A (7:03)

You're the thyroid pharmacist.

B (7:05)

So what prompted you to dive more into the gut and specifically ibs?

A (7:10)

Well, Amy, and it's so great to be here with you. I love your work. I so appreciate everything that you do for thyroid patients. But really, there's this huge gut and thyroid connection. And most of the patients that I've worked with and clients that I've worked with, they have some kind of a gut component related to their thyroid dysfunction. Especially true when somebody has autoimmune disease. We do know that every case of autoimmune disease has to have three things to be present in order for it to manifest. The first one being the genetic predisposition for the second one is some kind of a trigger. And then the third one is intestinal permeability, which is also known as leaky gut. And then guess what the symptoms are of leaky gut. Right? So some people can be asymptomatic, and other people can have essentially IBS symptoms such as acid reflux, bloating, constipation, diarrhea, cramping, urgency with defecation. And many people that have intestinal permeability get the IBS label. Doctors don't really do anything for them. 5, 10, 15 years down the road, they end up with an autoimmune diagnosis or a thyroid diagnosis. This was the case with me. I was diagnosed with IBS during pharmacy school. Went to my doctor. Doctor said, you're in pharmacy school, you're stressed out. That's what causes ibs. I could Tell you to drop out of school, but I'm not going to do that, right? So here's some medication. And then, of course, five years, six years later, I got the Hashimoto's diagnosis. And I wish I had known that having IBS would put me at risk for autoimmunity later on in life, but I didn't know that. And so my hope is that women who have IBS can prevent a lifetime of various health conditions by treating their ibs. And then for women who already have an autoimmune disease or condition like Hashimoto's hypothyroidism, that they'll have a roadmap on how to heal their gut once and for all. Because. Because it's not as easy to heal your gut as just like drinking bone broth, right? Like, you and I love bone broth. But, like, let's be real. Like, that's not gonna heal most cases of leaky gut.

B (9:18)

And we're definitely, we're gonna talk about things that people can do and absolutely go over some of the misconceptions about gut healing protocols. But I want to stick with this IBS term really quickly because I don't think a lot of people know or understand exactly what irritable bowel syndrome is. Or they may have gotten that label, that diagnosis from their doctor. Maybe they've even heard of ibd. So can you really break down what does that typical patient, why do they get that diagnosis? They walk into the doctor's office, they say, hey, doc, here's what I'm experiencing. And then, oh, you have ibs?

A (9:56)

Yeah, here's the thing. It used to be a diagnosis of exclusion, where doctors would run tests with for other things, and if the tests came back normal, they would say the person has ibs. Back in the day, the tests, as you can imagine, weren't that helpful to find causes of digestive distress. And then the guidelines were updated because the tests were coming back normal. Thyroid patients probably have heard that phrase too many times in their lives. But essentially it's a diagnosis that's clinical. So a person can walk into a doctor's clinic and self report their symptoms, which is typically constipation, bloating, diarrhea, or a combination of both over the course of a few weeks to a few months, where then they will receive the IBS label. Now, I have a concern with this because underneath that label is 20 different colors causes. Plus, a research done in 2011 by Dr. Haba found that out of 303 people who had the IBS label, 98% of them actually had some treatable cause of their IBS, right? And so things like celiac disease or exocrine pancreatic insufficiency, these can all produce IBS like symptoms. And when you treat the cause, you get a complete resolution of your symptoms. Whereas the conventional medical approach, less than 25% of people get rid of their symptoms over the course of like five years plus. So we have all these people walking around with ibs. They're getting really basic bitch recommendations like eat more fiber, be less stressful, stressed, you know, like lose weight, exercise, whatever. They're just getting this band aid approach sometimes, sometimes medications, right? Or take a probiotic. Like really basic guidance where there's 20 different causes, more than 20 different causes, and like, let's figure out what the cause is so we can actually treat it, right?

B (12:06)

Oh my gosh. Yeah. That is unbelievable. And it falls under the, the whole guise of medical gaslighting again. So even though they're getting a few more tips and tricks to heal them, it still is a blow off. It's still a dismissal of what that person is actually going through. And that's a shame. That's an absolute shame. So you actually, like, you shared, went through your own IBS diagnosis. What was your personal experience? Like, what were your symptoms? How did you uncover it? Like, how do you go deeper and avoid the dismissal from conventional medicine?

A (12:41)

Well, it's a little bit embarrassing. I was in my second year of pharmacy school, and during pharmacy school I was in class about 40 hours a week. I was taking organic chemistry, biochemistry, physiology, pharmacology, all kinds of disease classes, Right? And in addition to that, I had exams twice a week. And the exams were at 7:30 in the morning two times a week. And I commuted about 45 minutes to class in Chicago traffic. So as you can imagine my lifestyle, like, I wasn't cooking my own food and I wasn't sleeping. And one night I was studying for an exam. I believe it was organic chemistry. And I decided to make myself a really delicious meal of ramen noodles and soy sauce in the microwave. Right? Like typical.

B (13:32)

We ate back then, you know.

