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How long does it take to heal leaky gut? Are miracle pills or potions the answer? And is leaky gut even a real thing? As a functional nutrition registered dietitian, I am here to bust some myths and provide you with the evidence-based information you need to empower you (yes, you) to cultivate your best gut health. This article covers it all: what is leaky gut, what causes it and most importantly: how long does it really take to heal leaky gut. Let’s dive in! Photo by Lili Popper on Unsplash What is Leaky Gut? Leaky gut is a condition that is on more and more of our radars lately. And as folks are learning how important it is to cultivate gut health, a common question I’m getting is “how long does it take to heal leaky gut?” Great question! And I hate to start on a grumpy foot, but I prefer to use the scientific term for leaky gut: increased intestinal permeability or intestinal hyperpermeability. Why? Because our small intestine is actually always a bit "leaky" (semi permeable); this is normal digestion and absorption. We have to be able to get the nutrition from our food into our body to be able to use it which means these nutrients go from being in the small intestine to in the bloodstream by crossing the mucosa. The trouble brews if your intestines become too leaky. Food particles that are not digested enough, pathogens and other “bad guys” can get into your body and cause inflammation. What causes leaky gut? What causes increased intestinal permeability? Unfortunately, a lot of things these days. Our intestinal lining is living, dynamic tissue that continuously regenerates every few days. It is composed of several layers of tissue, blood vessels, lymphatic tissue and a whole lot of immune cells, keeping guard. In our modern, hectic lifestyle, we are exposed to continued environmental factors that take a toll on our gut health. Let’s explore this with a quick analogy: A brand new fence will keep your dog securely in your backyard, other neighborhood pets out and you can choose when to open or close the gate. But what if a tree fell on that fence and knocked part of it down? Now there is a gap and your dog is no longer being kept in and other neighborhood pets are no longer being kept out. Regulating who comes and goes through the gate is no longer working due to the gap in the fence. The good news? Just like a fence can be repaired, your gut health can be repaired, too. Photo by Gustavo Zambelli on Unsplash In our lives, having chronic stress, not sleeping soundly, eating a less-than-optimal diet, genetics, infection and even medications (both prescription and over-the-counter) can all stress the natural ability of your gut to regulate how permeable it is. And if it took years to develop your symptoms, your journey to healing will not be accomplished in a few short weeks. As much as I wish I could offer fast solutions to complete healing, I know from experience that this is slow and steady work. It can take months. But let me tell you: nothing is more rewarding than partnering with my clients to win their health back. So, how long does it take to heal leaky gut? First stop: managing acute symptoms - let’s cover that first. Short term solutions (managing symptoms) First things first: we need to manage any acute symptoms that are making your life miserable right now. How does freedom from emergency dashes to the bathroom sound? Short term: it is powerful to be able to calm down the immune system. An elimination diet might help to soothe your digestive tract. One example of an elimination diet you may have heard of is the Low-FODMAP diet. Another is AIP. Do keep in mind that it is possible to be on an elimination diet for too long (especially if you continue to try one after another. More about that, here.) (Pssst: you can read more about calming an IBS flare on this blog post) Getting down to root causes We have to know that is the root cause in order to have any hope of true healing. Increased intestinal permeability can go hand in hand with many conditions, especially IBS. IBS, SIBO and other conditions are ones that can quickly come on back if conditions are right. Do you have Small Intestinal Bacterial Overgrowth (SIBO)? A Diagnosis of IBS? Undiagnosed celiac disease? Food sensitivities and intolerances on top of autoimmune conditions? Or maybe you have an issue related to your medications or had an infection? These effects can compound if you’re experiencing more than one. The human body doesn’t just “fall apart” overnight, things compound slowly, sometimes so slowly that you don’t even realize that you’re not feeling your best. For example, did you know that it is common for people with one autoimmune condition to have more? Twenty-five percent of folks with an autoimmune condition will be more prone to developing three or more autoimmune conditions altogether - yikes (1). And the truth is, you may have been suffering – with compounding symptoms – for years. One symptom or condition can make you more vulnerable or susceptible to additional, other conditions. Dang! This is why it is so very important to do careful digging to get down to root causes: you can’t hope to prevent relapse if you don’t know why these conditions are happening to begin with. Photo by Markus Winkler on Unsplash What’s the quick fix or magic potion to heal leaky gut? Is that the sound of crickets chirping? Unfortunately, there are no quick fixes or magic cures to healing leaky gut. As much as gluten is vilified and probiotics are heralded, those simple answers aren’t the real path to healing for most people with increased intestinal permeability. Healing the gut is like peeling back layers of onion: you address one aspect and it can bring to light something else. And if that sounds negative, I like to see this as an opportunity to further help your body to achieve homeostasis. Ok: Tell me now: How long does it take to heal leaky gut? I mean: how long does it take to heal increased intestinal permeability? Realistically, it can take months. Slow and steady, folks. This is a journey that will deliberately cultivate your best health. For my practice, I start with a minimum commitment of three months for new clients. As a clinician, my role is to set realistic expectations for true recovery. And while I have many tools to use to get down to the real root causes of your intestinal permeability, know that it can take months, even a year, to walk this journey together. As much as I wish I could wave a magic wand to relieve your symptoms or tell you to just eliminate gluten, gut health isn’t that simple. And you should be wary of anyone promising a quick fix. I like to share with my clients that the gut isn't like a broken arm that gets casted and unused for six to eight weeks to heal. We still need to eat! We can't avoid it’s job to digest our food. This is no different than a cut on your finger: the first day or two it's red, swollen and hurts but by day 3, it's feeling better. Is it healed? Not quite: it's going to take another 4-5 days to truly be healed. And as much as I’d love for things to be faster, healing does take time and deliberate action. Unfortunately, it's unrealistic to have been suffering with symptoms for several years and expect a full recovery in a few weeks. Photo by John Thomas on Unsplash On the path to recovery, you’ll have better days mixed with symptomatic days: this is normal and to be expected. Health isn’t a straight path, it meanders! And testing foods to see which ones are a good fit for you, right now, is powerful information. As a Certified Leap Therapist (CLT), I have an amazing tool in my tool box for helping clients to feel better fast, which is a great start on the healing journey. I’m ready to be your partner and guide to healing your increased intestinal permeability; you deserve to feel great. Let's chat! Get started by scheduling an initial visit.

Have you ever been feeling stressed, sad or bored and found yourself in the kitchen looking for a snack? I think we’re all familiar with how our mood affects our food choices. When we’re feeling down or stressed we may crave highly processed and sugary snacks (12). Here is what might surprise you: the relationship between food and mood works both ways. Not only does your mood influence your food choices, but your food choices can also affect how you feel! In this blog post, I’m going to take a closer look at how the nutrients from food influence your gut, brain, and ultimately your mood! And if you're new here: welcome! My name is Marissa Mekelburg MS, RDN, CLT, HHP and I am a functional nutrition dietitian who specializes in digestive health. Let’s take a look at how mood, food, and digestive health are all tied together. Photo by Hello I'm Nik on Unsplash How Can Your Food Choices Affect Your Mood? Did you know that the nutrients from the food you eat has a big impact on your mood and emotions? One direct way that our nutrients impact our mental health is through our neurotransmitters; those chemical messengers in your brain. Serotonin and dopamine are both examples of neurotransmitters that help to regulate your mood and emotions (17). They’ve even been dubbed the “feel-good hormones” because that’s what they do! Your mood can also be negatively impacted by foods that impair gut health. For example, having a lot of heavily processed foods and too much sugar cause inflammation and can make your mood worse. Processed foods are missing a lot of vitamins and minerals you need and this can impact your mental health. Let’s take a look at some of the vitamins and minerals deficiencies that can have an impact on how you feel Nutrient Deficiencies that Worsen Mood Let’s explore three nutrients that can really make your mood take a dive if you’re too low, starting with the sunshine vitamin, Vitamin D. Vitamin D Vitamin D helps your body release neurotransmitters including dopamine and serotonin (remember those feel-good hormones?). Several studies have shown that correcting low levels of Vitamin D can help to improve symptoms of depression (16). Food sources of vitamin D include (18): ● Liver ● Grass-fed butter ● Fatty fish ● Egg yolks ● Fermented cod liver oil B Vitamins B vitamins help your body to make and regulate the levels of those feel-good hormones, dopamine, and serotonin (5). In particular, low levels of folate, vitamin B12, and vitamin B6 have been linked to an increased risk of depression (6,7). Food sources of B12 include (19): ● Lean meat ● Fish ● Dairy products ● Eggs ● Fortified nutritional yeast and some fortified cereals Food sources of folate include (20): ● Dark green leafy vegetables ● Nuts, Beans, and legumes ● Fruits (especially oranges and orange juice) ● Beef liver Food sources of B6 include (21): ● Beef liver ● Salmon ● Tuna ● Chickpeas ● Poultry Magnesium Like vitamin D, magnesium is involved in regulating the release of dopamine and serotonin. People who are depressed tend to have lower levels of magnesium (8). Food sources of magnesium include (22): ● Nuts and seeds ● Whole grains ● Fish (salmon, halibut) ● Milk Your vitamin and mineral intake is one important part of how food & mood are linked. Did you know that 95% of your serotonin is produced in your gastrointestinal (GI) tract? As a digestive health dietitian, you know I want to talk about how your gut ties into this! Photo by Towfiqu barbhuiya on Unsplash Why Gut Health Matters If serotonin is coming from your digestive tract, then it’s not hard to believe that the food you eat will have a direct impact on how you feel and your mood. Your GI tract and your brain communicate through a system referred to as the Gut-Brain-Axis (GBA). Think of it like a back-and-forth conversation between your brain and your intestine. Have you ever been nervous and felt butterflies and then suddenly had to run to the bathroom? That’s your GBA at work! Your GBA has a few different communication pathways. One is through hormones and neurotransmitters that are produced by the bacteria living in your gut - amazing! That means having the right type of bacteria ensures that your brain is getting the best messages and your mood is good, too. On the flip side, having too much of the wrong type of bacteria can increase stress, inflammation, and feelings of grumpiness and sadness (12). Having the wrong mixture of bacteria in your digestive tract is called dysbiosis. Your digestive health is changing all of the time. When we feel good, and we eat well, our microbiome sends messages back to our brain that continue to make us feel good. But it can also become a negative spiral; we feel bad and then we crave processed and high-sugar foods. These foods then lead to dysbiosis and inflammation which leads to depression and anxiety (3). If you have dysbiosis, you may also be dealing with a leaky gut. A really common question I get from clients is how long it takes to heal leaky gut. It isn’t a short journey, but I explain exactly what to expect here: How Long Does It Take to Heal Leaky Gut? In my experience helping people to improve their digestive health, we have been able to resolve many different symptoms that will influence how you feel, including: ● Restlessness, nervousness, inability to relax ● Feeling overwhelmed by small things ● Emotional outbursts, anger, or crying frequently The Gut-Brain-Axis and how it affects your brain and emotions has been the focus of a lot of research. Studies have shown that improving your gut microbiome can improve many symptoms that directly affect your mood including: Headaches: Treating digestive diseases like IBS, celiac disease, and helicobacter pylori infection can lead to improvements in migraine headaches (1). Insomnia: Did you know that your gut microbes have a circadian rhythm just like you do? The changes in bacteria and their byproducts throughout the day can affect your sleep-wake cycle. There has even been research completed that shows sleep deprivation and shift work changes your gut bacteria (15). Sex Drive: Your microbiome can positively and negatively regulate sex hormone levels (2). Weight gain: Think about the cycle, gut bacteria affect food cravings which leads to inflammation and more food cravings (12). Depression: Optimizing your microbiome can improve feelings of depression and anxiety (3). Memory, cognitive function, and attention have all been linked to the gut microbiome. (15, 14) With all of those benefits of having a healthy gut, let’s talk about how to cultivate your gut health with a few specific habits. We’ll call these good-mood foods. Photo by CA Creative on Unsplash Mood-Boosting Nutrients All of the nutrients discussed in this section can improve your gut health and your mood. Let’s start with the heavy-weight star: Omega-3 fatty acids! Omega-3 fatty acids Omega 3 fatty acids are an integral part of your central nervous system. Did you know that 60% of your brain is fat (23)? Omega 3 fatty acids make up an important part of the cells in your brain and they affect how your brain sends information with the neurotransmitters we keep talking about. Important to note, anyone who has a low intake of omega-3 fatty acids has a higher risk of anxiety and depression (24). Several studies have shown that supplementation with omega-3 fatty acids may