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10 Minutes Read

Exercise and the Brain: The Mental Health Benefits of Exercise

Exercise can help to regulate stress hormones and trigger the release of mood-boosting neurotransmitters. When combined with other treatments, exercise can help with symptoms of several mental health conditions, including depression and ADHD.

It’s well known that regular exercise has numerous positive health outcomes for the body, such as strengthening the muscles, bones, heart, and lungs and helping to prevent certain diseases. One often-overlooked benefit is the impact of physical activity on mental health. Considering the high prevalence of anxiety, depression, and other mental health conditions worldwide, countless people may benefit from the positive mental health effects of exercise.

In this article we’ll address the relationship among exercise, various mental health conditions, and the brain, as well as how diet may impact your mental health.

How Does Exercise Impact the Brain?

While exercising may seem fairly simple on the surface, a complex chemical cascade occurs inside your body each time you go for a run, hit the gym, or participate in any other physical activity.

This chemical cascade is responsible for several positive effects on your brain.

Releases Neurotransmitters

As you begin exercising, depending on the intensity, a number of important chemical messengers called neurotransmitters are released throughout your nervous system.

Endorphins and Endocannabinoids

Perhaps the most common neurotransmitters people think of in relation to exercise are endorphins. But lesser known neurotransmitters called endocannabinoids also play an important role in your brain when you’re working out. Endorphins block pain and increase sensations of pleasure, and exercise certainly increases your endorphin levels.

But recent research suggests that the euphoric feeling you get after a hard workout may result from endorphins and endocannabinoids working in tandem. Endocannabinoids, in particular, are a group of neurotransmitters that are thought to be responsible for that “runner’s high” — the feeling of calm euphoria that occurs after a strenuous workout.

Dopamine

Another impactful exercise-related neurotransmitter is dopamine.

Dopamine plays an important role in how you feel pleasure. It’s also responsible for other processes in your body, such as regulating heart rate, sleep cycles, mood, attention, motivation, working memory, learning, and pain processing.

Promotes Neuroplasticity

Neuroplasticity is the ability of your brain and nervous system to change their activity in response to internal or external stimuli. This plays a huge role in learning new skills, activities, and languages. Some research suggests that exercise can promote neuroplasticity by increasing certain signaling factors.

Increases oxygen supply to the brain

As your heart starts to pump faster during exercise, it increases the oxygen supply to your brain. This results in certain changes to the blood vessels of your brain, promoting potential improvements in executive function, which includes working memory, flexible thinking, and self-control.

In a 2021 study in 48 adults with mild cognitive impairment, researchers looked at the impact of exercise on blood flow to the cerebrum. This is the largest part of the brain and is responsible for higher intellectual function, sensory impulses, and motor activity. They found that a 1-year moderate to vigorous exercise program increased cerebral blood flow and reduced the risk of further cognitive decline.

This suggests that regular physical activity can improve blood flow to important parts of your brain, in turn reducing your risk of conditions related to cognitive decline, such as Alzheimer’s disease and stroke.

Summary

When you exercise, a number of neurotransmitters are released, including endorphins, endocannabinoids, and dopamine. Exercise also promotes neuroplasticity and increases oxygen supply to your brain.

What are the Mental Health Benefits of Exercise?

Can relieve stress

It may be no surprise to you that regular exercise is touted as a potent stress reliever. You may have experienced this firsthand. For example, maybe you’ve come home from a brutally stressful day at work and decided to hit the gym, and suddenly you’ve felt a bit of relief. Exercise is thought to reduce stress by reducing levels of stress-related hormones such as cortisol and adrenaline.

In animal studies, regular exercise has also been shown to provide resistance to various stressors. In other words, exercise doesn’t just help you handle stress — it may help prevent stress in the first place.

A 2015 study in a sample of highly trained and sedentary young men found that those who completed 30 minutes of moderate-intensity exercise were much more resilient to an acute stressor than those who did not exercise. Therefore, those who exercise may be able to better deal with common stressors, and this could improve their overall quality of life.