A (13:34)

Yep, yep. And I'm like, okay, I've been studying all day. I'm ready for my exam. This is gonna be like, I'm ready for it. Like, this is gonna be great. And so I go to bed after my delicious meal and I wake up at like 4:30 in the morning with like urgency and cramping, right? And so I basically had explosive diarrhea. I know, super glamorous. And I had to miss my exam. And when you're in grad school, you can't really miss an exam because that affects your entire grade. And then you can flunk and you don't want to flunk. And so I'm like freaking out. I'm calling my school and I'm trying to explain because I'm like, you know, I was studying at the library. The professor saw me. It's not like I just didn't study and I'm pretending and they're like, well, you need to get a doctor's note anyway. And then the doctor did diagnose me with IBS and essentially gave me this medication called Levsync, which was supposed to slow down my, my digestion. And it kind of helped with my digestion, but it also gave me like blurry vision and brain fog, which, you know, you really can't have when you're in grad school. Like you cannot have blurry vision and brain fog. Right. So that was a no go. And I just like resorted to basically carrying around like a shit kit, which was Imodium, baby wipes and an extra set of pants because every now and then I had to like leave in the middle of a class and like run to the bathroom. Yeah, so that's hard.

B (15:00)

That's really hard and that's really embarrassing. But you know what, the listeners that are resonating with you are resonating deep with you right now because there's such embarrassment with that.

A (15:08)

Yeah, it was definitely not super glamorous. Made dating interesting. It made everything interesting to say the least. And so it really wasn't anything that I got from conventional medicine. Unfortunately, that helped.

B (15:22)

Okay, now real quick, was this before or after your Hashimoto diagnosis?

A (15:27)

This was about six years before my Hashimoto's diagnosis. So I got diagnosed with Hashimoto's after pharmacy school when I was already a practicing pharmacist. But it's interesting to note that many people will get a Hashimoto's or autoimmune diagnosis after an IBS diagnosis. I've noticed that in many of my clients timelines. And it was actually that IBS diagnosis that helped me put together the whole path to remission. Because we know that intestinal permeability and gut health is such an important driver of autoimmunity and Hashimoto's. And so I guess I'm thankful for that awful, awful experience that I had and for all those challenges because it helped me figure out what the driving factor was for Hashimoto's, for myself and many people.

B (16:13)

So would you say that IBS is, is it a trigger to turn on that Hashimoto switch? Is it like a precursor, like Epstein Barr virus? Like, how is it connected to Hashimoto's?

A (16:26)

That's such a great question. So we know that there's the three legged stool of autoimmunity. And ibs, especially if you have IBS with diarrhea, is very much correlated with intestinal permeability. So what do our intestines do when they're permeable? They give us diarrhea. Right. And so a lot of the digestive distress. And even if it's only short lived, like some people will experience digestive distress, maybe they have food poisoning or ibs that kind of goes away after a while, or maybe they eliminate a couple of foods and things are better. There might still be that underlying intestinal permeability that is essentially still throwing off your immune system, leading to autoimmunity.

B (17:05)

Okay, so let's actually unpack leaky gut a little bit further and let's go deeper into that three legged stool. Because I think, you know, as practitioners, we throw that term around and we think that everybody knows what it is, but until we really explain it, I don't think people can actually grasp what we're talking about when we say our gut is leaking or we have permeability. So that three legged stool you had mentioned, I talk about it on the show a lot too, that you have. Like you mentioned that the one leg of the stool is the genetic predisposition. So that's somewhere in your family. You have an autoimmune condition. Mom, sister, aunt, whatever. Then the other leg is that trigger stressor. That could be what you and I have discussed on both of our shows. Pregnancy, puberty, per menopause, menopause stress, some life situation that that's just the, the trigger. But to have the stool stand the. Basically for autoimmunity to be present, you need all three legs. That third leg is leaky gut. And I had said when, when you interviewed me for your show, I'm like, I, I'm pretty sure everybody has leaky gut. Is that a true statement? And can you go deeper and really explain what is this term leaky gut, I. E. Intestinal permeability?

A (18:21)

Sure. So normally the intestine acts as a barrier between what's in our digestive tract and what's in our bloodstream. Right. And so it allows nutrients to pass into the bloodstream while blocking out harmful substances. Such as toxins, you know, poop, bacteria, undigested food particles. We want to keep those inside of our gut. We don't want those in our bloodstream. The issue is when we have little tiny holes in our gut or the gut actually expands and makes itself permeable, there's different compounds that can cause it to become permeable. This can trigger an autoimmune response. This could trigger chronic inflammation. This can trigger food sensitivities. And so do we all have intestinal permeability, leaky gut. So we can have it. Like, if we eat gluten once with celiac disease, we're gonna have a leaky gut for months. If we're a regular person without any gluten sensitivity, eating gluten once can trigger intestinal permeability for maybe minutes at a time. Like, the gut is meant to be making itself permeable and then closing itself back up so it can go back and forth. I think the issue is when it's leaky all the time. And there are different things that can make it leaky all the time, such as having ongoing food sensitivities. Sibo, a lot of these things that can lead to an IBS diagnosis. It's like when you've got these things in your system, then your gut is going to be constantly leaky. And, I mean, I've done testing on people for intestinal permeability, and I'll tell you, not everybody has it, but people typically that I've worked with, with autoimmunity will have it. And then we use that as a marker for trying to get them into remission and getting their gut health optimized. It's like, this is something that everybody's gut can do, but we want to try to keep it contained.

