April 11, 2025 • 45 mins
In this episode of Thyroid Strong Podcast, Dr. Patrick Hanaway MD discusses the crucial role of gut health in managing Hashimoto's disease. Emphasizing a food-first approach, Dr. Hanaway explains how what you eat and prebiotics, rather than probiotics, can help balance the gut microbiome and improve your overall health. He highlights the connection between gut permeability, inflammation, and autoimmune diseases, and delves into the impact of diet on gut diversity. The episode also covers the potential effects of medication on the gut microbiome, the importance of prebiotics, and the role of postbiotics in maintaining gut health. Dr. Hanaway shares insights on the gut-brain axis, fecal transplants, the significance of vagal tone, and practical steps for improving gut health, including the five Rs: Remove, Replace, Reinoculate, Repair, and Rebalance.
Highlight:
00:00 Introduction to microbiome that can play a role in Hashimoto's
00:31 Understanding Hashimoto's and Gut Health
01:44 The Role of the Gut Microbiome in Autoimmune Diseases
06:52 Medications and Their Impact on Your Gut Health with Hashimoto’s
11:13 How what you eat can shift your gut
16:35 Probiotics, Prebiotics, and Postbiotics Explained
22:19 Fecal Transplants and Postbiotics
31:01 How the Gut-Brain Axis works and Mental Health
38:06 Practical Steps for Improving Gut Health
44:22 How to find certified practitioners
If you need a root cause functional medicine approach to your Hashimoto's: https://www.dremilykiberd.com/functional-health-coaching/
If you are looking for the only doctor-designed work out program for Hashimoto's: https://www.dremilykiberd.com/thyroid-strong/
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Dr.
Patrick Hanaway, welcometo Thyroid Strong Podcast.
I am so excited to have you here.
I watched so many of your lecturesinside of Institute for Functional
Medicine, and they were so approachableand digestible and so informative, so
I wanted to bring you on to share withthe listeners your wealth of knowledge.
Thank you so much.
(00:20):
It's a great pleasure to be ableto reach out to Thyroid Strong and
your great following that you have.
the listeners of this podcast haveHashimotos and oftentimes if they
have only been maybe just diagnosedand then given medication, and then
sometimes they're just sent on theirway, they don't know that our gut health.
And the health and diversity ofour microbiome inside our gut
(00:43):
can play a role in Hashimotos.
Can you connect those two pieces?
Because some women are like, oh,I just thought it was my thyroid.
Why are we talking about my gut?
Right.
Well, I might even bring it up alevel from there cuz it's not just the
microbiome, but it is, the gut has suchan essential role in what's going on
and I'm sure you're familiar with, Dr.
(01:05):
Alessio Fasano's work on lookingat intestinal permeability.
And what we find is that is, so 12 anda half percent of the population has.
Hashimotos, something in that natureor something in, in that range, or at
least has the, predisposing factors forit and maybe have, autoantibodies but
not yet have changes that are going on.
(01:27):
Of course, there's the whole questionabout testing and diagnosis, but
we're not gonna go into that indepth cuz you've talked about
that a number of times previously.
Yeah.
So the first thing is, okay,so this person has some
kind of autoimmune diseases.
Autoimmune disease, thereare over a hundred different
types of autoimmune disease.
(01:48):
Hashimotos is actually themost common of all of them.
that's there.
And while many p people, includingendocrinologists, think that it's
just connected to the, thyroid itself,it's actually a representation of
an imbalance in the immune systemthat has systemic ramifications.
certainly thyroid imbalances havesystemic ramifications, but we
(02:11):
also find that people who have anautoimmune disease, The, number one
risk factor of an autoimmune diseaseis having another autoimmune disease.
So you're actually at increased riskfor celiac disease and lupus and
rheumatoid arthritis and Crohn's diseaseand many, many other kinds of things.
So that's important, but thatalso tells us, Hmm, there's
(02:32):
something else going on here.
And so when we start to lookat, what are common factors?
One of the things that Dr.
Fasano has highlighted through his,discovery of the zul and protein and
working with intestinal permeability,is that most autoimmune diseases,
and we won't say every single one cuzthere are a few exceptions, but most
(02:55):
autoimmune diseases will have somedegree of permeability in the gut lining.
And that permeability wherethere, where the molecules that
are in the gut, whether it's.
Foods, undigested foods, partiallydigested foods, bacteria, viruses,
parasites, toxins, many different kinds ofthings that come into our gastrointestinal
(03:19):
tract are moving through that those opengates and stimulating the immune system.
And the immune system is reacting.
So we know, like with Hashimoto'sthyroiditis, that there's a relationship
with gluten, and not everybody whohas Hashimotos has issues with gluten,
but certainly there are a number ofpeople who will have autoantibodies
(03:42):
to gluten and have difficulty,and that will have an impact.
and whether it's due to some molecularmimicry at the thyroid peroxidase enzyme,
the t the quote unquote TPO o antibodies,we're not entirely clear on that.
We've, see that there is a relationshipthat goes on, so we know that.
So there's permeability.
(04:06):
One of the things that has an effecton permeability is the balance of, is
there some inflammation or is thereirritation, or is there dysbiosis
in the gut microbiome itself?
so is there dysbiosis orimbalance that term we use?
Dysbiosis just means imbalance,and so think about it as there's
(04:26):
a community in each of us.
We have between 150 and 200different bacterial org families
of organisms, species of organisms.
Overall, there's trillions andtrillions of organisms that are there,
but they form a community and in thatcommunity they work and act together
(04:49):
to be able to perform the functions.
So I'm just gonna go brief side note here.
Yeah.
Functions as in functional medicineand we talk about functions, what we're
talking about, there are the functionsof do I assimilate and get what I need?
Do I have a mechanism to getrid of that which I don't need?
Do I have a mechanism for energyproduction, for communication,
(05:11):
transportation, infrastructureand defense and repair?
Those are the functions.
Those all have to happen evenwithin the gut, within this
community that is living there.
One of my teachers at WashingtonUniversity when I was there became the
head of the Human Microbiome Project,and he has said that the human gut is
(05:34):
the most complex ecosystem that hasever been discovered, and there are 8
billion of them on this planet, right?
We're all different in that way.
So you think, wow, that's really,there's a lot going on there.
And the microbiome.
If, the functions aren't being performedproperly, it will lead to permeability,
(05:55):
it will lead to inflammation, it willlead to maldigestion, it will lead
to immune dysregulation, also willlead to changes in the, products, the
chemicals that are produced will changethe way we feel, Anxiety, depression.
So there's a lot going on there.
(06:15):
And it has an impact directlyon the thyroid as well.
And so when we see Hashimoto thyroiditis,we have to first think the gut and think
about permeability and the microbiome.
We can go into depthon any of those things.
They said a whole bunch of stuff there.
Yeah.
So there you mentioned someof the things that can affect
(06:38):
our microbiome as well as the.
Permeability of the gut lining.
Mm-hmm.
I think one of the things that womendon't know is that certain medications
can change the gut microbiome.
Can you share, cuz I can't speakto medication as a chiropractor,
but I would love to tap into yourwealth of knowledge in terms of Okay.
You know, a lot of women think, oh, I'mjust taking this medication for a certain
(07:01):
condition, not knowing that it couldpotentially change our gut microbiome.
Well, I talked about the thingsthat the microbiome changes
will affect in the body.
What changes the microbiome will,the first piece is going to be
food, and I just have to notethat and we'll come back to that.
But the diversity of our foods, thenumber of different colors and types of
(07:23):
vegetables and things we eat will directlyaffect the diversity of our microbiome.
And we want a diverse microbiome.
Now the diversity in my microbiome,yours are gonna be different, but
as long as the functions happen.
And then there are a number of otherthings that if we eat foods that aren't
(07:45):
organic and we get exposed to toxins, thatwill have an effect on the gut microbiome.
If we eat foods or have medicationsthat have particular additives in them,
that will change the gut microbiome.
we find that a number of medicationswill have gluten in them.
we don't even know that, but you googleit online, you say medications with
(08:06):
gluten and you can get medicationsthat do not have gluten in them.
And you're like, why wouldthere be gluten in medications?
But, you know, a number of 'em aremade, with fillers or things that
have various kinds of, gluten orwheat-based, components in them.
but you can find ones that don't then.
Then of course, the anti-inflammatorymedications, the NSAIDs, the non-steroidal
(08:31):
anti-inflammatory and anti-inflammatories.
And whether we're talking aboutibuprofen or acetaminophen or aspirin
or nain or an naproxen or, Long list.
Yeah.
All are going to havea fundamental impact.
They actually cause some degree oflow-grade I irritation in the gut.
(08:54):
We know that, right?
That's like, oh, you could getulcers, you could get bleeding.
They actually cause permeability, thatpermeability that we talked about earlier.
And they cause changesin the gut microbiome.
Things like steroids of course,will have that kind of effect.
various hormones will have effects onshifting the distribution, composition
(09:15):
and distribution of the gut microbiome.
And so we've kind of gone through anumber of different classes there.
Now, the larger classes aroundantidepressants, anti-anxiety drugs,
and statins, those are things thatthere appears to be a shift when
they're given in the microbiome itself.
Whether that shift is sufficient toactually lead to an inflammatory process,
(09:40):
or systemic effects that part's unknown.
The things I've talked about upto this point in time, those are,
clearly known and documented.
but having awareness that there is goingto be a shift the simplest way frankly,
to understand, well, am I doing okay?
how do I tell if I'm doing okay or not?
