Can SIBO cause fibromyalgia?

Although fibromyalgia is among the most common causes of chronic, widespread pain (believed to affect an estimated 5 million people in the US alone) it remains one of the least understood. (1, 2)

Researchers generally agree that the key problem in fibromyalgia is a change in how pain signals from the skin, joints and muscles are processed in the brain, leading to the characteristic and diagnostic long-term, body-wide pain. (1, 3) But, to date, no one has been able to definitively prove what causes these changes, and how. (3, 4)

However, growing evidence suggests that fibromyalgia may be caused by poor gut health — specifically, by a condition called “small intestinal bacterial overgrowth (SIBO)”, in which colon bacteria begin colonizing the normally relatively sterile environment of the small intestine. (5)

Let’s explore this growing body of evidence, what it means, and it’s possible implications for ways to address fibromyalgia symptoms.

Fibromyalgia, SIBO and the Breath Test

The most direct, and perhaps the most important, evidence supporting the idea that fibromyalgia may be caused by SIBO came from a 2001 study by researchers at Cedar-Sinai Medical Center which first linked the two conditions. (6) Inspired by epidemiological studies that showed extremely high rates of gut dysfunction in people with fibromyalgia, (7, 8, 9) the researchers decided to look at the state of their intestinal health more closely. Close examination of the epidemiological studies showed that gastrointestinal symptoms reported by fibromyalgia patients were similar to the symptoms seen in Irritable Bowel Syndrome (IBS). (7, 8, 9)

Since previous work in the Cedar-Sinai lab had established strong links between SIBO and IBS, they thought looking for SIBO in fibromyalgia patients may be a smart place to start. (10)

So, they put it to the test!

They organized a group of 123 volunteers with fibromyalgia to undergo SIBO breath testing. Results showed that nearly 80% of the group tested positive for SIBO, a much higher rate than seen in healthy groups of volunteers, or even in groups of individuals with IBS. (6)

Though not conclusive proof of a direct link, this data was a huge tip-off that it might be a relationship worth looking into further.

Does SIBO Cause Fibromyalgia?

To determine if there was a causal relationship between SIBO and fibromyalgia, researchers set up an experiment that compared markers of SIBO severity to markers of fibromyalgia severity. If one condition causes another, generally you would expect that increasing the severity of that condition would directly cause a worsening of the other.

As a marker for SIBO severity, researchers used the amount of hydrogen detected in a SIBO breath test. Since the hydrogen detected in the test is made by the bacteria in SIBO, greater levels of hydrogen generally indicate greater numbers of bacteria. And as a marker of fibromyalgia severity, they used self-reported pain levels. (5)

When the data was analyzed, they found that, consistent with a causal relationship, greater levels of hydrogen production were associated with greater reported pain levels. (5)

Now the question remained: did SIBO cause fibromyalgia or did fibromyalgia cause SIBO?

In order to figure this out, researchers took a step back and took a look at all the evidence linking gut health, gut bacteria, brain function and pain regulation and asked themselves: which direction makes more sense? Which one does the scientific literature support more?

The clear answer here was — SIBO is more likely to cause fibromyalgia than the other way around. Close examination of all the evidence allowed researchers to find two step-by-step mechanisms by which SIBO could cause the symptoms of fibromyalgia.

Let’s look at them both!

SIBO May Cause a Tryptophan Deficiency

Tryptophan is one of the 20 standard amino acids and your body uses it to help build proteins. It is also absolutely critical for making an important chemical messenger used to carry nerve signals through the brain called serotonin. It is so important, in fact, that changes in tryptophan levels in your body is sufficient to directly change levels of serotonin in your brain. (11)

One of serotonin’s jobs in the brain is to modulate signals that control the sense of pain. (12)  Based on the symptoms of fibromyalgia, it was suspected that serotonin signaling might play a role in the disorder. And, indeed, when researchers compared those with fibromyalgia to those without the pain disorder they found that people diagnosed with fibromyalgia consistently had lower levels of serotonin in their bodies.  (13, 14, 15, 16)

So, how might SIBO be able to lower tryptophan and serotonin levels?

Well, tryptophan belongs to a group of amino acids called “essential amino acids.” This means that your body can’t make tryptophan by itself; you have to get all of it by absorbing it from the food you eat. SIBO can decrease your ability to absorb tryptophan in three ways:

1. By using up tryptophan from your food

Like us, bacteria use tryptophan to build proteins and keep their cell machinery functioning properly. They can even take it out of the food we eat, just like we can. (17) It doesn’t matter when bacteria do this to food in your colon because you’ve already absorbed what you needed while the food was still in your small intestine.

When colon bacteria move into your small intestine, though, like they do in SIBO, they may use up some of the tryptophan before you get a chance to absorb what you need, driving the levels of tryptophan in your body down. (17)

2. By damaging the lining of your small intestine

SIBO can damage the lining of your small intestine, where tryptophan should be absorbed. This damage may make it difficult for your intestines to absorb the tryptophan not snatched up by the bacteria normally. (17)

3. By decreasing sugar absorption

Changes in the function of your small intestine may also be able to decrease the ability of your body to absorb free sugars. Too many free sugars in your small intestine may directly impair tryptophan absorption. (16)

This is because free sugars, particularly free fructose, can react with tryptophan to create sugar-tryptophan complexes. These complexes are too big to be transported through the intestinal wall the way tryptophan normally is, so they can’t be absorbed. (16)

This, of course, may lower the amount of tryptophan absorbed by the body, and, in turn, lower serotonin levels. (16)

This theory of the development of fibromyalgia is supported by epidemiological studies which consistently show that the disorder is overwhelmingly seen in women; around 96% of those with fibromyalgia are women. (13)

Women’s bodies are less efficient at making serotonin out of tryptophan than men’s. This means that women need higher levels of tryptophan from their diets to make the same amount of serotonin. It also means that decreases in tryptophan absorption lead to a drop off in serotonin levels more quickly in women than men. If tryptophan deficiency were a driving cause behind fibromyalgia, one would indeed expect women to be at much greater risk for developing it, which is exactly what we see in the real world. (16)

SIBO Causes Systemic Inflammation

SIBO causes systemic inflammation, boosting levels of inflammatory chemicals throughout your entire body. (18, 19, 20)  

We now know that when these inflammatory chemicals get into the brain, they can directly induce changes in levels of two other chemical messengers believed to be involved in fibromyalgia called glutamate and γ-aminobutyric acid (GABA). (21) People with fibromyalgia have been consistently found to have an imbalance in signals carried by these two chemicals in a specific area of the brain, the insular cortex. (22, 23, 24)

This area is responsible for integrating sensory signals from the skin, muscles and joints of the body, including pain signals (25) and researchers strongly suspect that this imbalance in the insular cortex play a direct role in the pain dysregulation seen in fibromyalgia. (22, 23, 24)

This theory of the development of fibromyalgia is also strongly supported by epidemiological data. Studies consistently find that those with fibromyalgia have marked increases in levels of inflammation and oxidative stress in their bodies, (2, 19, 26) potentially stemming from SIBO.

What to Do if You Have Fibromyalgia

Given all we know about fibromyalgia, here are a few things to do if you want to reduce the symptoms you experience from this disorder:

1. Get Tested for and Treat SIBO

The evidence clearly supports at least getting tested for SIBO if you have been diagnosed with fibromyalgia.

SIBO is usually tested for by measuring the amount of hydrogen and/or methane in your breath over the course of several hours. It’s simple, non-invasive and may be covered by your insurance.

If your SIBO test comes back positive, your doctor may choose to prescribe a course of antibiotics for you which can kill off the bacteria in your small intestine. You can also use antimicrobial herbs to this effect.

SIBO is linked to a variety of medical conditions, so even if it turns out clearing SIBO does not affect your fibromyalgia, it is still something that absolutely should be dealt with.

If you’re interested in learning more about testing for SIBO and using antimicrobial herbs, check out my 8-week Build Your Biome program.

2. Support Healthy Serotonin Production

As discussed above, serotonin is very important when it comes to fibromyalgia. Here are some steps to take that may help support healthy serotonin levels in your brain:

  • Eat a diet full of tryptophan-rich foods, such as walnuts, rice, potatoes and dark chocolate (16)
  • Avoid foods rich in free sugars which might bind and inhibit tryptophan absorption, such as processed foods made with table sugar or high fructose corn syrup (16, 27)
  • Avoid foods containing aspartame, which can make it difficult for tryptophan to get out of your bloodstream and into your brain (16, 27)
  • Exercise regularly; physical activity has been shown to boost serotonin production in the brain and ease the symptoms of fibromyalgia (28, 29, 30)
  • Get outside; exposure to natural sunlight may boost serotonin production (29)

3. Decrease Inflammation and Oxidative Stress

The clear markers of systemic inflammation and oxidative stress in fibromyalgia also strongly suggest that steps to combat them may be useful in addressing fibromyalgia symptoms, even if determined not to be caused by SIBO.

Steps that may be useful in decreasing inflammation and oxidative stress include:

  • Eating a plant-rich diet; plants are rich in antioxidants and anti-inflammatory phytonutrients (27)
  • Avoid smoking and cigarette smoke which has been proven to cause oxidative stress throughout the body (31, 32)
  • Consider taking a CoQ10 supplement, which is a natural compound known to be depleted by oxidative stress and which has been specifically shown to be helpful in fibromyalgia (27)

If you have fibromyalgia, have you been tested for SIBO? Let me know in the comment section below!

Do Gut Bacteria Influence Autoimmunity?

Autoimmune disorders are conditions that occur when the body’s immune system attacks its own healthy tissues. There are many different autoimmune conditions, depending on which healthy tissues are attacked. Some examples include multiple sclerosis, rheumatoid arthritis and lupus.

