Is Your Bloating A Sign Of A More Serious Condition?

Coming up on this episode of the Doctor's Pharmacy.

Bloating just means that your belly is getting bigger. There's so many reasons behind the causes of bloating.

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Week'S episode of the Doctor's Pharmacy. Hi, this is Lauren Fein, one of the producers of the Doctor's Pharmacy podcast. Bloating is so common and can be incredibly uncomfortable. Often it can increase throughout the day and leave us feeling less than optimal by the time we go to bed. While bloating may be a sign of an imbalance in our gut bacteria and is often associated with irritable bowel syndrome, It can also be a symptom of a more serious condition. In today's episode, we feature three conversations from the Doctor's Pharmacy on the importance of treating bloating. Dr. Hyman speaks with Dr. Elizabeth Boham on what bloating is and why it happens, with Dr. Todd LePine on how gut problems can lead to autoimmune conditions such as rosacea, and with Dr. George Papam: on how bloating can be a.

Symptom of gallbladder disease. Let's jump in. It's estimated that 20 to 30% of the population is dealing with bloating on a regular basis. People with irritable bowel syndrome, it's 96%. So people who are struggling with digestive issues or irritable bowel, as we've talked about before, that is something that we really work to define greater than just putting that into a waste paper basket, right? It's even higher. It's at 96%. So bloating just means that your belly is getting bigger, right? You have this increase in abdominal girth. And it typically, when we're talking about abdominal distension from gas or bloating, what we're going to talk about today, it increases after you eat. So people will feel more bloated after they eat, or they may feel more abdominal fullness or sensation of gas as the day goes on.

And.

There'S so many reasons behind the causes of bloating. And I think that's really what we want to focus on today, you know, is what we really work to get to that underlying root cause in functional medicine, right? What is that underlying cause for that person? Because there's so many different reasons for bloating. And I think that's really critical to focus on and not just saying, okay, well, take gas X or just take something to suppress the bloating. We really want to figure out why is it going on because that really then can help work on that person's of symptoms that are causing them a lot of discomfort.

And I think, you know, when I was in medical school, we didn't really ever learn about what we call SIBO or SIFO. We didn't learn about that. Did you learn about that?

No, not at all.

It was kind of a new insight about irritable bowel, which is that it's really about the often, not always, and we're gonna go through the causes, but it's often about the overgrowth of bacteria or fungus yeast in the small bowel. Now, you've got like 22 feet of, you know, small intestine, about 10, 12 feet of large intestine. The small intestine is generally sterile, but sometimes the poop from the large intestine kind of migrates up and we'll talk about the reasons for that and leads to the SIBO. So some conventional doctors now are treating people with antibiotics, right? What kind of things are you seeing them do?

Right, so you're talking about SIBO. So, you know, We're checking one of the major causes of bloating is SIBO or small intestinal bacterial overgrowth. And as you mentioned, there's a lot of other reasons that people get bloating, but one reason could be because there's the wrong bacteria that have migrated up into the small intestine as you have mentioned. And when that happens, that dysbiotic or not good bacteria, the bacteria that shouldn't be there, consumes some foods and then produces gas. so it's consuming foods that.

Get fermented.

Get fermented and then you produce a bunch of gas from it. And so the combination of certain foods and not always bad foods, but certain foods that cause this gas when there's the wrong bacteria in the wrong place can cause a lot of bloating. And so, you know, SIBO is something we check for all the time. You know, you can check for it with a breath test. Conventional doctors are checking for it as well. We check for it all the time. now the time. Yep, now they are. And there's a few ways you can work on treating that, and we'll delve into that more. But one is getting rid of the bacteria that's in the wrong place, and you can do that with medication like antibiotics, like you mentioned. You can do that with herbal substances that lower the bacteria in the wrong place. And you can also change the diet for a period of time that takes away the food that's feeding this wrong bacteria that's allowing it to overgrow.

That'S good. So, so, so the conventional doctors are sort of getting the point a lot about SIBO and they're using antibiotics and then they'll use, you know, different diets to restrict the fermentation of the foods. But they really don't have a comprehensive 360 approach from my perspective. They don't deal with the overall ecosystem of the gut. They don't look at all the other food sensitivities. They don't look at how to repair and rebuild the gut after the problem is taken care with antibiotics. And they, these often people, and they don't often treat yeast or SIFO, which is often coexisting with the SIBO, and then they end up you know, having recurrent bloating. So that maybe get better for a few weeks or a month and then it comes back. So functional medicine has a very different perspective. And, you know, we understand the problem, but then we also understand how to navigate like medical detectives to the cause. And, you know, what I think is challenging with SIBO is it's just such a persistent and uncomfortable thing and there's not a lot of insight about what really happens. So I would love it if you sort of take us through, you know, what are all the types of reasons people can start to develop SIBO and all this and develop this fermentation process. Because by the way, the thing that struck me was such a big insight was humans don't make gas. It's the bacteria eating the food that you eat that make the gas. So, if you have gas or bloating and you have distension and air in there, it's not you making it, it's the bugs and it's an imbalance in your relationship with your bugs. So, you got to get in harmony with your bugs basically. so take us through, Liz, what are the common reasons why we get this bloating and dysbiosis and imbalances in the bacteria?

I mean, one of the biggest reasons that we see that, that people get imbalances or dysbiosis, imbalances in their gut bacteria, are antibiotics. I mean, when we over-prescribe antibiotics or people have been on large courses of antibiotics for certain reasons, you know, chronic infections or they just, they got on too many antibiotics when they were younger. What happens is it can result in this imbalance in the good and bad bacteria in our system. It can get rid of some of the good bacteria and fungus, yeasts and things that keep that ecosystem in better balance. So, too many antibiotics in our food supply. We know that things like that stress has a huge impact because stress in our life impacts our motility and how well things move through our system. So, you know, we know that people get bloating, you know, not just, this isn't just SIBO, but bloating because of, sometimes if they're eating too quickly, you know, they're not digesting their food properly, so they are swallowing air or eating too fast.

Probably that's what I do. I eat too fast. I may explain some of my issues.

Yeah, moving on, right. And then there's things like lactose intolerance, which is lactose intolerance is so common. That's the decrease in that lactase enzyme that's in our intestines that breaks down lactose. And when we don't have enough of that lactase enzyme, then we can't digest our lactose very well, which is in dairy. so we've done a lot of different podcasts on dairy and all of the issues, but what we know is that for everybody, by the time they reach 100, they become lactose intolerant. So everybody in the whole world is that way. And some people become lactose intolerant at.

Age- so no cheese after 100?

