The Dr. Hyman Show - Bloating: Getting Rid Of Your Food Baby With Functional Medicine with Dr. Elizabeth Boham

Episode Date: October 18, 2021

This episode is sponsored by ButcherBox and Tushy. Bloating is a very common and uncomfortable condition where your belly increases in size, often occurring after eating and increasing as the day goes on. Twenty to thirty percent of the population regularly experiences bloating. If you have Irritable Bowel Syndrome, that percentage jumps to 96%. Bloating is a sign of an imbalance in the gut, often caused by dysbiosis, food intolerances, bacterial overgrowth, and stress. While conventional medicine usually treats the symptoms of bloating, Functional Medicine treats the entire ecosystem of the body, including repairing and rebuilding the gut. In this episode, Dr. Hyman discusses bloating and “food babies” with Dr. Elizabeth Boham. They talk about lactose intolerance as a common cause of bloating and how this uncomfortable condition can be successfully treated. They also share a case study of a 35-year-old man and the protocol that helped him. Elizabeth Boham is a physician and nutritionist who practices Functional Medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dr. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the Functional Medicine approach to keeping your breasts and whole body well. This episode is sponsored by ButcherBox and Tushy. Right now, you can get a free turkey when you sign-up for ButcherBox. Just go to butcherbox.com/farmacy. Explore the entire suite of Tushy products, including the bidet attachments, new Tushy Ace, bamboo toilet paper, and more by visiting hellotushy.com/hyman. In this conversation, Dr. Hyman and Dr. Boham discuss: The prevalence and characteristics of bloating in the general population and IBS patients How SIBO can be a cause of bloating Conventional medicine vs Functional Medicine treatment of bloating Why antibiotics can be harmful and helpful in gut health Addressing imbalances in the gut How foods and food intolerances may lead to bloating Negative effects of PPIs on the gut Dietary approach to treating bloating Case study of a 35-year-old male How different probiotics can affect the gut

Coming up on this episode of The Doctor's Pharmacy. If you take a probiotic and feel more bloated or your digestion doesn't feel, it feels worse, not better, then that's the wrong probiotic or could be the right probiotic, but at the wrong time. Hey everyone, it's Dr. Hyman. One of today's episode sponsors is ButcherBox. Now one part of my life that I'm consistently grateful for is good food. It helps me take care of my health, and preparing tasty meals is one of my favorite ways to show love for people in my life.

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And that means you also have to save money by buying 80% less toilet paper since you just need a few squares to pat dry. Once you experience the just-showered clean of Tushy, you'll never go back to wiping with dry, scratchy toilet paper. Visit hellotushy.com forward slash hymen to explore the entire suite of TUSHY products, including the bidet attachments, new TUSHY Ace, bamboo toilet paper, and more. That's hellotushy, T-U-S-H-Y dot com slash hyman. Now let's get back to this week's episode of The Doctor's Pharmacy. Welcome to The Doctor's Pharmacy. That's a pharmacy with an F. I'm Dr. Mark Hyman. This is a place for conversations that matter. And today we have a special episode of The Doctor's Pharmacy called House Call with none other than our medical director at the Ultra Wellness Center, Dr. Elizabeth Boham. And we are going to be talking about one of my favorite topics today, which is bloating, otherwise known as a food baby. We're going to get into that in great detail. I'm just

so happy to have Liz back on again. As you know, she's the medical director at the Ultra Wellness Center. She's really an extraordinary physician who's trained in nutrition, exercise physiology, family practice, functional medicine. She teaches all over the world. She's contributed to textbooks. She's promoted in all sorts of media. And she's just an all-around amazing human being. And I'm so happy to have you back on The Doctor's Pharmacy. Thanks, Mark. It's great to be with you. Okay. So here we go. This is one of the most vexing problems that face people creates a lot of misery, discomfort, not like killing people for sure, but it makes our life really miserable.

And it's bloating. Now, bloating means a lot of things to a lot of people. We're going to define what bloating means. But in this case, we're talking about abdominal bloating, gas in your belly and what that is from, what causes it and what we have to do about it. So if you've ever eaten a meal and then afterwards felt like your stomach was going to explode or some variation thereof, then you better listen up because we're going to explain everything you need to know about it from a functional medicine perspective. So let's get started by talking about

the prevalence of this problem, how common it is, and what is the general perspective of traditional medicine? How do we deal with it? And how many people have it? And what's going on? Yeah, yeah. You know, I mean, it's estimated that 20 to 30% of the population is dealing with bloating on a regular basis.

