← Extend Podcast with Darshan Shah, MD
Extend Podcast with Darshan Shah, MD
187. Dr. Izabella Wentz: 30+ Root Causes Behind An IBS Diagnosis
00:59:28
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- [00:00]
A
Before we get started with this episode, I'd like to invite all of you to the first ever next Health Longevity Summit happening in Nashville, Tennessee at the Conrad Hotel on Saturday, September 12, 2026. This is an all day summit where you're going to be hearing from some of the best speakers in longevity medicine, including Dr. Vonda Wright, Dr. Luisa Nicola, many of the podcast guests that you've heard here on the Extend podcast. And of course I'm going to be there curating the entire day. We also have incredible vendors coming so that you can try the latest technologies in health, wellness and longevity. Go to next health.com summit and buy your ticket today. We only have 400 spots and they're going quickly. That's next health.com summit. I look forward to seeing you all there. Welcome to Xtend with me, Dr. Darshan Shah, a podcast dedicated to cutting edge science, research, tools and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results. When it comes to your health span, we are living in a new era where we are creating a new healthcare system no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world renowned experts who are offering you a step by step guide to proactively avoid disease and most importantly, extend your health span. Welcome to xtend, the podcast dedicated to helping you live a longer, healthier life. Today we're thrilled to welcome back a true pioneer in functional medicine, Isabella Wenz. Many of you know her as a thyroid pharmacist. She's renowned for her groundbreaking work and multiple books on Hashimoto's and thyroid disease. But today we're going to be diving into a fascinating new chapter. Her latest book on Irritable Bowel Syndrome, or ibs, Isabella challenges conventional wisdom, revealing that IBS is not a singular diagnosis, but a constellation of symptoms with over 30 potential different root causes. We're going to explore the profound connection between gut health and autoimmune conditions like Hashimoto's the Critical role of Intestinal Permeability and why a comprehensive workup is essential for for anyone struggling with ibs. So get ready to rethink everything you thought you knew about gut health and its impact on your overall wellbeing. Let's extend Our Knowledge with Isabella Wentz. Isabella, I'm so glad you came back to the podcast. Thanks for being here again.
- [02:38]
B
Thank you so much for having me again. Just always such a joy to be with you.
- [02:41]
A
I know. It's so great to get to know you and see kind of your journey through life and your journey through your different books now, and just such a pleasure all the time. I always say you're one of the smartest people I know.
- [02:54]
B
Oh, my gosh. That's so kind.
- [02:55]
A
Yeah. No, you truly are. So people know you as the thyroid lady, right? Like, you have written so many books on the thyroid. Our last podcast was about Hashimoto's and thyroid disease. And you have a tremendously tremendous practice around thyroid medicine. And now all of a sudden there's this book with your name on it about ibs. What is that all about?
- [03:16]
B
I think it's throwing people off. My branding is thyroid pharmacists. I've been talking about thyroid and Hashimoto's for over a decade. But if you are in functional medicine, as you know, there's a big connection between the thyroid and gut health. And a lot of the work that I've been doing and advocating for and educating about for people with thyroid illness and Hashimoto's is that it starts in the gut and many times there are gonna be consequences of poor gut health that are gonna be resulting in thyroid dysfunction and autoimmunity. So basically with everybody that I've worked with, with Hashimoto's, I'm always working on the gut, and many of them have had IBS diagnoses as well or symptoms that could have been diagnosed as ibs. And conventional medicine has one size fits all approach to IBS. Right. It's always like, okay, you have IBS, do X, Y and Z. And then less than 25% of people feel better when they have IBS. Yet there are so many different root causes of IBS. 30 plus that I've found in my research, in working with clients, talking to other healthcare professionals, and I was like, okay, everybody needs to know that there are various causes of ibs, but most people have been focusing on food reactions and SIBO and putting people on super restrictive diets without really moving the needle. So this is why the thyroid pharmacist is talking about ibs, I guess, is because there's a big gut and thyroid connection.
- [04:51]
A
I love it. Yeah. And clearing up all the misconceptions around IBS is what I'm really looking forward to talking to you about today. But I Just want to unpack that a little bit more because I think that, you know, as a thyroid pharmacist, you said that almost all of the patients that you were treating their Hashimoto's had some sort of gut dysfunction. Is that true? Like almost 100% of those people did,
- [05:13]
B
majority of them that I have seen had some degree of either intestinal permeability, they would have symptoms, constipation being the most common. But oftentimes, bloating, abdominal pain, diarrhea, and when the gut is out of balance, various things can happen that can impact our thyroid function and our immune health. Yeah, many people with Hashimoto's, usually they have low stomach acid. They might have symptoms like acid reflux. And this can result in poor absorption of the various nutrients that are required for proper thyroid hormone production, proper thyroid function, proper immune system function. And also when we have intestinal permeability, we can end up with our immune system leading us down the autoimmune path.
- [06:00]
A
Sure, yeah. So I mean, it seems like, you know, the gut, when it's permeable, when there's a lot, when there's poor gut health just in general. Right. And you get this intestinal permeability and then you have all, all these LPs and food stuffs floating around in your, around your gut epithelium and your immune system goes crazy and get this chronic inflammation that then turns into chron inflammation throughout the body which then leads to thyroid dysfunction in Hashimoto's. And it seems like that could potentially be one way that they're connected in that inflammatory mechanism. Right. Are there any other mechanisms that you see where the gut health could lead to Hashimoto's?
- [06:40]
B
Well, definitely if you have poor nutrient absorption. So that's going to be impactful on Hashimoto's. Right. You end up with low iron, you're going to end up with a thyroid condition down the road. You're not absorbing your iron properly because you have low stomach acid. You're not breaking down your protein properly. And so you can become low in zinc and L tyrosine, various other amino acids. So this is another mechanism. And then of course it's a two way street. So we do know that people with thyroid dysfunction, gut symptoms are going to be present. So we can have a person with hypothyroidism. Typically constipation is going to be what, what occurs. But oftentimes they might also have diarrhea and it is kind of a vicious cycle. So we do need to address both things many times.
