Episode 203: The Gut-Thyroid Connection: How Your Microbiome Impacts Your Metabolism

In this episode of Thyroid Answers, Dr. Eric Balcavage sits down with functional health coach Anu Simh to explore the critical connection between gut health, thyroid function, and overall metabolism.

 

What You'll Learn:

• Why normal TSH doesn't mean optimal thyroid function - and what's really happening at the cellular level 
• How chronic stress disrupts your gut microbiome and creates a cascade of health issues 
• The difference between homeostasis and allostatic regulation - and why understanding this changes everything 
• Why gut protocols often fail long-term (and what's missing from most approaches) 
• The truth about probiotics, fermented foods, and prebiotic fibers 
• How ultra-processed foods damage your microbiome - and how quickly you can reverse it 
• Why GLP-1 medications work but don't address root causes 
• The behavioral and mindset shifts that make healing sustainable

 

Key Topics Covered:

• The mitochondria-microbiome-thyroid connection
• Why restrictive diets often backfire
• How to eat for your individual body and microbiome
• The role of nervous system regulation in gut healing
• Practical strategies for sustainable behavior change

ANU SIMH is a board-certified functional health coach and the founder of 9 Arms of Wellness. She specializes in helping busy women lose weight and maintain their goal weight by focusing on gut health. Her personalized and unique philosophy has successfully guided hundreds of women in achieving and maintaining their goals. Anu is now training other coaches in her methodology.

Based in La Jolla, California, Anu sees clients nationwide virtually. Her passion lies in the microbiome; she is also a skilled plant-based chef. Her new book, Flourish From Within, reveals the importance of gut health for overall well-being and includes over 50 plant-based recipes. Anu's guiding principle is to help people get off medications for lifestyle diseases through diet and lifestyle changes.

Find her at: ninearmsofwellness.com and @ninearmsofwellness on Instagram.

Episode Transcript

Eric Balcavage (00:20):
Hey
Hey everybody, it's Dr EricBalcavage. We're back for
another edition of the thyroidAnswers podcast. We have another
guest today. Her name is AnuSimh. She's a functional health

(00:40):
coach with a, I guess we couldsay, like a specialty in a
evaluating gut function, gutphysiology, and what goes on
within the GI tract, and howthat may relate to other health
conditions and signs andsymptoms. So welcome to the
Thyroid Answers Podcast.

Anu Simh (00:58):
Such a pleasure.

Eric Balcavage (01:00):
Before we dive in, can you tell us what led you
to focus on gut health as kindof where you landed? I mean,
there's obviously, from afunctional health perspective,
we look at the big picture, butyou really focus on gut health.
Why? What led you there?

Anu Simh (01:16):
Well, it's not just gut health. I just started
seeing patterns emerging in myclients, right? You know typical
client who comes to see me?Maybe there are a couple of
typical ones. One women withnormal TSH. They haven't been
that's all they know about theirthyroid, but they're struggling

(01:38):
with weight gain. They have likedeep, deep fatigue. They're
constipated, your gut motilityis compromised, and they don't
know what to do. And then theother client is a woman who's
already on medication, probablyT4, but still struggling with
weight gain, deep fatigue,constipation. So I don't see the

(02:01):
symptoms changing as much, andthat seems to happen almost as a
pattern in the clients that Isee. And these are women from
anywhere from 35 to, you know,45-50 you know, and they're
presenting this over and overagain, and it really begs the
question, what's what's goingon. So a lot of time they come

(02:22):
with this diagnosis, they'veforgotten, forgotten it. Some of
them don't even remember thatthey are on a T4 medication,
because it's been so long and,and, and because they they don't
really present as over medicatedor under medicated. I don't see
that as a huge question thatthey bring up with your

(02:45):
allopathic doctor or yournaturopath, or whoever they're
seeing at the at the moment. Sothat really and so all of these
other symptoms are just somehownot connected with the thyroid
because they they feel likethat's been taken care of.
So I usually see this a lot, andthe patterns keep emerging. And

(03:05):
I am a board certifiedfunctional health coach. I do
not diagnose, I do not treat. Ijust coach to the terrain. And
the terrain is very clear. Theseare the patterns emerging. And
I'm I'm thinking how are theyall connected? So my big thing
is microbiome connected to themitochondria. There's that

(03:28):
endosymbiosis. We know thatthere they are connected through
all the research for my bookthat was very interesting, and I
learned a lot through that. Andof course, the thyroid and other
hormones are connected. And forme, it's the brain as well. And
and I say brain, I mean ournervous system, you know, and

(03:51):
the connection to nervous systemand mitochondria, all of this
emerged as a pattern, and I justcoach, coach to that. So in
other words, it's behavior andempowering them with education.
And education is notprescriptive. It's more an
invitation to learning more,because they haven't connected
the dots. They've gone to somany practitioners by then that

(04:15):
they have bits and pieces ofinformation, but they're not
quite sure how it all fits. Theyhave a bucket full of
supplements and but still, thethe symptoms continue.

Eric Balcavage (04:27):
Yeah, so I want to ask a couple questions off of
that, because I think it'll behelpful for the for the
listener.
Why do you why do you thinkthere's a disconnection and lack
of connection there. Do youthink? I guess my take would be
that the reason people have adisconnect in putting all these

(04:50):
pieces together is because it'snot the model we grew up in. We
grew up in a reductionist modelwhere it's either you that's a
thyroid issue, that's a gutissue. That's a sex hormone
issue, that's an adrenal issue,that's a neurologic issue,
that's a neurotransmitterdeficiency issue, and we kind of
siloed all these systems, and sowhy would a person connect them

(05:14):
in the first place? If how weall kind of grew up, especially
in the US with our with watchingTV and listening to doctors and
Doctor shows that it's connectedwhen we've siloed it, even in
our training, it's siloed. Sowhat's your How would you link
why people are having a hardtime seeing a connection between

(05:35):
all their systems and all theirsymptoms?

Anu Simh (05:38):
I mean, I really have to agree with you on this,
because I see that, you know, Isee that doctors are not, it's
not it's not teamwork. It's likeeveryone has an opinion, someone
with a thyroid issue who has wasalso seeing a cardiologist.
Let's say, for example, no one'sreally, actually having a
conversation. And I'm more of asystems thinker. I'm always

(06:01):
thinking, what else could begoing on if that energy is
tanking? Is that a mitochondrialfunction? Is it a microbial
function? What is happening? Andthat really comes it's very
client led in my you know,because every client responds to
these questions verydifferently, and they see their
own patterns emerging in a verydifferent way.

(06:23):
But from all of this, I see onething, they don't think of all
these symptoms as a soup thatthey've created. It's more like
system one. This is theendocrine system, this is the
cardiovascular system, this isthe nervous system, but there's
no connection between that. AndI try in my coaching to bring
that all together and singasking questions that kind of

(06:45):
help them see the connections.

Eric Balcavage (06:47):
Yeah, I think that's really important, and I
think that's really what weshould be focused on in
functional medicine, becausethat really is our wheelhouse.
Is, how does this system, thewhole body system, connect?
Versus the allopathicprofession, which is is very
specified, because they'retypically treating disease, and

(07:09):
so I'm worried about thistissue, this organ, and the
disease there, and how do Imanage it with drugs or surgery?
They have a different job thanwe do, in my opinion.

Anu Simh (07:19):
They do and they don't have the luxury of even asking
these questions, because theyare in a model where there's the
patient is not a participant,you know? They're just so in and
out 15 minutes. That's all theyhave. I blame the model. I just
don't blame the doctors or theMDS, because first of all, the
education is very it's, it'scaters to that particular

(07:41):
system, and ours is more okay.We're thinking outside. We've
seen this. We've seen whatworks. You have an immediate
issue, go to an allopathicDoctor fix the issue. But if you
really want to dig deeper andsay, where are these symptoms
coming from, and you wantanswers, then I think function,
functional medicine, or even Iwouldn't say root cause is, is

(08:05):
so interesting. And, yeah,

Eric Balcavage (08:08):
I agree to me, it doesn't matter the name and
the shingle. It's the thinkingprocess, because there are very
functionally thinking allopathicphysicians, but they're limited
to their model, and there arevery allopathic functioning, or
practicing functionalpractitioners who are really

(08:29):
doing the same thing asallopathic medicine. They're
just using a different they'reusing Hort sexual hormone
replacement therapy, they'reusing supplementation, and
they're saying, this is low, I'mgoing to manage that. That's how
I'm going to manage that. And tome, that's not truly where our
that's not a functionally basedpractitioner, that is a person
practicing potentiallyfunctional or integrated

(08:50):
medicine, but they have anallopathic approach. And I think
that's where we have to evenhelp educate people to say, Hey,
these are the things you're ifyou go, if you want a functional
based approach or true rootbased approach, these are the
kind of things that you shouldmaybe the kind of questions you
should be asking yourpractitioner. And it's not that.

