Someone needs this!

Recent research is confirming that gut health is at the absolute HEART of the pain, stiffness, depression, and exhaustion (and often so much more!) that are trademarks of arthritis and fibromyalgia.1

Few people connect pain in their joints to gut health. But the fact is, if you don’t heal your gut, you may never improve your joint health…or many other problems that may be plaguing you.  

We finally understand that gut health plays a huge role in psoriatic arthritis, rheumatoid arthritis, fibromyalgia, and many other chronic diseases. While there is still much we don’t understand, I have been successfully using gut-healing supplements and diets to improve arthritis for my husband and clients for the last few years.

Let’s take a peek at 5 ways to heal your gut in order to heal your joints, and the best supplements and foods to help you do so.

I’ve also created several supplement protocols with the specific supplements I recommend (that I have linked to below). I hope you find this incredibly helpful and actionable!

*When you set up your own Fullscript account through these links, you will get access to a large discount, a huge database of prescription-grade supplements from only verified sellers, and free shipping right to your door as often as you’d like. It is totally free to join, there are no membership fees, and it’s an awesome resource! It’s also more affordable and safe than ordering from Amazon or your local store.

**I earn a small commission on any supplements you order through my Fullscript links and I appreciate your support so that I can continue to provide free, valuable information for my readers. I will only recommend supplements, research, or clinical experience that I have found effective.  

#1 | Optimize Your Digestion

Best gut healing supplements and diet for arthritis

This is a big category where a lot could go wrong! Your digestive system includes your mouth, esophagus, stomach, small and large intestines, gallbladder, liver, and pancreas. Even your mood affects how well you digest!

Here are some common gut-health mishaps that might be affecting your joint health:

Eating in a state of “fight or flight” instead of “rest and digest”

When you eat while you’re stressed and on the go, your sympathetic nervous system gears down your digestion, and turns up your inflammatory response2. Both will impact your joint health. Instead, try to sit down and relax during meals. Take a deep breath and enjoy your food, even if you only have 10 minutes.

Eating quickly and not chewing your food thoroughly

This simple and often overlooked step alone may improve heartburn, indigestion, bloating, constipation,3 AND have a trickle-down effect that actually improves your arthritis symptoms as well! Try to slow down and make sure you’re thoroughly chewing your food.

Low stomach acid (hypochlorhydria)

If you often have heartburn, burping, fullness, constipation, or weak/peeling fingernails, low stomach acid (aka hypochlorhydria) could be your problem.4 A very acidic stomach with a pH around 2 is needed in order to digest and absorb protein, vitamin B12, iron, calcium, vitamin C, vitamin D, and more.5 This acid also kills bacteria and other pathogens that could be detrimental to your system. Hypochlorhydria can also inflame your stomach lining, leading to more digestive troubles. 

Learn how to test low stomach acid and which supplement to use to fix this issue here. Talk to your doctor first if you have peptic ulcers or other health conditions.

If you are on acid-reducing medications, your stomach pH is closer to 5, which causes many serious risks like intestinal infections, bacterial and yeast overgrowth, frequent sickness, osteoporosis, heart problems, immune deficiencies, poor protein digestion, and protein deficiencies.6–11.

Many foods and supplements can help heal the stomach lining and increase acid production until you and your health care provider can trace and treat the true cause of your low stomach acid.6,12–15.

Low stomach acid is associated with many joint pain diseases including rheumatoid arthritis, psoriasis, Lupus, and autoimmunity in general.4 Working with a functional medicine practitioner to fix the root cause of low stomach acid is important!

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Not enough enzymes

If you feel full for a long time after meals, have stomach aches, see undigested foods in your stools, or have pale-colored, frothy, or floating stools, your body may not be making enough digestive enzymes.

These powerful enzymes are released by your pancreas and small intestine. They help most of your food to be broken down and absorbed within the first few feet of your small intestine. If you aren’t making enough, you won’t digest fat, protein, and some carbohydrates properly.

This puts you at risk for many nutrient deficiencies that will impact the health of your whole body, including your joints.