May improve self-confidence

Another mental health benefit closely linked with exercise is improved positive personal image and self-confidence. Several studies have found that regular exercise can contribute to an improved body image and better self-compassion. Therefore, being physically active can be a great way to boost self-esteem and feel good about your body.

Can improve mood

Yet another positive mental health benefit of exercise is its effect on your overall mood. Several studies indicate that performing regular physical activity is associated with a more positive mood and a reduction in negative thoughts. So, if you’re feeling down in the dumps, you may be one workout away from having a more positive outlook and beating mild feelings of depression.

Can promote better sleep

One commonly overlooked factor in maintaining mental health is how well you sleep at night. Although several factors affect your sleep quality, your level of physical activity appears to be particularly influential. A 2017 review of 34 studies concluded that exercise, regardless of the type, can improve sleep efficiency and duration. What’s more, exercise may improve sleep onset latency, or the time it takes you to fall asleep. Therefore, if you have difficulty getting enough quality sleep, incorporating regular exercise — regardless of the type — may provide great benefits.

May promote sharper memory and thinking

In addition to its numerous positive effects on mental health, exercise may positively impact your thinking and memory. Research suggests that exercising regularly can boost mental clarity and improve working memory and attention span. In addition, exercise has been shown to help reduce cognitive decline in adults over age 50.

While regular exercise can provide several general mental health benefits, it can also help relieve the symptoms of some specific mental health conditions, which we will look at in depth below.

Summary

The most commonly experienced, science-backed benefits of physical activity on mental health are reductions in stress, improved self-confidence, improved mood, better sleep quality, sharper memory, and clearer thinking.

Exercise and Depression

Depression is a common mental health condition worldwide, with about 5% of the global adult population experiencing it in varying degrees. The main symptoms are:

  • depressed mood
  • loss of interest in previously pleasurable activities
  • low self-worth
  • disrupted sleep
  • thoughts of suicide

Regular exercise has been repeatedly shown to help manage symptoms of depression, with the most significant benefits being higher self-esteem, better life satisfaction, and fewer negative thoughts. In fact, a 2018 research review found that aerobic exercise in particular can have antidepressant effects.

Exercise may decrease depressive thoughts by increasing levels of brain-derived neurotrophic factor, an important protein in your brain that’s responsible for learning and cell growth. While aerobic exercise has been shown to be beneficial in reducing symptoms of depression, any type of exercise — from running to playing basketball or lifting weights — is likely helpful.

Exercise and Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a common mental health condition. People who have ADHD may experience difficulty paying attention, impulsive behavior, and overactivity. The cause is an imbalance of neurotransmitters (chemical messengers) in the brain, primarily dopamine. ADHD is often treated with medications to promote concentration and reduce impulsive behavior, but research suggests that exercise can be an excellent complementary treatment for ADHD.

Specifically, physical exercise has been shown to help regulate dopamine levels in the brain, improve executive functions, and improve attention in children and adults with ADHD. While most studies use aerobic exercise in ADHD interventions, it’s important to incorporate a combination of aerobic (cardio) and resistance training into your exercise routine to maximize the health benefits.

Exercise and Anxiety

While we all may feel anxious at times, generalized anxiety disorder (GAD) is defined as experiencing excessive anxiety or worry most days for at least 6 months. Some common symptoms of GAD are:

  • restlessness
  • fatigue
  • irritability
  • sleeplessness

Medications, cognitive behavioral therapy (CBT), and meditation are common treatment methods. One alternative method of managing the symptoms of GAD is regularly engaging in purposeful exercise. In fact, a 2018 research review found exercise to be a viable treatment method for anxiety disorder and concluded that higher intensity exercise was more beneficial than lower intensity regimens. Therefore, regular exercise seems to be a viable alternative treatment option for anxiety disorder in combination with prescribed medications.

