Does your gut need a reset?

Yes, I'm Ready

Do you want to start feeling better?

Yes, Where Do I Start?

Do you want to start feeling better?

Yes, Where Do I Start?

How to Heal Your Gut in 8 Steps: A Clinician-Approved Guide

8 Simple Steps for Healing Your Gut & Boosting Your Overall Health

Key Takeaways:
  • Your gut is the seat of your overall health and well-being.
  • You can support a healthy gut by identifying your ideal anti-inflammatory diet through a simple elimination diet process. 
  • Supplements like probiotics, collagen, omega-3 fatty acids, and L-glutamine can all help with healing your gut (but you may not need all of them or all at once).
  • Getting enough sleep and reducing stress can improve your gut health.
  • Working through the potential treatments in a systematic way and addressing things in strategic order is the most effective way to approach healing your gut.

Your gut is at the center of your overall health and well-being. It’s the seat of your immune system, it’s where most of your body’s serotonin is made, and it’s where nutrients are broken down and assimilated to feed all the systems of your body. In other words, gut health is not just digestive health, it’s whole-body health.

So when things are a little off—whether you’re experiencing digestive symptoms (like bloating or diarrhea) or other seemingly unrelated symptoms like exhaustion, aches and pains, skin eruptions, or mood changes—improving your gut health is the critical first line of defense.

But how and whether your gut needs attention might not be immediately obvious. In fact, you might be unwittingly doing things you don’t realize are harmful to the human gut. For example, taking over-the-counter pain meds like ibuprofen (or other NSAIDs) can compromise your gut lining [1, 2]. And prolonged, strenuous exercise may temporarily harm the gut lining and contribute to leaky gut syndrome, which I describe in detail in the Cause and Effect section [3].

Reducing gut irritants and accidental damage are the first steps to healing your gut. From there, a diet particular to your condition could come into play, but you may simply find that removing inflammatory foods and adding in probiotics, other supplements, and a few lifestyle tweaks will be enough to get you going in the right direction and feeling better. Let’s discuss science-backed ways of healing your gut and the full-body health benefits of healthy gut maintenance.

Action Plan: How to Heal Your Gut

A healthy gut is one with an intact, sealed barrier between it and the rest of the systems in your body. Nothing should be leaking through the tight junctions of your intestinal lining, and everything should be moving through the system smoothly. The food you’re digesting should stay inside the digestive tract until it’s time for your body to release it as waste (poop).

At the beginning of the gastrointestinal (GI) tract, a healthy gut contains adequate amounts of digestive enzymes (in the salivary glands and stomach) and stomach acid to break down the food you’ve eaten before it enters your small intestine. A healthy gut contains a wide array of microbes, mainly in the large intestine, that aid in digestion, reduce inflammation, and play an active role in keeping the gut wall sealed.

To begin outlining how to heal your gut, I recommend that my patients use an evidence-backed, step-by-step process that starts by resetting the gut (typically with a short-term liquid fast) and supporting it while we remove potentially problematic foods from the diet. After the gut has had a chance to recover, we move to slowly reintroducing some of the foods that we eliminated and eventually get to a happy place of gut maintenance. I call this protocol the Great-in-8 Action Plan, but not everyone needs all eight steps. 

I’ll briefly outline the steps as I use them in the clinic, but you can also find them in great detail with specific instructions and dosing in my book, Healthy Gut, Healthy You. Ideally, you’ll go through the steps with support from your trusted healthcare provider

Step 1: Reset

This first step is a two-to-four-day modified fast, in which I suggest my patients drink bone broth or a cleansing lemonade to reduce inflammation and let the gut rest. A popular alternative to this is an elemental diet, which can have the added benefit of reducing inflammation [4, 5] and starving any potential bacterial overgrowths in your small intestine [6]. 

Whichever they choose, the next step is a modified fast with an anti-inflammatory elimination diet that reduces allergens and irritants. For some, that means a Paleo diet. For others, a low-FODMAP diet is more helpful.

Step 1 also involves some lifestyle resets, such as removing alcohol (for now), introducing easy exercise like walking, drinking plenty of water, reducing stress, and creating a consistent sleep schedule.

A Note on Stress

Sometimes simply telling someone to reduce stress actually causes them stress. I understand that this advice given out of context can sometimes feel like pressure when so many stressors in life feel outside of our control. The way you choose to reduce stress is personal to you—it’s about finding something that provides a release valve for you and allows you to take time for yourself. Here are some science-backed suggestions for managing stress.

  • Breathwork or meditation can reduce stress and may improve digestion [7].
  • Time in nature may improve mood, calm the nervous system, reduce reactivity to stress, lower blood pressure, boost immunity, and increase the diversity of beneficial gut microbes [8, 9, 10, 11, 12].
  • Moderate exercise can reduce stress and may help reduce gut-related symptoms [3, 13, 14, 15, 16, 17, 18, 19]. 
  • Psychological support: Working with a therapist who offers cognitive-behavioral therapy (CBT) or mindfulness-based stress reduction (MBSR) may improve gut-related symptoms [20, 21, 22, 23, 24, 25, 26].
  • Gut-focused hypnotherapy, in person or online, may help reduce digestive symptoms [27, 28].

Maybe one of these will work for you, or perhaps you have something else in mind, like a relaxing art project, working on a puzzle, or calling a supportive family member or a friend who makes you laugh. Whatever works to provide relief is something to engage in regularly to lower your stress levels.

Back to Step 1 of how to heal your gut. For many of my patients, following Step 1 for a month or more brings complete relief. In that case, they can skip to step 5 (see below) and begin reintroducing some of the foods they removed. It’s important to do this slowly and deliberately to figure out which foods are irritating and which are fine to eat without causing symptoms. 

However, if Step 1 doesn’t bring a patient significant relief, they have the option of continuing onto steps 2, 3, and 4. Steps 5–8 are all about easing up on restrictions and enjoying life.

Step 2: Support

The second step of healing your gut is about getting additional gut support with probiotic supplements and sometimes digestive enzymes and hydrochloric acid (HCl) acid supplements. Additionally, amino acids and other helpful nutrients, like vitamin D, may support the intestinal lining and reduce inflammation. 

Step 2 helps to further heal and seal the gut lining and support the gut as it breaks down foods that could be creating stress for the system. 

Probiotic Supplements

Probiotics are easily the best way I’ve found to tackle the first part of Step 2. Both my clinical experience and high-quality research point to probiotics as the cornerstone of effective gut treatment [29, 30, 31, 32, 33, 34, 35, 36, 37, 38]. A blend of different types of bacteria can work to encourage healthy populations of intestinal bacteria and inhibit the growth of inflammation-causing microbes in the GI tract.

Many clinicians have overlooked a trend in the research suggesting that three well-studied categories of probiotic supplements are particularly effective at balancing gut microbiota and improving gut health [39, 40, 41, 42, 43, 44, 45, 41, 44, 46, 47]. These most effective probiotic categories are as follows:

  1. A blend of gut bacteria called Lactobacillus and Bifidobacterium 
  2. A single strain of Saccharomyces boulardii, a healthy fungus 
  3. Soil-based microorganisms, typically species of Bacillus

In my clinical experience, combining these three categories leads to substantially better improvements than standard single- or double-strain probiotic treatments. I call this approach to probiotics triple therapy. To correct microbial imbalances and reduce inflammation, I recommend the following approach to my patients:

  1. Try a quality formula probiotic from category 1, category 2, and category 3—take all three together.  
  2. Track symptoms for 2–3 months. If symptoms improve, stick with this regimen until you reach a plateau.
  3. Continue the same protocol for about another month to allow your system to adjust. Then reduce the dose incrementally to find the minimal effective dose. Once you’ve found it, stay on that dose.
How to Heal Your Gut in 8 Steps: A Clinician-Approved Guide - Evidence%20Based%20Probiotic%20Meta%20Protocol%20landscape%20update L

Probiotics are also present in fermented foods, but you’d have to eat a lot of them consistently every day. Although fermented foods can be part of a healthy diet*, they likely aren’t potent enough to reach the therapeutic levels—good bacteria and fungi in the billions or trillions per dose—that probiotics have. For more detail, see this table comparing the doses of probiotics in foods versus supplements.

*Some people may benefit from eating fermented foods, such as kefir, sauerkraut, and kimchi. However, some people may find these foods irritating and should eat them with caution or avoid them. 

Digestive Enzymes or Acid

If combining diet and lifestyle changes with probiotics for a few weeks hasn’t led to a significant improvement, we then consider digestive enzymes or focusing on stomach acid. 

Some people don’t make enough of the enzymes required to break down certain carbohydrates, proteins, or fats and may notice bloating, gas, abdominal discomfort, or bowel movement changes. In such cases, taking digestive enzymes that include amylase, protease, or lipase at the start of a meal could help reduce or eliminate such symptoms [48]. I tend to recommend trying each of these separately for 2–3 weeks each, looking for improvements, worsened symptoms, or no effect at all. 

Others may have low stomach acid and could benefit from taking betaine HCl to improve digestive function and nutrient absorption [49, 50]. Check out my video explaining how to do this safely and effectively:

If they feel worse or no different after trialing these digestive aids, we stop using them and look to some other supplements that may benefit a potentially damaged gut lining.

