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We can’t swing a short stick these days without bumping into something in the news or an advertisement about the gut microbiome. There’s probiotic this and prebiotic that. What does it all mean? And do we really need them? I thought I’d bring some clarity to the conversation about supplements for the microbiome to help you out. After all, our digestive tract carries about 70% of our immune system and all the same neurotransmitters as the brain, making this a pretty important topic to understand. What is the Gut Microbiome, Anyway? Our health and our digestion really lean on a healthy gut microbiome. So what is that? The gut microbiome is literally the collection of microbes - bacteria, viruses, fungi, and other infinitesimally small living organisms - that make a home in our digestive tract, especially in the large intestine. In total, this microbial collection can weigh up to five pounds. Our whole bodies, especially our guts, are populated with these microorganisms as we travel through the birth canal and then encounter the outside world (fun fact: babies born by c-section have different, sometimes less robust, microbiomes than those by vaginal birth). Here’s one terrific short article I used for reference. The Microbiome Keeps Us Healthy → It works symbiotically with its human host (when it’s in balance). In fact, there are bacteria that really go all out to keep us healthy: making certain B vitamins and vitamin K; maintaining the mucosal layer that protects the lining of the digestive tract; regulating our immune system; and helping us digest our food. I learned recently that bacteria even metabolize drugs we take before we absorb them, which may critically inform how well they work. → It directs our food choices and hunger and satiety cues. Literally, if you find yourself really wanting a certain food, it’s probably because a portion of your gut microbiome is asking for more of something so that group can live and grow. The microbiome composition has an effect on fat accumulation as well. → It helps us prevent or heal from everything from the common cold to cancer. → It also assures things run smoothly, i.e. comfortable, easy to pass stools. Don’t come at me! Stool quality tells me so much about what’s happening in there. → It plays a key role in mood balance, mental health, and brain function. Anywhere from 80% to 90% of serotonin and 50% of dopamine is produced along the gut’s nervous system. They require production of short chain fatty acids by bacteria in the gut microbiome to underpin their synthesis and release. The gut produces all of the same neurotransmitters that the brain does, and a healthy microbiome vitally supports a balanced mood, mental wellness, and brain health. So you can see that we want to take good care of it! The Big Picture TBH, the microbiome is like outer space or the ocean. There’s a lot we know, and there’s even more still to find out. While research has parsed out many specific benefits and health risks of various genera and species of bacteria, we’re still working on the best way to use, increase, or reduce the right organisms to support our health. Complicating it even further, there are different strains of the same bacteria. Sometimes a specific strain is well studied, but others in the species aren’t as well understood. But that’s ok! What we do know is hugely helpful and has allowed clinicians like me to use supplements and food to nourish the garden of a healthy microbiome. Here are the categories of products we use and what they do. Probiotics Probiotics are beneficial (pro-) bacteria (biotics) known to exist across the body, especially in the digestive tract, vagina, and mouth, that actively support our health - they are “pro-” human. They primarily can be found in two broad groups: live bacteria or spore-based bacteria. Live bacteria fall into the genera of lactobacillus and bifidobacterium. When you read the label of a probiotic container, you’ll see names like L. acidophilus, or B. infantis. Live bacteria in supplements must be properly encapsulated so they can withstand stomach acid and be stored carefully to maintain their live status before consumption. Many commercial products have to be refrigerated, but there are brands that offer convenient and reliable shelf-stable containers. These good bugs will hang around in the gut for about two weeks once you stop the supplement. They are amazing to support the body through healing (like traveler’s diarrhea or IBS/IBD) and can play an important role in therapeutic interventions. There’s one I really love to use for overcoming yeast infections! However, if you want them to proliferate so that they colonize your gut (yes, you want that), you’ll need to increase your prebiotic fiber intake, which I discuss