Beat Holiday Bloat: Secrets to a Happier Stomach (Revisit)

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Hey everyone, Dr. Mark Hyman here. I just wanted to take a moment to say thank you to all of you who joined me on this journey through the very first season of Health Hacks. Whether you've been tuning in since day one or just discovered the show, I can't tell you how much your support has been meant to me and the Health Hacks team. It's been an amazing season packed with insights, tips and practical hacks to help you take control of your health. As this season wraps up, I hope you continue applying what you've learned to support your well being and live your healthiest life. Thank you again for being a loyal listener and here's to all the great things you're going to achieve in your health journey. In the social media world, there's a trending hashtag hot girls have IBS IBS and it's caught the attention of over 28.2 million viewers on TikTok. And the reason why is it reflects a shift in how women are addressing their digestive health issues using humor and community bring light to what many have kept hidden for way too long now by poking fun at their experiences with IBS and bloating and constipation other gut troubles, women are challenging the stigma around these taboo bodily functions now. It's empowering to see these conversations happening openly, but it's really critical to remember these symptoms are not just everyday annoyances to laugh off, they're real concerns that need to be addressed seriously. And today we're going to discuss why it's important to move beyond the normalization of this to understanding and treating the issues effectively. Hi, I'm Dr. Mark Hyman and welcome to Health Hacks.

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We're diving deep into a topic that affects millions of people worldwide and yet often goes undiscussed in public. Stomach issues. Whether it's bloating, constipation, diarrhea, or just an uncomfortable feeling of fullness that just won't go away, these symptoms can be more than just a nuisance. They can seriously impact the quality of your life and a whole slew of chronic illnesses. Now, when we talk about stomach issues, we're really opening up a conversation about a range of conditions from irritable bowel syndrome to with constipation or diarrhea, to indigestion or what we call dyspepsia, or to what some people jokingly refer to as a food baby. I heard that first from one of my patients and I knew exactly what she was talking about. You know that swollen stomach you get after indulging in a big meal? That bloating just feel full and your stomach pooches out. That ain't normal. Okay, something's going on. We're going to talk about what it is and how to fix it. Now, behind these common experiences lies a complex interplay of dietary habits, hormone fluctuations, and even stress and toxins, all of which affect our gut health. We're going to explore the root causes of these issues and why they tend to be more prevalent and more severe in women. We're going to look at the influence of everything from the menstrual cycle to stress on our digestive systems. We got some fascinating science to unpack about how our bodies react to different foods and stressors and what you can do to manage or even alleviate these symptoms. And I want you to be free of all of this nonsense. This is optional given what we know now in the science. So let's jump in and get started. So what do we mean by stomach issues? Well, there's a lot of them, right? The common term we call irritable bowel syndrome. It describes a phenomena that when I was in medical school was often thought of as psychological. Anxious people, especially women, just got this condition and it was just because it was all in their head. And we had a horrible term for it that we used to jokingly call supratentorial, which in medical speak means in your brain, meaning in your head. And anytime we See, the word syndrome in medicine, like irritable bowel syndrome, it means we don't have a fricking clue or what causes it or what's really going on. It's a syndrome which means a collection of symptoms that seem to go together, but we have no idea why or really what to do about it. And unfortunately, there's a lot of these, from premenstrual syndrome to chronic fatigue syndrome to fibromyalgia syndrome and so forth. Now, there are two main types of irritable bowel we call IBS C and IBS D, or maybe a combo or IBS C D. Right. IBS C is constipation. C stands for constipation, D stands for diarrhea, and CD stands for constipation, diarrhea. Pretty fancy technology naming these things. Okay, now, there's other times of stomach upset that you can get, like dyspepsia, which is sort of indigestion, upset stomach, nausea. There's bloating, which is really common. That's feeling full right after you eat and getting this food baby. Constipation, diarrhea, gas, heartburn, stomach pain, all this stuff, right? It's not normal. Our digestion should not make any noise. We should not know they're there until we get a gentle urge to go to the bathroom. We should