Is to just basically look at, how manybowel movements are you having a day?
(10:04):
One or two is the best answer to that.
anymore, any less.
Generally gonna beproblematic in different ways.
And are they formed?
there's something called the BristolStool Scale, and it rates your poop
from being, runny to, to super hard.
from one to seven, andyou wanna be at four.
you wanna have it just be like a nice,as my friend Patch Adams used to talk
(10:29):
about a footlong floater, you wantlittle gross, but, you want to have
a well-formed stool and that's key.
Yeah.
so anyways, I'm kind of jumping ahead.
Yeah.
But people would ask that question, well,how will I know if things are IMB or not?
Is 70% of Americans will havean imbalance in their, will
have dysbiosis in their guts.
(10:50):
so it's a really high, percentage.
That's a very high percentage.
Do you think it's because of just someof the things that you mentioned that
we're exposed to or maybe, shiftingshifts in our eating patterns?
cause I know you do take like a foodfirst approach, like 70% is really high.
Almost everyone should be workingon their gut health Right, exactly.
(11:10):
In some capacity.
Exactly.
Well, and that's one of the things, whenwe're talking a little bit earlier, it is
like when someone who I'm working with,Isn't doing well, they're not improving.
I keep going back to thoseprinciples, food first and
what's going on with the gut.
Like, I want to getthat into balance first.
(11:31):
and what I found in my practice, evenearly on where I was really emphasizing
the food, but then I was finding, ohwow, these people actually aren't able
to digest and assimilate the food.
They had too much imbalance going onthat I needed to work to be able to
use what we commonly talk about as likea five hour program of remove what's
(11:53):
not working and replace what you needsupport and rebalance the gut microbiome.
And we can talk about that,with these terms of prebiotics,
probiotics, and postbiotics.
And then working onbeing able to, help to.
Reinoculate, or repopulate cuzyou're not really inno inoculating,
(12:14):
but repopulating the gut.
I wanna ask you this question though.
So I took this from your lectureand I love this and I don't
think many people know this.
Changes in diet can cause large shiftsin the microbiome in just 24 hours,
which is profound.
Cause I think a lot of people think,and we'll touch upon this kind of like,
prebiotic, probiotic and postbiotics.
(12:34):
But I think a lot of people think, oh,it's gonna be this long journey of like
rebuilding gut health and, but you couldliterally start to make large shifts
in your microbiome within 24 hours.
how does that happen?
Yeah, so it's repair, but repair.
Ah, I know you remember.
so we thought 20 years ago that therewas a core microbiome that everyone
(12:58):
had and that it was just tryingto help get people back to that.
It's through the techniques of themore recent molecular techniques,
which I could talk about atlength, but nobody really cares.
They're just like, we'vefigured out that there's a huge
difference amongst all of us.
and so we also found a.
When they were testing kidsand adults and following people
(13:21):
longitudinally, with earlier kinds ofapproaches, they find found that the
gut microbiome was pretty similar.
If you keep eating the samefoods, if you change your diet,
you can actually change it.
Dr.
Mez, most of us have heard of himand he did a little experiment
with using a smoothie, and he wasable to begin showing changes.
(13:45):
In a day in 24 hours with verysignificant changes at, or three days
period of time, in three days, you couldfundamentally change the gut microbiome.
And we'd seen this in mice, but wehadn't actually seen it in adults.
And it was like, oh, it'lltake about a month for it.
And he showed like, oh no, itactually starts happening in 24
(14:05):
hours and you're at a significantshift at three days period of time.
And then there's some further studiesthat have gone on and, and used like
a vegetarian diet, group that just avegetarian diet and then, had a washout
period, and then just a carnivorous dietwhere it was just like meat and cheese
and they could show shifts again in themicrobiome within 24 hours period of time.
(14:27):
So it kind of goes to what you eat andwhat's in your gut is what you eat.
Do you know if in that study that youmentioned, if there was a difference
in diversity, because I know therewas, huge shift in diversity that
happened at that point in time as well.
Yeah.
And, and so that's why, I reallyemphasize, the ability to, if you're gonna
(14:48):
use a smoothie, doing something that'sgot lots of different kinds of vegetables
or s sprouted vegetables in it, as a wayof, of being able to have a simple way
to do it if you're not, looking at yourplate and you should have five different
colors of fruits and vegetables, when yousit down to have at least your main meal.
But the other thing that's interesting,and my friend Deanna Minnick kind
(15:11):
of pointed this out and did thisreally fun, online program about it.
I think I have a diversity of fruitsand vegetables in my diet and I looked
down and I see lots of differentcolors, but she said how many different.
Vegetables you eat in a week period oftime, I can go through, it's like, okay,
so kale, cauliflower, broccoli, mushrooms,basil and avocado that can go through.
(15:37):
But there's about 12 to 15things that I eat all the time.
and then I started looking at, becauseshe said you should try to have 30
different kinds of vegetables every week.
30 and all of a sudden you're like, wow,I gotta go shop at the Chinese market.
I gotta get some thingsI haven't tried before.
I gotta learn how to cook them.
I gotta be more diverse.
I gotta bring other things in.
(15:59):
And she did an online thing of how manydifferent vegetables could people eat?
and my recollection is that thewinner was a woman and her 12 year old
daughter who was really compelled andthey had 149 different vegetables that
they ate in a week period of time.
That's pretty impressive.
That's impressive.
Yeah.
Yeah.
I didn't even know there waslike 149 in season at one time.
(16:22):
I wanted to speak to, a lot ofpeople know about a probiotic, right?
That's kind of like general public knows.
Not a lot of the general public knowsabout prebiotics or postbiotics and why
they are important for our gut microbiome.
Let's first talk about probiotics,because probiotics, we know, we take them.
(16:43):
These are, bacteria that are, created to,be similar to what's in our gut and to
help bring balance back to the system.
But what we found is is thatthe probiotics act as tourists.
They move through, theycause changes in the economy.
I live in Asheville, North Carolina,which has become a great tourist place,
(17:03):
and it's kind of like the town I movedto 27 years ago is fundamentally changed
because there's so many tourists andit's like you, over-rely on tourists.
You don't want that.
Probiotics can be very useful,just like antibiotics when they're
targeted a specific probiotic.
(17:25):
And even a strain at a specificdosage for a specific period of
time for a specific condition.
So that's great.
Now, a lot of people are saying,oh, I take probiotics to help
my overall health and wellbeing.
That's not actuallyever been demonstrated.
what we find is that the probiotics,even if someone is using a nice,
well-balanced probiotic formulationwith multiple different components,
(17:48):
you should shift it up every sixmonths if you're going to do that.
Now, what's more importantare the prebiotics.
The prebiotics are gonna be the foodsthat feed your bacteria in your God
to bring them back into balance.
And so there are prebiotics.
things like inulin andfr oligosaccharides.
(18:09):
I particularly like Acacia rootcan use potato starch as an agent.
those are both relatively inexpensiveand easily accessible as powders.
and then there's some other, fanciernamed Xlo oligosaccharides and,
ara, galactans and things like that.
But the prebiotics are helpingthe beneficial bacteria to grow.
(18:32):
And then what you also wanna bringwith that is you want to bring in
what are the foods that are goingto help direct the populations,
the right populations to grow.
And interestingly enough, the data showsus that the best foods to eat are berries.
And, the berries that have a redand black skin on them are gonna
(18:54):
be the best, red, blacker blue.
And so it's cranberries, blueberries,raspberries, black raspberries,
pomegranate, cherries, all of those.
And it's in the skin actuallythat has the flavonoids that help
the beneficial bacteria to grow.
So people will say, gosh, I'veheard of this thing called amania.
(19:15):
Yes.
and there's there's a product out thereACR mania has been associated with
decreased inflammation, but there's lotsof different bacteria that will have
an anti-inflammatory quality to them.
And so just taking the one thing is aprobiotic and it's a tourist that goes on,
but if you take a combination of somethinglike a Keisha root with blueberries and
(19:40):
blackberries and pomegranate, you actuallygrow amania and you can do that for
like, 15 bucks a month and eat berries,as opposed to, taking a probiotic that
may cost a hundred bucks a month andhas not been shown that when you take
the akkermansia, as soon as you stop,you don't have Akkermansia anymore.
(20:03):
Mm-hmm.
It's only good while it's there.
Whereas if you're eating the foods,you'll continue to help it to grow.
So it's an example.
So there's prebioticswhere my emphasis is now.
Probiotics are whenthere's a true imbalance.
If there was a probiotic for, Hashimotothyroiditis, I would tell you immediately,
I'd say This dose, this strain.
(20:24):
there's no data there.
There are things for irritablebowel syndrome and especially.
that aspect that's, mixed in nature.
There are probiotics forinflammatory bowel disease.
There are probiotics for interstitialcystitis and urinary tract infections.
These have been studiedand we can dial that in.
but for Hashimotos or for other autoimmunediseases, we do not have that yet.
(20:49):
we may find some that really act asspecific agents, but we don't yet.
So then we go to, well, what'sthis other term that you said?
I've never heard that before.
Postbiotics.
What does that mean?
Recall that I said we want to havethe functions of the gut to be working
(21:10):
all in balance with each other.
And I talked about those seven functions.
The way in which that happens, thediversity of many different people's
balanced gut microbiome, whether it'sa microbiome in Singapore or in Paris
or in Sao Paulo, there's diversity inbalance and we can tell there's balance
(21:32):
because the functions are workingproperly and the functions happen
through the production of postbiotics.