Some people become lactose intolerant at age two. Some people at age 50. I don't know.

I was just in Sardinia and I saw these little 100-year-old people eating a lot of goat cheese and sheep cheese and we're doing good.

Well, you know, and what do we know about when we say lactose intolerant? It's important to recognize it's a spectrum, right? So that there is, you know, when you're, you know, what does it mean to be lactose intolerant? It means you're not as tolerant to digesting as much of the lactose. And that's what gets people so confused all the time about foods and food sensitivities. They're like, well, I ate that yesterday and I was fine, but then today, I'm really struggling and it's really because of the volume, right? You can, you know, many times you can get away with a certain amount of lactose, right? And then other times if it's, if it's a, you have two servings or whatever, then it pushes your body over the edge because you don't have enough of that enzyme to digest it. So it's, you know, it's a spectrum and, and, and that's what we see all of the time. You know, it's also important to recognize there's other things that can cause bloating, things like Constipation can cause bloating. We know not having good motility, you know, maybe because of autoimmune processes or just a gastroparesis, like not good motility, right? Exactly. If your bloating is all the time or if it's not getting better, you really want to get evaluated because there are some cancers that can cause bloating and GYN issues, gynecological cancers, so there's more things that can cause bloating. It's important that we pay attention to all of those when we're getting a really good history and timeline from our patients.

I agree. I mean, I think there's certain things, we see commonly like the bacterial overgrowth, it's often because of people taking antibiotics or other drugs. In fact, one of the things that people really don't realize is that the acid blocking drugs, which are the third leading class of drugs sold in America, okay? prilosec, protonix, Nexium, mass effects, all those drugs. They're given all that candy, and they cause bacterial overgrowth, and they cause fungal overgrowth because they change the pH, they change the environment. And so while you may not have heartburn, you end up getting irritable bowel. That's one of the side effects of these drugs. So I think it's important for people taking those to, to realize they're not lifelong drugs. There's ways to fix the underlying problem. And the other thing you know, that I found often is these sugar alcohols that are now in all these healthy products that are highly fermentable, non-digestible sugar alcohols like erythritol, xylitol, sorbitol, maltitol, and they are in a lot of these foods. And some people do fine with them, some people don't. But I know if I have a way back when, I think it was like 20 years ago when this stuff was just coming out, someone gave me this like sugar-free chocolate bar, which is full of maltitol. and I ate the thing at Kenyon Ranch, and I literally couldn't see patients the whole afternoon because my stomach just was going crazy.

And you were doubled over in pain, right?

Oh, my God. And then, you know, I think you've got other things that I found clinically. You know, I wonder. You found this, too, is. I don't know how much document this is, but certainly it's like. Like tick infections, like the Bc and others can cause motility issues in the gut or heavy metals. So I often, you know, if we don't get better. initially, I started to look for other factors. So I think, so these are really common problems. And, you know, 10% of all like loss of productivity in corporate healthcare is from irritable bowel. So it's a huge economic burden on society. And it's the number one reason for visits to the doctor for anything.

I mean, it's so important about the additives in foods. And sometimes people, you know, that's something you really have to delve in deep with people on. and look about, okay, what bars are you eating? What even certain shakes that have, like you said, some of the sugar alcohols in them, chewing gum. People always forget about chewing gum and how much that can cause bloating because of some of the sugar alcohols in them. And so you've got to pull those away just to help people feel better.

Absolutely. And I think you know, it's a bit of a detective job, and a lot of processed foods has emulsifiers and thickeners that tend to cause leaky gut and other issues. So there's just so much opportunity by focusing on a very detailed history to figure out what are the culprits. And if you're not eating anything that's real food, if you're anything that's not real food, you know, it could be a thing like fructose is a big factor. A lot of high fructose corn syrup and stuff. And people have fructose intolerance. So there's a lot of issues that we can really deal with. So take us now. Those are the causes, and those are the things we tend to think about and test for. We test for gluten, we test for food sensitivities, we test for a lot of things. what would be an approach that we would take typically to deal with these people with the food baby bloating thing? Let's just say it's kind of the typical kind of cancer, Lyme disease, right?

Right, right. I mean, exactly, right. So you mentioned about the Lyme disease. That's really, I think, important when people are not getting better, when they're being treated so many times and they're not getting better. But so, yes, so we often will test for dysbiosis. So we're testing for SIBO. We also do stool testing that is fascinating, just some of the revelations we're having and improvements in stool testing, we can look at levels of good and bad bacteria and balances in good and bad bacteria and work to shift those as well, which can be really helpful. One of the first things we always start with, of course, is dietary changes. So, you know, we'll either put somebody, depending on their history, their story, and where they are and their level of motivation, we either put them on a dairy-free diet or we put them on a gluten dairy-free diet or we might put them on low FODMAPs diet. So FODMAPs, you know, people have, maybe people have heard about FODMAPs and so it's important for us to just sort of delve into that a little bit.

But FODMAPs, yeah, what does that mean? What does that mean?

Yeah, so FODMAPs foods are fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. And so these are these carbohydrates that are not completely absorbed for some reason, either because of some mal digestion or just because they're harder to absorb carbohydrates. And then they get, when there's the wrong bacteria in the wrong place, they consume those carbohydrates and produce gas.

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And now let's get back to this week's episode of the Doctor's Pharmacy. You know, so the oligosaccharides, those are things like wheat and rye and onions and garlic and legumes. Disaccharides are things like lactose and dairy. Monosaccharides are things like fructose, like high fructose corn syrup, like you mentioned, honey and apples. The polyols, those are things like sorbitol and mannitol, the artificial sweeteners, and some fruits, contain some of these polyols. And so one of the first things we do is say, okay, maybe we should try a low FODMAPs diet for a period of time. So there are some foods on this list that are good, healthy foods that you don't want to stay off of forever. So it's usually with a low FODMAPs diet, it's for a period of time that you're taking people off of these these carbohydrates that are fermentable and then over time working to reintroduce the healthy ones for that person. The Monash University has a really good website, lots of good resources on FODMAPs foods. But in general, you pull away things like wheat and rye and onions and leeks and cauliflower and apples and dried fruits. and sugars and high fructose corn syrups and legumes. And you do that for a period of time. Not everybody needs to go to that level.

And.

For many people, it's important that they work with somebody who's, you know, a nutritionist or somebody who can help them navigate the world with this because it can be, you know, like I was mentioning earlier, you got to figure out what you're able to eat.

So what's been, let's talk about some of the other sort of approaches besides the dietary restrictions that we would take, you know, we might get off gluten, get off grains, get off beans, get off sugars, get off all the things that you mentioned. Then, you know, what do you do for the bad bugs? How do you reset the gut? How do you sort of rebuild the gut?

