For today’s edition of Dear Mark, I’m answering three questions. First up, what can a person do to help their gut recover its barrier function after too many antibiotics? Are there any foods, supplements, or dietary strategies? Second, what can explain rapid fatigue during sprint sessions on a keto diet? Is this simply part of the deal, or are there modifications you can make? And finally, what do I do when I know I’m going to get a bad night’s sleep?
Mark – any idea how to cure leaky gut caused by overuse of antibiotics. Tried raw dairy for a month to no avail.
First of all, check out my post on leaky gut . Read through it and follow my suggestions for preventing and treating intestinal permeability. It’s a great place to start.
Then, let’s look at some other interventions that have been shown to improve recovery from antibiotic therapy. While most of the studies referenced don’t explicitly describe antibiotic-induced leaky gut, anything that improves gut function and restores healthy gut bacteria will also normalize leaky gut—since it’s the eradication of native gut bacteria that causes antibiotic-induced leaky gut.
Fermented dairy. You tried raw dairy . What about fermented dairy? While raw dairy has its merits, it’s fermented dairy that just works  for recovery from antibiotics. Yogurt  is a good option to try, although the evidence is a bit inconsistent . Kefir  is probably better; it’s been shown to improve patients’ tolerance  to triple antibiotic therapy during treatment for H. pylori infection. This is even worth consuming during antibiotic therapy, as many of the probiotic bacteria found in fermented dairy show resistance  to common antibiotics.
Fermented vegetables  like sauerkraut  are also must-eats. The fermented cabbage contains ample amounts of L. plantarum, a bacteria strain that’s been shown  to prevent antibiotic-related diarrhea in piglets (another omnivorous mammal). Good options exist in stores (check the refrigerated section; shelf-stable pickles and kraut aren’t lactofermented), and even more are available in farmer’s markets, but the best way to get the most bacteria-rich vegetable ferments is to make your own .
Supplemental probiotics  are fantastic here , too: large doses of the desired microorganisms delivered directly to your gut. Some of the strains used in Primal Probiotics , like B. clausii and S. boulardii, have been shown to be effective against antibiotic-related diarrhea, so that could be a good choice.
Don’t forget the food for your gut bugs: prebiotics . You need to eat fermentable fibers and other prebiotics like resistant starch  to support the growth and maintenance of the helpful bacteria that improve gut barrier function. Consider eating cooked and cooled potatoes, unheated potato starch , leeks, garlic, onions, green bananas, apples, pears, berries, and pretty much any fruit or vegetable you can get your hands on. Plenty of them are low-carb enough to work on a keto diet, if that’s your desire. Oh, and dark chocolate  is a great source of fiber and polyphenols, which have prebiotic effects in the gut .
Incorporate intermittent fasting. Going without food for a spell gives your gut a break and induces autophagy , which can help with tissue healing.
Get dirty , too, to introduce potentially helpful bacteria. Go out and garden . Go barefoot  at the park (do your due/doo diligence, of course) and practice tumbling , or roughhouse with your kids (or friends). Don’t immediately rush to wash your hands all the time (unless you’ve been handling raw meat and/or dog poop).
Whatever you do, don’t stress too much about the antibiotics you had to take. Stress is awful for gut health  and you’ve already taken the antibiotics—which were probably necessary—so that ship has sailed.
If probiotics with prebiotics aren’t helping (or making things worse), you might want to try going the opposite direction—removing all plant foods and doing a carnivore diet  for a few weeks. While I have doubts about the long term viability and safety of eschewing all plant foods , enough people have written to me about their great experiences resolving gut issues with a bout of carnivory that it’s worth trying.
When on a strict keto plan, why do I become so quickly fatigued while attempting a HIT sprint workout?
The first five seconds of a sprint are primarily powered by phosphocreatine (or creatine phosphate), a “quick burst” energy source that burns hot but disappears quickly. This is the stuff used to perform max effort Olympic lifts, short sprints, and other rapid expressions of maximum power. It doesn’t last very long and takes a couple minutes to replenish itself. A keto diet doesn’t affect our creatine phosphate levels. If anything, it should improve them if we’re eating meat.
After five seconds, anaerobic metabolism of muscle glycogen provides the lion’s share of your energy needs. The longer your sprint, the more glycogen you’ll burn. The less glycogen you carry in your muscles, the shorter your sprint. Because once you run out of creatine phosphate and glycogen, you’re left with aerobic metabolism—great for longer distances, not so great for max effort sprints.
Keto dieters tend to walk around with less glycogen in their muscles. If that’s the case, longer sprints will be harder.
If you want to keep sprinting:
Do shorter sprints. Try a 10-second hill sprint rather than a 20-second one. Really go hard. Heck, you can even do 5-second sprints and derive major benefits; just do more of them and make sure to recover in between. There’s no rule saying you have to sprint for 20-30 seconds.
Take longer rest periods. Give your muscles a chance to replenish more creatine phosphate (and take creatine  or eat red meat and fish, which are the best sources of dietary creatine).
Eat 20-30 grams of carbs 30 minutes before a sprint session. See if it helps. Alternatively, you can eat the 20-30 grams of carbs after the sprint session to replenish lost glycogen stores (without really impacting your ketone adaptation, by the way).
Most people figure out their sprinting sweet spot while doing keto. They may have to play around with the dosages, durations, and rest periods, but you can usually make it work. Be open to trying new permutations.
If you knew you were going to have a poor nights sleep, what measures would you take to reduce some of the damage?
I would exercise hard that night. Normally, a bad night’s sleep tanks your insulin sensitivity the next day, giving you the insulin resistance and glucose tolerance of a diabetic. A good hard interval session the night before a bad night’s sleep, however, counters the next-day insulin resistance .
I would make the most of it. Don’t dawdle. Don’t beat yourself up because of the impending sleep deprivation. It’s going to happen. You have to accept it, not let it destroy you.
Enjoy it. A little-known acute treatment for depression is sleep deprivation. That’s right: a single night of sleep deprivation has been shown to ameliorate depression in patients with clinical depression . Sometimes the effect lasts up to several weeks. It’s not a long term or sustainable fix for clinical depression, obviously, and you can’t do it every single night—chronic sleep deprivation is a major risk factor for developing depression—but it can improve your mood if you give in to it.
I would set out a jar of cassia cinnamon. I always add cassia cinnamon to my coffee in the morning after bad sleep; cassia cinnamon the day after a bad night’s sleep attenuates the loss  of insulin sensitivity and glucose tolerance.
That’s it for today, folks. Thanks for writing in and reading! If you have any input on today’s round of questions, let me know down below.
De vrese M, Kristen H, Rautenberg P, Laue C, Schrezenmeir J. Probiotic lactobacilli and bifidobacteria in a fermented milk product with added fruit preparation reduce antibiotic associated diarrhea and Helicobacter pylori activity . J Dairy Res. 2011;78(4):396-403.
Bekar O, Yilmaz Y, Gulten M. Kefir improves the efficacy and tolerability of triple therapy in eradicating Helicobacter pylori . J Med Food. 2011;14(4):344-7.
Erginkaya Z, Turhan EU, Tatl? D. Determination of antibiotic resistance of lactic acid bacteria isolated from traditional Turkish fermented dairy products . Iran J Vet Res. 2018;19(1):53-56.
Yang KM, Jiang ZY, Zheng CT, Wang L, Yang XF. Effect of Lactobacillus plantarum on diarrhea and intestinal barrier function of young piglets challenged with enterotoxigenic Escherichia coli K88 . J Anim Sci. 2014;92(4):1496-503.
Jitomir J, Willoughby DS. Cassia cinnamon for the attenuation of glucose intolerance and insulin resistance resulting from sleep loss . J Med Food. 2009;12(3):467-72.