The Dr. Hyman Show - Is Your Bloating A Sign Of A More Serious Condition?

Episode Date: April 10, 2023

This episode is brought to you by Rupa Health, BiOptimizers, and InsideTracker. If you have felt the uncomfortable sensation of your stomach expanding after eating, you are not alone. Up to 30% of Americans experience bloating and distention regularly, which are common symptoms of an imbalance in the gut, and they may even be a sign of other health conditions. Functional Medicine places a high value on a healthy gut and uses a whole-body approach to get to the root cause of bloating. In today’s episode, I talk with Dr. Elizabeth Boham, Dr. Todd LePine, and Dr. George Papanicolaou about why so many people experience bloating and the importance of treating it. Dr. 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. Todd LePine graduated from Dartmouth Medical School and is board certified in Internal Medicine, specializing in Integrative Functional Medicine. He is an Institute for Functional Medicine Certified Practitioner. Prior to joining The UltraWellness Center, he worked as a physician at Canyon Ranch in Lenox, MA, for 10 years. Dr. LePine’s focus at The UltraWellness Center is to help his patients achieve optimal health and vitality by restoring the natural balance of both the mind and the body. Dr. George Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is board certified in Family Medicine from Abington Memorial Hospital. Upon graduation from his residency, he joined the Indian Health Service. In 2000, he founded Cornerstone Family Practice in Rowley, MA. He began training in Functional Medicine through the Institute for Functional Medicine. In 2015, he established Cornerstone Personal Health. Dr. Papanicolaou joined The UltraWellness Center in 2017. This episode is brought to you by Rupa Health, BiOptimizers, and InsideTracker.  Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests from over 35 labs like DUTCH, Vibrant America, Genova, and Great Plains. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com. BiOptimizers is offering my listeners 10% off Sleep Breakthrough. If you buy two or more you’ll get a free bottle of Magnesium Breakthrough. This is a limited-time offer. Go to sleepbreakthrough.com/hyman and use the code hyman10. InsideTracker is a personalized health and wellness platform like no other. Right now they’re offering my community 20% off at insidetracker.com/drhyman. Full-length episodes of these interviews can be found here: Dr. Elizabeth Boham Dr. Todd LePine Dr. George Papanicolaou

Coming up on this episode of The Doctor's Pharmacy. Bloating just means that your belly is getting bigger. There's so many reasons behind the causes of bloating. Hi everyone, it's Dr. Mark. As a functional medicine doctor looking at hormones, organic acids, nutrient levels, inflammatory factors, gut bacteria, and so many other internal variables, it helps me find the most effective path to health and healing for my patients. But such extensive testing can be very complicated and time-consuming for both the practitioner,

somebody like me, and our patients. But lab ordering became very quick and painless since I started using Rupa Health. I can order, track, and get results from over 35 different lab companies within a few clicks in one lab portal. And this means one invoice for all labs paid online up front. Plus, patients get practitioner pricing and receive full patient support through easier personalized collection instructions, automated follow, super bills, and answers to testing questions, and so much more. And best of all, it's free for practitioners. So sign up free today. You can find out more

information by going to rupahealth.com. That's R-U-P-A health.com. It's hard to overstate how important sleep is. Our bodies know this, and that's why we spend, on average, a third of our entire lives sleeping. Now, I've had my own share of issues with falling and staying asleep over the years, and as a result, I spent a lot of time optimizing my sleep, and one of the best tools I found is BiOptimizer's Sleep Breakthrough.

Now, most over-the-counter melatonin products can actually cause you to overdose on melatonin, which can be kind of dangerous. Sleep Breakthrough, on the other hand, is melatonin-free. Instead, it gives your body the precursors to melatonin and the molecules that help your body produce melatonin naturally. That way, the body doesn't downregulate melatonin production and you don't become dependent on sleep supplements and you don't experience any sleep hangovers. With Sleep Breakthrough, you'll fall asleep in minutes and wake up feeling refreshed and energized. Now, Bioptimizers is offering my listeners 10% off Sleep Breakthrough. And if you buy two or more, you'll get a free bottle of Magnesium Breakthrough. This is a limited time offer,

so go to sleepbreakthrough.com forward slash hymen and use the code hymen10. And now let's get back to this week's episode of The Doctor's Pharmacy. Hi, this is Lauren Feehan, one of the producers of The Doctor's Pharmacy podcast. Bloating is so common and can be incredibly uncomfortable. Often it can increase throughout the day and leave us feeling less than optimal by the time we go to bed. While bloating may be a sign of an imbalance in our gut bacteria and is often associated with irritable bowel syndrome, it can also be a symptom of a more serious condition. In today's episode, we feature three conversations from the doctor's pharmacy on the importance of treating bloating. Dr. Hyman speaks with Dr. Elizabeth Bohm on what bloating is and why it happens, with Dr. Todd Lapine on

how gut problems can lead to autoimmune conditions such as rosacea, and with Dr. George Papanikolaou on how bloating can be a symptom of gallbladder disease. Let's jump in. It's estimated that 20 to 30 percent of the population is dealing with bloating on a regular basis. People with irritable bowel syndrome, it's, you know, 96 percent. 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, it increases after you eat. So people will feel more bloated after they eat, or they may feel more abdominal fullness or sensation of gas as the day goes on. Um, and, and, uh, there's, you know, 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. And I think 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 in 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 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 this bacterial overgrowth. So, some conventional doctors now are treating people with antibiotics, right? 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. 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, you know, 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 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, you know, we understand the problem, but then we also understand how to navigate like medical detectives to the cause. And, you know, what I think is challenging with SIBO is it's just 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 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, this isn't just SIBO, but bloating because of, you know, 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.

