In Crisis, She Went to an Illinois Facility. Two Years Later, She Still Isn’t Able to Leave.

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Series: Culture of Cruelty:Inside Illinois’ Mental Health System

State-run facilities in Illinois are supposed to care for people with mental and developmental disabilities. But patients have been subjected to abuse, neglect and staff misconduct for decades, despite calls for change.

Kaleigh Rogers was in crisis when she checked into a state-run institution on Illinois’ northern border two years ago. Rogers, who has cerebral palsy, had a mental health breakdown during the pandemic and was acting aggressively toward herself and others.

Before COVID-19, she had been living in a small group home; she had been taking college classes online and enjoyed going out with friends, volunteering and going to church. But when her aggression escalated, she needed more medical help than her community setting could provide.

With few viable options for intervention, she moved into Kiley Developmental Center in Waukegan, a much larger facility. There, she says she has fewer freedoms and almost nothing to do, and was placed in a unit with six other residents, all of whom are unable to speak. Although the stay was meant to be short term, she’s been there for two years.

The predicament facing Rogers and others like her is proof, advocates say, that the state is failing to live up to the promise it made in a 13-year-old federal consent decree to serve people in the community.

Rogers, 26, said she has lost so much at Kiley: her privacy, her autonomy and her purpose. During dark times, she cries on the phone to her mom, who has reduced the frequency of her visits because it is so upsetting for Rogers when her mom has to leave.

The 220-bed developmental center about an hour north of Chicago is one of seven in the state that have been plagued by allegations of abuse and other staff misconduct. The facilities have been the subject of a monthslong investigation by Capitol News Illinois and ProPublica about the state’s failures to correct poor conditions for people with intellectual and developmental disabilities. The news organizations uncovered instances of staff who had beaten, choked, thrown, dragged and humiliated residents inside the state-run facilities.

Advocates hoped the state would become less reliant on large institutions like these when they filed a lawsuit in 2005, alleging that Illinois’ failure to adequately fund community living options ended up segregating people with intellectual and developmental disabilities from society by forcing them to live in institutions. The suit claimed Illinois was in direct violation of a 1999 U.S. Supreme Court decision in another case, which found that states had to serve people in the most integrated setting of their choosing.

Negotiations resulted in a consent decree, a court-supervised improvement plan. The state agreed to find and fund community placements and services for individuals covered by the consent decree, thousands of adults with intellectual and developmental disabilities across Illinois who have put their names on waiting lists to receive them.

Now, the state has asked a judge to consider ending the consent decree, citing significant increases in the number of people receiving community-based services. In a court filing in December, Illinois argued that while its system is “not and never will be perfect,” it is “much more than legally adequate.”

But advocates say the consent decree should not be considered fulfilled as long as people with disabilities continue to live without the services and choices that the state promised.

Across the country, states have significantly downsized or closed their large-scale institutions for people with developmental and intellectual disabilities in favor of smaller, more integrated and more homelike settings.

But in Illinois, a national outlier, such efforts have foundered. Efforts to close state-operated developmental centers have been met with strong opposition from labor unions, the communities where the centers are located, local politicians and some parents.

U.S. District Judge Sharon Johnson Coleman in Chicago is scheduled in late summer to decide whether the state has made enough progress in building up community supports to end the court’s oversight.

For some individuals like Rogers, who are in crisis or have higher medical or behavioral challenges, the state itself acknowledges that it has struggled to serve them in community settings. Rogers said she’d like to send this message on behalf of those in state-operated developmental centers: “Please, please get us out once and for all.”

“Living Inside a Box”

Without a robust system of community-based resources and living arrangements to intervene during a crisis, state-operated developmental centers become a last resort for people with disabilities. But under the consent decree agreement, the state, Equip for Equality argues, is expected to offer sufficient alternative crisis supports to keep people who want them out of these institutions.

In a written response to questions, Rachel Otwell, a spokesperson for the Illinois Department of Human Services, said the state has sought to expand the menu of services it offers people experiencing a crisis, in an effort to keep them from going into institutions. But Andrea Rizor, a lawyer with Equip for Equality, said, “They just don’t have enough to meet the demand.”