It's what the bacteria make.
And we now begin to see that,those things can affect the
mitochondria and energy production.
Those things can affect thebalance of the immune system.
(21:53):
Those postbiotics can affect thegut-brain access and lead to changes
in feelings of depression or anxiety orimprovement of those kinds of things.
So it's the postbiotics, which isprobably where You've heard some of
your people have heard about fecaltransplants, and that it's probably
(22:15):
through the postbiotics that thefecal transplants are having their
beneficial effect on the person overallof bringing them back into balance.
So there's a lot goingon in the conversation.
Yeah.
Fecal transplant is not the firststep or the first probably 20 steps.
I've, for people who I know whohave gotten a fecal transplant,
(22:37):
it's usually like the last resort.
And from what I understand,not always successful.
No, and where you get it from.
And there are peoplewho are, do it yourself.
Ooh.
where they get it well, where theyget it from someone that they know
and they create it themselves.
It's not actually legal in theUnited States to do a fecal
(22:57):
transplant at this point in time.
there are some new postbioticsformulations that come from
basically fecal transplants whereall the bacteria have been killed.
And so it creates apostbiotics, but what was it?
But you want to get it from a healthycohort, a healthy group of people.
(23:17):
So I wanna share just a brief story where.
A colleague of mine, Dr.
Tom Salt and I were talking in 20008, 9 10, about, starting a program
with fecal transplants for people.
And, I had gone to Australia andlearned how to do it from Dr.
Ted Barra, who's the mostwell-known person in this area.
(23:40):
And then I was talking to a colleague,at the group in, Cork Ireland, who
have some of the best GI doctors interms of the microbiome in the world.
And Dr.
Fergus Shanahan, said to me,Patrick, you understand that
changes in the gut microbiomecan have an effect on, of course.
(24:02):
Clostridium difficile, but also on heartdisease, on cognition, in Alzheimer's,
on liver disease, on osteoporosis, oninflammatory bowel disease, on mood
disorders of anxiety and depression.
I'm like, yeah.
And he said, so if you are taking a fecaltransplant from someone and you don't
(24:24):
understand what it's going to do, you giveit to them, and that person who wasn't
necessarily on a track for developingsome cognitive problems or some behavioral
problems or heart disease ends up movingin that direction and we just don't know.
do you want to do that?
(24:45):
Do you want to take on that risk?
Certainly if you have someone who's gotthis infection called C difficile that
it's approved for, these people are,are really sick and you can die from it.
And so you need to do somethingand it's 98% effective.
So it makes sense in that setting.
But if you've got someone with infl,with irritable bowel syndrome or
(25:07):
Hashimotos thyroiditis or depression,and they think that they're going to get,
benefit from a fecal transplant, wellthey may in that domain, but they may
develop some other kinds of problems.
And there are ways that we canwork to heal the lining of the gut.
through focusing on the diversity of themicrobiome, repairing the permeability
(25:31):
damages that are going on, replacing thedigestive enzymes and things that are
missing, removing the foods in generalthat are going to be processed foods.
I mean, that's job one, get rid of theprocessed foods and, then moving towards
balance in that way and that doesn't haveany risk associated with it of long-term
(25:54):
problems caused by the treatment.
Yeah.
I had a friend get a fecal transplant anda month later she had, her appendix burst.
She had surgery and I was like, oh,that's like a weird correlation.
And then she needed abunch of antibiotics, after
getting a fecal transplant.
Right.
Which was kind of a bummer.
Right.
and so I mean, there are ways, thereare some, clinics in the uk, in The
(26:15):
Bahamas, um, that have done these andthat use a very healthy cohort of people,
who are eating organic and they'reyoung and they're healthy and they've
been qualified and they don't haveany kinds of parasites or imbalances.
And I think that's areasonable way to do that.
But even in the patients I've had whohave gone to have that done, it's about
(26:36):
50% of them get significantly better.
And if 50% don't, and as a pretty bigask now, I had one patient who did a.
Do it fecal transplant, from herhusband, and she got improvement.
But, she continued to have problems.
She started taking this, postbiotics,kind of blend, and she got really
(26:57):
significant improvement from it.
So, I believe that there's ways thatwe can work with the concept without
actually doing a full fecal transplant.
And then there's poop pillsthat are coming out now.
One was just approved by the f D Alast week, and it's not really poop.
It's, basically a combination of bacteriathat have been derived, um, and have been
(27:21):
demonstrated to help with c diff, thisclostridium difficile, this bad infection.
but that's just where the data is on that.
there's some fascinating, research on.
Fecal transplant with autoimmunedisease, with autism, with mood
disorders, and with liver diseases.
There's some really cool stuff.
(27:42):
So we know that changing the microbiomewill change the overall physiology
of what's going on for people.
It's just there's ways to do withfood that are much simpler and easier.
In terms of the five Rs, thefirst one is remove, right?
And it's not only maybe removingcertain foods for potentially a period
(28:04):
of time, but then also addressingunderlying, infections or maybe
bacterial overgrowth or fungal overgrowththat could be happening in the gut.
Mm-hmm.
How does someone who maybe hasjust kind of gone like, okay, I
have medication for my thyroid.
How, can I even start to discover.
maybe I have a gut infection.
What would it be, working withsomeone and taking a thorough history?
(28:26):
Would it be doing a stool sample?
I know there's a lot of differentlabs that do different stool testing.
to start to kind of like walk thatpath of, okay, now we first is remove.
So in, the remove stage, I'm taking thehistory to find out when did this begin?
And if it's something that occurredafter, doses of antibiotics or something
that occurred after travel or somethingthat had more of like a, real defined
(28:50):
point source, it's like, oh, thisday, this is when it happened, then I
for sure go and, and wanna do a stooltest to be able to say, is it possibly
an infection that's going on there?
And, there's it, these kinds ofstool tests, the ones that are more
comprehensive are not the ones donethrough Quest and LabCorp, but done
(29:11):
through other specialty laboratorieslike the one that I used to be
the chief medical officer at, and.
In that process, they're gonna lookfor parasites, they're going to
look for worms, they're gonna lookfor, various kinds of potentially
pathogenic bacteria that are there.
they're gonna look for anovergrowth of yeast or fungus to
(29:33):
be able to see what's going on.
And they're also going toassess well, what kinds of, anti
bacterias or antimicrobial herbsare these things sensitive to?
And so, you can measure certain aspects ofthe immune system that will say, something
called immunoglobulin that when it'sreally high, it's like there's something
(29:53):
going on that the immune system is saying,Hey, I'm feeling attacked and I need to.
To go after this.
So there's ways to be able to lookat that testing to say, yeah, there's
something that needs to be done interms of an infection, that needs
to be brought back into balance.
And, while we can use foods andthings like that, if you've got the
(30:14):
irritant continuing to be there,it's hard to get back into balance.
And so yeah, it's removing foods and likein the case of Hashimotos thyroiditis
for sure, removing gluten and removingprocessed foods and doing that and
something like a whole 30 diet, a foodplan is a great kind of off-the-shelf
food plan that you can gain access to.
(30:37):
so that's the remove part of it.
Yeah.
You mentioned earlier this gut-brainaccess, And I wanna bring this up
because a lot of women with Hashimotoswill struggle with depression,
anxiety, and then also brain fog.
Mm-hmm.
And.
Maybe we'll kind of go the tr uh,route of, oh, well, maybe I should go
(30:57):
to therapy, or maybe I should work outmore to try and boost my endorphins.
And they don't know that there is thisconnection of the gut to the brain,
and maybe this should tap into that.
Yeah.
Yeah, there's a whole field, that wasdeveloped by, Danana and Cryer in Cork
Ireland called Psychobiotics, wherethey've been looking deeply at this area.
(31:21):
It's still in its infancy interms of is there a clear organism
that's going to be really helpful.
And, the one I favor at this point intime is something called Zen Biome.
it's made by Microbiome Labs.
I don't have any affiliation withthem, but the specific organism,
that's in there has been shown to bereally quite helpful for dealing with,
(31:43):
depression, anxiety, kind of neuroimbalances in the gut brain axis.
And people say, well, Really?
What, do you tell, like,how does that happen?
does the poop go into your brain?
Is, like, no, no, no.
There's pathways, both through thenerves as well as through the blood.
where sometimes, people may not know,but 95% of the serotonin in your
(32:06):
body, you've heard of serotonin.
your.
Audience is sort of serotonin becauseit's like this is what many of these
antidepressant drugs are, based upon.
They're, reuptake inhibitors.
You don't have enough serotonin but95% of it's produced in the gut.
it moves up into the brain.
there are also other kindsof neurotransmitters.
There are anti-inflammatories andpro-inflammatory agents that can move up.
(32:29):
They can move through the blood, theycan move through the vagus nerve, and
they actually aggregate in a certainarea, called the insular cortex.
Now, I won't get too, too detailed.
I told you, I, I wouldn't, butI, I love this stuff because it's
like what our gut feelings are.
Actually, they're our gut feelings.
They're like, what's happening in ourgut is having an effect on how we feel.
(32:52):
You know?
and it's that direct.
So yeah, there are agents now that we arebeginning to learn can have an effect.
now here I'm back on probiotics andyou can say, wait, he said before,
he doesn't focus on probiotics.
But if I'm working on a specificproblem, a specific issue that's there,
then I'm gonna use that as an agentfor a specific period of time at a
(33:13):
specific dose to try to affect change.