People with irritable bowel syndrome, it's, you know, 96%. So people who are struggling with digestive issues or irritable bowel is, you know, we've talked about before, that is, you know, something that we really work to define, you know, greater than just putting that into a waste paper basket, right? You know, it's even higher. It's that 96%. So bloating just means that your belly is getting bigger, right? You have this increase in abdominal girth and it, and, and it typically when, when we're talking about, um, uh, abdominal distension from gas or bloating, what we're going to talk about today, itated after they eat, or they may feel more abdominal fullness or sensation of gas as the day goes on. And there's so many reasons behind the causes of bloating. And I think that's really what we want to focus on today, is what we really work to get to that underlying root cause in functional medicine, right? What is that underlying cause for that person? Because there's so many different reasons for bloating.

And I think that's really critical to focus on and not just saying, okay, well, take gas X or just take something to suppress the bloating. We really want to figure out why is it going on because that really then can help work on that person's symptoms that are causing them a lot of discomfort. So on the average, Joe or Jane, and I go to my internal medicine doctor or my GI doctor, I go, hey, doc, you know, I got bloating. And every time I eat, my stomach feels like it's going to explode. I just feel really uncomfortable. You know, what do I do? And, you know, up until fairly recently, it was like, well, you have irritable bowel.

It's probably psychological. Take some Metamucil. And, you know, hopefully that'll work. And if that doesn't work, we'll give you some, you know, antispasmodics for your stomach so it doesn't spasm. And otherwise, you know, go meditate or take Valium or Prozac. It's not a very satisfying answer for a lot of people. Yeah, a lot of people walk away dissatisfied and they're frustrated and they don't feel good. And

like you were mentioning before, it's not always something that's causing death for people, but sometimes it causes significant issues. I have patients who come in and they have such significant bloating that it's stopping them from being able to eat enough nutritious food, you know, so they have to, they've had to really restrict their diet or they don't feel like eating so much. And I have some patients, and we'll talk about one later, where they're getting thinner and thinner and they're losing their lean muscle mass because the amount of bloating they're having is restricting their intake of nutritious food. And that can be really significant for people. I mean, that doesn't happen to everybody, but there are people where they're dealing with it that significantly. No, it's a big issue. And I think, you know, when I was in medical school, we didn't really ever learn about what we call SIBO or SIFO. We didn't learn about that. Did you learn about that? No, not at medical school.

It was kind of a new insight about irritable bowel, which is that it's really about the often, not always, and we're going to go through the causes, but it's often about the overgrowth of bacteria or fungus used in the small bowel. Now, you've got like 22 feet of, you know, small intestine, about 10, 12 feet of, you know, small intestine, about 10, 12 feet of large intestine. The small intestine is generally sterile, but sometimes the poop from the large intestine kind of migrates up, and we'll talk about the reasons for that, and leads to the spectral overgrowth. So, some conventional doctors now are treating people with antibiotics, right? What do they do? What kind of things are you seeing them do?

Right. So you're talking about SIBO. So we're checking, one of the major causes of bloating is SIBO or small intestinal bacterial overgrowth. And as you mentioned, there's a lot of other reasons that people get bloating, but one reason could be because there's the wrong bacteria that have migrated up into the small intestine, as you have mentioned. And when that happens, that dysbiotic or not good bacteria or the bacteria that shouldn't be there consumes some foods and then produces gas. So it's consuming foods that get fermented, and then you produce a bunch of gas from it. And so the combination of certain foods, and not always bad foods, but certain foods that cause this gas when there's the wrong bacteria in the wrong place can cause a lot of bloating. And so SIBO is something we check for

all the time. You know, you can check for it with a breath test. Conventional doctors are checking for it as well. We check for it all the time. Yep, now they are. And there's a few ways you can work on treating that and we'll delve into that more. But one is getting rid of the bacteria that's in the wrong place. And you can do that with medication like antibiotics, like you mentioned, you can do that with herbal substances that lower the bacteria in the wrong place. And you can also change the diet for a period of time that takes away the food that's feeding this wrong bacteria that's allowing it to overgrow. So that's good. So conventional doctors are sort of getting the point a lot about SIBO and they're using

