We dig into where traditional gastroenterology often falls short—and how functional medicine can fill in the gaps. I’m joined by Shefaly Ravula, PA-C a Physician Assistant and Functional Medicine Certified Practitioner, who shares how her background in GI and nutrition evolved into a more personalized, whole-person approach.
We cover common clinical red flags, what to do when patients have “normal” GI tests but still feel terrible, and how to blend diagnostics with nutrition and long-term strategy. We also explore how menopause impacts gut health, the nuance around HRT, and why patient education is everything when it comes to sustainable results.
This episode is packed with insight for healthcare professionals and curious listeners alike who want to better understand the gut-brain-body connection.
What You’ll Learn in This Episode
- Red flags that may point to deeper gut dysfunction (chronic bloating, constipation, diarrhea)
- How microbiome stool tests compare to SIBO breath testing
- Why antibiotics, low FODMAP diets, and gut supplements only offer temporary relief
- The connection between IBS and SIBO—and how many are misdiagnosed
- How functional medicine combines traditional diagnostics with root-cause care
- The relationship between estrogen, motility, microbiome health, and inflammation in menopause
- Why HRT decisions should be individualized, not one-size-fits-all
- How pelvic floor dysfunction and trauma can influence GI symptoms
- What providers can do, even in short visits, to screen more effectively
Timestamps:
00:00 Introduction to the Episode
00:12 Meet Shafaly Founder of Precision Gut Health
00:55 Episode Overview: Key Topics and Takeaways
02:32 Dr. Mary's Approach to Whole Body Healing
03:17 Shafaly’s Journey into Functional Medicine
06:13 Challenges in Integrating Functional Medicine
14:31 Understanding IBS and SIBO
18:30 The Role of Testing in Gut Health
24:09 Antibiotics and Gut Health: A Complex Relationship
29:11 Patient Advocacy and Navigating the Medical System
32:27 Chronic Constipation and Structural Issues
33:04 The Multifaceted Nature of IBS
33:56 The Role of Trauma in IBS
35:01 The Importance of Personalized Medicine
40:43 Challenges with Restrictive Diets and Antibiotics
46:16 Menopause and Gut Health
50:31 The Controversy of Hormone Replacement Therapy (HRT)
57:41 Conclusion and Contact Information
You can find Shefaly below:
IG: @precisionguthealth
https://precisionguthealth.com
If you are a health or movement professional and want to stay in touch with future episodes, webinars, courses, events and more. Subscribe to my email list here
I’ll see you in a week!
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome back to TMI talk withDr.
(00:01):
Mary.
Today we're gonna be talkingabout the gaps between
traditional GI care andfunctional gut health management
and how to bridge them intopractice.
And in order to understand thisbetter, I brought on Shafai Ula,
who is a PA and a functionalmedicine certified practitioner.
She is the visionary founder ofPrecision Gut Health, a virtual
(00:24):
telehealth practice on a missionto unlock the secrets of gut
health.
Nutrition and longevity at theheart of her practice lies a
powerful fusion betweenfunctional medicine, culinary
nutrition, and a profoundcommitment to digestive and
metabolic optimization using adeeply individualized approach.
She's dedicated to guidingpatients towards a future where
(00:45):
gut health and longevity areintricately intertwined, and
where vibrant health is not justa destination, but a lifelong
journey.
In this episode, you're gonna bewalking away with practical red
flags to recognize such aschronic bloating and diarrhea.
Even if you don't know that muchabout gut health, then that way
(01:06):
you can refer your clients tosomebody to get help clarity on
testing, we're gonna bereviewing how the differences
between a standard microbiomestool test versus SIBO breath
testing.
We're gonna be talking about theinsight on bandaid approaches,
so why antibiotics, low FOD batdiets and gut healing
supplements.
Can sometimes help temporarily,but it won't fix the root cause.
(01:29):
Next we're gonna be talkingabout the IBS and SIBO
connection.
Why many patients are labeled asIBS, but have actually been
undiagnosed, as with sibo.
And how to start thinking beyondthe symptom suppression.
We'll be also talking about therealistic view of functional
medicine.
It's not all about beinganti-medicine, it's about
combining conventionaldiagnostics with a personalized
(01:51):
root cause.
Approach to truly help peopleheal.
And finally, we'll be talkingabout menopause and gut health,
which is also a bonus dive intohow declining estrogen levels
impact gut motility microbiomehealth and overall inflammation.
And why HRT decisions should bepatient-centered and nuanced.
So why does this matter asclinicians?
(02:13):
Well, you'll be better equippedto a spot when something.
That the patient might seem asnormal, is actually not normal.
You'll be able to ask betterquestions and know when to refer
for deeper workups, and thishelps empower your patients so
that way they can understandmore about their body.
So thank you for listening, andnow we'll jump into the episode.
Welcome back to TMI talk withDr.
(02:34):
Mary where we dive intonon-traditional forms of health
that were once labeled as tabooor dismissed as Woo.
I'm your host, Dr.
Mary.
I'm an orthopedic and pelvicfloor physical therapist who
helps health.
Movement and rehab professionalsintegrate whole body healing by
blending the nervous system intotraditional biomechanics to
maximize patient outcomes.
(02:56):
I use a non-traditional approachthat has helped thousands of
people address the deeper rootsof health that often get
overlooked in conventionalwestern training.
And now we are gonna be startingour next episode.
mary (03:08):
Welcome to the show, thank you.
So nice to be here.
Love the space.
Yeah.
We're excited to have you.
Thank you.
And we'll just dive right in.
Sounds good.
Okay, so what inspired you tocreate Precision Gut Health?
It happened because of mybackground.
So I have a background in, soI'm a pa.
And had an, a first job out ofschool that was in, strangely, a
(03:34):
very unique niche in bone marrowtransplant in Seattle.
And but around that time my, myfather had a heart attack and he
was only 54 and he was very thinand lean and vegetarian.
And I hadn't learned anythingabout nutrition, so I was so
confused, yeah.
Wait, why is this vegetarian,thin, young man having a heart
attack and he survived and allthat, but it really led me into
(03:57):
this path of nutrition because Ijust felt like, okay, this is
not making any sense.
And, they don't teach any ofthis.
I got into nutrition and then I,we moved here to Austin and I
couldn't find a job.
In the field that I had alreadybeen trained in, which was this
bone marrow transplant.
Very unique field, but the job Ifound was in gastroenterology.
(04:19):
And so I started in the GIworld, but at the same time, on
the side, I'm sitting herelearning about nutrition and
cholesterol and cardiology andnutrition for cardiac health for
my dad.
It didn't apply to gi, reallydirectly at the time.
And then, yeah.
And then I actually, for aperiod in my life stayed home
(04:40):
and with my kids, I wanted to bea stay at home mom for a little
while, but it ended up being along time.
Yeah.
And I ended up teaching cookingclasses, to keep myself busy for
fun.
But that turned into a careerand that was where that old
business that you might befamiliar with, chef's Kitchen
was born from.
So I had this little culinarybusiness, which was a nutrition
business to a, oh, I, it wasculinary medicine, so it was
(05:01):
like initially Indian cooking.
And then I'm like, wait thisdoesn't jive with my dad's
health history.
He grew up eating this way.
It didn't fit into my nutritionplan.
We weren't eating it every day.
So it really morphed into foodas medicine, a lot of more
healthier cooking and reallyglobal cooking, honestly.
(05:22):
Yeah.
And then I went back to gi.
After I'm like, oh, my kids areolder and I miss, being a pa I
miss using my medical brain.
So and so that's what I did.
I went back to gi same group,different location different, a
little bit of different people.
Great experience.
And then the pandemic hit andthen.
That kind of broke that wholething apart.
(05:43):
But I will say while, rightbefore I rejoined being at
Austin at the GI practice, I Istarted studying functional
medicine because I had beenstudying nutrition and I'm like,
oh this makes sense.
Like it's just a pathway tofunctional medicine a lot of
times in integrated medicine.
So I thought, I'll bring that togi.
I'm like, why not?
(06:03):
Take what I've learned.
I had just done the GI module atIFM and I'm like, I gotta bring
this to the practice.
And it is just, was just hard todo for many reasons.
We don't, we can go into that ifyou want to, but very hard to
do, I would say, because theinsurance companies dictate us.
That's really the main reason.
There's no way, in those likefive, 10 minute sessions, how
are you gonna teach somebodyabout gut health, and there's so
(06:25):
much, I've just seen so muchdisconnect in just like in, in
modern medicine.
Yeah.
And actually acknowledging thegut brain.
Connection.
The connection.
Yeah.
Yeah.
You cannot deny like it isthere, yeah.
And you can feel it too.
Yeah.
I know that brain fog is onethat I'll get if I eat certain
foods that flare me up and it'sa direct correlation with all
(06:47):
the serotonin in the gut too,that's produced.
Yeah.
Is it like 90%?
Yeah, 80.
Yeah.
80.
80, 85.
Yeah.
Yeah.
And that instead we put peopleon SSRIs instead of, and we
didn't know that, definitelywhen I was in school, but we
didn't even know that, weren'ttaught that in the continuing
medical education courses thatwe took to keep up our license,
so there's been a lot of newscience, which you have to
(07:10):
really stay up to speed on.
And so I think in theconventional path, sometimes you
don't stay up to speed on somethings.
Sometimes you're just, stayingwithin your specialty.
And I.
I see how it happens.
Yeah, absolutely.
I see how it happens.
'cause you get into your nicheand you're in there.
Yeah.
And you go in day in, day out.
(07:30):
But the reality is it is hardbecause we have five, 10 minutes
appointments and people tend toblame the physicians.
It's or the practitioners.
And it's listen it's a shitshow.
I mean it's, and the amount of,it's a system.
Yeah.
It's a, that's messed up.
It's a system.
And then people blame the facesthat they see when it's like,
Hey, no, this is a multi thing.
(07:51):
Yeah.
And so it's so important that wetalk about, yeah.
What are some things that peoplecan do even, and we'll dive into
this later.
Yeah.
But just knowing what we can doto help restore our gut health.
Obviously modern medicine iswonderful for like
colonoscopies, and doing allthese other tests To help us
when to.
Rule out major things.
Yeah.
But how many people get allthese tests and say everything's
(08:13):
fine.
Yeah.
And they're having all thesesymptoms.
So it's a, it's, I love to, Ifeel like I bridge the gap
between conventionalTraditional, yeah.
GI and modern, holistic,integrative gi And that I think
is where I shine because bothare important, just like you
(08:33):
just said.
And it's not an and orsituation.
It's a, or whatever that phraseis.
It's not a or it's an and.
Yes.
Thank you.
I always mess up phrases.
I got you.
No, I do that.
I do that too.
So yeah, I wanna I do wannacomment on the.
You know what to say in five or10 minutes.
'cause I can, there are thingsyou can say as a clinician or a
provider and you can do themwith some caveats and nuances
(08:55):
that you might want to say atthe same time.
But let me ans finish answeringyour question, which was, how
did I get to Precision GutHealth?
Because right after that, afterthe pandemic, I was like, oh, I
really need, I can't prescribeanother PPI where there's no,
finite end to it or I can't, Ijust can't keep giving people
Bentyl for their IBS and Ican't.
(09:16):
I just was I could, I justneeded more for my patients and
so I was like, should I openthis little practice?
And I decided not to.
'cause I'm like, I.
I don't know how to be anentrepreneur.
It's scary.
Yeah.
So then I got handed this job,like somebody, the urologist
said, Hey I can't get to whereI'm at with functional medicine
in my practice where I want tobe, you know this urologist, but
(09:39):
I want to have functionalnutrition and medicine.
Can you bring, can you do thatpiece for me?
So instead of me being my ownentrepreneur, I did it for them,
which was a great learningexperience.
And I got back into male men'shealth, which is metabolic
health, which is cardiovascularhealth and also hormone health.
And I got to do that.
And still, lots of GI peoplewere coming our way.
(10:02):
And then finally I said, okay,I'm ready to do my own thing.
'cause I really missed, I wantedto bring the culinary aspect and
the nutrition aspect more to it.
So now we have a big nice littlethey go together.
Yeah.
They go together.
Gut and nutrition exactly.
No, that's what's the cool piecethough, is that not only are
you're blending all of ittogether and you're definitely
(10:22):
onto something.
There's no doubt in my mind Iknow it, but you're, I think
you're a trailblazer, right?
And so what that, in my eyes, itjust means that you're one of
the first people to be talkingabout this in this capacity that
I've seen doesn't mean peoplearen't out there.
Yeah.
But in that, when I was justtalking about this with somebody
(10:43):
earlier today, it's just in thatthere's a bit more of an uphill
Yeah.
Battle with that because you'regoing against a lot of different
things that have been in systemsfor decades.
Yeah.
And yeah.
I can't imagine what it must belike being you and being like,
yeah, here's some medicine,knowing that somebody with IBS
needs so much more.
(11:03):
Because the gut.
With, especially with history ofpeople with history of
unprocessed trauma and how likechronic fight or flight, we know
we literally hear the saying,I'm sick to my stomach.
Yeah.
That's a saying.
Yeah.
And butterflies in the stomachtoo, like that is you know that
there is a gut brainin accessconnection.
Yeah.
A hundred percent.
If we've been talking about thisfor a long time.
(11:24):
The other piece of it too that Ithink is fascinating is that we
almost, and then we treat likethe dentist oh, this is nothing
to do with our GI tract.
Oh no, yeah let's remind, remindpeople of the tube that goes
from the mouth to the anus.
It's a tube.
Yes, exactly.
And then we say dentists overhere, GI over here.
Yeah.
(11:44):
Mental health over here.
And sometimes even liver isseparated from GI because you do
have hepatologists that arefellowship trained in hepatology
but then you're like, wait, theliver is connected.
And then hormones.
It's so all connected, whichmakes it very difficult for a
new provider to this.
F type of thinking, or for apatient too.
(12:08):
We have, we will, I think in thefuture, come to a place where
it's all embraced again.
I don't know.
Sometimes I like to study thehistory of medicine because, not
that I have really studied it,but I've read certain things
about like when didevidence-based medicine come
into play?
I think it's, it was about 150years ago.
It wasn't that long ago.
And then Eastern Medicine islike 33,000 years.
(12:29):
Yes.
And it's we act like modernmedicine.
Yeah.
Is it?
Is it?
And I'm like, like you haveyeah.
You have not been row.
And it's like midwives deliveredbabies before.
All the time.
Yeah.
