By Monazza Ahmad, B.Pharm, MSc

In the fascinating world of our microbiome, there is one bacterium that has been making waves, and that is Akkermansia muciniphila. 
Among the trillions of bacteria residing in our body (yes, that's 10 times more than our own cells!), this particular species has caught the attention of researchers and health enthusiasts alike. Discovered about 20 years ago, A. muciniphila has been continuously showing promising results in promoting healthier gut lining and overall wellbeing.1*
You might wonder, don't all good bacteria do that? What sets A. muciniphila apart? Let's explore the unique attributes of this remarkable bacterium and discover how you can increase its levels to unlock its outstanding health benefits.* 

Uncovering Akkermansia muciniphila and the secret to its success
A. muciniphila is quite a unique character on the stage of the bacterial world. It thrives in areas with limited oxygen supply, making it particularly adept at flourishing even in tissues that have less oxygen supply.2

A. muciniphila does not follow the same dietary rules as its bacterial counterparts. While many bacteria rely on fiber for growth, A. muciniphila doesn't need it to survive. It can thrive on its own, without the need for any additional nutrients to reproduce.

Originating from Greek, muciniphila translates to “mucin-loving.” And true to its name, this bacterium resides in the mucus lining of our intestines, where it finds its energy source—mucin. By feasting on mucin, it encourages our epithelial cells to produce even more of it. What's so special about mucin? Mucin is a molecule that lubricates the gut lining, playing a crucial role in strengthening the walls of our gut against allergens and debris.*

Unveiling the impact of A. muciniphila on the microbial community
Here is another interesting fact about Akkermansia muciniphila: It turns mucin into something incredibly beneficial for our gut health—short-chain fatty acids (SCFAs), such as butyrate, which can be used as food by other friendly bacteria in our body. This quality makes A. muciniphila a “cross-feeder.” It makes up about 3-4% of the gut lining in healthy people, populating our gastrointestinal tract within the first year of life through breast milk but gradually decreasing as we age. Hence, it’s critical to give it lifelong care to maintain a thriving gut environment.3*

Unraveling the importance of Akkermansia in improving health
Research on the effects of A. muciniphila on human health is ongoing, but some studies have shown encouraging results, indicating that A. muciniphila may offer potential benefits for various aspects of health:

Excess weight: Overweight individuals are mostly found to have lower levels of A. muciniphila alongside other beneficial bacteria as compared to their lean counterparts. By increasing the thickness of the protective mucus layer in the intestines and enhancing gut barrier function, this microbe blocks bacteria and other substances from entering our bloodstream. The result? Our metabolic health gets a boost! From blood sugar and cholesterol to blood pressure and waist circumference, A. muciniphila helps keep them all in check.4,5*

Glucose regulation: Did you know that a thinner mucus layer is associated with health risks? This is why, if you have an adequate amount of A. muciniphila in your body, it will boost healthy gut mucus lining and improve glucose metabolism. By degrading the mucus layer in the intestines, A. municiphila can increase the production of SCFAs, which keeps the glucose regulated and produces energy in your body.6*
Therefore, supplementation with A. muciniphila can lead to reduced fat mass, improved insulin metabolism, and better blood sugar control—factors that are essential in tackling blood sugar health.7*

Cardiovascular health: There are several cardiovascular markers shown to improve with the presence of Akkermansia in the body. This bacterium works wonders helping to promote healthy arteries and healthy blood pressure. How does it support our hearts? By producing the superstar butyrate!8-13*

Understanding the difference between live vs. pasteurized forms
One more thing to consider is the live and pasteurized forms of Akkermansia. Although the difference in their effects is still inconclusive, most studies found the pasteurized form to be more effective than the live form.14,15*

Nurturing the growth of Akkermansia for optimal health
There are many ways to naturally enhance the production of this beneficial bacteria in your body.

Foods that help16,17

• Dietary fiber: Adopt a diet rich in fiber from fruits, vegetables, whole grains, legumes, and nuts, such as a Mediterranean diet, that encourages the growth of A. muciniphila.*
• Prebiotics: Incorporate prebiotic-rich foods into your diet. Prebiotics are nondigestible fibers that support the growth and activity of beneficial gut bacteria.* Foods like onions, garlic, leeks, asparagus, yacon root, and bananas are good sources of prebiotics.
• Polyphenol-rich foods: Foods rich in polyphenols, such as berries (especially cranberries), cocoa, green tea, and red wine (in moderation), may have a positive impact on your gut health and promote the growth of A. muciniphila.*
• Probiotics and fermented foods: While A. muciniphila itself is not commonly available as a probiotic supplement, consuming other probiotics and fermented foods (e.g., yogurt, kefir, sauerkraut, kimchi) may help create a gut environment that supports A. muciniphila growth.*
• Omega-3 fatty acids: Fatty fish such as salmon, mackerel, sardines, etc. as well as flaxseeds and chia seeds are a good source of fish oils to boost Akkermansia production.*

Lifestyle that helps6,16

• Avoid high-fat diets and alcohol: High-fat diets, especially those rich in unhealthy fats, as well as alcohol may negatively impact the gut microbiome. Strive for a balanced diet with healthy fats, stay away from fast food, and limit alcohol consumption.16

• Regular exercise: Regular physical activity has been associated with a more diverse and beneficial gut microbiome, which may also promote the growth of A. muciniphila.18

• Stress management: Chronic stress can negatively affect gut health. Engaging in stress-reducing activities such as meditation, yoga, or spending time in nature may be beneficial.19

Remember that individual responses to dietary and lifestyle changes can vary, and it's important to make these adjustments as part of an overall healthy lifestyle. So don’t forget to consult with your healthcare provider before making significant changes to your diet or lifestyle!

Navigating the caveats: potential risks of overabundance of Akkermansia
Just like anything out of balance in life, the overabundance of this bacteria may bring some risks as well. For example, excess Akkermansia in the body may upset the intestinal barrier due to overconsumption of mucin that makes up the epithelial lining to prevent the passage of bacteria.20*

There are other emerging studies on the possible association of the abundance of A. muciniphila with certain health parameters. Whether it’s detrimental or supportive is yet to be concluded.21-24

Remember, moderation is the key! Just like any other supplements, make sure to avoid overconsumption and always consult with your healthcare practitioner before starting supplementation. 

