Category Archives: gut

Why is BILE so important?

When I say bile, you probably think of that awful digestive fluid. Maybe you know what it is and what it does, maybe you don’t. While it seems inconsequential, it is anything but.

Bile is fluid made by the liver and stored in the gallbladder that helps digestion and absorption of fats (and fat soluble vitamins) in the small intestine. That’s the well-known function (in the health community). It turns out, bile does a lot more than that. It is anti-microbial, gets rid of waste in the body, regulates cholesterol homeostasis, and has now been shown to play a role in glucose metabolism.(1,2,3,4) In fact, bile acids are now regarded as important hormones and are emerging as regulators of the gut microbiome.(5,6)

If you know me and my work at all, you know how important the gut microbiome is. Our microbiome is supposed to be primarily in the large intestine. When microbes live and grow in the small intestine a whole host of unpleasant symptoms and consequences arise. This is SIBO, small intestine bacterial overgrowth. So, bile kills microbes in the small intestine (and then the bile gets absorbed before entering the large intestine, leaving the large intestinal microbiome alone). They have done experiments in mice and rats: normal bile, no bacterial overgrowth. Without bile, the mouse gets SIBO. Adding bile acids (as a supplement) back and the SIBO goes away again! (7). In summary, reduced bile acids in the gut are associated with bacterial overgrowth and inflammation.(5) We also know that bile helps to maintain the integrity and health of the gut lining (8).

There is also a chicken and egg dilemma happening. The lack of bile could be causing the microbial overgrowth, but the microbial overgrowth (from another root cause) can break down bile, causing fatty stools.

What affects bile acid production?

● Diet
● Antibiotics
● Various disease states

Symptoms and conditions related to low bile:

● Diarrhea
● Fat maldigestion and malabsorption
● Deficiencies in fat soluble vitamins A,D,E,K
● Interference with absorption of Coenzyme Q10 and beta-carotene
● Poor liver function/disease
● Gallbladder removal

Consuming adequate amounts of healthy fats will help to stimulate bile production. For the average adult consuming an estimated 2,000 calories a day that translates to 25-35% of calories from fat or 44-78 grams a day.(9) Of course, the amount and sources will vary by person and individual tolerance to certain foods so always listen to your body and eat was feels good for you. A diet rich in fruits and vegetables is also key to feeding your good bacteria and promoting bile production.

What can you do? How to stimulate bile acid secretion and support a healthy gut:

● Consume adequate amounts of healthy fats like olive oil, eggs, avocado, and fatty fish
● Licorice root extract (10,11)
● Ensure healthy liver function
● Avoid foods that bad bacteria thrive on such as: refined foods and sugars and trans fats
● Consume probiotic foods that contain beneficial bacteria such as kefir/yogurt, greek olives, and other fermented foods
● Consume prebiotic foods that feed the good bacteria such as bananas, garlic, leafy greens and other foods high in fiber (a variety of fruits and vegetables)

How can we help? Nutrition therapy with a Registered Dietitian (who specializes in digestive disorders) is essential:

● Identify the root cause of the problem (what is causing low bile acid production or inadequate function?)
● Identify gut dysbiosis (microbial imbalance)
● Recommend supplements/enzymes to stimulate bile secretion and assist with fat absorption
● Recommend dietary strategies

1. Bile. Wikipedia. 2017. Available at:
2. Bile. National Library of Medicine – PubMed Health. 2017. Available at:
3. Goel. SIBO and Liver Diseases. 2015. Available at:
4. Staels B, Fonseca VA. Bile Acids and Metabolic Regulation: Mechanisms and clinical responses to bile acid sequestration. Diabetes Care. 2009;32(Suppl 2):S237-S245. doi:10.2337/dc09-S355.
5. Distrutti E, Santucci L, Cipriani S et al. Bile acid activated receptors are targets for regulation of integrity of gastrointestinal mucosa. Journal of Gastroenterology. 2015;50(7):707-719. doi:10.1007/s00535-015-1041-8.
6. Houten SM, Watanabe M, Auwerx J. Endocrine functions of bile acids. The EMBO Journal. 2006;25(7):1419-1425. doi:10.1038/sj.emboj.7601049.
7. Lorenzo-Zúñiga V. Oral bile acids reduce bacterial overgrowth, bacterial translocation, and endotoxemia in cirrhotic rats. Hepatology. 2003;37(3):551-557. doi:10.1053/jhep.2003.50116.
8. Fabian T. The Importance of Bile Acids: Part One. Microbiome Mastery. 2016. Available at:
9. Appendix 7. Nutritional Goals for Age-Sex Groups Based on Dietary Reference Intakes and Dietary Guidelines Recommendations – 2015-2020 Dietary Guidelines – Healthgov. 2017. Available at: Accessed October 26, 2017.
10. Sokol R, Devereaux M, Dahl R, Gumpricht E. “Let There Be Bile”-Understanding Hepatic Injury in Cholestasis. Journal of Pediatric Gastroenterology and Nutrition. 2006;43(Supplement 1):S4-S9. doi:10.1097/01.mpg.0000226384.71859.16.
11. Gumpricht E, Dahl R, Devereaux M, Sokol R. Licorice Compounds Glycyrrhizin and 18β-Glycyrrhetinic Acid Are Potent Modulators of Bile Acid-induced Cytotoxicity in Rat Hepatocytes. Journal of Biological Chemistry. 2005;280(11):10556-10563. doi:10.1074/jbc.m411673200.

