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Gut Health Could Help Fight Depression, Study Says

Gut Health Could Help Fight Depression, Study Says


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A new study is giving insight into the link between gut and mental health.

We’ve all heard by now how gut health can impact our digestion, immunity, and help us manage chronic disease, but what about our mental health? Scientists have thought for years there might be a link between the two, and a recent study shows just how interconnected gut and mental health could really be.

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Researchers from the Catholic University of Leuven in Belgium, analyzed the gut and brain health of 1,054 participants, 173 of which were diagnosed with depression or a mood disorder. Their findings, published by Nature Microbiology, found the presence (or lack thereof) of certain types of bacteria seriously impacted both mood and depression in participants.

The researchers set out to assess what a normal microbiome ought to look like and sought to discover if there was a true link between gut bacteria and mental health. Faecalibacterium and Coprococcus are two bacteria indicative of better mood, according to the study. Evidence showed several species of gut bacteria, including these, were missing in the participants with depression. Even those participants on antidepressants still showed to have too few of these important bacteria. While researchers cannot yet declare this a cause or effect of depression itself, evidence showed certain substances produced by gut bacteria can affect nerve cell function and possibly mood.

Interested in adopting a more “gut-friendly” diet?

Researchers noted age, sex, and antidepressant use were all taken into account, as those factors can influence gut health and bacteria on their own. They also discovered some depressed participants had higher amounts of a specific bacteria related to Crohn's Disease, which is related to inflammation and digestive problems. This is an interesting link, as many studies have showed the prominence of inflammation-associated depression.


The bottom line: While we don’t advise ditching antidepressants for kimchi and kombucha, there are many studies out there suggesting our diets can have a serious impact on our mental health. Changing the way you eat by opting for healthy fats, choosing whole grains over refined, and incorporating more produce won’t cure your ailments, but it could be a good start in fueling your body (and good bacteria) with what it needs to fight illness. Until then, more evidence needs to come forth to show just how much gut and mental health are intertwined


Changing Your Diet Can Help Tamp Down Depression, Boost Mood

Depression symptoms dropped significantly in a group of young adults who ate a Mediterranean-style diet for three weeks. It's the latest study to show that food can influence mental health. Claudia Totir/Getty Images hide caption

Depression symptoms dropped significantly in a group of young adults who ate a Mediterranean-style diet for three weeks. It's the latest study to show that food can influence mental health.

Claudia Totir/Getty Images

There's fresh evidence that eating a healthy diet, one that includes plenty of fruits and vegetables and limits highly processed foods, can help reduce symptoms of depression.

A randomized controlled trial published in the journal PLOS ONE finds that symptoms of depression dropped significantly among a group of young adults after they followed a Mediterranean-style pattern of eating for three weeks. Participants saw their depression "score" fall from the "moderate" range down to the "normal" range, and they reported lower levels of anxiety and stress too.

Alternatively, the depression scores among the control group of participants — who didn't change their diets — didn't budge. These participants continued to eat a diet higher in refined carbohydrates, processed foods and sugary foods and beverages. Their depression scores remained in the "moderate severity" range.

"We were quite surprised by the findings," researcher Heather Francis, a lecturer in clinical neuropsychology at Macquarie University in Sydney, Australia, told NPR via email. "I think the next step is to demonstrate the physiological mechanism underlying how diet can improve depression symptoms," Francis said.

Scientists are learning more about how a poor diet can increase inflammation, and this can be one risk factor for depression. "Highly processed foods increase inflammation," Francis said. What's more, "if we don't consume enough nutrient-dense foods, then this can lead to insufficiencies in nutrients, which also increases inflammation," she said.

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In this study, participants in the "healthy eating" arm of the study ate about six more servings of fruits and vegetables per week, compared with the control group. Participants "who had a greater increase in fruit and vegetable intake showed the greatest improvement in depression symptoms," Francis said.

Participants were also instructed to increase consumption of whole grains to a recommended three servings per day, as well as three servings per day of protein from lean meats, poultry, eggs, tofu and beans. In addition, they were told to get three servings of fish per week.

As for dairy, the recommendation was three servings per day, unsweetened. Participants were also instructed to consume three tablespoons of nuts and seeds per day, as well as two tablespoons of olive oil per day, and were advised to add in spices, including turmeric and cinnamon.

One of the shortcomings of nutrition science is that it often relies on asking people to recall what they ate in the past. Given our flawed memories, these measures can be unreliable. But this study included a clever way to validate how many fruits and vegetables people consumed. Using a device called a spectrophotometer, the participants had their palms scanned. The device can detect the degree of yellowness in your skin, which correlates with your intake of carotenoids, which you get from eating fruits and vegetables.

The scientists used several research questionnaires to evaluate participants' mental health, including one that asked them how often over the prior week they'd experienced symptoms of depression.

The new study adds to a growing body of research that supports the connection between diet and mental health. "We have a highly consistent and extensive evidence base from around the globe linking healthier diets to reduced depression risk," says Felice Jacka, a professor of nutritional and epidemiological psychiatry at Deakin University's Food & Mood Centre in Australia.

For example, a 2013 meta-analysis of 22 previously published studies showed that the Mediterranean diet was associated with a lower risk of depression.

Similarly, a 2017 study found that a diet rich in fruit, whole grains, vegetables, fish, olive oil and low-fat dairy was associated with a lower risk of depression, whereas a diet rich in greater amounts of red meat, refined grains, sweets and high-fat dairy products was linked to a higher risk of depression.

These associations between diet and depression are independent of other confounding factors such as "education, income, body weight and other health behaviors," notes Jacka, who's also the president of the International Society for Nutritional Psychiatry Research. And "this is true across countries, cultures, and — importantly, age groups," added Jacka in an email.

"The field is certainly very exciting," says Jerome Sarris, a professor of integrative mental health at the NICM Health Research Institute at Western Sydney University in Australia.