- [07:32]
A
It's so interesting. I mean, I think like endocrinology. I remember being in medical school and I did so many, so much education on endocrinology and thyroid. Must have spent hours, months on thyroid disease. Never once did the gut come up, you know, and it's interesting to see kind of like this shift in thinking now through functional medicine about relating the two. And what I'm really excited about is the way people would treat hypothyroidism before was just with thyroid hormones, right. And I think there was this kind of, I would say, thought that the thyroid disease was permanent. Right. It was almost like once you're in thyroid hormone, you're going to be on it forever. Is it the case that once you treat the gut disease that potentially the Hashimoto's could get better and you might not need thyroid hormone?
- [08:15]
B
In some cases, if you figure out what's causing the gut dysfunction, people can get Hashimoto's into remission. Most cases I've seen, we can get people into remission where their thyroid antibodies reduce, all their symptoms go away. Some cases, people might be able to lower their dosage of thyroid medications. In few cases, they can also get off of their thyroid medications. But generally speaking, if you have had your thyroid gland removed, or if you've been on thyroid medications for many years, or have had an autoimmune attack against your thyroid for decades and your thyroid has been substantially damaged, it's not gonna be super easy. I know there are some regenerative therapies coming down the road that might make that happen. But in this day and age, it's much easier to prevent the damage than it is to regrow a new thyroid.
- [09:04]
A
So the sooner you address it, the better. So if you have a diagnosis of Hashimoto's, please see a functional practitioner that can potentially help you treat your gut as well and get your gut evaluated.
- [09:13]
B
Absolutely. And to your point, talking about endocrinology and gastroenterology, it's like these separate categories, like different silos of medicine. I remember when I was first researching Hashimoto's, I went to an endocrinology conference and I had just read Dr. Alessios Fasano's paper on intestinal permeability being the common connector in autoimmune disease. So his thesis was that every autoimmune condition has to have three factors in order for it to manifest. And it was. Intestinal permeability was one factor, genetic predisposition was another factor. And then having a trigger. Now we know in this Day and age, we can't change our genes. Maybe one day we'll be able to. We don't always know what the trigger is. Sometimes we can find it and we can remove it. Right. But we can always work on that intestinal permeability piece. The exciting part of his work was that if you remove the intestinal permeability, the autoimmune condition can go into remission. And I was super excited about this paper and I went to an endocrinology conference and I was talking to people and I asked, have you seen this new paper that came out? And they said no. And it was, it was a gastroenterology journal, not an endocrinology journal that published it. So a lot of the people who were very much focused on endocrinology and really geniuses in their field, but they had this tunnel vision of like, how do you do better thyroid surgery? Right. That that's what they were learning about and focusing on. Or rather than how do we prevent this, how do we optimize people's health? Right.
- [10:50]
A
Oh, that's so crazy. I didn't know Fasano's paper was in a gastroenterology journal. That's interesting. Yeah, It's a game changing, mind blowing paper on autoimmune disease. And what we found is almost for every autoimmune condition, I would say we see some level of improvement or reduction of their medication that they need once we start healing the gut. It works very, very predictably along many different aspects of autoimmune disease.
- [11:15]
B
It's very fascinating. There's a big connection between gut health and mental health, between gut health, fibromyalgia. I've. Even in my research I've seen like, TMJ is related to gut health. And who would have thought?
- [11:28]
A
Yeah, who would have thought? Right? I know. So what is ibs? Can you define that for people that are maybe a little bit nebulous on the term? I know I was nebulous on it even through medical school. What is diabes?
- [11:39]
B
Irritable bowel syndrome. So it doesn't sound very glamorous. Right. And so typically the symptoms would be abdominal pain, bloating, and you can have some changes in bowel function. Some people have constipation, some people have diarrhea, others might have the best of both worlds and people might get that diagnosis. We talked about how it used to be a diagnosis of exclusion. So doctors would do a whole bunch of different tests and say, oh, well, you don't have this, you don't have that you don't have this other thing. Therefore, it's ibs. Now, if a patient walks into a doctor's office and says, at least one day a week, I'm having abdominal pain with some changes in bowel function over the last three months, the doctors don't need to do any tests. They can just give them that IBS label.
- [12:26]
A
Yeah. And what's really interesting about that is IBS now just turned into, like, a constellation of symptoms occurring together. So to me, it's not really a real diagnosis. You haven't made a diagnosis on the person. You've just basically said that they have this constellation of symptoms. And whenever you have a constellation of symptoms, the next step in my mind is go looking for the cause. Right. There has to be a cause for this group of symptoms coming together. And to your point and in your book, there's many different causes of ibs. Right. And I think it's worth for our audience to kind of go down the path of some of these. Most of these, if we can get to them, and kind of define what these causes are so people understand, like, don't just get the diagnosis of IBS and sit there and just say, woe is me. I have ibs. And just take medication for it. Start looking for the causes.
- [13:15]
B
Yeah, absolutely. And the conventional medicine path is very much focused on we give you this label, and then you can try these medications. And I'm a pharmacist. I love medications. In pharmacy school, I had a shirt that said I heart drugs. And I fully meant that. Right. Proper medication use can change lives. But with IBS, less than 25% of people get better with the conventional approach, and they still can progress to autoimmunity. IBS can happen 5, 10, 15 years before an autoimmune condition develops. And if we don't treat the gut, then we're just gonna end up having more and more symptoms down the road and other types of illnesses. So I'm super passionate about finding the cause, not just. I think not just giving somebody a label. Label is very convenient. It's like, okay, great. I was wondering what that was called. Right. Like, I'm running to the bathroom and I'm having abdominal cramps.
- [14:08]
A
Okay. I have ibs. I get it.