So, 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 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 age... So no cheese after 100? Some people become lactose intolerant at age 2, 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 they were doing good. Well, you know, and what do we know about what, when we say lactose intolerant, it's hundred-year-old people eating a lot of goat cheese and sheep cheese and we're doing good. Well, you know, and 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 ofating. 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.

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 a lot of 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 that are now in all these healthy products that are highly fermentable, non-digestible sugar alcohols like erythritol,

xylitol, sorbitol, amylotol and they are in a lot of these foods and some people do fine with them say well 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 melatonol 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. You were doubled over 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 these 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, what bars are you eating? What even certain 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 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, you know, 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. We also do stool testing that is 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. One of the first things we always start with, of course, is dietary changes. So 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, you know, people have – maybe people have heard about FODMAPS and so it's important for us to just sort of delve into that a little bit. Yeah, what does that mean? What does that mean?

Yeah. What does that mean? What does that mean? Yeah. So, FODMAPs foods are fermentable 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 when there's the wrong bacteria in the wrong place, they consume those carbohydrates and produce gas. Hey, everyone. It's Dr. Mark here. If you've been following me for a while, you've heard me talk a lot about the benefits of regular blood testing for health optimization, which is why I'm

excited to share today's sponsor with you, InsideTracker. InsideTracker takes a personalized approach to health and longevity by using data from your blood, DNA, and fitness trackers to give you a science-based recommendation based on your own body about the things you can do to take control of your health. InsideTracker tests and provides optimal ranges for over 40 biomarkers like ApoB, magnesium, vitamin D, testosterone, cortisol, and ferritin. And if a specific biomarker level is unoptimized, InsideTracker provides practical recommendations backed by dozens of peer-reviewed studies and personalized for your body. For a limited time, you can get 20% off the entire InsideTracker store when you sign up at InsideTracker.com slash Dr. Hyman. So if you're

ready to get a crystal clear picture of what's going on inside your body, along with science backed recommendations to optimize what's not working, then visit InsideTracker.com slash Dr. Hyman. And now let's get back to this week's episode of The Doctor's Pharmacy. 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 FODMAPS 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 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 gluten, 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 antifungal medication. And then there are times- Because you always follow the antibiotic with 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, that there are many different herbs that we have, 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, um, bacteria and yeast overgrowth. And that's one of the nice things about herbal regimens I find, um, is that with, when you're resetting the bacteria in the gut and the yeast in the gut is, you know, they, they may be a little slower to act, but they sometimes are, um, are really effective long-term. So there's, there's a few herbal regimens that we use very often. And then some have been really well studied. Um, we also

do things that help the body with digesting their food, your, 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 the 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, 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 and any fungal 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. So tell us about, um, tell us about the cases. You had a 35 year old guy had quite a remarkable story. 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, 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, you know, what really helps many times is when people take that really detailed history, you know, what really helps many times is when people take that really detailed history, you know, and they think about their own timeline. When did this start? You know, how long has it been going on? You know, trying to help get the clues as to what triggered this

to occur for them, right? And, you know, so we knew that as a child, 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 at 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, you know, 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, um, we just decided, okay, let's pull away gluten and dairy. You know, he was, um, 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, 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. So, we used something that had a combination of different herbs, oregano, berberine. It was a combination product. And he took it for six weeks and he found that extremely helpful. We did add in probiotics. We did wait to add in probiotics. So we were done with his herbal regimen. Um, but once we did, we, we did add in like a general, uh, probiotic, um, and, and there's so much to discuss with probiotics, but he,

you know, he found that to be really helpful. And, um's back to, I mean, he really 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 somebody does have an overgrowth 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 feel, it feels worse, not better, then that's the wrong probiotic or the, or, or could be the right probiotic, but at the wrong time. So it's really important that, um, um, that you're either working with somebody who knows what to, how to recommend what order things to do it in, or, you know, your, um, or just knowing that if, if it doesn't feel right to you, put it

on hold. Um, 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, it's hard for me to say, well, take this one because 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 after you've gotten rid of

the dysbiotic bacteria. Some people 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, you know, 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. In functional medicine, we take a very different view, which is we treat things from the inside out, not the outside in, right? Dermatology is all about lotions, potions, and creams and

slathering stuff on your face to sort of get it good from the outside in. But it's kind of backwards. So what are the traditional treatments for rosacea? And why are they not the best idea? You know, when I went through my medical training, there was an old saying that the dermatologist basically, if it's dry, wet it. If it's wet, moisturize it. And if you don't know what's going on, give it a steroid.

That's essentially what- That's pretty much right. That's pretty much dermatology i learned the same lesson yeah right that's that's that's it and you know dermatology and if it's if it's wet dry it if it's dry wet it and if you don't know give it a steroid exactly that's that's that's the the mantra of the modern uh dermatologist um but again it's like you said it's it's an it's an external manifestation of something going on internally uh so the question is is what's driving this and uh in in preparing for this talk i mean i've seen so many patients with rosacea it's not funny what do they put on there

they give antibiotics on the face yeah they'll give like give like uh uh you know metronidazole cream which is a topical uh uh anti uh antibiotic it like an anti-parasite antibiotic. Yeah, one of the newer medications, and this is sort of an interesting thing, is a cream called ivermectin. So this sort of blew me away because this is relatively new. And I think we were talking about it earlier. Yeah, it's a worm pill. It's a parasite pill.

