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.


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.


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.  


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!

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!

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!


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!

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?


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

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.


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

Got Anxiety Here's How Your Gut Microbiome Plays a Part

Learn about the connection between gut health and anxiety and how you can improve your anxiety by improving your gut health.

What is Anxiety?

Anxiety is the most prevalent mental illness affecting those living in the United States with about 40 million sufferers. (1) If you deal with this condition, you know that anxiety can be debilitating and affect your quality of life. But did you also know that the trillions of microbes living in your gut can play a part in your condition and potentially help you heal? That’s right, there is a connection between your gut health and anxiety.

The Gut-Brain Connection: How Gut Health and Anxiety Connect

These microbes living in us are often referred to as the “forgotten organ” because they play such a large role in our well-being, but it is only recently that we’ve started to realize the impact this organ has on the body. (2) Unfortunately, the Western lifestyle takes a significant toll on the health of our microbiome with constant stress, unhealthy diets, lack of sleep, and more leading to a condition called dysbiosis.

Dysbiosis, the imbalance of gut bacteria, has been associated with a variety of mental disorders including anxiety. (3) While there aren’t many studies done on humans, we have seen mice exhibit increased anxious behavior when exposed to pathogenic bacteria in the gut. (4) It’s probably no surprise, then, that those with anxiety are also likely to suffer from a digestive disorder associated with imbalanced gut bacterial as well like Irritable Bowel Syndrome (IBS).

I recommend that you test your microbiome for dysbiosis and pathogens by using a functional medicine lab – your healthcare practitioner can then interpret this information for you and prescribe the correct treatment depending on what is going on in your gut. This is the #1 step anyone with anxiety should take! You don’t want unwanted pathogens hanging around wreaking havoc on your gut health (and in turn your mental health!). Directlabs.com offers a number of stool tests that you can order yourself – I have tests from both Metametrix and Doctor’s Data (two of my favorites) listed in my portal here.

Best Probiotics for Anxiety

When humans are given specific strains of probiotics, their anxiety improves as does their HPA axis function. (5) The strains of probiotics used in this study (Bifidobacterium longum R0175 and Lactobacillus helveticus R0052) can be found in two products in the United States: Pure Encapsulations’ ProbioMood (which you can purchase in my supplement dispensary) and Xymogen’s Probio Defense.

Prebiotics for Anxiety

Prebiotics, which feed healthy gut bacteria, are also useful for anxiety. Stress-related disorders seem to respond to the prebiotic GOS (galactooligosaccharide) in particular, which help the HPA axis to function appropriately in addition to making us pay more attention to positive stimuli vs negative stimuli. (6) My go-to GOS prebiotic is Galactomune from Klaire Labs, which you can purchase in my dispensary.

Best Diet for Anxiety

Eating a healthy, ancestral diet is also associated with lower anxiety scores, while Westernized diets are associated with the opposite effect. (7) This is thought to be due to many factors including inflammation, but also to the effects of these diets on the microbiome. Another reason to keep up your healthy diet!

The Gut-Brain Connection

The microbiome and the brain operate on a bi-directional axis, meaning that the gut affects the brain and vice versa. Because of this, anxiety and gut problems can be a vicious cycle where anxiety  makes you more likely to develop dysbiosis (the imbalance of gut bacteria) and dysbiosis makes you more likely to suffer from anxiety. But dealing with both conditions simultaneously (i.e. treating dysbiosis and reducing stress to the degree you can) can help alleviate both problems. To learn more about stress and its impact on the gut, check out my article on the topic here.

While anxiety can be a difficult diagnosis to deal with, there is more and more research coming out every day about the relationship between anxiety and the microbiome. If you suffer from anxiety, your treatment plan should definitely address any problems in the gut!

Gut Health and Anxiety: How to Improve Anxiety by Improving Your Gut

To recap, those with anxiety should focus on:

  • Reducing stress as much as possible by incorporating mind-body activities like meditation, yoga, etc
  • Testing and treating for dysbiosis with a trusted practitioner (I can help!)
  • Adding probiotics to their routine, in particular the Bifidobacterium longum R0175 and Lactobacillus helveticus R0052 strains  which can be found in the probiotic supplements ProbioMood and Probio Defense.
  • Adding prebiotics, especially GOS, which has shown to have a positive impact on the HPA axis and anxiety. Try Galactomune to get more GOS in your diet.
  • Eating a healthy, ancestral diet consisting of fruits, vegetables, meats, nuts, etc. (e.g. a Paleo diet!)

