Stanford Lifestyle Psychiatry Clinic

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By Sharon Brock, MEd, MS

Top Recommendations for Brain Health as we age:

  1. Physical exercise – both aerobic and resistance training
  2. Healthful nutrition – fresh, fibrous whole foods
  3. Cognitive engagement – educational achievement and continued engagement in cognitively challenging and meaningful activities

The Stanford Lifestyle Psychiatry Clinic offers holistic psychiatric care, psychotherapy, nutritional counseling, medication management, mind-body practices, and health-and-wellness coaching. The clinic is different from other psychiatric facilities in that it offers lifestyle interventions (including exercise, nutrition, yoga, mindfulness, and sleep optimization) as primary modalities for mental health management, in addition to medication and psychotherapy.

“The clinic is for patients who prefer to take an active role in their healing by adding lifestyle practices to their treatment plan, rather than take the passive route of just taking medication,” says Douglas Noordsy, Founder and Director of the Stanford Lifestyle Psychiatry Clinic. “Patients should be interested and motivated to implement lifestyle practices in their daily life to acquire skills they can continue to use to take responsibility for their mental health.”

The clinic also offers rising mental health care professionals opportunities to train in lifestyle psychiatry and incorporate lifestyle interventions into medicine at Stanford and worldwide.

Focusing on Collaboration

Care in the Lifestyle Psychiatry clinic begins with a comprehensive assessment of past and current behaviors related to the patient’s health and well-being. The health provider identifies which behaviors may have contributed to the patient’s mental health symptoms and offers treatment options that may include medications, psychotherapy, and lifestyle interventions.

The provider then collaborates with the patient to review the potential advantages and disadvantages of a menu of lifestyle interventions. Together, the provider and patient create a treatment plan that sets manageable goals and promotes healthy behaviors. With ongoing sessions, the provider and patient continually revise the plan until the patient achieves the desired results.

“When working with patients, we offer a menu of lifestyle interventions, and they choose which option they would like to use,” says Dr. Noordsy. “With this shared decision-making approach, patients are more engaged and have a greater sense of ownership regarding their health. I’ve found that when lifestyle interventions are part of the treatment plan, patients feel more confident about managing their mental health and are likely to achieve better outcomes.”

Faculty at the clinic investigate various lifestyle practices to discern which are most effective for specific psychiatric conditions. For example, research shows that physical exercise results in increased brain activity by signaling neurons to form synapses (connections among brain cells). Also, brain imaging reveals that regular exercise causes critical areas of the brain to grow larger in volume. Increasing brain activity and volume is particularly supportive for those with schizophrenia and bipolar disorder.

“Neurotrophic factors released during exercise tell your brain, ‘It’s time to wake up; we are out of hibernation and into activity mode.’ This increased activity in the brain is especially beneficial for people with bipolar and schizophrenia who have impairment in the activity of certain parts of the brain as well as loss of brain volume,” says Dr. Noordsy. “Also, brain regions grow larger due to physical exercise, and a larger brain is healthier whether or not you have a brain disorder.”

Lifestyle Psychiatry and Depression

To treat depression, Dr. Noordsy explains that taking a standard antidepressant medicine could help decrease depression faster than a lifestyle intervention such as exercise but may not be effective over time. Also, patients often experience a flatness of emotion and sexual side effects from antidepressants.

Physical exercise is typically on the treatment plan for patients with depression because it releases neurotransmitters involved with mood and well-being, such as dopamine, norepinephrine, and serotonin. Although physical exercise may take longer to decrease symptoms of depression, this intervention has a more lasting effect. Additionally, exercise positively affects fatigue, cognitive function, heart health, and overall health.

“When lifestyle interventions are effective, patients often reduce the dose of their medication and sometimes come off of it entirely. This can be an ideal way to minimize medication side effects,” says Dr. Noordsy. “Ultimately, if a patient’s desired outcomes are a greater sense of well-being and greater ability to function in the world, then lifestyle interventions are the best way to get there.”

For some patients, their symptoms are so severe that they struggle to adopt lifestyle interventions such as regular exercise or optimal sleep without using medication.  In these cases, Dr. Noordsy prescribes an antidepressant to get them moving. Over time, as the amount of exercise, healthy nutrition, and mindfulness practice increase the patient may get to a point where symptoms are manageable and they can decrease medication dosage to minimize side effects.

Yoga and Mind-Body Practices in Psychiatric Care

Along with psychiatrists, the clinic’s team of providers includes a health-and-wellness coach and two psychologists trained in Stanford’s therapeutic yoga program, YogaX, which aims to bring yoga and mind-body practices into healthcare. With a full range of expertise, the clinic provides multidisciplinary care across the pillars of Lifestyle Medicine.

YogaX instructors are trained psychologists who promote the science and application of therapeutic yoga. YogaX offers yoga teacher training tailored to healthcare providers who want to bring yoga practices and philosophy to their patients. YogaX also provides free yoga and wellness classes for the public on its YouTube channel.

In the future, Dr. Noordsy will continue to train mental healthcare professionals in the value and application of lifestyle medicine in psychiatry. In this training, he emphasizes the importance of educating patients about the research behind the recommendations. For example, he believes that if patients know about the evidence-based mental health benefits behind the yoga intervention, they are more likely to engage in a regular yoga practice.

“I’d love to see the day where every psychiatrist offers lifestyle interventions as part of their treatment plan,” says Dr. Noordsy. “Whether it’s a weekly yoga group, eating salads for lunch, or taking daily walks in nature, seeing their psychiatrist for regular care is just one of many things the patient is doing for their well-being.”

***For more information or to schedule an appointment at the Stanford Lifestyle Psychiatry Clinic, please call (650) 498-9111.

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What Excessive Screen Time Does to the Adult Brain

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By Mary Grace Descourouez, MS, NBC-HWC

Binge-watching television, watching YouTube videos for hours, or scrolling on your phone every morning may seem harmless, but research shows that too much screen time may be detrimental to your health.

We know children’s brains are affected by spending too much time glued to their cell phones, however research shows that adult brains are also negatively impacted by excessive screen time, defined as more than two hours a day outside of work hours.

Too much screen time can impact our health in a myriad of ways, from eye strain and neck pain to social isolation and mental health, and in some cases, it may cause harm to our brains.

“The negative effects of screen time are insidious because you can’t see what’s happening in your brain as you’re staring at the screen,” says Maris Loeffler, MA, Family and Marriage Therapist, member of the Stanford Lifestyle Medicine Cognitive Enhancement pillar. “If you scrolled on your phone in bed for an hour just one morning, the negative impacts would be minimal. But if it becomes a habit, day after day, month after month, this behavior can take a toll.”

Since the eyes are directly connected to the brain, Loeffler encourages us to think about our eye health to ensure overall brain health. Rather than looking at our phones upon waking, Loeffler recommends starting each morning looking at the horizon or an object outside and far away.

To prevent eye strain throughout the workday, The American Academy of Ophthalmology recommends the 20-20-20 rule for adults who work on a computer. This rule suggests that individuals look at something 20 feet away for 20 seconds every 20 minutes of the day.

What is Happening in the Brain During Screen Time?

This study found that increased use of screens among adults may harm learning, memory, and mental health, as well as the potential to increase the risk of early neurodegeneration. The study shows that in adults aged 18 – 25, excessive screen time causes thinning of the cerebral cortex, the brain’s outermost layer responsible for processing memory and cognitive functions, such as decision-making and problem-solving.

Another study found that adults who watched television for five hours or more per day had an increased risk of developing brain-related disease like dementia, stroke, or Parkinson’s.

This study found that excessive screen time can hinder sleep, especially when looking at screens late at night. Light from the screen can delay melatonin release from the brain’s pineal gland, impacting the body’s natural circadian rhythm and causing difficulty sleeping.

Additional studies found that adults who engage in excessive screen time or have a diagnosed smartphone addiction had lower gray matter volume. Gray matter is brain tissue essential for daily human functioning and is responsible for everything from movement to memory to emotions. Gray matter volume naturally decreases as we age, so along with reducing screen time, engaging in activities that maintain our gray matter volume and promote brain health, such as exercise and movement, restorative sleep, social engagement, and stress management, is crucial.

