December 2008

Season’s Greetings!

Many months have passed since our last newsletter was sent to you. Our sincerest apologies for the delay (and we hope you missed us at least a little). We plan to be more active in coming months in sharing insights and practical information with you about the Fourfold Path to Healing.

This edition pays special attention to GAPS challenges, and includes one patient’s very compelling story of his serious bout with gastrointestinal issues and how things have turned around for him.

We start this issue by sharing with you tips and insights on how to stay healthy during this winter season. As well, we have an update on our Community Supported Healthcare Plan (CSH), available to all my patients. And of course, no newsletter is complete with a nourishing and delicious recipe.

Do you have a story about how you have been helped by any of our therapies or diets? Would you like to share that story with others? We’re looking for brief patient stories (approximately 750 words) to use in upcoming newsletters, with your permisssion of course. We’re also looking for people willing to share their email address for us to provide to future patients who would like to communicate with a patient who has experienced a similar situation. Please send your story, your email and your thoughts directly to me at drcowansoffice@yahoo.com.

I also want to personally invite you to join us at the next Fourfold Healing Conference in Westford, Massachusetts on Jan 30-Feb 1, 2009 – coming right up! Sally Fallon, Jaimen McMillan and I will be hosting this incredible weekend of dynamic discussions, presentations and lectures. It’s not too late to register. I hope to see you there.

We appreciate receiving your comments about our newsletter and our efforts, and hope you’ll continue to share with us as we continue along the Fourfold Path to Healing.

Warmly,
Tom Cowan

Staying Healthy in Winter

As the winter cold and flu season approaches, there are some practical and easy suggestions I want to share that should make you less susceptible to these types of illnesses. One of the more interesting and rarely discussed mysteries in medicine is why we get sick more often in the winter than in the summer. The usual explanations of why the flu hits at this time are on many levels deeply unsatisfying, particularly because we are never given a reason why viruses should become more active or virulent in the winter. Rather than blaming this on microbial cycles, we should look to factors in our lives that make us more susceptible during the cold, dark winter months. Actually, we might want to leave the cold part out because one of my shocking findings of the past five years since I moved to San Francisco is that even though, compared to New Hampshire, it is never that cold here, it certainly does grow dark.

As I have pointed out before, dark days translate physiologically into low vitamin D levels. Low vitamin D levels have many repercussions, but the one most relevant here is a slowing down of the immune system. Studies on this subject, many posted on the vitamin D council website, suggest that vitamin D is the elusive “winter susceptibility factor” and that perhaps the most important preventative measure you can take is to maintain an adequate vitamin D level in the winter. The best way to do this is to have a 25(OH)D level taken sometime in November and make sure it stays above 45 the entire winter (optimal is probably 60 to 80).

My strategy to achieve this is to start with one teaspoon of high vitamin cod liver oil (from greenpasture.org ) and if possible recheck the level again in a few weeks. If it is adequate, fine; if not, add plain vitamin D3 at a dose of 20,000 IU per week, best in two divided doses of 10,000 IU. For most people this will be adequate to maintain optimal levels and is a great step in preventing the winter susceptibility to colds and flus.

The next crucial step, which I will discuss more about in the article on the GAPS diet, is to maintain a healthy gut ecology. Again, numerous lines of inquiry point to the fact that our best defense against foreign, pathogenic microorganisms is our own healthy flora. Our own bacteria make vitamins (B12 and K, at the least), help digest our food, and importantly to this discussion, actually make antibiotic, antiviral substances that directly inhibit the growth of pathogens. Caring for our inner ecology turns us into a fermentation factory that makes healthy yoghurt and sauerkraut, not moldy, rotting vegetables. This is the basis of sound nourishment and a robust immune system.

The strategy for this is the basic Nourishing Traditions diet program with its robust supply of living and lacto- fermented foods as well as healthy fats (such as coconut oil) which support their growth. Everyone should be eating sauerkraut or a similar fermented vegetable, or drinking beet kvass every day in the winter. In addition, the probiotic Biokult (obtainable on a few sites on the internet, including gapsdiet.com) is a powerful addition to your probiotic supply. My suggested dose for preventative use is one capsule twice per day all winter long.

