do it if insurance covers it. Good to check the box on these and make sure nothing abnormal is found. But if nothing comes back as being wrong, yet you have symptoms, don’t give up! These tests do not show everything and often you need to go deeper, on a more microscopic level, with the functional labs. 
    • Endoscopy: CAMERA goes through the stomach and the beginning of the small intestine. Endoscopy will miss candida and SIBO for example. The endoscopy doesn’t tell us too much about the microbial ecosystem in the small intestine.
    • Colonoscopy: Also a CAMERA to view the inside. Things like colon cancer screening, tissue changes + a lot of prep like clearing your bowels the whole day prior.
      • These tests can show some stuff like: celiac, h. pylori infection, gastritis (stomach inflammation), gastroenteritis (inflammation intestine), ulcers, polyps (abnormal growths of tissue projecting from the colon wall), colon cancer, and esophagitis. 
    • Endo/Colon does not detect microbial infections, dysbiosis, etc. — basically what is GROWING in your microbiome on a MICROSCOPIC level.
  • The stool testing difference:
    • What do these tests look for? 
      • Digestive function. How is gut working, absorption, etc. 
      • Intestinal Inflammation.
      • Immune function. 
      • State of microbiome (ecosystem). What’s living in there, who’s living in there, how many of them are living in there (both good & bad guys), imbalances, etc. 
      • Infections and pathogenic organisms that may be present.
    • Conditions:
      • Just a short list: Chronic low B12, skin conditions, autoimmune conditions, food intolerances, etc… all these can be addressed via gut stool test. 
      • Chronic constipation and/or diarrhea, also run a SIBO breath test. 
      • Hashimotos, you really should check on candida as they often go hand in hand. Candida (yeast/fungi) overgrowth is super tricky to detect and heal. 
  • GI MAP 
    • It is a qPCR test, confirms the presence of DNA material for each tested microorganism + assigns a quantity. 
      1. (This is similar to the current COVID PCR test—detects RNA genetic information even in extremely small amounts.)
    • With GI MAP, if certain markers grow to pathogenic or opportunistic levels this can lead to clinical symptoms and chronic inflammation.
    • So a GI MAP, in theory, can help pinpoint the ROOT cause of one or multiple of the following: 
      1. (acute) nausea, vomiting, loose stools, bleeding, mucus, abdominal pain; 
      2. (chronic) gastritis, bloating, constipation, abdominal discomfort, belching, gas, chronic bad breath and undigested food in the stools.
    • GI MAP also looks at *healthy* flora and if those are low that can contribute to imbalances. 
    • Example of markers on GI MAP and/or GI Effects: 
      1. Cal Protectin – inflammation measure, helps with assessing whether Chrons/Colitis (i.e. IBD) vs. IBS; autoimmune component, cancer risk, and so forth. Cal Protectin ranges shed insight of certain risks.
      2. Secretory IgA– immune defense, if this is low more likely to have problems. (I often see low in athletes who aren’t feeling well.)
      3. Anti-gliadin – gluten sensitivity or celiac risk 
      4. Elastase-1 – pancreatic enzyme; “marker for identifying pancreatic exocrine insufficiency. Clinical indications for assessing PE1 include diarrhea; weight loss or other possible symptoms of maldigestion; diarrhea-predominant irritable bowel syndrome; diabetes; celiac disease or other malabsorption disorders; cystic fibrosis; aging; low bone density; inflammatory bowel disease; obesity; and gallstones”
      5. Lactobacillus/bifido  – the good “guys” we want in abundance especially athletes. 
      6. Short-chain fatty acids – a product of colonic bacterial degradation of unabsorbed starch and non-starch in food (fiber). The primary fuel for a healthy microbiome, e.g. Butyrate a primary energy source for colonocytes 
  • Why stool testing with a functional doc/health coach can really get you far:
    • Depending on the severity, healing the gut could take several phases including test, re-test, and adjusting supplements. You want to work with someone who will be by your side on this journey!
    • Going the functional route with a functional med doc is usually going to land you into a more holistic assessment and protocol with more of a whole-body approach and natural healing protocol with herbal supplements and vitamins rather than prescription meds/pharmaceuticals. Meds have their place when necessary and indicated, but things like dysbiosis and imbalances can often be healed without the use of Rx that could introduce side effects. 
  • Reasons why stomach acid may be low:
    • Chris Kresser’s article How to Cure GERD without Medication
    • Eating too fast, distracted, in a stressed-out state. 
      • Sight, smell, anticipation, and chewing of food
    • High Stress
      • The release of HCL depends on the stimulation by the parasympathetic nervous system
      • If SNS is on it shunts blood away from the whole digestive tract, stomach and intestines both
    • Chronic overeating or eating one huge meal a day
      • Will exhaust the pancreas eventually
    • NSAID/medication use
    • H Pylori flourishes in this environment, and it further lowers stomach acid. Even worse heartburn and GERD symptoms
  • How to increase stomach acid: Where to go from here?
    • Reduce stress – 3 slow deep breaths before eating
    • Chew!
    • Acid: Betaine HCL, with pepsin
      • 600mg — if it doesn’t produce a warming sensation take one more and continue to increase the amount until you feel the warming sensation
    • Zinc
      • The production of HCL depends on sodium and zinc
    • DGL – deglycyrrhizinated licorice after every meal and before bed
      • Healing herb – repairs the mucus lining of the stomach
    • Lower Esophageal Sphincter
      • Avoid Mint – relaxes the sphincter
      • Coffee
      • Alcohol
      • Garlic/onions/raw tomatoes/chocolate
      • Fatty and spicy foods
      • NSAIDs
      • Acid blockers no longer than 2 weeks
  • PPI is likely doing you more harm than good.
    • Talk to your provider to see if you can slowly and safely come off your PPI.
    • IFM resource: https://www.ifm.org/news-insights/gut-alternatives-ppis-h2-blockers/
      • “A significant number of researchers have independently linked PPIs to adverse health problems such as bone fractures,4 chronic kidney disease,5 and pneumonia,4 among others.”
    • Fracture risk and anemia risk!
    • Also may contribute to bacterial overgrowths, IBS development, reduced resistance to infection, IBD flares, cancer, reduced absorption of nutrients in food > nutrient deficiencies (B12, iron, calcium, zinc, Mg)
      • Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110863/

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