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Many of us are aware of and may even know someone that has a negative reaction to food. Maybe it’s your best friend that has to avoid shellfish or a family member that avoids peanuts. In these situations, these are most likely food allergies and can be quite severe leading to hives, wheezing and even anaphylaxis. Maybe you experience gas, bloating or diarrhea after consuming dairy – classic food intolerance. But have you ever given thought to food causing symptoms like: Headaches/Migraines Joint or muscle pain/stiffness Sinus congestion, pain or post nasal drip Fatigue, anxiety, depression Other GI symptoms such as heartburn, abdominal pain or nausea Skin issues like rashes, eczema or psoriasis These can be classic symptoms of food sensitivity. So how do you know if you have a food allergy, intolerance or sensitivity? While many people (including some healthcare practitioners) tend to lump allergy, sensitivity and intolerance all together there are very specific differences between all three. Food Allergy Also known as a Type 1 hypersensitivity reaction is the attack that is launched by IgE antibodies, which cause mast cells in your tissues to “degranulate” (break apart) and release histamine and other chemicals that cause the traditional symptoms of allergy. Reactions or symptoms typically occur within a short period of time (sometimes just minutes) of eating the offending food and can range from hives and itching to swelling of the face, tongue or lips, abdominal pain, nausea, vomiting diarrhea, dizziness, wheezing, nasal congestion or life-threatening anaphylaxis. The top 8 Food Allergens are: 1. Peanuts 2. Shellfish (such a crab, lobster, shrimp) 3. Fish (such as bass, flounder, cod) 4. Eggs 5. Tree nuts (such as almonds, cashews, walnuts) 6. Cow’s milk 7. Soy 8. Wheat Food Intolerance Intolerance does not involve the immune system at all. Food intolerance is much more common than allergies or sensitivities and occur when the body lacks the correct enzyme to break down a food/food component. 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. It’s also possible to be intolerant to other sugars in foods like fructose (fruit sugar) but is less common. A person can also be histamine intolerant (meaning the body is unable to break down histamine in foods) or amine intolerance (in aged foods). Food intolerances are treated by avoiding the food that you have trouble digesting, taking digestive enzymes with meals or consuming products that already contain the necessary enzymes (like Lactaid products which are enriched with lactase). Food Sensitivity Food sensitivities do involve the immune system but they do NOT involve IgE antibodies and unlike allergies, sensitivity reactions are often delayed by up to 72 hours after ingestion (crazy right? I mean how is anyone supposed to determine what may be bothering them from three days ago? More on this in a bit). There are two different types of sensitivity reactions that can occur (in a nutshell): Type 3 hypersensitivity reaction which occurs when IgG and/or IgM antibodies (which are different than the IgE involved with true allergies) attach to offending food antigens in the bloodstream and form immune complexes. Once these immune complexes reach and attach to tissue, your immune system gets signaled that an invader is present and white blood cells go to the area and release “chemical mediators” in an attempt to destroy the immune complex. These mediators can lead to inflammation and damage in the tissue which is what leads to symptoms (because they are really meant to be fighting infection). Type 4 Hypersensitivity doesn’t involve any antibodies but instead T cells decide that the food antigen is a threat; which stimulates the white blood cells to release the mediators previously mentioned that leads to inflammation, pain and other symptoms. Since food sensitivities are not mediated by IgE antibodies and mast cells, traditional allergy testing will not work for identifying them. How do food sensitivities get identified then? The most accurate way to identify food sensitivities currently is with MRT (Mediator Release Test). This blood test measures your body’s inflammatory response to food no matter what pathway triggered them (IgG, IgM, T-cells etc.) so that you can know what foods are or are not contributing to your food sensitivity symptoms. With that being said, having the test results and not knowing how to apply them is only going to be so effective. Many times, practitioners that do some type of food sensitivity testing (whether MRT or IgG only), will typically tell you to avoid your reactive foods BUT by taking that approach, there most likely is still offending foods in your diet. There is NO way to test every food out there…… The BEST way to be tested for food sensitivities is to work with a Certified LEAP Therapist (CLT). CLT’s are certified in food sensitivities, the MRT test and the therapeutic diet using test results known as LEAP (which is what produces the best results quickly!). To find a CLT, you can search near you on Healthprofs or depending upon your states licensure and telehealth laws, you may be able to work remotely with a CLT (like me!). Wondering if your symptoms might be related to food sensitivities? Let's chat! Get started by scheduling an initial visit. Photo Courtesy of Oxford BioMedical Technologies

Gluten is one of the most common food allergens that people are exposed to on a regular basis. For some, it's just an inconvenience; for others, it can be life-threatening. If you want to see symptom relief, how long does gluten stay in your system? You may be wondering: if you're going gluten-free or have already done so, how long does gluten stay in your system after you stop eating it? It's important to know how long gluten stays in your body and what you should do about it. This article will help answer that question and more! Photo Credit: Polina Rytova on Unsplash Real quick: what is gluten? Gluten is a protein that naturally occurs in wheat, barley and rye. In people with celiac disease it can cause serious damage to the small intestine if consumed. For this reason, many people who have been diagnosed with this condition must go on a gluten-free diet for life. This means avoiding foods that contain gluten: wheat (ALL forms including spelt, Eikhorn etc.), rye, barley and anything made from those grains...which is a lot, once you really start looking at labels. If you don't have a reaction to gluten, there is no reason to avoid it. Protein digestion Gluten is an example of just one of the many proteins found in our food. And whether we’re talking about beans, eggs or gluten, digestion of proteins follows the same steps and timeline. Proteins are enormous molecules that are made up of amino acids. Our body does the hard work of taking proteins apart into their individual parts so that they’re small enough to be absorbed in the small intestine. The timing varies from one person to another, but in general, the digestion of proteins doesn’t take any longer than a day or two ( 1 ). So while non-expert bloggers are quick to claim that gluten will “remain in your system” for weeks or even months, it simply isn’t true. What is true, however, is that the inflammation reaction to gluten can last for a very long time. Let’s talk about that fine print, now. Photo credit: Wesual Click on Unsplash. Lasting reactions to gluten Your body having an overreaction to gluten – such as gluten intolerance – can last for a while, even if the protein is completely out of your system. This varies by person, but can last for weeks or even months. This all depends on the degree to which your gut has been affected by the gluten, how thoroughly you’re able to remove all gluten from your diet as well as how well you’re nourishing your body with the right nutrients to be able to optimize recovery. Who needs to avoid gluten? There are a lot of people who need to avoid gluten, and how long they have to stay away from it will depend on how severe their reaction is. For some with milder symptoms or less-severe conditions like dermatitis herpetiformis (which causes skin problems), avoiding eating gluten for just three days can help clear up the issue. If you have a diagnosis of any of the following conditions, you may need to avoid gluten for a time (long enough to reduce inflammation and heal leaky gut) or you may need to avoid gluten for life. And while it can seem like food allergies and intolerances are the same thing, they actually aren’t. More on that here: Food allergies, food intolerance and food sensitivities...what's the difference? What are the symptoms of gluten intolerance? If you're having a negative reaction to gluten, what does that look like or feel like? It can be remarkably different from one person to the next. Allergy If you're having a gluten allergy (which is quite rare and not to be confused with a wheat allergy) or celiac disease, you'll experience an immune response in your small intestine ( 2 ). Symptoms of wheat allergy are like that to a peanut allergy: Itchy mouth, lips or throat Difficulty breathing Headaches Cramps, diarrhea Celiac disease Celiac disease is an autoimmune condition in which the body self-destructs and attacks its own living tissue. In this case, the immune system attacks the cells of the digestive system, causing damage. The damage can accumulate over time (and takes a while to heal, once the person has an accurate diagnosis and is able to fully eliminate gluten from his or her diet.) Celiac disease symptoms can include ( 3 ): Diarrhea and belly pain Unintended weight loss Nutritional deficiencies Brain fog Fatigue And the last known reaction to gluten? Gluten intolerance, otherwise known as gluten sensitivity. Gluten intolerance If you're having a gluten intolerance the symptoms will involve how food makes you feel or how it affects other parts of your body like how well you sleep. Some people who are intolerant to gluten report issues with their digestion, just not quite as quickly as with an allergy ( 4 ). Symptoms may include: Bloating, belly pain, diarrhea Headache and brain fog Fatigue Joint pain Anemia Depression You may have noticed that some of the symptoms overlap. So, how do you know which condition you have related to gluten, if any? How do you know if you have gluten intolerance? While there is currently no one specific test available to determine gluten intolerance/sensitivity, if you have been tested for celiac and are negative then you can give the removal of gluten a try and see if you feel better. One thing to keep in mind though, is that gluten containing foods (such as wheat, rye and barley) are also high in the FODMAP fructan so it might be the FODMAP and not the gluten that is causing an issue. Sometimes determining if there is a gluten intolerance requires looking at the big picture and working with a clinician that can help put the pieces of the puzzle together. For example, I use MRT testing, a blood test, to see how my clients are reacting to gluten-containing grains and other potential food offenders. I also use GI MAP to help identify if gluten may be an issue since it looks at markers such as zonulin and anti-gliadin IgA. While intestinal biopsy is an option for testing to see if you have celiac disease, it isn’t an accurate measure for gluten sensitivity . Those with gluten sensitivity don’t have the same measurable damage to their intestine as those with celiac ( 5 ). ( P.S. This is why gluten sensitivity was considered to be a fake syndrome for so long - the usual testing wasn’t able to detect anything wrong. Turns out we just needed a different tool to be able to test for the different condition.) How do you know if you have celiac? There are three ways to test for celiac disease. Do an intestinal biopsy to note the damage to your intestine Do blood testing to look for the antibody to gluten Genetic testing If you are suspicious that you have one of the above three reactions to gluten, should you just stop eating it? Should I just stop eating gluten? No! Let me be crystal clear here: if you suspect that you have celiac disease, do NOT stop eating gluten before doing testing. The blood testing measures a reaction to gluten. If you’re not eating gluten, we cannot measure the reaction. This creates a “false-negative” test result. The test says that you do not have a reaction to gluten, but it isn’t actually true. And without the reaction to gluten, you also will not be able to see the damage done with a biopsy (Or the biopsy will be skipped based on the false-negative reaction from the blood testing). If you have celiac disease, it's critical that doctors know how much damage your intestines have already sustained. [1] [2] [3] When gluten enters the digestive system and starts its trip through the small intestine, a person with undamaged intestines might only experience mild bloating or discomfort at worst from eating too many noodles. Will Going Gluten Free Help My IBS? A GI Dietitian Explains. Photo Credit: Jose Aragones on Unsplash What if I have already stopped eating gluten? Because the blood testing looks for markers that your immune system is responding to gluten , you won’t be able to measure them if you’ve been avoiding gluten for a while. This means you cannot accurately test for a reaction to gluten without eating gluten. Before you can do testing, you’ll need to eat gluten. I know that this can feel scary, but it is the only way to get accurate results. The recommended gluten intake will range from 1-2 servings per day for 2-8 weeks before testing ( 6 ). Bread is usually one of the easiest ways to incorporate gluten into the diet before testing. For my clients, especially if you’re eating gluten for the first time in a while, I recommend eating spelt bread, or even spelt sourdough bread. Spelt contains gluten but tends to be a bit better tolerated. I’m stopping gluten: how long will it stay in my system? The gluten proteins themselves are only physically in your body for a day or two. Normal digestion is fast and efficient. However, if you’re having an immune reaction to gluten, the inflammatory response to having eaten gluten can stick around for a while. Especially if your gut is damaged during the process, causing a leaky gut. You need to heal your leaky gut before you see the most complete remission of your symptoms. Unfortunately, that isn’t a fast process either, but I can help make it as efficient as possible for you. How Long Does It Take to Heal a Leaky Gut? Key takeaways: how long does gluten stay in your system If you suspect that you’re having a reaction to gluten, keep eating it long enough to do thorough testing. While the treatment – avoiding gluten – may be the same, there is no reason to avoid gluten unless you’re 100% sure it is causing your symptoms. If you’re ready to see remission from your digestive health issues, reach out! Get started by scheduling an initial visit. Discover the Low FODMAP Diet :  Your Gut's New Best Friend! Learn how the Low FODMAP Fix Diet can help you identify  food triggers, manage symptoms, and regain control of your digestive health. Take the FIRST   step towards a happier gut with the Low FODMAP Fix!