(09:11):
And people listen to me, and alot of people come to me because
of my discussion on thyroidphysiology, but I'm not really
trying to fix thyroidphysiology, because I don't,
think it's broken. I think it'san adaptive response, but I talk
through that lens because thatattracts a certain type of
person, and then I can deal withthem from a functional

(09:32):
standpoint. And I'm guessing youdo the same thing, like I've
talked through the lens of thegut microbiome and the gut
function and gut physiology, butI'm not just a gut specialist,
because that's not functionalmedicine, right? That is, I need
to have a conversation withsomebody that is in that's
interested in the topic, andthen once I get them to me, now

(09:52):
I can explain to them, well,you're these are all the things
that are influencing your GIsymptoms. So if we can either
manage your GI symptoms, or wecan address the root cause, but
you have to get them there inthe first place. Is that fair?

Anu Simh (10:06):
I think I 100% agree with that. Because, you know,
when someone says, Oh, you arethe gut gut person, I find that
an odd comment, because youcan't really just focus on one
thing, right? You know, likethey say that it takes two to
tango. But for me, it's likeI've been seeing in my practice,
it takes three to tango. It'sthe mitochondria, it's the

(10:28):
thyroid and and the gutmicrobiome. So I can't really
just focus on one thing, butneed to see the connection
between all of these things andhow it's affecting us, you know,
or any in our prospective clientor patient. And I think, I think
it's spot on, you know? I thinkit's, it's really about a client

(10:48):
led conversation and how they'refeeling their body at that. And
that can change too, yeah, thatcan change, you know, and
that's, and we have to beconstantly aware of it. And as
far as behavioral changes also,

Eric Balcavage (11:00):
Yeah, we'll get, we're gonna get into all that. I
do want to ask, I one, it'sreally two questions to tie into
that. The first comment, whenyou because this, this is the
two people that you say theycome to see you a lot, you know,
obviously there you might get alot of people that are have gut
related problems, because, youknow, that's kind of the window
through which you reach people,but when you have people coming

(11:23):
in and they have classichypothyroid signs and symptoms
and their TSH is normal, andthey've been told they don't
have a thyroid condition, I knowyou don't diagnose but how do
you explain that to them? Do yousay, Well, you do have a thyroid
condition, or do you just say,No, there's something else
that's causing your symptoms?How do you how do you bridge

(11:45):
that conversation?

Anu Simh (11:47):
Well, they've already been told so much about
everything, right? And it alldepends on where the client is.
Are they willing to are theycurious? You know, are they
really interested in I do haveclients who come and say, Tell
me what to do. They've alwaysbeen in that model of they want
to be told they want, they wanta quick fix. And I usually

(12:12):
through my first you know,strategy call. If the client is
in that frame of mind, I usuallycoach to that. I tell them why
that's in work, and I I, I tellthem, this is a therapeutic
partnership, and we need tobuild on that, and that's how we
get answers. It's not as it'snot a quick fix.

(12:34):
Having said that, so if a clientis willing to dig deeper, then I
usually ask them, What do youknow about thyroid? What do you
know about low thyroid? Whathave you been told? What's going
on? What do you think is goingon? So, oh, they a lot of times,
they will say, Oh, it's not mythyroid. It's a very nonchalant

(12:56):
I've been on medication, andthey don't really think it's
connected, because, you know,doctors have told them the
thyroid medication is perfect,the TSH is perfect, so it's
nothing beyond that. So have youand, and that's when the
questioning, really, you know,helps. You know, are you do you

(13:18):
see the connection between yourthyroid. I mean, go back to when
you were really struggling witha thyroid, over medication or
under medication. How did youfeel? Really? The history really
helps a lot. That wholetriggering event on when this
translated to weight gain orbeing cold all the time, or

(13:42):
constipation. All of that reallyis coming from the client.

Eric Balcavage (13:47):
Yeah, I think for me, I think one of the big
things to make sure theyunderstand is, if it's not about
your TSH or your lab value, wecan manipulate those. It's about
what's happening in the cellsand tissues, which we don't
really have a great window of.We can look at a reduced
conversion of t4 to t3 and ifthat wasn't looked at, hey, we
can look at that. We can evenlook at the free t3 to free t4

(14:07):
ratio, and see that there'sunder conversion in the tissues,
and that's resulting inhypothyroid signs and symptoms.
But I think it's importantbecause people get they're like,
my TSH is normal, so I don'thave a thyroid problem. No, your
TSH is in the normal range. Butit doesn't mean you don't have
thyroid signaling issues andinflammation and dysfunction
going on. It just means the labvalue that somebody is looking

(14:28):
at is within the range they careabout to to medicate you or
treat you. But it doesn't meanyou have optimal health. We that
happens all the time wheresomebody says, You look great,
suit, labs look good. You're allperfectly healthy, and then the
next day, they dropped out of aheart attack, like, or, right?
Or they have the I just foundout I have cancer.

Anu Simh (14:46):
So we just need to find what is the weakest link.
You know what's going on. And Iusually tell my clients, it's
just not about just the hormonethat you're producing or the
DTC, just normal. How are youutilizing it? How are you
clearing it? All of matters, andthat's why I connected to the
microbiome. I connected to themitochondria. Show them and say

(15:06):
this is so interesting, justthis connection between
mitochondria and microbiome, theendosymbiosis between the two. I
explained the story behind itand this, and most of it, I
usually, I'm very researchbased, you know, the sense that
there's so many things that wecan we can cherry pick data. So

(15:27):
I really kind of dig into it andsay, Is this something that
you'd be interested in learningmore about? And then I leave it
to the client. If the client isinterested. Then we dig deeper,

Eric Balcavage (15:36):
Perfect. So let's get, kind of get bigger,
big picture with this question,how does our modern lifestyle,
processed food, emotionalchallenges, sleep deprivation,
how does this affect somebody'sgut biome, and what are the

(15:56):
downstream effects? Or whatdownstream effects do you see
most commonly in your clients,especially related to weight and
energy.

Anu Simh (16:06):
So generally, when they come to me, doctor Eric,
they've already been on veryrestricted diets. Um, they've
kind of cut out so manydifferent food sources and
struggling because they're on,like, low calorie just the other
day, I had a client who said, Idon't think I can eat less than
this. So she was on a 500calorie diet, and she'd heard

(16:30):
somewhere online that that wasthe way to lose weight. So what
I see the bigger picture is,when you are on such a
restrictive diet, yourmicrobiome is taking a beating.
You're not thinking when you'reon a restricted diet, oh, I need
all of these prebiotic fibers togrow my butyrate to nourish my

(16:50):
mitochondria. That's nothappening, right? So for me,
that becomes a beautiful segueinto talking about the
microbiome and the connection toenergy, to thyroid, to other
hormones. So they see that andthey they're really uptight.
They come in like this becausethey're wondering, what else am
I going to have to take? Howmuch, how much, how less should

(17:14):
I be eating? I'm already eating,so little. What else do I need
to do? So as soon as I say, thisis your journey. This is you
make the call. We'll just lookat it together, and we'll figure
out what's happening next. Theyrelax, and then it's only when
the nervous system relaxes thatany of these other things are
going to happen. So I A lot oftimes it's like they come in

(17:38):
hoping that they will start withlosing weight. And I usually
have a conversation, but you'vedone all of this before. You've
done elimination diets, you'vedone this. Where do you want to
start? Oh, be really nice tohave a good night's sleep. Or I
am stressed all the time. Theseare indications for me that your
nervous system is out of whackand maybe just relaxing a little

(18:01):
bit in your body and giving themsome support there will take us
to the next step, whatever thatstep may be. For the client,
it's usually like they're sotired of living in not living at
the ideal weight, that they dowant to lose weight, but they
are not able to do it becausetheir metabolism is tanked.