improve depression, anxiety, and inflammation (4). Practice pearl: ideally, we prefer omega-3s from fish, not plants like walnuts or chia seeds. The specific omega-3 fat that boosts your brain is called DHA (or docosahexaenoic acid). In food, DHA comes from fatty fish. Aim to have 2-3 servings of fatty fish every week. Although you can get omega 3’s from vegetarian sources like walnuts, your body is not very good at converting those other omega-3s into the DHA form that is most useful. Tryptophan Tryptophan is an amino acid and a precursor to serotonin. Tryptophan can help with mild to moderate depression, and feelings of irritability (9). And while I’m a “food first” dietitian, tryptophan may be a case for considering a supplement; more of the research here has linked supplemental tryptophan to the benefits in mood than the food sources. However, the foods that have tryptophan are certainly healthy and worth incorporating on a regular basis. Food sources of tryptophan include: ● Whole milk ● Canned tuna ● Poultry ● Salmon ● Oats ● Nuts and seeds Fiber There are 2 ways that dietary fiber can help to improve your mood. Fiber helps improve your gut microbiome by feeding the good bacteria that make serotonin. Fiber also helps to control your blood sugar. When you eat foods that are high in fiber, food travels more slowly through your digestive tract. This helps to prevent large swings in blood sugar that can leave us feeling tired and grumpy. Foods high in fiber include: ● Vegetables and Fruit ● Beans and legumes ● Whole grains ● Nuts and Seeds Probiotics Probiotic foods naturally contain the mood-boosting bacteria we want. Probiotics can lower your risk of depression and anxiety (27). You can find probiotics in fermented foods including: ● Unsweetened yogurt ● Sauerkraut ● Kimchi ● Kefir ● Tempeh What about supplements? I know what you’re thinking - with all these nutrients that can affect my mood - why don’t I just take supplements? If you have an identified nutrient deficiency, then yes, supplements may be an important part of correcting the problem. If you rely on supplements alone to meet all your micronutrient requirements - then what are you eating? We know that eating a whole foods diet that is high in fiber will help the good bacteria in your gut to thrive AND it will provide the key nutrients discussed. If you take supplements but rely on highly processed foods, you will still be fueling the wrong type of bacteria in your gut. Think of it like being on a sinking boat. You could use a bucket to start bailing the water in the beginning, but eventually, if you don’t fix the root cause - the boat is still going to sink. Even More Gut Health & Mood Boosters Food isn’t the only thing to consider if you’re looking at lifestyle options to improve your mood. Bright light increases serotonin production and helps to reduce feelings of depression (9). Exercise (particularly aerobic exercise) improves mood (9). I’m sure you’ve heard of the runner’s high. Don’t worry! You don’t have to run a marathon to get the mood-boosting effects of exercise. Choose something you enjoy and build on what you can already do. Examples of aerobic exercise include walking, hiking, biking, and swimming. Added bonus if you can get a bit of exercise outside in the bright light! Hydration: I’m sure you’re not surprised to see this one on the list! There isn’t a cell in your body that doesn’t depend on water and your brain is no exception. Aim for half your bodyweight in ounces of water daily. If you find it difficult to drink water in the colder weather, a warm cup of caffeine-free herbal tea will also give your body the fluid it needs. Mindfulness, meditation, prayer, yoga and even spending time with family and friends are all ways to reduce stress. Remember how stress affects your gut microbiome? Sleep: Who doesn’t feel great after a good night’s sleep? Studies have shown that even small amounts of sleep deprivation increase feelings of irritability, sadness, and stress. (26) To get the rest you need, practice good sleep hygiene by: ● Going to bed by 10:00 pm ● Avoiding electronic devices 2 hrs before bed (or use blue-light-blocking glasses) ● Keep your bedroom cool and dark with minimal electronics ● Don’t eat too close to going to bed If you want more information on improving sleep, be sure to check out my blog post on sleep here: Do Pistachios Help You Sleep? Yes! Key Takeaways Wow! That was a lot of information! The good news is that following general guidelines for eating healthy will provide all the nutrients we discussed above. To ensure you are getting everything you need to feel good AND to help promote a healthy gut microbiome: ● Choose whole grains ● Eat a variety of vegetables and fruit including green leafy vegetables ● Include nuts and seeds ● Choose lean protein ● Have fatty fish 2-3 times per week ● Try adding fermented foods daily ● Limit highly processed foods and added sugar The relationship between food and your mood is complicated! If your gut health has been compromised by your lifestyle, it can be a long road to recovery…and a good mood! If you are ready for a personalized plan to improve your mood, I am here to help. As a functional nutrition dietitian, I can order the specialized lab testing to identify the root causes of your symptoms and with a clear understanding of your health, I can create a personalized anti-inflammatory diet to restore your gut microbiome to balance. If you want to break the cycle of feeling down, get started with an inital consult with me and let’s talk!

Are you having a harder time falling asleep, or staying asleep? Are you wondering if the Google rumors are true: do pistachios help you to sleep? Turns out there are many things that you can do, both to fall asleep more quickly and to stay asleep longer. Having a good night’s sleep helps you to feel better the next day and to move through your schedule more smoothly, with less effort and mental sludge. Pistachios do help you sleep: woohoo! Not only can we optimize your midnight snack (I mean, prior-to-10pm-snack), there are several small tweaks that you can make, that will have a big impact on how rested you feel each morning. Photo by Joanna Kosinska on Unsplash Risks of not sleeping well (or not sleeping enough) Not sleeping well is a big threat to your health. And if you’re struggling with this, please know that you’re not alone. As many as 1 in 3 people are struggling with insomnia - yikes (1). Not only can poor sleep make you feel sluggish and less productive the next day, it also increases your risk of chronic diseases including hypertension and diabetes. You can also feel more anxious and moody and have cravings for carbs and sugars. And if you are chronically stressed, don’t have regular exercise that you enjoy, and eat in a way that doesn’t support a good night’s sleep, this cycle can be on repeat. So, how do we modify things so that we get a better night’s sleep? It might start with a better evening snack! Do pistachios help you sleep? Yes! Pistachios may be a better option than Ben and Jerry’s before bed; want to know why? They’re a naturally occurring source of melatonin (2). Melatonin is a hormone that our bodies make naturally. Melatonin helps your body to sleep by putting your mind in a restful state so that it is easier to drift off to sleep. As the sun sets, the darkness signals your body that it is evening and time to wind down. Melatonin levels rise, preparing your body for sleep (3). But a lot of things can go awry here, starting with our indoor lighting. Most of us use lights and screens in the evening, long past sunset. This artificial light hijacks the natural rhythms that support optimal sleep. Having a melatonin boost, from foods or supplements, is one strategy to support a better night’s sleep. (Psst - there are a lot more we’re going to cover, so keep reading!) And pistachios are not the only naturally occurring source of melatonin, a few other foods are as well! In addition, pistachios are a great source of protein and magnesium, two other nutrients that are important for blood sugar management and sleep. We’ll cover both of those, in a bit. A better nightcap Now, what to drink with your pistachios, now that you know that they can help you to sleep? While a glass of wine is tempting and quick to be an evening ritual, there are some other options that are better at promoting good quality sleep, not just an accidental nap on the couch. Just like pistachios, tart cherry juice is a source of melatonin. It is also chock-full of phytochemicals that decrease inflammation - double win! In the winter, try a DIY dry hot toddy with cinnamon herbal tea, a splash of tart cherry juice, a bit of lemon juice and a drizzle of honey, to taste. Not only is it warm and soothing, but the tart cherry juice will also help your night’s sleep to be more restful. Tart cherry juice is in fact, quite tart, so a bit of sweetness from the honey can make the drink very enjoyable. And in the summer: try a few ounces of tart cherry juice with your favorite seltzer water flavor and perhaps a splash of apple juice or other juice that is a bit more sweet. Fizzy, refreshing and sleep-promoting, with no hangover risk in the morning. Keep your cool We sleep more soundly when the bedroom is cool. Not only will dropping the heat at night save you money on your next energy bill, but the cooler temperature will also make it easier to sleep soundly. And in the winter, you may even sleep better with the window cracked. The fresh air is refreshing and plus, you won’t dilly dally getting dressed in the morning! Cap the screen time We all know that we’re on screens far too often. Unfortunately, there are repercussions of this excessive screen time, including your sleep. The light from screens includes a few different colors, including blue and red (remember the ROYGBIV from your high school science classes?). Blue light is stimulating and red light is soothing. Not only are the usual screen time activities activating your reward system (ahem, scrolling on social media while watching Netflix episode after episode), the blue light stimulates your brain to stay awake and active. The best practice for a good night’s sleep is to not be looking at your phone (or any screen) for an hour before bed. I know, I know, that is really hard. But, it is a good habit to work towards. You can start with a 10-minute window of screen-free time before bed and build from there. And if you can’t stay off? Try wearing blue-light blocking glasses to minimize the stimulating effects of the blue light. If I can convince you to read at night instead of watching a show or movie, try reading with a red light to further create a soothing atmosphere before bed. Go to bed a bit earlier As much as some of us are independent night owls, going to bed late can have repercussions on your daytime activities. Going to bed too late disrupts your hormonal levels and sequences (this is called your circadian rhythm). What’s the best practice? Getting to bed before 10 pm. Cortisol (most commonly referred to as your stress hormone) is the hormone that wakes your body up in the morning. But, the work of cortisol is actually slow and steady. It starts to rise naturally around 11 or 12 and eventually wakes our body up in morning. But if you go to bed too late, it can be much harder to fall asleep to begin with because the cortisol levels are already picking up. We fall asleep most easily when we’re ahead of the cortisol levels. Blood sugar levels...and the midnight bathroom run? If you wake up in the night and have to urinate, it can be a sign of that your blood sugar is dipping. If your blood sugar dips, your body secretes cortisol to bring blood sugar back up. But remember that cortisol is your natural alarm clock: the action of cortisol brings your blood sugars up, but it also wakes you up. Ugh! Of course, sometimes we do drink too much before bed and truly do have to urinate. But if it's happening a lot especially if someone tends to skip dinner or works out late in the evening, then they may want to consider blood sugar balance. What can you do to prevent this? I like to joke that you should wind down with a "meat pill" - a slice of lunch meat, a small spoonful of nut butter, pumpkin seeds or pumpkin butter (natural source of tryptophan), something with a little protein and fat can keep that blood sugar from dipping. And dare I plug pistachios for their protein, too? What a powerful little nut! Minerals and sleep Magnesium is a hard-working mineral in our bodies. It is essential for 100s of different enzymes and you know what? Most of us are low! Our typical food choices are processed and low in this essential nutrient. Magnesium and sleep are linked together; if we’re too low (and many of us are), we can have a harder time falling asleep and staying asleep. One good source of magnesium? Nuts and seeds. For example...drumroll please...pistachios! Tryptophan and sleep Is it really true - turkey can make you fall asleep? Sort of. Tryptophan is an amino acid, found in protein-rich foods such as turkey. Tryptophan is a precursor to serotonin and melatonin. Low tryptophan is associated with anxiety and poor mood (4). If you’re low in tryptophan, your body is not able to make enough melatonin for sleep or serotonin for mood. So while you might be prone to a delightful nap on the couch after Thanksgiving dinner, that is likely the effects of a huge meal and a cocktail more than the turkey. But, a slice or two of turkey before bed might help on an ongoing basis. Hormones and sleep Hormonal imbalances, environmental triggers (like caffeine or alcohol) and inflammation (hello, personalized anti-inflammatory diet and gut health!) are also issues. Melatonin, cortisol, and other hormones rise and fall throughout each day and night in an intricate dance. And if something falls off its pattern, the consequences can continue, like the ripples on water after throwing in a pebble. Other natural remedies for better sleep? Your evening cup of tea might include chamomile or valerian root (with a splash of tart cherry juice) for an even better night’s sleep. You can also diffuse or spray soothing essential oils such as lavender, chamomile or vetiver. A drop of essential oil can be dropped right on your pillowcase or mixed with witch hazel to spritz into the air and on your bedding. Inhale and slowly exhale - nice, isn’t it? Photo by Lisa Hobbs on Unsplash Where is the root cause? If you’re a gardener, you know that just plucking a few leaves off of a weed is not going to deter the weed’s growth. Those weeds will be bouncing back before you’ve even gotten your tools back in the shed. And the same is true for symptom management. We can’t fight symptoms and expect lasting results. While it sure was simpler to fall asleep and stay asleep while we were younger, things can get more complicated with less-than-optimal nutrition, excessive screen time, chronic stress and not having the right snacks before bed (ok, ok, we all know about pistachios now). But if the problem is related to nutrient status (like magnesium), food sensitivities or something else, it can take a bit more digging to figure it out. You deserve a good night’s sleep; I’d love to help! You can get started here.