The final simple step you can take to prevent colds and flus is to take a good elderberry mixture throughout the flu season. Elderberry has been used in folk medicine for centuries as a winter tonic to ward off sickness. Recent research has shown many different anti-viral components in elderberry which, like many natural medicines, have variable mechanisms. Some of the elderberry compounds are directly toxic to pathogens, other components stimulate our immune response, while others seem to nourish our own healthy flora. The best way to use elderberry is the old-fashioned way of making elderberry syrup from your own fresh picked elderberries in the autumn. Most of us don’t have access to this option, so the company True Botanica makes a very good elderberry/thyme syrup which mixes elderberry with other similar infection fighting botanicals. I usually use one tsp twice per day for prevention, again every day throughout the cold and flu season.

A simple note on treatment if you still happen to get sick is to use these simple measures, just increase the dose. So, at the first sign of any sickness, I put people on a soup broth/coconut oil diet with some sauerkraut in the soup. Then I give a one time dose of about 30,000 IU of vitamin D3 (much less for children depending on their size). I also give about four to six capsules of Biokult and one tablespoon of elderberry/thyme syrup six times per day until they feel better. These simple measures can often turn long, debilitating illness into a much quicker and easier experience.

FOCUS: GAPS Diet

Back a number of years ago there was a startling paper published in The Lancet, the biggest English language medical journal in the world. The article was by a researcher named Andrew Wakefield, who claimed he had discovered the cause of autism.

What Wakefield did was to take a number of children with autism, do small intestine biopsies on them and from those he discovered that they had abnormally wide holes in their small intestinal lining. He postulated that these holes in their intestines were allowing proteins to leak from the inside of the bowel into the bloodstream, and that these foreign proteins were acting like neuro-toxins and interfering with the neurological functioning of these children. He further went on to say that these intestinal defects were caused by the MMR vaccine. This last part is what became big news. In fact, I can remember clearly watching a 60 Minutes show about this, in which Wakefield showed the biopsies, named some of the proteins which were found to leak through the intestinal wall, and made the case as to why he thought it was caused by the MMR vaccine.

Interestingly, the media and the medical establishment attacked Wakefield, not for the theory of autism (which as far as I know has never really been disputed) but for claiming it was caused by the MMR vaccine. The shame of this is that Wakefield had in fact uncovered one of the most important mechanisms which lead people to get and stay sick, but he got the cause wrong. Not that I’m a big fan of the MMR vaccine but, as claimed by the medical establishment, there are many autistic children who have never had this vaccine. In other words, while the vaccine is not healthy for a child’s immune system or even their gut flora, Wakefield was off base in claiming it was the sole cause of what he called autistic entero-colitis. It is the entero-colitis that is the big news here.

Parallel to this story of Dr. Wakefield, a neurologist in England named Natasha Campbell-McBride had a son with autism and was not finding much help in the conventional medical world. Her own research into the problem convinced her that the problem does stem from the gut, and so she set about to heal her son’s intestines and see what effect that would have on his autism. Many years later, having essentially healed her son of autism and treated hundreds of other such patients, we have the program now called the GAPS (Gut And Psychology Syndrome) diet.

The theory of this diet is that we have millions of intestinal villi, which are tiny finger-like hairs projecting into the intestine. These villi increase dramatically the surface area of the intestinal lining, making it a more effective semi-permeable barrier, which means it keeps unwanted things out of our bloodstream while absorbing the nutrients. These villi are covered with a layer of healthy intestinal flora, in some estimates about five to seven pounds of millions of varied bacteria, viruses, yeast and other microbes.