Now I want to hear from you: what have you done to combat your anxiety? Are you focusing on the gut?

Does Stress Cause Digestive Problems?

Most of us can probably guess that stress affects the body negatively – but what’s the connection between stress and digestion?

The Gut-Brain Axis

Changes in our mental state, like feeling scared or nervous, can lead to problems in the gut. Ever had to do a big presentation or take an important test and experienced heartburn or diarrhea as a result? That’s the brain and the gut in communication. This goes the other way too. Changes in our gut microbiota and changes in our intestinal permeability can affect our mental state, causing depression and anxiety. (1) These bidirectional signals going from the gut to the brain and vice versa can either keep us healthy or they can cause a great deal of discomfort.

It is vital to deal with any significant health issues that affect either the brain or the gut, but it’s important to note that neither will truly heal if you don’t also focus on the other. If you have a parasite and you treat it without dealing with your chronic stress, you leave yourself open to reinfection or sometimes, your body simply won’t be able to get rid of the parasite because of the chronic stress.

Chronic stress leads to negative changes in the gut, while relaxation promotes gut health. On the flip side, poor gut health exaggerates our stress level, while improvement in gut health lowers stress.

The fact that the gut-brain axis is a two-way street is especially important to remember. No matter how hard you try to boost the well-being of your digestive system, you’ll never fully feel better without dealing with stress; it will put you right back where you started if you don’t address it. Chronic stress is a risk factor for digestive disease, and those with digestive conditions are also likely to suffer from mood disorders. (2,3) In a country where over 40 million people suffer from psychiatric illness and 70 million are diagnosed with a digestive disorder, addressing the gut-brain connection is essential. (34)

Before we jump into the wild world of neurogastroenterology (that’s a fun one!) and learn how stress affects our gut, let’s get better acquainted with the nervous systems that make up the gut-brain axis: the central nervous system and the enteric nervous system.

The Central Nervous System (CNS)

The central nervous system consists of the spinal cord and the brain. It sends and receives signals to and from the peripheral nervous system and governs nearly everything we do with our body. Given the crucial role it plays, it is commonly referred to as the “control center” of the body. The CNS communicates with our gut via the vagus nerve, the longest cranial nerve we have, running from near the hypothalamus all the way to our intestines where it reaches the other big player in the gut-brain axis, the enteric nervous system.

The Enteric Nervous System (ENS)

The enteric nervous system is considered to be a part of the autonomic nervous system which is housed under the peripheral nervous system. The ENS is often called the “second brain” which explains why we can sometimes “feel” our emotions in our gut. This “second brain” has many similarities to our true brain – it contains over 100 million neurons (more than the spine, though less than the brain) and produces many of the same neurotransmitters found in the brain such as serotonin, dopamine, and acetylcholine. (5) 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. (6) No other organ can claim this impressive feat – all require signals from the brain to function. Neat, huh?

Consider this other incredible fact: about 95% of our serotonin (the “feel good” chemical) is found in the gut, not the brain. (7) Normally associated with its anti-depressive properties, this chemical serves many different purposes and is mostly found in the enterochromaffin cells in the gut. Serotonin is released by these cells when food finds its way into the GI tract, signaling contractions to move the food down the intestinal tract. It’s also responsible for the stomach upset we experience when we eat spoiled food – serotonin is released in high amounts when the gut comes into contact with an irritating food and triggers both diarrhea and vomiting to expel the dangerous food.

Stress: The “Fight or Flight” Reaction

Two other relevant nervous systems to consider are the parasympathetic and sympathetic nervous systems. In times of great stress our sympathetic nervous system is activated, causing the universal experience of a racing heart and rapid breathing. You may have heard of it referred to as the “fight or flight” reaction, owing to the two courses of action our bodies are preparing us to take in these stressful situations. The parasympathetic nervous system, on the other hand, is often called our “rest and digest” system because when we are in a relaxed state the body focuses on exactly those activities.

In today’s world, we spend far too much time in the “fight or flight” mode and not nearly enough time “resting and digesting”. We’re constantly activating our “fight or flight” response with the many stressors we experience on a daily basis like traffic, a big project at work, financial issues, etc.