For example, the state offers stabilization homes where people can live for 90 days while they receive more intensive support from staff serving the homes, including medication reviews and behavioral interventions. But there are only 32 placements available — only four of them for women — and the beds are always full, Rizor said.

Too many people, she said, enter a state-run institution for short-term treatment and end up stuck there for years for various reasons, including shortcomings with the state’s discharge planning and concerns from providers who may assume those residents to be disruptive or difficult to serve without adequate resources.

That’s what happened to Rogers. Interruptions to her routine and isolation during the pandemic sent her anxiety and aggressive behaviors into overdrive. The staff at her community group home in Machesney Park, unsure of what to do when she acted out, had called the police on several occasions.

Doctors also tried to intervene, but the cocktail of medications she was prescribed turned her into a “zombie,” Rogers said. Stacey Rogers, her mom and legal guardian, said she didn’t know where else to turn for help. Kiley, she said, “was pretty much the last resort for us,” but she never intended for her daughter to be there for this long. She’s helped her daughter apply to dozens of group homes over the past year. A few put her on waitlists; most have turned her down.

“Right now, all she’s doing is living inside a box,” Stacey Rogers said.

Although Rogers gave the news organizations permission to ask about her situation, IDHS declined to comment, citing privacy restrictions. In general, the IDHS spokesperson said that timelines for leaving institutions are “specific to each individual” and their unique preferences, such as where they want to live and speciality services they may require in a group home.

Equip for Equality points to people like Rogers to argue that the consent decree has not been sufficiently fulfilled. She’s one of several hundred in that predicament, the organization said.

“If the state doesn’t have capacity to serve folks in the community, then the time is not right to terminate this consent decree, which requires community capacity,” Rizor said.

Equip for Equality has said that ongoing safety issues in these facilities make it even more important that people covered by the consent decree not be placed in state-run institutions. In an October court brief, citing the news organizations’ reporting, Equip for Equality said that individuals with disabilities who were transferred from community to institutional care in crisis have “died, been raped, and been physically and mentally abused.”

Over the summer, an independent court monitor assigned to provide expert opinions in the consent decree, in a memo to the court, asked a judge to bar the state from admitting those individuals into its institutions.

In its December court filing, the state acknowledged that there are some safety concerns inside its state-run centers, “which the state is diligently working on,” as well as conditions inside privately operated facilities and group homes “that need to be addressed.” But it also argued that conditions inside its facilities are outside the scope of the consent decree. The lawsuit and consent decree specifically aimed to help people who wanted to move out of large private institutions, but plaintiffs’ attorneys argue that the consent decree prohibits the state from using state-run institutions as backup crisis centers.

In arguing to end the consent decree, the state pointed to significant increases in the number of people served since it went into effect. There were about 13,500 people receiving home- and community-based services in 2011 compared with more than 23,000 in 2023, it told the court.

The state also said it has significantly increased funding that is earmarked to pay front-line direct support professionals who assist individuals with daily living needs in the community, such as eating and grooming.

In a statement to reporters, the human services department called these and other improvements to the system “extraordinary.”

Lawyers for the state argued that those improvements are enough to end court oversight.

“The systemic barriers that were in place in 2011 no longer exist,” the state’s court filing said.

Among those who were able to find homes in the community is Stanley Ligas, the lead plaintiff in the lawsuit that led to the consent decree. When it was filed in 2005, he was living in a roughly 100-bed private facility but wanted to move into a community home closer to his sister. The state refused to fund his move.

Today, the 56-year-old lives in Oswego with three roommates in a house they rent. All of them receive services to help their daily living needs through a nonprofit, and Ligas has held jobs in the community: He previously worked in a bowling alley and is now paid to make public appearances to advocate for others with disabilities. He lives near his sister, says he goes on family beach vacations and enjoys watching professional wrestling with friends. During an interview with reporters, Ligas hugged his caregiver and said he’s “very happy” and hopes others can receive the same opportunities he’s been given.