antibiotics and then they'll use, you know, different diets to restrict the fermentation of the foods. But they really don't have a comprehensive 360 approach from my perspective. They don't deal with the overall ecosystem of the gut. They don't look at all the other food sensitivities. They don't look at how to repair and rebuild the gut after the problem is taken care of with antibiotics. And they often people, they don't often treat yeast or SIFO, which is often coexisting with the SIBO. And then they end up, you know, having recurrent bloating. So, that maybe get better for a few weeks or a month and

then it comes back. So, functional medicine is a very different perspective. And we understand the problem, but then we also understand how to navigate like medical detectives to the cause. And what I think is challenging with SIBO is it's such a persistent and uncomfortable thing. And there's not a lot of insight about what really happens. So I would love it if you sort of take us through, you know, what are all the types of reasons people can start to develop SIBO and all this and develop this fermentation process? Because by the way, the thing that struck me was such a big insight was humans don't make gas. It's the bacteria eating the food that you eat that make the gas. So,

if you have gas or bloating and you have dissension and air in there, it's not you making it, it's the bugs and it's an imbalance in your relationship with your bugs. So you got to get in harmony with your bugs basically. So take us through Liz, what are the common reasons why we get this bloating and dysbiosis and imbalances in the bacteria? I mean, one of the biggest reasons that we see that people get imbalances or dysbiosis, imbalances in their gut bacteria are antibiotics. I mean, when we over-prescribe antibiotics or people have been on large courses of antibiotics for certain reasons, you know, chronic infections, or they just, you know, they got on too many

antibiotics when they were younger. What happens is it can result in this imbalance in the good and bad bacteria in our system. It can get rid of some of the good bacteria and fungus, yeast, and things that keep that ecosystem in better balance. So, you know, too many antibiotics, too many antibiotics in our food supply. We know that things like that stress has a huge impact because stress in our life impacts our motility and how well things move through our system. So, you know, we know that people get bloating, you know, not just that this isn't just SIBO, but bloating because of, sometimes if they're eating too quickly, you know, they're not digesting their food properly.

So they are swallowing air or eating too quickly. Probably that's what I do. I eat too fast. That explains all my issues. So yeah. Moving on to the next thing? Right, right. So, I mean, and then there's, you know, things like lactose intolerance, which is, you know, lactose intolerance is so common, you know, that's the decrease in that lactase enzyme that's in our intestines that breaks down lactose. And when we don't have enough of that lactase enzyme, then we can't digest our lactose very well, which is in dairy, you know, and so we've done a lot of different podcasts on dairy and all the issues. But what we we know is that for everybody, by the time they reach 100, they become lactose intolerant. You know, so everybody in the whole world is that way and some people become

lactose intolerant at no cheese after 100 some people become lactose intolerant at age two some people at 50 i was just in sardinia and i saw these little 100 year old people eating a lot of goat cheese and sheep cheese and we're doing well you know and what what do we know about what when we say lactose intolerant it's important to recognize it's a spectrum, right? So that there is, you know, when you're, you know, what does it mean to be lactose intolerant? It means you only, you're not as tolerant to digesting as much of the lactose. And that's what gets people so confused all the time about foods and food sensitivities. They're like, well, I ate that yesterday and I was fine. But then today I'm really struggling. And it's really because of the volume, right? You can, you know, many times you can get away with, with a certain amount of lactose, right? And then other times, if it's, if it's, you have two servings or whatever, then it pushes your body over the edge because you don't have enough of that enzyme to digest it. So it's, you know, it's, it's, it's a spectrum and, and, um, uh, and, and that's what we see all, all of the time. You know, it's also important to recognize

there's other things that can cause bloating. Things like constipation can cause bloating. Um, we know not having good motility, you know, maybe because of autoimmune processes or just a gastroparesis, like not good motility, right? Exactly. If your bloating is all the time or if it's not getting better, you really want to get evaluated because there are some cancers that can cause bloating and GYN issues, gynecological cancers. You know, so there's more things that can cause bloating. It's important that we pay attention to all of those when we're getting a really good history and timeline from our patients. I agree. I mean, I think there's certain things, you know, we see commonly like the bacterial overgrowth. It's often because of people taking antibiotics or other drugs. You know, in fact, one of the things that people really don't realize is that the acid blocking drugs, which are the third leading class of drugs sold in America, okay, these are like Prilosec, Protonix, Nexium, Massifex, all those drugs, they're given out like candy. And they cause bacterial overgrowth and they cause fungal overgrowth because they change the pH, they change the environment.