eliminate quickly and that should be the end of that. Unfortunately, it's not like that for most people. Digestive issues are the number one reason people go see the doctor. Now, there's an extreme form of this, which is extreme bloating after eating. People use the term food baby. It's a term for this bloated swollen stomach that results from eating. And it could be eating a small meal, a large meal, and it makes you look like you're pregnant. Now, I have lots of patients with this, and they. They all eat something and they'll get this distension, discomfort, pain. They can. It can be associated with constipation or diarrhea. And. And they. It really affects the quality of their life. I had a patient once who would have these attacks where she would get bloated and be distended. She would sometimes have to fast for a week and. And couldn't get this resolved. And it turned out she finally had what we call a small intestinal bacterial overgrowth. We're going to get deep into that. But basically, when I was in medical school, this wasn't even a thing. We didn't learn about it. It's only recently we've been talking about this phenomena of small intestinal bacterial overgrowth, or sibo, which is now a recognized medical condition, and it speaks to the root causes of ibs. Now we have to get also to the root cause of sibo, which is basically the whole purpose of functional medicine, which is to get to their cause of the cause of the cause cause. But we'll get there. We treated this patient, she got better. We did a whole cocktail of things. But it's around improving motility, it's around killing all the bad bugs. It's about resetting the gut and so forth. But we'll get into exactly what we did and why we did it. Now, why is this phenomenon of irritable bowel syndrome more common in women than men? Is it just men don't report it, or is it just really true? Well, it actually is more common in women, about two times more common. The question is why? Well, it may be because, and we don't quite understand this yet, but it may be because there's hormonal fluctuations that impact the gut brain microbial axis. So there's this gut brain axis for sure. And your gut brain talks to your brain brain and your brain brain talks. Your gut brain and the microbiome plays a huge role in regulating that cross talk and communications. What happens when this whole system gets dysregulated? In fact, you know, there's actually a really great study that came out, an article in JAMA years and years ago which kind of turned the whole idea on its head. Anxious people or neurotic people and irritable bowel, it actually flipped it on its head and said, you know what, it's the small bowel overgrowth and irritable bowel that causes an irritable brain. Because when your gut microbiome is bad, it makes you anxious and neurotic. A friend of mine calls them bitchy bugs. Whenever she gets bacterial overgrowth, she gets what she calls bitchy bugs. It makes her really mean and angry and not nice. And she knows it's not her, that it's the bugs talking, and we know this is true. Now, what are the effects of this whole dynamic system on gut function? Well, about 40% of women report that their irritable bowel symptoms are correlated with their menstrual cycle. That's from the world of gastronology. Women with irritable bowel often report pcos or premenstrual syndrome, or a more severe form, which is premenstrual DD or PMDD depression disorder, and also heavy periods or painful periods we call DYSMENORRHEA now, sometimes symptoms worsen during phases with low hormone levels like menstruation and the late luteal phase. So early on you'll get low hormones and late, late luteal phase, you'll get low estrogen. So estrogen and progesterone basically fluctuate all the time in a woman who's in the menstrual cycle period of her life. And this affects the, the motility of the gut, how, how your GI tract contracts, the transit time, how fast things move through secretion of various digestive substances and the sensitivity of the viscera to insults. In other words, the hypersensitivity of the nerves in the gut. Now, this visceral sensitivity and pain processing is affected by these changes in hormones. Now, estrogen receptors, including what we call estrogen receptor alpha and beta, are widely distributed in the brain and also in the gut. And their activation is associated with colonic motility, visceral pain, and irritable bowel androgens, or male hormones, which are higher in males and females, appear to protect against the development of chronic pain and exert analgesic effects. Now, gastric motility is another thing that these affect, right? Which is how fast things move through, because if things aren't moving through, they'll back up. And then you get bacteria migrating into the small intestine, which you don't want. And I'll explain exactly what SIBO is in a minute, but basically you're just getting bacteria that should be in the lower intestine migrating the upper intestine. And when your motility is low or your basic, you know, processing and the speed at which things move through is slow, it