​References:
1. Zitong L et al. Front Microbiol. 2022;13:1037708.
2. Rodrigues CF et al. Front Immunol. 2022;13:934695.
3. Zhang T et al. Microb Biotechnol. 2019;12(6):1109-1125.
4. Mayorga-Ramos A et al. Front Nutr. 2022(9).
5. Xu Y et al. Front Micriobiol. 2020;11:219.
6. Suriano F et al. Front Immunol. 2022;13:953196.
7. Hasani A et al. J Med Microbiol. 2021;70(10).
8. Li J et al. Circulation. 2016;133(24:2434-2446.
9. Wassenaar TM et al. Eur J Microbiol (Bp). 2018;8(3):64-69.
10. Mohammad S et al. Front Immunol. 2020;11:594150.
11. Luo X et al. Int J Mol Sci. 2023;24(5):4955.
12. Tilves C et al. JAHA. 2022;11(13).
13. Yan J et al. Gut Microbes. 2021;13(1):1984104.
14. Choi Y et al. Microorganisms. 2021;9(10):2039.
15. Ashrafian F et al. Scientific Reports. 2021;11:17898.
16. Zhou K. J Funct Foods. 2017;33:194-201.
17. Anonye BO. Front Immunol. 2017;8.
18. Hintikka JE et al. Scientific Reports. 2023;13:11228. 
19. Madison A et al. Curr Opin Behav Sci. 2019;28:105-110.
20. Qu S et al. Front Microbiol. 2023;14:1111911.
21. Wang K et al. Front Microbiol. 2022;13:932047. 
22. Nishiwaki H et al. NPJ Parkinsons Dis. 2022;8:65.
23. Fang X et al. Curr Med Sci. 2021;41(6):1172-1177.
24. Floch N. Science Direct. 2017. 

You’ve probably heard that vitamin C supports your immune system. This essential micronutrient seems to be everywhere! And it’s a good thing because, unlike most mammals, humans can’t synthesize vitamin C on their own.1 Also, vitamin C is water-soluble, which means the body quickly loses this essential vitamin through urine, so it’s important to make vitamin C a daily part of your diet.1
Having extremely low levels of vitamin C for prolonged periods can result in scurvy, a historical disease linked to pirates and sailors who faced long journeys at sea without fresh fruits and vegetables. While cases of scurvy in the United States are rare, a recent study reported that 31% of the US population are not meeting the daily recommended intake of vitamin C.1 Greater than 6% of the US population are severely vitamin C deficient, while low levels of vitamin C, associated with weakness and fatigue, were observed in 16% of Americans.2 As a whole, 20% of the US population showed marginally low levels of this essential micronutrient.2
How much vitamin C do I need?The US recommended daily dietary allowance of vitamin C is 75 mg for women and 90 mg for men.3 Experts recommend an estimated 200 mg of vitamin C daily for favorable health benefits.4 Adults can take up to 2,000 mg of vitamin C per day; however, high doses of vitamin C may cause diarrhea, nausea, and stomach cramps.5 Due to the varying health needs of individuals, it’s always a good idea to work with your healthcare practitioner to ensure that you are getting the right amounts of micronutrients in your daily diet.
Where can you find this marvelous, multifaceted micronutrient?

Written by Julia Mellios

Your gut is one of the hardest working systems in your body. Meal after meal, it hustles to digest your food and extract the nutrients required to sustain you. Despite it’s solid work ethic, your gut can experience occasional performance hiccups, leading to digestive symptoms. While many of these are normal, others may indicate something more serious. Read on to discover what your symptoms say about your gut and ways to improve them.

Normal, Everyday Symptoms

Transient Belly Bloating
​What is it? Short-lived abdominal swelling due to trapped gas.

• What causes it? During and after meals, your gut produces enzymes and acids that break down your food, creating gas during this process. While bloating isn’t considered normal, it commonly occurs if you deviate from your standard diet, such as eating larger portions, rich and fatty meals or foods that are more laborious to breakdown, including excess carbohydrates and fibre. These place more burden on your digestive processes, subsequently increasing gas production and bloating. 
• How do you improve it? While mild bloating generally passes with time, chewing your food thoroughly, consuming smaller meals and spacing out your carbohydrate and fibre intake can help.

During and after meals, your gut produces enzymes and acids that break down your food, creating gas during this process. While bloating isn’t considered normal, it commonly occurs if you deviate from your standard diet, such as eating larger portions, rich and fatty meals or foods that are more laborious to breakdown, including excess carbohydrates and fibre. These place more burden on your digestive processes, subsequently increasing gas production and bloating. 

Flatulence

• What is it? Farting.
• What causes it? Gas is produced by normal digestive processes, and ‘passed’ at regular intervals. Additionally, increased fibre, fat or sugar intake can create gas. Your microbiome (gut bacteria) also influences the amount of gas produced by fermenting foods to help your digestion.1
• How do you improve it? It is normal to pass wind around 15 times per day.2 Additionally, the odd smelly fart is no big deal, particularly if caused by an increase in refined, processed foods (who can say no to the occasional slice of pizza?). However, if you would like to reduce flatulence, moderate your intake of these foods.

Borborymus

• What is it? Stomach growling or rumbling.
• What causes it? The movement of food, liquid or gas through your digestive tract. Your gut may also ‘growl’ to signal hunger.
• How do you improve it? Give your gut a helping-hand by chewing your meals thoroughly, which helps break down your food more efficiently prior to digestion, and reduces gas. Additionally, satisfying your hunger will stop the growl.

Symptoms That Require Attention

Chronic Constipation

• What is it? The infrequent passage of hard poop (less than once daily), often accompanied by straining, a sense of incompletely emptying the bowel and discomfort.3
• What causes it? Insufficient fibre or reduced fluid intake can slow your transit time (the time it takes for your food to travel from your mouth through to the other end), making you less ‘regular’. Dysbiosis (an imbalance in the types and levels of gut bacteria) can also influence digestive processes and reduce your transit time.4 Additionally, chronic constipation is associated with irritable bowel syndrome (IBS), a condition that affects the function of the bowel.5
• How do you improve it? Consume more fibre-rich foods, including fruit and vegetables, and drink enough water. A prebiotic and probiotic supplement may also support bowel regularity and provide relief for symptoms of medically diagnosed IBS.

