Tofu and Sauerkraut Salad

Tofu and Sauerkraut Salad By Michelle Chang One of my favorite vegetables in Taiwan is cabbage. It is a vegetable that can be found in all seasons and is easy to store in the refrigerator. After washing and slicing, cabbage can be stir-fried directly with garlic and become a very delicious vegetable dish. It has a crisp texture and a sweet taste. In addition to stir-frying, cabbage is also suitable for use in soups or to be pickled. In Taiwan, there is a famous street food called, stinky tofu. It is a type of fermented tofu and is most often prepared by frying it to a crispy golden brown and serving it with a plate of pickled cabbage. The pickling sauce is sweet and sour, sometimes with a touch of spicy taste, and the pickled cabbage will take the greasiness out of the fried tofu. (Note: This preparation of cabbage is a pickle, not a fermentation.) Food is a necessity for human’s body and spirituality, a source of security. For an immigrant who has left his home country, the first thing he needs to find in a foreign country is the familiar food of his home country. When I arrived in France, I started to look for cabbage in the supermarkets and open-air markets in France. I saw a kind of cabbage called "Chou Blanc", but after I bought it, I found that it was very hard and not suitable for quick stir-fry. Most commonly, Chou Blanc is fermented, which is also known as sauerkraut. I personally do not like stewed vegetables, so fermenting chou blanc is the best way for me to eat it. There are many kinds of vegetables that belong to the cruciferous family, including cauliflower, broccoli, and radish. The interesting thing is that the cabbage family can be considered like the cheaper truffle. Because in the cabbage family there is the same DNA as in truffles - sulfur. These sulfur-containing organic compounds (truffles or fermented cauliflower, kale, etc.) produce a sulfurous, garlicky smell through microbial decomposition, so when you open a container of fermented cabbage (broccoli, radish...), don't put your nose to it yet. Let these unpleasant smells dissipate and then taste the richness of its chemical reaction. The chemical reactions between the various flavor-presenting amino acids and the mono- or disaccharide molecules that break down in fermented cabbage produce a fascinating flavor that makes them…

What Is All the Hype About SIBO?

What Is All the Hype About SIBO? By Emeran Mayer, MD As the COVID-19 pandemic has engulfed the world, there has never been a time in which topics like Gut Health, Immune Support, Gut Cleansing, and Improvement of Gut Health have been more popular. Suddenly self-declared experts from different fields of medicine, nutrition and wellness have all jumped on this new trend to explain old symptoms and to promote novel treatments. Podcast, master classes, social media posts and advertisements, bestselling books have all driven the frenzy around these topics, while scientific evidence from well controlled human studies have been lagging behind. In the last Gut Health Insights post, I have discussed the flawed concepts about the need for “Immune Support” to make it through the pandemic. “There are few concepts and syndromes in Medicine and particularly in Gastroenterology which have gone through a similarly remarkable historical transformation as SIBO”. Another one of these highly popular, yet controversial topics is Small Intestinal Bacterial Overgrowth, better known by its acronym SIBO (other references: 1, 2). There are few concepts and syndromes in Medicine and particularly in Gastroenterology which have gone through a similarly remarkable historical transformation as SIBO. The term first emerged in the literature more than 80 years ago and was a relatively rare diagnosis. However, the concept was adopted more recently by functional and integrative medicine practitioners, by the lay media and even the medical establishment and the pharmaceutical industry and has been promoted in social media as a diagnosis explaining some of the most common symptoms of abdominal discomfort. Unfortunately, it has led to the widespread and in my opinion unnecessary use of antibiotic treatments for symptoms most likely unrelated to gut microbes. “…the diagnosis and overall conception of SIBO has become mired in uncertainty and controversy…” SIBO is a clinical disorder that was first described in the 1930s in patients with serious symptoms of malabsorption, bloating, abdominal pain, and diarrhea, following surgical alterations of the gastrointestinal tract. However, since these early descriptions, the concept of SIBO has undergone significant change and challenges in light of emerging insights and speculations from studies into the gut microbiome. The diagnosis of SIBO which originally was limited to a small number of individuals with a specific medical history, has all of a sudden been given to a large number of patients complaining of such common, non-specific symptoms of abdominal bloating, sensations of…

Will Ketamine Help with My Chronic Abdominal Pain?

Will Ketamine Help with My Chronic Abdominal Pain? By Sarah Abedi, MD Ketamine has been in the medical toolbox for a long time. With its first use as a surgical anesthetic in 1970, ketamine quickly also gained popularity for its ability to maintain hemodynamic stability on the battlefield. Unlike other anesthesia that can sometimes bring down blood pressure and respiratory rate, ketamine does not cause much fluctuation in hemodynamics. This is another reason why ketamine has become a popular choice in the emergency room for unstable patients as well as a frequent choice for sedating children during painful procedures. Ketamine is currently only approved by the food and drug administration (FDA) for short-term sedation and anesthesia and recently obtained FDA approved for a nasal spray ketamine version (Spravato) for treatment-resistant depression. We have also found ketamine to have psychedelic properties aiding in psychedelic assisted psychotherapy. But can ketamine help with chronic abdominal pain? “There is another, less common condition of abdominal pain that is chronic or frequently recurring, which is not associated with changes in bowel habits.” People with functional gastrointestinal (GI) disorders can have a variety of symptoms that range from painless diarrhea or constipation, to pain associated with diarrhea and/or constipation (usually called irritable bowel syndrome). There is another, less common condition of abdominal pain that is chronic or frequently recurring, which is not associated with changes in bowel habits. This condition is called Centrally Mediated Abdominal Pain Syndrome (CAPS). There are no abnormal x-rays or laboratory findings to explain the pain. It occurs because of altered processing of nerve impulses in the central nervous system, and it is not associated with altered motility in the intestines. CAPS is characterized by continuous or frequent abdominal pain that is often severe. It has little or no relationship to events such as eating, defecation, or menses. For people with CAPS, the pain can be so all-consuming that it becomes the main focus of their life. Unfortunately, many patients end up on narcotics as the last resort. Ketamine’s most important pharmacological properties are linked to its blocking effect on an important receptor in the brain and spinal cord that plays a crucial role in pain sensitization. This effect is a result of the drugs antagonism to the N-methyl-D-aspartate (NMDA) receptor. The NMDA receptor is involved in the amplification of pain signals, opioid tolerance and the development of sensitization of the spinal…