Oh, great question. So, you know, depending on what's going on in terms of the dysbiosis, right? Dysbiosis just means imbalance in good and bad bacteria. and yeasts. And depending on what we find is going on, we will treat that. And so we can treat that with a prescription medication. So sometimes we'll use an antibiotic. I know that sounds kind of crazy because you're like, we're counterintuitive, right? Yeah, we're like, wait, we know antibiotics cause dysbiosis. True. But sometimes if people, depending on their level of symptoms, they do, you know, we can improve symptoms with a short course of a non-absorbed antibiotic. So sometimes we'll use an antibiotic for a period of time and then then we'll use an antifungal medication.

And then there are antibiotics. Because you always follow the antibiotic with antifungal?

Yeah, I mean, I often do. And again, it depends on what I find with the testing we do through stool testing and breath testing and their clinical situation. So, I often will follow with an antifungal or I'll follow with an herbal medication that includes that there are many different herbs that we have, they have effect at both treating bacteria and yeasts. So we can use some herbal regimens. There's a lot of good ones out there that will treat both bacteria and yeast overgrowth. And that's one of the nice things about herbal regimens I find is that with, when you're resetting the bacteria in the gut and the yeast in the gut is, you know, they, they may be a little slower to act, but they sometimes are, are really effective long term. So there's a few herbal regimens that we use very often and some have been really well studied. We also do things that help the body with digesting your food. So whether that's something that increases acid in the stomach like betaine HCL or a digestive enzyme, there's digestive enzymes that are plant-based digestive enzymes and then there are other digestive enzymes that are, you know, they come from their porcine, their glandular digestive enzymes. Those things help with breaking down.

Your.

Food, your protein, your carbohydrates. They help with breaking them down so that they're easier to absorb into the body and less likely to feed the dysbiotic bacteria that we were talking about. That's great. You know, that's also really helpful.

So I think the unique thing about functional medicine is that you, you not only just sort of get rid of the bugs, but you focus on resetting the whole gut and, you know, whether it's an antibiotic, antifungal and herbs, and I would love you to talk about what herbs or then you add in enzymes and other pre and probiotics and repair components for the gut. It's what really helps people get better.

Right.

So tell us about, tell us about the cases you had a 35 year old guy. quite a remarkable story.

Yeah, so, you know, there's this gentleman, he was 35 and he came in to see us and he was really frustrated with his bloating. And, you know, what he said is that, you know, he felt fine in the morning and then as the day went on, he became more and more distended. He became more bloated in his belly and distended. And so it's really important, as I said, that we get really detailed clues as to his history. And, you know, you know, what really helps many times is when people take that really detailed history, you know, and they think about their own timeline. When did this start? You know, how long has it been going on? You know, trying to help get the clues as to what triggered this to occur for them, right? And, you know, so we knew that as a child he had ear infections, so he was on multiple rounds of antibiotics. But then two years ago he developed a pneumonia. and he ended up the first round of antibiotics wasn't helpful getting rid of his pneumonia and he needed a second round of antibiotics. And so we can also need to delve into this, you know, this risk for pneumonia here and everything, but it was that, you know, those recurrent rounds of antibiotics at that point, since that point, he's been struggling with bloating. So, you know, he's been really.

At.

That point he started saying, okay, now every time I was eating, I was getting more bloated. And prior to that, he could eat whatever he wanted. He really didn't have to be careful with his diet at all. Now, if he noticed if he ate too much dairy, he would get bloating and diarrhea. We did do a SIBO test and it was negative. But while we were waiting for his stool test to come back, we we just decided, okay, let's pull away gluten and dairy. He wasn't really ready to go on a full low FODMAPs diet, and I didn't even know if it was really necessary for him right away, so we said, okay, let's pull away gluten and dairy. And when we did, he had significant improvement in his symptoms, but not complete improvement. He still would, he felt better, but he still was getting some bloating depending on what he ate. And so the stool test came back, and it was really interesting. showed a dysbiosis, right? It showed an overgrowth of many different bacterias and some yeasts. And so we then treated him with an herbal regimen. So we used something that had a combination of different herbs, oregano, berberine. It was a combination product and he took it for six weeks and he found that extremely helpful. We did add in probiotics. We did wait to add in probiotics till we were done with his herbal regimen. But once we did add in like a general probiotic and there's so much to discuss with probiotics, but he found that to be really helpful and.

Now.

He'S back to, I mean, he really is careful with dairy and has a really good healthy diet, but he's really much more comfortable all the time now.

Well, let's talk about that. I mean, the probiotics, you know, can be problematic. If, you know, a lot of people with irritable bowel, they go, oh, I'm going to take probiotics. They go to the drugstore, they go.

To the health food store, and they.

Get the probiotics, and they take them, and often they get worse. Yes. So, you know, can you explain that.

There'S an important order to doing things and that what would be beneficial at one point might be harmful at another point? I think that's absolutely true. You know, order is really important. And, you know, if, if somebody does have an overgrowth of, of bacteria in the wrong place, sometimes Probiotics make that worse, you know, and you can get, if you take a probiotic and feel more bloated or your digestion doesn't feel, it feels worse, not better, then that's the wrong probiotic or the, or, or could be the right probiotic, but at the wrong time. So it's really important that, that you're either working with somebody who knows what to, how to recommend what order things to do it in, or just knowing that if it doesn't feel right to you, put it on hold. There's lots of different brands of probiotics out there and quality of probiotics out there. Some probiotics have dairy in them and so for people who are dairy sensitive, they don't work and other ones don't. There are also some strains of probiotics that can in of themselves, depending on the milieu, increase the amount of bloating for certain people. So there are, it's hard to give a general recommendation. Like, it's hard for me to say, well, take this one because it doesn't work for everyone. But just know that if you try one and it makes you feel worse, put it aside. And it may be that it's just not the right one for you or it's one to try at a later date. After you've gotten rid of the dysbiotic bacteria. Some people get a probiotic and they feel better right away and then that's great. Wow. Yeah, it's complicated.

So if you're struggling with this, don't lose heart. There's a lot of things. I mean, you didn't mention histamine intolerance. There's a lot of things that cause problems, which we've covered a lot on the podcast. But the key is that if you suffer from bloating, if you have this food baby, if you're really miserable and uncomfortable, all that, there is a way to kind of get through it and fix it. In functional medicine, we take a very different view, which is we treat things from the inside out, not the outside in. Dermatology is all about lotions, potions, and creams and slathering stuff on your face to sort of get it good from the outside in, but it's kind of backwards. So, what are the traditional treatments for rosacea? Why are they not the best idea?