(18:23):
They've been on such low caloriediets, the sleep is compromised.
When the sleep is compromised,the microbial diversity is
affected. So it's all this dancethat's going on that I just
approach it.
I have a overall framework. Icall it mbhr, microbiome brain,
brain, meaning nervous system,neurotransmitters, how they are,

(18:46):
behavioral changes, all of that,age hormones, all of the
hormones that are, I kind oflook at that, look at those
patterns. And R stands forreframing the mindset. So that's
where the coaching comes in. Howdo I present all of this to the
client, you know, in aconsumable way that they
understand and say, Okay, thiscan be a goal. I'm taking this

(19:08):
I'm I'm accomplishing this goal,but I have a system to support
it.

Eric Balcavage (19:12):
Okay, but how does so? I think you said, like
disrupted sleep has an can havean impact on the gut microbiome.
Is it fair to say that excessivestress for that individual can
disrupt their gut biome?

Anu Simh (19:32):
100% I've seen this instrument so a lot of research
that being that fight or flightall the time that's us. I mean,
it's every day is like, there'sso many tigers we're chasing
that a lot of women that's,that's what they're doing.
They're like, really trying tostruggle with that. So even just

(19:55):
calming the nervous system,really helping them. Because
when the nervous system is souptight, the mitochondria gives
gets a signal to shut down, itgoes into repair mode. So I tell
them, look, listen, this is theconnection. And without not
going becoming too nerdy orsciency for them, I show them
the connection betweenmitochondria and the nervous

(20:17):
system. Thyroid and the nervoussystem. You know, the stress is
such a big part of what we aregoing through right now, and and
we're so divided as people thatis causing stress, it's crazy.

Eric Balcavage (20:34):
Yeah, so I, for the listeners this, the key is,
and I talk about this all thetime, we typically operate in
one of two states. We're eitherin homeostasis, which is a state
where I make enough energy torun all the systems in my body
under my current stress load,and that could be a lot of
stress, but you're it'smanaging. So that's homeostasis.

(20:55):
And if you have chronic signs,symptoms, gut dysfunction,
you're
The other state is Allostaticregulation, and this is kind of
what she was referring to, isthat, hey, when there's more
stress on the system, thatstarts to create danger signals,
signals in the physiology andyour mitochondria, which are
these engines inside your cells,are the danger sensor. And so

(21:19):
when there's danger cues beingpicked up by the mitochondria,
from organisms, from toxins,from inflammatory chemicals,
from disrupted sleep patterns,from disrupted oxygen getting to
the tissues that activates thiscell danger response, and that's
going to result in up regulationof your fight or flight system.

(21:42):
It's going to result in downregulation of the
parasympathetic system, which isthe gut is a huge part of that
parasympathetic nervous system,and you are going to have down
regulation of mitochondria. It'snot dysfunction, it's
adaptation, and the big hormonethat helps regulate this cell
danger response is the decreasedconversion of t4 to t3. So with

(22:05):
lower t3 in the cell, we canslow down the less important
systems in that framework, andshift the limited energy to more
of the cell defense mechanismsreleasing inflammation, and
we're going to haveunfortunately, signs and

(22:28):
symptoms. That's our bodytelling us we're in danger.
We've We've spent a lot of timecompromising it.

Anu Simh (22:35):
Beautifully said, and the mitochondria, I mean really
response. I mean, it's affectedby oxidative stress. So I see
that, you know, through food,through toxins, all of that
happening in our systems. Andyou said it perfectly, and, and,
of course, enterohepav pathwaysand T 43 conversion. So when

(22:56):
clients even hear that, oh,that's happening in the gut or
the liver and, and theconnections, it just becomes a
little bit easier to understand,you know, than just a TSH,

Eric Balcavage (23:09):
yeah,
It's not just TSH. It's not justyour gut. I think that one of
the most important things that Iwant to get across the patients
is, I don't care what theconditions are. You're not
broken in most cases. Okay, youmay. You can get to a broken
state, but a lot of people thatare coming to us have been
they're either getting theirbroken state managed somewhere
else, or they've been told theydon't have a disease that needs

(23:31):
to be cut out or drugged, butthey still are kind of stuck in
what I call purgatory, that kindof in between state from optimal
health to illness.
But do you see? I'm sure you seepeople who have been to other
functional health providers,who've done gut protocols and
dietary strategies. And whilethey may work short term for

(23:53):
them, they don't last. What doyou think is the big factor
there that limits some of thosewell intentioned strategies from
working Do you think it's theactual state of the individual?

Anu Simh (24:10):
I think it's both. But I think a lot of it is not
treating a symptom. Even you canbe functional. You can call
yourself a functionalpractitioner, do all of the
right things, get them all ofthe ox bile in the world. But if
you're not really coachingbehavior, which a lot of doctors

(24:32):
obviously don't have the timefor, the end result is kind of
as well. So what I'm saying isthat in every practice, there's
room for practitioners, there'sroom for coaches, there's room
for MDS, there's room for, youknow, naturopaths, there's room
for all of this. But ultimately,boils down to the client, and

(24:53):
what the client is, how theclient is responding. I'll give
you an example, you know, aclient came to me with several
supplements for herconservation. She'd gone through
the four abs, you know, thenaturopath, I told her to, you
know, eat more fiber, eat beef,it, you know, have more fruit,

(25:16):
or, you know, things like that.

Unknown (25:18):
But there was, and then there was, like, a protocol, you
know, like, this is how you youincrease all of this. But it's
very confusing sometimes to theclient, like, Okay, I have this,
I have this prebiotic fiber. Ifeel worse because I have more
symptoms from it. I'm bloated,gassy, so it becomes so

(25:41):
convoluted, you know? I mean,it's not a it's not an easy
answer. You know, for someonewho's been struggling with,
let's say, gut issues, to justgive them a protocol, it just
has to come from reallyunderstanding where the client
or the patient is, and reallytaking one step at a time and
asking, what is the next thingyou want to add into your

(26:04):
protocol, or into what do yousee as the next thing that would
help you and give them choices?If I tell them that, butyrate is
this multitasker. It's shown toactivate AMPK. It's cellular
energy, you know thing, but andthen just leave it at that and
give them a few choices. It mayor may not happen.

Anu Simh (26:24):
But if i i say there are many choices here, as far as
prebiotic fibers, it's false.It's Goss, it's all of these
patterns, lactulose what is itthat you would like to start
with, and what makes sense andreally describe each one. Then
the autonomy, er taking the nextdecision lies with the client,

(26:49):
and I do not explain it, exceptthat it works every single time,
because they feel so much morein charge that they relax in the
body. The nervous system is alittle bit more. You know,
they're able to handle it alittle bit. I don't know if I'm
making sense of it, but that'show I see it, not rather than
just giving them somethingprescriptive, yeah.

Eric Balcavage (27:11):
Well, I think the challenge is, for some time
for people, is they the if theyhave a GI issue, the thought
process is, you do this 30 dayor 60 day gut protocol, and
that's worked on this client andthis client. So it should work
on you because of as aclinician, we've used it a lot
of times.
I think part of what you weresaying before is you gotta work

(27:33):
with habits and behaviors. And Iagree with that. Part of it,
it's huge. And what I would whatI would add to that, to what you
were saying is, if we don'tchange habits and behaviors, and
our patient is still in a higherlevel of stress or threat or
that cell stress response, wecan provide a strategy that, on

(27:56):
paper, seems appropriate, lowstomach acid. We can probably
poor bile physiology. Going toprovide biome they have low
short chain fatty acids, so I'mgoing to give them fiber and
probiotics and maybe somebutyrate temporarily.
But if they're in the samestate, and they still have
disrupted sleep and badrelationships, and they hate

(28:17):
their job and they've got awhole bunch of other stressors
that are keeping in them, themin that fight or flight state, a
well intentioned protocol thatdoes make sense on paper is
likely going to be short termsymptom changing at best, but it
won't improve long term. And soI think that's what I was that's

(28:38):
what I was kind of leaningtowards when you were talking
about habits and behaviors,because if that is what you're
saying, I fully think thatthat's one of the most important
reasons that people start tofail, especially with gut
protocols, because they changetheir food. I've gone gluten
free, I've gone dairy free, I'vegone grain free, oxalate free,
all this stuff free. They'vegone fun free, right? But their

(29:01):
state, their nervous system,state, has not changed, so
they're still not going toproduce acids and enzymes and
have a healthy gut, right?