Diarrhoea

• What is it? Soft, loose or watery stool that occurs more than three times daily.
• What causes it? Diarrhoea may be a symptom of a bacterial or viral infection, such as gastroenteritis, or be related to certain medications, particularly antibiotics.6 Additionally, IBS and inflammatory bowel disease (IBD), a condition involving inflammation of the digestive tract, may cause diarrhoea.
• How do you improve it? IBS and IBD are serious conditions that require a professional diagnosis and care from a health Practitioner. However, if your symptoms are associated with antibiotic use, Metagenics Ultra Flora Intensive Care may help to restore healthy intestinal bacteria and relieve diarrhoea.

Malodorous Gas

• What is it? Farts that clear a room.
• What causes it? Your microbiome consists of a range of bacteria (38 trillion microbes!) that help digestion by fermenting your food, particularly fibre. Imbalances in the levels of different bacterial species can lead to increased gas production with a pungent odour.
• How do you improve it? Metagenics Ultra Flora Intensive Care provides three specific probiotic strains (types of bacteria), Lactobacillus rhamnosus (LGG®), Saccharomyces cerevisiae (boulardii) and Bifidobacterium animalis ssp lactis (BB-12®), which have been shown to help restore a healthy balance of bacteria within your microbiome.

Abdominal Pain

• What is it? Sharp, dull, stabbing, cramp-like, or twisting pain in your abdomen. Most people experience occasional gut discomfort, however severe gut pain that is episodic, regular or continuous requires assessment, particularly if accompanied by other symptoms such as fever, changes to your poop, nausea and/or vomiting.
• What causes it? Abdominal pain has many potential causes, the most common being gas pain, food intolerances or allergies, or indigestion. However, abdominal pain can also be a sign of something more serious, including appendicitis, gallstones, ulcers, infections, kidney stones, and many other conditions.
• How do you improve it? If gut pain has become a pattern rather than a one-off incident, seek guidance from a healthcare professional.

If you regularly experience one or more problematic symptoms, consult with a Natural Health Practitioner for further investigation, particularly if it is new or getting worse. Additionally, healthcare Practitioners have a suite of testing available to investigate the driver behind your symptoms. For instance, a stool test enables Practitioners to identify all of the bacteria and other microorganisms that inhabit your gut and how they contribute to your gut function and digestive symptoms.

Ditch the Gut Glitches
Don’t let your gut feelings bum you out! Instead, switch up your diet and lifestyle habits and rid yourself of symptoms such as bloating, gurgles and gas. If your gut symptoms are troubling you, speak with a natural healthcare Practitioner for a comprehensive plan to get you gut comfort, today.

References1 Manichanh C, Eck A, Varela E, Roca J, Clemente JC, González A, et al. Anal gas evacuation and colonic microbiota in patients with flatulence: effect of diet. Gut. 2014 Mar;63(3):401-8. doi:10.1136/gutjnl-2012-303013.
2 Victoria State Government, Better Health Channel. Flatulence [Internet]. Melbourne VIC: Victoria State Government, Better Health Channel; 2014 [updated 2014 Aug; cited 2020 Jan 30]. Available from: https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/flatulence.
3 Colledge NR, Walker BR, Ralston SH. Davidson’s principles and practice of medicine. 21st ed. Edinburgh (UK): Elsevier/Churchill Livingstone; 2010. p. 763-844.
4 Zhao Y, Yu YB. Intestinal microbiota and chronic constipation. Springerplus. 2016 Jul 19;5(1):1130. doi: 10.1186/s40064-016-2821-1.
5 Colledge NR, Walker BR, Ralston SH. Davidson’s principles and practice of medicine. 21st ed. Edinburgh (UK): Elsevier/Churchill Livingstone; 2010. p. 763-844.
6 NPS Medicinewise. What are the side effects of antibiotics? [Internet]. Sydney NSW: NPS Medicinewise; 2012 [updated 2017 Mar; cited 2020 Feb 18]. Available from: http://www.nps.org.au/medicines/infections-and-infestations/antibiotics/for-individuals/side-effects-of-antibiotics.

Written by Rachel Baudistel

​Fermented foods and beverages, such as sauerkraut, kimchi and kombucha, were a regular part of our ancestors’ diets for thousands of years. Originally a method of preserving produce from harvest time through the cold days of winter;1 fermentation involves adding a bacterial or yeast starter to a food. These organisms convert starches and sugars to alcohol or acids, lengthening the food’s shelf life and producing the unique and tangy flavours we associate with fermented foods. Recently, these foods have seen a resurgence in popularity, not for their shelf lives but for their claimed digestive health benefits. As probiotics have also risen in popularity for similar reasons, let us explore how fermented foods stack up against a high quality probiotic.

It All Begins In The Gut
Our interest in strategies to improve digestive health has been fuelled by an expanding body of research indicating that poor gut health negatively affects many other body systems.2 Specifically, imbalances in the microbiome, the ecosystem of approximately 38 trillion bacteria and other organisms living in your digestive tract, have been connected not only to gut disorders but to mood, immune, inflammatory and autoimmune diseases, cancer and even cardiovascular disease.3,4 

Research shows that taking live beneficial bacteria, such as probiotics, can improve microbiome health, reducing the symptoms of many health conditions,5,6 improving general health and lowering the risk of diseases such as those mentioned above.7 In light of this, probiotic supplements and fermented foods, both sources of potentially beneficial bacteria, have been put forward as effective options for improving microbiome health. Consequently, there is a misconception that they are interchangeable; however, there are fundamental differences between them.

The Pros of Probiotics
​Probiotics are defined as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host”.8 Research has shown that specific types (strains) of probiotics, at defined doses, can help manage particular health conditions or symptoms, such as hayfever9 or bloating.