Supplements to Heal the Gut Lining

If diet, stress reduction, probiotics, and digestive enzymes or HCl haven’t helped someone after a few weeks, leaky gut could be at play. Now we might consider trying supplements that can strengthen the intestinal wall and repair a leaky gut, which I’ll detail in the Cause and Effect section. In short, a strong gut wall keeps microorganisms and undigested food particles from escaping into your bloodstream, where they should not be. Research shows that these supplements may directly help heal a leaky gut:

  • L-glutamine, an amino acid [51, 52, 53, 54, 55]
  • Colostrum [56, 57]
  • Zinc [58, 59] and zinc carnosine [57, 60]
  • Zeolite [61]

Although bone broth has less clinical research behind it, it’s a whole-food source of L-glutamine, other amino acids, and minerals that may help heal the gut lining. However, given its lower concentrations of healing elements, bone broth may also be less effective than supplements. 

As with the digestive aids, I typically recommend that my patients try each gut-lining supplement separately for 2–3 weeks to gauge whether they help, harm, or make no difference. If neither digestive aids nor gut-lining supplements clearly help, they might consider trialing any of the next types of supplements.

Supplements to Reduce Inflammation

Sometimes, when none of the previous steps or supplements seem to have helped considerably, chronic inflammation is at play. The good news is that certain supplements can help reduce inflammation and support the gut microbiome. Those with signs of leaky gut may want to give any of the following science-backed supplements a try:

With all supplements, it’s good to give each one a try, ideally with a clinician’s support, for 2–3 weeks and make note of whether they help, harm, or do nothing. Keep track of those that help and stop taking those that don’t.

I’ll acknowledge that high-quality supplements can add up quickly, and it’s not necessary for most people to take everything I’ve mentioned above. That amount of supplementation would quickly get expensive, unwieldy, and stressful, which is not what anyone wants when working to heal the gut. If you ever find yourself lost in a heap of supplements, it’s a good idea to get some guidance.

One option is to read through the full Great-in-8 Action Plan in my book, Healthy Gut Healthy You. Another option is to work with someone who specializes in gut health and functional medicine, such as the clinicians at our clinic.

Step 3: Remove

This step is only necessary for those who aren’t feeling better after Steps 1 and 2. It involves eliminating any harmful bacteria that persist after the first two steps. The natural option here is to try antimicrobial herbs that can remove unwanted gut bacteria. Clinical research has shown some herbal antimicrobials to be just as effective as rifaximin, the prescription antibiotic that gastroenterologists often prescribe to target harmful gut microbes [77, 78, 79].

Next Steps

Once we’ve cleared out any harmful microbes, I move my patients on to Step 4: Rebalance. If their digestion is still sluggish (causing constipation), it’s likely that their gut microbes are having a hard time staying balanced. Step 4 introduces prokinetic supplements, which can improve motility (the rate at which contents move through the digestive tract) to support healthy gut bacteria. A natural prokinetic supplement, such as peppermint oil [80, 81, 82, 83] or ginger [84, 85, 86], can improve motility so that partially-digested food doesn’t sit too long in any part of the digestive system and encourage bacterial overgrowth. 

In Step 5: Reintroduce, we start bringing back eliminated foods slowly and strategically. Reintroducing one (typically lower-allergen) food at a time can help my patients develop a clear sense for which foods are best for their unique system. This trial-and-error approach also helps people build the confidence to know that if a flare-up occurs, they can return to the diet that worked best in Step 1 until things calm down and try again.

In Step 6: Feed, we work to incorporate foods that feed the beneficial bacteria the healthier gut now supports. Prebiotic foods, like legumes, onions, and whole grains, contain fiber that beneficial gut bacteria and fungi eat. But it’s important to start slowly when reintroducing prebiotic foods because too much at one time can be stressful on the digestive system [87, 88].

In Step 7: Wean, it’s time to cut back on the supplements we added during the previous steps. The goal of this step is to get each patient to the bare minimum of supplements they need to remain in a good state of gut health. I typically recommend a methodical approach of removing one supplement at a time while noting how it feels to go for a few days or a week without each one. People often find they need to stay on one or a few supplements to feel their best and maintain feeling well, which brings me to the last step.

Step 8: Maintenance and Fun is the final step in this process. Everyone’s Step 8 looks different, but reaching it means they have the tools they need to assess how they feel and what they should tweak to recover from dips in gut health. Maintenance is about feeling good and having fun with your newfound gut health. A sample maintenance plan could look like this:

  • Adopt a regular diet that is lower in inflammatory foods (like sugar and processed foods) and higher in anti-inflammatory, gut-healing foods like fruits and veggies, wild fish and meat, and gluten-free grains and legumes.
  • Take a broad-spectrum probiotic supplement [89, 90, 91].
  • Eat probiotic and prebiotic foods in moderation and to tolerance [92].
  • Drink plenty of water.
  • Get moderate daily exercise [93].
  • Get consistent, restful sleep (7–9 hours a night) [94].
  • Incorporate a regular stress management/reduction activity like yoga or meditation [95, 96, 97].
  • As a gut healing meal replacement, use an elemental diet for one or more meals daily.
  • To reset the gut after an occasional splurge, use an elemental diet for one or more meals per day for 1–4 days.

How Do You Know It’s Time for Healing Your Gut?

The most obvious signs that your gastrointestinal health may be compromised are recurring digestive symptoms, such as gas, bloating, constipation, diarrhea or loose stools, reflux, indigestion, or heartburn. However, there are many other seemingly unrelated symptoms that could emerge as a result of an unhealthy gut.

A poorly functioning digestive system may limit nutrient absorption [98, 99, 100] and promote inflammation, which can deregulate your entire immune system. Over time, insufficient nutrients, chronic inflammation, and immune dysregulation may manifest as one or more of the following symptoms or diagnoses:

Each of these is an indication that it may be time to start healing your gut. With support from your healthcare provider, you can start with Step 1 and take it slowly, day by day.

Cause and Effect: Digestive Health and Overall Health

Addressing the symptoms of poor gut health is important so you can get relief, but getting to the root cause is the best way to prevent further and future poor gut health.While there’s a wide array of potential causes of gut disturbance, one common culprit at the root of many health challenges is leaky gut syndrome. A leaky gut is a compromised gut lining that allows partially digested food particles and potentially harmful microorganisms into the bloodstream. Also called increased gut permeability, a leaky gut can arise from gut insults like chronic stress, toxins, unhealthy microbes, inflammatory food particles, certain drugs and medications, and infections.

How to Heal Your Gut in 8 Steps: A Clinician-Approved Guide - Leaky%20Gut%20Progression Artboard%201 L

Eventually, intestinal permeability gives rise to chronic gut inflammation, which has the potential to contribute to a host of health issues, including [154]:

  • Food sensitivities or allergies
  • Unregulated blood sugar
  • Overactive immunity (autoimmune disease)
  • Excessive inflammation
  • Skin problems
  • Mood issues
  • Weight loss or weight gain
  • Liver disease

Leaky gut is also highly correlated with chronic conditions such as celiac disease, Crohn’s disease (an inflammatory bowel disease), type-1 diabetes, food allergies, and cardiovascular disease [155, 156, 157, 158, 159, 160]. Since a leaky gut can both arise from and worsen inflammation, dietary and lifestyle approaches that reduce inflammation are vital for healing the gut.

Gut Dysbiosis

A leaky gut can contribute to gut dysbiosis, and vice-versa. Gut dysbiosis is an imbalance in the gut microbiome, meaning you have too few healthy microbes and too many harmful ones within the digestive tract. A healthy gut microbiome is important for digestion, gut health, immune system health, detoxification, and metabolism [161]. So, when gut dysbiosis is present, it can negatively impact the gut, brain, and every other major organ in the body [161].

Dysbiosis often conjures an image of off-kilter bacteria in the large intestine, but it may also mean you have too many bacteria growing in the small intestine, where their numbers should be low. This condition is called small intestinal bacterial overgrowth, or SIBO for short.

Fungal dysbiosis is common, too. For example, Candida overgrowth is when a normal fungus in most people’s digestive tracts becomes too numerous (often after taking antibiotics) and causes harm [162]. 

Gut dysbiosis can arise from gut stressors like poor diet, certain medications (like antibiotics or proton-pump inhibitors), chronic stress, an infection, or excessive inflammation [161]. So, it’s important to take steps to minimize these insults whenever possible.

While leaky gut syndrome and gut dysbiosis aren’t the only gut-related problems you could have, they are common and resolvable. Correcting them can help eliminate a lot of symptoms and lead to a better quality of life. Indeed, these two conditions are interrelated, and the solutions to ameliorate both will help with healing your gut over time.

Why Does Gut Health Matter?

It might not seem like health issues like depression, food allergies, food intolerances, constipation, low energy, bladder problems, or a skin rash from eczema could all stem from the same underlying condition, but it’s true. It bears repeating that gut health is often at the center of a wide variety of overall health issues, and healing your gut could clear up a long list of seemingly unrelated symptoms. For example (and this is by no means exhaustive), 

  • Skin issues are often gut issues [125, 126, 163]. This includes acne [123], rosacea [124], eczema [127], psoriasis [130], hives [164], and other conditions that manifest on the skin [161]. 
  • Mental health challenges also correlate to gut problems [161], especially IBS (irritable bowel syndrome), IBD (inflammatory bowel syndrome), and low diversity in the gut microbiome [110, 114]. 
  • Hormonal imbalances could arise in part from gut dysbiosis [161].
  • Overweight and obesity could arise in part from a leaky gut [154] or gut dysbiosis [161]. 
  • Joint and muscle pain and fatigue have also been linked to digestive challenges [112, 143, 161].
  • Bladder problems, like urinary tract infections or bladder pain, could arise in part from gut dysbiosis [161].

