Should you be taking vitamins?

Should you be taking vitamins

Here’s a question I get ALL THE TIME:

“Should I be taking multivitamins or supplements?”

I wish the answer was simple…

In general, I am a fan of getting your nutrients from a well-balanced diet.

One that includes about 10 servings of fruits and vegetables each day, high-quality proteins, healthy fats, and lots of fiber. I believe in real food, mindful eating, and self-care to help your body absorb and utilize the nutrients it needs.


Most people are NOT eating a well balanced diet.

Only about 13% of American adults eat enough fruit each day, and only about 9% eat enough vegetables. Yikes!

Fruits and vegetables are one of the main sources of vitamins, minerals, fiber, and antioxidants. If you’re not eating enough of them (at least 2 1/2 cups of fruit & 3 cups of veg), there’s a high likelihood that you’re not getting enough of one or more nutrients.

Even if you eat a well-balanced diet, you could have issues with digestion/absorption, medical conditions or medications that affect your nutrient status, or genetic polymorphisms that change how your body utilizes certain micronutrients, leaving you functionally deficient.

Sometimes people can go for years without realizing they are undernourished.

Symptoms vary widely, depending on which nutrient(s) you are deficient in, but common symptoms include fatigue and lack of energy, low immunity, or feeling a little “off” & not at your best.

Other less-obvious symptoms can include weak or brittle nails, cracking/scaly skin, excessive bruising, poor wound healing, infertility, increased inflammation, cataracts/macular degeneration, numbness/tingling in hands & feet, night blindness, & muscle spasms or cramps.

Often, people who struggle with chronic diseases like depression & anxiety, cardiovascular disease, diabetes, and hypothyroidism also suffer from micronutrient deficiencies.

Medications can also cause nutrient depletions.

You’d be surprised how common this is! I always check my client’s meds, and I’d say roughly 80% of the time they have a drug-nutrient interaction that the client is unaware of.

Some common meds that can cause nutrient deficiencies include:

  • Antacids & Ulcer Meds
  • Antibiotics
  • Anticonvulsants
  • Antidepressants
  • Anti-inflammatory Drugs
  • Antiviral Drugs
  • Birth Control Pills
  • Blood Pressure Lowering Meds
  • Cholesterol Lowering Drugs
  • Diabetes Meds
  • Diuretics
  • Estrogen / Hormone Replacement

In case that wasn’t enough, your genetics also play a role.

Even if you are doing everything right, you could have genetic polymorphisms (SNPs) that impact how you utilize nutrients within your body.

For example, many people have mutations in their MTHFR gene that affects how their body metabolizes folate and vitamin B12, and can lead to elevated homocysteine levels (a risk factor for heart disease). For these clients, supplementing with methylated folate and methylated cobalamin can help their bodies utilize these nutrients properly. Some may also need to avoid synthetic folic acid (which is tough to do, since it is added to fortified flours & thus in almost every commercial baked good!).

You may never know if you have these conditions without micronutrient testing to give you more insight.

But once you know, you are empowered, and have the ability to nourish your body & get its nutrient levels back up to optimum!

If you’re not sure if you could benefit from micronutrient testing, ask yourself the following questions:

  • Do I eat at least 2 cups of fruit and 3 cups of vegetables every day?
  • Do I eat fish twice a week?
  • Do I make sure at least half the grains I eat are whole grains?
  • Do I curb my alcohol intake to moderate limits? (no more than 1 drink/day for women, or 2 drinks/day for men)
  • Do I get at least 15 minutes of direct sunlight on most of my body each day?
  • Do I feel vibrant, well, and full of life and vitality?

If you answered “No” to any of the above questions, it is likely that you could benefit from micronutrient testing & a multivitamin or specific supplement (like fish oil or vitamin D).

*Please note* This is not intended to be specific medical advice for any individual. Please see a doctor or dietitian if you would like personalized recommendations.

If you are interested in getting your micronutrient levels checked…

I am now a provider!!


So freaking excited.

I can order the Spectracell Micronutrient Test for you.

If you’re interested in having the test done (it can be done remotely, you don’t need to live in the Los Angeles area), shoot me an email at 

Here’s how it works:

  • I order the test & paperwork to be sent to your home.
  • We chat & I explain the paperwork & collection procedures.
  • You head to an approved blood draw center and get your blood drawn.
  • You bring a copy of your insurance card & all the appropriate paperwork with you, and pay $190 for the exam. If you don’t have insurance, the cost is $390.
  • The blood draw center preps your sample & sends it off to Spectracell laboratories the same day.
  • After 2-3 weeks, the results are sent to me, & we schedule an appointment to go over the results & discuss recommendations! ($295/ 1hour custom consultation)
  • After 6 months, you can get retested to see if your micronutrient levels/ antioxidant status has improved (if desired).

How does the test measure your nutrient levels?

The lab extracts the lymphocytes (a type of white blood cell) from your blood sample, and then grows them under different conditions.

