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

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

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

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

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

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

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

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

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

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

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

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

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

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

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