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

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! wholisticworks.com

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

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. wholisticworks.com

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

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 die t; 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. wholisticworks.com

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

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

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/ wholisticworks.com #digestive #IBS

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

“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. 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.

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