“Passive screen time is like eating sugar but for your brain. It ‘tastes’ good, and you want it now, but you’re not actually feeding yourself. You’re not giving your brain any nutrition,” says Loeffler. “Instead, replace screen time with an intentional healthy habit that feeds your brain in a healthy way. Lifestyle medicine activities, like exercise, good sleep, social connection, and stress management, function like ‘nutrition’ for your brain and mental health.”

Specifically, Loeffler cautions us not to pick up the phone after the alarm goes off in the morning. She explains that looking at our email or social media on our phones while still in bed jolts the nervous system and can trigger the fight-or-flight response since we aren’t fully awake yet.

Also, if we look at our phones first thing every morning, we create a pattern and can set the flight-or-flight response as our default mode of operation. So, not only does this behavior set an anxiety-filled tone for the day, but we are also training our brains to be more hypervigilant in general.

“One of the biggest issues with picking up the phone right away in the morning is that when you have an object close to your face, it’s registered as a threat,” says Loeffler. “You wouldn’t want to wake up and look a bear in the face every morning. On a physiological level, it’s the same thing.”

Practice of the Month: No Screen Time for the First Hour of the Day

Stanford Lifestyle Medicine experts recommend no screen time for the first hour of the day to support cognitive enhancement. Instead, we suggest engaging in a lifestyle medicine activity upon waking to promote whole-body health:

  • Exercise
  • Call a friend or family member
  • Prepare a healthy breakfast
  • Meditate and count your blessings
  • Listen to music
  • Create a gratitude list
  • Read a book
  • Spend time outside and get morning light

“How do you want your day’s energy and mood to start?” says Loeffler. “Intentionally implementing a morning routine that reflects lifestyle medicine choices instead of screen time sets a positive tone for the day and supports brain health and cognitive enhancement.”

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Metabolic Psychiatry: Bridging Brain and Metabolic Health

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By Maya Shetty, BS

In recent years, a groundbreaking field known as Metabolic Psychiatry has emerged at the intersection of metabolic and brain health. Spearheaded by Shebani Sethi, MD, a Clinical Associate Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University, this innovative field sheds light on the powerful connection between our metabolic health and mental well-being.

As rates of mental illnesses like Alzheimer’s, bipolar disorder, and schizophrenia rise alongside metabolic conditions such as obesity, diabetes, and cardiovascular disease, researchers are uncovering how these seemingly distinct issues may be intertwined. A Stanford study found that developing a metabolic disorder like insulin resistance can double your risk of depression, even if you’ve never experienced mental illness before. As such, emotional and metabolic disorders often occur together, with over forty percent of individuals with severe mental illnesses also experiencing metabolic syndrome.

It’s easy to see how mental illness could lead to conditions such as obesity or diabetes because someone struggling emotionally might be unable to eat well or exercise. However, it’s becoming increasingly apparent that metabolic disorders have a distinct role in the onset and progression of mental illnesses.

“Many psychiatric diseases have underpinnings in metabolic dysfunction,” explains Dr. Sethi. “We are seeing insulin and glucose handling differences in the brain in patients with psychiatric conditions.”

These metabolic issues in the brain are present even at the early stages of disease detection and progression. Dr. Sethi explains that patients diagnosed with a first episode of schizophrenia—before any treatment with medications—already show disrupted energy metabolism in the brain. Similarly, Alzheimer’s disease has been referred to as type III diabetes due to its strong link to disrupted insulin signaling in the brain.

Dr. Sethi has been a trailblazer in this area since 2015, founding the first academic Metabolic Psychiatry Clinic focused on treating patients with both mental health and metabolic disorders. Metabolic Psychiatry examines how improving metabolic health through nutritional interventions can significantly enhance brain health and mitigate the symptoms of severe psychiatric conditions.

How Metabolic Health Impacts Brain Health

Many psychiatric diseases are characterized by metabolic dysfunctions, which impair the brain’s ability to function properly. These dysfunctions occur when chemical processes are disrupted, hindering the body’s ability to produce and utilize energy efficiently.

A well-known example is insulin resistance, where the body’s cells don’t respond appropriately to insulin—the hormone that allows glucose to enter cells and be metabolized for energy. The brain, one of the most metabolically active organs, requires large amounts of energy to function. It is highly dependent on glucose due to its limited flexibility to use other energy sources. This dependence makes metabolic conditions like insulin resistance particularly harmful, as any disruption in glucose supply puts the brain at risk for cognitive decline and neuronal degeneration.

“If you don’t have optimal metabolic functioning in the brain, then you won’t process and create energy as efficiently as a healthy brain,” states Dr. Sethi. “The brain will have all this glucose around it, but you can’t actually use it properly. This is called cerebral glucose hypometabolism, and it’s very common in psychiatric and neurodegenerative diseases.” 

Other metabolic abnormalities commonly seen in psychiatric conditions include oxidative stress, mitochondrial dysfunction, and neurotransmitter imbalances, which all have downstream effects on synapse connection and neuronal excitability.

“We don’t know for sure what the primary drivers for these metabolic dysfunctions are, but it is likely a combination of factors influencing one another,” says Dr. Sethi. “For example, insulin resistance is correlated with higher inflammation levels and oxidative stress in the brain, which in turn exacerbates mitochondrial and neurotransmitter dysfunction.”

Chronic inflammation disrupts brain activity and undermines the integrity of the brain’s protective mechanisms. The blood-brain barrier (BBB), a critical structure that protects the brain from harmful substances in the blood, becomes compromised. This “leaky” BBB allows inflammatory molecules, pathogens, and toxins to enter the brain from the bloodstream, exacerbating the inflammatory response within the brain and creating a self-perpetuating cycle of neuroinflammation. “We see significantly more inflammation in the brains of people with mental illness, especially in treatment-resistant patients, than in healthy people,” states Dr. Sethi.

How Nutrition Can Improve Brain Health

Dr. Sethi’s metabolic approach to brain health not only enhances our understanding of psychiatric conditions but also opens up new avenues for treatment, such as nutritional interventions. Studies have shown that nutritional interventions can impact the balance of neurotransmitters in the brain, which is crucial for regulating mood and behavior.

By targeting metabolic dysfunctions such as insulin resistance, oxidative stress, and improper energy utilization, nutritional interventions can help restore brain function and reduce inflammation. This comprehensive approach addresses the symptoms of psychiatric conditions while tackling their underlying causes, offering a more effective and holistic treatment strategy.

The Stanford Metabolic Psychiatry group, led by Dr. Sethi, is investigating whether dietary changes, such as adopting a ketogenic diet, can stabilize brain health. The ketogenic diet, which is high in fat and low in carbohydrates, encourages the brain to use fat and ketone bodies as primary fuels instead of glucose. This metabolic shift helps counteract issues related to glucose metabolism and insulin resistance. The diet adopted in the study focuses on consuming whole, unprocessed foods, including protein and non-starchy vegetables, without restricting fats.

“The ketogenic diet is a strong, powerful metabolic intervention. It can improve neurological and psychiatric conditions by making changes in the brain through these pathways,” says Dr. Sethi. “By providing ketones as an alternative energy source, the ketogenic diet reduces glucose dependency, which is beneficial in counteracting glucose hypometabolism.”

In Dr. Sethi’s study among participants with schizophrenia consuming a ketogenic diet, there was a 32 percent reduction in Brief Psychiatric Rating Scale scores. There was also increased life satisfaction and enhanced sleep quality among participants.

The ketogenic diet can also have a positive influence on brain aging for everyone and has been experientially understood to help normalize the brain for centuries. Dating back to roughly 500 BC,  fasting (which mimics the ketogenic diet) was used to treat epilepsy. Current research shows that the destabilization of brain networks might indicate early signs of reduced metabolism, which is linked to dementia. By increasing the use of ketones for energy, dietary interventions like the ketogenic diet can provide more energy to the brain and potentially protect against aging-related cognitive decline.