That's what the job was.
And and then also nutrition usedto be a GI doctor's job before
the colonoscopies andendoscopies were invented.
(12:51):
Not only nutrition, they weredoing a lot of physiology.
But if I saw an oldgastroenterology textbook from
the fifties how'd you find that?
It was at a silent retreat thatI do, and it's said a some house
in the hill country and therewere all these old medical books
and I was so fascinated andthere was not a lot of talk
about acid reflux in the tableof contents.
(13:12):
Really?
Yeah.
I took a picture.
I was like, there's not a lot.
SIBO was not mentioned.
Sibo.
We know SIBO for your listenersis small intestinal bacterial
overgrowth, which has a bigoverlap with irritable bowel
syndrome.
And by the way, this month isIBS Awareness month and today
SIBO Awareness Day, SIBO onlygets one day, but it's quite a
dis, quite a condition I wouldsay.
(13:35):
It's very.
Troublesome for a lot ofpatients and can be long lasting
for some what if somebody'slistening to this, right?
So if a practitioner or aprovider or somebody is
listening and they're workingwith patients that are dealing
with gut issues, and that can bephysical, pelvic floor, physical
therapy.
That can be, honestly, anybodywith back pain, we need to be
(13:56):
looking at gut health too.
The rectum is right there by thesacrum.
True.
And then you've also got anypressure right there is gonna be
pulling, pushing onto the backas well.
Constipation.
Yeah.
All of those things.
Yeah.
And so what are some things thatthey can look for in in their
clients and maybe help directthem in some capacity?
Because in the physical therapyworld, we're really not trained
(14:18):
a lot on SIBO and IBS and I'vedone my own training more on
IBS.
But sibo, there hasn't been aton of stuff that I've seen
Yeah.
To help practitioners navigatethat.
Maybe differentiate the twouhhuh and then what could be a
way that they could, obviouslythey can follow you on social
media and a hundred percent andsend your way, but also what are
(14:41):
some things, so IBS is irritablebowel syndrome, not to be
confused with IBD, which isinflammatory bowel disease.
So IBD is more like Crohn'scolitis, those are definitely
different physiologies,different conditions.
IBS used to be, and still is adiagnosis of exclusion in the
conventional GI space.
So it's like somebody that'scomes to you in the conventional
space that has had blood workmaybe from their primary care
(15:04):
and then they come to youbecause the primary care is
referring them to you or theycome to you on their own and
they're like.
I just have abdominal pain or Ihave constipation, I have
diarrhea, I have gas, I havebloating.
That's usually, I would saythose are mostly the symptoms
that somebody would have withIBS.
And after a careful analysisexam, maybe a colonoscopy or
(15:25):
endoscopy in some individualsmight be indicated if that
nothing is found.
Excuse me.
And there isn't pathology, theword for finding something
organic.
'Cause really what they'relooking for in a colonoscopy
would be making sure you don'thave Crohn's or colitis.
'Cause sometimes that IBS canlook like IBD in some cases.
But let's say all the workup'snegative then, and you still
(15:48):
have abdominal pain, gas,bloating, diarrhea,
constipations, or some, one ortwo of those things, they might
label you with the diagnosis ofIBS.
But there's no test per se forIBS.
However, there are a couple oftests developed by Dr.
Mark Penal.
And he does, he's a, he doespresent data every year to the
(16:09):
annual GI conference about IBS,and he talks about a test that
he's developed.
It's not routinely used.
It certainly wasn't routinelyused when I was in practice in
that space.
But I do wanna say that there isan, like I said earlier, and a
big overlap with the sibo.
And so those symptoms can looklike SIBO as well and vice
(16:30):
versa.
So there's a Venn diagram forboth.
I don't know.
There's a lot of, there's quitea, there may be a few of us in
the SIBO world that do believethat a lot of IBS is SIBO and
that they just don't know it yetor haven't been tested properly
for it.
Now, some people might have gasand bloating in some of the
diary constipation.
And you might get a a quick, nota quick fix, but you might like
(16:51):
address fiber maybe, and maybethat would help your
constipation.
Or you might hydrate or youmight do a squatty potty or you
might work with someone like youwork on your pelvic floor pelvic
pelvic, maybe you have pelvicfloor dys.
I always pronounce that wrong.
Maybe you have gut brain accessstuff, but there's stuff that
could be slightly simpler thanhaving to go down the rabbit
(17:15):
hole of, oh my God, do I haveSIBO or not?
And so I would say people cometo me.
By the time they've already beendiagnosed, often with IBS or
SIBO or both, and they've oftenhad a treatment and it's not
gotten better or it's come back.
And that is when it's a verynuanced approach.
Like you've got to really do theright testing, look for the
(17:38):
right gases, look for the rootcause of why you got it in the
first place, address motility ofthe gut address, gut, brain,
nervous system, all the stuffthat you do too.
So it can get complex.
Some SIBO does come back.
There's a percentage of SIBOthat does, can be recurrent or
refractory.
(17:58):
So did that answer your questionabout Yeah, I would say, I'm
wondering to.
The thing that's confused meabout SIBO is people are given
antibiotic for it.
Yeah.
But don't antibiotics like justdestroy the gut.
Great question.
Yeah.
'Cause I've always been confusedby that.
And then what are, what is theway they distinguish between
(18:20):
SIBO and IB Bs IBS is exclusion,but I know, are there some tests
for sibo, right?
I know there's some tests fromthat.
Yeah, there's some great tests.
Yeah.
And so what, yeah.
What are those tests?
As well.
Okay.
So I like, let's maybe startquestion with the test and then
we'll ask, answer the antibioticquestion'cause so with testing,
so you know, a lot of peoplehave heard about the microbiome
testing companies out there,Genova, gi, FX, et cetera GI
(18:44):
Map.
So those are tests that go lookat.
Your microbiome, maybe 20 or 30sp species.
They're looking at virus,they're looking at yeast,
they're looking at parasite,they're looking at overgrowth.
Or, and so overgrowth can meanovergrowth of just your good
stuff, like your good keystonebacteria.
You want that imbalance too.
You don't want that to be toolow, too high.
(19:07):
But it's also looking atpathogenic overgrowth.
And they are very sensitivetests for some of these
organisms.
Or, we're looking at the DNA,like of h pylori in that test.
We're not doing a true goldstandard h pylori test.
So it's a very sensitive test.
So it's picking up stuff.
When I look at those tests, I'm,by the way, so those tests are
not SIBO tests.
(19:28):
Okay.
Those are stool, microbiomestool health tests, if you will.
They're looking at, like I said,the microbiome population.
They're looking at digestiveenzyme production.
They're looking at, s one onefactor that helps with estrogen
detoxification.
They're looking at whether youhave fat maldigestion, because
(19:49):
you can look for somethingcalled tcrt.
So a couple of those tests youcan do with a GI doctor or using
insurance, but sometimes yourinsurance company doesn't cover
them.
You get a lot more informationdoing these tests, but they're
also not a game changer of atest necessarily.
They give me a picture of thepatient.
(20:10):
They give me a map.
I'm not treating any onebacteria, I'm not treating any
one test in that, big GI map.
I'm looking at the pattern ofwhat I see and then I'm taking
that with the story of thepatient.
And then I'm also taking thatwith okay, what are their
dietary restrictions?
What is their family history?
What are their other labs like?
(20:30):
It's a big picture that we'relooking at and it's a lot of
work.
Yeah, that's what I'm saying,even from an outsider
perspective, where with guthealth it's.
We help with the nervous system,we help, we teach people with
exercise and movement andmobility and like gut motility
in that sense.
Yeah.
But there's this whole otherpiece of the microbiome, right?
(20:53):
Yeah.
And then understanding thesethings that I think so many
practitioners outside of GI andmaybe even in GI, that are
unaware of Yeah.
These other tests and how tomanage this.
And and then we get, one of thethings that, the questions I had
sent you before the podcast washow like gut health is this
whole trendy thing.
Yeah.
And now everybody is treatinggut health.
(21:13):
And I think that there, noteverybody, but there's a lot of
unqualified people out theresaying these protocols and
things like that, that I thinkcan be very harmful.
Yeah.
If in, in the wrong hands,right?
Yeah.
And so you can, so in that,yeah, it's so many different
things.
And so what.
(21:34):
But then, so then what is this?
Are there specific, was it thetest that you were talking
about?
So that one's just a more basic,like I was saying, the
microbiome test, but it's not aSIBO test.
Okay.
And then there are there's SIBOtesting.
Okay.
And that is breath testing.
I was gonna say.
I thought.
Yeah.
And what they're doing, whatthose tests are trying to
capture is how much of the gasis, how much of the gas is being
(21:57):
produced by the overgrowth, bythe bacteria.
How do they know?
What is it, do you know?
Like specific Yeah.
You basically have to drink asubstrate, a particular type of
sugar.
Excuse me.
I feel like I need to take asip.
No, go ahead.
Of my strawberry expensivedrink, but it's delicious and it
(22:18):
looks really good.
Strawberry nut milk.
Oh my gosh.
With chaga mushroom in it.
That's so fun.
Maya Papaya always like coming.
Got a little bit of sweet in itand a little bit of sweetness.
Maya's can I have some, I didn'tbring my water, but do you want
some water?
No, I can wait.
Yeah, I've got that.
Thank you.
My gosh.
If okay, so yeah, you have todrink a particular type of sugar
(22:39):
just to see what is happeningwith how much of the bacteria is
fermenting this and what'shappening with the gases that
produces, it's a little bitmore, yeah.
And it's a pain in the butt of atest.
And honestly, there is nuancedway to do the test too.
I don't always, I have my owndirections for patients to do it
and my own substrates that Ilike for specific scenarios.
(22:59):
So again, it's an art, and Iknow you mentioned unqualified
professional people that may bedoing this, but.
I wonder if it's more thatthey're not looking at the
person.
I think this is a verypersonalized thing.
This is why I'm a high touchclinic, where I only have a
small number of people becauseit, that's it's involved, and I
(23:20):
have to do, I wanna know allabout you.
I wanna know your prenatalhistory.
Everything like every input intoyour body and into your person
and into your mind goes on mytimeline.
Because it can affect your guthealth for sure.
It's not just about, oh, I had aCI was born by C-section, or Oh,
I had lance antibiotics.
There's more to it than that.
There are other types of CBOtests as well.
(23:40):
They're all breath tests, butthey're different companies
doing them.
And there are multiple gases.
It's not just one gas that we'relooking for.
We now know there are threegases that these organisms,
these overgrowths can produce.
And there's different types.
And so depending on the type,you might have a different
treatment protocol.
Afterwards.
(24:01):
So I answered your questionabout the SIBO testing.
Oh.
And then my question was the anlike the antibiotics?
Yes.
Okay.
So how is that,'cause there's somuch on, on antibiotics Yeah.
And how that affects the gut aswell.
Yeah.
So why would, yes.
Great question.
So you may, have you also heardof the low FODMAP diet?
Yes.
(24:21):
Yeah.
So I view a lot of these thingsas band-aids.
SIBO is a manifestation.
It's not necessarily it is adiagnosis and it, but it is
really a result of somethinggoing on.
And SIBO causes symptoms andthey can be pretty bad.
(24:44):
And typically it's.
A belly that's getting more andmore distended throughout the
day.
Belly being bloated feelingbloated, trapped gas, but it can
also have abdominal pain.
That's very significant.
I have a patient, been workingwith her for quite a while, and
she's I've, you've fixed mypain.
You fix my pain.
(25:04):
I never had anyone fix my pain.
I went to multiple doctors, butshe still has bloating.
So we're working on that now,but the pain can be really bad.
The malnutrition can be reallybad.
There can be weight loss, therecan be systemic effects with,
rosacea, rashes, joint pains,brain fog.
And then there's a whole longlist of other root causes that
can cause it.
Besides that, that can get alittle bit.
(25:25):
It was like two pages of rootcauses.
To answer the question aboutthe, so why the, why do
antibiotics work?
They work because there's thismassive overgrowth of these
bacteria.
They're just going crazy.
And anytime you eat somethingand they're like having fun,
they're just like eating all,they're just like, oh my God,
I'm just enjoying and I'mgrowing and I'm building, and
I'm building, building.
And I like, and they'reoverpopulating.
So I like that analogy of thegrass, like a grass, like a
(25:49):
lawn.
You have good soil and if youhave good soil, you have good
grass growth.
But sometimes you'll have someweeds, but the weeds can
overpower the grass if thesoil's not great, and so then
you have to kill the weeds.
But by killing the weeds, you'renot really addressing the root
cause.
So the antibiotics are the weedkiller, but you have to address
(26:09):
the soil.
So antibiotics help.
I.
People with sibo, differenttypes.
There are very specific typesfor different gases too.
And then there are herbalantibiotics that you can use
that work very well.
They just take longer.
Which ones are those?
Oh, there are many.
But you could think of oil oforegano is a big one.
Or I've seen that they're likeconcoctions of herbal medicines.
(26:30):
They can be, put into capsulesand sold by some of the higher
quality medical grade supplementcompanies.
But I would encourage nobody togo do this on, it should be
guided.
'cause you can feel pretty sick.
Yeah.
You don't wanna, yeah, you don'twanna, yeah.
And then you don't, and ifyou're a practitioner listening,
you don't, we don't wanna justbe telling people to take this
stuff.
Because we are not, ordering thetest.
(26:51):
Yeah, exactly.
And you're also, and are thesetests, are they ordered through
Western medicine?
The SIBO breath test is Okay.
Some people do.
Some still don't.
Some still don't.
Oh, Uhhuh.
Yeah.
So when they go in, they'rebasically what given a
colonoscopy then, and then anendoscopy, and then you're
(27:13):
clear.
So there's nothing, is that kindof the standard?
So then they're like maybe anantispasmodic something to help
with their constipation.
If they have constipation,something to help with their
diarrhea.
If they have diarrhea.
Those, sometimes I've seenconservative things like, hey,
drink some water, have somefiber.
Maybe take MiraLax, Metamucilthat I, that they are doing in
the conventional GI space forsure.
(27:35):
But sometimes patients aremiserable and not having a bowel
movement except for once a week.
Ugh.
In that case, we call it rapidrelief.
I do rapid relief in ourpractice too.
Sometimes I'm like, you gottatake all this stuff.
We gotta get you feeling better.
We got you sleeping.
We need to, we've gotta clearpeople out.
You've got,'cause they'reholding and that uhhuh and then
they releasing all the estrogentoo and Yep.