- [14:09]
B
Thank you for the name. Wonderful. And now. Now we have to figure out what's the driving factor behind these symptoms. And it's not. Spoiler alert. It's not always, like, one thing. So not everybody with IBS needs probiotics and bone broth. As, you know, functional medicine or the wellness space might make you believe. And not everybody with IBS has small intestinal bacterial overgrowth, although that can be a relevant factor for some people. And so I went through, looking the latest research and I learned about some causes that I had never seen clinically. And I've also had seen some things clinically that I had never seen. In the research, I've come up with over 30 different causes of IBS. And it can start with the foods that we're eating, how we're digesting our foods, what kind of environment we're living in, what kind of environment is within us. So what kind of bacteria we have, what kind of viruses, what kind of microbes live inside of us, as well as various toxic reactions. And so I feel like if somebody has gotten this diagnosis, they really deserve a comprehensive workup to see what is causing their symptoms.
- [15:28]
A
Yeah. And what would that comprehensive workup include?
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B
There are definitely red flag symptoms if people have. Unfortunately, I've seen people misdiagnosed with IBS when they have had very serious conditions like colon cancer and inflammatory bowel disease, Conditions that require different set of tools.
- [15:50]
A
Right.
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B
Than the different root causes of IBS might. And so if somebody had like rectal bleeding, if they had significant weight loss, if their symptoms started after age 50, this would be as well as any kind of a fever. Right. This would be a reason to get referred to a gastroenterologist and do a workup. So colonoscopy, endoscopy might be part of the workup. It might be testing for infections just to make sure, you know, testing, figuring out if somebody has cancer, just to make sure we know what we're working with.
- [16:25]
A
Yeah. We're not missing something big, a major diagnosis like that. CAT scan, colonoscopy, always a good place to start, especially if you have rectal bleeding. For sure. You gotta rule that out first. But then say all that's clean. Where do we go next?
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B
Yeah, if all of that, you know, you've done, even if you've done all
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A
that, because a lot of people stop there because they'll see a gastroenterologist and they're like, this is a specialist in the GI system. They should know what to do about my ibs. And they'll get the colonoscopy and that's it, it's clean, nothing to worry about. See you later. It's just ibs.
- [16:59]
B
Right. So you can check off that box. Right. And if you don't have those symptoms, you might not need a colonoscopy. So now I would Encourage you to look at the foods that you're eating. I am a big proponent of nourishing your body properly and of eating a varied diet. But when you look at which foods trigger you, this can be a clue. For some people, it might be foods that are high in fiber and raw veggies. This could be a sign that you might have small intestinal bacterial overgrowth, or you might have some dysbiosis in your gut, because our gut bacteria are the ones that ferment our fibrous foods. If you have issues with fatty foods, this could be indication that something is going on with your gallbladder or that you might have enzyme deficiencies, such as pancreatic enzyme deficiencies, or perhaps a bile deficiency. If you are sensitive to carbohydrates and certain fermented. Fermented foods, that might be another indication that you might have something like small intestinal bacterial overgrowth. These are some of the foods that I would say most people should eat, should be able to eat without. You know, they're not like bad foods. Right.
- [18:13]
A
Not like ultra processed garbage. Yeah, exactly. So that these are foods our bodies are designed to eat. Right.
- [18:19]
B
Like, we don't want you eating no fat. Right. If fat triggers your symptoms, that's a sign that something is out of balance internally.
- [18:26]
A
Got it.
- [18:26]
B
Then there's also like, okay, ultra processed junk foods. So amazing, incredible research has been done on food additives. Erythritol, all of these sugar alcohols. As you know from pharmacology, they work as osmatic laxatives. Right. When you dose them up correctly, there a lot of these food additives, artificial sweeteners, food preservers, they can actually cause a disruption of the gut microbiome and they can lead to IBS and also inflammatory bowel disease. So definitely I'm not a proponent of eating these kind of foods. This might be something that triggers you and really look into that. Another category of things I would like to look at is medications. I'm a pharmacist, so I'm always looking at the meds. Like, what is going on? So metformin can cause diarrhea.
- [19:19]
A
That's true.
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B
Right. So there's so many different side effects of medications. When I was in pharmacy school, it was like we had these multiple choice questions, and it was like, what side effect does this drug cause? And if I didn't know the drug, I would always guess that it caused GI symptoms.
- [19:34]
A
Yes.
- [19:35]
B
So constipation, diarrhea, abdominal pain. Talk to your pharmacist, talk to your physician, and See if perhaps one of your medications is contributing. Do you need to be on that medication? Can you switch to a different medication? Right. Because thing that I hate to see as a pharmacist is the prescribing cascade. So you get on one medication for this symptom and then this causes additional symptoms, so you get on another medication and so on and so forth. Right. And so you don't want to be on dozens of medications when sometimes lifestyle change, different medication, potentially an herbal remedy or a nutritional remedy can make all the difference. One particular medication that I feel like is very relevant for IBS is actually birth control. The drospirenone contraining containing birth control pills like Yaz and Yasmin were some of the brand names back when I was in pharmacy school. These can actually have been now clinically studied to cause irritable bowel syndrome.
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A
Really?
- [20:33]
B
Yes. So there is research behind that. So switching birth control pills might be something that might be relevant. And of course we know GLP1 medications can slow down our motility. So this is a great place to think about, especially if you can time and correlate that your symptoms started after starting a medication.
- [20:53]
A
Yes, yes. So I'm 52 right now, but I'm still pushing all of my limits. I'm running long distances, I travel across many time zones to support my work, and I just want to live my life to the fullest. Staying active as I age isn't just about willpower. It's about supporting my mitochondria, the powerhouses of my cells with the energy that they need to recharge my muscles and recharge my brain. Mitopure is a supplement that I take. It's backed by solid research showing that it can boost cellular energy, increase muscle strength, and support overall healthy aging. Personally, I take Mitopure every single day has helped me continue my active lifestyle, whether it's a high intensity workout or keeping up with my kids. So if you are looking to support your body and want to feel younger from the inside out, my friends at Timeline are offering you a 10% discount on your first order. Go to timeline.com Dr. Shah to get started. That's timeline.com DrShah your future self will thank you. So with the foods jumping back to that, you know, I think one way to kind of discover which foods are causing your symptoms is to do like an elimination diet, Right. So you eliminate most things and you slowly reintroduce. And if your symptoms come with a new food that you reintroduce, you can kind of pinpoint it to that food. Is that one technique that you use when you're trying to sort through what foods could potentially be leading to symptoms?