In a previous post I discussed how IBS is defined as a medical diagnosis, why it can be hard to actually treat IBS and why you are doing yourself a disservice by accepting an IBS diagnosis and not continuing to look for the underlying reason for your IBS. While everyone is unique and their underlying cause for IBS symptoms will be different, today, I would like to share with you five of the most common root causes that I see in my “IBS” clients. What is a “root cause” and why is it important? As I mentioned previously, it’s important to keep in mind is that IBS is a diagnosis or label that is given to someone who experiences a certain set of symptoms and is not in and of itself a cause or explanation for these specific symptoms. Treating IBS symptoms may provide short term relief but without getting to the underlying cause, your symptoms are bound to come back and depending upon the reason for the symptoms, chances are will progressively worsen. Think of it like this – if the check engine light comes on in your car and you go to the mechanic – do you want them to just turn off the light or do you want them to figure out why the light came on in the first place, fix that problem and have the light go off by itself? I think most of us would choose the latter. Ten people can have the same diagnosis, similar symptoms but entirely different root causes (or combination of causes) which is why one size fits all protocols don’t work and why you need to know what your root cause is. While this list is far from exhaustive, these are some of the most common root causes that I see in my practice working with those that have been diagnosed with IBS. Root Cause #1 – Food Sensitivities/Intolerances Food sensitivities are different from food allergies and are probably one of the most under addressed areas of modern medicine yet can be present in up to 30-40% of the population (although not everyone with a food sensitivity will present with IBS symptoms). In a nutshell, a sensitivity occurs when the body’s immune system overreacts to food (or chemicals like MSG, caffeine, food dyes etc.) and releases chemicals that cause inflammation and/or pain in the body. (1) Sensitivities can be difficult to identify because they can occur up to 72 hours after eating the offending food and many are dose dependent (meaning that a small amount may not create a reaction, but a larger amount will). Common foods that can create issues are gluten, dairy, eggs, corn and soy but a person can be sensitive to ANY food including ones that are considered healthy or anti-inflammatory like salmon, olive oil, turmeric or spinach and many times, a person will be sensitive to more than one food. Food intolerances are different from a food sensitivity as they do not involve the immune system and are most commonly caused by a lack of appropriate enzymes to digest certain foods. An example of this would be lactose intolerance, which is very common and is caused by the body’s reduced or absent production of the enzyme lactase which is what breaks down the sugar in milk called lactose. When there isn’t enough lactase, lactose remains undigested and passes into the large intestine which creates an osmotic effect increasing fluid into the large bowel and results in pain, gas and diarrhea. (2). Root Cause #2 – Increased intestinal permeability (aka “leaky gut”) Leaky gut and food sensitivities often go hand in hand. The lining of the small intestine’s job is to act like a gatekeeper separating the inside of your intestines from your bloodstream and controlling what gets access into your blood. Normally only nutrients from fully digested food such as vitamins, minerals, amino acids etc. are allowed to cross the intestinal lining and get into the bloodstream and things like bacteria and undigested food particles (macromolecules) are kept out. With leaky gut, there is damage to the lining of the intestinal tract and it becomes more permeable meaning that the gates are more open between the intestine and bloodstream and the things that are normally kept out, can now sneak through. Think of it like leaving the front door of your home wide open and inviting burglars in. Once these pathogens, toxins or macromolecules of food are in the blood, your immune system goes on alert and creates an inflammatory immune response which is what leads to symptoms. Some common causes of leaky gut can be frequent antibiotic use, medications (such as NSAIDs, steroids, chemotherapy etc.), autoimmune disease (like Celiac disease), damage from bacterial toxins from conditions like small intestinal bacterial overgrowth (SIBO) and undiagnosed food sensitivities. Root Cause #3 SIBO (Small Intestinal Bacterial Overgrowth) Bacteria are normally present throughout the entire GI tract but in various amounts. The small intestine when compared to the large intestine has considerably less bacteria living there and some of the types of bacteria are different from those in the large intestine. SIBO occurs when there is an increased number in normal bacteria and/or abnormal type of bacteria in the small intestine (3). For most, SIBO is an overgrowth of various types of bacteria that should normally be found in the large intestine. (4) Most common symptoms of SIBO include: Abdominal pain/discomfort Bloating and abdominal distention (many times within one hour of meals) Diarrhea, constipation or alternating between the two Gas/belching or reflux after meals Weight loss and nutritional deficiencies (in severe cases) SIBO also has sub types: diarrhea dominant, constipation dominant or alternating between the two. Sound familiar? That would be because some studies indicate that as many 80-85% of those diagnosed with IBS have underlying SIBO (4,5). Yet SIBO remains largely underdiagnosed due to people not seeking care for their symptoms (or accepting an IBS diagnosis and not digging deeper) or because many doctors are either not familiar with SIBO or are unaware of how common this condition can be in those diagnosed with IBS. Root Cause #4 Dysbiosis of Gut Microbiome Our GI tracts contain a complex ecosystem of over 100 trillion microbial cells that influence human physiology, metabolism, nutrition and immune function and is referred to as our “gut microbiome” (6,7). Recent research into the gut microbiome shows that the gut microbiota can interfere with normal intestinal functions, can affect intestinal motility and influence mucosal inflammation which may lead to or exacerbate IBS symptoms (7). Some recent studies show that up to 83% of those with IBS have abnormal fecal biomarkers and 73% have intestinal dysbiosis (11) Dysbiosis, which is often due to antibiotic use, is a lack in number or diversity of beneficial bacteria which can lead to the onset of IBS type symptoms and unfortunately, just one round of antibiotics can impact and alter the gut flora. Root Cause #5 Gut Infections/Post Infectious IBS Post infectious IBS is when IBS symptoms occur after having acute gastroenteritis (inflammation of the stomach and intestines as a result of bacterial or viral infection) and symptoms are believed to be related to persistent sub-clinical inflammation, changes in intestinal permeability and alteration of gut flora. (8) Some common infections that I see in my practice are bacterial such as Heliobacter pylori (h. pylori) and Clostridium difficile, fungal like candida albicans or even parasites. Gut infections can occur from overseas travel, from digging in dirt in a garden, food poisoning, from an overly affectionate pet or caring for farm animals. Prior use of antibiotics can be a risk factor and contribute to overgrowth of Candida or SIBO (10) since they disrupt the microbiome by killing off not only the bad bacteria but also the good which creates an environment suitable to overgrowth and opportunistic pathogens. (10) What Next? You may be wondering at this point how in the world are you able to figure out if one (or more) of these common root causes is something you have? The answer? Fortunately, all of these root causes can be discovered by working with a functional medicine/nutrition practitioner who will utilize a thorough assessment and health history to determine what testing needs to be done and will be proficient in interpreting the results to create a health re-building plan tailored just for you. In the meantime, I really hope that you can now see why it is so important to keep looking for the root cause for IBS. If you would like to learn more about how I can help, get started by scheduling an initial visit. References: 1. Food Allergy in Irritable Bowel Syndrome: The case of the non-celiac wheat sensitivity World J Gastroenterol. 2015 Jun 21; 21(23): 7089–7109. Published online 2015 Jun 21. 2. The FODMAPs Approach — Minimize Consumption of Fermentable Carbs to Manage Functional Gut Disorder Symptoms By Kate Scarlata, RD, LDN Today’s Dietitian Vol. 12 No. 8 P. 30 3. Gastrointestinal bacterial overgrowth: pathogenesis and clinical significance Amit H. Sachdev, Mark Pimentel Ther Adv Chronic Dis. 2013 Sep; 4(5): 223–231. 4. Small intestinal bacterial overgrowth syndrome Jan Bures, Jiri Cyrany, Darina Kohoutova, Miroslav Förstl, Stanislav Rejchrt, Jaroslav Kvetina, Viktor Vorisek, Marcela Kopacova World J Gastroenterol. 2010 Jun 28; 16(24): 2978–2990. Published online 2010 Jun 28. 5. Small Intestinal Bacterial Overgrowth: A Comprehensive Review Andrew C. Dukowicz, Brian E. Lacy, Gary M. Levine Gastroenterol Hepatol (N Y) 2007 Feb; 3(2): 112–122. 6. Role of the gut microbiota in health and chronic gastrointestinal disease: understanding a hidden metabolic organ Caitriona M. Guinane, Paul D. Cotter Therap Adv Gastroenterol. 2013 Jul; 6(4): 295–308. 7. Gut microbiota role in irritable bowel syndrome: New therapeutic strategies Eleonora Distrutti, Lorenzo Monaldi, Patrizia Ricci, Stefano Fiorucci World J Gastroenterol. 2016 Feb 21; 22(7): 2219–2241. Published online 2016 Feb 21. 8 Post-infectious irritable bowel syndrome Marroon Thabane, John K Marshall World J Gastroenterol. 2009 Aug 7; 15(29): 3591–3596. Published online 2009 Aug 7 9. Gut Reaction: Environmental Effects on the Human Microbiota Melissa Lee Phillips Environ Health Perspect. 2009 May; 117(5): A198–A205. 10. Antibiotic treatments and microbes in the gut. Macfarlane, S. Environ Microbiol, 2014 April; 16(4), 919-24 11. Irritable bowel syndrome, inflammatory bowel disease and the microbiome. Major, G., & Spiller, R. Current Opinion in Endocrinology, Diabetes, and Obesity, 2014 Feb; 21(1), 15–21 #IBS

Photo by Mae Mu on Unsplash So you’ve been feeling crummy for a while. What you want to know most is how to feel better. You might be asking yourself: will going gluten-free help my IBS? The answer is maybe. But IBS is a complicated condition with many potential root causes so let’s address that, first. What is IBS? IBS means irritable bowel syndrome. Symptoms of IBS vary by individual and with time and might include: ● Gas ● Fatigue ● Bloating ● Nausea ● Feeling full too soon after eating ● Diarrhea ● Constipation ● Unintended weight loss ● Abdominal pain With gluten-free options becoming more plentiful by the day, it is easy to wonder if they’re the answer to your symptoms. Will gluten-free help? Unfortunately, I cannot say that for sure. And while I want nothing more than for you to feel better quickly, please know that jumping on the gluten-free bandwagon actually comes with some risks. Have you ruled out celiac disease? Celiac disease is an autoimmune condition where your body attacks itself in an overzealous response to eating gluten. Gluten is a protein found in wheat, rye, barley and oats by cross contamination. In both people with celiac disease or with non-celiac gluten-sensitivity, your body is having a negative reaction to the gluten protein. Celiac disease is lifelong - there is no cure. The good news is that eating a gluten-free diet should make you feel better! And if you suspect that you might have celiac, it is really important to do testing to know for sure BEFORE removing gluten. If you remove gluten, your body stops producing the antibodies that you can measure in your blood and your gut will heal from the damage the gluten is causing. Without those measurable signs, you cannot get the diagnosis that you need. While it is easy to assume that the terms are interchangeable, celiac and gluten-sensitivity are not the same things. But, there can be overlap. The research suggests that about 4% of people with IBS have celiac-disease (1). FODMAPs vs. Gluten-free Along with gluten, FODMAPs are also top of mind when investigating ways to feel better with IBS. FODMAPs are carbohydrates found in many foods but in higher amounts in specific fruits, vegetables, dairy and grains. Some of us have issues with some, but rarely with all, of the FODMAPs. One thing to note is that FODMAPs are carbohydrates while gluten is a protein. FODMAPs are found in a diverse group of foods that include lactose in milk, fructans in onions and garlic, high-fructose fruits (apples, cherries, apricots, watermelon), galacato-oligosaccharides (GOS) in beans and more. And - whomp whomp - you can have issues with both the gluten protein AND the FODMAP carbohydrate in wheat. Sleuthing with sourdough So, how do you know if your digestive system is reacting to the gluten in bread or something else? Real sourdough might be better tolerated if your issue is the FODMAP in wheat and not the gluten (2). Sourdough bread is made with a really long fermentation process. Sometimes the bread is slowly fermenting for 24 hours or more! This slow and gentle fermentation makes the fructan easier to digest because the active bacteria are working to break it down a bit. The gluten in wheat will still be present and intact, even after a slower fermentation. True sourdough bread may offer a bit of information to you about your gut health and what might be best. But it won’t offer a complete plan of action. For my patients, we may start with a low FODMAP diet first. Depending on their symptoms, we may also explore gluten-free, but it isn’t something that I would start with or recommend you jump too, first. There are simply too many possible root causes to IBS to be able to say that a single intervention will work for you. Other root causes of IBS? What makes getting to the root cause of your IBS symptoms tricky is that there are many possible root causes. And you can have more than one root cause. Ugh. And when you feel like garbage, the last thing you want to do is waste time or precious energy trying an intervention that may or may not work. IBS may be caused by many things. Some risk factors for IBS include: ● Having just had an infection (food poisoning) ● Small intestinal bacterial overgrowth (aka SIBO) ● Altered motility - the muscles propelling your food through the digestive tract are moving too fast or too slow (medications can be one culprit) ● Excessive stress ● Your genetic make-up ● Increased intestinal permeability (aka Leaky Gut) Other changes that might improve IBS symptoms Eliminating or reducing other foods and drinks might offer relief. These include: ● Eliminating alcohol ● Reducing or eliminating caffeine ● Avoiding additives, such as artificial sweeteners or preservatives It is also important to have a good night’s sleep, be hydrated, to manage stress and so on. Even things like having smaller meals can influence your IBS. Bottom line: will going gluten-free help my IBS? Maybe. But without ruling out other options and working through a systematic process, you’re just guessing. I hope that this article sheds some light on just how complicated gut health can be. If you’re ready to get to the bottom of your gut health issues and find relief from your symptoms, I have the tools to help. I invite you to get started by scheduling an initial visit today!