Autoimmune conditions are often thought of as “rare” (1) because most of the individual disorders affect a relatively small number of people (2). As a disease class, though, autoimmune disorders are actually among the most common conditions in the United States.

In 2012, the U.S. National Institutes of Health reported that a staggering 23.5 million Americans have at least one autoimmune disease. According to the American Autoimmune Related Diseases Association (AARDA), however, even this remarkable number may be significantly too low, since it was calculated using data concerning diseases that are entirely autoimmune mediated. The AARDA estimates that, if all diseases believed to have any autoimmune component were included in the calculation, the real number of Americans affected by autoimmunity may actually be closer to 50 million.

That means that up to 20% of the population — or 1 in every 5 people — may suffer from autoimmune symptoms.

And autoimmune symptoms can be extremely severe. Depending on the tissues being attacked, autoimmune diseases can cause intense pain, disability, loss of quality of life, loss of income, and even promote premature death. (1, 3)  

Genetics are believed to play an important role (4), but so are a wide variety of environmental factors, such as birth-weight, infections, (5) dietary intake of certain compounds (like gluten, mercury or tryptophan), and exposure to toxins from things like cigarette smoke, air pollution and paint thinners.

While all of these factors have interesting implications for the development, prevention, and treatment of autoimmunity, this article will focus on the newly discovered connections between autoimmunity and the health of your gut microbiota.

Not only are these connections now among the most solidly established, (6, 7) they may also ultimately provide some of the most practical opportunities to develop new treatment options, since, unlike many other factors, gut bacteria are relatively easy to manipulate. (8, 9)

To fully understand the links between autoimmunity and gut bacteria, though, let’s first take a quick step back and look at how your immune system normally works, and what researchers now know goes wrong in autoimmune diseases.

THE HEALTHY IMMUNE SYSTEM & SELF-TOLERANCE

If you think about it, your immune system has a really tricky job. It has to scan your whole body all day, everyday and find dangerous bacteria, infectious viruses, and sick or malfunctioning cells and kill them. If it misses any, you may end up with a serious infection or cancer, either of which could kill you — so it really can’t let any slip by!

On the other hand, your immune system also can’t overshoot and kill cells if it’s not positive they are dangerous because if it kills off your healthy cells, your organs can’t work. Of course, that can be fatal as well!

The immune system has to find the perfect balance: find each and every danger while leaving each and every healthy cell alone.

In order to be able to do this, the human body has evolved a very sophisticated network of immune cells that regulate each other directly (via proteins bound to their surfaces) and indirectly (via special hormones called cytokines).

There are hundreds of types of cells involved in keeping the whole immune system working properly, but for the functions that prevent/cause autoimmunity, the relationships between individual members of a family of cells called T-cells are considered among the most important. (6, 7)

There are three key members of the T-cell family: cytotoxic T-cells, helper T-cells, and regulatory T-cells.

  1. Cytotoxic T-cells (Tcyt-cells) are the cells responsible for actually killing a sick or malfunctioning cell once the rest of the immune system has found it.
  2. Helper T-cells (Th-cells), like their name suggests, help the cytotoxic T-cells. They double check that the cell really needs to be killed and gives the Tcyt-cells the “green light” to actually go through with it. They do this both via protein signals on their surfaces and the release of a special mixture of cytokines. Without these signals from Th-cells, Tcyt-cells are pretty powerless.
  3. Regulatory T-cells (Treg-cells) act as a counter-balance to cytotoxic and helper T-cells. Treg-cells use the proteins on their surfaces and a different mixture of cytokines to call off Tcyt-cells and Th-cells from carrying out attacks.

For a long time, researchers thought that under normal circumstances, all Tcyt-cells that recognized healthy cells in your body as dangerous were forced to undergo “apoptosis” (cellular suicide). In healthy people, this system worked perfectly and no self-reactive cells survived. In people who developed autoimmune diseases, however, one (or more) self-reactive Tcyt-cell did not die for some reason, allowing them free-reign to attack their bodies. (2, 10, 11)

Newer research indicates, however, that even in perfectly healthy people, there are always small numbers self-reactive Tcyt-cells that do not undergo apoptosis. They are always present in your body, trying to attack random, healthy organs, but are simply stopped from doing so by constant suppressive signals from healthy Treg-cells. (2, 10, 11) With a normal, healthy balance between Treg-cells and Tcyt-cell/Th-cells, no Tcyt-cells attack any of your healthy cells. This is referred to as the state of self-tolerance.

As you can imagine, though, this set-up to maintain self-tolerance means that even relatively small manipulations in the number of Tcyt-cells/Th-cells or Treg-cells can easily lead to a problem.

If your levels of self-attacking Tcyt-cells/Th-cells increase, or your levels of Treg-cells decrease, you may end up with too many Tcyt-cells/Th-cells and not enough Treg-cells to stop all of them. (6)

If this happens and Tcyt-cells/Th-cells begin killing your healthy tissue, you have, by definition, developed an autoimmune disorder.

SELF-TOLERANCE, AUTOIMMUNITY & GUT BACTERIA

So what do your gut bacteria have to do with any of this?

It turns out, a lot.

In fact, if we wanted to go down to the individual protein and cytokine signals, we would probably have thousands of effects and interactions to talk about!

Luckily, all of the effects gut bacteria have on regulating self-tolerance and autoimmunity can more or less be grouped together into two basic effects which we can talk about more generally:

  1. Regulating the ratios of Th-cells-to-Treg-cells in your body
  2. Influencing your risk of developing more self-attacking Tcyt-cells than normal

Let’s look at these one at a time.

REGULATING HELPER T-CELL TO REGULATORY T-CELL RATIOS

Mounting evidence now clearly shows that the types, numbers, and ratios of bacteria in your gut directly influence how many Th– and Treg-cells you have in your body. (6, 7)

Healthy gut bacteria boost Treg-cell levels in your body by helping your immune system decide to turn immature T-cells into Treg-cells. (6, 7, 12)  Studies in mice have shown that healthy gut bacteria increase Treg-cell numbers through their production of a group of molecules called short-chained fatty acids (SCFAs). (13, 14) Healthy gut bacteria make SCFAs when they break down fiber for energy. (6, 15)

SCFAs can be absorbed into the bloodstream and enter immature T-cells which haven’t decided if they are going to be Tcyt-cells, Th-cells or Treg-cells. There, SCFA turn on the genes that turn them into Treg-cells. (13, 16) This leads to a greater number of Treg-cells in the body, decreasing the chances of a cytotoxic T-cell being able to slip past and start attacking your healthy cells.

Unhealthy gut bacteria, on the other hand, can boost the levels of Th-cells in the body, making it easier for Tcyt-cells to attack your body.

For example, studies show that the growth of even one species of unhealthy bacteria (B. adolescentis) in the gut is able to increase the numbers of Th-cells in the blood. (17)

This effect can even occur just from the wrong ratios of normally healthy gut bacteria in the gut! Overgrowth of the normally healthy E. coli species E. coli 2A, for example, has been shown to to boost Th-cell levels. (18)  

Combined, the effects of decreased healthy bacteria, abnormal ratios of healthy bacteria or the growth of unhealthy bacteria in the gut may shift the ratio of Th-cells-to-Treg cells decidedly in the favor of Th-cells. This can make it much more likely that the “attack” signals outweigh the “don’t attack” signals given to your Tcyt-cells, which can ultimately result in the development of an autoimmune disease. (6, 18)

INFLUENCING YOUR RISK OF DEVELOPING SELF-REACTIVE Tcyt-Cells

In addition to helping to determine which balance of signals your Tcyt-cells receive, your gut bacteria also influence your risk of producing Tcyt-cells that recognize your body as dangerous in the first place.They do this through their role in helping your intestinal wall maintain normal “barrier function.”

Normally, healthy gut bacteria help create a solid barrier between you and the outside world, letting only small nutrients through, while keeping larger molecules and bacteria out. If your gut bacteria become unhealthy, however, you can develop a condition called a “leaky gut” that allows larger molecules to get into your body. (19)

Though rare, some of the molecules that can leak into your gut may be what researchers call “molecular mimics”. (20)

A “molecular mimic” is a molecule that happens to have a structure very similar to one that naturally exists in your body.

If one of these mimics gets into your body, your immune system correctly recognizes it as foreign and mounts a defense. As part of this defense, new Tcyt-cells are made that specifically recognize the molecular mimic. Unfortunately, these Tcyt-cells may also accidentally also recognize the mimicked molecule in your body, too. (20) For example, certain human retroviruses contain a protein, VP7, that happens to look very similar to a protein found on human pancreatic β-cells called IA-2. If you become infected with VP7, your body may make Tcyt-cells that correctly identify VP7 as dangerous. Unfortunately, they may also recognize IA-2, since it is so similar. If this happens, these Tcyt-cells may begin attacking the β-cells in your pancreas, leading to type 1 diabetes. (21)

By regulating how many foreign molecules get into your body through your intestinal wall (19), your gut bacteria help determine the risk of your immune system coming into contact with a molecular mimic and producing a Tcyt-cell that will attack both the mimic and your own molecule.

The fewer foreign molecules leak into your body, the smaller the chance one that makes it in will happen to look like one of your own proteins. The more molecules that leak in, the higher the risk!

When combined with the fact that the same unhealthy gut bacteria that cause a leaky gut also promote a high Th-cell-to-Treg cell ratio that encourages Tcyt-cells to kill their targets, you can see how poor gut health can put you at serious risk for autoimmunity.

