A Path to Poor Gut Health
I’m always asked how I came to have poor gut health, something I’ve been reflecting on for years. In hindsight, the more I’ve learned about what causes poor gut health, the more I understand how it happened to me. It’s like it was the perfect storm of, “I didn’t know, what I didn’t know.”
So I thought I’d share a chronological timeline of what I believe have been influencing factors. I share this because my story is not unusual. Yes, it is unique to me, as all of our stories are to each of us, but what I experienced are common things that so many, perhaps even you, have as well.
Let’s dive in.
I was 11 years old, and I believe I was in the 5th grade. In my school photo, I proudly wore my JPO (Junior Police Officer) badge, and my forehead was covered in newly appeared zits - the beginning of a 30 year battle with acne.
I’m now 14 yrs old and in the 8th grade. My zits have turned to full blown acne, so my mom takes me to see a dermatologist where he treats both of us for it. I distinctly remember him saying, “Food has nothing to do with zits.” then prescribe erythromycin, Retin-A, and tetracycline. While these prescriptions somewhat tame the acne, I also use Neutrogena, Oxy-5 and any other product I can get my hands on that will tame the excessive oil and redness.
#thethingsIwishIknew: We now know that short-term use of antibiotics can cause long-term gut dysbiosis, and I continued to take antibiotics for acne for the next 30 (THIRTY!) years.
I’m now in my 20’s and notice that the end third of both eyebrows have disappeared. I blame it on the lady at the Nordstrom makeup counter who insisted on “cleaning up my brows" for me. She may have over plucked them, but they never fully grow back.
#thethingsIwishIknew: Thinning eyebrows, in particular on the outer ⅓ is a sign of hypothyroidism; a symptom of poor gut health.
In early 2004 I decided I was sick and tired of feeling sick and tired and finally chose to do something about it. I joined a brand new Golds Gym in my neighborhood, began working with a personal trainer. I dropped 40+ lbs and four dress sizes; it was the best I ever felt in my life!
But it was also unknowingly the start of orthorexia. I’ll never forget my trainer sitting me down and telling me, “Being healthy is simply about burning more calories than you eat.” I began using CalorieKing, then MyFitnessPal to obsessively track every single calorie I ate, in spite of already being at my goal weight, and working out daily, sometimes two to three times a day!
#thethingsIwishIknew: I was so afraid of overeating, when in fact, I was likely not eating enough given my activity level. Undereating kept my body in a chronic state of stress and deprivation. Without sufficient nutrients, my stressed body hung on to whatever little nutrients it did have doing the reverse of what I wanted.
It’s so easy to adopt this mentality, and I think those who have a story of overcoming obesity can relate to the fear that is always present of gaining the weight back.
Back to acne again. After being on antibiotics for cystic acne for 30 (THIRTY!) years, they stopped working. Nothing I tried could control it. So my doctor replaced the antibiotics with birth control pills.
#thingsIwishIknew: It’s now known that birth control pills can be just as damaging to your gut health as antibiotics!
I've never been a great sleeper, but 2007 is the earliest that I can remember that sleep became a big issue for me because that's when I started taking Ambien.
I was traveling to Asia for work and my manager told me to get sleeping pills from a doctor for the trip. My physician wrote me a prescription for Ambien, no questions asked. The first time I took it, I remember having the best sleep that I’d had in a long time so of course, I wanted more.
I continued taking it after that trip, to the point where it no longer worked for me. So my physician prescribed Lunesta instead, with just a warning that it might leave a metallic after taste (it did).
Silicon Valley is an exciting place to work with unparalleled opportunities, but it comes with a price. For me, it was the fear of layoffs. If your company doesn't meet Wall Street expectations, there's always the risk of layoffs - every. single. quarter.
I’d only been with my company (which no longer exists) for less than a year, but I could see the writing on the wall. So I used my network and landed a new job with a large corporation. It was a GREAT opportunity, but it had strings attached - micro-management.