Dr. Sethi warns, however, that “the ketogenic diet is very specific and may not be suitable for everyone. It can be incredibly beneficial for people with insulin resistance, obesity, or diabetes, but it may not be feasible or appropriate for all individuals.”

Future studies will reveal further dietary interventions that benefit brain health. For example, Dr. Sethi and her team plan to conduct a randomized controlled trial with the ketogenic diet versus the Mediterranean diet in cases of serious mental illness. Whichever diet one chooses, Dr. Sethi recommends the reduction of sugar, ultra-processed foods, and refined carbohydrates to promote both metabolic and brain health.

“Our diet provides the precursors for neurotransmitters and other vital cellular structures in the brain, while also impacting inflammation levels. If we have deficiencies in our diet, we’re not going to be able to create the components and environment we need for optimal brain function and regulation of mood,” states Dr. Sethi.

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Douglas Noordsy, MD, Bringing Lifestyle Interventions to Psychiatry

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By Sharon Brock, MEd, MS

Stanford psychiatrist Douglas Noordsy, MD, is a physician who literally walks his talk. For the last 40 years, he has woken up at 6 a.m., drank a glass of water, and gone for a run, often with his dog.

“Living a healthy lifestyle has always been an integral part of my life. I share lifestyle interventions [such as daily exercise] with my patients because these practices have worked for me,” says Dr. Noordsy, Head of the Stanford Lifestyle Medicine Cognitive Enhancement pillar.

As a practicing psychiatrist for more than 35 years, editor of the book Lifestyle Psychiatry, and founder of the Stanford Lifestyle Psychiatry Clinic, Dr. Noordsy has played an integral role in incorporating lifestyle medicine into traditional psychiatry care. Dr. Noordsy’s research interests at Stanford include medication and the impact of exercise and nutrition for individuals with schizophrenia and bipolar disorder. He is currently Director of the Lifestyle & Sports Psychiatry special initiative in the Department of Psychiatry.

“With lifestyle psychiatry, clinicians utilize three methods of care—psychotherapy, medication, and lifestyle interventions,” he says. “This three-pronged approach helps us to be more effective physicians, and patients have a better chance at achieving their best outcomes.”

Northeastern Roots

Doug Noordsy always knew he wanted to be a physician. Initially thinking he would go into primary care, he shadowed his family’s doctor as a high school student in Syracuse, New York. As an undergraduate, he took pre-med courses at St. Lawrence University, a small liberal arts college in upstate New York.

“In my junior year, I took the ‘Introduction to Psychology’ course and I fell in love with it,” he says. “I was particularly interested in those with significant disorders such as schizophrenia—I was intrigued by how they thought. So those early experiences drew me into psychiatry.”

In the 1980s, he attended medical school at Washington University in St. Louis, Missouri. During this time, neuroscience and psychopharmacology were becoming more advanced, which led to debate among mental healthcare professionals about the relative merits of pharmaceuticals over psychotherapy.

“We learned about psychotherapy and medication, but lifestyle medicine wasn’t on the table at that time,” says Dr. Noordsy. “There was discussion about the importance of social support, but we didn’t consider how other aspects of lifestyle affected mental health, such as exercise, nutrition, and mind-body practices.”

After completing his residency at Dartmouth-Hitchcock Medical Center in New Hampshire, he served as a Professor of Psychiatry at the Geisel School of Medicine for 25 years. At Dartmouth, he was also the Director of Psychosis Services and an Investigator in the Psychopharmacology Research Group.

“At Dartmouth, there was an emphasis on treating patients in a collaborative, recovery-oriented way rather than a paternalistic approach,” says Dr. Noordsy. “It was important in my early development to be trained in a model of care that was respectful of the wishes and preferences of the patient.”

Leading a Movement

Dr. Noordsy was ahead of his time regarding the connection between lifestyle medicine and mental health. As a medical school student, he managed his own mental health using lifestyle practices such as daily exercise, healthful nutrition, and quality sleep. He found benefit with these practices and shared them with his patients.

“At first, I was shy about sharing my experiences because they weren’t evidence-based at that time. It’s counter-academic to share things with patients from your own life that are not supported by clinical trials,” he says. “But over time, the evidence caught up.”

Indeed, over the last 15 years, research on lifestyle medicine has shifted the narrative from personal anecdotes to gaining attention and respect within the medical community. Specifically, Lifestyle Psychiatry has moved from something psychiatrists recommended softly to valid, evidence-based medicine.

In the fall of 2015, Dr. Noordsy came to Stanford to join the Department of Psychiatry & Behavioral Sciences, which was building a team for student-athletes. Many of the athletes wanted to minimize medication exposure, so he continued to recommend lifestyle interventions as options to support their mental health.

In 2019, Dr. Noordsy coined the term “Lifestyle Psychiatry” by publishing a book with that title. This book is a curation of research from around the world detailing the evidence on lifestyle practices in psychiatry. In 2020, he opened the Stanford Lifestyle Psychiatry Clinic. In 2024, the president of the American Psychiatric Association (APA) promoted lifestyle interventions as a core component of psychiatric treatment, bringing this approach into the mainstream.

In his 35-year career, Dr. Noordsy has been a member of the Schizophrenia International Research Society, the International Early Psychosis Association, the American College of Lifestyle Medicine, and a fellow of the APA. He received the Exemplary Psychiatrist Award from the National Alliance on Mental Illness in 2001 and the Excellence in Leadership Award from the Stanford Department of Psychiatry and Behavioral Sciences in 2018.

Although Dr. Noordsy is a nationally acclaimed psychiatrist, his most significant source of pride is his influence on how psychiatric care is delivered. For severe disorders, psychiatry has had a long history of authoritarian care in some settings. With lifestyle psychiatry, where patients choose from a menu of lifestyle practices as part of their treatment plan, the care model shifts from “the doctor knows all” to one where the psychiatrist collaborates with their patients, respects their wishes, and takes a whole-person approach.

“What I’m most proud of is being part of a movement toward empowering and engaging patients to participate in their own health and well-being, rather than just be compliant to their doctor’s instructions,” says Dr. Noordsy. “I’m proud to be part of a new approach to care that promotes mental health by fostering relationships, savoring nutritious meals, and experiencing the beauty of nature at sunrise.”

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How Exercise Reduces Risk of Alzheimer’s Disease

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By Tanya Thakur, MBBS

Alzheimer’s disease (AD) is one of the most devastating illnesses among older adults. The disease not only degrades memories but also affects one’s independence and takes a toll on family members.

AD is a progressive neurodegenerative disorder caused by the accumulation of abnormal misfolded protein deposits in the brain, including beta-amyloid plaques, tau tangles, and Hirano bodies. These deposits disrupt normal neuronal function, leading to the gradual loss of memory, cognitive skills, and, eventually, the ability to carry out daily activities.

AD is the most common cause of dementia, accounting for approximately 60 to 80 percent of cases. Presently, an estimated 6.7 million individuals in the U.S. have AD. In 2019, Alzheimer’s was ranked as the sixth leading cause of mortality among individuals aged 65 and above. Notably, between 2000 and 2019, while fatalities from stroke, heart disease, and HIV declined, deaths related to Alzheimer’s increased by more than 140 percent.

Even though scientists are working toward curing AD, we can take preventative measures by incorporating healthy habits, such as regular exercise, into our routine.

“It is a common misconception that we have minimal control over our risk of developing Alzheimer’s disease. However, nearly half of the Alzheimer’s cases could have been prevented or delayed by modifiable factors, including lifestyle changes,” says Sarita Khemani, MD, Clinical Associate Professor of Medicine and Neurosurgery Hospitalist at Stanford University. “Therefore, we should do everything in our power to incorporate healthy lifestyle habits as early as possible.”

The Link Between Exercise and Alzheimer’s Disease

There are many things we can do to reduce our risk of developing dementia. Several research studies have concluded that physical activity is one of the best ways to reduce risk significantly. For example, after analyzing 16 studies on exercise and dementia, the Alzheimer’s Society found that regular exercise reduces the risk of developing dementia by 28 percent and, specifically, AD by 45 percent.