You know, when I went through my medical training, there was an old saying that the dermatologist basically if it's dry, wet it. If it's wet, moisturize it. And if you don't know what's going on, give it a steroid.

That's essentially that's pretty much dermatology.

I learned the same lesson. Yeah, right. That's it.

And, you know, dermatology and dry it. If it's wet, dry it.

If it's dry, wet it. And if you don't know, give it a steroid. Exactly. That's the mantra of the modern dermatologist. But again, it's like you said, it's an external manifestation of something going on internally. so the question is what's driving this? And in preparing for this talk, I mean, I've seen so many patients with rosacea, it's not funny.

What do they put on there? They give antibiotics on the face.

Oh yeah, yeah, they'll give like, you know, metronidazole cream, which is a topical antibiotic.

It's like an anti-parasite antibiotic.

Yeah, one of the newer medications, and this is sort of an interesting thing, is a cream called ivermectin. so this sort of blew me away because this is relatively new and I think we were talking about it right?

It's a worm pill.

It's a parasite pill.

They're using it for COVID even.

Really?

Yeah.

Yeah. So it's really, it was, so I was reading and I actually had a patient who came in and was on the ivermectin cream and was doing very, very well on the ivermectin cream. And then I said to myself, well, how is an anti-parasitic medication topically helping with worms in your face.

Yeah.

Well, it's also, that's also interesting because one of the things that is strongly tied in with rosacea, now remember rosacea is just over the face. It's this facial manifestation of an internal issue is that we have these little creepy crawlers on our face and they're called mites, skin mites.

Yeah.

Dermadex.

Dust mites.

We all have them. Everybody has these. And the interesting thing is that patients who have rosacea have a much, much higher density of skin mites on them for whatever reason. And normally they basically, they're like little, you call them like little parasites, they're ectoparasites, and they sit on the skin and they eat your dead tissues and they eat off of the oils on the glands. And normally you don't have a reaction to them. They're sort of like a benign parasite. but in some people who have high concentrations of these skin mites, the body makes a very, very high immune response to it. So, getting back to the ivermectin, which is basically an antiparasitic, it may be actually working as an antiparasitic for some of these skin mites.

Yeah, so maybe there's an infectious cause to this.

Yeah, so the things they use are.

Minocycline, which is an antibiotic, flagyl or metronidazole, which is an any parasite in an antibiotic, Ivermectin, which is an anti-worm.

Oral doxycycline is another one.

Yeah, oral antibiotics, which probably is a really bad idea given the fact that you have a microbiome and you don't want to be killing it to fix your skin. Exactly, exactly, yeah. And why might that minocycline work?

Why might antibiotics orally work? Well, there's a thought and it's actually in the literature is that small intestinal bacterial overgrowth is also one of the triggers for rosacea. A lot of patients that you see with rosacea will have irritable bowel type symptoms or bloating type symptoms. And when you do some testing for that and you treat it, that oftentimes will clear up their rosacea.

Yeah, absolutely. So I think, you know, we're not averse to using topicals and topical medication when necessary, but if you really focus on root causes, which is what functional medicine does, you come up with a very different set of approaches that actually works better is longer lasting and doesn't require you to keep putting on lotions, potions, and creams. for the rest of your life or taking oral antibiotics.

Right, exactly. And then, getting back to the ivermectin. Ivermectin, in preparing for this talk, I did a little bit of research and the patients who are more prone towards rosacea have a problem with too much of what's called the cathelicidin antimicrobial peptides. So these are- Are these a big mouthful? Yeah, they're called CAMPS, C-A-M-P-S, cathelicidin antimicrobial peptides. these peptides are part of the built-in innate part of the immune system to protect our skin against various types of infections. And it turns out that ivermectin actually helps with these antimicrobial peptides because people who have rosacea have too much of these peptides. They have an over robust response to antimicrobials. So it's thought that the, it's actually a breakdown product, it's called LL-37. and ivermectin actually works on dampening down these antimicrobial peptides to decrease inflammation in the skin.

Okay, so in terms of the cause, it seems to be a combination of internal and external factors, right? Something on the skin and then something internally, but from traditional medicine, there really isn't an approach to helping heal the skin from the inside out.

No, not at all.

And whether you have acne or eczema or psoriasis, or rosacea or any one of the myriad skin conditions that we get, most of them have their root cause inside, not on the topical level.

Exactly.

And often it's the gut.

Yeah, absolutely.

So you mentioned a little bit earlier a leaky gut. So take us through from a functional medicine perspective our thinking about the root causes. What are the things that you think about when someone comes to your office and their face is all all red and they got all this acne on there and they've got these telangiectasia, these little red lines everywhere and you can see the blood vessels dilated and they're kind of looking like Santa Claus.

Yeah, exactly. And they also get photosensitivity too, which is the other thing. And the interesting thing is they can't.

Go in the sun without getting it worse.

And that also ties in with these antimicrobial peptides because it's thought, it's theorized that the Kelts, the ones who live in the higher northern latitudes, they don't get as much sun as we do. So it's thought that from an evolutionary standpoint that they benefit by having this. They have a more robust immune system when there's not enough sunshine. And sunshine will actually activate this innate immune system. And that's why sun exposure oftentimes makes it worse because they produce more of these antimicrobial peptides. And then those antimicrobial peptides have to get processed. And in the process of breaking them apart, the immune system then starts responding to it. so that's why there's a sort of a photosensitivity aspect to it.

And what are the other sort of things you think about when someone comes.

To your office with rosacea? Well, one of the things I oftentimes look at is their vitamin D levels. Vitamin D is part of the immune system and it's tied in with intimately with the antimicrobial peptides system in the body. So oftentimes patients who have this have low vitamin D levels. We'll look at the microbiome testing to see if there's any evidence of dysbiosis, bacterial overgrowth testing, the SIBO testing, checking for hydrogen and methane. I mean, probably the majority of patients who I see of rosacea have problems with bacterial overgrowth. Other thing is low stomach acid, which also promotes and contributes to bacterial overgrowth. So checking for the patients, sometimes these patients are also on PPIs.

Acid blocking.

Acid blocking medications. Absolutely.

Yeah.

Because we have acid in our stomach to help us to digest food. It's also there. to decrease the amount of bacteria higher up in the colon. So it's good to have stomach acid.