While each type of health challenge is multifaceted, my approach to functional medicine starts with the gut. In my practice, I’ve been amazed over and over again to see a wide array of symptoms improve with simple, science-based, natural steps to rebalance and heal the gut. From there, if my patients need further specialized interventions to clear up remaining symptoms, we’ll address those individually. For example, we might bring in psychotherapy for persistent mental health issues or topical treatments for the skin.

Where to Start When Healing Your Gut

When it comes to learning how to your gut, each step requires time, energy, and focus. It’s important in the process to ask for help if you need it, and expect things not to go perfectly all the time. The process isn’t always linear, and it’s normal and ok to have occasional setbacks along the way. A setback doesn’t mean you should give up—it just means you’re learning what works and what doesn’t for your unique body. 

You might find that having a mindset of adding in rather than taking out is helpful for getting more beneficial foods into your diet, especially after Step 1 of the Great-in-8 gut-healing process. For example, if you’re in Step 6 and learning how to feed your beneficial gut microbes, you might try adding a few bites of prebiotic-rich whole grains or legumes to one meal per day, if you tolerate them, and increase your servings over time. 

Or, if you’ve discovered in Step 5 that you can tolerate some fermented foods, you could start each meal with a few bites of kimchi or sauerkraut, or make it a goal to drink half a bottle of kombucha or 4–8 oz of kefir every day. You could even challenge yourself to make any of these foods at home so eating them regularly is more satisfying.

Similarly, throughout every step, you might find that starting your day with a 10-minute walk and a 5-minute meditation is a great place to start building those foundations of regularly moving and offsetting stress. By starting where you are and adding a little at a time, you’ll likely find that, as each new change becomes a habit, the next task on the list is easier to incorporate. 

Last but not least, make sure you have the support of a trusted healthcare provider. If you’re looking for one, we welcome you to reach out to our clinic for support as you dive in to understanding how to heal your gut.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References