They're using it for COVID even. Really? Yeah. Yeah. Yeah. So it's really, so I was reading and I actually had a patient who came in and was on the ivermectin cream and was doing very, very well on the ivermectin cream. And then I said to myself, well, how is an anti-parasitic medication topically helping with rosacea? You got words in your face? Yeah. Well, that's also interesting because one of the things that is strongly tied in with rosacea. Now, remember, rosacea is just over the face.

It's this facial manifestation of an internal issue is that we have these little creepy crawlers on our face. And they're called mites, skin mites. Yeah. Dermadex. Kind of like dust mites. We. A dermadex. They're like dust mites, but they're on your- We all have them. Everybody has these. And the interesting thing is that patients who have rosacea

have a much, much higher density of skin mites on them for whatever reason. And normally they basically, they're like little, I call them like little parasites, they're ectoparasites, and they sit on the skin and they eat your dead tissues and they eat off of the oils on the glands. And normally you don't have a reaction to them. They're sort of like a benign parasite. But in some people who have high concentrations of these skin mites, the body makes a very, very high immune response to it. So getting back to the ivermectin,

which is basically an anti-parasitic, it may be actually working as an anti-parasitic for some of these skin mites. Yeah. So maybe there's an infectious cause to this. Yeah, so- The things they use are minocycline, which is an antibiotic,

flagyl or metronidazole, which is an anti-parasite and an antibiotic, ivermectin, which is an anti-worm pill. in an antibiotic ivermectin which is an anti-worm pill oral oral doxycycline is another one yeah oral antibiotics which probably is a really bad idea given yeah the fact that you have a microbiome you don't want to be killing it to fix your skin exactly exactly yeah and why that why might that minocycline work why might antibiotics orally work well it there's a there's a thought and there's actually it's actually in the literature, is that small intestinal bacterial overgrowth is also one of the triggers for rosacea. A lot of patients that you see with rosacea will have irritable bowel-type symptoms or bloating-type symptoms.

And when you do some testing for that and you treat it, that oftentimes will clear up their rosacea. Yeah. Yeah. Absolutely. So I think, you know, we're not averse to using topicals and topical medication when necessary. But if you really focus on root causes, which is what functional medicine does, you come up with a very different set of approaches that actually works better, is longer lasting,

and doesn't require to keep putting on lotions, potions, and creams for the rest of your life or taking oral antibiotics. Right. exactly. And then getting back to the ivermectin, ivermectin, in preparing for this talk, I did a little bit of research, and the patients who are more prone towards rosacea have a problem with too much of what's called the cathelicide and antimicrobial peptides. That's a big mouthful. Yeah, they're called CAMP, C-A-M-P, cathelicide and antimicrobial peptides. So these are these- That's a big mouthful. Yeah, they're called CAMP, C-A-M-P, cathelicide and antimicrobial peptides.

And these peptides are part of the built-in innate part of the immune system to protect our skin against various types of infections. And it turns out that ivermectin actually helps with these antimicrobial peptides because people who have rosacea have too much of these peptides. They have like an over robust response to antimicrobials. So it's thought that the, it's actually a breakdown product, it's called LL37. And ivermectin actually works on dampening down these antimicrobial peptides to decrease inflammation in the skin. Okay, so in terms of the cause, it seems to be a combination of internal and external factors, right? Yeah.

Something's on the skin and then something's internally. But from traditional medicine, there really isn't an approach to helping heal the skin from the inside out. No, not at all. And whether you have acne or eczema or psoriasis or rosacea or any one of the myriad skin conditions that we get, most of them have their root cause inside, not on the topical level. Exactly. And often it's the gut. Yeah, absolutely.

Yeah. So you mentioned a little bit earlier leaky gut. So take us through from a functional medicine perspective, our thinking about the root causes. What are the things that you think about when someone comes in your office and their face is all red and they got all this acne on there and they've got like telangiectasia, these little red lines everywhere and you can see the blood vessels dilated and they're kind of looking like Santa Claus. Yeah, yeah, exactly.

Yeah. And they also get photosensitivity too, which is the other thing. And the interesting thing- They can't go in the sun without getting it worse. And that also ties in with these antimicrobial peptides because it's thought, it's theorized that the Celts, the ones who live in the higher northern latitudes, they don't get as much sun as we do. So it's thought that from an evolutionary standpoint that they benefit by having this. They have a more robust immune system when there's not enough sunshine.

And sunshine will actually activate this innate immune system. And that's why sun exposure oftentimes makes it worse because they produce more of these antimicrobial peptides. And then those antimicrobial peptides have to get processed. And in the process of breaking them apart, the immune system then starts responding to it. So that's why there's a sort of a photosensitivity aspect to it. And what are the other sort of things you think about when someone comes to your office with rosacea? Well, one of the things I oftentimes look at is their vitamin D levels. Vitamin D is part of the immune system

and it's tied in intimately with the antimicrobial peptides system in the body. So oftentimes patients who have this have low vitamin D levels. We'll look at the microbiome testing to see if there's any evidence of dysbiosis, bacterial overgrowth testing, the SIBO testing, checking for hydrogen and methane.