This is very different from how our hunter-gatherer ancestors experienced stress. While they may have been chased by predators on occasion, much of their time was spent in the “rest and digest” mode. Their ratio of “fight or flight” time to “rest and digest” time was the exact opposite of ours – and they had better digestive (and overall) health because of it.

I’m going to briefly go over what happens when we come into contact with a stressor so that you can understand the rest of this article, but if you want a more in-depth review, you’ll want to check out our free eBook, Overcoming Adrenal Fatigue, which you’ll receive when you sign up for our newsletter.

The hypothalamic-pituitary-adrenal (HPA) axis is the stress “control center” and begins the activation of the sympathetic nervous system by coordinating the many moving parts in a stressful situation. Upon recognizing a stressor, the HPA axis is stimulated and corticotropin-releasing hormone (CRH) is released from the hypothalamus. CRH travels within the blood to the anterior pituitary gland where it stimulates the production of adrenocorticotropic hormone (ACTH). ACTH then travels to the adrenal cortex where it ultimately stimulates the release of cortisol. You may have heard of cortisol as the body’s main “stress hormone”. During times of crisis, as in our bear attack, cortisol works to keep blood sugar elevated so we can meet the glucose demands of the brain and helps the body retain sodium to keep blood pressure up. It also moves blood away from the digestive tract and instead toward the muscles and brain. This process is vital to keep us alive during a true “fight of flight” situation as it helps us do exactly that – fight or run away.

Our ancestors led lives that allowed them to have a balanced stress level. Despite running from the occasional predator, as long as they survived the attack they would then have plenty of time to rest, calm down, and turn the stress reaction off afterwards. This enabled them to produce the right amount of cortisol – not too much, which has been associated with gaining abdominal fat and developing chronic disease, and not too little, which is correlated with exhaustion.

Unfortunately, most of us don’t live like our ancestors did. Instead, we experience chronic minor stressors all day long for our entire lives. Sadly, the HPA axis can’t differentiate much between major stressors like being attacked by a bear and minor ones like being reprimanded by our boss for being late to work. It’s stimulated just the same either way, going through the same motions and putting us into “fight or flight” mode in either situation.

In the next few sections, we’ll review the connection between chronic stress and digestion and how stress leads to gut issues by altering intestinal permeability, increasing inflammation and lowering immunity, changing the gut microbiota, and finally, actually increasing the amount of pain we feel.

Stress Opens the Intestinal Gates

We want to prevent our gut lining from becoming permeable – you’ve probably heard about the negative effects of “leaky gut” already. Consider the placement of the gut; from mouth to anus it’s not technically “in” our body, it’s outside. If you think of the body as a donut, the gastrointestinal tract is the donut hole, outside the rest of the donut. Pretty amazing to think that our entire digestive system is technically not even “inside” us.

When we think of the GI tract like this, we realize that it’s exposed to a lot on a daily basis. The gut barrier comes into contact with many different substances, from possibly harmful bacteria to food particles that need to be digested before being allowed into the body. It’s crucial that this barrier functions appropriately to keep the things we don’t want out and only allow the things we need in. When working normally, the gut lining acts as a sieve, only allowing particles that fit through to get to the other side. When the sieve breaks, things that aren’t supposed to get across now flow through freely. When the gut barrier leaks, we’ve got a big problem.

Researchers have known for a long time that severe physical stress such as trauma or surgery causes the intestinal lining to become “leaky”, but more recent research has started to look at the effect of chronic psychological stress on the gut barrier. (8) To approximate chronic psychological stress in humans, rats are repeatedly subjected to water aversion stress where they are placed on a platform surrounded by water. Researchers have found that this is a mild stressor to the rats, similar to the type of chronic mild stressors we face today. So what happens to these rats? They develop intestinal permeability that takes several days of no stress to heal. (9) Yes, several days. When’s the last time you went several days without any stress whatsoever?

This research has also shown that mast cells play a large part in the increased intestinal permeability that occurs as a result of stress. You may have heard of mast cells as the cells involved in allergic responses, as they are responsible for releasing histamine when they become unstable or “degranulate”, causing the typical allergic response – runny nose, watery eyes, congestion, etc. What you might not know about mast cells is that they’re also found along the gut’s mucosal wall and they contain CRH receptors. Remember, CRH is released at the start of the “fight or flight” reaction. Since mast cells have CRH receptors it means that they are responsive to the amount of CRH flowing through the body. When CRH attaches to mast cells, they degranulate and release their many chemicals, including histamine.