However, most of these studies show an association and "can't imply causation," cautions Sarris. In other words, the studies don't prove that changes in diet directly cause the improvement or decline in mood.

It's complicated to unravel how dietary changes may help improve mental health. Though this new study was a randomized controlled trial — considered the gold standard in medical research — people in the study knew that they were part of the group assigned to eat healthy foods. And there's lots of research showing that if you tell people that they're doing something that may make them less depressed, they will indeed report less depression. That's known as the placebo effect. Unlike in a study of medication, in a diet study there's no way to "blind" the participants so that they don't know if they're getting the "medicine" or the "placebo."

"We need further mechanistic studies to understand how diet influences mental and brain health," notes Jacka.

In addition to inflammation, there's also some preliminary evidence from animal studies suggesting that the gut microbiome can affect brain functioning and, therefore, mental health — for example, by altering levels of the neurotransmitter serotonin, which is largely synthesized by gut bacteria.

More studies are needed to understand those connections in humans and to be able to develop targeted interventions for individuals with different mental illnesses, notes Jacka.

Even so, mental health doctors should consider assessing their patients' diet and lifestyle as a routine part of care, says Drew Ramsey, a psychiatrist at Columbia University. "We need to talk to mental health patients about what they eat," Ramsey says. "When people make efforts to care for themselves and adhere to a belief system they feel is good for them, their mental health is going to improve." He teaches a medical education course for health care providers who want to learn more about incorporating nutrition into their practices.

However, while diet may be important to our mood and mental health, it is unlikely to be a silver bullet for treating mental illness, notes Sarris.

"Diet is certainly part of the picture, but so are physical activity, good psychological care, medication [when needed] . adequate sleep, adequate exposure to nature and balanced lifestyle," he says. "My general take-home message is about having an integrative approach."


I’m not alone

And if you’ve struggled with depression, you’re not alone either.

Depression affects more than 120 million people worldwide, making it the leading cause of disability, according to the World Health Organization.

In North America, the problem is even more pronounced. Statistics vary a bit, but most data sources show that at least 6 percent of U.S. adults are depressed and one in 10 are on antidepressants.

But not everyone reveals their secret sadness. This means depression might affect even more people than we realize.

And depression isn’t just a mind game. It stamps itself all over our bodies.

  • 23 percent couldn’t sleep.
  • 36 percent couldn’t remember things.
  • 30 percent felt overwhelmed.

Others felt lost, ate too much or too little, or felt like they were almost literally drowning — short of breath, gasping for air.

Even if they’re not calling themselves “depressed” or going to the doctor for treatment, their bodies bear witness.

Though the 1980s-era Generation Xers supposedly invented the downer and 1990s grungers perfected it, Millennials vastly outnumber them in depressive symptoms.

Not only is depression distressing, it’s frustratingly, mockingly ironic: It’s one of the most common diseases, but uncommonly — and notoriously — hard to treat.

About a third of people being treated for clinical depression are considered “nonresponders.” They try drug after drug, with no relief. Another third feel a little better, but still not great.

If you’re depressed, you already feel bad. On top of that, you feel like you’ll never get any better.


Gut Health Could Help Fight Depression, Study Says - Recipes

A patient’s gut may not be the most obvious place to look for the origins of depression. But that was the hunch of George Porter Phillips in the early 20th Century.

As he walked the wards of London’s notorious Bethlem Royal Hospital, Phillips had observed that his patients with melancholia often suffered from severe constipation, along with other signs of a “general clogging of the metabolic processes” – including brittle nails, lustreless hair and a sallow complexion.

The natural assumption might have been that the depression had led to those physiological problems, but Phillips wondered if the arrow of causation instead pointed in the other direction. By targeting the gut, could you ease the melancholia?

To find out, he fed the patients a reduced diet devoid of all meats, except fish. He also offered them a fermented milk drink known as kefir, which contains the lactobacillus bacteria, a “friendly” microbe that was already known to ease digestion.

Amazingly, it worked. Of the 18 patients Phillips tested, 11 were cured completely, with two others showing significant improvement – offering some of the first evidence that our gut bacteria can have a profound influence over our mental wellbeing.

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BBC Future’s Microbes and Me series has now examined various claims about the power of our gut microbiota to harm or heal – but the notion that they could be responsible for our mental health is perhaps the most difficult to behold. How could these microscopic scavengers, feeding on the debris of our digestion, possibly affect the brain?

As we have seen with the other articles in this series, some of these findings have been overhyped. But more than a century after Phillips’ initial experiment, the fundamental idea of a gut-brain axis is now remarkably solid. “There is no debate, in my mind, that microbes influence mental health,” says Jane Allyson Foster, whose lab at McMaster University in Canada is leading research in this area. And that means we may be able to heal the brain through the belly. “There is the potential both for the development of novel therapeutics and for precision medicine.”

Foster emphasises that an unhealthy gut is just one of many possible causes of mental illness, meaning that only a subset of patients will respond well to the new “psychobiotic” treatments. But for those patients who are suffering from an imbalance in their gut bacteria, the new therapies might bring much-needed relief.


9 Recipes for the Stressed Out Gut

Hot Chocolate Smoothie

  • ¼ cup coconut milk
  • ¼ cup water
  • 1 tablespoon cocoa powder
  • 1 scoop Multi Collagen Protein Chocolate
  • 2 tablespoons chia seeds
  1. Heat the coconut milk and water in a saucepan. In a high-powered blender, combine all ingredients.
  2. Purée on high until smooth.