And so while you may not heartburn, you end up getting irritable bowel. That's one of the side effects of these drugs. So I think it's important for people taking those to realize they're not lifelong drugs. There's ways to fix the underlying problem. And the other thing, you know, that I found often is these sugar alcohols. They're not all these healthy products that are highly fermentable, non-digestible sugar alcohols like erythritol, xylitol, sorbitol, malitol. And they are in a lot of these foods.

And some people do fine with them. Some people don't. But I know if I have a – way back when, I think it was like 20 years ago when this stuff was just coming out, someone gave me this like sugar-free chocolate bar, which is full of maltitol. And I ate the thing at Kenya Ranch and I literally couldn't see patients the whole afternoon because my stomach just was going crazy. Yeah, you were doubled over it in pain, right? Oh my God. And then, you know, I think you've got other things that I found clinically. You found this too.

I don't know how much documented this, but certain things like tick infections, like Babesia and others can cause motility issues in the gut or heavy metals. So I often, you know, if we don't get better initially, I start to look for other factors. So I think, so these are really common problems. And, you know, 10% of all, like, loss of productivity in corporate healthcare is from irritable bowel. So, it's a huge economic burden on society. And it's the number one reason for visits to the doctor for anything. I mean, it's so important about the additives in foods. And sometimes people, you know, that's something you really have to delve in deep with people on and look about, okay, what bars are you eating? What even certain, you know, shakes that have, like you said, some of the sugar alcohols in them, chewing gum, you know, people always forget about chewing gum and how much, you know, that can cause bloating because of some of the sugar alcohols in them. And so you've got to pull those away just to help people feel better. Absolutely. And I think, you know, it's a bit

of a detective job. And a lot of processed foods has emulsifiers and thickeners that tend to cause leaky gut and other issues. So there's just so much opportunity by focusing on a very detailed history to figure out what are the culprits. And if you're not eating anything that's real food, if you're eating anything that's not real food, it could be a thing like fructose is a big factor. A lot of high fructose corn syrup and stuff, and people have fructose intolerance. So there's a lot of issues that we can really deal with.

So take us now, those are the causes, and those are the things we tend to think about and test for. We test for gluten, we test for food sensitivities, we test for a lot of things. What would be an approach that we would take typically to deal with these people with the food baby bloating thing? And let's just say it's kind of the typical kind of cancer or Lyme disease. Right, right, right. I mean, exactly, right. So you mentioned about the Lyme disease. That's

really, I think, important when people are not getting better, when they're being treated so many times and they're not getting better. But so, yes, so we often will test for dysbiosis. So we're testing for SIBO, but we also do stool testing that is, you know, it's fascinating just some of the revelations we're having and improvements in stool testing. We can look at levels of good and bad bacteria and balances in good and bad bacteria and work to shift those as well, which can be really helpful. And one of the first things we always start with, of course, is dietary changes. So, you know, we'll either put somebody, depending on their history, their story, and where they are and their level of motivation, we either put them on a dairy-free diet or we put them on a gluten-dairy-free diet, or we might put them on a low FODMAPS diet. So FODMAPS, maybe people have heard about FODMAPS. And so it's important for us to just sort of delve into that a little bit. But FODMAPS- Yeah, what does that mean? What does that mean?

Yeah. So FODMAPS foods are fermentableable oligosaccharides, disaccharides, monosaccharides, and polyols. And so these are these carbohydrates that are not completely absorbed for some reason, either because of some maldigestion or just because they're harder to absorb carbohydrates. And then they get, when there's the wrong bacteria in the wrong place, they consume those carbohydrates and produce gas. So, you know, so the oligosaccharides, those are things like wheat and rye and onions and garlic and legumes. Disaccharides are things like lactose and dairy. Monosaccharides are things like fructose, like high fructose corn syrup, like you mentioned, honey and apples. The polyols, those are things like sorbitol and mannitol, the artificial sweeteners, and some fruits contain some of these polyols.