I mean, probably the majority of patients who have ICF rosacea have problems with bacterial overgrowth. Other thing is low stomach acid, which also promotes and contributes to bacterial overgrowth. So checking for the patients. Sometimes these patients are also on PPIs. Acid blocking medications. Acid blocking medications. Absolutely. Yep. because we have acid in our stomach to help us to digest food it's also there to to decrease uh the amount of bacteria higher up in the colon so uh it's good it's good to have stomach acid yeah because if you don't have stomach acid then the ph of your small intestine changes becomes more alkaline and then bugs grow

in there that wouldn't necessarily grow yeah and that's when you get this overgrowth of bad bugs in there. And it can be what we call SIBO, which is small intestinal bacterial overgrowth, where bad bugs migrate up from the lower intestine into the small intestine. And then when you eat food, you get bloating, distension. It causes leaky gut. You end up causing damage to the lining of the gut and food particles and bacterial toxins leak in and create inflammation throughout the body and on the skin. So, you know, leaky gut can cause hundreds

of different manifestations, one of which is rosacea. And unless you think about that and learn how to treat it, you may not be able to be successful with it. There's also another condition that I've seen, Todd, in a lot of my patients called SIFO. SIFO. Small intestinal fungal. Small intestinal fungal overgrowth.

Yeah. And a lot of people talk about it as candida, but there's many, many species of yeast and fungus. And so what I found often is that treating the gut through addressing the bacterial overgrowth, the yeast overgrowth, healing the leaky gut, dealing with the food sensitivities makes a profound impact. And a lot of times it is food sensitivities that can trigger. I mean, for example, gluten, we've talked about on the show, that is one of the biggest

drivers of leaky gut. And even if you are not celiac, and even if you don't think you have any symptoms or don't notice any symptoms when you eat gluten, Dr. Alessio Fasano, who's the world's expert at Harvard on gluten gluten he said everybody who eats gluten creates some level of leaky gut and most people kind of handle it right transient leaky gut exactly so i don't know like it's probably not a good idea to eat that much gluten because of the potential to create leaky gut and how that is linked to so many chronic diseases including weight gain diabetes cancer heart disease alzheimer's autoimmune diseases allergies act i mean you just name it depression all this stuff is connected by

by leaky gut so i really i think you know getting a very different thinking about this is key and you did you talked about the stomach acid you talked about the acid blockers you talked about maybe other things that that relevant in the gut. Certain infections like H. pylori, which is a common bacteria that causes ulcers, also has been linked to H. pylori. And food sensitivities. So how do we approach these patients when they come in? What are the kinds of things that we would do from a diagnostic point of view that you wouldn't get when you went to the dermatologist? Well, from a diagnostic standpoint, again, I would do testing for leaky gut.

I would do intestinal permeability testing, checking for antibodies to zonulin with the Cyrex testing that we do, Cyrex Array No. 3. So that's basically, there's a test that we do at the Ultra Wellness Center here in Lenox, Massachusetts, where we're recording live, is Cyrex testing. It's a lab that looks at antibodies that you produce against these proteins that are in your gut that come from gluten or even from bacteria. And so if you're creating a lot of antibodies to these proteins,

it's clear that they're getting across the lining of your gut, leaking into your bloodstream and causing an immune response, which is not only local, but systemic. bloodstream and causing an immune response, which is not only local, but systemic. Right. And there are other ways.

You can actually measure zonulin in the blood and you can measure it also in the stool. And that's only like a snapshot in time. So you can develop leaky gut for a couple hours or a day or so. But if it stops, then you're all fine. The antibodies against zonulin is the one that tells you that there's this chronic leaky gut, which is really more valuable. Because if I gave you a shot of tequila, then an hour later measure your zonulin,

it's gonna go up. Okay, where's the tequila? That sounds good. Right, so that's why I think that the testing for the antibodies against zonulin is even more valuable in these patients with chronic conditions. And then what other kinds of tests besides the zonulin is even more valuable in these patients with chronic conditions. And what other kinds of tests besides the zonulin and the lipopolysaccharide tests that we do to look at the antibodies against these proteins in the gut that come from a leaky gut?

We'll do the small intestinal bacterial overgrowth where we'll measure the production of fermentation products. So hydrogen and methane are gases that are normally produced in the body. When people have small intestinal bacterial overgrowth, those will be produced at higher levels. So we can check that. And over time, or I think the test that we do is a three-hour test. So you measure baseline hydrogen methane, check it at intervals of about every half hour,

and you do that over a three-hour time period. And that can tell you definitively, do you or do you not have bacterial overgrowth and how bad is it? And is it predominantly hydrogen or is it methane? So essentially what you're saying is that is that when we eat foods you know humans don't produce gas it's the bacteria that are fermenting the foods we eat that produce the gas so if you go bloated or distended or you're passing gas it's not you you can blame it on the bugs but but the problem is that we don't know how to regulate the bucks bugs and get a healthier ecosystem.

And that is what most physicians never were trained to do. And it's the foundation of functional medicine. It's the foundation of our practice here at Delta Wano Center, where we really dig into these issues. And we look at bacterial overgrowth. We look at fungal overgrowth. We look at a leaky gut. We look at food sensitivities. We'll do other testing. We'll look at whether you're reacting to gluten or dairy or eggs or other foods. And it's really helpful in drilling down on what's really going on with people. Absolutely. Yeah. And that, you know, we're talking basically producing gases. That's basically a fermentation process. And normally fermentation happens lower in the colon. That's in the colonic area. It was more of

an anaerobic environment or a lack of oxygen. And that's normal for that to be happening. But when that process is taking place higher up in a different neighborhood, it's not a good thing. Yeah. And I mean, you want your upper intestine to be sterile. Or mostly sterile. Mostly sterile.