Knowing that my goal all along isto change the diet and to change
to the relationship, to stress.
I'm gonna kind of go off topicfrom here, but there's data now.
So the vagus nerve.
(33:34):
in your training, you knowa lot about the vagus nerve.
Yeah.
But the vagus nerve is not like Las Vegas.
It's, it's V A G U S and it's thewandering nerve and the wandering
nerve that comes down and comesdown the back of our throat.
And it, it affects ourproduction of digestive enzymes.
It affects our stomach, it affectsmotility, it affects our breathing,
(33:55):
it affects our heart rate.
It affects the rate ofmotility of the gut.
And there are differentbranches of the vagus nerve.
They go front and back,anterior end dorsal.
And there are Differenteffects that go on now.
One of the things that I've been learningrecently, and I've been interested in
the vagus nerve for a long time, butI've found that if your vagus nerve
(34:19):
isn't working properly because you'reoverly stressed, you're in fight or
flight response instead of in moreof a chill parasympathetic tone.
So you have parasympatheticchill sympathetic.
Flight, freeze appease.
And if you're, in that zone, thenyour vagus nerve isn't working very
(34:40):
well, you're not actually gonna beable to digest your food properly.
You're not necessarily gonnahave, even the supplements you're
taking be able to be incorporatedeffectively in what's going on.
and the vagus nerve is used asalso a conduit both to the brain
and back from the brain aboutwhat's happening in the microbiome.
(35:00):
it's a loop system, that is givingfeedback to what's happening in your gut
is affecting your feelings, is affectingyour overall habituated behaviors of
fight or flight or, freeze appease.
So how do we get into, a deepertone, a deeper balance point, and,
(35:21):
And I'm, want say one more thingabout that because it's typical
things like yoga, slow down, takea walk, be in nature, say prayers,
meditate, knit, all these things.
Help sitting in front of a TV and watchinga movie love, that's not gonna help.
(35:41):
it's gotta be active and then there'snow external vagal nerve stimulators
that actually can help with that as well.
Then one would say, well, I'm prettychill, I mean, my friends say I'm a pretty
chill guy, so I must not have a problem.
I really like measuringheart rate variability.
(36:02):
So heart rate variability is away to be able to say, where am I?
Because when we're young, in ourteens and early twenties, our
heart rate has a variability.
It doesn't just go dumb,dumb, dumb, like a metronome.
There's a little bit of variation.
So when we're young, that variation isas much of a hundred milliseconds, a 10th
(36:26):
of a second variation, and that's tellingus that we've got really good vagal tone.
We've got really good balancebetween our parasympathetic
and sympathetic nervous system.
Now, when you get to be in yoursixties like I am with aging, the
normal is that rate, we becomeless flexible, more restricted,
(36:49):
and that beat to beat variationis between 10 and 20 milliseconds.
It's like 10 90% less,
But you can, and you can measure it.
You can measure it using a toollike this aura ring that I have on
my hand right here on my finger.
You can use it by measuringother kinds of tools.
There's even new tools that are gonnabe coming out that will be able to
(37:10):
use the camera from your cell phoneto look at you and tell you what
your heart rate variability is.
So there's, it's an importantthing to understand and where
am I and what will help me.
you've maybe heard some of my ownjourneys, but I found that while being
in nature actually made the biggestshift for me, to be able to do that.
(37:31):
And so that's what works best for me.
The other things are helpful, but, findingout what works best so that there's,
it decreases intestinal permeability.
It changes the gut microbiome.
So between stress and food, thoseare your two biggest things that
you can So if because you alwayshear like, oh, trust your gut.
(37:51):
What does your gut say?
And I'm like, well, Imight have gut dysbiosis.
I don't know what my gut says.
My intuition might be off.
Yeah.
And you can actuallymeasure, what's going on.
there's stool testing that willhelp to be able to see is it
imbalance or is it, out of balance?
And one of the things, I'm gonna talkclinically for a moment, one of the things
I've learned is that what I wanna do withthe people who come to see me is I wanna
(38:14):
get 'em on a better diet right away.
I wanna get 'em off of processedfoods and I want to, help them.
Usually I stop gluten at leastfor a trial and then add it back.
And so it's a four, six week process.
Then I see if they're still notfeeling well, then I test the gut
because I, already know like, well themain drivers are gonna be there, so
(38:38):
let's see if things are in balance.
Are you in balance?
if your food and nutrients andthings are moving in a good way.
And then I I think a lot of women,like to default to food sensitivity
testing to kind of determine what theyshould eat and what they shouldn't eat.
And I think, it's not the right approach.
Can you share why I, cuz I think,I get a lot of messages like.
(39:00):
What food sensitivity testing,and I was like, maybe none.
Maybe there's a better way.
Well, I'm, I think I'm a littlecontroversial in this area and
as I said, I worked for a labthat did this kind of testing and
so I'm really familiar with it.
but I was never supportive of itbecause what happens is that if you have
(39:23):
permeability, you will have reactivityto the foods that you're eating.
And if you switch the foods that you'reeating and you have permeability,
now you'll have a reaction tothe new foods that you're eating.
Mm-hmm.
So there, are some aspectswhere some people are uniquely
(39:43):
responsive and are reactive tospecific food groups, whether it's.
Corn, dairy or, beef or gluten.
but that's why I work with a foodchallenge, an elimination diet to
remove those things initially, andthen, and then start adding back
after three to four weeks periodof time and see how do I feel?
(40:06):
Yeah.
because is, There's novalidation of i g G food testing.
Now I hear, I'm talking about allergytesting, cuz there that's important.
And the IgE E food allergy testingcan be really useful if you have a
specific thing that you are reacting to.
but the IgG G testing, it's justnot re reproducible, across labs
(40:29):
or over time because it's moreof a reflection of permeability.
And the other big thing, and I'm sureyou've seen this in practice, I see people
walking around carrying cards and thingsand saying, oh, I can't eat all these.
I have this test.
I can't eat all these foods.
And has developed something that the term,that has emerged is orthorexia nervosa.
(40:52):
and that is, why my immunology friendsand rheumatology friends really don't
really speak strongly against thiskind of testing because it gives
a false notion and it limits thediversity of foods that people eat.
Not a good thing.
Which then in turn limits potentiallythe diversity in our gut microbiome.
(41:13):
Right?
Exactly.
Yeah, exactly.
Yeah.
And we see this with people who areeating like a sibo, low FODMAPs diet also.
I mean, if people have smallintestinal bacterial overgrowth, yes.
It's a real thing.
Yes.
There's bloating there.
Yes.
Eating a diet that does not contain, a lotof these, what are called FODMAPs, fructo,
(41:34):
Olivo, monosaccharides, and polyols.
You don't have to remember that, but,They come from lots of vegetables.
What's useful in the short term to helpbe able to get, gain some balance back,
but it's not useful in the long term.
But I see a lot of people whostay on that diet, and it's,
it's not a good long-term diet.
For, people who do introducean increase in vegetables and a
(41:59):
diversity, and they might have somebloating or maybe indigestion, what
do you recommend for those people?
Because they're like, I wannatake a food first approach.
And then they start to, maybe itdoesn't sit well with them at first.
there's a couple different things.
One of 'em is like with a lot of theprebiotics that I mentioned, if you
(42:23):
actually don't have a balance in yourgut and you take a prebiotic like inulin
or fructooligosaccharides, f o s, theycall it, that's gonna cause more of
a non-specific growth of everything.
And if you're outta balance, You're gonnakind of accentuate that, So starting
slow with it and going with a low doseof a, of a prebiotic, and then beginning
(42:44):
to look at it, journaling like, well,what foods do I notice are a problem?
and they tend to fall in categories.
So sometimes it's, it's morelike the, the Allisons, like the
garlic and the onions and theshallots and things of that nature.
For other people, it may be more ofthe nightshades that cause imbalances.
And so work to say, how doI begin to parse this out by
(43:05):
the foods that I'm eating?
and the other thing is thatwhen you change your diet,
it is totally expected, dude.
You're gonna have some shifts.
In the gut in the first weekperiod of time, and you wanna kind
of move through seven to 10 daysto say, well, where am I at now?
Now if you're still having bloatingand problems at that point in time,
(43:26):
then you gotta do what I just said,start to look at which food is it.
but give it seven to 10 days on the frontend because that's when the, shifts are
occurring and you're trying to find whatthe new balance is to be able to do that.
and as I said earlier, and, as youwork with those things, if after a
four to six week period of time you'restill having significant issues, then
(43:47):
that's a time to be able to do testing.
Such a great mindset shift, right?
Cause I think some people think, oh,I've been doing this for two days.
why isn't my bloating better?
so I think that's a great reframe.
drhanaway, thank you so much forall the information you've shared.
Where can people find you andwhere can people work with you?
(44:07):
Well, I'm laughing because, I'm nottaking new patients at this time that my
career is focused on being able to educateproviders through the Institute for
Functional Medicine at this point in time.
And, it's a passion toteach and I love to do it.
So where I encourage peopleto go is if fm.org/find
a practitioner or if you justgo to the main page on the upper
(44:30):
right hand side, there's a find apractitioner, and these are people
who have been through the training.
if you find someone who's an I FM, certified practitioner, they've
gone through, they've been tested,they understand what's going
on, and you can search by yourzip code or by your state and.
set a distance area.
We've got, thousands of practitionerswho are trained now and tens of thousands
(44:53):
of practitioners who have, begun tolearn the process that's occurring.