Researchers studying rats under water aversion stress found that rats bred to have no mast cells in their intestines didn’t show increased intestinal permeability under stress, unlike their normal mast-cell containing counterparts. (8) This tells us that mast cells play a very important role in the integrity of the gut lining when it comes to stress, and that unstable and degranulated mast cells lead to intestinal permeability. By stabilizing these cells, we can help prevent the breach in our gut barrier.

These rat studies give us a glimpse into what’s going on in our gut while under chronic psychological stress, and it’s not good. Hardly any of us can go a few days without being stressed about something, which never gives our gut barrier time to heal after it’s become permeable thanks to the unstabilized mast cells. Because of this, we’re leaving ourselves open to harmful substances not meant to enter our bodies.

Stress Fuels Inflammation

Glucocorticoids are steroid hormones made by the adrenals in times of stress. We’ve already discussed the most important one in the human body: cortisol. Cortisol plays a significant role in turning off inflammatory reactions. In fact, if you suffer from an inflammatory bowel condition, you may have been prescribed a steroid like prednisone to reduce the inflammation in your gut. When prednisone enters the body it is converted by the liver to prenisolone, a derivative of cortisol, to exert its anti-inflammatory effects.

Let’s say we were running away from the bear chasing us, but we got caught. The bear bit us, but allowed us to survive. The body’s reaction to physical trauma – being bitten – is to rush blood to the wound, which swells the area, turns it red, and makes it hurt a lot. These are all signs of inflammation, which is the body healing itself. Once inflammation’s job is done, the inflammatory reaction is shut off and cortisol helps this happen. Short-term inflammation like this is a completely normal response and under usual circumstances it helps us. It’s chronic inflammation that gets us in trouble.

One of the recent theories suggests that we can develop chronic inflammation – in the gut and elsewhere – when we’re under prolonged stress. (10) This is thought to occur because chronic stress alters the way our cells respond to cortisol. In effect, when cortisol is high for a significant period of time, our body simply becomes less sensitive to its anti-inflammatory effects. When we are under stress for even longer and consistently activating the HPA axis, the axis can eventually become overwhelmed and stop producing the hormones that it’s supposed to (like cortisol).

Think about it like the story of the boy who cried wolf. When the body constantly cries out for help with these little stressors and activates the HPA axis over and over again, eventually the HPA axis doesn’t bother answering the cries anymore – or at least not with as much vigor as it did before. As a result, we produce less cortisol than we’re supposed to. Low cortisol levels also lead to chronic inflammation because we don’t have the ability to fight off bacteria and other unwanted substances that make it through the now permeable gut barrier.

It’s important to remember that we want just enough cortisol: too much, and our tissues become less sensitive to its anti-inflammatory effects; not enough, and we’re open to attack from bacteria and other particles crossing the gut barrier, causing inflammation; just enough, and we’re able to keep inflammation down and respond to stress appropriately.

Are you starting to see the chain reaction developing here? The stress response turns on, our gut gets leaky, cortisol levels soar, and then eventually fall, causing inflammation either way. What’s next?

Stress Lowers Immunity

Did you know that the majority of our immune system is actually housed in the gut? Our gut-associated lymphoid tissue (GALT for short) makes up almost 70% of our immune system by weight. You might be able to imagine why the gut would need to have such a strong immune system – it’s in constant contact with things from the outside world such as food particles, bacteria, and all the other things we inadvertently swallow. That’s a lot to deal with!

As part of the gut’s immune system, our gastrointestinal system secretes something called secretory IgA (sIgA), which is our first line of defense when it comes to all the substances our gut is in contact with. This important antibody is also produced in other parts of the body that are exposed to the outside world – it’s found in saliva, tears, and lung secretions. Chronic stress reduces our production of sIgA and by doing so, leaves us open to colonization by pathogenic bacteria in the gut.

Studies show that students under academic stress have lower levels of sIgA than those under less stress. (11) Up to two weeks after exam stress has dissipated, students still show lower levels of sIgA with no indication of recovery. Relaxation exercises, on the other hand, actively increase sIgA production. (12) Low sIgA leaves us susceptible not only to infections of the gut but also to infections in the rest of the body. With infections come even more inflammation, thus fueling the inflammatory fire already going when we’re under chronic stress. Low sIgA also gives bad bacteria the chance to take charge, changing our gut microbiota.