And when all that bacteria migrates up there, it's just a bad situation. And when we take acid blockers, when we, you know, are low in magnesium, which half of us are, when we're under stress and our gut motility is slow, when we, you know, have taken lots of antibiotics and it screws up our whole system in there. You know, all these are reasons why we get these bacterial overgrowth issues and they're super common and they're easy, relatively easy to treat with functional medicine. Now, the other thing we do is look at stool testing, right? So we look at not just the proteins from leaky gut, or we look at the food sensitivities or baculobar growth, gas production, but we actually look at

the poop. So what are we looking for in the poop that helps us figure out what's going on? Well, there's a lot of things, you know, there's gold in there. It really is. Gold in them, their hills. Yeah. So a lot of information can be determined by doing a microbial analysis. So you can look at the overall balance of bacteria. So there are, you know, everybody's got hundreds of different kinds of bacteria in the GI tract. And we can measure those using DNA PCR analysis, and we can do quantitative, we can measure how many there are

of each different species, look at ones that are normally found, look at ones that are found in the gut, but normally they wanna be at low levels, look at bacteria that are associated with autoimmunity, so things like citrobacter, Klebsiella, Salmonella, et cetera. we can look at now analyze uh for uh yeast overgrowth various forms of yeast um and then also microbial markers

of inflammation things like calprotectin looking for fat so you can get a lot of function exact enzyme function uh butyrate checking for butyrate chain fat short chain fatty acids indicators of healthy ecosystem so you know what you're what you're saying is that, you know, traditional sort of microbiome testing, they just look at the genetic material of the microbiome, and they can't really test everything, although they can do some really extraordinary tests now. But there are kits out there where you can look at your microbiome, but it's far more than just what bugs you have in there it's what they're doing so we look at the the result the function on the ecosystem we look like you said at the enzyme function you're absorbing your food is there

inflammation are you having good bugs in there that are producing the the super fuel for the gut these short chain fatty acids that are so important oh huge you have the right balance i've got are you missing some key bugs? You have overgrowth of bad bugs. You have yeast, you have parasites. And it's such a much more comprehensive stool test that we do here at Delta Wellness Center. We were talking earlier about Delta sleep. And the interesting thing is, is that when you have good bugs in the, in the digestive tract and the, and you're eating in a fiber in your diet and you're producing higher levels

of butyrate, that has an effect on the brain and also improves uh sleep that's amazing yeah yeah so you have to have your get your poop together to sleep better i got it okay that's that's a good good strategy it's better than taking the ambien yeah um all right so we also look at uh you know other things like omega-3 fats and and other fats because a lot of uh inflammation come from not having the right balance of fats in your body. Absolutely, yep, yeah. And I think, you know, so when you have a patient come in, what are the steps you would take initially

to treat a patient with rosacea from a functional medicine perspective? You know, again, taking the history is the big one. You know, I always will ask people, what's your ethnic background? A lot of people say, you know, I'm white. No, it's like, you know, are you Irish, English, German, Jewish, Russian, whatever? Because the rosacea is typically found in light skin, fair skin people.

And from a genetic standpoint, they are the ones who are more likely to have that. It's just an interesting part to have in terms of the history. And then I'll just ask them, you you know what is it you're eating are you eating a standard american diet uh how much alcohol are you drinking um how much stress do you have stress also caffeine yeah caffeine can play a role spicy foods yeah those are those are all things which can sort of you know it's like adding gasoline to the fire uh because literally rosacea is the skin on fire in the in the in the in the uh in the facial area but um doing the testing for essential fatty acids making sure that um uh they have the right balance of the essential fats in

their diet a lot of people are have too much omega-6 which tends to be more pro-inflammatory lack of the omega-3s one of the oils i don't know if you've used it that i i've found it very helpful with um patients who have rosacea is borage oil and even criminal's oil. They tend to be very, they help to dampen down that inflammatory response. And that's a very key omega-6 that people don't think about much, but it's called gamma-linolenic acid,

which is a very powerful anti-inflammatory. It's not like the omega-3s, but it's sort of like the omega-3s, but on the omega-6 side. Exactly. And it's something we really have a hard time getting in our diet. It's from like borage oil and a few other things, but evening primrose oil.

So yeah, that's very powerful, I agree. And I also think that when I see these patients, I also think about looking for other clues, like do they have yeast issues? Have they been in lots of antibiotics? Are they on acid blockers, which cause yeast overgrowth? Do they have other fungal issues? They have dandruff.

Do they have anal itching? Do they have thrush or white coating in their tongue? Do they have vaginal yeast infections? Do they have other skin markers of yeast, like little tinea or other kinds of things? So you'll see often a pattern of other issues around fungal stuff. I'll check for H. pylori. I'll check, again, all the tests we did talk about and see what's really going on. And then, you know, from the treatment point of view, you know, you start with an elimination

diet, with an anti-inflammatory diet, right? Exactly, yeah. Putting patients on an anti-inflammatory elimination diet, you know, 80% of the time, doesn't matter what they come in with. They're going to actually, they'll actually get better. They, you know, getting them off of the pro-inflammatory foods and then putting in foods which are anti-inflammatory, cold water fish, sardines, wild salmon, the essential oils like evening primrose oil help to sort of dampen down that inflammatory response. Yeah, I agree.

