0:04

This is Open Mind. In

0:21

the social media world, there's a trending hashtag.

0:24

Hot Girls have IBS, and it's

0:26

caught the attention of over 28.2

0:29

million viewers on TikTok. And

0:32

the reason why is it reflects a shift

0:34

in how women are addressing their digestive health

0:37

issues, using humor and community to bring light

0:39

to what many have kept

0:41

hidden for way too long. Now, by

0:43

poking fun at their experiences with IBS

0:45

and bloating and constipation, other gut

0:48

troubles, women are challenging the stigma

0:50

around these taboo bodily functions. Now, it's

0:52

empowering to see these conversations happening openly,

0:54

but it's really critical to remember these

0:57

symptoms are not just everyday annoyances to

0:59

laugh off. They're real

1:01

concerns that need to be addressed seriously. And

1:03

today we're going to discuss why it's important

1:05

to move beyond the normalization of this to

1:08

understanding and treating the issues effectively.

1:13

Hi, I'm Dr. Mark Hyman, and welcome to

1:15

Health Hacks. We're

1:21

diving deep into a topic that affects

1:23

millions of people worldwide and yet

1:25

often goes undiscussed in public. Stomach

1:28

issues, whether it's bloating, constipation, diarrhea,

1:30

or just an uncomfortable feeling of

1:33

fullness that just won't go away.

1:35

These symptoms can be more

1:37

than just a nuisance. They can seriously impact

1:39

the quality of your life and

1:41

a whole slew of chronic illnesses. Now,

1:43

when we talk about stomach issues, we're

1:46

really opening up a conversation about a

1:48

range of conditions from irritable bowel syndrome

1:50

to with constipation, diarrhea to indigestion,

1:52

or what we call dyspepsia, or

1:55

to what some people jokingly refer to as a

1:57

food baby. I heard that at first from one

1:59

of my patients. patients and I knew exactly what

2:01

she was talking about. You know that swollen

2:03

stomach you get after indulging in a big

2:05

meal, that bloating, just feel full and your

2:07

stomach pooches out? That ain't normal, okay? Something's

2:09

going on, we're gonna talk about what it

2:11

is and how to fix it. Now

2:14

behind these common experiences lies a

2:16

complex interplay of dietary habits, hormone

2:19

fluctuations, and even stress and

2:22

toxins, all of which affect

2:24

our gut health. We're gonna explore the root causes

2:26

of these issues and why they tend to be

2:29

more prevalent and more severe in

2:31

women. We're gonna look at the influence

2:33

of everything from the menstrual cycle to

2:35

stress on our digestive systems. We

2:37

got some fascinating science to unpack about how our

2:39

bodies react to different foods and

2:41

stressors and what you can do to manage

2:43

or even alleviate these symptoms. And I want

2:46

you to be free of all of this

2:48

nonsense. This is optional, given what we know

2:50

now in the science. So let's

2:52

jump in and get started. So what do

2:54

we mean by stomach issues? Well, there's a

2:56

lot of them, right? The common term we

2:58

call irritable bowel syndrome and

3:01

it describes a phenomena that, when I

3:03

was in medical school, was often thought

3:05

of as psychological. Anxious people,

3:07

especially women, just got this condition

3:11

and it was just because it was all in their head. And

3:13

we had a horrible term for it

3:15

that we used to jokingly call supratentorial,

3:18

which in medical speak means

3:21

in your brain, meaning in your head.

3:24

And anytime we see the word syndrome

3:26

in medicine, like irritable bowel syndrome, it

3:28

means we don't have a fricking clue

3:31

what causes it or what's really going on.

3:33

It's a syndrome, which means a collection of

3:35

symptoms that seem to go together, but we

3:37

have no idea why or really what to

3:39

do about it. And unfortunately, there's a lot

3:41

of these, from premenstrual syndrome to chronic fatigue

3:43

syndrome to fibromyalgia syndrome and

3:46

so forth. Now there are two main

3:48

types of irritable bowel. We call IBS-C

3:50

and IBS-D, or maybe a combo,

3:53

or IBS-CD, right? IBS-C is constipation,

3:55

C stands for constipation, D

3:58

stands for diarrhea, and C-D is constipation. stands

4:00

for constipation diarrhea.

4:03

Pretty fancy technology naming these things.

4:05

Okay now there's other times of

4:07

stomach upset that you can get like dyspepsia

4:09

which is sort of indigestion, upset

4:11

stomach, nausea, there's bloating which is

4:13

really common that's feeling full

4:16

right after you eat and getting

4:18

this food baby, constipation, diarrhea, gas,

4:20

heartburn, stomach pain, all this stuff

4:22

right. It's not normal. Our digestion should not make

4:24

any noise. We should not know they're there until

4:27

we get a gentle urge to go to the bathroom.

4:29

We should eliminate quickly and that should be the

4:31

end of that. Unfortunately it's not like

4:33

that for most people. Digestive issues are the

4:35

number one reason people go see the doctor.

