Protein supplements, diverticulitis, and proton pump inhibitors

July 2025 | Gut Advisor Monthly Newsletter

Author

Lisa Goehler
July 23, 2025

Gut Advisor

Hi friends,

Welcome to the Gut Advisor Newsletter! We hope you are all having a nice summer.

For anyone new- this is a monthly newsletter where we address new, or older but relevant, research findings as well as summarize recent findings or gut-related news. Here, “gut-related” is broadly interpreted, so we will be covering anything that might affect the gut, both “top down” and bottom up”. This means brain/mind things (‘top down”) such as psychology of stress, resilience, and emotion regulation, as well as body-based things (“bottom up”) including inflammation and typical comorbidities of gut disorders, such as pain conditions and autoimmunity.

Dr. Lisa Goehler

Table of Contents

News & Views

Can you have too much protein?

In a story for the The Atlantic (The protein madness has started- it has come to protein iced tea), the author, Lila Schroff, relates her experiences with the proliferation of protein supplemented foods and health claims made about them.

Concerns

Fad recommendations are going way beyond standard dietary recommendations, and this is a real worry. In general, intake of either too little or too much of a nutrient causes problems for metabolic regulation. What are the potential problems with very high protein intake?

I researched this for a bit when writing my book, because the levels of certain amino acids called branched chain amino acids (BCAA)s in the blood may be a biomarker for insulin resistance, and may link insulin resistance to inflammation. Ultimately, I decided to omit it from the book because it really seemed relevant only when someone is consuming a very high protein diet. And who does that?

Well, lots of people are at risk now, it seems.

What are the BCAAs?

The three BCAAs are leucine, valine, and isoleucine and are three of the nine essential amino acids. They are considered essential because our bodies cannot make them so we need to get them from our food. Normally, we get them in protein-rich foods such meats, poultry, fish, eggs, and dairy.

Findings from animal and in vitro studies indicate that higher levels of BCAAs are associated with accelerated aging, insulin resistance, and mTor activation. What is mTOR? mTOR is an enzyme contributes to the regulation of insulin sensitivity, and may link BCAAs to diabetes (Bloomgarden 2018, Liang 2024).

Elevated levels of branched chain amino acids may drive inflammation, especially associated with aging. A caveat is that most of the studies done in dishes/in vitro, or in flies, and may not reflect reality. However, human genes associated with BCAA transport and metabolism are associated with aging-related inflammation (Liang 2024). Further, epidemiological studies link type 2 and gestational diabetes to elevated BCAA levels (Tanase 2023). A study with 19,000+ women who were not diabetic and did not have cardiometabolic disease, higher levels of circulating BCAAs were associated with higher levels of inflammatory mediators and dyslipidemia (Hamaya 2021). Together with findings from studies addressing molecular effects of BCAAs in cells (Liang 2024), research indicates that too many BCAAs in blood dysregulates metabolic pathways, including the insulin signaling pathways, and may contribute significantly to disease. Still, this is a fairly new focus of research and we need more studies with human participants. Unfortunately, with the latest high protein fads, we may be inadvertently generating more data on the link between high protein, especially BCAA, intake and disease.

The bottom line

We need protein and BCAAs in our diet, but too much can disrupt the metabolic pathways in cells of our bodies (Yadao 2018), potentially leading to inflammation, accelerated aging, insulin resistance and type 2 diabetes, and atherosclerosis. It seems like a good idea to steer clear of protein supplemented foods, as well as BCAA supplements.

Anti-aging with BPC-157?

Something else I just heard about, from the “Biohacking” world: Body protecting compound (BPC)-157. This is a gut peptide that people believe can act as an “anti-aging” agent. (Vukavic 2022). It was originally studied for potential benefits for inflammatory gut conditions using animal models, based on observed “cytoprotective” actions such as wound healing, but has since been studied in other inflammatory conditions, and is being tested (but no published results yet) in humans to address Ulcerative Colitis and Multiple Sclerosis (Seiwerth 2021).

Compared to other supplements, BPC157 has a huge advantage. Unlike most gut peptides, which are broken down by gastric juice, BPC-157 is stable and therefore can be taken orally. It is also water soluble meaning it does not need to be given oil or alcohol, which can be unpalatable. This is super convenient for commercialization!

Does it really live up to the hype?

This is hard to know, because although there are a fair number of research papers published about it, most of the papers come from animal or in vitro models (e.g. cultured tissue) from the same group. There not very much information from human studies, and FDA has made no evaluation of safety or effectiveness. As long as it is marketed as a “supplement”, evidence of effectiveness and safety are not required. Caveat emptor! (Buyer beware). It might be safe. Or not. It might have “cytoprotective” effects. Or not.

Misconception of the Mononth
❝

Probiotics can help with weight loss, stomach flattening and cellulite smoothing

From a subscriber: “I would love to see you do you Misconception of the Month on supplements such as Bioma- a probiotic that suggests weight loss, stomach flattening and cellulite smoothing as a result of talking it.”

Where did this claim come from?

Bioma is an example of a company that sells “personalized” probiotic formulations, determined by taking a quiz about how much weight you want to lose, what kind of food you eat, and your activity levels. It claims to use the results of the quiz to tell which formulation you need. I stopped here… but apparently they only have one formulation (!).

The misconception here is that specific gut microbes can control things like weight, fat distribution, and appetite in very specific ways, and that taking specially targeted supplements of these specific gut microbe populations can fix problems with weight, appetite and fat distribution.

The kernel of truth

Microbes do influence many functions of the body, mostly clearly gut and metabolic system (liver, pancreas etc) health and immune system regulation. The major mechanisms of these benefits seem, so far, to result from substances such as butyrate (short chain fatty acid that nourishes gut cells, regulates immune cells, and may influence gene expression) vitamins, and neurotransmitters such as serotonin and acetyl choline (Chakraborty 2024). Probiotics that contain microbes that produce butyrate, or more reliably, prebiotics or diets that support butyrate producing microbes do seem to have beneficial effects on conditions related to inflammation or immune dysregulation.

Extrapolation beyond reality

Specific benefits, such as reducing “cellulite” or flattening your stomach, or even more general benefits such as weight loss, cannot be linked reliably or specifically to any microbes right now.

Most of the in vivo reports, for instance, are based on findings from mostly mouse studies, in which specific probiotic stains had specific effects on e.g. bone, muscle and fat. Unfortunately, mice are not as good of models for humans as many would hope. Results from human studies are thin on the ground, and do not reliably support beneficial effects of specific probiotics (Huber 2023).

In general, such studies so far only address weight loss and are both few and variable in their methodology (Hamed Rivera 2024). Further, the studies described in a recent review (Alvarez 2021), for instance, reported very short treatment periods (8-12 weeks) so it is unknown whether any benefits from the probiotics were maintained. And if you look at the data (not just the statistics) you see the effect sizes are small, for example 0.64 kilograms, which is about 1.5 pounds (Hamed Rivera 2024). This is actually not very impressive.

The challenge for any intervention is that weight, fat distribution, appetite, etc. are regulated in complex ways, including genetic ways. Yes, certain classes of microbes may, based on the molecules they produce, support beneficial outcomes. But the outcomes are general, such as reductions in inflammation and the consequent “sickness syndrome” of mood symptoms, fatigue, and cognitive “fuzziness”. Importantly, we don’t really know what the mechanisms actually are for any benefits of any specific strain, so it’s hard to know how real the findings are. Beware of any program promising a probiotic formula “tailored for you!”, because the science isn’t there. On the other hand, any program that encourages consumption of a variety of pre- and probiotic foods will support the classes of gut microbes for whom there is an evidence base of general benefits, such as reduced inflammation and improved glucose tolerance, is likely to be legitimate.

Journal Club

Every month, we pick a published (and peer reviewed) article to highlight and discuss.

This month’s selected article

Title

Diverticulitis: An Update From the Age Old Paradigm

Authors

Hawkins AT, Wise PE, Chan T, Lee JT, Glyn T, Wood V, Eglinton T, Frizelle F, Khan A, Hall J, Ilyas MIM, Michailidou M, Nfonsam VN, Cowan ML, Williams J, Steele SR, Alavi K, Ellis CT, Collins D, Winter DC, Zaghiyan K, Gallo G, Carvello M, Spinelli A, Lightner AL

Publication

Curr Probl Surg., 2020

The paper gives an overview of the history of the diagnosis of diverticulitis and its treatments, with an evidence-based contemporary critique.

Title Translation

We think this paper is worth a read! Check it out →

Background

  • Diverticulitis is an inflammatory condition of diverticula, which are little outpouchings from the colon (they can look like caves).

  • Diverticula are very common with aging; it is estimated that 50% of people over the age of 60 have them, and the incidence goes up as we get older.

  • Incidence of diverticulitis is increasing worldwide, and like other inflammatory diseases, correlates with an urban lifestyle.

Main Takeaways

  • The key importance of this paper is that it is quite comprehensive, and clearly lays out how “traditional” prevention and management approaches can be misguided. It outlines newer, evidence-based recommendations. I outline some of the highlights here.

  • The authors clearly call out claims that people should avoid nuts, popcorn, and seeds (I hear this one a lot, and it makes no sense). In fact, in a study of 47,000 men, eating MORE nuts and seeds was associated with LESS likelihood of developing diverticulitis. Eating a diet containing insoluble fiber, especially cellulose (from plants) was the most protective factor. The authors point out that diets that are good in general for the gut, such as eating lots of fruits and veg, being sure to get plenty of fiber, and avoiding ultra-processed foods, have been shown to be true specifically for diverticulitis as well.

  • Antibiotics have been a mainstay of treatment for diverticulitis, but recent findings now suggest that diverticulitis is more of an ongoing inflammatory condition, rather than an acute “infection”. Thus, the benefits of antibiotics are questionable. In fact, as the paper describes, clinical trials have shown that there is no difference in outcomes between patients with diverticulitis treated with antibiotics, and those who were not. It is important to note that with studies were done with “uncomplicated” diverticulitis (which is most cases) and that more serious cases will require more aggressive treatment.

The good news here to me is that long held assumptions about management of gut disorders such as diverticulitis are finally being tested and interpreted in the light of evidence-based understanding of how the gut actually works. Previous recommendations and management were really based on not much more than “old wives tales”, and people suffering from these disorders often never really recover. Newer appreciation for gut function, gut microbes, and lifestyle factors especially diet, give real hope for healing.

Dr. Lisa Goehler

Here we will pass on “tips” or observations from practitioners or patients about approaches they found helpful for dealing with symptoms of gut problems or ways to keep the gut healthy that have not yet been tested with clinical trials. So, the evidence is anecdotal, but may be worth trying

Getting off proton pump inhibitors

One of the most popular topics for pro-tips I have heard over the years concerns how to get off of proton pump inhibitors (PPIs).

Why is it important to get off PPIs?

PPIs are medications prescribed for gastro-esophageal reflux disease (GERD) and heartburn. They work by preventing the acid-secreting cells of the stomach from secreting acid. This is believed to prevent damage to the esophagus from the reflux of acidic stomach contents onto it. However, PPIs do not actually treat the reflux, and may make it worse. PPI use is also associated with increased risk of liver and gastrointestinal cancer, possibly including esophageal cancer (Tran 2023). Further, PPI use increases the likelihood of C. difficile overgrowth/infection, likely due to impairment of the gut environment conducive for a health gut microbe population (Jaynes 2019)

Long term use of PPIs is associated with kidney, bone, and possibly neurological problems, which is believed to result from mineral and vitamin deficiencies due to poor mineral uptake from the gut (Jaynes 2019). PPIs cause this because minerals including calcium, magnesium and iron are normally bound to substances such as carbonate or citrate to keep them stable. But in order to be absorbed into our bodies, the minerals must come off of the carrier, and that process requires acid. This is true for some B vitamins too. For this reason, PPIs are actually not supposed to be taken for more than 4 weeks. In those 4 weeks, patients are supposed to be working on ways to reduce the reflux.

Theoretically anyway. PPIs may slow down digestion, which increases pressure inside the stomach, which leads to reflux. So the medication can worsen the condition it is used to treat. Great business plan though! A key barrier for people who want to stop taking PPIs are “rebound effects” of artificially suppressing acid production with a drug. Acid-sensing cells in the stomach detect that there is not enough acid in the stomach, and try to drive the acid secreting cells harder. While taking the drug, this does not work, but once the drug is withdrawn you get more acid secreted normally, which is painful when refluxed. Fear of the pain keeps people on the drug.

So here is what I have heard from people who were able to get off of PPIs themselves or were able to help their patients do so:

  • It is essential to reduce the dose slowly, rather than stop taking them abruptly (”cold turkey”). So the first week (or two) take one pill less, per week. The second week take two pills less per week, and so on until you are taking no pills at all. Expect the process to take about 2 months.

  • In the meanwhile, address the reflux. By slowing down eating, chewing food well, and eating small meals. This can help reduce the pressure in the stomach that leads to reflux. The weakness of the sphincter between the stomach and esophagus, through with the stomach contents reflux through, can be strengthened by diaphragmatic breathing, a yoga and physical therapy technique (Zrdhova 2023).

  • It has been suggested that one reason for reflux is that the stomach is not producing ENOUGH acid, slowing down digestion and increasing pressure in the stomach. Many people have told me that taking a small amount of apple cider vinegar (the kind with the “mother”) has helped them reduce reflux while getting off of the PPIs. Some people say you need to dilute it a bit, and unfortunately there doesn’t seem to be a standard brand or amount that I can pass on.

  • One way to address the heartburn pain is drinking alkaline water. This likely works because the alkaline water can buffer the acidity of the reflux. This maybe the only reasonable use for alkaline water.

Do you have a tip for us? Let us know!

What we're Eating

Every month we will highlight an easy to make, gut healthy dish that we are eating now!

Meatless moussaka

I love Greek food and over the years I have wanted to have moussaka- it looks and smells so good. But it always contains ground lamb or beef, which I can’t eat (alph gal meat allergy). Recently I ran across a couple of moussaka recipes that were meatless, and this recipe is inspired by them. The meat is replaced by intact grains, which mimic the consistency of the ground meat. I use bulghur or farrow (wheat) but for gluten-free, quinoa could be substituted. I also add portobello mushrooms. Both intact grains and mushrooms are great gut-friendly foods!

One other possible problem of traditional moussaka for me is that it uses a rich egg and butter Bechamel-style sauce, which doesn’t always agree with my gut. So I have developed a gut friendly fermented food version using soft cheeses and Greek yogurt.

Ingredients

  • 1 medium/large eggplant

  • 4 (or so) small potatoes

  • 2-3 portobello mushroom caps

  • 1 jar Classico type tomato-based pasta sauce, 28 oz

  • ½ cup bulgur (or other whole grain such as quinoa or barley)

  • 1 cup water

  • Juice from 1 lemon

  • 8 oz marscapone (Italian cream cheese)

  • 8 oz ricotta

  • ½ cup Greek yogurt about ½ cup Greek feta cheese

  • 8 oz mixed Italian cheeses, grated

  • Basil

  • Oregano

  • Fresh mint, chopped (about 1 TBS)

  • Fresh garlic, about 2 cloves, chopped

  • Roasted garlic powder

  • Poultry seasoning

  • Moroccan seasoning

  • Olive oil

  • Coarse salt, such as sea salt or Himalayan salt

Steps

  1. Slice eggplants, toss in olive oil, sprinkle roasted garlic powder, and grind coarse salt. Roast at 350 F for 20 min.

  2. Slice portabella caps (about 3-4 big ones) and cut into little cubes. Toss with spices and olive oil. Roast at 350 F for 20 minutes. Collect the broth and use it for cooking the grains.

  3. Slice potatoes, toss in olive oil and layer on bottom of the casserole dish. Sprinkle poultry seasonings, basil, oregano garlic. Roast at 350 F for 30-45 minutes, depending how thickly sliced they are.

  4. Cook bulgur (or other whole grain such as quinoa or barley)- heat 1 cup of water (with mushroom broth) until boiling, add ½ cup bulgur. Reduce heat to medium low and cook until water is absorbed, about 15 minutes. Remove from heat, add lemon juice and let rest for 10 minutes. Then add chopped garlic and mint, and dried seasoning, and roasted mushroom cubes.

  5. Just before assembling moussaka, add about 1/3 of a jar of Classico-type pasta sauce to grain/mushroom mix and add seasonings to taste. Reserve rest of the sauce as the bulgur/grain will suck up all the sauce.

To make “bechamel”, substitute either or both (I like to do all these together):

  1. Combine ricotta and marscapone and add seasonings

  2. Combine marscapone with diced feta and Greek yogurt and add seasonings

To assemble moussaka:

  1. Spoon ½ of the bulgur/pasta sauce mixture over the potatoes.

  2. Spoon some of the reserve pasta sauce over the potatoes and bulgur

  3. Layer eggplants over the potatoes and bulgur

  4. Spoon more bulgur/mushrooms/pasta sauce over the eggplants, and then spoon the rest of the pasta sauce over that.

  5. Layer the bechamel substitute (whichever) over the bulgur/pasta sauce

  6. Cover with the shredded Italian cheese.

  7. Bake at 350 F for 30 minutes.

  8. Enjoy!!

Enjoy!

Our meatless moussaka

Community Affairs

Follow Gut Advisor on Facebook!

I have revived the old Facebook page and will be posting links to interesting news articles and such! If you’d like more content between newsletters, or another way to ask me questions, join me over there! Here’s a link.

About the Author

Lisa E. Goehler, Ph.D. is a neuroscientist and expert in the science and treatment of psychological stress, chronic inflammation, and gut-related disorders. She pioneered the study of how GI-tract related bacteria can interact with the brain to lower mood and increase anxiety. Throughout her career, she authored over fifty publications and contributed to peer review for scientific journals and funding agencies, including the National Institute for Health.

References

Capurso C. Whole-Grain Intake in the Mediterranean Diet and a Low Protein to Carbohydrates Ratio Can Help to Reduce Mortality from Cardiovascular Disease, Slow Down the Progression of Aging, and to Improve Lifespan: A Review. Nutrients. 2021 Jul 25;13(8):2540. doi: 10.3390/nu13082540. PMID: 34444699; PMCID: PMC8401068.

Chakraborty N. Metabolites: a converging node of host and microbe to explain meta-organism. Front Microbiol. 2024 Mar 5;15:1337368. doi: 10.3389/fmicb.2024.1337368. PMID: 38505556; PMCID: PMC10949987.

Chang CH, Tsai WC, Lin MS, Hsu YH, Pang JH. The promoting effect of pentadecapeptide BPC 157 on tendon healing involves tendon outgrowth, cell survival, and cell migration. J Appl Physiol (1985). 2011 Mar;110(3):774-80. doi: 10.1152/japplphysiol.00945.2010. Epub 2010 Oct 28. PMID: 21030672.

Giron M, Thomas M, Dardevet D, Chassard C, Savary-Auzeloux I. Gut microbes and muscle function: can probiotics make our muscles stronger? J Cachexia Sarcopenia Muscle. 2022 Jun;13(3):1460-1476. doi: 10.1002/jcsm.12964. Epub 2022 Mar 12. PMID: 35278043; PMCID: PMC9178375.

Hamaya R, Mora S, Lawler PR, Cook NR, Ridker PM, Buring JE, Lee IM, Manson JE, Tobias DK. Association of Plasma Branched-Chain Amino Acid With Biomarkers of Inflammation and Lipid Metabolism in Women. Circ Genom Precis Med. 2021 Aug;14(4):e003330. doi: 10.1161/CIRCGEN.121.003330. Epub 2021 Jul 15. PMID: 34264743; PMCID: PMC8496994.

Hamed Riveros NF, García-Corredor L, Martínez-Solarte MA, González-Clavijo A. Effect of Bifidobacterium Intake on Body Weight and Body Fat in Overweight and Obese Adult Subjects: A Systematic Review and Meta-Analysis. J Am Nutr Assoc. 2024 Aug;43(6):519-531. doi: 10.1080/27697061.2024.2320192. Epub 2024 Mar 18. PMID: 38498828.

Hawkins AT, Wise PE, Chan T, Lee JT, Glyn T, Wood V, Eglinton T, Frizelle F, Khan A, Hall J, Ilyas MIM, Michailidou M, Nfonsam VN, Cowan ML, Williams J, Steele SR, Alavi K, Ellis CT, Collins D, Winter DC, Zaghiyan K, Gallo G, Carvello M, Spinelli A, Lightner AL. Diverticulitis: An Update From the Age Old Paradigm. Curr Probl Surg. 2020 Oct;57(10):100862. doi: 10.1016/j.cpsurg.2020.100862. Epub 2020 Jul 18. PMID: 33077029; PMCID: PMC7575828.

Jaynes M, Kumar AB. The risks of long-term use of proton pump inhibitors: a critical review. Ther Adv Drug Saf. 2018 Nov 19;10:2042098618809927. doi: 10.1177/2042098618809927. PMID: 31019676; PMCID: PMC6463334.

Koutoukidis DA, Jebb SA, Zimmerman M, Otunla A, Henry JA, Ferrey A, Schofield E, Kinton J, Aveyard P, Marchesi JR. The association of weight loss with changes in the gut microbiota diversity, composition, and intestinal permeability: a systematic review and meta-analysis. Gut Microbes. 2022 Jan-Dec;14(1):2020068. doi: 10.1080/19490976.2021.2020068. PMID: 35040746; PMCID: PMC8796717.

Liang Y, Pan C, Yin T, Wang L, Gao X, Wang E, Quang H, Huang D, Tan L, Xiang K, Wang Y, Alexander PB, Li QJ, Yao TP, Zhang Z, Wang XF. Branched-Chain Amino Acid Accumulation Fuels the Senescence-Associated Secretory Phenotype. Adv Sci (Weinh). 2024 Jan;11(2):e2303489. doi: 10.1002/advs.202303489. Epub 2023 Nov 15. PMID: 37964763; PMCID: PMC10787106. Peptides Institute. https://www.peptidesinstitute.org/bpc-157

Seiwerth S, Milavic M, Vukojevic J, Gojkovic S, Krezic I, Vuletic LB, Pavlov KH, Petrovic A, Sikiric S, Vranes H, Prtoric A, Zizek H, Durasin T, Dobric I, Staresinic M, Strbe S, Knezevic M, Sola M, Kokot A, Sever M, Lovric E, Skrtic A, Blagaic AB, Sikiric P. Stable Gastric Pentadecapeptide BPC 157 and Wound Healing. Front Pharmacol. 2021 Jun 29;12:627533. doi: 10.3389/fphar.2021.627533. PMID: 34267654; PMCID: PMC8275860.

Tanase DM, Gosav EM, Botoc T, Floria M, Tarniceriu CC, Maranduca MA, Haisan A, Cucu AI, Rezus C, Costea CF. Depiction of Branched-Chain Amino Acids (BCAAs) in Diabetes with a Focus on Diabetic Microvascular Complications. J Clin Med. 2023 Sep 19;12(18):6053. doi: 10.3390/jcm12186053. PMID: 37762992; PMCID: PMC10531730.

Tran TH, Myung SK, Trinh TTK. Proton pump inhibitors and risk of gastrointestinal cancer: A metaanalysis of cohort studies. Oncol Lett. 2023 Nov 20;27(1):28. doi: 10.3892/ol.2023.14161. PMID: 38073768; PMCID: PMC10698841.

Trautman ME, Richardson NE, Lamming DW. Protein restriction and branched-chain amino acid restriction promote geroprotective shifts in metabolism. Aging Cell. 2022 Jun;21(6):e13626. doi: 10.1111/acel.13626. Epub 2022 May 8. PMID: 35526271; PMCID: PMC9197406.

Vukojevic J, Milavić M, Perović D, Ilić S, Čilić AZ, Đuran N, Štrbe S, Zoričić Z, Filipčić I, Brečić P, Seiverth S, Sikirić P. Pentadecapeptide BPC 157 and the central nervous system. Neural Regen Res. 2022 Mar;17(3):482-487. doi: 10.4103/1673-5374.320969. PMID: 34380875; PMCID: PMC8504390.

Yadao DR, MacKenzie S, Bergdahl A. Reducing branched-chain amino acid intake to reverse metabolic complications in obesity and type 2 diabetes. J Physiol. 2018 Aug;596(16):3455-3456. doi: 10.1113/JP276274. Epub 2018 Jun 21. PMID: 29791751; PMCID: PMC6092286.

Zdrhova L, Bitnar P, Balihar K, Kolar P, Madle K, Martinek M, Pandolfino JE, Martinek J. Breathing Exercises in Gastroesophageal Reflux Disease: A Systematic Review. Dysphagia. 2023 Apr;38(2):609-621. doi: 10.1007/s00455-022-10494-6. Epub 2022 Jul 16. PMID: 35842548; PMCID: PMC9888515.

© 2025 Gut Advisor.

Privacy policy

Terms of use

Powered by beehiiv