In my last post, I discussed the “gut-brain-skin” axis theory—which suggests that what we eat, what lives in our gut, our mood and the health of our skin are all intimately related.

In the 1930’s it was popular to treat acne internally with the use of L. acidophilus and L. acidophilus –fermented milk products, though there was little research into this approach and interest waned despite its apparent effectiveness.  More recently, studies have shown that many patients with acne vulgaris and acne rosacea have low stomach acid (hypochlorhydria), small intestinal bacterial overgrowth (SIBO) and disturbances in normal gastrointestinal microflora.  In 1961, a physician by the name of Robert Silver conducted a study in which he orally administered L. acidophilus and L. bulgaricus—and showed that 80% of the 300 patients studied had some degree of clinical improvement in their acne.  Since that time, advances in molecular biology have shown that probiotics can regulate the release of inflammatory cytokines within the skin, including substance P—which may be a primary mediator of inflammation and sebum production in acne.  Both Bifidobacterium longum and Lactobacillus paracasei can reduce the inflammation mediated by substance P.  Certain bacterial strains such as Streptococcus salivarius secrete substances with antimicrobial properties, which limit the growth of Propionibacterium acnes, thought to play a major role in the development of acne lesions.

Probiotics may also act in the “gut-brain-skin” axis via glycemic control.  New research shows that gut flora contribute to glucose tolerance—for example, Bifidobacterium lactis improved fasting insulin levels and glucose turnover rates.

Of note, milk may play a role in acne development via insulin-like growth factor 1 (IGF-1), which is absorbed across colonic mucosa but reduced in fermented dairy products.  Thus, avoidance of milk (and substituting fermented milk products such as cheese, yogurt, kefir) may help improve acne in some patients.

More research is forthcoming with regard to the specific molecular mechanisms at play, but so far the evidence is quite compelling that dietary changes and modification of gut microflora can have an impact on skin inflammation and acne.

TIP:  A topically applied yogurt mask (which contains the lactic acid bacteria Streptococcus thermophilus) can increase ceramide production—which have activity against P. acnes and a direct anti-inflammatory effect.

BOTTOM LINE:  Acne may respond to changes in diet (increased fermented dairy consumption and nutrient rich foods; reduce sugar, carbohydrates, processed foods) as a result of normalization of gut microbiota.


PROBIOTICS and your mood

How does diet affect our mood?

Some scientists believe that what we eat encourages certain types of microbes to thrive in our gastrointestinal tract, and these microbes can affect our mood, skin, weight, immune system and risk for chronic diseases such as autoimmune disease and cancer.  The “gut-brain-skin” theory has been around since 1930 when dermatologists John H. Stokes and Donald M. Pillsbury noted that skin conditions such as acne are often associated with mood disorders and gastrointestinal disturbances—which increase gut permeability and lead to systemic inflammation.

Since the 1930’s, animal and human research has supported the idea that mental health disorders are frequently associated with low levels of Lactobacillus and Bifidobacterium, an omega-3 deficient diet and low stomach acid (hypochlorhydria).  The microflora of our GI tract is intimately involved in gut permeability—which when breached can allow foreign proteins across the gut’s barrier and trigger immune reactions and systemic inflammation, leading to inflammatory acne lesions and depressed mood/ anxiety.  In fact, it has been shown in animal studies that a circulating endotoxin, E. coli lipopolysaccharide (LPS)—which is usually not present in blood but can be if the intestinal barrier is not working proprerly—can itself produce depression-like behavior in animals.  In addition, if the gut is not populated with beneficial microbes (or they’re not in the appropriate location), small intestinal bacterial overgrowth (SIBO) can result—which has been associated with fibromyalgia, chronic fatigue syndrome, constipation, depression and anxiety.  One cause of this disturbance of normal gut microflora is hypochlorhydria, sometimes caused by medication (e.g. proton pump inhibitors, H2 blockers), hypothyroidism, atrophic gastritis, naturally occurring with age, or other less common conditions such as tumors, mucolipidosis or pellagra (niacin deficiency).

Probiotics including Lactobacillus and Bifidobacterium species have been shown to limit systemic oxidative stress and reduce inflammatory cytokines in various tissues of the body, inhibit the release of substance P and decrease monoamine oxidase activity—resulting in decreased anxiety- like behavior in animals.  Stress hormones and substance P are known to cause anxiety, depression and aggression.  The addition of probiotics to lab animal feed increases tissue levels of omega-3 fatty acids, peripheral tryptophan levels, and increase serotonin and dopamine turnover in the frontal cortex and limbic system—which can have a positive impact mental health.

This “gut-brain-skin” theory also works in reverse—stress and anxiety can adversely affect the gut microflora, as can a poor diet.  In the Western diet, which is typically high in fat, sugar as well as processed foods, the loss of Bifidobacteria can lead to increased intestinal permeability, encroachment of LPS endotoxins through the intestinal barrier, low grade inflammation, insulin resistance and mood disorders.  As we learn more about the prebiotic-probiotic-mood relationship, perhaps physicians will consider treating mood disorders with a prescription for a certain diet or HCl supplement, as opposed to a psychopharmaceutical drug.