leads to the backup of bacteria in the small intestine. And then you get these food babies and you get bloating and ascension, because the bacteria, which shouldn't be there, start to ferment the food and create gas. And your body doesn't produce gas at all. It's the bacteria munching on the food that you're feeding it that are producing the gas. Now, low levels of ovulation are associated with a slower GI transit time and the resulting in constipation and also increased symptoms in the gut like bloating and water retention. When you're menstruating, you release prostaglandins, which cause inflammation, and that also might contribute to bloating. High estrogen can also increase GI motility, which can lead to diarrhea. So it's kind of works in different ways in different people. Higher progesterone levels in the luteal phase, that's the second half of your cycle. Also slow the transit time of food through your gut and increase constipation and lower levels during menstruation actually make you have more pain and bloating. Basically, hormones affect the motility and function of your gut and can actually lead to some of these GI symptoms. Also, psychological stress can be a factor. Women are far more susceptible to stress due to hormonal fluctuations, particularly in estrogen and progesterone. And that affects mood and stress. And we all know that, right? For example, estrogen interacts with serotonin, dopamine and norepinephrine and gaba, all these neurotransmitters which regulate mood and stress. And this makes women more sensitive to these stressors during certain phases of a hormonal cycle. Also, brain structure plays a role. Women have a larger limbic brain, which is the part of the brain involved in emotion and memory, which can make them more responsive to emotional stimuli and stress. And women who have this higher levels of stress response in the brain can lead to higher levels of cortisol. And that has various effects on the body, including increased anxiety, disrupted sleep, altered immune and gut microbiome function. Now, cortisol helps the body manage stress by increasing blood sugar and enhancing cognitive function, while suppressing non essential functions like digestion and immune response. So it prioritize what's important, like saving your life. So for example, if you're being chased by a tiger, you don't want to be digesting your food. You want your blood sugar to go up, your blood pressure to go up, you want your brain to work better, but you do not want to be digesting your food. All your energy should be going to running as fast as you can or fighting to save your life. Now what happens when you have ibs? We often see a decrease in the parasympathetic activity of your nervous system. This is the relaxation response and an increase in the sympathetic nervous system activity. And that's the stress response in patients with ibs. Now, estrogen also can influence cortisol levels by increasing the sensitivity of cortisol receptors. So basically, whatever cortisol receptors you have, they work better and that leads to a more profound reactive stress response, right? Basically makes your sensitivity to stress higher. That's why women are more likely to experience stress related conditions like irritable bowel fibromyalgia, chronic fatigue syndrome. Now, our gut is our second brain. There's more neurons in our gut than our spinal cord. The bidirectional relationship between irritable bowel and inflammatory bowel and anxiety, depression, stress is really clear. They make each other worse. Okay? Gut bacteria produce hormones and neurotransmitters like serotonin, GABA and dopamine. And if we don't have the right gut bacteria, we can't produce these neurotransmitters that help regulate our nervous system and our immune system. Now, social and cultural aspects are also important in regulating the whole phenomena of ibs. Diet, culture, the desire for thinness, social media, all do bad things to women particularly. And this whole comparison culture, right, comparing yourself to others appearance, it just fuels body image dissatisfaction, extreme dieting, restricting behaviors, which is disaster. There's an article in plos Global Public Health, the medical journal that says it's called the Social Media Diet. A scoping review to investigate the association between social media, body image and eating disorders amongst young people. And we know this is true. This is a book by Jonathan Haidt. We're going to have him on the podcast Doctors Pharmacy talking about these issues. Calls it the anxious generation, a little bit terrifying. And women are far more affected than men. Girls are often focused on photos of themselves. They basically are supporting this whole thin fit ideal of their bodies. They compare themselves to others. They have higher levels of disorder eating, higher levels of dieting, emotional eating. And it's not just women. Boys also favored a muscular ideal. They prioritize fitness and functionality over weight loss. And there's a significant association between social media use and algorithms that fuel disordered eating