Anu Simh (29:10):
And that's the problem. You see? I mean, if I
tell them, Do this, do this, I'mgiving them a bunch of
directive, kind of prescriptivethings, but really not paying
attention to how is the nervoussystem? I see that overwhelm. I
see that, oh my gosh. One morething on my plate. I have to
remember to take thissupplement. I have to do this. I
have to do that. But they're notseeing they're not connecting

(29:33):
the dots. But instead, if, forexample, I'll give you an
example of a client who he is aCEO, and just really, I, you
know, a high end job and just alot of stress, doing really well
in his whatever it is that he'sdoing, but his family life has

(29:56):
taken a significant beating. Youknow, he comes home so
exhausted, it's not able toconnect with this child. It's
not connecting with his wife.And so when I coach someone like
him, first thing, I remember himconstantly complaining about
this. You know, I do so much,I'm making a lot of money, but

(30:19):
my my family doesn't see this.They don't see that I'm working
so hard, because all they seeis, oh, you've come home tired.
You're not there for it'semotionally. The wife might say
that the child said, Daddy, youdon't have time to play with me.
But dad is so exhausted, he'stanked. He has no nothing more
to give. And how do I coachsomeone like that? I can't say,

(30:43):
Stop working so hard. Give upyour dream job or this thing,
this purposeful job that youhave, that you really have
worked so hard for. Instead, Isay, Okay, what happens between
you going between leaving workand going home, is there
anything that you can do to kindof just kind of pack that CEO in

(31:07):
and bring out the dad and thehusband, you know? And then so
he this, this particular clientcame to mind because he said,
Well, I know every day I drivepast, you know, in La Jolla,
drive past, you know, I see theocean. And I always think, Gosh,

(31:29):
how beautiful. But I have neverreally had the time to stop and
enjoy the ocean.
Because he's rushing home to bethat parent, to be that husband,
right? Because he's alreadyworked so many crazy hours. So I
said, What if you took just afew minutes for yourself? It
sounds like you're doing a lotof work. You have to come home,

(31:53):
shift gears, put on a differenthat. What if you just took a few
minutes to enjoy that? Enjoy theview?
Would that help you just relaxin your body? And then we
started coaching around that,and so we started using it as a
goal. So we did that for about aweek. And the next time he came
in and said, it was amazing, mymy son started responding to me.

(32:18):
My wife said, what's going on,honey? You're a different
person. Just that few minutesfor himself where he could shift
here, and I taught him somehumming and deep reading just to
relax. And it seems so small,but it's in these small shifts,
big changes happen, and we'realways looking at big changes,

(32:41):
we want to give our clients, ourpatients, this big victory if we
weren't able to, because it'sreally about meeting them where
they are, and that little thingled to so many other changes.
And I don't know, without that,if I, I wouldn't, may not have
had the success I I did havethis client because he was
pretty wound up.

Eric Balcavage (33:02):
yeah, and I think that's critically
important, and I think thatwhat's what makes the difference
sometimes, for clients who'vetried a lot of different
strategies and they haven'tworked or lasted, it's because
their state hasn't reallychanged, and what you're doing
and trying To focus on sleep andtheir emotional fitness and how

(33:23):
they perceive their environment,from am I perceiving that as
danger, as threat, andcontinually winding up the
limbic system, sympatheticnervous system and down
regulating the parasympathetics.We can get a lot further with
gut improving, gut health andgut physiology, if we address
the habits, the behaviors thatare contributing to the

(33:45):
excessive load and raisesomebody's level of what I call
fitness in their emotionalfitness, in their personal care
fitness in their mindsetfitness. I'm sure that person
was living even though he'shighly successful in one avenue
of his life that came at thecost of reduced self care,

(34:07):
reduced relationships, and thatin itself, creates internal and
anguish and internal conflictand danger in winding it up. And
so do you think that that's oneof the kind of the hallmarks to
why you've you make it maybe ahigher level of success in
helping somebody reset their gutphysiology, their gut biome and

(34:30):
their health in general. Becauseit's not just about which
probiotic I take or which gutrepair formula it is. Sometimes
people are like, well, that oneprobably didn't work, and I'll
try a different one. I'm like,one. I'm like, if you've done
two or three gut protocols, it'snot about your gut, it's about
something more. But I do agreewith you that not everybody on

(34:50):
day one is ready to talk aboutwhat's going on consciously and
subconsciously in their mind andwhat's creating the conflict.
They're like, No. Don't have anyproblems. I'm good. I'm good,
yeah, just fix my gut.

Anu Simh (35:02):
My God, men are notorious for it, you know, and
I don't want to just make itgender based, but I women are
really more apt to share thingsand a lot, and men is in my
experience, in my practice, ittakes a bit of time, and a lot
of times the male clients I getare from my female clients. They

(35:24):
they push their husbands my way.Go go see her. Go see her. And
they're not ready. And if aclient is not ready, they're not
in that stage of change wherethey're not even they're not
even contemplating change.There's nothing much as a coach
or a doctor, you know that youcan really do you just listen
and be the best.

(35:46):
You just listen. You justactively listen and look for
those clues. What? What is hereally saying? I had this one
client who came to me, his wifewas really tired of smoking,
says, What the heck. You know,he's still smoking, and she was,
like, an avid everything abouthealth. She couldn't really
understand it. And he was like,not at all keen to have the

(36:09):
conversation. I haven't seen anyproblem with it. The smoking
relaxes me. I want to continuesmoking. What am I going to do?
I'm going to help him withsmoking cessation when he's not
even approaching the subject. Sowe started talking about other
things. I said, what makes youhappy? What do you enjoy? So he

(36:30):
brought up golf. And I said,Wow, you like golf. How's your
game? So we started talkingabout about golf, and he never
made the connection betweensmoking and golf.
And he was also, he had alsogained a lot of weight. So I
said, Would you, would you? Itsounds to me that you really

(36:50):
want to to up your game. And hesaid, Yeah, that's my one goal.
I really want up my game. So allthe coaching was around golf,
and his how he showed up for thegame, rather than telling him,
you've gotta stop smoking, youneed these supplements, or you
need this food. So within abouta month, he was he dropped about

(37:12):
five to 10 pounds, then dropweight very easily, and and he's
feeling a little bit better, youknow, as far as this game and
this went on and on. We had manyconversations, and within about
three to four months, he said,Yeah, I think I want to stop
smoking. I didn't suggest it. Hesuggest, and I think that's

(37:36):
about behavior change, that itall has to come from the client
or the patient, we can only bethat guide by the side, whether
you're a doctor or a coach, youcan't do anything more than
that. It's just the informationhas to be at the right moment. I
think

Eric Balcavage (37:57):
What is it when you're talking to somebody who's
comes to you with chronic willkeep the focus, you know,
chronic gut issues that lend youto say, You know what this is,
less about their diet and moreabout their life, their
lifestyle, their habits, theirbehaviors and their thought
processes.

(38:19):
What are the things like, ifsomebody's listening to this
conversation and saying, Well, Ithink I just have a gut problem.
I don't think it's caused. Ithink it's just my gut and maybe
just the food I eat. What? Whatare the key things that you hear
when you're when you're havingthat conversation, when you're
doing that active listening thathelps you key in, that there's

(38:40):
something more here than justbad nutrition.

Anu Simh (38:43):
Well, again, that comes from that active listening
and looking for clues, right?You know, client comes in, and I
usually do an intake form, I geta lot of information. We talk,
and I see that. I see howthey're even the demeanor, you
know, are they just movingaround? They were looking

(39:04):
around. They're not able tofocus. They don't even have to
say that they're anxious. Theypresent as an anxious person.
And there's a big differencebeing calm and you know, being
in your being present to theconversation or the person in
front of you, then, then aperson who is not so that right

(39:28):
away gives me some clues, and Ikind of dig deeper into that.
Saying, how are you feeling? Youknow, just finding out more
about the system. What doesstress look like? Questions like
that, and if they want to go,there we go, there. They're
like, more like, No, I thinkit's my gut. Then we have a
conversation about the gut.