And so one of the first things we do is say, okay, maybe we should try a low FODMAPS diet for a period of time. So there are some foods on this list that are good, healthy foods that you don't want to stay off of forever. So it's usually with a low FODMAPs diet, it's for a period of time that you're taking people off of these carbohydrates that are fermentable. And then over time working to reintroduce the healthy ones for that person. The Monash University has a really good website, lots of good resources on FODMAP's foods. But in general, you pull away things like wheat and rye and onions and leeks and cauliflower and apples and dried fruits and sugars and high fructose corn syrups and legumes. And you do that for a period of time. Not everybody needs to go to that level. And for many people, it's important that they work with somebody who's, you know, a nutritionist or somebody who can help them navigate the world with this because it can be, you know, like I

was mentioning earlier, you got to figure out what you're able to eat. So, Ben, let's talk about some of the other sort of approaches besides the dietary restrictions that we would take, you know, we might get off gluten and dairy, get off grains, get off beans, get off sugars, get off all the things that you mentioned. Then, you know, what do you do for the bad bugs? How do you reset the gut? How do you sort of rebuild the gut? Oh, great question. So, you know, depending on what's going on in terms of the dysbiosis, right? Dysbiosis just means imbalance in good and bad bacteria and yeast. And depending on what we find is going on, we will treat that. And so we can treat that with a prescription medication.

So sometimes we'll use an antibiotic. I know that sounds kind of crazy because you're like, yeah, we're like, we know antibiotics cause dysbiosis. True. But sometimes if people, depending on their level of symptoms, they do, you know, we can improve symptoms with a short course of a non-absorbed antibiotic. So, sometimes we'll use an antibiotic for a period of time and then we'll use an antif a period of time, and then we'll use an antifungal medication. And then there are times- Because you always follow the antibiotic with an antifungal? Yeah. I mean, I often do. And again, it depends on what I find with the testing we do through

stool testing and breath testing and their clinical situation. So I often will follow with an antifungal or I'll follow with an herbal medication that includes, there are many different herbs that they have affected both treating bacteria and yeasts. So we can use some herbal regimens. There's a lot of good ones out there that will treat both bacteria and yeast overgrowth. And that's one of the nice things about herbal regimens, I find, is that when you're resetting the bacteria in the gut and the yeast in the gut, they may be a little slower to act, but they sometimes are really effective long-term. So there's a few herbal regimens that we use

very often, and some have been really well studied. We also do things that help the body with digesting your food. So whether that's something that increases acid in the stomach, like betaine HCL, or a digestive enzyme, there's digestive enzymes that are plant-based digestive enzymes. And then there are other digestive enzymes that are, you know, that comes from their porcine, their glandular digestive enzymes. Those things help with breaking down your food, your protein, your carbohydrates. They help with breaking them down so that they're easier to absorb into the body and less likely to feed the dysbiotic bacteria that we were talking about. So, you know, that's also really helpful. So, I think the unique thing about functional

medicine is that you not only just sort of get rid of the bugs, but you focus on resetting the whole gut. And, you know, whether it's an antibiotic, an antifungal, and herbs, and I would love you to talk about what herbs. Or then you add in enzymes and other pre and probiotics and repair components for the gut. It's what really helps people get better, right? Yeah, absolutely. So tell us about the cases. You had a 35 year old guy had quite a remarkable story. Um, yeah. So, you know, there's this gentleman, he was 35 and he came in to see us and he was, he was really frustrated with his bloating. And, you know, he,

what he said is that, you know, he felt fine in the morning. And then as the day went on, uh, he became more and more distended. He became more bloated in his belly and distended. And so, it's really important, as I said, that we get really detailed clues as to his history. And what really helps many times is when people take that really detailed history and they think about their own timeline. When did this start? You know, how long has it been going on? You know, you know, trying to help get the clues as to what, what triggered this to occur for them. Right. And, you know, so we knew that as a child, he had, he had ear infections. So he was on multiple rounds of antibiotics, but then two years ago, he developed a pneumonia.