As I said in the flu article above, these healthy bacteria are vital for healthy life. They make vitamins, they digest food, they make antibiotic substances to keep down pathogens and they function as our immune system. I tell my patients that this system is analogous to a lush meadow with a thick layer of soil (the villi) covered by a lush layer of grass (the healthy bacteria). When both are intact, the meadow is healthy, but if you went to the meadow and stripped off the grass (this would be the equivalent of using an antibiotic in a person, or even not eating probiotic food), a whole cascade of catastrophic events will follow. First, you will get erosion of the soil, then the soil that’s left will be weak and unsupportive of healthy grasses. Weaker varieties of grass will grow or even no grass at all. Next, as the soil develops erosion cracks, poisons, runoff, etc., will start to seep into the ground water. At this point the land is dying.

This is exactly what happens inside us. First we strip our grass, then the soil erodes – the villi get weak and blunted, and then can’t support healthy micro-orgnisms. The cracks develop, and finally poisons seep into our groundwater, the blood. We now have foreign proteins in our blood, which either directly poison our nervous system (i.e. autism) or create antibody formation in reaction to these abnormal proteins, which is the whole process of auto-immune illness. Diseases which are the direct result of this process include not only intestinal diseases such as IBS (Irritable Bowel Syndrome), ulcerative colitis and Crohn’s disease, but all the auto- immune problems such as eczema, asthma, rheumatoid arthritis, and on and on. It is not a stretch to confirm what natural medicine has claimed for literally thousands of years: The majority of human illness starts in the gut and must be healed by treating the gut.

There is one more part of the GAPS diet theory which is crucial to understanding how this illness comes about and why it is so debilitating. These intestinal villi are the sole site in the body where production of an enzyme called disaccharidase occurs. Just as lipases digest lipids (fats) and proteases digest proteins, these disaccharidases digest disaccharides. When the villi become blunted, they lose the ability to make this important enzyme, and we lose the ability to digest disaccharides. When we keep eating foods with disaccharides and can’t digest them, they become perfect food for the pathogens that always reside in our gut, particularly species of candida. We then produce an overgrowth of candida, other yeasts, clostridia and other potent pathogens – and these often make unhealthy proteins instead of the B vitamins made by our healthy gut flora.

At this point we are deeply immersed in an unhealthy vicious cycle: poor gut flora, eroding villi, cracks in our intestinal walls, poor enzyme products, eating food we can’t digest, worse flora, more erosion, worse nutrition, more leaking, worse and worse immune function, more and more toxicity, finally the diagnosis of auto-immunity or a neurological problem. This is GAPS. Luckily it is totally reversible, and many of these patients can be restored to full health.

The therapeutic strategy is fairly simple: Restore the gut flora, heal the villi, seal the cracks. We heal the villi with the Nourishing Traditions diet with a particular emphasis on soup broth, the magic gut restoring food. We replant the villi grass with probiotic foods and Biokult (a probiotic developed by Natasha McBride for the GAPS program), and until we are healed we completely avoid all foods which contain disaccharides: grains, most beans, potatoes, sweet potatoes, most sweeteners, milk (but not other cultured dairy products), and a few other foods. I use this program extensively in my practice now as a transition to the full Nourishing Traditions diet for those who suffer from the above mentioned illness.

We have a lot of information on how to implement this diet and a support group where GAPS patients can share their stories. The results have been probably the most gratifying of anything I have seen in my years of doing medicine. We would like to share one such story to help you realize that this effective program, while admittedly tough, is also rewarding and do-able for those who want to really heal these otherwise intractable illnesses. Read on…

One Patient’s Experience With Ulcerative Colitis and the Gaps Diet

Contributed by: Kurt Worthington, Berkeley, California, December 2008

It all started about three years ago. I am a self employed architect who was fortunate enough to be asked to help with designing the master plan of Kigali, the capitol city of Rwanda. As someone who has travelled extensively throughout my life, I welcomed this opportunity to participate in something so important and was excited about the adventure that lay ahead. I have since been over there six times to this beautiful, small and hilly, green African country.