Sound harsh? Maybe. But I say this from a place of genuine caring and the desire to help you understand what IBS really is (and isn’t). I get it, you have felt bad for so long, the symptoms that you experience are very real and have a huge impact on your life; they may cause you to miss work or not be as productive while you are there, to miss out on plans with family or friends because you are afraid to leave the house (and the comfort of your own bathroom) or you may not be as active as you once were because let’s face it who wants to get outside on a 5 mile walk, run or hike (or be in the middle of kickboxing class at the gym that you used to love) and risk having diarrhea hit? Right? You’ve gone to your doctor, you’ve have had probably what seems like an endless number of tests done and finally, you get diagnosed with IBS – irritable bowel syndrome. Yeah! There you have it, the answer you have been seeking, right? Wrong and here’s why. You see IBS while technically is a diagnosis, in reality it is a label, a description of what your symptoms are but it doesn’t tell you WHY you have the symptoms that you do (I mean think about it....WHY is your bowel irritable anyway?) That’s why I’m encouraging you to keep looking, to not accept this diagnosis as the be all, end all because if you do decide to learn to live with this label, then you are making a terrible mistake that’s bound to keep you feeling miserable. There is much more that you can do, that you can take charge of that your doctor most likely didn’t talk you about and YOU, your health is worth fighting for! So let’s talk a bit more about IBS and I will show you what I mean...... The Medical Definition of IBS The technical criteria for diagnosing IBS is set by the Rome Foundation which is “independent not-for-profit organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of functional gastrointestinal disorders (FGIDs)” (1) New Rome IV criteria for diagnosing IBS states that (2): Recurrent abdominal pain, “should be present at least 1 day per week during the previous 3 months” and be: – Related to defecation and/or – Associated with a change in frequency of stool and/or – Associated with a change in form (appearance) of stool Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis. Even though the new Rome criteria has been updated, it’s still pretty broad and it’s no surprise then how many people will fit these criteria and be diagnosed with IBS. Also, as you can see the Rome criteria describes a set of symptoms but offers no explanation for WHY does someone have abdominal pain at least 1 day per week? WHY might the pain be relieved with defecation? WHY does someone experience a change in the frequency or appearance of stool? These are questions that have to be answered in order for you to get feeling better. Why you shouldn’t settle for an IBS diagnosis A “diagnosis” is a label given to a consistent group of symptoms and then the symptoms are treated according to that label. Did you know that IBS is considered to be a diagnosis of exclusion? (3) This means that you go to your doctor with common symptoms like gas/bloating, abdominal pain, diarrhea, constipation (or both) and based upon your history, he or she will typically run a few tests to rule out more serious conditions like inflammatory bowel disease (IBD), colon cancer, celiac disease and possibly common pathogens like giardia. Once these tests come back negative, the digging stops and you are labeled with IBS. From this point, you most likely will be prescribed whatever the most common IBS medication is and sent on your way. The doctor’s work is done. But due to this approach, many times you may be receiving an IBS diagnosis and be prescribed medication too quickly. And while you may find temporary symptom relief from this approach, in reality, if the underlying cause is not addressed most likely you will eventually begin to feel like crap again, old symptoms may return, or new symptoms may arise and the cycle of trial and error begins - going back to the doctor, perhaps trying a new one, desperately trying to get relief from your symptoms. While there are pros and cons to receiving a medical diagnosis or label; IBS as a label is a particularly problematic one because it implies that you have found the problem, that there is no reason to continue to look for a specific root cause yet it provides no real guidance on what your next steps should be beyond taking the latest prescription or just living with it. Let me be clear, I am not against medication, prescription or otherwise to provide some temporary symptom relief. I get it. If taking some anti-diarrhea medicine allows you to have a life, to do fun things with friends and family, I’m all for it but please don’t stop there. Remember IBS is not a cause but rather it is a description of your symptoms and having a label for your symptoms or taking a medication that temporarily alleviates those symptoms doesn’t help you get better. For example, your symptoms may be abdominal pain, bloating and diarrhea but the underlying root cause could be food intolerances, bacterial or yeast overgrowth or malabsorption issues just to name a few. If you are unable to stop a medication without symptoms returning, then your root cause has not been identified or properly addressed. Symptoms are our bodies way of telling us something is wrong, is out of balance. When we try to only manage symptoms, and don’t look for and address the root cause for why we have them, it can have an impact on our health in the long term. Think of it like this – if you have a campfire that looks like it has been put out unless you stir it up to make sure, it’s possible that there are still embers burning below the top ash that could set off a forest fire. The same goes for only addressing your IBS symptoms and not addressing the underlying root cause that is still “burning”. Final Thoughts At the end of the day, ultimately, I don’t mind someone being told or labeled as having IBS. By receiving this diagnosis, it tells me that they have been checked for more serious conditions by a physician and that they have gut issues that require more investigative work, which is something for me to work with. What I do mind is people who are still suffering and don’t know where to turn or what to do because receiving an IBS diagnosis seems so final and there isn’t a treatment for IBS, only for the root causes for IBS. If you have received an IBS diagnosis, I would recommend finding a functional practitioner to work with that can help identify and address your specific underlying causes because there is always a reason for a symptom. If you would like to learn more about how I can help, you can get started by scheduling an initial visit. References: 1. Rome Foundation. www.theromefoundation.org 2. J Neurogastroenterol Motil. 2017 Apr; 23(2): 151–163. Published online 2017 Apr 1. doi: 10.5056/jnm16214 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383110/ 3. Camilleri, M. (2012). Irritable bowel syndrome: how useful is the term and the “diagnosis”? Therapeutic Advances in Gastroenterology, 5(6), 381–386 Camilleri, M. (2012). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491678/ #digestive #IBS

Do you like to enjoy a drink or two with friends? Or maybe you like to have a glass of wine with dinner? If so, you may be wondering if there is any connection between alcohol and your SIBO symptoms. Can SIBO flare up after drinking alcohol? Is it better to avoid alcohol altogether if you have SIBO? In this blog post, we will answer all of your questions about the (many!) connections between SIBO and alcohol. We will discuss the effects that alcohol can have on SIBO symptoms, as well as answer all of your questions, helping you make an informed decision about whether or not to drink. Photo by Jon Parry on Unsplash Link to image: https://unsplash.com/photos/C8eSYwQkwHw What is SIBO? First things first: what is SIBO, exactly? SIBO stands for Small Intestinal Bacterial Overgrowth. This condition occurs when there is an overgrowth of bacteria in the small intestine, which can lead to a variety of symptoms including bloating, gas, abdominal pain, diarrhea, and more. We are supposed to have bacteria in our digestive tract, but their home is supposed to be primarily in the colon ( 1 ). When the little bugs set up shop in the small intestine, you start to feel crummy. By the way, SIBO isn’t an infection, it is a case of the right bacteria and other organisms in the wrong place. SIBO is often caused by a combination of factors, including diet, low stomach acid, changes in the anatomy of your digestive tract, and more. And spoiler alert: alcohol consumption increases your risk of SIBO, too ( 2 ). SIBO is a complicated condition to properly diagnose as well as treat ( 3 ). When your digestive system is inflamed and irritated, you’re looking for answers and relief. With a proper diagnosis ( I don’t recommend self-diagnosing ), the first step of a treatment protocol is to remove anything that might be making your symptoms worse. A break gives your digestive system an opportunity to rest and recover, kind of like an afternoon on the couch with Netflix gives your brain and body a much-needed break. But for your digestive tract, this break – dun dun dun – will probably include alcohol. P.S. Drinking alcohol before doing diagnostic testing for SIBO can throw a wrench in obtaining accurate results. There are very specific foods that can be eaten prior to taking a SIBO test. Each company has its own guidelines, the basics are lean meat, poultry, fish, plain steamed jasmine or basmati rice, eggs, meat broth, salt/pepper, weak black tea or coffee with no additives, and plain water. Some protocols allow you to eat small amounts of fats or oils for cooking. But alcohol? It is a major no-no before test prep and will result in invalid results . Why remove alcohol? For as much as we are an alcohol-loving society, asking anyone to abstain can feel like a real bummer. Let’s talk about the “why” here so that you better understand that this break from alcohol may be necessary to see true healing from your SIBO. What’s wrong with alcohol? Alcohol is an irritant ( 4 ). When your digestive tract is already irritated and inflamed, alcohol simply makes things worse - what a bummer, right? When working with a digestive health dietitian , we’re using a specific treatment protocol to help you get better. This protocol is called the 5R Protocol. It is a systematic way to identify what you need to do to get better as quickly as possible - no more guessing! Curious about the 5-R protocol? Check out this post: The Best Gut Healing Protocol to Resolve Your Symptoms . The first step on this journey is “Remove”. This means removing anything that is not serving your healing. This includes: ● Infections (could mean a round of antibiotics) ● Foods that you’re sensitive to ● Supplements that are causing unwanted side effects And yes, this will probably include alcohol, at least for a bit. So, what’s the big deal with alcohol? Alcohol can have a big impact on your digestive tract… and not in a good way. Less stomach acid Alcohol can affect your body’s ability to make stomach acid. Having low stomach acid is a risk factor for developing SIBO in the first place ( 5 ). Impaired motility Your digestive tract has a cool web of muscles that – when healthy – keep things moving along. If this motility is curbed, your risk of SIBO goes up. And unfortunately, alcohol does just that: pumps the brakes on the regular movement of your digestive tract ( 6 , 7 ). Fewer enzymes Next issue? Alcohol can get in the way of your body making the enzymes that it uses to digest food normally. Enzymes are powerful little proteins that allow your body to take apart food so that the body can absorb and use the tiny pieces. When your meals are not digested as well, you have more symptoms as well as less absorption of the nutrients from your food. Microbiome imbalance In a person with a healthy digestive tract, their colon is home to a diverse and robust community of bacteria and other little critters. These healthy bacteria help to keep our intestine healthy, boost our immune system, and contribute to our overall wellness. Unless: the mix is off. When the microbiome is out of balance, the effect can be far and wide. In most cases, alcohol can make this community worse. Inflammation Inflammation is your body’s natural and normal response to irritation or injury. When you get a paper cut, your skin looks red and swollen as your immune system rushes to the scene to keep bad guys out and let the injured area heal. Alcohol can cause inflammation - big time ( 8 )! Liver impact It is probably worth mentioning (but also probably not a surprise) that alcohol is no friend to your liver. Why? Alcohol reduces the absorption of nutrients in the small intestine and increases the transport of toxins through the intestinal walls, which might contribute to liver and other organ damage ( 9 , 10 ). And that’s not all… And as a general note, alcohol has 7 calories per gram: almost as much as fat. And unlike fat, alcohol offers your body zero nutritional value. It can also wreak havoc on your blood sugars and even raise triglycerides (which is a risk factor for cardiovascular disease). So while it can feel fun and social to enjoy alcohol, it is not without risk. To recap - alcohol can affect stomach acid production, slow down motility of the GI tract, reduce the number of enzymes the body produces (so food doesn’t digest well contributing to digestive symptoms), increase the risk of developing SIBO, can lead to or worsen leaky gut, can disrupt the normal balance of flora (which many times is already imbalanced), increases inflammation in the gut (which we are trying to heal), not to mention the effect it has on organs such as the liver and pancreas. All alcohol? Really? Is there any kind of alcohol that is safer than another? This is a tricky question. In otherwise ordinary, healthy people – who are not the people coming to me for help – a moderate 1-3 drinks of red wine includes a potential benefit. The polyphenol content has been shown to help promote diversity in the microbiome ( 11 ). However, for the folks I’m helping – clients who have been fighting gut infections like SIBO, leaky gut, food sensitivities, and inflammation – I recommend skipping every drop of alcohol, even red wine. What can be confusing is that some spirits are actually considered to be low FODMAP , so people want to take that as the go-ahead for drinking. However, while they may be low in certain carbohydrates that are irritating to folks with digestive issues, they still have alcohol, so they’re not going to help you to recover from SIBO. Time for the tough talk: if a person has a serious digestive issue like SIBO, the answer to "is there a safer type of alcohol?" is a big fat NO. In fact, it's pretty much non-negotiable for me: if a client is serious about healing their gut, alcohol has to be out while we do the work. When can you drink again? You’re not going to like this answer, but I always aim to be as upfront with my clients as possible. Here’s the lowdown: I recommend not consuming alcohol at all during your treatment program (remember that “remove” part of the 5R protocol we talked about earlier?). Once you are in remission from your SIBO symptoms, I recommend starting your clock…and waiting for six months of symptom-free living before trying alcohol again. How do you know it is ok to try alcohol again? Once you’ve clocked in with six months of symptom-free living, you may want to try a tiny amount of alcohol to see how things go. My recommendation? Plan to keep things very minimal. Maybe a glass of wine with dinner every now and then or have a cocktail at a special event, like a wedding. Ultimately though, if you have had past struggles with SIBO, IBS, or IBD (which is managed and not cured), alcohol is one of those things that should really be eliminated long-term. This is kind of like someone with non-celiac gluten sensitivity or celiac disease: there is no such thing as 95% gluten-free, you either are gluten-free or you aren't. (On a related note, my clients often ask about gluten hanging around and their symptoms, so I wrote this post: How Long Does Gluten Stay in Your System After You Stop Eating It? ) In my experience with many clients, most of the time, bringing alcohol back into the equation on any kind of regular basis is setting the person up for symptom relapse down the road. Healing the gut is a long enough journey that I can't imagine intentionally setting yourself up to have to do it all over again. How long is long? …pretty long! I answer this common question right here: How Long Does It Take to Heal Leaky Gut? Photo by Mae Mu on Unsplash Link to image: https://unsplash.com/photos/YNMjGIPgD_c What can I drink instead? So, I know that you’re going to want something besides a boring glass of ice water. Let’s discuss a few fun alternatives to try while keeping alcohol in time out. There are so many products available these days to make mocktails. A couple of delicious options include: ● Ritual ● CleanCo ● Seedlip ● Curious Elixirs ● H2OPS Sparkling Hop Water You can also use seltzer waters, teas , and juices to make your own custom blends. The TAZO tea company has mocktail recipes and a Berry Hibiscus Margarita base (which is fabulous! I mix it with lemon or lime La Croix). A lot of the appeal of having a drink in the evening is about the ritual of unwinding and relaxing, a signal that the work day is done. As important as it is to remove alcohol for the sake of your digestive health, it is also important to replace that drink with something new that you actually enjoy…otherwise this booze-free period is going to be much more of a drag. A new drink is a great place to start. You may also enjoy a nudge to journal, do a few stretches, have a peaceful walk, or read a few pages of a delicious novel. You’re worth having a fun new custom that better supports your digestive healing. Key takeaways SIBO and alcohol are not a good mix. Ultimately, continuing to drink is going to slow your progress in healing the gut…especially if you’re dealing with SIBO. These journeys can be long enough, so why add to them and undo some of the work that’s being done? Alcohol creates a two-step forward, one-step back scenario. Your digestive health can quickly get complicated. One thing going awry can cause a domino effect and make it harder and harder to actually get better. If you suspect that you’re dealing with SIBO, please feel welcome to get started by scheduling an initial visit so that we can chat. You deserve to have an expert to guide you through this process and actually make a recovery. Discover the Low FODMAP Diet: Your Gut's New Best Friend! Learn how the Low FODMAP Fix Diet can help you identify food triggers, manage symptoms, and regain control of your digestive health. Take the FIRST step towards a happier gut with the Low FODMAP Fix!