Lyme Disease, what you haven’t heard


When you or your child gets a tick bite, fear goes straight to your heart. As well it should. Because some tick bites lead to Lyme disease. Lyme disease is caused by the bacteria borellia burgdorferi and it can wreak havoc on any and every part of your body, especially your gut and your immune system.

The symptoms of Lyme are widespread, and typically antibiotics are presented as the main and sole solution. Doctors hand out a prescription and send you on your way with no guidance on the healing. While antibiotics are necessary, they don’t provide a whole systems approach to recovery, which you definitely need. Additionally, antibiotics leave your microbiome in bad shape, and with a taxed immune system (from the Lyme), you won’t be able to fight out any bad yeast that cropped up during antibiotic treatment.

What does it look like?

It’s necessary to recognize the signs and symptoms of Lyme, as they are vast and could be masked under other diagnoses.

Early symptoms

  • bull’s eye type rash
  • fever and or chills
  • headache
  • stiff neck
  • painful muscles or joints
  • fatigue
  • swollen glands
  • symptoms can appear within 3-30 days after the bite

Advanced symptoms

  • fatigue (systemic exertion intolerance disease)
  • migratory joint and muscular pain
  • neck and shoulder stiffness
  • daily persistent headaches
  • neuropathies
  • tingling and numbness
  • disordered sleep
  • recurrent flu-like symptoms
  • cognitive dysfunction
  • mood and psychiatric dysfunctions
  • increased sensitivity to foods, smells, light and noise

Because the symptoms are so widespread, it makes sense that Lyme disease has a systemic burden, including ongoing inflammation, immune system exhaustion, cellular oxidative stress, and neurotoxin release.

What to do?

It is hopeful to know that the symptoms of Lyme can be attenuated through different lifestyle, diet, and supplemental protocols.

Sleep should be addressed within a holistic approach to Lyme disease. Sleep disturbances and chronic fatigue are prevalent with Lyme. And sleep is so necessary for healing and building the immune system up.

  • Arrange your schedule to allow for 8 hours of sleep.
  • Practicing good sleep hygiene is important: not using screens for a couple hours before bed, making sure you go to bed at the same time every night and sleeping in a cool dark room.
  • If falling asleep or staying asleep is a problem, there are numerous natural sleep aids: melatonin, passionflower, lemon balm, or GABA precursors.

Stress management is essential. External stress can further the stress inside your body and prevent recovery.

  • Meditation
  • Down time
  • Laughter
  • Deep breaths, taken throughout the day

Diet: the goals of being to reduce inflammation, rebuild the immune system, improve gut health (repair after the pathogens and antibiotics), and nourish the person.

  • Eat whole foods
  • Avoid high sugar and fat foods, such as processed starches, candy and junk food, fried foods
  • Increase intake of fresh vegetables, fruits, and grains
  • Choose organic when possible
  • Eat more anti-inflammatory foods (plant based, omega-3 fatty acids, Mediterranean diet)
  • Repopulate the gut with probiotic rich fermented foods (contraindicated in some people)
  • Address food sensitivities, such as gluten and dairy, as all food sensitivities can increase inflammation, weaken the immune system and worse Lyme symptoms

For gut health, we might need to kill off any yeast or other pathogens that are present. (There are many options for this, but I don’t recommend trying them without supervision from a qualified practitioner.) Then also heal the gut lining from any injury from the Lyme or other pathogens as well as reinoculate with probiotics.

Supplementation should be utilized in order to address and TREAT poor immune function, chronic fatigue, neurological symptoms, muscle spasms, joint pain, and gut and hormonal imbalances.

Some ideas to decrease overall inflammation and inhibit pro-inflammatory cytokine production:

  • Curcumin/turmeric
  • Quercetin
  • EPA/DHA (omega 3 fatty acids or fish oil)
  • Alpha lipoic acid
  • Tart cherry juice
  • Antioxidants
  • Coconut oil
  • Green tea

Some ideas to address chronic fatigue or neurological symptoms and boost general immune health:

  • High quality multivitamin
  • Co-Enzyme Q10
  • Acetyl L-Carnitine
  • Vitamin B Complex (with activated Bs)
  • Gamma linolenic acid (GLA)
  • Omega 3 EFA fish oil
  • Alpha lipoic acid
  • Magnesium

Here is a testimonial from a client of mine. She came to me, feeling like crap, after the doctor had put her on numerous rounds of antibiotics for the Lyme:

“My sophomore year of high school I was diagnosed with Lyme’s Disease. This led to multiple rounds of doxycycline and amoxicillin along with my 5 year battle of joint pain, fatigue, and the ever present stomach issues. I finally began seeking help, and was led to Dianne. She put me on a treatment plan, for the lifetime of stress my body’s been under due to the high amounts of antibiotics I had been on, and quickly began rebuilding my gut. Alongside the supplements Dianne recommended, I changed my diet and almost immediately began feeling a change! Within three months I felt like a new person. I have a new lease on life that I had never experienced before and began living a life without fearing of the pain that was coming. I am now studying abroad in France and have the freedom from suffering with fatigue, pain, or digestive issues.”