Taking a good digestive enzyme for support while you heal your gut is pretty safe for most people and can be really helpful. After several months of gut healing, you can try weaning off of the enzymes and see how you feel.

Slow motility

Motility is how your gut moves food through your digestive system, using wave-like contractions. If your guts are sluggish, you are at higher risk for problems like acid reflux, constipation, and dysbiosis (too many bad bacteria). We will discuss why having the right bacteria is really important for gut and joint health later on.

If you are often constipated, bloated, or feel like food sits in your gut a long time after meals, slow motility could be the problem. Having surgery or certain conditions (like colitis or Crohn’s) that cause damage to your intestines puts you at a higher risk. Conditions that affect nerves or muscle contraction (like Parkinson’s, diabetes, or scleroderma) could also be a cause of slow motility. 

Improve healthy gut motility by:

–   eating in the “rest and digest” mode

–   taking in more magnesium-rich foods

–   including plenty of fiber from fruits, vegetables, and beans

–   adding seasonings and spices to food

–   taking prokinetic supplements like Iberogast, magnesium, peppermint, and ginger with your meals14,15

–   adding a good, quality probiotic to your routine

–   drinking plenty of filtered water every day

A daily bowel movement that is not difficult to pass is a good indicator that you are on the right track with motility. 

Check out my gut-healing prokinetics/motility supplement protocol on Fullscript.

#2 | Fortify Your Gut Immune System

Gut healing foods and supplements for autoimmune arthritis

You may not think of your digestive tract as a major player of the immune system, but it actually contains more immune cells than any other organ! It is estimated that 70% of your immune system lies within your gut.18

This makes sense because it is a main entry point into the body, right? Only when things are absorbed by your digestive system do they truly enter your body. You have a strong defense system in the digestive tract to keep pathogens from entering…or if they do enter, this defense system protects you from getting sick.

In the event of an invasion, a healthy immune system revs up, neutralizes the threat, and then goes quiet again.

BUT when chronic disease is present, the immune system stays “turned on” at a low level. We call this “chronic inflammation.” Inflammation is helpful in the event of a cut, infection, or broken leg, but can be very damaging for your body to continually remain in this constant state for the long term. 

Chronic inflammation is a root problem in EVERY chronic condition that I can think of, including all types of arthritis and fibromyalgia. So let’s explore your immune system (AKA inflammatory response) a bit more closely.

The 4 Layers of Your Gut’s Immune System

The immune system becomes very complex very quickly! To keep it simple, we have some basic layers of defense in our intestinal immune system.

4 Layers of Gut Immune System

First, you have the “good” microbes in the lumen of your intestines- these are beneficial bacteria that help protect you. There can also be “bad” microbes like yeast, parasites, or the wrong types of bacteria. More about their role in a minute!19

Second, you have a thick mucous membrane that coats and protects the cells that line your intestine from damage. It also contains an important antibody called IgA that helps protect you from harmful microbes.19

Third, you have the cells themselves that line your stomach and intestines. These powerhouse cells are only one layer thick, but in a healthy lining they are clasped tightly together and are able to carefully control what is absorbed into the body and what is not. If your lining becomes damaged, we call this “increased intestinal permeability” or “leaky gut.19–23

Fourth, patrolling behind the cell barrier lie the “soldiers” of the immune system-called T cells, mast cells, and other immune system components that are ready to attack any foreign invaders that happen to slip past the first 3 layers of defense.19

You can see how compromising any of these defensive layers of the gut lining could lead to an irritated immune system, inflammation, and the havoc that inflammation wreaks! This causes a downward-spiral to more inflammation, more symptoms, and more disease!

We now believe that ALL autoimmune diseases, like rheumatoid arthritis and psoriatic arthritis, begin with a leaky gut.20,22

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Gut Healing Supplements and Diet

There are many things that you can do to heal your gut, but let’s start with the basics and see how far that takes you! 