4:38

Now there's an extreme form of this which

4:40

is extreme bloating after eating. People

4:42

use the term food baby. It's a term for

4:45

this bloated swollen stomach that results from eating

4:47

and it could be eating a small meal,

4:50

a large meal and it makes you look

4:52

like you're pregnant. Now I have lots of

4:54

patients with this and they all eat something

4:56

and they'll get this distention, discomfort, pain. It

5:00

can be associated with constipation or diarrhea and

5:03

it really affects the quality of their life. I

5:06

had a patient once who would have

5:08

these attacks where she would get bloated and

5:10

be distended. She would sometimes had to fast

5:12

for a week and couldn't get

5:14

this resolved and it turned out she finally

5:16

had what we call small intestinal

5:19

bacterial overgrowth. We're gonna get deep into that

5:21

but basically when I was in

5:23

medical school this wasn't even a thing. We

5:25

didn't learn about it. It's only recently we've

5:28

been talking about this phenomenon of small intestinal

5:30

bacterial overgrowth or SIBO which is now a

5:32

recognized medical condition and it speaks to

5:34

the root causes of IBS.

5:36

Now we have to get also to

5:38

the root causes of SIBO which is basically the whole

5:41

purpose of functional medicine which is to get to the

5:43

cause of the cause of the cause. Oh we'll get

5:45

there. We treated this patient. She got

5:47

better. We did a whole cocktail of things but

5:50

it's around improving motility. It's around killing

5:52

all the bad bugs. It's about resetting the gut and

5:55

and so forth but we'll get into exactly what we

5:57

did and why we did it. Now why is is

5:59

this phenomenon? of irritable bowel syndrome more common in women

6:01

than men. Is it just men don't report it or

6:03

is it just really true? Well, it actually is more

6:05

common in women, about two times more

6:08

common. The question is why? Well, it

6:10

may be because, and we don't quite understand this

6:12

yet, but it may be because there's hormonal fluctuations

6:15

that impact the gut-brain microbial

6:17

axis. So there's this gut-brain axis

6:19

for sure, and your gut-brain talks

6:21

to your brain brain, and your brain brain talks to your gut

6:24

brain, and the microbiome plays a

6:26

huge role in regulating that cross-talk and

6:28

communications. What happens when this whole

6:30

system gets dysregulated? In fact, there's actually

6:32

a really great study that

6:34

came out an article in JAMA years and

6:37

years ago, which kind of turned the whole

6:39

idea on its head, anxious people or neurotic

6:42

people get irritable bowel. It actually flipped it on its

6:44

head and said, you know what? It's

6:46

the small bowel overgrowth

6:49

and irritable bowel that

6:51

causes an irritable brain. Because when

6:53

your gut microbiome is bad, it

6:55

makes you anxious and neurotic. A

6:58

friend of mine calls him bitchy bugs.

7:00

Whenever she gets bacterial overgrowth, she gets

7:03

what she calls bitchy bugs. It makes

7:05

her really mean and angry

7:07

and not nice, and she knows it's

7:09

not her that the bug is talking.

7:11

And we know this is true. Now,

7:14

what are the effects of this

7:16

whole dynamic system on gut function? Well,

7:18

about 40% of women report that their

7:20

irritable bowel symptoms are correlated with their

7:22

menstrual cycle. That's from the world of

7:25

gastroenterology. Women with irritable bowel often report

7:28

PCOS or premenstrual

7:30

syndrome or a more severe form,

7:33

which is premenstrual DD

7:36

or PMDD, depression disorder, and

7:39

also heavy periods or painful periods.