below. Health promoting bacteria also can be found in traditionally fermented foods like yogurt, sour cream, kefir, kombucha, miso (refrigerated only), sauerkraut, kimchi, and real pickles (fermented, not with vinegar). Interestingly, most of these contain prebiotic fibers that help the bacteria in the food establish themselves in the gut. Real food is the best way to populate and perpetuate a variety of good bacteria in your gut. Spore-based bacteria or spore-based organisms (SBO) are typically sourced from soil and are species of the genus bacillus, such as B. clausii or B. subtilis. Here’s a terrific description of SBOs. Once upon a time we did not use antibacterial cleaners, antibiotics, pesticides, or herbicides, or scrub everything clean, and our food and water carried these important bacteria into our bodies. Playing in the dirt, with other people, and with our pets also transfers them to us. Another reason gardening is good for you! SBOs are hearty souls and can withstand harsh environments, like stomach acid, and can’t be killed by antibiotics. When they reach the large intestine, they blossom and multiply, permanently colonizing the gut. They actively refurbish the cells and mucosal layer of the intestinal tract and promote the increase of other beneficial bacteria that we can’t consume in food or supplements. S. boulardii: I would be remiss in not mentioning one of the best tools in my toolkit, a yeast-based probiotic called Saccharomyces boulardii. It’s terrific to treat diarrhea, including preventing or stopping antibiotic-triggered diarrhea. Like SBOs, it won’t be destroyed by antibiotics. It offers many of the same health benefits of other probiotic strains, and treatment for Helicobacter pylori infection is more effective when S. boulardii is given at the same time as the antibiotics. When you work with a practitioner, they might choose specific probiotic species to help you heal from a particular health condition. However, we also choose products with variety. This allows us to cover the waterfront, assuring that there’s a good balance of health promoting bacteria being introduced. Prebiotics Prebiotics are fibers mostly in the carbohydrate categories of fructooligosaccharides (FOS), inulin, and galactooligosaccharides (GOS). Big words! These are types of indigestible fibers made from chains of tightly bound sugars. Because only bacteria can digest them, they are sometimes used in sugar substitutes because they provide a sweet flavor without causing a spike in blood sugar. Prebiotic fibers feed and nourish beneficial bacteria. Their benefit comes from the fact that they are fermentable, and it is out of this fermentation process that we receive the health benefits. We see how they support our health by the increase in Bifidobacteria and Lactobacilli, better calcium absorption, lower protein fermentation (ultimately less gas and better BMs!), fewer pathogenic bacteria, lower allergies and risk of developing them, a healthier gut lining, a better lipid profile (cholesterol), and improvement in our immune functioning. Prebiotics help create an overall anti-inflammatory environment in the body. We can deliciously provide prebiotic fibers with foods especially rich in them: chicory root, dandelion greens, Jerusalem artichoke, onions, leeks, asparagus, avocado, bananas (the less ripe ones), barley, oats, apples, cocoa, flaxseeds, jicama, wheat bran, and seaweed. All fibrous foods, though, will support a healthy microbiome: whole grains, vegetables, fruits, nuts, and seeds are all great sources of fiber. There’s also inulin in some new brands of carbonated soft drinks. Some people see a difference in their bowel habits when they drink these, but the amount of the inulin is honestly pretty meager. There are better sources, but no harm in enjoying these drinks! Be aware that some people overdo a prebiotic supplement or foods and find themselves with uncomfortable gas and bloating. Their guts are unused to so much fiber! Definitely increase prebiotics and all fiber gradually to allow your system to grow into being able to utilize it. If you find you still have symptoms, it’s time to talk to a clinical nutritionist. Phytochemicals This is an area of research that is still developing, honestly. That said, what we’re learning is still very cool and encouraging: “Phytochemicals are non-nutrient biologically active plant components that can modify the composition of gut microflora through selective stimulation of proliferation or inhibition of certain microbial communities in the intestine.” (read the article here). That is to say, the more you eat the colorful rainbow of plant-based foods, the more complex and richly health-promoting your microbiome will be. Questions I Get About Taking Probiotics Should everyone be taking a pre- or probiotic supplement?