First, they let your lymphocytes grow with an unlimited amount of every micronutrient available, to see how quickly they can grow under optimal conditions.

Then, they repeat this roughly 30 times, each time removing just ONE nutrient from the growth medium, so that the lymphocytes have to rely on their own internal stores of that nutrient to grow.

If your lymphocytes have high levels of the nutrient, then they will be able to grow just fine using their own supplies.

If, however, you have low levels of that nutrient, your lymphocytes will grow much more slowly.

By comparing the growth rates, the lab is then able to determine whether you have optimal, sub-optimal, or deficient levels of each nutrient.

They give you an awesome printout showing the functional levels of each nutrient:

Screen Shot 2015-11-11 at 10.50.51 AM

By doing this test, you will know which nutrients you are deficient or borderline deficient in.

Then we work together to talk about the best ways to replenish your body & get your nutrient levels into desirable ranges so you can feel your absolute best.

They test the following micronutrients:

B-Complex Vitamins:

  • Vitamin B1
  • Vitamin B2
  • Vitamin B3
  • Vitamin B6
  • Vitamin B12
  • Folate
  • Pantothenate
  • Biotin

Amino Acids:

  • Serine
  • Glutamine
  • Asparagine


  • Choline
  • Inositol
  • Carnitine

Fatty Acids

  • Oleic Acid

Other Fatty Acids:

  • Vitamin D3
  • Vitamin A
  • Vitamin K2


  • Calcium
  • Zinc
  • Copper
  • Magnesium
  • Manganese

Carbohydrate Metabolism:

  • Glucose-Insulin Interaction
  • Fructose Sensitivity
  • Chromium


  • Glutathione
  • Cysteine
  • Coenzyme Q-10
  • Selenium
  • Vitamin E
  • Alpha Lipoic Acid
  • Vitamin C


  • Total Antioxidant Function (whether you have enough antioxidants to prevent harmful oxidation inside your body)


  • LPI (lymphocyte proliferation index- how well your immune system is functioning)

So you have a very comprehensive image of your health.

How awesome is that??

Email me at for more information & to book your test!

Can’t wait to join you on your personalized journey towards better health.

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How to Start a Nutrition Private Practice- Checklist and Cost Breakdown

How to Start A Nutrition Private Practice

Please note that this post contains affiliate links. As an Amazon Associate I earn from qualified sales. If you click on those links and make a purchase, I will earn a small percentage of the sale, at no extra cost to you. 

I’m thrilled to talk about this with you guys.

It’s a hugely important topic, and there aren’t a lot of (free) resources out there to help guide you through the process!

Here’s how it usually goes…

You’ve finally completed all the coursework & internship hours, sat for & passed the RD exam, & all of a sudden…

You’re actually a dietitian!!

(If you’re still not sure exactly what a dietitian is, find out here, and if you want to know how to become a dietitian, read this article).

Now what??

That’s pretty much how I felt after I passed the RD exam on July 29th, 2014.

The process of becoming a dietitian (especially if you are also working) is an all-consuming one.

At times, it feels like you’re just trying to make it through the hour, the day, the week, the month. Project after project, deadline after deadline, it’s easy to lose sight of the big picture.

What exactly are you going to DO once you’re a dietitian?

You basically have 2 options:

  1. Become an employee
  2. Start your own business

I knew from a very young age that I was meant to be self-employed. I just have that entrepreneurial spirit! From selling “polished rocks” (rocks that I painted with nailpolish…. HAHA) and lemonade from a stand in front of my house, to selling stenciled t-shirts in high school, to hawking my services as a tutor in college, I’ve always been a hustler.

So on July 29th, 2014, the day that I passed the RD exam, I was ready to jump head first into the world of entrepreneurship & learn as I went.

As scary as that decision was, and as many times as I fell flat on my face during my first year in business, it was hands-down the best decision I made.

You can plan, and plot, and learn, and prepare for AGES, but it won’t get you anywhere without action to go with it. The sooner you start, the sooner you’ll get to where you want to be!

If you have even an ounce of desire to go into business for yourself, you should probably give it a go.

So here’s what I did in my 1st month as an RD entrepreneur:

First, I had to figure out when I could legally start practicing as a dietitian.

The results of the RD exam are instantaneous. You know whether you passed the minute you step out of the testing room. However, it was a little unclear whether I could legally start practicing as an RD right that second, or whether I had to wait for my ID card & for my status to officially change from “student” to “dietitian” within the AND database.

So, I called up CDR and they let me know I could legally practice right away. Yahoo!

On August 1st, I received an email from CDR with instructions for paying the $60 registration fee. You have to pay this fee annually to maintain your status as a registered dietitian (if you don’t pay the fee within 240 days of the annual deadline, you lose your registration & have to take the exam all over again! Eek!).