7:41

We call it dysmenorrhea. Now, sometimes

7:44

symptoms worsen during phases

7:46

with low hormone levels like menstruation

7:49

and the late luteal phase. So early on,

7:51

you'll get low hormones and late

7:53

luteal phase, you'll get low estrogen. So estrogen

7:55

and progesterone basically fluctuate all the time in

7:58

a woman who's in the menstrual. cycle

8:00

period of her life and this affects

8:02

the Motility of the

8:05

gut how higher GI tract contracts

8:07

the transit time how fast things

8:09

move through secretion of

8:11

various digestive substances and the

8:14

sensitivity of the viscera to Insults

8:17

in other words the hypersensitivity of the

8:19

nerves in the gut now this visceral

8:21

sensitivity and pain processing is Affected

8:24

by these changes in hormones now estrogen

8:26

receptors including what we call estrogen receptor

8:29

alpha and beta are widely

8:31

distributed in the brain and also in

8:33

the gut and their activation

8:35

is associated with colonic motility

8:37

visceral pain and irritable bowel androgens or

8:39

male hormones Which are higher in males

8:41

and females appear to protect against the

8:43

development of chronic pain and exert analgesic

8:45

effects I know gastric motility is another

8:47

thing that these affect right? Which is

8:49

how fast things move through because if

8:52

things aren't moving through they'll back up

8:54

and then you get Bacteria migrating into

8:56

the small intestine which you don't want

8:58

and I'll explain exactly what SIBO is

9:00

in a minute basically you're just getting

9:02

bacteria that should be in the lower

9:04

intestine migrating the upper intestine and

9:06

when your motility is low or your Basic,

9:08

you know processing and the speed at which

9:10

things move through is slow It

9:12

leads to the backup of bacteria in the small intestine

9:14

and then you get these Food

9:17

babies and you get bloating and dissension because

9:19

the bacteria which shouldn't be there Start to

9:21

ferment the food and create gas and your

9:24

body doesn't produce gas at all. It's the

9:26

bacteria Munching on the food

9:28

that you're feeding it that are producing the

9:30

gas now low levels of ovulation are associated

9:33

with a slower GI transit time

9:35

and They're resulting in

9:37

constipation and also in grease

9:39

symptoms in the gut like bloating and water

9:41

retention When you're menstruating you

9:44

release prostaglandins which cause inflammation and

9:46

that also might contribute to bloating

9:48

high estrogen can also increase GI

9:51

motility which can lead to diarrhea So

9:54

it's kind of works in different ways in different

9:56

people higher progesterone levels in the luteal phase That's

9:58

a second half of your cycle. Also slow

10:00

the transit time of food through your gut

10:02

and increase constipation and lower

10:04

levels during menstruation actually make you have

10:06

more pain and bloating. Basically hormones affect

10:09

the motility and function of your gut

10:11

and can actually lead to

10:13

some of these GI symptoms. Also psychological

10:15

stress can be a factor. Women are

10:17

far more susceptible to stress due to

10:20

hormonal fluctuations particularly in estrogen and progesterone

10:22

and that affects mood and stress and

10:24

we all know that right. For example

10:27

estrogen interacts with serotonin, dopamine, and norepinephrine

10:29

and GABA all these neurotransmitters which regulate

10:31

mood and stress and this makes women

10:33

more sensitive to these stressors during certain

10:36

phases of a hormonal cycle. Also brain

10:38

structure plays a role. Women have a

10:40

larger limbic brain which is

10:42

the part of the brain involved in emotion

10:44

and memory which can make them more responsive

10:46

to emotional stimuli and stress and women who

10:49

have this higher levels of stress response

10:51

in the brain can lead

10:53

to higher levels of cortisol and that

10:55

has various effects on the body including

10:57

increased anxiety, disrupted sleep, altered

11:00

immune and gut microbiome function. A cortisol

11:02

helps the body manage stress by increasing

11:04

blood sugar and enhancing cognitive function while

11:06

suppressing non-essential functions like digestion and mean

11:08

response. So it prioritizes what's important like

11:10

saving your life. So for example if

11:12

you're being chased by a tiger you

11:14

don't want to be digesting your food.

11:17

You want your blood sugar go up, your blood pressure go up, you

11:19

want your brain to work better but you do

11:21

not want to be digesting your food. All your

11:23

energy should be going to running as fast as

11:25

you can or fighting to save your life. Now

11:27

what happens when you have IBS? We often see

11:29

a decrease in the

11:32

parasympathetic activity of your nervous system.

11:34

This is the relaxation response and

11:36

an increase in the sympathetic nervous system

11:38

activity and that's the stress response in

11:41

patients with IBS. Now estrogen also can

11:44

influence cortisol levels by increasing

11:46

the sensitivity of cortisol receptors.

11:48

So basically whatever cortisol receptors you

11:50

have they work better and

11:52

that leads to a more profound

11:55

reactive stress response. Basically makes

11:57

your sensitivity to stress higher.

12:00

women are more likely to experience stress-related

12:02

conditions like irritable bowel, fibromyalgia, chronic fatigue

12:04

syndrome. Now, our gut is our second

12:07

brain. There's more neurons in our gut

12:09

than our spinal cord. The bidirectional relationship

12:11

between irritable bowel and inflammatory bowel

12:13

and anxiety, depression, stress is really clear.

12:16

They make each other worse. Gut

12:19

bacteria produce hormones and neurotransmitters like serotonin,

12:21

gab, and dopamine. And if we don't

12:23

have the right gut bacteria, we

12:26

can't produce these neurotransmitters that help regulate our

12:28

nervous system and our immune system. Now,

12:31

social and cultural aspects are also important

12:33

in regulating the whole phenomenon of IBS.

12:36

Diet culture, the desire for

12:38

thinness, social media, all do bad

12:40

things to women particularly. And this

12:43

whole comparison culture, right, comparing yourself

12:45

to others, appearance, it

12:47

just fuels body image dissatisfaction,

12:49

extreme dieting, restricting behaviors, which

12:52

is disaster. There's an article

12:54

in PLOS Global Public Health, a medical

12:56

journal that says it's called The Social

12:58

Media Diet, a scoping review to

13:01

investigate the association between social media,

13:04

body image, and eating disorders

13:06

amongst young people. And we know this

13:08

is true. This is a book by Jonathan Haidt. We're going

13:10

to have him on the podcast, Doctors Pharmacy, talking

13:12

about these issues. He calls it the anxious generation.

13:14

A little bit terrifying. Women are far more effective

13:16

than men. Girls are often focused on photos of

13:19

themselves. They

13:21

basically are supporting this whole thin

13:24

fit ideal of their bodies. They

13:26

compare themselves to others. They have higher

13:28

levels of disorder eating, higher levels of

13:31

dieting, emotional eating. And it's

13:33

not just women. Boys also favor a

13:35

muscular ideal. They prioritize

13:37

fitness and functionality over weight loss.