Not in my opinion. While supplements are really useful for therapeutic purposes and sometimes for prevention (e.g. traveler’s diarrhea), they also cost $$$. I make probiotic recommendations when I can see their therapeutic value, but I don’t just tell everyone to take them. It’s much more effective over the long haul to serve your microbiome with probiotic-, fiber-, and phytonutrient-rich foods and to attend to your stress, sleep, and movement. How would I know if I should be taking one? On your own it may be hard to know for sure. That said, if you were digesting your food well and feeling pretty good, and then something triggered a bout of digestive difficulties, a multistrain probiotic with some prebiotic fiber added (a combo product called a “synbiotic”) could be just the OTC ticket to help you recover. Go for it if you develop a yeast infection. Yeast will show up in your vagina or penis, mouth, as jock itch and athlete’s foot, and even under finger and toe nails. If it’s in those places, then it’s almost for sure in the digestive tract. A probiotic that is designed for vaginal health and S. boulardii (see above) can crowd out the yeast and help reestablish balance, either alone or in conjunction with antifungal medications. Clinically I thoroughly assess my clients to determine whether certain bacterial strains or blends will support the desired health status. However, if the symptoms are complicated or not resolving, I like to ask my clients for a stool panel so I can really target the imbalances. How do I know which product to buy? If you aren’t willing to or can’t go through an assessment and/or just really feel like taking a probiotic is right for you, keep these things in mind:
Yes, there can be too much, but really only under specific circumstances. Most people with average health concerns are safe with following package directions. Always ask your doctor before taking a probiotic if you have an exceptional health condition. One time I recommend you not take a probiotic is if there is any chance you have small intestinal bacterial overgrowth (SIBO) - please get tested. The overgrowth needs to be treated, which can be done with a very targeted antibiotic from your GI doc and/or a really effective herbal program from your clinical nutritionist. Most of the time, it’s really an issue of diminishing returns. You’ll be spending a bunch of money to be doing something you could be doing with your delicious food choices instead.
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When my clients return from their relaxing summer vacations, they tell me about how their digestion, mood, energy, cravings, and sleep all improved, and they feel so much better. This is yet another reminder of how critical it is to my clients’ healing, health, and overall well-being that they quite literally feel safe in their bodies, or know how to get there. Psychological and emotional safety give our bodies time to heal and then thrive. This is some of my favorite stuff! We’re learning how to harness our own nervous systems to help our mental and physical health. The body communicates a veritable firehose of information about the status of the body to the brain, which informs both our health and our mood. So I’ll tell you all about that firehose, called the vagus nerve. Then I’ll give you a useful theory about how our bodies orient toward or away from feeling safe. Finally, I’m going to share some super accessible practices that use this theory to help you heal both physically and emotionally. The Vagus Nerve The vagus nerve is a “wandering nerve” known as cranial nerve X (ten in Roman numerals) that starts in the brain and “wanders” through the body. The other eleven cranial nerves serve the five senses and the movements of the head and neck, like our facial, eye, and neck muscles, and the tongue - even things like saliva production. The vagus nerve is in constant bidirectional communication with the other cranial nerves, the heart, the organs, and the digestive tract. A whopping 80% of the vagus nerve’s communication is from the body up to the brain. When you have an instinctive gut feeling, feel stimulated (excitement? anxiety?), or feel the heart’s intuition and emotion, your brain automatically translates that feeling into a response. The same messaging and responding happens when there’s something occurring in the body, like relaxation or stress, slow/strong or rapid heart beat, or good or poor digestion. That’s the vagus nerve sensing what’s happening in your body and sending a message to your brain: “This is what’s going on and we are safe (or not safe).” The brain assigns that message a meaning, creates a story to explain it, and instantly sets you up with thoughts, words to describe your experience, and actions. The action might be movement, like smiling or hitting something; an emotion, like joy, anger, or depression; or a biochemical or physiological process, like an immune response, sleepiness, hunger, or thirst. The upshot is that the body-mind is enmeshed in tightly designed programming to seek, support, protect, and defend our health and safety. And the vagus nerve is our key. There’s so much to know about how the vagus nerve allows the gut, the organs, the heart, and the brain to talk to each other! Do some exploring in this informative, succinct article about the many physiological roles of the vagus nerve. The quality of the bidirectional messages between brain and body through the vagus nerve directly influences our health. Persistent messages of “danger” result in increased risks of colds/viruses, digestive woes, heart disease, high or low blood pressure, blood sugar imbalances, metabolic diseases (diabetes, cholesterol, arteries)…even mood disorders, focus/attention issues, sleeplessness, sexual dysfunction, and cancer. Understanding this allows integrative practitioners to bring