Coconut Crepes

  • 6 eggs
  • 1 cup coconut milk
  • 3 tablespoons coconut flour
  • 3 teaspoons coconut oil, melted, plus additional for greasing pan
  • ½ teaspoon sea salt
  1. In a medium bowl, combine all ingredients. Beat with an electric mixer for 3 minutes. Let stand 15 minutes.
  2. Heat a skillet greased with the coconut oil over medium-high heat. Ladle the batter into the skillet and swirl around to form a thin crepe. Cook until bubbles start to form, 1–2 minutes. Flip and cook until golden. Repeat with the remaining batter.
  3. Add fresh berries on top with a little bit of maple syrup.

Curried Cauliflower Soup

  • ½ cup chicken bone broth (or ½ scoop Bone Broth Protein mixed with ½ cup water)
  • 1 pound chicken, cooked and shredded
  • 1 onion, chopped
  • 1 cauliflower head, cut into florets
  • 2 tablespoons coconut oil
  • 1 teaspoon sea salt, plus a pinch
  • 1 teaspoon pepper
  • 3 cups chicken bone broth (or 3 scoops Bone Broth Protein mixed with 3 cups water)
  • ½ teaspoon coriander
  • ½ teaspoon turmeric
  • 1½ teaspoon cumin
  • 1 cup coconut milk
  • 2 tablespoons parsley
  1. First, prepare the chicken. Place broth and chicken into an Instant Pot. Season the chicken breast or thighs with salt, pepper or other seasonings. Secure the lid and seal the pressure valve. Cook on high pressure for 15 minutes.
  2. While the chicken is cooking, preheat the oven to 375 degrees F. Spread out the onion and cauliflower on a baking sheet. Drizzle with the coconut oil and season with the salt and pepper. Roast for 10 minutes.
  3. Stir and place back in the oven for another 5–10 minutes, until golden.
  4. Remove chicken from Instant Pot when it’s done. Transfer chicken to a cutting board and shred with 2 forks.
  5. Place the cauliflower and onions and in a pot and add the bone broth. Stir in the coriander, turmeric, cumin and a pinch of the salt. Bring the mixture to a boil. Reduce the heat to medium and let mixture simmer for another 5-10 minutes.
  6. Add all ingredients (except the chicken, coconut milk and parsley) to a high-powered blender and purée until a smooth consistency is achieved. Add in the chicken, coconut milk and parsley. Mix until well combined and serve warm.

Slow-Cooker Lemon-Kale Chicken Soup

  • 2 pounds boneless, skinless chicken, chopped
  • 6 cups chicken bone broth (or 6 scoops Bone Broth Protein mixed with 6 cups water)
  • 1 onion, chopped
  • 3 handfuls of chopped kale
  • ½ cup fresh lemon juice
  • sea salt and pepper
  • 2 tablespoons chopped fresh parsley
  1. In a slow cooker, combine the chicken, broth, onion, kale and lemon juice. Season with the salt and pepper.
  2. Cook on low for 6–8 hours. Stir in the parsley. Taste and adjust the seasoning if necessary.

Eggplant Parmesan Recipe

  • 1 eggplant
  • 2 large tomatoes
  • 4 tablespoons almond flour
  • 1–2 tablespoons coconut oil
  • basil and sea salt to sprinkle on top
  • 1 cup shredded raw sheep cheese (such as Pecorino Romano rather than cow milk Parmesan)
  • 1 jar of organic marinara sauce
  1. Cut eggplant and tomatoes into one-inch thick pieces.
  2. Put flour in bowl and coat both sides of eggplant and tomatoes.
  3. Melt coconut oil over medium heat.
  4. Sauté eggplant and tomatoes in pan and sprinkle basil and sea salt on top.
  5. Cook for 5–6 minutes on each side.
  6. Make sure you add more coconut oil when you flip the veggies.
  7. Stack the eggplant lasagna, with eggplant on the bottom, layering in tomatoes. Place shredded cheese on top of each layer. Create three separate "lasagnas."

Spaghetti Squash “Alfredo”

Total Time: 1½ hrs plus soaking time

  • 1 cup raw cashews
  • 2 cups water
  • 6 cloves garlic, minced
  • 1 teaspoon sea salt
  • ⅛ teaspoon nutmeg
  • 1 teaspoon fresh
  • lemon juice
  • 1 pound ground bison
  • coconut oil
  1. Soak the cashews in water for 4 hours. Drain and set aside.
  2. Preheat the oven to 425 degrees F.
  3. Prick the squash all over with a small sharp knife. Place on a sheet pan and roast the whole squash until tender when pierced with a knife, 45–90 minutes, depending on the size. Let cool.
  4. In a blender, combine the cashews and the 2 cups of water. Purée until a paste is formed. Add to a small saucepan over medium heat with the garlic, salt and nutmeg. Cook until heated through. Stir in the lemon juice. Keep warm.
  5. In a skillet over medium-high heat, cook the bison in the coconut oil until no longer pink. Keep warm.
  6. When the squash is cool enough to handle, cut it in half lengthwise and remove the seeds with a spoon. Use a fork to remove the “spaghetti” strands and place in a serving bowl. Top with the cooked bison and cashew sauce.

Easy Chicken Burrito Bowl

  • 1 cup shredded cooked chicken
  • ½ cup cooked kidney beans
  • ½ cup cooked black beans
  • shredded romaine lettuce
  • no-added-sugar salsa
  • guacamole
  1. For the shredded chicken, follow the instructions in the Curried Cauliflower Soup recipe.
  2. Heat up the beans.
  3. In a serving bowl, combine all ingredients and toss until well mixed.

Almond-Crusted Salmon

  • ½ cup almond flour
  • 2 tablespoons chopped fresh parsley
  • 1 tablespoon grated
  • lemon zest
  • 1 teaspoon sea salt
  • 1 teaspoon pepper
  • 4 wild-caught salmon fillets, skinned
  • 2 tablespoons coconut oil
  • 4 cups fresh spinach
  • fresh lemon juice
  1. In a bowl, stir together the flour, parsley, lemon zest, salt and pepper. Dredge the salmon in the mixture, coating the fillets on both sides.
  2. 2 In a skillet over medium-high heat, cook the salmon in the coconut oil, turning once, until fish is opaque and flakes easily, about 10 minutes.