- [22:26]
B
Absolutely. So elimination diet can be very, very helpful. And I just wanna warn people, if you go on an elimination diet, that does not mean you have to stay on that diet forever. The point is to see which foods are causing stress in your digestive system and then getting off of these foods temporarily and then we can also work to get those foods back. So I do have protocols in my book IBS on IBS on how to figure out which foods are causing you reactions and how to get rid of the various food sensitivities. So typically gluten and dairy are some of the most common reactive foods in ibs, but also like fibrous foods. And I've seen like raw veggies, lettuce and blueberries, like really healthy foods that can be potential triggers. For some people it might be excess caffeine, coffee can make give some people diarrhea, a lot of these high fat foods. So doing an elimination diet can be very, very helpful. There are some people who have a hard time with that and maybe they feel like it's overwhelming. And in that case, I might recommend food sensitivity testing. In my experience with ibs, thyroid dysfunction and acid reflux, I've used the allitest food sensitivity test. They're igg and that does seem to correlate for symptoms. I know when I throw out the word food sensitivity test, there are a hundred opinions from different people who say they do not work or don't waste your. They're not evidence based. And I agree with all of that because there's a hundred different tests on the market and all of them are different. So from my experience, this one particular lab seems to produce results.
- [24:11]
A
Yeah, yeah, I hear what you're saying about food sensitivity testing and I agree with you. There's so many different tests on the market. The one that we use is from Vibrant and we get IGA and igg, IGA being more of a antibody that relates to inflammation of the gut wall as well and IGG more systemic. And I found it to be a pretty good starting place when people come in with gut health issues because I find elimination diets are really difficult for people to execute on, especially in our modern day environment. Like, you know, you go out to eat one time to the restaurant and the elimination diet's like done right. And so you have to be really faithful to elimination diet for it to really give you good data and people have problems with that because they're hard. Right. You're eliminating all these foods, and then you have to, like, slowly reintroduce foods back. And people just cheat on that all the time. So I use it more as like a starting point. I don't use it for a definitive diagnosis that this is the food. But, like, we start there and if that doesn't give us any results on making your symptoms go away, then we go to a more aggressive form of elimination.
- [25:17]
B
Yeah. I find that some people just need to see things on paper. Right. And so that's when a test might be helpful or they. They really struggle with the elimination diet. And it's free. It's the gold standard. It's like the best thing you can do. But I do admit that it can be very tricky for people, especially if you're trying to do it for 21 days to eliminate all the foods properly. Sometimes it helps to have a template. Let's just say, why don't you try the autoimmune paleo diet or the paleo diet, which eliminates some of these common foods. I would say if a person was overwhelmed and didn't want to spend money, one of the things they can do is a low food additive diet. And eat at home, if you can, or eat at healthier restaurants that don't have a lot of food additives that can be actually healing for conditions like inflammatory bowel disease that can get an ibs, that can be it.
- [26:12]
A
Yeah, absolutely. So other than food sensitivity testing and the food piece of this, what is the next test that you sometimes have people get for looking at ibs?
- [26:23]
B
Well, if they have done the food route, and I work with a lot of clients who are much healthier eaters than I am. Right. They eat a perfect diet and everything's organic and home cooked and whatnot. And they still have symptoms. Right. And so at that point, we're thinking about, well, why are you not able to eat these beautiful foods? Like what's happening in your body?
- [26:47]
A
Yeah.
- [26:48]
B
And it could be digestive enzyme deficiencies. Right. And one of the tests, it's not really a test that I do, but it's more like a trial where they might try some betaine with pepsin, which is a digestive enzyme, especially with acid reflux. And people that have a lot of fatigue and feel very heavy after their meals taking this protein digestive enzyme with your protein containing meals can help with digestion. And so you get fewer food sensitivities. Your food doesn't feel so heavy. You're not gonna Be as bloated, you're not gonna have that abdominal pain. That might be a place to start with people or doing some broad spectrum digestive enzymes, encouraging them to like, chew their food properly. Have some apple cider vinegar diluted in water, not straight up, please, to help with their digestive process. That can be very helpful for a lot of people and a really great place to start and can really change things as far as digestion and symptoms go. But again, if they're already doing that, I've got some clients that have already done that. They're better at their digestive enzymes than I am, and they eat when they're relaxed and they say their prayers and meditate and all of that. But if that was like you're kind of doing the diet, you're have a relatively great eating environment, then I would think about doing some stool testing and potentially some breath testing. I love Vibrant America's Gut Zoomer test. I know you and I are both fans of that. I have not done their food sensitivity test. I have to do that next. So I'm excited to try that out. But the Gut Zoomer test can be incredibly helpful to figure out what's out of balance. It could look at if somebody has low fecal elastase, for example, which can indicate that they're not going to be breaking down their fats, right? And so they might benefit from pancreatic enzymes, they might benefit from ox bile, they might benefit from various bitters. A dandelion that can help with breaking down fats. It could look at if they have a dysbiosis. So if they have beneficial bacteria that are too low or pathogenic bacteria that are too high. It could look at whether they're reacting to gluten. It could look at whether they have low levels of something called secretory iga, which is the gut's immune barrier. And when that is low, that means we're not gonna be keeping that barrier intact, that we're not gonna be keeping the peace of the microbes in our gut. And that can also find some of these chronic infections, chronic low grade infections that conventional medicine doesn't even think about. It can be viral infections. I've seen people with NOR virus after years of having an infection, right? And it's still there and it's still symptomatic, Right. I've seen people with protozoa infections. They said, 10 years ago, I traveled to South America and I got dysentery or whatnot, and I got antibiotics and, you know, the infection is still there.
- [30:02]
A
Wow.