  • You can jumpstart a gut healing diet using this free 5 Day Action Plan to Improve Joint Pain with Food.
  • Add in some probiotic foods at each meal, such as yogurt, fermented sauerkraut (must say “live cultures”), kimchi, kombucha, kefir, Kevita, fermented vegetables and salsa, raw dairy, etc. Also, a probiotic supplement with a high potency and many strains of beneficial bacteria might be helpful.
  • Clear infections. An imbalance of bad bacteria in your digestive system or outright infections of harmful yeast, viruses, or parasites could be affecting your gut and your joints. We will talk more about this in the next section. I also have a free Microbiome Balancing Supplement Protocol here.
  • Improve digestion. I’ve explained how to do this in-depth in the “Optimize Your Digestion” section above.
  • Heal leaky gut. All of the above points will help heal leaky gut. We’ll discuss this in more detail in just a moment. 

#3 | Balance Your Gut Microbiome

Gut healing supplements and foods for arthritis.

Our bodies have trillions of microbes populating them. The large intestine is especially heavy in microbes like bacteria and yeast. Some are helpful, while some are harmful.

When you get too many of the bad bugs growing in your large intestine, this is called dysbiosis. When you get way too many, OR a really “wrong” bug like a virus or parasite, it’s called an infection. Or they could overpopulate in places like the small intestine (called SIBO, or Small Instestine Bacterial Overgrowth), where there should not be much bacteria at all. 

Dysbiosis symptoms might not be obvious. You could have bloating, digestive pain, sugar cravings, lots of burping and flatulence… or no digestive symptoms at all. Instead, you could have less obvious problems like leaky gut, joint pain, diabetes, skin rashes, or struggles with your weight. 

However, the helpful bacteria play many VERY important roles in your body. They could almost be considered as another organ because they are SO essential to your health! Seriously. 

Among other things, these friendly microbes help:18,19,24

  • Compete with bad microbes, keeping them from over-populating your gut and making you sick.  
  • Train your immune system to develop proper immunity and tolerance so that it does not overreact and start attacking everything (leading to allergies, food sensitivities, and autoimmune diseases). 
  • Break down resistant starches and fibers in your diet to form important short-chain fatty acids like butyric acid, which is the preferred fuel for your intestinal cells. Good bacteria literally FEED your cells and keep your lining healthy! (PS your intestinal cells use a lot of energy and need a lot of good bacteria, fiber, and resistant starches to keep them fed!)
  • Produce important vitamins (like vitamin K) that you can then absorb and use. 
  • Prevent leaky gut by keeping your mucous lining and cells healthy and intact.

Unfortunately, very few people think about those friendly bacteria before they pop antibiotics, antacids, steroids, and birth control pills haphazardly (that’s not to say you shouldn’t take them when you need them). 

Or when we subsist off the typical American diet that is so lethal to these “good bugs,” with very few probiotic foods (food with live, active cultures of good bacteria), or even prebiotic foods (fruits, vegetables, or whole grains rich in fiber and resistant starches) that these helpful microbes flourish on. 

Instead, the top 10 foods in the American diet are highly processed, fiber-poor white flours, white rice, white sugar, and animal proteins which harmful bacteria thrive on.25

Chronic stress or experiencing a traumatic event can also change your microbiome. It’s important to find ways to reduce or handle stress in healthy ways.

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How to Heal Gut Dysbiosis

Keeping your digestive system well-populated with beneficial bacteria (and clear of harmful bacteria that may have taken over) is essential to the health of your gut and plays an important role in prevention or treatment of psoriatic arthritis, rheumatoid arthritis, fibromyalgia, and many other conditions that cause joint pain!17

I recommend the following steps for a healthier microbiome:

  • First, clean up your diet using this free 5 Day Action Plan to Improve Joint Pain with Food.
  • Add probiotic foods at each meal, such as yogurt, fermented sauerkraut (must say live cultures), kimchi, kombucha, kefir, Kevita, fermented vegetables and salsa, raw dairy, etc. Also, a probiotic supplement with a high potency and many strains of beneficial bacteria might be helpful.
  • Clear infections. I like to use a broad-spectrum herbal antimicrobial that can kill not only bad bacteria, but also fungus and parasites. It usually takes several rounds and I like to switch the herbal formula up every month or so (or whenever the bottle is gone.)
  • Access my free Microbiome Balancing Supplement Protocol on Fullscript, which is where I order all the supplements for my family and clients. I recommend my favorite probiotics and antimicrobials. Fullscript is a high quality, verified discount supplement store that ships right to your doorstep. I love it! 
  • Regular exercise causes positive changes in the microbiome, reduces inflammation, and has many other benefits for joint health.

Keep in mind that the microbiome is very resistant to long-term change! It might take between 2 to 5 rounds of antimicrobial supplements (for roughly one month each) to clear bad microbes. For some infections, it will take testing, prescription drugs, and specialized diets to clear infections.17

You may also benefit from a broad spectrum, potent probiotic supplement to give those good microbes the upper hand.26–33 Be sure to take your probiotic 2 hours apart from your antimicrobials! Since antimicrobials are often taken with meals, bedtime could be a good time to take your probiotic. 

It will also take several months of diligently eating plenty of probiotic foods, fruits, vegetables, beans, and other whole plant foods, as well as reducing sugar and processed foods, before you permanently change your microbiome for the better.17 

If you have low stomach acid, you are inviting bad microbes to overpopulate and wreak havoc on your health over and over again. So be sure to fix that if it’s an issue for you! Learn how to test low stomach acid and which supplement to use here. It’s usually safe to support your stomach acidity with an HCL supplement while you work on other gut healing steps (unless you have peptic ulcers). Check with your doctor. 

It would probably not serve you to forever be on antimicrobial supplements, but you may benefit from them for a time. Follow up antimicrobial supplements by using food to keep your gut and microbiome healthy and balanced.

#4 | Heal Your Leaky Gut

Gut healing supplements and foods for dysbiosis and arthritis

The gaps between the cells of the gut are connected by “tight junctions” that typically regulate pretty closely what is able to be absorbed and what is not.19,20

Larger particles of partially-digested food cannot typically slip through this tight barrier (a little bit of flexibility in the permeability of the lining is normal, but we won’t get that technical). 

However, with a breakdown in gut health, this thin cell lining can also be damaged and the tight junctions become…quite literally, LEAKY! Some things that we know can cause leaky gut include:19

  • Tobacco
  • Alcohol
  • Ibuprofen, naproxen, and other NSAIDS
  • Sugar and processed foods
  • Antibiotics
  • Steroid medications
  • Birth control pills
  • Stress
  • Environmental toxins
  • Certain food additives

This means that things start slipping into the body that would not normally get through, like bacteria, toxins, and proteins that have not been completely broken down. The result? Basically, a ton of inflammation!

The immune system goes haywire because it treats all of these “foreign invaders” like they are harmful pathogens. Where once the components of that innocent pinto bean would normally be broken down and absorbed as simple sugars, amino acids, and fatty acids-NOW there are larger, partially digested pieces that are able to slip into the blood. 

The immune system does not recognize them in this form. So this once wholesome food now causes wide-spread inflammation. I heard a doctor explaining this concept say, “Once you have leaky gut, the most inflammatory thing you can do is eat.” 

Another problem that can develop is the immune system confusing the foods that it has flagged as the “enemy” with the healthy cells in the body, so it begins attacking those. This is called “autoimmunity.” Depending on your genetics and other factors, for one person this could mean the joints get attacked; for another, the skin; for another, the pancreas or thyroid, and so on. 

The thing about the immune system is that it has connections ALL OVER the body, so once these reactive bits enter the bloodstream, the reaction could happen somewhere entirely outside of the gut. When we are considering joint pain, low thyroid, infertility, or depression, it may not be intuitive to think, “Hey, I bet that’s connected with gut health!” But it very easily could be. In fact, it probably is!