IMPROVING SELF-TOLERANCE BY HEALING YOUR GUT BACTERIA

Since poor gut health puts you at greater risk for developing an autoimmune disease, it stands to reason that protecting your gut health is likely a good way to help prevent an autoimmune disease from developing.

Here are some diet and lifestyle changes that have been shown to improve gut bacteria balance:

  • Avoid refined sugars and fats – Both processed sugar and fat can induce dysbiosis and a leaky gut, letting more potentially mimicking molecules into your body. Note that the type of fat seems to be of importance; I discuss this in more detail in this podcast episode.  (22, 23)
  • Eat lots of fiber and prebiotics – Fiber feeds your healthy gut bacteria. It can help prevent or reverse dysbiosis. (24)
  • Eat an abundance of phytonutrient and polyphenol-rich fruits and vegetables – Polyphenols can boost levels of healthy gut bacteria.
  • Drink plenty of water – Staying properly hydrated prevents constipation and constipation can promote the growth of unhealthy bacteria. (25)
  • Exercising regularly – Exercise has been shown to boost levels of healthy gut bacteria in your intestines. (26)

Can improving your gut bacteria balance actually treat autoimmune disorders? Is there any evidence that improving gut health may also be helpful for individuals after they have already developed an autoimmune disorder?

Relatively few studies have specifically looked at treating gut health to improve the symptoms of autoimmune diseases.

However, a few possibly useful dietary and lifestyle changes have already been identified. These include:

  • Eat plenty of fiber-rich foods – Fiber feeds the good gut bacteria that make SCFAs and promote Treg-cell development. (12, 28)
  • Add specific probiotics – Some studies suggest that probiotics containing specific bacteria (B. infantilis, for example), may be able to boost Treg-cell levels (29); ultimately, which supplements might be effective for you would be best determined by examining your gut bacteria and identifying which bacteria are out of balance. (6)
  • Consume vitamin A rich foods or take a vitamin A supplement – There is growing evidence that retinoic acid, a metabolite made from vitamin A in the body, works in conjunction with gut bacteria to help them increase the number of  Treg-cells in your body. (30) I would recommend 5,000 IU per day, and potentially more under the supervision of your doctor or dietitian.

As always, it’s important to consult with your medical provider for any treatments for your autoimmune disease.

If you’d like to learn more about how your diet and lifestyle influence your gut health, I recommend checking out my 8-week online course Build Your Biome.

Are you hopeful that scientists will eventually find a way to cure autoimmune diseases by manipulating gut bacteria? Let me know your thoughts in the comments below!

,

Does Polycystic Ovary Syndrome Start with Your Gut Bacteria?

Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting 4-10% of menstruating women (1, 2, 3).

At the heart of the syndrome is the abnormally high production of androgens (male sex hormones) by the ovaries.

High androgen production creates a characteristic clustering of symptoms that define PCOS, which include (4):

  • Excess facial and body hair growth
  • New or worsening acne
  • Irregular menstruation or lack of menstruation
  • Anovulation
  • Infertility
  • Development of multiple small fluid-filled cysts on both ovaries

In addition to serious reproductive symptoms, the syndrome is associated with a high risk of developing life-threatening chronic metabolic conditions, including insulin resistance, type 2 diabetes, high blood pressure and cardiovascular disease (3, 4).

Despite nearly a century of research (5), scientists have struggled to understand the mechanisms that lead to PCOS (3, 4).

What causes the ovaries to start making too many androgens?

How are changes in reproductive function linked to chronic diseases like diabetes or cardiovascular disease?

We simply didn’t know.

But the latest research indicates that we might finally be on the brink of identifying at least one of the root causes of PCOS.

It seems so counterintuitive that one can almost understand why it’s taken a hundred years to discover: PCOS might actually start in your gut (4).  

As crazy as that sounds, the evidence that PCOS is caused by poor gut health is fast becoming overwhelming.

Let’s look at what the research shows us, and how it implicates gut health in the development of PCOS.

PCOS AND LOW-GRADE INFLAMMATION

Research now shows that PCOS is consistently coupled with low-grade inflammation (4).

The most recent meta-analysis combining the data from over 30 studies found that women with PCOS have, on average, around double the level of key inflammatory markers in their blood compared to women without PCOS (6).

Why is this so important? Two reasons:

  1. It instantly implicated a role for gut health in PCOS
  2. It explained the link between PCOS and the risk for chronic metabolic diseases.

Around the same time, PCOS was linked to low-grade inflammation, there was a flood of new data coming in linking low-grade inflammation to poor gut health and poor gut health to chronic metabolic diseases (7, 8, 9).

The core concept that came out of the studies examining the connections between inflammation, gut health and metabolic disease is the idea that unhealthy bacteria in the gut can cause “leaky gut”, which then allows the passage of immune-stimulating molecules into the bloodstream (10).

Normally, your gut microbiota and your intestinal wall work together perfectly to form a solid barrier between you and the outside world, letting only tiny nutrient molecules into your blood.

When your gut bacteria become imbalanced, however, the walls of your intestine become “leaky”, allowing big molecules that should be kept out to get into your body. Since they don’t belong in your bloodstream, these molecules activate your immune system, causing chronic, systemic inflammation (4, 10, 11).

This chronic inflammation then leads to metabolic disease by inducing insulin resistance (12, 13). Insulin resistance is a condition where the cells of your body don’t respond to the insulin in your blood (14).

Loss of insulin signaling to your cells sets off a chain reaction that ultimately results in hyperglycemia (too much sugar in your blood), hyperinsulinemia (too much insulin in your blood) and hyperlipidemia (too much fat in your blood) (15, 16). All of these are symptoms of metabolic disease.

So, in one fell swoop, discovering that PCOS involved inflammation provided an explanation for why women with PCOS were more likely to experience insulin resistance, diabetes, high blood pressure and cardiovascular disease and suggested that PCOS might involve gut health.

PCOS, LPS AND AGEs

So what are the molecules that pass into your bloodstream when you have imbalanced gut bacteria and leaky gut?

One of the main offenders is a group of molecules called lipopolysaccharides (LPS). As I’ve mentioned before, LPS are molecules that come from Gram-negative bacteria and they have been strongly implicated in inducing the inflammation associated with leaky gut syndrome. Study after study has shown that elevated LPS can lead to chronic inflammation and the development of a wide variety of chronic diseases, from diabetes and heart disease to autoimmune diseases and cancer (17).

To determine if LPS might also play a role in the inflammation seen in PCOS, researchers compared the blood of women who had been diagnosed with PCOS to that of women who had not.  Consistent with the previous research, the women with PCOS were indeed found to have significantly higher levels of LPS-markers in their bloodstreams (18), suggesting that, as with so many other diseases, a leaky gut and elevated LPS may be involved in the development of PCOS.

Interestingly, while examining the women’s blood, scientists noticed that LPS weren’t the only molecules significantly different between the two groups. The blood of women with PCOS also contained abnormally high levels of a class of compounds called advanced glycation end products (AGEs)  (19, 20).  

AGEs are large, complex molecules made by cross-reactions between sugars and proteins that are formed when plant or animal tissues are heated to high temperatures, such as when deep frying, broiling or roasting food (21, 22). Though naturally found in many foods, AGEs are too large to move easily through a healthy gut wall, and their levels are usually fairly low in the body (19, 20).

Intrigued by finding high levels of these molecules in the blood of women with PCOS, researchers decided to take a closer look at AGEs and their potential effects on the body. Their investigations found that, just like LPS, AGEs were able to activate the immune system and trigger inflammation in the body (11).

But that wasn’t all. AGEs were also shown to be able to promote inflammation a second way; they trigger the production of proinflammatory hormones, like tumor necrosis factor alpha (TNFα) and interleukin 6 (IL-6), from the cells outside the immune system. Scientists discovered that the cells of some organs in your body have a receptor on their surfaces called RAGE (receptor for advanced glycation end products) that, when bound by AGEs, promote inflammation (11).

And here is where scientists knew they were really on to something with AGEs and PCOS. While exploring how RAGE works in the body, researchers found that this receptor is abnormally concentrated in — you guessed it — the ovaries (23). Activation of RAGE in the ovaries was then shown to induce ovarian inflammation and prevent ovarian cells from responding to female sex hormones, particularly luteinizing hormone (LH), properly (21, 24). Since LH is responsible for allowing follicles to mature and ovulation to occur (25), blocking LH signaling by AGEs could directly cause the anovulation and menstrual irregularities seen in PCOS.  

INFLAMMATION TO ANDROGENS

The final piece of the puzzle linking gut health to PCOS fell into place with the realization that chronic inflammation caused by LPS and AGEs can directly lead to elevated androgen levels in the body (4, 26, 27).

As we discussed above, inflammation leads to hyperinsulinemia. Excess insulin has now been shown to be able to drive the ovaries to produce excess androgens. It appears that a special group of ovarian cells, called theca cells, respond to increased insulin by releasing more and more androgens into the blood (26, 27).

Healing PCOS from the Gut

With the final link between insulin and androgen levels, we now have a comprehensive, logical mechanism to explain how PCOS and all its symptoms develop (4). And, as unexpected as it is, it looks like it all starts with dysbiosis, a leaky gut, and the influx of LPS and AGEs into the bloodstream.

Perhaps the most exciting aspect of discovering the causative role of poor gut health in PCOS is the possibility of improving gut health as a potential cure!  

Since this theory is so new, there hasn’t been a ton of research examining the possibility of treating PCOS by balancing the microbiome. But the results of few that have been done suggest that the strategy is promising.

For example, one study placed 23 women with PCOS on a diet containing various amounts of AGEs. The researchers were able to demonstrate that a decreased intake of AGEs leads to lower levels of AGEs, insulin, inflammatory markers and testosterone in the women’s blood (28).