behaviors like binging, purging, laxative use, extreme dieting and orthorexia, which is a big problem. So all that kind of sets the stage. Right, so what, what then causes irritable bowel and stomach issues? Well, it's different for everyone. And we'll go through the reasons. Poor diet and lifestyle are at the top of the list. Right? The biggest driver. A population based prospective cohort study published in the Journal of Clinical Nutrition found that an unfavorable lifestyle, looking at modifiable lifestyle factors like weight and bmi, smoking status, diet, physical activity, sleep and alcohol consumption were associated with this 56% higher risk for irritable bowel compared to a favorable lifestyle, versus a 12% higher risk among those who are at higher genetic risk compared to those at low genetic risk. So basically, lifestyle had a greater impact on IBS than genetics. Maybe some will have families with irritable bowel and there may be some genetics there, but the combined genetics and lifestyle has a cumulative effect also. People are undereating real food. They're under eating nutrient dense whole foods with the right amount of protein, good fats and all the amino acids they need to function. They're overeating ultra processed foods, right? Even healthy. Quote plant based vegan plant meats, you know, I call it a plant meat, plant based meat because it's made in a plant, not grown on a plant. And gluten free foods, which are often junk food, they eat ultra processed foods that are high in refined sugars and carbs and refined oils, low quality protein like soy protein isolates and processed stuff. In fact, a large scale prospective cohort study reported that compared to the lowest consumption of ultra processed food, the highest consumption of ultra processed food had a significantly higher risk for irritable bowel. In fact, an 8% higher risk of irritable bowel is associated with every 10% increment in ultra processed food. And we eat about 60% of our calories as ultra processed food. That's a 48% increase in irritable bowel given the diet we eat now together. The undereating of the good stuff and the overeating of the bad stuff increases the risk of nutrient deficiencies like B12, iron, zinc, omega 3s and that actually affects how our gut functions and heals. Also, our diets are often causing disturbances in our gut and that can affect low stomach acid, it can be from taking acid blocking drugs. There's also another factor that affects irritable bowel, and I personally had this for sure, which was the effect of toxins on the gut. And you need a lot of enzymes and various things to make your gut work properly. And toxins basically bind to enzymes and they can cause significant disruption in your gut function. So for example, there's a whole bunch of endocrine disrupting chemicals like BPA or bisphenol A, phthalates, pesticides and chemicals, and plastics, all of which affect the gut. In fact, a study found that fecal microplastic concentrations in inflammatory bowel disease, which is sort of a worst form of IBS, was nearly 50% higher than in healthy people. And microplastics are pro inflammatory. We know that. And there's a positive correlation between higher levels of the concentrations of these microplastics and inflammatory bowel disease. What else can cause disruption of the gut? Food sensitivities, food allergens, environmental allergens, all can be a factor. And one of the most common food sensitivities, gluten, dairy, eggs, corn, soy, often grains and beans. Alcohol is Not a sensitivity so much as it's just a gut toxin. What these do is they tend to lead to the overgrowth of bad gut bacteria we call dysbiosis. And dysbiosis is basically the phenomena of the imbalance of bugs in your gut that creates more bad bugs and less good bugs. And what does that do? Well, that leads to a leaky gut and inflammation in the body. It can lead to motility issues. It can lead to overgrowth of bacteria, the bad bugs, in the wrong spot. It can lead to what we call sifo, or small intestinal fungal overgrowth, what some people refer to as candida. But it can be many species of fungus. And a lot of these symptoms overlap with ibs, right? Bloating, gas, cramping, diarrhea, constipation. So let's get into a more detailed conversation about sibo, because this is really at the root of so many people. Now, whether you have ibs, D or C, constipation or diarrhea, there may be different bugs involved. And there's. There's a dump of different gases we measure. Because what we're seeing is when you have overgrowth of bacteria, they ferment the food you're eating, particularly starches and sugars and fermentable carbohydrates. And that causes the production of gases. And those gases are what causes distension. And the food, baby. The first thing that goes wrong is what we call dysbiosis. We talked about that briefly, but there's a lot of reasons for that. It's our poor ultra processed diet, it's our lack of fiber, it's too much starch and sugar, alcohol, artificial sweeteners, all kinds of stuff. And from drugs, too. Antibiotics, steroids, the birth control pill, acid