B (20:17)

Okay, so I'm going to circle back to testing, but on the autoimmune hashimoto, leaky gut connection, so what actually happens? So those particles, toxins, just. We'll say bad things. Those particles permeate the gut and enter into the bloodstream. Now, this is a question for you people with leaky gut, People with ibs, are they always going to have gut symptoms? Or could it be that they get a rash, they have acne, they get migraines because of that intestinal permeability.

A (20:51)

That's such a great question. So 50% of the people might actually be asymptomatic, and they might not have any symptoms at all. And then for some people, they might have those IBS symptoms, and other people can have completely different symptoms. That are unrelated to the gut. So they can have migraines, they can have anxiety, they can have skin breakouts. And it's just something that's so fascinating and so important that I feel like anybody whose health is out of balance really needs to work on their gut and test their gut and figure out how to get it optimized.

B (21:24)

Okay, so what kind of testing do you like? Because you said you've tested people, and good news, not everyone has leaky guts. So that's, that's good. But what do you. What do you use to really see whether or not someone has a gut issue or leaky gut?

A (21:39)

I like to use comprehensive stool tests. So you take a poop and you send it away to a lab to be analyzed? I like ones that look at a lot of different markers. One of the markers that I like to look at is zonulin. And this is an indication that when this is elevated that you have some degree of intestinal permeability. Zonulin is a protein that basically modulates the intercellular tight junctions. So this is a fancy way of saying it manages the channels that expand your gut and make it more leaky. So when you have too high levels of zonulin, you're going to get that intestinal permeability presentation, and that's going to be common in autoimmune disease. I like the GI map and the Gut Zoomer are a couple of tests that utilize zonulin. I believe it's an add on, on the GI map the last time I checked.

B (22:34)

I'm happy that you said that because when we do GI maps on people, I usually leave off zonulin because I admittedly was under the impression that we all had leaky guts, so why not save some money and just not test the zonulin? But now that you're saying, like, wow, we're actually seeing people that don't have that marker that legitimately do not have leaky gut. I think it's important to know and then actually showing people that they do as, you know, sometimes when they see it in black and white, they take it more seriously and are more willing to implement the. The healing protocols that you design.

A (23:06)

Yeah, yeah, absolutely. And I feel like just having leaky gut in itself isn't necessarily it, like, we can't have an action plan. So there are things like berberine that have been shown to repair leaky gut, Various nutrients supplements, zinc and glutamine. They can be helpful for repairing that gut wall. However, we also want to look for causes. Right. And so Some of the biggest drivers of that could be SIBO or celiac disease or infections, food sensitivities, type of diet that we're eating. And so we want to make sure. And this is why I love doing the gut testing, too, because a lot of times they can show me somebody has an infection or if they have a reaction to gluten.

B (23:51)

And what about parasites? Because, you know, we hear if you have a heartbeat, you have parasites, basically. So how do those play a role? Or do those come in as a contributor?

A (24:02)

Definitely. So parasites are a known factor for increasing that gut permeability. And one of the things that I'm very proud of, and it's kind of my nerd moment, is when I was going through my Hashimoto's diagnosis and trying to get myself into remission, I started doing some stool testing, and I was found to have a protozoa called blastocystis hominis. And the interesting thing is it's found in about 70% of people with IBS. It's very commonly found in people with chronic hives, urticaria, which. Which I also had. And in my experience, about 29% of people with Hashimoto's have this protozoa. And the cool thing is, a lot of the research at the time pointed to, if you treat it, your IBS can go away, if you treat it, your chronic hives can go away. But there was no research at the time connecting it to Hashimoto's. But I started seeing, okay, this person has that, I think, better out than in, right? If I find an infection, like, let's recommend some kind of treatment for it. And I was starting to see people's numbers, Hashimoto's numbers improve. So TSH and thyroid antibodies improving, as well as their symptoms. A lot of times people who were, like, doing the autoimmune paleo diet or like really restrictive diets, all of a sudden, they're not reacting to grains, they're not reacting to a ton of foods. And so I thought this was kind of cool. And then a few years later, I wrote a blog about it. I was like, I'm going to get it out in the blogosphere. And then a few different researchers have studied this connection now at this point. And so they have found that eliminating this protozoa can reduce thyroid antibodies, it can reduce tsh, and it can also normalize the interleukins that are out of balance in Hashimoto's, which are kind of like the inflammatory cells, inflammatory markers. And some people can actually get into Complete remission from Hashimoto's, especially in the early stages where they're just. Their thyroid's just a little bit out of whack when they treat this infection. And so for me, this is like, okay, you've got ibs. You could have this infection as the potential root cause. And we do know what it does to the immune system. And later down the road, you could end up with Hashimoto's. So this is just like kind of that puzzle that people can think about when they have a weird diagnosis or autoimmune diagnosis to figure out, okay, what's the driving horse behind it.