The connection between the brain and aerobic exercise is likely due to neuroplasticity, which is the brain’s ability to adapt and form new neural connections or strengthen the existing ones. During aerobic exercise, our brain expresses cAMP response element binding (CREB) proteins that influence the transcription of synaptic genes, including those encoding for brain-derived neurotrophic factor (BDNF). BDNF supports neurogenesis (the formation of new neuron cells), neuroprotection, and angiogenesis (the formation of new blood vessels). BDNF also increases the volume of gray matter and the hippocampus (the site of memory in the brain).

Physical activity also serves as a potent modulator of other health risk factors, including hypertension, hypercholesterolemia, and insulin resistance, all of which increase the risk of developing dementia. Vascular damage caused by atherosclerosis can accelerate the cognitive decline associated with AD due to reduced blood and oxygen flow to the brain, leading to hypoxia of neural cells.

“Brain changes associated with Alzheimer’s begin approximately 20 years before symptoms appear,” says Dr. Khemani. “Exercise stands out as one of the most effective strategies for prevention, offering a low-cost, non-pharmacological, and low-risk option accessible to everyone.”

The Best Exercises to Prevent Alzheimer’s

While aerobic exercise increases BDNF levels, resistance exercises, such as lifting weights, are thought to have a greater influence on insulin-like growth factor-1 (IGF-1) levels. IGF-1 is a hormone that manages the effects of growth hormone in the body and is essential for promoting cognitive abilities.

Because aerobic and resistance exercises elicit different neurophysiological changes, studies have indicated that combining both modalities can enhance exercise-induced neuroplasticity to a greater extent than either modality alone.

For example, one study compared the effects of combined aerobic and strength training, aerobic exercise alone, and no exercise on cognitive function among dementia patients. After nine weeks, the combined exercise regimen yielded the most pronounced results across cognitive domains. Also, the observed gains in both motor and cognitive areas regressed towards baseline levels more than two months post-intervention, meaning it is essential to exercise regularly to sustain its neurological benefits.

Regarding the type of aerobic exercise most effective for AD prevention, Dr. Khemani recommends incorporating sprint intervals into our workouts. “We encourage our patients to engage in moderate-intensity exercises incorporating some high-intensity interval training, if possible, as these activities have been shown to be more impactful for Alzheimer’s prevention than light exercise alone,” she says.

 

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Jumping into the Ice Bath Trend! Mental Health Benefits of Cold Water Immersion

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By Maya Shetty, BS

Key Takeaways

  • Research shows that cold water immersion (CWI) may improve mental health by increasing endorphin and norepinephrine levels. 
  • CWI may also improve resilience to stress by decreasing cortisol levels.
  • CWI can be adapted to meet different wellness goals, whether for immediate relief or long-term mental health benefits.
    • For individuals seeking a quick boost in mood, daily cold water face immersions and occasional full-body plunges might be beneficial.
    • For those aiming for long-lasting benefits such as lowered cortisol levels, enhanced mood regulation, and increased resilience to stress, research shows that consistent full-body CWI may be beneficial.

Have you ever considered how taking a cold plunge might affect your mental state? Beyond the initial shock, CWI is proving to have profound effects on brain health and mental well-being. Initially popular as a recovery technique among athletes, it has now evolved into a bold wellness practice for those seeking to enhance their overall health. This practice, which involves plunging into cold water (roughly 10-15°C, 50-60°F), has ignited significant research interest, and emerging studies now suggest that CWI can improve mood, decrease stress, and potentially slow the progression of neurodegenerative diseases.

“I personally do cold water immersion and find it to be an immensely rejuvenating activity,” says Stanford Psychiatrist, Vanika Chawla, MD, member of the Lifestyle Medicine Cognitive Enhancement pillar.

CWI can take many forms, each involving its own protocol and equipment. The most common forms include:

  • Ice Baths: Traditionally utilized by athletes for recovery after intense physical activity, ice baths require submerging the body up to the neck in ice-cold water. Also known as cold plunging, this practice generally lasts only a few minutes and involves limited movement.
  • Cold Showers: A more accessible form of CWI, taking cold showers can offer many of the same benefits as ice baths but are easier to incorporate into daily routines.
  • Open Water Swimming: This active form of CWI involves swimming in cold rivers, lakes, or oceans, allowing for longer exposure times to the cold.
  • Cryotherapy Chambers: Though they do not involve water, cryotherapy chambers expose the body to extremely cold air temperatures for brief periods, stimulating a physiological response similar to that achieved through water immersion.

Choosing the type, temperature, and duration of CWI depends on your cold tolerance and the resources available to you. It is generally recommended to aim for a temperature that feels uncomfortable but still safe (no colder than 10°C, 50°F). If you have any form of access to cold water, whether it be a lake, a river, or your home shower and bathtub, you can participate in CWI and begin to explore its benefits.

Can Cold Water Plunges Improve Mental Health?

While the idea of diving into extremely  cold water seems unappealing to most, recent studies have shown that CWI offers emotional benefits. In 2021, researchers recruited undergraduate students to take a 20-minute dip in chilly sea water (13.6°C, 56.5°F) and report their emotions before and after using a Profile of Mood States questionnaire. Compared to controls, the students who engaged in CWI experienced a shift in mood, noting a significant decrease in negative emotions like tension, anger, depression, fatigue, and confusion. Moreover, they experienced boosts in positive emotions such as vigor and self-esteem. Further research involving thirty-three adults new to cold-water swimming highlighted similar benefits. After immersing in a cold bath (20°C, 68°F) for just five minutes, participants reported feeling more active, alert, attentive, proud, and inspired.

These studies, which utilize self-reported questionnaires, indicate that cold-water immersion may significantly enhance mood and overall psychological well-being. It appears to activate traits associated with increased motivation and vitality, while simultaneously diminishing feelings of distress and nervousness. 

How to Lower Cortisol Levels Naturally

CWI presents a unique stimulus for the body, prompting significant shifts in its hormonal stress response, particularly involving cortisol, a key regulator of stress. Unlike other stress hormones such as noradrenaline, cortisol levels remain relatively unchanged during the initial shock of cold water. Research highlights an intriguing aspect of cortisol dynamics: while levels do not significantly change during CWI, they significantly decrease afterward.

For example, a study concluded that a one-hour CWI session, whether in thermoneutral (32°C, 90°F), cooler (20°C, 68°F), or cold (14°C, 57°F) water, did not lead to an increase in blood cortisol concentrations. Instead, cortisol levels tended to decrease across all temperatures tested and remained below initial levels an hour after immersion. These findings suggest that cortisol production is not significantly activated by CWI, contrary to what might be expected under typical stress conditions. In fact, CWI may have potent stress-modulating effects. Further research indicates that cortisol levels remain considerably lower for up to three hours after just 15 minutes of CWI (10°C, 50°F). This pattern of response reveals a sophisticated regulatory mechanism, suggesting that CWI can effectively diminish feelings of stress following a session.

CWI may have the potential to modify our body’s stress response to stressors in everyday life. In a study where participants engaged in winter swimming (water 0-2°C, 32-36°F) for twenty seconds or cryotherapy (-110°C, -166°F) for two minutes, three times a week for twelve weeks, the body adapted remarkably. After just four weeks, participants showed significantly lower cortisol levels post-exposure, with levels continuing to drop in the following weeks. This adaptation contrasted with the noradrenaline response, which remained consistent even as the body became accustomed to the cold stress. This reduced cortisol response not only diminished the stress perceived from cold but also potentially enhanced the body’s capacity to manage other stressors more effectively. 

The main take away from this study is that by reducing cortisol production in response to repeated cold exposure, participants might also release less cortisol in response to other stressors in everyday life, thus fostering a more resilient physiological state over time.

“Resilience is the ability to adapt to life’s stressors and adversities,” says Dr. Chawla. “The body and mind are interconnected, therefore greater physiological resilience may lead to greater psychological resilience as well.”

How Cold Water Immersion Impacts the Brain

CWI has been scientifically observed to influence brain function, affecting mood, stress response, and potentially brain health through several mechanisms. The immediate physiological response triggered by CWI is largely due to the dramatic change in temperature. A dense concentration of cold receptors in the skin detects this change, leading to a surge of electrical impulses from peripheral nerve endings to the brain. This intense stimulation activates various neural pathways, initiating a cascade of chemical responses designed to help the body manage and adapt to the stressor.