Stress Unbalances Gut Bacteria

The gut microbiota is absolutely vital to our digestive health (not to mention the health of our whole body!), but stress changes its composition in our gut, shifting it in a less favorable manner. Under chronic psychosocial stress, mice develop a condition called dysbiosis, the relative overabundance of bad bacteria coupled with low amounts of good bacteria in the gut. (13) This imbalance is associated with digestive problems like IBS and Crohn’s disease, and even conditions like fatty liver disease and acne. Not only does stress alter the balance of our bacteria, but it also reduces our gut’s microbial diversity (how many different types of gut bacteria we have). Interestingly, the less diverse our gut bacteria, the more likely we are to be overweight and have allergic diseases.

Using germ-free mice, researchers have been able to prove that the intestinal microbiota also play a vital role in the development of the HPA axis (remember that’s our stress control center). Germ-free mice are often used in studies because they allow us to monitor what happens when the body exists without gut bacteria, providing us the opportunity to see exactly how the microbiota affects physiology. When these adult mice are exposed to stress, they produce higher levels of ACTH and cortisol than mice with normal gut microbiota. (14) To further elucidate this relationship, researchers then colonized the gut of the germ-free mice with bacteria from the normal mice which partially reversed the exaggerated stress response. The effect was fully reversed when the mice were colonized with a specific strain of probiotics (good bacteria).

It is clear that stress alters our gut microbiota, and that the opposite is true too – our gut bacteria affect how we respond to stress. When our microbiota is negatively altered as a result of stress, it then sends signals back to the brain which manifest as even further stress. But wait, there’s more!

Stress Increases Pain

Did you know that most patients with IBS and other gut disorders often show enhanced perception of pain? (The fun science term for that one is visceral hypersensitivity.) While the normal response to stress is to increase the pain threshold, patients with digestive diseases unfortunately experience the exact opposite. Think about it like this: if you were being chased by a bear and you stepped on a sharp twig, you’d probably continue running and barely even notice that you’re hurt. That’s an exaggerated example of the normal pain experience in response to stress – we can handle more of it.

However, in studies looking at the pain response to gastric distention (gas or air in the gut causing bloating), those with gut disorders have a lower pain threshold – meaning they experience more pain – than those without digestive problems. (15) Research further shows that patients with gut conditions exhibit even more digestive symptoms like gas and pain when they’re under mental stress and feeling anxious. These symptoms decrease during periods of relaxation, further proof of the tight link between the brain and the gut. Here’s the unfortunate fact: if you’re someone with a digestive disorder, stress literally makes your stomach hurt.

Let’s go back to how the stress response starts for a moment: CRH is released from the hypothalamus, which begins the cascade of hormones eventually resulting in the production of cortisol. In rats, CRH administration causes mast cell degranulation in the colon. Remember the mast cells? These are the cells that, when not present in the intestines of rats, resulted in the rats no longer developing intestinal permeability as a result of stress. Research has shown that when those with IBS are given a mast cell stabilizer they are less sensitive to pain. (16) This tells us that having stabilized mast cells is vital to having an intact gut barrier and having appropriate pain sensation. It’s theorized that stress management techniques such as yoga can inhibit mast cell activation, thus having a positive effect on all types of conditions where mast cell activation is problematic. (17)

This brings us to the end of the stress train-wreck. When we’re stressed, our gut becomes permeable and inflamed, our immune system is compromised, and we’re subject to an altered balance of the bacteria living in our gut. As if this weren’t enough, being stressed out makes us feel worse by increasing the amount of pain we experience!

Stress and Digestion: Overcoming A Stressful Life for Better Digestive Health

I don’t want all of this to overwhelm you or make you feel like you’re destroying your gut health by being stressed out. I wanted to take you through this so that you can recognize the many negative effects chronic stress can have on the digestive system. So what should you do if you’re always stressed out?

Laura and I have outlined some specific steps to take in our free eBook, Overcoming Adrenal Fatigue that you can get by signing up for our newsletter. You’ll learn exactly what you need to do to help your body overcome the effects of chronic stress.

Now I want to hear from you: Did any of these effects surprise you? What do you plan to do differently now that you know about the connection between stress and digestion?

elemental diet

An elemental diet is an effective treatment for those with SIBO (a common cause of IBS) who have failed to eliminate the condition with typical treatment approaches like antibiotics or herbal antimicrobials.

