This interview was originally published by Jo on Wondergut - a fabulous resource for all things microbiome.
Life is rarely a straight line. Alana Holloway knows this only too well. Her understanding of the enormous influence our gut microbiome has on our health comes from direct experience of what can happen to health when things aren’t right in the gut department.
Alana and I met at Otter Farm in Devon whilst attending a food fermentation course run by the unsurpassable Naomi Devlin. Whilst massaging salt into cabbage (which is very therapeutic by the way), Alana and I got talking.
To say that you have learnt about gut health the hard way Alana, would be a bit of an understatement. How did your health issues first start to manifest themselves and how old were you when they did?
My mum tells me I was born scratching! Not literally, of course, but I was born with eczema. I continued to have eczema on and off throughout my life, although it completely disappeared between the ages of about 14 and 20. I am not sure why it abated then. It could have been due to the ‘seven-year cycle’ theory, whereby eczema appears and disappears – without rhyme or reason – in seven year cycles. I’m not sure whether I believe that theory but I also recall that some familial upheaval settled down when I was around 14. When I was 20, I went to University and I suspect the plentiful consumption of alcohol, combined with lack of sleep, may have been a trigger.
When I moved to London in my early twenties, it came back with a vengeance.
Initially, how did you manage your symptoms?
In the same way that most people with eczema manage their symptoms; with prescribed steroid creams.
Did you or your parents have any awareness at that time of supporting your health through nutrition or through alternative therapies?
As a child, symptoms were always managed in the conventional way (topical steroids). As I grew older, I became extremely interested in the link between diet and health and my interest in alternative therapies blossomed too.
What was your lifestyle like?
I’ve always lived a pretty healthy, active lifestyle, but my biggest downfall is stress management, or lack of it!
Did any doctor or medical practitioner give you any advice in terms of your diet/sleep levels/lifestyle?
Unfortunately, my GP did not. However, I also saw Naturopaths and Traditional Chinese Medicine Practitioners, who did.
How did things deteriorate?
As a direct result of using the topical steroids, I developed a condition called Topical Steroid Addiction (TSA). It’s an odd name, but it basically meant that my entire body – and its daily functions – became completely reliant on the use of topical steroids. Every time I broke from using them, I entered a hideous withdrawal cycle. Over time, the steroids cause deterioration of, not only the skin, but areas throughout the body, including the gut microbiome and gut lining, normal repair and regeneration function, adrenal function, temperature regulation… the list goes on! The only way to break the cycle is to cease use.
What were the practical consequences of this, Alana?
Anyone with eczema knows how uncomfortable it is, but TSA takes things to another level. For the whole TSA period, including the withdrawal (which adds up to years rather than months), my skin was a mess. It was so fragile that it would break at the lightest touch. I had so many raw, weeping patches and each one would take months to heal. My skin was bright red from my head to my toes, as if I had third degree burns. There was no position in which I could find comfort. My face was swollen due to the inflammation and the steroid use (steroid bloat, I suppose). Children used to stare and whisper about me if I passed them in the street and I even caused my young niece to cry once when she saw my face. I frightened her. It was not a surprise – I was frightened of seeing myself in the mirror.
Around my knees and elbows, I had what the TSA community call “Elephant Skin” – where it is so dry that it becomes thickened. I got painful boils on my legs which took eons to heal. My skin would shed constantly, although there wasn’t fresh new skin underneath, it was just raw.
I also seemed to have a very metallic smell to me. I don’t know what caused it, but it was quite strong and very unpleasant. And the nerve pain; just shocks of pain which went off like fireworks in my body. About once a month, I'd wake to find my whole body swollen, especially my face and hands. My body temperature was all out of whack, too. My skin would be red hot, yet I’d be shivering – similar to a fever. I would have to wrap myself in 3 blankets on the sofa (with about 4 layers of clothes on), with a hot water bottle and I would still be shivering. I wouldn’t want to get out of bed most days – I felt and looked dreadful and the sheer effort and pain involved in simply getting dressed was too much to bear. I rarely left the house.
I had to stop work and, as someone who was self-employed, that meant no income. My partner and I had to move home to live with my Dad and Step-mum as we couldn’t afford rent. As you can imagine, my mental health really suffered as a result. As a very positive person, I’d say it’s the closest I’ve been to depression. Even eating was a real struggle; every morning after my 2-hour long Dead Sea Salt bath (the only time in my life I haven’t found baths relaxing), my skin would set, drum tight. I therefore couldn’t open my mouth more than a straw’s width otherwise my skin would split.
I developed a pattern of insomnia, where I’d only be able to sleep for about an hour at a time, waking for two hour stints in between. I couldn’t sleep in the same bed as my partner as it was just too uncomfortable if his skin touched mine. The constant hoovering and daily sheet changing due to shedding skin was insane. This all went on for about two years.
What was your lowest point?
Do you know, I’d actually say it was a year after the day I quit using steroids. I remember it quite clearly. There’s something called an ‘Anniversary Flare’, which people on the TSA Facebook group and forums (the only source of information available at that time) talked about. After a year of slow progress, people found they regressed, almost back to square one. I don’t know what causes it, but it happened to me. You reach the stage where you think you’re finally on the road to recovery and then out of the blue, you’re back at the beginning of it all. Mentally, it was so very tough. I felt I might never reach a stage in my life when I could live normally. Luckily for me though, it was just three months after this that I reached a major turning point.
What was this turning point?