blockers which are so common like Prilosec or Prevacid, all these can balance the gut flora, psychological stress, high carb diet, alcohol, environmental toxins. All these things cause this problem of dysbiosis. And they also can affect the motility of the gut. And there's a lot of things that cause motility issues. It can be diabetes, it can be GLP1 agonists, by the way. And I worry about how they're affecting people's GI tract. Drugs like Ozempic. And we're seeing even things like small bowel overgrowth. And also, also we're seeing risk of bowel obstruction because of the way in which it affects the gut. So I'm a little worried about that. But they can be a helpful class of drugs. I just think they're overused. But when you have impurant mortality from stress or from different kind of inflammatory bowel disease, it can, it can again cause a backup and growth of bacteria in the wrong spot. Basically you've got like 1012ft of large intestine and about 22ft of small intestine. And mostly the small intestine should be mostly sterile. But when the bacteria migrate up to the top of it and then the food ends up hitting it first, that's when you get this food baby stuff. Now stress also will have an effect on your bacteria. They, they actually are listening to your thoughts, right? Your bacteria are listening there. When you have stress also, it increases permeability of the gut, it causes leaky gut, affects motility, slows it down and affects immune system function. So it's quite common.

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One of the things that happens is low stomach acid. Now low stomach acid is not that common, but it can be in degrees. The more severe form is achlorhydria, which happens when you get older and you get atrophy of your stomach or if you have B12 deficiency and so forth that can, that can really affect this. But there's a lot of reasons for it. But a lot of the reason is because we, we take these acid blocking drugs, right? And that leads to low stomach acid and that leads to changing the ph, and that leads to the ph of the small intestine changing and the overgrowth of fungus and bacteria that shouldn't be there because of the change in climate, but aging itself leads to this. Chronic stress leads to low stomach acid. Certain intestinal infections like H. Pylori, autoimmune diseases like hypothyroidism, certain medications. Obviously if you're blocking stomach acid with acid blockers or PPIs, antacids, certain nutrient deficiencies which are important for the production of gastric acid like zinc and B vitamins. If you're low in those, that can cause low stomach acid. Also, poor diet will cause sibo, right? High intake of processed foods, sugar, unhealthy fats, also has a negative impact on Sibo and also stomach acid. Also, if you're not eating properly, irregular meal times, eating too quickly, overeating, you'll tend to potentially get sibo. And this, this allows bacteria to colonize the upper intestine, which is supposed to have low levels of bacteria. All right, so this is sort of what it is. Basically bad bugs growing in the wrong spot, fermenting the food you're eating, causing you to have a food baby and be miserable and have all sorts of other consequences on your mood, your energy, your cognitive function. It's not just your stomach that's being affected here. Now, how do you diagnose it? Well, we use a breath test. There's a number of different kinds of breath tests. There's lactulose, there's glucose, and another test called trio smart test. But essentially we're looking for three gases that are produced after we give you a digestible sugar like lactulose or like glucose. And what these do is they actually help you to identify whether or not you're producing extra forms of these gases. Because the small intestinal bacteria. The trio smart test looks at for three different gases developed by Mark Pimentel and others at ucla. Looks for methane, which is commonly associated with constipation, hydrogen, more likely to have diarrhea, and hydrogen sulfide, which is often not tested for. But it can be important to find, particularly in tough cases of sibo. And I particularly use the trio smart test. You can learn about it online, your doctor can order it, but it's a really important test. There are stool tests that help and that'll help you identify what's going on in the gut, maybe helps you look at the overall health of the microbiome. Six underlying issues. It can help you identify yeast overgrowth, lack of short chain fatty acids, lack of important bacteria like Akkermansia, low growth of bacteria. So all that is sort of like clues that's things are going on. Also use organic acid testing, a urine test, because a lot of the metabolites from overgrowth of fungus or bacteria will show up in the urine. And you can measure these. And it's another clue. And there's certain blood tests that are important to look for nutrient deficiencies that can affect your, that can affect SIBO or your body, like B12 or iron that maybe also occluded malabsorption. So what's a traditional approach? Well, it's pretty good