Hundred percent get, and thecholesterol dominance.
(27:55):
And then the cholesterol, you'vegotta clear it out.
But.
Yeah.
That's why I think this blendedapproach is so important.
Yeah.
'cause the reality is people aregonna need medication.
Yes.
I'm not gonna not takemedication.
If I need to take an antibiotic,I'm gonna sit and be like, do I
actually need to take this?
I'm gonna question it.
Yeah.
And I'm gonna see, I don't wannaunnecessarily take it, but hey,
(28:16):
the issue is that we're not justlike blindly doing things.
We're looking at it, okay, hey,this medicine's gonna help me,
but why did I get sick in thefirst place?
Yeah.
Yeah.
So treat the symptom but not thecause.
Yeah.
And that's the issue I think inWestern medicine so much, is
that we treat symptoms.
Yes.
Yes.
And there's not a root, which isso interesting to me.
'cause I'm like, don't you thinkinsurance companies, like they
(28:37):
would benefit from everybodyfeeling better, they's benefit
from I don't know.
F cash flow.
Yeah.
Lots of patients, lots ofprocedures.
The insurance companies, thenthey pay out more.
Yeah, I think I'm not, I'mdefinitely not an expert there,
but I just think that I, yeah, Idon't have an answer for that.
(29:01):
There's, it's just, it's sointeresting to me.
'cause you would thinkpreventative, that's another
podcast episode maybe that hasto do with.
Culture demand.
I don't know, if patientsdemanded it more, but I don't
think patients, we also havethis hierarchy in the medical
system, like patients getgaslit, so then they don't
sometimes speak for themselvesor vouch for themselves.
(29:21):
But there, that's a fine balancetoo.
I don't think patients should goaround disrespectfully yes.
Yes, there's a balance.
There is a balance.
If you go in and you're bossingyour practitioner around, get
out of here.
Yeah.
Yeah.
It's more of.
Hey, what do you think?
I've read this.
I feel strongly about this.
What do you think?
Do, are you very against it ordo you have any comment on it?
(29:43):
What would you do if you were inmy shoes?
Yes.
Those are the kinds of questionsto be asking the provider.
Yeah, but you do have to go in,you have to be your own
advocate, but you, at the sametime, you can do it with a
respectful tone.
And honestly, if they're not, ifthey're gaslighting you or not
open, you gotta find someoneelse.
Totally.
Yeah.
But that's the thing that sucksthough.
'cause that takes so much time.
(30:03):
I'll tell my patients, and ifyou're all listening and you
have patients as well that are,they're experiencing this is
just knowing that, hey I'll prepthem.
Do your research before.
Come up with your top threequestions.
You've got five or 10 minutes.
Like you do the work ahead oftime.
Yeah.
And you get in there and thenthey have the information.
'cause otherwise there's justno, there's just no time.
(30:25):
There's just no time for that.
But what it, are there clinicalsymptoms that are
differentiating between SIBO andIBSA lot?
Or they look the same?
They can look similar.
IBS may not always be.
I don't think, I don't see.
Plain IBS anymore.
But that's because I'm lookingfor a lot more and finding a lot
(30:49):
more.
But if I go back to the years ofconventional GI that we did it,
there are many people that comein and they're like, I'm a
little gassy.
I'm a little bloated and I havement, just every other day.
And because they're in my o inour office and they're seeking
you out, you feel like helpingthem.
(31:12):
And a lot of times they werehelped by medication and maybe a
little fiber, try this, comeback in six weeks and if they
don't come back, you don't knowwhat happened.
So you don't really know if theywent and found someone else
'cause they didn't get anybetter or you don't know if they
did get better.
So you just don't know.
But then if they come back andmaybe they're a little better.
(31:33):
It's hard to say.
There are people that can behelped from just a little fiber
or a little hydration or alittle meditation or a little
squatty potty action.
Good bowel hygiene, good eatinghygiene is what I call it.
Those are little things that canwork.
And maybe you don't have sibo.
Maybe you, maybe it's reallyhonestly just fixing some
(31:53):
lifestyle things and diet alittle bit, I also, I've seen
from the pelvic floor P PT side,people forget how to poop.
Yes.
So they push through their bellyinstead of down.
And they're like, it's not goinganywhere.
So you're literally like aimingout through the belly button.
This is also for giving birth topeople, push through the belly
instead of down and we almostforget like the physics of it.
(32:14):
And then people forget.
We'll do, anal biofeedback aswell to be like, Hey, contract,
contract the anus, relax.
Contract.
'cause they'll do the opposite.
And so isn't that what thepelvic floor dys synergia is?
Yes.
Okay.
Yes.
So the, that, that happens a lotwith people that I've seen with
chronic constipation or chronicdiarrhea.
(32:35):
And the other thing too that canhappen that I've seen with
bloating and constipation ismore so constipation, but is
rectocele.
Yeah.
So the bladder pro, the rectumprolapsing into the vagina.
Yeah.
Yeah.
And so I've seen people's, theirsymptoms improve with just
putting a pry in there andpushing the vaginal wall up.
(32:57):
So then the rectum has to staymore in its place too.
Yeah.
So it's like there's so manythings that are even
structurally.
Structurally, yes.
Then you've got the nervoussystem, then you've got your
diet.
Yeah.
And then you've got whateverbacteria, whatever is happening.
And.
It's so many multifaceted.
The physician that wrote theBody keeps the score when I
(33:17):
listen to that book,'cause I'mgonna be full audience.
I am an audible person.
I try so hard to read the books,but sometimes it's just easier.
I'm the opposite.
I can't do Audible.
Yeah.
It depends.
Weird on the day.
It depends on the day.
I wish I could get both audibleand the visual just for if
you're.
You wanna actually read?
Yeah.
But anyways, it was soeye-opening for me because this
(33:40):
was several years ago and he wasthe first in my eyes to
correlate IBS with the historyof trauma.
Yeah.
And how much of that though, isit, I've heard people say Hey,
it's actually the nerves Yeah.
Around the gut.
And so hard to say.
I what?
Hard to say that it's not.
Hard to say that's not true.
(34:00):
But it can't be like, yes, itcan be, but I feel like there's
this trend happening right nowwhere people are relating
everything to trauma.
Yeah.
I, and not actually treating thephysical side of stuff too.
Yeah.
So there is, like I'll getpeople in chronic pelvic pain,
but, yes, the nervous system isa piece of it, but what about
the labrum, right?
(34:20):
What's going on in the hips?
What's going on in the lowerabdomen?
How's the back'cause a referralfrom the lumbar spine?
Is there thoracic spine moving?
Yeah.
How are they walking?
Yeah.
So there's all these differentcomponents and so I feel it can
be harmful to just blanketstatements.
Just say, oh, it's due totrauma, when there's still a
physical body to be treated.
Yeah.
Yeah.
I don't, I think blanketstatements should be a sign in
(34:44):
medicine or science aren'tanything really.
Yeah.
I think there's not a lot ofblanket stuff we can say.
There's no blanket supplements.
I could even say maybe fish oil,but not for everybody.
Like I, there's no blanket diet.
I'm very diet agnostic in ourpractice.
Yeah.
You can come to me on thecarnivore diet and you can come
to me vegan and we will tell youand figure out whether that's
(35:05):
right for you or not.
But that's based on yourbiochemistry, your labs, your
family history, what you'redealing with, what's your GI
tract like.
All that stuff.
Yeah, I don't know.
I agree with you.
Like I, that is true.
I'm seeing that trend as well.
I'm seeing it and I believe ithas a massive component, right?
I, the way that I look at.
Unprocessed trauma is it's thefuel to the fire, right?
(35:27):
So there's already a fire andthen you're adding gasoline to
it.
Or you know what some of theresearchers have said?
It's like it's festering.
Like that is the thing that likesets it off.
Yeah.
Yeah.
And then we're predisposed tothese other things.
But then I go, okay, so say I,he heal my trauma.
I work through it and I processmy trauma.
And then I eat McDonald's everyday.
Yeah.
Do you, you see what I'm saying?
And maybe I'm not traumatized.
(35:48):
Yeah.
I bucket and you tip the bucketat some point.
And that is a big core tenet offunctional medicine is that you,
I.
You could be on the same.
This is why we do that timelinein our practice of people let's,
where did we tip the bucket?
What are the factors that tippedthe bucket?
And sometimes we don't alwaysknow, but there's always,
there's often a time point wherethe bucket was tipped, but we
(36:08):
don't really know how muchpercentage of the trauma at age
five affected the GI tract atage 40.
'cause maybe menopause happenedbefore that too.
And you had estrogen completelywiped out from your system, from
all the receptors of the body.
Maybe before that you had,abdominal surgery, maybe.
So everyone's map is sodifferent.
(36:30):
So different.
And that's why it's so importantthat we encourage our patients
to know and advocate forthemselves.
I feel what I've seen here isjust not just here, like I'm
saying like in the us.
I don't know if it's like thisin other countries, but
basically we've just blindly goto practitioners and ask them
for answers.
(36:51):
And where I'm trying to go islet's get people to start
understanding their bodiesintuitively.
So they can ask the rightquestions.
Because if you add in, if.
A very well un like a, a patientwho is, who understands their
medical history, who can say,Hey, I know it started at this
time.
This is, these are some othersymptoms I have.
(37:11):
So starting to get our patientsto correlate Yeah.
These things even before theysee, yeah.
Because if you go in maybe to aGI doctor and you're like, Hey,
every time I eat this, I havethese symptoms, right?
Or every time I experience this,I have this.
And so you're almost doing,they're almost doing their own
little experiment.
Or research study, end of one.
(37:33):
Yeah.
Yeah.
And so that way it's so muchmore consolidated.
So by the time they go into thatpractitioner, they're like, Hey,
I notice I have these symptomswith X, Y, Z.
And so even people knowing theirown anatomy and being like, oh,
what's going on?
Even, if you have bladder pain,is it your bladder or is it
Yeah.
Or is it your uterus?
'cause they're right there.
Or is it referral from lumbarspine or do you notice it with
(37:55):
different movements?
Do you notice it with emotionalstress or for certain foods?
And so getting people to Yeah.
Know all of those things.
'cause the patients their ownadvocate, but they don't know
the power because we've had thishierarchy Yes.
The hierarchy of the medicalsystem for so long.
And I just keep shouting thisfrom the rooftops, is that
evidence-based medicine is thepractitioner, the patient and
research.
(38:16):
Yes.
It's all three.
That's a great phrase.
Yeah.
It just try it though.
It makes me bonker and alsojust, I'm not against, I'm not,
I'm thankful for EBM, but it, weget one endpoint.
We don't EBM, evidence-basedmedicine.
Sorry.
Oh, sorry.
The mic.
I just remembering the coursewas EBM that I took in grad
(38:36):
school.
So luckily I just said it andI'm like, I'm weaning from
caffeine.
Everybody to my brain is alittle foggy and well who says
EBM?
I don't think anybody does.
I don't know why is said thatyou're just like, ebm.
I'm like, Hey, okay, I'm gonna,I was like, I don't wanna
pretend like I know what clearlywe just said it anyways.
So was it was the name of thesemester course, and it was
(38:57):
like, it's great.
Yes.
But let's also start thinkingoutside the box.
And no one is gonna argue inWestern medicine that we treat
the patient in front of us, sowe treat the patient in front of
us.
And that's not necessarily atrial.
So it's an informed decisionbetween me and you.
Yeah, what we had looped back tobefore is one of the things that
(39:20):
you said, like in that 15 to 10minutes or five to 10 minute
sessions to say, this can be anyclinician.
This can even be people in thefitness world or physical
therapy world, wherever.
What are some like little thingsthat, that you can just steer
them in the right direction.
So I don't want people thinkingout there that they, that having
(39:43):
GI issues is normal.
Ah, okay.
So a lot of people live withchronic diarrhea, constipation
and constipation, chronicdiarrhea, excessive gas and
bloating.
Malodorous, flatts, marou acid.
Smells like rotten eggs all thetime, ugh, those are the worst
belching.
I know.
Belching incessantly not beingable to sleep because you have
(40:05):
acid reflux.
I just don't, you, you should,you or your, the provider that's
listening, just let them know,Hey, this can be likely restored
and reversed.
Or at least looked at andevaluated appropriately from a
root cause.
Perspective.
I was gonna mention one thingand I we were briefly talking
(40:25):
about the antibiotics.
Si I do think that's a bandaidstill.
I hopefully that came across No,you said that.
Yeah, you said that.
But so is a low FODMAP diet.
It's, that is classically usedin conventional gi we gave it
out all the time.
Go on a low FODMAP diet.
You've got IBS try that.
Maybe they, maybe we would tryfiber or maybe we would try
hydration, or maybe we triedsome, something like Metamucil
(40:47):
or something for constipationfor the patient.
Or, and then sometimes we wouldsay, or maybe if they later on
we'd say, try a low FODMAP diet.
Here's a handout.
First of all, it's a really harddiet.
It's very complicated.
Once you get the hang of it,it's not that hard.
But you have to follow theserules and they don't give you
any guidance in some GIpractices.
(41:09):
They just give you the handout.
And what happens is a lot ofpeople go on that and then they
don't go off of it because itmakes'em feel good.
If that's you and you'relistening.
That's not a great thing.
You don't wanna be on thatrestrictive diet for that long
because you are then ultimatelyharming your diversity of your
microbiome.
It's just a bandaid.
Same with the antibiotic youmentioned.
Okay.
(41:30):
Doesn't the antibiotic wipe outthe bacteria?
It does.
So that's why it's a bandaid andit's gonna make you feel better.
But you, there are things thatneed to be take done in sequence
in our, like the way we do sibothat will help you restore your
gut function, your mucosalrepair, your butyrate
production, and then ultimatelygive you your microbiome back.
(41:55):
Yeah.
So that you don't get it.
I know it's, it soundscomplicated, but No, I think it
makes sense.
So basically like the top twothings that you would tell a
practitioner or a coach orsomebody that's working with
patients in healthcare orexperiencing a health related
issue with their gut.
So the top two things that yousaid.
(42:15):
What are the top two things thata provider can tell their
patient.
To maybe help di direct them inthe right direction.
Okay.
Is what you're saying?
Yeah.
Related to gut health.
Related to gut health.
It's really easy for me to sayoh, the one thing would be tell
them to eat fiber.
No.
What you, what I was going towas you had said, number one,
(42:36):
tell, letting them know Yeah.
That's not normal.