As you can see a functional approach to Lyme is much more comprehensive than what you will get from the doctor alone. Antibiotics kill the Lyme but don’t support the healing or clean up the mess that the Lyme (or the antibiotics themselves) created.

Foods that are good for the GUT


The digestive tract houses 100 trillion microbes. This is referred to as the microbiome. These bugs have tremendous influence over our health and mood. We hope that in our microbiome there are more good than bad bugs. Simply put, if the bugs are good we are healthy and happy, if they are bad we suffer. There isn’t a health condition to which the microbiome isn’t linked. Seriously. (some examples: anxiety/depression, ADHD, Autism, IBS, IBD, Parkinson’s, Chronic Fatigue, Fibromyalgia, All autoimmune diseases, eczema/psoriasis). If you have a health condition, your gut may need a full overhaul, not just probiotics and prebiotics as outlined below.

Most of us have heard of probiotics. The research on probiotics is overwhelmingly strong and positive. You can ingest probiotics in a pill form. This is a good option for anyone. But especially those who have histamine intolerance or Candida overgrowth or some other condition where eating fermented foods is a bad idea. Make sure your probiotic is a reputable brand (which guarantees to have in it what it says it has in it). The best brands can be bought through Wellevate, create an account and shop away!

In this blog post I wanted to just touch upon the foods that are good for our microbiome.

Fermented foods:

Fermented foods have probiotics in them. Some foods were produced with live probiotics (such as yogurt), make sure these say “active live cultures”. Some foods are fermented with whatever wild bacteria are on the original vegetable (sauerkraut). These need to be found in the refrigerated section and not be pasteurized.

Examples of fermented foods:

  • acidophilus milk
  • buttermilk
  • cheese (aged)
  • fermented meats
  • fermented vegetables
  • fermented grains
  • kefir
  • kimchi
  • kombucha
  • kvass
  • miso
  • natto
  • pickled vegetables (raw)
  • raw vinegars
  • sauerkraut
  • sour cream
  • tempeh
  • yogurt (plain, no added sugar, active cultures)

Prebiotic foods

Prebiotics are fibers that feed the beneficial probiotics in your gut. These are helpful to feed the good so they can proliferate. Sometimes prebiotics are added to foods (bars, probiotic supplements, etc). These are:  galactooligosaccharides (GOS), fructooligosaccharides (FOS), oligofructose (OF), chicory fiber, or inulin.

Foods we find prebiotics in:

  • Asparagus
  • Apples
  • artichokes
  • banana
  • berries
  • black beans
  • cherries
  • dandelion greens
  • chicory root
  • chickpeas
  • eggplant
  • endive
  • flaxseeds
  • garlic
  • honey
  • jerusalem artichokes (sunchokes)
  • jicama
  • kefir
  • kiwis
  • leafy greens
  • leeks
  • legumes
  • lentils
  • mangoes
  • oatmeal
  • onions
  • peas
  • pears
  • quinoa
  • radicchio
  • tomatoes
  • white beans
  • whole grains
  • yogurt


These are chemical compunds that come from plants. They are used by your gut bacteria to make beneficial substances. These chemical compounds have names such as flavanones, isoflavones, flavonols, anthocyanins, flavones.

Foods that we find them in:

  • cloves
  • cocoa powder
  • flaxseed meal
  • dried sage
  • berries
  • pomegranate
  • apples
  • hazelnut
  • dried peppermint
  • dried rosemary, dried thyme
  • grapes
  • capers
  • pecan
  • celery seed
  • dark chocolate (70% or higher)
  • chestnut
  • black olives
  • plums
  • lemons
  • tea

How many of these can you eat on a regular basis?


An email made me cry

While I invest my attention and experience in every client, some of the stories that I hear from prospective clients can strike me deep in my heart. By the time some people reach out to me, they have endured frustrating and confusing symptoms with misdiagnoses and misdirected treatment efforts.

The following story affected me especially deeply. I share it now because I suspect that there are many others out there who may be facing similar struggles. To anyone out there who finds that this story resonates with your own, I say to you, things can get better. (shared with permission)

It started with an email from someone seeking my services: “I’m 17 and have a plethora of digestive issues and am in desperate need of a nutritionist who understands and actually believes in poor gut health. I have read your website and you seem like the PERFECT fit, I could really use your help to help put me out of my misery.” In all the emails that I receive from prospective clients, it is always striking how each one has a unique story to tell. What struck me about this one is that she was so young and so committed to getting the help that she desperately needs. I replied with my usual details (hours, rates, etc) and never heard back from her. That happens sometimes, as people just aren’t ready.

A couple of weeks went by, and I decided to follow up. I might not have, except she seemed so ready and like such an ideal client for my services. This time she did respond, thanking me for checking in. Then she told me why she had not responded the first time:

She said that she wished she could come see me, but her parents don’t believe in leaky gut. Since she was still a legal minor, they had legal authority over her medical care. So, until she turned 18, she would have to suffer. I replied that we didn’t have to use the term leaky gut.