So I feel really, pleased that wehave, been able to do training get
people in into your neighborhood.
And I send people to that link all thetime cuz I have, women are like, where
do I find someone in North Dakota?
And I'm like, well go to if f m Yeah.
Check for practitioners.
(45:13):
Yeah.
Mm-hmm.
Yeah.
Well, thank you so much.
I have taken a bunch of notes andI'm sure the listeners have as well.
So thank you for sharing your wealthof knowledge and I really loved our
conversation and thank you for being on.
Oh, you bet.
Thank you so much.
And thank you for the work that you'redoing to empower women, and help them
to recognize that, when we're outtabalance, it's just a call to be able
(45:35):
to help find what's going on in my lifeand how do I move back into balance.
And then you're sharing that andhelping people to be on that journey
of healing to become a whole.
I really appreciate it.
Yeah, thank you.
Dr.
Patrick Hanaway, welcometo Thyroid Strong Podcast.
I am so excited to have you here.
I watched so many of your lecturesinside of Institute for Functional
Medicine, and they were so approachableand digestible and so informative, so
I wanted to bring you on to share withthe listeners your wealth of knowledge.
Thank you so much.
(00:20):
It's a great pleasure to be ableto reach out to Thyroid Strong and
your great following that you have.
the listeners of this podcast haveHashimotos and oftentimes if they
have only been maybe just diagnosedand then given medication, and then
sometimes they're just sent on theirway, they don't know that our gut health.
And the health and diversity ofour microbiome inside our gut
(00:43):
can play a role in Hashimotos.
Can you connect those two pieces?
Because some women are like, oh,I just thought it was my thyroid.
Why are we talking about my gut?
Right.
Well, I might even bring it up alevel from there cuz it's not just the
microbiome, but it is, the gut has suchan essential role in what's going on
and I'm sure you're familiar with, Dr.
(01:05):
Alessio Fasano's work on lookingat intestinal permeability.
And what we find is that is, so 12 anda half percent of the population has.
Hashimotos, something in that natureor something in, in that range, or at
least has the, predisposing factors forit and maybe have, autoantibodies but
not yet have changes that are going on.
(01:27):
Of course, there's the whole questionabout testing and diagnosis, but
we're not gonna go into that indepth cuz you've talked about
that a number of times previously.
Yeah.
So the first thing is, okay,so this person has some
kind of autoimmune diseases.
Autoimmune disease, thereare over a hundred different
types of autoimmune disease.
(01:48):
Hashimotos is actually themost common of all of them.
that's there.
And while many p people, includingendocrinologists, think that it's
just connected to the, thyroid itself,it's actually a representation of
an imbalance in the immune systemthat has systemic ramifications.
certainly thyroid imbalances havesystemic ramifications, but we
(02:11):
also find that people who have anautoimmune disease, The, number one
risk factor of an autoimmune diseaseis having another autoimmune disease.
So you're actually at increased riskfor celiac disease and lupus and
rheumatoid arthritis and Crohn's diseaseand many, many other kinds of things.
So that's important, but thatalso tells us, Hmm, there's
(02:32):
something else going on here.
And so when we start to lookat, what are common factors?
One of the things that Dr.
Fasano has highlighted through his,discovery of the zul and protein and
working with intestinal permeability,is that most autoimmune diseases,
and we won't say every single one cuzthere are a few exceptions, but most
(02:55):
autoimmune diseases will have somedegree of permeability in the gut lining.
And that permeability wherethere, where the molecules that
are in the gut, whether it's.
Foods, undigested foods, partiallydigested foods, bacteria, viruses,
parasites, toxins, many different kinds ofthings that come into our gastrointestinal
(03:19):
tract are moving through that those opengates and stimulating the immune system.
And the immune system is reacting.
So we know, like with Hashimoto'sthyroiditis, that there's a relationship
with gluten, and not everybody whohas Hashimotos has issues with gluten,
but certainly there are a number ofpeople who will have autoantibodies
(03:42):
to gluten and have difficulty,and that will have an impact.
and whether it's due to some molecularmimicry at the thyroid peroxidase enzyme,
the t the quote unquote TPO o antibodies,we're not entirely clear on that.
We've, see that there is a relationshipthat goes on, so we know that.
So there's permeability.
(04:06):
One of the things that has an effecton permeability is the balance of, is
there some inflammation or is thereirritation, or is there dysbiosis
in the gut microbiome itself?
so is there dysbiosis orimbalance that term we use?
Dysbiosis just means imbalance,and so think about it as there's
(04:26):
a community in each of us.
We have between 150 and 200different bacterial org families
of organisms, species of organisms.
Overall, there's trillions andtrillions of organisms that are there,
but they form a community and in thatcommunity they work and act together
(04:49):
to be able to perform the functions.
So I'm just gonna go brief side note here.
Yeah.
Functions as in functional medicineand we talk about functions, what we're
talking about, there are the functionsof do I assimilate and get what I need?
Do I have a mechanism to getrid of that which I don't need?
Do I have a mechanism for energyproduction, for communication,
(05:11):
transportation, infrastructureand defense and repair?
Those are the functions.
Those all have to happen evenwithin the gut, within this
community that is living there.
One of my teachers at WashingtonUniversity when I was there became the
head of the Human Microbiome Project,and he has said that the human gut is
(05:34):
the most complex ecosystem that hasever been discovered, and there are 8
billion of them on this planet, right?
We're all different in that way.
So you think, wow, that's really,there's a lot going on there.
And the microbiome.
If, the functions aren't being performedproperly, it will lead to permeability,
(05:55):
it will lead to inflammation, it willlead to maldigestion, it will lead
to immune dysregulation, also willlead to changes in the, products, the
chemicals that are produced will changethe way we feel, Anxiety, depression.
So there's a lot going on there.
(06:15):
And it has an impact directlyon the thyroid as well.
And so when we see Hashimoto thyroiditis,we have to first think the gut and think
about permeability and the microbiome.
We can go into depthon any of those things.
They said a whole bunch of stuff there.
Yeah.
So there you mentioned someof the things that can affect
(06:38):
our microbiome as well as the.
Permeability of the gut lining.
Mm-hmm.
I think one of the things that womendon't know is that certain medications
can change the gut microbiome.
Can you share, cuz I can't speakto medication as a chiropractor,
but I would love to tap into yourwealth of knowledge in terms of Okay.
You know, a lot of women think, oh, I'mjust taking this medication for a certain
(07:01):
condition, not knowing that it couldpotentially change our gut microbiome.
Well, I talked about the thingsthat the microbiome changes
will affect in the body.
What changes the microbiome will,the first piece is going to be
food, and I just have to notethat and we'll come back to that.
But the diversity of our foods, thenumber of different colors and types of
(07:23):
vegetables and things we eat will directlyaffect the diversity of our microbiome.
And we want a diverse microbiome.
Now the diversity in my microbiome,yours are gonna be different, but
as long as the functions happen.
And then there are a number of otherthings that if we eat foods that aren't
(07:45):
organic and we get exposed to toxins, thatwill have an effect on the gut microbiome.
If we eat foods or have medicationsthat have particular additives in them,
that will change the gut microbiome.
we find that a number of medicationswill have gluten in them.
we don't even know that, but you googleit online, you say medications with
(08:06):
gluten and you can get medicationsthat do not have gluten in them.
And you're like, why wouldthere be gluten in medications?
But, you know, a number of 'em aremade, with fillers or things that
have various kinds of, gluten orwheat-based, components in them.
but you can find ones that don't then.
Then of course, the anti-inflammatorymedications, the NSAIDs, the non-steroidal
(08:31):
anti-inflammatory and anti-inflammatories.
And whether we're talking aboutibuprofen or acetaminophen or aspirin
or nain or an naproxen or, Long list.
Yeah.
All are going to havea fundamental impact.
They actually cause some degree oflow-grade I irritation in the gut.
(08:54):
We know that, right?
That's like, oh, you could getulcers, you could get bleeding.
They actually cause permeability, thatpermeability that we talked about earlier.
And they cause changesin the gut microbiome.
Things like steroids of course,will have that kind of effect.
various hormones will have effects onshifting the distribution, composition
(09:15):
and distribution of the gut microbiome.
And so we've kind of gone through anumber of different classes there.
Now, the larger classes aroundantidepressants, anti-anxiety drugs,
and statins, those are things thatthere appears to be a shift when
they're given in the microbiome itself.
Whether that shift is sufficient toactually lead to an inflammatory process,
(09:40):
or systemic effects that part's unknown.
The things I've talked about upto this point in time, those are,
clearly known and documented.
but having awareness that there is goingto be a shift the simplest way frankly,
to understand, well, am I doing okay?
how do I tell if I'm doing okay or not?
Is to just basically look at, how manybowel movements are you having a day?
(10:04):
One or two is the best answer to that.
anymore, any less.
Generally gonna beproblematic in different ways.
And are they formed?
there's something called the BristolStool Scale, and it rates your poop
from being, runny to, to super hard.
from one to seven, andyou wanna be at four.
you wanna have it just be like a nice,as my friend Patch Adams used to talk
(10:29):
about a footlong floater, you wantlittle gross, but, you want to have
a well-formed stool and that's key.
Yeah.
so anyways, I'm kind of jumping ahead.
Yeah.
But people would ask that question, well,how will I know if things are IMB or not?
Is 70% of Americans will havean imbalance in their, will
have dysbiosis in their guts.
(10:50):
so it's a really high, percentage.
That's a very high percentage.