Blueberry Pudding

  • 1 cup coconut milk
  • 1 cup goat’s milk kefir
  • 1 cup blueberries
  • 3 avocados, halved and pitted
  • ¼ cup sprouted chia seeds, ground
  • 1 tablespoon vanilla extract
  • ½ teaspoon sea salt
  • 1 drop peppermint oil
  • stevia
  1. In a high-powered blender, combine the coconut milk, kefir and blueberries. Scoop the avocados into the blender. Add the chia seeds, vanilla extract, salt and peppermint oil.
  2. Sweeten with the stevia to taste (such as a full dropper of the liquid variety). Purée until smooth.
  3. Transfer the pudding into a saucepan and warm over medium-low heat until heated through. Serve warm.

Dr. Josh Axe, DC, DNM, CNS, is a doctor of chiropractic, doctor of natural medicine, clinical nutritionist and author with a passion to help people get well using food and nutrition. He operates leading natural health website DrAxe.com and is co-founder of Ancient Nutrition, a health supplement company. He’s also author of the books Eat Dirt, Essential Oils: Ancient Medicine, Keto Diet, Collagen Diet and the newly published Ancient Remedies.

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Discussion

These results provide preliminary RCT evidence for dietary improvement as an efficacious treatment strategy for treating major depressive episodes. We report significant reductions in depression symptoms as a result of this intervention, with an overall effect size of –1.16. These effects appear to be independent of any changes in BMI, self-efficacy, smoking rates and/or physical activity. Concordant with our primary outcome, significant improvements were also observed on self-reported depressive and anxiety symptoms and on the Clinical Global Impressions Improvement scale. Whilst other mood (POMS) and wellbeing (WHO-5) scores did not differ between groups, changes were in the expected direction and were likely affected by lack of statistical power. Critically, substantial improvements on the ModiMedDiet score were evident in the dietary support group but not in the social support control group, and these changes correlated with changes in MADRS scores.

The results of this trial suggest that improving one’s diet according to current recommendations targeting depression [31] may be a useful and accessible strategy for addressing depression in both the general population and in clinical settings. Whilst there are many data to suggest that eating a more healthful diet is more expensive than a less healthful diet [45], our detailed modelling of the costs of 20 of the SMILES participants’ baseline diets compared to the costs of the diet we advocated showed that our strategy can be affordable [46]. Indeed, we estimated that participants spent an average of AU$138 per week on food and beverages for personal consumption at baseline, whilst the costs per person per week for the diet we recommended was AU$112 per week, with both estimations based on mid-range product costs [46].

A pertinent observation was that improvements in depressive symptoms were independent of weight change. These findings were expected, as the diet intervention was ad libitum and did not have a weight loss focus, but provide further support for the beneficial role of dietary improvement per se. The extensive observational evidence linking diet quality to mental health has repeatedly shown that the observed relationships exist independently of various measures of body composition.

Although dietary changes were not reflected in the traditional cardiovascular disease biomarkers, the protective effects of healthful dietary patterns are often independent of these risk factors [47]. There are many other biological pathways by which dietary improvement may influence depressive illness previous discussions have centered on inflammatory [18] and oxidative stress [19] pathways, as well as brain plasticity [16] and the new evidence base focused on the gut microbiota [17]. Each of these pathways is suggested to play a role in depression and is also influenced by diet quality. Moreover, behavioural changes associated with food (cooking/shopping/meal patterns) are an expected outcome of a nutrition intervention, and these changes in activity may also have had a therapeutic benefit.

Strengths and limitations

There are methodological features of our study that must be considered. Firstly, there is the issue of expectation bias due to the fact that we needed to be explicit in our advertising regarding the nature of the intervention and to the inability to blind the participants to their intervention group this may have biased the results and also resulted in differential dropout rates. Moreover, in regard to our randomisation process, a block size of four, whilst recommended for small sample sizes to avoid imbalances in allocation, may have been insufficient to support allocation concealment. As discussed above, to mitigate these issues significant effort was made to mask our hypothesis from the participants, and emphasis was placed on the potential benefit of social support to mental health. Clearly, our results must also be considered in light of the small sample size. Failure to reach our planned sample size increases the possibility that our sample was not representative and limited our ability to conduct subgroup analyses. It may also have inflated the effect size we observed. However, our original power calculations were based on a very small effect size arguably, this would not have been clinically significant. There were differential completion rates in each group: 94% versus 73.5% in the dietary and social support groups, respectively. This suggests that the mechanisms underpinning missingness may be different between the two groups however, results from comprehensive sensitivity analyses testing alternatives to the MAR assumption revealed that, whilst under the NMAR assumptions observed intervention effects moved towards the null, our findings remained robust against departures from the MAR assumption. A larger sample size and assessments at more than two time points would have afforded more sophisticated statistical modelling this should be a key focus of future replication studies.

Importantly, the high completion rates in the intervention group point to the acceptability of the dietary intervention to the participants. The fact that the dietary intervention group was able to make significant improvements to their diet quality suggests that dietary improvement is achievable for those with clinical depression despite the fatigue and lack of motivation that are prominent symptoms of this disorder. On the other hand, the challenges we had with recruiting this clinical population, likely due to the aforementioned symptoms and the requirement to attend the study centre on several occasions, points to the need to utilise different methods for delivering the intervention that do not require attendance with the dietician in person, such as telephone or Skype. Finally, given that we recruited participants on the basis of existing ‘poor’ quality diet, this may limit the generalisability of our findings to the wider population of individuals with depression. However, evidence suggests that our study sample was not necessarily a special subgroup the recent 2014–2015 Australian Health Survey tells us that only 5.6% of Australian adults had an adequate intake of vegetables and fruits. In this study, only 15 out of 166 people screened were excluded on the basis of a pre-existing ‘good’ diet, suggesting that — concordant with the wider population — poor diet is the norm in those with depressive illness.