What do yogurt, sauerkraut, and kombucha all have in common? They’re all sources of living critters called probiotics…and they can boost your health! If you suffer from irritable bowel syndrome (IBS), you may be considering taking probiotics to help ease your symptoms. But what exactly are probiotics and do you need to take them? Keep reading to find out. In this blog post, I’ll be walking you through probiotics 101: what they are, what foods and drinks you can incorporate into your usual routine, and how these habits may boost your overall health. New around here? Welcome! I’m Marissa, digestive health registered dietitian. I help clients improve their health through personalized nutrition and lifestyle programs based on functional nutrition and a "food as medicine" approach. Let’s begin this article with a quick overview of what probiotics actually are. Photo by Tiard Schulz on Unsplash Introduction to probiotics So what are these little critters? Probiotics are living microorganisms that have health benefits when consumed. Some probiotics are bacteria, others are fungi. While we might think about bacteria as being “bad” or something to squash with a dose of Purell, not all bacteria cause disease. In fact, many probiotics have very important health benefits. In your digestive system, there is an entire ecosystem of living organisms that work with you. You may have heard the term “microbiome” and that’s exactly what we’re talking about here. When things are going well, these little members of your microbiome help to digest your food, nourish your digestive tract, send and receive messages to your brain and even bolster your immune system. …if your community is out of balance, the ripple effect can be substantial. Just like a thriving city needs trash collectors, school teachers, and a librarian, your microbiome needs the right balance of different kinds of probiotics. When things get out of whack, whether because of an illness, medication, or lifestyle habit, your microbiome can suffer and in turn, you may have a variety of symptoms. How do we cultivate our microbiome? It begins when we are born! Our microbiome We start building our microbiome at birth; and your microbiome will be different based on how you were born, what you were fed, and if you ever had medications, such as antibiotics (1). As adults, everything from our usual dietary choices, exposure to pathogens (the bad guys), our usual physical activity, stress levels, and our medications influence what kinds of organisms are in our microbiome. We can continue to cultivate a healthy microbiome by having a high-fiber diet (the bacteria digest the fiber) and by eating foods that contain probiotics; this is kind of like planting fresh seeds in your garden to keep the garden healthy and thriving. Where do we get probiotics? We can get probiotics from certain foods, drinks, and supplements (2, 3). Foods that contain probiotics include: ● Yogurt ● Kefir ● Kombucha ● Sauerkraut ● Fermented pickles ● Kimchi ● Tempeh Note: not all of these products have the live probiotics in them. Pasteurized products are heated to kill the kinds of bacteria that can cause illness, but the process kills all organisms, including healthy probiotics. An exception to that is yogurt made with pasteurized milk; the milk is free from potentially harmful bugs and is then inoculated with the probiotics that turn the milk into yogurt. In addition to incorporating food sources of probiotics, you can also consider taking supplements. Probiotic supplements There are many, many different kinds of probiotic supplements. If you think about probiotics like a zoo, there are elephants, alligators, and flamingos (not to mention, lions, tigers, and bears - oh my). Certain probiotic strains are known to help with specific health goals and conditions; anything from reducing anxiety to treating diarrhea (4, 5). Common categories of probiotics include: ● Lactobacillus ● Bifidobacterium ● Yeast ● Spore based In order to have the best possible outcome with your unique goals, you have to pick 1) the right kind 2) the right dose If we continue with our zoo analogy, your symptoms might not get better if you’re taking a dose of 12 elephants when what you actually need is 50 flamingos. As for my clients, many of them are seeking relief from their digestive symptoms. Let’s talk about those potential benefits now. Probiotics and their benefits for gut health Probiotics are beneficial microorganisms that can improve gut health. When included in the daily diet, probiotics play a key role in aiding digestion, alleviating symptoms related to gastrointestinal issues such as bloating and gas, and restoring balance to the microflora in the gut. Studies have also shown that probiotics provide an array of other health benefits including improved immunity, reduced risk for certain chronic illnesses, and better mental health. Through complex metabolic machinery powered by probiotic bacteria, toxins and pathogens can be neutralized while inflammation is downregulated–resulting in improved gastrointestinal health and a happy gut! Taking probiotics regularly is a simple and often effective way to stay healthy from the inside out. I recommend working with a registered dietitian to find the best-matched probiotics for your needs and goals. But I also recommend keeping in mind that probiotic supplements are not the only factor in the overall health of your microbiome. If your microbiome has gotten out of balance, it is important to get curious about why it happened so that you can address those root causes. Photo by Daily Nouri on Unsplash Do you need to take a probiotic supplement? Probiotic supplementation has become increasingly popular in recent years as more people seek to take proactive steps to improve their overall health and wellness (6). While there are certainly benefits associated with opting for daily probiotics, it is important to remember that a varied diet rich in plant-based foods will already contain natural probiotics that can help maintain your gut microbiome. Therefore, if you have no known digestive problems, probiotic supplementation may not be necessary. However, for those who are dealing with specific digestion issues, probiotic supplementation may provide considerable relief. If you are uncertain whether or not you need this additional support, consulting a healthcare professional is recommended. Are there any risks of taking probiotics? There may be certain risks related to taking probiotics. Supplements are not regulated, so one risk is that you choose a product that isn’t high quality. Perhaps there are not as many probiotics present or maybe the supplement is contaminated. It is important to be an informed consumer so that you’re able to pick a high-quality product. Additionally, probiotics can interact with medications; therefore it is best to discuss their use with your doctor prior to consuming any supplements. And lastly, there can be an acclimation period with taking probiotics. It is common to experience some gas and bloating as your digestive tract adjusts to the new community members, but this tends to settle out over time. Nevertheless, when consumed correctly probiotics have been found to offer numerous health advantages and thus can be beneficial for many individuals. How to choose a quality probiotic? Choosing a quality probiotic supplement requires doing some research and due diligence. Before buying, read the label carefully to determine the type of probiotic strain it contains as well as how many billions of CFUs (colony-forming units) it provides per daily serving. Consider looking for one that provides multiple strains, as different strains offer different benefits. Additionally, look for supplements in a delayed-release capsule form: these are designed to help protect beneficial bacteria traveling through the digestive system. Finally, be sure to follow the recommendations for proper storage. Most lactobacillus and bifido strains will require refrigeration while for example, spore based products won’t. Refrigerating helps ensure that the fragile strains of probiotics remain viable and active upon consumption. Key takeaways Probiotics are beneficial bacteria that help keep your gut healthy. They work by crowding out bad bacteria, improving the barrier function of the intestine, reducing inflammation, and enhancing immunity. You can get probiotics from fermented foods such as yogurt, sauerkraut, kimchi, and kefir. You can also take a probiotic supplement. When choosing a probiotic supplement, look for one that contains multiple strains of live bacteria, has been refrigerated (if needed) to ensure potency, and is third-party tested for quality. If you’re ready to have an expert guide to optimizing your gut health and digestion, I'm ready to help! You can use this link to schedule an intial visit; we’ll discuss your health history and goals and explore how I can help you finally feel better.