Do you think it's because of just someof the things that you mentioned that
we're exposed to or maybe, shiftingshifts in our eating patterns?
cause I know you do take like a foodfirst approach, like 70% is really high.
Almost everyone should be workingon their gut health Right, exactly.
(11:10):
In some capacity.
Exactly.
Well, and that's one of the things, whenwe're talking a little bit earlier, it is
like when someone who I'm working with,Isn't doing well, they're not improving.
I keep going back to thoseprinciples, food first and
what's going on with the gut.
Like, I want to getthat into balance first.
(11:31):
and what I found in my practice, evenearly on where I was really emphasizing
the food, but then I was finding, ohwow, these people actually aren't able
to digest and assimilate the food.
They had too much imbalance going onthat I needed to work to be able to
use what we commonly talk about as likea five hour program of remove what's
(11:53):
not working and replace what you needsupport and rebalance the gut microbiome.
And we can talk about that,with these terms of prebiotics,
probiotics, and postbiotics.
And then working onbeing able to, help to.
Reinoculate, or repopulate cuzyou're not really inno inoculating,
(12:14):
but repopulating the gut.
I wanna ask you this question though.
So I took this from your lectureand I love this and I don't
think many people know this.
Changes in diet can cause large shiftsin the microbiome in just 24 hours,
which is profound.
Cause I think a lot of people think,and we'll touch upon this kind of like,
prebiotic, probiotic and postbiotics.
(12:34):
But I think a lot of people think, oh,it's gonna be this long journey of like
rebuilding gut health and, but you couldliterally start to make large shifts
in your microbiome within 24 hours.
how does that happen?
Yeah, so it's repair, but repair.
Ah, I know you remember.
so we thought 20 years ago that therewas a core microbiome that everyone
(12:58):
had and that it was just tryingto help get people back to that.
It's through the techniques of themore recent molecular techniques,
which I could talk about atlength, but nobody really cares.
They're just like, we'vefigured out that there's a huge
difference amongst all of us.
and so we also found a.
When they were testing kidsand adults and following people
(13:21):
longitudinally, with earlier kinds ofapproaches, they find found that the
gut microbiome was pretty similar.
If you keep eating the samefoods, if you change your diet,
you can actually change it.
Dr.
Mez, most of us have heard of himand he did a little experiment
with using a smoothie, and he wasable to begin showing changes.
(13:45):
In a day in 24 hours with verysignificant changes at, or three days
period of time, in three days, you couldfundamentally change the gut microbiome.
And we'd seen this in mice, but wehadn't actually seen it in adults.
And it was like, oh, it'lltake about a month for it.
And he showed like, oh no, itactually starts happening in 24
(14:05):
hours and you're at a significantshift at three days period of time.
And then there's some further studiesthat have gone on and, and used like
a vegetarian diet, group that just avegetarian diet and then, had a washout
period, and then just a carnivorous dietwhere it was just like meat and cheese
and they could show shifts again in themicrobiome within 24 hours period of time.
(14:27):
So it kind of goes to what you eat andwhat's in your gut is what you eat.
Do you know if in that study that youmentioned, if there was a difference
in diversity, because I know therewas, huge shift in diversity that
happened at that point in time as well.
Yeah.
And, and so that's why, I reallyemphasize, the ability to, if you're gonna
(14:48):
use a smoothie, doing something that'sgot lots of different kinds of vegetables
or s sprouted vegetables in it, as a wayof, of being able to have a simple way
to do it if you're not, looking at yourplate and you should have five different
colors of fruits and vegetables, when yousit down to have at least your main meal.
But the other thing that's interesting,and my friend Deanna Minnick kind
(15:11):
of pointed this out and did thisreally fun, online program about it.
I think I have a diversity of fruitsand vegetables in my diet and I looked
down and I see lots of differentcolors, but she said how many different.
Vegetables you eat in a week period oftime, I can go through, it's like, okay,
so kale, cauliflower, broccoli, mushrooms,basil and avocado that can go through.
(15:37):
But there's about 12 to 15things that I eat all the time.
and then I started looking at, becauseshe said you should try to have 30
different kinds of vegetables every week.
30 and all of a sudden you're like, wow,I gotta go shop at the Chinese market.
I gotta get some thingsI haven't tried before.
I gotta learn how to cook them.
I gotta be more diverse.
I gotta bring other things in.
(15:59):
And she did an online thing of how manydifferent vegetables could people eat?
and my recollection is that thewinner was a woman and her 12 year old
daughter who was really compelled andthey had 149 different vegetables that
they ate in a week period of time.
That's pretty impressive.
That's impressive.
Yeah.
Yeah.
I didn't even know there waslike 149 in season at one time.
(16:22):
I wanted to speak to, a lot ofpeople know about a probiotic, right?
That's kind of like general public knows.
Not a lot of the general public knowsabout prebiotics or postbiotics and why
they are important for our gut microbiome.
Let's first talk about probiotics,because probiotics, we know, we take them.
(16:43):
These are, bacteria that are, created to,be similar to what's in our gut and to
help bring balance back to the system.
But what we found is is thatthe probiotics act as tourists.
They move through, theycause changes in the economy.
I live in Asheville, North Carolina,which has become a great tourist place,
(17:03):
and it's kind of like the town I movedto 27 years ago is fundamentally changed
because there's so many tourists andit's like you, over-rely on tourists.
You don't want that.
Probiotics can be very useful,just like antibiotics when they're
targeted a specific probiotic.
(17:25):
And even a strain at a specificdosage for a specific period of
time for a specific condition.
So that's great.
Now, a lot of people are saying,oh, I take probiotics to help
my overall health and wellbeing.
That's not actuallyever been demonstrated.
what we find is that the probiotics,even if someone is using a nice,
well-balanced probiotic formulationwith multiple different components,
(17:48):
you should shift it up every sixmonths if you're going to do that.
Now, what's more importantare the prebiotics.
The prebiotics are gonna be the foodsthat feed your bacteria in your God
to bring them back into balance.
And so there are prebiotics.
things like inulin andfr oligosaccharides.
(18:09):
I particularly like Acacia rootcan use potato starch as an agent.
those are both relatively inexpensiveand easily accessible as powders.
and then there's some other, fanciernamed Xlo oligosaccharides and,
ara, galactans and things like that.
But the prebiotics are helpingthe beneficial bacteria to grow.
(18:32):
And then what you also wanna bringwith that is you want to bring in
what are the foods that are goingto help direct the populations,
the right populations to grow.
And interestingly enough, the data showsus that the best foods to eat are berries.
And, the berries that have a redand black skin on them are gonna
(18:54):
be the best, red, blacker blue.
And so it's cranberries, blueberries,raspberries, black raspberries,
pomegranate, cherries, all of those.
And it's in the skin actuallythat has the flavonoids that help
the beneficial bacteria to grow.
So people will say, gosh, I'veheard of this thing called amania.
(19:15):
Yes.
and there's there's a product out thereACR mania has been associated with
decreased inflammation, but there's lotsof different bacteria that will have
an anti-inflammatory quality to them.
And so just taking the one thing is aprobiotic and it's a tourist that goes on,
but if you take a combination of somethinglike a Keisha root with blueberries and
(19:40):
blackberries and pomegranate, you actuallygrow amania and you can do that for
like, 15 bucks a month and eat berries,as opposed to, taking a probiotic that
may cost a hundred bucks a month andhas not been shown that when you take
the akkermansia, as soon as you stop,you don't have Akkermansia anymore.
(20:03):
Mm-hmm.
It's only good while it's there.
Whereas if you're eating the foods,you'll continue to help it to grow.
So it's an example.
So there's prebioticswhere my emphasis is now.
Probiotics are whenthere's a true imbalance.
If there was a probiotic for, Hashimotothyroiditis, I would tell you immediately,
I'd say This dose, this strain.
(20:24):
there's no data there.
There are things for irritablebowel syndrome and especially.
that aspect that's, mixed in nature.
There are probiotics forinflammatory bowel disease.
There are probiotics for interstitialcystitis and urinary tract infections.
These have been studiedand we can dial that in.
but for Hashimotos or for other autoimmunediseases, we do not have that yet.
(20:49):
we may find some that really act asspecific agents, but we don't yet.
So then we go to, well, what'sthis other term that you said?
I've never heard that before.
Postbiotics.
What does that mean?
Recall that I said we want to havethe functions of the gut to be working
(21:10):
all in balance with each other.
And I talked about those seven functions.
The way in which that happens, thediversity of many different people's
balanced gut microbiome, whether it'sa microbiome in Singapore or in Paris
or in Sao Paulo, there's diversity inbalance and we can tell there's balance
(21:32):
because the functions are workingproperly and the functions happen
through the production of postbiotics.
It's what the bacteria make.
And we now begin to see that,those things can affect the
mitochondria and energy production.
Those things can affect thebalance of the immune system.
(21:53):
Those postbiotics can affect thegut-brain access and lead to changes
in feelings of depression or anxiety orimprovement of those kinds of things.
So it's the postbiotics, which isprobably where You've heard some of
your people have heard about fecaltransplants, and that it's probably
(22:15):
through the postbiotics that thefecal transplants are having their
beneficial effect on the person overallof bringing them back into balance.
So there's a lot goingon in the conversation.
Yeah.
Fecal transplant is not the firststep or the first probably 20 steps.
I've, for people who I know whohave gotten a fecal transplant,
(22:37):
it's usually like the last resort.
And from what I understand,not always successful.