However after returning from my first visit there, which lasted our typical ten days, I noticed blood in my stool. I always seem to get traveler’s diarrhea when I travel to unusual places, but this was the first time that I noticed blood. Somewhat worried but not overly so, I went to a Gastro Intestinal doctor. I explained where I had been and figured I must have caught a bug of some kind. At first he thought the same and prescribed the normal western treatment – antibiotics. I took them for a while but my symptoms remained. As a result, I returned to his office a few weeks later. He told me since the antibiotics did not work, it was probably something else. He then decided to do a sigmoidoscopy and explained that he suspected I had Ulcerative Colitis, a disease I had never heard of. The sigmoidoscopy retuned results classic of what he suspected – I did indeed have UC.

The doctor explained to me that this was a disease that was hereditary and can happen anytime in your life; however it is more common in the early years (teens and twenties) or shows up in people in their fifties. Having this occur in my mid-forties was a little unusual. He went on to explain that it was a disease of the immune system. His simple explanation was that a bug of some sort entered my system; my immune system went to attack it, and was now not shutting off. The only way to shut it off was by medication. He then went on to explain the medicinal treatment “pyramid” as he called it. At the base of this pyramid was a wide array of medicines, all not too intense, but as you worked your way up the pyramid, there were fewer choices in medicine, and these medicines were more intense and strong.

So we started at the bottom and he prescribed 12 to 14 tablets of Asacol. “How long would I need to take these?” I asked. “Probably for the rest of your life,” he said. I was starting to understand that this was a serious disease. The Asacol did not work. He then starting working his way up the pyramid. I was learning more about this disease both through my GI as well as from my own reading. There seemed to be two theories. One was what my GI believed; the other was that it was based on diet. I brought up the diet philosophy to my GI, but he disregarded it – which frustrated me.

Onward we marched up that pyramid of medicine; I worked my way to the middle and now was being prescribed 60 mg of prednisone a day as well as other medications. The prednisone steroid was horrible. I could not sleep, I was incredibly irritable and it turns out (as I later discovered) it was giving me steroid induced osteoporosis and cataracts in my eyes. My face puffed out and I started losing my hair. The prednisone did not work that well either and, from what I was experiencing from the side effects, I wanted off it.

I was now extremely frustrated as my disease just seemed to be getting worse and worse, even though my medicine was getting stronger and stronger. I was having 10 to 15 to 20 bloody, uncontrollable bowel movements a day. Everywhere I went, I mapped out the bathrooms because I literally had about 20 seconds from the time I got the urge until the time I had to go to the bathroom. For the first time in my life I felt handicapped. I was not in control of my body and that frustrated the hell out of me.

Well, I made it to the top of the pyramid which included Remacaid, via an infusion into my body taking three hours about once every three weeks and Imuran, an immune suppressant drug that does just that – it hinders your immune system (an idea I did not feel that good about). These treatments did not work as well. I was miserable, had lost weight because my intestines were not absorbing what they should and I was incredibly lethargic. I felt like I had constant jet lag. All this was a result of my disease and the drugs I was taking for it.

My doctor then said that since the medication was not working, my only other option was surgery. A second opinion supported this and the doctor actually said to me, “Just do it, you do not need your colon anyway.” I could not believe this was happening, it was like a bad, bad dream and I was not waking up from it. The operation that he said I needed would be a two part operation, each one taking me out for about a month at a time. It was called a “J pouch” operation where during the first part they take out the colon and create an internal sack, but they then give you an external bag for your waste. Then in a month, after your intestines have a chance to heal, they take away the external bag and reconnect your inside so that this J pouch now acts as your colon. There are common problems with the J pouch such as infections, etc. If it fails completely, you must wear the external bag for the rest of your life. However, some people do not have many problems except that they need to go more often then they did. Even still, this operation horrified me. But it had been three long years of living with this and it was getting worse and worse. I kept holding on to the belief that it was diet related and kept bringing this up with my GI. However, it kept falling on deaf ears. I started to look outside the traditional medicine path. I tried a strict diet prescribed by a Chinese acupuncture doctor but that did not work either.