Once you pay the fee, CDR sends you an ID card in the mail that proves you’re legally a dietitian, and sends you information on how to set up your Professional Development Portfolio to keep track of your 5-year cycle of continuing education credits.

(There’s no rush to set up the PDP, but you have to set up your online learning plan before you can start logging your continuing education hours).

CDR also sends you a free wall certificate to hang in your office for your 1st year as an RD. But you have to pay to receive a new one for the following years.

Now that I had my certification, I decided to jump right into what I thought would be my best chance of entrepreneurial success: private practice.

Turns out this might not have been the best choice, but more on that later.

I had 5 main options for running my private practice:

  • Rent my own private office space
  • Rent a private office within a wellness center
  • Sublet an office from another practitioner to use when they weren’t using it (usually a few days a week, nights, or weekends)
  • Use a rent-by-the-hour office to book clients whenever they came up
  • Not rent an office & meet clients at coffee shops, their houses, via Skype, or on the phone

I decided to rent a small office within an established wellness center in west Los Angeles.  

I found the space on Craigslist & signed the lease before I even passed the RD exam! I started decorating in late July so that I would be ready to open as soon as I was an RD.

I chose this space because even though it was very small (like 8 ft x 10 ft) & windowless 😉 it was very affordable (only $750/mo for your own private office, whereas other places were charging $250/mo for just ONE DAY a week in an office space!).

I also liked that it was located inside a wellness center so I could connect with other wellness professionals & perhaps share clients with them.

Plus, I loved that I could decorate to my personal tastes & book clients at any time without having to work around other practitioner’s schedules.

However, if I had to do it again, I probably would have gone with the rent-by-the-hour offices. Yes, they’re slightly less convenient, & you can’t decorate them, have an official business address, or store paperwork there, but they save you SO MUCH MONEY.

Joyce Guenther is a popular option in West LA, and she charges just $15/hour for use of her offices! This is a great deal if you only have a few clients per week.

Next up, revamping my website.

I had already been sporadically blogging over the past few years on my website,, so I decided to run with that name & launch my counseling services under the same name & website.

I was only getting ~2,000 visitors per month on, but I figured that was better than starting from 0! (I later chose to scrap this business name and website, but, my goal of this post is to be honest about where I started!)

I updated my site to include new information on my counseling services (including prices!), and added Acuity Scheduling for clients to book & pay for appointments directly on my website.

Acuity costs $10/mo, but makes scheduling SO easy. It displays a calendar of your availability, and allows clients to book sessions (individual or packages) directly from your website. It also sends confirmations & reminders if you set it up that way. I love how it syncs to your google & ical too. Fabulous & well worth the money.

If you don’t have a website yet, I highly recommend purchasing a domain & getting started. I recommend Google Domains for registering your domain name and SiteGround for hosting.

Domain names (the name of your website url, like are pretty cheap, only a few bucks per year. Hosting (having actual space on the web to run your website) is a little more expensive, roughly $60 – $200/year, paid upfront or monthly.

Once you have a domain name & hosting, I highly recommend installing WordPress to manage your website. It gives you full control & ownership of your site, no matter what happens. There are a bazillion wordpress themes that you can download & install to make your website beautiful.

I recommend anything that uses the Genesis Framework if you want to incorporate a blog into your brand. Otherwise, a drag-and-drop visual builder, like Divi, is a great option!

Let’s talk about prices for a sec.

There are two camps in this world- those who post their prices on their website, and those who don’t.

Those who don’t post their prices argue that truly interested & motivated customers will take the extra step to contact you for a consultation. These owners like having the chance to “sell” their services before revealing prices to their customers.

The other camp of people like to just be upfront & honest about how much they charge. I find this helpful because it saves both the business owner & customers so much time. There’s no sense in selling someone on a product or service they can’t afford. I prefer to post my prices upfront, so my customers can save or budget to include my services in their lives.

How much to charge??

 I googled a whole bunch of dietitians in my area to see how much others were charging. I found a wide range of charges, from $60/hour on the low-end, to $250+/hr on the high end. I decided to settle in the mid-range ($150/hr) because I have a masters degree & I know that I go above & beyond for my clients & personalize all of their sessions. $150/hr felt like a comfortable price point for me, and pretty average for my area. Plus, I think it’s better to start where you’d like to be than start low & keep having to raise prices on people.

There’s also something to be said for the perception of value. People tend to value what they pay for, and if they’re paying decent $$$ for your services, they may be more likely to respect your time.

Here’s a biggie: Should you take insurance??

This was a tough decision for me. On the one hand, being a registered dietitian allows me to take insurance, whereas other unregulated nutrition professionals (health coaches, nutrition coaches, nutritionists) cannot.

Taking insurance opens you up to a HUGE pool of potential clients whose visits would be covered by their insurance.

However, taking insurance is a lot of work! You have to contract with each insurance company, and deal with co-pays, deductibles, etc. Sometimes claims can get denied, and then it is a huge headache and hassle.