Your doctor has given you the news: You officially have an explanation for your digestive health issues. So you think to yourself, “I have IBS, now what?” This blog covers some of the very first steps that you can take to begin to learn about what IBS is and how to best manage your symptoms. Everyone is a bit different, and it can take some time and practice to figure out how to feel your best. But you should also know that these are not the last steps you’ll be taking to get a handle on your IBS. Quick note: the purpose of this blog post is to help you get started with what IBS is and how to manage your symptoms so that you’re not feeling so crummy all the time. It is not meant to be an exhaustive list of all that you can do to live life to the fullest with this diagnosis. Once you’ve gotten started with the management of your symptoms, then you might feel good enough to start digging a little deeper. Why did you get a diagnosis of IBS to begin with? The deeper level of exploration can offer further clarification on how to best treat your condition. So let’s start at the beginning: What is IBS? Photo by Matthew Henry on Unsplash What is IBS? IBS is a condition that affects your large intestine. It can cause cramping, gas, pain in the stomach, and diarrhea or constipation. IBS is a chronic condition which means you will have to take care of it for a long time (1). IBS symptoms can vary, but might include: Constipation, diarrhea (or both) Abdominal pain Gas and bloating Fatigue IBS can be caused by more than one thing, which is why a concrete diagnosis can be a bit elusive. IBS can be caused by: Changes in how your GI tract muscles contract Infection Changes in the microbiome (the community of organisms in your gut) Stress The above factors can lay the foundation for being more susceptible to IBS. And then, different things can trigger IBS symptoms, such as specific foods and stress. IBS is more common in women than in men and is more common in younger people. Before you assume that your doctor’s diagnosis is correct, I always recommend a few steps to confirm that you do have the correct diagnosis. Let’s walk through how to do that, now. Confirm your diagnosis It surprises many of my clients to learn that IBS doesn’t have an exact lab test or way to confirm that you have it. Because of this, it is important that you know how your doctor came to the conclusion that you do have IBS and what has been ruled out. IBS is a difficult diagnosis to pin down because the symptoms can overlap with so many other conditions, such as Crohn's disease or celiac. But, one very important note, the treatments for these conditions are very different. Unfortunately, you cannot expect to have maximum symptom relief if you have not reached the correct diagnosis. For the full scoop on confirming your correct diagnosis, please review this blog post: Do I have IBS or Something else? No self-diagnosis, please! Photo by Agence Olloweb on Unsplash Calm your flare If your body is in IBS crisis mode, the first step is to put out the fire. Think of this as a sick day and offer your body rest, quiet and easy-to-digest foods, such as well-tolerated soups and smoothies. You’ll want to bookmark this post to have a reference for when you have a flare day: How to Calm IBS Flare-Ups: Things You Can Try Today. Begin tracking Get started tracking very basic things such as food and symptoms to see if you notice any connections. For my clients, I recommend the MySymptoms app for this as it also allows tracking of sleep and other things, and then it will help provide feedback regarding connections between food and symptoms. It also allows for logs to be exported and sent to a practitioner. Meals Using your favorite app, keep track of meals, snacks and drinks throughout each day. Even the afternoon iced coffee, even the evening snack. It all counts! The more complete and comprehensive this data is, the more easily you’ll be able to see patterns between what you eat and how you feel. Symptoms The reason I love the MySymptoms app is that it also allows you to track symptoms all in one place. So if you’re feeling energetic, bloated, fatigued, or constipated, the app can track it. Meshing your food and symptoms is powerful information to use to make changes to have you start feeling better, more quickly. Track symptoms such as your bowel movements, belly pain, and bloating. Then you’ll mesh this data with potential triggers, such as sleep, stress, and intense exercise. Sleep Did you know that having a good night’s sleep is important to allow your digestive system to rest and recharge? If you’re not sleeping enough, not having restful sleep, or eating well into the evening, this actually impacts your digestion. Did you know that there are certain foods that can actually boost your sleep quality? If you’re curious about those, check out this post for delicious snack ideas (just not too late at night, please) Do Pistachios Help You Sleep? Yes! Quick disclaimer: Pistachios are a high-FODMAP food and might make your IBS symptoms worse. Keep the above article bookmarked for when you’re ready to do reintroductions. Stress Your digestion is connected to your brain by multiple pathways. If you’re feeling stressed, anxious, happy, or calm, your gut knows all about it. And if your digestive system is not feeling great, be prepared for headaches and brain fog. Tracking your stress levels and moments of calm is also important for managing your IBS. Exercise We all know that exercise is supposed to be good for us...and it is. For IBS, certain exercises can help to manage symptoms. Exercise can help to reduce stress, help with muscle movements along the digestive tract (something that can be different for folks with IBS) and it can even promote microbiome diversity – cool, right (2, 3)? The best exercises for IBS are walking, yoga, biking, and other activities that you enjoy, just not at a breakneck pace. Intense activities, such as sprinting and HIIT exercises might actually make your IBS worse. As you’re tracking, note the important details of the type of activity, time of day, and duration. This data collection will be so useful as you figure out what lifestyle helps you to feel your best. Hydrate Chances are if you’ve been experiencing constipation, diarrhea, or both, you probably need a bit more water. Sip on water throughout the day and drink enough to make your urine pale like lemonade. When you go to the bathroom, if your urine is dark like apple juice, you’re dehydrated. Drink up! If you’re in a flare, you might feel better hydrated with electrolyte replacement, such as a sports drink or coconut water with a pinch of salt. On a regular basis, they’re probably not needed. Focus on stress management If you think about how feeling excited or anxious can lead to a feeling of butterflies in your stomach, it might not come as a surprise to learn that your brain and gut health are intimately linked. When we’re stressed, even if we don’t have IBS, we can experience diarrhea and constipation. If you have IBS, those symptoms might be even worse. If you have IBS, you might also suffer more symptoms if you’re eating too quickly or in an agitated state of mind, such as eating at your desk while you’re rushing to meet a work deadline. IBS management isn’t just about what you’re eating, it is also about how you’re eating. What helps you to unwind and feel more at ease? I don’t mean tuning out such as scrolling through social media or watching a few episodes of your favorite show. I’m suggesting activities like stretching each morning or as part of your routine to wind down at night. Taking a leisurely walk and not listening to headphones (crazy, I know), having a hot bath, or writing in your journal. These may seem like unexpected suggestions coming from a dietitian, but our whole lifestyle can impact how we digest our food! You can also ease digestion if you take a few deep breaths before and after meals and do your best to slow down and really chew each bite of food. Not only does this get digestion started by breaking the food down into a more digestible paste, but it also stops you from swallowing so much air with speedy bites. Your belly will thank you! Try a digestive enzyme You might feel better if you try a digestive enzyme to support your body as it recovers from this IBS flare. I recommend trying an enzyme that doesn't contain HCL initially just in case you do have something like H. Pylori. A probiotic can sometimes be helpful, too. P.S. Finding the right supplement and dose is something I help my clients with! ​​ Begin gentle food eliminations Figuring out what foods might be a trigger for your IBS involves a bit of trial and error. There isn’t a perfect or best place to start. Basic dietary change can be trying a Paleo diet or the low FODMAP diet. The low-FODMAP diet is an evidence-based intervention that has helped many people to subdue their symptoms. But it is a bit tricky to implement well. That is why I created The Low-FODMAP fix as an option to work your way through the details in a systematic and effective way. Remember how I mentioned that these suggestions are the preliminary steps for IBS management? It is 100% possible to be on an elimination diet for too long. I’ve seen it again and again with my clients. Here’s more on that topic: Have you been on an elimination diet too long? Photo by Brett Jordan on Unsplash Ask for help If you’re not making good progress on your own, please reach out to a digestive health dietitian such as myself. There are too many good strategies and resources available! Please don't suffer for months, or worse, years, as some of my clients have before finding me. Don't get stuck removing so many foods that you’re only left with 6-10 safe foods. Try a few things and if those few things don't work, don't keep compounding different things - get help to dig deeper. Key Takeaways: I have IBS, now what? If you’ve recently been diagnosed with IBS, don’t feel stuck or lost wondering, “I have IBS, now what?”. This blog post offers many tools to get a handle on your own triggers and for how to calm a flare. If you’re ready to try a low-FODMAP diet with the guidance and support of a registered dietitian, you can get started by scheduling an initial visit or if you want to give it ago on your own first, consider my signature program The Low-FODMAP Fix, which guides you through the same methods that have helped hundreds of my clients finally feel good after months or years of IBS misery.

You’ve decided to start taking probiotics - But how do you choose? The supplement aisle can be overwhelming and you’re wondering “What do I look for in a probiotic?”. If you’ve been reading my blog this year, you know we’ve been talking about probiotics a LOT! To find out more about what probiotics are, read my blog post Probiotics 101: What Are They and Do You Need Supplements? I’m going to break down everything you need to know when looking for a probiotic, so you can be confident you are making the right choice. If you are new here: Welcome! I’m Marissa, a digestive health registered dietitian specializing in IBS, food sensitivities, and autoimmune conditions. I help clients improve their GI symptoms with food and lifestyle programs using functional nutrition and a food-as-medicine approach. Probiotics are classified as supplements which means they are not regulated by the Food and Drug Administration (FDA). This means that manufacturers can put anything into the supplement and claim that it will help a specific condition. I’m going to teach you the detective skills you need to be sure you’re making a good choice. Grab your magnifying glass and we’ll start this investigation by looking for supplements that are third-party reviewed. Photo by Daily Nouri on Unsplash Third-Party Reviewed Even though your probiotic isn’t regulated by the FDA, there are several organizations that test supplements to ensure they have the ingredients they claim to have, and do not have harmful contaminants (1). Organizations that offer this testing include: ConsumerLab.com NSF International U.S. Pharmacopeia Supplements that pass the testing will have a seal of quality assurance displayed on the label. Once you’ve found a brand of probiotics that has been tested (and passed) for quality, you can start looking for the correct strain. Let’s dive in! Strains When it comes to probiotics, there isn’t just one kind that you need. Each type of bacteria contributes differently to help your body function well. Think about your microbiome like an orchestra. You need to have the right number of flutes, violins, cellos, and french horns to make the music balanced and sound the best. If you are taking probiotics to treat a specific condition, you need to know what kind of probiotics have been researched to improve that condition. Using our orchestra example, it won’t help to improve your IBS if you are taking a supplement of french horns if flutes are the type of bacteria shown to improve IBS. Probiotic names have three parts: the genus, species, and strain designation. You need to have all 3 parts of the name to be sure you have a match. Just like mailing a letter - you need to have the right house number, street name, and zip code to have your letter get to the right destination. Let’s look at an example: Bifidobacterium bifidum MIMBb75 is a bacteria that has been shown to help with symptoms of IBS (2). In this case, Bifidobacterium is the genus, bifidum is the species and MIMBb75 is the strain. Let’s circle back to our orchestra. If you take a supplement with flutes to improve your IBS, you are helping to increase the number of flutes you have… If you continue to take a supplement with only flutes, eventually your orchestra will have too many flutes and not enough violins, french horns, or cellos. For this reason, I recommend rotating strains of probiotics every 2-3 months. This can be as easy as changing from a 7-strain probiotic to one that has 10 or 14 strains. You can also change from taking a lactobacillus and bifidobacterium strain to taking one that is more spore based. Once you’ve found the correct strain of probiotics, you need to make sure you are taking the right amount. The next clue we’re going to investigate is how to find the right dose. Dosage Probiotics are measured in colony-forming units or CFUs. This tells you the number of active bacterial cells you are getting in each dose. Maintenance doses of probiotics can range from 1 billion to 5 billion CFU. If you are looking to address a specific condition, you may need as much as 20 billion to 50 billion CFU. The label should list the number of CFU for each strain of probiotic in the supplement. Example for supplement XYZ (using the orchestra example again): Flutes 50 billion CFU Violins 10 billion