I think, you know, we don't most of us, how powerful food is as medicine and how it can drive tremendous amounts of inflammation throughout the body. And obviously, if it's on your skin, it's visible. But there's also invisible inflammation that you're not seeing that's driving all the chronic diseases. And you actually just triggered a thought because there's actually a paper that says if you have rosacea, you have a higher incidence of alzheimer's disease oh wow so it's not just it's not just a you know a cosmetic issue it's actually systemic of a red face and a red brain

that's on fire exactly yeah isn't that yeah that's i i'm sort of blown away by that that's fascinating yeah especially in women it's actually more more common in women so so you you know you advise people the obvious things cut out the alcohol the, stay away from the sun, stay away from spicy foods. We also tell them stay away from gluten, which triggers leaky gut, often dairy. You actually add in all the anti-inflammatory foods that are important, all the phytochemicals from plant foods and turmeric and ginger and garlic and rosemary and all these powerful foods that can really help to reduce inflammation. And then we often directly treat the issues that are going on. It could be leaky gut. So we give them a gut repair program.

This could be fungal or bacterial overgrowth. So we'll take care of those with either herbs or antibiotics or any fungals. And you'll see these patients really dramatically improve when they change their diet and they resort their gut. And then sometimes we'll use things like even primrose oil. I found that digestive enzymes and hydrochloric acid often are really helpful too. Yeah, I've been surprised at how many people have a,

what I would call a relative lack of hydrochloric acid in the stomach. I venture to say that the majority of people don't have too much acid. They have not enough acid in the stomach. Yeah, well well that's interesting because the third leading uh category of drugs are the acid blockers like prilosec and prevacid and pepsi and all these other drugs these uh yeah nexium massive facts i mean they're just like out there everywhere and now they're now they're over the counter and anybody exactly yeah i mean i i just i we've talked about this before on the podcast but when i was in medical school, the drug reps came in because it's drugs that just come out

and they're like, listen guys, these guys, these drugs work, they're great. They will help people with ulcers if they're really bad. You don't want to keep anybody on it for more than six weeks. Right, those are huge. It's gonna suppress your stomach acid, it's really bad long-term.

These are the drug reps telling us this. And now it's like, people are on it for decades and it causes B12 deficiency, magnesium deficiency, zinc deficiency. Osteoporosis. Osteoporosis, pneumonia, bacterial overgrowth, irritable bowel syndrome. When you get rid of your heartburn,

but you get all these other problems. Yeah, that's it. And then it's one of those drugs, it's so sneaky because it's addictive. Once you get on it, it's hard to get off it because it causes this rebound. So when you suppress the stomach acid and you stop the drug, the acid production goes crazy, which makes you feel horrible.

And then you go, I need the drug. But you can actually taper it down and use other strategies to help people get off it. And you bring up a really good point because a lot of the pharmaceutical medications, especially some of the psychotropic, so the antidepressants are like that too. The PPIs and the antidepressants, when you try to get off of them, you get this rebound process. So the body tries to get back into balance and it can be very difficult. So you've got to go low and slow when you're trying to taper off the PPIs or taper off antidepressant psychotropic meds. This woman came and, you know, her, her concerns were that, you know, she was really, you know,

feeling fatigued. She had sudden weight gain. You know, she had gone to her PCP, you know, she was told that her thyroid looks fine. The numbers are okay. Not to worry. You know, you still got kids, you know, the same old, you're getting older. You have kids. You're running around.

You're busy. And so she was just living with this fatigue and this weight gain. And then she started having gut issues. She started having bloating and distension. And so she just couldn't take it anymore. And she came to visit us um she had i think one episode of pain that sounded like it was gallbladder disease um and um she it had lasted for an evening it was after having a really fatty meal um and she hadn't gone to the doctor. She sort of suffered through the night.

And so she never really dealt with it. So after our first visit, I told her, I really want you to go get an ultrasound in your gallbladder. I said, you have a lot of things going on. But one of the things I need to really find out is if you do have gallbladder disease. And so it turned out that she did. She has some stones and she probably did have an episode of a stone that passed and caused her some pain. So the complete workup for her involved looking at her hormones, looking at her thyroid and looking at her microbiome and food sensitivities. And so when I got her thyroid numbers back, her TSH was 3.9. Okay. So now, you know, doctors, you know, will look at that and say that's within the normal

range because traditionally they've been taught that anything from, you know, 0.45 to 4.5 can be considered normal. But we've learned more and more that that's not the case. When you see a 3.9, you see a 4.2, you start to think, I don't think that that thyroid really is an optimal function. Well, I also, when I check the thyroid, I also checked for antibodies. And wouldn't you know, her antibodies against her thyroid were sky high. She had Hashimoto's thyroiditis. On her food sensitivity panel, she had gluten sensitivity.

She did not have celiac disease, but she had gluten sensitivity, Hashimoto's, hypothyroidism, which then set her up for a couple of different things. But certainly it slowed her gallbladder down and set her up for having a stone, you know, by the mechanisms that I've already explained. And so, and she was estrogen dominant, meaning that relative to progesterone, she had more estrogen than she needed. And she had a history of, you know, a cycle that had been irregular, a cycle that she had a lot of breast tenderness. She had a lot of water retention around her period.