Eric Balcavage (39:51):
I think, I think that's great. I think that's one
of the things that we need todo. And we'll close this kind of
this section of the podcast, andjust kind of summarize it that
you. Your habits, yourbehaviors, your beliefs, your
thought processes all influenceyour overall health, your gut
physiology, your thyroidphysiology, all of this system.
So my recommendation, and Ithink it would probably align

(40:14):
with yours, before we starttreating this system and what we
see as a sign or a symptom or adiagnosis, we need to start
asking better questions, what'sthe state my individuals in, and
what's causing them to be inthis state? And how do I address
that? Because if you neveraddress what's keeping them in
that stress state, you're likelynot going to have any long term

(40:38):
success. They're not going tohave long term success, and
everybody's going to befrustrated.

Anu Simh (40:44):
And they know that, you know, because they might
say, oh my gosh, I went to thispractitioner. All I got was,
supplements, or I just got somany protocols. It didn't really
help me, and it's because theydidn't take the time to
understand the patient or theclient. So in my practice, I

(41:09):
spend about the first two tothree hours really getting to
know, getting a real screenshotof who my my client is, without
that, without understanding thestory, your back story, what is
some of the triggering events inyour life? What is the suit that

(41:31):
they've created called body,very hard for me to come up with
anything substantial orsustainable for this client.

Eric Balcavage (41:41):
Okay, so we're gonna, we're gonna put a lid on
that conversation. It's almosthard to go to this next piece,
because we just talked about howhabits, behaviors and and
mindset and your state reallyhas an impact on dysfunction.
But we'll shift gears and assumethat we're working on our state,
we're reducing the overallstress load, and now we want to

(42:05):
start to nurture a healthier GItract. So let's talk first about
food.
There is lots of opinions aboutwhat's the healthiest food to
eat. And you hear, you may havea different opinion, but I'm
just going to say you hearnonsense. Like, if you have this

(42:27):
condition, you need this type ofdiet. If you have this
condition, you need this type ofa diet and and, like, there's a
thyroid specific diet, there's aadrenal specific diet. I think
all of that is nonsense. I thinkthere's things that we say
because it's sexy to bringpeople in and attract eyeballs,

(42:48):
but ultimately, I think a lot ofthose things, any dietary
change, in my opinion, is goingto create a change in somebody's
physiology. It's going to createa change in the biome that can
make them feel better or worse.But ultimately, if we had to
give somebody who's just saying,but I need to know, there's keto
over here, there's carnivoreover here, there's vegan,
there's vegetarian, there'sMediterranean, there's paleo,

(43:10):
there's AI, AIP, like for you,when you think about what is the
standard overall diet thatsomebody should be focused on if
they want to be healthy. Wheredo you land on that?

Anu Simh (43:27):
It's a great question, and it's a complicated and the
answer is very nuanced, becauseit always is with nutrition.
It's not easy. Nutrition iscomplicated, and because it
really is about food, and foodis so personal, food is
bioindividual. Food is social.So many aspects to food, and

(43:47):
it's very hard to just I findlabels very like, like cages,
right? It's like, when peoplesay I'm carnivore or vegan or
something like that, it putsthem in this box. And even if
that little cage is not it'sit's trapping them. It's really,
kind of really suffocating them.They want to be in that cage
because they're so at this pointit becomes personal. It's about

(44:12):
that's the whole mentality of,you know, really belonging to
something, and saying, I believeso far, so much into it. I'm not
willing to look at science. I'mnot looking at anecdotes in my
own life to even change it. So Ifind that very challenging,
because, yes, my clients willcome and say, I really had a lot

(44:32):
of luck with being keto orcarnivore or vegan, and then my
underlying question is, so whyare you here? You know what's
going on so, but if I, if I wereto make some rules around food,
it would be simply the eat foryour body.

(44:54):
Don't listen to an influencer ordoctor or even me and say this
is what they believe in. Findout up make a lot of
experimental goals. How does Howdo you react to food? How food
can be poisoned? Food can bemedicine. There's a wide gamut
of things. And inside of that,there are single nutrients that
affect people in different ways.But if you look at food

(45:17):
collectively, I think the onlythings I can come up with is
like, make sure that you eatadequate protein. And that is a
that's a pretty loaded question.Depends on where you are in your
journey, or you menopausal, postmenopausal. Are you? Are you an
older person? Do you need more?Are you exercising? Or you're a

(45:37):
couch potato? Totally different.
I think for me, I feel like,choose your protein, do what you
have to the big thing I've Ifocus on, based on all the
research that I went into forthe book, eat your fiber.
You know, that's something thatI've come to a conclusion, that

(45:58):
it does help to have thesebeauty producers, have some, you
know, something to feed yourmicrobiome, because you're
feeding yourself and you're mostof us are not protein deficient.
We're not, you know. And again,the whole thing about fats is
another pretty loaded question.How is your cardiovascular

(46:19):
system? Where's your Apo B, ordo you have an genetic marker,
like LPa. So it's it's hard toreally kind of just kind of
pinpoint and say, This is thebest diet. It's totally
dependent on the client. Theonly thing I would say to them
is make sure you have a bit ofeverything. So when you're

(46:39):
looking at your plate, you haveprotein, your good fats, and you
have a microbiome, accessiblecarbohydrate to support your
microbes. That's pretty muchwhere I land, you know, and I
don't if someone wants more thanthat. Of course, I have a
protocol, I have a lot of ideas,and I have a bunch of meal

(47:00):
plans. But it all starts with,what do you want in your life?
What? What do you see assustainable?
I had a client who came to mewith, I mean, he was miserable
because he was his his exercisecoach had put him on a high
protein diet because the guy,South Asian wasn't gaining any

(47:21):
muscle. They said protein is thekey. Man. You need to eat a lot
of protein. So the poor guy wentfrom being vegetarian, no animal
protein, to tons of meat, redmeat and all kinds of animal
protein. And he his stuff wasjust a mess. And so coaching to

(47:43):
the terrain, coaching to theclient, really makes a lot of
sense, even with nutrition,especially with nutrition, I
think,

Eric Balcavage (47:53):
I agree with that part of it, but I think for
the average person who's saying,Alright, I don't even know where
to start to say, well, eat.What's going to make you feel
good? That may be a veryprocessed food diet, and that
may make them feel goodemotionally, but it doesn't

(48:13):
necessarily make them feel goodphysiologically.

Anu Simh (48:16):
Oh, of course. Doctor Eric, what I'm saying is that,
yes, you know, I usually willsay, Listen, in my practice, we
usually try to see why you'rehaving these problems, and you
may have as and have you gonethrough something called
elimination? Have you eliminatedcertain triggers? And the usual
triggers that we see in theWestern world, in the standard

(48:38):
American diet, are things likegluten or dairy stuff, you know,
and it's an individual response.Have you done that? And
sometimes they will say yes, butI don't know what came off of
it. So we really focus on theanswers. How does gluten affect
you? How does dairy affect you?How does corn affect you?

(48:59):
Anything that they say is reallycoming up as a red flag, and
that can be the first step. Butat the same time, I'm more
interested in not just takingthings out. How do we feed you?
Really starving that you knowyou've been on restrictive diets
for so long. You've eliminatedso many things because you've

(49:19):
been told to, or, like in my ownstory, I had a gut issue. I I
grew up eating a lot of veggiesand fruits and things like that,
but I I was at a point where Ihad to kind of really cut out a
lot of these things, because Iwasn't, I wasn't responding to
them. And that came from many,many years of being on a

(49:40):
standard American diet, thinkingthat was the way to go, no,
because it was fast, it wasconvenient. So I see myself in a
lot of my my my clients, youknow, they are rushing to work.
They're eating something in apackage, you know, brown boxed
whatever, and it's not givingthem prebiotic help, or the

(50:03):
getting the microbiome ready andgeared up for doing things that
they they should be doing forus, as our forever guests, as
our symbiotic partners.