Implications

Recent updates to clinical guidelines for the treatment of mood disorders in Australia have, in recognition of the emerging and established data regarding the importance of health behaviours (diet, exercise, sleep and smoking) to mood disorders, made explicit recommendations regarding the need to address these behaviours as a first step in the treatment of patients [48]. The results of this RCT offer further support for the need to focus on addressing poor diet in clinical practice and provide some guidance regarding the strategies that may be used to support this imperative. They suggest the new possibility of adding clinical dieticians to multidisciplinary mental health teams and making dietician support available to those experiencing depressive symptoms in primary and other care settings. Clearly, successfully improving diet quality in patients will also benefit the physical illnesses that are so commonly comorbid with depression and which are both a cause and consequence of depression. Upskilling dieticians to best deliver this program to this patient population may also be required.


The Gut-Food-Mood Connection

I know you hear me say it all the time, but the gut really is the foundation of your health. What’s happening in the gut can explain why different foods can impact your mood in different ways. There are a few major factors that connect the gut and your mood, but the first has everything to do with the gut bacteria, which are collectively known as the gut microbiome. These trillions of bacteria are constantly working behind the scenes to make us feel good. One of the main neurotransmitters, serotonin (known as the “happy hormone” because of its role in feelings of contentment, well-being, and happiness) is produced by specific gut bacteria. In fact, research has shown that more than 90% of serotonin is produced by these bacteria. ( 6 ) This explains why one of the most common side effects of SSRIs (which stands for selective serotonin reuptake inhibitors) are nausea, diarrhea, or GI issues.

Certain foods, like sugar and refined carbohydrates, can also contribute to chronic inflammation in the body. This might not seem like it would be related to your mood, but actually, inflammation is an underlying factor in not just depression but also bipolar disorder, anxiety, and even PTSD. In fact, one study has shown that inflammation has been found to trigger depression, almost like an allergic reaction and that immunotherapy might be a potential way to treat depression. ( 7 )

To make this connection more complicated, stress and depression can also alter your taste, perception of sugary and fatty foods, and your food choices. For example, a 10-year study conducted in frame showed that there was a link between depression and a poor diet but also that depression led to an increase in poor eating behaviors.


The gut-brain connection

The gut-brain connection is no joke it can link anxiety to stomach problems and vice versa. Have you ever had a "gut-wrenching" experience? Do certain situations make you "feel nauseous"? Have you ever felt "butterflies" in your stomach? We use these expressions for a reason. The gastrointestinal tract is sensitive to emotion. Anger, anxiety, sadness, elation — all of these feelings (and others) can trigger symptoms in the gut.

The brain has a direct effect on the stomach and intestines. For example, the very thought of eating can release the stomach's juices before food gets there. This connection goes both ways. A troubled intestine can send signals to the brain, just as a troubled brain can send signals to the gut. Therefore, a person's stomach or intestinal distress can be the cause or the product of anxiety, stress, or depression. That's because the brain and the gastrointestinal (GI) system are intimately connected.

This is especially true in cases where a person experiences gastrointestinal upset with no obvious physical cause. For such functional GI disorders, it is difficult to try to heal a distressed gut without considering the role of stress and emotion.

Gut health and anxiety

Given how closely the gut and brain interact, it becomes easier to understand why you might feel nauseated before giving a presentation, or feel intestinal pain during times of stress. That doesn't mean, however, that functional gastrointestinal conditions are imagined or "all in your head." Psychology combines with physical factors to cause pain and other bowel symptoms. Psychosocial factors influence the actual physiology of the gut, as well as symptoms. In other words, stress (or depression or other psychological factors) can affect movement and contractions of the GI tract.

In addition, many people with functional GI disorders perceive pain more acutely than other people do because their brains are more responsive to pain signals from the GI tract. Stress can make the existing pain seem even worse.

Based on these observations, you might expect that at least some patients with functional GI conditions might improve with therapy to reduce stress or treat anxiety or depression. Multiple studies have found that psychologically based approaches lead to greater improvement in digestive symptoms compared with only conventional medical treatment.

Gut-brain connection, anxiety and digestion

Are your stomach or intestinal problems — such as heartburn, abdominal cramps, or loose stools — related to stress? Watch for these and other common symptoms of stress and discuss them with your doctor. Together you can come up with strategies to help you deal with the stressors in your life, and also ease your digestive discomforts.

Image: © ChrisChrisW | GettyImages


Heal The Gut: 17 Gut-Healing Strategies to Start Today

Our gut health influences everything from our weight, to our mood, to our cognitive ability. It can be the reason for our back pain, the root of our depression, and of course, the cause of our digestive issues. That's why testing the health of our gut and then healing our gut is absolutely essential for improving our mental and physical health.

Why I Want to Help You Heal Your Gut

I never thought much about my gut. I'm a psychologist and well-being expert, so I focus mostly on what you can do to boost well-being (take my well-being quiz). But this all changed when my gut completely gave out on me. In the blink of an eye, I started getting nauseous, bloated, and belchy anytime I ate anything. I quickly dropped 15 pounds, became exhausted, and developed intense anxiety.

Had I thought more about my gut health, I could have seen the signs and prevented this nightmare. My gut had been screaming, "Pay attention to me!" for years by giving me new food allergies, migraines, and tummy troubles. These were all signs that my gut was unhealthy. I just didn't realize it yet.

Why You Want to Heal the Gut Before You Get Sick

When my gut got mad at me, I had no idea what the problem was. It took me months to figure it out. Eventually I took the GI-MAP stool test and learned that I had a parasite called blastocystis hominis (check out that parasite cleanse I did to get rid of it), which I likely picked up in Mexico a few years back. I also ate dairy (despite knowing I was sensitive to it), and lived in a moldy apartment—all things that contribute to poor gut health.