During the initial shock of CWI, the body experiences stress and discomfort due to the sudden drop in temperature. To counteract this, endorphins, the body’s natural pain relievers, are released. These endorphins not only reduce pain but also enhance feelings of well-being, akin to the “runner’s high” that often occurs in other physically demanding or stressful situations. 

CWI also activates the sympathetic nervous system (SNS), which controls our “fight-or-flight” responses. This activation leads to a significant increase in noradrenaline (also known as norepinephrine), an excitatory neurotransmitter that not only helps manage stress but also boosts energy and focus. The surge in noradrenaline increases blood flow to the brain, potentially causing feelings of euphoria.

These two neurotransmitters play complementary roles. While norepinephrine prepares the body to handle acute stress by enhancing alertness and readiness, endorphins work to soothe pain and promote a positive mood. This dual response helps individuals cope with the immediate impacts of cold exposure more comfortably and can make the experience of cold water immersion more tolerable–and potentially even rewarding.

Regarding whether CWI has long-term positive effects on the brain, research indicates inconsistent results with respect to the increase of endorphin levels. It is possible that not everyone experiences this endorphin response to CWI, and among those who do, the effect may diminish over time, as the body becomes accustomed to the cold exposure. On the contrary, the increase in noradrenaline continues with each session of CWI, even after the body has adapted after months of regular practice. 

These findings underscore the potential of CWI to be used as a reliable tool for improving energy, focus, and mood. These findings also point to the potential of CWI to be used in the treatment of neurological conditions that involve low noradrenaline, including anxiety and depression. However, more research is needed to understand if CWI has long-term effects on emotional well-being outside the water.

Also, CWI may improve brain function through the release of cold-shock proteins, which are produced by the body in response to cold conditions. Animal studies reveal that proteins like RNA binding protein (RBM3) play a crucial role in repairing and regenerating nerve cell connections after they’ve been exposed to cold. Additionally, studies have demonstrated that over-expressing RBM3 can help prevent neuronal connection loss in mice with neurodegenerative diseases. Although there is limited evidence in humans, these findings in mice suggest that regular CWI could potentially boost the expression of such beneficial proteins in humans, offering protection against or slowing the progression of neurodegenerative diseases by preserving and reinforcing neural connections. 

Reaction to Cold Water: Full-Body vs. Facial Immersion

Physiological responses to CWI differ significantly based on whether the exposure is to the full body or just the face. Full-body immersion exposes a significant surface area to cold, inducing thermal stress that can substantially lower skin and core body temperatures. This extensive exposure activates the sympathetic nervous system, which in turn triggers a release of neurotransmitters and hormones that drive the stress response. Consequently, this leads to vasoconstriction, an increased heart rate, and a heightened metabolic rate, all of which help preserve body heat and maintain core temperature.

In contrast, immersing just the face in cold water activates parasympathetic activity, which is responsible for “rest and digest” functions in the body. This effect is likely due to the mammalian diving reflex—an evolutionary adaptation that optimizes respiration and conserves oxygen by preferentially directing oxygen to vital organs. The diving reflex is mediated by the vagus nerve, which activates the parasympathetic system and releases a sense of calm. The trigeminal nerve in the face also plays a crucial role when stimulated by cold, sending signals that further enhance parasympathetic output, decreasing heart rate, and boosting digestive activity. 

These differences highlight how CWI can be strategically used to target specific physiological responses and therapeutic outcomes, depending on whether the exposure is localized to the face or involves the entire body.

“I sometimes recommend facial cold water immersion to my patients as part of the T in TIPP skills to help people with emotion regulation. TIPP stands for temperature, intense exercise, progressive muscle relaxation, and paced breathing,” says Dr. Chawla. “These skills involve changing your body chemistry to shift emotions. Some people find brief facial immersion in cold water or taking a cold shower to be helpful in shifting their body chemistry and thereby shifting their emotional state.” 

Safety Considerations

CWI can offer several health benefits, but it’s essential to approach this practice with caution due to potential risks. One of the most obvious risks is hypothermia, as immersing in cold water significantly drops body temperature. To prevent hypothermia, limit immersion time to no more than 10 minutes. 

Furthermore, it is important to understand the cold shock response. Entering cold water suddenly can trigger an involuntary gasp reflex followed by hyperventilation. Hyperventilation increases the risk of drowning (especially in open water plunging) and can also lead to arrhythmias or even a heart attack, particularly in those with underlying heart issues. To better manage the cold shock response, it’s advised to enter the water slowly, allowing your body to adjust to the temperature gradually. 

It is also important to never swim alone regardless of your swimming strength or experience. Having a partner ensures that help is readily available in case of an emergency, such as cramps, sudden illness, or difficulty in the water.

Finally, remember to allow your body to gradually acclimatize to whatever CWI technique you choose. If you are a beginner, begin with shorter durations (2 minutes) in warmer water (roughly 20°C, 68°F), progressively moving to colder temperatures with longer durations as your body adapts.

“This intervention is not for everyone. It’s important for people to consider what works best for their individual needs,” says Chawla. “If you are going to try CWI, be mindful of how it impacts your mind and body and incorporate the activity into your routine accordingly.”

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How Exercise Improves Microbiome Health (and Vice Versa)

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By Mary Grace Descourouez, MS, NBC-HWC 

The human gastrointestinal tract is home to trillions of microorganisms that create the gut microbiome. The gut is where the body digests and absorbs nutrients from our food and, therefore, where we get our energy to perform daily human functions. Microbiota are microorganisms in the gut microbiome that help the body harvest energy, fight pathogens, and regulate immunity. Having a high diversity of microbiota helps us to process food effectively, providing the substrates and nutrients needed to keep us going throughout the day. Therefore, it is crucial to make lifestyle choices that promote a healthy and diverse microbiome.

Many people know that a nutrient-rich diet contributes to a healthy microbiome, however, research shows that movement and exercise may also have a positive effect, and, inversely, a healthy microbiome may improve athletic performance.

“It is a relatively new field, but available studies suggest a bidirectional relationship between performance and the health of the microbiome,” says Anne Friedlander, PhD, Exercise Physiologist and Assistant Director of Stanford Lifestyle Medicine. “People who are more active have a healthier and more diverse microbiome, and that, in turn, provides the person with the nutrients required to enhance physical and cognitive performance. It is a mutually beneficial relationship.” 

How Exercise Improves the Microbiome

Movement and exercise have many benefits on our overall health, including positive effects on the microbiome. Studies show that athletes have a more diverse microbiome composition than non-athletes. Microbiome diversity is important because it helps make our food’s nutrients more bioavailable for optimal functioning of the body.

Another study found that active women were associated with high microbiome diversity compared to sedentary women. Specifically, researchers found that consistent physical activity increased the amount of 11 genera of “good” bacteria, including Bifidobacterium spp, Roseburia hominis, Akkermansia muciniphila, and Faecalibacterium prausnitzii. 

How the Microbiome Improves Athletic Performance

Just as exercise positively impacts the microbiome, emerging research shows that microbiome health may also play a part in enhancing exercise performance.

For example, a 2019 study showed that a specific gut microbiota in marathon runners may have enhanced their athletic performance on race day.  In this study, researchers collected fecal samples from the runners before and after the marathon and compared them to microbiota of non-runners. The “good” bacteria Veillonella emerged as the most common in the runners, especially post marathon. Veillonella is a bacterial strain that converts exercise-induced lactate into propionate, which is a natural enzymatic process known to enhance athletic performance.

Researchers then put the Veillonella bacteria from the marathon runners into lab mice who underwent a treadmill exertion test to investigate the hypothesis that this bacterial strain enhances athletic performance. The results showed the mice improved performance by 13 percent after inoculation. This study is one of the first to infer that a healthy microbiome could enhance athletic performance.