She replied: “I was avoiding gluten and dairy and eating more veggies in order to try to heal my gut” (she had done some homework!). Unfortunately, her parents remained resistant to the concept of leaky gut and any attempts to treat it with dietary management. So, they took her to her pediatrician, who was equally appalled at this treatment plan. He referred her to the hospital, where she was “diagnosed with an eating disorder”. Her parents and the doctor were convinced that “leaky gut isn’t real”. Their response was to force her to eat gluten and dairy at every meal, even though these were the very foods that she told them were “inflaming [her] gut even more”.

In hearing her story, I was heartbroken. This smart and resourceful girl was stuck in a tragic dilemma. Not only would she be forced to suffer until she was 18; but, by that point, she would be so much further down the gut pathology road that it was pretty likely her gut would sustain some significant damage, damage that could be avoided or reduced by preventative treatment.

I replied that I was so sorry to hear about her dilemma, and I wished her the absolute best. I was tempted to send her all the published research articles I have on leaky gut. Instead I just told her that intestinal permeability (the proper term for leaky gut) is real. If she or her parents were to search that term on the National Institute of Health’s pub med website, 22,000 research articles would come up. I just left it at that. Was I defending against what felt like a professional criticism (by her parents and the doctor)? Or was I wisely planting a seed? Both.

Only a couple of hours later I received another email from her: “I believe I just made an impact on my parents. You gave me an idea with what you said about pub med. I took this idea and put all of my research into a document and presented this document to my parents (over 50 pages worth of research, I might add!). They were astonished by all of the science that backs this up, and they are now willing to have your support!! I am amazed and feel such a wave of relief.”

A story that began with heartbreak was transformed into triumph.

It is such a shame that many doctors aren’t interested in learning what’s new since medical school. Some doctors are so entrenched in conventional professional thinking that they dismiss any new treatment paradigms that do not fit within those conventions. Yet there are patients who are getting sicker and sicker, and conventional medicine is unable to help them. The lucky patients have the courage, the determination, or the resourcefulness to seek out alternative treatments. Those are the ones who find someone like me, and get well. But what about the rest? While that question saddens me, this story gives so much hope, because it shows how the research is out there. More and more professionals are learning about intestinal permeability, and that knowledge will eventually seep into the mainstream. This story proves that open-minded people who examine the research do actually change their opinions on leaky gut! So I will end by repeating my earlier point: to anyone out there who finds that this story resonates with your own, I say to you, things can get better.

The Gut Healing Protein


Glutamine is a nutrient that is involved in numerous biochemical processes that impact our immune system, muscles, digestion and other GI processes. Glutamine is an amino acid, a building block of protein, naturally found in food and in the body. Extreme exercise, infection, surgery, and trauma are all known to deplete our body’s glutamine stores, particularly in our muscle cells.

Glutamine is often used as a supplement for individuals with:

  • Diarrhea
  • Leaky Gut
  • Ulcerative colitis
  • Crohn’s Disease
  • Nerve pain
  • Stomach ulcers
  • Depression
  • Anxiety
  • Insomnia
  • Athletic performance treatment

Glutamine and the Gut

The small intestine is the primary organ of glutamine use. Glutamine feeds the cells of the GI lining. This uses about 20-30% of our glutamine. Individuals with a ‘stressed gut’ should consider glutamine supplementation, as it is an essential component for the maintenance of gut metabolism, and function especially during trauma or when the stability of the gut wall is compromised. The gut can be compromised as a result of the following:

  • Consuming Trigger foods (foods your are allergic, or sensitive to. Often gluten, dairy, or soy)
  • Excessive sugar intake
  • Leaky gut
  • Overuse of antibiotics
  • Chronic Inflammation
  • Environmental Pollutants/Toxins
  • Smoking
  • Stress

…And these are just a few!

Glutamine supplementation is a support to the healing process and works to regenerate and repair the cells of the intestine. Because glutamine is the primary fuel for the cells of the intestine, high quality L-Glutamine can be absorbed directly into the cells- and the healing begins!

Glutamine and the rest of the body

Because our immune and intestinal cells rely on glutamine for energy, an individual who is deficient may experience fatigue as our cells become drained and functionality decreases. As cell function decreases, the inability to complete the necessary processes required to maintain optimal health causes our immune system to weaken, increasing the risk of infection and the common cold. This process is exacerbated during times of stress, trauma, chronic injury, or extreme exercise.

Glutamine is an essential component in the process of detoxing, as is helps to remove excess ammonia. It also plays a role in maintaining proper immune and brain function. Glutamine increases the production of Gamma-Amino Butyric Acid (GABA), a neurotransmitter that has a calming effect on the body and mind during stressful situations, permitting improved concentration and enhanced sleep.