  1. Bjarnason I, Hayllar J, MacPherson AJ, Russell AS. Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans. Gastroenterology. 1993 Jun;104(6):1832–47. DOI: 10.1016/0016-5085(93)90667-2. PMID: 8500743.
  2. Mujagic Z, de Vos P, Boekschoten MV, Govers C, Pieters H-JHM, de Wit NJW, et al. The effects of Lactobacillus plantarum on small intestinal barrier function and mucosal gene transcription; a randomized double-blind placebo controlled trial. Sci Rep. 2017 Jan 3;7:40128. DOI: 10.1038/srep40128. PMID: 28045137. PMCID: PMC5206730.
  3. Chantler S, Griffiths A, Matu J, Davison G, Jones B, Deighton K. The Effects of Exercise on Indirect Markers of Gut Damage and Permeability: A Systematic Review and Meta-analysis. Sports Med. 2021 Jan;51(1):113–24. DOI: 10.1007/s40279-020-01348-y. PMID: 33201454. PMCID: PMC7806566.
  4. Warners MJ, Vlieg-Boerstra BJ, Verheij J, van Rhijn BD, Van Ampting MTJ, Harthoorn LF, et al. Elemental diet decreases inflammation and improves symptoms in adult eosinophilic oesophagitis patients. Aliment Pharmacol Ther. 2017 Mar;45(6):777–87. DOI: 10.1111/apt.13953. PMID: 28112427. PMCID: PMC5324627.
  5. Wechsler JB, Schwartz S, Amsden K, Kagalwalla AF. Elimination diets in the management of eosinophilic esophagitis. J Asthma Allergy. 2014 May 24;7:85–94. DOI: 10.2147/JAA.S47243. PMID: 24920928. PMCID: PMC4043711.
  6. Pimentel M, Constantino T, Kong Y, Bajwa M, Rezaei A, Park S. A 14-day elemental diet is highly effective in normalizing the lactulose breath test. Dig Dis Sci. 2004 Jan;49(1):73–7. DOI: 10.1023/b:ddas.0000011605.43979.e1. PMID: 14992438.
  7. Gerbarg PL, Jacob VE, Stevens L, Bosworth BP, Chabouni F, DeFilippis EM, et al. The effect of breathing, movement, and meditation on psychological and physical symptoms and inflammatory biomarkers in inflammatory bowel disease: A randomized controlled trial. Inflamm Bowel Dis. 2015 Dec;21(12):2886–96. DOI: 10.1097/MIB.0000000000000568. PMID: 26426148.
  8. Bray I, Reece R, Sinnett D, Martin F, Hayward R. Exploring the role of exposure to green and blue spaces in preventing anxiety and depression among young people aged 14-24 years living in urban settings: A systematic review and conceptual framework. Environ Res. 2022 Nov;214(Pt 4):114081. DOI: 10.1016/j.envres.2022.114081. PMID: 35973463.
  9. Shuda Q, Bougoulias ME, Kass R. Effect of nature exposure on perceived and physiologic stress: A systematic review. Complement Ther Med. 2020 Sep;53:102514. DOI: 10.1016/j.ctim.2020.102514. PMID: 33066853.
  10. Sudimac S, Sale V, Kühn S. How nature nurtures: Amygdala activity decreases as the result of a one-hour walk in nature. Mol Psychiatry. 2022 Nov;27(11):4446–52. DOI: 10.1038/s41380-022-01720-6. PMID: 36059042. PMCID: PMC9734043.
  11. Roe J, Mondschein A, Neale C, Barnes L, Boukhechba M, Lopez S. The urban built environment, walking and mental health outcomes among older adults: A pilot study. Front Public Health. 2020 Sep 23;8:575946. DOI: 10.3389/fpubh.2020.575946. PMID: 33072714. PMCID: PMC7538636.
  12. Rook GA. Regulation of the immune system by biodiversity from the natural environment: an ecosystem service essential to health. Proc Natl Acad Sci USA. 2013 Nov 12;110(46):18360–7. DOI: 10.1073/pnas.1313731110. PMID: 24154724. PMCID: PMC3831972.
  13. Marques A, Marconcin P, Werneck AO, Ferrari G, Gouveia ÉR, Kliegel M, et al. Bidirectional Association between Physical Activity and Dopamine Across Adulthood-A Systematic Review. Brain Sci. 2021 Jun 23;11(7). DOI: 10.3390/brainsci11070829. PMID: 34201523. PMCID: PMC8301978.
  14. Ribeiro FM, Petriz B, Marques G, Kamilla LH, Franco OL. Is There an Exercise-Intensity Threshold Capable of Avoiding the Leaky Gut? Front Nutr. 2021 Mar 8;8:627289. DOI: 10.3389/fnut.2021.627289. PMID: 33763441. PMCID: PMC7982409.
  15. Boytar AN, Skinner TL, Wallen RE, Jenkins DG, Dekker Nitert M. The Effect of Exercise Prescription on the Human Gut Microbiota and Comparison between Clinical and Apparently Healthy Populations: A Systematic Review. Nutrients. 2023 Mar 22;15(6). DOI: 10.3390/nu15061534. PMID: 36986264. PMCID: PMC10054511.
  16. Clauss M, Gérard P, Mosca A, Leclerc M. Interplay between exercise and gut microbiome in the context of human health and performance. Front Nutr. 2021 Jun 10;8:637010. DOI: 10.3389/fnut.2021.637010. PMID: 34179053. PMCID: PMC8222532.
  17. Gao R, Tao Y, Zhou C, Li J, Wang X, Chen L, et al. Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials. Scand J Gastroenterol. 2019 Feb;54(2):169–77. DOI: 10.1080/00365521.2019.1568544. PMID: 30843436.
  18. Nunan D, Cai T, Gardener AD, Ordóñez-Mena JM, Roberts NW, Thomas ET, et al. Physical activity for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2022 Jun 29;6(6):CD011497. DOI: 10.1002/14651858.CD011497.pub2. PMID: 35766861. PMCID: PMC9243367.
  19. Jones K, Kimble R, Baker K, Tew GA. Effects of structured exercise programmes on physiological and psychological outcomes in adults with inflammatory bowel disease (IBD): A systematic review and meta-analysis. PLoS ONE. 2022 Dec 1;17(12):e0278480. DOI: 10.1371/journal.pone.0278480. PMID: 36454911. PMCID: PMC9714897.
  20. Zhao S-R, Ni X-M, Zhang X-A, Tian H. Effect of cognitive behavior therapy combined with exercise intervention on the cognitive bias and coping styles of diarrhea-predominant irritable bowel syndrome patients. World J Clin Cases. 2019 Nov 6;7(21):3446–62. DOI: 10.12998/wjcc.v7.i21.3446. PMID: 31750328. PMCID: PMC6854400.
  21. Lackner JM, Jaccard J, Keefer L, Brenner DM, Firth RS, Gudleski GD, et al. Improvement in gastrointestinal symptoms after cognitive behavior therapy for refractory irritable bowel syndrome. Gastroenterology. 2018 Jul;155(1):47–57. DOI: 10.1053/j.gastro.2018.03.063. PMID: 29702118. PMCID: PMC6035059.
  22. Cassar GE, Youssef GJ, Knowles S, Moulding R, Austin DW. Health-Related Quality of Life in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. Gastroenterol Nurs. 2020;43(3):E102–22. DOI: 10.1097/SGA.0000000000000530. PMID: 32487960.
  23. Naliboff BD, Smith SR, Serpa JG, Laird KT, Stains J, Connolly LS, et al. Mindfulness-based stress reduction improves irritable bowel syndrome (IBS) symptoms via specific aspects of mindfulness. Neurogastroenterol Motil. 2020 Sep;32(9):e13828. DOI: 10.1111/nmo.13828. PMID: 32266762.
  24. Ewais T, Begun J, Kenny M, Rickett K, Hay K, Ajilchi B, et al. A systematic review and meta-analysis of mindfulness based interventions and yoga in inflammatory bowel disease. J Psychosom Res. 2019 Jan;116:44–53. DOI: 10.1016/j.jpsychores.2018.11.010. PMID: 30654993.
  25. Langhorst J, Wulfert H, Lauche R, Klose P, Cramer H, Dobos GJ, et al. Systematic review of complementary and alternative medicine treatments in inflammatory bowel diseases. J Crohns Colitis. 2015 Jan;9(1):86–106. DOI: 10.1093/ecco-jcc/jju007. PMID: 25518050.
  26. Kuo B, Bhasin M, Jacquart J, Scult MA, Slipp L, Riklin EIK, et al. Genomic and clinical effects associated with a relaxation response mind-body intervention in patients with irritable bowel syndrome and inflammatory bowel disease. PLoS ONE. 2015 Apr 30;10(4):e0123861. DOI: 10.1371/journal.pone.0123861. PMID: 25927528. PMCID: PMC4415769.
  27. Peters SL, Muir JG, Gibson PR. Review article: gut-directed hypnotherapy in the management of irritable bowel syndrome and inflammatory bowel disease. Aliment Pharmacol Ther. 2015 Jun;41(11):1104–15. DOI: 10.1111/apt.13202. PMID: 25858661.
  28. Miller V, Carruthers HR, Morris J, Hasan SS, Archbold S, Whorwell PJ. Hypnotherapy for irritable bowel syndrome: an audit of one thousand adult patients. Aliment Pharmacol Ther. 2015 May;41(9):844–55. DOI: 10.1111/apt.13145. PMID: 25736234.
  29. Rodiño-Janeiro BK, Vicario M, Alonso-Cotoner C, Pascua-García R, Santos J. A review of microbiota and irritable bowel syndrome: future in therapies. Adv Ther. 2018 Mar 1;35(3):289–310. DOI: 10.1007/s12325-018-0673-5. PMID: 29498019. PMCID: PMC5859043.
  30. Kuo P-H, Chung Y-CE. Moody microbiome: Challenges and chances. J Formos Med Assoc. 2019 Mar;118 Suppl 1:S42–54. DOI: 10.1016/j.jfma.2018.09.004. PMID: 30262220.
  31. Newberry F, Hsieh S-Y, Wileman T, Carding SR. Does the microbiome and virome contribute to myalgic encephalomyelitis/chronic fatigue syndrome? Clin Sci. 2018 Mar 15;132(5):523–42. DOI: 10.1042/CS20171330. PMID: 29523751. PMCID: PMC5843715.