Another study looked at more directly dysbiosis and PCOS. Here, the researchers conducted a double-blind placebo-controlled study with 40 women diagnosed with PCOS. Half the women were given probiotics of healthy gut bacteria that can help heal dysbiosis, while the other half received a placebo. After 2 months, the women taking the probiotics had lower insulin levels than the women taking the placebo (29).

Together, these studies suggest that improving the health of your gut to decrease LPS and AGE absorption may prove a simple and effective way to minimize your symptoms or potentially even cure your PCOS.

So, what steps can you take if you want to improve your gut health and decrease your absorption of AGEs and LPS?

Some useful dietary and lifestyle changes you may consider implementing include:

  • Avoiding AGE-rich foods, such as roasted peanuts, fried or roasted meats or canned foods that have been sterilized by high heat (30).
  • Eating a diet low in refined sugars and fats, as both of sugar and fat can induce dysbiosis and a leaky gut (31, 32); as I discussed in a previous article, the type of fat makes a difference, but I’d still recommend a moderate fat intake for those with metabolic issues and PCOS.
  • Eating a diet rich in fiber; fiber can help prevent or reverse dysbiosis (33) and prebiotic intake can also decrease LPS levels in the blood (34).
  • Exercising regularly, which has been shown to promote the growth of healthy bacteria in your gut (35).
  • Taking a probiotic to help keep your bacterial balance healthy (29, 36).

While these diet and lifestyle changes are a great start to addressing your gut health and associated PCOS, it may also be a good idea to see a practitioner about more in-depth and personalized ways to help you deal with this condition.

Having PCOS is a good sign that you likely have significant dysbiosis. A practitioner would be able to test your microbiota and determine how you should best deal with your microbial imbalance.

If you’d like to dive right into a more comprehensive, systematic approach to addressing microbial imbalances like SIBO or dysbiosis (including testing), check out my 2-month online course Build Your Biome.

If you have PCOS, does this information change how you think about this condition? Let me know in the comments below!

,

The Role of Gut Bacteria in Fertility and Estrogen Dominance

I’ve talked before about the importance of optimizing your gut health before getting pregnant in order to promote a healthy pregnancy for both you and your baby.

But what about getting pregnant in the first place… Can your gut bacteria play a role in your hormone balance and fertility?

The science suggests that it very well might!

To understand why let’s take a closer look at infertility and one of its common causes: estrogen imbalance.

INFERTILITY & ESTROGEN DOMINANCE

When you hear the term “infertility,” you likely think of a person or a couple that cannot and will never be able to have children. In the medical world, however, infertility does not refer to a permanent state at all.

A diagnosis of infertility simply means that you have not been able to get pregnant after a year of normal, unprotected sex (1).

It’s actually a diagnosis that is far more common than you might realize. According to recent statistics, between 7% and 15.5% of American women experience infertility in any given year, and the majority of women (51.8%) meet the criteria for infertility at least once during their menstruating years (2).

While there are many reasons a couple might have difficulty getting pregnant, among the most common are hormone imbalances (3, 4). And abnormally high levels of one specific sex hormone is frequently implicated in infertility in both men and women: estrogen (5, 6, 7, 8).

Let’s look at each of these individually.

ELEVATED ESTROGEN AND FEMALE INFERTILITY

Most women need little reminder that our fertility depends on a highly-coordinated 28ish-day cycle in our hormone levels. Most of us also know that one of the key players in this hormonal dance is estrogen.

Estrogen has two very important jobs in the female menstrual cycle. First, it triggers a spike in the levels of a hormone called luteinizing hormone (LH) from the pituitary gland in the brain. This spike in LH levels is what triggers the ovary to release a mature egg into the fallopian tube, where it can be fertilized (9).

After a successful ovulation, though, estrogen works together with yet another hormone called progesterone to prevent a second ovulation from occurring. Estrogen and progesterone do this by acting on the pituitary gland in the brain to make sure no more LH is made until the following cycle (or, if pregnancy occurred, until after birth). At the beginning of the next cycle (menstruation), estrogen and progesterone levels dip down, signaling to the brain that it is safe to produce another spike of LH (9).  

Constant high levels of estrogen, without a significant dip signaling the start of a new cycle, can trick your brain into thinking you’ve already ovulated, and prevent you from ovulating again (9). This is actually the logic behind hormonal birth control (the pill).

As you might imagine, this can play a significant role in infertility.

ELEVATED ESTROGEN AND MALE INFERTILITY

While we often think of estrogen as a female hormone, men also have healthy baseline levels of estrogen that are required for sexual and reproductive functions.

At moderate levels, estrogen promotes (and is necessary for) a healthy libido and the production of sperm in men. At elevated levels, however, estrogen can have the opposite effects (6).

Too much estrogen in men decreases their libido. This is because, as in women, estrogen in men acts on the pituitary gland in the brain to decrease the production of LH. In men, this hormone stimulates the testes to produce testosterone. Without enough LH, there is a drop in testosterone, and low testosterone lowers male libido (6).

Elevated levels of estrogen also decrease the production of sperm by the testes. This is due to the estrogen-induced decrease in LH and testosterone levels, both of which directly stimulate the testes to produce mature sperm (6).

ESTROGEN & YOUR GUT BACTERIA

Clearly, a buildup of estrogen is not optimal for you, or your partner’s, fertility. But what’s any of this have to do with your gut bacteria?

A lot, believe it or not! There are multiple mechanisms which link your gut bacteria to your estrogen levels.

GUT BACTERIA AND ESTROGEN REABSORPTION

Your gut bacteria are actually an integral part of the normal regulation mechanisms your body uses to keep estrogen levels normal.   

See, every day your liver pulls estrogen out of your blood and binds it to a sugar-metabolite called glucuronic acid. This sugar-estrogen complex is then mixed with your bile, which is dumped into your digestive tract to help with digestion (10, 11, 12).

Now, this sugar-estrogen complex is bigger than estrogen by itself and it can’t be absorbed through the intestinal wall very well. Because of this, much of the estrogen gets stuck in the intestines and is eliminated from your body via bowel movements (10, 11, 12).

And this is where your gut bacteria come in. They have special enzymes that are able to cut estrogen free from the sugar, called β-glucuronidases. The freed estrogen molecule can then be easily absorbed and re-enter your bloodstream (10, 11, 12).

This is a natural part of the process and the liver binds more estrogen to bile acids than needed with the knowledge that some of it will be coming back, thanks to your gut bacteria.

This balance can be upset, however, if you have abnormal numbers, types or ratios of bacteria in your intestines (called dysbiosis) (13).

This is because some gut bacteria have β-glucuronidases that free estrogen better than others (14). With an unhealthy mix of gut bacteria, your microbiota can free too much estrogen, allowing much greater levels of estrogen to be reabsorbed back into your body than normal and pushing estrogen levels in your blood up (13).

GUT BACTERIA AND ESTROGEN FROM FOOD

In addition to the role the gut microbiota play in balancing the levels of estrogen you make yourself (called endogenous estrogen), they also regulate how much estrogen and estrogen metabolites you absorb from food sources (called exogenous estrogen).

Some gut microbes have enzymes that enable them to breakdown phytoestrogens (from plants) and polycyclic aromatic hydrocarbons (from barbequed or fried meats) into estrogens (15, 16). These estrogens can then be absorbed through the intestinal wall, raising your blood levels.

In fact, studies show that in men and postmenopausal women, the number one source of estrogen for their whole bodies is intestinal absorption from their food (17). And dysbiosis is associated with higher levels of estrogen in these populations, presumably at least partially through increasing the breakdown of dietary molecules such as phytoestrogens and polycyclic aromatic hydrocarbons (13).

INDIRECT WAYS GUT BACTERIA AFFECT ESTROGEN LEVELS

In addition to the direct ways dysbiosis links your gut health to higher estrogen levels, there are also several indirect links.

For example, an abnormal balance of gut bacteria has been strongly linked to constipation (18, 19), inflammation (20) and obesity (21), all of which may be able to further drive up estrogen levels in your blood (8, 22, 23).

IMPROVING YOUR ESTROGEN BALANCE WITH BETTER GUT HEALTH

So, what does this mean for you if you are planning to get pregnant? What can you do to optimize your estrogen levels and boost your fertility?

Research shows that one of the most beneficial things you can do to optimize your estrogen levels is increase your fiber intake.

A high fiber diet is associated with improved microbial health and decreased risk of dysbiosis (24). In fact, increasing the amount of fiber in your diet for just 2 weeks is enough to significantly improve the composition of your gut bacteria (25).  

Additionally, fiber may be able to directly bind the estrogen-sugar complex in the digestive tract, helping eliminate it from the body. In a study examining estrogen (re)absorption in women, there was a direct and significant relationship between a woman’s fiber intake, the size of her stool, and the amount of estrogen she was able to flush from her body (26).

How you choose to increase your fiber intake is up to you, but boosting your fiber intake by increasing the amount of fiber-rich foods in your diet, rather than through adding fiber supplements, may give you more bang for your buck.

This is because the dietary source of fiber — plants — are also rich in polyphenols (27, 28, 29). As I outline here, polyphenols can help boost the health of your gut bacteria, so plant-based fiber-rich foods treat your dysbiosis to a one-two punch.

While fiber (and fiber-polyphenol-rich plants) is the most well established dietary tool to prevent dysbiosis and lower blood estrogen levels, other dietary and lifestyle changes may also be helpful. These include:

  • Exercising regularly (30)
  • Drinking enough water to stay properly hydrated, preventing constipation (31)
  • Taking a probiotic, which contains healthy gut bacteria that can help repopulate your gut with healthy microbes (32)
  • Avoiding broiled, fried and barbequed meats that are likely to contain high levels of polycyclic hydrocarbons (33)

However, if you have a lot of digestive symptoms like constipation, diarrhea, bloating, or gas, you may need help beyond these simple dietary and lifestyle changes.