Exercise and Bipolar Disorder

Bipolar disorder is a mental health condition that causes unusual shifts in mood and energy levels, impacts your ability to concentrate, and may impact your ability to complete everyday tasks. This condition in commonly characterized by episodes of depression and mania, although in some cases symptoms are mixed. Traditional treatment methods include mood-stabilizing or antipsychotic medications and psychotherapy. In addition to traditional treatment methods, exercise has been shown to help manage symptoms of bipolar disorder.

More specifically, regular physical activity may help reduce shifts in mood and promote an improved sense of well-being in people with bipolar disorder. Many of the medications commonly prescribed for bipolar disorder list weight gain as a side effect, and regular exercise may also help limit this effect.

Exercise and Obsessive-Compulsive Disorder (OCD)

OCD is a condition that can cause uncontrollable recurring thoughts (obsessions) and behaviors (compulsions) that you feel the urge to repeat over and over. Depending on the severity, this disorder can affect all aspects of life, including work, school, and home life. The most common treatment approach is medication — such as serotonin reuptake inhibitors (SRIs) — paired with CBT, a type of psychotherapy that targets specific behaviors.

A popular alternative treatment method for OCD is a regimented exercise program. In a 2017 study in 56 adults with OCD, researchers noted a significant reduction in OCD symptoms following a 12-week aerobic exercise program. In addition, they found reductions in feelings of anxiety and depression, two other symptoms common in people with OCD. This suggests that regular exercise may be a beneficial complementary treatment for OCD.

Exercise and Post-Traumatic Stress Disorder (PTSD)

PTSD is a condition that may develop in people who have experienced a shocking, scary, or dangerous event. People living with PTSD may experience flashbacks, bad dreams, or frightening thoughts associated with their initial traumatic experience. They may also be easily startled, feel edgy, or have trouble sleeping. Traditionally, treatment for PTSD includes taking antidepressant medications and participating in psychotherapy (talk therapy) to overcome negative feelings associated with the traumatic event.

In recent years, exercise has become a common complementary treatment approach. Several studies suggest that regular physical activity can help reduce PTSD symptoms in a number of ways, including:

  • desensitizing a person to internal arousal cues
  • enhancing brain function
  • regulating levels of hormones associated with stress
  • promoting neuroplasticity

Including regular exercise alongside traditional treatment methods appears to be hugely beneficial for addressing PTSD symptoms.

Summary

Regular physical exercise may have positive effects on several mental health conditions, including depression, ADHD, generalized anxiety disorder, bipolar disorder, OCD, and PTSD.

Tips for Developing an Exercise Routine for Mental Health

Whether you’re just starting to exercise or you’re a seasoned veteran, there are a few important things to keep in mind when developing your routine, especially if you live with a mental health condition.

Some mental health conditions may make it harder to feel motivated to exercise. Therefore, creating a strategy to stay consistent may be very helpful.

Here are the top tips to help ensure success when developing an exercise routine:

  • Find your ideal time of day. Some people are morning people, while others do best working out in the evening or at night. If you find your ideal time for physical activity, you’ll be more likely to stick to your routine.
  • Set attainable goals. Creating achievable goals is super important for staying motivated. Set small goals and celebrate those wins.
  • Include exercises you enjoy. It can be hard to stay motivated to exercise if you don’t enjoy the activities you’re doing. Choose exercises that make you feel good, and try to have fun while doing them.
  • Work out with a friend or a group. Working out with a friend or group may just give you the motivation and accountability you need to stay consistent.
  • Work with a personal trainer. If this is an option for you, having a professional guide you through your exercises may provide a boost of motivation and encourage you to get the most out of each session and keep coming back.

Summary

Set attainable goals and make your workout something you enjoy. You’ll reap the most mental health benefits from exercise if you find something you enjoy doing and maintain the habit long-term.

The Bottom Line

Mental health conditions affect a significant percentage of the worldwide population. Medications and psychotherapy are common traditional treatment methods, but regular exercise has been shown to be a promising complementary treatment approach.

Exercise promotes the release of hormones in your brain that can contribute to reduced stress, improved self-confidence, improved mood, better sleep quality, and sharper memory and thinking. More specifically, regular exercise can positively impact many mental health conditions, including depression, ADHD, generalized anxiety disorder, bipolar disorder, OCD, and PTSD.

Consistency is important when you’re exercising for mental health benefits. It can be helpful to set attainable goals, find your ideal time of day to exercise, include exercises you enjoy, and maybe even work out with a friend. It’s also important to follow a nutritious diet, as diet has been shown to be an influential factor in mental health. By participating in regular exercise and following a nutritious diet, you’ll be well on your way to improved mental health and an overall better quality of life.

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11.04.2025

Nitric Oxide: More About This Important Tiny Molecule With Big Impact on Brain, Heart, Healing, Fitness, and Longevity

Nitric oxide (NO) is a gas your body makes that relaxes blood vessels, supports mitochondrial function, modulates immunity, and helps nerves communicate. Low NO shows up as higher blood pressure, slower recovery, poorer sexual function, and age-related disease risk. NO is built from dietary nitrate (leafy greens, beets) and from arginine/citrulline pathways—and it’s strongly influenced by your oral microbiome and even sunlight. You can restore it with smart nutrition, training, mouth-friendly habits, and targeted supplements where appropriate. PMCWhat Exactly Is Nitric Oxide (NO)?NO is produced by enzymes called nitric oxide synthases (NOS) and by a diet-microbiome pathway that turns nitrate → nitrite → NO. In blood vessels, NO tells smooth muscle to relax, increasing blood flow and lowering vascular resistance—central to healthy endothelial function, the “youth” of your arteries. When endothelial NO is low, vessels get stiff, inflamed, and pro-thrombotic. PMCPubMedWhy NO Matters Across Health Domains1) Cardiovascular health & blood pressureNO is a primary regulator of vascular tone; impaired NO signaling is a hallmark of endothelial dysfunction and a starting point for atherosclerosis and hypertension. Improving NO (through diet, activity, sunlight exposure within safe limits, and—in select cases—supplements) correlates with better blood pressure and vascular function. PMCPubMedAHA Journals2) Brain & cognition (including Alzheimer’s)NO influences cerebral blood flow and neuronal signaling. Recent reviews connect NO dysregulation with Alzheimer’s disease pathology (amyloid, tau, mitochondrial stress). While we don’t have a cure, maintaining NO bioavailability is a plausible target alongside sleep, exercise, and metabolic care. PMCPubMed3) Wound healing & tissue repairTopical and biomaterial strategies that deliver NO can accelerate closure, angiogenesis, and antimicrobial defense—especially relevant in diabetic or “hard-to-heal” wounds. (This is an active research area; therapies are evolving.) PMCPubMed+14) Physical fitness & exercise performanceDietary nitrate (e.g., beetroot) and NO-precursor strategies may lower the oxygen cost of exercise and modestly improve certain performance metrics—effects appear stronger in older adults and in longer, submaximal efforts. Results vary by study and individual. EatingWellNew York PostPubMed5) Sexual function (all genders)Penile and clitoral erection rely on NO-cGMP signaling; endothelial and neuronal NO drive genital blood flow and arousal physiology. Oxidative stress reduces NO bioavailability and contributes to erectile dysfunction (ED); improving endothelial health and NO can help, though severe cases need medical evaluation. PMC+2PMC+26) Age-related chronic diseaseAging, insulin resistance, and oxidative stress reduce NO generation and increase NO “scavenging,” linking low NO to cardiometabolic disease and possibly neurodegeneration. Strategies that restore NO—and reduce oxidative burden—are foundational longevity levers. PMC+1The Oral Microbiome–NO Highway (And Why Mouthwash Can Backfire)Leafy greens and beets supply nitrate. Oral bacteria convert nitrate → nitrite, which your body turns into NO—especially when oxygen is low (like during exercise). Antiseptic mouthwashes can blunt this pathway, and several studies associate routine use with higher blood pressure and loss of the nitrate benefit. Older adults may benefit most from dietary nitrate because the oral microbiome and endothelial NO decline with age. PubMed+1EatingWellPractical swapsAvoid daily antiseptic mouthwash unless medically indicated; try gentle rinses and good brushing/flossing instead.Eat nitrate-rich veggies (see list below) and chew them well—the conversion starts in the mouth. PubMed Sunlight & Skin-Stored NOYour skin stores nitrite/nitrate. Non-burning UVA exposure can mobilize NO and acutely lower blood pressure (separate from vitamin D). Be sun-smart—brief, regular exposure appropriate for your skin type; avoid burns. PMCScienceDirectWhat Dr. Nathan Bryan EmphasizesDr. Nathan Bryan—NO biochemist—highlights that modern lifestyles (processed diets, antiseptic oral products, PPIs/antacids, sedentary behavior) erode NO production, while simple habits restore it: nitrate-rich foods, protecting oral bacteria, resistance training, and targeted NO-generating tools. For color and context, see his Diary of a CEO interview and transcript; treat podcasts as commentary, then anchor choices in primary literature. Apple PodcastsThe Singju PostYouTubeHow to Build (and Keep) Your Nitric Oxide1) Eat the NO diet (daily)Prioritize nitrate-rich plants:Beets, beet greens, arugula/rocket, spinach, chard, lettuce, fennel, celery, bok choy, kale.A pattern of these foods consistently supports blood pressure and vascular function; older adults may see the clearest wins. EatingWellNew York Post 2) Train your endotheliumZone 2 cardio (150+ min/week) and resistance training improve endothelial function and NO signaling over time. (Mechanistic vascular literature supports this even when individual supplement trials are mixed.) PMC 3) Protect the oral-nitrate pathwaySkip routine antiseptic mouthwash; maintain gum health with brushing/flossing/pro cleanings. PubMed 4) Smart sunlight (if appropriate)Short, sensible daylight exposure can release NO from skin stores; still use sun safety. PMC5) Consider targeted supplementation (case-by-case)Dietary nitrate (e.g., beet juice shots) may lower BP and aid performance in some—especially older or less fit adults.L-citrulline (often 3–6 g/day) increases arginine and may help blood flow and perceived exertion in some settings; performance results are mixed across meta-analyses and trials.L-arginine can support NO but is more heavily metabolized by the gut/liver; citrulline often raises arginine more reliably.Always screen for interactions (e.g., nitrates + PDE-5 inhibitors), kidney concerns (oxalates in high-dose beet products), and medical conditions. EatingWellPubMedTaylor & Francis Online Where NO Touches Specific ConditionsHypertension & heart disease: Boosting NO via diet and endothelial fitness is foundational; sodium/potassium balance and metabolic health still matter. 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In older adults, concentrated beet juice (nitrate-rich) has shown clinically meaningful systolic BP reductions and beneficial oral-microbiome shifts versus nitrate-depleted placebo; effects are smaller or inconsistent in younger adults. EatingWellNew York PostDoes mouthwash raise blood pressure? Antiseptic mouthwash can reduce nitrate-to-nitrite conversion and has been associated with higher BP in some studies. Occasional use is fine; avoid daily use unless directed. PubMedCan sunlight lower BP because of NO? Non-burning UVA can mobilize NO from skin stores and modestly lower BP—complementary to, not a replacement for, other therapies. Practice sun safety. PMCCitrulline or arginine for NO? Citrulline often raises plasma arginine more effectively and may aid certain exercise or circulation outcomes, but performance benefits are not guaranteed. Test your response and monitor BP. 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Salt, Sodium, and Blood Pressure: Why the Real Story Is More About Insulin and Metabolic Health

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Human data followed, leading to generalized anti-sodium recommendations.Salt sensitivity actually applies to a subset of people—estimated at 25–50%; many individuals exhibit minimal blood pressure changes regardless of sodium intake (salt-resistant) .Large observational studies like PURE (Prospective Urban Rural Epidemiology) found a J-shaped curve: very high sodium was harmful, but so was very low sodium intake. Cardiovascular risk was lowest in moderate intake ranges .Individual variability matters—kidney function, age, insulin resistance, and genetics significantly modify how sodium affects you.So, the blanket statement “salt causes hypertension” is outdated and overly simplistic.Insulin Resistance: The Hidden Driver of Sodium RetentionInsulin controls how your kidneys handle sodium. In hyperinsulinemia states, the kidneys retain more sodium, increasing blood volume and pressure .Additionally, insulin may activate the sympathetic nervous system, tightening blood vessels and further raising blood pressure .This implies many with hypertension are “insulin-sensitive” rather than “salt-sensitive.” Addressing insulin sensitivity—with diet, movement, sleep, and stress reduction—can impact blood pressure independently of sodium intake.Sodium + Potassium: The Balancing ActPotassium counters sodium. It helps the kidneys excrete excess sodium and relaxes blood vessels. Diets low in potassium, which are common in the Western diet, worsen sodium’s effects on blood pressure .Traditional diets rich in fruits, vegetables, beans, and tubers naturally provide this balance.The DASH diet (Dietary Approaches to Stop Hypertension) lowers blood pressure in part by emphasizing potassium-rich foods—even without extreme sodium restriction.How Much Sodium Do We Really Need?General Guidelines (Non-Training Days)The AHA recommends up to 2,300 mg/day (≈1 tsp salt), aiming toward 1,500 mg/day for those with hypertension .The PURE study suggests lowest cardiovascular risk with 3,000–5,000 mg/day, depending on potassium and metabolic health .Training Days / AthletesSweat can lose 500–2,000 mg sodium per liter. Endurance athletes, especially in heat, may need 3,500–5,500 mg/day or more.Guidance:90 min intense/hot: ~500–1,000 mg sodium/hour.Signs You’re Getting It WrongToo little sodium (relative to need):Dizziness, headaches, muscle crampsBrain fog, fatigue, nauseaFrequent urination with very clear urineIn extreme cases: hyponatremia—an emergencyToo much sodium (chronically):Elevated blood pressure in salt-sensitive individualsBloating, swelling (hands, ankles)Constant thirstThe Type of Salt Matters (But Not As Much As You Think)Your body cares about sodium, not crystal color—but the form of salt has context:Iodized table salt: Adds iodine (essential for thyroid health).Sea salt / Himalayan pink salt: Trace minerals present but negligible nutrition-wise; sodium per gram nearly identical to table salt.Kosher salt: Larger crystals, great for cooking; often lacks iodine.Electrolyte salts: Blend sodium with potassium and magnesium—useful for athletes and hot training days.Specialty salts may taste or look different, but they don’t alter sodium’s effect on blood pressure or physiology.Smarter Sodium StrategiesSalt whole foods—not processed ones. 70–80% of dietary sodium comes from packaged and restaurant foods, not your shaker.Boost potassium. Incorporate avocado, beans, leafy greens, yogurt, and squash.Control insulin. Prioritize exercise, protein-forward whole foods, sleep, and stress management for better sodium handling.Use the right salt for your iodine needs. If seafood isn’t in your diet, iodized salt is important.Personalize intake. Monitor blood pressure at home over 2–4 weeks as you adjust sodium and lifestyle.Sample Day FrameworksBalanced Rest DaySodium Targets & Strategy ~2,000 mg sodium totalBreakfastGreek yogurt + salted pumpkin seeds (~250 mg)LunchChicken salad with olives, feta, vinaigrette (~600 mg)SnackCottage cheese with cucumber (~400 mg)DinnerSalmon, roasted potatoes, green beans, pinch of sea salt (~750 mg)Hot Training Day~3,500 mg sodium totalPre-WorkoutWater + pinch of salt + half a banana (~200 mg)During TrainingElectrolyte drink (~1,000 mg sodium total)Post-Workout MealRice bowl with steak, salsa, avocado (~900 mg)DinnerSoupy stew with chicken and vegetables (~1,000 mg)SnacksPickles/olives if craving salt (~400 mg)FAQsQ: Does salt cause high blood pressure in everyone? No. Only 25–50% are salt-sensitive; insulin resistance, age, and low potassium often play larger roles .Q: Should I avoid all processed foods? Not necessarily—but since most sodium comes from processed sources, cooking at home gives you control.Q: Is Himalayan salt healthier? Not for sodium content. Its trace minerals are negligible. If iodized salt isn’t used, ensure iodine from seafood or dairy .The TakeawaySodium is essential, not evil.Insulin resistance and low potassium drive hypertension more than salt alone.Most people do well with 2,000–3,500 mg/day, though athletes and hot-weather exercisers may need more.Personalization beats one-size-fits-all.Prioritize whole foods, metabolic health, and mindful sodium intake.ReferencesSalt sensitivity estimates and individual variation in blood pressure responsePURE study findings on J-shaped sodium-risk curveInsulin’s effect on renal sodium retentionInsulin, sympathetic activation, and blood pressurePotassium’s sodium-excretion effect and guidelinesAHA sodium intake recommendationsNIH iodine guidelines for iodized saltSodium sources — processed vs home-cooked (widely reported estimates) …and based on prior evidence and dietary surveys.

10.16.2025

Understanding SIBO: How It Starts and How to Reverse Its Effects

Small Intestinal Bacterial Overgrowth (SIBO) is a condition where bacteria from the colon overpopulate the small intestine, leading to bloating, gas, malnutrition, and a host of frustrating symptoms.1. What is SIBO—and How Does It Begin?The small intestine typically has very few bacteria, thanks to protective mechanisms like stomach acid, bile, digestive enzymes, and intestinal motility. But when these systems break down, bacteria can thrive where they shouldn’t.Protective barriers include gastric acid, bile, digestive enzymes, the migrating motor complex (MMC), intact ileocecal valve, and immune defenses (e.g., secretory IgA) PMC+15NCBI+15Dr Stavy Nikitopoulou+15.When they fail—due to low stomach acid, enzyme insufficiency, anatomical changes, autoimmune conditions, hypothyroidism, diabetes, scleroderma, IBS, or post-infectious gut damage—SIBO can take hold NCBI.Other common triggers include prior food poisoning, medication use (like PPIs or painkillers), and structural issues like surgeries or fistulas Health.2. Common Symptoms & Diagnostic ChallengesPatients with SIBO often experience:Bloating, abdominal pain, diarrhea or constipation, and nutrient malabsorption IFN Academy+15PubMed+15stevegranthealth.com+15Health.Nutrient deficiencies—particularly in iron, B12, folate, fat-soluble vitamins A, D, and E—due to impaired absorption EatingWell+1.Extraintestinal symptoms like fatigue, brain fog, and skin conditions (e.g., rosacea) EatingWell.Diagnosing SIBO is not straightforward. While the jejunal aspirate culture is the gold standard (detecting >10^5 bacteria/mL), it’s invasive and often impractical PMC+12Wikipedia+12Health+12. Instead, breath tests measuring hydrogen and methane are commonly used, though they come with false positives and variability Verywell Health+2Wikipedia+2.3. Reversing SIBO—A Functional Medicine BlueprintRoot-Cause HealingThe functional medicine approach looks beyond symptoms to heal underlying causes:Evaluate triggers like digestive motility issues, immune dysfunction, enzyme insufficiency, dysbiosis, or structural dysfunctions functional-medicine.associates+7PubMed+7thechi.ca+7stevegranthealth.com+1.Treating the underlying cause—not just the symptoms—is essential for long-term resolution PMCPubMed.Clinical & Therapeutic StrategiesEradicate OvergrowthAntibiotics: Rifaximin is often preferred; neomycin may be used for methane-predominant cases PMC+1.Herbal antimicrobials: Emerging evidence indicates they can be as effective as rifaximin The Institute for Functional Medicine+1.Dietary InterventionsLow-FODMAP diet can reduce fermentation and symptoms—but isn’t meant for long-term use due to potential negative effects on gut microbiome diversity WikipediaVerywell Health.Elemental diet (a pre-digested liquid formula) can starve bacteria while nourishing the body—shown to normalize breath tests in up to ~85% of cases over 14–21 days Wikipedia.Supportive TherapiesProkinetics to restore MMC function and prevent recurrence Wikipedia+1.Targeted supplementation for underlying deficiencies (like B12, iron, or fat-soluble vitamins) Health+1.Probiotics: Can be effective when timed appropriately—e.g., Lactobacillus strains post-antibiotic therapy PMC+3Wikipedia+3Health+3.Functional Medicine Clinical ModelIdentify the root cause (motility, acid/enzyme function, immune, structural).Eradicate the microbial overgrowth using herbal or pharmaceutical interventions.Rebuild and rebalance gut health with nutrition, prokinetics, nutrients, and microbiome support.Monitor and prevent recurrence with periodic re-evaluation and maintenance strategies Wikipedia+10NCBI+10Rupa Health+10PMC+4PubMed+4EatingWell+4.4. Why Functional Medicine Delivers ResultsUnlike single-solution strategies, this approach:Addresses multiple layers—digestion, motility, immune function, gut microbiota, and structural health.Seeks long-term remission by fixing root causes, not just suppressing overgrowths.Uses rotation of therapies (diet, elemental, antimicrobials, prokinetics) to minimize recurrence risk EatingWell+5NCBI+5Wikipedia+5. Supplements for SIBO Recovery1. Antimicrobial Phase (Eradicating Overgrowth)(Typically 4–8 weeks, guided by a practitioner)Herbal antimicrobials (shown in studies to be as effective as rifaximin):Oregano oil (enteric-coated) – broad spectrum antimicrobial【PubMed: PMID 24891990】Berberine (from goldenseal/barberry) – antibacterial, antifungal, anti-inflammatory【PubMed: PMID 33274096】Neem – supports bacterial balance, especially methane SIBOGarlic extract (allicin) – targeted against methane-producing archaea【PubMed: PMID 16842559】Caution: These are potent — best rotated or combined under guidance to prevent resistance and minimize die-off symptoms (Herxheimer reaction).2. Motility & Prevention (Keeping the Gut Moving)(Supports the Migrating Motor Complex, MMC — prevents relapse)Prokinetics (usually at night, after antimicrobial phase):Ginger extract (1–2 g/day) — stimulates gastric emptying5-HTP or low-dose melatonin — modulates serotonin, improves motilityIberogast (herbal blend) — clinically shown to support MMC function【PubMed: PMID 15836424】Optional: prescription prokinetics (prucalopride, low-dose erythromycin) if natural support isn’t enough.3. Gut Lining Repair (Reduce Inflammation, Support Absorption)(Rebuilds the intestinal barrier after bacterial damage)L-Glutamine (5–10 g/day) — primary fuel for enterocytes, reduces permeability【PubMed: PMID 26447961】Zinc carnosine — promotes mucosal healing【PubMed: PMID 23028914】Collagen peptides or bone broth — provide glycine and proline for gut repairAloe vera extract or slippery elm/marshmallow root — soothing botanicals for irritated mucosa4. Rebalancing the Microbiome(Usually added after antimicrobials, otherwise may worsen symptoms)ProbioticsSoil-based strains (Bacillus species) are better tolerated early onLactobacillus & Bifidobacterium blends can be reintroduced laterSome studies show probiotics may improve breath test results and symptoms post-treatment【PubMed: PMID 28708949Prebiotics: Introduce slowly (e.g., partially hydrolyzed guar gum, PHGG) to support long-term microbiome diversity once stable5. Nutrient Repletion (Fixing Deficiencies Caused by SIBO)Because SIBO often leads to malabsorption:B12 (methylcobalamin or injections if deficient)Iron (if ferritin

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