Also, anyone who takes insurance has to follow HIPAA privacy guidelines (that means no Skype appointments!), which I didn’t really want to worry about when I was just getting established & had so much on my plate. This is up to interpretation, but some believe that the strict HIPAA guidelines don’t apply to private-pay dietitians since you are not a “covered entity”, according to the HHS definition.

I decided to start out with private-pay only, so I wouldn’t have to deal with the hassle of insurance & HIPAA requirements. This way, I could receive payment immediately when I saw my clients, do Skype appointments if I pleased, and not have to worry about HIPAA requirements like putting a privacy disclaimer in the footer of all my emails. (*Please note I am not a lawyer, and not everyone agrees with this! Some believe that HIPAA applies to all dietitians, whether private pay or not. I recommend consulting with a lawyer in your state for more clarification).

For the legal stuff…

I had to decide whether I wanted to run my business as a sole proprietor, LLC, or corporation.

Ideally, I would have loved to be an LLC (limited liability corporation), because it protects your personal assets if you go bankrupt or are sued. However, it actually costs money to establish an LLC (In California, it’s a $20 reporting fee + $149 for Legal Zoom to file for you + $800 annual LLC tax due 75 days after filing).

I decided to save $1,000 and take my chances as a sole proprietor since I wasn’t sure how much business I would actually do during my first year, and didn’t really have any assets to protect (I definitely had a negative net worth at this point).

*Side note* Legal requirements vary by state. Everything mentioned in this article is specific to the requirements for California. Check with your state for more specific information. 🙂

Once I decided my business structure, I did the following:

1. Registered my business with the City of Los Angeles Office of Finance.

You have to register your business no matter what, but if you make less than $100,000 in Los Angeles, you get a small business exemption & don’t have to pay business taxes.

2. Filed my DBA paperwork at the local courthouse.

This allowed me to legally do business as “Eat Healthy Feel Good” instead of just Erica Julson. This way, clients can make checks out to Eat Healthy Feel Good or Erica Julson, and both will go through at my bank.

*Note * you have to renew your DBA every 5 years, or else you lose your business name.

3. Published a DBA announcement in the newspaper.

This was the strangest requirement to me! You have to legally publish a statement saying “[Your Name] is doing business as [Your Business Name]”. That way the public can find out the name of the person behind any business.

I published mine in the British Weekly for $30 (via The whole process was pretty easy. It just required payment & faxing some paperwork. The company mails you a copy of the paper your notice is published in :).

4. Applied for a Tax EIN (Employer Identification Number).

You don’t HAVE to do this, but it’s a wise choice. Having an EIN allows you to avoid putting your personal social security number on forms, so it helps protect your identity.

5. If you also want to sell stuff, you need a seller’s permit.

If you want to sell goods at your office (vitamins, supplements, t-shirts, etc.), you’ll need a seller’s permit to legally do this. I decided not to jump into this right away, but it’s something to be aware of!

Next, I set up my financials.

1. Opened a business banking account.

 I walked into my current bank with my DBA documentation & tax EIN in hand & set up my business banking/checking account!

Having a separate business account makes it easy to keep your financials straight. You can take payments directly into your business account & make business purchases on a separate business debit/credit card. They also provide you with business checks so you can look super official when paying for stuff!

2. Signed up for Square.

This is my preferred method for taking payments. I love how you can swipe people’s credit cards wherever you are for just a 2.75% processing fee, or have your clients submit credit card processing forms and hand-enter their card information for recurring payments (helpful if they are on a monthly payment plan).

Funds are deposited into your bank account the next business day, in comparison to PayPal which takes like 5 days to go through. This is HUGE when you’re just starting out and need quick cash.

3. Created an accounting spreadsheet

I know a lot of people like to use Quickbooks for their accounting, but I like keeping it old school!

I created an excel spreadsheet with 1 tab for each month. In each tab, I tracked my income, expenses, and gross/net profits for the month & the year to date.

As a small business owner, it is ESSENTIAL that you know where your finances are. It’s a great idea to track your income & expenses weekly, so you always know where you’re at, & how far you have to go to reach your goals. Being organized also helps a ton come tax time.

There were also a lot of professional-related things I needed to do…

1. Renew my professional liability insurance

I chose to renew through Proliability to protect myself from malpractice lawsuits. I already had malpractice insurance through them while I was an intern, so I decided to just use them again. They offered a slight discount for new RDs, so that was helpful. The cost was only $60 for the whole year.

2. Purchase general liability insurance.

This is a separate insurance that covers slip & fall accidents in my office space. I was required to add the owners of the wellness center as co-insured on my policy as well (a common requirement), which increased the cost a little bit. I ended up purchasing a policy through Hiscox because they were able to find me the best deal. It cost $60 for the 1st month, and then roughly $40/month for the rest of the year.