While much of that progress has come only in recent years, under Gov. JB Pritzker’s administration, it has proven to be vulnerable to political and economic changes. After a prolonged budget stalemate, the court in 2017 found Illinois out of compliance with the Ligas consent decree.

At the time, late and insufficient payments from the state had resulted in a staffing crisis inside community group homes, leading to escalating claims of abuse and neglect and failures to provide routine services that residents relied on, such as help getting to work, social engagements and medical appointments in the community. Advocates worry about what could happen under a different administration, or this one, if Illinois’ finances continue to decline as projected.

“I acknowledge the commitments that this administration has made. However, because we had so far to come, we still have far to go,” said Kathy Carmody, chief executive of The Institute on Public Policy for People with Disabilities, which represents providers.

While the wait for services is significantly shorter than it was when the consent decree went into effect in 2011, there are still more than 5,000 adults who have told the state they want community services but have yet to receive them, most of them in a family home. Most people spend about five years waiting to get the services they request. And Illinois continues to rank near the bottom in terms of the investment it makes in community-based services, according to a University of Kansas analysis of states’ spending on services for people with intellectual and developmental disabilities.

Advocates who believe the consent decree has not been fulfilled contend that Illinois’ continued reliance on congregate settings has tied up funds that could go into building up more community living options. Each year, Illinois spends about $347,000 per person to care for those in state-run institutions compared with roughly $91,000 per person spent to support those living in the community.

For Rogers, the days inside Kiley are long, tedious and sometimes chaotic. It can be stressful, but Rogers told reporters that she uses soothing self-talk to calm herself when she feels sad or anxious.

“I tell myself: ‘You are doing good. You are doing great. You have people outside of here that care about you and cherish you.’”

This article is republished from ProPublica under a Creative Commons license. Read the original article.

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  • Asparagus vs Edamame – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing asparagus to edamame, we picked the edamame.

    Why?

    Perhaps it’s a little unfair comparing a legume to a vegetable that’s not leguminous (given legumes’ high protein content), but these two vegetables often serve a similar culinary role, and there is more to nutrition than protein. That said…

    In terms of macros, edamame has a lot more protein and fiber; it also has more carbs, but the ratio is such that edamame still has the lower glycemic index. Thus, the macros category is a win for edamame in all relevant aspects.

    When it comes to vitamins, things are a little closer; asparagus has more of vitamins A, B3, and C, while edamame has more of vitamins B1, B2, B5, B6, and B9. All in all, a moderate win for edamame, unless we want to consider the much higher vitamin C content of asparagus as particularly more relevant.

    In the category of minerals, asparagus boasts only more selenium (and more sodium, not that that’s a good thing for most people in industrialized countries), while edamame has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and zinc. An easy win for edamame.

    In short, enjoy both (unless you have a soy allergy, because edamame is young soy beans), but edamame is the more nutritionally dense by far.

    Want to learn more?

    You might like to read:

    Take care!

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  • How Your Sleep Position Changes Dementia Risk

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    This is not just about sleep duration or even about sleep quality… It really is about which way your body is positioned.

    Goodnight, glymphatic system

    The association between sleeping position and dementia risk is about glymphatic drainage, which is largely powered by gravity (and thus dependent on which way around your head and neck are oriented), and very important for clearing toxins out of the brain—including beta-amyloid proteins.

    This becomes particularly important when the glymphatic system becomes less efficient in midlife, often 15–20 years before cognitive decline symptoms appear.

    The video’s thumbnail headline, “SCIENTISTS REVEAL: THE WAY YOUR SLEEP CAN CAUSE DEMENTIA” is overstated and inaccurate, but our adjusted headline “how your sleep position changes dementia risk” is actually representative of the paper on which this video was based; we’ll quote from the paper itself here:

    ❝This paper concludes that 1. glymphatic clearance plays a major role in Alzheimer’s pathology; 2. the vast majority of waste clearance occurs during sleep; 3. dementias are associated with sleep disruption, alongside an age-related decline in AQP4 polarization; and 4. lifestyle choices such as sleep position, alcohol intake, exercise, omega-3 consumption, intermittent fasting and chronic stress all modulate* glymphatic clearance. Lifestyle choices could therefore alter Alzheimer’s disease risk through improved glymphatic clearance, and could be used as a preventative lifestyle intervention for both healthy brain ageing and Alzheimer’s disease.❞