13:39

And there's a significant association between

13:41

social media use and

13:43

algorithms that fuel disordered eating behaviors

13:45

like binging, purging, laxative use, extreme

13:48

dieting, and orthorexia, which is a

13:50

big problem. So all that kind

13:52

of sets the stage, right? So

13:54

what then causes irritable bowel and

13:56

stomach issues? Well, it's different for

13:58

everyone. acid-locking

16:00

drugs. There's also another factor that affects irritable

16:02

bowel and I personally had this for sure

16:04

which was the effect of toxins on the

16:06

gut and you need a lot of enzymes

16:08

and various things to make your gut work

16:10

properly and toxins basically bind to enzymes and

16:13

they can cause significant disruption in your gut

16:15

function. So for example there's a

16:17

whole bunch of endocrine disrupting chemicals like

16:20

BPA or Bisphenol A, phthalates, pesticides and

16:22

chemicals and plastics all of which affect

16:24

the gut. In fact a study found

16:26

that fecal microplastic concentrations in inflammatory bowel

16:28

disease which is sort of a worse

16:31

form of IBS was nearly 50%

16:33

higher than in healthy people and microplastics

16:36

are pro-inflammatory we know that and

16:38

there's a positive correlation between higher

16:40

levels of the concentrations of these

16:42

microplastics and inflammatory bowel

16:44

disease. What else can cause disruption of

16:46

the gut? Food sensitivities, food

16:49

allergens, environmental allergens all can be a

16:51

factor. One of the most common food

16:53

sensitivities, gluten, dairy, eggs,

16:56

corn, soy, often grains

16:58

and beans. Alcohol is not a sensitivity so much

17:00

as it's just a gut toxin. What these do

17:02

is they tend to lead to the overgrowth of

17:04

bad gut bacteria we call dysbiosis

17:07

and dysbiosis is basically

17:09

the phenomena of the

17:12

imbalance of bugs in your gut

17:14

that creates more bad bugs and less good bugs.

17:16

What does that do? Well that leads

17:18

to a leaky gut and inflammation in the body.

17:21

It can lead to motility issues, it can lead

17:23

to overgrowth of bacteria, the

17:25

bad bugs in the wrong spot, it

17:28

can lead to what we call a CFO or small

17:30

intestinal fungal overgrowth, what some people refer

17:32

to as candida but it can be

17:34

many species of fungus and a lot

17:37

of these symptoms overlap with IBS, right?

17:39

Bloating, gas, cramping, diarrhea, constipation.

17:41

So let's get into a more detailed

17:43

conversation about SIBO because this is really

17:45

at the root of so many people

17:47

now whether you're IBSD or C, constipation

17:49

or diarrhea there may be different bugs

17:51

involved and there's there's a dump of

17:53

different gases we measure because

17:55

what we're seeing is when you have overgrowth

17:58

of bacteria they ferment

18:01

the food you're eating, particularly starches

18:03

and sugars and fermentable carbohydrates, and

18:06

that causes the production of

18:08

gases. And those gases are

18:10

what causes distension and the

18:12

food baby. The first thing that goes wrong is

18:14

what we call dysbiosis. We talked about that briefly,

18:16

but there's a lot of reasons for that. It's

18:18

our poor ultra-process diet, it's our lack of fiber,

18:21

it's too much starch and sugar, alcohol,

18:23

artificial sweeteners, all kinds of stuff.

18:25

And from drugs too, antibiotics, steroids,

18:28

birth control pill, acid blockers, which are

18:30

so common like pralosec or

18:33

prebacid, all these can balance

18:35

a gut flora, psychological stress,

18:37

high carb diet, alcohol, environmental

18:39

toxins, all these things cause

18:41

this problem of dysbiosis, and

18:44

they also can affect the

18:46

motility of the gut. And there's

18:48

a lot of things that cause motility issues, it can be

18:50

diabetes, it can be GLP1 agonist,

18:53

by the way, and I worry about how they're

18:55

affecting people's GI tract. Drugs like Ozep, and we're

18:57

seeing even things like small bowel overgrowth, and

19:00

also we're seeing risk

19:03

of bowel obstruction because of the way

19:05

in which it affects the gut. So I'm a little

19:07

worried about that, but they can be a helpful cause

19:09

for drugs, I just think they're overused. But when you

19:11

have important mortality from stress or from different

19:14

kind of inflammatory bowel disease, it

19:16

can again cause a backup and growth of

19:19

bacteria in the wrong spot. Basically you've

19:21

got like 10, 12 feet of large

19:23

intestine and about 22 feet of small intestine,

19:26

and mostly the small intestine should be

19:28

mostly sterile, but when the

19:30

bacteria migrate up to the top of it,

19:33

and then the food ends up hitting it

19:35

first, that's when you get this food baby

19:37

stuff. Now stress also will have an effect

19:39

on your bacteria, they actually are listening to

19:42

your thoughts, right, your bacteria

19:44

listening there. When you have stress also it

19:46

increases permeability of the gut, it causes leaky

19:48

gut, affects motility, slows it

19:50

down, and affects immune system function, so

19:52

it's quite common. Thanks for watching. Bye-bye.

19:56

Have a great day. Bye-bye.