“We have a long way to go to fully understand the complex system that involves the microbiome and athletic performance, but the early data look promising regarding gut health and exercise,” says Dr. Friedlander.  “Exercise, along with eating fermented foods and fiber, is a great place to start if you want to improve your gut health and overall health.”

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Probiotics, Prebiotics, and Postbiotics: What Are They and Why Are They Important?

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By Maya Shetty, BS

Key Takeaways:

  • Probiotic and prebiotic supplements lack substantial scientific evidence that they promote microbiome health. 
  • Rather than taking supplements, experts recommend eating fermented foods (probiotics) to promote microbiome diversity and fibrous foods (prebiotics) to feed and sustain “good” bacteria in the gut.  
  • Recommended fermented foods (probiotics): 
    • Fermented vegetables: kimchi, sauerkraut, and certain pickled vegetables
    • Fermented dairy: yogurt, cottage cheese, kefir, and certain cheeses
    • Fermented soy: tempeh and miso
  • Recommended high-fiber foods (prebiotics):
    • Legumes: lentils, chickpeas, black beans, and kidney beans
    • Seeds: chia seeds, flaxseeds, pumpkin seeds, and sunflower seeds
    • Whole grains: quinoa, brown rice, oats, and barley
    • Nuts: almonds, walnuts, pistachios, and pecans
    • Vegetables: broccoli, Brussels sprouts, artichokes, carrots, and sweet potatoes
    • Fruits: apples, pears, berries (raspberries, blueberries, strawberries), and bananas
  • Postbiotics, the byproduct of probiotic and prebiotic activity, not only reduce the risk of chronic diseases and support brain health, but also offer anti-inflammatory and beneficial metabolic effects.

Within our bodies, there exists a bustling community that often goes unnoticed but plays a pivotal role in our well-being—the microbiome. Understanding the impact of the microbiome on our health is not just a scientific curiosity, it’s a crucial aspect of our health that underscores our body’s complex equilibrium. Through continuous negotiations, our body and microbiome engage in a symbiotic relationship—a dynamic exchange where we provide our microbiome with nourishment and “good” inhabitants, and in return, it synthesizes beneficial compounds to support our health.

“We are, in essence, walking ecosystems. Our health is intimately connected to the trillions of bacteria, viruses, and fungi that make up this community,” says Sean Spencer, MD, PhD, Gastroenterologist and Physician Scientist at Stanford University.

The microbiome actively participates in various bodily functions, from aiding digestion and nutrient absorption to eliminating toxins and synthesizing vitamins and amino acids.

“The influence of our microbiome extends far beyond the confines of the digestive system, reaching major body systems like the immune system, metabolism, and the central nervous system,” states Rachele Pojednic, PhD, Stanford University  nutrition and exercise scientist.

While the definition of a healthy microbiome remains unclear, the majority of studies find that high microbiome diversity is linked to better health outcomes. “A healthy microbiome is one that is equipped to process a diverse array of dietary fiber to produce  health-promoting compounds for our body,” states Dr. Spencer. “Low microbiome diversity is linked to various health conditions, including diabetes and obesity and likely has reduced fiber-degrading potential and lower production of health promoting compounds.”

A recent study revealed that the average Californian has a microbiome that contains 277 microbial species, a stark contrast to the average of 730 found in non-industrialized populations. This finding aligns with a mounting body of evidence suggesting that modern lifestyles and Westernized diets have significantly depleted the essential diversity of our gut microbiome.

Therefore, many individuals have sought ways to manipulate their microbiome and increase its diversity via supplementation. Commonly referred to as probiotics and prebiotics, these supplements have surged in popularity, achieving sales of $35 billion in 2015 and projected to reach $65 billion by the end of 2024.

Despite their widespread use, there is significant confusion about what they are, where to find the best ones, and what they can and can’t do. Regardless, experts say the most powerful and beneficial sources for all your biotic needs are often overlooked (hint: they are in your refrigerator).

What Are Probiotics and Why are They Important?

Probiotics are live microorganisms that are consumed for health benefits and typically found in fermented foods like yogurt, kimchi, and sauerkraut. They play a crucial role in supporting our gut by introducing beneficial bacteria to our microbiome community. Simultaneously, they reduce the proliferation of harmful bacteria by constraining their available space for growth.

Upon hearing the term “probiotics,” many individuals associate it with the supplement pills that have long been advertised to improve digestive health. However, these supplements are not recommended over food, as they can displace favorable microbial residents in the gut.

“The doses of microbes found in supplements are overly potent, with billions to trillions of microbes, far exceeding the amounts in fermented foods, which contain hundreds of thousands to millions,” states Dr. Pojednic. “In this context, more is not better; natural sources provide a gentler, more physiologically effective way to support your microbiome.”

Another problem with probiotic supplements is they are created under the assumptions that the same bacteria strains are beneficial to everyone. But research indicates that microbiota composition and function varies significantly among individuals. What benefits one person may not necessarily work for another, and the scientific community is yet to develop the means to tailor probiotic prescriptions on an individual basis. Moreover, most beneficial gut bacteria that promote health are not yet available in probiotic supplement form.

“While healthy microbiomes may display certain shared characteristics, such as diversity, the specific types of bacteria that truly confer benefits remain unclear. Therefore, the limited selection of bacterial strains found in probiotic supplements may not be what your gut needs,” states Dr. Spencer.

Rather than taking probiotic supplements, Spencer and Pojednic recommend increasing the intake of probiotics by consuming fermented foods. Furthermore, fermented foods contain metabolic byproducts and other signaling molecules that probiotic supplements alone do not. Growing evidence suggests these metabolites confer additional health benefits and may aid the colonization of beneficial bacteria in our gut.

Fermented foods have been associated with enhancing microbiome diversity and overall health in several studies. A notable study was conducted at Stanford University, where participants adhered to a diet rich in fermented foods. Following a ten-week regimen of daily intake of five servings of fermented foods, participants demonstrated increased microbiota diversity and a notable reduction in inflammation in the body.

Dr. Spencer highlights this intriguing correlation, stating, “As the diversity of participants’ gut microbiome increased, there was a simultaneous decrease in various markers of inflammation, emphasizing the beneficial impact of fermented foods on overall health.”

“It’s important to remember that not all fermented foods have probiotic properties. When identifying probiotic foods, look on the labels for terms like ‘live cultures’ or ‘active cultures.’ Additionally, look for foods in the refrigerated section of the grocery store,” states Dr. Pojednic.

Should I Take Probiotics After Antibiotics?

A popular strategy to mitigate the depletion of one’s microbiota following antibiotics is to take probiotic supplements. However, a study revealed that probiotic supplements could unintentionally impede the normal recovery of the microbiota by displacing beneficial microbes in the gut. Participants who received the probiotic supplement took more than five months for their microbiome to recover, in contrast to those who received a placebo, whose microbiome returned to normal within three weeks. These findings suggest that taking probiotic supplements after antibiotic treatment did not help balance the microbiome; in fact, these supplements impaired its recovery.

“When this trial came out a few years ago, it created a paradigm shift in the field by showing that taking probiotics after antibiotics may actually delay the recovery of your microbiome,” states Dr. Spencer. “Now, I spend a lot of my time in GI clinics convincing people not to take probiotic supplements after antibiotics.”

While probiotic supplements are often used to alleviate symptoms linked to gastrointestinal conditions, such as irritable bowel syndrome and diarrhea, the American Gastroenterological Association does not recommend probiotics for the treatment of any adult gastrointestinal conditions outside of pouchitis. In any case, it’s advisable to consult with a physician before incorporating a probiotic supplement into one’s routine.

“As of now, there are very few probiotic supplements that have strong evidence of their beneficial effect in treating gastrointestinal disease,” states Dr. Spencer. “Nevertheless, this landscape is evolving quickly with ongoing research and advancements in probiotics. I’m hopeful that the next generation of probiotics will target GI disease more effectively.”

What Are Prebiotics and Why are They Important?

After establishing a diverse and healthy microbiome (by consuming a variety of probiotic foods), it becomes crucial to actively sustain it. What you eat directly fuels your microbiome community and determines which microbes will flourish and which will parish in the competitive landscape of your gut.