Leaky gut (or if you want to sound really smart, “increased intestinal permeability”) is kind of a hot topic and is getting more research. We still have a lot to learn, but it seems to play an important role in everything from insulin resistance to autoimmune disease to Parkinson’s disease.19 Taking measures to have a good, healthy cellular lining is important!

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Foods and Supplements to Heal Leaky Gut

Fixing a leaky gut involves many of the solutions we’ve discussed in the other steps, including:

  • First, jumpstart a gut-healing diet using this free 5 Day Action Plan to Improve Joint Pain with Food.
  • Add probiotic foods at each meal, such as yogurt, fermented sauerkraut (must say live cultures), kimchi, kombucha, kefir, Kevita, fermented vegetables and salsa, raw dairy, etc. Also, a probiotic supplement with a high potency and many strains of beneficial bacteria might be helpful.
  • Clear infections. Bad microbes will prevent your gut from healing. I like to use a broad-spectrum herbal antimicrobial that can kill not only the bad bacteria, but also fungus and parasites. It usually takes several rounds and I like to switch the herbal formula up every month or so (or whenever the bottle is gone.) Access my free Microbiome Balancing Supplement Protocol on Fullscript. 
  • Eliminate foods that your immune system is reacting to because of leaky gut. If you don’t remove those foods, you will cause major inflammation and damage to your gut (and other organs) every time you eat them. Don’t worry, once you’ve healed you can eat most foods again without a problem! More on this next!
  • Removing things from life that are damaging your gut like stress, processed foods, infections, toxins, antibiotics or medications (talk with your doctor of course!)

#5 | Eliminate Sensitive Foods

Leaky gut healing supplements and foods for arthritis.

Once you have leaky gut, you can now develop multiple food sensitivities, which is when your immune system begins reacting to foods leaking through your damaged gut lining. This could be causing strange new symptoms all over your body. 

Your immune system could decide to attack just about anything, even healthy foods like spinach and apples. As we mentioned, the worst thing you can do when you have leaky gut is EAT foods you’ve become sensitive to. 

So what is the solution? The solution is avoiding the foods YOU are sensitive to TEMPORARILY while enjoying a healthy, wholesome, healing diet that will give your body all of the vitamins, minerals and high quality proteins it needs to function optimally and maintain a healthy gut lining, and a diet that is rich in fruits, vegetables, and fiber to feed the healthy bacteria.

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How to Identify Food Sensitivities

How do you know which foods are a problem for you?

You have 2 options:

  • An elimination diet that restricts common problem foods for a time, such as wheat, gluten, dairy, soy, corn, and nightshade vegetables. The Autoimmune Protocol Diet (AIP) or the ITIS elimination diets may be helpful for joint pain. Or I can guide you through an effective elimination diet (and all the other principles discussed in this article) in my online Joint Pain Course.
  • A food sensitivity blood test that identifies exactly which foods your immune system is reacting to without much guesswork. I’ve researched this extensively and only recommend the Mediator Release Test and LEAP diet that goes with it. It helped my husband and dozens of clients tremendously when other test methods did not. I can help you order and implement MRT/LEAP (and everything else discussed in this article) when you enroll to work with me one-to-one

If you want to learn more about these options, I wrote a very thorough article: The 4 Best (+7 Worst) Food Sensitivity Tests.

I researched for MONTHS for my husband to find the best way to figure out if he had food sensitivities.

  • First we tried elimination diets, but could never nail down which foods were causing flares. And it was difficult for him to give up all the foods he loved while we experimented. 
  • Then we tried an IgG test, even though the evidence around the helpfulness of them is shaky. It didn’t really help. 
  • I was introduced to the Mediator Release Test (MRT) from fellow dietitians that had been using it with great success for a variety of autoimmune and other chronic diseases. I went through over 30 hours of training to get certified to use it for my husband. Within a couple of weeks, his heart burn, migraines, brain fog, and fatigue were all GONE! Most importantly, his joint pain greatly improved and he was no longer hobbling around in pain. 