Because I ignored the signs, my gut problems snowballed—I developed Small Intestinal Bacterial Overgrowth (SIBO), Estrogen dominance, and an intolerance to dairy, gluten, eggs, and almonds. In addition, I couldn't eat anything that was difficult to digest (e.g., raw veggies, nuts, popcorn) or anything that fed mold (e.g., mushrooms, grains, even vitamins cased in cellulose capsules).

The GI-MAP stool test also revealed that my gut's immune system was completely shot. This meant that my body couldn't clear the toxins in my gut. As a result, I would get so tired that I literally couldn't keep my eyes open after eating a meal. And when I was awake, I had a hard time concentrating—my foggy brain just could not think. Needless to say, this made it difficult to work and I often skipped eating on days when I needed my brain and body to function.

Knowing what I know now, I would have done just about anything to heal the gut and prevent this. So I feel compelled to share what I've learned in hopes that it might help you or someone you know who needs to heal their gut. Read on to learn more.

Do You Need to Heal Your Gut?

Do you have common gut health issues such as: digestive troubles, stomach aches, weight changes, fatigue, skin issues, emotional issues, or food intolerances? Then consider testing the health of your gut and taking action now to heal your gut before your gut issues start to snowball.

If you'd like to know exactly what your gut problems are, you can take a stool test to find out. The GI-MAP stool test even has a report to help you interpret your results.

Get Started

In the section below, I'm going to review a bunch of gut healing strategies. These strategies can be even more effective if you know a bit more about the gut. So let's start by getting to know your gut bugs.

Get to Know Your Gut Bugs

It turns out that our guts are populated by all sorts of bacteria, fungi, and other unknown critters—these "gut bugs" are collectively referred to as the microbiota.

Just like humans, our gut bugs have personalities which are affected by nature (their genes) and nurture (the environment they live in). As a result, some of them tend to be good guys, some tend to be bad guys, and some can be fickle, and end up being good or bad depending on the circumstances.

For example, some strains of the often-feared E. coli are good for us while other strains are bad. The potentially deadly bacteria, staphylococcus aureus (i.e., staff) is present in 25% of healthy people—it only hurts us when it overgrows. And even good bugs, when there are too many of them, can cause a world of hurt when they move up into the small intestine and overgrow (causing SIBO).

Why does it help to know your gut bugs? Well, because when we understand what leads to an unhealthy society of microbiota, we can take the right steps to create a healthy society of microbiota and heal the gut.

Here's exactly how to do it.

When you start healing your gut, its best to start by gently supporting and encouraging healthy gut bugs. But if your gut is in a state of distress (as mine was), then you'll likely need to ramp up slowly to the more harsh gut healing strategies, forcing those gut bullies in your microbiota to "get out!".

To help you find the right protocol for healing your unique gut, I've listed 17 gut-healing strategies below in order from most gentle to most harsh.

I've also split these strategies into 3 phases to help you ramp up slowly and effectively.

What to expect

If your gut is unhealthy, it's going to get worse before it gets better. You're almost guaranteed to get die-off (Herxheimer) symptoms at some point in the gut healing process.

What are die-off symptoms?

Die-off symptoms can include fatigue, brain fog, gastrointestinal distress such as nausea, gas, bloating, diarrhea or constipation, low-grade fever, headache, sore throat, itching, muscle and joint soreness, chills, flu-like symptoms, lethargy, intense sweet cravings, rashes, and irritability.

Don't confuse die-off symptoms with a lack of calories or nutrients, which can also make us feel tired and weak. Die-off symptoms tend to come on suddenly (whereas insufficient calories can leave us feeling chronically tired and ill). Some people also find that they have die-off symptoms only at a certain time of the day—morning, afternoon, or evening.

When I started healing my gut, I had intense die-off reactions (chills and nausea) each night for 6 weeks. It decreased to every few days (as I moved through the phases), then once per week, and now very rarely, only when I use one of the more intense strategies below to amp up my detox.

How to minimize die-off

The die-off symptoms you'll experience will depend on the health of your liver, your gut bugs, and so forth.

  • If your die-off symptoms are making you feel miserable, then you're killing bad gut bugs too quickly. Slow down, support your liver (with supplements like Milk Thistle), take epsom salt baths to support your body's ability to get those dead gut bugs out of your body as quickly as possible, and eat foods with collagen (e.g., bone broth) to keep the bad stuff in your gut and out of your bloodstream.
  • If you feel fine one day and then complete crap the next, you might be getting die-off from parasites. It can be confusing because they have weird lifecycles, they die, reproduce, and create symptoms at weird times.
  • If your symptoms are consistently getting worse or staying the same over time, even though you haven't been adding new gut healing strategies, then it's likely NOT a result of die-off. See a doctor to make sure your symptoms are not a result of another health issue.

In this phase, you'll focus on generally improving your gut health.

1. Decrease Your Stress

It turns out that stress can actually help bad bugs, like Blasto, to thrive—a phenomenon that I experienced first hand (take the stress quiz to learn a bit more).

As I mentioned earlier, my gut switched from okay to completely berzerk in the blink of an eye. The cause of this switch was stress—I had a super stressful month. The stress taxed my immune system even further, enabling Blasto, and a bunch of other bad gut bugs to grow. They moved up into my small intestine (where they are not supposed to be)—and they even started "leaking" out of my gut.

This is how a short period of stress can snowball into major gut health issues. And it's why creating an anti-stress lifestyle is key to both gut health and mental health.

2. Support Your Immune System

If your gut is unhealthy, your immune system is already churning away trying to heal it. Without proper support, your immune system can get overworked and worn down. So a nice gentle way to heal the gut is to support your immune system in doing its job.