  32. Balato A, Cacciapuoti S, Di Caprio R, Marasca C, Masarà A, Raimondo A, et al. Human microbiome: composition and role in inflammatory skin diseases. Arch Immunol Ther Exp (Warsz). 2019 Feb;67(1):1–18. DOI: 10.1007/s00005-018-0528-4. PMID: 30302512.
  33. du Teil Espina M, Gabarrini G, Harmsen HJM, Westra J, van Winkelhoff AJ, van Dijl JM. Talk to your gut: the oral-gut microbiome axis and its immunomodulatory role in the etiology of rheumatoid arthritis. FEMS Microbiol Rev. 2019 Jan 1;43(1):1–18. DOI: 10.1093/femsre/fuy035. PMID: 30219863.
  34. Abdul Rahim MBH, Chilloux J, Martinez-Gili L, Neves AL, Myridakis A, Gooderham N, et al. Diet-induced metabolic changes of the human gut microbiome: importance of short-chain fatty acids, methylamines and indoles. Acta Diabetol. 2019 May;56(5):493–500. DOI: 10.1007/s00592-019-01312-x. PMID: 30903435. PMCID: PMC6451719.
  35. Rácz B, Dušková M, Stárka L, Hainer V, Kunešová M. Links between the circadian rhythm, obesity and the microbiome. Physiol Res. 2018 Nov 28;67(Suppl 3):S409–20. DOI: 10.33549/physiolres.934020. PMID: 30484668.
  36. Li Q, Ren Y, Fu X. Inter-kingdom signaling between gut microbiota and their host. Cell Mol Life Sci. 2019 Jun;76(12):2383–9. DOI: 10.1007/s00018-019-03076-7. PMID: 30911771.
  37. Virili C, Fallahi P, Antonelli A, Benvenga S, Centanni M. Gut microbiota and Hashimoto’s thyroiditis. Rev Endocr Metab Disord. 2018 Dec;19(4):293–300. DOI: 10.1007/s11154-018-9467-y. PMID: 30294759.
  38. Shamasbi SG, Ghanbari-Homayi S, Mirghafourvand M. The effect of probiotics, prebiotics, and synbiotics on hormonal and inflammatory indices in women with polycystic ovary syndrome: a systematic review and meta-analysis. Eur J Nutr. 2020 Mar;59(2):433–50. DOI: 10.1007/s00394-019-02033-1. PMID: 31256251.
  39. Yuan F, Ni H, Asche CV, Kim M, Walayat S, Ren J. Efficacy of Bifidobacterium infantis 35624 in patients with irritable bowel syndrome: a meta-analysis. Curr Med Res Opin. 2017 Jul;33(7):1191–7. DOI: 10.1080/03007995.2017.1292230. PMID: 28166427.
  40. Tiequn B, Guanqun C, Shuo Z. Therapeutic effects of Lactobacillus in treating irritable bowel syndrome: a meta-analysis. Intern Med. 2015;54(3):243–9. DOI: 10.2169/internalmedicine.54.2710. PMID: 25748731.
  41. Zhang J, Wan S, Gui Q. Comparison of safety, effectiveness and serum inflammatory factor indexes of Saccharomyces boulardii versus Bifidobacterium triple viable in treating children with chronic diarrhea: a randomized trial. Transl Pediatr. 2021 Jun;10(6):1677–85. DOI: 10.21037/tp-21-195. PMID: 34295782. PMCID: PMC8261597.
  42. Zhang T, Zhang C, Zhang J, Sun F, Duan L. Efficacy of Probiotics for Irritable Bowel Syndrome: A Systematic Review and Network Meta-Analysis. Front Cell Infect Microbiol. 2022 Apr 1;12:859967. DOI: 10.3389/fcimb.2022.859967. PMID: 35433498. PMCID: PMC9010660.
  43. Kang S, Park MY, Brooks I, Lee J, Kim SH, Kim JY, et al. Spore-forming Bacillus coagulans SNZ 1969 improved intestinal motility and constipation perception mediated by microbial alterations in healthy adults with mild intermittent constipation: A randomized controlled trial. Food Res Int. 2021 Aug;146:110428. DOI: 10.1016/j.foodres.2021.110428. PMID: 34119240.
  44. Mourey F, Sureja V, Kheni D, Shah P, Parikh D, Upadhyay U, et al. A Multicenter, Randomized, Double-blind, Placebo-controlled Trial of Saccharomyces boulardii in Infants and Children With Acute Diarrhea. Pediatr Infect Dis J. 2020 Nov;39(11):e347–51. DOI: 10.1097/INF.0000000000002849. PMID: 32796401. PMCID: PMC7556239.
  45. McFarland LV, Goh S. Are probiotics and prebiotics effective in the prevention of travellers’ diarrhea: A systematic review and meta-analysis. Travel Med Infect Dis. 2019;27:11–9. DOI: 10.1016/j.tmaid.2018.09.007. PMID: 30278238.
  46. Fu H, Li J, Xu X, Xia C, Pan Y. Effectiveness and Safety of Saccharomyces Boulardii for the Treatment of Acute Gastroenteritis in the Pediatric Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Comput Math Methods Med. 2022 Sep 20;2022:6234858. DOI: 10.1155/2022/6234858. PMID: 36176742. PMCID: PMC9514928.
  47. Wombwell E, Patterson ME, Bransteitter B, Gillen LR. The Effect of Saccharomyces boulardii Primary Prevention on Risk of Hospital-onset Clostridioides difficile Infection in Hospitalized Patients Administered Antibiotics Frequently Associated With C. difficile Infection. Clin Infect Dis. 2021 Nov 2;73(9):e2512–8. DOI: 10.1093/cid/ciaa808. PMID: 32575126.
  48. Ullah H, Di Minno A, Piccinocchi R, Buccato DG, De Lellis LF, Baldi A, et al. Efficacy of digestive enzyme supplementation in functional dyspepsia: A monocentric, randomized, double-blind, placebo-controlled, clinical trial. Biomed Pharmacother. 2023 Dec 31;169:115858. DOI: 10.1016/j.biopha.2023.115858. PMID: 37976892.
  49. Yago MR, Frymoyer AR, Smelick GS, Frassetto LA, Budha NR, Dresser MJ, et al. Gastric reacidification with betaine HCl in healthy volunteers with rabeprazole-induced hypochlorhydria. Mol Pharm. 2013 Nov 4;10(11):4032–7. DOI: 10.1021/mp4003738. PMID: 23980906. PMCID: PMC3946491.
  50. Yago MR, Frymoyer A, Benet LZ, Smelick GS, Frassetto LA, Ding X, et al. The use of betaine HCl to enhance dasatinib absorption in healthy volunteers with rabeprazole-induced hypochlorhydria. AAPS J. 2014 Nov;16(6):1358–65. DOI: 10.1208/s12248-014-9673-9. PMID: 25274610. PMCID: PMC4389759.
  51. Shu X-L, Yu T-T, Kang K, Zhao J. Effects of glutamine on markers of intestinal inflammatory response and mucosal permeability in abdominal surgery patients: A meta-analysis. Exp Ther Med. 2016 Dec;12(6):3499–506. DOI: 10.3892/etm.2016.3799. PMID: 28105083. PMCID: PMC5228558.
  52. Kim M-H, Kim H. The roles of glutamine in the intestine and its implication in intestinal diseases. Int J Mol Sci. 2017 May 12;18(5). DOI: 10.3390/ijms18051051. PMID: 28498331. PMCID: PMC5454963.
  53. Zhou Q, Verne ML, Fields JZ, Lefante JJ, Basra S, Salameh H, et al. Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome. Gut. 2019 Jun;68(6):996–1002. DOI: 10.1136/gutjnl-2017-315136. PMID: 30108163. PMCID: PMC9549483.
  54. Wang B, Wu G, Zhou Z, Dai Z, Sun Y, Ji Y, et al. Glutamine and intestinal barrier function. Amino Acids. 2015 Oct;47(10):2143–54. DOI: 10.1007/s00726-014-1773-4. PMID: 24965526.
  55. Achamrah N, Déchelotte P, Coëffier M. Glutamine and the regulation of intestinal permeability: from bench to bedside. Curr Opin Clin Nutr Metab Care. 2017 Jan;20(1):86–91. DOI: 10.1097/MCO.0000000000000339. PMID: 27749689.
  56. Hałasa M, Maciejewska D, Baśkiewicz-Hałasa M, Machaliński B, Safranow K, Stachowska E. Oral Supplementation with Bovine Colostrum Decreases Intestinal Permeability and Stool Concentrations of Zonulin in Athletes. Nutrients. 2017 Apr 8;9(4). DOI: 10.3390/nu9040370. PMID: 28397754. PMCID: PMC5409709.
  57. Davison G, Marchbank T, March DS, Thatcher R, Playford RJ. Zinc carnosine works with bovine colostrum in truncating heavy exercise-induced increase in gut permeability in healthy volunteers. Am J Clin Nutr. 2016 Aug;104(2):526–36. DOI: 10.3945/ajcn.116.134403. PMID: 27357095.
  58. Tran CD, Hawkes J, Graham RD, Kitchen JL, Symonds EL, Davidson GP, et al. Zinc-fortified oral rehydration solution improved intestinal permeability and small intestinal mucosal recovery. Clin Pediatr (Phila). 2015 Jun;54(7):676–82. DOI: 10.1177/0009922814562665. PMID: 25520366.
  59. Rerksuppaphol L, Rerksuppaphol S. Efficacy of zinc supplementation in the management of acute diarrhoea: a randomised controlled trial. Paediatr Int Child Health. 2020 May;40(2):105–10. DOI: 10.1080/20469047.2019.1673548. PMID: 31578136.
  60. Mahmood A, FitzGerald AJ, Marchbank T, Ntatsaki E, Murray D, Ghosh S, et al. Zinc carnosine, a health food supplement that stabilises small bowel integrity and stimulates gut repair processes. Gut. 2007 Feb;56(2):168–75. DOI: 10.1136/gut.2006.099929. PMID: 16777920. PMCID: PMC1856764.
  61. Lamprecht M, Bogner S, Steinbauer K, Schuetz B, Greilberger JF, Leber B, et al. Effects of zeolite supplementation on parameters of intestinal barrier integrity, inflammation, redoxbiology and performance in aerobically trained subjects. J Int Soc Sports Nutr. 2015 Oct 20;12:40. DOI: 10.1186/s12970-015-0101-z. PMID: 26500463. PMCID: PMC4617723.
  62. Bosman ES, Albert AY, Lui H, Dutz JP, Vallance BA. Skin exposure to narrow band ultraviolet (UVB) light modulates the human intestinal microbiome. Front Microbiol. 2019 Oct 24;10:2410. DOI: 10.3389/fmicb.2019.02410. PMID: 31708890. PMCID: PMC6821880.