Note: This article was originally published on ChrisKresser.com. It has been updated and re-published on this site.

For those with small intestinal bacterial overgrowth (SIBO), the symptoms can sometimes be unbearable. SIBO symptoms include bloating, excessive gas, diarrhea, constipation, abdominal pain…the list goes on. SIBO is also a common cause of IBS.

While simply getting diagnosed in the first place is half the battle, when it is diagnosed, how do we deal with it? If you’ve tried some of the treatment options out there like rifaximin, neomycin or herbal antimicrobials with no luck, what’s left?

What is SIBO?

Before we talk about treatment options, it’s important to know exactly what SIBO is. Small intestinal bacterial overgrowth is exactly what it sounds like – an overgrowth of bacteria in the small intestine.

Normally, the small intestine has very little bacteria compared to the large intestine, which houses most of our gut bacteria. However, bacteria from the large intestine can translocate to the small intestine under some circumstances, leading to the development of SIBO. There are many underlying factors that relate to this translocation, including low stomach acid, pancreatic enzyme insufficiency, and intestinal motility disorders, among others. (1)

SIBO symptoms include bloating, excessive gas, diarrhea, constipation, abdominal pain, reflux, and more.

The usual treatment of SIBO can include diets like the Specific Carbohydrate Diet (SCD) or the GAPS diet (usually in combination with a low-FODMAP approach), antibiotics or herbal antimicrobials. (2) Unfortunately, diet alone is simply not going to get rid of a SIBO infection, as I’ve written about here.

Rifaximin, the antibiotic most commonly used to treat SIBO, is expensive, thus many patients cannot afford treatment. These patients may choose to forgo antibiotics completely and opt for natural antimicrobials such as oregano oil or berberine. These can be very useful in eradicating SIBO.

However, I’ve had more than one client claim that they can’t tolerate the herbal antimicrobials. Or perhaps you’ve tried antibiotics or antimicrobials before to treat your SIBO, but it’s failed. Round after round of antimicrobials and antibiotics, and you’re still stuck with SIBO. This is where the short-term elemental formula can be helpful.

What is an elemental formula?

In the simplest terms, an elemental formula is one that contains pre-digested carbohydrates, proteins, and fats. This means that it is absorbed very quickly from the digestive system. This is key for those with SIBO as we don’t want food sitting in the small intestine, where it would be used as fuel for the unwanted bacteria living there.

Instead, an elemental formula provides a way to nourish you while starving the bacteria. When implementing the elemental diet, you drink the formula instead of your regular meals for two to four weeks, depending on your case.

How effective is an elemental diet?

In a study using the elemental formula Vivonex Plus, patients were instructed to consume only the formula for 14 days. On the 15th day, they were re-tested for the presence of SIBO. Remarkably, 80% tested negative. Those who were still SIBO-positive were instructed to continue the formula for another 7 days, after which the cure rate went up to 85%. (3)

So how does this compare to the other SIBO treatments I discussed above (rifaximin, herbal antimicrobials)? Though figures vary for the efficacy of rifaximin, the majority of studies I’ve seen estimate it to be around 50% effective, but some studies show even lower rates. (4) One study in particular showed the cure rate for rifaximin to be 34%, while herbal antimicrobials were more effective at 46%. (5)

An 85% cure rate for a three-week elemental formula diet is impressive and should certainly be considered as a treatment option for those with SIBO. However, that doesn’t mean that it’s for everyone.

What are the drawbacks of an elemental diet?

There are definitely some downsides to the elemental formula. First, and probably most important in terms of compliance – it’s not the tastiest thing to subsist on for 2-4 weeks. You have to be willing to stick it out for at least two weeks (where we get the 80% cure rate) and potentially up to 3 three weeks to see results. While this doesn’t sound that long, it can be tough to stick to when the drink doesn’t taste so good! This means that anyone about to try this treatment has to be very committed.

The best-tasting elemental formula on the market right now is Integrative Therapeutics Physician’s Elemental Formula. (Click this link to order.)

You can also make your own elemental formula if you choose. If you’re interested to see what goes into a homemade formula, check out this recipe from SIBO researcher, Dr. Allison Siebecker. Both homemade and commercial elemental formulas are expensive (though less expensive for most than a course of rifaximin), which is also a barrier.