To understand this further, let us use irritable bowel syndrome (IBS), a painful digestive disorder, as an example. (To read more about IBS, click here). Research indicates that the specific probiotic strain, Lactobacillus plantarum 299v, can relieve the bloating, intestinal pain and inflammation of medically diagnosed IBS.10,11 This benefit occurs when the probiotic is taken at a dose of 20 billion colony-forming units (CFU), which is a way of expressing the amount of live bacteria contained per probiotic capsule or dose of powder.

Scientists give probiotic bacteria three names we can use to identify them and connect them to their health benefits: genus (e.g. Lactobacillus), species (e.g. plantarum), and strain (e.g. 299v). To get the health benefits associated with that strain, all three names must match the probiotic used in the scientific research, as well as the dose. Luckily, you can find information on strains and doses in a probiotic supplement just by reading the label.

By choosing a probiotic from a reputable brand committed to quality, you can feel confident that you will receive:

• A guaranteed strain of bacteria effective for your health condition
• A correct quantity of live bacteria necessary for the benefit you require
• Bacteria that are alive at the label dosage until the expiry date

So, if you are looking to improve a particular health condition, choose a strain-specific probiotic for best results. What’s the easiest way to find the right probiotic for your condition? See a Natural Healthcare Practitioner.

Fermented Foods Vs Probiotics
Although fermented foods contain live bacteria, the microbes responsible for fermentation do not confer the same health benefits as a probiotic supplement. In fact, an expert panel of scientists concluded that fermented foods have unidentified microbial content, meaning there is no guarantee of what bacterial strains or doses will be present in them. For this reason, they are fundamentally different from probiotics.12

That being said, many people experience non-specific digestive health benefits from including fermented foods in their diet, which could be related to the bacteria present, however, more research is needed to confirm this. Since fermentation breaks ingredients down into simpler parts, these foods are generally easier to digest, and fermentation also increases the nutritional value of the food.13 If you are healthy and do not require specific health benefits, fermented foods may be appropriate for you.
​
Be aware that, while fermenting at home can be fun, it is not a risk-free process. Exposure to oxygen, for example, can allow mould, yeast and less beneficial bacteria to grow. High-quality probiotics, on the other hand, are produced under strict hygienic conditions that minimise the risk of introducing ‘bad’ microorganisms into your gut. If your digestive system is sensitive, you may be better off taking a probiotic.

Choose What’s Right For You
Fermented foods are a tasty addition to the diet and do appear to provide some non-specific digestive benefits to relatively healthy people, on the proviso that they are prepared correctly. However, for support with specific health conditions, it is important to choose a specific probiotic strain, at the right dose, for your condition. To access high-quality probiotics for your particular health needs, contact a Natural Healthcare Practitioner.

References1 Chambers PJ, Pretorius IS. Fermenting knowledge: the history of winemaking, science and yeast research. EMBO Rep. 2010 Dec;11(12):914-20. doi: 10.1038/embor.2010.179.
2 Alam R, Abdolmaleky HM, Zhou JR. Microbiome, inflammation, epigenetic alterations, and mental diseases. Am J Med Genet B Neuropsychiatr Genet. 2017 Sep;174(6):651-660. doi: 10.1002/ajmg.b.32567.
3 Alam R, Abdolmaleky HM, Zhou JR. Microbiome, inflammation, epigenetic alterations, and mental diseases. Am J Med Genet B Neuropsychiatr Genet. 2017 Sep;174(6):651-660. doi: 10.1002/ajmg.b.32567.
4 Maranduba CM, De Castro SB, de Souza GT, Rossato C, da Guia FC, Valente MA et al. Intestinal microbiota as modulators of the immune system and neuroimmune system: impact on the host health and homeostasis. J Immunol Res. 2015;2015:931574. doi: 10.1155/2015/931574.
5 Niedzielin K,  Kordecki H, Birkenfeld B. A controlled, double-blind, randomised study on the efficacy of Lactobacillus plantarum 299v in patients with irritable bowel syndrome. Eur J Gastro Hepat 2001;13:1-5. PMID: 11711768.
6 Costa DJ, Marteau P, Amouyal M, Poulsen LK, Hamelmann E, Czaaubiel M, et al. Efficacy and safety of the probiotic Lactobacillus paracasei LP-33 in allergic rhinitis: a double-blind, randomised, placebo-controlled trial (GA2LEN) study. Eur J Clin Nutr. 2014;1-6. doi: 10.1038/ejcn.2014.13.
7 Kalliomäki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 2001 Apr 7;357(9262):1076-9. doi: 10.1016/S0140-6736(00)04259-8.
8 Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014 Aug;11(8):506-14. doi: 10.1038/nrgastro.2014.66.
9 Costa DJ, Marteau P, Amouyal M, Poulsen LK, Hamelmann E, Czaaubiel M, et al. Efficacy and safety of the probiotic Lactobacillus paracasei LP-33 in allergic rhinitis: a double-blind, randomised, placebo-controlled trial (GA2LEN) study. Eur J Clin Nutr. 2014;1-6. doi: 10.1038/ejcn.2014.13.
10 Niedzielin K,  Kordecki H, Birkenfeld B. A controlled, double-blind, randomised study on the efficacy of Lactobacillus plantarum 299v in patients with irritable bowel syndrome. Eur J Gastro Hepat 2001;13:1-5. PMID: 11711768.
11 Ducrotté P, Sawant P, Jayanthi V. Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome. World J Gastroenterol. 2012 Aug 14;18(30):4012-8. doi: 10.3748/wjg.v18.i30.4012. 
12 Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat RevGastroenterol Hepatol. 2014 Aug;11(8):506-14.doi: 10.1038/nrgastro.2014.66.
13 Coyle D. What Is Fermentation? The Lowdown on Fermented Foods.  https://www.healthline.com/nutrition/fermentation#what-it-is. Healthline. Accessed July 8, 2019.