  63. Conteville LC, Vicente ACP. Skin exposure to sunlight: a factor modulating the human gut microbiome composition. Gut Microbes. 2020 Sep 2;11(5):1135–8. DOI: 10.1080/19490976.2020.1745044. PMID: 32339065. PMCID: PMC7524261.
  64. De Pessemier B, Grine L, Debaere M, Maes A, Paetzold B, Callewaert C. Gut-Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions. Microorganisms. 2021 Feb 11;9(2). DOI: 10.3390/microorganisms9020353. PMID: 33670115. PMCID: PMC7916842.
  65. Sansone RA, Sansone LA. Sunshine, serotonin, and skin: a partial explanation for seasonal patterns in psychopathology? Innov Clin Neurosci. 2013 Jul;10(7–8):20–4. PMID: 24062970. PMCID: PMC3779905.
  66. Akimbekov NS, Digel I, Sherelkhan DK, Lutfor AB, Razzaque MS. Vitamin D and the Host-Gut Microbiome: A Brief Overview. Acta Histochem Cytochem. 2020 Jun 26;53(3):33–42. DOI: 10.1267/ahc.20011. PMID: 32624628. PMCID: PMC7322162.
  67. Khalighi Sikaroudi M, Mokhtare M, Janani L, Faghihi Kashani AH, Masoodi M, Agah S, et al. Vitamin D3 Supplementation in Diarrhea-Predominant Irritable Bowel Syndrome Patients: The Effects on Symptoms Improvement, Serum Corticotropin-Releasing Hormone, and Interleukin-6 – A Randomized Clinical Trial. Complement Med Res. 2020 Mar 23;27(5):302–9. DOI: 10.1159/000506149. PMID: 32203968.
  68. Fletcher J, Cooper SC, Ghosh S, Hewison M. The role of vitamin D in inflammatory bowel disease: mechanism to management. Nutrients. 2019 May 7;11(5). DOI: 10.3390/nu11051019. PMID: 31067701. PMCID: PMC6566188.
  69. Luthold RV, Fernandes GR, Franco-de-Moraes AC, Folchetti LGD, Ferreira SRG. Gut microbiota interactions with the immunomodulatory role of vitamin D in normal individuals. Metab Clin Exp. 2017 Apr;69:76–86. DOI: 10.1016/j.metabol.2017.01.007. PMID: 28285654.
  70. Abbasnezhad A, Amani R, Hajiani E, Alavinejad P, Cheraghian B, Ghadiri A. Effect of vitamin D on gastrointestinal symptoms and health-related quality of life in irritable bowel syndrome patients: a randomized double-blind clinical trial. Neurogastroenterol Motil. 2016 Oct;28(10):1533–44. DOI: 10.1111/nmo.12851. PMID: 27154424.
  71. López-Muñoz P, Beltrán B, Sáez-González E, Alba A, Nos P, Iborra M. Influence of vitamin D deficiency on inflammatory markers and clinical disease activity in IBD patients. Nutrients. 2019 May 11;11(5). DOI: 10.3390/nu11051059. PMID: 31083541. PMCID: PMC6567866.
  72. He C, Deng J, Hu X, Zhou S, Wu J, Xiao D, et al. Vitamin A inhibits the action of LPS on the intestinal epithelial barrier function and tight junction proteins. Food Funct. 2019 Feb 20;10(2):1235–42. DOI: 10.1039/c8fo01123k. PMID: 30747184.
  73. Suzuki T, Hara H. Quercetin enhances intestinal barrier function through the assembly of zonula [corrected] occludens-2, occludin, and claudin-1 and the expression of claudin-4 in Caco-2 cells. J Nutr. 2009 May;139(5):965–74. DOI: 10.3945/jn.108.100867. PMID: 19297429.
  74. Glenn JOH, Wischmeyer PE. Enteral fish oil in critical illness: perspectives and systematic review. Curr Opin Clin Nutr Metab Care. 2014 Mar;17(2):116–23. DOI: 10.1097/MCO.0000000000000039. PMID: 24500437.
  75. Weinstock LB, Jasion VS. Serum-Derived Bovine Immunoglobulin/Protein Isolate Therapy for Patients with Refractory Irritable Bowel Syndrome. OJGas. 2014;04(10):329–34. DOI: 10.4236/ojgas.2014.410047.
  76. Chen Q, Chen O, Martins IM, Hou H, Zhao X, Blumberg JB, et al. Collagen peptides ameliorate intestinal epithelial barrier dysfunction in immunostimulatory Caco-2 cell monolayers via enhancing tight junctions. Food Funct. 2017 Mar 22;8(3):1144–51. DOI: 10.1039/c6fo01347c. PMID: 28174772.
  77. Chen C, Tao C, Liu Z, Lu M, Pan Q, Zheng L, et al. A Randomized Clinical Trial of Berberine Hydrochloride in Patients with Diarrhea-Predominant Irritable Bowel Syndrome. Phytother Res. 2015 Nov;29(11):1822–7. DOI: 10.1002/ptr.5475. PMID: 26400188.
  78. Gatta L, Scarpignato C. Systematic review with meta-analysis: rifaximin is effective and safe for the treatment of small intestine bacterial overgrowth. Aliment Pharmacol Ther. 2017 Mar;45(5):604–16. DOI: 10.1111/apt.13928. PMID: 28078798. PMCID: PMC5299503.
  79. Chedid V, Dhalla S, Clarke JO, Roland BC, Dunbar KB, Koh J, et al. Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Glob Adv Health Med. 2014 May;3(3):16–24. DOI: 10.7453/gahmj.2014.019. PMID: 24891990. PMCID: PMC4030608.
  80. Hawrelak JA, Wohlmuth H, Pattinson M, Myers SP, Goldenberg JZ, Harnett J, et al. Western herbal medicines in the treatment of irritable bowel syndrome: A systematic review and meta-analysis. Complement Ther Med. 2020 Jan;48:102233. DOI: 10.1016/j.ctim.2019.102233. PMID: 31987249.
  81. Tan N, Gwee KA, Tack J, Zhang M, Li Y, Chen M, et al. Herbal medicine in the treatment of functional gastrointestinal disorders: A systematic review with meta-analysis. J Gastroenterol Hepatol. 2020 Apr;35(4):544–56. DOI: 10.1111/jgh.14905. PMID: 31674057.
  82. Black CJ, Yuan Y, Selinger CP, Camilleri M, Quigley EMM, Moayyedi P, et al. Efficacy of soluble fibre, antispasmodic drugs, and gut-brain neuromodulators in irritable bowel syndrome: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol. 2020;5(2):117–31. DOI: 10.1016/S2468-1253(19)30324-3. PMID: 31859183.
  83. Mosaffa-Jahromi M, Lankarani KB, Pasalar M, Afsharypuor S, Tamaddon A-M. Efficacy and safety of enteric coated capsules of anise oil to treat irritable bowel syndrome. J Ethnopharmacol. 2016 Dec 24;194:937–46. DOI: 10.1016/j.jep.2016.10.083. PMID: 27815079.
  84. Wu K-L, Rayner CK, Chuah S-K, Changchien C-S, Lu S-N, Chiu Y-C, et al. Effects of ginger on gastric emptying and motility in healthy humans. Eur J Gastroenterol Hepatol. 2008 May;20(5):436–40. DOI: 10.1097/MEG.0b013e3282f4b224. PMID: 18403946.
  85. Hu M-L, Rayner CK, Wu K-L, Chuah S-K, Tai W-C, Chou Y-P, et al. Effect of ginger on gastric motility and symptoms of functional dyspepsia. World J Gastroenterol. 2011 Jan 7;17(1):105–10. DOI: 10.3748/wjg.v17.i1.105. PMID: 21218090. PMCID: PMC3016669.
  86. Micklefield GH, Redeker Y, Meister V, Jung O, Greving I, May B. Effects of ginger on gastroduodenal motility. Int J Clin Pharmacol Ther. 1999 Jul;37(7):341–6. PMID: 10442508.
  87. Hustoft TN, Hausken T, Ystad SO, Valeur J, Brokstad K, Hatlebakk JG, et al. Effects of varying dietary content of fermentable short-chain carbohydrates on symptoms, fecal microenvironment, and cytokine profiles in patients with irritable bowel syndrome. Neurogastroenterol Motil. 2017 Apr;29(4). DOI: 10.1111/nmo.12969. PMID: 27747984.
  88. Huaman J-W, Mego M, Manichanh C, Cañellas N, Cañueto D, Segurola H, et al. Effects of prebiotics vs a diet low in fodmaps in patients with functional gut disorders. Gastroenterology. 2018 Oct;155(4):1004–7. DOI: 10.1053/j.gastro.2018.06.045. PMID: 29964041.
  89. Hoveyda N, Heneghan C, Mahtani KR, Perera R, Roberts N, Glasziou P. A systematic review and meta-analysis: probiotics in the treatment of irritable bowel syndrome. BMC Gastroenterol. 2009 Feb 16;9:15. DOI: 10.1186/1471-230X-9-15. PMID: 19220890. PMCID: PMC2656520.
  90. Demirel G, Celik IH, Erdeve O, Saygan S, Dilmen U, Canpolat FE. Prophylactic Saccharomyces boulardii versus nystatin for the prevention of fungal colonization and invasive fungal infection in premature infants. Eur J Pediatr. 2013 Oct;172(10):1321–6. DOI: 10.1007/s00431-013-2041-4. PMID: 23703468.
  91. Toribio-Mateas M. Harnessing the power of microbiome assessment tools as part of neuroprotective nutrition and lifestyle medicine interventions. Microorganisms. 2018 Apr 25;6(2). DOI: 10.3390/microorganisms6020035. PMID: 29693607. PMCID: PMC6027349.
  92. Shokryazdan P, Faseleh Jahromi M, Navidshad B, Liang JB. Effects of prebiotics on immune system and cytokine expression. Med Microbiol Immunol. 2017 Feb;206(1):1–9. DOI: 10.1007/s00430-016-0481-y. PMID: 27704207.
  93. Petersen AMW. The anti-inflammatory effect of exercise. J Appl Physiol. 2005 Apr 1;98(4):1154–62. DOI: 10.1152/japplphysiol.00164.2004. PMID: 15772055.
  94. Swanson GR, Burgess HJ. Sleep and circadian hygiene and inflammatory bowel disease. Gastroenterol Clin North Am. 2017 Dec;46(4):881–93. DOI: 10.1016/j.gtc.2017.08.014. PMID: 29173529.