B (26:23)

Now I know people are going to listen to this and immediately go out and buy some parasite kit, right? Or, or we do know that, that people really go aggressive and they jump all into fixing their gut. And they're taking five different probiotics and bone broth and berberine and collagen and some, you know, other gut supplement. They're doing all the things. They're doing a parasite cleanse. They're doing it all. Should we really be doing that or how should we really approach gut healing, especially if we have Hashimoto's?

A (26:56)

Well, so I will say one of the key things in gut health is your secretory IGA levels. So secretory IGA is something that gets depleted when we are under stress, when we are immune compromised, such as living in a moldy situation, when we have parasitic and chronic infections. And secretory IGA is like our gut's first line of defense. If we have optimal secretory IGA levels, we can actually fight a lot of infections on our own. And this kind of keeps our gut in balance. Doing gut tests over many years, I see majority of people with Hashimoto's have either elevated or low levels of secretory iga. And some of the people who I've noticed had like a whole bunch of infections. Like one person had six different parasites. Their secretory IGA levels were super, super low. So one of the things you can do is you can work on your secretory IGA levels, your immune resilience in your gut, so that you can overcome infections naturally. And I love using Sarcomyces boulardii, which is a beneficial yeast for that. One study in children showed about more than 80% success rate of using Sarcomaces boulardii for treating blasto. Over the course, I believe it was 14 days. I'm like, do it for 30 days just to make sure you cover double that. And it's a very gentle probiotic. I'm not against parasite cleanses per se, but being a pharmacologist, I'm always like, okay, this is, this bug, this drug, this herb, they work, right? And then this bug, these two drugs, these two herbs are not gonna work for it. And so I will say, and I've had people do parasite cleanses, they feel amazing. Good for them. Then I've had people do parasite cleanses, they feel like they are about to have a psychotic break after them and not better and still having symptoms after investing all this time, money, resources, energy, hope, whatever, into their healing journeys. And so for me, a lot of the times I'm like, okay, well, if you can actually find the exact thing, then let's do it. Right.

B (29:16)

Yeah, no, exactly. And I'm with you. There are some. And I have, you know, a couple parasite cleanses in my pantry, in my supplement. Pantry. And. And it's like that innate feeling of this is too much. I started one and I immediately got supplement fatigue because it's so many different things. And you do start to question and. And this is absolutely a question for you as a. As a pharmacist, when you have a boatload of different. I'll just say things, nutrients, herbs, whatever, and you're bringing them together. It's one thing to study, okay? Vitamin D works in the system. And I'm just using vitamin D. I know that's not part of a parasite protocol, but vitamin D works in the system this way. We know this, this, this. But when you bring in 15 to 20 to 30 other factors, does that change how that one nutrient, that one herb, that one parasitic cleanse, does it change how it works in our body? I mean, can we overload our body with too many healing modalities?

A (30:17)

Yeah, unfortunately, I've seen that. So artemisia is an herb that's used for parasites, and it can be very effective, but when used long term and in certain people, it can cause issues with the liver. So you might see elevated liver enzymes. Right. And for it to properly treat a parasitic infection, you need like 60 days worth, where sometimes you just need three days of a drug for the same infection. So I'm kind of like, I. And the drugs might be more gentle in some cases because they're more specific to parasites versus the herbs might work on the whole body. I love berberine, but sometimes people might need to use it for a very long time, and that can actually impact their gut microbiome. So you can get yourself depleted from beneficial nutrients when using that for too high doses for too long of a time. Right. I do think there's wisdom to knowing exactly what you have. And sometimes when you are throwing the whole kitchen sink at your body, you might not be doing yourself any favors or your liver any favors. And I've unfortunately, I've seen people do like those 90 day parasite cleanses and you run a stool test on them and they still have a bunch of parasites in the stool test.

B (31:29)

Yeah, yeah, exactly, exactly. So when we're talking about digestion, you know, we talk a lot about this in the thyroid space and in the hormone space of how important it is to poop every day, because that's really how our bodies detox. It's how we, I mean, we can easily become estrogen dominant if we're not having a bowel movement daily because of the estrogens recycling and beta glucuronidase. So can you first describe what does normal digestion look like? Because some people think it's normal to poop once every three days.

A (32:02)

Yeah, absolutely. And I know I was one of those people that thought it was normal to have stomach aches after I ate. I thought that was part of the digestive process and to have very loose stools multiple times a day. But that's not how normal digestion works. So for most people, you should poop every day, maybe twice a day, maybe every other day. And the stools should be relatively soft, not too hard, not little pebbles. Also not diarrhea. You should not have a lot to wipe and it shouldn't be painful. You should not have urgency with your stooling. You shouldn't have incomplete stools. It should be a very, very predictable process where you know it comes out every day. Right. And then you kind of go through that process and you can have problems at both ends of the spectrum. So if you are having diarrhea, you're gonna be malabsorbing. A lot of nutrients can become very nutrient depleted. If you have constipation, you can end up recycling a lot of things like you talked about, such as problematic estrogens. You can also end up with ammonia toxicity. And that manifests as having like really severe brain fog and a lot of neurological symptoms.