To support your immune system, you can eat immunity supporting foods, like citrus fruits, garlic, and spinach. If your immune system is already weak, it can also be helpful to supplement with key vitamins and minerals that may have become depleted like, Vitamin B, Vitamin D, and Zinc. I also found that taking vitamins to support adrenal function was incredibly helpful as adrenals can get taxed when we are overstressed by gut health issues.

3. Reduce Inflammation

Another way to heal the gut is by removing inflammatory foods. This helps your immune system decrease it's workload so it can spend more energy on healing the gut.

Although each of us have different problem foods, wheat and dairy tend to be problematic for many people with gut health issues. Sugar feeds many bad bacteria (all carbs are digested as sugar). And partially-hydrogenated oils are toxic, so they busy the immune system leaving other problems in your body unaddressed. That's why it can be really helpful to remove these inflammatory foods if we want a healthy gut.

4. Consume Collagen

Collagen makes up the gut’s connective tissue—or the barrier between what's in your gut and the rest of your body. If this barrier gets "leaky", particles from the gut can seep into the bloodstream, causing everything from the herxheimer reaction (flu-like symptoms), to mental health issues, to autoimmune disease.

Consuming collagen is likely helpful for everyone, but especially those with an unhealthy microbiota. In general, those with gut-health issues tend to have low levels of collagen. In addition, your microbiota affect which symptoms (or diseases) you might get from a leaky gut. So if you have an unhealthy gut, leaky gut may be more problematic.

For example, research shows that one type of autoimmune arthritis called Ankylosing Spondylitis is caused by the bacteria, Klebsiella. Many of us have Klebsiella in our microbiome, so researchers hypothesize that's it's only when these bacteria "leak" into our bloodstream that they cause arthritis. So eating collagen (or high-collagen foods like bone broth) can potentially prevent these negative outcomes.

5. Eat Gut-Soothing Foods

We often eat with little consideration for what our gut must then do with our food. In fact, our guts must break down all the chunks, absorb the nutrients, and then push along the indigestible fiber to feed the gut bugs in the lower intestine—that's a lot of work for an unhealthy gut.

To help ease the burden on the gut, we can eat gut-soothing foods such as soft foods, cooked foods, and juiced fruits and vegetables. These foods are already broken down, which helps ease the burden on the gut.

6. Focus on Macronutrients

When it comes to the role of macronutrients (i.e., Carbs, Protein, and Fat) in gut health, the experts are split. Some say that feeding our gut bugs with carbs like fiber, vegetables, and fruits is the best approach. Others say that starving our gut bugs by eating primarily fat is the best approach. Indeed, both approaches seem to have benefits. depending on your unique gut and microbiota. So it's important to pay attention to how specific foods make you feel.

For some folks, consuming fiber can exacerbate gut issues. For others, certain types of carbs exacerbate gut issues. For others, consuming high-fat meals exacerbate gut health issues (e.g., those without the enzymes to break down fats). When it comes to your gut health, the key is to eat mindfully and explore how different foods make you feel. Only then can you know that you're eating to heal your gut.

If the tips in Phase 1 aren't resolving your gut health issues, move on to Phase 2. In this phase, you'll focus on more nuanced strategies to improve gut health.

Although a Ketogenic diet doesn't seem to work for everyone, it appears to be a good way to reduce inflammation in the body more generally, improve insulin resistance, and clear gunk from the cells. It's also tends to be good for getting rid of bad bacteria and parasites. Why? Because the Ketogenic diet is a low-carb diet, and gut bugs primarily eat carbs.

Keep in mind that starting a Ketogenic diet can often result in a few days or weeks of Keto flu—headaches, leg cramps, sugar cravings, and some other annoying symptoms. To prevent Keto flu, make sure you're getting electrolytes (especially sea salt, magnesium, and potassium). An easy way to do this is by drinking homemade "ketorade".

And if you don't feel good eating Keto after a few days, stop! If your body is already stressed, Keto can be too stressful for your body to handle. You might instead opt for a moderate to low carb diet just to reduce your sugar intake.

8. Detox The Liver

Our livers are responsible for detoxing us of the harmful byproducts of dying gut bugs. Eating liver supportive foods can help us reduce die-off reactions and kill bad gut bugs with more ease.

To help the liver and body detox, consider taking milk thistle supplements, calcium D-Glucarate, NAC, or liposomal glutathione. Next, eat bitter greens like dandelion leaves, raw radishes, and mustard greens to promote more bile excretion and process toxins effectively. And be sure to eat cruciferous veggies like broccoli, kale, collard greens, bok choy, and arugula. These contain diindolylmethane (DIM), a substance that helps the liver detox effectively.

9. Take Natural Digestive Aids

If your gut is having a hard time digesting, for whatever reason, help it out by consuming natural digestive aids.

  • Betaine HCL and Apple Cider Vinegar are helpful for folks with insufficient stomach acid to break down food (common signs of this are heartburn or upset stomach).
  • Digestive enzymes are helpful for folks with a sluggish gallbladder or pancreas.
  • And ginger is helpful for those with sluggish migrating motor complex (MMC), which helps clean out the small intestine between meals.

10. Eat Less to Starve Gut Bugs

If you have an overgrowth of bad gut bugs, part of the goal is to starve them without starving yourself. Some folks advocate for fasting, intermittent fasting, or eating fewer carbs to reduce bacteria like firmicutes, which have been shown to be linked to obesity. Just be sure you're consuming enough calories not to stress your body out.

11. Remove Toxins from Your Life

Sometimes it seems like we are doing everything right, but we still can't seem to get a handle on our gut health issues. In this case, there is often some hidden toxin that's bogging down our immune system.

For example, are we eating all of our food out of plastic with BPA, a known gut toxin? Or are we living in a home that's covered in gut-harming mold? Or are we sleeping on a new bed that sprayed in toxic flame-retardant chemicals?