And he ended up the first round of antibiotics wasn't helpful getting rid of his pneumonia, and he needed a second round of antibiotics. And so we can also need to delve into this, you know, this risk for pneumonia here and everything. But it was, you know, those recurrent rounds of antibiotics, at that point, since that point, he's been struggling with bloating. So he's been really – at that point, he started saying, okay, now every time I was eating, I was getting more bloated. And prior to that, he could eat whatever he wanted. He really didn't have to be careful with his diet at all.

Now, he noticed if he ate too much dairy, he would get bloating and diarrhea. We did do a SIBO test and it was negative. But while we were waiting for his stool test to come back, we just decided, okay, let's pull away gluten and dairy. You know, he wasn't really ready to go on a full low five MAPS diet. And I didn't even know if it was really necessary for him right away. So we said, okay, let's pull away gluten and dairy. And when we did, he had significant improvement in his symptoms. And but but not complete improvement, you know, he still

would, he felt better, but he still was getting some bloating depending on what he ate. And so the stool test came back and it was really interesting. It showed a dysbiosis, right? It showed an overgrowth of many different bacterias and some yeasts. And so we then treated him with an herbal regimen. We used something that had a combination of different herbs, oregano, berberine. It was a combination product. He took it for six weeks and he found that extremely helpful. We did add in probiotics. We did wait to add in probiotics until we were done with his herbal regimen. But once we did, we, we did add in like a general probiotic and, and there's so much to

discuss with probiotics, but he, you know, he found that to be really helpful. And, and, and now he's back to, I mean, he's is careful with dairy and has a really good healthy diet, but he's really much more comfortable all the time now. Well, let's talk about that. I mean, probiotics, you know, can be problematic. You know, a lot of people with irritable bowel, they go, oh, I'm going to take probiotics. And they go to the drugstore and they go to the health food store and they get the probiotics. And they take them and often they get worse.

Yes. So can you explain that there's an important order to doing things and that what would be beneficial at one point might be harmful at another point. I think that's absolutely true. You know, order is really important. And, you know, if, if somebody does have an overgrowth of, of bacteria in the wrong place, sometimes probiotics make that worse, you know, and you can get, um, if you take a probiotic and feel more bloated or your digestion doesn't to, how to recommend, what order things to do it in, or, you know, you're, or just knowing that if, if it doesn't feel right to you, put it on hold. There's lots of different brands of probiotics out there and quality of probiotics

out there. Some probiotics have dairy in them. And so for people who are dairy sensitive, they don't work. Other ones don't. There are also some strains of probiotics that can, and of themselves, depending on the milieu, increase the amount of bloating for certain people. So it's hard to give a general recommendation. Like I, it's hard for me to say, well, take this one. Cause it doesn't work for everyone, but just know that if you try one and it makes you feel worse, put it aside. And it may be that it's just not the right one for you, or it's one to try at a later date. Um, after you've gotten rid of the, uh, dysbiotic bacteria, some people get the, get a probiotic and they feel better right away,

and then that's great. Wow. Yeah, it's complicated. So, if you're struggling with this, don't lose heart. There's a lot of things. I mean, you didn't mention histamine intolerance. There's a lot of things that cause problems, which we've covered a lot on the podcast. But the key is that if you suffer from bloating, if you have this food baby, if you're really miserable and uncomfortable, all that, there is a way to kind of get through it and fix it. You also, I think you had one other case of a woman who was 25 and was also struggling. Yeah. So, yeah.

I mean, she was also. Classic history kind of. Lots of antibiotics for, she had acne. So, she was on lots of antibiotics for, you know, between the ages of 17 and 22. And this is what we were talking about before. Her bloating was so significant at this point that it was preventing her from doing things. She wasn't getting out during the day. She wasn't seeing friends all the time. She also couldn't eat as much. And just with her body type, if she wasn't eating enough calories or enough protein, she was starting to lose weight and she was getting underweight. She was

also losing lean muscle mass. And this then creates this vicious cycle because if you don't have enough nutrients coming in, then the body can't heal. I always talk to people about that. You know, people are always restricting foods at which, you know, I, you know, the elimination diets can be so helpful, but sometimes if we're eliminating, eliminating, eliminating, and then not getting an enough nutrition, then the body can't heal. And this is what was happening with her. She was eliminating so much that she was, um, she was, you know that she was wasting. Her lean muscle mass was decreasing. She was feeling more weak.