  95. Schumann D, Anheyer D, Lauche R, Dobos G, Langhorst J, Cramer H. Effect of yoga in the therapy of irritable bowel syndrome: a systematic review. Clin Gastroenterol Hepatol. 2016 Dec;14(12):1720–31. DOI: 10.1016/j.cgh.2016.04.026. PMID: 27112106.
  96. Yoshikawa K, Kurihara C, Furuhashi H, Takajo T, Maruta K, Yasutake Y, et al. Psychological stress exacerbates NSAID-induced small bowel injury by inducing changes in intestinal microbiota and permeability via glucocorticoid receptor signaling. J Gastroenterol. 2017 Jan;52(1):61–71. DOI: 10.1007/s00535-016-1205-1. PMID: 27075753.
  97. Vanuytsel T, van Wanrooy S, Vanheel H, Vanormelingen C, Verschueren S, Houben E, et al. Psychological stress and corticotropin-releasing hormone increase intestinal permeability in humans by a mast cell-dependent mechanism. Gut. 2014 Aug;63(8):1293–9. DOI: 10.1136/gutjnl-2013-305690. PMID: 24153250.
  98. Adike A, DiBaise JK. Small intestinal bacterial overgrowth: nutritional implications, diagnosis, and management. Gastroenterol Clin North Am. 2018 Mar;47(1):193–208. DOI: 10.1016/j.gtc.2017.09.008. PMID: 29413012.
  99. Clark R, Johnson R. Malabsorption Syndromes. Nurs Clin North Am. 2018 Sep;53(3):361–74. DOI: 10.1016/j.cnur.2018.05.001. PMID: 30100002.
  100. Owens SR, Greenson JK. The pathology of malabsorption: current concepts. Histopathology. 2007 Jan;50(1):64–82. DOI: 10.1111/j.1365-2559.2006.02547.x. PMID: 17204022.
  101. Frändemark Å, Jakobsson Ung E, Törnblom H, Simrén M, Jakobsson S. Fatigue: a distressing symptom for patients with irritable bowel syndrome. Neurogastroenterol Motil. 2017 Jan;29(1). DOI: 10.1111/nmo.12898. PMID: 27401139.
  102. Han CJ, Yang GS. Fatigue in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis of Pooled Frequency and Severity of Fatigue. Asian Nurs Res (Korean Soc Nurs Sci). 2016 Mar;10(1):1–10. DOI: 10.1016/j.anr.2016.01.003. PMID: 27021828.
  103. Volta U, Bardella MT, Calabrò A, Troncone R, Corazza GR, Study Group for Non-Celiac Gluten Sensitivity. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. BMC Med. 2014 May 23;12(1):85. DOI: 10.1186/1741-7015-12-85. PMID: 24885375. PMCID: PMC4053283.
  104. Maes M, Leunis J-C. Normalization of leaky gut in chronic fatigue syndrome (CFS) is accompanied by a clinical improvement: effects of age, duration of illness and the translocation of LPS from gram-negative bacteria. Neuro Endocrinol Lett. 2008 Dec;29(6):902–10. PMID: 19112401.
  105. Altobelli E, Del Negro V, Angeletti PM, Latella G. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients. 2017 Aug 26;9(9). DOI: 10.3390/nu9090940. PMID: 28846594. PMCID: PMC5622700.
  106. Marum AP, Moreira C, Saraiva F, Tomas-Carus P, Sousa-Guerreiro C. A low fermentable oligo-di-mono saccharides and polyols (FODMAP) diet reduced pain and improved daily life in fibromyalgia patients. Scand J Pain. 2016 Aug 22;13:166–72. DOI: 10.1016/j.sjpain.2016.07.004. PMID: 28850525.
  107. Vara EJ, Valeur J, Hausken T, Lied GA. Extra-intestinal symptoms in patients with irritable bowel syndrome: related to high total IgE levels and atopic sensitization? Scand J Gastroenterol. 2016 Aug;51(8):908–13. DOI: 10.3109/00365521.2016.1157890. PMID: 27161383.
  108. Koloski NA, Jones M, Talley NJ. Evidence that independent gut-to-brain and brain-to-gut pathways operate in the irritable bowel syndrome and functional dyspepsia: a 1-year population-based prospective study. Aliment Pharmacol Ther. 2016 Sep;44(6):592–600. DOI: 10.1111/apt.13738. PMID: 27444264.
  109. Yang B, Wei J, Ju P, Chen J. Effects of regulating intestinal microbiota on anxiety symptoms: A systematic review. Gen Psych. 2019 May 17;32(2):e100056. DOI: 10.1136/gpsych-2019-100056. PMID: 31179435. PMCID: PMC6551444.
  110. Geng Q, Zhang Q-E, Wang F, Zheng W, Ng CH, Ungvari GS, et al. Comparison of comorbid depression between irritable bowel syndrome and inflammatory bowel disease: A meta-analysis of comparative studies. J Affect Disord. 2018 Sep;237:37–46. DOI: 10.1016/j.jad.2018.04.111. PMID: 29758449.
  111. Masuy I, Van Oudenhove L, Tack J, Biesiekierski JR. Effect of intragastric FODMAP infusion on upper gastrointestinal motility, gastrointestinal, and psychological symptoms in irritable bowel syndrome vs healthy controls. Neurogastroenterol Motil. 2018 Jan;30(1). DOI: 10.1111/nmo.13167. PMID: 28762592.
  112. Skodje GI, Minelle IH, Rolfsen KL, Iacovou M, Lundin KEA, Veierød MB, et al. Dietary and symptom assessment in adults with self-reported non-coeliac gluten sensitivity. Clin Nutr ESPEN. 2019 Jun;31:88–94. DOI: 10.1016/j.clnesp.2019.02.012. PMID: 31060839.
  113. Zamani M, Alizadeh-Tabari S, Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2019 Jul;50(2):132–43. DOI: 10.1111/apt.15325. PMID: 31157418.
  114. Simpson CA, Mu A, Haslam N, Schwartz OS, Simmons JG. Feeling down? A systematic review of the gut microbiota in anxiety/depression and irritable bowel syndrome. J Affect Disord. 2020 Apr 1;266:429–46. DOI: 10.1016/j.jad.2020.01.124. PMID: 32056910.
  115. Umrani S, Jamshed W, Rizwan A. Association between psychological disorders and irritable bowel syndrome. Cureus. 2021 Apr 16;13(4):e14513. DOI: 10.7759/cureus.14513. PMID: 34007764. PMCID: PMC8121199.
  116. Croall ID, Hoggard N, Aziz I, Hadjivassiliou M, Sanders DS. Brain fog and non-coeliac gluten sensitivity: Proof of concept brain MRI pilot study. PLoS ONE. 2020 Aug 28;15(8):e0238283. DOI: 10.1371/journal.pone.0238283. PMID: 32857796. PMCID: PMC7454984.
  117. Rao SSC, Rehman A, Yu S, Andino NM de. Brain fogginess, gas and bloating: a link between SIBO, probiotics and metabolic acidosis. Clin Transl Gastroenterol. 2018 Jun 19;9(6):162. DOI: 10.1038/s41424-018-0030-7. PMID: 29915215. PMCID: PMC6006167.
  118. Takakura W, Pimentel M. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update. Front Psychiatry. 2020 Jul 10;11:664. DOI: 10.3389/fpsyt.2020.00664. PMID: 32754068. PMCID: PMC7366247.
  119. van Langenberg DR, Yelland GW, Robinson SR, Gibson PR. Cognitive impairment in Crohn’s disease is associated with systemic inflammation, symptom burden and sleep disturbance. United European Gastroenterol J. 2017 Jun;5(4):579–87. DOI: 10.1177/2050640616663397. PMID: 28588890. PMCID: PMC5446137.
  120. Yelland GW. Gluten-induced cognitive impairment (“brain fog”) in coeliac disease. J Gastroenterol Hepatol. 2017 Mar;32 Suppl 1:90–3. DOI: 10.1111/jgh.13706. PMID: 28244662.
  121. Isasi C, Tejerina E, Morán LM. Non-celiac gluten sensitivity and rheumatic diseases. Reumatol Clin. 2016 Feb;12(1):4–10. DOI: 10.1016/j.reuma.2015.03.001. PMID: 25956352.
  122. Khanijow V, Prakash P, Emsellem HA, Borum ML, Doman DB. Sleep dysfunction and gastrointestinal diseases. Gastroenterol Hepatol (N Y). 2015 Dec;11(12):817–25. PMID: 27134599. PMCID: PMC4849511.
  123. Lee YB, Byun EJ, Kim HS. Potential role of the microbiome in acne: A comprehensive review. J Clin Med. 2019 Jul 7;8(7). DOI: 10.3390/jcm8070987. PMID: 31284694. PMCID: PMC6678709.
  124. Parodi A, Paolino S, Greco A, Drago F, Mansi C, Rebora A, et al. Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication. Clin Gastroenterol Hepatol. 2008 Jul;6(7):759–64. DOI: 10.1016/j.cgh.2008.02.054. PMID: 18456568.
  125. Polkowska-Pruszyńska B, Gerkowicz A, Krasowska D. The gut microbiome alterations in allergic and inflammatory skin diseases – an update. J Eur Acad Dermatol Venereol. 2020 Mar;34(3):455–64. DOI: 10.1111/jdv.15951. PMID: 31520544.
  126. O’Neill CA, Monteleone G, McLaughlin JT, Paus R. The gut-skin axis in health and disease: A paradigm with therapeutic implications. Bioessays. 2016 Nov;38(11):1167–76. DOI: 10.1002/bies.201600008. PMID: 27554239.
  127. Lee SY, Lee E, Park YM, Hong SJ. Microbiome in the Gut-Skin Axis in Atopic Dermatitis. Allergy Asthma Immunol Res. 2018 Jul;10(4):354–62. DOI: 10.4168/aair.2018.10.4.354. PMID: 29949831. PMCID: PMC6021588.
  128. Varjonen E, Vainio E, Kalimo K. Antigliadin IgE–indicator of wheat allergy in atopic dermatitis. Allergy. 2000 Apr;55(4):386–91. DOI: 10.1034/j.1398-9995.2000.00451.x. PMID: 10782525.
  129. Nosrati A, Afifi L, Danesh MJ, Lee K, Yan D, Beroukhim K, et al. Dietary modifications in atopic dermatitis: patient-reported outcomes. J Dermatolog Treat. 2017 Sep;28(6):523–38. DOI: 10.1080/09546634.2016.1278071. PMID: 28043181. PMCID: PMC5736303.