to bear both nutrition and non-nutrition healing practices. There’s This Theory … And it has a name: Polyvagal Theory. It was conceived by Dr. Stephen Porges in 1994 (you can learn about him here). Understanding it allows us to create tools that retrain our bodies to reorient toward safety, and therefore better physical and mental health. As the brain interprets and reacts to nervous system communications, it does it based on one of two broad, overarching messages that help it direct the body’s responses. The first message is safety, during which it allows the body to heal, rest, and renew itself. The second is when we feel unsafe, which is all about defense and protection. Polyvagal Theory offers up the visual of a ladder, and each rung is whatever is primarily being communicated to the body and brain through the vagus nerve. Whichever rung is the top rung becomes the dominant, prevailing response. There are three rungs on this theoretical ladder:
Sympathetic: When we’re in danger, our brains and bodies typically prompt us into action. We are prepped to turn and battle the danger or turn the other way and run. Fight or flight is a highly stimulated stress response, and it is directed by the sympathetic nervous system. If the sympathetic branch is the top rung, we will be anxious and overwhelmed. Dorsal Branch: However, sometimes when we’re in danger we feel trapped, unable to run or fight even though we don’t feel safe. Polyvagal Theory says there’s a branch of the vagus nerve called the dorsal branch, which essentially shuts us down, like a possum playing dead. In an acute situation, a human might actually faint, and over a somewhat longer span that person might become sad, unmotivated, sluggish, etc. If the dorsal branch is the top rung, we will be depressed and unable to engage. Ventral Branch: The ventral branch shepherds us to safety without feeling overstimulated or shut down, even in the face of something that we might see as dangerous. It is the essence of resilience and widens our Window of Tolerance. It borrows energy, focus, and clarity from the sympathetic nervous system and relaxation from the dorsal branch. That is to say, we feel like we have the mental space, ability, and confidence to make good decisions and act in our own and others’ best interest. This can be described as flow. We’re in the moment. We can identify, absorb, and act on good information for a positive outcome, or hit the ball right in the sweet spot, or make our best work presentation, or ace the test. Importantly, both consciously and unconsciously we are better equipped to protect and defend our health and well-being while simultaneously cultivating our ability to heal and renew. A body-mind that primarily has ventral dominance will be healthier - physically, mentally, emotionally, and even in spirit. (Please seek proper professional support if you suffer from a mental or physical illness). Practices: The Ventral Branch is Yours for the Taking The beauty of it all is that we can train our bodies to attune to a dominant ventral response, even if right now our emotional, psychological, and environmental triggers typically lead directly to stress, anxiety, or depression. Physical and mental resilience, more balanced emotions, focus/attention, improved cognition and memory, and flow are within reach with some accessible practices. We can use cranial nerve X - the vagus nerve - to reorient our bodies to safety by using other cranial nerves and our lungs to communicate with it. The more we practice any combination of the exercises you’ll find below, the more resilient we become. And there you go! This issue ends with suggestions for practices that can help you build resilience in the face of hard things. Practice them away from your triggers as training. That way your body will automatically respond when you choose to use them during the hard stuff. When our body feels safe, our mind, emotions, and health follow suit, fostering a state of balance, well-being, and peace. Check out the exercises below! Breath Work Of all the autonomic processes that we can’t control, we can control our breath. We only breathe deeply when we’re safe. Intentional breathing engages the stretch receptors of our lungs, which sends a signal through the vagus nerve to the brain that the body is safe. It also increases heart rate variability. Box Breathing: Breathe in for a slow count of four, pause for a slow count of four, release the breath for a slow count of four, pause for a slow count of four. Repeat at least three times. 4-5-6 Breathing: Breathe in for a slow count of four. Pause at the top for a slow count of five. Release for a slow count of six. Pause for a couple of seconds and repeat at least three times. Once this is familiar, increase to 5-6-7 breathing, then 6-7-8 breathing. Engaging Cranial Nerves Eyes Dr. Porges’ Basic Exercise:
Ears
Smell Take in the odor of real lavender or rosemary, which are especially calming. Perhaps grow them in your garden or kitchen window for easy access. Vocal Cords Gargle with water three or four times in a row. Repeat as many times as you’re comfortable. Sing! Sing hymns, showtunes, etc. or along with your favorite songs as loudly as practical. Hum to engage the vocal cords. Choose one that also resonates in the chest. Touch
Hug and be hugged by someone you consider safe for at least 10 seconds. Hold hands. Get a back rub or massage. Rub your hands up and down your own arms and/or legs. Snuggle with your pet. |
AuthorI am Mary Virginia Coffman (I go by “Mary Virginia”), a clinical nutritionist who focuses on mental health, digestive health, metabolic health, and nervous system regulation. My unique combination of clinical interventions, education, and coaching will help you feel well in body, mind, and spirit. Archives
October 2024
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