Are you ready to stop guessing – and start testing – so that you can finally get to the bottom of your lurking symptoms? While there are many food sensitivity tests available today, there is one gold-standard test that I recommend for my clients: the MRT food sensitivity test . Why? It is the best! FYI, sometimes the MRT food sensitivity test is often mislabeled as the “LEAP food sensitivity test” but the LEAP part is actually the dietary protocol to go along with the test. In this blog post, I’ll explain what the different options are for food sensitivity testing and why MRT testing and the accompanying LEAP protocol is the absolute best, most accurate way to know what is going on with your body. And with the data that these food sensitivity tests provide, you start to resolve your symptoms ASAP. Photo by Louis Reed on Unsplash If you’re new here, welcome! I’m Marissa, Registered Dietitian Nutritionist, Functional Nutrition Practitioner, Certified LEAP Therapist, and Digestive Health Expert. I am the founder of Wholistic Works, an online nutrition clinic based in Colorado where I help clients resolve their digestive symptoms, once and for all. Let’s start this post with a quick discussion of the different kinds of reactions that your body can have to food. Understanding the difference between these three reactions will help you to better understand which food sensitivity test is best for you (and why!). What are allergies, sensitivities, and intolerances? Unfortunately, your body can have an overreaction to food through a couple of different methods. It is possible to have allergies, sensitivities, and intolerances to food. They’re unique in terms of what is going on with your body and your immune system. Understanding these differences helps you to understand which test will provide you with the information you need to resolve your symptoms. Let’s start by exploring what a food allergy is. What are food allergies? A food allergy is what you might think of with a kiddo who has an allergy to peanuts. If they accidentally eat something with peanuts, their reaction might be incredibly quick and incredibly dangerous; difficulty breathing, hives, itching and swelling on the face, mouth, and tongue, dizziness and abdominal pain, vomiting, and diarrhea. Treatment might involve an EpiPen and an ER visit. During an allergic reaction, your immune system releases special proteins called IgE antibodies ( 1 ). They’re sounding the alarm that there is “danger”. This process causes your body to release defense chemicals that cause your rapid and severe symptoms. If you get blood testing with an allergist, they’re measuring IgE activity in the blood ( 2 ). The top 8 Food Allergens are ( 3 ): 1. Peanuts 2. Shellfish (such as crab, lobster, or shrimp) 3. Fish (such as bass, flounder, and cod) 4. Eggs 5. Tree nuts (such as almonds, cashews, and walnuts) 6. Cow’s milk 7. Soy 8. Wheat An allergic reaction is different from a food intolerance. Let’s compare that to an allergy, now. Food intolerance Interestingly, an intolerance does not involve the immune system at all. Food intolerances are much more common than allergies or sensitivities and may occur when for example, the body lacks the correct enzyme to break down a food component. 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, resulting in pain, gas, and diarrhea. Or, an intolerance can happen if your body is mal-absorbing a food component, such as fructose. Fructose intolerance is less common . A person can also be histamine intolerant or amine intolerant Lastly, a food intolerance can also be the result of a gut infection – like SIBO – causing a FODMAP intolerance. In the case of food intolerances, there are no immune messengers being sent around the body so a food sensitivity test would not be helpful to offer a diagnosis. Food intolerances are treated by avoiding the food that you have trouble digesting, taking digestive enzymes with meals, or consuming products that already contain the necessary enzymes. And last but not least: what is a food sensitivity? A different reaction than an allergy or an intolerance. Food sensitivity A food sensitivity is a less severe reaction to a food that may take hours or even days to manifest. Food sensitivities do involve the immune system, but they do NOT involve IgE antibodies. Unlike allergies, sensitivity reactions are often delayed by up to 72 hours after ingestion. This delay makes food sensitivities much more difficult to diagnose…can you remember every single thing you ate in the past three days? Nope? Me neither! Food recalls might help to identify patterns, but they’re much more prone to human error. There are two different types of sensitivity reactions that can occur: Type 2 hypersensitivity is a reaction that occurs when the body makes IgG and/or IgM antibodies in response to a perceived threat ( 4 ). Although their names are similar, they are different from the IgE involved with true allergies. These IgG or IgM antibodies attach to offending food antigens in the bloodstream and form immune complexes, kind of like putting a nametag on. Once these immune complexes reach and attach to tissue, your immune system gets signaled that an “invader” is present. White blood cells are summoned to the area and release “chemical mediators” in an attempt to destroy the immune complex that is deemed to be harmful and unwelcome. This is like spraying bear spray if a brown bear gets too close. But, the mediators aren’t without fallout. The mediators can cause inflammation and damage in the tissue, just like it would hurt if you got bear spray in your eyes ( 5 ). It is the mediators that lead to symptoms, not the food itself. Type 4 Hypersensitivity doesn’t involve any antibodies. Instead, they involve a different member of the immune system called T-cells. T-cells decide that the food antigen is a threat. Again, white blood cells are called to the scene and release the same mediators that we talked about with the type 3 reaction. And the results are the same; inflammation, pain, and other symptoms. Ouch! For more information about these three reactions, check out this post: Food allergies, food intolerance, and food sensitivities...what's the difference? Quick recap That was a lot of scientific info, right? To summarize - your body can have an overreaction to foods through different immune pathways. Depending on which pathway your body will send different messengers; just like we can send information via snail mail, email, text, or instant messenger. ● In food allergies, your body is sending IgE antibodies. ● In food sensitivities, your body could be sending IgG or IgM antibodies or T-cells ● And in food intolerances, there are no antibodies. So, to accurately test what is going on, you have to have the right test to be able to accurately measure the messengers and mediators. Photo by Julia Koblitz on Unsplash Risk factors for food sensitivities Who can develop food sensitivities? Many of us, unfortunately. Our modern lifestyle is pretty challenging to our gut health, and if our gut health is compromised, we are at greater risk for many other conditions, including food sensitivities. Your risk goes up if you have any gut infections like SIBO or parasites. Or, if you’ve had a foodborne illness or any other disease that damages the intestine such as celiac. You can also develop a sensitivity due to molecular mimicry; if your body thinks that another food looks like a food you’re already sensitive to, you can start having issues with that food as well. Quick recap? Basically, anything that can damage the lining of the intestine and increase permeability can lead to developing sensitivities. Gut health is so important! Symptoms of food sensitivity What does a food sensitivity feel like? Symptoms vary greatly, but may include: ● Bloating/gas ● Migraine/headache ● Brain fog ● Diarrhea ● Constipation ● Skin issues like rosacea or eczema ● Insomnia ● Fatigue ● Sinus issues ● And more! There are also differences in how strong the reactions are. Some people have a reaction to a large serving of a food but are able to tolerate a small amount; this is different from an allergic reaction where a tiny bit of food may cause a severe, life-threatening reaction. Why is the MRT/LEAP food sensitivity testing the best? As we learned earlier in this post, food sensitivities are not mediated by IgE antibodies and mast cells. And so, traditional allergy testing, which is measuring IgE activity, will not identify them. However, there are several food sensitivity tests on the market. What makes MRT testing different? The most accurate way to identify food sensitivities currently is with the Mediator Release Test (MRT for short). This blood test measures your body’s inflammatory response to 170 foods and chemicals, no matter what pathway triggered them (IgG, IgM, T-cells, etc.) ( 6 ). This test is measuring the release of cytokines, histamine, leukotrienes, prostaglandins, etc., from neutrophils, monocytes, eosinophils, and lymphocytes that lead to all the negative clinical effects that you are enduring; these are the causes of your symptoms! Other food sensitivity tests are far less comprehensive…and far less accurate . Most of them are only testing for IgG antibodies, which can be elevated just due to exposure to that food. This is important to understand: just because the IgG antibody is present does not mean that the body is creating an inflammatory response to that food. This is the main difference between the MRT test and other options on the market…and it’s why I like the MRT test the best. MRT is actually measuring the inflammatory response to a food, not just that your body can identify a food. Additionally, MRT is still the ONLY test available that tests for food chemicals. This includes both naturally occurring chemicals like solanine and man-made chemicals, like artificial colors. Getting these results is actually just the beginning of your healing journey…receiving your results can feel pretty darn overwhelming. You have discovered the many foods that your body is not tolerating well…now what? How an RD can help Food is complicated. And our reactions to foods can be complicated, delayed, and difficult to understand. I recommend working with a registered dietitian, specifically one that is a Certified LEAP Therapist (CLT). My CLT training goes above and beyond the baseline training that dietitians receive in college. We have additional training in inflammation, the immune system, and food. We have also been trained on how to guide clients through the LEAP dietary protocol that utilizes the results from MRT. Most other practitioners will only tell clients to avoid reactive foods. In my experience, this is not enough for a person to actually feel better because there are usually many foods that a person is responding to. This means that inflammation is still occurring…and the person is still feeling crummy. An elimination diet is still considered the “gold standard” when it comes to food sensitivities, but it is far from precise. They’re also pretty difficult to follow. Plus, sensitivities are delayed many times by 72 hours so even with food logs, it can be really difficult to pinpoint the offending food. MRT lets us see exactly which foods cause inflammation and the accompanying symptoms. Then, when we use LEAP therapy and use MRT to guide the elimination diet, we have much better results. With MRT testing, I am able to progress my clients through the elimination diet MUCH faster. Many times, people will be on an elimination diet for 3 months or more because they can’t tell what is causing the problem and so they just keep pulling this food or that food and eventually have 6-10 foods they are consuming and still don’t feel well. This can be really frustrating and demoralizing - I want you to feel better far sooner. What to expect As a CLT registered dietitian, I use MRT testing and the LEAP protocol to precisely identify and treat my client’s food sensitivities. With these tools, I am able to guide my clients to feel better more quickly and with less confusion. We get to reintroduce eliminated foods back into their diets more quickly. But, it is important to know that, even with the best test, this work is not overnight. Food sensitivities develop because of issues in your gut health. Healing the gut takes time and work. Here is a bit more info about what your journey might look like and how long it will take: How Long Does It Take to Heal Leaky Gut? Key takeaways If you want the best answers, you need to use the right test…and partner with the right guide. Our modern lifestyle is pretty challenging for our gut health. Food sensitivities  and their myriad of symptoms are becoming more and more common. They’re not the same as allergies, and so an allergy test will not help you to get to the bottom of things. The right test for food sensitivities is the MRT test. The MRT food sensitivity test will help you to make sense of how your body is responding to almost 200 different foods and chemicals. As a functional nutrition practitioner, I can help you understand the root causes of your symptoms. With your personalized plan, you’ll feel better far more quickly. If you're ready to get to the bottom of your symptoms, set up an appointment . Together, we’ll discover which foods are causing your symptoms and optimize your gut health so that you’re feeling better more quickly and with less frustration.

Anymore, it seems everywhere you look, there is some form of an elimination diet being touted as “THE” diet to go on to improve health or to address a certain health condition like IBS. As a GI Specialist Dietitian/Nutritionist who works primarily with women suffering from IBS, elimination diets can be an extremely useful clinical tool, when undertaken correctly and I use them in my practice with great success. However, many times I see some form of dietary restriction or elimination diet that has been self-imposed by my clients with little to no understanding or awareness of long-term consequences that could be occurring from undertaking an elimination diet without guidance. This got me to thinking that since elimination diets are so common but the consequences of doing them is not, maybe it would be helpful for me to cover this topic. So let’s dig in, shall we? Let’s start with the basics – what is an elimination diet? To make sure we are on the same page, let’s clarify what an elimination diet is. An elimination diet is a short term systematic dietary approach that omits (for a period of time) a food or food group that is believed to be causing symptoms, before reintroducing back into the diet. Elimination diets are actually considered the gold standard for identifying food sensitivities and intolerances (you can read more here about the differences here ). When talking about digestive symptoms such as those that occur with IBS, there are some common elimination diets that practitioners use such as the low FODMAP diet, Specific Carbohydrate Diet (SCD), some will remove whole foods groups like foods containing gluten or dairy while other approaches can become quite restrictive such as an Autoimmune Paleo/Protocol (AIP) (which removes grains, dairy, eggs, legumes, nightshades etc.). While these different approaches can provide initial relief from symptoms, what they are not designed for is long term symptom management (especially the more restrictive approaches) and ultimately, staying on an elimination diet long term can have real consequences. And let me clarify something before moving on, if say for example, you feel better being gluten free and every time you try to reintroduce gluten containing foods, your symptoms come back, it’s perfectly acceptable to remain gluten free as long as you are replacing nutrients like fiber, B vitamins and minerals that many times are lacking when we remove gluten containing grains from our diet. Keeping these things in mind is the science and art of nutrition…… Now that we established what an elimination diet it, let’s move onward….. Let’s talk about some signs that you may have been on an elimination diet for too long. Your diet is progressively becoming more and more restrictive. Maybe you started by going gluten free but not all symptoms resolved so you decided to try dairy free, then you layered on removing all grains, then you felt like beans were an issue so out those went……see where I’m going with this? And now, here you are, having arrived at chicken, steamed broccoli, olive or coconut oil and potatoes…..day in and day out and guess what? You still have symptoms……am I right? I see this all the time in my practice, so many clients eating 6-10 foods and still miserable. You are struggling to reintroduce any foods Most likely one reason you have ended up at chicken, broccoli, olive oil and potato is because when you did try to reintroduce a food, symptoms came back or worsened. But let’s face it, if you still have symptoms on such a limited diet or symptoms quickly return when you try to add foods, it’s time to move on to a different level of intervention and get some help to dig deeper into why this is occurring. Underlying issues such as dysbiosis (imbalance in the gut bacteria or microbiome), reduced digestive “fire” (natural or medication induced loss of digestive enzyme production), intestinal hyperpermeability (aka "leaky gut") or unidentified food sensitivities can all be underlying root causes and if they are not addressed appropriately, you will continue to struggle with your symptoms and your diet. Your symptoms either never completely went away, are worsening, returning or new ones are arising Many IBS sufferers do experience initial improvement in symptoms when trying some type of an elimination diet; this is the main reason why most do not pursue the reintroduction phase of a diet. People want to feel good and if you are finally having some success, who wants to rock the boat by reintroducing foods, am I right? I get it but when you eliminate food for too long, especially foods that are beneficial to our overall digestive health (like those higher FODMAP foods for example) or the diet becomes so restrictive that you are consuming only a handful of foods, ultimately, the diet can end up contributing to the worsening of gut function as well as nutrient deficiencies (which can contribute to other health issues). Due to this, eventually, the effectiveness of the restrictive diet begins to wear off (because now there are different underlying issues contributing to symptoms) but because of the initial connection between food and some symptom relief, this is what leads to continuing to look for and eliminating a continually growing list of “triggers” and the more restrictive the diet becomes. But, sooner or later, you realize there is nothing left to eliminate, your symptoms are back, and you are feeling a whole lot worse than when you began the elimination diet journey. You’ve stopped relying on resources to be able to tell if something is low FODMAP, AIP or SCD friendly and/or your friends or family are coming to you as an “expert”. The truth is, an elimination diet done correctly, will eliminate foods for about 4-6 weeks on average at which point, a structured reintroduction/challenge phase should be started. Many of these diets can be quite complex as far as what is or isn’t allowed, specific serving sizes etc. so it can take quite a bit of time to really get comfortable with what you can eat. So if you are no longer needing to refer to an app, have a food list tucked away in your purse or your best friend’s sister is asking for help on implementing the diet……..can we say, red flag? Now that we covered some signs you’ve been on an elimination diet to long, let’s discuss the why behind it. You may be asking yourself, if an elimination diet is considered the gold standard for determining food sensitivities, there are studied diets like low FODMAP for IBS and ultimately these diets are supposed to help, what’s the big deal about being on them long term? I’m glad you asked…. While I mentioned some things throughout this post, let’s talk about them again here, in one spot. In general, for optimal health, we want to have a primarily whole, real food diet steeped in variety and as much as possible eat with the seasons. To clarify, whole, real foods are foods that came from the earth, grew on a tree or had a mother and are minimally processed. They are the foods that for the most part don’t require labels and or come in a package (this doesn’t mean all foods in a package are bad; think low sodium canned beans, a bag of brown rice, a snack bar made with whole foods like dates, nuts and other fruit). And for variety, I teach my clients to “eat the rainbow” by keeping track of the different colored foods they eat every day so they can make good decisions on foods to include that may be lacking. When we eat with the seasons, this also helps us to naturally get variety as well. By eating this way, we provide our bodies with a wide variety of nutrients that is crucial to our health. When we start to eliminate foods or groups of foods, if it is going to be long term (as I mentioned above with gluten for example), we need to make sure that we are making up for nutrients lost from that elimination with other foods. Most elimination diets though, especially when we are talking about ones to help with relief from IBS (like low FODMAP), remove large amounts of many healthy foods and it can be very difficult to make sure that all nutrients are being replaced (thus the need for it to be short term). In addition to crucial nutrients, using low FODMAP again for an example, FODMAPs are prebiotic foods which means that they help feed our microbiome (gut bacteria) and keep it healthy some examples include apples, cherries, cauliflower, and many types of beans to name a few. Pulling these foods for a few weeks and focusing on low FODMAP sources of fiber during that time, isn’t a big deal but if you stay on it indefinitely, then the microbiome pays the price which leads dysbiosis. Even the researchers behind the low FODMAP diet have stressed that it is a temporary diet . At this point, you may be wondering what do you do if you want to eat normally but your struggling to do so without making IBS symptoms worse? Great question! Ideally, if you have started an elimination diet without the help of a health practitioner and several of the signs discussed in this article sound familiar, it’s time to begin to work with someone who can really assess your situation, make appropriate testing recommendations and get to the root cause of your IBS. If you would like to learn more about working with me and how I can help, head on over to my scheduling page and get started by scheduling an initial visit. This will provide an opportunity for me to learn more about your situation and make recommendations for working together. Discover the Low FODMAP Diet :  Your Gut's New Best Friend! Learn how the Low FODMAP Fix Diet can help you identify  food triggers, manage symptoms, and regain control of your digestive health. Take the FIRST   step towards a happier gut with the Low FODMAP Fix!