19:58

Bye-bye. Bye-bye. One

22:04

of the things that happens is a low

22:07

stomach acid. A low stomach acid is not that

22:10

common, but it can be in

22:12

degrees. The more severe form

22:14

is achlorhydria, which

22:16

happens when you get older

22:18

and you get atrophied of your stomach or

22:20

if you have B12 deficiency and so forth,

22:22

that can really affect this. But there's a

22:24

lot of reasons for it, but a lot

22:26

of the reason is because we take these

22:28

acid blocking drugs, and

22:31

that leads to low stomach acid and that leads to

22:33

change in the pH, and that leads to the

22:35

pH of the small intestine changing and the overgrowth

22:37

of fungus and bacteria that shouldn't be there because

22:39

of the change in climate. But

22:41

aging itself leads to this. Chronic stress leads to

22:44

low stomach acid. Certain intestinal infections

22:46

like H. pylori, autoimmune diseases

22:48

like hypothyroidism, certain

22:50

medications obviously for blocking stomach

22:52

acid with acid blockers or

22:54

PPIs, antacids. Some nutrient

22:57

deficiencies which are important for the

22:59

production of gastric acid like

23:01

zinc and B vitamins. If you're low

23:03

in those, that can cause low stomach

23:05

acid. Also poor diet will cause SIBO,

23:07

right? High intake of processed foods, sugar

23:10

on healthy fats also has a negative impact

23:12

on SIBO and also stomach

23:14

acid. Also if you're

23:16

not eating properly, regular meal times, eating too

23:19

quickly, overeating, you'll tend to potentially get SIBO.

23:22

This allows bacteria to colonize the

23:26

upper intestine which is supposed to have low levels of

23:28

bacteria. All right, so this is sort of what it is.

23:31

Basically bad bugs growing in the wrong spot, fermenting

23:33

the food you're eating, causing you to have a

23:35

food baby and be miserable and

23:37

have all sorts of other consequences on your mood, your

23:39

energy, your cognitive function. It's not just your stomach that's

23:41

being affected here. Now how do you diagnose it? Well

23:44

we use a breath test. There's a number of different

23:46

kinds of breath tests. There's lactulose, there's glucose, and

23:49

another test called TrioSmart test. But

23:51

essentially we're looking for three gases

23:54

that are produced after we give

23:56

you a digestible sugar like lactulose

23:58

or like glucose. And

24:00

what these do is

24:02

they actually help you to identify whether

24:04

or not you're producing extra forms of

24:06

these gases because the small intestinal bacteria.

24:09

The TRIO SMART test looks at for

24:11

three different gases developed by

24:13

Mark Pimentel and others at UCLA. Looks

24:15

for methane, which is commonly

24:17

associated with constipation, hydrogen, more likely

24:20

to have diarrhea, and hydrogen

24:22

sulfide, which is often not tested

24:24

for, but it can be important

24:27

to find, particularly in tough cases of SIBO.

24:29

I particularly use the TRIO SMART test. You

24:31

can learn about it online. Your doctor can

24:33

order it, but it's a really

24:35

important test. There are stool tests that help, and that'll

24:37

help you identify what's going on in the gut. Maybe

24:39

it helps you look at the overall health of the

24:41

microbiome, six underlying issues. It can

24:44

help you identify yeast overgrowth, lack of short-chain

24:46

fatty acids, lack of important bacteria

24:48

like acromancy, a low growth of bacteria. So

24:50

all that is sort of like clues, things

24:53

are going on. Also use organic acid testing

24:55

and urine tests because a lot of the

24:57

metabolites from overgrowth of fungus or bacteria will

24:59

show up in the urine, and you can

25:01

measure these, and it's another clue. There's certain

25:04

blood tests that are important to look for

25:06

nutrient deficiencies that can affect

25:08

SIBO or your body, like B12

25:10

or iron that maybe also include

25:12

a malabsorption. So what's a traditional

25:14

approach? Well, it's pretty good approaches

25:16

in traditional medicine, but they kind

25:18

of like stop short. They give

25:20

you an antibiotic, declare the

25:22

bacteria that's kind of advanced from what we used to

25:24

do when I was in training, but

25:27

it doesn't really address the full spectrum of

25:29

what's going on in the gut. So what's

25:31

a good comprehensive functional medicine approach to treating

25:33

irritable bowel and also the related GI stomach

25:35

issues? Well, we have a methodology. It's

25:37

basically a system of how we approach

25:40

people with gut issues. It's called the

25:42

5R program. The first is to remove.

25:44

Remove the bad stuff. Remove foods that

25:46

might be bothering you, bacteria, parasites, yeast.

25:48

Get rid of the bad stuff. The

25:50

second is replace. Replace what's missing. Robotics,

25:53

prebiotics, enzymes, and so forth. The third

25:55

is to re-inoculate, which is use probiotics.

25:57

The fourth is to... repair, that means

25:59

repair the gut lining with the right

26:01

nutrients that heal the leaky gut and

26:04

repair your gut lining. The fifth is to restore,

26:06

which means to regulate your nervous system and stress.

26:08

So let's go through the five-hour program in more

26:10

detail. The first R is to remove. Move

26:13

common triggers for problems

26:15

with the gut. These are commonly known

26:17

as food sensitivities, not true allergies, or just things

26:19

that your body shouldn't be eating that much of.