Where to Find Glutamine in our Diet

Some of the best sources include:

  • Dark leafy greens
    • Spinach
    • Cabbage
    • Raw Parsley
  • Beans
  • Meat
    • Chicken
      • Beef
  • Fish
    • Pork
  • Dairy
    • Ricotta Cheese
    • Yogurt
    • Cottage Cheese

If you think supplemental glutamine may be something to consider, talk to your functional dietitian! Anyone with a compromised gut would benefit from glutamine supplementation. It comes in a powder form that can be added to smoothies, soups, or any drink. You can also click on supplements (above) and see my “heal your gut” powder-it is 100% glutamine.


How to Lose Weight-the secret that you don’t know


Have you tried numerous diets and even when sticking to them with perfect discipline, still can’t seem to lose weight? Well, within the last few years, research has revealed a fundamental breakthrough that could be the key to weight loss…a healthy microbiome!

What is the Microbiome?

I have written about the microbiome many times (here, here, here). But let’s refresh our memories.

The microbiome is made up of trillions of non-human microbes that govern our gastrointestinal tract. The microbes are a combination of bacteria (both good and bad), yeast (both good and bad), and some viruses and other microbes. Bacteria make up the majority of the microbiota and we hope, ideally, that we have more good than bad bacteria.

The bacteria have many roles: digesting our food, controlling our appetite, metabolism, and immune system, as well as cuing our body to store fat. They can also affect our mood and how genes are expressed. The microbiome make up about 90% of all your cells, and they are not human. The microbiome is an entirely separate ecology that works in conjunction with the rest of our body’s processes. When the bacteria and organisms of our microbiome function at optimal levels, so do we. But when our microbiome is out of balance due to things like damaged intestinal walls, too much bad bacteria, not enough of the good bacteria, and stress, our microbiome suffers, and we will feel the effects. With lots of bad bacteria, our gut often craves sugar and can be responsible for: an individuals inability to lose weight, increased fatigue, anxiety, depression, brain fog, headaches, acne, congestion, frequent colds and infections, joint pain, and muscle pain- many things you may not realized were linked to our gut! In fact, an unhealthy microbiome is linked to ALL illnesses and diseases.

When damaged, healing our microbiome and keeping it balanced is essential to our overall health. A healthy microbiome ensures we digest our food properly and get the vitamins and minerals we need.

Research shows our microbiome is tremendously dynamic and can change composition within 24 hours in response to stress, antibiotics, and illness, and can also change within weeks or days in response to diet, supplements, and exercise. The typical western-American diet is full of highly processed high fat and sugary foods which feed the bad bacteria and yeast.
The microbiome and your weight

Some scientists have argued that the destruction of the microbiome is a huge factor behind the obesity epidemic. There was a study done on mice, where germ free mice were given gut bacteria from an obese person and the mice became obese. What are some of the ways this happens?

  1. An unbalanced microbiome can negatively affect our immune system leading to inflammation. Inflammation is an immune system response that can lead to weight gain.
  2. An unbalanced microbiome has lead to damage of the intestinal wall creating a problem called Leaky gut. Leaky gut is a condition where the tight junctions of your intestinal wall open allowing contents/food to leak through. This causes the immune system to attack foods that normally would be healthy, leading to even more inflammation. In addition to inflammation, the research shows leaky gut leads to: impaired glucose metabolism, insulin resistance, obesity, and contribute to the development of metabolic syndrome, type 2 diabetes, inflammatory bowel diseases, autoimmunity and carcinogenesis. (Study: The role of dysbacteriosis in obesity, insulin resistance, diabetes and metabolic syndrome)
  3. An unbalanced microbiome can disrupt our hormonal balance. As a result, the hormones that make you feel full or hungry are out of sync, making it hard for you to notice when you are full or have eaten enough. (Study: Gut microbes affect satiety-inducing signaling leading to weight gain)
  4. Some bacteria species can extract MORE calories from the same foods, compared to other bacteria species. (Study: Bacteria causing weight gain are thought to induce the expression of genes related to lipid and carbohydrate metabolism thereby leading to greater energy harvest from the diet. )
  5. Bacteria can influence the way your cells store and release fat. (study:  Gut Microbiota interacts with the individual’s epithelial cells to indirectly control energy expenditure and storage.

All these things can cause the body to gain weight.

What to do

Fortunately there are things we can do to heal our guts back to health! In my practice I use the 5 R program which is more rigorous that what is described below but it is comprehensive and personalized. And it works! But what is described below is a good general plan for a lot of people.

  1. Eliminate the processed, high fat, sugary foods in our diet. By eliminating the processed foods and sugar we stop feeding the bad bacterial in the gut.
  2. Eat a lot of vegetables and fibers. These feed the good bacteria.
  3. Be sure to eat healthy fats such as avocado, fish, olive oil and nuts. These are good for the gut but also keep up your metabolism while you ‘diet’.
  4. Eat fermented foods such as kefir and sauerkraut. These fermented foods have tons of beneficial bacteria.
  5. Take a probiotic. (good bacteria in a concentrated pill form)

What is a good probiotic?

  • Can make it through stomach acid with the microbes still alive
  • Contains many (5-14) strains of bacteria
  • Has 25-225 billion CFUs
  • Some specific strains to look for:
    • Acidophilus
    • Plantarum
    • Rhamnosis
    • Gasseri
    • Bifido bacteria (many good strains)

Getting a good probiotic at the store is difficult. I recommend Klaire Labs or Pure Encapsulations, both of which can only be bought through a health care practitioner. Feel free to use patient assess code “dianne” at to order whatever you need.