Also, for those who are underweight already, embarking on a two to three week elemental diet can cause them to lose even more weight if they’re not careful to consume enough of it. This is potentially dangerous, thus an elemental diet should be very carefully implemented or not implemented at all in those who are underweight. Whether you’re underweight or not, an elemental diet should always be implemented under the supervision of a medical professional who recommends a calorically-appropriate amount of formula for you to drink each day to prevent weight loss.

An elemental diet can also be a short-term fix. SIBO is a condition that recurs frequently, thus during and after any type of treatment for SIBO, it’s imperative that the patient addresses these underlying factors to prevent future SIBO episodes. This means that those looking to an elemental diet to solve their problem forever still have a long road ahead of them after completing the diet. You need to address stress, exercise, motility, and diet after your elemental formula to make sure that you’re giving yourself the best shot of not getting SIBO again.

When to consider an elemental formula

There certainly are benefits to an elemental formula, namely its short duration (2-3 weeks).  Some people need to be on antibiotics or antimicrobials for months to get rid of SIBO, while an elemental diet clears bacterial overgrowth in 80-85% of people in 2-3 weeks.

Not to mention that having an 85% cure rate is pretty incredible compared to the other options as well.

If you’re someone who has trouble tolerating supplements or medications, an elemental diet is a great option. Or, perhaps you don’t want the process to take months to complete. As long as you can tolerate the taste of elemental formula, it’s a great option for many people to cure SIBO.

However, choosing to do an elemental diet to treat SIBO should be a careful decision that one should make with their medical team and not something to take lightly, but its 80-85% cure rate deserves a look.

Hopefully reading this article has made you think about the pros and cons of an elemental diet and allows you to make this decision more easily!

How to Take Elemental Formula

If you’ve decided to do an elemental diet to treat SIBO, there are a few ways that you can consume elemental formula.

You can either consume your elemental formula in a few different “meals” per day, or drink it evenly over the course of the day.

Most of my clients prefer to drink it evenly throughout the day as it helps to mitigate some of the potential side-effects of an elemental diet like headaches, low blood sugar, and energy fluctuations.

Where to Buy Elemental Formula

The best-tasting elemental formula on the market right now is Physicans Elemental Formula. Click the button below to purchase elemental formula easily.

Purchase products through our Fullscript virtual dispensary.

Now I’d like to hear from you. What do you think about elemental diets for SIBO? Do the positives outweigh the negatives or vice versa? Have you tried an elemental diet?

Do Polyphenols Improve Your Gut Bacteria?

This article was originally published on ChrisKresser.com.

While you’d be hard-pressed to find anyone who doesn’t think polyphenols are healthy for you, one of the lesser-known benefits of consuming a diet high in polyphenols is its beneficial impact on your gut bacteria.

There are certain substances that have a very significant impact on our gut bacteria balance, like probiotics for example, but other foods and beverages have a smaller, more moderate beneficial effect on our microbiota. Even though these effects are mild, consuming foods and beverages that have beneficial effects on a regular basis is one of the keys to good gut health. Polyphenol-rich foods are excellent to include as part of your overall gut-healing plan along with some of the other heavy-hitters like probiotics and prebiotics. Why? Let’s break it down.

What are Polyphenols?

Polyphenols are naturally-occurring compounds found in in plants. Many of these plants make up our food supply, including fruits, vegetables, coffee, tea, and wine. Once consumed, only about 5-10% of polyphenols are directly absorbed in the small intestine, while the rest make their way to the colon to be broken down by our gut bacteria into metabolites, which then exert their important physiological effects. (1) Researchers are now discovering that the relationship between polyphenols and the gut microbiota is a two way street: that is, the polyphenols change the composition of the gut bacteria, and the gut bacteria are responsible for metabolizing the polyphenols into their bioactive metabolites.

Polyphenols Increase Good Bacteria and Decrease Bad Bacteria

The gut contains over 100 trillion bacteria (that’s ten times the amount of bacteria than we have human cells!) that play a vital role in our overall health. (2) These bacteria are negatively altered by antibiotics, stress, the food we eat, and more, eventually leading to a problem called dysbiosis. Dysbiosis is an imbalance of bacteria that can occur in any of our mucus membranes, such as in the lungs, mouth, nose, and of course, the gut. (3) We’ll be focusing on gut dysbiosis in this article, as it’s something we definitely want to avoid or fix if we’re suffering from digestive problems. Dysbiosis is probably much more common than you’d think: it’s often seen in those with inflammatory bowel disease, fatty liver, obesity, colon cancer, IBS, and more. (4, 5, 6, 7, 8) One of the best things we can do for our digestive (and overall) health is balance our gut bacteria. Luckily, there are plenty of ways for us to do that and consuming polyphenols is one of them!