She had PMS around her period. And that's just, that's just, you know, that just, you know, screams estrogen dominance. she's had that most of her life. So what did I do? Step by step. We just started to deal with the underlying issues. I started to treat her thyroid, treat her Hashimoto's thyroiditis. I treated her. She had SIBO, by the way.

So the first thing we did, we stopped the gluten. So she was off of gluten. And that's going to, you know, you definitely want to do that because if you have sensitivity to it and you get one autoimmune disease like Hashimoto's, then you're going to set yourself up for more because it's more likely that you'll get another one once you have one. So gluten stopped. And then we addressed her SIBO. SIBO is small intestinal bacterial overgrowth. We put her on a low FODMAP diet, which helped address that. I used some antimicrobials that were botanicals that addressed that.

How did she do? She did great, obviously. It took a while to get her hormones under control and balance those out. It took a little while to get her SIBO under control. But once we had the SIBO under control, we got her thyroid function down from, what would I say, it was 3.9. 3.9, yeah. Got it down to 1.2. Her energy was back. She felt great. And then as we worked with her diet and we cleaned up her SIBO, she was back to normal in a very short course of time, within three months.

That's amazing. So we really can't affect people's course. And she really didn't need surgery then. She did not need surgery. Amazing. And as I said before, and i explained this to her i said that the stones are just enigmatic of the bigger problem you know they're they're they're the canary in the coal mine of of your nutrition not being where it needs to be and you may be having

excess excess toxins in your system and the estrogen dominance estrogen you know needs to be metabolized and it is in the liver and it ends up in the gallbladder but if it's in two higher concentrations it can have a very negative impact on gallbladder function so her dominance her SIBO her thyroid she was just it was just she's you know it was a matter of time before she had a stroke. And, you know, if she had had that stone and gone to the emergency room and hadn't passed it, she would have had her gallbladder taken out and nobody would have ever addressed these other issues. Of course. So, you know, gallbladder is such a common problem. It's like one of the most common surgeries.

It's such a common problem in America. Tell us about gallbladder disease and what is it, who gets it, how many people have it, and what are the symptoms and why is it such a big deal? And what do we know about who's getting it and all that? So kind of take us down the whole rabbit hole of gallstones. And then we're going to get into how conventional medicine treats it and what functional medicine approach might be that might be worth trying. Yeah, sure. So, you know, it's almost, you know, so common that it's invisible. And what I mean by that is that people don't really think about it. They don't think about their gallbladder.

Why would they think about their gallbladder until it hurts? So gallbladder disease affects 6% to 9% of adult age people between 20 and 70. And of all of those people, they've either had gallbladder disease or have their gallbladder taken out. So it's a pretty large problem. It's a huge healthcare expenditure. It's very, you know, it's fairly expensive surgery. So it has a big drain on our system. You know, when, you know, gallbladder disease, people really don't know that there's anything going on with the gallbladder until they have the symptoms, which is going to be what we call biliary colic. And that's when you've eaten a meal and then within half an hour to an hour, you begin to feel really bad pain in your right upper quadrant. And then where's that? That's going to be below your ribs to the right. And it's going to be really, really painful.

And you're not going to like it at all. You're thinking you're having a baby and it's going to be really, really painful. And you're not going to like it at all. You're thinking you're having a baby and it's not coming out. It's really painful. And then you're going to end up in the emergency room and then you're going to be given some medications that will hopefully relieve your pain. And then if it is a gallstone, then hopefully it will pass on its own.

And hopefully there will be no complication. And then you'll leave the emergency room. You'll see your primary care. Your primary care will confirm that you're feeling better and then tell you to use that and send you on your way. Right? And then we're missing so much. I mean, we've just lost, like, okay, it's not just that you had a stone that didn't pass

and you had pain. Get to the root cause. What is the root cause? Yeah, why did the stone end up there in the first place, right? And so where does it come down to? It comes down to what we always start almost every conversation you and I have. It starts with diet. It starts with the foods that you eat. Yes, there's genetic predisposition. Yes, you can be a female, you can be overweight, you can be pregnant, you can be 40. You can be a diabetic. You can,

you know, have other chronic underlying diseases that predispose you to gallbladder disease, particularly gallstones. But when it comes down to it, it's a lot of it's going to have to do with your diet. Are you eating a high fiber diet? Are you eating a nutritious diet where you're getting all of the nutrients that actually keep your gallbladder healthy? Are you drinking enough water in your day? Because the bile that's in the gallbladder is 95% water. And then it's made up of bile acids, bilirubin, fats, amino acids, proteins, enzymes, hormones like estrogen, toxins. Your bile plays a very important role in the detoxification process in your body. And so if you're not getting if you're not getting what you need to make good bile, then you're going to put your gallbladder, you know, in, you know, under, under pressure.

And so if you're not drinking enough water, here's what happens. Where's the gallbladder? Where's the gallbladder in the first place? It sits right under the liver on the right side. Your liver makes bile. And then that bile goes into bile goes into the gallbladder where it's stored. And then when you're eating, when fat that you've eaten enters your small intestine, it triggers something called cholecystokinin, which then sends a message or is the messenger to the gallbladder to release the bile. The bile is released, and it will then start breaking down your fat so that you can get all the nutrients that you need out of your fat. And so that's what happens. That's what the gallbladder does.