  130. Bhatia BK, Millsop JW, Debbaneh M, Koo J, Linos E, Liao W. Diet and psoriasis, part II: celiac disease and role of a gluten-free diet. J Am Acad Dermatol. 2014 Aug;71(2):350–8. DOI: 10.1016/j.jaad.2014.03.017. PMID: 24780176. PMCID: PMC4104239.
  131. Fu Y, Lee C-H, Chi C-C. Association of Psoriasis With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. JAMA Dermatol. 2018 Dec 1;154(12):1417–23. DOI: 10.1001/jamadermatol.2018.3631. PMID: 30422277. PMCID: PMC6583370.
  132. Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas. 2017 Sep;103:45–53. DOI: 10.1016/j.maturitas.2017.06.025. PMID: 28778332.
  133. Goedert JJ, Jones G, Hua X, Xu X, Yu G, Flores R, et al. Investigation of the association between the fecal microbiota and breast cancer in postmenopausal women: a population-based case-control pilot study. J Natl Cancer Inst. 2015 Aug;107(8). DOI: 10.1093/jnci/djv147. PMID: 26032724. PMCID: PMC4554191.
  134. Tremellen K, McPhee N, Pearce K, Benson S, Schedlowski M, Engler H. Endotoxin-initiated inflammation reduces testosterone production in men of reproductive age. Am J Physiol Endocrinol Metab. 2018 Mar 1;314(3):E206–13. DOI: 10.1152/ajpendo.00279.2017. PMID: 29183872. PMCID: PMC5899218.
  135. Zuvarox T, Belletieri C. Malabsorption Syndromes. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. PMID: 31971746.
  136. Vergnat M, Suzanne J, Entraygues H, Laurent R, Gisselbrecht H, Agache P. [Cutaneous manifestations of malabsorption diseases (author’s transl)]. Ann Dermatol Venereol. 1978 Dec;105(12):1009–16. PMID: 380445.
  137. Trost LB, Bergfeld WF, Calogeras E. The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. J Am Acad Dermatol. 2006 May;54(5):824–44. DOI: 10.1016/j.jaad.2005.11.1104. PMID: 16635664.
  138. Podas T, Nightingale JMD, Oldham R, Roy S, Sheehan NJ, Mayberry JF. Is rheumatoid arthritis a disease that starts in the intestine? A pilot study comparing an elemental diet with oral prednisolone. Postgrad Med J. 2007 Feb;83(976):128–31. DOI: 10.1136/pgmj.2006.050245. PMID: 17308218. PMCID: PMC2805936.
  139. Nilholm C, Roth B, Ohlsson B. A Dietary Intervention with Reduction of Starch and Sucrose Leads to Reduced Gastrointestinal and Extra-Intestinal Symptoms in IBS Patients. Nutrients. 2019 Jul 20;11(7). DOI: 10.3390/nu11071662. PMID: 31330810. PMCID: PMC6682926.
  140. Horta-Baas G, Romero-Figueroa MDS, Montiel-Jarquín AJ, Pizano-Zárate ML, García-Mena J, Ramírez-Durán N. Intestinal Dysbiosis and Rheumatoid Arthritis: A Link between Gut Microbiota and the Pathogenesis of Rheumatoid Arthritis. J Immunol Res. 2017 Aug 30;2017:4835189. DOI: 10.1155/2017/4835189. PMID: 28948174. PMCID: PMC5602494.
  141. Wu X, He B, Liu J, Feng H, Ma Y, Li D, et al. Molecular Insight into Gut Microbiota and Rheumatoid Arthritis. Int J Mol Sci. 2016 Mar 22;17(3):431. DOI: 10.3390/ijms17030431. PMID: 27011180. PMCID: PMC4813281.
  142. Maeda Y, Kumanogoh A, Takeda K. Altered composition of gut microbiota in rheumatoid arthritis patients. Nihon Rinsho Meneki Gakkai Kaishi. 2016;39(1):59–63. DOI: 10.2177/jsci.39.59. PMID: 27181236.
  143. Maeda Y, Kurakawa T, Umemoto E, Motooka D, Ito Y, Gotoh K, et al. Dysbiosis contributes to arthritis development via activation of autoreactive T cells in the intestine. Arthritis Rheumatol. 2016 Nov;68(11):2646–61. DOI: 10.1002/art.39783. PMID: 27333153.
  144. Knezevic J, Starchl C, Tmava Berisha A, Amrein K. Thyroid-Gut-Axis: How Does the Microbiota Influence Thyroid Function? Nutrients. 2020 Jun 12;12(6). DOI: 10.3390/nu12061769. PMID: 32545596. PMCID: PMC7353203.
  145. Levy J, Bernstein L, Silber N. Celiac disease: an immune dysregulation syndrome. Curr Probl Pediatr Adolesc Health Care. 2014 Dec;44(11):324–7. DOI: 10.1016/j.cppeds.2014.10.002. PMID: 25499458.
  146. Briani C, Samaroo D, Alaedini A. Celiac disease: from gluten to autoimmunity. Autoimmun Rev. 2008 Sep;7(8):644–50. DOI: 10.1016/j.autrev.2008.05.006. PMID: 18589004.
  147. Sander LE, Lorentz A, Sellge G, Coëffier M, Neipp M, Veres T, et al. Selective expression of histamine receptors H1R, H2R, and H4R, but not H3R, in the human intestinal tract. Gut. 2006 Apr;55(4):498–504. DOI: 10.1136/gut.2004.061762. PMID: 16299042. PMCID: PMC1856162.
  148. Schink M, Konturek PC, Tietz E, Dieterich W, Pinzer TC, Wirtz S, et al. Microbial patterns in patients with histamine intolerance. J Physiol Pharmacol. 2018 Aug;69(4). DOI: 10.26402/jpp.2018.4.09. PMID: 30552302.
  149. Enko D, Meinitzer A, Mangge H, Kriegshäuser G, Halwachs-Baumann G, Reininghaus EZ, et al. Concomitant prevalence of low serum diamine oxidase activity and carbohydrate malabsorption. Can J Gastroenterol Hepatol. 2016 Nov 30;2016:4893501. DOI: 10.1155/2016/4893501. PMID: 28042564. PMCID: PMC5155086.
  150. Lappinga PJ, Abraham SC, Murray JA, Vetter EA, Patel R, Wu T-T. Small intestinal bacterial overgrowth: histopathologic features and clinical correlates in an underrecognized entity. Arch Pathol Lab Med. 2010 Feb;134(2):264–70. DOI: 10.5858/134.2.264. PMID: 20121616.
  151. Bures J, Cyrany J, Kohoutova D, Förstl M, Rejchrt S, Kvetina J, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010 Jun 28;16(24):2978–90. DOI: 10.3748/wjg.v16.i24.2978. PMID: 20572300. PMCID: PMC2890937.
  152. Coucke F. Food intolerance in patients with manifest autoimmunity. Observational study. Autoimmun Rev. 2018 Nov;17(11):1078–80. DOI: 10.1016/j.autrev.2018.05.011. PMID: 30213697.
  153. Pietschmann N. Food Intolerance: Immune Activation Through Diet-associated Stimuli in Chronic Disease. Altern Ther Health Med. 2015 Aug;21(4):42–52. PMID: 26030116.
  154. Leech B, McIntyre E, Steel A, Sibbritt D. Risk factors associated with intestinal permeability in an adult population: A systematic review. Int J Clin Pract. 2019 Oct;73(10):e13385. DOI: 10.1111/ijcp.13385. PMID: 31243854.
  155. Sander GR, Cummins AG, Henshall T, Powell BC. Rapid disruption of intestinal barrier function by gliadin involves altered expression of apical junctional proteins. FEBS Lett. 2005 Aug 29;579(21):4851–5. DOI: 10.1016/j.febslet.2005.07.066. PMID: 16099460.
  156. Michielan A, D’Incà R. Intestinal permeability in inflammatory bowel disease: pathogenesis, clinical evaluation, and therapy of leaky gut. Mediators Inflamm. 2015 Oct 25;2015:628157. DOI: 10.1155/2015/628157. PMID: 26582965. PMCID: PMC4637104.
  157. Vaarala O. Leaking gut in type 1 diabetes. Curr Opin Gastroenterol. 2008 Nov;24(6):701–6. DOI: 10.1097/MOG.0b013e32830e6d98. PMID: 19122519.
  158. Ventura MT, Polimeno L, Amoruso AC, Gatti F, Annoscia E, Marinaro M, et al. Intestinal permeability in patients with adverse reactions to food. Dig Liver Dis. 2006 Oct;38(10):732–6. DOI: 10.1016/j.dld.2006.06.012. PMID: 16880015.
  159. Mujagic Z, Ludidi S, Keszthelyi D, Hesselink MAM, Kruimel JW, Lenaerts K, et al. Small intestinal permeability is increased in diarrhoea predominant IBS, while alterations in gastroduodenal permeability in all IBS subtypes are largely attributable to confounders. Aliment Pharmacol Ther. 2014 Aug;40(3):288–97. DOI: 10.1111/apt.12829. PMID: 24943095.
  160. Moludi J, Maleki V, Jafari-Vayghyan H, Vaghef-Mehrabany E, Alizadeh M. Metabolic endotoxemia and cardiovascular disease: A systematic review about potential roles of prebiotics and probiotics. Clin Exp Pharmacol Physiol. 2020 Jun;47(6):927–39. DOI: 10.1111/1440-1681.13250. PMID: 31894861.
  161. Afzaal M, Saeed F, Shah YA, Hussain M, Rabail R, Socol CT, et al. Human gut microbiota in health and disease: Unveiling the relationship. Front Microbiol. 2022 Sep 26;13:999001. DOI: 10.3389/fmicb.2022.999001. PMID: 36225386. PMCID: PMC9549250.
  162. McBurney MI, Davis C, Fraser CM, Schneeman BO, Huttenhower C, Verbeke K, et al. Establishing what constitutes a healthy human gut microbiome: state of the science, regulatory considerations, and future directions. J Nutr. 2019 Nov 1;149(11):1882–95. DOI: 10.1093/jn/nxz154. PMID: 31373365. PMCID: PMC6825832.
  163. Levkovich T, Poutahidis T, Smillie C, Varian BJ, Ibrahim YM, Lakritz JR, et al. Probiotic bacteria induce a “glow of health”. PLoS ONE. 2013 Jan 16;8(1):e53867. DOI: 10.1371/journal.pone.0053867. PMID: 23342023. PMCID: PMC3547054.
  164. Podder I, Jaiswal S, Das A. Dietary strategies for chronic spontaneous urticaria: an evidence-based review. Int J Dermatol. 2021 Nov 26; DOI: 10.1111/ijd.15988. PMID: 34826140.

Getting Started

Book your first visit


I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

Description Description