Eric Balcavage (50:14):
Yeah. I mean, I think one of the biggest
challenges for a lot of peoplewhen they've been on lots of
different diets. They've triedcarnivore, keto, and it helped
for a while, but it doesn'tlast, and then they're confused
as to, what can I eat? I thinkthey're the place even before
you meet a me, maybe a new isjust return to a whole food

(50:36):
based diet and see how youtolerate that eat as close to
the way foods come from natureas minimally processed as as
possible. And that's a greatstart. And then I think it is
important to consider where yourcalories are, what your macros
are. And there's plenty of likegeneral calculators that you can
put in and get your your putyour age in your weight, your

(50:57):
height, your activity level, andget a general feel, because you
you you have to make sure you'reeating for your your close to
your burn rate. So if your burnrate is really low, then you
don't need, you know, 1000 timesmore calories. If your burn
rates really high, and you're ina 500 calorie deficit, that is
not going to help you, that iscreating more stress. Yeah.

(51:21):
Sure. And you're right aboutprocessed foods, because I think
one of the big changes, and Imean, why we're having this
rampant obesity, I have to, wehave to look at food and our
food sources, and it's largelythe ultra processed, hyper
palatable foods that we've allgotten so accustomed to. And
it's so hard from a brainperspective, from that food

(51:43):
chapter, and from having thatinsatiable hunger for these
foods to really just kind ofcut, cut off and say no to them.
I usually give them a foodaddiction scale. I think that, I
think was a hill that came outwith it, and that kind of tells
me right away how, how addictedare they to these processed
foods, flour, sugar, things likethat. And gives me an idea like

(52:06):
how the conversation should go.I mean, if it's kind of like at
the some, some say yes to everysingle thing you know, can you
ever think of a day withoutprocessed stuff, you know, like
the donut or something, oh mygosh, I go looking for it or I I
need ice cream at the end of theday.

(52:27):
Those are real good ways for usto figure out how, how, how much
they are influenced by processedfoods and hyper palatable foods.
And for someone like that, Idon't know, I have clients on
GLP, and they the food chatterseems to really kind of diminish

(52:52):
and but at the same time, theywork with me because they want
behavioral changes. They don'twant to be on a drug for a
lifestyle disease all theirlives, but I see that chatter
coming down. I mean, all I cantell you is what I see in the
practice scene. And of course,as as a coach, I mean, it's
always like, gosh, anothermedication, you know, like,

(53:14):
they're already on so many otherthings, Metformin, they're on
high blood pressure medication,without really understanding how
all of these medications be thebeta blocker or platform all of
that is changing this body.
Yeah, yeah, you mentioned it, soI'll make some comments on it

(53:35):
and maybe get some feedback onit. You say you see some
benefits when people are on theGLP one drugs. And obviously we
can, we can see some of thosebecause of the way GLP has an
effect on the neurochemistry, onglucose regulation. But there's
also some potential, reallysignificant challenges that come

(53:58):
with it. But it, we have to askthat question, and I don't know
if you how you bridge that withyour clients, because when
people ask me about GLP onemedications, I'm like, Look, you
could do anything you want todo, if that's what your goal is.
If you're trying to do it,because you have to get an
address for your wedding in twoweeks, and if it helps you and
that makes you happy, then youcan do that. But the big

(54:20):
question here is, if the GLP onedrug helps you, that means
you're not generatingappropriate levels of GLP one or
the signaling mechanisms aren'tworking. A medic, a medical
provider, can provide that GLPone drug, and it may have a
positive effect that gets youcloser to whatever your goal is,
but taking the GLP one drugultimately does not address the

(54:44):
real issue that's going oninside that person. They've got
dysbiosis, they've got alteredsignaling, they've got DL
decreased GLP one. And for thelistener that GLP one drug can
create lots of changes, but youmake it if you have a healthy
gut. IO and a healthy GI tract.You make it, your body didn't
forget how to make it. So that'sthe real issue here. And I think

(55:08):
that's where you know, it'seasier to take a to take a GLP,
one drug, than to change habitsbehaviors. But

Anu Simh (55:18):
Metabolic inflexibility. I mean, that's
not going to change. What we'veseen from studies is, the minute
you stop taking the drug, theweight comes back and then some,

Eric Balcavage (55:28):
Because the broken physiology, or the
adaptive physiology, is stillthere. There's still dysbiosis,
right?

Anu Simh (55:34):
But instead, if I'm able to coach the client to
better habits, teach them theimportance of these vegetal
greens or fibers that can mimicthat GLP. They're learning the
how to eat for their body ratherthan and for your microbiome,
and seeing that connection, thatwhen they finally are ready to

(55:56):
wean off the drug, they havesomething, a system in place
that really helps them deal withthe aftermath of taking the
drug, because it can be likethis, and that is just very sad,
because some of these women andmen, Dr Eric, they're not
looking to lose 20 pounds.They're looking to lose about
100 pounds. 100 pounds is a lotof weight to lose, and I, that's

(56:21):
where I that's so it's a verymeasured answer. It's a it's a
little bit, I have a lot oftrepidation even saying that I'm
okay with it. I'm not okay withit. It's just that when a client
says that they they want to takeit because they see the
superficial benefits, or beingon a drug like that, you know,
because they see their friendlosing tons of weight without

(56:44):
having to go on, you know, justthis juice fast or something
like that. It's a veryattractive, it's very attractive
if people things, people aresaying, This is great, it's very
hard to compete with that, iswhat I've said.

Eric Balcavage (57:01):
Yeah, well, our job is still not to be the boss.
Our job is to is to be thecoach, right? And so I think if
we, if we had the ability tohave a functional health coach
in every practice that prescribeGLP one drugs, and say, Okay,

(57:25):
this you're coming in, you'reasking for this GLP one drug.
Let me explain to you the prosand the cons, and let me explain
to you the options. Ultimately,you should be able to make this
GLP one drug, but you're not,because of these reasons, and we
can provide the medication thatyou want with no education and

(57:46):
assistance, and you just takethe drug. And when you're done,
you're done, but be aware thatthere's side effects that come
with it, reduction of bowelmovement motility that can
create some significant issues,gallbladder problems,
micronutrient deficiencies,there's a whole host of awesome
yeah, right, right. So if you'regoing to take it, I want you to

(58:08):
know that we can just prescribeit, and you can walk out the
door and nobody bugs you. Or wecan also provide life lifestyle
strategies along with that, sothat way you understand how you
need to can eat while you'retaking this. You're it's going
to have an you have to befocused on what your protein

(58:29):
intake is with this and some ofthe other factors with it. And
we can help educate you as towhat probably caused you to have
the obesity and the decreasedGLP one production, so that as
you learn those things and youmake the appropriate changes in
your diet and your lifestyle,and we use some things to help

(58:50):
change your gut biome, you awon't need the medication, and
when you come off you won't havethe typical rebound effect that
a lot of people do, whereThey've lost weight, but they've
lost a lot of muscle mass, nowthey return regular eating,
back, whatever that is for them,with less actual muscle mass and

(59:11):
still a chaotic and dysbioticbow. And you're going to be
you're going to gain weight andit and it'll be even harder to
lose the second time if we gavethem that option. And maybe it
is, I don't spend much time in apractice,

Anu Simh (59:24):
But it's that would be the ideal situation, right? That
is what is going to help us as anation, change from this, you
know, this metabolic mess thatwe find ourselves in, to really
kind of changing and for ourchildren. I, I am so bothered by

(59:45):
it at so many stages, with justkids being so obese, kids having
type two, which is an adultonset, is no longer adult onset.
Blood sugars rampant. I comefrom a country where I, when I
left my country, India. I, Idon't think I ever saw obese
people, you know, it wasn't, itwasn't the norm. I came to
America and so, oh my gosh,there are obese people, you

(01:00:08):
know? I didn't even it. Didn'teven was in an art, you know
what I grew up with. Now, it isjust shocking to see obesity
being so rampant in cities.Insulin resistance is rising
every single day, people onmedications, it's same thing.

(01:00:28):
Everybody is on the standardAmerican diet. You know, it's
the or the Western diet, and youhave to connect that Western
diet with the microbiome, withthe Mito, mitochondrial
dysfunction, with the hormonalimbalances, all of that really
work together, not just onething, but I start with the

(01:00:49):
microbiome, because it'sconnected to food, and it's an
easier step into it for forcoaching purposes.