26:22

Bluten, dairy, corn, soy,

26:25

sometimes eggs for people, certainly

26:27

ultra-processed foods, certainly refined carbs

26:29

and sugars and alcohol.

26:31

Now a landmark paper published in

26:33

the prestigious British medical journal Gut

26:35

found that eliminating foods identified through

26:38

the delayed food allergy test, which

26:40

is not typically well accepted by

26:42

traditional medicine. It measures IgG antibodies,

26:44

not true food allergy, but food

26:46

sensitivity. When they eliminate those

26:48

foods, they dramatically improve their IBS symptoms.

26:51

The next thing we want to get rid of are

26:53

the bad bucks, right? And

26:56

that means identifying what they are through

26:58

testing. Maybe it's a breath test. Maybe

27:00

it's stool testing, urine testing. But

27:03

it involves getting rid of overgrowth

27:05

of bacteria, overgrowth of fungus, overgrowth

27:07

of parasites, through sometimes

27:10

medications or herbal therapies. Now

27:13

the typical medications used are antibiotics. Rifaximin

27:16

is the most common one now used. This

27:19

is a non-absorbed antibiotic, approved for

27:21

irritable bowel. And a randomized trial published in

27:23

the animal of internal medicine showed that using

27:25

Rifaximin for 10 days resulted in a dramatic

27:27

improvement in bloating and overall symptoms of

27:30

irritable bowel syndrome by clearing out the overgrowth of

27:32

bad bacteria. But sometimes you need to use combinations.

27:34

For example, if you have Methane, SIBO, you might

27:36

need Neomycin. Sometimes there's resistance.

27:39

You need to use Bactrim or

27:41

other antibiotics. But it's important to work carefully with

27:43

your doctor on this. Also you

27:45

might need an antifungal to get rid of

27:47

the bad bugs like Diflucan, Nistatin or Spornox.

27:50

You might need an antiparasitic if you find you

27:52

have a parasite like Alinea or

27:55

Flagell. And then there's

27:57

some herbal therapies that can be really helpful. There's

27:59

a protocol. a Trantil or

28:01

a Trantil which is a specific

28:04

herbal formula that's designed for methane recebo.

28:06

That's if you have high methane on

28:08

your test and tend to have constipation.

28:10

Certain antibiotics like neomycin can be also

28:12

important for methane recebo.

28:15

There are certain herbs that I like to

28:17

use like candibactin AR and BR which

28:20

are herbal herbal therapies for bacterial

28:22

and use over growth can be great. Sometimes I

28:24

use a combination of antibiotics followed by herbs for

28:26

a while and I'll

28:29

treat people with an antibiotic regimen and then

28:31

follow it up with herbal antimicrobials. It'll

28:33

include oregano, berberine, wormwood,

28:36

yarrow, thyme, ginger, licorice and other things. And

28:38

that's the first R. And also we look

28:40

at toxins. That's the other thing is to

28:42

remove toxins. So we have heavy metals, we

28:45

have pesticides, chemicals. All those

28:47

need to be reduced or removed. Personally

28:50

I had three recebo from mercury poisoning because

28:52

it poisoned all my digestive function and enzymes

28:54

and it didn't work and

28:56

I had to fix that. Now the next R

28:59

is to replace. So digestive enzymes

29:01

and hydrochloric acid. I use digestive

29:03

enzymes. There's different kinds like digestive

29:06

enzyme ultra from pure encapsulations. There's

29:09

digest gold. There's a lot of other ones.

29:12

There's spectra time 9x which is an animal

29:14

based enzyme for metagenics. By the way all

29:16

these supplements I mentioned you can find. They're

29:18

usually through professionals but I've curated

29:21

some of the best in class that I've used for

29:23

my patients that are

29:26

available through me and you can just go to

29:28

drhyman.com and go to the supplement store there and

29:30

you'll you'll be able to find it. Beta nitrochloride

29:32

which is a kind of a

29:34

counterintuitive if you think you have digestive issues

29:36

we're taking all these acid blockers but this

29:39

is actually giving you stomach acid and it

29:41

can help digestive food and actually help reduce

29:43

SIBO. And then we re-inoculate which

29:46

is really important and that involves

29:48

giving you the right probiotics.

29:51

It's really important and that is

29:53

good bacteria can be lactobacillus,

29:55

bifidobacterium. Some guys will

29:57

use saccharomyces which is Agnese

30:00

against yeast that helps with the ogeus

30:03

stover growth. We use

30:05

a whole different combination of probiotics. We

30:07

also use polyphenols and prebiotics to

30:10

actually help fertilize the good bugs. And we now

30:12

know that polyphenols, the colorful compounds in plant foods,

30:15

are really important for helping

30:17

to improve the growth of the

30:20

good bacteria. And lastly, the next

30:22

R is to repair. And that

30:24

means repairing the gut lining, using

30:26

food as medicine, eating whole, minimally

30:28

processed foods, lots of good protein,

30:30

because protein's needed for gut lining

30:32

repair. Pasturease eggs, grass-fed organic, non-genetically

30:34

modified sources of food, lots

30:37

of low mercury fish like salmon,

30:39

mackerel, herring, sardines. I

30:42

like Ctopia.fish. It's got a great source

30:44

of clean fish sometimes that are regenerally

30:46

farmed. So, you know, be careful of

30:48

farmed fish. But there's a lot of

30:50

other protein options, grass-fed beef, wild game,

30:53

buffalo, elk, lamb, venison, all are great.