approaches in traditional medicine, but they kind of like stop short, they give you an antibiotic to clear out the bacteria. That's it's kind of an advance from what we used to do when I was in training, but it doesn't really address the full spectrum. What's going on in the gut. So what's a good comprehensive functional medicine approach to treating irritable bowel and also the related GI stomach issues? Well, we have a methodology. It's basically a system of how we approach people with gut issues. It's called the 5R program. The first is to remove, remove the bad stuff, stuff, move foods that might be bothering you. Bacteria, parasites, yeast. Get rid of the bad stuff. The second is replace, replace what's missing, probiotics, prebiotics, enzymes and so forth. The third is to reinoculate, which is use probiotics. The fourth is to repair. That means repair the gut lining with the right nutrients that heal the leaky gut and repair your gut lining. The fifth is to restore, which means to regulate your nervous system and stress. So let's go through the 5R program in more detail. The first R is to remove remove Common triggers for problems with the gut. These are commonly known as food sensitivities, not true allergies or just things that your body shouldn't be eating. That much of gluten, dairy, corn, soy, sometimes eggs for people, certainly ultra processed foods, certainly refined carbs and sugars and alcohol. Now, a landmark paper published in the prestigious British medical journal Gut found that limiting foods identified through the delayed food allergy tests, which is not typically well accepted by traditional medicine. It measures IgG antibodies, not true food allergy, but food sensitivity. When they eliminate those foods, they dramatically improve their IBS symptoms. The next thing we want to get rid of are the bad bugs, right? And that means identifying what they are through testing. Maybe it's a breath test, maybe it's stool testing, urine testing. But it involves getting rid of overgrowth of bacteria, overgrowth of fungus, overgrowth of parasites through sometimes medications or herbal therapies. Now, the typical medications used are antibiotics. Rifaximin is the most common one now used. This is a non absorbed antibiotic approved for irritable bowel. And a randomized trial published in the ML of internal medicine showed that using rifaximin for 10 days resulted in dramatic improvement in bloating and overall symptoms of irritable bowel syndrome by clearing out the overgrowth of bad bacteria. But sometimes you need to use combinations. For example, if you have methane sibo, you might need neomycin. Sometimes there's resistance, you need to use Bactrim or other antibiotics. But it's important to Work carefully with your doctor on this. Also, you might need an antifungal to get rid of the bad bugs like diflucan, Nystatin or sporinox. You might need an anti parasitic if you find you have a parasite like alinea or flagyl. And then there's some herbal therapies that can be really helpful. There's a product called Atrantil or Atrantiol which is a specific herbal formula that's designed for methane with sibo. That's if you have high methane on your test and tend to have constipation. Certain antibiotics like neomycin can be also important for methane sibo. There are certain herbs that I like to use like candybact and AR&BR, which are herbal. Herbal therapies for bacterial and yeast overgrowth can be great. Sometimes I use a combination of antibiotics followed by herbs for a while and, and I, and I will treat people with an antibiotic regimen and then follow it up with herbs. Herbal antimicrobials. It'll include oregano, berberine, wormwood, yarrow, thyme, ginger, licorice and other things. And that's the first R. And also we look at toxins. That's the, that's the other thing is to remove toxins. So we have heavy metals. If you have pesticides, chemicals, all those need to be reduced or removed. Personally, I had severe SIBO from mercury poisoning because it poisoned all my digestive function and enzymes and it didn't work and I had to fix that. Now the next R is to replace so digestive enzymes and hydrochloric acid. And I use digestive enzymes. There's different kinds like digestive enzyme Ultra from pure encapsulations. There's digest gold. There's a lot of other ones. There's Spectratime 9X which is an animal based enzyme for metagenics. By the way, all these supplements I mentioned you can find, they're usually through professionals, but I've curated some of the best in class that I've used for my patients that are available through me. And you can just go to Dr. Hyman.com and go to the supplement store there and you'll, you'll be able to find it. Beta nitro chloride, which is kind of counterintuitive if you think you have digestive issues. We're taking all these acid blockers, but this is actually giving you stomach acid and it can help digestive food and actually help reduce sibo. And then we reinoculate, which is really important and that involves giving you the right Probiotics, it's just really important. And that is good bacteria