If you suspect food sensitivities may be behind your symptoms and you can’t seem to figure out which foods are your triggers, or you’d rather not mess around with playing the guessing game and just cut right to the chase, I recommend considering the Mediator Release Test (MRT) combined with a gut-healing protocol, as I do with my clients. 

Since chronic disease can be quite complicated and it’s not something you really want to mess around with, I recommend working with a Certified LEAP Therapist like myself or another qualified functional medicine practitioner that will help you get to the heart of your issues quickly and thoroughly.

Gut Healing Supplements and Diet

Gut-healing foods and supplements for food sensitivities.

We have considered only 5 of many ways that gut health contributes to joint pain conditions like arthritis and fibromyalgia.

Now here is a list of some steps you can implement to improve your overall gut health (and consequently, joint health, exhaustion, weight loss, and so much more!). We’ve discussed all of these above, but let’s lay them out clearly as a whole! 

  • Jumpstart your gut-healing diet using this free 5 Day Action Plan to Improve Joint Pain with Food.
  • Enhance digestion:
    • Eat slowly, chew thoroughly, and enjoy food in a “rest and digest” state.
    • A basic supplement regimen that includes a multivitamin, probiotic, and a few other basics can be really helpful. I use Fullscript for all of the supplements for my family and clients because I can get high-quality supplements from verified sellers at a discount. You can set up your own free account and have access to my practitioner discount! Access my free Joint Pain Basic Supplement Plan on Fullscript. 
    • Add on digestive enzymes or hydrochloric acid (HCL) as needed. You can get digestive enzymes or HCL in separate supplements, or you can get them together as one supplement (if you need both) on Fullscript as well. Access my How to Test for Low Stomach Acid protocol here. Talk with your doctor first, especially if you have peptic ulcers or are on any acid-blocking medication.
    • Taking peppermint, ginger, or other prokinetics with meals can improve both irritated and sluggish digestion. If you use them as teas, be sure to cover the pot that they are steeping in so that you keep the helpful, yet fragile oils in the tea. See which prokinetics/digestion enhancers I recommend here.
  • Add probiotic foods at each meal, such as yogurt, fermented sauerkraut (must say live cultures), kimchi, kombucha, kefir, Kevita, fermented vegetables and salsa, raw dairy, etc. Also, adding a probiotic supplement with a high potency and many strains of beneficial bacteria is a safe and helpful option for most people. 
  • Balance your microbiome. Bad microbes will prevent your gut from healing. I like to use a broad-spectrum herbal antimicrobial that can kill not only bad bacteria, but also fungus and parasites. It usually takes several rounds, and I like to switch the herbal formula up every month or so (or whenever the bottle is gone.) Access my free Microbiome Balancing Supplement Protocol on Fullscript. 
  • Eliminate foods your immune system has decided to react to because of leaky gut. If you don’t remove those foods, you will cause major inflammation and damage to your gut and other organs every time you eat them. Don’t worry, once you’ve healed, you can eat most foods again without a problem! 
    • You have 2 options to discover your problem foods:

i. An elimination diet that restricts common problem foods such as wheat, gluten, dairy, corn and nightshade vegetables. I can guide you through an effective elimination diet (and all the other principles discussed in this article) in my online Joint Pain Course.

ii. A food sensitivity blood test that identifies exactly which foods your immune system is reacting to without much guesswork. I’ve researched this extensively and only recommend the Mediator Release Test and LEAP diet that goes with it. It helped my husband and dozens of clients tremendously when other test methods did not. I can help you order and implement MRT/LEAP (and everything else discussed in this article) when you enroll to work with me one-to-one.

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Here to Help

I’ve linked many free resources and protocols above. I’ve also done my best to explain these various issues as clearly and organized as possible. 

But if you still find all of this overwhelming, don’t worry! I am here to help! I found it all a little overwhelming at first too as I searched for safe, natural treatments that would relieve my husband’s debilitating psoriatic arthritis. And I had the benefit of already being a dietitian, with a sound understanding of the human body, immune system, nutrition, and how to read and interpret research. 