    …and specifically, they found:

    ❝Glymphatic transport is most efficient in the right lateral sleeping position, with more CSF clearance occurring compared to supine and prone. The average person changes sleeping position 11 times per night, but there was no difference in the number of position changes between neurodegenerative and control groups, making the percentage of time spent in supine position the risk factor, not the number of position changes❞

    Read the paper in full here: The Sleeping Brain: Harnessing the Power of the Glymphatic System through Lifestyle Choices

    *saying “modulate” here is not as useful as it could be, because they modulate it differently: side-sleeping improves clearance; back sleeping decreases it; front-sleeping isn’t great either. Alcohol intake reduces clearance, exercise (especially cardiovascular exercise) improves it; omega-3 consumption improves it up a degree and does depend on omega-3/6 ratios, intermittent fasting improves it, and chronic stress worsens it.

    And for a more pop-science presentation, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    How To Clean Your Brain (Glymphatic Health Primer)

    Take care!

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  • What Flexible Dieting Really Means

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    When Flexibility Is The Dish Of The Day

    This is Alan Aragon. Notwithstanding not being a “Dr. Alan Aragon”, he’s a research scientist with dozens of peer-reviewed nutrition science papers to his name, as well as being a personal trainer and fitness educator. Most importantly, he’s an ardent champion of making people’s pursuit of health and fitness more evidence-based.

    We’ll be sharing some insights from a book of his that we haven’t reviewed yet, but we will link it at the bottom of today’s article in any case.

    What does he want us to know?

    First, get out of the 80s and into the 90s

    In the world of popular dieting, the 80s were all about calorie-counting and low-fat diets. They did not particularly help.

    In the 90s, it was discovered that not only was low-fat not the way to go, but also, regardless of the diet in question, rigid dieting leads to “disinhibition”, that is to say, there comes a point (usually not far into a diet) whereby one breaks the diet, at which point, the floodgates open and the dieter binges unhealthily.

    Aragon would like to bring our attention to a number of studies that found this in various ways over the course of the 90s measuring various different metrics including rigid vs flexible dieting’s impacts on BMI, weight gain, weight loss, lean muscle mass changes, binge-eating, anxiety, depression, and so forth), but we only have so much room here, so here’s a 1999 study that’s pretty much the culmination of those:

    Flexible vs. Rigid Dieting Strategies: Relationship with Adverse Behavioral Outcomes

    So in short: trying to be very puritan about any aspect of dieting will not only not work, it will backfire.

    Next, get out of the 90s into the 00s

    …which is not only fun if you read “00s” out loud as “naughties”, but also actually appropriate in this case, because it is indeed important to be comfortable being a little bit naughty:

    In 2000, Dr. Marika Tiggemann found that dichotomous perceptions of food (e.g. good/bad, clean/dirty, etc) were implicated as a dysfunctional cognitive style, and predicted not only eating disorders and mood disorders, but also adverse physical health outcomes:

    Dieting and Cognitive Style: The Role of Current and Past Dieting Behaviour and Cognitions

    This was rendered clearer, in terms of physical health outcomes, by Dr. Susan Byrne & Dr. Emma Dove, in 2009:

    ❝Weight loss was negatively associated with pre-treatment depression and frequency of treatment attendance, but not with dichotomous thinking. Females who regard their weight as unacceptably high and who think dichotomously may experience high levels of depression irrespective of their actual weight, while depression may be proportionate to the degree of obesity among those who do not think dichotomously❞

    Read more: Effect of dichotomous thinking on the association of depression with BMI and weight change among obese females

    Aragon’s advice based on all this: while yes, some foods are better than others, it’s more useful to see foods as being part of a spectrum, rather than being absolutist or “black and white” about it.

    Next: hit those perfect 10s… Imperfectly

    The next decade expanded on this research, as science is wont to do, and for this one, Aragon shines a spotlight on Dr. Alice Berg’s 2018 study with obese women averaging 69 years of age, in which…

    Flexible Eating Behavior Predicts Greater Weight Loss Following a Diet and Exercise Intervention in Older Women

    In other words (and in fact, to borrow Dr. Berg’s words from that paper),

    ❝encouraging a flexible approach to eating behavior and discouraging rigid adherence to a diet may lead to better intentional weight loss for overweight and obese older women❞

    You may be wondering: what did this add to the studies from the 90s?

    And the key here is: rather than being observational, this was interventional. In other words, rather than simply observing what happened to people who thought one way or another, this study took people who had a rigid, dichotomous approach to food, and gave them a 6-month behavioral intervention (in other words, support encouraging them to be more flexible and open in their approach to food), and found that this indeed improved matters for them.

    Which means, it’s not a matter of fate or predisposition, as it could have been back in the 90s, per “some people are just like that; who’s to say which factor causes which”. Instead, now we know that this is an approach that can be adopted, and it can be expected to work.

    Beyond weight loss

    Now, so far we’ve talked mostly about weight loss, and only touched on other health outcomes. This is because:

    • weight loss a very common goal for many
    • it’s easy to measure so there’s a lot of science for it

    Incidentally, if it’s a goal of yours, here’s what 10almonds had to say about that, along with two follow-up articles for other related goals:

    Spoiler: we agree with Aragon, and recommend a relaxed and flexible approach to all three of these things

    Aragon’s evidence-based approach to nutrition has found that this holds true for other aspects of healthy eating, too. For example…

    To count or not to count?

    It’s hard to do evidence-based anything without counting, and so Aragon talks a lot about this. Indeed, he does a lot of counting in scientific papers of his own, such as:

    How much protein can the body use in a single meal for muscle-building? Implications for daily protein distribution

    and

    The effect of protein timing on muscle strength and hypertrophy: a meta-analysis

    …as well as non-protein-related but diet-related topics such as:

    Does Timing Matter? A Narrative Review of Intermittent Fasting Variants and Their Effects on Bodyweight and Body Composition

    But! For the at-home health enthusiast, Aragon recommends that the answer to the question “to count or not to count?” is “both”:

    • Start off by indeed counting and tracking everything that is important to you (per whatever your current personal health intervention is, so it might be about calories, or grams of protein, or grams of carbs, or a certain fat balance, or something else entirely)
    • Switch to a more relaxed counting approach once you get used to the above. By now you probably know the macros for a lot of your common meals, snacks, etc, and can tally them in your head without worrying about weighing portions and knowing the exact figures.
    • Alternatively, count moderately standardized portions of relevant foods, such as “three servings of beans or legumes per day” or “no more than one portion of refined carbohydrates per day”
    • Eventually, let habit take the wheel. Assuming you have established good dietary habits, this will now do you just fine.

    This latter is the point whereby the advice (that Aragon also champions) of “allow yourself an unhealthy indulgence of 10–20% of your daily food”, as a budget of “discretionary calories”, eventually becomes redundant—because chances are, you’re no longer craving that donut, and at a certain point, eating foods far outside the range of healthiness you usually eat is not even something that you would feel inclined to do if offered.

    But until that kicks in, allow yourself that budget of whatever unhealthy thing you enjoy, and (this next part is important…) do enjoy it.

    Because it is no good whatsoever eating that cream-filled chocolate croissant and then feeling guilty about it; that’s the dichotomous thinking we had back in the 80s. Decide in advance you’re going to eat and enjoy it, then eat and enjoy it, then look back on it with a sense of “that was enjoyable” and move on.

    The flipside of this is that the importance of allowing oneself a “little treat” is that doing so actively helps ensure that the “little treat” remains “little”. Without giving oneself permission, then suddenly, “well, since I broke my diet, I might as well throw the whole thing out the window and try again on Monday”.

    On enjoying food fully, by the way:

    Mindful Eating: How To Get More Nutrition Out Of The Same Food

    Want to know more from Alan Aragon?

    Today we’ve been working heavily from this book of his; we haven’t reviewed it yet, but we do recommend checking it out:

    Flexible Dieting: A Science-Based, Reality-Tested Method for Achieving and Maintaining Your Optimal Physique, Performance & Health – by Alan Aragon

    Enjoy!

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  • Can We Drink To Good Health?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Can we drink to good health?

    We asked you for your thoughts on alcohol and heart health, and we got quite an even spread of results!

    If perchance that’s too tiny to read, the figures were:

    • 32% voted for “Alcohol is a relaxant, reduces stress, and can contain resveratrol too. It’s good for the heart!”
    • 32% voted for: “Moderate alcohol consumption can be at least neutral for the health, if not positive ⚖️”
    • 36% voted for: “Alcohol is bad for pretty much everything, including heart health ✋”

    One subscriber who voted for “Alcohol is a relaxant, reduces stress, and can contain resveratrol too. It’s good for the heart!” added the following thoughts:

    ❝While it isn’t necessary to consume alcohol, moderate amounts can be beneficial and contribute to well-being through social activity, celebrations, etc.❞

    That’s an interesting point, and definitely many people do see alcohol that way! Of course, that does not mean that one will find no social activities, celebrations, etc, in parts of the world where alcohol consumption is uncommon. Indeed, in India, wedding parties where no alcohol is consumed can go on for days!

    But, “we live in a society” and all that, and while we’re a health newsletter not a social issues newsletter, it’d be remiss of us to not acknowledge the importance of socialization for good mental health—and thus the rest of our health too.

    So, if indeed all our friends and family drink alcohol, it can certainly make abstaining more of a challenge.

    On that note, let’s take a moment to considerThe French Paradox” (an observation of a low prevalence of ischemic heart disease despite high intakes of saturated fat, a phenomenon accredited to the consumption of red wine).

    As it happens, a comprehensive review in “Circulation”, a cardiovascular health journal, has suggested the French Paradox may not be so paradoxical after all.

    Research suggests it has more to do with other lifestyle factors (and historic under-reporting of cardiovascular disease by French doctors), which would explain why Japan has lower rates of heart disease, despite drinking little wine, and more beer and spirits.

    So, our subscriber’s note may not be completely without reason! It’s just about the party, not the alcohol.

    One subscriber who voted for “Moderate alcohol consumption can be at least neutral for the health, if not positive ⚖️” wrote:

    ❝Keeping in mind, moderate means one glass of wine for women a day and two for men. Hard alcohol doesn’t have the same heart benefits as wine❞

    That is indeed the guideline according to some health bodies!

    In other places with different guiding advisory bodies, that’s been dropped down to one a day for everyone (the science may be universal, but how government institutions interpret that is not).

    About that wine… Specifically, red wine, for its resveratrol content:

    While there are polyphenols such as resveratrol in red wine that could boost heart health, there’s so little per glass that you may need 100–1000 glasses to get the dosage that provides benefits in mouse studies. If you’re not a mouse, you might even need more.

    To this end, many people prefer resveratrol supplementation. ← link is to an example product, but there are plenty more so feel free to shop around

    A subscriber who voted for “Alcohol is bad for pretty much everything, including heart health ✋” says:

    ❝New guidelines suggest 1 to 2 drinks a week are okay but the less the better.❞

    If you haven’t heard these new guidelines, we’ll mention again: every government has its own official bodies and guidelines so perhaps your local guidelines differ, but for example here’s what that World Health Organization has to say (as of January this year):

    WHO: No level of alcohol consumption is safe for our health

    So, whom to believe? The governments who hopefully consider the welfare of their citizenry more important than the tax dollars from alcohol sales, or the World Health Organization?

    It’s a tough one, but we’ll always err on the side of the science.

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  • Stop Sabotaging Your Gut

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    This is Dr. Robynne Chutkan. She’s an integrative gastroenterologist, and founder of the Digestive Center for Wellness, in Washington DC, which for the past 20 years has been dedicated to uncovering the root causes of gastrointestinal disorders, while the therapeutic side of things has been focused on microbial optimization, nutritional therapy, mind-body techniques, and lifestyle changes.

    In other words, maximal health for minimal medicalization.

    So… What does she want us to know?