“My doctor diagnosed me with irritable bowel syndrome (IBS) and told me to follow the FODMAP diet. I’ve done some reading on the FODMAP diet, but it seems overwhelming. Does it even work? Where do I start?” If this sounds familiar, you are not alone. According to the International Foundation for Gastrointestinal Disorders, IBS has a worldwide prevalence of 10-15 percent, making it the most common functional gastrointestinal disorder. (1) However, compared to other conditions and disorders, relatively little is known about treating IBS. What is the FODMAP diet? The FODMAP diet (which is an abbreviation that stands for f ermentable o ligosaccharides, d isaccharides, m onosaccharides a nd p olyols) was created by Monash University researchers to limit foods containing high amounts of the FODMAP short-chain carbohydrates. FODMAPS are incompletely absorbed in the gastrointestinal tract, can be easily fermented by gut bacteria and exert an osmotic effect, increasing fluid delivery into the large intestine, which can result in gas, pain and diarrhea. (2) Evidence of the FODMAP diet improving symptoms of IBS has been mounting in recent years. (3, 4, 5, 6) The FODMAP diet was designed to be a short-term, information-gathering exercise, helping individuals with IBS identify whether FODMAP-rich foods trigger IBS symptoms. A diet limiting all foods high in FODMAPs removes important foods from the diet, and can lead to micronutrient deficiencies, negative changes in the gut microbiome and unnecessarily limited options of whole foods, especially things like fruits, vegetables and beans. In individuals with limited access to some of the pricier dietary items included in the low-FODMAP diet, deficiencies in fiber, calcium, iron, zinc, B and D vitamins and natural antioxidants may be seen. (7) Some FODMAPs have prebiotic effects, namely fructans and galacto-oligosaccharides (also called GOS). These two types of FODMAPS are both oligosaccharides (the “O” in FODMAP). Fructans are the storage carbohydrates in vegetables including onions and garlic, and are also found in some fruits and cereal grains. GOS mainly occur naturally in legumes such as lentils and beans. A low FODMAP diet restricts the intake of these prebiotic fibers, which is the fuel for gut bacteria. Diets rich in prebiotic fiber are beneficial, and there are concerns about long-term gut health in individuals who restrict these FODMAPs. Many point to a “load effect” or “stacking effect” of FODMAPs; that is, a single FODMAP-containing food might cause symptoms if the individual has been consuming other high-FODMAP foods throughout the day. Foods that are known to have high levels of one of more of the FODMAPs include: Lactose : cottage cheese, ricotta cheese, cow’s milk, goat’s milk, evaporated milk, yogurt, ice cream and custard. Fructose: asparagus, sugar snap peas, sun dried tomatoes, apples, cherries, fresh figs, mangos, pears, watermelon, agave, high-fructose corn syrup and honey. Fructans/GOS: artichokes, garlic, leek and scallion bulbs, shallot, onion, onion and garlic powder, peas, soybeans, kidney beans, ripe bananas, currents, dates, dried figs, grapefruit, nectarine, persimmon, plums, prunes, white peaches, watermelon, rye, wheat, barley, pistachios, cashews, mature soybeans (most soy milk), baked beans, black beans, fava beans, kidney beans, navy beans and split peas. Polyols: cauliflower, mushrooms, snow peas, apples, apricots, blackberries, cherries, nectarines, pears, yellow peaches, plums, prunes, watermelon, sorbitol, mannitol, isomalt and xylitol. How does the diet work? In a typical FODMAP diet trial, individuals work with a registered dietitian to design meal plans that remove all foods high in FODMAPs for a period of time, often 3-4 weeks (sometimes bit longer, depending on diet compliance and symptom resolvement). Then, a customized approach is created to reintroduce each FODMAP category, one-by-one, in a controlled way to be able to pinpoint exactly which category of FODMAPs is causing IBS symptoms. This category can be further explored to determine if all foods in the category are problematic or just a few. The reintroduction phase takes approximately 6 weeks to complete. It's important to note, that FODMAPS do not cause IBS and merely represent an opportunity for reducing symptoms. (8) For some, FODMAP can improve their IBS symptoms but since FODMAPs are an intolerance and don’t involve the immune system, those with food sensitivities most likely will not experience a reduction in symptoms. This can be a clue that there is something else going on and is a great time to work with a functional nutrition expert to dig deeper to identify and address the underlying root cause of IBS . For example, if IBS symptoms are being caused by an underlying dysbiosis (a lack in number or diversity of beneficial bacteria), IBS symptoms may temporarily be relieved by following a low FODMAP diet plan but the low FODMAP diet also has the unintended consequence of reducing the abundance of total fecal bacteria and reducing specific bacteria that are known to be markers of health (9) ultimately, potentially exacerbating the dysbiosis if on the diet for too long . What can I do next? If you are struggling with symptoms of IBS and are interested in trying a low FODMAP elimination diet and reintroduction trial, I would love to help you navigate the nuances of the diet and develop an inclusive, personalized eating plan. The FODMAP diet can be a good first step to reducing IBS symptoms while we work together on identifying the underlying root cause of your IBS. Get started today by scheduling your initial visit with Marissa. Discover the Low FODMAP Diet :  Your Gut's New Best Friend! Learn how the Low FODMAP Fix Diet can help you identify  food triggers, manage symptoms, and regain control of your digestive health. Take the FIRST   step towards a happier gut with the Low FODMAP Fix! References: 1 International Foundation for Gastrointestinal Disorders. “Statistics, Facts About IBS.” About IBS, https://www.aboutibs.org/facts-about-ibs/statistics.html . Accessed Sept. 28, 2019. 2. Barrett JS, Gibson P. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals? Therapeutic Adv in Gastroenterology 2012; 5: 261-268. 3. Ong DK, Mitchell SB, Barrett JS et al. Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol 2010; 25: 1366–1373. 4. Shepherd SJ, Gibson PR. Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management. J Am Diet Assoc 2006; 106: 1631–1639. 5. de Roest RH, Dobbs BR, Chapman BA et al. The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study. Int J Clin Pract 2013; 67: 895–903. 6. Staudacher HM, Whelan K, Irving PM et al. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet 2011; 24: 487–495. 7. Catassi G, Lionetti E, Gatti S, Catassi C. The low FODMAP diet: many question marks for a catchy acronym. Nutrients 2017; 9 : 292. 8. Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010; 25(2): 252-8. 9. Halmos EP, Christophersen CT, Bird AR, Shepherd SJ, Muir JG, Gibson PR. Consistent Prebiotic Effect on Gut Microbiota With Altered FODMAP Intake in Patients with Crohn's Disease: A Randomised, Controlled Cross-Over Trial of Well-Defined Diets. Clin Transl Gastroenterol . 2016;7(4):e164.

Is there anything more miserable than having digestive problems, gas, cramps, brain fog, and a belly that looks six months pregnant…and you’re not? If you’ve been struggling to discover what has been going on, or have received a diagnosis of SIBO, you’re in the right spot. Changes to your diet can help you to resolve your SIBO symptoms. In this article, I’ll cover what SIBO is and how a multipronged approach – including diet – can help to manage symptoms. I’ll also cover possible root causes of SIBO and explain why figuring out your root causes is so critical in the ability to prevent a SIBO relapse. What is SIBO? SIBO, which stands for Small Intestine Bacterial Overgrowth is about bacteria being in the wrong place at the wrong time. We have good bacteria in and around our bodies; we need them to be healthy. In our digestive tract, most of these “good guys” are in the large intestine (aka the colon). These bacteria help us to get more nutrition from our food. They also help to keep our gut healthy by feeding the cells of the gut with short-chain amino acids; kind of like passing out snacks. But…they’re supposed to stay in the large intestine. SIBO is when too many of these bacteria are hanging out in your small intestine. Wrong place, wrong time. Image courtesy of Canva. How many bacteria are we talking about? We measure the population in terms of how many living bacteria are in one milliliter of fluid. In case you’re curious, 1 milliliter is about the same as 20 drops of water ( 1 ). 1 milliliter of fluid from the small intestine has about 10,000 living bacteria inside. And while that sounds like a lot, the large intestine has far more. 1 milliliter of fluid from the large intestine has about 100 billion living organisms - i.e., 10,000,000 times the population of the small intestine. A common misconception is that SIBO is an infection of a “bad guy” bacteria. Usually, this is not the case. The bacteria that are in your small intestine are normal organisms in your body, they’re just too many of them in the wrong spot. Most often, these bacteria have traveled and set up shop from the large intestine. Rarely, they’ve come all of the way down from your mouth. So - why does this matter? Turns out there are a lot of things that can go wrong when these bacteria are not where they belong. Why SIBO is a bad thing Having SIBO can cause issues in a number of ways. When bacteria overgrow in the small intestine it can affect both the structure and the function. Let’s explore those possibilities right here. Interrupts normal digestion and absorption There are three ways that the displaced bacteria can cause trouble for your body. 1. The bacteria can destroy the enzymes that are needed for the regular digestion of carbohydrates. No enzymes breaking down the carbs means that we can’t absorb them. 2. What happens to the carbs? The sneaky bacteria eat them. They’re “stealing” our food – this can cause nutritional deficiencies. 3. And what else? They interrupt fat absorption by deactivating bile, the fluid that we make and require in order to absorb fat. Since we aren’t able to absorb fat, we are left with fatty stools and deficiencies in fat-soluble nutrients, such as vitamins A and D. And that’s not all. The bacteria can also damage the lining of your small intestine. Gut damage There are also three ways in which the bacteria can damage the lining of your gut. This includes: 1. In your small intestine, you have the ability to absorb nutrients from your food in structures called villi. These kind of look like feathers (or a shag rug) with lots of waving strands. In SIBO, the villi may be damaged, which means you are no longer able to digest or absorb nutrients as well. 2. Also in your small intestine, one cell is supposed to be tightly linked to one another, which gives your body the ability to manage what is absorbed and what is kept in the gut. In SIBO, the tight junctions loosen, causing hyperpermeability (which you’ve probably heard of as leaky gut). 3. Leaky gut can lead to food sensitivities, Autoimmune disorders (molecular mimicry, etc.), and contribute to LPS (Lipopolysaccharide), an endotoxin of gram-negative bacteria, getting into the bloodstream. So, having SIBO is a big deal - that is why it is so important to have an accurate diagnosis and a thoughtful treatment plan to prevent remissions. We’ll talk about treatments further along in this article, so keep reading. Now that we know what the rogue bacteria can do, this will help us to understand the symptoms more easily. Symptoms of SIBO The symptoms of SIBO are pretty diverse; they can also increase and decrease in severity, depending on what you eat and so on, which makes SIBO more difficult to diagnose. Bacteria produce gas after eating our food leading to symptoms such as belching, flatulence, abdominal pain, bloating, constipation, and diarrhea. The bacteria also excrete high amounts of acid, which can cause both neurological and cognitive symptoms. What does this look like? Here are the symptoms that I see most often with my own clients: ● Abdominal pain and/or cramps ● Bloating and distension (belly looks “pregnant.” This is something I listen for – when people say I can’t button my pants by the end of the day, I have to wear elastic pants, I look 6 months pregnant, this is a BIG clue we are dealing with SIBO.) ● Belching (if sulfur-like, rotten egg smelling may be associated with hydrogen sulfide gas production) ● Flatulence ( if sulfur-like, rotten egg smelling may be associated with hydrogen sulfide gas production) ● Constipation (most often associated with methane gas production) ● Diarrhea (most often associated with hydrogen gas production) ● Nausea ● Heartburn ● Reflux ● Skin issues (rosacea, eczema, etc.) ● Food sensitivities ● Malnutrition (B12 or iron anemia, etc.) ● Histamine intolerance ● Headaches ● Fatigue ● Mood disorders ● Joint pain ● Restless legs syndrome So now that we know how SIBO can present and what is happening in your body…where did it come from, to begin with? Let’s explore risk factors. Risk factors for SIBO What causes SIBO? There is more than one thing that can make you at greater risk of developing SIBO. This is a long list, so let’s dive right in! Insufficient migrating motor complex (MMC) What is the MMC you ask? MMC is the small intestine’s “cleaning action wave” that moves bacteria and debris down into the large intestine in between meals and during fasting at night. The MMC sweeps the small intestine clean, preventing bacteria from colonizing there. How often? The MMC usually happens about 11 times per day or about every 90-120 minutes. But if you have SIBO, it may only happen three times per day, which means that the bacteria have a LOT more time to get settled and reproduce. The MMC may not function properly if you have: ● Intestinal nerve damage (Diabetes, surgery, GI infection) ● High histamine levels ● Eating too often (the MMC only occurs during periods of fasting) Photo by Jan Kopřiva on Unsplash Link to image: https://unsplash.com/photos/77La8Of1F9g Acute gastroenteritis Montezuma’s revenge? If you’ve ever had food poisoning while traveling your risk of SIBO just went up. (Sorry to pile bad news on a bad situation!) What’s going on? Certain pathogenic bacteria that cause acute illness secrete a toxin. When the body is working to defend itself and attacking the toxin, the insufficient MMC can be collateral damage. Anything which slows motility Remember how we learned that regular movement of food and bacteria along the small intestine is important to keep scooting bacteria along in the MMC section above? A few other conditions can slow those movements down, paving the way for bacteria to flow backward and colonize. These include: ● Hypothyroidism ● Scleroderma ● Stress ● Heavy metal toxicity ● Neurotransmitter imbalance (low serotonin) ● Opiate medications Insufficient stomach acid, pancreatic enzymes, and/or bile A dream team combo of HCL (the acid in your stomach), pancreatic enzymes, and bile acids keep your small intestine mostly sterile. This means that even if you have a pathogen in something you ate, it should be nuked by your body’s acidic defense system. But if these fluids are out of balance, the bacteria can sneak through and grow. Low levels can be caused by: ● H. pylori ● Use of medications that lower stomach acid (i.e. PPIs, antacids) ● Pancreatitis ● Gall bladder removal Parasitic infections Parasites such as giardia, and cryptosporidium can damage the GI tract and increase susceptibility to SIBO ( 2 ). Alcohol consumption While a small amount of alcohol is fine for most of us, moderate to heavy alcohol consumption increases the risk of SIBO. In fact, a Swedish study found that 90% of alcoholics had SIBO - yikes ( 3 )! Ileocecal valve (ICV) dysfunction The ileocecal valve – or ICV – is the doorway between the small intestine and large intestine. When the ICV is doing its job as it is supposed to, it closes after digested food goes through the door. But if not, bacteria can creep backward from the large intestine back into the small intestine. Crohn’s disease many times will cause damage all along the GI tract, including the ileocecal valve. This damage can lead to inflammation that can harm the valve so much that it may have to be surgically removed which means that the natural barrier helping to protect backflow from the colon has been removed. Vagus nerve compromise or damage The vagus nerve – which starts in the brain stem – controls the MMC we’ve been speaking about a few times now. If the captain (in this case, the vagus nerve) of this process is compromised, it can’t send the corrected messages along the MMC and the movements don’t happen as often as they’re supposed to or they aren’t as well coordinated. Dysfunction can be caused by: ● Misaligned neck vertebrae ● Hiatal hernia ● Bacterial/viral infections ● Heavy metal toxicity ● Pesticide exposure ● MSG ● Stress ● Parkinson’s disease ● Autism ● Diabetes ● Lyme disease ● Vitamin B1 or Acetylcholine deficiency Altered anatomy If there is something different in how your GI tract is formed, bacteria can get stuck and reproduce instead of being swept along. Altered anatomy/structure possibilities include: ● Non-draining pockets (from a surgical blind loop or diverticulosis - bacteria gets trapped) ● Fistulas (direct “tunnel” from the large intestine to your small intestine) ● Partial obstruction (from a tumor, etc.) ● Adhesions (bands of tissue that form from surgery or injury to your abdomen) ● Endometriosis (tissue can compress the small intestine) ● Kinks in the bowel ● Strictures in the bowel (narrowing of the intestinal wall) ● Ileocecal valve removal (surgical removal as a result of an appendectomy, Crohn’s disease, etc.) SIBO + other conditions SIBO might overlap with a few other conditions, including Crohn’s disease, celiac disease, H. pylori infection, and IBS. In fact, SIBO has been shown to exist in up to 84% of IBS patients and is thought to be the underlying cause. As mentioned above, Crohn’s can be a risk factor and may have many of the same digestive symptoms. You’re at higher risk of developing SIBO if you have celiac, especially if your symptoms remain after removing gluten ( 4 ). I explained the possible overlap of SIBO and H. pylori in this blog post: H. pylori and SIBO: Can you have both? Diagnosis of SIBO The diagnosis of SIBO can involve a few different tests, an examination of your medical history, as well as elimination of other possible diagnoses. As we saw in the previous section, there is a lot of possible overlap between SIBO and other conditions. Fluid Culture Remember how we talked about the normal levels of bacteria in the large and small intestine? The most accurate way to diagnose SIBO is to measure the fluid in the small intestine…but this is also quite invasive ( 5 ). So most often, SIBO is diagnosed with breath testing and other tests to rule other conditions in or out. Breath testing Bacteria are living organisms that use and “exhale” gas, just like we do. We breathe in oxygen and breathe out carbon dioxide as a normal part of our own metabolism. Different species of bacteria “exhale” hydrogen, methane or hydrogen sulfide. To do breath testing you’ll breathe into a machine that can measure the gasses present, and then you’ll drink a sugary drink and see what changes. If you have an overgrowth of bacteria in your small intestine, they will chomp down on this sugary snack and exhale hydrogen, methane, or both, letting your doctor know that overgrowth is present. Knowing