30:55

Poultry, if it's, you know, pastures, turkey,

30:57

chicken, that's really good. You also

30:59

need gut healing nutrients, like

31:01

omega-3s and vitamin A. And

31:04

you can get ghee, which has

31:07

butyric acid, which also contains a

31:10

gut healing compound. Bone broth is really

31:12

great. It's rich in aglutamine, which can

31:14

help provide, you feel like full,

31:16

but also it can help provide added minerals

31:19

and collagen support that helps your leaky

31:21

gut. Also, there's certain supplements that

31:23

are important, like omega-3s. I like omega-3

31:26

rejuvenate from Big Boath Health.

31:28

You can take eating primozoyl, magnesium,

31:30

certain vitamins like D and A

31:32

are important, zinc and multivitamin, all

31:35

help heal the gut. So these are just things that we use

31:37

to help heal the gut. Now, after you've

31:39

done this SIBO treatment, you don't wanna be

31:41

eating a diet that's gonna cause you to

31:43

reintroduce foods that are gonna cause, again, the

31:45

overgrowth. So you gotta be careful. Now, you

31:47

also wanna learn how to regulate your nervous

31:50

system, because that also is important. Because

31:52

both stress works to make it worse,

31:55

but when you're having your bowel, it makes your

31:57

stress worse. So it's kind of a vicious cycle.

31:59

Meditation. breathwork, yoga, whatever it is

32:01

to help restore your nervous system. Also,

32:04

exercise is great. Exercise that's done regularly,

32:06

this is from randomized controlled trials, actually

32:09

helps reduce IBS. Even a 30-minute walk can help.

32:11

Now, let's talk about diet. There's a whole diet

32:14

that's being used. It's called a low FODMAP

32:17

diet, low in fermentable starches

32:20

and sugars, essentially, right? You're not giving the

32:22

bacteria something to chomp on and then produce

32:24

gas and make you miserable. This is crazy.

32:26

One in seven people in the entire world

32:28

is affected by symptoms of irritable

32:31

bowel syndrome and many have one or more

32:33

foods that are known to trigger symptoms like

32:35

gas, bloating or diarrhea. Now, carbs and fiber

32:37

are the most common because they can be

32:39

fermented. So, this diet

32:41

is called the low FODMAP diet and

32:43

it was developed in Australia, which was

32:45

extensively researched with irritable bowel and

32:48

it's basically considered a low carbohydrate diet.

32:50

It can be super effective for treating

32:52

IBS. Like basically, if you eat protein and vegetables,

32:54

you'll be fine. Okay? Except

32:57

certain vegetables are not great. We'll talk

32:59

about that. Now, many of those irritable bowel

33:02

suffers symptoms improved on

33:04

this low FODMAP diet. And

33:06

clinical research has shown that low FODMAP diets improve

33:09

the symptoms in 70% of IBS

33:11

patients. So, you both want to

33:13

do the 5R program and part of the

33:15

first R is to remove and it means

33:17

removing some of these fermentable starches. Real world

33:19

studies continue to show that this works, right? In

33:21

improving abdominal pain, quality of life. So, what

33:24

does actually FODMAP stand for? It

33:26

stands for fermentable ole saccharides, which

33:28

are fructans and galacto olego

33:30

saccharides, basically olego saccharides, which means

33:32

single sugars, disaccharides like

33:35

lactose, monosaccharides like fructose.

33:37

These are all types of sugars that

33:39

are gut bacteria feed on and polyols,

33:41

which are sugar alcohols, right? Which

33:44

is in all the kind of, quote,

33:46

health foods that have artificial sweeteners

33:49

or sugar alcohols to make them

33:51

sweet, like sorbitol, xylitol, malitol, isomaltol,

33:55

mouthetol, and these are

33:57

terrible. When I had SIBO, I

33:59

accidentally... got, well

34:01

not accidentally, on purpose got

34:04

a chocolate bar that was given to

34:06

me by patients as a no sugar chocolate bar. You

34:08

should love it. I'm like great. I was, I don't

34:10

know, at work and I was a little tired, stressed.

34:13

I ate it, the whole thing and it was full

34:15

of mouth at all and I was in the bathroom

34:17

and I was miserable. It's really bad so you have

34:19

to be careful. So how do five meps foods

34:22

cause IBS? Well these carbohydrates and sugars

34:24

are not readily absorbed in the gut

34:27

and basically they path through the small

34:29

intestines and they attract water and they

34:31

cause bloating and motility changes that can

34:33

result in diarrhea or constipation. But once

34:35

they read the large intestine, they got

34:37

bacteria ferment them and they produce lots

34:39

of gases like hydrogen, methane, carbon dioxide

34:41

and the accumulation of these gases leads

34:43

to gas bloating dissension. So what

34:45

are the foods that have the highest and

34:47

the lowest amounts of FODMAPs? And what are

34:49

other things that have FODMAPs like

34:52

drinks, right? So let's just go through the

34:54

beverages. Apple juice, mango juice, pear juice, high

34:57

fructose corn syrup, sodas, certain alcoholic drinks

34:59

like beer, wine, all that will make

35:01

you worse. Processed foods, I

35:03

should say no more but you know those you

35:05

should mean anyway but cereals with high fructose corn

35:07

syrup, snack foods with high fructose

35:10

corn syrup, protein bars, diet foods, often

35:13

they'll contain inulin or high FODMAP ingredients.