And you need healthy bile to then do its job to breaking down the fats. And so where does the problem become? These stones are actually the compounds that are in the bile in the gallbladder that begin to precipitate out. So they start to connect to each other and form crystals. And then these crystals can get really big. So when those crystals get big enough and they become stones or they become hundreds of thousands of little crystals that sit in your gallbladder and on an ultrasound that will be done will just look like sludge. It will look like sand at the bottom of the hourglass

sitting in your gallbladder. And so that's how you get the gallstone. Interestingly, this is very interesting. What's the other thing we talk about all the time? The immune system. The immune system. So when you start creating these crystals, because you're not supporting a healthy gallbladder, or you have a disease process that slows the gallbladder so it doesn't empty, it gets filled up with bile, the bile can't get out, and that's going to trigger again the precipitation out of these compounds that are in your bile and they'll form the crystals.

But here's the interesting thing. There's been research that shows that you have an immune response to these crystals. Your immune system actually sees them as foreigners and sends xenophils, which are white blood cells, to attack the crystals. down in the acidic environment. And when they become damaged, they begin to form this matrix around the crystal that exponentially increases the precipitation and the formation of the crystals. And then you can get these huge stones that won't pass or get stuck in the duct that leads from the gallbladder into the intestine. Pretty fascinating. Amazing. That's how we get there.

You know, a lot of, from a functional medicine perspective, you know, we see a lot of this in diabetics. A lot of it has to do with insulin resistance and poor metabolic health, which affects, you know, 88% of Americans. So that's why gallbladder disease is such a big deal. And the problems that people suffer from are miserable, you know, pain, vomiting, nausea, you know, just severe issues, and they can't digest their food. And often the traditional treatment is just surgery. But from a functional medicine perspective, what do we think about? How do we begin addressing this? What are the ways that we support these patients? And how do we sort of get them

better? And sometimes they do need surgery, but talk about the approach we would take in terms of what diagnostics we would use and how we would help people. Yeah, sure. So, you know, just for sake of contrast, I would say that, you know, just doing my research in this podcast, it was really fascinating that the gallbladder and bile play a really important role in the body. And to just look, I think this is one of the classic examples or the differences between functional medicine and conventional medicine. Because in conventional medicine, it's the stone, it's the pain, it's the complications of the stone.

And so if you continue to have stones, we'll take your gallbladder out. If you have a complication to the stone, you have an infection, then we'll take your gallbladder out. And that's it. That's it. There's absolutely no thought as to the role, what got you there, and what the role of bile is in the rest of the process, because it just doesn't break down fat.

Because of the contents of bile which spills into your intestine it can have a huge impact on your gut microbiome so I just wanted to size that you know that's why I said earlier it's sort of like it's so common it's invisible and and then because you know we just take it, there's even more reason to not think about it. Talk about that connection between the microbiome and the gallbladder. Well, yeah, that's okay. So I can enter that it from this perspective, that when the bile, you know, if it's too acidic, if you have too many toxins in it, and it enters into the, and your nutrition's poor. So you don't have, you know, you don't have enough amino acids in it. You don't have enough proteins or enzymes that actually can be an aid

to the bacteria in the gut microbiome to do their job. Then it will start to alter the environment of the gut microbiome. And then you'll end up with what we call dysbiosis. You'll, you know, the bile will cause damage to the gut microbiome. When that happens, then the organisms that are really healthy start to decline. They become destroyed. Then you start to develop some organisms like candida that will alter the gut microbiome even more. And some of those commensals that live there, they've been hanging on, you know, in the poop party where it's nice for bacteria to grow. They will start to grow.

Now all these bad bacteria take over, you get inflammation, you have a breakdown of the mucosal lining that plays a very important role of protecting your immune system and allowing for the bacteria, the healthy bacteria in your gut microbiome to communicate to the immune system in a very precise way because that happens and it's very important. And when that communication system breaks down because the gut mucosa has been damaged then the immune system begins to be overwhelmed and starts to have inappropriate responses leading to autoimmunity and leading to inflammation throughout the body and so that then triggers you know this inflammation then it affects the gallbladder. The gallbladder then, you know, will be affected.

And I'll give you an example. If, let's say, you have a gluten sensitivity and you don't know it. And you eat gluten. Gluten is a real strong potentiator for creating autoimmunity against your thyroid. And it can create Hashimoto's thyroiditis. And there have been studies that show a very strong connection between Hashimoto's and gallbladder disease. Oh, interesting. Right. And so, okay. So what happens? Well, gluten has antigens on it very similar to the thyroid.

So when the immune system makes antibodies against the gluten, it can confuse, and those antibodies can attack the thyroid. Okay, what happens? Well, now that's called Hashimoto's. And Hashimoto's, in its endgame, stops your thyroid from working. Your thyroid loses function. We call it hypothyroidism. Hypothyroidism slows down the gallbladder's ability to move the bile out. And that becomes the first step in your stones developing.

Because if you can't get the bile out and sluggish gallbladder then the bile builds up and now you set up that environment for all those compounds to precipitate out the threshold for that precipitation to occur lowers as you have more and more bile sitting there under pressure so so that's you know you can see there's a cycle there. That's why I said, you can't just ignore the fact that somebody got a stone. You've got to look for root causes. You've got to look for other disease processes that may have predisposed them to form that stone. The stone's just the beginning of the process. I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below.

Until next time, thanks for tuning in. 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 wanna 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 and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays, nothing else, I promise. And all you do is go to drhyman.com forward slash pics to sign up. That's drhyman.com forward slash pics, P-I-C-K-S, and sign up for the newsletter, and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger, longer. Just a reminder that this podcast is for educational purposes only.

This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes,

especially when it comes to your health.