I had a couple, actually – the first was when I realised what was ‘wrong’ with me. My insomnia resulted in incessant night-time Googling sessions, trying to find someone else who was going through the same thing. I remember seeing a picture of someone’s hand on Google Images and a light going on in my head. TSA can be defined by a ‘red sleeve’ where there is a distinctive colour change between the bright red of your arm and the pale colour of your palm. I saw it and almost shouted – THAT’S ME!! And then I cried. From that moment onwards, I knew I wasn’t alone and after reading the blog I had stumbled upon, I knew I could do something to help myself.
The second turning point was three months after my ‘anniversary flare’, which was 15 months after quitting steroids. Throughout those 15 months, I had tried every ‘diet’ and way of eating under the sun; Paleo, Vegetarian, Alkaline, Sugar Free, Juice Cleanses – with no real success. Nothing brought about lasting change and I always ended up bingeing because these diets left me feeling so deprived. After my anniversary flare, I had a serious word with myself and cut out dairy, gluten, sugar and nightshades, for good. After doing so, my body was healing a bit faster than before, but it wasn’t enough. I kept reading about gut health and learned that fermented foods were a good way to help ‘heal’ your gut (and therefore your whole body). I made my first jar of red cabbage sauerkraut. When it was ready, I ate a bit every day and after a couple of weeks, I noticed that my body was healing at a much faster rate than before. The only thing I had changed during that period was the inclusion of some fermented cabbage in my diet!!
If you had not have made your own diagnosis and helped yourself, what were the remaining standard medical options left open to you?
Internal steroids and immune-suppressants. After reading the side-effects of both, I knew they weren’t an option for me.
What changes did you notice – both physically and emotionally after introducing fermented foods and drinks?
So many! Everything from patches of raw skin that I’d had for months finally healing, to feeling better within myself – both physically AND emotionally. I had more energy and more physical and emotinal resilience. And, my traumatised bowels finally began producing regular (and now brilliant!) bowel movements. So much changed on so many levels to be honest, it felt pretty miraculous!
Was there anything else you changed later on to try to better support your health?
I tried to rest more, I moved to a quieter, more peaceful location and did what I could to remove the big stressors from my life. I also had acupuncture and later on down the line, when my skin could cope with it, I took up yoga.
Was there any particular milestone on your road to recovery that stands out for you?
I think I’d say the first fermentation workshop that I gave, although at the time, I probably didn’t realise it. Looking back, it’s the time that I felt comfortable enough for people I didn’t know to see me, my face and my skin, and it was the first time I earned money from something that had evolved as a direct result of TSA. The saying ‘no experience is ever a wasted experience’ couldn’t be more appropriate for me.
Looking back, with what you now know about the importance of a healthy gut microbiome, are there trigger points in your childhood that you think may have contributed to your health issues?
I was born vaginally and was breastfed (both generally thought to be positives for gut microbiome development), but my Mum suffers with eczema and asthma and as a result, has been taking and using steroids (both topical and internal) throughout her life. Her mother also passed away just before I was born, which must have caused a great deal of stress for my mum (and we know that stress affects the state of our gut microbiome). I now know that we inherit the maternal gut microbiome to some extent, so I think I started with both a genetic and a microbial leaning towards these illnesses. I was also given steroids and antibiotics as a child, which both have a detrimental effect on the gut microbiome so, in truth, I didn’t have much hope of getting off to a great start. I also suffered with severe constipation when I was little and until I started to look after my gut. This is a sure sign that all is not well in the gut department. And when all is not well there, we now know that this generally has consequences for our health in other areas too!
How is your health now?
Mostly, it’s great. My biggest downfall is stress and lack of sleep, both of which play a HUGE role in how I feel. It’s quite ironic though, because the business I’ve started to help others with their health has had the opposite effect on mine! I have to do something about it if I am to continue to thrive (both in business and personally), though. My next plan of action is to incorporate yoga, meditation and sensible bed times into my daily routine (she says, typing away at 9pm!). I need to commit to this because if I don’t, I pay the price with my health.
This incredible journey has resulted in you setting up Fodder + Plonk and latterly, Fermented by LAB. Can you tell us a little about these businesses, what they do and the motivation behind them?
Fodder + Plonk is on a bit of a holiday right now! I would love to get it going again, once I have more of a handle on Fermented by LAB (LAB stands for lactic acid bacteria – the bacteria responsible for the fermentation action in fermented foods). Essentially though, it is my blog and a place that I share my recipes (gluten and dairy free, as well as fermented and gut-friendly) and information about living a healthy life. It was really a culmination of everything I learnt during TSA, but I never had the guts(!) to share whilst I was in the thick of it.
Fermented by LAB evolved out of the fermentation workshops I taught (which came about after putting some fermentation recipes up on Fodder + Plonk). I realised that not everyone who attended the workshops was able to ferment at home. I wanted to find a way for them – and anyone else who was interested – to experience the enormous benefits of eating fermented foods daily. Now I make fermented foods under the guise of Fermented by LAB, which I sell online and deliver to people’s homes throughout the UK. They come in boxes, which contain a variety of ferments such as sauerkraut, kimchi and kefir. The flavours change seasonally and they’re raw/unpasteurised, organic and celebrate the best of British produce.
If you had to choose just one fermented food or drink, which would be your favourite (not pomegranate kefir with gin!!!)
Ha!! Oh, I’ve mixed many-a kefir cocktail since!! I would have to say sauerkraut, though. With a versatile base of cabbage, the flavour possibilities are endless. And the beneficial effects on health are mind-boggling. I think I will be eating it and benefiting from its health-giving properties for the rest of my life.