what kinds of bacteria are present also helps to guide treatment. So while breath testing isn’t quite as precise as fluid testing, it is far less invasive, and much more common as well. No matter what, an accurate diagnosis of SIBO requires expert guidance and testing from your doctor or other healthcare professional. I don’t recommend attempting to diagnose this, or any condition on your own. I talk about this a bit more in this recent blog post: Do I Have IBS or Something Else? No Self-diagnosis, Please! Treatment of SIBO There is a misconception you may have heard that diet alone can treat SIBO. Unfortunately, friends, this is false. SIBO treatment will depend upon the predominant gas being produced (hydrogen, methane (or both), or hydrogen sulfide). If hydrogen sulfide is suspected, then a low sulfur diet can be helpful. Eliminating SIBO requires a multi-faceted approach to eradicate bacterial overgrowth. This can include: Antibiotics Common antibiotics used in the treatment of SIBO include Rifaximin/Xifaxan for 14 days. If methane is dominant, the antibiotic will typically be combined with neomycin or metronidazole. Photo by Towfiqu barbhuiya on Unsplash Link to image: https://unsplash.com/photos/ssZ6x-gaO0c Herbal supplements Herbal treatments vary but will typically include products like oil of oregano, berberine, neem, or products specially formulated for SIBO. Methane dominant herbal protocols will have additional herbs such as Atrantil, Allicin, or peppermint oil. Correct dosing is important as some herbs can have side effects such as nausea or diarrhea or may not be safe during breastfeeding or pregnancy. Pro tip: I do NOT recommend trying to create herbal protocols on your own. Please work with a knowledgeable practitioner with experience in the herbal treatment of SIBO. Other supplements that may need to be a part of your SIBO treatment protocol are prebiotics during active treatment (such as partially hydrolyzed guar gum). This is usually well tolerated by those folks that are not tolerating FODMAPs since a higher FODMAP diet is encouraged DURING active treatment as it makes bacteria more susceptible to the treatment. Additional supplements may include biofilm disruptors, spore-based probiotics, and/or additional digestive support such as HCL, enzymes, bile salts, etc. Completing a comprehensive stool panel such as GI MAP in addition to breath testing can provide the information needed to determine what other supplements might be necessary. Other medications/supplements You may also find that a prokinetic medication/supplement is helpful. Prokinetics are medications that help with the motility of the GI tract. SIBO Diet While there are different types of “SIBO diets” there isn’t one right solution that will work for everyone and it's important to note that "SIBO diets" are there mainly for the purpose of managing symptoms. Some of the dietary plans that are used as an intervention for SIBO include: ● The Low FODMAP Diet ● The Specific Carbohydrate Diet (SCD) ● The Bi-Phasic Diet ● The AIP Elimination Diet In my experience helping clients to find relief from their digestive symptoms, I find that most clients come to me already restricting their foods. A lot. And as a dietitian, I don’t want to make things more complicated. Since we’ve been through how many different conditions can lead to SIBO, it makes sense that a treatment protocol, including diet, needs to be personalized in order to work. I find that starting with a Low-FODMAP approach and potentially doing MRT food sensitivity testing helps to find the most effective SIBO diet plan with the fewest restrictions. It’s also important to note that an elimination diet is not intended to be followed forever; it is meant to help manage GI symptoms and determine which foods are actually problematic. It is possible to follow an elimination diet for too long, and I have seen a lot of clients making this same well-intended mistake. I cover this in detail in this blog post: Have you been on an elimination diet too long? Addressing any root causes And last but not least, it is very important to resolve any issues that may have caused the SIBO to begin with. If you are not able to correct the root cause, your chance of SIBO coming back is much higher. For a quick review, root causes might include low stomach acid, slow motility, abdominal adhesions, and more. It may also include healing your gut if you have leaky gut. More on that here: The Best Gut Healing Protocol to Resolve Your Symptoms . Symptom management vs. root cause treatment I’ve had clients tell me before how frustrated they are with their recurring issues. It seems like they figured things out with dietary changes or medication…only to have the symptoms come back a few months later. Symptoms may be managed through diet (primarily low FODMAP) since the bacterial food source is being reduced but SIBO can be very damaging to the GI tract, and cause nutrient deficiencies, etc. so it is important to address the SIBO and the reason why you got SIBO in the first place. Expected timelines How I wish I could tell you that treatment –- once you know the root cause – is fast. Here is what you need to know: fully addressing and eradicating SIBO is a PROCESS. Unfortunately, this is a long road. But if you can stick it out through the hard work, you have the opportunity to be rewarded with no returning SIBO symptoms. Sometimes I hear that SIBO has a reputation for being difficult to treat. In my experience, SIBO is treatable, but you have to stick with the full protocol, including follow-ups. I’ve seen this before with many clients: they only get a single round of medications, they don’t retest or have any kind of follow-up and then – bam – SIBO is back. This makes clients feel like their SIBO keeps coming back, again and again, when in my experience, it was (most likely) never fully eradicated, to begin with. Most of the time, treatment begins with medications or herbals. One round of antibiotics is typically two weeks; antimicrobial herbals are typically taken for a month. The number of rounds of either kind of treatment depends on how high your gas levels were during the breath testing. Treatment timelines include the time after medications, with dietary management and testing to ensure that you’re actually in remission. Once a negative retest is achieved, post-therapy begins. For all clients, I recommend these things: Prokinetic medications/supplements (3 months or longer) Low FODMAP diet (minimum 3 months) Repairing the damage caused by SIBO. This can include healing leaky gut, identifying and replenishing deficient nutrients as well as addressing food sensitivities. In addition, depending on your unique SIBO case, there might be more included in your treatment plan. For some clients, I also recommend: HCL replacement Enzyme replacement Vagal nerve stimulation Ileocecal valve manipulation Repairing leaky gut How long altogether? The full timeline from beginning to end varies but you’re typically looking at about 6 months on the low end to a year or more if fully addressed. As my client, you should be prepared to take retests, investigate and address root causes, and be willing to take necessary supplements and medications. How I help Not all doctors or practitioners are the same; in order to actually help clients achieve remission and prevent SIBO relapse, a practitioner needs to have extensive training and experience and be willing to guide their clients through the journey. That is me in a nutshell! SIBO is a complicated condition that can overlap with other conditions and can be caused by a myriad of different root causes. As a Digestive Health Dietitian, I help clients navigate the testing process in case they don’t have a physician willing to order SIBO testing. I also help navigate all the nutritional nuances from symptom management to nutrient deficiencies to food sensitivities. I am knowledgeable in herbal protocols and can provide personalized supplement protocols to help support my clients. I am able to run other tests like a GI MAP so that we have a thorough big picture and can help navigate things brought to light by this testing. Overall, I am here to support my clients to expertly navigate this complex condition and finally achieve lasting relief. Key takeaways: SIBO and diet SIBO is a condition that is becoming better known, better understood, and unfortunately, more common. Diet is part of a good treatment plan, but as we saw in this article, it is just one piece of the puzzle. Treatment of SIBO should start with an accurate diagnosis, identifying the root cause(s), as well as dietary, pharmaceutical, and herbal treatment. Without identifying the root cause, you’re only playing a game of symptom management and you’ll not likely win remission long term. I’d love to help you get there. If you’re ready to work with a knowledgeable guide to support you through your best gut health protocol, get started by scheduling an initial visit. This lets us both feel confident that we’re the right fit to partner together to achieve lasting results. I can’t wait to help you feel so much better. Discover the Low FODMAP Diet :  Your Gut's New Best Friend! Learn how the Low FODMAP Fix Diet can help you identify  food triggers, manage symptoms, and regain control of your digestive health. Take the FIRST   step towards a happier gut with the Low FODMAP Fix!

What is H. Pylori? H. Pylori is a bacteria that has a unique ability to survive the very acidic environment of your stomach. For most bugs, the stomach acid kills them, but not H. Pylori! You can get H. Pylori from infected water or food, even through shared utensils and (here is a surprise) through kissing. H. Pylori can survive your stomach acid and makes itself at home by secreting an enzyme to make things more comfortable for itself. The enzyme – urease – reduces acid in the stomach ( 1 ). While more comfortable for the H. Pylori to settle in, not having enough acid in your stomach is a big problem for you. We’ll cover why a bit later in this article. Many of us have H. Pylori in our stomachs without even knowing it. The bacteria can live in our stomach, without causing any issues at all. But for some of us we can develop symptoms from this resident bug, sometimes years after we may have gotten it! What does H. Pylori do in your body? There are multiple strands of H. Pylori and not all cause infection. If we have an infectious strand, we might not start to feel symptoms for months or even years later. Normally, we have a stable lining of mucus along the inside surface of our stomach. The role of this lining is to protect our own tissue from the very acidic contents of our stomach. The acid has several very important roles which include helping us to digest proteins, killing pathogenic bugs and allowing us to release vitamin B12 from our food. But, we need to protect our own muscle tissue from the acid: it is protein, after all! Certain strains of H. Pylori can burrow through the lining and expose the stomach wall. Without the protection of the mucus layer, the acid in your stomach attacks your own stomach tissue. This is where you can start to feel unwell: the infectious H. Pylori bug has just led to an ulcer! H. Pylori can cause ulcers in your stomach and in the upper GI tract. Before the discovery of H. Pylori in 1982, we used to blame spicy foods and stress for causing ulcers. Now we know that this bacteria is to blame ( 2 ). Photo by Hari Krishnan on Unsplash What are the symptoms of an ulcer? Everyone is different, so you may not have the exact same symptoms as anyone else. If you have an ulcer, you may feel any pain in your stomach that might be worse when your stomach is empty and may feel better with food, milk or taking an antacid. You might also have: ● A loss of appetite ● Bloating ● Burping ● Nausea ● Vomiting ● Unintended weight loss If your ulcers are in your intestine, you might also: ● See dark black or red stool ● Feel dizzy or faint, tired ● Have pale skin These symptoms all relate to blood loss. If you suspect that you have an H. Pylori infection, please visit your doctor. He or she can offer breath testing to diagnose an H. Pylori infection. Your doctor can also confirm the presence of ulcers by a few testing methods, including using a small camera to look down your throat into your stomach. Treatment of a stomach ulcer Conventional treatment of a stomach ulcer involves using antibiotics to kill the bacteria as well as acid-reducing medication to protect the lining of the stomach as you heal. While the antibiotics may do a great job of killing the intended bacteria, they may have the unintended consequence of throwing the good bacteria in your intestine out of balance. And, the trouble with taking acid-reducing medication for the long term is that it interferes with normal digestion and absorption. Having an acidic environment is important for protecting against pathogens, the absorption of vitamin B 12 as well as triggering the release of digestive enzymes in your small intestine. Not only does having reduced stomach acid increase your risk of an ulcer, it can increase your risk of many other issues. H. Pylori is one tricky bug. What else can H. Pylori do? H. Pylori is probably the most notorious for its role in stomach ulcers. What may surprise you is that H. Pylori infection can actually cause other issues, some that are a bit more subtle than the stomach ulcer symptoms we have already discussed. H. pylori doesn't always create GI symptoms, sometimes it's fatigue. Why? Because with reduced stomach acid we have a harder time breaking down protein-rich food into amino acids. Amino acids are building blocks for our body’s machinery, things like hormones, muscle tissue and hemoglobin. Without sufficient hemoglobin to carry around oxygen to each and every cell in our body, we feel tired and worn down, even if we are breathing deeply. Other issues brewing from low stomach acid can be things like reduced immune function. Can you guess what antibodies are made from? Protein! Once again, without optimal digestion to gather the building blocks that we need from the food we eat, we can’t optimally build the important machinery to perform at our best. One more example of H. Pylori causing a ruckus? How about having rogue blood sugars that might have nothing to do with food and everything to do with not producing enough insulin which – yep you guessed it – requires amino acids. Hormones, including thyroxine, melatonin and serotonin, can’t be built without the proper building blocks. As you can see, H. Pylori modifying your stomach environment to suit their preferences has a profound impact on your health and wellness. Having a stomach environment that is not acidic enough, or overuse of antibiotics (or both) can make you at risk of developing many conditions, including SIBO. What is SIBO? SIBO is short for small intestinal bacterial overgrowth. When things are working as they should, we have a diverse colony of bacteria and other helpful organisms living in our large intestine. You may have heard of this by another name: the microbiome. These beneficial organisms help with the digestion of our food, feed the cells lining our digestive tract and we thank them by giving them their preferred foods: fiber. The trouble comes when the bacteria migrate: if the bacteria aren’t where they should be – mostly in the large intestine – they can cause symptoms. Our small intestine is not sterile, or free of all bacteria, but there should be far more in the large intestine. There is a kind of door between the large intestine and the small intestine that helps to keep most of the bacteria contained in the large intestine. If that door – the ileocecal valve – is not working properly, you’re at greater risk of bacteria roaming into your small intestine. What are the symptoms of SIBO? Your symptoms of SIBO may vary from those of others, but may include: ● Nausea ● Bloating ● Loss of appetite ● Unintended weight loss ● Fullness too soon while eating Look familiar? There is a lot of overlap between the symptoms of these two conditions, which is why having an expert in functional nutrition can help you to uncover which condition (or conditions) might be making you feel bad, as well as get to the bottom of why you got the condition to begin with. This is important: without understanding the root cause of why you have SIBO, you are susceptible to relapse. Without treatment to put SIBO in check, further complications to your health and wellness may be on the way. SIBO – left untreated – can lead to malnutrition. And the domino effect continues: we know that lack of nutrients can lead to fatigue, low immunity, hormonal imbalance, disturbed sleep, depression/anxiety and more. Yikes! SIBO and ulcers require more care than an antacid and antibiotic. That’s the magic – well, science – of an functional nutrition registered dietitian. We get down to root causes to craft effective solutions. What can cause SIBO? Unfortunately, a lot of things can increase the chance that you can develop SIBO ( 3 ). These can include: ● Gastric surgery for ulcers ● Crohn’s disease ● Diabetes ● Celiac disease ● Food poisoning ● Medications or treatments that slow the passage of food along the digestive tract How to diagnose SIBO? The most accurate, “gold standard” testing for SIBO is quite invasive. It involves a healthcare provider running a very small tube down your nose, down into your stomach, and all the way to your small intestine. There it can collect fluid for testing. However, because that is invasive, that isn’t usually a physician’s first choice. As with H. Pylori, the more common method of diagnosing SIBO is through breath testing. It is much less invasive and can even be done at home. What is the recommended treatment for SIBO? Physicians typically offer antibiotics and/or herbal remedies as a standard treatment for SIBO. And more than likely, they’ll offer relief. However, a relapse may be around the corner. From a functional nutrition perspective, the best treatment for SIBO helps to prevent relapse. As a registered dietitian, my recommended SIBO protocol will depend largely on investigating why the SIBO developed to begin with. If H. Pylori and SIBO are happening together, the H. Pylori may have happened first. While it is common to treat stomach pain and GERD with antacids, having low stomach acid may create more problems later. As we chatted about earlier, having enough stomach acid is important for normal digestion and absorption, to help protect us from getting sick from pathogens in our food and to trigger the release of needed digestive enzymes. And, only treating symptoms means that SIBO can happen again. To be most effective, we have to identify and address the root cause to work towards long-lasting remission. That is the magic of functional nutrition: to get to root causes to prevent relapse. Key take-aways about H. Pylori and SIBO It is absolutely possible to have issues with both H. Pylori and SIBO. It is tricky to tell which one might be causing problems, or if you have both conditions, since so many of the symptoms overlap. There are so very many factors that contribute to how you feel on a given day: it can feel really confusing and frustrating to be dealing with symptoms that are not specific – how do you know what is really going on when so many conditions share the same symptom list? I’d love to help! 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 and get started today! Discover the Low FODMAP Diet :  Your Gut's New Best Friend! Learn how the Low FODMAP Fix Diet can help you identify  food triggers, manage symptoms, and regain control of your digestive health. Take the FIRST   step towards a happier gut with the Low FODMAP Fix!