Tried everything and still feel sick?


Suffer from a range of symptoms and haven’t had any success with treatment? There is a condition that gets overlooked by doctors. And it can explain a lot for people who can’t find answers anywhere else: Histamine Intolerance

What is histamine?

Histamine is a natural compound found in the body. Mast cells of the body produce histamine (in regulated appropriate amounts, if all is working well).

We need histamine for multiple reasons:

-Regulation of stomach acid; digesting your food

-Effectively moving your bowels

-Muscle contraction

-Enhance exercise

-Brain function; paying attention and staying focused

-Deliver blood, nutrients, and oxygen to various areas of the body.

Histamine is also found naturally in some foods and the microbes on our food or in our gut produce it. If we have enough histamine degrading enzymes (DAO is the main one), then we should be able to degrade all the histamine that is produced or ingested.

Histamine Intolerance

Histamine intolerance occurs when there is an accumulation of histamine and/or the inability to degrade it. High histamine can cause all kinds of unpleasant symptoms including:

  • Diarrhea
  • Headache
  • Flushing
  • Rashes, eczema
  • Low blood pressure
  • Rapid heart beat
  • Runny nose, watery eyes
  • Swelling
  • Heartburn
  • Insomnia
  • And others…


Histamine comes from:

  • The body (mast cells doing their job)
  • Foods
  • Microbes (in gut)

The causes of histamine intolerance are many and complicated. Just to name a few: nutrient deficiencies (B vitamins, Zinc, Copper) that lead to the inability to produce histamine degrading enzymes, lifestyle factors (like excessive exercise or too much alcohol), and hormone imbalances. But for clarity I like to break down the causes into two categories: overproduction of histamine and inability to break down histamine.


  • Mast cell activation syndrome. Mast cells release histamine, but if the mast cells release too much, or you have too many mast cells (as many with IBS do) then you will produce and release too much histamine. There is a spectrum of mast cell disorders, ranging from severe to mild.
  • Dysbiosis: an imbalance of bacteria in the gut. Too much bacteria or too much of the bacteria that produce histamine will lead to histamine intolerance. The species that we know are producers are: L. Casei, L. delbreckii, and L. bulgaricus. These are commonly found in multi-species probiotics. This illustrates how important it is to choose a probiotic that suits the person and their health situation.

Inability to break down histamine:

  • Genetic issues: impaired methylation, not being able to produce enough DAO (histamine degrading enzyme)
  • Dysbiosis: not having enough of the histamine degrading bacteria. The species that degrade histamine: B. Infantis and L. plantarum.


The best way to know if you have histamine intolerance is to go on a low histamine diet for 4-6 weeks. If you feel better, then you are indeed histamine intolerant.

A low histamine diet excludes foods that are high in histamine or that promote histamine release. (This is not a complete list, just a taste)

  • Aged foods: bacteria produce histamine during the aging process
    • Fermented foods
    • Cheeses
    • Wine
    • Leftovers
  • Eggs
  • Seafood
  • Citrus fruits
  • Berries
  • Spinach
  • Ripe avocados and bananas


There are many supplements that can be used to help with histamine intolerance.

  • Vitamin C is a powerful antioxidant, and natural antihistamine. Vitamin C is known to help stabilize mast cells and reduce histamine intolerance.
  • B vitamins are extremely important in the process of methylation. With a deficiency in B vitamins methylation begins to fail, causing a multitude of heath problems, including histamine intolerance.
  • Diamine oxidase (DAO): you can take this histamine-degrading enzyme in a pill.
  • Quercetin is a mast cell stabilizer found in fruits and vegetables and can be taken in a supplement form.
  • Bromelain is an enzyme found in pineapple and can be taken in supplement form.
  • Probiotics, tailored to the histamine intolerant person of course.

And the main treatment, in my opinion, is to rebalance the gut and restore overall health. Doing that, can cut the histamine intolerance at the root.

Heartburn Solutions

Background made of different pills, isolated on white

How often do you suffer from heartburn? GERD (GastroEsophageal Reflux Disease) effects 25-30% of the US population. GERD is a serious condition that goes well beyond the occasional symptoms of unpleasant heartburn. GERD is consistent chronic heartburn. Individuals with chronic heartburn are at increased risk of damage to the esophageal lining. This damage begins with mild irritation leading to scarring, constriction, ulceration, and even cancer in a small percentage.


During normal digestion, the lower esophageal sphincter (LES), located at the end of the esophagus, opens to allow food to pass into the stomach. After a bolus of food passes through this sphincter, it closes in order to prevent food and the acidic contents of the stomach from flowing back through the sphincter and up into the esophagus. In some cases of heartburn, the LES has weakened, or relaxed when it shouldn’t, allowing stomach contents to flow back up the esophagus. Another new theory about the cause of the esophageal damage and symptoms is inflammation (see below).