This is because digestive symptoms can indicate that you have severe dysbiosis, or conditions like SIBO or parasites that need a more in-depth approach, including antimicrobials (or antibiotics) and other supplements.

That said, you can have imbalanced gut bacteria without any symptoms at all, so if you want to maximize your chances of getting pregnant or prevent estrogen dominance, it’s a good idea to test even if you don’t have digestive symptoms.

There are multiple tests to determine the health of your gut microbiota that can give you more precise information regarding your gut health. This can provide you with a roadmap to optimizing your digestive health and, in turn, your fertility.

If testing indicates you have dysbiosis, SIBO, or any other type of imbalanced gut flora, you’ll want to clear out that bad bacteria and balance your biome. If you need more help with that, check out my 8-week online program, Build Your Biome.

For women who have ever struggled with infertility, did you experience that taking care of your gut health through diet and lifestyle changes made a difference in your ability to get pregnant?

For women who are thinking about starting a family in the near future, do you think you will consider your gut health more now, before you start trying? Tell me in the comments below!

Does Gut Bacteria Impact Your Pregnancy?

Thinking about starting a family?

If so, now is a very important time to consider your own digestive health — it has a much bigger impact on your baby’s health than you might think!

Gut Bacteria is Passed to Your Baby

For decades, conventional wisdom told us that the womb is a sterile environment, devoid of any microbes to protect your baby and its growing immune system. It was thought that your baby doesn’t get exposed to any bacteria until during birth when it passes through the vaginal canal. (1)

But recently, researchers have been able to detect some bacteria in the placenta and even in the intestines of a fetus. (2,3) They posit that this bacteria is derived from your (mom’s) gut microbiome, meaning your gut bacteria can travel via the placenta to reach your baby and affect its development.

So, your baby’s microbiome begins developing and acquiring bacteria from you far earlier than we previously thought.

That makes it even more important that you have the healthiest gut you can prior to getting pregnant — If you have a healthy gut, chances are that your baby will have a healthy gut and a healthy start to life too.

Imbalanced Gut Bacteria Can Complicate Pregnancy

During pregnancy, a woman’s gut microbiome goes through many dramatic changes.

One of these is how a woman’s gut will naturally become dysbiotic (or imbalanced) in her third trimester: certain bacterial colonies become fewer and less diverse, and more bad bacteria are temporarily present.

Specifically, researchers observe increases in the abundance of Proteobacteria and Actinobacteria, which are strains commonly seen in inflammatory bowel disease. (5) It’s thought that this temporary dysbiosis somehow helps prepare mom for birthing, although it’s still not exactly known.

However, what happens if you already have gut dysbiosis before pregnancy? Does this affect the course of your pregnancy?

It’s possible for your gut bacteria to become too dysbiotic by the third trimester if you’re already starting off imbalanced. This imbalance can complicate other essential pregnancy adaptations (i.e. increase in blood volume, altered immune response) and result in gestational diabetes, hypertension, or excess weight gain. (6)

Imbalanced flora is also associated with obesity, increased growth of pathobionts (good bacteria that turn bad), and increased inflammation. (7, 8, 9, 10) These can complicate pregnancies and lead to preterm births or pre-eclampsia, a dangerous condition of high blood pressure during pregnancy. (11)

Furthermore, recall how your gut bacteria can reach the baby via the placenta — dysbiosis and too much of the ‘wrong’ bacteria have been linked to premature rupture of membranes and premature birth, and babies who are born prematurely are more likely to have health issues. (12, 13)

Therefore, it’s important to make sure your gut is well-balanced before pregnancy to set yourself and your baby up for the best possible outcomes!

Weight and its Impact on Gut Bacteria and Metabolic Outcomes for Babies

Being at a healthy weight before becoming pregnant is a great way to help ensure better metabolic health for your baby. (Not sure if you’re a healthy weight? You can use a BMI calculator to gauge where you are).

Dysbiosis is a big problem when it comes to metabolic health (which I’ve discussed before here). When you have dysbiosis, you develop intestinal permeability and chronic, low-grade inflammation that is highly associated with metabolic health issues, such as obesity, insulin resistance, and diabetes.

And not only does obesity impact your own health, but it also has both short- and long-term consequences for your baby. For instance, one study found that the infants of obese mothers had greater percent body fat and had already developed insulin resistance in the womb.

Obese women also have a higher risk of developing pregnancy complications and metabolic diseases, such as increased risk of miscarriage, increased risk of C-section delivery, gestational diabetes, hypertension, and preeclampsia. (16, 17, 18) All of these can greatly compromise infant health outcomes.

Furthermore, starting off with a balanced gut can ensure that your infant will have a healthy metabolic outcome and a normal body weight. To illustrate this point, let’s look at this diagram below:

Source: Gohir, W., Ratcliffe, E. M., & Sloboda, D. M. (2014). Of the bugs that shape us: maternal obesity, the gut microbiome, and long-term disease risk. Pediatric research, 77(1-2), 196-204.

 

  • (A) depicts a woman with a normal body weight that possesses a stable, healthy gut microbiota which changes over the course of pregnancy.

Women with a normal body weight are more likely to have balanced gut bacteria. It is proposed that this balance helps facilitate normal gut development and function in the baby, and helps the baby regulate a healthy body weight.

  • (B) depicts an obese woman, who is more likely to present with disrupted gut microbiota already before pregnancy. This imbalance is further amplified through the course of her pregnancy.

This imbalance could also lead to poor or altered gut development, adverse metabolic health outcomes, and mediated increased chronic disease risk for the baby.

 

As you can see, managing your body weight by developing a balanced gut before becoming pregnant is essential to make sure you’re passing down a healthy gut to your baby.

A Healthy Gut Makes For a Healthy Pregnancy

By now, you understand that it is important to start your pregnancy off by having balanced gut bacteria and being at a healthy body weight, both of which go hand in hand.

Here are some steps you can take to make sure you’re passing on a healthy gut microbiome to your baby:

  • Get your gut tested. Especially if you already feel like you have symptoms of gut dysbiosis, it’s important to start dealing with this before pregnancy! But even if you don’t have any digestive symptoms, you can still have dysbiosis, and it’s important to get tested before becoming pregnant. Check out the last section in my article for more information about testing.
  • Consume probiotics and prebiotic-rich foods regularly. Probiotics can influence the immune system in a way that weeds out “bad” bugs and makes more room for good bugs, while prebiotics can increase counts of good bacteria that colonize the gut. Doing both can help improve your overall balance of gut flora, some of which will then be passed onto the placenta to affect your baby’s development. Probiotic supplementation can also help regulate the unbalanced microflora composition observed in obesity and diabetes. (19)
  • Eat a diet with plenty of plant matter, high-quality meats, and fat. Eating lots of fruits and vegetables that contain polyphenols and fibers can help you get those prebiotics into your diet. Healthy fats include olive oil, avocado oil, pastured animal fats, and coconut oil.
  • Exercise. Recent studies suggest that exercise can increase the number of beneficial microbial species, enrich the microflora diversity, and improve the development of commensal bacteria. All of these effects are beneficial for preparing a healthy, balanced gut for your and your baby. (20, 21)

I discuss all of this (and more) in my 8-week digestive health program, Build Your Biome. If you’re thinking about starting (or expanding) your family soon, BYB is a great way to go through all the steps to take care of any gut bacteria imbalances before you become pregnant.

Or, if you want to just dive a bit deeper into all things gut-health, check out my free 60-minute training on digestive issues!

Click here to get access to that.

For those of you who are preparing to get pregnant or have had kids — did you consider your gut health? Tell me in the comments!

Does Gut Health Impact Mental Health?

When we think about our mental health, I’m sure most of us don’t think about our gut.

But did you know that your mental well-being may be influenced by the microscopic creatures living in your gut microbiome? The connection between gut health and mental health is one that has recently been gaining more attention, as scientists believe that the gut microbiome has enormous potential to yield new “psychobiotics.”

Psychobiotics are beneficial bacteria (probiotics) or support for such bacteria (prebiotics) that act on your bacteria-brain relationships. (1)

When I say “bacteria-brain relationships”, I’m referring to the “gut-brain axis,” an important concept that I’ve talked about before, but I’ll briefly outline it again below.

The gut-brain axis is comprised of two kinds of nervous systems: the central nervous system (CNS) and the enteric nervous system (ENS).

 

  • The CNS consists of the spinal cord and brain, and contains a crucial feature called the vagus nerve. The vagus nerve is the longest cranial nerve you have, running from near the hypothalamus all the way to your intestines where it reaches the other big player in the gut-brain axis, the enteric nervous system.

 

  • The ENS is connected to the CNS by the vagus nerve, and this system is embedded in the lining of the gastrointestinal system. The ENS is often called the “second brain” which explains why you can sometimes “feel” your emotions in your gut. Despite the fact that under normal circumstances the ENS is in conversation with the central nervous system, research shows that it is entirely capable of functioning all on its own, even when severed from the vagus nerve that connects it to our brain.

 

So altogether, we have something that looks something a bit like this:

Source: Alcock, J., Maley, C. C., & Aktipis, C. A. (2014).

 

The researchers who created this diagram used a very fitting analogy to think about our gut microbes, which I find helpful. They described our gut bacteria as “microscopic puppet masters” that can do an amazing number of things that change how our body works.  