Yeah. It says if you don't have stomach acid, then the pH of your small intestine changes, becomes more alkaline, and then bugs grow in there that wouldn't necessarily grow. Yeah. And that's when you get this overgrowth of bad bugs in there. And it can be what we call SIBO, which is small intestinal bacterial overgrowth, where bad bugs migrate up from the lower intestine into the small intestine. Then when eat foods, you get bloating, distension, it causes leaky gut, you end up causing damage to the lining of the gut and food particles and bacterial toxins leak in and create inflammation throughout the body and on the skin. So, you know, leaky gut can cause hundreds of different manifestations, one of which is rosacea. And unless you think about that and know how to treat it, you may not be able to be successful with it. There's also another condition that I've seen, Todd, in a lot of my patients, called SIFO. CIFO, which is small intestinal fungal overgrowth. And a lot of people talk about it as Candida, but there's many, many species of yeast and fungus. And so what I found often is that treating the gut through addressing the bacterial overgrowth, the yeast overgrowth, healing leaky gut, dealing with the food sensitivities makes a profound impact. And a lot of times it is food sensitivities that can trigger. I mean, for example, gluten we've talked about on the show, that is one of the biggest drivers of leaky gut. And even if you are not celiac, and even if you don't think you have any symptoms or don't notice any symptoms when you eat gluten, Dr. Alessio Fasano, who's the world's expert at Harvard on gluten, he said, Everybody who eats gluten creates some level of leaky gut. Now, most people will kind of handle it.

Right, transient leaky gut.

Exactly. So, I don't know. it's probably not a good idea to eat that much gluten because of the potential to create leaky gut and how that is linked to so many chronic diseases, including weight gain, diabetes, cancer, heart disease, Alzheimer's, autoimmune diseases, allergies, acne. I mean, you just name it. Depression, all this stuff is connected by, by leaky gut. So I really, I think, you know, getting a very different thinking about this is key. And you, you did. You talked about the stomach acid, you about the acid blockers. You talked about maybe other things that are relevant in the gut and fix certain infections like H. Pylori, which is a common bacteria that causes ulcers, also has been linked to H. Pylori and food sensitivities. So how do we approach these patients when they come in? What are the kinds of things that we would do from a diagnostic point of view that you wouldn't get when you went to the dermatologist?

Well, from a diagnostic standpoint, again, I would do testing for leaky gut that would do intestinal permeability testing, checking for antibodies to zonulin with the Cyrex testing that we do, Cyrex array number three.

So that's basically, there's a test that we do at the Center for, at the Ultra Wellness Center here in Lenox, Massachusetts, where we're recording live, is Cyrex testing. It's a lab that looks at antibodies that you produce against these proteins that are in your gut that come from gluten, or even from bacteria. And so if you're creating a lot of antibodies to these proteins, it's clear that they're getting across the lining of your gut, leaking into your bloodstream and causing an immune response, which is not only local but systemic.

Right, and there are other ways you can actually measure zonulin in the blood and you can measure it also in the stool. And that's only a snapshot in time. So you can develop leaky gut for a couple hours or a day or so, but if it stops, then you're also fine. the antibodies against zonulin is the one that tells you there's this chronic leaky gut, which is really more valuable. Because if I gave you a shot of tequila, then an hour later measure.

Your zonulin, it's going to go up.

Okay, where's the tequila? Sounds good.

Right.

So that's why I think that the testing for the antibodies against zonulin is even more valuable in these patients with chronic conditions.

And one of the kinds of tests besides the zonulin and the lipopolysaccharide tests that we do to look at get the antibodies against these proteins in the.

Gut that come from a leaky gut. We'll do the small intestinal bacterial overgrowth where we measure the production of fermentation products. So hydrogen and methane are gases that are normally produced in the body. When people have small intestinal bacterial overgrowth, those will be produced at higher levels. So we can check that. And over time, or I think the test that we do is a three hour test. So you measure baseline hydrogen methane, check it at intervals of about every half hour. and you do that over a three hour time period, that can tell you definitively do you or do you not have bacterial overgrowth and how bad is it? And it's a predominantly hydrogen or is it methane?

So essentially what you're saying is that when we eat foods, humans don't produce gas. It's the bacteria that are fermenting the foods we eat that produce the gas. So if you feel bloated or distended or you're passing gas, it's not you. You can blame it on the bugs. But the problem is that we don't know how to regulate the bugs bugs and get a healthier ecosystem. And that is what most physicians never were trained to do. And it's the foundation of functional medicine. It's the foundation of our practice here at the UltraWellness Center where we really dig into these issues and we look at bacterial overgrowth, we look at fungal overgrowth, we look at leaky gut, we look at food sensitivities, we'll do other testing, we'll look at whether you're reacting.

To gluten or dairy or eggs or other foods. And it's really helpful in drilling down on what's really going on with people. Absolutely, and we're talking basically producing gases, that's basically a fermentation process. and normally fermentation happens lower in the colon. That's in the colonic area. It was more of an anaerobic environment or a lack of oxygen. That's normal for that to be happening. But when that process is taking place higher up in a different neighborhood, it's not a good thing. Yeah.

And, I mean, you want your upper intestine to be sterile and... Or mostly sterile. Mostly sterile. And when all that bacteria migrates up there, it's just it's a bad situation. And when we take acid blockers, when we, you know, are low in magnesium, which half us are, when we're under stress and our gut motility is slow, when we, you know, take in lots of antibiotics and it screws up our whole system in there, you know, all these are reasons why we get these bacterial overgrowth issues. And they're super common and, and they're easy, relatively easy to treat with functional medicine. Now, the other thing we do is look at stool testing, right? So we look at not just the, the proteins from leaky gut, or we look at the food sensitivities or Bacteriolar growth, gas production, but we actually look at the poop.

Yeah.

So what are we, what are we looking for in the poop that helps.

Us figure out what's going on? Well, there's a lot of things, you know, there's gold in there.

There really is.

It's, it's golden. Golden them there Hills. Golden them there Hills. Yeah. So a lot of information can be determined by doing a microbial analysis. So you can look at the overall balance of bacteria. So there are, you know, everybody's got hundreds of different kinds of bacteria in the GI tract. And we can measure those using DNA PCR analysis and do we can do quantitative. We can measure how many there are of each different species. Look at ones that are normally found, look at ones that are found in the gut, but normally they want to be at low levels. Look at bacteria that are associated with autoimmunity. So things like Citrobacter, Klebsiella, Salmonella. Yeah. et cetera. We can look at now analyze for yeast overgrowth, various forms of yeast, and then also microbial markers of inflammation, things like calprotectin, looking for fat. So, you can get a lot of enzyme function, butyrate, checking for butyrate, short-chain.