No, and where you get it from.
And there are peoplewho are, do it yourself.
Ooh.
where they get it well, where theyget it from someone that they know
and they create it themselves.
It's not actually legal in theUnited States to do a fecal
(22:57):
transplant at this point in time.
there are some new postbioticsformulations that come from
basically fecal transplants whereall the bacteria have been killed.
And so it creates apostbiotics, but what was it?
But you want to get it from a healthycohort, a healthy group of people.
(23:17):
So I wanna share just a brief story where.
A colleague of mine, Dr.
Tom Salt and I were talking in 20008, 9 10, about, starting a program
with fecal transplants for people.
And, I had gone to Australia andlearned how to do it from Dr.
Ted Barra, who's the mostwell-known person in this area.
(23:40):
And then I was talking to a colleague,at the group in, Cork Ireland, who
have some of the best GI doctors interms of the microbiome in the world.
And Dr.
Fergus Shanahan, said to me,Patrick, you understand that
changes in the gut microbiomecan have an effect on, of course.
(24:02):
Clostridium difficile, but also on heartdisease, on cognition, in Alzheimer's,
on liver disease, on osteoporosis, oninflammatory bowel disease, on mood
disorders of anxiety and depression.
I'm like, yeah.
And he said, so if you are taking a fecaltransplant from someone and you don't
(24:24):
understand what it's going to do, you giveit to them, and that person who wasn't
necessarily on a track for developingsome cognitive problems or some behavioral
problems or heart disease ends up movingin that direction and we just don't know.
do you want to do that?
(24:45):
Do you want to take on that risk?
Certainly if you have someone who's gotthis infection called C difficile that
it's approved for, these people are,are really sick and you can die from it.
And so you need to do somethingand it's 98% effective.
So it makes sense in that setting.
But if you've got someone with infl,with irritable bowel syndrome or
(25:07):
Hashimotos thyroiditis or depression,and they think that they're going to get,
benefit from a fecal transplant, wellthey may in that domain, but they may
develop some other kinds of problems.
And there are ways that we canwork to heal the lining of the gut.
through focusing on the diversity of themicrobiome, repairing the permeability
(25:31):
damages that are going on, replacing thedigestive enzymes and things that are
missing, removing the foods in generalthat are going to be processed foods.
I mean, that's job one, get rid of theprocessed foods and, then moving towards
balance in that way and that doesn't haveany risk associated with it of long-term
(25:54):
problems caused by the treatment.
Yeah.
I had a friend get a fecal transplant anda month later she had, her appendix burst.
She had surgery and I was like, oh,that's like a weird correlation.
And then she needed abunch of antibiotics, after
getting a fecal transplant.
Right.
Which was kind of a bummer.
Right.
and so I mean, there are ways, thereare some, clinics in the uk, in The
(26:15):
Bahamas, um, that have done these andthat use a very healthy cohort of people,
who are eating organic and they'reyoung and they're healthy and they've
been qualified and they don't haveany kinds of parasites or imbalances.
And I think that's areasonable way to do that.
But even in the patients I've had whohave gone to have that done, it's about
(26:36):
50% of them get significantly better.
And if 50% don't, and as a pretty bigask now, I had one patient who did a.
Do it fecal transplant, from herhusband, and she got improvement.
But, she continued to have problems.
She started taking this, postbiotics,kind of blend, and she got really
(26:57):
significant improvement from it.
So, I believe that there's ways thatwe can work with the concept without
actually doing a full fecal transplant.
And then there's poop pillsthat are coming out now.
One was just approved by the f D Alast week, and it's not really poop.
It's, basically a combination of bacteriathat have been derived, um, and have been
(27:21):
demonstrated to help with c diff, thisclostridium difficile, this bad infection.
but that's just where the data is on that.
there's some fascinating, research on.
Fecal transplant with autoimmunedisease, with autism, with mood
disorders, and with liver diseases.
There's some really cool stuff.
(27:42):
So we know that changing the microbiomewill change the overall physiology
of what's going on for people.
It's just there's ways to do withfood that are much simpler and easier.
In terms of the five Rs, thefirst one is remove, right?
And it's not only maybe removingcertain foods for potentially a period
(28:04):
of time, but then also addressingunderlying, infections or maybe
bacterial overgrowth or fungal overgrowththat could be happening in the gut.
Mm-hmm.
How does someone who maybe hasjust kind of gone like, okay, I
have medication for my thyroid.
How, can I even start to discover.
maybe I have a gut infection.
What would it be, working withsomeone and taking a thorough history?
(28:26):
Would it be doing a stool sample?
I know there's a lot of differentlabs that do different stool testing.
to start to kind of like walk thatpath of, okay, now we first is remove.
So in, the remove stage, I'm taking thehistory to find out when did this begin?
And if it's something that occurredafter, doses of antibiotics or something
that occurred after travel or somethingthat had more of like a, real defined
(28:50):
point source, it's like, oh, thisday, this is when it happened, then I
for sure go and, and wanna do a stooltest to be able to say, is it possibly
an infection that's going on there?
And, there's it, these kinds ofstool tests, the ones that are more
comprehensive are not the ones donethrough Quest and LabCorp, but done
(29:11):
through other specialty laboratorieslike the one that I used to be
the chief medical officer at, and.
In that process, they're gonna lookfor parasites, they're going to
look for worms, they're gonna lookfor, various kinds of potentially
pathogenic bacteria that are there.
they're gonna look for anovergrowth of yeast or fungus to
(29:33):
be able to see what's going on.
And they're also going toassess well, what kinds of, anti
bacterias or antimicrobial herbsare these things sensitive to?
And so, you can measure certain aspects ofthe immune system that will say, something
called immunoglobulin that when it'sreally high, it's like there's something
(29:53):
going on that the immune system is saying,Hey, I'm feeling attacked and I need to.
To go after this.
So there's ways to be able to lookat that testing to say, yeah, there's
something that needs to be done interms of an infection, that needs
to be brought back into balance.
And, while we can use foods andthings like that, if you've got the
(30:14):
irritant continuing to be there,it's hard to get back into balance.
And so yeah, it's removing foods and likein the case of Hashimotos thyroiditis
for sure, removing gluten and removingprocessed foods and doing that and
something like a whole 30 diet, a foodplan is a great kind of off-the-shelf
food plan that you can gain access to.
(30:37):
so that's the remove part of it.
Yeah.
You mentioned earlier this gut-brainaccess, And I wanna bring this up
because a lot of women with Hashimotoswill struggle with depression,
anxiety, and then also brain fog.
Mm-hmm.
And.
Maybe we'll kind of go the tr uh,route of, oh, well, maybe I should go
(30:57):
to therapy, or maybe I should work outmore to try and boost my endorphins.
And they don't know that there is thisconnection of the gut to the brain,
and maybe this should tap into that.
Yeah.
Yeah, there's a whole field, that wasdeveloped by, Danana and Cryer in Cork
Ireland called Psychobiotics, wherethey've been looking deeply at this area.
(31:21):
It's still in its infancy interms of is there a clear organism
that's going to be really helpful.
And, the one I favor at this point intime is something called Zen Biome.
it's made by Microbiome Labs.
I don't have any affiliation withthem, but the specific organism,
that's in there has been shown to bereally quite helpful for dealing with,
(31:43):
depression, anxiety, kind of neuroimbalances in the gut brain axis.
And people say, well, Really?
What, do you tell, like,how does that happen?
does the poop go into your brain?
Is, like, no, no, no.
There's pathways, both through thenerves as well as through the blood.
where sometimes, people may not know,but 95% of the serotonin in your
(32:06):
body, you've heard of serotonin.
your.
Audience is sort of serotonin becauseit's like this is what many of these
antidepressant drugs are, based upon.
They're, reuptake inhibitors.
You don't have enough serotonin but95% of it's produced in the gut.
it moves up into the brain.
there are also other kindsof neurotransmitters.
There are anti-inflammatories andpro-inflammatory agents that can move up.
(32:29):
They can move through the blood, theycan move through the vagus nerve, and
they actually aggregate in a certainarea, called the insular cortex.
Now, I won't get too, too detailed.
I told you, I, I wouldn't, butI, I love this stuff because it's
like what our gut feelings are.
Actually, they're our gut feelings.
They're like, what's happening in ourgut is having an effect on how we feel.
(32:52):
You know?
and it's that direct.
So yeah, there are agents now that we arebeginning to learn can have an effect.
now here I'm back on probiotics andyou can say, wait, he said before,
he doesn't focus on probiotics.
But if I'm working on a specificproblem, a specific issue that's there,
then I'm gonna use that as an agentfor a specific period of time at a
(33:13):
specific dose to try to affect change.
Knowing that my goal all along isto change the diet and to change
to the relationship, to stress.
I'm gonna kind of go off topicfrom here, but there's data now.
So the vagus nerve.
(33:34):
in your training, you knowa lot about the vagus nerve.
Yeah.
But the vagus nerve is not like Las Vegas.
It's, it's V A G U S and it's thewandering nerve and the wandering
nerve that comes down and comesdown the back of our throat.
And it, it affects ourproduction of digestive enzymes.
It affects our stomach, it affectsmotility, it affects our breathing,
(33:55):
it affects our heart rate.
It affects the rate ofmotility of the gut.
And there are differentbranches of the vagus nerve.
They go front and back,anterior end dorsal.
And there are Differenteffects that go on now.