Microbes can:

  1. Produce toxins in the absence of nutrients that can alter mood.
  2. Change how certain receptors (like taste) work.
  3. Manipulate our brain’s reward pathways.
  4. Hijack neurotransmitter communication between the gut and brain via the vagus nerve.

These effects are represented in the diagram by the hand-controllers that look like a cross, and our little microbes are the ones “running the show.” 

Although there are multiple ways that gut microbes can act on the gut-brain axis, the vagus nerve (depicted as the thin, gray lines with tendrils shooting off from the side of inside the torso) has been posited as one of the main pathways since it is the main neural axis between the gut and the brain. (3,4)

We still don’t know entirely know how this communication line works, but we do know that signals can move along the vagus nerve or be carried by chemical messengers (i.e. serotonin), and have the potential to alter brain function and activity.

A Healthy Gut Makes for a Healthy Brain

 

Brain health and gut health have a tremendous effect on one another. Twenty years ago, scientists noticed that our gut microbiota directly affects our central nervous system.

When they administered oral antibiotics to patients with hepatic encephalopathy (a condition of brain dysfunction from liver insufficiency), it was associated with a dramatic improvement. (5) So, targeting and changing the gut microbiome somehow led to a positive change in brain function.

Lately, there has been more research exploring whether our gut health is tied to neurological disorders such as Parkinson’s disease. (6,7) Unfortunately, it’s still somewhat of a “chicken-or-the-egg” dilemma. Is it

Is it having Parkinson’s that changes our gut? Or is it changes in the microbiome that can predict Parkinson’s? What we do know is that gastrointestinal symptoms (such as inflammation or constipation) can often be the first signs of Parkinson’s, which is a sign that our gut health may very well have a lot to do with our mental health. (8)

One working hypothesis is that, in response to microbial imbalance, certain intestinal microbes release neurotransmitters, or chemical messengers, that can travel down the vagus nerve and alter brain behavior. 

It’s important to know that the release of neurotransmitters from both the gut and brain must maintain a careful balance.

If the microbiome churns out too much norepinephrine–a stress hormone–it can ramp up our HPA-axis and result in a larger stress response in our bodies. (9) If the microbiome produces too much or too little serotonin, it could result in changes in sleep, behaviour, mood, and also in some conditions such as autism, since altered serotonin systems have been shown to be associated with these changes. (10,11,12)

Although more research is needed, it’s possible that therapies that regulate microbiome imbalance could help treat or even prevent diseases such as Parkinson’s or Alzheimer’s before neurologic function is compromised. These findings also further highlight the importance of a balanced microbiome for lifelong health.

Gut Microbiota Can Influence Anxiety and Depression

 

There is increasing data that supports the role of microbiota in influencing anxiety and depressive-like behaviors.

In fact, it has been posited that the gut-brain axis may be the “missing link” in depression. (13) Many researchers have used animal models to demonstrate this link: experimentally elevated stress response and depression in germ-free rats can be reversed by administering a single bacterium like Bifidobacterium infantis, a strain found predominantly in the neonatal intestinal tract. (14,15 16)

Clearly, there’s a connection between our gut and how we feel.

So, to dig deeper into this idea, a research team at McMaster University in Toronto discovered that if they colonized the intestines of one type of germ-free mice with bacteria taken from the intestines of another mouse type, the recipient animals would take on aspects of the donor’s personality. Naturally timid mice would become more exploratory, whereas more daring mice would become apprehensive and shy. Pretty cool, huh?

To take it a step further, they took fecal material (that’s right folks, poop) from depressed patients and nondepressed patients; when compared, they found that depressed patients had far less diverse and rich gut microbiota. But what they found next was even more startling. Using lab rats for some classic microbiome meddling, they first gave antibiotics to rats to erase all of their microbiota. Then, they gave these rats a depressed patient’s microbiota via fecal transplant.

The results? When the rats received the transplant from a depressed patient, they became depressed; their cortisol levels and other types of stress hormones increased. Meanwhile, the rats who received a fecal transplant from nondepressed people exhibited no change.

So what does that tell us? Our brain isn’t always culprit behind mental illness, as is commonly thought. It tells us that if there’s mental distress, there’s very likely digestive distress. It’s a two-way street, and both must be addressed.

Improve Your Digestive Health for Better Mental Health

 

The microbes in our gut have an enormous influence on our brain and behaviors. Luckily, there are some steps that you can take to improve your digestive health.

Here are my top tips to keep your gut bacteria healthy to improve your mental health:

 

 

  • Eat probiotics. Fermented foods typically contain Lactobacillius and Bifidobacteria which have both demonstrated potential benefits to mental health. (17,18)

 

  • Choose a diet packed with prebiotic foods. Prebiotics support the growth of beneficial microbes which help regulate and balance our microbiome. You can either get prebiotics from your diet by eating plenty of fruits and vegetables which contain polyphenols and fibers. In addition to this, you may want to consider supplementing with prebiotics. My two favorites are GOS and FOS, which can be found in Galactomune from Klaire Labs and FOS Powder from NOW Foods, respectively.

 

  • Eat high-quality fats. Studies of deceased patients with Alzheimer’s found significantly reduced amounts of fats in their cerebrospinal fluid compared with controls. (19, 20) People with low cholesterol are at much greater risk for neurological problems, including depression and dementia. (21)

 

  • Manage stress. There is evidence to show that stress (especially if experienced early in life) alters the gut microbiota negatively, and can throw our system off balance. (22) Incorporate mind-body activities like meditation, deep breathing, tai chi, yoga, and more to keep your HPA axis in tip-top shape. Remember, both mental and digestive health need to be functioning optimally for us to feel our best!

WANT TO LEARN MORE?

If you’re ready to learn more about gut health and how to build a robust microbiome, join my mailing list to get access to my 60-minute training on the reasons you might be suffering from digestive symptoms and what to do about it.

Click here to get access to the free training!

Clearly, our gut health is incredibly important when it comes to mental health. What do you think? Will you change any of your dietary or lifestyle habits to improve your digestive and mental health? Tell me about it in the comments!

Can Taking Prebiotics Heal Lactose Intolerance?

75% of the world’s population suffers from lactose intolerance, and if you’re one of that 75% you know how *ahem* uncomfortable the symptoms can be.

However, new research released in January of this year might have a solution for those dealing with this annoying condition: prebiotics.

If you don’t know already, I’m a huge fan of prebiotics (probiotics are great, too, but I think they get all the glory!).

Never heard of a prebiotic? Prebiotics feed probiotics. They are specific types of carbohydrates that selectively feed beneficial bacteria in the gut. Probiotics are the bacteria living in your gut, and prebiotics feed them to keep them alive and healthy.

The Study

In this study, researchers gave lactose intolerant individuals increasing dosages of GOS (galacto-oligosaccharides, a specific type of prebiotic) over the course of about a month as they avoided dairy in their diet. They began participants at 1.5g of GOS and worked their way up to 15g. Each dose was given once per day.

After a month of being on GOS, participants stopped taking it and started including dairy products in their diet for the next 30 days.

The Results

After a month of GOS supplementation, 71% of participants reported improvement in at least one symptom (pain, bloating, diarrhea, cramping, or flatulence) and after incorporating dairy back into their diet, 69% said that their symptoms were improved.

GOS supplementation and dairy introduction had a pretty significant impact on the microbiome of these participants. Researchers noted that 90% of those treated with GOS had what’s called a “bifidogenic” response, meaning that counts of Bifidobacterium were increased.

Now, not everyone will respond to GOS. “Nonresponders” simply don’t see a bifidogenic response, so their counts of Bifidobacterium don’t rise in response to GOS supplementation.

Interestingly, the folks who were nonresponders in this study did not see improvement in their lactose intolerance symptoms, while all participants that did have a bifidogenic response to GOS supplementation saw improvements in their symptoms. This was a pretty small study with just 30 participants, but the fact that the 3 participants who didn’t have a bifidogenic response also did not see any improvement in their symptoms is pretty telling — it likely means that at least part of the mechanism by which GOS supplementation works to improve lactose intolerance is by increasing counts of Bifidobacteria in the microbiome. Some of these types of bacteria are lactose-fermenting, so they can help you digest the lactose coming in through your diet.

Should You Try GOS Supplementation to Help with Lactose Intolerance?

This is, of course, just one small study, so we need to take it with a grain of salt. However, given that prebiotics have so many other benefits, I think adding GOS to your supplement regimen is a great idea in general, but especially if you’re looking to improve your lactose tolerance.

As for dosing, this study went up to 15g, which is pretty high. Other studies have shown that 5g has a bifidogenic effect, while minimizing other negative symptoms. My recommendation is to start with a small amount (in this study, they started at 1.5g) and work your way up to 5g. If you would like to go beyond that, keep an eye out for some negative symptoms that can go along with higher doses of prebiotics, like bloating. Whatever dose you decide on with your healthcare practitioner, I would give yourself a solid 30 days on the GOS supplement before attempting to add dairy products back in.

This study used a 95% pure GOS supplement, which, as far as I know doesn’t exist in commercial form. Jarrow used to offer a GOS syrup, but unfortunately it looks like it’s been discontinued. I’ve been using Galactomune with my clients which is a mix of GOS and beta-glucan. While I wish there was a straight GOS supplement on the market, I haven’t been able to find one (if you have, let me know in the comments!). That said, I’ve had great success with Galactomune, so I absolutely recommend it.

What do you think? Will you add GOS to your supplement regimen to help improve your lactose tolerance?

WANT TO IMPROVE YOUR DIGESTION?

Join my newsletter to download my 5S Protocol to Optimize Digestion at Mealtime. In it, I’ll teach you how to stimulate the production of digestive enzymes and stomach acid, calm your system so it’s in “rest and digest” mode, and slow down to allow the proper breakdown and absorption of your nutrients.