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B
From a food poisoning or situation that they had 5, 10, 15 years ago. And that can lead to inflammation and IBS down the road. So I really love to do those kind of tests because sometimes we can find these, like, hidden pathogens, hidden imbalances that could be throwing off the gut wall, and then small intestinal bacterial overgrowth testing. Unfortunately, you can't see that on a stool test. There might be some, I guess, soft markers, like if you see certain bacteria are high or, you know, if you do a blood test and people have low levels of B12 or low ferritin, you might suspect that if they're very bloated after meals. But the breath test is gonna be the gold standard. Such a pain to do.
- [30:49]
A
Yeah.
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B
You have to do it over a few hours and. And whatnot. But sibo, small intestinal bacterial overgrowth, can also be a contributor or a root cause of ibs.
- [31:00]
A
Absolutely. And I think what I've also seen is some people with heavy metal toxicities, they sometimes have SIBO associated with it very frequently as well. So if you do a heavy metals test and you have many heavy metals that are elevated, look at SIBO as a potential diagnosis as well. Just a quick little clinical tip there. Have you seen that?
- [31:20]
B
No, but it makes so much sense, because when our gut is compromised, we end up hoarding all of our toxins. So our gut is one of those elimination paths. Right. And so gut is a great way to get rid of heavy metals, toxins, even microplastics. Now they're showing microplastics. Sweat is another great way to get rid of it. And in my thyroid patients, clients, I see that they're not sweating. They never complain about not sweating.
- [31:46]
A
Right.
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B
Because it's like, who wants to sweat? Like, it's great. So they're not eliminating. Eliminating through their skin, through their sweat, and they're also not eliminating through their gut, and so they end up becoming very, very toxic.
- [31:59]
A
Yeah. The breath test for sibo, I don't know which one you use. I usually. When I say sex, Sibo, there's one on Amazon. They just have them get that ships to their house, they drink the stuff, they send it in, and I found it to be pretty good, actually. Just the Amazon test. Do you have a test that you recommend for that one?
- [32:18]
B
There's a Trio Smart one.
- [32:19]
A
That's the one. Trio Smart, right? That's the one, yeah.
- [32:21]
B
Ooh. It's on Amazon.
- [32:22]
A
It's on Amazon. Anyone can get it from Amazon. Yeah.
- [32:24]
B
I did not know that I was using rupa, but I love. I love rupa, because people can order labs there and it's like, comes to their house and any kind of lab they want, they can get from that, from that and empower themselves. Yeah, any functional lab, I should say.
- [32:41]
A
Right. It's a really great tool to get labs just done at your house and then your practitioner can look at it with you and interpret them for you. But, yeah, I think people have so much better access now to kind of go down the rabbit hole of lab testing. But also, I think it's also really good to work with a functional practitioner like yourself who can guide them on what to do first based on their symptoms so they don't waste too much money. I see a lot of people just buying so many labs on their own and trying to figure this out because they're frustrated. They've seen their doctor, the doctor can't figure it out, and they go out there and buy thousands of dollars worth of labs. And I just feel like finding a good functional practitioner can save you a lot of money.
- [33:19]
B
Yeah, absolutely. So I see people spending money on special foods, diets, supplements, and all of this. Right. And labs, I would say food sensitivity labs. You can probably interpret them yourself. Right. It's like, oh, this is like a three plus, or this is in red so you can avoid eating that. The gut tests get a little bit more complicated to interpret yourself and to try to figure out a protocol. I know ChatGPT and Claude are popular tools these days, but I've seen them take people down a rabbit hole of stuff that doesn't exist, conditions that don't exist, like protocols that don't work. So definitely work with somebody that's experienced. And then, yeah, organic acid tests is another test that I love to do. That one, I would say, is like, you definitely want somebody that's seasoned and has been at it for like, 5, 10, 15 years. Because I've been using that test for 10 years plus, and I feel like I'm still learning things about it. Every other day I'm like, oh, my
- [34:20]
A
gosh, what do you use that test for?
- [34:22]
B
Organic acid tests. So this can be very helpful to see if somebody has candida colonization or if they have mold colonization, if they also have mitochondrial dysfunction in some cases, or if they have oxalate issues, salicylate issues. So there's a lot of different types of random, weird things where I see these wonderful individuals that follow me online. And I've written so many books that tell you exactly what you need to do to feel better, including my IBS book and have resources online on how to free articles that people can read. So a lot of people are very knowledgeable about like nutrition and diet just from reading. Right. But they end up with some of these random obscure things where they could be eating a very healthy diet. And it turns out that they actually have mold toxicity or they have salicylate toxicity or they have oxalate issues. And so their green smoothies are causing damage and causing them to have irritable bowel symptoms, interstitial cystitis symptoms, you know, bladder issues, joint pain and so on and so forth. So I love to use the organic acid test to find some of these nuanced things that when a person has like done the gut test and they've done a lot of the wellness things, but they're still struggling with symptoms, this can uncover a deeper layer. Right. And I wouldn't say everybody needs to do this, but again, if you've been on this healing journey for quite some time and you're like, okay, I've done this, I've done that, but I'm still struggling, then that might be an opportunity to do a urinary organic acid test.
- [36:04]
A
Right, Right. Yeah, that's definitely another valuable test, I think. When you're going further down the rabbit hole and you've gotten. You haven't had a diagnosis made yet or you don't still know the root cause for sure. What do you think about parasite testing?
- [36:18]
B
I love parasite testing. I will say that a lot of the gut tests on the market don't do it well.
- [36:25]
A
No.
- [36:25]
B
And so a person will say, oh, I was tested for parasites and my test came up negative. But it's kind of like, okay, they don't shed in every stool sample. And it depends on the diagnostic methods that are used. I used to use this old school test that had people collect four to five samples over four consecutive days. People hated it.
- [36:47]
A
Oh yeah. It doesn't sound like fun.