3. Obtain an NPI number from the Centers for Medicare & Medicaid Services.

You need an NPI number if you want to take insurance or if you DON’T want to take insurance, but want to be able to create superbills for your clients to submit to their own insurance for reimbursement.

I also had to decorate & furnish my office!

This was the fun part 🙂 I went on a World Market shopping spree & decked out the space at a very reasonable price.

I opted to set up my office with 2 comfy plush chairs rather than a formal desk option. I felt that sitting side by side with my clients would make them feel more comfortable & able to open up to me, compared to sitting behind a desk, with my client sitting before me as if I am the ultimate authority on nutrition. I got really good feedback from my clients on the vibe of my office, so I think it was a good choice!

Once I had my office ready to go, it was time to create my business paperwork!

For many people, this is a tough task to tackle. But luckily, creating forms & procedures & structure is a strength of mine, so I enjoyed the process!

Here’s a handy checklist of the templates I created:

  • Welcome email that people received after booking their 1st appointment.
  • A 9-page “Initial Appointment Welcome Letter & Health Information Form” for clients to fill out & return to me before our 1st session. This helped me prepare & be on the same page as my client when we first met.
  • A “New Client Agreement Form” to help protect myself against litigation.
  • A “What to Expect at Your 1st Appointment” letter to help clients understand exactly what our first session would be like.
  • Recurring Payment Authorization form so that I could store people’s credit cards on file & charge monthly for packages.
  • Superbill template for clients to submit to their insurance companies for reimbursement.
  • Client session templates for me to take notes on during our sessions.
  • Newsletter sign-up sheets to use at events.
  • Gift certificate templates.

To organize my client forms, I did the following:

  • Created 1 manila folder for each client.
  • Stored client folders alphabetically in a locked filing cabinet.
  • I stored the health information form, health agreement form, session notes, & any handouts I gave them in their folder.
  • I took this folder to each session for easy reference, in case there was any confusion about what we talked about in the past or what handouts were provided when.
  • If I was seeing a client for a long period of time, I split their materials into several folders, but kept it organized chronologically.

I chose to take notes by hand during our sessions because it’s just the way my brain works best. I like to jot down notes, draw arrows to connect things, cross things out as I cover them. Plus it felt a little impersonal to have my computer or tablet in front of me during our sessions. I wanted my full attention on my client.

Since I didn’t have a lot of clients, and wasn’t coordinating or sending notes to physicians, the old-school pen & paper method worked well for me. I know other people who absolutely love their electronic charting methods though, especially Practice Better!

Next up, creating marketing materials!

I was basically starting from square one in terms of marketing, & I was on a super low budget! I’ll outline my marketing methods in more detail in my next post, but I’ll give you a quick preview of what materials I created when I first started out.

  • Rack cards (with my picture, logo, story/philosophy, business info, & coupon). My uncle owns a printing company (Fineline Printing), so I was able to get these done for free! (Thanks, Uncle Richard!!)
  • Business cards from (my fave!)
  • A business facebook page (I technically already had this, but it’s a marketing essential if you don’t already have one)
  • A business Twitter handle (technically already had)
  • A business Instagram account
  • An updated LinkedIn page
  • A Yelp page
  • A Google+ business page
  • If you don’t already have a logo, you can design your own on, pay someone to design for you on, or have people compete to create your logo at

Don’t skimp on any of these! I got new clients from both Yelp & Google+, so make sure you’re highly visible & easy to find on the internet.

And finally, creating handouts!

Even though I didn’t have any clients yet, I wanted to have at least a few handouts to provide as a standard part of my 1st session.

I created a handout with my general nutrition/wellness philosophy, and some questionnaires I thought I might want to use, centered around emotional eating, self-care, & general wellness.

I figured I would make the rest as I went on, based on client need.

A few resources that really saved my butt during this time:

 To help guide me through this process, I purchased Making Nutrition Your Business by the amazing dietitians Faye Berger Mitchell & Ann M. Silver. This book was a godsend for helping me figure out the steps I needed to take to set up my office & business. Without this book, I would have struggled to understand the pros & cons of taking insurance vs private pay, the paperwork I needed to file, and how to go about marketing myself.

I also joined the Nutrition Entrepreneur dietetic practice group (NEDPG) & the Dietitians in Integrative & Functional Medicine practice group (DIFM), which were HUGE invaluable resources. I was able to search their listserv archives to answer almost any question I might have about starting a private practice & treating clients.

I also read a bunch of nutrition books!

There is A LOT of self-education that goes on when you first start your practice. Here are some books that I relied on heavily while crafting my counseling style:

And NOW, if I had to do it over again, I would strongly consider investing in more 1:1 guidance. 

Working with a coach or taking a course that was specific to starting a private practice would have gone a LONG way in speeding up my success.

There is a lot of trial and error involved in business, so working with someone who has been-there-done-that can save you from these missteps.

My favorite course is Jennifer McGurk’s Pursuing Private Practice (this is my affiliate link for her course). 

