Importance Of Fermented Foods & Gut Health For PKD Patients | ft. Kelly Welsh

The Renew program is our plant-focused ketogenic therapy where you work with a dietitian to safely get you into ketosis while making sure that we are keeping your entire body healthy as well. So far we've had about 200 people go through and we have a little bit about what people are doing to help their gut health. Gut health has been an interest for dietitians at Kidney Nutrition Institute and Renew for a long time for chronic kidney disease. What's interesting is we started digging into PKD and we saw that there were a lot of links back to PKD specifically with the gut. Just to give you a little bit of background on why this is important: in the gut we have bacteria, and that's what helps us metabolize food, it's what helps create nutrients. There are nutrients that bacteria help us create. It's such a core part of our health. That bacteria in our gut talks with our immune system in our body, and one of the toxic byproducts of bacteria breakdown seems to impact cyst growth. Now for us as dietitians, we don't have a solid human study, we don't have a way to necessarily diagnose a poor gut or an imbalance of microbiome. Practically speaking, we want to focus on things that we see in the literature, things we've seen in the research that actually make a difference for gut health overall. What we a lot of times can see in health is that if you focus on really simple but consistent habits, that's the foundation of health. We know that things like diarrhea, heartburn, bloating, constipation are really good indicators that there is an imbalance in your gut and something is not working and needs to be worked on. In the Renew program, when we are looking to improve someone's gut health and help a root cause that they're having, we have different approaches to gut health. One of the things we do is prioritize plant proteins, more fiber by including more low-carb vegetables. A variety of fiber is super important, and even prioritizing those healthy fats like nuts and seeds. Fermented foods are a great source, and the great thing about fermented foods is that you don't need a large amount, just a small amount can go huge distances for you. Some of those fermented foods that people like to include: sauerkraut is a great one, you only need about a tablespoon a day put on some salads or your sandwich. Kimchi is another one that our participants love to include, and there are many low-carb versions these days. Pickles are another one, but with pickles you have to make sure that they're actually fermented. Prebiotics are also important to feed the good bacteria in our gut. Some easy sources to include on a regular basis: chicory root, garlic, using a lot of garlic in your cooking and everyday meal prep, onions, leeks. A lot of participants love black seeds in their low-carb smoothie or yogurt parfait. Jicama is fabulous, and if you get a really good jicama with a nice crunch, it's an excellent addition to salads or even just snacking on. And of course the ever-famous avocado in our ketogenic diets is a huge prebiotic source as well. So those are just some ideas, working in a little bit starting from there.

I think most importantly it has to be monitored because in the beginning if you're just starting out keto, it's very easy to forget that you need to include those plant sources and a variety of plant sources to get all the different types of fiber. It's easy to just stay focused on the meat and cheese because that'll get you into ketosis and you're reaching those numbers, but what's important is all of those vitamins and minerals that you're missing in the meantime, including fiber to help promote that gut health. Some people feel really good with a lot of fiber, but some people don't feel good with a lot of fiber because their digestion is not working. Most people feel really, really good with a lot of fiber.

I think it's important as you're moving to low carb, as we talked about, to make sure that you are really looking for the amount of fiber that you absolutely need and looking for opportunities in places that you can sneak some more veggies in. Making those the primary source of your meals is a really good place to start. And then of course it's super important to always be aware and monitor how am I feeling with this? Is this too much? Is this too little? Am I having symptoms? What might I do to improve? Constant monitoring and evaluating what's going on with yourself is really key to what's working for you and what needs to be modified.

Yes. Those processed low-carb keto treats, I think they can have their place if you're using them sporadically. But we had a participant who went through the Renew program and thought that diarrhea was just part of the process for her, that this was just normal. Turns out she had been daily consuming an artificial sweetener, and the second she eliminated it, her diarrhea went away. It's really interesting because again, this is where that personalization comes in. Everybody's bodies are made up differently, they're going to react differently. So noticing if you have those gut symptoms, am I using keto chocolate bars every day? Am I using this specific sweetener every day? And then experimenting, taking it out, changing it. For me personally, if I have any of those sugar alcohols like maltitol, I do not feel great. I get bloated and gassy within a few hours. So that's just for me, I don't like how that feels, so that's not on my plate. Even though I really like the keto sweets, I just can't go there. So I've got to work with stevia or pure monk fruit, or there are some other interesting natural sweeteners I've seen out recently. Now with an easy Google search you can actually find sweet treats. It takes a little bit more time because you're making them yourself, but making them yourself you know exactly what's going in there.