Eric Balcavage (01:00:57):
Yeah, it's a shame. I think, you know, we, we
have two industries that havetwo different jobs, the
allopathic approach and thefunctional approach. And we've
looked at these as competingentities for for way too long.
And what we really need to do isbuild that bridge so that if

(01:01:18):
you're in crisis, we have thetools to do that. But if you
have a disease or a condition,and we manage the crisis effect,
or you're you're not in a needyet for crisis management,
there's an option for peoplejust to say, Well, you're not
bad enough yet to come backlater. We need to be able to

(01:01:38):
have that bridge where that yourthat GP says, Look, you're
gaining weight. Your obesityisn't the cause of disease.
Obesity is the effect of chroniclow grade inflammation. Yeah.
And so if you want to loseweight, you got to fix your
chronic low grade inflammatoryprocess going on. I don't have a

(01:01:59):
tool to fix it for you, that isdiet, lifestyle and management,
but there are, here's thefunctional medicine
practitioner, functionalmedicine coach, who can help you
with those diet, lifestylethings, it and so you don't have
to come back to me for a crisistreatment, but I'm here if you
need me, but that's the option.We're either going to be loading

(01:02:20):
you with drugs into perpetuity,or we can get busy trying to
address the root issues and letit to the person, but I don't,
unfortunately, people think it'sone or the other, and the
clinicians, I think sometimesthink like negatively of the

(01:02:41):
other profession, because, andthey're like,

Anu Simh (01:02:44):
There's no room, like I was, we were on our podcast,
we had an very an acupuncturist.He said, I have no place in this
model, so I have to find my ownplace in the sense that in the
allopathic world, oh yeah, anacupuncturist is not I mean,
they may just say, oh, somepeople, well, who knows

(01:03:05):
something about acupuncture? Maysay, Yeah, you know, go see an
acupuncturist or a chiropractoror something like that. But most
people have a very black andwhite approach to that. Oh,
chiropractors, they don't knowanything. Or acupuncturist,
that's all Eastern medicine,Ayurveda. But who's really
thinking of asking the clientwhat he or she wants? Right?

(01:03:28):
Maybe they are, are Asian. Maybethey need to go to an Asian
practitioner who understandstheir metaphors and and their,
you know, lifestyle way better.So a lot of it becomes, even
though we are melting pot, itbecomes a cultural issue. You
know, food is so cultural. Soreally speaking to their

(01:03:49):
language makes such it's moreimpactful. I think, rather than
just saying, Oh, you need to goon a Mediterranean diet, and you
say that to someone who'sdoesn't know what that is or
cannot connect, that's reallynot achieving anything. And
that's the same thing that'shappening with the medical model
as well.

Eric Balcavage (01:04:08):
Yeah, and that, and that may you know, for the
same you know, somebody who'sfrom a different area of the
world, what's your culture? Whatdo they eat? Let's eat a healthy
version of your cultural diet,right? Versus a maybe processed
version of your cultural dietthat could be more beneficial
for them.

Anu Simh (01:04:24):
Italian. Stop eating pasta.

Eric Balcavage (01:04:29):
You can, but they may not listen.

Anu Simh (01:04:31):
So how do you eat the pasta? Right? I mean, that's
what I coach them to for bloodsugar balance. I mean, if you
are going to eat pasta, why notchoose a pasta that has a little
bit more fiber in it, or add allof these bitter beans that
trigger those bitter receptors,and then maybe having some
adequate protein so you insulin,your blood sugar spike is not as

(01:04:53):
profound. That is the best wecan do, as you know, as doctors
or because. You can't give theman ultimatum like that is going
to kill you. Don't eat that. Youcan say that. But what? What are
the chances it's going to besustained?

Eric Balcavage (01:05:08):
Yeah? Yeah. I think learning how to eat from
that, from sitting down,relaxing, chewing your food, not
drinking a lot of fluid, how youprepare your food so it's so
that it manages blood sugar andhas the best effect. Those are
all things that I don't a lot ofus didn't learn, and nobody's

(01:05:29):
taught us. We just throw stufftogether, right? And

Anu Simh (01:05:32):
I mean, I, I, you know, my grandfather was a
physicist, doctor Eric, and hewas also a renaissance man. Was
always experimenting with foodand Ayurveda and connecting it
to science and and he was thefirst person I saw really
sitting down and and chewing hisfood. And he said, I know, chew
your food about 32 times. Isaid, Grandpa, where did you get

(01:05:54):
that from? And he had heard, Ithink his name was Harold
Fletcher. You know, he was thisAmerican Hippie kind of person
who was would kind of proposethe idea that we need to really
Chew it well. And then he camewith the 32 you know, twos, but
my grandfather that time wasactually testing it out, and he

(01:06:16):
said, I remember my digestion isbetter. I'm not sitting in the
toilet, as much as I used to myyou know, he connected, started
connecting the dots, and hestarted telling everybody about
it, saying there's some truth tothis. Slow down. Enjoy your
food. Listen to that. Where doesdigestion really begin? It

(01:06:37):
begins when you see the food,you smell the food. What's
happening in your mouth? Psych,IgA, all of that. You know, it's
that's a lot of there's a lot oftruths to that, and just getting
that ancient wisdom andconnecting to modern science is
something that I absolutely lovedoing, because I see value in

(01:06:58):
all of this.

Eric Balcavage (01:07:00):
Yeah, we could talk more about that, but I want
to move on to another topic. SoI wanted, I want to get your
opinion, like, in where in yourmodel, where do you see the use
of probiotics? Probiotic foods,prebiotic foods. How do you

(01:07:25):
where do you see them? There'sso many probiotics on the
market, there's a lot ofdisinformation regarding
probiotics. I've had discussionswith people about, and we've
talked about on the podcast someof the kind of the warnings,
things to look for when you'rewhen you're purchasing a
probiotic. But where does wheredoes the probiotic conversation
and fermented foods fit in yourmodel of healing?

Anu Simh (01:07:49):
Great question. In the book, I propose a simple diet. I
call it the flourish diet. I'malways being fascinated with the
idea of flourishing. So Ibelieve that to flourish from
within is the best place tostart. You know, because if
you're not flourishing fromwithin, all of the things that
we want to do in our life, youknow, be it an ED guy or, you

(01:08:11):
know, purpose in life is for notbecause we're not feeling well
in our bodies. And connect thatto eating and feeding our
microbiome, and feeding ourbodies and and taking that
further, we have a foundationlayer. Foundation layer comes
from all these diverse prebioticfibers. The prebiotic fibers

(01:08:34):
feed the gut bacteria, and it'svery easy to say, just take this
supplement or a probiotic. Butit really depends on the client
and what the client if theclient has a problem, let's see
the the media's darling,akermansia. You know, everyone's

(01:08:54):
talking about it. So a lot of myclients will will say, Should I
be taking akermansia Well, firstof all, why do you need that?
You know, what are you? What doyou know about a akermansion?
Well, I feel like if I takethat, I'll drop the weight. So I
talked to them in that contextabout transient microbes. And

(01:09:17):
you know, what kind of benefit aprobiotic will give the body
when it's when it when you'retaking it. What sees this to
happen? Do they attach to theyou know, to your lining and and
and just education aroundprobiotics? The biggest
confusion around probiotics isaround food probiotics and and

(01:09:39):
supplements. They they buy anyshiny new object, a yogurt that
looks really yummy and you know,but looking at the label,
looking at if it says containsprobiotic culture solutions, to
my client, don't bother, becauseif they haven't taken the time
to even tell you what kind ofprobiotic strains are. In the

(01:10:00):
yogurt. Why do you want to spendyour hard earned money on it?
Instead? Look for yogurt thathas very specifically a strain
that's mentioned. So let's say,give me that is 212 or lactic
suicide, dry or all wellstudied, you know, strains, and

(01:10:20):
then you can make do your ownresearch, go to PubMed, research
it, and see what the connectionis. Do you really need that? You
know, a lot of times they'lltake something. It makes them
feel worse, for instance. And soI always start to answer your
question. I start with food.Yeah, I feel like feeding the

(01:10:42):
microbiome is better. And it's,it's cheaper, it's, it's
sustainable, and it, it reallyhelps. It's easy to grow,
butyrate producers, you know,faculty bacterium from HCA, or
superior or ubacumen, just byeating the right kinds of good

(01:11:03):
probiotic, probiotic, fabulous.So that's where I started
conversation,

Eric Balcavage (01:11:09):
And that's where you know, we weren't designed to
get a capsule with 50,000colonizing units in it, or or 50
million colonizing units in it.That's not really how the
physiology was designed. It wasdesigned to get it from food,

(01:11:31):
from fiber, the combination ofthose things. But we, you know,
I get it. It's sexy. And peoplesay stuff. There's other things.
There's other challenges withprobiotics, especially when we
start to see combinations ofprobiotics put together that
don't play well together in acapsule.