Gut-harming toxins are all around us. The electromagnetic waves from our smartphones can even mess with our guts. So finding and removing these toxins is often instrumental in healing the gut.

If the tips in Phase 1 and 2 aren't resolving your gut health issues, your gut bugs just aren't going to go quickly into the night—now it's time for war! In this phase, you'll focus on evicting unhealthy gut bugs from your body. by force.

12. Break Up the Biofilms That House Bad Gut Bugs

When bad gut bugs just won't leave, it's often because they have a protective home, or biofilm, to hide in. Taking biofilm disrupting supplements can start to jar them loose. The biofilm disrupters include:

13. Eat Probiotic Foods

Consuming probiotic foods is probably the best thing you can do for gut health. Although probiotic supplements can be helpful, they are usually too small to make much of an impact. If you do want to try pills, get pills with 50 billion colony forming units (CFUs). I suggest the probiotic Saccharomyces boulardii, which has been shown to combat digestive issues.

The reason I include this strategy in Phase 3 instead of Phase 1 is because probiotics can often be intense and cause bad die-off symptoms. So, how do you add probiotics to your diet successfully? Try the sauerkraut protocol.

The Sauerkraut protocol

Buy a jar of sauerkraut. Be sure that the jar is refrigerated, has live cultures, and doesn't include any preservatives whatsoever. Here is a handy guide to help you find the right stuff.

Consume 1 tablespoon of sauerkraut with a meal. Pay attention to how you feel. If you feel die-off symptoms (I did!) then keep eating this small amount once per day until it doesn't feel bad anymore. If you feel fine with the amount of kraut, go to the next step.

Increase the amount of sauerkraut you eat by 1 tablespoon per meal. Keep paying attention to how you feel to keep die-off symptoms to a minimum. And keep increasing your dosage until you get to 1/2 cup sauerkraut per meal. Make sure you don't go too fast or you'll kill too many bad bugs and feel like absolute garbage.

Continue this slow-build process with other probiotic foods. Once you tolerate sauerkraut, try kimchi, coconut yogurt, kefir (if you tolerate dairy), coconut kefir, kvass, kombucha, fermented fruit, and so forth until you can eat as many fermented foods as you desire without any symptoms.

Make your own fermented foods. Once you tolerate store-bought fermented foods, ideally, you should make your own fermented foods. These are far higher in probiotics and have a bigger positive impact on your gut.

When I did the sauerkraut protocol, it took me about 6 weeks to get through step 3 and about 2 months to get through all the steps. But everyone is different.

14. Eat Anti-Bacterial Foods

Probiotics crowd out bad bacteria anti-bacterials kill bad bacteria. To eradicate stubborn bad gut bacteria, try taking some anti-bacterial herbs.

Some experts recommend you start with less aggressive anti-bacterials like cinnamon, clove, or garlic. Test each of these a little at a time to see how they make you feel. If these don't help, try more intense anti-bacterials like oregano oil, olive leaf, berberine, or grapefruit seed extract in small doses. That stuff is powerful!

15. Eat Anti-Parasitic Foods

One great, and cheap, way to find out if you have parasites is with anti-parasitic foods, specifically, papaya seeds. You can even test yourself for parasites at home with the papaya seed test.

The papaya parasite test

Make a papaya smoothie. Toss 1/2 of a papaya in a blender (or less if you prefer). Toss in all the papaya seeds from that half of the papaya. Feel free to add a little juice or water if you like a thinner smoothie.

Drink the smoothie on an empty stomach. Don't eat anything else for 3 hours (water is fine). This should be enough time for the papaya seeds to get through your small intestine. Pay attention to how you feel. If you get any die-off symptoms, then you might have parasites, and the papaya seeds have just made them angry.

If you get any die-off symptoms, get a parasite test to find out for sure (the papaya parasite test isn't a sure thing). This is also necessary to see which parasites you have if you do have them.

16. Eat Anti-Fungal Foods To Kill Gut Candida and Yeast

Just as papaya seeds kill parasites, anti-fungal foods kill gut fungi like candida. A great, and cheap, way to find out if you have problems with gut fungi is with the coconut oil test.

The coconut oil test

Eat 1 tablespoon virgin coconut oil on an empty stomach. Don't eat anything else for 1-2 hours (water is fine). Pay attention to how you feel.

If you feel die-off symptoms then keep eating this amount of coconut oil (or less) until it doesn't feel bad anymore. If you feel fine, go to the next step.

Increase the amount of coconut oil you eat by just a tiny bit per day. Keep paying attention to how you feel. Keep increasing your dosage until you get to 2-3 tablespoons of coconut oil per day (you can include this oil in food if that's easier, but it might not be as effective).

17. Combine Anti-Microbial Supplements

Since we don't know which approaches and which herbs will work best on our unique gut bugs, it's helpful to combine different herbs to see which ones work best for us. Here's a few more anti-microbial herbs to explore. But follow the directions carefully these are potent herbs.

Although I'm not happy that I got sick, I am grateful that I now have the opportunity to become truly well. And on a personal note, this whole experience has made me realize that all we have are these moments. At any point, we can end up sick and lose them all. Now that I'm on the mend, I see the silver lining of all this—I'm a bit more grateful for small things (like breathing and digestion) and strive to live my life with more purpose.


A Word From Verywell

Our bodies interact with the foods we eat, and the choices we make each day can impact our body's ability to function at its best. Although there is no specific diet that has been proven to alleviate depression, we can see that there are plenty of nutrient-rich foods that can help to keep our brains healthy.

It is a good idea to talk with your medical provider before making significant changes to your diet. Remember to also be patient with yourself as you begin to try new foods and give your body time to adjust to the changes you are making. Making better food choices can help your overall health as well as make a positive impact on your emotional wellness.

If you or a loved one are struggling with depression, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.



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