Does Stress Cause Digestive Problems?

Does Stress Cause Digestive Problems?

Most of us can probably guess that stress affects the body negatively – but how does it affect the gut?

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 how chronic 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!

Overcoming A Stressful Life

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 how stress can affect your digestive system?


Can a Short-Term Elemental Diet Help Treat SIBO?

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?

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

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!

How To Heal Your Gut After Antibiotics

How To Heal Your Gut After Antibiotics

Now that you’ve learned what probiotics to take while you’re antibiotics, you’re probably concerned with what you should do after you’ve finished your course.

Antibiotics take a toll on our microbiome, destroying lots of our good bacteria and causing overgrowth of others like yeasts. This imbalance of gut bacteria is called dysbiosis. So how do we fix it?


I suggest taking the probiotics you started during your course for at least a month following the antibiotics. If you were taking a single strain supplement like Florastor, you might consider adding a probiotic supplement that has a couple strains like VSL #3 just to bring in some other strains. You can continue taking this supplement for a few months (consult with your practitioner for advice on this).

You’ll also want to focus on including plenty of probiotic-containing foods for the next few months (you should always include these in the diet, but it’s especially important to do so right after taking antibiotics). Here’s a list of fermented foods, including (but not limited to) the following:

  • Water or Dairy kefir – fermented water (often with juices or fruit included for flavoring in a “second ferment”) or dairy with kefir “grains”. Click here for a recipes, or purchase at your local natural foods store
  • Kombucha – a fermented tea drink. Click here for a recipes, or purchase at your local natural foods store
  • Kimchi – a spicy fermented cabbage, a Korean staple (and my personal favorite!). Click here for a recipe and try it at a Korean restaurant for a taste. You can often purchase this in tubs at Korean grocery stores as well.
  • Sauerkraut – another fermented cabbage, but a German version this time! Click here for a recipe or you can pick up some Bubbie’s sauerkraut at Whole Foods or other natural foods store
  • Pickles – the deli classic can be made by fermenting cucumbers! Click here for a recipe and keep in mind these are different from the pickles in vinegar you’d find on the shelf of your regular grocery store.
  • Salsa – another classic dish that can take a fermented turn! Click here for a recipe and give it a shot!
  • Beet kvass – a fermented beet juice drink. Click here for a recipe or you can usually find this in your Whole Foods or other natural foods store.
  • Yogurt – if you tolerate dairy, yogurt is a great source of probiotics. Click here for a recipe or of course you can pick some up from your grocery store (choose one that uses a good quality milk though and ALWAYS buy full fat!)

Keep in mind that you can ferment pretty much anything! My favorite resource for fermentable foods is the book Wild Fermentation by Sandor Katz and I’m eagerly awaiting the release of Fermented by Jill Ciciarelli. This is one of the most fun ways to experiment in the kitchen, so get fermenting!


A prebiotic is a “nondigestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon, and thus improves host health.” (1) This definition was later revised to include that a prebiotic:

“a) resists gastric acidity, hydrolysis by mammalian enzymes and gastrointestinal absorption;

b)  is fermented by the intestinal microflora;

c) stimulates selectively the growth and/or activity of intestinal bacteria associated with health and wellbeing.” (2)

As of this writing, only three substances fit this definition (though there are certainly other substances that need more research). Below is a list of the only true prebiotics, where to find them, and what supplements contain them. It’s crucial to consume prebiotic substances after antibiotic treatment as it helps to fix the dysbiosis created.

1) Fructo-oligosaccharides: FOS is found is a variety of foods including Jerusalem artichokes, chicory root, onions, bananas, honey, garlic and leeks. (3) The appropriate dose of FOS is about 10 grams per day (this leads to increases in bifidobacteria and has the least amount of side effects (which tend to be gas and bloating)). (4) Whether you get this dose from food or supplement is up to you, but it will help to correct the dysbiosis caused by antibiotic treatment. If you choose to supplement, I recommend Pure Encapsulations FOS powder.