Friends of my parents who live in Germany, one of whom is an anthroposophic eye doctor, were appalled at the treatment that I was being prescribed. They told me to search out an anthroposophic doctor in the Bay area to see if he or she could help with an alternative method. That is how I found Dr. Cowan. I was literally at my wits’ end because in the week that I met Dr. Cowan, I also interviewed two surgeons who could possibly do the J pouch surgery. I must say I was a little reluctant that Dr. Cowan could help. But he said one key phrase that convinced me to postpone surgery: “I sure as hell would try this first before you remove your colon because there is no going back after you do the J pouch surgery.”

I told Dr. Cowan my story, about the trips to Rwanda, the medications I was on, etc. But he also wanted to hear more about me. So I told him about myself, my personality, as well as the fact that five years ago I had a stint put in one of my arteries, that I was on a statin to lower my cholesterol, and I was on a very low fat diet. My LDL was about 79 and my heart doctor wanted it below 70.

Dr. Cowan took in all this info and started drafting a recovery plan for me. The first thing was to stop the statin and to not worry about my cholesterol. If anything he wanted my cholesterol higher because he said cholesterol has healing abilities, and the fact that my cholesterol was low was actually hindering my recovery from ulcerative colitis. He introduced me to the Nourishing Traditions cookbook and told me to look at it not only as a cookbook but as a philosophy because the diet he was going to prescribed for me would not, for now, allow me to use all of the recipes in the book.

The diet he prescribed was the GAPS diet by Natasha McBride, which is related to Elaine Gottschalls Specific Carbohydrate Diet (SCD). The Nourishing Traditions ideas dovetailed well with the GAPS diet in many ways. At first the GAPS diet was difficult to do. It is very restrictive in that you eliminate virtually all starches, carbohydrates and sugar. Corn, soy, wheat, rice, barley and many other items were forbidden as well. When you take these ingredients out of your diet, the supermarket gets real small, real fast.

As I mentioned though, I was at the end of my rope. It was either this diet and the protocol that Dr. Cowan prescribed or it was off to the cutting table. The latter thought made the diet seem really easy.

Honestly, I was both skeptical and hopeful at the same time when I started the GAPS diet. I did not know if it was going to work. Dr. Cowan warned me that I would not see results right away and that the diet would have to be continued for at least one year after my symptoms stopped. I knew I was looking at a long road ahead of me.

I diligently read Dr. McBride’s book and followed the recipes in her book as well as the basic ones in the Nourishing Traditions cookbook. I started on the broths and cooked only organic meat and organic vegetables. Joining a chat room and getting some names from Dr. Cowan, I was able to find new recipes. The diet went from hard work to a lot of fun because I started to experiment with a new ways of cooking. I also learned about a very valuable book by Kendal Conrad called Eat Well, Feel Well. This book took the diet to another level and showed me that this diet could be tasteful, creative and even gourmet.

The first thing I needed to do was find a substitute for typical starches or carbohydrates like rice, potatoes, pasta or bread at my meals. Conrad’s book talks about this and gives recipes (to name a few) for mashed celery root and mashed carrot for potato substitutes, spaghetti squash to replace pasta, and cashew bread to replace the traditional bread that I was so used to eating. For breakfast, almond flour became my friend when making carrot muffins; ground up pecans for scrumptious pecan waffles with honey is also a favorite. I started to make my own kefir with the kefir grains given to me from Karen Hamilton-Roth at Dr. Cowan’s office. Letting the grains sit in whole, raw milk from Organic Pastures for 24 hours provided a great morning fruit and raw-egg smoothie. Often I would substitute yogurt made from the raw milk for the kefir. I also tried to eat as much fermented food like sauerkraut and beet kvass.