Jennifer is a powerhouse RD with years of experience coaching other dietitians on launching and growing private practices. She also does 1:1 mentorship and clinical supervision for eating disorder RDs and is an all-around excellent resource.

Total costs to open:

  • $750 security deposit
  • $750 first month’s rent
  • $25 business cards from
  • $10 for acuity scheduling software for my website
  • $200 for office supplies (clipboards, pens, folders, filing system, tissues, candles, notebooks, thank you cards, etc.)
  • $26 to file my “Doing Business As” paperwork
  • $30 to publish my DBA announcement in the newspaper
  • $58 for general liability insurance
  • $59 for professional liability insurance
  • $125 for a scale & blood pressure monitor (which I never used lol)
  • $2000 for office furnishings (chairs, rug, tables, décor)
  • $100 if you don’t already have a website (this covers the cost of your domain name, hosting fees, and wordpress theme)
  • $100 on miscellaneous books to help me learn counseling styles/theories

= $4,233

And yep, that all went on a credit card. Eek!

Check out the next post for the lessons I learned during my 1st year in business. I share the details on exactly what my expenses were, & how much I earned over the course of my first year. You’ll learn a ton, promise!

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Is Your Gut Microbiome Affecting Your Health?

gut microbiome

Did you know that bacteria make up the majority of your poop??

Yep, that’s right. Roughly 60% of the dry weight of your feces comes from bacteria.

Sounds kind of crazy, right?

But actually, these gut bacteria are more important than you might think.

They live within our intestines, and we have a pretty neat mutualistic relationship with them (both the bacteria and ourselves benefit).

We provide the bacteria with food (undigested remnants of what we ate), and the bacteria do the following for us:

  • Create vitamins! Gut bacteria are most famously known for producing vitamin K2 (an essential vitamin critical for blood clotting), which we absorb from the gut into our blood stream, but they also produce smaller amounts of biotin, vitamin B12, folic acid, and thiamine.
  • Break down fiber & keep our gut lining strong. Humans lack the digestive enzymes to break down the fiber found in plant foods. Luckily, the bacteria in our gut take care of that job. Once the undigested fibers reach the large intestine (where most of our gut bacteria live), they get to work breaking down the fibers and producing short chain fatty acids (butyrate, propionate, and acetate), which lowers the pH of the gut, creating an environment less favorable to pathogens. Butyrate is used as an energy source by the cells that line your colon (known as colonocytes). Some studies suggest that ulcerative colitis (an inflammatory disease that causes ulcers in the colon) is associated with low levels of butyrate-producing bacteria, and that eating more fermentable fibers (like those found in oat bran) can increase butyrate concentrations in the colon and reduce abdominal pain & reflux. So feeding those butyrate-producing bacteria is important!
  • Break down & recycle compounds. Some compounds that are metabolized in the liver and then secreted into the gut (ike bilirubin and bile acid, cholesterol, estrogens, vitamin D metabolites, and some medications), are broken down by the gut bacteria into new forms that can be reabsorbed through the gut wall and sent back to the liver. This process saves the body so much time and energy, since it can essentially “recycle” these components and not have to build them from scratch again.
  • Protect us from pathogens. The ecosystem of gut bacteria is relatively stable. The good bacteria that live there want to stay there, and actively fight off the colonization of other pathogenic bacteria and parasites. Thanks gut bacteria!
  • Keep our immune system strong. When we are infants, the lymph (immune) tissue in the gut learns to recognize healthy gut bacteria that lives there, and will not mount an immune response against them. In contrast, when a new type of bacteria enters the body, the immune system recognizes it as foreign and launches an attack against it. Without the hundreds of species of healthy gut bacteria living in our bodies, the immune system would have a much greater likelihood of launching an unnecessary immune response against harmless bacteria. There is exciting new research suggesting that there is a “critical window” of colonization, during which time the gut must be properly colonized by a wide range of bacteria, or else it may increase the risk of developing atopic diseases later in life (asthma, eczema, and allergies). How fascinating is that?? PS- guess where you get a significant portion of your colonizing bacteria?? During vaginal birth. Yep. It’s exactly what you think it is. Bacteria from the mom’s vaginal area enter the mouth of the baby & colonize their gut. In contrast, infants born via C-section get their gut bacteria from the environment (the skin of the mom & nurses, the air, and the hospital environment) & tend to have a harder time colonizing their gut properly (it can take them 6 months to have a stable gut, compared to 1 month in vaginally born babies). (There is newer research suggesting that a small amount of bacteria exists in the placenta, so technically the gut is colonized pre-birth by bacteria from the mother, but environmental exposure upon birth plays a significant role.)

These awesome gut bacteria are often referred to as “the microbiome” or “microbiota”.

This name makes sense, since “micro” means “small” (and bacteria certainly are tiny!), and “biome” or “biota” means “a community of organisms that occupies a distinct region” (aka your gut).