BOTTOM LINE:  Prebiotics and probiotics can have a positive impact on mood.  Anyone who wishes to lead a healthier lifestyle and promote a normal mood state should eat a healthy diet and consider consuming fermented dairy products daily (see PROBIOTICS overview).


The concept of probiotics—live microorganisms which when administered in adequate amounts confer a health benefit to the host—is not new.  It has only been recently that the scientific community has taken a closer look at probiotics and their practical applications.  There are too many areas under investigation to discuss, so here’s a brief list of possible uses of probiotics in the medical arena (the items at the top of the list have more supporting evidence than the more speculative/ uncertain items toward the end):

• Infectious diarrhea (antibiotic associated, rotavirus, c. diff, traveller’s)

• Irritable Bowel Syndrome (IBS)

• Lactose intolerance

• Hyperlipidemia

• Small intestinal bacterial overgrowth (post op gastric bypass or Crohn’s Disease)

• Helicobater pylori

• Bacterial vaginosis

• Necrotizing Enterocolitis (NEC) in pre-term infants

• Colon cancer (prevention and possibly treatment)

• Metabolic syndrome (obesity, hyperlipidemia, hypertension)—and thus type 2 diabetes and coronary artery disease

• Dermatologic conditions: acne, rosacea

• Inflammatory Bowel Disease (IBD)–Crohn’s Disease and Ulcerative Colitis

• Prevention of the common cold

• Hypertension (high blood pressure)

• Hepatic encephalopathy (due to liver disease)

• Nursing Home Care: decreased febrile episodes, reduced constipation and diarrhea, reduced MRSA

• Autoimmune disorders—such as multiple sclerosis, Type 1 Diabetes (still under investigation; demonstrated in mice)

• Allergic conditions—food allergies, atopic dermatitis (still under investigation)

• Anxiety, depression (still under investigation)

Though it might seem like wishful thinking that these bacteria can be so helpful, it makes absolute sense.  Humans have evolved with these bacteria living symbiotically inside our guts, which have come to serve as an organ within an organ—aiding digestion, improving nutrient absorption, warding off infection, regulating gut permeability, and modulating the host’s immune system.   As a result of our modern industrialized society, practices such as surgical childbirth, use of pasteurized food products, synthetically supplemented food, cleaner homes, overuse of antibiotics, etc. have affected the microenvironments on our skin and in our gastrointestinal tract.  This may very well be contributing to the surge in modern diseases such as diabetes, allergies and autoimmune disorders that we are currently witnessing.

Note:  the relationship between host and gut microflora is extremely complex and the strains of bacteria studied for the above conditions are very specific.  Much of the research thus far has investigated Lactobacillus and Bifidobacterium species.   If you were interested in incorporating probiotics in your daily life, you may consider adding fermented milk products (such as yogurt or kefir with live active cultures) to your diet.   These usually contain many beneficial strains of bacteria including L. acidophilus, B. bifidus, S. thermophilus, and are generally regarded as safe.

BOTTOM LINE:  We have been big yogurt fans for years, but have added homemade kefir to our diet.   Making your own kefir is very simple and has no added sugars–you can flavor with banana & strawberry or other fruit in a smoothie.  Many websites walk you through the process and have great tips & videos, including: and .  There are also many online sites where individuals offer kefir grains for free–look for a local donor.  Tips:  avoid using any metal(spoons, strainers) and avoid ultra- pasteurized milk (use pasteurized milk instead).

GRAPEFRUIT a tool for weight loss?

Can certain foods actually encourage your body to break down fat and discourage the deposition of additional fat?  Possibly.

Grapefruit has been regarded as a health food and a diet aid for many years, but it is only recently that evidence of grapefruit’s metabolism and interaction with the human gut is shedding light on the mechanisms involved.  And it may actually prove to be a useful adjunct to diet and exercise in the battle of the bulge.

In a study done at the Scripps Clinic in La Jolla, CA in 2006, it was shown that patients randomized to 1/2 a fresh grapefruit (or 8 ounces of grapefruit juice) three times a day before each meal lost more weight than the placebo group and there was a significant reduction in insulin levels after food intake.  Insulin is a hormone which regulates carbohydrate and fat metabolism–and encourages the storage of fat while simultaneously preventing the breakdown of stored fat.  If an individual’s goal is to lose weight (and fat), it would be advantageous to prevent any surges in insulin release.  In addition, grapefruit has been investigated as a prebiotic–defined as an undigested food ingredient which encourages the growth of beneficial bacteria within the gut.  This relationship is quite complex and still under investigation, but evidence thus far suggests that the undigestible sugars in grapefruit (fructooligosaccharides, FOS) support the growth of Bifidobacterium and Lactobacillus species in the gut–both which confer numerous health benefits to be discussed in PROBIOTICS post.

Other than the above mentioned advantages of regular grapefruit ingestion, grapefruit contains powerful antioxidants (eg. lycopene) and vitamin C , has been shown to improve lipid profiles, lower blood pressure in people with hypertension and reduced the risk of kidney stones (Calcium oxalate type).