By Melissa Blake, ND

Our bodies have an amazing natural ability of keeping to a daily schedule via an internal 24-hour master clock.1 This clock contributes to the patterns, also known as circadian rhythms, of many biological activities including sleep-wake cycles, eating patterns, and hormone function.1
Finding ways to support and balance this clock, along with the many systems it regulates, may offer a novel way to optimize health. One way to optimize is through diet timing.
The circadian diet as a way of eating takes into account not only what we eat, but when.2 It is an approach to eating that synchronizes food intake around our biological clocks, emphasizing eating in sync with the body’s natural tendencies and instincts. This means eating during daylight hours or hours when we are naturally more active. Eating in this way can help support circadian rhythms and contribute to overall health and wellness.2

As diets and terms including intermittent fasting, circadian diet, and time-restricted eating gain popularity, the question may arise as to whether the principle on which this “circadian approach” applies to other aspects of nutrition, including supplementation.

5 common supplements
Although there’s still much to learn about optimal timing for both food and supplements, current evidence suggests it may play a role.3 Here are a few general guidelines for five common supplements to help you add the extra layer of timing and optimize your plan:

B complex
B vitamins are often recommended to support healthy energy and mood.4 There is some evidence that taking B vitamins before bed can have a negative effect on sleep quality.5 Consider taking any B vitamins, including a B complex, earlier in the day with food.

Fish oil
The most common complaints I hear about fish oil are burping or nausea. Taking fish oil supplements with food, divided into two doses, may help reduce these harmless yet annoying side effects.

Magnesium
Magnesium is an essential micronutrient that plays a role in hundreds of reactions in the body.6
Due to the overall benefits of magnesium supplementation, consistency is more important than any timing in this case. Known for muscle relaxation and improved sleep, taking magnesium before bed may enhance those benefits in some people.7 Others may notice digestive issues and may choose to take with food.

Probiotics
Any recommendation related to probiotic supplementation should be based on the specific strain; however, much of this detailed evidence does not yet exist.  Meal timing has more or less of an impact on probiotics depending on the strain, the dose, delivery method, etc.8 The consensus, however, is to take probiotics 30 minutes before or during a meal versus after eating.9 Another guideline is to space probiotics away from antibiotic medications by two hours to reduce interaction.

Vitamin D
Along with vitamins A, E, and K, vitamin D is a fat-soluble vitamin that is better absorbed when taken with a fat-containing meal (ex. fatty fish, avocado, olive oil, cheese, eggs).10 Although we do not have substantial evidence to support specific timing, it may make sense to take vitamin D supplements in the morning with breakfast to mimic the timing of exposure to natural sunlight.

Summary
As we continue to learn about specific supplements and optimal timing, consider that the best timing is the one you can stick with. You cannot benefit from a supplement you do not take. The most important thing is to take your supplements at a time that is convenient for you so you can be consistent.
Work with a knowledgeable healthcare provider to determine the optimal plan for you that includes quality, quantity, and timing.

References:

1. Rosenwasser AM et al. Sleep Med Clin. 2015;10(4):403-412.
2. Challet E. Nat Rev Endocrinol. 2019;15(7):393-405. 
3. Oike H et al. Curr Nutr Rep. 2014;3(3):204-212.
4. Young LM et al. Nutrients. 2019;11(9):2232.
5. Aspy DJ et al. Percept Mot Skills. 2018;125(3):451-462.
6. Rosanoff A et al. Adv Nutr. 2016;7(1):25-43.
7. Altura BM et al. Med Hypotheses. 2001;57(6):705-713.
8. Pot B et al. Eur J Med Res. 2021;26(1):40.
9. Tompkins TA et al. Benef Microbes. 2011;2(4):295-303.
10. Dominguez LJ et al. Metabolites. 2021;11(4):255.

Feeling off? An unbalanced gut microbial community, also known as dysbiosis, can wreak havoc on your health. Your gut is home to around 100 trillion microbes, and most of these little critters are good for you.1 However, not all microbes provide the same health benefits. When potentially harmful bacteria have stronger effects than your good bacteria, it can negatively affect your health.

Here are 7 signs that your gut could use some love:
Acne
Has your skin been suffering from breakouts? An unbalanced gut might be the culprit. Recent studies have revealed a link between reduced bacterial diversity in the human gut and acne.2 Acne affects up to 50 million people in the United States and is the nation’s most common skin condition.3 What can you do to fight back against stubborn blemishes? Take a close look at your diet. Research has identified a link between the Standard American Diet (SAD) and acne.2 An overabundance of saturated fats, dairy products, and refined carbohydrates leaves Americans undernourished and can contribute to the development of blemishes.2 Omega-3 fatty acids are also in short supply in the SAD; supplementation with omega-3s has been shown to help reduce acne.4

Mood
Feeling down? The bacteria living in your gut could be partially to blame. You’ve probably heard of the gut-brain connection; many studies have shown a relationship between mood and the gut.5 Via the vagus nerves, your thoughts and moods send signals to your digestive tract (and immune system) and vice versa.6 Recent studies suggest that a high-quality probiotic may help to improve mood and cognition.7-10

​GI upset
Too many trips to the porcelain throne? Losing friends to flatulence? Confounded by occasional constipation? These annoying symptoms could be signs of dysbiosis.11 To address these issues, a good place to start is to look at your medications and supplements to see if any may cause occasional diarrhea or constipation. Additionally, an elimination diet can be a good way to help determine if certain foods might be contributing to your symptoms. Your poop could be telling you a lot about your health, so keeping tabs on your bathroom visits is important.

Immune system
70% of your immune system resides in your gut.12 A healthy balance of gut bacteria helps support a sufficient immune response.

Sleep
Are you counting sheep by the thousands, yet sleep is still elusive? The critters living in your gut could be partially to blame. A recent study showed that better and longer sleep is associated with microbiome diversity.13

Sugar cravings
If you often find yourself craving sugary treats, this could be partially due to the microbes in your gut.14 For example, the bacteria in your gut may signal that they would like a bacon maple doughnut, even though you planned to have a salad instead. The most effective way to turn down the volume on the signals for sugary snacks? Starve those nasty bugs by changing up your daily diet. You can improve your guts microbiome by favoring vegetables, fruits, and fermented foods. Over time the cravings can diminish.

​Weight fluctuations
Are you struggling to maintain a healthy weight? The bacteria in your gut could be a major player. Everyone’s microbiome is unique—made up of various strains of bacteria and protozoa (a group of single-celled microorganisms)—some of these gut dwellers have been shown to influence weight and even overall health. If you are experiencing sudden weight loss or unusual changes in your bowel habits, you should contact your healthcare practitioner.

7 ways to improve gut health
Diet
The more diverse your diet, the more diverse your microbiome! Eat the rainbow by loading up on a variety of different-colored fruits and vegetables, whole grains, and lean protein sources like fish and legumes. Another great way to support your gut is by eating fermented foods. Building a rich microbiome is a fantastic way to care for your health and immune system. Additionally, here are 5 foods to reduce to support your gut health.

Probiotics
High-quality probiotics can be a fantastic way to support your gut health. When you have a rich and diverse “forest” of good bacteria, the harmful bacteria are crowded out. This increase of good bacteria and the resulting reduction in harmful bacteria can improve your digestion and ability to better absorb macronutrients and micronutrients. Two important things to remember when selecting a probiotic: 1. Different strains for different gains, meaning different probiotic strains support specific health goals. 2. Not all probiotics are created equal. Here are six things to look for in a probiotic.

Prebiotics
Remember to feed your good bacteria! The good bacteria in your gut live on prebiotics. Prebiotics resist digestion so that they can reach the good bacteria living in your colon. Your good bacteria then ferment (eat) the prebiotics. So, probiotics and prebiotics go together like…well, probiotics and prebiotics!

Supplements
Many supplements are formulated to support a healthy gut and a strong digestive tract. Some great options are glutamine, inner leaf aloe, and zinc-carnosine. Additionally, recent studies have shown the benefits of vitamins C, B2 (or riboflavin), and D on the digestive tract and microbiota of the human gut.15-17

Exercise
Need another reason to exercise? Studies have shown that exercise can increase microbiota diversity within the gut.18 So find your favorite way to break a sweat and get moving. Your gut will thank you!  Developing a yoga practice may be a great place to start, as studies have shown that yoga has proven benefits for relieving intestinal distress.19-20

Hydrate
Drink up; the gut’s mucosal lining is 98% water!21 Water not only helps to expel toxins through urine and stool, but it also helps to prevent occasional constipation. It’s important to support the mucosal lining of your gut; this lining helps shield your gut’s inner epithelial walls from undesirable microbes.21

Relax
The gut and brain are in constant contact via the vagus nerves. Relaxation has been found to positively impact gut health.22 
If you think your gut may be the source of your symptoms or just needs some love, reach out to your healthcare practitioner to create a plan of action to reach your best gut health. Unusual GI symptoms can be a sign of a more serious health concern.

​References

1. Guinane CM et al. Role of the gut microbiota in health and chronic gastrointestinal disease: understanding a hidden metabolic organ. Therap Adv Gastroenterol. 2013;6(4):295-308.
2. Deng Y et al. Patients with acne vulgaris have a distinct gut microbiota in comparison with healthy controls. Acta Derm Venereol. 2018;98(8):783-790.
3. American Academy of Dermatology. https://www.aad.org/media/stats/conditions/skin-conditions-by-the-numbers. Accessed May 15, 2019.
4. Jung JY et al. Effect of dietary supplementation with omega-3 fatty acid and gamma-linolenic acid on acne vulgaris: a randomised, double- blind, controlled trial. Acta Derm Venereol. 2014;94: 521–525.
5. Liu Y et al. Proteomics analysis of the gut–brain axis in a gut microbiota-dysbiosis model of depression. Translational Psychiatry. 2021;11(1):1-8.
6. Breit S et al. Vagus nerve as modulator of the brain-gut axis in psychiatric and inflammatory disorders. Front Psychiatry. 2018;9:44.
7. El Dib R et al. Probiotics for the treatment of depression and anxiety: a systematic review and meta-analysis of randomized controlled trials. Clinical nutrition ESPEN. 2021;45:75-90.
8. Bravo JA et al. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proc Natl Acad Sci USA. 2011;108:16050– 16055.
9. Kim CS et al. Probiotic supplementation improves cognitive function and mood with changes in gut microbiota in community-dwelling older adults: a randomized, double-blind, placebo-controlled, multicenter trial. The Journals of Gerontology Series A, Biological Sciences and Medical Sciences. 2021;76(1):32-40.
10. Petra AI et al. Gut-microbiota-brain axis and its effect on neuropsychiatric disorders with suspected immune dysregulation. Clin Ther. 2015;37(5):984-995.
11. Cao H et al. Dysbiosis contributes to chronic constipation development via regulation of serotonin transporter in the intestine. Scientific Reports. 2017;7(1):10322-10412.
12. Vighi G et al. Allergy and the gastrointestinal system. Clin Exp Immunol. 2008;153 Suppl 1(Suppl 1):3-6.
13. Smith RP et al. Gut microbiome diversity is associated with sleep physiology in humans. PLoS One. 2019;14(10):e0222394.
14. Alcock et al. Is eating behavior manipulated by the gastrointestinal microbiota? Evolutionary pressures and potential mechanisms. Bioessays. 2014;36(10):940-949.
15. Pham VT et al. Effects of colon-targeted vitamins on the composition and metabolic activity of the human gut microbiome- a pilot study. Gut Microbes. 2021;13(1):1-20.
16. Choi Y et al. E (α-tocopherol) consumption influences gut microbiota composition. Int J Food Sci Nutr. 2020;71 (2):221–225.
17. Chatterjee I et al. Vitamin D receptor promotes healthy microbial metabolites and microbiome. Sci Rep. 2020;10:7340.
18. Clarke SF et al. Exercise and associated dietary extremes impact on gut microbial diversity. Gut. 2014;63(12):1913-1920.
19. Dalton A et al. Exercise influence on the microbiome-gut-brain axis. Gut microbes. 2019;10(5):555-568.
20. Schumann D et al. Effect of yoga in the therapy of irritable bowel syndrome: a systematic review. Clin Gastroenterol Hepatol. 2016;14(12):1720–1731.
21. Hansson GC. Role of mucus layers in gut infection and inflammation. Curr Opin Microbiol. 2012;15(1):57-62.
22. Househam et al. The effects of stress and meditation on the immune system, human microbiota, and epigenetics. Advances in Mind-Body Medicine. 2017;31(4):10-25.