B (33:15)

Oh, interesting. I, I did not know that. That's just something I learned. Okay, so if we have a patient that has a lot of brain fog and, and neurological symptoms, symptoms like that, and they are not eliminating daily, it literally could be that a buildup of ammonia. How do you test that?

A (33:32)

I love doing the organic acid test. And that can show elevated ammonia levels. That test has Been a really big game changer for me for some chronic complex people. And you know, the things that can drive ammonia toxicity would be constipation being one of them, but also low stomach acid and eating a high protein diet. So if you're not breaking down your protein properly, you can actually have these really high ammonia levels and that can lead to some brain fog and bloating and just a lot of unpleasant symptoms.

B (34:05)

Well, and low stomach acid is very common with Hashimoto's. So can you talk a little bit more about that? Because that's not something I, I do briefly touch on that betaine hydrochloric acid topic with Hashimoto's, but I'd love for you to go a little bit deeper and how that ties in as well.

A (34:23)

Yeah. So kind of being a detective and going back to my own story, one of my symptoms that was really, really frustrating with Hashimoto's, before my diagnosis even was acid reflux. And I was like ready to cut my head off to stop the chronic cough that I was getting from it. Of course my doctors recommended proton pump inhibitors and so on and so forth. But a lot of times people think they have acid reflux because their stomach acid is too high.

B (34:47)

Right.

A (34:48)

Actually, acid reflux oftentimes occurs when we don't have enough stomach acid. Not having enough stomach acid means we're not going to be digesting our food properly, especially protein containing foods which then can produce that ammonia. Right. And it's very, very common in people with hypothyroidism. It's been described as one of the consequences of DYS thyroidism or not having enough thyroid hormone on board. Where most people with hypothyroidism have either low levels of stomach acid or even no stomach acid. And it's very, very common that I see this in my client population. And these are people that feel exhausted after eating. These are people that are walking around with brain fog. People oftentimes will have joint pain in their bodies. They might struggle, you know, with, with bloating and indigestion, all of these different symptoms. And what I like to utilize, as you alluded to, is betaine with pepsin. It's a protein digestive enzyme. In my personal experience, this was like a huge aha moment on my healing journey where I started to take that protein digesting enzyme. And all of a sudden I went from sleeping 11 hours, the thyroid meds got me from 12 hours clear. Waking up like after 7 hours being bright eyed and bushy tailed, my personality coming back, I used to be very bubbly and sharp. And Hashimoto's made me very brain fogged. And so this is something. When you are properly digesting your protein, you're gonna be utilizing all of these nutrients that you might have been missing. And you're also going to be clearing out some of those toxic byproducts like the ammonia we talked about.

B (36:33)

That is huge. That is huge for thyroid sufferers because, oh, gosh, they just so resonate. I can't tell you the amount of people that think that their acid reflux is due to too much acid and so they suppress the acid, suppress, suppress. When really they just need help building it up. Now, the other thyroid gut connection, we know that the gut is a main conversion location of the T4 inactive thyroid hormone to T3. How does IBS play a role? Does it affect the deiodinase enzymes? How does it affect our conversion in the gut?

A (37:09)

Well, we do know that nothing works quite well when we tend to be too constipated or when we have diarrhea. So there have been a few different studies looking at gut health, how it relates to thyroid function. And some of the things we see, for example, might be alterations in our microbes that can impact how we do the conversion. Right. And so a lot of times when we have dysbiosis and these alterations in our microbiome that's going to impact how we utilize and thyroid hormone.

B (37:41)

So will you see in, in your practice, will you see more cases of elevated reverse T3 accompanied by IBS or IBS comes first and then we see conversion issues and an elevator reverse.

A (37:56)

You know, the biggest thing that I found is actually with liver function, as far as reverse T3 goes and Adrenal issues, I feel like those are usually the things where I'm thinking with reverse T3, I'm thinking either ferritin levels or liver issues or adrenals. Those would be my first three go tos. But of course, you know, low ferritin can be associated with low stomach acid. It can be associated with gut infections. So I feel like it all connects. My thing is I kind of look at everything with everybody, everybody that I work with. It's like liver, adrenals, gut. Anyway, so I'll have to parse that out to see where, what the connection might be there. I'm like, I'm going to make a note to myself, like I like to do like outcomes research where I like take different variables and isolate them, but I haven't really done that isolation, so. So thank you for that idea well, there you go.

B (38:52)

So you can do the research. I don't like doing that so you can report back to me. But just like you said, everything is connected. Everything in our body is so beautifully connected. So what about hormones? Now, how do hormones affect ibs? Or how is that? How are they tied together?

A (39:08)

We do know that stress hormones can definitely impact ibs, and. And so stress doesn't help anything. I wrote a book about the adrenals a couple of years ago, and we do know what stress can do to our immune resilience. When, again, going back to low stomach acid when we're stressed out, that can lower our stomach acid. When we're stressed out, that could also lower our secretory iga. And then we're more likely to have these food reactions. And we're also more likely to catch infections when we are not digesting our food properly. You know, we're going to have these bigger particles that get into our digestive tract and then potentially our bloodstream. And as far as the infections go, you know, you could be eating a lovely sushi lunch and there might be some pathogens growing in that sushi, but if you have enough stomach acid, that's going to kill off whatever is growing in there. If you don't have enough stomach acid, then you can take that food in along with the infection, and that infection is allowed to propagate in your system.