Let me start by saying, I don't like the term leaky gut. Leaky gut is something that is being talked about all the time. And as a GI dietitian, I love the fact that people are digging deeper into their own health and discovering the root causes of why they’ve been feeling crappy for so long. But the term leaky gut is a bit misleading and doesn't sound very evidence based. So let's clarify what it is (and isn't) shall we? What is Leaky Gut? The truth is, all of our guts are technically a bit “leaky" (or semi-permeable). This is normal digestion and absorption. In order for our bodies to be able to utilize the nutrients from our food, food needs to be broken down and get from our digestive tract to our cells via the bloodstream. I like to think of the gut like a kingdom that has guards standing by, shoulder to shoulder and protecting the gate to entry. These "guards" are the tight gap junctions that in a healthy gut will naturally have good control over what is allowed inside the kingdom (the bloodstream) and what is kept out (for example, bad bacteria, toxins or incompletely broken down food). To understand further, when we consume food, through the process of digestion, food is broken down into components until they’re small – really small – small enough to be absorbed and pass through the lining of the digestive tract and then into the bloodstream. These food components are micronutrients (vitamins, minerals, amino acids, monosaccharides, etc). As an example, a complex carbohydrate molecule is broken down into individual simple sugar molecule such as glucose. Glucose is then small enough to be absorbed (pass through the lining of the gut), enter the blood stream and be carried to our cells where it can be utilized. It is also possible for our digestive tract have increased intestinal permeability (or hyperpermeability aka "leaky gut") and now those tight gap junctions aren't so tight (back to the kingdom analogy - think of it as having less guards at the gate, so instead of guards standing shoulder to shoulder, there is a guard every 15 feet). When this happens, things that normally would be kept out like undigested food particles, toxins, bacteria can get through, they then become marked as foreign by your immune system and your immune system attacks. Causes of Increased Intestinal Permeability Increased intestinal permeability (aka leaky gut) – can be caused by a number of things. If you’re feeling symptomatic, it can require some detective work to get to the bottom of things. It wasn’t that long ago that leaky gut was brushed off as pseudoscience. But, research has uncovered mechanisms to explain why some people are experiencing symptoms. For example, the work of Dr. Fasano discovered that gluten can trigger leaky gut for some people. He discovered a protein called zonulin which is the main "gatekeeper" (that we know of at this time) of those tight gap junctions mentioned earlier (1, 2, 3). Discovering zonulin was an important advancement in science because it was something that we can actually detect and measure. In our chaotic modern lifestyle, your dietary choices are one important factor in how permeable your intestinal lining is, but diet is far from the only factor. Other factors can cause increased permeability. These include: ● Having an infection, such as traveler’s diarrhea, SIBO or candida overgrowth ● Certain medications ● Chronic stress ● Certain food additives Foods That Can Contribute to Leaky Gut While there is no need to have a “perfect” diet but our habitual choices over time influence our health for the long run. To cultivate a healthy intestinal tract and prevent an increase in intestinal permeability, you might choose to avoid: ● Excessive added sugar ● Alcohol (2) ● Highly processed foods ● Unnecessary additives, such as emulsifiers and preservatives (for example, polysorbate 80) (3) ● Lectins ● Foods that you are sensitive too that may be causing inflammation. Common offenders are soy, gluten and corn although a person can be sensitive to any food (even ones typically considered "healthy"). Foods That Can Heal Leaky Gut There are a few mechanisms in which foods can promote having a sound intestinal barrier. Different foods offer different benefits. Overall, a healthy eating plan is one with lots of fruits and vegetables, diversity, lots of water and not too many unnecessary additives. Easier said than done, right? Here are a few foods that may help to heal leaky gut. Probiotics Including probiotics and fermented foods keeps the population of “good guys” in your gut microbiome happy. Probiotics can come from fermented foods (if they’re not pasteurized) as well as supplements. ● Yogurt (if you tolerate dairy) ● Kimchi ● Fermented pickles ● Kombucha ● Raw apple cider vinegar Tip: supplements are not regulated in the USA. Please work with a knowledgeable practitioner to source high-quality supplements. High Fiber Foods Fruits, vegetables, nuts and seeds are all rich sources of naturally occurring fiber. We can’t actually digest fiber, but the cool thing is, the bacteria in our digestive system can. Fiber is their food. By having a fiber-rich diet, you are enjoying the health benefits for your own body as well as setting out the welcome mat (and a snack) for the bacteria in our gut that we want to thrive. ● Fruits, especially berries and pears ● Vegetables, especially leafy greens, beans, and pears ● Nuts and seeds - almonds, chia seeds, flaxseeds ● Whole grains - as tolerated And before you reach for a fiber supplement, consider the fact that the above foods have fiber plus many other vitamins, minerals and phytochemicals – all with health-boosting properties. A fiber supplement is only that: fiber. Note of caution: supplementing fiber can cause constipation in some individuals. Herbs and Spices You may be surprised to learn that your spice cabinet can offer relief more than your medicine cabinet. Cooking with herbs and spices not only boosts the flavor and satisfaction of your meals, they also offer anti-inflammatory benefits, too! ● Turmeric (pair with black pepper for best absorption) ● Garlic - if tolerated (garlic is a high FODMAP food) Bone Broth (aka collagen) Collagen can help to promote the integrity of your intestinal lining (4). While it sounds tricky to make bone broth, you can boil your chicken bones after having a roasted chicken for a few hours - et voila! You can also buy bone broth or collagen supplements. Collagen can be added to hot coffee, smoothies or used in your golden milk turmeric latte. Note: “chicken stock” may or may not be rich in collagen, the beneficial protein that helps our gut. Foods Rich in Zinc Food rich in zinc, or even zinc supplements, can strengthen the gut linings (5). Meat, shellfish, nuts, seeds and (wonderfully), chocolate, are all good sources of zinc. Note: Be cautious of supplementing with too much zinc or for too long as a delicate balance between zinc and copper needs to be maintained. Anti -Inflammatory Diet While the above suggestions focused on individual foods for their specific impact on the gut lining, what you eat overall matters and having a diet that is anti-inflammatory for your body supports the health of your gut lining, minimizing leaky gut. My work with my clients is personalized, helping them to have a truly personalized nutrition plan that promotes their best health. Bottom line: Foods for Leaky Gut You don’t have to assume that just because the term leaky gut is trending that you are experiencing it. But if you are not feeling well and your doctors have been unable to get to the bottom of your symptoms, it might be time to see a specialist. As a GI Specialist Dietitian, I help women get to the bottom of their GI issues for good.

You’ve been struggling with bloating and other belly issues, so you think to yourself, do I have IBS? What you should really be asking yourself is: “Do I have IBS or something else?”. An accurate diagnosis of your digestive issues is critical for being able to have effective treatment. Photo by Cookie the Pom on Unsplash It's not a surprise that IBS can be difficult to deal with. IBS symptoms can range from feeling bloated and uncomfortable in your stomach, to having diarrhea or constipation. The good news is that IBS doesn't have to rule your life. In this post, I’ll walk you through steps to ensure that you have an accurate diagnosis so that you can partner with a healthcare professional to resolve your symptoms. What is IBS? You just got the new diagnosis, explaining your symptoms that have been forcing you to the bathroom again and again: IBS. First off, what is IBS, exactly? IBS stands for irritable bowel syndrome. IBS is a chronic disorder that affects the large intestine and by proxy, the rest of your body, too (hello fatigue and brain fog) (1). There are a lot of potential causes of IBS. It surprises a lot of my clients that management of IBS isn’t just about food; it is about getting down to the root causes of why your IBS flared up, to begin with. Food is an integral part of the solution, but so too is stress management, supplements, sleep, and more. If you’re interested in diving a little deeper into causes, check out my post: Top 5 Root Causes of IBS That You Should Know About. Symptoms of IBS IBS can present itself in many ways: Constipation or diarrhea (or both) Feeling bloated after eating Cramps and stomach pains Feeling full too soon Fatigue What makes diagnosing IBS tricky is that those same symptoms are also caused by other conditions. That is why it is important to have an accurate diagnosis so that you receive the care and treatment you need to feel your best. For example, SIBO and IBS have a lot of overlapping symptoms...and it is possible that you can have both conditions at the same time. Yikes! What about H. Pylori and SIBO: Can you have both? And to further complicate things, IBS symptoms aren’t always the same. Symptoms can wax and wane and sometimes we can have LOTS of IBS symptoms, known as a flare. If this sounds like you, I have strategies for How to Calm IBS Flare-Ups: Things You Can Try Today. Don’t self diagnose yourself IBS or something else? This is a question many people ask themselves when they experience symptoms such as abdominal pain, diarrhea, and bloating. Unfortunately for those who suffer from IBS, there isn't an easy answer to this question. Symptoms of IBS are very similar to other gastrointestinal diseases like Crohn's disease, ulcerative colitis, and celiac disease, which means that it can be difficult to diagnose without the help of a medical professional. Let's take a look at some symptoms associated with IBS so you know what to expect if you think you might have IBS. Accurate diagnosis of IBS When it comes to first being diagnosed with IBS, it is very important to know that IBS is diagnosed by ruling out other things that share similar symptoms. There is not a specific test or lab marker for IBS, your doctor will come to that conclusion by ruling other things out (2). Expert tip: I recommend asking your doctor what has been ruled out to come to the conclusion that you have IBS. Celiac disease Celiac disease is always crucial to rule out anytime there are GI issues. People think Celiac only happens as children or only involves diarrhea and so if someone is 30 and has constipation they don’t suspect celiac...but that isn’t always the case. And as such, it doesn't always get ruled out by doctors. Good news: there is precise testing for celiac disease (3). Note: if you suspect that you might have celiac disease, please (oh please) don’t immediately eliminate gluten. Accurate testing for celiac disease depends on being able to measure your body’s reaction to gluten. If you’re not eating gluten, you cannot measure a reaction to it and therefore cannot have an accurate diagnosis. If you're wondering how long gluten stays in your system after eating it, check out How Long Does Gluten Stay in Your System After Eating It. Going gluten-free might actually help your IBS...but once again – for the seats in the back – you’ll want to have an accurate diagnosis before beginning your interventions. ​​Will Going Gluten-Free Help My IBS? A GI Dietitian Explains. Inflammatory bowel disease It's also good to know if inflammatory bowel disease (IBD) has been ruled in or out. IBD is a group of digestive health disorders that includes Crohn’s disease and Ulcerative Colitis (4). Testing for IBD typically starts with a calprotectin test for inflammation and if elevated then a colonoscopy is typically ordered. Other options There are a few more conditions to think about, too. Other conditions to rule out are H. pylori and SIBO. Your doctor should also be working to rule out infections and parasites. Why does an accurate diagnosis matter? Why is it crucial to have an accurate diagnosis of IBS or any other digestive health condition? Because nutrition plays a huge role in managing all of them, but the specific treatment has to match the condition. You need to get the RIGHT therapy for your symptoms. And in order to do that, we have to know what condition (or conditions, as you could have more than one) to begin with. It is completely normal to want to try different things to see if you can figure out what eating plan helps you to feel your best and to minimize symptoms. The problem is that without expert guidance, it is easier than you’d think to make mistakes that actually set your progress back. For example, when people consider the Low-FODMAP diet as their first step dietary intervention (new to that term? Here is my post with the full explanation: What is the Low-FODMAP diet?). The Low-FODMAP diet is evidenced based – there is great research to support its use for managing IBS. I’ve had a lot of clients make great strides with their IBS. But here is where the fine print comes in: you’re not supposed to be in the elimination phase of the low-FODMAP plan for forever...and a lot of my clients have been on elimination diets for far too long before working with me to safely add foods back in. Wondering if you’ve been on an elimination diet for too long? Check out this post for the full scoop: Have you been on an elimination diet too long? Key takeaways: IBS or something else? The most important thing to take away from this post is to have an accurate diagnosis of what is causing your symptoms. You cannot get the best interventions that will actually work without an accurate diagnosis - many different conditions share similar symptoms but need very different treatment plans.

Do you ever feel like no matter what you do, you can't seem to lose weight? You may be surprised to learn that the root of your stubborn weight might not simply be the balance of what you're eating vs. your activity level, but rather how your body is reacting to certain foods. There may be foods that you’re eating that are causing your immune system to go haywire. Enter food inflammation tests. Food sensitivities can play a role in weight gain and inflammation, and if that is the case for you, it is important to get tested for them if you want to achieve your overall health goals. In this blog post, we'll discuss the link between food sensitivities and inflammation, and we'll explore how a food inflammation test can help you identify which foods are causing problems for your body. First of all: what is inflammation, really? Photo by Graphic Node on Unsplash. What is inflammation? Inflammation is a normal and natural process in our body. In short, it's the body's natural response to injury or infection (1). For example, when you get a paper cut (ouch!) inflammation is what causes the redness and swelling around the wound. This swelling response happens because our bodies hold more water around the injured area creating space for healing white blood cells to easily get to the area. This is kind of like pulling over to the shoulder of the road so that an ambulance can get by more quickly. This kind of inflammation goes away once your finger is healed and is called “acute” inflammation. In some cases, however, inflammation can last for long periods of time, like months or even years. This is what we call chronic inflammation. We can’t really tell just by looking at someone that they have chronic inflammation because it is happening on the inside of their body, such as in their joints or along the digestive tract. This long-term inflammation is not so normal or natural and is the kind that we need to worry about. Why? Because chronic inflammation can lead to various health problems ranging from (2): ● Type 2 diabetes ● Alzheimer's disease ● Crohn's disease ● Psoriasis ● Increased risk of stroke ● Cardiovascular disease ● Insulin resistance ● And more! Many things can cause inflammation, including stress, environmental toxins, and even obesity (talk about a vicious cycle). Chronic inflammation can also be a reaction to foods that we eat. If we have an overreaction to a food, that can be an allergy or a sensitivity. In this post, we are talking about food sensitivities. What is a food sensitivity? A food sensitivity is your body having an over-reaction to a food that is different from an allergy. An allergic reaction is usually quick and can be life-threatening. A food sensitivity is usually a slower response, but it can still make you feel like, ahem, garbage. Food sensitivities are also harder to pinpoint than allergies because they can take up to 72 hours to show symptoms. If you have a hard time remembering what you ate yesterday, or heavens, two days ago, you’re not alone. What’s tricky is that even healthy, anti-inflammatory foods can be the culprit (3). I’ve had clients with sensitivities to salmon, blueberries, and almonds – all “healthy” foods. That’s why testing is so important; generic anti-inflammatory food lists are not tailored to your unique needs. If you’d like to dive a little deeper into the three ways our body can have a negative reaction to foods, check out this post: Understanding food allergy, sensitivity & intolerance. Food sensitivity symptoms So how do you know if you have a food sensitivity? Symptoms vary from one person to the next, but they might include: ● stuffy nose ● headache ● joint pain ● digestive issues ● brain fog ● weight gain or difficulty losing weight Food sensitivities can cause inflammation and that is one reason they might be linked to weight gain. When we are inflamed, our bodies hold on to water and that can show up as a few extra pounds on the scale. In my practice, I have worked with many clients who are struggling with joint pain. As many of them are overweight, they assume that it is only their body size that is contributing to the joint pain. In my experience, the extra weight isn’t helping, but it also isn’t the whole explanation of why they’re having painful, stiff joints. Inflammation, often caused by food sensitivities, is a factor as well. Good news: with the right food sensitivity test, you can find out for sure if you have issues with any foods. So how do you know if you have a food sensitivity, or something else? You may want to consider a food sensitivity test. Are food sensitivities causing my weight gain? It's possible. Food sensitivities can cause inflammation. When our bodies are inflamed, they hold on to water. Inflammation can cause weight gain. If you're struggling with your weight and think food sensitivities might be to blame, there are a few things you can do. Less directly, if you’re struggling with food sensitivities, you might not be feeling your best. If you’re struggling with headaches, joint pain and brain fog, you’re not going to feel as motivated and able to cook the nutrition meals that you want to eat. Less healthy meals can further the spiral to inflammation and weight gain. Not all weight is fat tissue But first, is all weight adipose (aka fat) tissue? We tend to think of any change on the scale as a gain or loss of fat tissue. But the truth is, we are far more complicated than that. Our weight includes our hydration, our muscle tissue, our skeleton, and yes, our fat tissue. Our weight is also influenced by whether we are inflamed or not. When we are inflamed, our bodies hold on to extra water. While you might just be looking at the scale, there are so many other health issues to think about that can make that number go up or down. Chronic inflammation is a big factor, and ultimately, that's part of what taking a holistic approach is about. And getting a handle on the whole big picture is how I’m able to help my clients achieve success that lasts. Where do I begin? By ruling other things out. Rule out other possible issues, first. You know the saying in medicine, “when you hear hooves, think horse, not zebra?” In my practice, it is important to rule out other possible explanations for why my clients are not feeling their best. No one wants to be held back by brain fog, poor sleep, achy joints, and stubborn weight! By finding the root causes, we get to make a plan for achieving our best health and wellness. A diagnosis is easy to get wrong and unfortunately, being wrong is risky. For more info about that, please check out my post about IBS and why I have a No Self-diagnosis recommendation. As we work together, my clients and I consider a few things. This includes: ● Current dietary habits ● Current physical activity ● Sleep patterns ● Hormone balance ● Thyroid health ● Leaky gut ● Current medications - is weight gain a side effect? Leaky gut is often part of the picture, and so clients are wondering how long it takes to heal that. I wrote a whole blog post on that, right here: How Long Does It Take to Heal Leaky Gut? And if you have leaky gut, your body is more likely to have food sensitivities. Photo by National Cancer Institute on Unsplash. Next, consider food sensitivity testing What is the best food sensitivity test? There are a few options; some are better than others. Food sensitivity tests are somewhat trendy, and the right tests are helpful, but not everyone has food sensitivities. Plus, many factors work together to influence how you feel on a day-to-day basis, including what you eat. But if we ignore the rest of the factors, optimizing only what you eat will not achieve your best health. The simplest way to explore how foods make you feel is to keep track of what you’re eating and how you’re feeling. After a week or two, you may be able to identify patterns between specific foods and changes in how you feel. The trouble is, that it can be difficult to identify those links between foods and symptoms because the symptoms can be delayed by a few days. For a more precise and accurate approach, I work with my clients using a food sensitivity test called MRT, which stands for Mediator Release Testing. What makes MRT testing different from other options for food sensitivity testing is what it is measuring. This test, measures how your body reacts to 140 different foods and is the only test that also measures the body's response to 30 food chemicals (both naturally occurring like solanine in nightshades and man made like food colorings). Ready to delve into a bit of science? Our immune systems are complicated. Your body is working hard to keep you safe from unwelcome invaders, injuries, and anything that might be considered “bad news bears”. Your immune system can track and send messages in a few different ways. Some food sensitivity tests look at a protein messenger called IgG, which is kind of like putting a name tag on a particle. This antibody helps our body to label things, like, “Hello, my name is carrot, we’ve seen this before”. However, our body being able to identify something doesn’t automatically mean that we’re having a bad reaction to it. Photo by Fernando Andrade on Unsplash Some food sensitivity tests are just measuring IgG antibodies, which have not been well correlated to people having symptoms (4). What makes MRT testing different is that it is measuring the inflammatory chemicals (mediators) that the body produces in response to a food that we are sensitive to. MRT looks at: ● Cytokines ● Histamine ● Leukotrienes ● Prostaglandins ● And more! Our body doesn't release these molecules just to slap a name tag on something; it means that we know what this thing is and we don’t like it. MRT testing helps us to really understand what foods are making you feel crummy and which foods are safe. From there, we get to make a comprehensive plan that we are confident will help you to feel better. A comprehensive approach If you’ve felt like you've tried everything before and are still frustrated by your weight, fatigue, and joint pain, know that you’re not alone. Nutrition can feel really confusing. And it doesn’t help when not-so-helpful friends, doctors, and nurses offer terrible advice like “just eat less and move more.” Your health is far more complicated than that. That’s why my clients see better results. We use the best food sensitivity test available and formulate a plan to achieve your best wellness. Food sensitivities, inflammation, leaky gut, and other factors all play a role. Food sensitivities do not have to be permanent, but you have to be able to identify the root causes in order to calm down your immune system. Key takeaways: Food sensitivity testing So, while a person may just be looking at the scale, there are so many other implications for health issues that weight gain and chronic inflammation contribute to and ultimately, that's part of what taking a holistic approach is about - looking at all the aspects. With the right food sensitivity test – The MRT test – you and I can identify not only the foods that are making you feel crummy but also the foods that will make you feel your best. We’ll also explore your lifestyle, stress levels, physical activity, and all of the other factors that are contributing to how you feel today. And then, you’ll finally have clarity – and a plan – that empowers you to finally feel great. Sounds pretty good, doesn’t it? I can’t wait to get started with you. Your next step to get started is to schedule an initial visit. We’ll review your health history, I’ll be able to answer your questions and we’ll get this show on the road.