Many of us have learned to “trust our gut.” But if we ask most people what our digestive tract is for, they’ll probably explain it as a way of absorbing nutrients and disposing of waste. So where do phrases such as “trusting our gut” or “unable to stomach the results” come from? It turns out there is a two-way street between our digestive organs and our brains. What we eat and the state of our digestive tract can have a profound impact on our moods and behaviors. And probably unsurprisingly at this point, our gut microbiome is also involved.
Our vagus nerves, which control much of our “rest and digest” response, make a direct connection from our brains to our digestive tracts. Incidentally, these nerves also innervate our heart and communicate with our immune systems.1 These nerves help our brains communicate to our stomachs to start releasing stomach acid and digestive enzymes, and they carry signals from our digestive organs that tell our brains whether we’re hungry or full.1 But there’s a whole lot more to the story than these basic logistical messages.
Our thoughts and moods are sending signals to our digestive tract (and immune system) and vice versa.1 Have you ever felt nausea from a stressful situation or lost your appetite from bad news? That message was carried from your brain to digestive tract via your vagus nerve.2 What might be news is that the situation in your digestion can also send signals to your brain.2 Is your digestive system reacting with something you ate? That signal is conveyed to your brain and can color the rest of your day or night.2
And to add another layer of complexity, the bacteria and other organisms in our gut can make or simulate neuroactive molecules like gamma-aminobutyric acid (GABA), melatonin, and serotonin.2 As you may know, these substances can make a big impact on our mood and how alert we feel. And stress can change the number of healthy bacteria (such as lactobacilli) in our guts and weaken the digestive tract and blood-brain barriers—letting molecules and even bacteria in that would be excluded under normal conditions.2,3 Conversely, consuming some probiotic species can improve our mood.2
This is all to say, everything is connected. I’ve seen many patients with digestive troubles (myself included) who’ve been told by someone, “It’s all in your head.” This is an oversimplified message, because stress and emotions absolutely play a role in digestive health, and the opposite is also true. Likewise, many patients who come in for issues with their mood have related concerns in their digestion that must be addressed before they see significant progress. Often when it comes to health, the symptoms can lead to the root of the problem, but only when you understand the connections.
​References:

1. Breit S et al. Vagus nerve as modulator of the brain-gut axis in psychiatric and inflammatory disorders. Front Psychiatry. 2018;9:44.
2. Petra AI et al. Gut-microbiota-brain axis and its effect on neuropsychiatric disorders with suspected immune dysregulation. Clin Ther. 2015;37(5):984-995.
3. Obrenovich MEM. Leaky gut, leaky brain? Microorganisms. 2018;6(4):107.

Did you know that the majority of your immune system is in your gut?1 Picture a lush, harmonious rainforest teeming with diverse forms of life; this is what a healthy gut should look like at a microbial level. With more than 1,000 microbial species, most of which are bacteria, your gut’s microbiome makes up an essential part of your immune system.2 The good bacteria in your gut protect you from pathogenic invaders and keep harmful bacteria from growing out of control. The good bacteria that live in your gut are an essential part of your body’s microbiome. Here are 10 of the best ways to increase your good gut bacteria.  
1. Eat whole foods
The human body is not meant to run on food-like substances; diet matters! Eating processed foods and refined sugars starves the good bacteria in your gut, allowing harmful bacteria to grow out of control, also known as dysbiosis.3,4 Instead of filling up on processed foods, eat the rainbow. Choosing to eat a wide variety of whole high-fiber foods feeds your good bacteria and, in turn, nourishes your microbiome. Choosing organic produce is also a great way to add good bacteria to your gut’s ecosystem.5 By keeping your good bacteria strong and healthy, they can keep you healthy too. 
2. Eat fermented foods
The creation of fermented foods dates back thousands of years, as far as 10,000 BCE, with the advent of yogurt; the health benefits of yogurt are described in Ayurvedic scripts from 6,000 BCE.6 Fermented foods are a great way to support your health by adding good bacteria to your gut’s population of roughly 100 trillion bacteria and microbes. Here are some tasty options for adding fermented foods to your daily diet:

• Aged cheese
• Fermented vegetables
• Kefir
• Kimchi
• Kombucha
• Miso
• Natto (fermented soybeans)

• Olives
• Pickles (fermented)
• Sauerkraut
• Tempeh
• Umeboshi (Japanese fermented plums)
• Yogurt

3. Take a high-quality probiotic
Probiotics are “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.”7 Choosing a high-quality clinically supported probiotic is a great way to introduce some new friends to your gut. Different strains of probiotics offer different health benefits; here are six things to look for in a probiotic.
4. Feed your good bacteria
Now that you’ve loaded up on good bacteria from probiotic foods, it’s time to feed your new friends! Probiotics and prebiotics go together like, well, probiotics and prebiotics!
Prebiotics are fibers that can resist the digestive process; once prebiotics reach the colon, they are “eaten” (selectively fermented) by specific strains of friendly gut bacteria.8,9 Here are some whole foods filled with prebiotics to feed your microscopic friends:10

• Apples
• Apple cider vinegar
• Asparagus
• Bananas (with a bit of green)
• Barley
• Buttermilk
• Celery
• Chicory root
• Dandelion greens
• Flaxseeds
• Garlic
• Honey (raw)

• Human milk oligosaccharides (HMOs)
• Jerusalem artichoke
• Jicama
• Leaks
• Legumes
• Oats
• Onions
• Rye
• Seaweed
• Scallions
• Watermelon
• Wheat bran