And number two is restrictivediets can be harmful long term.
Oh yeah.
Would you say those to me, thoseare two good things to say.
But I, it's hard to just limitit to two.
I know.
I'm just saying Would, are thereothers?
Yeah.
Would you say three?
I would say I was gonna say, youmight think that I might answer
the question by saying telleverybody, get on 35 grams of
(42:58):
fiber a day because that's whatyou should do.
Okay.
But, yes.
Ultimately, that's a great placeto ultimately get to.
But if fiber bothers you, that'sa red, that's a flag.
Something's going on.
If fiber bloats you up, youcan't tolerate it.
It's doing something to you,giving you diarrhea, giving you
constipation, bloating, reflux,huh?
What's going on?
(43:19):
Yeah.
Okay.
Yeah.
So basically the top threethings, okay.
You would tell a practitionerthat's working with a patient
that has gut issues would benumber one to know that, hey,
acid reflux or gut symptoms arenot normal long term.
Number two any, oh my gosh, Ican't even get my words out.
Any restrictive diet long termis not sustainable and it's not
(43:40):
healthy for your microbiome.
And then number three, fiber isnot necessarily something that.
Everyone can tolerate, but thatdoesn't mean that you ultimately
should avoid it.
Yes.
It's the sim it's the signal.
Yeah.
It's basically saying, Hey,something's going on.
Yeah.
Yeah.
And let's look at this deeper.
(44:00):
Yeah.
And now that being said, there'sare people out there that are
like not doing lectins and maybeon a, on various kinds of diets
like the autoimmune paleo dietand avoiding grains and low like
carnivore, which is no fiber.
I'm not saying there's anythingwrong with those.
I just think that they, thereare some of those, like the
carnivore diet can be probably atherapeutic diet for a while
(44:24):
because it's, there's something,why is it working for you?
Why is it making you feel good?
Because you probably have someinflammation there.
So anything that's not thecarnivore diet that's maybe
excessively inflammatory to youis bothering you.
Always ask why?
Yeah.
'cause I know a lot of peoplewith IBS, they can't eat raw
veggies.
Yeah.
And that's fiber right there.
(44:45):
So that makes sense.
And that's because a lot of thetimes that's that overgrowth
happening.
So they can't eat the veggiesbecause the veggies make the
bacteria really happy and youknow what I'm saying?
And the bacteria are like, oh, Ilove this.
Let me give more gas and fermentthis, these carbohydrates, and
then you feel badly.
(45:06):
So it's more because of that,most likely is what I tend to
think.
But still, no, I think it's,there's so much we don't know
about the microbiome still, sothere's still so much we don't
know.
Yeah.
There's still so much evolving.
Yeah.
And it's being patient with thesystem and it's science, it's
constantly evolving, constantlylearning.
I love this phrase I learnedactually recently.
I'm not.
(45:26):
A know it all.
I'm a learn it all.
There you go.
Just to, to dive in a little biton menopause if practitioners
are working with somebody goingthrough menopause, can you
explain how menopause.
Menopause, I said menopause me,meno, me meno.
How does gut health affect isaffected?
(45:47):
How is it affected by menopause?
I got this, I get this questionasked and I don't answer it very
well every time because I stillfeel like hrts a little bit of
the wild west.
Totally.
And and that's because it's,we're back in it and it's
relatively new.
Menopause is trending now forgood, for great things, all good
things, but I just don't know.
(46:09):
I don't think we know a lotother than we know that we are
depleted with these reallycrucial hormones that are all
over our body.
And including the gut and, brainand everywhere.
And so wh the, why do we getdepleted at such young ages is
the question.
It's not fair because we do livelonger now.
(46:32):
And so it's almost and I'mdigressing a little bit, but
I'm, I don't think it's,menopause is not fair.
Oh yeah.
To I mean it, I'm trying toembrace it like, for people, my
patients, for myself, et cetera.
But it's harder and harder toembrace it when you're like, oh,
so you only wanted me on thisearth to have a baby.
And then goodbye.
(46:52):
You don't need your hormonesanymore.
'Cause people will have the mostpristine bowel movements, no GI
issues, not a single problem.
And I know this'cause I havefamily members and I've done
their stool testing.
Pristine.
Nothing wrong with it.
Menopause.
Comes and they're like, huh, I'ma little con.
I'm not constipated.
But things are a littlesluggish.
(47:13):
They're a little slow.
They don't come out.
Yeah.
That could be okay.
Maybe the bucket's tipping forsomething else.
Maybe something's about tohappen.
I don't know.
Or maybe we blame menopause.
Honestly, I've seen a wholecassia stuff.
I've seen a DHD symptoms justflare up like crazy.
I've seen anxiety.
I've seen pain with sex.
I've seen just loss of interest.
(47:34):
I've seen depression.
I've seen gut issues.
Yeah.
And with all the estrogenreceptors on the gut too.
Yeah.
You're saying you're seeing thisrelated to menopause, right?
Oh yeah.
That's, yeah.
Exactly mean, that's, butthey'll, it's all over.
They'll come in and then theythink they're crazy and I'm
like, no, you're not.
You're really not.
There's a lot, there's so manythings going on, and now there's
a big menopause movement, whichI think is great.
(47:54):
But there are also this, a wholethere side of just like over
pushing like the hormones.
Like I'm a person where I have,I had never been able to
tolerate any hormones before andI'm like almost dreading, not
dreading, I don't wanna say I'mdreading, but I'm worried about
going through menopause becauseI believe I might be in
perimenopause currently.
(48:16):
And that's, I think it'shappening younger for me.
'cause I went throughchemotherapy five years ago or
six years ago.
And I guess my point is that noteverybody can tolerate hormones.
And and there's still a lot Ithink that can be done in my
experience to help.
So I'll say it's interestingbecause I'm a, I am a food is
(48:37):
medicine person and all that,but I'm also a longevity person.
And if we know that thesehormones affect our longevity in
the sense of improved bonehealth, heart health and
cognition, it's really hard tosay, let me do this naturally.
(49:00):
So I'm torn about itphilosophically, but I also know
that the science is there forthese, for estrogen,
testosterone, DHEA for all theseto be really great things that
we should have not been deprivedof at these early ages.
And we are.
And so now I think we're alldealing with okay, do we go on
these or not Now?
(49:20):
Yes, there are great.
All kinds of things.
Herbals, supplements, naturalthings, maca, co black, osh,
blah, blah, blah forperimenopausal symptoms, but
that does not affect longevity.
So I think there's a bigdifference between symptoms.
And what's your target goalhere?
You're saying longevity'cause oflike bone health?
(49:42):
Yeah, muscle mass, things likethat.
Yeah.
Yeah.
And, but there are some peopleespecially people with the
history of breast cancer.
Yeah.
There's debate on whether or notpeople can go on that, but then
there's also if you play thisout, if you, if.
Don't go on estrogen.
There's also this thing aboutcancer that I feel like pisses
me off in the medical communityis it's let's just get people
(50:02):
let's just make sure that theircancer, there's some evidence
that maybe shows X, Y, Z.
So let's just remove thiscompletely from this person.
Yeah.
But let's roll this back nowlet's look at their quality of
life.
Yeah.
Yeah.
So if I know, if I'm a, if I, ifsomebody's told, Hey, don't go
on estrogen, it could increaseyour breast cancer risk to come
back.
(50:22):
What are we say this persondevelops severe anxiety and then
their bone loss and then theyfall and break their hip.
So there's this, okay, theymight live like Yeah.
Longer with without cancer, butwhat's their quality of life?
Yeah.
So there's this, fear is therefor cancer.
Yeah.
But which I.
Of course, but there's thenumber one killer in the world
(50:42):
is heart disease.
Yeah.
And what men and women, what'sestrogen receptors on the heart?
Yeah.
Yeah.
So just look at the statisticsof Yeah.
Worldwide cause of death andcause of mortality.
That doesn't mean I don't, I dounderstand where those providers
are coming from.
Oh, I get it.
But how about a more informeddecision making process with the
patient?
Like with the patient, let themdecide Hey, this is it's more
(51:05):
likely that hey, this is therisk.
Yeah.
But then this is also your moremore the like your quality of
life.
Yeah.
And you get to decide.
Yeah.
Yeah.
That's my issue with it is itlike, but I do think we can
blame the, the WHI study and allthat on some of this.
Oh my gosh, it's horrible.
Probably the next generation ofmed students are going to be
more well informed and not that,not more well informed, but they
(51:27):
will be.
Able to look at the longevitypiece a little bit more and
maybe then have thosediscussions because, that study
for the people that don't know,it was probably the worst thing
I think for women ever Uhhuh.
Yep.
Yep.
And it basically said thatbreast cancer was caused by
estrogen, but they gave it topeople.
It was like 10 years aftermenopause.
(51:48):
Yeah.
And it was lots of problems inthe study.
So many issues.
And so we've got, we still gotso many people scared of
estrogen now.
And I'll say, Hey, there's noand actually maybe some people
don't know this'cause I didn'teven know about that study until
I went to pelvic health.
Into pelvic health.
Oh, really?
Yeah.
Okay.
So it wasn't well in the, it'snot as well known in like the
Oh, general physical therapyworld.
(52:09):
Yeah.
So if you are a physicaltherapist or a chiropractor or a
practitioner that works in thefield, people are scared of
estrogen because of the Women'sHealth Initiative study.
But this study was extremelyflawed and it scared a lot of
people not to get estrogen.
Yeah.
People and practitioners.
Yeah, and practitioners.
'cause like even in trainingour, my good friend so we all
(52:31):
were, in the medical field, med,med students and PA students and
we're all friends and ones inob, GY none of this was talked
about.
Like you just didn't, no onetalked about menopause first of
all, but it was a cult culturalmindset to be like, oh yeah,
that is just not a thing youdon't do.
HRT.
Period.
(52:51):
So everything's changed fromwhen we all went to med school,
pa school to now.
So I just, I would be curious tohear like you should have a
medical student on Yeah.
Or like a resident.
Yeah, that's a good ideaactually.
Yeah.
But I think the thing thatfrustrates me about now, we've
almost swung so much to theother side, the other direction.
Yeah.
And Hey I'm pro whatever peoplewanna do.
Yeah.
But that's what I was say,alluding, like saying before is
(53:13):
that now we're just like overpushing it without letting,
without addressing all thesedifferent populations and.
It is, there are plenty ofpeople on HRT now that are
having problems likepostmenopausal bleeding.
Okay.
What do we do with that?
How do we adjust the hormones?
Do we adjust the progest?
Do we adjust the estrogen dose?
Do we, or like hair loss.
(53:33):
I'm not trying to scare peoplefrom HRT, but I'm with you.
Like it is a nuanced approach.
It is.
And that is why I think it'sstill a little bit of the wild
west because there's differentdeliveries.
There's different testing,saliva, urine serum.
How it overwhelming and thetesting the testing's hard too.
'cause it's if somebody's on ora birth control, how do they
test that?
And then I've had somebody onand come on here and talk about
(53:55):
the Dutch test.
Yeah.
Because that's supposed to behelpful for that as well.
And so then you can get testedfor that.
But not a lot of practitionersuse the Dutch test.
Yes.
It's a pretty expensive test andit takes a long time.
To review it unless you do themevery day, which, yeah.
And so then people are going andthey getting their blood work
done and they're like, oh,things are normal, but they're
symptomatic.
And so then I've seen so manytimes people are given hormones
(54:15):
and they're not monitored.
Oh, that is the conventionalway.
They're, I had somebody Yeah Iwas, I the symptoms they were
having, I said, we need to, isanybody, so I'll ask people, and
this is important forpractitioners, is are they doing
routine follow-ups?
Are you being tracked?
Are you just blindly givingthis?
Yeah.
Because that will cause a lot ofissues.
(54:36):
And then people think it's theestrogen, it's the dosage.
Yeah.
But then they come back to youand say we're, I went back to my
doctor and I said, can we check?
And they'll say, no, serumchecking doesn't make any sense.
So it's really tricky.
You could still, I think theOprah special was good.
It was really like just gettingthe word out and people, I think
it's great.
It wasn't not, I, the people Iwatched it with had already gone
(54:59):
through menopause and two ofthem and the third one had tried
HRT and felt like, oh my God, Ihad so many side effects.
I got off of it.
And then that show convincedher, even though I've been
talking to her to consider goingback on it.
So honestly, I think it wasgreat for lay people to start
the discussion.
I don't think the discussion wasthorough.
(55:20):
It's only was an hour.
There were so many, like I said,all these nuances that I'm
talking about that need to beaddressed.
And so I think, she plans tohave podcast episodes about it.
Great.
I do, they did focus on thecognition a lot.
There was a neurologist there,so I feel like they were really
talking about I was like braingut, but they were talking about
brain, gut, vagina.
Access.
(55:40):
Yeah.
That, and then there's anotherpiece too where, okay.
HRT, but I've seen it wherepeople like they're experiencing
vaginal dryness and pain withsex because of the decrease in
estrogen in the vagina.
So even local estrogen, I'lltell people to get that a lot.
And then sometimes I'll comeback and be like, my
practitioner wants to know thedosage.
Yeah.
But it's just so interesting tome that then they're coming back
and then asking a physicaltherapist, I'm like, oh my gosh,
(56:04):
I don't prescribe these things.
But yeah, it's just, it it's allvery new.
It's, I think still so veryfresh.
It'll be different in 10 years.
Yeah.
It's crazy.
Yeah.
But thank you so much for comingon.
For sure.
Such a great time to talk withyou.
I love talking about all this.
We could probably talk anotherhour about, I know.
I was just like, oh my gosh, Idon't want take your time
anymore.
(56:24):
In summary, we went over IBS, wewent over sibo, different things
to look for as a practitioner,when to potentially get more
testing.
And so understanding how westernmedicine.
And how, and incorporating thatinto looking at the person from
a holistic perspective andencouraging our patients or
(56:46):
clients to really advocate forthemselves and get to know their
bodies so that when they do gointo Western medicine, they go
into these five or 10 minuteappointments that they can
really ask these directquestions and get some help from
that standpoint.
Yeah.
And yeah.
And then how menopause canaffect the gut as well.
The gut.
Yeah.
Yeah.
So tell them how they can reachyou.
Oh.
So Precision Gut Health is ourwebsite.
(57:08):
Instagram Precision Gut Health,Facebook Precision Gut Health,
TikTok, precision Gut Health.
Okay.
It's all precision gut health.