B (40:07)

Okay, Yep. That makes sense. H, Stress, adrenals, such a root cause. And then, you know, I'm thinking of all of these people that we run into, and, you know, I'm one of them the type A drivers, the overachievers, where you just push, push, push. And I've heard you say IBS is the burnout of the digestive system, you know, just pushing past our stress levels, battling through the fatigue because we can't take time. What is that connection between IBS and burnout of the digestive system?

A (40:41)

Yeah, I mean, it's such a huge connection. And I identify as being one of those type A overachievers like you do. It's. It's a. It's a. We're a work in progress. Aren't we all? We are.

B (40:52)

It's a problem, but we're. We're working on it. Yeah, yeah.

A (40:56)

Through this podcast and writing our books.

B (40:58)

Right, exactly, exactly.

A (41:01)

So it's very interesting because what happens when we are stressed as we release hormones like adrenaline. Right. And adrenaline actually sends a signal to our microbiome to be more aggressive. So the. We have good bacteria, we have bad bacteria. Right. That could live in our digestive tract. Everybody's got a balance of those. And typically you're hopeful to have more of the good bacteria than the bad bacteria to keep things in check. Other than these, you also have opportunistic bacteria. What does that mean to be an opportunistic bacteria? That means that you're going to behave well if the situation calls for it. But you can act pathogenic when things are out of balance. When you see like, hey, everybody's raiding, I'm going to raid too. Right. And so that adrenaline actually sends a signal to the opportunistic bacteria that it's time to attack our gut wall and time to, you know, throw a riot. And so this is something that I see oftentimes in people where they say, like, oh, my God, I was so stressed out and I just started to have digestive issues. And I'm like, it's that adrenaline. It's like rocket fuel for your opportunistic bacteria.

B (42:17)

So that there's a big difference between that will say acute stress. Like, I'm really nervous to go on stage and talk and I have to go use the bathroom really quick because it speeds up everything and you might have a little bit of diarrhea and then you're okay. That's different from the chronic stress, the overachiever. And it long term affecting your gut health. Right.

A (42:41)

You know, I feel like the saying is that small doses of toxins on a regular basis or even large doses of toxins every now and then are better than like a tiny dose of toxin every single day because that just really depletes your body and then you don't have an opportunity to heal from it. Right. So you never kind of detox that stress, for lack of a better word. You are constantly shifting your autonomic nervous system. You're in that fight or flight instead of in your rest and digest. And so when we're in fight orf flight, our body takes resources from our gut, such as L, glutamine and zinc, that are needed to keep that gut lining, you know, fresh and clean and, and work it through its thing. And that can really shift our overall health.

B (43:30)

Well, and even just the phrase that you just said, which it didn't even hit me until you said it, fight or flight versus rest and digest. Digest is in that phrase for a reason, because it's tied back to that fight orf flight high stress mode. So it's literally like in a cliche phrase. So of course there's a connection there. Now, what about Bloating. I mean, we know that this is a huge symptom with all of our hypothyroid Hashimoto peeps out there bloating. You know, everybody thinks, I know I ate too much, but it's not necessarily from that. Can you explain where bloating, where people say like, oh my gosh, it's like, I'm six months pregnant, I didn't do anything. Where does that come from?

A (44:15)

Gosh, I've been there, done that. I know. I used to work at an office and with one physician who would be like, congratulate me all the time on my pregnancy. And I was like, thank you. This just. Just like baby, right? Or like that. That's just my lunch express stressing itself. And so, yeah, I mean, if you wake up with a flat stomach and you're pregnant by the end of the day, there's a really good chance your microbiome needs a little bit of love. One of the more common causes behind bloating could be something like small intestinal bacterial overgrowth where you have bacteria growing in the small intestine and they are basically throwing a party every time you eat certain foods and releasing gas. Right. And that's kind of expanding, expanding your belly. Potential reason for that. Food sensitivities can cause bloating. Not having enough digestive enzymes on track can cause bloating. And then protozoa, different parasites can cause bloating. I think for me, if I am thinking of a starting place for somebody that's bloated is doing some digestive bitters or digestive enzymes, that can be a really great start for you to see if that helps the system. Because definitely you want to start with having good digestion and going back to that fight or flight or parasympathetic state. If you can just do something of eating your food when you're relaxed instead of like on the go, like, do not eat your food while running a marathon. I know, I know. Like, most of us wouldn't do that, but we kind of do that on a daily basis. If we are on the go and we're eating, you know, we should be sitting down, we should be not eating at our desks. We should be hopefully taking deep breaths and putting ourselves in that rest and digest state.