5. Get quality sleep
Research shows a relationship between sleep and diversity within the gut microbiome.11 Consistent, uninterrupted sleep of between seven to nine hours per night has been shown to have a positive correlation to bacterial strains related to good health.12,13
6. Get moving
Consistent exercise results in increased good bacteria. In a six-week study, exercise was shown to increase the numbers of certain strains of good bacteria.14 However, when followed by a six-week sedentary period, the increase of microbiota returned to baseline, so it’s important to get moving and stay moving.14
7. Destress
Stress has been shown to have a negative impact on gut health. Heightened stress levels can trigger an increase in bad/pathogenic bacteria, crowding out good bacteria.15,16 Try these six simple ways to reduce stress.
8. Get some vitamin D
A 2019 study found that skin exposure to UVB light positively impacts the diversity and composition of the human microbiome.17 Vitamin D supplementation also has positive impact on the gut’s microbiome by increasing bacterial diversity and richness.”18,19
9. Take it easy on the cocktails
It’s well known that red wine can support good health, but too much alcohol has been shown to have a negative impact on good gut bacteria.20,21 The CDC 2020-2025 guidelines recommend one drink or less in a day for women and two drinks or less in a day for men.22 The CDC guidelines also caution against beginning drinking for possible health benefits and advise that “drinking less is better for health than drinking more.”22,23 The health benefits of red wine likely stem from polyphenols from the grape skins present in the wine-making process.24-27 Polyphenols are complex compounds found in fruits and vegetables that protect plants from pathogens and UV radiation; these compounds act as an antioxidant and as a prebiotic in the human body.28,29 Plenty of foods are packed with polyphenols, such as:30

• Apples
• Blueberries
• Coffee
• Cranberries
• Dark chocolate
• Dried oregano

• Dried parsley
• Flaxseed
• Kiwis
• Pecans
• Tahini
• Tea

10. Break up with cigarettes
Smoking causes a decrease in microbiome diversity; smoking withdrawal has been found to increase gut microbial diversity.31 Quitting smoking is a great way to show your little critters some love.31
All of these are great ways to help increase the friendly bugs working hard in your gut. Which will you try first?

References:
1. Vighi G et al. Allergy and the gastrointestinal system. Clin Exp Immunol. 2008;153 Suppl 1(Suppl 1):3-6.
2. Wang W et al. Gut microbiota and allogeneic transplantation. J Transl Med. 2015;13:275.
3. Gagliardi A et al. Rebuilding the gut microbiota ecosystem. Int J Environ Res Public Health. 2018;15(8):1679.
4. Di Rienzi SC et al. Adaptation of the gut microbiota to modern dietary sugars and sweeteners. Adv Nutr. 2020;11(3):616-629.
5. Blum WEH et al. Does soil contribute to the human gut microbiome? Microorganisms. 2019;7(9):287.
6. Fisberg M et al. History of yogurt and current patterns of consumption. Nutr Rev. 2015;73 Suppl 1:4-7.
7. Hill C et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506-514.
8. Charalampopoulos D et al. Prebiotics in foods. Curr Opin Biotechnol. 2012;23(2):187-191.
9. Gibson GR et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nat Rev Gastroenterol Hepatol. 2017;14(8):491-502.
10. Jovanovic-Malinovska R et al. Oligosaccharide profile in fruits and vegetables as sources of prebiotics and functional foods. Int J Food Prop. 2014;17(5):949-965.
11. Smith RP et al. Gut microbiome diversity is associated with sleep physiology in humans. PLoS One. 2019;14(10):e0222394.
12. Fei N et al. Gut microbiota alterations in response to sleep length among African-origin adults. PLoS One. 2021;16(9):e0255323.
13. Bowers SJ et al. Repeated sleep disruption in mice leads to persistent shifts in the fecal microbiome and metabolome. PLoS One. 2020;15(2):e0229001.
14. Mailing LJ et al. Exercise and the gut microbiome: a review of the evidence, potential mechanisms, and implications for human health. Exerc Sport Sci Rev. 2019;47(2):75-85.
15. Zeng MY et al. Mechanisms of inflammation-driven bacterial dysbiosis in the gut. Mucosal Immunol. 2017;10(1):18-26.
16. Kiecolt-Glaser JK et al. Modulation of cellular immunity in medical students. J Behav Med. 1986;9:5–21.
17. Bosman ES et al. Skin exposure to narrow band ultraviolet (UVB) light modulates the human intestinal microbiome. Front Microbiol. 2019;10:2410.
18. Bashir M et al. Effects of high doses of vitamin D3 on mucosa-associated gut microbiome vary between regions of the human gastrointestinal tract. Eur J Nutr. 2016;55(4):1479-1489.
19. Waterhouse M et al. Vitamin D and the gut microbiome: a systematic review of in vivo studies. Eur J Nutr. 2019;58(7):2895-2910.
20. Zhang X et al. Alcohol-induced changes in the gut microbiome and metabolome of rhesus macaques. Psychopharmacology. 2019;236(5):1531-1544.
21. Dubinkina VB et al. Links of gut microbiota composition with alcohol dependence syndrome and alcoholic liver disease. Microbiome. 2017;5(1):141.
22. https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm. Accessed September 21, 2021.
23. https://www.dietaryguidelines.gov/sites/default/files/202012/Dietary_Guidelines_for_Americans_2020-2025.pdf. Accessed September 21, 2021.
24. https://journalsblog.gastro.org/is-red-wine-consumption-good-for-your-intestinal-microbiome/. Accessed September 21, 2021.
25. https://www.winespectator.com/articles/understanding-wine-polyphenols-health-benefits. Accessed September 21, 2021.
26. Wiciński M et al. The influence of polyphenol compounds on human gastrointestinal tract microbiota. Nutrients. 2020;12(2):350.
27. Cavallini G et al. Resveratrol requires red wine polyphenols for optimum antioxidant activity. J Nutr Health Aging. 2016;20(5):540-545.
28. Pandey KB et al. Plant polyphenols as dietary antioxidants in human health and disease. Oxid Med Cell Longev. 2009;2(5):270-278.
29. Nazzaro F et al. Polyphenols, the new frontiers of prebiotics. Adv Food Nutr Res. 2020;94:35-89.
30. Yang J et al. Polyphenols in foods. Nutri Today. 2016;51(6):290-300.  
31. Capurso G et al. The interaction between smoking, alcohol and the gut microbiome. Best Pract Res Clin Gastroenterol. 2017;31(5):579-588.