Actually, we started asprecision metabolic health
because I really, oh, I didremember seeing that Uhhuh.
And then it's, that's amouthful.
And I don't think people knowwhat metabolic means Exactly.
Yeah.
And I was like, oh, marketingagency that I hired basically
(57:29):
told me that's not gonna workfo.
And it, and it.
Because it's just a mouthful.
And I still do metabolic health.
I do a lot of lipids andcholesterol and things like
that.
We do a full chemistry panel ifyou're in the state of Texas.
It's a very like, comprehensiveblood work panel that's a really
good starting point.
(57:49):
That can give us clues tonutrition, to all inflammation,
to blood sugar regulation,cholesterol, all the things.
I love doing that.
That's important to get yourblood work done properly,
comprehensively.
Great.
Cool.
I'll put all that info.
Okay, cool.
And the link below.
All right.
Awesome.
Thanks for having me.
Thank you.
Thank you so much for listeningto my podcast.
It would be a huge help if youcould subscribe and rate the
(58:12):
podcast.
It helps us reach more peopleand make a bigger impact.
I would also love it if youcould join my email list, which
is LinkedIn, the caption forpodcast updates, upcoming offers
and events.
You can also find me on TikTok,YouTube and Instagram at Dr.
Mary pt.
Thanks again.
Welcome back to TMI talk withDr.
(00:01):
Mary.
Today we're gonna be talkingabout the gaps between
traditional GI care andfunctional gut health management
and how to bridge them intopractice.
And in order to understand thisbetter, I brought on Shafai Ula,
who is a PA and a functionalmedicine certified practitioner.
She is the visionary founder ofPrecision Gut Health, a virtual
(00:24):
telehealth practice on a missionto unlock the secrets of gut
health.
Nutrition and longevity at theheart of her practice lies a
powerful fusion betweenfunctional medicine, culinary
nutrition, and a profoundcommitment to digestive and
metabolic optimization using adeeply individualized approach.
She's dedicated to guidingpatients towards a future where
(00:45):
gut health and longevity areintricately intertwined, and
where vibrant health is not justa destination, but a lifelong
journey.
In this episode, you're gonna bewalking away with practical red
flags to recognize such aschronic bloating and diarrhea.
Even if you don't know that muchabout gut health, then that way
(01:06):
you can refer your clients tosomebody to get help clarity on
testing, we're gonna bereviewing how the differences
between a standard microbiomestool test versus SIBO breath
testing.
We're gonna be talking about theinsight on bandaid approaches,
so why antibiotics, low FOD batdiets and gut healing
supplements.
Can sometimes help temporarily,but it won't fix the root cause.
(01:29):
Next we're gonna be talkingabout the IBS and SIBO
connection.
Why many patients are labeled asIBS, but have actually been
undiagnosed, as with sibo.
And how to start thinking beyondthe symptom suppression.
We'll be also talking about therealistic view of functional
medicine.
It's not all about beinganti-medicine, it's about
combining conventionaldiagnostics with a personalized
(01:51):
root cause.
Approach to truly help peopleheal.
And finally, we'll be talkingabout menopause and gut health,
which is also a bonus dive intohow declining estrogen levels
impact gut motility microbiomehealth and overall inflammation.
And why HRT decisions should bepatient-centered and nuanced.
So why does this matter asclinicians?
(02:13):
Well, you'll be better equippedto a spot when something.
That the patient might seem asnormal, is actually not normal.
You'll be able to ask betterquestions and know when to refer
for deeper workups, and thishelps empower your patients so
that way they can understandmore about their body.
So thank you for listening, andnow we'll jump into the episode.
Welcome back to TMI talk withDr.
(02:34):
Mary where we dive intonon-traditional forms of health
that were once labeled as tabooor dismissed as Woo.
I'm your host, Dr.
Mary.
I'm an orthopedic and pelvicfloor physical therapist who
helps health.
Movement and rehab professionalsintegrate whole body healing by
blending the nervous system intotraditional biomechanics to
maximize patient outcomes.
(02:56):
I use a non-traditional approachthat has helped thousands of
people address the deeper rootsof health that often get
overlooked in conventionalwestern training.
And now we are gonna be startingour next episode.
mary (03:08):
Welcome to the show, thank you.
So nice to be here.
Love the space.
Yeah.
We're excited to have you.
Thank you.
And we'll just dive right in.
Sounds good.
Okay, so what inspired you tocreate Precision Gut Health?
It happened because of mybackground.
So I have a background in, soI'm a pa.
And had an, a first job out ofschool that was in, strangely, a
(03:34):
very unique niche in bone marrowtransplant in Seattle.
And but around that time my, myfather had a heart attack and he
was only 54 and he was very thinand lean and vegetarian.
And I hadn't learned anythingabout nutrition, so I was so
confused, yeah.
Wait, why is this vegetarian,thin, young man having a heart
attack and he survived and allthat, but it really led me into
(03:57):
this path of nutrition because Ijust felt like, okay, this is
not making any sense.
And, they don't teach any ofthis.
I got into nutrition and then I,we moved here to Austin and I
couldn't find a job.
In the field that I had alreadybeen trained in, which was this
bone marrow transplant.
Very unique field, but the job Ifound was in gastroenterology.
(04:19):
And so I started in the GIworld, but at the same time, on
the side, I'm sitting herelearning about nutrition and
cholesterol and cardiology andnutrition for cardiac health for
my dad.
It didn't apply to gi, reallydirectly at the time.
And then, yeah.
And then I actually, for aperiod in my life stayed home
(04:40):
and with my kids, I wanted to bea stay at home mom for a little
while, but it ended up being along time.
Yeah.
And I ended up teaching cookingclasses, to keep myself busy for
fun.
But that turned into a careerand that was where that old
business that you might befamiliar with, chef's Kitchen
was born from.
So I had this little culinarybusiness, which was a nutrition
business to a, oh, I, it wasculinary medicine, so it was
(05:01):
like initially Indian cooking.
And then I'm like, wait thisdoesn't jive with my dad's
health history.
He grew up eating this way.
It didn't fit into my nutritionplan.
We weren't eating it every day.
So it really morphed into foodas medicine, a lot of more
healthier cooking and reallyglobal cooking, honestly.
(05:22):
Yeah.
And then I went back to gi.
After I'm like, oh, my kids areolder and I miss, being a pa I
miss using my medical brain.
So and so that's what I did.
I went back to gi same group,different location different, a
little bit of different people.
Great experience.
And then the pandemic hit andthen.
That kind of broke that wholething apart.
(05:43):
But I will say while, rightbefore I rejoined being at
Austin at the GI practice, I Istarted studying functional
medicine because I had beenstudying nutrition and I'm like,
oh this makes sense.
Like it's just a pathway tofunctional medicine a lot of
times in integrated medicine.
So I thought, I'll bring that togi.
I'm like, why not?
(06:03):
Take what I've learned.
I had just done the GI module atIFM and I'm like, I gotta bring
this to the practice.
And it is just, was just hard todo for many reasons.
We don't, we can go into that ifyou want to, but very hard to
do, I would say, because theinsurance companies dictate us.
That's really the main reason.
There's no way, in those likefive, 10 minute sessions, how
are you gonna teach somebodyabout gut health, and there's so
(06:25):
much, I've just seen so muchdisconnect in just like in, in
modern medicine.
Yeah.
And actually acknowledging thegut brain.
Connection.
The connection.
Yeah.
Yeah.
You cannot deny like it isthere, yeah.
And you can feel it too.
Yeah.
I know that brain fog is onethat I'll get if I eat certain
foods that flare me up and it'sa direct correlation with all
(06:47):
the serotonin in the gut too,that's produced.
Yeah.
Is it like 90%?
Yeah, 80.
Yeah.
80.
80, 85.
Yeah.
Yeah.
And that instead we put peopleon SSRIs instead of, and we
didn't know that, definitelywhen I was in school, but we
didn't even know that, weren'ttaught that in the continuing
medical education courses thatwe took to keep up our license,
so there's been a lot of newscience, which you have to
(07:10):
really stay up to speed on.
And so I think in theconventional path, sometimes you
don't stay up to speed on somethings.
Sometimes you're just, stayingwithin your specialty.
And I.
I see how it happens.
Yeah, absolutely.
I see how it happens.
'cause you get into your nicheand you're in there.
Yeah.
And you go in day in, day out.
(07:30):
But the reality is it is hardbecause we have five, 10 minutes
appointments and people tend toblame the physicians.
It's or the practitioners.
And it's listen it's a shitshow.
I mean it's, and the amount of,it's a system.
Yeah.
It's a, that's messed up.
It's a system.
And then people blame the facesthat they see when it's like,
Hey, no, this is a multi thing.
(07:51):
Yeah.
And so it's so important that wetalk about, yeah.
What are some things that peoplecan do even, and we'll dive into
this later.
Yeah.
But just knowing what we can doto help restore our gut health.
Obviously modern medicine iswonderful for like
colonoscopies, and doing allthese other tests To help us
when to.
Rule out major things.
Yeah.
But how many people get allthese tests and say everything's
(08:13):
fine.
Yeah.
And they're having all thesesymptoms.
So it's a, it's, I love to, Ifeel like I bridge the gap
between conventionalTraditional, yeah.
GI and modern, holistic,integrative gi And that I think
is where I shine because bothare important, just like you
(08:33):
just said.
And it's not an and orsituation.
It's a, or whatever that phraseis.
It's not a or it's an and.
Yes.
Thank you.
I always mess up phrases.
I got you.
No, I do that.
I do that too.
So yeah, I wanna I do wannacomment on the.
You know what to say in five or10 minutes.
'cause I can, there are thingsyou can say as a clinician or a
provider and you can do themwith some caveats and nuances
(08:55):
that you might want to say atthe same time.
But let me ans finish answeringyour question, which was, how
did I get to Precision GutHealth?
Because right after that, afterthe pandemic, I was like, oh, I
really need, I can't prescribeanother PPI where there's no,
finite end to it or I can't, Ijust can't keep giving people
Bentyl for their IBS and Ican't.
(09:16):
I just was I could, I justneeded more for my patients and
so I was like, should I openthis little practice?
And I decided not to.
'cause I'm like, I.
I don't know how to be anentrepreneur.
It's scary.
Yeah.
So then I got handed this job,like somebody, the urologist
said, Hey I can't get to whereI'm at with functional medicine
in my practice where I want tobe, you know this urologist, but
(09:39):
I want to have functionalnutrition and medicine.
Can you bring, can you do thatpiece for me?
So instead of me being my ownentrepreneur, I did it for them,
which was a great learningexperience.
And I got back into male men'shealth, which is metabolic
health, which is cardiovascularhealth and also hormone health.
And I got to do that.
And still, lots of GI peoplewere coming our way.
(10:02):
And then finally I said, okay,I'm ready to do my own thing.
'cause I really missed, I wantedto bring the culinary aspect and
the nutrition aspect more to it.
So now we have a big nice littlethey go together.
Yeah.
They go together.
Gut and nutrition exactly.
No, that's what's the cool piecethough, is that not only are
you're blending all of ittogether and you're definitely
(10:22):
onto something.
There's no doubt in my mind Iknow it, but you're, I think
you're a trailblazer, right?
And so what that, in my eyes, itjust means that you're one of
the first people to be talkingabout this in this capacity that
I've seen doesn't mean peoplearen't out there.
Yeah.
But in that, when I was justtalking about this with somebody
(10:43):
earlier today, it's just in thatthere's a bit more of an uphill
Yeah.
Battle with that because you'regoing against a lot of different
things that have been in systemsfor decades.
Yeah.
And yeah.
I can't imagine what it must belike being you and being like,
yeah, here's some medicine,knowing that somebody with IBS
needs so much more.
(11:03):
Because the gut.
With, especially with history ofpeople with history of
unprocessed trauma and how likechronic fight or flight, we know
we literally hear the saying,I'm sick to my stomach.
Yeah.
That's a saying.
Yeah.
And butterflies in the stomachtoo, like that is you know that
there is a gut brainin accessconnection.
Yeah.
A hundred percent.
If we've been talking about thisfor a long time.
(11:24):
The other piece of it too that Ithink is fascinating is that we
almost, and then we treat likethe dentist oh, this is nothing
to do with our GI tract.
Oh no, yeah let's remind, remindpeople of the tube that goes
from the mouth to the anus.
It's a tube.
Yes, exactly.
And then we say dentists overhere, GI over here.
Yeah.
(11:44):
Mental health over here.
And sometimes even liver isseparated from GI because you do
have hepatologists that arefellowship trained in hepatology
but then you're like, wait, theliver is connected.
And then hormones.
It's so all connected, whichmakes it very difficult for a
new provider to this.
F type of thinking, or for apatient too.
(12:08):
We have, we will, I think in thefuture, come to a place where
it's all embraced again.
I don't know.
Sometimes I like to study thehistory of medicine because, not
that I have really studied it,but I've read certain things
about like when didevidence-based medicine come
into play?
I think it's, it was about 150years ago.
It wasn't that long ago.
And then Eastern Medicine islike 33,000 years.
(12:29):
Yes.
And it's we act like modernmedicine.
Yeah.
Is it?
Is it?
And I'm like, like you haveyeah.
You have not been row.
And it's like midwives deliveredbabies before.
All the time.
Yeah.
That's what the job was.
And and then also nutrition usedto be a GI doctor's job before
the colonoscopies andendoscopies were invented.
(12:51):
Not only nutrition, they weredoing a lot of physiology.
But if I saw an oldgastroenterology textbook from
the fifties how'd you find that?
It was at a silent retreat thatI do, and it's said a some house
in the hill country and therewere all these old medical books
and I was so fascinated andthere was not a lot of talk
about acid reflux in the tableof contents.
(13:12):
Really?
Yeah.
I took a picture.
I was like, there's not a lot.
SIBO was not mentioned.
Sibo.
We know SIBO for your listenersis small intestinal bacterial
overgrowth, which has a bigoverlap with irritable bowel
syndrome.
And by the way, this month isIBS Awareness month and today
SIBO Awareness Day, SIBO onlygets one day, but it's quite a
dis, quite a condition I wouldsay.
(13:35):
It's very.
Troublesome for a lot ofpatients and can be long lasting
for some what if somebody'slistening to this, right?
So if a practitioner or aprovider or somebody is
listening and they're workingwith patients that are dealing
with gut issues, and that can bephysical, pelvic floor, physical
therapy.
That can be, honestly, anybodywith back pain, we need to be
(13:56):
looking at gut health too.