Anu Simh (01:11:49):
Thing, you know, you could have one strain, like
yesterday, I was talking tosomeone who said 299, feet, you
know. And but it wasn't justthat, which, in it, by itself,
is being studied really well,but they had added a whole bunch
of other things to make it theirproduct, that connection, that
symbiosis, right there. Do weknow if it works? Do we know if

(01:12:12):
that that thing is going towork? No, we don't. So I said,
well, the bottom line is, wedon't know. You know, we just
know about this particularstrain. But together, this
marriage, is that working? Wedon't know. So do you want to
take it, you know?

Eric Balcavage (01:12:27):
Yeah, I've had Jeff Thurston on he, he's, uh,
he's the owner of mastersupplements, and he's been
making probiotics. He's like,you know, there's this world
behind there, and he's a littlebit resistant sometimes to
really dig in and say things outloud. But he says that, like a
lot of these things, just youput them together, and we put

(01:12:47):
them together because they'rethe sexy probiotic at the
moment, we put them in acapsule, but we know that they
don't, they don't play welltogether in in there. So you're
there, essentially you'regetting in an effort to get this
sexy looking combination of ofprobiotic bacteria you may not
have much in there by the timeit gets in. And the other pieces

(01:13:09):
is that getting if you if youreally have healthy gut
physiology, your saliva iskilling some of the bacteria,
your stomach acids killing someof the bacteria, your bile, your
pancreatic enzymes,

Anu Simh (01:13:23):
Yes at every level, we have so many parameters, like,
Stop, you know, like, it's agatekeepers, you know, for
what's happening. But if entrylands in the COVID, I mean that
I see a lot that holds SIBO, youknow, issue and and that's where
the problems really start forpeople. When they end up with

(01:13:46):
something like SIBO, they reallycut out a lot of these trigger
trigger foods. And a lot of themare these high fought map foods.
And they've been off of thesehigh FODMAPS foods for for a
long time, and they don't knowhow they're going to respond to
it, and really get nervous aboutadding it back, you know? So I

(01:14:09):
do see that a lot. And then inthere the MMC, there's fasting
that can really help. There's somany, so many things that that
can help, not just getting themgetting rid of a bunch of
bacteria that have translocatedto the wrong you know, that's

(01:14:29):
not the only thing. It's theaftermath of that. How do you
coach them to start eating thefoods that they are so afraid of
eating?

Eric Balcavage (01:14:38):
Yeah, and yeah. I think you have to coach two
things, right? Because the SIBOis always the result of and what
happens, typically intraditional SIBO is they treat
and then they know they're goingto wind up treating 90 to 120
days later, because it tends toreoccur. And part of the reason
it reoccurs is the state of theindividual. They're in a

(01:14:59):
sympathetic DOM. And it statesso stomach acid is down
regulated. Bile physiology isdownregulated. Pancreatic
enzymes down regulated. Nowwe've lost the innate immune
system in the GI tract to befunctional, to be as functional
as it should be. And nowbacteria from our oral cavity or
food gets into that, into thesmall bowel, and it's like, hey,

(01:15:19):
there's nobody here to managelike it's a party, and it can
hang out there, and they getfirst crack at that food that's
coming in, and can ferment it.And people do exactly what you
say. They go on a SIBO baseddiet, and they do
antimicrobials. And I'm like,but if you're not, what about
your stomach acid production?And what about physiology?

Anu Simh (01:15:38):
I really have an opinion about if I have an
opinion, it's about that. It'sabout, if you take, like, let's
say, a stool test that's goingafter these pathogenic bacteria,
how many pathogens are you goingto fight instead? What if we did
grow a lot of the beneficialbacteria to fight the battles
for us is, I feel like a lot ofstudies are kind of pointing to

(01:16:03):
in that direction, and I findthat a little bit more doable
than just saying, We kill thisbacteria, kill that bacteria. I
mean, like, it doesn't makesense, and it's easier for the
client to rather than justchasing, unless it's something
huge, right? Yeah, right, orsomeone has Giardia, or, you

(01:16:25):
know, things like that,

Eric Balcavage (01:16:27):
Most of the problems are an imbalance of the
commensal bacteria in the firstplace. They're not pathogenic
issues. And the argument

Anu Simh (01:16:35):
It is like 1% Yeah, something very small, yeah.

Eric Balcavage (01:16:38):
And the argument I make, even from a pathogenic
standpoint, is if you alreadyhave a healthy gut biome and
healthy defenses, even if youget a pat more pathogenically,
an organism that's more likelyto create a pathology if you
have a we've never test how manypeople have been exposed to one

(01:16:58):
and dealt with it. We always seethe people that didn't have the
capacity to manage and deal withit, but we have systems in place
to deal with the a lot of thesethings coming in. So if you're
in a healthier state and youpick up a bug, somehow you're
many times, your body's going tobe able to deal with it. Yeah,
you may get some level ofsickness or illness short term,

(01:17:19):
and then it goes and your bodyrecovers. It's the person,

Anu Simh (01:17:22):
You are right about the immune system, right? I
mean, and then connecting it toa Brazilian microbiome, a
resilient microbiome, bydefinition, is a microbiome that
can bounce back after anillness, after a trip to Mexico
and after round of antibiotics.And the immune system plays a

(01:17:42):
huge part. And the microbiome islike the training ground, these
beneficial bacteria the trainingground for the immune system. So
it's so connected, so we can'treally look at it from a single
lens, you know, just us.

Eric Balcavage (01:17:56):
Absolutely it is. It's a complex topic, but
it's good to to keep nuancingthe conversation a little bit,
and we didn't in thisconversation. We didn't get into
strategy and like what productsor anything, I usually shy away
from that to begin with, but Ithink we covered what's really

(01:18:16):
important, which is a ingeneral, we should eat a whole
food based diet as kind of ageneral idea. And then two, we
really have to be focused on thestate we're in, because that
changes the biome. And we needto start nurturing. We got to
look at our habits and ourbehaviors and say, Okay, what

(01:18:38):
are the things that are the thatI have, that I have the lowest
level of health in and how can Iincrementally start to improve
those things, which thenproduces less stress on the
physiology, which then allowsfor a healthy, healthier
digestive capacity, healthiergut biome, and that's how we get
healthy. That's how we stayhealthy, versus what's the best

(01:19:00):
gut protocol, and what's thebest way? What's the best fad
diet I can do that's going tocreate change? Fad diets can
create change. They can changethe biome like pretty quickly,
but that doesn't mean it's along term benefit in most cases.
So let's wrap this up, becausewe're kind of at the end of that
time frame. But tell people alittle bit about you, what you

(01:19:24):
do, your book and your podcast.

Anu Simh (01:19:28):
So I am a board certified functional health
coach. That really means that Itake people from where they are
to where they want to go, andit's largely women who are busy,
women who are struggling with,struggling with living at the
ideal weight. They have a lot ofthe thyroid symptoms, you know,
gut issues, you know, and Iconnected, and I use my

(01:19:51):
Protocol, or I didn't even wantto call it a protocol. It's just
an a system that helps them digdeeper in. Into the microbiome,
brain, nervous system,regulation, hormones, and I
coach them. And we all of thisthrough helping them see

(01:20:12):
behavioral changes. My businessand my philosophy is nine arms
of wellness. You know, I justreally don't think it's a single
prong approach. It's all ofthese arms that really help us
take us to optimal wellness. Andmy website is nine arms of
wellness com. My Instagram isnine arms of wellness as well.

(01:20:35):
And my book is called flourishfrom within, and it's going to
be out end of the month, andit's available where all books
are sold, and it's also going tobe on my website.

Eric Balcavage (01:20:46):
Fantastic. Well, thanks so much for coming on the
thyroid Answers podcast, and I'mI'm looking forward to maybe
another conversation in thefuture.

Anu Simh (01:20:54):
Thank you so much, and I'm looking forward to having
you on ours on that message.

Eric Balcavage (01:20:58):
Awesome. I'm looking forward to it too.