B (46:02)

So now I'm just seeing the type A overachiever who of course just grabs food on the go because we don't have time to actually sit down and eat our lunch, for goodness sake. We have 10,000 emails, we have five more meetings. And just how you described it hit me and I'm hoping it's hitting the listeners too. Picture yourself eating while you're running 26 miles. Would you do that? You're like, no, that's crazy. That doesn't even make sense. And yet we do that every single day. And we wonder why we're bloated and we have GI issues. Just that alone. I mean, that's not even going into all the different areas that we already talked about, but just that fast eating and not allowing yourself to digest, wow, what an impact on the gut. Now, what about people that actually get worse at night? Like you would think, okay, once you stop the rat race of the day and you chill, why would all of a sudden your symptoms flare?

A (47:03)

Yeah, I think it's a buildup over the day. Right. Because overnight we're fasting, we're not eating the foods, and so our bacteria isn't necessarily digesting all that food.

B (47:15)

Okay, well, and same thing with vacation, like IBS flaring on vacation or disappearing on vacation. What is that connection to our, our stress and nervous system?

A (47:24)

It's incredible because, you know, have you heard of the Europe effect for like gluten sensitivity?

B (47:30)

Oh, yeah, yeah. People can eat gluten over, over in the uk. Absolutely.

A (47:34)

And a lot of times people think it's like, oh, their gluten doesn't have glyphosate or it's different. But it's like, okay, there's another variable to consider is like, were you relaxed when you were on vacation? Right. And so, yeah, we're going to be digesting food a lot better when we're on vacation. And same goes when we're stressed out. So I can tell you, once I was cooking dinner for myself and my husband and we got into a very, very huge fight. Like a huge fight. I don't remember what it was about, but you know, you're married, you know. Right, right. And he didn't eat the food. He was so mad, he like left. I ate the food and I got sick. Right. And so we know that like when you're super stressed out, you can get really, really sick from eating. Another time, my uncle was leaving my house, my parents house on Christmas and he got into a really huge accident. He was hit by a drunk driver. And the next day we got a call from the hospital that he was in the icu. My parents both had to go to work and I went to see him at the hospital and I ended up with like, you know, severe digestive distress after seeing my uncle. Right. And so it's like, it's just that stressful response that can occur when you are like, that's what it does to your digestion, right? Yeah.

B (48:54)

That is crazy. That's just crazy. I mean, it just, it's, it's all tying together how much stress affects our body and that trickle effect of our gut to our immune system, to our thyroid, to our hormones, to just everything, it just everything is connected and really, really does start with the gut. So let's actually talk about what people can do. And we're not going to give away the farm because they need to get your book and get all the fantastic information and answers that are in the book. But let's give them a few nuggets. We know that people, I mentioned it earlier, love to go right to probiotics. And I joke, remember Jamie Lee Curtis with her Activia yogurt? Like, just eating Activia yogurt will cure everything in your belly, the bloated belly. Everything will be better. And you know, every woman went, ran out and started eating activia yogurt or taking a probiotic that they got from CVS or Costco. So let's start with probiotics and then we'll kind of go into some other real healing protocols that people can do. What is your take on probiotics or over probioticing that people like to do?

A (50:04)

I love probiotics for the right person and they can be a really big game changer depending on what's going on in your body, where things can get a little bit tricky. Okay. So if you have sibo, certain probiotics, like the Lactobacillus containing ones, can make your symptoms worse. If you have histamine intolerance, which is usually caused by parasites or mold exposure, other probiotics can make you feel worse. And then a lot of times I actually recommend if you have ibs, that you utilize something like Sarcomyasis boulardi when you have diarrhea, because that helps to raise your immune dysfunction in the gut. And so that can be really, really helpful to overcome whatever infections you have. It can be helpful for Candida, it can be helpful for a mold, it can be helpful for, for parasites, dysbiosis, so on and so forth. So you might want to start with something like that. The other thing to consider is a lot of the probiotics on the market, I guess the doses they have in them are used to maintain health. So you actually need to have really high dose probiotics to move the needle, right. To induce health. If you're unhealthy. Just taking, like, Activia yogurt or just taking, like, the basic Walgreens probiotic won't really do much for you. You have, like, trillions of bacteria in your gut. Do you think, you know, it's 5 billion? Sure sounds like a lot, but it's probably not going to move the needle for you. And then there's, like, going into the nuances of different probiotic types. Sometimes you might be missing something specific. There is a probiotic called E. Coli Nisil that people with inflammatory bowel disease might be missing. And sometimes taking that probiotic can optimize your digestive function and help you get into remission. And so there's a little bit of nuance to that. Like, again, if we're talking about maintaining health, you're already healthy. Taking yogurt. Probiotics out there, like, go for it. Like, but if you have an autoimmune condition, if you have ibs, if you have an actual health problem that you're trying to solve, like, you're gonna need to get more nuanced than that.

B (52:10)

So basically, don't just take a boatload of probiotics. Work with someone that knows what they're doing with the gut that can direct you and really specify what type of probiotic you need. Now, you and I had talked about collagen on your podcast, so I'm going to bring it back around. I've also heard that collagen is often part of gut healing protocols that can help our gut. Is that true? Is there a tie in with IBS as well?