    Live dirty

    While attentive handwashing is important to avoid the spread of communicable diseases*, excessive cleanliness in general can result in an immune system that has no idea how to deal with pathogens when exposure does finally occur.

    *See also: The Truth About Handwashing

    This goes doubly for babies: especially those who were born by c-section and thus missed out on getting colonized by vaginal bacteria, and especially those who are not breast-fed, and thus miss out on nutrients given in breast milk that are made solely for the benefit of certain symbiotic bacteria (humans can’t even digest those particular nutrients, we literally evolved to produce some nutrients solely for the bacteria).

    See also: Breast Milk’s Benefits That Are (So Far) Not Replicable

    However, it still goes for the rest of us who are not babies, too. We could, Dr. Chutkan tells us, stand to wash less in general, and definitely ease up on antibacterial soaps and so forth.

    See also: Should You Shower Daily?

    Take antibiotics only if absolutely necessary (and avoid taking them by proxy)

    Dr. Chutkan describes antibiotics as the single biggest threat to our microbiome, not just because of overprescription, but also the antibiotics that are used in animal agriculture and thus enter the food chain (and thus, enter us, if we eat animal products).

    Still, while the antibiotics meat/dairy-enjoyers will get from food are better avoided, antibiotics actually taken directly are even worse, and are absolutely a “scorched earth” tactic against whatever they’re being prescribed for.

    See also: Antibiotics? Think Thrice ← which also brings up “Four Ways Antibiotics Can Kill You”; seriously, the risks of antibiotics are not to be underestimated, including the risks associated only with them working exactly as intended—let alone if something goes wrong.

    Probiotics won’t save you

    While like any gastroenterologist (or really, almost any person in general), she notes that probiotics can give a boost to health. However, she wants us to know about two shortcomings that are little-discussed:

    1) Your body has a collection of microbiomes each with their own needs, and while it is possible to take “generally good” bacteria in probiotics and assume they’ll do good, taking Lactobacillus sp. will do nothing for a shortage of Bifidobacteria sp, and even taking the correct genus can have similar shortcomings if a different species of that genus is needed, e.g. taking L. acidophilus will do nothing for a shortage of L. reuteri.

    It’d be like a person with a vitamin D deficiency taking vitamin B12 supplements and wondering why they’re not getting better.

    2) Probiotics are often wasted if not taken mindfully of their recipient environment. For example, most gut bacteria only live for about 20 minutes in the gut. They’re usually inactive in the supplement form, they’re activated in the presence of heat and moisture and appropriate pH etc, and then the clock is ticking for them to thrive or die.

    This means that if you take a supplement offering two billion strains of good gut bacteria, and you take it on an empty stomach, then congratulations, 20 minutes later, they’re mostly dead, because they had nothing to eat. Or if you take it after drinking a soda, congratulations, they’re mostly dead because not only were they starved, but also their competing “bad” microbes weren’t starved and changed the environment to make it worse for the “good” ones.

    For this reason, taking probiotics with (or immediately after) plenty of fiber is best.

    This is all accentuated if you’re recovering from using antibiotics, by the way.

    Imagine: a nuclear war devastates the population of the Earth. Some astronauts manage to safely return, finding a mostly-dead world covered in nuclear winter. Is the addition of a few astronauts going to quickly repopulate the world? No, of course not. They are few, the death toll is many, and the environment is very hostile to life. A hundred years later, the population will be pretty much the same—a few straggling survivors.

    It’s the same after taking antibiotics, just, generations pass in minutes instead of decades. You can’t wipe out almost everything beneficial in the gut, create a hostile environment there, throw in a couple of probiotic gummies, and expect the population to bounce back.

    That said, although “probiotics will not save you”, they can help provided you give them a nice soft bed of fiber to land on, some is better than none, and guessing at what strains are needed is better than giving nothing.

    See also: How Much Difference Do Probiotic Supplements Make, Really?