There are up to 1,000 different species of bacteria in your gut, and they outnumber our human cells by 10:1!

So yep, there are 10x more bacteria in your gut than human cells in your entire body! (Kind of creepy!)

To put that number into perspective, that’s 100,000,000,000,000 (100 trillion) bacteria hanging out inside your intestines at any given moment.

Now here’s a key point:

The number, types, and relative proportions of these gut bacteria change over time, depending on how we treat our bodies.

When the balance of your gut bacteria gets out of whack, you have gut dysbiosis.

When you have gut dysbiosis, you may experience gastrointestinal upset (gas, bloating, diarrhea, constipation, abdominal pain), irritable bowel syndrome, decreased immunity, inflammatory bowel disease (ulcerative colitis and Crohn’s disease), or even leaky gut or small intestinal bacterial overgrowth (SIBO).

This can happen for a lot of reasons:

  1. Eating an unbalanced diet. Different types of bacteria feed off of different types of macronutrients. To keep all your gut bacteria healthy & happy, you need to feed them! This means you need to eat a well rounded diet containing a balance of protein, carbohydrates, fat, & fiber. If you get too crazy & eliminate (or excessively eat) one of these macronutrients, your gut will get out of whack, and you’ll feel it!
  2. STRESS. Are you surprised? We keep discovering more and more toxic effects of chronic stress. When you’re psychologically stressed out (worried about bills, your relationship, your job), you activate what’s known as the HPA axis (the hypothalamic-pituitary-adrenal axis), which essentially is a pathway from your brain to your cortisol-releasing adrenal glands, located on top of your kidneys. High levels of cortisol (a stress hormone) circulating around your body wreak havoc on many bodily systems, and the gut is no exception. When you’re stressed, your body assumes your life is in danger, and mundane functions like digestion are put on the back burner. The sympathetic “fight-or-flight” nervous system is in overdrive, and the parasympathetic “rest-and-digest” nervous system is out of commission. Blood is shunted away from the digestive tract and towards the muscles (you might have to run for your life, right??), and digestive health suffers. Really interesting new studies have shown changes in the gut flora of mice from exposure to social stressors and early life maternal separation. For even more ways on how stress affects the gut, check out this article.
  3. Consumption of antibiotics (and birth control pills?). Antibiotics can be essential and life-saving in many situations, but they do have a dark side. While they do a great job killing pathogenic bacteria inside your body that cause diseases, they ALSO kill the good bacteria! (oops, talk about throwing the baby out with the bathwater). When the antibiotics wipe out the bacteria in your gut, your body has to re-colonize with whatever bacteria enters your body. Hopefully, you are consuming probiotics (healthy bacteria that colonize the gut) via fermented foods or supplements, and providing your body with a good supply of beneficial bacteria. But if you’re not, unhealthy bacteria that make us feel yucky can take over and colonize the digestive tract. They can be tough to get rid of once they’re there, so it’s important to take probiotics in conjunction with antibiotics! Some articles online also claim that birth control pills disrupt the gut flora, but I couldn’t find any studies to back this up. Comment below if you can find something!
  4. Serious illness can also throw off your gut flora, even if you aren’t taking antibiotics. If you are seriously ill, you may not be eating the same diet, which could disrupt your microbiome. Certain conditions (like certain cancers, or blood pressure or blood clotting disorders) could reduce blood flow to the gut, and many diseases affect the immune system, which we know is intricately linked to the gut.

Thankfully, once you are aware of the causes of gut dysbiosis, you can make diet and lifestyle changes to boost your gut health.

Some of the best ways to nurture a healthy gut are:

  1. Eat (or take) probiotics. Probiotics are healthy bacteria that colonize the gut & promote a healthy gut microbiome. They can be found naturally in fermented foods like kefir, kombucha, yogurt, sauerkraut, pickles, tempeh, and kimchi. Interestingly, the word “probiotic” literally means “pro-life”, how amazing is that? It’s definitely a true statement! In order to reap the benefits of natural probiotics, it’s important to get a large enough dosage. At the very minimum, you should consume 1-2 billion cfus (colony forming units, aka live bacteria) per day. A higher dose of 5-20 billion cfus per day might be even more effective, especially if you are experiencing GI discomfort & want to establish a healthier microbiome. For some perspective, 1 bottle of G.T. Dave’s kombucha contains 2 billion cfus, and 1 cup of Lifeway kefir contains 7-10 billion cfus. You can also take probiotics in supplement form, but this is probably not necessary unless you are actively experiencing gastrointestinal distress (like irritable bowel syndrome), in which case large dose probiotics might be helpful.
  2. Take the time to de-stress. The gut is intricately linked to the brain through the enteric nervous system, and specifically, the vagus nerve. The vagus nerve runs from brain to all the organs of the body (including the gut) and delivers parasympathetic (rest & digest) messages to the organs. Basically, when the vagus nerve is activated, it tells your body to slow down, relax, and focus on resting and digesting food. As you can imagine, if you are constantly stressed out, your sympathetic nervous system is always switched on, and you never give your body the opportunity to activate the rest & digest functions of the vagus nerve. You’ll certainly still digest some food, but not at optimal levels. Try to take a few deep breaths before meals to calm yourself and activate your vagus nerve. Sit at a table, and eat from a plate, without the distraction of television or cell phones. Let yourself relax, connect with loved ones, and truly enjoy and appreciate your meal. You won’t believe how much better you’ll feel after a slow, relaxed meal compared to a meal in front of the TV or on the run. Think about the stress levels in your life, and how you can try to enjoy more relaxation time. Your gut will thank you!
  3. Exercise regularly. Several animal studies have found that exercise is correlated with more diverse microbiomes (yay!). These results have yet to be replicated in humans (it would be hard to study, as you can imagine), but one study of full-time rugby players found a correlation between regular exercise and a more diverse gut flora (although this could also be explained by differences in diet). Diverse microbiomes are more robust, better able to ward off infections, and help maintain a healthier gut lining. Exercise is just one component of a healthy, happy, thriving body (gut included!).
  4. Consume a well-balanced diet (and don’t forget about prebiotics). The biggest problem with the typical American diet is that we simply don’t eat enough plant-based foods, like fruits, vegetables, nuts, seeds, legumes, and whole grains. We tend to go heavy on processed foods (which have simple sugars but usually not much fiber. Remember, fiber is one of the essential nutrients for your gut bacteria!), meat, and fats. One of the best things you can do for your gut is make sure you are eating enough high-fiber natural foods so that all of the healthy gut bacteria can survive and thrive. Of special importance are prebiotics. Prebiotics are the food for the probiotics (bacteria). They are usually types of carbohydrates that we humans can’t digest. Foods rich in natural prebiotics include chicory, jerusalem artichokes (also called sunchokes, not the same as regular artichokes), jicama, garlic, onion, leeks, and asparagus. Want some scientific evidence that diet really can impact your gut & overall health? Although this study was conducted in mice, it shows a really cool connection between diet & asthma risk! Mice fed high-fiber diets had a healthier, more diverse microbiome that produced more short chain fatty acids, leading to a healthier gut, stronger immune system, and reduced risk of developing asthma. Amazing what diet can do!!
  5. Deliver vaginally and breastfeed, if possible. This is the best way to set your baby up for a healthy gut from infancy. The general template of our microbiomes is established in the first three years of life, so it’s important to create a healthy gut from the start. Breastmilk provides healthy bacteria to the infant (both directly in the milk & from the skin of the breast) and contains prebiotics (food for the bacteria) that help nurture a healthy microbiome. Formula, on the other hand, lacks these natural bacteria and healthy prebiotics.
  6. Stop using hand sanitizer and don’t be afraid to get dirty. We consume bacteria from our environment ALL THE TIME. Usually, we get a balanced dose of healthy (and not so healthy) bacteria, and our immune system & gut microbiota are able to fight off infection. But what happens when you disrupt this natural process and douse yourself in sanitizer or prevent your kids from getting down & dirty in nature? Well, you kill all the bacteria (good and bad) and prevent your body from being exposed to a healthy diverse range of bacteria. If your body never gets exposed to these healthy bacteria, it could over-react when it finally is exposed to them, and increase your risk of unnecessary immune responses (like in allergies and other autoimmune diseases like multiple sclerosis and type I diabetes). If you’re interested in learning more about this, check out the “hygiene hypothesis.” or, my favorite term, “microbial deprivation syndromes of affluence.”

So where is all this research headed?

Super interesting studies are being published as we speak, suggesting links between gut dysbiosis and obesity, type 1 diabetes, and even mental disorders like anxiety, depression, and autism, since a large portion of the peripheral nervous system is located in the gut. While this research is still new, it is certainly exciting.

Another hot topic right now? Fecal transplants. Yep. The transfer of fecal gut bacteria from one person to another. It is being investigated as a treatment for intestinal infections (like c. diff, which is common in hospitals and very tough to get rid of) & even as a treatment for obesity, since obese people have a less diverse microbiota with different proportions of bacteria than normal weight people.

Some animal studies have even suggested that fecal transplants can change the mood/behavior of the recipients to be more like that of the donor! Presumably this is because the fecal transplant changes the gut microbiota, which is closely connected to the brain and the rest of the central nervous system. This study found that fecal transplants from anxious mice to mice with sterile guts caused the inoculated mice to behave anxiously, like the mice from which they received the fecal transplant! This is some seriously amazing stuff!

Wow. How fascinating is your gut?

Hippocrates once said,

“All disease begins in the gut.”

While this is not entirely true, having a healthy microbiome clearly plays a large role in general wellbeing!

What tips do you have for maintaining a healthy gut? Share your stories & experiences below!

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