can be Lactobacillus, bifidobacterium. Sometimes we'll use saccharomyces, which is a yeast against yeast that helps with yeast overgrowth. We use a whole different combination of probiotics. We also use polyphenols and prebiotics to, to actually help fertilize the good bugs. And we now know that polyphenols are colorful compounds in plant foods, are really important for helping to improve the growth of the good bacteria. And lastly the next R is to repair and that means repairing the gut lining using food as medicine, eating whole, minimally processed foods, lots of good protein because protein's needed for gut lining repair. Pasture raised eggs, grass fed, organic, non genetically modified sources of food. Lots of low mercury fish like salmon, mackerel, herring, sardines. I like seatopia dot fish. It's got a great source of clean fish sometimes that are regeneratively farmed. So you know, be careful of farm fish. But there's a lot of other protein options. Grass fed beef, wild game, both buffalo, elk, lamb, venison, all are great poultry. If it's, you know, pasture raised turkey, chicken, that, that's really good. You also need gut healing nutrients like omega 3s and vitamin A. And you can get ghee which has butyric acid which also contains a gut healing compound. Foreign. Bone broth is really great. It's rich in a glutamine which can help provide you feeling full. But also it can help provide added minerals and collagen support that helps your leaky gut. Also there are certain supplements that are important like omega 3s. I like omega 3. Rejuvenate from big bold health. You can eat, take evening primozoil, magnesium, certain vitamins like D and A are important. Zinc, a multivitamin, all help heal the gut. So these are just things that we use to help heal the gut. Now after you've done the sibo treatment, you don't want to be eating the diet that's going to cause you to reintroduce foods that are going to cause again the overgrowth. So you got to be careful. You also want to learn how to regulate your nervous system because that also is important. Because both stress works to make it worse, but when you're having your bowel, it makes your stress worse. So it's a kind of a vicious cycle. Meditation, breath work, yoga, whatever it is to help restore your nervous system. Also exercise is great exercise that's done regularly. This is from randomized controlled trials actually helps reduce IBS. Even a 30 minute walk can help. Now let's talk about diet. There's a whole diet that's being used. It's called a low fodmap diet. Low in fermentable starches and sugars, essentially. Right. You're not giving the bacteria something to chomp on and then produce gas and make you miserable. This is crazy. One in seven people in the entire world is affected by symptoms of irritable bowel syndrome. And many have one or more foods that are known to trigger symptoms like gas, bloating or diarrhea. Now, carbs and fiber are the most common because they can be fermented. So this diet is called the low fodmap diet and it was developed in Australia, which was extensively researched with irritable bowel. And it's basically considered a low carbohydrate diet. And it can be super effective for treating ibs. Like basically, if you eat protein, vegetables, you'll be fine. Okay, except certain vegetables are not great. We'll talk about that. Now, many of those earbuds sufferers symptoms improved on this low fat fodmap diet. And clinical research has shown that low fodmap diets improve the symptoms in 70% of IBS patients. So you both want to do the 5R program, and part of the first R is to remove, and it means removing some of these fermentable starches. Real world studies continue to show that this works, right. In improving abdominal pain, quality of life. So what does actually fodmap stand for? Stands for fermentable ol saccharides, which are fructans and galactooligosaccharides, basically oligosaccharides, which means single sugars. Disaccharides like lactose, monosaccharides like fructose. These are all types of sugars that our gut bacteria feed on. And polyols, which are sugar alcohols. Right. Which is in all the kind of quote health foods that have artificial sweeteners or sugar alcohols to make them sweet, like sorbitol, xylitol, malitol, isomaltal, maltitol, and these are terrible. When I had sibo, I accidentally got, well, not accidentally on purpose, got a chocolate bar that was given to me by patients as a no sugar chocolate bar. You should love it. I'm like, great. I was, I don't know, at work and I was a little tired, stressed. I ate it, the whole thing, and it was full of maltitol and I was in the bathroom and I was miserable. It's really bad. So you have to be careful. So how do fodmaps foods cause ibs? Well, these carbohydrates and sugars are not readily absorbed in the gut and basically they pass through the small intestines and they attract water and they cause bloating and motility changes that can result in diarrhea, constipation. But once they reach the large intestine, the gut bacteria ferment them and they produce lots of gases like hydrogen, methane, carbon