Olive Oil – A Medicine Produced by Nature and Refined by Human Expertise and Traditions

Olive Oil - A Medicine Produced by Nature and Refined by Human Expertise and Traditions By Emeran Mayer, MD Long before becoming aware of the unique qualities of extra-virgin olive oil (EVOO), we have always used the oil in our salad dressings and preparation of Italian meals. However, in addition to its delicious flavor, various health benefits of EVOO have been reported from preclinical and clinical studies and are applicable to a wide range of metabolic disorders and cardiovascular diseases. EVOO is considered to be one of the key health-promoting ingredients of the Mediterranean diet. There are at least two major components that mediate the oil’s health benefit—the high concentration of monounsaturated fatty acids (primarily oleic acid) and the high content of polyphenols (primarily oleuropein and hydroxytyrosol). As I have discussed in previous posts, polyphenols exert their health benefit with the help of the gut microbiome. Research suggests this may be true for oleic acids, too. Oleic acid is the predominant fatty acid in olive oil—73 percent of its total oil content—while 11 percent is polyunsaturated, such as omega-6 and omega-3 fatty acids. Monounsaturated fatty acids (MUFAs) are quite resistant to high heat, making EVOO a healthy choice for cooking. Some sources put the smoke point of olive oil somewhere around 374–405°F (190–207°C) (17). This makes it a safe choice for most cooking methods, including most pan frying. Extra virgin olive oil's smoke point is somewhere around 374–405°F (190–207°C). “Polyphenols, unlike the vitamins found in the oil, are largely unabsorbable in the human gut, and have to travel to the end of the small intestine and colon to be broken up into absorbable molecules by specialized communities of gut microbes.” Traditionally, the high content of MUFAs was considered to be responsible for the protective effects of EVOO, but current evidence suggests benefits are largely related to polyphenols and vitamins A and E found in the oil. While both polyphenols and these vitamins have antioxidant effects when studied in a test tube, only the vitamins which are rapidly absorbed in the small intestine have such an effect when consumed. In contrast, polyphenols are largely unabsorbable in the human gut, and have to travel to the end of the small intestine and colon to be broken up into absorbable molecules by specialized communities of gut microbes. Contrary to common belief and advertisements, the majority of these molecules are believed to exert their…

Does a Gluten-Free Diet Help with IBS Symptoms?

Does a Gluten-Free Diet Help with IBS Symptoms? By Juliette Frank The majority of patients seen for IBS treatment are either on a gluten-free diet, or have tried such a diet with mixed success. Marketing campaings have promoted a gluten free diet for a variety of common digestive symptoms ranging from abdominal bloating and pain, gas and altered bowel habits. However, the evidence for the effectiveness of such a dramatic dietary approach in the treatment of IBS is rather sparse and inconsistent. If you’ve been paying any attention to the bread aisle at your grocery store, you would have noticed how much it has expanded in the past few years with items labeled “gluten-free”. This is ideal for those diagnosed with celiac disease, which is an inherited autoimmune condition that is triggered by consuming foods containing gluten. Those affected by celiac disease often experience gastrointestinal symptoms such as bloating, diarrhea, unintentional weight loss and constipation after consuming gluten from wheat products and related prolamins from grains such as rye and barley due to the maladaptive response of the gut’s immune system to this protein and the gut, damaging the villi of the small intestine and if severe enough resulting in malabsorption of nutrients. Considering the prevalence of celiac disease is about one percent of the general population in the U.S., including both diagnosed and undiagnosed cases, there are clearly other factors causing the recent demand for gluten-free products. “Gluten free diets have become the latest health food fad…” Gluten free diets have become the latest health food fad, with more and more consumers decreasing their gluten intake regardless of their diagnosis or sensitivity to wheat products. A major contributing factor to the widespread adoption of this diet is the media’s role in sensationalizing a few studies claiming that avoiding gluten leads to weight loss, and improved cardiovascular and gut health. Various celebrities and athletes have touted the benefits of this diet which has created misconceptions about it’s nutritional effects and has accelerated it’s rise in popularity in the U.S. and much of the Western world. Without any scientific research backing up many of these claims, more and more people without celiac disease are adopting a gluten free diet in hopes it will improve their overall health and physical appearance. In a 2017 survey of 1,000 consumers of gluten-free products in the United States and Canada, 46% of those surveyed reported…