The conventional treatment for heartburn is medication that blocks the production of stomach acid. This means there is less stomach acid to splash back up through the lower esophageal sphincter into the esophagus. This does relieve heartburn. However, this is just treating the symptom, not the underlying problem. The cause of heartburn, contrary to popular belief and logic, is not too much stomach acid. A majority of individuals suffering from heartburn are noted to have too little stomach acid. One theory as to why low stomach acid would lead to heart burn is that low levels of stomach acid results in the food sitting in the stomach longer than it should (food can’t advance to the intestines until the pH of the stomach is acidic), increasing the chance of back flow and heartburn. Whether a person has low stomach acid or normal stomach acid, lowering stomach acid production through medication is slapping a pill on the symptom and NOT fixing the problem.

To their credit, acid lowering medications do prevent heartburn and damage to the esophagus, but since they don’t address the underlying cause of the heartburn, they are not really a good solution. Not only are these medications just a temporary fix, but many research studies also link long-term use of these medications to the increased risk of conditions such as asthma, vitamin deficiencies, kidney disease, allergies, skin disorders, insomnia, osteoporosis, heart attacks, GI infections, dementia, and depression.

Causes of GERD?

So what are some potential causes of GERD?

  • Consumption of foods that weaken the lower esophageal sphincter, and esophageal irritants (see below)
    • Treatment: If this is the cause, then simple dietary and lifestyle changes can fix the problem.
  • Smoking
  • Hiatal Hernia
  • Overweight
    • Extra weight in the abdomen can create pressure on the stomach and push the contents back up toward the esophagus.
  • Eating large meals
    • A too full stomach will put pressure back up on the lower esophageal sphincter.
  • Eating right before bed
  • High stress levels
  • Magnesium deficiency
    • Magnesium helps the sphincter at the bottom of the stomach to relax, encouraging the stomach to empty-the right way
  • Food sensitivities or allergies
  • Small intestinal bacteria overgrowth
    • The bloating and gas from the bacteria can put pressure upwards on the stomach.
  • Yeast overgrowth in the gut
    • The bloating and gas from the yeast can put pressure upwards on the stomach.
  • Inflammation!
    • See below


Dietary and lifestyle changes can be extremely effective in treating GERD/heartburn.

Avoid the following

  1. Lower Esophageal Sphincter Weakeners (if the lower esophageal sphincter is opened or weakened, the contents of the stomach can splash up to the esophagus):
  • Fats, fried and greasy foods
  • Chocolate
  • Coffee
  • Mint (especially peppermint and spearmint)
  • Sugar
  • Alcohol
  • Onions
  • Foods that you are allergic or sensitive to

Esophageal Irritants (these foods, if backed up into the esophagus, will irritate the lining):

  • Citrus fruits and juices
  • Tomato based foods
  • Spicy foods
  • Coffee
  • Carbonated drinks
  • Garlic


A study was just published in May in JAMA, which demonstrated that a person’s immune system is responsible for the injury (not acid). In other words an immune response (inflammation) is responsible for these symptoms and not acid burning the esophagus.

A general anti-inflammatory diet is a good way to lower your inflammation. This would consist of cutting out inflammatory foods:

  • Sugar
  • Gluten
  • Dairy
  • Alcohol
  • Processed foods, fats and starches.

The other side of an anti-inflammatory diet is eating lots of anti-inflammatory foods:

  • Fish
  • Fruits
  • Vegetables
  • Healthy fats (olive oil, avocados, nuts)

Another thing that causes inflammation is the body’s immune response to a specific food. Food sensitivities are different than allergies (where the reaction is immediate and usually severe). Sensitivities are the cause of low chronic inflammation. Common food sensitivities include dairy and gluten, but a person can be sensitive to anything (even anti-inflammatory foods like avocado and fish). Once you are aware of which foods you are sensitive to, it is beneficial to eliminate them from the diet as they may trigger symptoms. Food sensitivity testing or full elimination diets are ways to determine if you are sensitive to certain foods.


Aside from dietary changes, there are addition lifestyle changes that are important.

  • Eat small meals
  • Minimize activity that may increase intra-abdominal pressure such as heavy lifting. Avoid postures that may aggravate GERD (inverted yoga poses).
  • Wear loose fitted clothing that does not squeeze the abdomen and put additional pressure on the LES
  • Limit food intake before sleeping.
  • Taking a short walk after consuming meals
  • Keep up with sleep hygiene: Elevate the head of the bed; avoid sleeping in the left decubitus position.
  • Avoid smoking


  • DGL (licorice) heals the lining of the stomach (and esophagus and intestines)
  • Zinc carnosine (healing)
  • L-glutamine (healing)
  • Magnesium (opens the lower stomach sphincter to promote gastric emptying, so food doesn’t sit in the stomach and put pressure on the esophageal sphincter)
  • This is a liquid herbal mixture that promotes gastric emptying so food doesn’t sit in your stomach for so long.

As a functional medicine nutritionist, I believe that treating the root cause of this condition is better than slapping a pill on the symptom. Treatment can be achieved through proper nutrition and the elimination of trigger agents, food allergies and sensitivities, and adding deliberately chosen natural supplements, if needed. With this treatment plan, digestion can return to normal and, in time, the LES will be able to heal itself.