Prebiotics are nutrients that foster the growth and proliferation of beneficial bacteria in the gut, ultimately contributing to overall gut health. The main prebiotics our microbiome thrives on are known as microbiota-accessible carbohydrates (MACs), commonly referred to as dietary fiber. These complex carbohydrates, found in fruits, vegetables, whole grains, legumes, and other plant materials, resist our body’s degradation and absorption processes. This digestive resistance allows them to reach the colon still intact, providing a feast for our gut bacteria.

For individuals consuming diets high in sugar, fat, and protein, but lacking in dietary fiber, these macronutrients will break down and enter the bloodstream before reaching our colons. As a result, the typically diverse microbial community found in our colons will starve. Over time, the microbiome, in its quest for sustenance, may resort to consuming the gut’s protective mucus layer. This degradation can lead to a cascade of adverse effects, including inflammation within the gastrointestinal tract.

“Without the nourishment provided by fiber, the microbiome is left to fend for itself, potentially resulting in detrimental consequences for both its composition and the overall health of the gut,” states Dr. Spencer. “Eating prebiotic-containing foods is critical to sustain a healthy microbiome.”

In recent years, prebiotic supplements have gained popularity, however, our experts advise opting for fibrous foods over supplements to meet your microbiome’s probiotic requirements. This preference is rooted in the fact that foods offer a diverse array of fiber types, whereas supplements commonly feature a single type. The consumption of a singular fiber type restricts the nutritional support available to our microbiome, and can limit overall diversity that is crucial for a healthy microbiome. Moreover, fiber-rich foods offer various nutritional health benefits not found in supplements. Dr. Spencer suggests that if occasional supplement use is preferred to meet prebiotic needs, choosing supplements with a mix of fiber types is advisable. Nevertheless, opting for fiber-rich foods proves to be a more dependable and cost-effective source.

While more research is needed to fully understand the microbiome and how probiotics and prebiotics work in harmony, it’s reasonable to infer that the presence of one may enhance the function of the others. To promote microbiome diversity and a healthy gut, it’s essential for one’s diet to be a balanced combination of fermented foods (probiotics) and dietary fiber (prebiotics).

“My favorite breakfast is yogurt (a probiotic food) topped with berries and whole-grain granola (which are prebiotic foods). In one delicious meal, I fulfill all my biotic needs,” states Dr. Pojednic.

What Are Postbiotics and Why are They Important?

While many have heard of probiotics and prebiotics, the term postbiotics is relatively new. Postbiotics are the byproduct of probiotic and prebiotic activity. Essentially, they are the waste products left behind by the breakdown of fiber by the bacteria  in your microbiome.

These byproducts can be both beneficial and harmful to your health. The breakdown of fiber yields a treasure trove of beneficial postbiotics. Among these are essential elements such as vitamins, enzymes, amino acids, and short-chain fatty acids (SCFAs). One standout SCFA is butyrate, a superpower molecule throughout the body that plays a pivotal role in various aspects of health. Linked to a reduced risk of chronic diseases, butyrate also exhibits anti-inflammatory properties, supports brain health, and has beneficial metabolic effects.

Conversely, the breakdown of meat in the digestive process yields molecular byproducts such as choline and L-carnitine. In the microbiome, these compounds get broken down further into trimethylamine (TMA), which is subsequently absorbed by the circulatory system and oxidized in the liver to form trimethylamine N-oxide (TMAO). Elevated levels of TMAO have been associated with an increased risk of clot-related cardiovascular events. Intriguingly, a study conducted at Stanford suggests that refraining from meat consumption for eight weeks could potentially suppress the “bad” bacteria associated with TMA production when reintroducing meat into the diet, however, additional research is required to validate this hypothesis.

Postbiotic Supplements

While the concept of postbiotics is relatively new, the popularity of postbiotic supplements is on the rise. Butyrate supplements, for instance, are becoming increasingly common. It is essential to recognize that a deficiency in Butyrate might signify an underlying issue with one’s diet and digestive system, which a supplement alone may not rectify. The most effective strategy for boosting postbiotics involves embracing a diet rich in fermented food and fiber.

Take Home Message: Food is Better than Supplements

Compared to supplements, fermented and fibrous foods provide a diverse array of microorganisms that benefit your microbiome. Moreover, supplements miss out on the synergistic biotic combination of components found in whole meals. Research consistently underscores the pivotal role of diet in shaping the composition and function of a healthy gut microbiome, serving as the most comprehensive and research-backed biotic source.

“We have abundant data to demonstrate that food affects the microbiome. And while supplements certainly have their place–to address nutrient deficiencies and improve specific health outcomes–the evidence for the supplements widely marketed for benefiting the gut are limited at best,” states Dr. Pojednic. “To ensure your microbiome is getting the sustenance it needs, it is best to get your probiotics from fermented foods and prebiotics from high-fiber foods, which have the added bonus of numerous other health benefits.”

Another thing to consider is safety and efficacy of the supplements. Most supplements are loosely regulated by the FDA, meaning manufacturers don’t need to prove safety and efficacy. For this reason, it’s always better to get a nutrient or biotic source from food over supplementation unless it has been recommended by your physician or dietitian.

Most importantly, relying on biotic supplements cannot remedy the consequences of a poor diet. Long-term dietary habits play a pivotal role in the adaptability of the gut microbiome, with the consumption of diverse fermented and high-fiber foods being paramount. As our dietary habits evolve, so does the microbiome, adapting and diversifying to create a resilient and well-balanced ecosystem. In essence, the journey to a healthier gut extends beyond the allure of quick-fix supplements.

“While there is some regulation on manufacturing and marketing of supplements, enforcement is rare unless there is a well-documented negative health effect. Third party testing is key to ensuring you are consuming a safe product. Otherwise, you can fall prey to deceptive claims, mislabeled ingredients or possible contamination,” states Dr. Pojednic. “Safe, well studied supplements have their place, but we just aren’t there yet with these products.”

With ongoing advances in microbiome research, the future may hold more precise probiotic, prebiotic, and postbiotic interventions, potentially enhancing the effectiveness of supplements. However, the foundation of gut health remains deeply rooted in dietary habits, emphasizing the enduring value of natural, food-based approaches over supplementation.

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Microbiome Expert Sean Spencer, MD, PhD: On a Mission to Prove that Food is Medicine

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By Sharon Brock, MEd, MS

Sean Spencer, MD, PhD is a Gastroenterologist and Physician Scientist at Stanford University School of Medicine. Along with seeing patients in the clinic, Spencer conducts cutting-edge research on the microbiome in the Sonnenburg Lab. In his research, Spencer focuses on how nutrition affects the microbiome and the immune system, as well as how our diet can prevent and treat gastrointestinal disease and potentially increase longevity.

“There’s a clear association between the microbiome and healthy aging. Studies of centenarians show a different microbiome configuration and metabolite production compared to those with a shorter life span and unhealthy aging,” says Spencer. “The microbiome is a key aspect of lifestyle medicine because what we eat and how we exercise affects our microbiome composition.” 

 The Medical Path

 Growing up amidst the rich agricultural tradition in Madison, Wisconsin, Spencer learned from an early age the importance of nutritious food for optimal health. As an undergraduate at the University of Wisconsin, Spencer majored in medical microbiology and immunology, and knew since his sophomore year that he wanted to practice medicine.

“After taking a human physiology course, I just knew that learning as much as I could about the human body and using that knowledge to help people was the only thing I wanted to do,” says Spencer. “As an undergrad, I also discovered that I could conduct research while caring for patients, and that clarified my career path further.”

These career goals prompted Spencer to pursue an MD-PhD program in immunology at the University of Pennsylvania, which he completed in 2015.

“In graduate school, I realized how our diet has a profound impact on the microbiome, and can directly influence the immune system,” says Spencer. “You want to think of the three aspects [nutrition, microbiome, and immune system] at the three corners of a triangle. They each impact the other.”

After completing an internal medicine residency at the Harvard-affiliated Massachusetts General Hospital, Spencer came to Stanford in 2017 for a fellowship in gastroenterology (GI).