The rectum is right there by thesacrum.
True.
And then you've also got anypressure right there is gonna be
pulling, pushing onto the backas well.
Constipation.
Yeah.
All of those things.
Yeah.
And so what are some things thatthey can look for in in their
clients and maybe help directthem in some capacity?
Because in the physical therapyworld, we're really not trained
(14:18):
a lot on SIBO and IBS and I'vedone my own training more on
IBS.
But sibo, there hasn't been aton of stuff that I've seen
Yeah.
To help practitioners navigatethat.
Maybe differentiate the twouhhuh and then what could be a
way that they could, obviouslythey can follow you on social
media and a hundred percent andsend your way, but also what are
(14:41):
some things, so IBS is irritablebowel syndrome, not to be
confused with IBD, which isinflammatory bowel disease.
So IBD is more like Crohn'scolitis, those are definitely
different physiologies,different conditions.
IBS used to be, and still is adiagnosis of exclusion in the
conventional GI space.
So it's like somebody that'scomes to you in the conventional
space that has had blood workmaybe from their primary care
(15:04):
and then they come to youbecause the primary care is
referring them to you or theycome to you on their own and
they're like.
I just have abdominal pain or Ihave constipation, I have
diarrhea, I have gas, I havebloating.
That's usually, I would saythose are mostly the symptoms
that somebody would have withIBS.
And after a careful analysisexam, maybe a colonoscopy or
(15:25):
endoscopy in some individualsmight be indicated if that
nothing is found.
Excuse me.
And there isn't pathology, theword for finding something
organic.
'Cause really what they'relooking for in a colonoscopy
would be making sure you don'thave Crohn's or colitis.
'Cause sometimes that IBS canlook like IBD in some cases.
But let's say all the workup'snegative then, and you still
(15:48):
have abdominal pain, gas,bloating, diarrhea,
constipations, or some, one ortwo of those things, they might
label you with the diagnosis ofIBS.
But there's no test per se forIBS.
However, there are a couple oftests developed by Dr.
Mark Penal.
And he does, he's a, he doespresent data every year to the
(16:09):
annual GI conference about IBS,and he talks about a test that
he's developed.
It's not routinely used.
It certainly wasn't routinelyused when I was in practice in
that space.
But I do wanna say that there isan, like I said earlier, and a
big overlap with the sibo.
And so those symptoms can looklike SIBO as well and vice
(16:30):
versa.
So there's a Venn diagram forboth.
I don't know.
There's a lot of, there's quitea, there may be a few of us in
the SIBO world that do believethat a lot of IBS is SIBO and
that they just don't know it yetor haven't been tested properly
for it.
Now, some people might have gasand bloating in some of the
diary constipation.
And you might get a a quick, nota quick fix, but you might like
(16:51):
address fiber maybe, and maybethat would help your
constipation.
Or you might hydrate or youmight do a squatty potty or you
might work with someone like youwork on your pelvic floor pelvic
pelvic, maybe you have pelvicfloor dys.
I always pronounce that wrong.
Maybe you have gut brain accessstuff, but there's stuff that
could be slightly simpler thanhaving to go down the rabbit
(17:15):
hole of, oh my God, do I haveSIBO or not?
And so I would say people cometo me.
By the time they've already beendiagnosed, often with IBS or
SIBO or both, and they've oftenhad a treatment and it's not
gotten better or it's come back.
And that is when it's a verynuanced approach.
Like you've got to really do theright testing, look for the
(17:38):
right gases, look for the rootcause of why you got it in the
first place, address motility ofthe gut address, gut, brain,
nervous system, all the stuffthat you do too.
So it can get complex.
Some SIBO does come back.
There's a percentage of SIBOthat does, can be recurrent or
refractory.
(17:58):
So did that answer your questionabout Yeah, I would say, I'm
wondering to.
The thing that's confused meabout SIBO is people are given
antibiotic for it.
Yeah.
But don't antibiotics like justdestroy the gut.
Great question.
Yeah.
'Cause I've always been confusedby that.
And then what are, what is theway they distinguish between
(18:20):
SIBO and IB Bs IBS is exclusion,but I know, are there some tests
for sibo, right?
I know there's some tests fromthat.
Yeah, there's some great tests.
Yeah.
And so what, yeah.
What are those tests?
As well.
Okay.
So I like, let's maybe startquestion with the test and then
we'll ask, answer the antibioticquestion'cause so with testing,
so you know, a lot of peoplehave heard about the microbiome
testing companies out there,Genova, gi, FX, et cetera GI
(18:44):
Map.
So those are tests that go lookat.
Your microbiome, maybe 20 or 30sp species.
They're looking at virus,they're looking at yeast,
they're looking at parasite,they're looking at overgrowth.
Or, and so overgrowth can meanovergrowth of just your good
stuff, like your good keystonebacteria.
You want that imbalance too.
You don't want that to be toolow, too high.
(19:07):
But it's also looking atpathogenic overgrowth.
And they are very sensitivetests for some of these
organisms.
Or, we're looking at the DNA,like of h pylori in that test.
We're not doing a true goldstandard h pylori test.
So it's a very sensitive test.
So it's picking up stuff.
When I look at those tests, I'm,by the way, so those tests are
not SIBO tests.
(19:28):
Okay.
Those are stool, microbiomestool health tests, if you will.
They're looking at, like I said,the microbiome population.
They're looking at digestiveenzyme production.
They're looking at, s one onefactor that helps with estrogen
detoxification.
They're looking at whether youhave fat maldigestion, because
(19:49):
you can look for somethingcalled tcrt.
So a couple of those tests youcan do with a GI doctor or using
insurance, but sometimes yourinsurance company doesn't cover
them.
You get a lot more informationdoing these tests, but they're
also not a game changer of atest necessarily.
They give me a picture of thepatient.
(20:10):
They give me a map.
I'm not treating any onebacteria, I'm not treating any
one test in that, big GI map.
I'm looking at the pattern ofwhat I see and then I'm taking
that with the story of thepatient.
And then I'm also taking thatwith okay, what are their
dietary restrictions?
What is their family history?
What are their other labs like?
(20:30):
It's a big picture that we'relooking at and it's a lot of
work.
Yeah, that's what I'm saying,even from an outsider
perspective, where with guthealth it's.
We help with the nervous system,we help, we teach people with
exercise and movement andmobility and like gut motility
in that sense.
Yeah.
But there's this whole otherpiece of the microbiome, right?
(20:53):
Yeah.
And then understanding thesethings that I think so many
practitioners outside of GI andmaybe even in GI, that are
unaware of Yeah.
These other tests and how tomanage this.
And and then we get, one of thethings that, the questions I had
sent you before the podcast washow like gut health is this
whole trendy thing.
Yeah.
And now everybody is treatinggut health.
(21:13):
And I think that there, noteverybody, but there's a lot of
unqualified people out theresaying these protocols and
things like that, that I thinkcan be very harmful.
Yeah.
If in, in the wrong hands,right?
Yeah.
And so you can, so in that,yeah, it's so many different
things.
And so what.
(21:34):
But then, so then what is this?
Are there specific, was it thetest that you were talking
about?
So that one's just a more basic,like I was saying, the
microbiome test, but it's not aSIBO test.
Okay.
And then there are there's SIBOtesting.
Okay.
And that is breath testing.
I was gonna say.
I thought.
Yeah.
And what they're doing, whatthose tests are trying to
capture is how much of the gasis, how much of the gas is being
(21:57):
produced by the overgrowth, bythe bacteria.
How do they know?
What is it, do you know?
Like specific Yeah.
You basically have to drink asubstrate, a particular type of
sugar.
Excuse me.
I feel like I need to take asip.
No, go ahead.
Of my strawberry expensivedrink, but it's delicious and it
(22:18):
looks really good.
Strawberry nut milk.
Oh my gosh.
With chaga mushroom in it.
That's so fun.
Maya Papaya always like coming.
Got a little bit of sweet in itand a little bit of sweetness.
Maya's can I have some, I didn'tbring my water, but do you want
some water?
No, I can wait.
Yeah, I've got that.
Thank you.
My gosh.
If okay, so yeah, you have todrink a particular type of sugar
(22:39):
just to see what is happeningwith how much of the bacteria is
fermenting this and what'shappening with the gases that
produces, it's a little bitmore, yeah.
And it's a pain in the butt of atest.
And honestly, there is nuancedway to do the test too.
I don't always, I have my owndirections for patients to do it
and my own substrates that Ilike for specific scenarios.
(22:59):
So again, it's an art, and Iknow you mentioned unqualified
professional people that may bedoing this, but.
I wonder if it's more thatthey're not looking at the
person.
I think this is a verypersonalized thing.
This is why I'm a high touchclinic, where I only have a
small number of people becauseit, that's it's involved, and I
(23:20):
have to do, I wanna know allabout you.
I wanna know your prenatalhistory.
Everything like every input intoyour body and into your person
and into your mind goes on mytimeline.
Because it can affect your guthealth for sure.
It's not just about, oh, I had aCI was born by C-section, or Oh,
I had lance antibiotics.
There's more to it than that.
There are other types of CBOtests as well.
(23:40):
They're all breath tests, butthey're different companies
doing them.
And there are multiple gases.
It's not just one gas that we'relooking for.
We now know there are threegases that these organisms,
these overgrowths can produce.
And there's different types.
And so depending on the type,you might have a different
treatment protocol.
Afterwards.
(24:01):
So I answered your questionabout the SIBO testing.
Oh.
And then my question was the anlike the antibiotics?
Yes.
Okay.
So how is that,'cause there's somuch on, on antibiotics Yeah.
And how that affects the gut aswell.
Yeah.
So why would, yes.
Great question.
So you may, have you also heardof the low FODMAP diet?
Yes.
(24:21):
Yeah.
So I view a lot of these thingsas band-aids.
SIBO is a manifestation.
It's not necessarily it is adiagnosis and it, but it is
really a result of somethinggoing on.
And SIBO causes symptoms andthey can be pretty bad.
(24:44):
And typically it's.
A belly that's getting more andmore distended throughout the
day.
Belly being bloated feelingbloated, trapped gas, but it can
also have abdominal pain.
That's very significant.
I have a patient, been workingwith her for quite a while, and
she's I've, you've fixed mypain.
You fix my pain.
(25:04):
I never had anyone fix my pain.
I went to multiple doctors, butshe still has bloating.
So we're working on that now,but the pain can be really bad.
The malnutrition can be reallybad.
There can be weight loss, therecan be systemic effects with,
rosacea, rashes, joint pains,brain fog.
And then there's a whole longlist of other root causes that
can cause it.
Besides that, that can get alittle bit.
(25:25):
It was like two pages of rootcauses.
To answer the question aboutthe, so why the, why do
antibiotics work?
They work because there's thismassive overgrowth of these
bacteria.
They're just going crazy.
And anytime you eat somethingand they're like having fun,
they're just like eating all,they're just like, oh my God,
I'm just enjoying and I'mgrowing and I'm building, and
I'm building, building.
And I like, and they'reoverpopulating.
So I like that analogy of thegrass, like a grass, like a
(25:49):
lawn.
You have good soil and if youhave good soil, you have good
grass growth.
But sometimes you'll have someweeds, but the weeds can
overpower the grass if thesoil's not great, and so then
you have to kill the weeds.
But by killing the weeds, you'renot really addressing the root
cause.
So the antibiotics are the weedkiller, but you have to address
(26:09):
the soil.
So antibiotics help.
I.
People with sibo, differenttypes.
There are very specific typesfor different gases too.
And then there are herbalantibiotics that you can use
that work very well.
They just take longer.
Which ones are those?
Oh, there are many.
But you could think of oil oforegano is a big one.
Or I've seen that they're likeconcoctions of herbal medicines.
(26:30):
They can be, put into capsulesand sold by some of the higher
quality medical grade supplementcompanies.
But I would encourage nobody togo do this on, it should be
guided.
'cause you can feel pretty sick.
Yeah.
You don't wanna, yeah, you don'twanna, yeah.
And then you don't, and ifyou're a practitioner listening,
you don't, we don't wanna justbe telling people to take this
stuff.
Because we are not, ordering thetest.
(26:51):
Yeah, exactly.
And you're also, and are thesetests, are they ordered through
Western medicine?
The SIBO breath test is Okay.
Some people do.
Some still don't.
Some still don't.
Oh, Uhhuh.
Yeah.
So when they go in, they'rebasically what given a
colonoscopy then, and then anendoscopy, and then you're
(27:13):
clear.
So there's nothing, is that kindof the standard?
So then they're like maybe anantispasmodic something to help
with their constipation.
If they have constipation,something to help with their
diarrhea.
If they have diarrhea.
Those, sometimes I've seenconservative things like, hey,
drink some water, have somefiber.
Maybe take MiraLax, Metamucilthat I, that they are doing in
the conventional GI space forsure.
(27:35):
But sometimes patients aremiserable and not having a bowel
movement except for once a week.
Ugh.
In that case, we call it rapidrelief.
I do rapid relief in ourpractice too.
Sometimes I'm like, you gottatake all this stuff.
We gotta get you feeling better.
We got you sleeping.
We need to, we've gotta clearpeople out.
You've got,'cause they'reholding and that uhhuh and then
they releasing all the estrogentoo and Yep.
Hundred percent get, and thecholesterol dominance.
(27:55):
And then the cholesterol, you'vegotta clear it out.
But.
Yeah.
That's why I think this blendedapproach is so important.
Yeah.
'cause the reality is people aregonna need medication.
Yes.
I'm not gonna not takemedication.
If I need to take an antibiotic,I'm gonna sit and be like, do I
actually need to take this?
I'm gonna question it.
Yeah.
And I'm gonna see, I don't wannaunnecessarily take it, but hey,
(28:16):
the issue is that we're not justlike blindly doing things.
We're looking at it, okay, hey,this medicine's gonna help me,
but why did I get sick in thefirst place?
Yeah.
Yeah.
So treat the symptom but not thecause.
Yeah.
And that's the issue I think inWestern medicine so much, is
that we treat symptoms.
Yes.
Yes.
And there's not a root, which isso interesting to me.
'cause I'm like, don't you thinkinsurance companies, like they
(28:37):
would benefit from everybodyfeeling better, they's benefit
from I don't know.
F cash flow.
Yeah.
Lots of patients, lots ofprocedures.
The insurance companies, thenthey pay out more.
Yeah, I think I'm not, I'mdefinitely not an expert there,
but I just think that I, yeah, Idon't have an answer for that.
(29:01):
There's, it's just, it's sointeresting to me.
'cause you would thinkpreventative, that's another
podcast episode maybe that hasto do with.
Culture demand.
I don't know, if patientsdemanded it more, but I don't
think patients, we also havethis hierarchy in the medical
system, like patients getgaslit, so then they don't
sometimes speak for themselvesor vouch for themselves.
(29:21):
But there, that's a fine balancetoo.
I don't think patients should goaround disrespectfully yes.
Yes, there's a balance.
There is a balance.
If you go in and you're bossingyour practitioner around, get
out of here.
Yeah.
Yeah.
It's more of.
Hey, what do you think?
I've read this.
I feel strongly about this.
What do you think?
Do, are you very against it ordo you have any comment on it?
(29:43):
What would you do if you were inmy shoes?
Yes.
Those are the kinds of questionsto be asking the provider.
Yeah, but you do have to go in,you have to be your own
advocate, but you, at the sametime, you can do it with a
respectful tone.
And honestly, if they're not, ifthey're gaslighting you or not
open, you gotta find someoneelse.
Totally.
Yeah.
But that's the thing that sucksthough.
'cause that takes so much time.
(30:03):
I'll tell my patients, and ifyou're all listening and you
have patients as well that are,they're experiencing this is
just knowing that, hey I'll prepthem.
Do your research before.
Come up with your top threequestions.
You've got five or 10 minutes.
Like you do the work ahead oftime.
Yeah.
And you get in there and thenthey have the information.
'cause otherwise there's justno, there's just no time.
(30:25):
There's just no time for that.
But what it, are there clinicalsymptoms that are
differentiating between SIBO andIBSA lot?
Or they look the same?
They can look similar.
IBS may not always be.
I don't think, I don't see.
Plain IBS anymore.
But that's because I'm lookingfor a lot more and finding a lot
(30:49):
more.
But if I go back to the years ofconventional GI that we did it,
there are many people that comein and they're like, I'm a
little gassy.
I'm a little bloated and I havement, just every other day.
And because they're in my o inour office and they're seeking
you out, you feel like helpingthem.
(31:12):
And a lot of times they werehelped by medication and maybe a
little fiber, try this, comeback in six weeks and if they
don't come back, you don't knowwhat happened.
So you don't really know if theywent and found someone else
'cause they didn't get anybetter or you don't know if they
did get better.
So you just don't know.
But then if they come back andmaybe they're a little better.
(31:33):
It's hard to say.
There are people that can behelped from just a little fiber
or a little hydration or alittle meditation or a little
squatty potty action.
Good bowel hygiene, good eatinghygiene is what I call it.
Those are little things that canwork.
And maybe you don't have sibo.
Maybe you, maybe it's reallyhonestly just fixing some
(31:53):
lifestyle things and diet alittle bit, I also, I've seen
from the pelvic floor P PT side,people forget how to poop.
Yes.
So they push through their bellyinstead of down.
And they're like, it's not goinganywhere.
So you're literally like aimingout through the belly button.
This is also for giving birth topeople, push through the belly
instead of down and we almostforget like the physics of it.
(32:14):
And then people forget.
We'll do, anal biofeedback aswell to be like, Hey, contract,
contract the anus, relax.
Contract.
'cause they'll do the opposite.
And so isn't that what thepelvic floor dys synergia is?
Yes.
Okay.
Yes.
So the, that, that happens a lotwith people that I've seen with
chronic constipation or chronicdiarrhea.
(32:35):
And the other thing too that canhappen that I've seen with
bloating and constipation ismore so constipation, but is
rectocele.
Yeah.
So the bladder pro, the rectumprolapsing into the vagina.
Yeah.
Yeah.
And so I've seen people's, theirsymptoms improve with just
putting a pry in there andpushing the vaginal wall up.
(32:57):
So then the rectum has to staymore in its place too.
Yeah.
So it's like there's so manythings that are even
structurally.
Structurally, yes.
Then you've got the nervoussystem, then you've got your
diet.
Yeah.
And then you've got whateverbacteria, whatever is happening.
And.
It's so many multifaceted.
The physician that wrote theBody keeps the score when I
(33:17):
listen to that book,'cause I'mgonna be full audience.
I am an audible person.
I try so hard to read the books,but sometimes it's just easier.
I'm the opposite.
I can't do Audible.
Yeah.
It depends.
Weird on the day.
It depends on the day.
I wish I could get both audibleand the visual just for if
you're.
You wanna actually read?
Yeah.
But anyways, it was soeye-opening for me because this
(33:40):
was several years ago and he wasthe first in my eyes to
correlate IBS with the historyof trauma.
Yeah.
And how much of that though, isit, I've heard people say Hey,
it's actually the nerves Yeah.
Around the gut.
And so hard to say.
I what?
Hard to say that it's not.
Hard to say that's not true.
(34:00):
But it can't be like, yes, itcan be, but I feel like there's
this trend happening right nowwhere people are relating
everything to trauma.
Yeah.
I, and not actually treating thephysical side of stuff too.
Yeah.
So there is, like I'll getpeople in chronic pelvic pain,
but, yes, the nervous system isa piece of it, but what about
the labrum, right?
(34:20):
What's going on in the hips?
What's going on in the lowerabdomen?
How's the back'cause a referralfrom the lumbar spine?
Is there thoracic spine moving?
Yeah.
How are they walking?
Yeah.
So there's all these differentcomponents and so I feel it can
be harmful to just blanketstatements.
Just say, oh, it's due totrauma, when there's still a
physical body to be treated.
Yeah.
Yeah.
I don't, I think blanketstatements should be a sign in
(34:44):
medicine or science aren'tanything really.
Yeah.
I think there's not a lot ofblanket stuff we can say.
There's no blanket supplements.
I could even say maybe fish oil,but not for everybody.
Like I, there's no blanket diet.
I'm very diet agnostic in ourpractice.
Yeah.
You can come to me on thecarnivore diet and you can come
to me vegan and we will tell youand figure out whether that's
(35:05):
right for you or not.
But that's based on yourbiochemistry, your labs, your
family history, what you'redealing with, what's your GI
tract like.
All that stuff.
Yeah, I don't know.
I agree with you.
Like I, that is true.
I'm seeing that trend as well.
I'm seeing it and I believe ithas a massive component, right?
I, the way that I look at.
Unprocessed trauma is it's thefuel to the fire, right?
(35:27):
So there's already a fire andthen you're adding gasoline to
it.
Or you know what some of theresearchers have said?
It's like it's festering.
Like that is the thing that likesets it off.
Yeah.
Yeah.
And then we're predisposed tothese other things.
But then I go, okay, so say I,he heal my trauma.
I work through it and I processmy trauma.
And then I eat McDonald's everyday.
Yeah.
Do you, you see what I'm saying?
And maybe I'm not traumatized.
(35:48):
Yeah.
I bucket and you tip the bucketat some point.
And that is a big core tenet offunctional medicine is that you,
I.
You could be on the same.
This is why we do that timelinein our practice of people let's,
where did we tip the bucket?
What are the factors that tippedthe bucket?
And sometimes we don't alwaysknow, but there's always,
there's often a time point wherethe bucket was tipped, but we
(36:08):
don't really know how muchpercentage of the trauma at age
five affected the GI tract atage 40.
'cause maybe menopause happenedbefore that too.
And you had estrogen completelywiped out from your system, from
all the receptors of the body.
Maybe before that you had,abdominal surgery, maybe.
So everyone's map is sodifferent.
(36:30):
So different.
And that's why it's so importantthat we encourage our patients
to know and advocate forthemselves.
I feel what I've seen here isjust not just here, like I'm
saying like in the us.
I don't know if it's like thisin other countries, but
basically we've just blindly goto practitioners and ask them
for answers.
(36:51):
And where I'm trying to go islet's get people to start
understanding their bodiesintuitively.
So they can ask the rightquestions.
Because if you add in, if.
A very well un like a, a patientwho is, who understands their
medical history, who can say,Hey, I know it started at this
time.
This is, these are some othersymptoms I have.
(37:11):
So starting to get our patientsto correlate Yeah.
These things even before theysee, yeah.
Because if you go in maybe to aGI doctor and you're like, Hey,
every time I eat this, I havethese symptoms, right?
Or every time I experience this,I have this.
And so you're almost doing,they're almost doing their own
little experiment.
Or research study, end of one.
(37:33):
Yeah.
Yeah.
And so that way it's so muchmore consolidated.
So by the time they go into thatpractitioner, they're like, Hey,
I notice I have these symptomswith X, Y, Z.
And so even people knowing theirown anatomy and being like, oh,
what's going on?
Even, if you have bladder pain,is it your bladder or is it
Yeah.
Or is it your uterus?
'cause they're right there.
Or is it referral from lumbarspine or do you notice it with
(37:55):
different movements?
Do you notice it with emotionalstress or for certain foods?
And so getting people to Yeah.
Know all of those things.
'cause the patients their ownadvocate, but they don't know
the power because we've had thishierarchy Yes.
The hierarchy of the medicalsystem for so long.
And I just keep shouting thisfrom the rooftops, is that
evidence-based medicine is thepractitioner, the patient and
research.
(38:16):
Yes.
It's all three.
That's a great phrase.
Yeah.
It just try it though.
It makes me bonker and alsojust, I'm not against, I'm not,
I'm thankful for EBM, but it, weget one endpoint.
We don't EBM, evidence-basedmedicine.
Sorry.
Oh, sorry.
The mic.
I just remembering the coursewas EBM that I took in grad
(38:36):
school.
So luckily I just said it andI'm like, I'm weaning from
caffeine.
Everybody to my brain is alittle foggy and well who says
EBM?
I don't think anybody does.
I don't know why is said thatyou're just like, ebm.
I'm like, Hey, okay, I'm gonna,I was like, I don't wanna
pretend like I know what clearlywe just said it anyways.
So was it was the name of thesemester course, and it was
(38:57):
like, it's great.
Yes.
But let's also start thinkingoutside the box.
And no one is gonna argue inWestern medicine that we treat
the patient in front of us, sowe treat the patient in front of
us.
And that's not necessarily atrial.
So it's an informed decisionbetween me and you.
Yeah, what we had looped back tobefore is one of the things that
(39:20):
you said, like in that 15 to 10minutes or five to 10 minute
sessions to say, this can be anyclinician.
This can even be people in thefitness world or physical
therapy world, wherever.
What are some like little thingsthat, that you can just steer
them in the right direction.
So I don't want people thinkingout there that they, that having
(39:43):
GI issues is normal.
Ah, okay.
So a lot of people live withchronic diarrhea, constipation
and constipation, chronicdiarrhea, excessive gas and
bloating.
Malodorous, flatts, marou acid.
Smells like rotten eggs all thetime, ugh, those are the worst
belching.
I know.
Belching incessantly not beingable to sleep because you have
(40:05):
acid reflux.
I just don't, you, you should,you or your, the provider that's
listening, just let them know,Hey, this can be likely restored
and reversed.
Or at least looked at andevaluated appropriately from a
root cause.
Perspective.
I was gonna mention one thingand I we were briefly talking
(40:25):
about the antibiotics.
Si I do think that's a bandaidstill.
I hopefully that came across No,you said that.
Yeah, you said that.
But so is a low FODMAP diet.
It's, that is classically usedin conventional gi we gave it
out all the time.
Go on a low FODMAP diet.
You've got IBS try that.
Maybe they, maybe we would tryfiber or maybe we would try
hydration, or maybe we triedsome, something like Metamucil
(40:47):
or something for constipationfor the patient.
Or, and then sometimes we wouldsay, or maybe if they later on
we'd say, try a low FODMAP diet.
Here's a handout.
First of all, it's a really harddiet.
It's very complicated.
Once you get the hang of it,it's not that hard.
But you have to follow theserules and they don't give you
any guidance in some GIpractices.
(41:09):
They just give you the handout.
And what happens is a lot ofpeople go on that and then they
don't go off of it because itmakes'em feel good.
If that's you and you'relistening.
That's not a great thing.
You don't wanna be on thatrestrictive diet for that long
because you are then ultimatelyharming your diversity of your
microbiome.
It's just a bandaid.
Same with the antibiotic youmentioned.
Okay.
(41:30):
Doesn't the antibiotic wipe outthe bacteria?
It does.
So that's why it's a bandaid andit's gonna make you feel better.
But you, there are things thatneed to be take done in sequence
in our, like the way we do sibothat will help you restore your
gut function, your mucosalrepair, your butyrate
production, and then ultimatelygive you your microbiome back.
(41:55):
Yeah.
So that you don't get it.
I know it's, it soundscomplicated, but No, I think it
makes sense.
So basically like the top twothings that you would tell a
practitioner or a coach orsomebody that's working with
patients in healthcare orexperiencing a health related
issue with their gut.
So the top two things that yousaid.
(42:15):
What are the top two things thata provider can tell their
patient.
To maybe help di direct them inthe right direction.
Okay.
Is what you're saying?
Yeah.
Related to gut health.
Related to gut health.
It's really easy for me to sayoh, the one thing would be tell
them to eat fiber.
No.
What you, what I was going towas you had said, number one,
(42:36):
tell, letting them know Yeah.
That's not normal.
And number two is restrictivediets can be harmful long term.
Oh yeah.
Would you say those to me, thoseare two good things to say.
But I, it's hard to just limitit to two.
I know.
I'm just saying Would, are thereothers?
Yeah.
Would you say three?
I would say I was gonna say, youmight think that I might answer
the question by saying telleverybody, get on 35 grams of
(42:58):
fiber a day because that's whatyou should do.
Okay.
But, yes.
Ultimately, that's a great placeto ultimately get to.
But if fiber bothers you, that'sa red, that's a flag.
Something's going on.
If fiber bloats you up, youcan't tolerate it.
It's doing something to you,giving you diarrhea, giving you
constipation, bloating, reflux,huh?
What's going on?
(43:19):
Yeah.
Okay.
Yeah.
So basically the top threethings, okay.
You would tell a practitionerthat's working with a patient
that has gut issues would benumber one to know that, hey,
acid reflux or gut symptoms arenot normal long term.
Number two any, oh my gosh, Ican't even get my words out.
Any restrictive diet long termis not sustainable and it's not
(43:40):
healthy for your microbiome.
And then number three, fiber isnot necessarily something that.
Everyone can tolerate, but thatdoesn't mean that you ultimately
should avoid it.
Yes.