Polyphenols seem to act as a prebiotic-type substance, meaning that they increase the amount of healthy bacteria in the gut, such as Lactobacillus and Bifidobacteria strains. Tea is possibly the most researched out of all the high-polyphenol foods, with many studies proving the prebiotic effects of tea extracts, leaves and polyphenol compounds. (9, 10, 11, 12, 13) Compared to those not treated with polyphenols, rats consuming red wine polyphenols have completely different predominant bacteria: those not consuming polyphenols showed predominantely Bacteroides, Clostridium and Propionibacterium species, while polyphenol-treated rats had mostly Bacteroides, Lactobacillus and Bifidobacterium species, showing that polyphenol intake can make quite an impact on gut bacteria. (14) In a study on humans, a wild blueberry drink significantly increases Lactobacillus counts. (15) Here’s the best news you’ll hear today: red wine also contains polyphenols that seem to have a similarly beneficial impact on gut bacteria. (16) Pretty sure that sentence made this article worth reading, didn’t it? It gets even better: cocoa also has prebiotic activity. (17) While this article isn’t meant to give you an excuse to go on a wine and chocolate free-for-all, it does mean that consuming these foods in moderation is likely beneficial for your gut flora.

Not only do polyphenols increase counts of beneficial bacteria, they also inhibit growth of potentially pathogenic bacteria. Catechin, a polyphenol found in tea, chocolate, apples, and blackberries (to name a few), has been shown to significantly inhibit proliferation of Clostridium histolyticum, a pathogenic bacteria. (18) Phenolic compounds contained in various berries have also been studied, showing antimicrobial effects on human pathogens such as Staphylococcus and Salmonella. (19) Studies also show that tea phenolics consumption repress the growth of Clostridium perfringens, Clostridium difficile, and Bacteroides spp. (20)

Include Polyphenol-Rich Foods for Balanced Gut Flora

By now you understand that it’s not just probiotics that can make a big difference in the balance of your gut bacteria. Eating polyphenol-rich foods on a regular basis, along with probiotics, prebiotics, and resistant starch will balance your microbiotia and get you on your way to good gut health! You will of course want to exclude any polyphenol-rich foods that you are sensitive to, but otherwise include as many as you’d like! There’s more research to be done in this area, and we don’t know all the ways that each different polyphenol affects us, so it’s best to consume a variety of polyphenol-rich foods for the best results. To get you started, below is a list of the Top 40 Paleo Polyphenol-Rich Foods from highest in polyphenols to lowest per serving. (21) Note that not all foods have been tested for their polyphenol content, so this list only includes those that have been studied. You can check out the polyphenol content of a food here, in case you’re wondering about one not on the list!

Top 40 Polyphenol-Rich Foods:

  • Black elderberry
  • Black chokeberry
  • Black currant
  • Blueberry
  • Globe artichoke heads
  • Coffee
  • Sweet cherry
  • Strawberry
  • Blackberry
  • Plum
  • Raspberry
  • Flaxseed meal
  • Dark chocolate
  • Chestnut
  • Black tea
  • Green tea
  • Apple
  • Hazelnut
  • Red wine
  • Black grape
  • Black olive
  • Spinach
  • Pecan
  • Prune
  • Red currant
  • Peach
  • Green olive
  • Red onion
  • Green grape
  • Potato
  • Shallot
  • Red chicory
  • Broccoli
  • Nectarine
  • Pear
  • Yellow onion
  • Apricot
  • Asparagus
  • Almond
  • White wine
How to Prevent Diverticulitis Naturally


If you’ve ever experienced a diverticulitis attack, I’m sure you’d be the first to say that it’s not a pleasant experience. I bet you’d be willing to do a lot of things to prevent it from happening again! Or maybe you’re someone who has been diagnosed with diverticulosis by your gastroenterologist, but you’re not quite sure what to do to prevent those painful attacks you’ve heard about and you want to learn more. Whatever brought you here, I’m happy to have you. Today I’ll be providing tips on how to prevent diverticulitis attacks naturally. Check out the full post on chriskresser.com here!