CAUTION:  Grapefruit and grapefruit juice are known to interact with many drugs such as blood pressure medications, statins, anti-arrhythmics,  anxiolytics, antidepressants, and protease inhibitors  (discuss this with your prescribing doctor; for a more complete list see  In addition, in large quantities, the components of grapefruit can have the opposite effect than that intended (e.g. with regard to gut flora).  Remember:  Poison is in everything, and no thing is without poison. The dosage makes it either a poison or a remedy.  ~ Paracelsus


BOTTOM LINE:  In moderation (and in the absense of drug interactions), grapefruit may help with weight loss/ weight control, particularly if added to a calorie restricted diet and regular exercise.  I personally love to eat grapefruit and try to incorporate it into our meals daily.



RECIPE simple & awesome guacamole

The most critical part of making good guacamole is to have perfectly ripe avacados—which can be a tough call, since they’re usually rock hard when you buy them and suddenly ripen before you know it (unless you check them by touch every day)!  Avacados are so creamy and flavorful, there’s really no need to add exotic ingredients or spices—the following ingredients can be found in most kitchens.


2 ripe avacados

Juice of ½ lemon (or lime)

½ medium sized red onion, minced

1 tomato, chopped

10-12 dashes Tabasco Sauce (or to taste)

coarse salt to taste


Cut avacadoes lengthwise, remove pit and mash with fork.

Add lemon, onion, tomato, salt and Tabasco, and mix well.

Adjust salt and Tabasco to taste.

Serve with tortilla chips (we like Garden of Eatin’ Blue Corn Tortilla Chips).

RECIPE pumpkin spice bread

I’ve made this pumpkin bread for years–and though it’s not the healthiest recipe I have (it has some sugar, which I’ve reduced with some success; and flour), it has become a family favorite and a wonderful addition to any holiday table or potluck gathering.   Note:  I have tried this recipe with Bob’s Red Mill Gluten Free All Purpose Flour and it was not as tasty as with regular whole wheat flour (please let me know if you come up with a better gluten free solution!)


2 cups canned pumpkin (Farmer’s Market Organic pumpkin has BPA free cans)

3 cups sugar (can reduce to 2 ½  without much suffering)

1 cup water

1 cup vegetable oil (I use canola oil)

4 eggs

3 1/3 cups  whole wheat flour

2 tsp baking soda

2 tsp cinnamon

1 tsp salt

1 tsp baking powder

½ tsp nutmeg

¾ tsp ground cloves

optional: 2 Tbsp flax seed and/or 2 Tbsp wheat germ

unhealthy option: add ~3/4 cup chocolate chips


Preheat oven to 350 degrees. In a large mixing bowl, combine the pumpkin, sugar, water, vegetable oil and eggs.  Beat until well mixed.

Measure the other ingredients in a separate bowl and stir.  Slowly add the dry ingredients to the pumpkin mixture, beating until smooth.

Grease two 9- by 5- inch loaf pans and dust with flour.  Evenly divide batter between the two pans. Bake for 60-70 min or until a toothpick inserted in the center comes out clean.  Cool 10-15 minutes.  Remove from pans by using a knife to loosen from edges of pan, then invert onto a rack and tap the bottoms.  Slice and serve plain, buttered or with cream cheese.

BISPHENOL-A (BPA) everywhere? no, but here’s a list…

Not to be an alarmist, but the more research I do on the topic of human exposure to bisphenol-A (BPA), the more concerned I have become.   The list of potential exposures is long, but we certainly have a choice to limit these.  And as consumers, we must make our preferences known to lawmakers and manufacturers.  Unfortunately, the FDA opted not ban the use of BPA in food packaging on 3/30/12, but stated that they will continue to evaluate the risks of BPA to human health.

Here’s a list of the most common (known) sources of BPA:

CANNED FOOD –most canned food has lining containing BPA; more manufacturers are starting to use BPA free cans (see Mark’s Daily Apple for specific brands); canned food is considered a significant source of BPA

THERMAL PAPER RECEIPTSeg. ATM, gas station, store receipts; large amount of BPA–in the order of 60-100mg, as opposed to nanogram amounts leached from polycarbonate bottles!

POLYCARBONATE BOTTLES  (labeled #7 or #3)–including water coolers at work, older Nalgene water bottles (newer Nalgene and Camelbak bottles are BPA free)

SODA AND BEER CANS –BPA is particularly soluble in alcohol, so opt for bottled beer

METAL WATER BOTTLES–such as Sigg (prior to their admission of BPA lining and exchange program in 2008/9);  Kleen Kanteen has no BPA and Sigg’s newer containers are BPA free

TUPPERWARE  (if labeled #7)

PLASTIC WRAP –no pthalates since 2006; now made with LDPE, which has fewer contamination concerns; best not to microwave.

BABY BOTTLES and PACIFIERS –look for BPA- free bottles and pacifiers; some states have outlawed the use of BPA in baby bottles (as have other countries including Canada, EU, United Arab Emirates, China, Malaysia)

DENTAL SEALANTS and FILLINGS (see post BPA and sealants)

MOUTHGUARDS  (check w/ manufacturer)

PIZZA BOXES –many are made from recycled newspaper and receipts, which both contain BPA

Here are some helpful resources: