Feeling tired and stressed? Dr. Amy Shah explains how to change your life by altering a few simple things; What you eat, when you eat and how you manage stress. Find out what a leaky gut is and how it leads to chronic inflammation from the book I’m So Effing Tired: A Proven Plan to Beat Burnout, Boost Your Energy, and Reclaim Your Life.

Read an excerpt from I’m So Effing Tired below. 


Chronic Inflammation Can Be a Sign of a Leaky Gut

Intestinal inflammation creates what we call a leaky gut, which influences not only our digestion, but overall health and neurobiology, and it is a huge source of inflammation elsewhere. We’ll get into leaky gut much more in chapter 5, but the term means what it says: your intestines start to become looser and more porous, letting food particles from your gut seep into your bloodstream. Gross, right? Since your immune system constantly guards the gut border, it sees these particles as intruders and attacks them. Typically, an “intruder” — say, the protein from gluten — travels through the gut epithelia, which is the intestine lining that plays a critical role in preventing anything from getting past that layer. But if it does get past that layer, into an inner layer called the lamina propria, inflammation can start. Many other factors — such as infections, toxins, stress, and age — can also cause these tight junctions to break apart. The research is still unclear on the exact mechanisms of how this works, but we do know that food allergies and food intolerances play a major role.

 Here are a few signs you have a leaky gut:

  • Gas, bloating, diarrhea, or irritable bowel syndrome (IBS)
  • Hormonal imbalances such as painful PMS or PCOS
  • Diagnosis of an autoimmune disease such as rheumatoid arthritis, Hashimoto’s thyroiditis, or celiac disease
  • Diagnosis of chronic fatigue or fibromyalgia
  • Depression, anxiety, ADD, or ADHD
  • Skin issues such as acne, rosacea, or eczema
  • Asthma
  • Food allergies or food intolerances

So what are common allergen triggers?

We are often sensitive to modern, convenient foods containing preservatives, pesticides, GMOs, and MSG. These substances can be hard for the digestive system to process, creating discomfort. We also know that certain foods like sugar, gluten, dairy, processed soy, peanuts, eggs, and corn can also be triggers for food sensitivities.


How can we reduce inflammation? Well, it shouldn’t come as a surprise by now that my answer is going to be mostly about your diet and lifestyle choices. And most of those choices are based on thousands of tiny decisions you make each day that are (whether or not you know it) either anti- or pro-inflammatory. What time will you wake up? What will you have for breakfast? What time will you eat? What does your morning routine look like? What kind of exercise will you do? What kind of dressing will you have on your salad? How long will you stay at work? What will you do when you get home to unwind? Small choices can have a BIG impact, and there are a few key factors that will help fend off chronic inflammation: mostly it’s eating the right food, getting good shuteye, and reducing stress.


A 2013 landmark study called PREDIMED followed 7,447 people, aged 55 to 80 years old, who had diabetes, high blood pressure, or high cholesterol over the course of about five years; 57 percent of the study participants were women. These individuals were put on a food plan similar to the Mediterranean diet, which included fruits, vegetables, fish, legumes, olive oil, certain nuts, and sofrito (a tomato sauce with garlic herbs and olive oil), and excluded processed foods of any kind— sugar, soda, spread fats like margarine, and red and processed meat.

After almost five years, there was a 30 percent difference in the heart attack/stroke rates of the two groups. Inflammatory markers were down, too, for those on the Mediterranean-type diet, and their telomere lengths were longer — meaning that they had “aged” less than those in the group not on the diet. What are telomeres, you ask? They are like the plastic tips on shoelaces — protective caps on the ends of DNA and protein that prevent them from fraying. Telomeres naturally shorten over the course of your life, but there is significant variation in how fast this happens. In short, a pro-inflammatory diet — characterized by a high intake of meat, refined (white) grains, added sugars, and foods rich in saturated and trans fats —increases the risk of telomere shortening, which eventually leads to earlier death. (Even though there was some controversy over the protocol of the study, its findings have held up over time.)

I was guilty of eating a very similar pro-inflammatory diet before my car accident. Although I considered myself a healthy eater since I had plenty of fruits and salads, I didn’t realize that I was also consuming a lot of hidden processed foods and sugar. Starbucks lattes and granola bars were my staples. And having grown up in New York, bagels were one of my favorite meals on the go. All these types of foods can turn your gut into a factory for chronic, or “silent,” inflammation. These foods increase the levels of blood sugar from processed carbohydrates or sugar and contribute to an increase in free radicals and pro-inflammatory cytokines, chemicals that kick off chronic inflammation in the body.

So I learned what foods were anti-inflammatory and started adding them into my diet, and I couldn’t believe the difference I felt in a matter of a few days. I now know that making simple changes —that is, eliminating high fructose corn syrup, white sugar, gluten, and white flours — can lead to big benefits. We’ll go into these dietary changes in more detail in chapter 8, but here’s an overview of what’s good to eat to lower inflammation and up your energy levels.

Add Fiber, Fiber, Fiber

 Food is the best lever for change in your inflammatory state. Centenarians are known to follow a whole foods diet with tons of vegetables. So if you want to live that long, fiber is key. And vegetables in particular will give you more antioxidants and polyphenols, which can fight free radicals and can calm inflammation. If there’s one thing I’ve learned from my research, it’s that adding fiber is crucial to healing your gut and lowering inflammation. Most gut bacteria live in the distal colon—the last area in the intestines—so getting food there is key. But most food (protein, carbs, and fats) gets digested before reaching the distal colon. Fiber doesn’t, so the good bacteria can feed on it when it reaches the distal colon.

Why is it important to feed that specific bacteria? Because these bacteria create short-chain fatty acids, which perform the vital function of calming the immune system and making it less reactive. These short-chain fatty acids signal more regulatory T cells, which help to prevent autoimmunity and allergies.

 If we don’t get enough fiber, the bacteria starve and start eating mucin, which is the lining between our intestinal cells and bacteria (which can lead to leaky gut). It’s estimated that hunter-gatherer societies consumed upward of 200 grams of fiber daily, while the average modern American now gets just 15 grams a day. Yep, you read that right.

The best source is complex carbohydrates from fermentable plant fibers. So you should eat more cellulose fibers, present in the tough parts of veggies and fruits, like broccoli stalks, the bottom of asparagus, kale stems, and orange pulp. Vegetables contain hundreds to thousands of phytonutrients — literally plant hormones — that have hormone-balancing and anti-inflammatory effects (a twofer!) in the body. Vegetables as well as fruits also supply us with fiber that binds itself to old estrogen, thereby clearing it out of the system, leading to better overall hormonal equilibrium. This is great for both men and women who suffer from estrogen dominance.

Vegetables also supply prebiotic fibers that good bacteria feed on in the gut. This fiber is most abundantly found in asparagus, chicory root, leeks, onions, and garlic. You will want to aim for at least three — but ideally up to nine —cups of vegetables a day. Start slowly with well-cooked vegetables twice a day (newbies to the plan may not be used to this much fiber, so cooking helps with digestion), and then gradually add more every day.

Excerpted from I’M SO EFFING TIRED: A Proven Plan to Beat Burnout, Boost Your Energy, and Reclaim Your Life by Amy Shah, MD., Copyright 2021 by Amy Shah, MD. Reproduced by permission of Houghton Mifflin Harcourt. All rights reserved.