I had NEVER experienced micromanagement to this extreme. I broke out in a sweat and my gut CHURNED every morning as I drove to the office. It was a culture shock - I’d never experienced anything so toxic in my entire career.
I turned to exercise to cope with the mounting stress, working out daily, sometimes two to three times a day. Within a few months I finished my first half-marathon, and I discovered my love for long-distance running.
Not only was I still having poor sleep, but by now I was having massive anxiety and some depression. I didn't feel like myself, so I began seeing a therapist (who I still check-in with today) for help.
I also finally start to get a clue that something wasn’t right with my body. I was still at my ideal size, but after five years maintaining a consistent weight, my body begins making subtle shifts. Knowing that thyroid disorders run in my family, I asked my physician (the same one who prescribes any pharmaceutical I asked for without much question) to test my thyroid. She ran a TSH test and reported back that everything was normal. “Well, that’s that,” I thought...
#thethingsIthoughtIknew: A single TSH test is not a full indicator of thyroid health, and “normal ranges” are relative.
My love for long-distance running grows and I ran my first marathon. And second marathon. Despite all this training, I was still counting calories, yet my weight was increasing. And I was always sore (kinda normal), in pain (so not normal) and injured (ugh). I lived on ibuprofen and Aleve to mask the pain.
#thethingsIthoughtWishIKnew: Pain relievers are simply that. They mask acute pain but don’t address the root cause of the problem. I took these pills like candy. Now I realize that they are huge factor in causing Leaky Gut Syndrome
By early 2011 I finished my third marathon but was having serious GI problems. But like anyone who does long distance running, I simply chalked it up to "runners trots" and accepted the idea this was common.
After my first DNF (Did Not Finish) where my gut exploded so bad, I had to drop out of a race; I went to see my same physician who told me that I had IBS and said that “some people just have it.”
#thethingsIwishIknew: Common is not normal and IBS is an “umbrella” diagnosis - there is a deeper underlying root cause.
Still counting calories, trying to lose weight I had no business in trying to lose and trying every theory possible to weigh less so I could run faster, and now needing to tame IBS, I decided to stop eating gluten. My cousin stopped eating it due to having an autoimmune disease so I was sort of familiar on how gluten is inflammatory.
But here’s where I went wrong going gluten-free: I thought that everything that was labeled gluten-free meant “healthy.” So after years of watching what I ate, I suddenly gave myself the green light to eat all the cookies and crackers and candy and pastries because they were gluten-free and gluten-free means healthy!
#thethingsIwishIknew: Processed gluten-free products are typically loaded with added sugar, which is also inflammatory and has zero nutrients. And hello, blood sugar problems!
The year I finally got a clue.
I’ve always known I had an issue with lactose. In elementary school when all the other kids had to have milk with their school lunch, I had a doctor's note allowing me to have juice instead.
Avoiding milk was never a problem for me, but cheese and ice cream was a whole ‘nother story. I finally had a wake-up call that dairy was no good for my belly (or IBS) during a disastrous shopping experience in the Container Store in downtown San Francisco. Let’s just say thank goodness for the unlocked, clean restroom on the second floor. That experience was enough for me to say adios to dairy forever (and I haven’t had it since).
This was the year that I also ran my 5th and last marathon to date. It was the toughest training cycle I’ve ever had. Despite all my hard work and commitment to my training plan, I regressed. I wasn’t able to finish very many long runs because I’d feel intense, unbearable pain in my legs. I sat on many benches in Golden Gate Park in tears from pain and defeat. I finished that race, much slower than expected.
Three months after crossing the Finish Line, my body still hadn’t adequately recovered from it. That combined with debilitating insomnia, night sweats, waking up starving in the middle of the night and everything else previously described finally clued me in that, “Hey, something isn’t right here.”