35:15

So what are the steps to try

35:17

a low FODMAP diet? Well all these

35:19

modern high FODMAP foods should be eliminated

35:21

for four to six weeks on the

35:23

low FODMAP food plan. So for

35:25

the next four to six weeks you

35:27

want to basically do that. Why does a low

35:29

FODMAP diet eliminate healthy foods? Like right, seems

35:31

like you shouldn't be

35:34

eliminating healthy foods but sometimes it says to

35:36

like asparagus, right? But that actually

35:38

has a lot of fermentable starches in it. And you

35:40

basically do this temporarily until your symptoms get better. Now

35:43

it's careful if you have an eating disorder or

35:45

whatever, you know, you want to be

35:48

aware of working with someone who can help you

35:50

do this right. But still you might need to

35:53

fix your gut and that can be a factor

35:55

in even in eating disorders. One FODMAP group is

35:57

introduced at a time so you saw that. sort

36:00

of go slowly to monitor your symptoms. One food at

36:02

a time, you start small and you sort of fill

36:04

up your tolerance. Now some people can only

36:06

tolerate food at a specific quantity, so maybe they have a

36:08

little bit, they'll be fine if they

36:10

have a little more, they're gonna be in

36:12

trouble. But some people need to avoid specific

36:14

foods or FODMAP groups indefinitely, right? There's an

36:16

app actually that the FODMAP group

36:19

in Monash University in Melbourne, Australia

36:21

put together and it's for the

36:24

public and it provides a searchable

36:26

database of foods low and high

36:28

in FODMAPs. It has recipes, recommended

36:31

food products, and on their website

36:33

for more information, you go to

36:36

monashfodmap.com, it's m-o-n-a-s-h-f-o-d-m-a-p.com. Now

36:39

research shows that tryptophan, which is the

36:41

precursor to serotonin, which is a neurotransmitter

36:43

that helps gut motility, can

36:45

improve constipation in

36:47

IBSC because it helps increase

36:50

intestinal transit time, intestinal

36:53

motility, which means moving things through, and

36:56

gastric emptying similar to fiber. So that's

36:58

good. If you have high levels of tryptophan though, it could

37:01

make IBSD worse, meaning

37:03

your diarrhea to predominate, you

37:05

wanna be careful. If you're doing this, I

37:07

encourage you to work with a practitioner, it's

37:09

pretty restrictive. I don't think everybody needs to

37:11

be on this actually. I think there's ways

37:13

of resetting the gut use of the five-word

37:15

program and helping people eat more normally, but

37:17

you wanna work with an experienced nutritionist or

37:19

functional medicine practitioner who can help you identify

37:21

what's going on, what you should be doing,

37:24

and the goal here is to improve digestion, not have

37:26

a long-term restrictive diet. The good

37:28

news is we now understand a lot

37:31

more about irritable bowel than we did.

37:33

We understand what is driving

37:35

this food baby. It's

37:38

called SIBO or CFO. We understand

37:40

how to treat it in the right

37:42

way with diet changes, lifestyle changes, the

37:44

right medication sometimes, the gut repair program,

37:46

and often traditional doctors will might give

37:48

you the antibiotic, but they won't treat

37:50

your yeast or fungal

37:52

issues. They won't put you on a full

37:54

five-bar program to reset you, they won't make

37:57

a lot of dietary suggestions, so you'll get

37:59

recurrence. be a problem, you can get

38:01

recurrence if you don't do it properly. So as

38:04

we wrap up today's episode, it's clear that

38:06

the playful hashtag hot girls have IBS is more

38:08

than just a trend. It's a conversation started about

38:11

real health issues that face a lot of people

38:13

every day. And it's great that social media is

38:16

helping these stigma ties discussions around women's

38:18

health, particularly digestive issues. And we've learned

38:20

today, these symptoms are signs that should

38:22

not be ignored. They're often rooted in

38:24

complex interactions between our diet or

38:27

hormones or our lifestyle. But

38:29

thanks to extensive research and

38:31

discussions that we covered today,

38:34

hopefully we're all better equipped to understand the

38:36

underlying causes of these common stomach issues. Remember,

38:39

it's not enough just to normalize these conditions.

38:41

They're not normal. We've

38:43

got to actively seek understanding of what to

38:45

do and get the right treatment. Whether you're

38:47

a woman dealing with these symptoms or know

38:49

somebody who is, I encourage you to explore

38:51

functional medicine approaches that we discussed and consult

38:53

with your healthcare professional who can tailor specific

38:55

treatments to your specific needs. So let's take

38:57

control of our health and work not

39:00

just toward feeling okay, but

39:02

to feeling great. Thanks for joining me today.

39:05

And I look forward to bringing you more

39:07

empowering health discussions on next Tuesday's episode of

39:09

Health Hacks.