You feel bad when you eat. You don't want to eat. Exactly. So she was just not eating. And she was more constipated. We did a SIBO test on her. It was positive. It was positive for both methane and hydrogen SIBO, but much more positive

for the methane positive SIBO. And what we know- Yeah. We'll talk about that. So we do this testing, which is you breathe in, you breathe in this, you just drink this liquid that tends to cause the fermentation, right? And then you breathe into this bag and you can tell whether it's hydrogen or methane and each are different and they actually respond to different treatments. So it's important to know which type of gas you're producing, because that means it's different bacteria. And so you need different drugs or different herbs for different bacteria. That's so true. That's so true. So what we know is that there's the methane-producing bacteria are more likely to cause constipation, right? They're more likely to impact the motility in the digestive system and cause more constipation. And so, the hydrogen-producing bacteria are more likely to cause diarrhea.

Now, that's not always the case. Like sometimes people have, you know, their testing looks one way and it doesn't always match up. But in general, we see the methanobacteria, the methane producing bacteria, more likely causing a constipation picture and bloating. And so, you're right. So, sometimes we, we you know the the medication there's a typical medication that is used prescription medication that's used for SIBO called xifaxin but when you find the methane producing it it typically works better when you use it with neomycin together you use both together and she also did well when we put her on that low five maps diet you We really pulled away. She needed a nutritionist on board because as we were mentioning, she was becoming underweight. So she really needed somebody to guide her through. And as you know, at the Ultra Wellness Center, we've got all our nutritionists working with all our patients, which is wonderful. And so, you know, they, they were really, you know, her nutritionist was really helpful to guide her through the pulling away of the foods that were making her feel worse,

but then getting her the nutrition she needed and then, and then slowly transitioning over time. So she could add back in those healthy, higher FODMAP foods, right? Like the onions and cauliflower and fruits that we want to be able to add back in when possible. So after we treated her and got rid of that dysbiosis, she started to feel so much better. And nutritionally, she responded well, right? She was able to digest and absorb her food better, which is really important because when there's that imbalance going on, you're not digesting well, you're not absorbing well. She was getting weaker, right? So she was able to digest and absorb better,

and she was nutritionally getting stronger and healthier, and her gut was healing. And we could add back in those good, healthy, higher FODMAP foods that she was able to tolerate. I mean, it's quite amazing how many people really struggle with this and how hard it is for people to overcome this and how traditional doctors really aren't that great at addressing this. And that there really is a new way to do this, more comprehensive way using kind of the approach of functional medicine and getting people the kind of support they need to kind of rebuild their whole gut. Because it's not just about taking the antibiotics and that's it. It's really about a whole gut healing and repair approach that's with functional medicine and also the right kinds of testing and everything. So I think it's super important to

understand for people listening that this is not something you have to live with your whole life. This is not just who you are. That, you know, it's really, really important to actually dig in and figure it out and get to the bottom of it. You made such a great point there, Mark, about the comprehensive approach. And I think that's what we need more of in healthcare. And it's really important in this situation that people get all of that comprehensive care with having a nutritionist on board, somebody they can check in with regularly, you know, that's really following up with how they're doing and really digging in and finding that underlying root cause for them. It's so much more successful than that knee-jerk approach, you know. Completely, completely important.

Wow. Well, you know, I think for those listening, if you've experienced bloating and then, and if you know what I'm talking about or what we're talking about, then it's important for you to take this seriously because it's not just something that is annoying. It actually indicates that your overall microbiome is out of balance and your health of your microbiome determines your overall health and longevity. So it is annoying, but it's also more than that. And so really working with the right practitioner, getting the right kinds of testing and diagnostics is so important. So I'm really excited we got to cover this, Liz. I think if anybody's listening,

you know, we're at the Ultra Wellness Center. We see patients from all over the world. We do a lot of virtual visits, although we're doing more now in person. And, you know, we'd love to help you out. So give us a call. And if you love this podcast, please share with your friends and family on social media. We'd love to hear from you. We'd love comments about maybe how you overcome your SIBO.

And of course, subscribe wherever you get your podcasts. And I will see you next week on The Doctor's Pharmacy. Thank you, Mark. Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize

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