Making sure you are optimizing your digestion is a great first step in improving your gut health!

Click here to download my 5S Protocol

How Do You Know If You Have Bad Gut Bacteria?

You’ve probably heard the words “microbiome”, “gut bacteria”, or “flora” quite a bit these days.

Maybe you’ve even read a few articles on why you should pay attention to your gut bacteria and how important they are for your overall health.

You know that “bad bacteria” aren’t great for your health…But now you’re wondering – how do I know if I have bad bacteria? Hint: you might have bad bacteria even if you don’t have digestive issues.

Let me walk you through it!

What is Unbalanced Gut Bacteria?

When you hear the terms “bad gut bacteria” or “unbalanced gut flora”, this can refer to a number of different conditions. The most common include small intestine bacterial overgrowth (SIBO), an imbalance of gut flora in the large intestine (commonly referred to as “dysbiosis”), pathogens, or parasites.

Let’s do a quick rundown of each of these conditions:

SIBO

The small intestine should be relatively sterile when compared to the large intestine, which houses the majority of our bacteria in what is called the “microbiome”. When bacteria translocate to the small intestine for any reason and overgrow, you now have an overgrowth of bacteria in the small intestine; hence, “small intestine bacterial overgrowth” or SIBO. This is a very common condition and one I see a lot in my practice.

Dysbiosis

The term “dysbiosis” simply means an imbalance of bacteria (which could be anywhere in or on the body), but it’s commonly used to describe an imbalance of gut bacteria in the large intestine, specifically. I like to break down dysbiosis into two categories (well, 3 really, but we’ll talk about the 3rd option – parasites and pathogens – next).

Insufficiency

This is when you don’t have enough beneficial bacteria like Lactobacillus or Bifidobacteria hanging out in the large intestine. These should be present in high amounts, but it’s very common to see folks with very little or no growth of these beneficial microbes.

General Imbalance

This is when you have too few beneficial bacteria and overgrowths of one or more commensal bacterial strains. Commensal bacteria are bacteria that are normal to find in small amounts and typically don’t cause any harm to you. However, when they start growing in high amounts, you might start developing symptoms.

Parasites or pathogens

Specific strains of bacteria that, when present, can cause harm or disease. With potential pathogens, you can usually have a small amount that won’t necessarily be problematic, but they may start to cause symptoms as their numbers grow higher.

Symptoms of Unbalanced Gut Flora

Okay, so now that you know what different types of unbalanced bacteria you might have, what are some symptoms you might experience if you were to have any of these types of bacterial issues?

The symptoms that can accompany the different types of imbalance are quite diverse. However, there are a few general symptoms you can look for with the different imbalances that might clue you in to whether you’re more likely to have one or the other.

SIBO

The most common symptom for SIBO is bloating. This is because when the overgrowing bacteria in the large intestine are exposed to carbohydrates or fiber from your diet, they ferment them and produce gas as a result. As you can imagine, this can not only cause bloating but it can also lead to symptoms like excessive flatulence or belching. The increased pressure in the GI tract can also lead to reflux. (1) SIBO is also associated with diverticulitis. (2)

When you test for SIBO, there are two different types that will show up: methane-positive or hydrogen-positive.

Constipation is highly associated with methane-positive SIBO, while diarrhea is associated with hydrogen-positive SIBO. (3)

You can also exhibit no digestive symptoms when it comes to SIBO. This is because having an infection in the gut can cause disease outside the digestive system. We’ll talk more about these different conditions in the next section, but I just want you to know that you can have absolutely zero digestive symptoms and still have bacterial imbalance in the gut.

Large Intestine Dysbiosis

The symptoms for dysbiosis of the large intestine vary a lot, and I find that a lot of the time dysbiosis is associated with disease states that occur outside of the digestive system. However, there are certainly people who develop gastrointestinal symptoms when they have dysbiosis.

With insufficiency dysbiosis, the most common symptom I see is constipation. Symptoms of just a general imbalance of bacteria in the large intestine vary widely. They can include constipation, diarrhea, bloating, or general pain or sensitivity in the abdomen.

Pathogens and Parasites

These have more specific effects depending on which parasite or pathogen you have. For example, if you have H.Pylori you might have reflux or ulcers, while klebsiella pneumoniae is associated with ankylosing spondylitis. Other pathogens and parasites can simply cause ongoing digestive symptoms like diarrhea or bloating.

Conditions Associated with Imbalanced Gut Bacteria

As I mentioned previously, you do not need to have digestive symptoms to have imbalanced gut flora. I think imbalanced gut flora is more common than most people think because of this – after all, it’s strange to think that the bacteria in your gut have anything to do with the rest of your body.

Here’s just a sampling of the conditions/diseases associated with SIBO:

Conditions/Diseases associated with dysbiosis:

Specific pathogens/parasites and their associated symptoms/diseases:

Test, Test, Test!

Testing your gut for imbalanced bacteria is hugely important. I wish it was cheaper to do so (and hopefully we’ll see prices go down on these tests in the coming years) because I think everyone should do it!

Because there are so many different symptoms of bacterial imbalance, I find it’s very useful to test so you know what bacteria you actually have and what might be missing.

Because not all bacterial imbalances show themselves in the way of digestive symptoms, you may not think you need to worry about your gut bacteria, but hopefully, you’ve learned a thing or two in this article that makes you think twice about that assumption!

To take a look at your gut bacteria, I recommend doing two types of tests: a SIBO test and a stool test.

I’m currently using the SIBO test from Biohealth in my practice, which I like a lot. If your doctor is familiar with SIBO or is open to learning more about it, you may be able to get them to order a SIBO test for you that might be covered by your insurance plan.

However, many doctors won’t test for it, unfortunately (though this is becoming less and less common as the topics of the microbiome and SIBO become more popular). If your doctor will order a test for you, I recommend asking to make sure it’s a 3-hour test that looks at both hydrogen and methane gas. Remember I said that which gas you produce dictates how you deal with it, so it’s important to get that information!

As for stool tests, I’ve recently begun using the GI-MAP test from Diagnostic Solutions Laboratory. It seems to be a very accurate test, needing only one stool sample for parasitology. Other stool tests companies recommend getting the higher sample rates (for example, Doctor’s Data offers a 1 sample, 2 sample, or 3 sample kit).

I still think other options for stool testing are good, like Doctor’s Data, Biohealth, and Genova, but personally, I’m using the GI-MAP now! These tests tend to be a bit harder to get from your doctor unless you’re going to a functional medicine doctor. I’ve seen some tests be covered by insurance (at least partly) before, but a lot of times it’s difficult to get these tests from someone who can help get it covered by insurance, sadly!

If you want to test your gut bacteria, I recommend asking your doctor about your options first. If you can’t get it covered or they can’t or won’t order them, you’ll need to find another healthcare practitioner to order them for you.

In my online program, Build Your Biome, you can order these tests (with a discount) and I’ll educate you on what everything means!

Gut health is so crucial to overall health, as I hope you’ve learned by reading this article! Imbalanced gut bacteria is associated with many health conditions and diseases, and clearing bad bacteria can make a world of difference if you’re suffering.

WANT TO IMPROVE YOUR DIGESTION?

Join my newsletter to download my 5S Protocol to Optimize Digestion at Mealtime. In it, I’ll teach you how to stimulate the production of digestive enzymes and stomach acid, calm your system so it’s in “rest and digest” mode, and slow down to allow the proper breakdown and absorption of your nutrients.

Making sure you are optimizing your digestion is a great first step in improving your gut health!

Click here to download my 5S Protocol

Can Your Gut Bacteria Help You Lose Weight?

Are you struggling to lose weight?

Perhaps you’ve tried restrictive diet after restrictive diet, exercise programs, and more – only to find that your weight doesn’t budge.

What if the answer to achieving and maintaining a healthy weight has been inside of you all along?

The Microbiome

Your digestive system is home to a vast ecosystem of trillions of bacteria that are diverse and complex. (1)

The different bacterial species all work together, much like a community, to ensure your digestive system and body functions appropriately. (2) The correct balance of microbiota can help your metabolism, increase your immunity, and can even enhance your brain functioning. (3)

Gut bacteria is acquired from birth, passed from mother to child (4), and there are many factors that could affect and alter your gut microbiota throughout your life, including:

  • The environment you live in. A large study investigated the differences in gut bacteria in rural and urban dwellers and found that urban people living in America had vastly different bacteria in their stool than those living in rural Malawi and Venezuela. They found that urban American fecal matter was the least diverse out of the groups, although this finding was only observed in adults and not in children. They also observed a difference in the clusters of bacteria found between the regions. (5) Another study showed that at least three species of bacteria differ in composition between people from different countries and continents. (6) These changes in bacteria could also be attributed to the differences in dietary habits between countries.
  • The food you eat. Carbohydrates, fat, and protein all have an effect on your microbiome. Protein-rich diets can encourage Bacteroidetes growth, while the Prevotella species is more dominant in the gut of those eating carbohydrate rich diets. (7). Your diet can have an impact on your gut bacteria in as little as 24 hours. (8)
  • The people you surround yourself with. The old saying that you become who you spend the most time with can also be true for gut microbiota and body weight. In mice studies, researchers found that when they housed obese mice together with lean mice and fed them both low-fat, low-sugar diets, the obese mice that lived together with the lean mice acquired lean bacteria faster than those who lived with other obese mice. (9
  • Your age. Even though a child’s gut bacteria can develop to adult-like maturity by the time they reach 3 years old, your gut bacteria changes as you age. The types of bacteria found in the microbiome are different in children and adults; in babies, more bacteria that make folate are present, whereas in adults the bacteria focuses more on metabolizing the folate from the diet. 