2) Galacto-oligosaccharides: GOS isn’t found in many foods, so if you’d like to try this one you’ll need to supplement. A dose of 5 grams per day has been shown to be bifidogenic (increases bifidobacteria counts) in most healthy people while consuming it along with their usual diet. (5) Try Jarrow Formulas Yum Yum GOS syrup.

3) Lactulose: Again, you won’t find this one in any foods, so you’ll need to supplement if you want to give this one a shot. Lactulose is more commonly known as a laxative, and in the United States you’ll need a prescription for it. The dose shown to be bifidogenic is 10 grams per day. (6)

You don’t need to supplement with all of these (nor should you). If you’re going to supplement, just choose one.

***Please note: if you are sensitive to FODMAP foods, it is not recommended that you consume these supplements (or foods containing them).

***Also note that if you are supplementing with any these, you’ll want to introduce them very slowly and work your way up to a higher dose over time. You’ll also want to split up your dosage (i.e. take it 3 times a day vs. once a day).

What if Probiotics and Prebiotics Aren’t Enough?

Because of the intense effect antibiotics can have on our gut flora, sometimes simply adding probiotics and prebiotics doesn’t quite cut it.

Maybe you’ve noticed that your digestion is just off after taking a course (or a few courses) of antibiotics. What do you do then?

Well, a good first step is to have your gut bacterial balance tested.

There are two common imbalances that can result from antibiotic treatment. The first, which we just discussed, is called dysbiosis.

The second is something called SIBO (small intestinal bacterial overgrowth).

Both of these conditions can cause many annoying digestive symptoms and can be difficult to deal with.

You can learn more about both of these conditions and the testing you need to identify them in this blog post.

If you’re experiencing lots of digestive symptoms like bloating, gas, diarrhea or constipation long after being on antibiotics, it’s definitely time to test for SIBO and dysbiosis. (Note: you’ll need to wait at least 2 weeks after being on antibiotics to do these kinds of tests.)

Once you identify these imbalances, you can get to work clearing out bad bacteria and healing your gut. This typically involves an antimicrobial protocol (or antibiotics — but don’t worry, these ones aren’t like the ones that got you here in the first place!), gut-healing supplements, stress management, and a proper diet.

I have an entire 8-week course dedicated to this process called Build Your Biome. If you’re totally overwhelmed by all the research you need to do to kick these symptoms to the curb, I invite you to join me in BYB where I make it all super easy!

Takeaway: By getting probiotics and prebiotics in the diet (or via supplementation), you’ll be helping your gut recover from the traumatic experience of dealing with antibiotics. However, some people may find that they are left with nagging symptoms even after incorporating probiotics and prebiotics. In this case, it’s very important to test for common conditions like dysbiosis and SIBO.


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


1) Pharmaceutiques, Universitad Catholique de Louuain. “Dietary modulation of the human colonie microbiota: introducing the concept of prebiotics.” Journal of Nutrition 125 (1995): 1401-1412.

2) Gibson, Glenn R., et al. “Dietary modulation of the human colonic microbiota: updating the concept of prebiotics.” Nutr Res Rev 17.2 (2004): 259-275.

3) Chow, JoMay. “Probiotics and prebiotics: a brief overview.” Journal of Renal Nutrition 12.2 (2002): 76-86.

4) Bouhnik, Yoram, et al. “Short-chain fructo-oligosaccharide administration dose-dependently increases fecal bifidobacteria in healthy humans.” The Journal of nutrition 129.1 (1999): 113-116.

5) Davis, L. M. G., et al. “A dose dependent impact of prebiotic galactooligosaccharides on the intestinal microbiota of healthy adults.” International journal of food microbiology 144.2 (2010): 285-292.

6) Bouhnik, Y., et al. “Lactulose ingestion increases faecal bifidobacterial counts: a randomised double-blind study in healthy humans.” European Journal of Clinical Nutrition 58.3 (2004): 462-466.