“I came to Stanford specifically to work with Justin Sonnenburg, so it was great to be accepted to both the GI clinical program and his lab,” says Spencer. “What I love most about Stanford are the people and the creativity. This focus on the microbiome and nutrition is unique to Stanford and I’m glad to be part of a community that thinks about lifestyle medicine in both research and clinical care.”

Living His Dream

For the last three years, Spencer has been a practicing, board-certified GI physician at Stanford Medicine and a researcher in one of the most prestigious microbiome labs in the country. Spencer lights up when he talks about his current research on the small intestine microbiome:

“Most microbiome studies look at poop, which represents the very end of the GI tract, but the small intestine is 20 feet long, and researchers have sampled almost none of it,” says Spencer. “We’ve developed a novel technology to sample and investigate the microbiota [bacteria] of the small intestinal microbiome, which has been a huge blank space for the longest time.”

The small intestine is where many nutrients, including glucose, are absorbed into the bloodstream. Since high glucose levels are linked to diabetes and obesity, Spencer believes this research will potentially lead to the development of therapies to be used alongside lifestyle medicine, to enhance its benefits, for individuals with these medical conditions.

Spencer also studies hormones in the small intestine, such as Glucagon-like peptide-1 (GLP-1), which is the hormone targeted in the popular weight-loss drugs Ozempic and Wegovy. “The new GLP-1-targeted medications are powerful and amazing drugs, but it’s important to recognize that we have the power to regulate these hormonal pathways with our diet and lifestyle choices,” he says.

Although his work in the lab is a source of fulfillment, Spencer also enjoys bringing his research findings directly to his patients as a GI physician. Spencer is able to offer this bench-to-bedside level of care since he attained both a medical degree and a PhD in immunology.  

“I’m most proud that I have the skillset to listen to patients and identify what they need clinically, and then do the research to fill in the gaps and conduct clinical trials to develop new therapies to help them,” says Spencer.

Looking to the Future

Spencer’s future plans are to work in a clinical setting where he can continue to see GI patients and perform clinical trials on nutrition-microbiome-immune research. Studies from the Sonnenburg lab he would like to continue are testing the anti-inflammatory effects of fermented foods, which help treat food allergies, and the mechanisms by which our diet, microbiome, and immune system impact each other.

Regarding patient care, Spencer takes a “food is medicine” approach and plans to conduct more research to back up that message. “My future goal is to perform research that reinforces the recommendations of lifestyle medicine; to build the evidence-base for types of food that promote a healthy microbiome and prevent and treat disease,” says Spencer. “This research will help us understand what aspects of food are critical for promoting health and wellness and has real potential to offer improved dietary advice and to help our patients promote health through what they eat.”

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Dr. Spencer’s Science-Based Smoothie for Gut Health

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By Maya Shetty, BS

In the complex world of gut health, finding straightforward solutions that effectively support the microbiome can be challenging. For this reason, Sean Spencer, MD, PhD, Gastroenterologist and Physician Scientist at Stanford University, created a meticulously engineered morning smoothie recipe to support his own gut health. Guided by his deep understanding of the gut’s delicate ecosystem, this smoothie is not just a meal but a strategic tool for fostering a flourishing microbiome.

Ingredients:

  • 1 cup spinach
  • ½ avocado
  • ½ apple
  • 1 tsp green banana flour
  • 1 tsp L-glutamine powder
  • 1 scoop (20 grams) pea protein powder
  • Top up with liquid of choice: water, coconut water, milk or nut milk (without additives)

Creating the Base

Dr. Spencer tailors his morning smoothie base with a focus on nutrient density and diversity, recommending a blend of apples, spinach, and avocado. Yet, he emphasizes the flexibility of the recipe to accommodate personal tastes and digestive responses. For those who find certain fruits, like apples, lead to bloating, Dr. Spencer says they can be easily substituted with other fruits like bananas or blueberries. 

“I find spinach, apple, and avocado make a tasty combination, yet the door is open to experiment with different fruits to achieve a healthy blend of nutrients and fiber,” he states.

Dr. Spencer points out the unique contribution of avocados to the smoothie. Unlike many fruits, avocados are rich in healthy fats, crucial for delivering steady energy throughout the day. Moreover, they are remarkably high in fiber, with half an avocado offering six to seven grams, making up about a quarter of the USDA’s daily recommended fiber intake. This dual benefit of avocados enhances the smoothie’s nutritional profile, making it a powerhouse of sustained energy and digestive health.

When it comes to liquid choices, almond milk is Dr. Spencer’s preferred option, but he notes the suitability of any type of milk or coconut water as long as it’s free from inflammatory additives, such as added sugars and thickeners, which can negatively impact the microbiome when consumed regularly. He also cautions against the deceptive practices of some brands that claim no added sugars while employing enzymes that convert complex carbohydrates into simple sugars (such as alpha-amylase added to oat milks), effectively sneaking in unwanted sugars.

“To ensure the healthiest choice for your microbiome, I recommend opting for products with short and simple ingredient lists,” he states.

Pea Protein Powder

Dr. Spencer chooses pea protein for its gentle impact on the digestive system and its impressive nutritional profile. It also boasts a comparable protein content to whey and includes all nine essential amino acids—vital nutrients your body is incapable of producing on its own.

Dr. Spencer advises that choosing the right protein powder for your gut is not about type, but rather additives. Most protein powders on the market, including pea protein, are formulated with emulsifiers. These additives, such as soy lecithin, cellulose gum, xanthan gum, guar gum, acacia gum, and polysorbate 80, are used to enhance the powder’s mixability in liquids. Despite their practical benefits, emulsifiers come with a downside–they’re notoriously harsh on the microbiome.

Recent research has shed light on the detrimental effects of common emulsifiers, revealing their capacity to directly alter the gut microbiota and incite inflammation. Such disruptions can compromise an otherwise healthy microbiome, underscoring the importance of choosing products wisely. A randomized controlled trial illuminated the extent of this impact, showing that the inclusion of emulsifiers in the diet over a mere 11-day period led to a noticeable decline in microbiome diversity and a reduction in the production of beneficial metabolic byproducts, or postbiotics.

Green Banana Flour (Resistant Starch)

Green banana flour enriches the microbiome with its high resistant starch content, a form of fiber with powerful benefits to the microbiome. Resistant starch has many health benefits and earns its name for its ability to bypass digestion in the small intestine, journeying instead to the large intestine. Here, it serves as a vital food source for beneficial gut bacteria, promoting a robust and healthy microbiome. The fermentation of resistant starch by these microbes results in the production of valuable postbiotics, such as short-chain fatty acids, essential for maintaining gut health. As bananas ripen they convert their starch to simple sugars, while the starch in green bananas remains intact, retaining its prebiotic properties. 

Dr. Spencer also mentions other fiber supplements like psyllium husk, which, although beneficial for digestion and adding moisture to bowel movements, does not serve as a fermentable food source for the microbiome. This distinction highlights the importance of choosing fibers that not only facilitate physical digestion but also actively contribute to the microbiome’s health.

“Other prebiotic supplements and sources exist. However, I choose to supplement with a resistant starch source because it has strong evidence that it is an accessible and fermentable source of fiber for microbiome,” he says.

While Dr. Spencer regularly uses green banana powder as a prebiotic supplement, he emphasizes the significance of incorporating a variety of fiber sources into one’s diet, noting this shouldn’t be the only fiber source in the day. 

“A diverse intake of fibers is crucial for a thriving microbiome, and I recommend consuming other prebiotic-rich foods such as potatoes, whole grains, beans, legumes, nuts, seeds, and a wide array of fruits and vegetables throughout the day,” he says.

L-Glutamine Powder

L-Glutamine offers a range of benefits for gut and microbiome health, such as reducing GI symptoms after morning workouts. It’s also recognized for its role in maintaining the integrity of the intestinal lining and reducing the inflammatory response during gut lining irritation. 

Furthermore, L-Glutamine serves as a vital energy source for the cells within the small intestine. This attribute is essential for maintaining intestinal health and addressing conditions where impaired intestinal barrier is present because it decreases gut permeability and reinforces the intestinal barrier.

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