It's the sim it's the signal.
Yeah.
It's basically saying, Hey,something's going on.
Yeah.
Yeah.
And let's look at this deeper.
(44:00):
Yeah.
And now that being said, there'sare people out there that are
like not doing lectins and maybeon a, on various kinds of diets
like the autoimmune paleo dietand avoiding grains and low like
carnivore, which is no fiber.
I'm not saying there's anythingwrong with those.
I just think that they, thereare some of those, like the
carnivore diet can be probably atherapeutic diet for a while
(44:24):
because it's, there's something,why is it working for you?
Why is it making you feel good?
Because you probably have someinflammation there.
So anything that's not thecarnivore diet that's maybe
excessively inflammatory to youis bothering you.
Always ask why?
Yeah.
'cause I know a lot of peoplewith IBS, they can't eat raw
veggies.
Yeah.
And that's fiber right there.
(44:45):
So that makes sense.
And that's because a lot of thetimes that's that overgrowth
happening.
So they can't eat the veggiesbecause the veggies make the
bacteria really happy and youknow what I'm saying?
And the bacteria are like, oh, Ilove this.
Let me give more gas and fermentthis, these carbohydrates, and
then you feel badly.
(45:06):
So it's more because of that,most likely is what I tend to
think.
But still, no, I think it's,there's so much we don't know
about the microbiome still, sothere's still so much we don't
know.
Yeah.
There's still so much evolving.
Yeah.
And it's being patient with thesystem and it's science, it's
constantly evolving, constantlylearning.
I love this phrase I learnedactually recently.
I'm not.
(45:26):
A know it all.
I'm a learn it all.
There you go.
Just to, to dive in a little biton menopause if practitioners
are working with somebody goingthrough menopause, can you
explain how menopause.
Menopause, I said menopause me,meno, me meno.
How does gut health affect isaffected?
(45:47):
How is it affected by menopause?
I got this, I get this questionasked and I don't answer it very
well every time because I stillfeel like hrts a little bit of
the wild west.
Totally.
And and that's because it's,we're back in it and it's
relatively new.
Menopause is trending now forgood, for great things, all good
things, but I just don't know.
(46:09):
I don't think we know a lotother than we know that we are
depleted with these reallycrucial hormones that are all
over our body.
And including the gut and, brainand everywhere.
And so wh the, why do we getdepleted at such young ages is
the question.
It's not fair because we do livelonger now.
(46:32):
And so it's almost and I'mdigressing a little bit, but
I'm, I don't think it's,menopause is not fair.
Oh yeah.
To I mean it, I'm trying toembrace it like, for people, my
patients, for myself, et cetera.
But it's harder and harder toembrace it when you're like, oh,
so you only wanted me on thisearth to have a baby.
And then goodbye.
(46:52):
You don't need your hormonesanymore.
'Cause people will have the mostpristine bowel movements, no GI
issues, not a single problem.
And I know this'cause I havefamily members and I've done
their stool testing.
Pristine.
Nothing wrong with it.
Menopause.
Comes and they're like, huh, I'ma little con.
I'm not constipated.
But things are a littlesluggish.
(47:13):
They're a little slow.
They don't come out.
Yeah.
That could be okay.
Maybe the bucket's tipping forsomething else.
Maybe something's about tohappen.
I don't know.
Or maybe we blame menopause.
Honestly, I've seen a wholecassia stuff.
I've seen a DHD symptoms justflare up like crazy.
I've seen anxiety.
I've seen pain with sex.
I've seen just loss of interest.
(47:34):
I've seen depression.
I've seen gut issues.
Yeah.
And with all the estrogenreceptors on the gut too.
Yeah.
You're saying you're seeing thisrelated to menopause, right?
Oh yeah.
That's, yeah.
Exactly mean, that's, butthey'll, it's all over.
They'll come in and then theythink they're crazy and I'm
like, no, you're not.
You're really not.
There's a lot, there's so manythings going on, and now there's
a big menopause movement, whichI think is great.
(47:54):
But there are also this, a wholethere side of just like over
pushing like the hormones.
Like I'm a person where I have,I had never been able to
tolerate any hormones before andI'm like almost dreading, not
dreading, I don't wanna say I'mdreading, but I'm worried about
going through menopause becauseI believe I might be in
perimenopause currently.
(48:16):
And that's, I think it'shappening younger for me.
'cause I went throughchemotherapy five years ago or
six years ago.
And I guess my point is that noteverybody can tolerate hormones.
And and there's still a lot Ithink that can be done in my
experience to help.
So I'll say it's interestingbecause I'm a, I am a food is
(48:37):
medicine person and all that,but I'm also a longevity person.
And if we know that thesehormones affect our longevity in
the sense of improved bonehealth, heart health and
cognition, it's really hard tosay, let me do this naturally.
(49:00):
So I'm torn about itphilosophically, but I also know
that the science is there forthese, for estrogen,
testosterone, DHEA for all theseto be really great things that
we should have not been deprivedof at these early ages.
And we are.
And so now I think we're alldealing with okay, do we go on
these or not Now?
(49:20):
Yes, there are great.
All kinds of things.
Herbals, supplements, naturalthings, maca, co black, osh,
blah, blah, blah forperimenopausal symptoms, but
that does not affect longevity.
So I think there's a bigdifference between symptoms.
And what's your target goalhere?
You're saying longevity'cause oflike bone health?
(49:42):
Yeah, muscle mass, things likethat.
Yeah.
Yeah.
And, but there are some peopleespecially people with the
history of breast cancer.
Yeah.
There's debate on whether or notpeople can go on that, but then
there's also if you play thisout, if you, if.
Don't go on estrogen.
There's also this thing aboutcancer that I feel like pisses
me off in the medical communityis it's let's just get people
(50:02):
let's just make sure that theircancer, there's some evidence
that maybe shows X, Y, Z.
So let's just remove thiscompletely from this person.
Yeah.
But let's roll this back nowlet's look at their quality of
life.
Yeah.
Yeah.
So if I know, if I'm a, if I, ifsomebody's told, Hey, don't go
on estrogen, it could increaseyour breast cancer risk to come
back.
(50:22):
What are we say this persondevelops severe anxiety and then
their bone loss and then theyfall and break their hip.
So there's this, okay, theymight live like Yeah.
Longer with without cancer, butwhat's their quality of life?
Yeah.
So there's this, fear is therefor cancer.
Yeah.
But which I.
Of course, but there's thenumber one killer in the world
(50:42):
is heart disease.
Yeah.
And what men and women, what'sestrogen receptors on the heart?
Yeah.
Yeah.
So just look at the statisticsof Yeah.
Worldwide cause of death andcause of mortality.
That doesn't mean I don't, I dounderstand where those providers
are coming from.
Oh, I get it.
But how about a more informeddecision making process with the
patient?
Like with the patient, let themdecide Hey, this is it's more
(51:05):
likely that hey, this is therisk.
Yeah.
But then this is also your moremore the like your quality of
life.
Yeah.
And you get to decide.
Yeah.
Yeah.
That's my issue with it is itlike, but I do think we can
blame the, the WHI study and allthat on some of this.
Oh my gosh, it's horrible.
Probably the next generation ofmed students are going to be
more well informed and not that,not more well informed, but they
(51:27):
will be.
Able to look at the longevitypiece a little bit more and
maybe then have thosediscussions because, that study
for the people that don't know,it was probably the worst thing
I think for women ever Uhhuh.
Yep.
Yep.
And it basically said thatbreast cancer was caused by
estrogen, but they gave it topeople.
It was like 10 years aftermenopause.
(51:48):
Yeah.
And it was lots of problems inthe study.
So many issues.
And so we've got, we still gotso many people scared of
estrogen now.
And I'll say, Hey, there's noand actually maybe some people
don't know this'cause I didn'teven know about that study until
I went to pelvic health.
Into pelvic health.
Oh, really?
Yeah.
Okay.
So it wasn't well in the, it'snot as well known in like the
Oh, general physical therapyworld.
(52:09):
Yeah.
So if you are a physicaltherapist or a chiropractor or a
practitioner that works in thefield, people are scared of
estrogen because of the Women'sHealth Initiative study.
But this study was extremelyflawed and it scared a lot of
people not to get estrogen.
Yeah.
People and practitioners.
Yeah, and practitioners.
'cause like even in trainingour, my good friend so we all
(52:31):
were, in the medical field, med,med students and PA students and
we're all friends and ones inob, GY none of this was talked
about.
Like you just didn't, no onetalked about menopause first of
all, but it was a cult culturalmindset to be like, oh yeah,
that is just not a thing youdon't do.
HRT.
Period.
(52:51):
So everything's changed fromwhen we all went to med school,
pa school to now.
So I just, I would be curious tohear like you should have a
medical student on Yeah.
Or like a resident.
Yeah, that's a good ideaactually.
Yeah.
But I think the thing thatfrustrates me about now, we've
almost swung so much to theother side, the other direction.
Yeah.
And Hey I'm pro whatever peoplewanna do.
Yeah.
But that's what I was say,alluding, like saying before is
(53:13):
that now we're just like overpushing it without letting,
without addressing all thesedifferent populations and.
It is, there are plenty ofpeople on HRT now that are
having problems likepostmenopausal bleeding.
Okay.
What do we do with that?
How do we adjust the hormones?
Do we adjust the progest?
Do we adjust the estrogen dose?
Do we, or like hair loss.
(53:33):
I'm not trying to scare peoplefrom HRT, but I'm with you.
Like it is a nuanced approach.
It is.
And that is why I think it'sstill a little bit of the wild
west because there's differentdeliveries.
There's different testing,saliva, urine serum.
How it overwhelming and thetesting the testing's hard too.
'cause it's if somebody's on ora birth control, how do they
test that?
And then I've had somebody onand come on here and talk about
(53:55):
the Dutch test.
Yeah.
Because that's supposed to behelpful for that as well.
And so then you can get testedfor that.
But not a lot of practitionersuse the Dutch test.
Yes.
It's a pretty expensive test andit takes a long time.
To review it unless you do themevery day, which, yeah.
And so then people are going andthey getting their blood work
done and they're like, oh,things are normal, but they're
symptomatic.
And so then I've seen so manytimes people are given hormones
(54:15):
and they're not monitored.
Oh, that is the conventionalway.
They're, I had somebody Yeah Iwas, I the symptoms they were
having, I said, we need to, isanybody, so I'll ask people, and
this is important forpractitioners, is are they doing
routine follow-ups?
Are you being tracked?
Are you just blindly givingthis?
Yeah.
Because that will cause a lot ofissues.
(54:36):
And then people think it's theestrogen, it's the dosage.
Yeah.
But then they come back to youand say we're, I went back to my
doctor and I said, can we check?
And they'll say, no, serumchecking doesn't make any sense.
So it's really tricky.
You could still, I think theOprah special was good.
It was really like just gettingthe word out and people, I think
it's great.
It wasn't not, I, the people Iwatched it with had already gone
(54:59):
through menopause and two ofthem and the third one had tried
HRT and felt like, oh my God, Ihad so many side effects.
I got off of it.
And then that show convincedher, even though I've been
talking to her to consider goingback on it.
So honestly, I think it wasgreat for lay people to start
the discussion.
I don't think the discussion wasthorough.
(55:20):
It's only was an hour.
There were so many, like I said,all these nuances that I'm
talking about that need to beaddressed.
And so I think, she plans tohave podcast episodes about it.
Great.
I do, they did focus on thecognition a lot.
There was a neurologist there,so I feel like they were really
talking about I was like braingut, but they were talking about
brain, gut, vagina.
Access.
(55:40):
Yeah.
That, and then there's anotherpiece too where, okay.
HRT, but I've seen it wherepeople like they're experiencing
vaginal dryness and pain withsex because of the decrease in
estrogen in the vagina.
So even local estrogen, I'lltell people to get that a lot.
And then sometimes I'll comeback and be like, my
practitioner wants to know thedosage.
Yeah.
But it's just so interesting tome that then they're coming back
and then asking a physicaltherapist, I'm like, oh my gosh,
(56:04):
I don't prescribe these things.
But yeah, it's just, it it's allvery new.
It's, I think still so veryfresh.
It'll be different in 10 years.
Yeah.
It's crazy.
Yeah.
But thank you so much for comingon.
For sure.
Such a great time to talk withyou.
I love talking about all this.
We could probably talk anotherhour about, I know.
I was just like, oh my gosh, Idon't want take your time
anymore.
(56:24):
In summary, we went over IBS, wewent over sibo, different things
to look for as a practitioner,when to potentially get more
testing.
And so understanding how westernmedicine.
And how, and incorporating thatinto looking at the person from
a holistic perspective andencouraging our patients or
(56:46):
clients to really advocate forthemselves and get to know their
bodies so that when they do gointo Western medicine, they go
into these five or 10 minuteappointments that they can
really ask these directquestions and get some help from
that standpoint.
Yeah.
And yeah.
And then how menopause canaffect the gut as well.
The gut.
Yeah.
Yeah.
So tell them how they can reachyou.
Oh.
So Precision Gut Health is ourwebsite.
(57:08):
Instagram Precision Gut Health,Facebook Precision Gut Health,
TikTok, precision Gut Health.
Okay.
It's all precision gut health.
Actually, we started asprecision metabolic health
because I really, oh, I didremember seeing that Uhhuh.
And then it's, that's amouthful.
And I don't think people knowwhat metabolic means Exactly.
Yeah.
And I was like, oh, marketingagency that I hired basically
(57:29):
told me that's not gonna workfo.
And it, and it.
Because it's just a mouthful.
And I still do metabolic health.
I do a lot of lipids andcholesterol and things like
that.
We do a full chemistry panel ifyou're in the state of Texas.
It's a very like, comprehensiveblood work panel that's a really
good starting point.
(57:49):
That can give us clues tonutrition, to all inflammation,
to blood sugar regulation,cholesterol, all the things.
I love doing that.
That's important to get yourblood work done properly,
comprehensively.
Great.
Cool.
I'll put all that info.
Okay, cool.
And the link below.
All right.
Awesome.
Thanks for having me.
Thank you.
Thank you so much for listeningto my podcast.
It would be a huge help if youcould subscribe and rate the
(58:12):
podcast.
It helps us reach more peopleand make a bigger impact.
I would also love it if youcould join my email list, which
is LinkedIn, the caption forpodcast updates, upcoming offers
and events.
You can also find me on TikTok,YouTube and Instagram at Dr.
Mary pt.
Thanks again.
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