- [36:49]
B
It does not sound like fun. I didn't love recommending it, but I loved seeing the results because for a lot of people with digestive issues would be able to see that they had an infection. The Gut Zoomer is a pretty good test for picking up parasitic infections. There's also parallel wellness research which people can self order. It's like a retired physician with a microscope that looks at stool that can reveal more of these parasitic infections. Giardia, beaver fever, not to be mistaken, with this Singer Bieber. Yeah, this is something that can cause diarrhea for. For many years. That can. It's been tied to chronic fatigue syndrome, a lot of conditions. And people can pick it up from hiking, they could pick it up from dogle, they could pick it up from contaminated water. I believe this was found in Los Angeles water somewhere in the last 10, 15 years at a certain point. So, you know, a lot of times people think you need to travel to a developing country to get a parasite. That's not necessarily the case. Another common parasite is Blastocystis hominis. This has been tied to chronic hives. It's been tied to Hashimoto's as well as irritable bowel syndrome. It's controversial in conventional medicine. Some doctors will say you don't need to treat it if you have it in your system. But the research consistently shows that if you do treat. If you have ibs, you have that bug, you treat it, that your IBS symptoms go away. And so I'm a big proponent of, like, really doing the deeper testing for people if they're symptomatic and then figuring out what's driving their symptoms.
- [38:29]
A
Is that last one blastocyst? Blastocystis. Is that how you say it? Blastocystis.
- [38:35]
B
Blastocystis hominis.
- [38:36]
A
Blastocystis hominis. Thank you. Is that also detected in the Vibrant test?
- [38:41]
B
The Vibrant test can detect that as well.
- [38:43]
A
Great, great.
- [38:44]
B
Yeah, it's one of the tests on it. And it's not like a giant tapeworm or something. You know, it's. All of these are. A lot of them are protozoa, so you can't see them with the naked eye. You're not going to be seeing them in your stool sample in the toilet.
- [38:55]
A
Right, exactly.
- [38:55]
B
They're going to be swimming around your toilet.
- [38:57]
A
Right, right, right. So I think the moral of the story here is that there are really good tests available, like the Vibrant gutsumer, the organic acids test, the. The food sensitivity test. And these are all tests that you can do if you're experiencing these symptoms and you can't find relief just with food changes and avoiding foods and also maybe taking some digestive enzymes. And so it's worth doing these further investigations to see if you can find something.
- [39:27]
B
I mean, yeah, sometimes it's that $300 test. I know testing can be very expensive, but that tests can be give you the answers for why you've been feeling off. And it might be digestive issues that you're having now, but it might be additional issues in the future with the example of the Blastocystis hominis. I've had clients with chronic hives for decades. And we treat that. Their chronic hives go away, their IBS goes away. And some of my clients, their thyroid antibodies have gone away from treating that. Their food sensitivities go away. And I wish every person just had one cause and it was that for every condition. But there are 30 different causes like that. And so that's why testing, educating yourself is going to be important.
- [40:13]
A
Yeah, absolutely. Hi, Dr. Shah here. I want to take a minute to talk to you about cellular health. So in my clinics, I've actually seen 30 year old people with cells that look like they're pushing retirement. And I've also seen 60 year olds with cells that look like they're 40 years old. So what's the difference? It's really about how fast their telomeres are breaking down. Your cells you see, are like phones and they have limited cell phone battery, poor sleep, stress, processed foods, all of these things can drain that battery way faster than it should. So this is the reason why I partnered with iM8. IMA powers that cellular battery. It's not just another multivitamin. It's a comprehensive 92 ingredient formula designed specifically for cellular health and longevity. I'm talking 900 milligrams of vitamin C. That's like 20 oranges worth of DNA protection, the clinical dose of CoQ10 that you need to power your cellular engine. You also get zinc, selenium, vitamin E, alpha lipoic acid. All of these work synergistically for cellular repair and protecting your telomeres. So instead of taking a handful of pills every day and all these supplements, Im8 actually gives you everything that you need in one scientifically formulated system. And this isn't just a theory anymore. IMAID had partnered with Oxford University, the International Space Station San Francisco Research Institute, and they've done studies and they've gotten this NSF certified to truly power your health. Most people are aging twice as fast as they should. Unfortunately, you don't have to be one of them. Try Im8. I actually have a discount secured for you if you go to DrShaw.com IMA or go to ImaidHealth.com discount DrShaw and you can get 20% off with my discount code DrShaw. You can also find the link below. So I think the next kind of fact that people need to know is that once you find the cause and you treat it, there's still another step. Like you're gonna get better, obviously, but the next step is actually healing your gut, right? Your gut has been assaulted basically by whatever the Cause is for probably a very, very long time. And what happens in your gut cells is that they become unhealthy. They separate. The microbiome layer has been depleted, the mucus layer has been depleted. So there's various layers here that you need to treat and heal so that you get become strong again. And one of the ways you know that your gut is healed, well, there's tests you can do, but also symptoms of immunity go away as well. Your chronic inflammation goes down, maybe your Hashimoto's gets better. Like you said, hives might go away. And that's why it's so important to get your gut healed. And I would love for you to talk about like what is the gut healing protocol that you like to use?
- [43:04]
B
So it takes about two months for it to properly heal. I think about if you were to fall off of a butt bike and you scrape your knee, right. You put something to wash the bacteria off, but you're still gonna have that scrape. Right. And you're gonna wait. It's gonna take for your body to heal. I love to utilize L glutamine and zinc. I love zinc carnosine to help with healing the gut and giving the gut cells an opportunity to restore themselves. These are two wonderful ingredients. I love using mucilaginous herbs as well. They can really be helpful in the healing process. Butyrate can be incredibly helpful for feeding our beneficial microbes using probiotics. I love bifidoprobiotics, spore based probiotics, Sarcomyces boulardii. Like, I love them. All right. Probiotics can be a big part of the healing journey. Bone broth can be very helpful for you. For people, fermented foods can be incredibly helpful. And you know, utilizing that over the course of two months can be game changing. It can really accelerate that healing. You're gonna see a lot of the inflammation going down in your body. You can look at yourself and see, wow, I'm looking in the mirror and I'm seeing my skin looks better, my hair looks better. I'm just so much less puffy. Right. With utilizing these kind of protocols, but they do take time. So a lot of times people think it's you eliminate the infection and things will go back to normal. They can, but it's gonna take a lot longer. If you can utilize some of these healing foods and nutrients, herbs supplements that can accelerate your healing.