What You Need to Know About Functional Nutrition

Human body with internal organs, composite by stomach, Great to be used in medicine works and health.

Conventional medicine is very effective if you have an acute problem, which needs immediate treatment. Despite all the advances in science and medicines, chronic diseases are on the rise. Most people suffer from some form of chronic problem (such as IBS, high cholesterol, Diabetes, insomnia, chronic fatigue, anxiety, ADHD, etc). Conventional medicine doesn’t seem to be able to treat these problems successfully. At best, conventional medicine doles out prescriptions to dampen the symptoms. That isn’t ‘treatment,’ and it certainly isn’t prevention. The problem? Neither the individual nor the root cause of the illness is treated.

Functional Medicine and Nutrition is an entirely different approach.

Functional Medicine Nutrition Therapy is a personalized method for getting to the root of your symptoms and restoring balance to your system. It is about promoting health, not just treating illness.


Everybody’s different. We each have different genes, different microbiomes (which influence everything), and different lifestyles. In Functional Nutrition, all information is taken into account: sleep, diet, stress level, activity level, energy level, mood, sunlight exposure, time in nature, and other data. Additionally, using tests that actually reveal what’s going on inside your body down to the cellular level and tests for genetic influences, diet and supplementation can be very targeted.

As the Institute of Functional Medicine explains: “The current healthcare system fails to take into account the unique genetic makeup of each individual and the ability of food, toxins and other environmental factors to influence gene expression.”

Treating the problem, not just the symptom:

If you throw drugs at a symptom, without addressing the root cause of the symptom, you are clearing the smoke but not putting out the fire. Left resolved, the cause will continue to persist, and therefore so with the symptoms. The drug will continue to be needed indefinitely (and possibly at greater and greater doses) to treat this symptom.

Chris Kresser articulates this: “In conventional medicine…they mostly focus on symptoms and diseases. If you go to a doctor and you have high cholesterol, you get a drug to lower your cholesterol…and there’s often little investigation into why your cholesterol is high in the first place. The intent is to just bring it down, and that’s generally the end of the story. In functional medicine… Symptoms are important in as much as they can give us clues as to what the underlying mechanisms might be that are contributing to the problem, but they’re not as important because when you focus on the underlying mechanisms and causes and you address those, the symptoms tend to resolve on their own, so you don’t have to worry about going after each and every symptom individually. You just address the root causes and the symptoms resolve.”

Dr. Mark Hyman, one of the leaders in Functional Medicine, articulates this point very well in the foreword he wrote for The Disease Delusion (a book written by Dr. Jeffery Bland, the father of Functional Medicine):     “Depression is not the cause of misery, it is merely the name we give to a constellation of symptoms. The actual cause of depression may vary greatly from patient to patient…knowing the name of a disease tells us nothing about its true cause; nor does it lead us to the right treatment”

Final thoughts:

Conventional medicine has its place. It has saved my life more than once. However, in other instances, it also left me disappointed. I know my clients have felt the same way before coming to see me.

Dr. Fitzgerald, another leader in the field, sums it up: “Simply, functional medicine is an individualized, systems-based, patient-centered approach to care. We look at the whole person, their environment, diet & lifestyle and genetics/epigenetics. An individual’s history is carefully mapped to a timeline, which we use to gather clues to the cause(s) and promoter(s) of disease/imbalance. Sensitive laboratory assessments help us “look under the metabolic hood” for contributing biochemical/genetic/microbial/nutrient/inflammatory/toxicity issues.”

For all these reasons, I am very excited about Functional Medical Nutrition Therapy. I am a Certified Integrative and Functional Nutrition Practitioner and have been practicing it with my clients (and on my own health) for several years.

Because patients are unique. Symptoms are not.


Gluten Free Breakfast Ideas

Homemade rye bread


Whenever I educate someone on going gluten free, I inevitably hear: “but what will I eat for breakfast??!!” Well I am here to tell you that breakfast doesn’t HAVE to be toast, muffins or pancakes. Here is a list of ideas

  • Fruit
  • Cream of Buckwheat
    • This hot cereal is delicious, especially with a splash of 100% maple syrup and fruit.
  • Granola (Udi’s)
    • Can be mixed with yogurt and fruit, or eaten in a bowl with cashew milk.
  • Precooked bacon (or chicken bacon)
    • Have a bacon, lettuce, tomato + avocado roll up with the lettuce as the bread.
  • Sausage
  • Eggs
    • endless possibilities here
  • Lox with a big slice of tomato as the ‘bagel’. Get creative with toppings (cream cheese, onions, capers)
  • Chia pudding
    • ½ cup chia seeds, 1 ½ cups coconut milk, ½ cup organic vanilla almond milk, 1 tablespoon 100% maple syrup. Mix and let sit
    • add fruit
  • Smoothies
  • Potatoes
    • Cut up and sauté with onions, sausage, other veggies
  • and if you absolutely need your ‘bread’ there are gluten free versions of bread-like breakfast foods:
    • Google: “gluten free breakfast” “gluten free muffins” “paleo breakfast” and you’ll get a million recipes and ideas