CFU Clarinets 10 billion CFU If you want to improve a specific symptom, you will also want to research how many CFUs and what specific strain is needed to treat the condition. This is where a health professional familiar with the use of probiotics – that’s me! – can be helpful. The last important part of our dosage investigation is how the CFU is listed. The number of active bacteria in supplements declines over time. Make sure the CFU is listed as “prior to the end of shelf life” instead of “at time of manufacture.” You want a guarantee that the amount listed is what you’re actually getting. Now you know the strain and dose that you want. You’re ready to make your purchase! But there is another important clue to look at before you bring them home. How should you store them? Even more importantly - how are they stored in the store? Here’s a hint - You might need to be looking in the refrigerated section. Keep reading for the full scoop! Photo by Samuel Sianipar on Unsplash Storage The most common type of probiotics are lactobacillus and bifidobacterium combinations. Heat can kill these traditional probiotics and you will need to keep them in the fridge. This means they should also be refrigerated at the store where you purchase them. Spore-based probiotics are different and only become active when they reach your GI tract. They do not need to be refrigerated during storage. You can tell if a probiotic is spore-based because it will begin with “Bacillus” (for example Bacillus Indicus). Spore-based probiotics have been shown to help reduce serum triglycerides and help with inflammation (3). If traditional probiotics are all instruments in an orchestra, spore-based probiotics are like members of a band. Both types help to create balanced music, but the instruments and the way they operate are a bit different. The final piece of our investigation is the best before date - And does it matter? Let’s take a look! Best Before So you checked your cabinet (ahem, I mean the fridge) and found a bottle of probiotics from last year - Can you still take them? The CFUs in probiotics decline over time. If you use the product past the “use by'' or “best before” date, you will not be getting the listed dosage. It isn’t harmful to take the supplements past the best-before date, but you will not be getting the full benefit from taking them. This is especially important if you are trying to improve a specific condition with a targeted dose. That wraps up our investigation. Congratulations! You are now an official probiotics label detective. Keep reading for my pro tips on how to get the most out of your supplement. Pro Tips You’ve spent your hard-earned money on probiotic supplements, so let’s discuss what you can do to get the full benefit of taking them. Help the Bacteria Survive The truth is, not all the bacteria in the supplement are going to reach your intestine. Once you swallow the capsule, the probiotics must make their way through the harsh conditions in your body to successfully reach their final destination. Think about stomach acid followed by digestive enzymes. Traditional lactobacillus/bifidobacterium probiotics are vulnerable and it’s more difficult for them to make it through your digestive obstacle course. Delayed-release capsules increase the chances that the bacteria will make it to your gut to live happily ever after. Spore-based varieties (remember our band?) are dormant until they reach your GI tract. This means they are able to tolerate the harsh conditions in your body and more of the bacteria will be successful on their journey to your large intestine. Taking your probiotic with food will also help to reduce the acidic conditions in your stomach. Should you take your probiotic with your morning meal or in the evening? Take a look at my next pro tip to find out! Take Them at The Right Time of Day Starting probiotic supplements can cause some mild side effects in the beginning. The most common complaints are changes in your bowel habits including gas and bloating. This is OK and a sign that the supplement is working! Over time your body will adjust and the side effects will go away. Taking your probiotic in the evening will make these symptoms less noticeable. On the flip side, some people report feeling less rested and having vivid dreams. In this case, you might need to change and take your supplement earlier in the day. Let’s shift the conversation more towards food - and I’m not talking about food for you but rather food for your microbiome. Prebiotics are just as important as probiotics for you and your bacteria. Let’s take a look! Prebiotics and Fiber Prebiotics are a source of food for probiotics. Including prebiotics in your diet from food or supplements means that the good bacteria will have the best chance of surviving in your body. Food sources of prebiotics include (4): Whole oats Wheat bran Apples Asparagus Onions, garlic, and leeks Flax Seeds Barley Bananas Dandelion greens Prebiotics in the form of inulin are also added to some probiotic supplements. This helps the bacteria grow once it reaches your digestive tract. Imagine showing up at your Mom’s house after a long journey and she has a nice home-cooked meal already on the table. Sounds inviting doesn’t it? Sources of prebiotic fiber are often classified as high-FODMAP foods. If you need to follow a low FODMAP diet, you may not tolerate probiotics with added inulin. Food as medicine is my first-line approach and you may be wondering if you can just get your probiotics from food and ditch the supplements altogether. For many people focusing on adding probiotic foods can make a difference. In the next section, we’ll discuss the pros and cons of using food vs. supplements. Photo by Niclas Illg on Unsplash Food vs. Supplements? This is a question I get asked a lot by my clients. Is there a benefit to taking supplements or can I get the same benefit from food? As a food-first dietitian, I always recommend starting with food when possible. Probiotics are naturally found in fermented foods including (5): Yogurt Kimchi Tempeh Sauerkraut Sourdough bread Pickles Miso Some cheeses that have been aged but not heat processed like swiss, provolone, gouda, and cheddar (6) In some cases though, using a supplement may be a better option. Supplements allow you to be more targeted with the strain of probiotics you are taking which can help when treating specific conditions. Other benefits of supplements include: Increased diversity of bacterial strains Accommodating food allergies and sensitivities like wheat, dairy, soy, or gluten Can be used when food sources are not tolerated Correcting an imbalance of bacteria in your body is not as simple as just adding a supplement. Many lifestyle habits common in North America make it difficult for good bacteria to survive inside your body. It’s important to ask yourself - What contributed to developing the imbalance? The population of bacteria living in your body can be affected by lifestyle habits including: Stress levels Sleep habits Processed foods high in sugar and added fat Combining daily food sources of probiotics with a variety of whole foods including vegetables, fruit, and whole grains will help to keep the probiotics growing and happy inside your body. As a digestive health dietitian, I love seeing how improvements in GI health can positively impact all areas of life. But just like with any supplement, they are not safe for everyone. Keep reading to find out if probiotics are safe for you. Can Everyone Take Probiotics? There is never a one-size-fits-all recommendation when it comes to health and probiotics are no exception. Probiotics are not recommended in these situations: Anyone who has a compromised immune system (i.e. critical illness, chemotherapy) GI infections like SIBO Pregnant women Infants If you are unsure if probiotics are the right choice for you, consult with a healthcare professional or your physician before starting any supplements. Key Takeaways Just like any supplement, probiotics are not regulated by the FDA. This means that you need to do your research and know what you’re looking for when you go to the store. The probiotics you choose should be reviewed for safety and efficacy. You should also be checking the label for the strains, dosage (measured in CFU), best-before date, and how the probiotics are stored. You can also get probiotics from food sources like yogurt, sauerkraut, tempeh, miso, kimchi, and sourdough bread. Including both probiotics and prebiotics in your diet will help to keep your microbiome balanced. If you want personalized diet and lifestyle recommendations that will help to improve your digestive health - I am here to help! Use this link to get started with me. Life is busy and I can help you do the investigative work to make sure you’re getting the right strain and dose of probiotics to help you feel better.

Bad news: your IBS is flaring up and you need to feel better – stat! How can you be spending more time in the boardroom and less time in the bathroom? Here are dietitian-approved recommendations for how to calm IBS flare-ups as fast as possible. Your gut and brain are chatting all the time. When you’re feeling serene and calm, it is more likely that your gut is, too. And if you’re feeling nervous or excited you’ll recognize the butterfly feeling in your belly. But what if your gut is having a really terrible day and your IBS is off the rails? You’re going to need these handy tips to know how to calm your IBS flare-ups as quickly as possible. In this post, I offer you holistic tips both for your nutrition as well as your lifestyle. Deep breathing techniques, tea, and a few healing foods can all offer your gut a chance to calm the heck down. Interventions how to calm IBS Flare: Food and Nutrition Chew well to give your digestive system a break While it is more and more common to eat while doing work, watching TV, chasing your kiddos and folding laundry, multitasking is not conducive to a relaxed state for your digestion. Whenever possible, try to eat without distraction - go rogue! Chew slowly and thoroughly - this offers two benefits to help your belly feel better, especially during an IBS flare. Well chewed food is easier for our body to digest. Not only are the pieces physically smaller and easier to deal with (this is called mechanical digestion) but also your body’s enzyme action actually begins in your mouth (this is called chemical digestion). No matter what, cultivate that sense of calm – even in your belly –- by eating more slowly and chewing each bite really well. Added bonus? Less air being swallowed with each bite means less bloating! Smooth foods for smooth sailing Photo by Hanna Balan on Unsplash Raw foods are more work for our gut to digest. While you’re feeling crummy with an IBS flare, you will feel better faster if you are gentle on your digestion. Eat foods that are as simple as possible for your body to digest. Cooked and blended foods are best. For example: ● Soups ● Stews ● Smoothies For your soups and smoothies, skip the dairy. The dairy might make your flare-up worse. Peel fruits and vegetables. While the high-fiber peels are usually a health boost, right now they’re more work for your upset belly. While you’re symptomatic, focus on gentle foods like well-cooked meats and well-tolerated grains like rice. Fats and oils might irritate your gut, so focus on lean meats for now. Hydrate well Whether you’re struggling with diarrhea, constipation or both, staying hydrated helps you to minimize the effects of your flare and helps you to bounce back more quickly as well. It can be hard to feel like drinking much if you’re bloated and full; try small consistent sips of any of the following drinks to keep your hydration levels high. ● Water ● Coconut water ● Bone broth ● Herbal tea - mint, fennel and chamomile may soothe your belly As mentioned above, dairy can be a culprit in aggravating your IBS, so removing dairy when in a flare can help. Boost your enzymes Photo by Brooke Lark on Unsplash You might think about enzymes as a supplement, and while that is possible, you can actually get enzymes in two special fruits! If you’re struggling with constipation, fresh papaya and pineapple can help. These two fruits contain naturally occurring enzymes that support digestion. Papaya contains papain and pineapple contains bromelain (SOURCE). Both fruits are also low FODMAP when eaten in 1/2 cup or less servings. FYI - canning makes the enzymes inactive. So while canned pineapple is delicious, it won’t have the same enzyme benefit as fresh or frozen. Frozen pineapple can be used to make a creamy smoothie without dairy. Lifestyle interventions to soothe an IBS flare Diarrhea ● Use a heating pad or hot water bottle to soothe your belly and relieve the pain caused by abdominal cramping. ● Apply diluted peppermint oil directly to your belly to help reduce pain and gas/bloating. Make sure you’re using a high-quality brand of essential oil that states for topical use. ● Stress reduction: remember how we talked about how much the gut and brain are chitchatting all day long? Deep breathing, meditating and aromatherapy can calm the mind and encourage your irritated gut to do the same. Constipation ● Gentle exercise. Exercise can help to – ahem – get things moving. A gentle walk, regular squats or yoga squats (even supported) can get things moving. ● Hydrate: being dehydrated can pump the brakes on your bowels. Consistent sips of water, herbal tea and coconut water throughout the day might feel better than trying to chug a big glass of water. ● Colon Massage: you can help to propel things along with gentle massage, tracing the path of your colon across your abdomen. Plus, some self-care and deep breathing can further soothe your gut. To try this, lie down, take a few slow deep breaths and begin rubbing small circles in the lower right quadrant of the body (inside your right hip bone). Move up the side, over the midline (under your ribs), and down the left side, across the lower abdomen and back over to the right. Basically, you’re making a square around your belly. To further enjoy this massage, diluted essential oils like peppermint can reduce pain, and get gas and a BM moving. A heating pad or hot water bottle can also help with pain. Having an IBS flare can really put a damper on your day! I hope that these tips for how to calm IBS flare-ups help you to feel better soon. There are so very many factors that contribute to how you feel on a given day: it can feel really confusing and frustrating to keep having flares, even when you’re trying your best to understand what your body needs. If you’re ready to dig into your gut health, identify your unique root causes and feel your best, I’d love to help. Schedule an initial visit to get started now!