- [44:44]
A
Yeah. So the idea is to reinvigorate your normal natural gut flora by feeding fermented foods by like you said, also using butyrate maybe to help feed them as well. And then maybe even taking some probiotics to rein inoculate the area. And then as far as the gut cells themselves go, glutamine powers the gut cells to heal and can get them in a much better place. You said there's some herbs that you can also recommend.
- [45:16]
B
Yeah, I love, like marshmallow. Not marshmallow, slippery elm. These can be very helpful and very soothing for the gut layer. I didn't mention this, but serum based immunoglobulins can also be very soothing and nourishing too.
- [45:30]
A
Serum based immunoglobulins, where do you get those from?
- [45:33]
B
You can get them from em. Well, let's see for fullscript.
- [45:38]
A
Oh, okay.
- [45:38]
B
So.
- [45:39]
A
So this is like a, this is a, this is like supplement.
- [45:43]
B
Yeah. It is considered a medical food. So enterogram is the prescription version of it. But you can also get it from Orthomolecular Products is one company that makes it.
- [45:54]
A
I didn't know that. Okay.
- [45:55]
B
It works really, really well. It can be helpful for ibs. It can be helpful for getting inflammatory bowel disease into remission as well.
- [46:03]
A
What do you think about colostrum?
- [46:04]
B
Colostrum can be incredibly helpful. Serum based immunoglobulins work in a similar fashion.
- [46:11]
A
That's what reminded me about colostrum.
- [46:13]
B
Yeah. For some people that are super dairy sensitive, colostrum might be an issue. Serum based immunoglobulins are not dairy derived, so that's always helpful.
- [46:24]
A
Yeah, got it. Yeah. I think healing the gut is. I found it to be very successful when you go after it with multiple different tools at the same time. And I think that it can get a little bit overwhelming for people having all these supplements that they're taking and doing all these things. But I think the moral of the story is you don't have to do all this forever. Right. It's like you said, it's about a two to three month process and then once you start feeling better, your inflammation goes down, you can cut back and get back to normal.
- [46:55]
B
Yeah. I own a supplement company, it's called rootcology and there's 30 some products in the portfolio. And people sometimes think that I Recommend Taking all 30 supplements at once. And I'm like, no, never. You want to take like five to six supplements at a time for two weeks to two months. Generally speaking, that's how long you're going to take most of the supplements. Right. Sometimes, you know, there might be maintenance supplements that you might want to utilize. Long term probiotics for example, if you have had a history of gut issues, you might want to do a probiotic rotation. So for a month you might take bifido based probiotics. The next month you might take Boulardi based probiotics. Another month you might take spore based probiotics to kind of prevent from new things to occurring and to improve your gut diversity. I think one of the challenges I've seen from the wellness space is long term elimination diets like the low fodmap diet, they can really reduce your gut diversity.
- [47:56]
A
That's true.
- [47:56]
B
Right, right. And when you have infections, they can impact your gut diversity. So doing probiotic rotations can be helpful for. For that.
- [48:04]
A
Yeah. I want to talk a little bit more about leaky gut. I think that, you know, a lot of people don't know that we actually have a blood test now for leaky gut and a few blood tests actually. So I'd love for you to talk about them and how they can be helpful and what they mean.
- [48:18]
B
I primarily have used stool tests and I would look at zonulin as a marker. Is there a blood test that you're utilizing?
- [48:25]
A
Yes. So you can do a serum zonulin level as well. And we also utilize anti LPS as a blood test as well. LPS for the listeners is a bacterial fragment that can be measured in your bloodstream and it usually comes from gut permeability. And so we measure that. And zolulin is a protein marker that holds those gut cells together. And so when it starts floating around in your bloodstream, it means that your gut cells are separating and the zonulin is in your bloodstream now. And so where it should not be, it should be there holding your gut together. So yeah, those are a couple ones that we check. And you can actually check a level so you can see it like reducing over time as your gut gets better.
- [49:08]
B
I love that. And I think a blood test is gonna be much more accessible than the stool test. I do love stool tests. I will say that they do take a long time to get back.
- [49:18]
A
Yeah, they take a long time to get back. And it's about 50, 50 if someone actually does it sometimes.
- [49:23]
B
Yes.
- [49:24]
A
Yeah. They're tough to do. They're not fun to do.
- [49:27]
B
No. I've had people like call me very panicky and they're like, what do you want me to do? What do you want me to do? And then, you know, there's like the walk of shame to the post office or whatnot with your box of poo. So it's not very glamorous to do a stool test, but it's really important to do that. It's not super glamorous to talk about your digestion, but it can be a game changer for your health and your longevity and your vitality.
- [49:53]
A
Absolutely. One of the other tests that kind of indicate to me that someone is having gut health issues, or one of the indicators of gut health issues that are pretty severe is when you get chronic inflammation. And so some of the tests that we use for that is a blood test called HSCRP, which if it's over 2, I'm really concerned, and I really want to get people to get their gut evaluated almost all the time. They have either symptoms of diarrhea, constipation, like IBS type of symptoms, and if they don't have those symptoms, we still evaluate the gut, but we also go looking the oral cavity. Because your gut starts in the mouth, right?
- [50:31]
B
Oh, absolutely. And a interesting thing is the H. Pylori infection. Yes. So this can be related to constipation. This can cause thyroid antibodies. Brian Johnson recently talked about how he has autoimmune gastritis. Autoimmune gastritis. There's a large percentage of individuals where H. Pylori causes that. And so if he were to treat his H. Pylori, his autoimmune gastritis could go away. Brian Johnson, if you're listening to this little clinical pearl here, and H. Pylori can have a res. This is something that we can test for on stool tests, with a breath test. Some of the stool tests might be more sensitive for it, and we can use triple antibiotics for it. We can use different herbal remedies for it. But the tricky thing is it can also have a reservoir in the mouth. And so some individuals might need to treat their mouth. Yes, they might. One of the things I recommend is that people throw their toothbrush out every week when they're on an H. Pylori protocol as well, because you can easily reinfect yourself.