Fatty acids, indicators of healthy ecosystem. So, you know, Todd, what you're saying is that, you know, traditional sort of microbiome testing, they just look at the the genetic material of the microbiome. And they can't really test everything, although they can do some really extraordinary tests now. But there are kits out there where you can look at your microbiome, but it's far more than just what bugs you have in there. It's what they're doing. So we look at the result, the function on the ecosystem. We look, like you said, at the enzyme function, absorbing your food, is there inflammation? Are you having good bugs in there that are producing the super fuel for the gut, these short chain fatty acids that are so important? you have the right balance of God, are you missing some key bugs? You have overgrowth of bad bugs, you have yeast, you have parasites. And it's such a much more comprehensive.

Stool test that we do here at the Ultra Wellness Center. We were talking earlier about Delta sleep. And the interesting thing is, is that when you have good bugs in the, in the digestive tract and you're eating in a fiber in your diet and.

You'Re producing higher levels of butyrate, that has an effect on the brain and also improves sleep. That's amazing. Yeah.

Yeah.

So you have to have your, get your poop together to sleep better. I got it. Okay. That's a good, good strategy. It's better than taking the Ambien.

Yeah.

All right. So we also look at, you know, other things like Omega-3 fats and, and other fats because a lot of inflammation come from not having the right balance.

Of fats in your body. Yep.

Yeah. And, and I think, you know, so, so when you have a patient come in, what are the, what are the steps you would take initially? to treat a patient with rosacea from.

A functional medicine perspective? Again, taking the history is the big one. I always will ask people, what's your ethnic background? A lot of people say, I'm white. It's like, are you Irish, English, German, Jewish, Russian, whatever? Because rosacea is typically found in light-skinned, fair-skinned people. And from a genetic standpoint, they are the ones who are more likely to have that. It's just an interesting part to have in terms of the history. And then I'll just ask them, what is it you're eating? standard American diet, how much alcohol are you drinking, how much stress do you have, stress also. Caffeine. Caffeine can play a role. Spicy foods can trigger it. Yeah, those are all things which can sort of, you know, it's like adding gasoline to the fire because literally rosacea is the skin on fire in the facial area. But doing the testing for essential fatty acids, making sure that they have the right balance of the essential fats in their diet. A lot of people have too much omega-6, which tends to be more pro-inflammatory. lack of the Omega-3s. One of the oils, I don't know if you've used it, that I found it very helpful with patients who have rosacea is borage oil and even criminal's oil. They tend to be very, they help to dampen down that inflammatory response.

And that's a very key Omega-6 that people don't think about much, but it's called gamma-linolenic acid, which is a very powerful anti-inflammatory. It's not like the Omega-3s, but it's sort of like the Omega-3s, but on the Omega-6 side. Exactly. And it's something we really have a hard time getting in our diet. It's from like borage oil. and, you know, a few other things, but evening primrose oil. So, yeah, that's very powerful. I agree. And I also think that, you know, when I see these patients, I also think about looking for other Clues, like, do they have yeast issues? Have they been in lots of antibiotics? Are they on acid blockers, which caused yeast overgrowth?

Yeah.

Do they have other fungal issues? They have dandruff. Do they have anal itching? Do they have thrush or white coating in their tongue? You know, do they have vaginal yeast infections? Do they have other skin markers of use, like the tinea or other kinds of things. So you'll see often a pattern of other issues around fungal stuff. I'll check for H. Pylori, I'll check again all the tests we did talk about and see what's really going on. And then from the treatment point of view, you start with an elimination diet, with an anti-inflammatory diet, right?

Exactly, yeah. Putting patients on an anti-inflammatory elimination diet, 80% of the time, doesn't matter what they come in with, they'll actually get better. Getting them off of the pro-inflammatory foods, and then putting in foods which are anti-inflammatory, cold water fish, sardines, wild salmon, the essential oils like evening primrose oil help to sort of dampen down that inflammatory response. Yeah, I agree. I think, you know, we don't understand.

Most of us how powerful food is as medicine and how it can drive tremendous amounts of inflammation throughout the body. And, you know, obviously if it's on your skin, it's visible, but there's also invisible inflammation that you're not seeing that's.

Driving all the chronic diseases. And is that you actually triggered a thought because there's actually a paper that says if you have rosacea, you have a higher incidence of Alzheimer's disease. Oh, wow. So it's not just a cosmetic issue, it's actually systemic. You have a red face and a.

Red brain that's on fire.

Exactly. Yeah. I was sort of blown away by that.

That's fascinating.

Yeah. Especially in women. It's actually more common in women.

So you advise people the obvious things, cut out the alcohol, the caffeine, stay away from the sun. stay away from spicy foods. We also tell them stay away from gluten, which triggers leaky gut, often dairy. You actually add in all the anti-inflammatory foods that are important, all the phytochemicals from plant foods and turmeric and ginger and garlic and rosemary and all these powerful foods that can really help to reduce inflammation. And then we often directly treat the issues that are going on. It could be leaky gut. So we give them a gut repair program. This could be fungal or bacterial overgrowth. we'll take care of those with either herbs or antibiotics or antifungals. And you'll see these patients really dramatically improve when they change their diet and they resort their gut. And then sometimes we'll use, like, things like even primrose oil. I found that digestive enzymes and hydrochloric acid.

Absolutely. Often are really helpful, too.

Yeah.

I've been so, I've been surprised at how many people have a, what I would call a relative lack of hydrochloric acid in the stomach. I was adventuring to say that the majority of people don't have too much acid, they have not enough acid in the stomach.

Yeah, well that's interesting because the third leading category of drugs are the acid blockers like Prilosec and Prevacid and Pepcid and all these other drugs, these Nexium, Mass Effects. I mean, they're just out there everywhere and now they're over the counter and anybody- Exactly, yeah. I mean, we've talked about this before on the podcast but when I was in medical school, the drug reps came in because it's drugs that just come out and they're like, listen guys, these guys, these drugs work. They're great. They will help you with ulcers if they're really bad. You don't want to keep anybody on it for more than six weeks.

Right.

That's a huge stomach acid. It's really bad long term. These are the drug reps telling us this. And now it's like people are on it for decades, and it causes B12 deficiency, magnesium deficiency, zinc deficiency, osteoporosis, pneumonia, bacterial overgrowth, irritable bowel syndrome. when you get rid of your heartburn.

But you get all these other problems. Yeah, that's true.

And then it's one of those drugs that's so sneaky because it's addictive. Once you get on it, it's hard to get off it because it causes this rebound. So, when you suppress the stomach acid and you stop the drug, the acid production goes crazy, which makes you feel horrible. And then you go, I need the drug, but you can actually taper it.