    What she recommends

    So to recap, we’ve had:

    • Wash less, and/or with less harsh chemicals
    • Avoid antibiotics like the plague, unless you literally have The Plague, for which the treatment is indeed antibiotics
    • Avoid antibiotic-contaminated foods, which in the US is pretty much all animal products unless it’s, for example, your own back-yard hens whom you did not give antibiotics. Do not fall for greenwashing aesthetics in the packaging of “happy cows” and their beef, milk, etc, “happy hens” and their meat, eggs, etc… If it doesn’t explicitly claim to be free from the use of antibiotics, then antibiotics were almost certainly used.
      • Dr. Chutkan herself is not even vegan, by the way, but very much wants us to be able to make informed choices about this, and does recommend at least a “plants-forward” diet, for the avoiding-antibiotics reason and for the plenty-of-fiber reason, amongst others.
    • Consider probiotics, but don’t expect them to work miracles by themselves; you’ve got to help them to help you.
      • Dr. Chutkan also recommends getting microbiome tests done if you think something might be amiss, and then you can supplement with probiotics in a more targetted fashion instead of guessing at what species is needed where.

    She also recommends, of course, a good gut-healthy diet in general, especially “leafy green things that were recently alive; not powders”, beans, and nuts, while avoiding gut-unhealthy things such as sugars-without-fiber, alcohol, or some gut-harmful additives (such as most artificial sweeteners, although stevia is a gut-healthy exception, and sucralose is ok in moderation).

    For more on gut-healthy eating, check out:

    Make Friends With Your Gut (You Can Thank Us Later)

    Want to know more from Dr. Chutkan?

    We recently reviewed an excellent book of hers:

    The Anti-Viral Gut: Tackling Pathogens From The Inside Out – by Dr. Robynne Chutkan

    Enjoy!

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  • Coughing/Wheezing After Dinner?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The After-Dinner Activities You Don’t Want

    A quick note first: our usual medical/legal disclaimer applies here, and we are not here to diagnose you or treat you; we are not doctors, let alone your doctors. Do see yours if you have any reason to believe there may be cause for concern.

    Coughing and/or wheezing after eating is more common the younger or older someone is. Lest that seem contradictory: it’s a U-shaped bell-curve.

    It can happen at any age and for any of a number of reasons, but there are patterns to the distribution:

    Mostly affects younger people:

    Allergies, asthma

    Young people are less likely to have a body that’s fully adapted to all foods yet, and asthma can be triggered by certain foods (for example sulfites, a common preservative additive):

    Adverse reactions to the sulphite additives

    Foods/drinks that commonly contain sulfites include soft drinks, wines and beers, and dried fruit

    As for the allergies side of things, you probably know the usual list of allergens to watch out for, e.g: dairy, fish, crustaceans, eggs, soy, wheat, nuts.

    However, that’s far from an exhaustive list, so it’s good to see an allergist if you suspect it may be an allergic reaction.

    Affects young and old people equally:

    Again, there’s a dip in the middle where this doesn’t tend to affect younger adults so much, but for young and old people:

    Dysphagia (difficulty swallowing)

    For children, this can be a case of not having fully got used to eating yet if very small, and when growing, can be a case of “this body is constantly changing and that makes things difficult”.

    For older people, this can can come from a variety of reasons, but common culprits include neurological disorders (including stroke and/or dementia), or a change in saliva quality and quantity—a side-effect of many medications:

    Hyposalivation in Elderly Patients

    (particularly useful in the article above is the table of drugs that are associated with this problem, and the various ways they may affect it)

    Managing this may be different depending on what is causing your dysphagia (as it could be anything from antidepressants to cancer), so this is definitely one to see your doctor about. For some pointers, though:

    NHS Inform | Dysphagia (swallowing problems)

    Affects older people more:

    Gastroesophagal reflux disease (GERD)

    This is a kind of acid reflux, but chronic, and often with a slightly different set of symptoms.

    GERD has no known cure once established, but its symptoms can be managed (or avoided in the first place) by:

    And of course, don’t smoke, and ideally don’t drink alcohol.

    You can read more about this (and the different ways it can go from there), here:

    NICE | Gastro-oesophageal reflux disease

    Note: this above page refers to it as “GORD”, because of the British English spelling of “oesophagus” rather than “esophagus”. It’s the exact same organ and condition, just a different spelling.

    Take care!

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