The Role of Gut Bacteria in Obesity

There’s been a lot of research done surrounding the idea that your gut bacteria alters your propensity for obesity and that gut bacteria change as a result of obesity or weight loss diets.

The increased interest in the role of gut bacteria on our metabolic health started when researchers microbiota from obese mice into mice with no gut bacteria and saw that when they did this, the mice with no bacteria gained fat mass, just like their obese counterparts.

Further research showed that when mice are fed a Western diet, they start to develop “obese microbiota.”

Obese microbiota can contribute to weight gain in the following ways: (10)

  • An increase the size of the villi in the small intestine (responsible for the absorption of nutrients) allows them to absorb almost double the energy of normal-sized villi
  • Gut motility slows down, allowing more time to digest food and absorb excess energy
  • Excess energy absorbed leads to increased fat in the liver and an increase in fat tissue throughout the body
  • Suppression of enzymes that break down fats lead to the increased conversion of triglycerides into fat cells

The idea that our microbiome plays a huge role in how we extract nutrients was confirmed in this study where they saw that when they gave germ-free mice a conventional microbiome, they produced 60% more body fat and developed insulin resistance, despite reduced food.

The Firmicutes/Bacteroidetes Debate

For many years, the main bacterial culprits for weight regulation have been thought to be the phyla Firmicutes and Bacteroidetes. If you’ve ever gotten a stool test done, you may have seen your Firmicutes and Bacteroidetes ratio listed. 

Much of the research available points to the fact that too many Firmicutes and too little Bacteroidetes can lead to weight gain. (10)

However, newer research has begun to challenge this mindset.

A study using data from the Human Microbiome Project and MetaHIT to investigate the relationship between gut bacteria and obesity found no difference in the Firmicutes:Bacteroidetes ratio between lean and obese participants. The researchers also found that bacterial diversity was not linked to obesity, which contrasts with the results of other studies. (11)

Another study looked at the gut bacteria in fecal matter from people from four different European countries and found that there was no link between BMI and the Firmicutes:Bacteroidetes ratio. The researchers did find evidence, however, to support the link between gut bacteria and its capacity to harvest energy, which is thought to promote weight gain. (12)

If you’d like to learn more about this topic, I recommend checking out this article.

The reality is that we don’t quite know if the Firmicutes:Bacteroidetes ratio really matters all that much when it comes to weight regulation. But the good news is that many of the interventions that seem to improve your ratio also seem to positively benefit your gut bacterial balance as a whole anyway.

Inflammation: the Underlying Factor Leading to Metabolic Dysfunction

While the research on whether the Firmicutes:Bacteroidetes ratio has much to do with weight regulation remains inconclusive, we do know that dysbiosis, in general, is a big problem when it comes to metabolic health.

This is because when we have unhealthy, unbalanced bacteria (dysbiosis), it leads to intestinal permeability and chronic, low-grade inflammation. This inflammation is highly associated with obesity and metabolic conditions like insulin resistance and diabetes.

If you have imbalanced gut bacteria, you develop localized inflammation within the gut, which contributes to intestinal permeability or “leaky gut”.

Leaky gut means that the cells that make up the gut barrier open up and allow larger particles into the bloodstream, like lipopolysaccharides (LPS). Once in the bloodstream, LPS causes chronic low-grade inflammation throughout the body.

This low-grade inflammation is associated with many diseases, but especially with metabolic disorders like obesity and diabetes.

Here is a list of the many different conditions LPS has been associated with:

Rodriguez-Castaño GP, Caro-Quintero A, Reyes A, Lizcano F. Advances in Gut Microbiome Research, Opening New Strategies to Cope with a Western Lifestyle. Frontiers in Genetics. 2016;7:224. doi:10.3389/fgene.2016.00224.

What Diet and Lifestyle Factors Increase LPS Concentrations?

Diet is probably the most studied contributor to LPS concentrations. When researchers do these diet studies, they’re typically comparing a high-fat, low-carb diet with low-fat, high-carb diet.

Pretty much across the board, it’s the high-fat diets that lead to a negative change in gut bacteria and higher LPS levels. (You can see one example here.)

Four weeks on a high-fat diet increased counts of LPS-containing bacteria and caused what researchers have deemed “metabolic endotoxemia” (essentially, high LPS concentrations causing chronic low-grade inflammation) in mice. This high-fat diet contained 72% fat (corn oil and lard), 28% protein, and <1% carbohydrate. When researchers used a 40% fat diet, they saw increases in LPS concentrations, but not as high as on a 72% fat diet. Metabolic endotoxemia caused increased fasting glucose levels, insulin levels, and levels of whole-body, liver, and adipose weight gain. (13)

Interestingly (though perhaps not so surprising to those who have been in the Paleo/Real Food world for a while), it is diets high in omega-6 fats that cause this reaction. Alternativately, diets high in fats like coconut oil or fish oil seem to be protective against high LPS levels. (14, 15)

How much you exercise also plays a role in your circulating LPS concentrations. High intensity exercise is associated with lower levels of LPS compared to being sedentary. (16)

If you’ve got a lot of stress in your life, you’re unfortunately promoting the growth of LPS-containing bacteria, which can lead to increased concentrations of LPS in your whole body. (17) (Want to learn more about how devastating stress can be for you digestive system? Read my article on the topic here.)

Though I hope most of you aren’t exposed to cigarette smoke on a regular basis, it also causes LPS-derived inflammation. (18)

A Healthy Gut Means A Normal Weight

OK, so you probably understand by now that high concentrations of LPS in the body seem to be responsible for many of the modern metabolic disorders we see today like obesity, insulin resistance, and diabetes. So how can you prevent getting high concentrations of LPS in your system and help yourself lose weight or prevent metabolic disease?

Here are my top tips:

  • Eat a varied diet with plenty of plant matter to get fiber, prebiotics, and polyphenols
    • Fiber and prebiotic intake have been shown to improve the cluster of symptoms seen in metabolic disorders and improve gut health. (19) Prebiotics also seem to ameliorate LPS-induced inflammation. (20)
    • Polyphenols reduce counts of LPS-containing bacteria and increase counts of beneficial bacteria as well as prevent metabolic endotoxemia and improve intestinal permeability. (21, 22) I’ve written an entire article about the benefits of polyphenols for gut health here.
  • Consume a moderate fat diet and reduce exposure to omega-6 fatty acids
    • I think a higher-fat diet is likely ok provided you have sufficient fiber and prebiotic intake, but to err on the side of caution, I’d recommend that most people consume a moderately-high fat diet (30-60% of calories). Within this amount, your fats should come from healthy options like omega-3s, coconut oil, olive oil, avocado oil, and pastured animal fats.
  • Consume probiotics regularly
    • Several studies have shown improvements in LPS concentrations, body weight, glucose metabolism, insulin and leptin sensitivity, among other benefits with probiotic treatment. (23, 24) Please note that probiotics’ effects are strain-specific, so we don’t know if all strains are equally as effective in this regard.
  • Exercise appropriately
    • As mentioned above, high intensity exercise seems to have a beneficial effect on LPS concentrations. In addition to this, exercise modulates the microbiome and gut health in a very beneficial way. (25)
  • Manage your stress levels
    • As I discussed previously, stress hormones seem to promote the growth of LPS-containing bacteria. Stress also causes intestinal permeability, meaning that LPS can then more easily get out of the gut and into other tissues, causing system-wide inflammation.

WANT TO IMPROVE YOUR DIGESTION?

Join my newsletter to download my 5S Protocol to Optimize Digestion at Mealtime. In it, I’ll teach you how to stimulate the production of digestive enzymes and stomach acid, calm your system so it’s in “rest and digest” mode, and slow down to allow the proper breakdown and absorption of your nutrients.

Making sure you are optimizing your digestion is a great first step in improving your gut health!

Click here to download my 5S Protocol

, ,

Sign up for the Fermented for 14 Challenge 2015!

Sign up for the Fermented for 14 Challenge 2015!

Are you ready to get your gut bugs in good shape?

fermented

Here’s the challenge: 1 serving (1/2 cup) of fermented foods every day for 14 days. 

 

Trust me, I know it can be hard to get in the habit of eating fermented foods. You might know that they’re great for you and that you should be eating them – but you just don’t do it. I think adding a fermented food a day is an easy change that could improve pretty much everyone’s health, but the fact is so many of us don’t do it on a regular basis (I’m guilty here, too!).

Our gut bacteria are the foundation of our health, and it’s our job to nourish them. From weight loss to eczema, fibromyalgia to chronic fatigue, fermented foods can help just about any health condition. It’s time to start eating them!  Join me in the Fermented for 14 Challenge to give those gut bugs some lovin’.

You can buy your fermented foods for the challenge or make your own (don’t worry, I’ve got recipes for you!). Or, buy some and make some – it all counts! What really matters is that your gut is getting fermented foods every day of the challenge.

When you sign up, you’ll get…

  • My Eat The Good Bugs eBook, complete with four easy fermented food recipes using simple ingredients from your local grocery store (lemon-ginger soda, pickles, yogurt, and kimchi – check out the picture above!) You’ll also get a list of my favorite brands you can buy at the store or online.
  • A weekly meal plan that includes 1 meal for each day of the challenge that incorporates one of the fermented foods from my eBook.
  • Daily emails with motivation, information about the microbiome, and more!
  • Access to the Fermented for 14 community on Facebook

Think you’re up for the challenge? Fill out the form below to register!

[activecampaign form=35]

P.S. Want to enter to win TONS of fermented foods? You can enter the giveaway below or check out the giveaway page here.
a Rafflecopter giveaway