Down and use other strategies to help people get off it. And you bring up a really good point because a lot the pharmaceutical medications, especially some of the psychotropic. So the antidepressants are like that too. The PPIs on the antidepressants, when you try to get off of them, you get this rebound process. The body tries to get back into balance and it can be very difficult. So you've got to go low and slow when you're trying to taper off the PPIs or taper off antidepressant psychotropic meds.

This woman came and her concerns were that that she was really feeling fatigued. She had sudden weight gain. She had gone to her PCP. She was told that her thyroid looked fine. The numbers are okay. Not to worry. You still got kids. The same old, you're getting older, you have kids, you're running around, you're busy. She was just living with this fatigue and this weight gain. and then she started having gut issues. She started having bloating and distension, and so she just couldn't take it anymore and she came to visit us. She had, I think, one episode of pain that sounded like it was gallbladder disease, and she had lasted for an evening. It was after having a really fatty meal. and she hadn't gone to the doctor. She sort of suffered through the night. And so that she never really dealt with it. Part of our, after our first visit, I told her, I really want you to go get an ultrasound in your gallbladder. I said, you, have a lot of things going on, but one of the things I need to really find out is if you do have gallbladder disease. It turned out that she did. She has some stones. and she probably did have an episode of a stone that passed and caused her some pain. The complete workup for her involved looking at her hormones, looking at her thyroid, and looking at her microbiome and food sensitivities. When I got her thyroid numbers back, her TSH was 3.9. okay so now you know doctors in a prior you know will look at that and say that's within the normal range because traditionally they've been taught that anything from you know 0.45 to 4.5 it can be considered normal but we've learned more and more that that's not the case when you see a 3.9 you see a 4.2 you start to think I don't think that that thyroid really is an optimal function. Well, I also, when I checked the thyroid, I also checked for antibodies. And when you know her antibodies against her thyroid were sky high, she had Hashimoto's thyroiditis. On her food sensitivity panel, she had gluten sensitivity. She did not have celiac disease, but she had gluten sensitivity, Hashimoto's, hypothyroidism. which then set her up for a couple different things. But certainly it slowed her gallbladder down and set her up for having a stone by the mechanisms I've already explained. And she was estrogen dominant, meaning that relative to progesterone, she had more estrogen than she needed. And she had a history of a cycle that had been irregular, a cycle that she had a lot of breast tenderness, she had a lot of water retention around her periods, she had PMS around her periods. And, that just screams estrogen dominance. And, she's had that most of her life. So, what did I do? Step by step, we just started to deal with the underlying issues. I started to treat her her thyroid, treat her Hashimoto's thyroiditis. I treated her, she had SIBO, by the way. So first thing we did, we stopped the gluten. So she was off of gluten and that's going to, you know, you definitely want to do that because if you have sensitivity to it and you get one autoimmune disease like Hashimoto's, then you're going to set yourself up for more because it's more likely that you'll get another one once you have one. So gluten stopped. and then we addressed her SIBO, SIBO small intestine bacterial overgrowth. We put her on a low FODMAP diet, which helped address that. I used some antimicrobials that were botanicals that addressed that.

And how did she do?

She did great, obviously. It took a while to get her hormones under control and balance those out. It took a little while to to get her SIBO under control. But once we had the SIBO under control, we got her thyroid function down from 4. What would I say? It was 3.9. Got it down to 1.2. Her energy was back. She felt great. And then as we worked with her diet and we cleaned up her SIBO, she was back to normal in a very short course of time within three months.

It's amazing. We really can affect people's course and she really didn't need surgery then.

She did not need surgery. As I said before, and I explained this to her, I said the stones are just enigmatic of the bigger problem. They're the canary in the coal mine of your nutrition not being where it needs to be and you may be having excess toxins in your system and the estrogen dominance. estrogen, you know, needs to be metabolized and it is in the liver and it ends up in the gallbladder. But if it's in too higher concentrations, it can have a very negative impact on gallbladder function. So her dominance, her SIBO, her thyroid, she was just, it was just, she was, you know, it was a matter of time before she had surgery. And if, you know, if she had had that stone and gone to the emergency room, and hadn't passed it, she would have had her gallbladder taken out and nobody would have ever addressed these other issues.

Of course. Gallbladder is such a common problem. It's one of the most common surgeries. It's such a common problem in America. Tell us about gallbladder disease and what is it, who gets it, how many people have it, and what are the symptoms and why is it such a big deal? what do we know about who's getting it and all that? So, kind of let's take us down the whole rabbit hole of gallstones and then we're going to get into how conventional medicine treats it and what functional medicine approach might be that might be worth trying.

Yeah, sure. So, it's almost so common that it's invisible. And, what I mean by that is that people don't really think about it. they don't think about their gallbladder. Why would they think about their gallbladder until it hurts? Gallbladder disease affects 6% to 9% of adult age people between 20 and 70. And of all of those people, they've either had gallbladder disease or had their gallbladder taken out. So it's a pretty large problem. It's a huge healthcare expenditure. It's fairly expensive surgery, so it has a big drain on our system. Gallbladder disease, people really don't know that there's anything going on with the gallbladder until they have the symptoms, which is going to be what we call biliary colic. That's when you've eaten a meal and then within half an hour to an hour, you begin to feel really bad pain in your right upper quadrant. and then where's that? That's going to be below your ribs to the right, and it's going to be really, really painful. And you're not going to like it at all. You're thinking you're having a baby and it's not coming out. It's really painful. And you can end up in the emergency room, and then you're going to be given some medications that will hopefully relieve your pain. And then if it is a gallstone, then hopefully it will pass on its own. And hopefully there will be no complication. And then you'll leave the emergency room, you'll see your primary care, your primary care will confirm that you're feeling better, and then tell you to take that and send you on your way.

Right?

And then we're missing so much. I mean, we've just lost like, okay, It's not just that you had a stone that didn't pass and you had pain. Get to the root cause.

Why did you- what is the root cause?