Do you feel like you’ve tried everything, but your darn digestive symptoms keep rearing their ugly heads? And most doctors come up empty for a gut healing protocol that will actually keep your symptoms at bay? Ugh! That is so frustrating! And I’m afraid it is really common in my clients’ experiences before working with me. Most doctors tend to approach gut health as something to manage with medications vs. getting down to the root cause. We can do better than that, together. You deserve better than just symptom management. Photo by Brett Jordan on Unsplash The truth is that there are many things that you can do to optimize your digestion so that your symptoms can diminish or even go away completely. But without getting down to the root cause, you won’t have that opportunity and those symptoms are not going to go away. The gut healing protocol that I recommend is not a quick fix, but it can be a lasting fix. It allows you to identify the root causes of your symptoms and achieve lasting remission. Did you know that there are many possible root causes of digestive issues such as IBS? Here are the Top 5 Root Causes of IBS That You Should Know About. Ready to hear about gut healing? Let me introduce you to the 5R gut healing protocol. What is the 5R gut-healing protocol? The 5-R Protocol is a systematic and comprehensive approach to maximizing gut health. The 5R gut-healing protocol is used by functional practitioners, such as myself. We use the protocol to get to the root of symptoms. (This is in contrast to many traditional medical professionals who tend to focus more on symptom management). Because of its comprehensive nature, the 5R protocol is deep, therapeutic work that is best accomplished with a savvy functional nutrition guide. I wouldn’t recommend the 5R protocol as a first-step response, rather, entered into after other things have been ruled in/out/tried and ONLY with a practitioner to serve as a guide. In my experience, people trying to undertake a 5R approach by themselves, just find themselves with a very limited diet and still suffering from symptoms. Many of my clients have been in these shoes before our work together. The 5 steps of the 5R protocol What is it like to work through the 5R protocol with me? While everyone’s needs are different, the 5R protocol allows us to create your personalized path to wellness, starting with getting those things out of your diet that are causing you symptoms. Step 1: Remove This is the part of the plan that is probably the least surprising to anyone who is working through gut issues: we need to start by removing anything that could be irritating to the gut. But good news: this is temporary! What are we removing? Things like alcohol, caffeine, food additives, as well as any foods that are causing a food sensitivity reaction. Now, who wants to guess which foods or chemicals are causing a reaction? I sure don’t! This is where my work as a Certified Leap Therapist (CLT for short) really shines. As a CLT, I am able to offer MRT testing to my clients. MRT tests 140 foods AND is the ONLY test that also looks at food chemicals like food colorings and caffeine, as well as naturally occurring food chemicals like solanine. It is hard enough to have to take a break from some of your favorite foods, let’s not eliminate anything unless we absolutely have to (as evidenced by a high-quality test). MRT testing affords my clients the opportunity to forgo the trial and error rollercoaster of starting an elimination diet, such as the AIP, and hoping for the best. For more on that, check out this post: AIP Elimination Diet: It Won't Work For Everyone. We also get to think beyond the plate. Remove also pertains to stress, gut infections, medications, or even supplements that you might be taking that could be causing undesirable side effects. (Note: do not make any changes to your medications without first speaking to your doctor). Now that we’ve talked about things to remove, the next step is to add a few things back in. This is the Replace step of the 5R protocol. Step 2: Replace Sometimes the digestion issue isn’t about something that is needing to be removed, it is about something that is missing. Replace in the 5R protocol refers to bringing back things that might be missing in a normally healthy, efficient digestive system. This might include digestive enzymes or replacing specific micronutrients that might be lacking due to malabsorption issues. When utilizing supplements, I believe in a deficiency to sufficiency approach, meaning most supplements are typically temporary; similar to how a cast supports the healing of a broken bone. Your digestion is unique and your plan to optimize it should be too! Step 3: Repopulate & Reinoculate Did you know that your microbiome – the community of bacteria and other organisms living in your gut – is intimately connected to your overall health and wellness? If you have too few or too many of the most important community members, your digestion and overall health can suffer. The repopulate and reinoculate step of the 5R protocol refers to replacing and rebalancing the microbiome through the use of pre and probiotics. Probiotics are the living organisms that you might think of from eating yogurt. Prebiotics are fibers that are digestible by those probiotics, i.e., their food. Well-fed probiotics = happy and thriving probiotics. Repopulate and reinoculate can also refer to the reintroduction of foods that you’ve taken out. For example, higher FODMAP foods, such as fructans and galactooligosaccharides (GOS) foods since these are primarily prebiotics. This is an exciting example of seeing how your gut has healed so far and what you’re able to better tolerate. But we’re not done: the 5R protocol continues with the next step: repair. Step 4: Repair The truth is, our guts are a bit “leaky" (or semi-permeable). This is normal digestion and absorption in action. In order for our bodies to be able to utilize the nutrients from our food, the food needs to be broken down and get from our digestive tract to our cells via the bloodstream. But, when our digestive tract is healthy and in good repair, it is quite selective about what it absorbs and what it keeps contained within the “tube.” But in the case of leaky gut, the openings that are supposed to manage what gets absorbed are not working properly and so things can sneak in...things like food fragments, bad bacteria, and more. These rogue particles can cause inflammation and other symptoms in your body. The repair step is about cultivating the gut lining so that it is able to work at its best. In part, this is about including specific foods that provide needed nutrients. It may surprise you that there are specific Foods for Leaky Gut that help. The repair step might also include certain nutrients like vitamins A, B, zinc, essential fatty acids, amino acids, and other targeted supplementation recommendations. Last step of the 5R protocol? Rebalance. Step 5: Rebalance There are far more things that impact digestion beyond food, which surprises a lot of my clients. Did you know that sleep impacts digestion? A good night’s sleep allows your digestive tract to rest and digest. We can also promote good sleep with the foods that we eat, including pistachios! Do Pistachios Help You Sleep? Yes! As part of the rebalance stage of the 5R protocol, we will also look into things like what movement do you actually enjoy doing. Do you enjoy an evening walk? Riding a bike? Swimming or hiking? We’ll keep optimizing your wellness plan so that your body feels good doing the movement that you enjoy. No more chronic fatigue, joint pain, or planning your activities around bathroom breaks. Movement also has the added benefit of reducing stress and promoting good quality sleep. We might talk about other techniques as well to further reduce stress. Maybe you’ll find that you enjoy journaling for 10 minutes each evening and that, for you, it is a great way to wind down and let the day go. There is no right or wrong answer here: it is all a matter of what truly supports your ability to have the energy and vitality to live the life you wish. Photo by Charlotte Karlsen on Unsplash Key takeaways: gut-healing protocol What is the best gut-healing protocol? The one that offers you the fastest, most complete remission from your symptoms so that you can live your best life, without worrying about where the next bathroom is or asking the server a zillion questions about what is really in the food. I’d love to help you get there. If you’re ready to work with a knowledgeable guide to work through your best gut health protocol, get started by scheduling your initial visit now! This lets us both feel confident that we’re the right fit to partner together to achieve lasting results. I can’t wait to chat!

Have you ever wondered if you should be adding probiotics to your daily routine? If you are a regular to my blog, you know that the topic of probiotics comes up frequently. Today we’re going to explore ​​what are the signs you need probiotics. For those of you who are new here: Welcome! My name is Marissa Mekelburg, MS, RDN, CLT, HHP, and I am a Digestive Health Dietitian Nutritionist. I specialize in GI conditions like IBS, food sensitivities, and autoimmune conditions. You might be surprised to learn that digestive issues like diarrhea and constipation are only one of the signs that you may benefit from taking probiotics. In my practice, I often see that improving the health of your digestive tract can have positive effects on your entire body. What exactly is a probiotic? Probiotics are bacteria and yeast that are in some way beneficial to your body (1). You can find a detailed explanation of what probiotics are in my recent blog, Probiotics 101: What Are They and Do You Need Supplements? Digestive issues are usually the first thing that people think of when they hear probiotics - so let’s start our discussion with my favorite topic - your digestive tract! Photo by Tyler Nix on Unsplash Digestive Symptoms Probiotics can help to improve many digestive symptoms, including: Constipation Diarrhea Nausea Gas/bloating Recent food poisoning Your body has its own ecosystem that includes all the bacteria and organisms that live on your skin and in your digestive tract - these are also referred to as your microbiota (or microbiome). The number of bacteria that your body is home to has been estimated in the trillions (10). Some of these organisms can improve your health - let’s call these the “good guys”. On the flip side, some of these organisms can cause harm to your health and body - we’ll call these the “bad guys”. Just like in any ecosystem, your body has a limited amount of resources (like food) available, and the good guys and the bad guys are competing to survive. If you have too many of one type of bacteria, it can be more difficult for others to live and survive. If you have recently recovered from a bout of traveler's diarrhea or food-borne illness, your digestive tract has been out of balance with too many of the bad guys. In these cases, the bad guys are infectious bacteria that caused your illness. Non-infectious causes of diarrhea and digestive issues like inflammatory bowel disease (IBD) have also been associated with having an imbalance of bacteria in your digestive tract (also called dysbiosis). If you suffer from IBD you may have an increased number of inflammatory bacteria (7). Your bowels (and your whole body) will function best if you have a good mix of different kinds of the good bacteria. Taking probiotics can help to restore your body’s ecosystem and help your digestive tract recover from the infectious or inflammatory bacteria. What may surprise you, is that probiotics can help with constipation too. Having the right mix of bacteria in your digestive tract can improve gut motility (how quickly food moves through your gut) and pain perception. There is research that shows taking probiotics can help to improve the frequency and consistency of bowel movements, helping to relieve symptoms of constipation (11). Antibiotics can have a big impact on your microbiome and probiotics can help to keep your system balanced. Have you ever taken antibiotics and had the unpleasant side effect of diarrhea? Keep reading to find out how probiotics can help to repair your ecosystem. Recent Course of Antibiotics Antibiotics are used to treat bacterial infections. Sometimes they are an important step in recovering from an illness. What you may not know is that antibiotics don’t discriminate against the bad guys. One of the negative side effects of taking antibiotics is they harm the good guys too. This leaves your digestive tract vulnerable. Probiotics can help to restore the population of bacteria in your digestive tract. Often we are sick from viruses like the common cold or influenza. In these cases, antibiotics are not useful to help us get better. If you find that you are often getting sick with viral infections, there is still a role that probiotics might play in restoring your health. Let’s take a look at how your digestive tract is connected to your immune system! Always Getting Sick Did you know that 70% of your immune system is in your digestive tract (18)? If you frequently get sick (even from viral infections), this may be a sign that you need probiotics. Even though the bacteria in your digestive tract are considered “good” - they’re only good if they stay in your digestive tract. Your body has several safety nets in place to make sure that the bacteria don’t travel into your body through the cells of your intestine. One of these safety nets is immune cells that recognize the good guys. Having a variety of good bacteria in your digestive tract means that your immune system is active and working hard. When you do get exposure to viral infections, your immune system is ready for the challenge. Having the right type of bacteria also helps to prevent your body from overreacting to infections. Are you familiar with the saying “too much of a good thing is bad?” If your immune system overreacts, your body will release a stress hormone called cortisol. Cortisol acts on many different areas of your body and causes inflammation. Restoring balance to your ecosystem by using probiotics has been shown to help control the immune response in some inflammatory diseases like rheumatoid arthritis and ulcerative colitis (8). Cortisol is also closely linked with mood and emotional stress. Keep reading to find out how probiotics can affect your emotional regulation! Photo by Tengyart on Unsplash Mood Swings Are you familiar with the feel-good hormones serotonin and dopamine? They help to regulate mood, sleep, food intake, and pain processing (3). Both of these chemical messengers are produced by the bacteria in your GI tract. Having an imbalance of bacteria means you won’t be producing the right amount of these messengers and that affects your mood. When you don’t have enough serotonin, your body will release cortisol. Too much cortisol leads to anxiety, depression, mood swings and irritability. This becomes a cycle because stress (from environment or emotions) stimulates more cortisol release, which worsens mood and irritability – yikes! Recent research has been looking at whether modifying your gut microflora using probiotics can help to improve mood-related symptoms and the results have been promising! Probiotics have been shown to reduce the stress-induced release of cortisol and also to improve anxiety and depression-related behavior (6) - Amazing! If you want more information on how your digestive health is related to your mood, check out my blog post, Mood Food: Cultivating Mental Health Via Gut Health. What ties in more closely to mental health than getting a good night’s sleep? Not only is serotonin responsible for regulating mood, but it also plays an important role in regulating our sleep cycle. Let’s discuss how your microbiome can help you get the sleep you need to feel your best. Difficulty Sleeping We’ve covered how serotonin can help with your mood, but it is also closely linked to sleep. Have you heard of tryptophan? It’s an amino acid found in high-protein foods, most famously in turkey. Tryptophan is digested by our intestinal bacteria to make serotonin. Serotonin is then used to make melatonin. Melatonin is a hormone that your brain produces in response to darkness and it helps to control your circadian rhythm - or your sleep/wake cycle (14). I have more information on sleep in my article: Do Pistachios Help You Sleep? Yes! Having more of the right kind of bacteria in your digestive tract (remember the good guys?) has been found to increase the amount of serotonin produced from the tryptophan you eat (3). More serotonin equals more melatonin and that means better sleep! Next, we’ll discuss the connection between your body weight and your digestive health. Let’s dive in! Weight Gain Did you know that obesity is an inflammatory condition? Remember the role of your intestinal microbiota in controlling inflammation? That means that even obesity and weight gain can be signs that you may need a probiotic supplement. Research has looked at the relationship between the type of bacteria found in the digestive tract of overweight and normal-weight study participants. Overweight individuals had more bacteria from the Firmicutes family and fewer bacteria from the Bacteroides family than the non-obese participants (8). The imbalance of bacteria leads to obese individuals releasing more energy from food and having a tendency to store more energy as fat. That means that overweight individuals with the wrong type of bacteria may eat less food than normal-weight individuals but still struggle to lose the weight (8). Overweight individuals are at greater risk for having metabolic syndrome. Metabolic syndrome describes conditions that occur together and increase your risk for heart disease, stroke, and type 2 diabetes (15). Having an imbalance of bacteria leads to elevated cortisol which contributes to metabolic syndrome (4). There are a number of factors that contribute to obesity. If you have been struggling to manage your weight, this might be a sign that you have an imbalance of bacteria. Probiotics could be a useful tool to help you on your journey to optimal health. As a digestive health dietitian, I love connecting the dots between your digestive health and your whole body! In the next section, we’re going to look at the role of probiotics on your skin. Photo by Viva Luna Studios on Unsplash Skin Conditions If you have skin conditions like acne, I’m sure you thought you’d tried EVERYTHING to improve it. But have you tried probiotics? Most people don’t realize that your gut health is even linked to your skin health. Your digestive tract isn’t the only place where bacteria live in your body. Your skin is also an important part of your microbiome. Recent research has been looking at the connection between the bacteria in your GI tract and the bacteria that live on your skin (14). One way that probiotics can help your skin is through your immune system. Remember how probiotics are important in regulating your immune response? Probiotics help to prevent your immune system from overreacting and causing inflammation. Research has been looking at the role of probiotics in helping with inflammatory skin conditions including (14): Acne Atopic dermatitis Rosacea Probiotics also help to improve your skin barrier and prevent dry irritated skin. If you are using acne treatments that cause dry skin, probiotics have been shown to increase compliance by improving this side effect (14). Probiotics are also used as a topical treatment for acne. The good bacteria in the probiotics compete with the acne-causing bacteria. The good bacteria also produce compounds that prevent the acne-producing bacteria from surviving (14). If you are taking antibiotics to treat acne, probiotics will help to restore your microbiome and prevent an imbalance in your body, including yeast infections (14). Yeast infections are another sign that you might benefit from probiotics. Yeast Infections Remember that ecosystem we were talking about? Your microbiome naturally includes yeast, but just like the bad bacteria, when you have too much yeast (also called fungus) your ecosystem is not balanced. Yeast infections include: Oral thrush Vaginal yeast infections Yeast infections on the skin It’s common to get yeast infections while taking antibiotics because your body will have fewer bacteria (good and bad) giving other organisms - like yeast - the opportunity to grow and thrive. Research shows that probiotics can help to stop the yeast from growing (17) and can be used to treat some yeast infections like thrush (16). Key Takeaways There is a role for probiotics to help with more than just digestive issues! Your GI tract is linked to your brain and immune system and this means that your digestive health can affect your mood, skin, sleep, and risk of developing chronic diseases like metabolic syndrome. Your path to recovery will likely involve more than just taking a probiotic supplement. With any ecosystem, you have to look at the whole picture. If you fertilize a plant but do not give it water - it will still not grow. BUT with the right environment including water, sun, AND fertilizer, your plant will do more than grow - it will thrive! If you think you might benefit from adding probiotics to your diet, I am ready to help! I can order specialized lab tests to get to the root cause of your inflammation and digestive issues. I can help you choose the right type of probiotics for your body and together we can make a plan to get you feeling better. Get started with an initial visit with me and let’s talk!