I sought out help from a functional medicine doctor (I also finally got a clue that my regular physician hadn’t done me any favors). There I learned that I had adrenal fatigue, hypoglycemia and heavy metals in my body.
This began my journey of figuring out how I got this way.
While I cleaned up my diet and cut back on exercise I still wasn’t feeling fabulous as others claimed to when they did that. “What was wrong with me?” I wondered. “I know, I’m still eating sugar.” So I signed up for a program to help me quit eating it. The program suggested having blood work done so that I could have a "Before and After" comparison of how I improved.
My regular physician ordered the tests without any questions (I swear I can get anything I want out of this doctor). The surprising results showed my liver panel was high. Wondering if it was a fluke, my doctor had redo the tests three weeks later. The second test results came back even higher than the first. She referred me to a gastroentologist who ordered an ultrasound. The ultrasound results showed abnormal tumors on my liver, so then I had an MRI.
It’s never a good thing when a doctor calls you into the office to review test results. My doctor sat me down and told me I was showing signs of “Non-Alcoholics Fatty Liver Disease.”
Me: But I’ve never drunk alcohol in my life.
Dr: That’s why it’s called “non-alcoholics.”
Me: What do I do?
Dr: You need to start eating healthy and exercising
This doctor had not heard a word I shared about my health history. After I had unloaded on him, he began stuttering (yes) saying, “Well, I don’t know anything about food, so I’ll have to refer you out to the Nutrition department.”
Me: You are a GI specialist, and you know nothing about food?!
The Nutrition Department: “Your insurance isn't going to cover your visits with us."
So: My doctor, says I have pre Non-Alcoholics Fatty Liver Disease. He is a specialist in gastrointestinal health yet knows nothing about food and refers me to the Nutritionist but my insurance doesn’t cover the treatment.
This was when I decided to take matters into my own hands. I needed to become proactive, not reactive. I enrolled in nutrition school, and the rest of that is history.
But what happened with my health?
I quit sugar. But I was still having massive gas and bloating, and my weight was still climbing. I had been reading about and suspected that I had SIBO. I went back to my GI doctor and had to talk him into ordering a lactulose test for me. It came back positive. By now I understood the importance of good gut health and I knew that antibiotics were the prescribed treatment for SIBO. But I also knew that antibiotics makes gut health worse. So I researched what functional medicine doctors recommend as the least damaging treatment for SIBO. Unfortunately, my GI doctor didn’t agree and had me go through two rounds of other antibiotic treatments which made my SIBO worse (proven by a lactulose breath test done after every round).
After two failed rounds, my GI doctor finally relented to what I’d asked for to begin with, and surprise, surprise, my final breath test came back negative.
However, after a year of following the low fodmap diet to ease SIBO symptoms, I was still feeling crummy and frustrated. You see, it's a restrictive diet that caused me to remain nutrient-deficient.
I happen to come across a social media post by a functional medicine doctor in San Francisco who worked for a major health care who accepted my insurance. I clicked on his profile and discovered the Institute of Health and Healing - a place where I could be treated by functional medicine doctors who took a whole-istic approach to medicine and have it covered by insurance!
The doctors at IHH performed extensive blood and stool testing that helped me learn:
- I had severe gut dysbiosis.
- I was also deficient in vitamin D
- I did not have candida.
- I indeed had hypothyroidism (finally, a diagnosis 15 years later!).
- 30+ specific foods I was intolerant of (sesame and black pepper?!)
- Specific grasses, animals and allergens I was allergic to.
- My SIBO was likely never entirely eradicated.
- I needed to go beyond diet, exercise, and supplements and change my mindset when it came to adrenal fatigue.
Beyond the lab tests, I had doctors who LISTENED to me and looked at me and my health history as a real human being and not a diagnosis (something I strive to practice with my own clients).
My knowledge and expertise as a health coach has been vital in working with my doctor in partnership to create and execute a plan to repair and heal my body.
Today that plan is in progress.