If you are experiencing symptoms that you cannot explain, it is important to know that the explanation may not always be obvious. For example, did you know that if you have celiac disease, warts can be one unexpected symptom? Is important to be aware of all the possible symptoms. Many people with celiac disease don't know they have it because the symptoms can be so varied and subtle…including warts! In this blog post, I’ll give you a full explanation of what celiac disease is and how to manage it. I will also explain why it is so important to see a doctor if you are experiencing any unusual symptoms, even if you think they may not be related to celiac disease. And once you have an official diagnosis, working with a dietitian is your best path forward to managing your condition, and to feeling great, even through your busy life, while traveling, and while visiting with friends and family. And if you're new here: welcome! My name is Marissa Mekelburg MS, RDN, CLT, HHP and I am a registered dietitian who specializes in digestive health. Let's kick off this post with an intro to celiac disease: what is it? Photo by Dustin Humes on Unsplash What is celiac disease? Celiac disease is an autoimmune disease in which the body attacks the lining of the small intestine when gluten (a protein found in wheat, barley, and rye) is consumed. This can lead to damage to the villi, which are tiny finger-like projections that line the small intestine and help with nutrient absorption. When your digestive tract is damaged – as in uncontrolled or undiagnosed celiac disease – there are a lot of potential consequences and symptoms (more on those in a moment). Celiac disease can develop after genetically vulnerable people begin eating gluten. Without treatment, celiac disease can progress to more severe health concerns. It surprises a lot of people just how common celiac disease is. Estimates are that about 1 in 133 people have it, but unfortunately, only about 1/3 of those with celiac disease have a proper diagnosis (1). If someone in your immediate family has celiac disease, you have a one in ten chance of developing it yourself (2). This is a big deal because untreated celiac disease has the potential for many serious consequences. Symptoms of celiac disease Did you know that there are an estimated 200 symptoms related to Celiac disease? This is pretty surprising to most of the clients that I've ever worked with. Celiac can show up in some pretty unexpected and challenging ways (and yes, you may be at increased risk of warts). Most of us probably think about GI symptoms with celiac, such as diarrhea and belly pain, but the truth is that those symptoms are actually more common in kids, and there are a lot more symptoms that can show up. As I mentioned above, if you’re eating gluten and have celiac, you’re going to have damage to your small intestine. This damage leads to a variety of symptoms that may occur not only because of the direct damage to the tissue but also because of the following nutrient malabsorption (damaged tissue doesn’t absorb the nutrition from your food nearly as well). Remember that gluten damages the villi of the intestine, the part where our body absorbs nutrients from food. There may also be symptoms that stem from cross-reactivity and/or molecular mimicry of other foods. Common foods such as cheese and chocolate (gasp!) can fool your body into thinking that you’ve eaten gluten and then cause symptoms (3). This is one thing I consider if someone is still symptomatic even being gluten-free. Some symptoms seem unusual for celiac but are actually pretty common. On top of that, celiac can present pretty differently in children than in adults. This disconnect is just another vote for more education in this area, not just for the general public but for medical professionals, too. Common celiac symptoms in children: ● Anxiety and depression ● Attention-deficit/hyperactivity disorder (ADHD) and learning disabilities ● Damage to tooth enamel ● Delayed puberty ● Failure to thrive ● Fatigue ● Headaches ● Iron-deficiency anemia ● Irritability ● Seizures and lack of muscle coordination ● Short stature ● Weight loss Common celiac symptoms in adults: ● Cognitive impairment ● Depression and anxiety ● Fatigue ● Headaches or migraines ● Iron-deficiency anemia ● Itchy, blistery skin rash (dermatitis herpetiformis) ● Joint pain ● Missed periods ● Mouth ulcers and canker sores ● Osteoporosis and osteomalacia ● Peripheral neuropathy ● Reduced functioning of the spleen (hyposplenism) ● Weight loss ● Infertility/high rate of miscarriage ● Skin issues, including warts Skin issues – including eczema, psoriasis, acne, chronic dry skin, hives, atopic dermatitis, and alopecia – may be more related to the damage/leaky gut/food sensitivities caused by the damage to the intestine vs the celiac disease itself. This topic is a bit controversial because the research is limited (4, 5). It is also possible to have skin issues that look like warts, but are actually other issues, such as Gottron’s papules, and end up discovering that you have celiac (6). With celiac, there is also an increased risk of cancer – most common types associated with celiac disease are enteropathy-associated T-cell lymphoma (EATL), non-Hodgkin's lymphoma, and adenocarcinoma of the small intestine (7). However, following a gluten-free diet reduces this risk dramatically (8). How to diagnose celiac disease? Celiac disease is diagnosed by a doctor. To journey to an accurate and official diagnosis of celiac disease start with a blood test. The lab is looking for an antibody that shows that your body is having an overreaction to gluten. VIP note: in order for this lab test to work, you have to be eating gluten. If you’re not eating gluten – even if you have celiac disease – this test will not find any antibodies in your blood; your body only makes them if you’re experiencing a reaction to gluten. No gluten, no reaction. There are a few blood tests that involve an alphabet soup of letters: ● Tissue transglutaminase (tTG) antibodies tTG IgA and tTG IgG ● Deamidated gliadin peptide (DGP) antibodies DGP IgA ● Deamidated Gliadin Peptide DGP IgG If the blood tests come back positive, it is recommended that you confirm your celiac diagnosis with an intestinal biopsy; this is considered to be the gold-standard (9). If your interested in testing for celiac disease, here is my affiliate link for at home testing https://www.imaware.health/?ref=wholisticworks Once you have a diagnosis – what is the treatment? What is the treatment for celiac disease? The treatment for celiac disease is both simple and complicated. The number 1 treatment for celiac disease is a gluten-free diet…with 100% compliance. You need to remove 100% of the gluten from your diet. Simple, right? Unfortunately, no. Gluten lurks in a lot of unexpected places and it can be tricky to figure everything out. And in the beginning, it can feel pretty darn overwhelming. Eating at restaurants? Picking the right condiments? How to eat over the holidays and so on. And beyond that, a lot of your favorite foods may contain gluten, so it can be a bit of a grieving process to learn to live without those exact foods and treats. Sometimes people think if they only eat gluten occasionally, that if they don’t eat gluten 95% of the time, that they’re gluten-free. Unfortunately, that isn’t the case. If you’re eating gluten, any gluten at all, you’re not gluten-free. And if you are eating gluten with a diagnosis of celiac, you are causing damage to your GI tract. Damage comes with the risk of many long-term complications mentioned above like peripheral neuropathy, increased risk of cancer, anemia, osteoporosis, and reduced spleen function. These possible consequences are still very real, even with low-gluten, or “mostly gluten-free” diets. On top of that, people with celiac disease have to be very careful about cross-contamination in their kitchen and anywhere else they eat food; this includes in restaurants and at friends’ houses. Eliminating the risk of cross-contamination may mean having your own set of cookware, utensils, cutting boards, and rolling pins (this is especially important if a person is doing hand washing vs using a dishwasher. A dishwasher can reduce a lot of this need). I recommend avoiding wooden utensils or cutting boards. Use separate pizza stones, and use aluminum foil or a separate cast iron pan if sharing a grill. Best case scenario: if there is gluten in your house and you’re following a gluten-free diet, have a shelf that is for gluten-free foods. I also recommend separate condiments and sandwich spreads like nut butters so that the risk of having touched gluten-containing foods is reduced. Use clean dishcloths and change them out after picking up breadcrumbs. Wash hands well and change out the hand towel frequently. The level of diligence required to prevent accidental gluten exposure is intense. It may make you wonder if there is a cure. Photo by Wesual Click on Unsplash Is there a cure? Gosh, I wish there was a cure, but at this point, there is no cure for celiac disease. The only treatment is to avoid all forms of gluten for the rest of your life. This can be difficult, but it's important to remember that celiac disease is a severe autoimmune disorder, and consuming even a small amount of gluten can cause damage to the small intestine. Common mistakes made with following a GF diet In my experience, there are a few common mistakes that people make when following a gluten-free diet. Let me share those here to spare you from making the same mistakes! Cross-contamination Not being aware of cross-contamination. This includes “nonfood items” like toothpaste, mouthwash, lip balms, nutritional supplements, and even medications. Not reading (or understanding) food labels For example, thickeners in soups may be from wheat, many vegetarian meat substitutes use wheat, additives like malt extract in cereals (like Rice Krispies) contain gluten since it is barley derived, and sometimes lunch meats will have “modified food starch” which may stem from wheat. Products may also list “produced in a facility that also produces wheat/gluten” so the risk of cross-contamination exists. Too much-processed food I’ve seen plenty of clients relying on too many processed gluten-free foods. While convenient, they usually are not all that nutritious and may contain extra fat, sodium, or sugar to help make them taste better. Also, many gluten-free foods (like bread) rely on a lot of starches, so they contain very little fiber or nutrition. Processed gluten-free foods also bring with them another issue and that is that in order to be considered “gluten-free” they have to have less than 20 PPM of gluten per serving. This means that legally something could have 19 PPM of gluten and still be able to be labeled gluten-free. So, if a person is relying on a lot of these types of foods, a small amount of gluten builds up after consuming enough. I have seen this in practice and once we reduce the amount of packaged foods, symptoms start to clear. Instead of processed foods, I recommend focusing on whole foods that are already naturally gluten-free like fruits, vegetables, proteins, beans, nuts, and seeds. Gluten-free: now what? It is normal to wonder what you can expect after removing gluten. When will you start to feel better? It can take time to feel a difference from removing gluten primarily depending upon the extent of the damage to the gut. If someone is an adult and has been eating gluten for 30 or 40 years, that’s a lot of damage to heal so it’s going to take time. It is important to be prepared with accurate information. If you’re expecting your symptoms to resolve very quickly, and they don’t, you might wonder if being gluten-free is even worthwhile. If you have celiac disease, I promise that gluten-free eating is extremely important, but it takes a while to recover. Related post: How Long Does Gluten Stay in Your System After You Stop Eating It? Along those lines, the more damage there is, the more there can be issues like food sensitivities that are contributing to additional inflammation and more issues with food. Working with a registered dietitian can help you make more progress, more quickly. How an RD can help Working with an experienced RD can help you to get set up for success and to make progress much more quickly as you embark on a gluten-free diet. I can help you to become a label reading expert and confidently prevent cross-contamination and the resulting risks. Sometimes you can think that you’re following a 100% gluten-free diet but are actually having some sneaky sources of cross-contamination…I can help you to identify those so that your gluten-free diet is, in fact, fully gluten-free. And because I am also an expert in food sensitivities and nutritional deficiencies, I can help anyone who has been diagnosed, and is gluten-free but still symptomatic (it is so frustrating but I can help get to the bottom of things!). We can do MRT testing to help further identify problematic foods and reduce inflammation. We can also do nutrient testing to identify what may be deficient and help identify foods and supplements to support needed nutrients. This work helps you to fully heal your gut so that you finally (finally!) feel good again and greatly reduces your risk of complications in the future. Competently managing your celiac disease with a fully gluten-free diet is immensely important but the learning curve is steep. It is far easier with an expert guide. If you’re ready to chat about how I can help you finally feel better, please book an initial session right here. You deserve to feel good again.