One of the things that I've been learningrecently, and I've been interested in
the vagus nerve for a long time, butI've found that if your vagus nerve
(34:19):
isn't working properly because you'reoverly stressed, you're in fight or
flight response instead of in moreof a chill parasympathetic tone.
So you have parasympatheticchill sympathetic.
Flight, freeze appease.
And if you're, in that zone, thenyour vagus nerve isn't working very
(34:40):
well, you're not actually gonna beable to digest your food properly.
You're not necessarily gonnahave, even the supplements you're
taking be able to be incorporatedeffectively in what's going on.
and the vagus nerve is used asalso a conduit both to the brain
and back from the brain aboutwhat's happening in the microbiome.
(35:00):
it's a loop system, that is givingfeedback to what's happening in your gut
is affecting your feelings, is affectingyour overall habituated behaviors of
fight or flight or, freeze appease.
So how do we get into, a deepertone, a deeper balance point, and,
(35:21):
And I'm, want say one more thingabout that because it's typical
things like yoga, slow down, takea walk, be in nature, say prayers,
meditate, knit, all these things.
Help sitting in front of a TV and watchinga movie love, that's not gonna help.
(35:41):
it's gotta be active and then there'snow external vagal nerve stimulators
that actually can help with that as well.
Then one would say, well, I'm prettychill, I mean, my friends say I'm a pretty
chill guy, so I must not have a problem.
I really like measuringheart rate variability.
(36:02):
So heart rate variability is away to be able to say, where am I?
Because when we're young, in ourteens and early twenties, our
heart rate has a variability.
It doesn't just go dumb,dumb, dumb, like a metronome.
There's a little bit of variation.
So when we're young, that variation isas much of a hundred milliseconds, a 10th
(36:26):
of a second variation, and that's tellingus that we've got really good vagal tone.
We've got really good balancebetween our parasympathetic
and sympathetic nervous system.
Now, when you get to be in yoursixties like I am with aging, the
normal is that rate, we becomeless flexible, more restricted,
(36:49):
and that beat to beat variationis between 10 and 20 milliseconds.
It's like 10 90% less,
But you can, and you can measure it.
You can measure it using a toollike this aura ring that I have on
my hand right here on my finger.
You can use it by measuringother kinds of tools.
There's even new tools that are gonnabe coming out that will be able to
(37:10):
use the camera from your cell phoneto look at you and tell you what
your heart rate variability is.
So there's, it's an importantthing to understand and where
am I and what will help me.
you've maybe heard some of my ownjourneys, but I found that while being
in nature actually made the biggestshift for me, to be able to do that.
(37:31):
And so that's what works best for me.
The other things are helpful, but, findingout what works best so that there's,
it decreases intestinal permeability.
It changes the gut microbiome.
So between stress and food, thoseare your two biggest things that
you can So if because you alwayshear like, oh, trust your gut.
(37:51):
What does your gut say?
And I'm like, well, Imight have gut dysbiosis.
I don't know what my gut says.
My intuition might be off.
Yeah.
And you can actuallymeasure, what's going on.
there's stool testing that willhelp to be able to see is it
imbalance or is it, out of balance?
And one of the things, I'm gonna talkclinically for a moment, one of the things
I've learned is that what I wanna do withthe people who come to see me is I wanna
(38:14):
get 'em on a better diet right away.
I wanna get 'em off of processedfoods and I want to, help them.
Usually I stop gluten at leastfor a trial and then add it back.
And so it's a four, six week process.
Then I see if they're still notfeeling well, then I test the gut
because I, already know like, well themain drivers are gonna be there, so
(38:38):
let's see if things are in balance.
Are you in balance?
if your food and nutrients andthings are moving in a good way.
And then I I think a lot of women,like to default to food sensitivity
testing to kind of determine what theyshould eat and what they shouldn't eat.
And I think, it's not the right approach.
Can you share why I, cuz I think,I get a lot of messages like.
(39:00):
What food sensitivity testing,and I was like, maybe none.
Maybe there's a better way.
Well, I'm, I think I'm a littlecontroversial in this area and
as I said, I worked for a labthat did this kind of testing and
so I'm really familiar with it.
but I was never supportive of itbecause what happens is that if you have
(39:23):
permeability, you will have reactivityto the foods that you're eating.
And if you switch the foods that you'reeating and you have permeability,
now you'll have a reaction tothe new foods that you're eating.
Mm-hmm.
So there, are some aspectswhere some people are uniquely
(39:43):
responsive and are reactive tospecific food groups, whether it's.
Corn, dairy or, beef or gluten.
but that's why I work with a foodchallenge, an elimination diet to
remove those things initially, andthen, and then start adding back
after three to four weeks periodof time and see how do I feel?
(40:06):
Yeah.
because is, There's novalidation of i g G food testing.
Now I hear, I'm talking about allergytesting, cuz there that's important.
And the IgE E food allergy testingcan be really useful if you have a
specific thing that you are reacting to.
but the IgG G testing, it's justnot re reproducible, across labs
(40:29):
or over time because it's moreof a reflection of permeability.
And the other big thing, and I'm sureyou've seen this in practice, I see people
walking around carrying cards and thingsand saying, oh, I can't eat all these.
I have this test.
I can't eat all these foods.
And has developed something that the term,that has emerged is orthorexia nervosa.
(40:52):
and that is, why my immunology friendsand rheumatology friends really don't
really speak strongly against thiskind of testing because it gives
a false notion and it limits thediversity of foods that people eat.
Not a good thing.
Which then in turn limits potentiallythe diversity in our gut microbiome.
(41:13):
Right?
Exactly.
Yeah, exactly.
Yeah.
And we see this with people who areeating like a sibo, low FODMAPs diet also.
I mean, if people have smallintestinal bacterial overgrowth, yes.
It's a real thing.
Yes.
There's bloating there.
Yes.
Eating a diet that does not contain, a lotof these, what are called FODMAPs, fructo,
(41:34):
Olivo, monosaccharides, and polyols.
You don't have to remember that, but,They come from lots of vegetables.
What's useful in the short term to helpbe able to get, gain some balance back,
but it's not useful in the long term.
But I see a lot of people whostay on that diet, and it's,
it's not a good long-term diet.
For, people who do introducean increase in vegetables and a
(41:59):
diversity, and they might have somebloating or maybe indigestion, what
do you recommend for those people?
Because they're like, I wannatake a food first approach.
And then they start to, maybe itdoesn't sit well with them at first.
there's a couple different things.
One of 'em is like with a lot of theprebiotics that I mentioned, if you
(42:23):
actually don't have a balance in yourgut and you take a prebiotic like inulin
or fructooligosaccharides, f o s, theycall it, that's gonna cause more of
a non-specific growth of everything.
And if you're outta balance, You're gonnakind of accentuate that, So starting
slow with it and going with a low doseof a, of a prebiotic, and then beginning
(42:44):
to look at it, journaling like, well,what foods do I notice are a problem?
and they tend to fall in categories.
So sometimes it's, it's morelike the, the Allisons, like the
garlic and the onions and theshallots and things of that nature.
For other people, it may be more ofthe nightshades that cause imbalances.
And so work to say, how doI begin to parse this out by
(43:05):
the foods that I'm eating?
and the other thing is thatwhen you change your diet,
it is totally expected, dude.
You're gonna have some shifts.
In the gut in the first weekperiod of time, and you wanna kind
of move through seven to 10 daysto say, well, where am I at now?
Now if you're still having bloatingand problems at that point in time,
(43:26):
then you gotta do what I just said,start to look at which food is it.
but give it seven to 10 days on the frontend because that's when the, shifts are
occurring and you're trying to find whatthe new balance is to be able to do that.
and as I said earlier, and, as youwork with those things, if after a
four to six week period of time you'restill having significant issues, then
(43:47):
that's a time to be able to do testing.
Such a great mindset shift, right?
Cause I think some people think, oh,I've been doing this for two days.
why isn't my bloating better?
so I think that's a great reframe.
drhanaway, thank you so much forall the information you've shared.
Where can people find you andwhere can people work with you?
(44:07):
Well, I'm laughing because, I'm nottaking new patients at this time that my
career is focused on being able to educateproviders through the Institute for
Functional Medicine at this point in time.
And, it's a passion toteach and I love to do it.
So where I encourage peopleto go is if fm.org/find
a practitioner or if you justgo to the main page on the upper
(44:30):
right hand side, there's a find apractitioner, and these are people
who have been through the training.
if you find someone who's an I FM, certified practitioner, they've
gone through, they've been tested,they understand what's going
on, and you can search by yourzip code or by your state and.
set a distance area.
We've got, thousands of practitionerswho are trained now and tens of thousands
(44:53):
of practitioners who have, begun tolearn the process that's occurring.
So I feel really, pleased that wehave, been able to do training get
people in into your neighborhood.
And I send people to that link all thetime cuz I have, women are like, where
do I find someone in North Dakota?
And I'm like, well go to if f m Yeah.
Check for practitioners.
(45:13):
Yeah.
Mm-hmm.
Yeah.
Well, thank you so much.
I have taken a bunch of notes andI'm sure the listeners have as well.
So thank you for sharing your wealthof knowledge and I really loved our
conversation and thank you for being on.
Oh, you bet.
Thank you so much.
And thank you for the work that you'redoing to empower women, and help them
to recognize that, when we're outtabalance, it's just a call to be able
(45:35):
to help find what's going on in my lifeand how do I move back into balance.
And then you're sharing that andhelping people to be on that journey
of healing to become a whole.
I really appreciate it.
Yeah, thank you.
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