Yeah, what why did the stone end up there in the first place? Right? And so where does it come down to? It comes down to what we always start almost every conversation you and I have. It starts with diet. It starts with the foods that you eat. Yes, there's genetic predisposition. Yes, you can be a female, you can be overweight, you can be pregnant, you can be 40, you can be a diabetic, you can have other chronic underlying diseases that predispose you to gallbladder disease, particularly gallstones. But when it comes down to it, a lot of it's going to have to do with your diet. Are you eating a high fiber diet? Are you eating a nutritious diet where you're getting all of the nutrients that actually keep your gallbladder healthy? Are you drinking enough water in your day? Because the bile that's in the gallbladder is 95% water and then it's made up of bile acids, bilirubin, fats, amino acids, proteins, enzymes, hormones like estrogen, toxins, your bile plays a very important role in the detoxification process in your body. If you're not getting what you need to make good bile, then you're going to put your gallbladder under pressure. and so if you're not drinking enough water, here's what happens. Where's the gallbladder in first place? It sits right under the liver on the right side. Your liver makes bile, and then that bile goes into the gallbladder where it's stored. And then when you're eating, when fat that you've eaten enters your small intestine, it triggers something called cholecystokinin, which then sends a message or is the messenger to the gallbladder to release the bile. The bile is released and it will then start breaking down your fat so they can get all the nutrients that you need out of your fat. And so that's what happens. That's what the gallbladder does. And you need healthy bile to then do its job to breaking down fats. And so where does the problem become? These stones are actually the compounds that are in the bile in the gallbladder that begin to precipitate out. So they start to connect to each other and form crystals. And then these crystals can get really big. So when those crystals get big enough and they become stones or they become hundreds of thousands of little crystals that sit in your gallbladder and on an ultrasound that will be done would just look like sludge. It would look like sand at the bottom of the hourglass sitting in your gallbladder. That's how you get the gallstone. Interestingly, this is very interesting. What's the other thing we talk about all the time? The immune system. Yeah. The immune system. So, when you start creating these crystals because you're not supporting a healthy gallbladder or you have a disease process that slows the gallbladder so it doesn't empty. It gets filled up with bile. The bile can't get out, and that's going to trigger again the precipitation out of these compounds that are in your bile, and they'll form the crystals. But here's the interesting thing. There's been research that shows that you have an immune response to these crystals. Your immune system actually sees them as foreigners. and sends the xanthophylls, which are white blood cells, to attack the crystals. The xanthophylls get broken down in the acidic environment, and when they become damaged, they begin to form this matrix around the crystal that exponentially increases the precipitation and the formation of the crystals. And then you can get these huge stones that won't pass or get stuck in the duct that leads from the gallbladder into the intestine. Pretty fascinating.

Amazing.

That's how we get there.

From a functional medicine perspective, we see a lot of this in diabetics. It has to do with insulin resistance and poor metabolic health which affects 88% of Americans. that's why gallbladder disease is such a big deal. And the problems that people suffer from are, are miserable. You know, pain, vomiting, nausea, you know, just severe issues. And they can't digest their food. And often the traditional treatment is just surgery. But from a functional medicine perspective, what do we think about, how do we begin addressing this? What are the ways do we support these patients and how do we sort of get them better? And, and sometimes they do need surgery. but talk about the approach we would take in terms of what diagnostics we would use and how you would help people.

Yeah, sure. Just for sake of contrast, I would say that just doing my research for this podcast is really fascinating that the gallbladder and bile play a really important role in the body. To just I think this is one of the classic examples or the differences between functional medicine and conventional medicine. Because in conventional medicine, it's the stone, it's the pain, it's the complications of the stone. And so if you continue to have stones, we'll take your gallbladder out. If you have a complication to the stone, you have an infection, then we're taking gallbladder out.

That's it. That's it.

There's absolutely no thought as to the role—what got you there and what the role of bile is in the rest of the process because it just doesn't break down fat because of the contents of bile, which spills into your intestine, it can have a huge impact on your gut microbiome. I just wanted to emphasize that that's why I said earlier, it's sort of like it's so common, it's invisible, and because we just take it out, there's even more reason to not think about it.

Talk about that connection between the microbiome and the gallbladder.

Dr. Pompa:Well, yeah, that's okay. So, all right, I can I can enter that highway from multiple routes.

So.

I will go at it from this perspective that when the bile.

If.

It'S too acidic, if you have too many toxins in it. And it enters into the, and your nutrition is poor, so you don't have enough amino acids in it. You don't have enough proteins or enzymes that actually can be an aid to the bacteria in the gut microbiome to do their job. Then it will start to alter the environment of the gut microbiome, and then you'll end up with what we call dysbiosis. biopsy, the bile will cause damage to the gut microbiome. When that happens, then the organisms that are really healthy start to decline. They become destroyed. Then you start to develop some organisms like Candida that will alter the gut microbiome even more. Some of those commensals that live there, they've been hanging on in the party where it's nice for bacteria to grow, they will start to grow. Now all these bad bacteria take over, you get inflammation, you have a breakdown of the mucosal lining that plays a very important role of protecting your immune system and allowing for the bacteria, the healthy bacteria in your gut microbiome to communicate to the immune system in a very precise way. because that happens and it's very important. And when that communication system breaks down because the gut mucosa has been damaged, then the immune system begins to be overwhelmed and starts to have inappropriate responses leading to autoimmunity and leading to inflammation throughout the body. And so that then triggers this inflammation. it affects the gallbladder, the gallbladder then will be affected. I'll give you an example. Let's say you have a gluten sensitivity and you don't know it. You eat gluten. Gluten is a real strong potentiator for creating autoimmunity against your thyroid, and it can create Hashimoto's thyroiditis. There have been studies that show a very strong connection between Hashimoto's and gallbladder disease.

Oh, interesting. Right.

And so, okay. What happens? Well, gluten has antigens on it very similar to the thyroid. So, when the immune system makes antibodies against the gluten, it also can confuse and those antibodies can attack the thyroid. Okay, what happens? Now, that's called Hashimoto's. Hashimoto's, in its end game, stops your thyroid from working. Your thyroid loses function, we call it hypothyroidism. Hypothyroidism slows down the gallbladder's ability to move the bile out. That becomes the first step in your stones developing because if you can't get the bile out and spoggish gallbladder, then the bile builds up. Now, you set up that environment for all those compounds to precipitate out. The threshold for that precipitation to occur lowers as you have more and more bile sitting there under pressure. You can see there's a cycle there. That's why I said you can't just ignore the fact somebody's got a stone. You've got to look for root causes. You've got to look for other diseases. processes that may have predisposed them to form that stone. The stone is just the end of the process.

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Hey everybody, it's Dr. Hyman. Thanks for tuning in to the Doctor's Pharmacy. I hope you're loving this podcast. it's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once once a week on Fridays, nothing else, I promise. And all you have to do is go to DrHyman.com/picks to sign up. That's DrHyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer.

Just a reminder that this podcast is for educational purposes only. this podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed health care practitioner and can help you make changes, especially when it comes to your health.

Don't forget, there's a way to listen completely ad free with Hyman plus on Apple podcasts. You can enjoy every episode without any breaks. Just open Apple podcasts and tap try free to start your seven day free trial.