As I mentioned, I was on multiple and very strong medications at the time I started this diet. However Dr. Cowan instructed me that we would slowly taper off these hard medications and substitute a few drugs that he prescribed coupled with this diet. I started noticing results within the first two weeks. They were not big changes, but there were changes. I started to see a reduction in my bowel movements from 15 down to maybe 10 a day. After a month, it dropped even more and after three months I really started to see a difference. But I also started losing more weight. The adjustment of eliminating carbohydrates and because my colon was still not absorbing nutrients the way it should caused me to lose weight – dropping from 165 to 140 pounds. However, I was now going only 5 to 6 times a day (almost all still bloody and still not very controllable) but this was so much less than before. I had reason to be encouraged and optimistic.

I started the diet in February of 2007 and by mid June my symptoms were completely eliminated. I felt more energetic and my weight was stabilizing. During the summer we slowly tapered off Imuran, the immune suppressant drug that my GI had told me I would need to be on for the rest of my life.

It is now late December, I still have not had a relapse. I feel great, people tell me I look great, and my weight has started to climb back up. But most important of all, I still have my colon. As someone who was hopeful but skeptical about this diet, I am living proof that it works!

Nourishing Recipe: Roasted Butternut Squash Soup

A winter GAPS recipe from Karen Hamilton-Roth, an easy-to-make creamy sweet comforting soup

When winter is here, soups and stews are warming and satisfying. These one-pot meals are the basis of the Nourishing Traditions and the GAPS diets. The gelatin-rich and mineral-rich bone broths feed and heal the intestinal system and our whole body.

Remember that it takes time and planning to prepare fresh whole foods that you enjoy. Be patient. It gets easier with practice!

Roasted Butternut Squash Soup

Ingredients:
1 large onion, chopped
2 Tbsp butter
2 apples, chopped
1 butternut squash
Chicken broth, homemade
1 lemon
Salt to taste
Yogurt for garnish, optional

Cut squash in half lengthwise, place cut side down on a pan. Add a small amount of water to the bottom of the pan and roast in a 350-degree oven until it is tender when pierced. Let cool, discard the seeds, then scoop out flesh and set aside.

Sauté onion with the butter in a soup pot until soft. Add chopped apples, cooked squash and chicken broth to cover. Bring to a boil and let simmer gently until the apples are cooked. Take off heat, add the juice of a lemon, salt to taste and puree with an immersion blender. Serve with a spoonful of 24-hour yogurt. Enjoy!

CSH Update

An update on our Community Supported Healthcare Plan from Sabine Luis

The Community Supported Healthcare Plan (CSH) that Dr. Cowan and I put together back in March is going well. We have about 200 patients on board who participate in this innovative program that is intended to provide ongoing health care at reasonable prices. We know how the economy has impacted many people financially, and the CSH is a solution to continue to receive medical care despite the hard times.

For those of you not yet familiar with the CSH, it is set up to encompass all long-standing patients, regardless of location, and is based on how much a person can afford to pay per month. The program sustains itself by the people themselves. Those who can pay more help those who can’t pay as much. The regular rates for people who do not wish to be long- standing patients will always be available. For more information on the CSH please see our website.

Fourfold Healing Conference in Westwood MA

The Fourfold Path to Healing
Westford, Massachusetts
Jan 30-Feb 1 2009

Please join us for an incredible weekend of dynamic discussions, presentations and lectures with Tom Cowan, MD, Sally Fallon and Jaimen McMillan, authors of The Fourfold Path to Healing

This conference is a unique opportunity for individuals, families and health professionals to learn more about diet and health from the internationally acclaimed authors of The Fourfold Path to Healing, who will challenge your deepest beliefs while showing you a practical approach to improving your health and your quality of life.

Visit our website for more information and to register.

I hope to see you there!

We welcome your feedback. Send comments to Dr. Cowan at drcowansoffice@yahoo.com. Mail sent to and from newsletter@fourfoldhealing.com is for newsletter and website administration issues only. For all other queries, please contact Dr. Cowan directly at drcowansoffice@yahoo.com.

Fourfold Path to Healing Newsletter © 2005-2008 by Thomas S. Cowan, MD. Not to be reproduced without permission. Material included in this newsletter is for informational purposes only and is in no way intended to replace consultation with a medical practitioner.