A (52:36)

I do love collagen, and I love bone broth. I think they can be an excellent part. Part of the gut healing diet. So glutamine and collagen are fantastic for our gut lining and repairing that. And so I am a big proponent of utilizing them again. For some people, histamines might be an issue or that collagen can convert to ammonia. Sometimes it might impact the glycoxylate pathway, which can produce too much oxalates. So there might be, like, different nuances for. For, you know, chronic health warriors, where that might not be appropriate for you, but I feel like for the most, the average person with ibs, I do encourage that as part of their healing routine of healing modalities, to utilize that. And if you have trouble with these, I would look into B6 deficiency, because that helps us tolerate. I didn't say glutamate, but sometimes people can have glutamate reactions when they get more anxious. From these things. So adding B6 can help counter that. But also look into like, okay, if you're doing the bone broth, if you're doing the collagen, but your gut's still not healthy. Like there's probably something else going on there. Like it could be candida, it could be mold, it could be parasites, it could be a nutrient deficiency beyond just glutamine or glycine.

B (53:54)

Right, okay. Nope, that all makes sense. Absolutely. That makes sense. We talked about betaine with pepsin, digestive enzymes. What about food elimination? A lot of people jump to that at the first sign of any GI distress.

A (54:08)

I think this is a really great place to start. So going off of gluten and dairy, these are the two most reactive foods. And both Hashimoto's and ibs. With ibs, there's additional considerations. A lot of times I see people actually reactive to lettuce, like leafy greens and blueberries and raw food foods. And I feel like, you know, my concern with elimination diets, a lot of times they villainize foods. Like this food is bad, you should never eat it. That's not my goal. It's my goal is to figure out like why is your gut not happy with these foods? And to try to give you back most foods. And so that points to if you're having issues with raw vegetables and fiber, there's probably a dysbiosis in your gut. So how do you resolve that? And then the one thing that I would hang my hat on is going to be food additives and processed foods. If you can go on a low processed food diet or an additive free diet, that's going to do you so many favors for your gut health. I'm a big keto proponent and I feel, I personally feel best when I'm eating a keto diet. But when I have gotten like those keto snacks with erythriol and my husband started eating them, he ended up with inflammatory bowel disease. That was a big trigger for him. And we do know a lot of those, you know, well meaning artificial sweeteners, non caloric sweeteners. They can really devastate our gut lining.

B (55:33)

Yeah, yeah, no doubt that that happened to me too, was just woo, horrible, horrible. So we are obviously going to put all the links in the show notes for people to get your book. And I'm so excited. I believe every single person listening to this show needs it because of that strong tie in that we discussed already with autoimmune and Hashimoto's. But I want to leave with one last question, just to give people some hope. What do you want IBS patients to know? If you leave them with one thing, what do you want to leave them with?

A (56:04)

I want to leave them with the fact that they deserve to feel better. And then I feel like my book can help like 98% of people figure out what's causing their IBS and get the proper treatment so they can have optimal gut function and potentially get rid of a lot of other conditions. There was a meme going around a few years ago that said I had 99 problems, but healing my gut solved 97 of them. And that's my hope for people who pick up the book, that they'll finally have a road map to figuring out how to heal themselves.

B (56:38)

Amazing. So her book is IBS Finding and Treating the Root Cause of Irritable Bowel syndrome, released today, March 17. So can you tell everyone where they can purchase it?

A (56:52)

Sure. So it's available on Amazon and Barnes and Noble and everywhere that fine books are sold. And if people go to thyroidpharmacist.com IBS they can still get some of my pre order bonuses as well.

B (57:03)

Those pre order bonuses are sweet, so I'm going to encourage people to use that website so you can get in on the fun. So Isabella, thank you so much for writing this. We need it, we need it. And thank you for coming on to talk about it and sharing it with my audience as well. I love having you as a guest.

A (57:20)

Thank you so much for having me, Amy. And thank you so much for all the work that you do to empower thyroid patients. I so appreciate you and your work.

B (57:28)

Amazing. Amazing. So please share this episode because I guarantee you, you know somebody with gut dysfunction whether you know they have IBS or not. You know that they have bloat and you know that they complain of acid reflux and all the gut belly issue. So share this episode with them so that they can get some help too. So until next time, thank you so much for listening. The information shared on the Thyroid Fixer podcast is intended solely for informational and educational purposes. It is not a substitute for professional medical advice, diagnosis or treatment. Always consult with your physician or other qualified healthc care provider with any questions you may have regarding a medical condition, treatment or before making changes to your healthcare regimen, including medications, supplements or other therapies. Use of the information provided in this podcast does not establish a doctor, patient or client provider relationship between you and the host or between you and any other healthcare professionals featured on the show. Any medical opinions or statements made by guests are their own and do not necessarily reflect those of the host or affiliated parties. Statements regarding dietary supplements or health related products mentioned in this podcast have not been evaluated by the fda. These products are not intended to diagnose, treat, cure, or prevent any disease. Some episodes of the Thyroid Fixer Podcast may include sponsorships or affiliate links. The host may receive compensation for discussing or promoting certain products or services. Any such sponsorships or affiliations will be clearly disclosed during the episode. All opinions expressed are those of the host or guests and do not not necessarily reflect the views of any sponsors. The inclusion of a product or service does not imply endorsement by any healthcare professional featured on this podcast.