It's that time of year again - cold and flu season. It seems like everyone you know is sick, and you're just waiting for your turn. Or maybe you've already been struck down by a virus and are looking for ways to speed up your recovery. Either way, a strong immune system is key to keeping yourself healthy during the winter months. In this blog post, we will discuss how to evaluate just how strong your immune system is (we have a 5-question quiz) and tips to improve it! If you're new here: welcome! My name is Marissa Mekelburg MS, RDN, CLT, HHP and I am a Digestive Health Dietitian Nutritionist specializing in the personalized nutritional management of GI conditions such as IBS, food sensitivities, and autoimmune conditions. I help people just like you get to the root causes of their health issues and finally feel good again. As a digestive health dietitian, the number one thing is to acknowledge that 70-80% of the immune system is in our gut. This means that there is an intricate balance between the microbiome, gut health, local gut immune response, as well as systemic immunity. They say that the gut is the key to all health and that is not an exaggeration (1). With that in mind, you'll be able to read through this guided quiz to assess if your immune system is supported by your lifestyle habits and nutrition...or if there is some room for improvement. Let's dive in. Photo by Deva Williamson on Unsplash Question 1: Are you eating a lot of added sugar? Do you have a sweet tooth? Unfortunately, if you overindulge on sweets and highly processed carbs, it can weaken your immune system. How? The explanation is that when we over consume sugar, it can lead to dysbiosis (an imbalance of gut flora) which then creates an inflammatory environment and can weaken our immune response (2, 3, 4). Foods that significantly raise blood sugar – such as those high in added sugars – increase the production of inflammatory proteins like tumor necrosis alpha (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6), all of which negatively impact your immune function (5). So if you find yourself eating a lot of candy, desserts, or processed foods with added sugars (think: sweet drinks, desserts, granola bars, and sweetened yogurt), it can make it harder for your immune system to fight germs. What counts as "a lot"? The CDC recommends keeping added sugars below 10% of your total calories (6). However, if you’re eating an average of 2,000 calories, that represents 200 calories or 12 teaspoons of added sugars…in other words, ¼ cup of sugar. That’s still a lot! I recommend that my clients keep their added sugars as far below 10% as possible, making progress each week. Question 2: Are you eating a lot of processed foods? While there isn't a strict definition of what "processed foods" means, I'm referring to packaged foods that may have a lot of preservatives and ingredients added that can impact gut health, and/or a fair amount of the nutrients removed. While slicing an apple and dunking the slices in lemon juice is technically "processing", I am actually thinking about the kinds of foods like crunchy packaged snacks with highly refined flour, sugar, dyes, and preservatives, frozen dinners with a bajillion ingredients, and bags of piping hot goodies from the drive through. Why does it matter? A diet rich in processed foods can mean there are nutrient deficiencies such as Vitamin A, D, C, and zinc. Each of these nutrients is crucial for a healthy immune system. Nutrient deficiencies can also contribute to chronic low-level inflammation which goes back to the above conversation about the dangers of a dysregulated innate immune system. What counts as "a lot"? I recommend that my clients keep the 80/20 guideline in mind: most of the time – 80% or more – choose whole, real foods. And then sometimes – 20% or less – have foods that feel more like a splurge. Over the course of a week, that amounts to about a few meals. Question 3: Are you eating a lot of Omega-6 fatty acids? If you're thinking about omega fatty acids, you're probably thinking about omega-3 fatty acids, the kind of essential fats that you find in healthy foods such as salmon and walnuts. Omega-6 fatty acids are also essential, but we usually have too much of them. More of a nutrient is not always better. Omega-6 fatty acids are found in many foods, including soybeans and corn (7). As we have more processed foods, they tend to be high in soybean oil and corn oil and so you get a lot of the omega-6 fatty acids. With less processed foods, you’ll reduce your omega-6 fatty acids. What we need for optimal health is not just measured in a set amount. While these fatty acids - omega-3 and omega-6 - are essential, we need them in an optimal ratio (8). When we have too much omega-6 and too little omega-3 (as is very common in the US) we can have inflammation crop up again. Question 4: Are you exercising? I know that it is not going to surprise you that I'm qualifying exercise as "healthy", but it may surprise you to learn that exercise has benefits beyond muscle strength and cardiovascular health. Exercise is actually being studied as a possible modulator of the microbiome; i.e., those who exercise consistently have better gut health. And as we keep learning, gut health is the foundation of all health, including your immune system. In addition, we know that exercise helps to reduce stress, which is a good thing for the immune system. Stress also impacts the immune system (and not in a good way). More on that in a moment. How much is enough? First of all, I encourage my clients to find movement that they actually enjoy. Doing something because you should is not going to stick because that is depending on willpower, which won't last. We're human. Instead: work on building a movement routine that brings you joy, in addition to the health benefits. As for me, I love lifting weights, rebounding, using the elliptical, yoga, hiking and walking. And enough? I recommend starting where you are and building from there. If you’re currently sedentary, start with 20-30 minutes of walking a few times per week and build from there. If you try to jump into a habit of five miles a day, seven days a week, you’ll be more likely to get sore (and possibly injured) and get burnt out. Better to build your habits in a slow and steady manner that will stick. Eventually, the goal is to have 30 minutes of movement most days. Aim for a mix of strength training, cardiovascular activities and stretching, too. Photo by Jon Flobrant on Unsplash Question 5: How're your stress levels? If your stress level was registering on a dial, would it be in the red? Not good for the immune system, I'm afraid! When we’re stressed, the immune system’s ability to fight off antigens is reduced, making us more susceptible to infection when stressed. The stress hormone cortisol can suppress the effectiveness of the immune system (e.g. lowers the number of lymphocytes). Stress can also have an indirect effect on the immune system as a person may use unhealthy behavioral coping strategies to reduce their stress, such as drinking, smoking, or eating sugary foods, etc. (P.S. Alcohol is especially problematic if you have SIBO. I explain in detail here: Alcohol and SIBO: The Dietitians’ Definitive Guide.) How can you boost your immune system? As we head into shorter days where we are exposed to less sunlight and are making less vitamin D…and holidays with more alcohol and sugary treats, what can we focus on to help keep our immune system strong? We can make changes to our daily routine that boost our immune system. You might be surprised at how simple some of these changes can be…with a big immune-boosting impact! Here is what I recommend! Include immune-boosting foods and supplements I recommend that you seek immune-boosting foods as regularly as possible. Vitamin A helps to protect against infections, increases white blood cells, and supports t-cell function. Vitamin A is found naturally in (9): ● Fermented cod liver oil ● Liver ● Carrots and other orange vegetables ● Spinach ● Kohlrabi Vitamin C has antiviral, antibacterial, and antihistamine functions and also boosts antibody production. Vitamin C is found naturally in (10): ● Papaya ● Red bell pepper ● Strawberries ● Citrus fruit ● Camu camu ● Goji berries ● Incan berries Vitamin D activated T-cells reduce the severity of autoimmunity, and enable monocytes to kill more viruses. While we can get vitamin D from the sun, the sun is not strong enough in the winter in most places to make much. Food sources of vitamin D include (11): ● Liver ● Grass-fed butter ● Fatty fish ● Egg yolks ● Fermented cod liver oil Pro-tip: I recommend getting your vitamin D blood levels checked next time you’re at the doctor’s office. Ideal levels are between 50 and 80 ng/mL. Zinc and selenium: these two minerals both boost the immune system. Zinc can shorten the duration and severity of the common cold. You can find these minerals in (12, 13): ● Liver ● Beef ● Oysters ● Scallops ● Lamb ● Oats ● Sesame and pumpkin seeds ● Brazil nuts Fiber is so important for our immune system; it is not just valuable for regularity. Rather than reach for a supplement, get fiber naturally from: ● Fruits and vegetables ● Whole grains ● Beans, peas, and legumes ● Nuts and seeds Fermented foods also support gut health and your immune system. Beyond yogurt, live and active cultures can be found in: ● Sauerkraut ● Kefir ● Kombucha (be mindful of added sugar here) ● Miso ● Kimchi Herbs that can boost your immune system include: ● Elderberry ● Garlic ● Echinacea ● Turmeric Mushrooms contain a special kind of fiber called beta-D-glucan which can help to improve your immune system. Mushrooms can be enjoyed with your meals, such as shiitake, but you can also get the benefits of mushrooms in the form of a tea, tincture, or powder. Examples of immune-boosting mushrooms include: ● Shiitake ● Maitake ● Chaga ● Reishi ● Turkey tail Photo by Thanh Soledas on Unsplash Reduce stress We can’t avoid stress entirely, but a lot of our health has to do with how well we manage and move through stress. Activities like walking, meditating and deep breathing are all solidly backed by a large body of research (14, 15). Exercising, yoga, and time with friends and family that you enjoy are all ways to reduce stress and boost your immune system (16). If you haven’t been finding time for movement or connection, stop right now and mark your calendar for a quick walk in the next day or two. And, send a text to a friend you’d like to connect with and schedule a time to do that. Your mood (and immune system) will thank you. Get enough sleep Did you know that if you’re not getting enough ZZZs, your immune system pays the price (17)? Winter is a perfect time to cultivate better sleep habits. It gets dark more quickly and the cold weather is just begging for you to get cozy, have a warm cup of tea (how about a mushroom tea?), and dive into a good book. Aim to get to bed by 10 pm at the latest. And instead of screen-on-screen time (scrolling on your phone while also watching Netflix), create a winddown routine that might include a warm bath, some gentle stretching, and a good book. You can enjoy some aromatherapy to help relax such as using some lavender essential oil. You can also boost your sleep with specific bedtime snacks, like pistachios: Do Pistachios Help You Sleep? Yes! Overall, little habits can snowball towards an immune system that is less equipped to fight off viruses and bacteria…or your habits can strengthen your immune system to be able to avoid illnesses as much as possible. Key takeaways While there is no single way to measure the strength of your immune system, a self-quiz such as this post can offer a glimpse into how your habits are impacting your health – and immune system – overall. Cutting back on added sugar, boosting fermented foods, fruits, and vegetables, having adequate vitamin D and sleep, and reducing stress are all foundational habits to support your overall wellness (not to mention, your immune system). I also know that implementing these habits is far harder than you’d guess. Life is busy and processed foods are so convenient. If you’d like some support with these changes, so that you can make progress with fewer roadblocks (and less frustration!) give me a call! Your immune system will thank you.

Is your sweet tooth harming your health and causing your digestive issues? You may be wondering if a sugar detox benefits your health. The answer to both? Maybe. While I am no fan of fad diets or "cleanses", there is some truth to merit cutting back on added sugars, whether or not you call it a detox. Hi! I’m Marissa, digestive health dietitian nutritionist. In this blog post, I’ll be walking you through the facts about sugar, how much is too much and if you should consider a sugar detox…or not. Let’s dive in! Photo by Mae Mu on Unsplash What is a sugar detox? A sugar detox is simply a term for taking an honest look at what you're consuming on a daily basis. Sugar is sneaky and added to foods and drinks in surprisingly large amounts. The first step is to do some sleuthing so that you can accurately acknowledge how much sugar you’re consuming on a regular basis. Enter the detox: this is where you make a conscious effort to reset your nutrition by reducing or eliminating sources of added sugars. Why do a sugar detox? Why do this? Because excess sugar has been linked to an increase in many serious health conditions such as ● fatty liver disease ● heart disease ● type 2 diabetes ● obesity In addition, added sugar can lead to poor immune function and can contribute to poor oral health (1, 2, 3, 4). Whew! That is a lot of potential risk associated with one sweet food group! Bottom line: sugar is inflammatory. Added sugar can worsen gut health and underlying infections. Too much sugar can lead to a scary downward spiral for your health. If you’re ready to consider doing a sugar detox, the first step is to know what counts as sugar and how much of it you’re eating (and drinking) on a daily basis. Let’s explore that next. What counts as sugar? To gain the benefits of a sugar detox, we are targeting foods and drinks with added sugars. We are not needing to worry about fruits or vegetables that have naturally occurring sugars in them (more on this in a moment). Your bananas are safe! For your sugar detox, I recommend taking a careful look at your usual packaged foods. On the nutrition facts panel, added sugars have to be singled out. The foods that come to mind first include sweet treats like cookies, cakes, doughnuts, pancakes, french toast, jam, soda, candy, energy drinks, and coffee drinks (I see you, PSL). Photo by Sascha Bosshard on Unsplash Examples of high-sugar foods Let’s start with cereal, a food that is commonly promoted as a healthy food…but many times has a LOT of added sugar. An example is Honey Nut Cheerios™ (5). While promoted as “heart healthy” – sugar is the second ingredient, honey is the 4th, and brown sugar syrup is the 5th. All that sugar together means that one cup has a total of 12g of added sugars (about 3 tsp). Even Multi Grain Cheerios™ has 8g of added sugars. Another common favorite that my clients like is Special KⓇ Red Berries Cereal. Once again sugar is the 3rd ingredient; a serving has 10 grams of added sugars. And let’s be honest here, most people just pour a bowl, right? They don’t measure, so they could be getting twice that amount of sugar in one sitting. Not to mention, if additional sugar is added as well. Instant oatmeal is another popular breakfast choice…and most people don’t choose plain, they get flavors like maple brown sugar (14g added sugar) or apple cinnamon (11g added sugar). Breads, even “healthy” whole wheat bread can have 3g of added sugar per slice, so when making a sandwich with two slices, you have 6 added grams. So then if that is paired with a soda for lunch (a 12oz soda on average has whopping 39 grams of added sugar!) and they had an instant oatmeal for breakfast – it can add up really quickly. Other foods are things like sweetened dairy products such as yogurt. Popular brands such as Yoplait ® Original Strawberry Yogurt has 13 grams of added sugar (6). Sauces, dressings and marinades, granola bars, many protein bars, dried fruit, nut butters, and that super large, sweetened coffee drink all contain added sugars. Ultimately, added sugar is sugar whether it comes from white sugar, honey, maple syrup, brown rice syrup, etc. and when trying to reduce added sugars in the diet, all forms need to be considered. Do I need to cut ALL added sugar? The answer to this depends on your goals. But probably. My recommendation to you depends upon whether you’re trying to reduce your added sugar intake or cut it out completely. Some people choose to do a no-sugar detox for a certain number of days to really reset things and help reduce the desire for sugar. Having the chance to reset your taste buds can help things to go more smoothly when you begin an eating pattern that focuses only on natural sugars in smaller amounts. What about artificial sweeteners? I don’t love artificial sweeteners. While the research on their potential risks and benefits continues to unfold, there is some research that is particularly important for the clients I help. There is research on some artificial sweeteners that show they can alter the microbiome. In my work, gut health is the foundation of all health and so I am quite wary about anything that can set back my clients' hard work to heal (7). Ideally, you want to reset your palate to appreciate natural sweetness instead of requiring the intense sweetness of artificial sweeteners. However, if you enjoy a plant-based sweetener such as stevia or monk fruit, and that helps you to reduce your overall added sugar intake, then in moderation, go for it. Average sugar intake? In the US, the average adult consumes between 17 and 22 teaspoons of added sugar every day. That is a LOT! That’s between 6,205 and 8,030 teaspoons each year, which translates to between 65 to almost 84 POUNDS of sugar every year. OUCH! Remember those risks of too much added sugar we discussed earlier? Your usual choices really matter! Having said that, I also know that reducing your usual sugar intake can be a big challenge. Sugar has a large pull…it can even seem to be addicting. Is sugar addicting? Yes! Here is a study that even though it’s in mice, showed that the mice chose sweet over cocaine so literally more addictive than cocaine (8). Sugar stimulates the reward center in our brain. The more often we eat it, the more we are strengthening that connection to it. Taking a break is a challenge, but it can help to rewire our brains. Here are some tips to manage sugar cravings…you’re probably going to need them! Photo by Myriam Zilles on Unsplash How to manage sugar cravings Here are eight tips that have helped my clients to reduce their sugar cravings. While no tip can make sugar cravings go away completely, these tips can help you to move through these feelings of discomfort. You’ve got this! Make a balanced plate. Make sure meals are balanced with whole foods representing healthy fats, fiber,and protein. Eat meals and snacks at regular intervals. Don’t let yourself get too hungry, then the temptation is there for a quick sugary pick me up. Enjoy fruit. The natural sweetness can take the edge off of a craving. Get enough ZZZs. When we’re tired we crave sugar. Manage stress which contributes to cravings. Notice if there is a specific trigger for you. If you can’t pass by the Starbucks on your way to work without a large sugar-filled coffee drink, find a new route to work. Try something new. If you crave sugar, you can try drinking a glass of water or a fruit-flavored seltzer or even take a walk. Sometimes, just changing the habit that you usually grab a sweet treat for can help. Address root causes. Sugar cravings can also stem from candida overgrowth in the gut and/or nutrient deficiencies such as zinc, chromium, iron, calcium, and magnesium. So if someone is really struggling, it might be a good idea to run some functional lab testing. Get support Sugar is a tricky thing to navigate. It is added – by the bucket full – to so many of our usual foods and drinks. The risks of too much sugar are real, but it can feel really difficult to break ties. As a registered dietitian nutritionist and health coach, I can help you to get to the bottom of your sugar relationship. If you are craving sugar because of a nutrient deficiency or candida, you’re going to feel like you’re spinning your wheels instead of gaining traction. The right gut testing will help us to craft your personalized plan for success. In addition, I can help you create a personalized, whole-food anti-inflammatory diet that will kick those sugar cravings to the curb for good! Get started by scheduling an initial visit.