dioxide. And the accumulation of these gases leads to gas bloating, dissension. So what are the foods that have the highest and the lowest amounts of FODMAPs? And what are other things that have fodmaps like drinks. Right, so let's just go through the beverages. Apple juice, mango juice, pear juice, high fructose corn syrup, sodas, certain alcoholic drinks like beer, wine, all that will make you worse. Processed foods, I should say no more, but you know, those you should meet anyway. But cereals with high fructose corn syrup, snack foods with high fructose corn syrup, protein bars, diet foods. Often they'll contain inulin or high fodmap ingredients. So what are the steps to try a low fodmap diet? Well, all these moderate and high fodmap foods should be eliminated for four to six weeks on the low fodmap food plan. So for the next four to six weeks you want to basically do that. Why does a low FODMAP diet eliminate healthy foods? Like. Right. Seems like you shouldn't be eliminating healthy foods, but sometimes it says to like asparagus. Right, but that actually has a lot of fermentable starches in it. And you basically do this temporarily until your symptoms get better. Now it's careful. If you have an eating disorder or whatever, you know, you want to be, be aware of working with someone who can help you do this. Right. But still, you might need to fix your gut. And that can be a factor in, even in eating disorders, one FADMAP group is introduced at a time. So you sort of go slowly to monitor your symptoms one food at a time. You start small and you sort of build up your tolerance. Now, some people can only tolerate food a specific quantity, so maybe they'll have a little bit, they'll be fine. If they have a little more, they're going to be in trouble. But some people need to avoid specific foods or FODMAP groups indefinitely. Right. There's an app actually that the fodmap group in Monash University in Melbourne, Australia put together and it's for the public and it provides a searchable database of foods low and high in FODMAPs. It has recipes, recommended food products and on their website. For more information you go to monash fodmap.com it's M O N A S H F O d m a p.com now research shows that tryptophan, which is the precursor to serotonin, which is a neurotransmitter that helps gut motility, can improve constipation in IBS C because it helps increase intestinal transit time, intestinal motility, which means moving things through and gastric emptying similar to fiber. So that's good. If you have high levels of tryptophan though, it could make IBS D worse, meaning your diarrhea depends Predominant. You want to be careful. If you're doing this, I encourage you to work with a practitioner. It's pretty restrictive. I don't think everybody needs to be on this actually. I think there's ways of resetting the gut used to the 5 or program and helping people eat more normally. But you want to work with an experienced nutritionist or functional medicine practitioner who can help you identify what's going on, what you should be doing. And the goal here is to improve digestion, not have a long term restrictive diet. The good news is we now understand a lot more about irritable bowel than we did. We understand what is driving this food baby. It's called sibo or sifo. We understand how to treat it in the right way with diet changes, lifestyle changes, the right medication, sometimes the gut repair program, and often traditional doctors will might give you the antibiotic, but they won't treat your yeast or fungal issues. They won't put you on a full 5R program to reset you. They won't make a lot of dietary suggestions. So you'll get recurrence. So it can be a problem. You can get recurrence if you don't do it properly. So as we wrap up today's episode, it's clear that the playful hashtag hotgirlshaveibs is more than just a trend. It's a conversation start about real health issues that face a lot of people every day. And it's great that social media is helping destigmatize discussions around women's health, particularly digestive issues. And we've learned today these symptoms are signs that should not be ignored. They're often rooted in complex interactions between our diet, our hormones, our overall lifestyle. But thanks to extensive research and discussions that we covered today, hopefully we're all better equipped to understand the underlying causes of these common stomach issues. Remember, it's not enough just to normalize these conditions. They're not normal. We've got to actively seek understanding of what to do and get the right treatment. Whether you're a woman dealing with these symptoms or know somebody who is, I encourage you to explore functional medicine approaches that we discussed and consult with your healthcare professional professional who can tailor specific treatments to your specific needs. So let's take control of our health and work not just toward feeling okay, but to feeling great. Thanks for joining me today, and I look forward to bringing you more empowering health discussions on next Tuesday's episode of Health Hacks.