According to my last cortisol tests, I am no longer in a state of adrenal burnout. Yay!
My blood sugar is stable, and so is my sleep.
My bowel movements are now Type 3 and 4 (normal).
We continue to work on my thyroid. Combined with SIBO, it’s been complicated.
After four SIBO tests and a year on the low fodmap diet, I told my functional medicine doctor I wasn’t going to do either one anymore, nor would I take any more antibiotics. He agreed.
So we added a functional medicine nutritionist to my health care team, and together we created a four-phase plan:
Phase 1 entailed eliminating sugar and taking supplements. I already rarely ate sugar, but decided to do a 21-day sugar detox anyway.
The result: No change.
So we moved on to Phase 2 which involved Phase 1 + completely avoiding grains. I had been intolerant of grains but had been trying to reintroduce quinoa and rice, with not much success. So Phase 2 also was not very different than how I already ate.
The result: Still no change.
Now we are in Phase 3, a detoxification. Having run my own whole foods detox programs in the past, again, there really isn’t anything different for me here. I already eat the foods allowed on a detox and avoid the foods not allowed (sugar, gluten, dairy, corn, soy, nightshades), and practice detoxification activities like Epsom salt baths, dry skin brushing, contrast showering, saunas, castor oil packs and oil pulling. But what is new for me in this phase are the supplements.
I’m won't go into detail what the specific supplements are because when it comes to supplements, the prescribed protocol has to be tailored to the individual. What’s worked for me may not work for you and what’s worked for you, may not work for me. The combinations and dosages are very different person-to-person.
What I’ve found in my work as a health coach is that many people rely heavily supplements without addressing the core basics (nutrition/hydration, exercise/movement, sleep/resilience, stress/mindset and relationships/communication).
Being already dialed in on food, exercise and sleep, I'm spending a lot of time managing my stress and reframing my mindset.
I’ll report back on how Phase 3 goes. If it doesn’t, then we move on to Phase 4. Once thing I do know is that this is figure-outable and we will get there.
I hope my transparency helps you to see that:
- Health goes beyond the food on your plate and the hours you exercise. It goes beyond calories and BMI.
- You are not what you eat; but you are what your body can do with what you eat. You can eat the cleanest diet in the world and have the perfect workout regimen, but if you have poor gut health and your body isn’t able to absorb nutrients, you can be malnourished.
- Poor gut health doesn’t always manifest itself as IBS or a GI issue. Skin problems like acne, rosacea, psoriasis, etc. are all signs of poor gut health. So are anxiety and depression. Hippocrates said it best, “All disease begins in the gut.”
If you’ve made it to the end of this excessively long post, you’ll see that everything I experienced is not uncommon. There was no rare disease or “you’re too young for that.” What I experienced are things that many experience. But just because many people experience these things, common doesn’t mean normal, and you don’t have to accept them as such.
Much of my symptoms were underlying issues that point back to inflammation and stress. This is why I spend a lot of time talking about clean living, gut health and self-care. These may sound like tired topics, but it's not; not when our society is having a health and healthcare crisis.
The biggest thing I'd like you to take away from this post is to understand that what you may experience now is not necessarily a result of a single incident or something that recently happened. It could be, but it could also be a snowball of events that's happened over your lifetime. That’s why in my 1x1 mentorship program we spend an extended amount of time in the initial session doing a deep dive examining your health history.
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Naomi Nakamura is a certified Holistic Health Coach who takes a holistic approach through functional nutrition. Through her weekly show, The Live FAB Live Podcast, coaching programs, and safer skincare solutions, she helps people with acne and other chronic skin issues clear up their skin by teaching them where food meets physiology and how food, gut health, stress, and toxins are intricately connected to the health and appearance of our skin. Naomi resides in the San Francisco Bay Area and can often be found romping around the city with her puppy girl, Coco Pop! Connect with Naomi at: Facebook | Twitter | Instagram | Pinterest.