The fact is that there’s usually more at play than JUST gut health when it comes to your arthritis. This is just one root cause to consider. 

If you want a tried-and-true, step-by-step plan to help you understand the many root causes of your joint pain and what you can do about it, I’d love to work with you!

Check out my comprehensive Improve Joint Pain with Food Online Course, or sign up to work with me one-to-one. We’d also love to have you come hang out in our free Facebook Community!

May you be blessed with hope and healing!

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You May Also Be Interested In:

References:

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3.     Ahn-Jarvis JH, Piancino MG. Chapter 14: Impact of oral health on diet/nutrition. In: Monographs in Oral Science. Vol 28. S. Karger AG; 2019:134-147. doi:10.1159/000455383

4.     Testing_Low_Stomach_Acidity.pdf. Accessed March 12, 2021. https://www.ifnacademy.com/wp-content/uploads/2015/06/Testing_Low_Stomach_Acidity.pdf

5.     Cavalcoli F, Zilli A, Conte D, Massironi S. Micronutrient deficiencies in patients with chronic atrophic autoimmune gastritis: A review. World J Gastroenterol. 2017;23(4):563-572. doi:10.3748/wjg.v23.i4.563

6.     Guilliams TG, Drake LE. Meal-Time Supplementation with Betaine HCl for Functional Hypochlorhydria: What is the Evidence? Integr Med Encinitas Calif. 2020;19(1):32-36.

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8.     Jung SB, Nagaraja V, Kapur A, Eslick GD. Association between vitamin B12 deficiency and long-term use of acid-lowering agents: a systematic review and meta-analysis. Intern Med J. 2015;45(4):409-416. doi:10.1111/imj.12697

9.     McColl KEL. Effect of proton pump inhibitors on vitamins and iron. Am J Gastroenterol. 2009;104 Suppl 2:S5-9. doi:10.1038/ajg.2009.45

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11.   Ali T, Roberts DN, Tierney WM. Long-term Safety Concerns with Proton Pump Inhibitors. Am J Med. 2009;122(10):896-903. doi:10.1016/j.amjmed.2009.04.014

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14.   Khalaf MHG, Chowdhary S, Elmunzer BJ, Elias PS, Castell D. Impact of Peppermint Therapy on Dysphagia and Non-cardiac Chest Pain: A Pilot Study. Dig Dis Sci. 2019;64(8):2214-2218. doi:10.1007/s10620-019-05523-8

15.   Kim YS, Kim J-W, Ha N-Y, Kim J, Ryu HS. Herbal Therapies in Functional Gastrointestinal Disorders: A Narrative Review and Clinical Implication. Front Psychiatry. 2020;11. doi:10.3389/fpsyt.2020.00601

16.   Module 3 – Nutraceuticals – An Advanced Approach to Using Dietary Supplements in Clinical Practice « IFN Academy. Accessed March 12, 2021. https://www.ifnacademy.com/modules/module-2-nutraceuticals-an-advanced-approach-to-using-dietary-supplements-in-clinical-practice-with-special-guest-faculty-kelly-morrow-ms-rdn/

17.   Blum SS, Bender M. Healing Arthritis: Your 3-Step Guide to Conquering Arthritis Naturally. Scribner; 2017.

18.   The Gut: Where Bacteria and Immune System Meet. Accessed March 12, 2021. https://www.hopkinsmedicine.org/research/advancements-in-research/fundamentals/in-depth/the-gut-where-bacteria-and-immune-system-meet

19.   Bischoff SC. “Gut health”: a new objective in medicine? BMC Med. 2011;9:24. doi:10.1186/1741-7015-9-24

20.   Fasano A. All disease begins in the (leaky) gut: role of zonulin-mediated gut permeability in the pathogenesis of some chronic inflammatory diseases. F1000Research. 2020;9. doi:10.12688/f1000research.20510.1

21.   Quigley EMM. Leaky gut – concept or clinical entity? Curr Opin Gastroenterol. 2016;32(2):74-79. doi:10.1097/MOG.0000000000000243

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