Have you been thinking about trying the AIP elimination diet? Or, have you been on the AIP diet for a while, without relief? Then this article is for you. Here I’ll discuss: What the AIP diet is Who the AIP diet is designed for Why things might not be going as smoothly as you’d like What else you can do What is the AIP Diet? The AIP diet stands for the Autoimmune Protocol (or sometimes you will see it listed as Autoimmune Paleo). AIP is an elimination diet (I’ll cover exactly what that means in a bit) designed to help those suffering from autoimmune conditions; diseases in which your body is attacking your own cells and tissue, causing harm. The intention of the AIP diet is to calm your overactive immune system by removing the foods that cause your body to have a big reaction, your immune system gets to simmer down, rest and repair. The AIP diet was first being created in 2011 by practitioners as well as lay people who were looking for answers beyond medication to their chronic autoimmune symptoms. There are different versions of the AIP diet. There is beginning research to support its use, but we are still in the early phase. And, the AIP diet won’t work for everyone. Especially if you’re on a restrictive phase for too long. Photo by Miti on Unsplash What are autoimmune disorders? Autoimmune diseases are more and more prevalent. There are several theories about why, which include our stressful lifestyle, medications, our low vitamin D status, and our (very highly-processed) typical diet. It is important to acknowledge that this uptick of autoimmune conditions cannot be explained by genes alone, or better recognition leading to more diagnosis. Autoimmune diseases are any condition where your immune system gets its signals crossed and believes that your own body cells are invaders. What does your body do when it senses an invader? It attacks. There are many different autoimmune conditions, depending on what part – or parts – of your body are under attack. Here are a few examples of autoimmune conditions: Celiac - your body attacks the lining of your GI tract Type 1 Diabetes (T1DM) - your body attacks your pancreas Rheumatoid arthritis (RA) - your body attacks your joints Hashimoto's - your body attacks your thyroid Multiple Sclerosis (MS) - your body attacks your nervous system And with the rise in our appreciation of the role of gut health in all health, there is even debate on if other conditions fall into the realm of autoimmune conditions, such as PCOS and Autism (1, 2). Benefits of AIP Diet The AIP diet is restrictive and a big change from what most of us eat on a given day. The benefits of the AIP diet are that it is very nutrient dense: full of the nutrients that provide your body with the tools to dial back inflammation. AIP is loaded with fruits and veggies which also means it's full of fiber and able to provide the nourishment that our gut microbiome needs to thrive. Did you know that we don’t actually digest fiber? Fiber is food for the bacteria living and “working” in our large intestine. And in thanks, they provide nutrition to the cells living in our gut and help to keep them healthy and intact - i.e. - the opposite of leaky. Is the AIP diet the same as paleo? There are different versions of the AIP diet as well as the paleo diet. There is a lot of overlap between the AIP diet, but the “rules” of the diet depends on who is talking about it. Some consider AIP a version of paleo, but a bit more strict. Who is the AIP diet designed for? As mentioned, AIP may benefit anyone with an autoimmune condition, however, because it eliminates so many foods, it would not be recommended to try “just because.” It is also not recommended to stay on the elimination phase of the AIP diet for forever. Psst: More information about not being on an elimination diet for too long in this blog post. What can I eat on an AIP elimination diet? AIP is not a one-and-done diet to try and then follow forever. The intention is to follow a rest and repair, elimination phase. Let the immune system wind down a bit, the gut to heal and then to begin reintroducing foods. The AIP diet elimination phase The AIP diet starts with an elimination phase. The goal is to remove anything that might be irritating the gut, making it leakier or causing inflammation. You can also focus on preparing foods in a way that makes them easier to digest, such as pureeing veggies into soups and fruits into smoothies. What to avoid on AIP diet? Gluten Dairy Grains (although some versions allow rice) Legumes Nuts/seeds Eggs Nightshade vegetables (ex: tomatoes and peppers) Added sugar Additives - including preservatives, dyes, and emulsifiers (ex: polysorbate 80, carrageenan) Coffee (gads, I know) Alcohol And includes: Most fruits and vegetables (not nightshade vegetables) Meat, poultry, fish Healthy fats and oils, like coconut oil and avocado Fermented foods Bone broth The elimination phase is also an opportunity to begin addressing other factors that are contributing to your health and wellness. For example, are you sleeping enough? Sleep is your body’s opportunity to rest, digest and repair your gut health. Are you managing your stress? Life is pretty nutty these days, but we can feel better when we have joyful movement, time to unwind, and to show gratitude. We’ll cover more about contributing factors later in this article, stay tuned. For now - let’s walk through the reintroduction phase. The AIP diet reintroduction phase Once you are starting to feel better, your symptoms are simmering down and you’ve done some of the work to reduce other factors holding your wellness back, it is time to do a systematic reintroduction of the foods that you’ve eliminated. The purpose of this phase is to reintroduce foods, one at a time, to see how your body reacts and how you feel. If something changes for the worse, you know exactly what caused it and you learn which foods to keep out, for now. What does the research say about AIP? For Inflammatory Bowel Disease (IBD) there are a few short studies so far and they show good remission of symptoms (3, 4). The participants felt better, but the lab data didn’t show much change. It is possible that the diet was off to a good start but needed to be followed longer to show those changes. Similarly, in a small group of women with Hashimoto’s thyroiditis, the participants felt a whole heck of a lot better, but the researchers didn’t see big changes in their bloodwork (5). The AIP elimination phase is not meant to be followed for forever. It is a therapeutic intervention to calm the immune system and to rest and repair the gut. Our gut (and body) thrives on diversity in our diet so being able to reintroduce foods is important. If you broke your leg - you’d expect to have a cast as part of your treatment and healing. But once your bone had knit back together, the cast would come off - right? You wouldn’t keep the cast on forever. Same with the AIP - it has powerful therapeutic potential, but it is also restrictive and not meant to be forever. If you’ve been following the diet for a while and not feeling better, there might be other factors at play. This is an opportunity to look for root causes and to address them. Photo by Jake Givens on Unsplash What other factors are at play? Our health – especially our gut health – is not a stagnant thing. And this is the important thing - if you’re following an AIP elimination diet for too long, you can actually be creating new issues by not having a diverse enough diet. Oof! So what else can be going on? Food sensitivities - if your body is wound up and overreacting to foods, it needs a break! In my experience, far too many of my clients have been diligently following a very restrictive diet and still feel terrible. When we do functional nutrition testing, it turns out that the few foods that they have been allowing themselves to eat are contributing to their symptoms - ugh! Prepare to be amazed at how good you can feel while following a truly personalized anti-inflammatory diet. Vitamin D Status - if your vitamin D status is too low (or any other nutrient) your immune system can be impacted. You can be low in nutrients because you’re not getting enough to begin with, you’re not able to absorb them well, or – eesh – both. Improving gut health means you’re able to better absorb the nutrients from your meals. Sleep - not enough sleep means that you’re not resting and repairing your gut. A good night’s sleep is good for all wellness, but especially for your digestive system. Stress - we all have stress – it is more important how you manage and move through stress. If you make time to do exercise, creative hobbies, connect with friends and family, meditate, journal and so on, you’re moving through that stress instead of holding onto it. Your digestion will benefit! Not enough stomach acid – we tend to think about stomach acid in the context of heartburn and thinking we have too much. But really, our stomach acid is critical for our digestion. If you’re not making enough stomach acid or using medications or supplements to reduce your acid, you might be experiencing some unintended consequences. Microbiome imbalances - we feel and function best when we have a diverse community of bacteria in our gut. We call this the microbiome. If we don’t have the best mixture of organisms, we can experience more symptoms. Environmental toxins – such as being in a house with mold, can have a huge impact on your health. Have you identified all possible environmental triggers to your health? Gluten contamination - it is also possible to think that you’re following an AIP diet and have actually been contaminated with gluten or other foods that you’re trying to avoid. Gluten can be sneaky - working with a functional nutrition dietitian can ensure that you’re eating (and avoiding) what you mean to. Photo by LinkedIn Sales Solutions on Unsplash When to Seek Help The thing is: food is tricky. Even on a good day. And if you’ve been struggling with digestive health and frustrated by symptoms that won’t let up, it’s time to seek help. As a registered dietitian nutritionist, I work to help you to uncover what root causes might have been making you feel poorly to begin with. And the thing is, food might be a huge part of that, but not the entire thing. I would like you to have as much freedom with your food as possible while still enjoying respite from your symptoms. It’s possible – I promise. Let's chat! Get started here. And if you’ve been struggling with unexplained issues, flares of your autoimmune condition or have been following the AIP diet for a while and are not feeling better, it is time to help.