- [51:38]
A
That's interesting. That's a great clinical pearl there too. Yeah. I think H. Pylori, the discovery of it changed medicine in a very big way. Because I'm a surgeon, we used to be treating people with gastric ulcers all the time in gastric cancers. And for a long time, people just thought it was too much acidity. But then when they discovered this bacteria in the stomach called H. Pylori and treated that, the ulcers went away. So it was actually the bacteria causing the stomach ulcers. And so it's a really important thing to get tested for. And like you say, you can test for it with a stool test or a breath test.
- [52:10]
B
Yeah. It's very tied to different cancers, ulcers, Hashimoto's antibodies, constipation, food sensitivities. It lowers your stomach acid. And so if you have that, then you're not gonna be able to digest your foods properly. So then you end up with deficiencies in iron, in B12 protein deficiencies. I've seen people with like muscle wasting when they have H. Pylori. And that's like. That's part of it. Right. The other part of it is then you become more susceptible to these buggers, infections like protozoa or giardia. Because part of what our stomach acid does is it cleans up our food. So for eating a beautiful sushi dinner, and there might be some pathogens in that sushi, if we have enough stomach acid, the stomach acid is going to kill off the pathogens and then you're not going to get infected. But if you have low stomach acid, then those pathogens can easily get passed into your digestive tract and build a home there.
- [53:17]
A
Yeah.
- [53:17]
B
Which we don't want.
- [53:18]
A
We don't want that. Right. For sure. Wow. We've gone through all of the different. Well, not all of them because there's 30, but we've hit on the big ones. Right. I think. Did we miss any of the big ones?
- [53:27]
B
Did we miss any of the big ones? We talked about food sensitivities, we talked about enzyme deficiencies. We did talk about different infections. I did want to mention inflammatory bowel disease.
- [53:41]
A
Yes.
- [53:42]
B
About 10% of people who have the IBS label actually have inflammatory bowel disease. And the treatment approach for this can be a little bit challenging. And people think they might have to have their colon surgically removed or that they're going to be at greater risk for cancer. Some individuals I've seen struggling with it for decades, and there is actually a functional medicine approach to getting inflammatory bowel disease into remission. It can be really different than what you would use for ibs. So high dose probiotics, for example, might aggravate inflammatory bowel disease. Berberine, which I love for various pathogens and for SIBO and for metabolic health. And I don't know if I could say weight loss, but it can help with weight loss. Right. That can actually inflame somebody with an inflammatory bowel disease and make them feel worse. However, people can utilize serum based immunoglobulins. Boswellia High dose fish oils, turmeric, partial elemental diet. And I've seen cases of inflammatory bowel disease going into remission within months. My husband was diagnosed with inflammatory bowel disease.
- [55:00]
A
Really?
- [55:01]
B
Two weeks after we had our first son.
- [55:03]
A
Oh, my gosh.
- [55:04]
B
And thankfully, we were able to get him into remission. And so I have a chapter on inflammatory bowel disease in the IBS book that goes over the details and the different protocols.
- [55:16]
A
Can you tell the audience what is inflammatory bowel disease? Why does it occur?
- [55:20]
B
Inflammatory bowel disease, this is going to be something that presents with somewhat similar symptoms to ibs, but perhaps more intense. So a person might have GI bleeding, they might have excessive weight loss, they might be that person with a fever. A lot of times people might have additional symptoms as well, but it tends to be autoimmune in nature. Right. And so it's the body attacking itself. A lot of the same driving factors as IBS as other autoimmune conditions, but we do need to tread more gently with it. So many of them use salaginous herbs. Might be a place to start. Like typically with a person with ibs, we might do. You can do some of these herbs and probiotics right away and they will feel better. And a person with ibd, that can make them feel worse. And so you might want to start off with a more gentle approach.
- [56:17]
A
Got it. And how would someone get diagnosed with inflammatory bowel disease?
- [56:22]
B
The gut Zumar does have a marker on it called calprotectin, which will be elevated. Inflammatory bowel disease. It can also mean other things. So if you have had a test like that and your calprotectin was elevated, then I would recommend seeing a practitioner. But essentially you would wanna go to a gastroenterologist and get a test biopsy.
- [56:48]
A
Right. A gastroenterologist will do a colonoscopy and do a biopsy and they'll look at it under a microscope and they can see inflammatory bowel disease a lot of times.
- [56:57]
B
Yeah, definitely. But tricky part is some people get misdiagnosed with it.
- [57:02]
A
Yes, that's true, too.
- [57:04]
B
The tricky part is some people are told they have IBS when they have ibd, and then they end up suffering needlessly. Right?
- [57:13]
A
Yeah, yeah, it's very nuanced. And the gut is complicated. We know that. And however, you know, with practitioners like yourself and the ones that we have here at Naxealth, we can definitely help you sort through everything and get on the right treatment program and not take two steps backwards instead of two steps forwards. Right, Yeah. I Love it. I think this is like a great masterclass, but also a starting point in inflammatory bowel disease for anyone out there suffering from constipation, diarrhea, bloating, other gut symptoms. If you have these symptoms, please pick up a copy of Isabella Wenz's book, ibs. Right. That's the name of it. Just ibs.
- [57:51]
B
There's a big IBS on the front and it's Irritable Bowel Syndrome. Finding and Treating the Root Cause.
- [57:56]
A
I love it. I love it. And it's on bookstores right now, right?
- [57:59]
B
Available on Amazon. Yep. And Barnes and Noble and everywhere that fine books are sold.
- [58:04]
A
I love it. This is definitely a fine book. And where else can people learn more from you?
- [58:09]
B
I am all over YouTube, Instagram, Facebook, TikTok. I have a podcast called Thyroid Pharmacist Healing Conversations. I had a wonderful guest on recently and My website is thyroidpharmacist.com thank you.
- [58:26]
A
Thank you so much for all the incredible information as always, and look forward to the next thing you do and having you back on again.
- [58:32]
B
Thank you so much for having me. It's been such an honor.
- [58:34]
A
Thank you. Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.