In this episode of Thyroid Strong Podcast, Dr. Patrick Hanaway MD discusses the crucial role of gut health in managing Hashimoto's disease. Emphasizing a food-first approach, Dr. Hanaway explains how what you eat  and prebiotics, rather than probiotics, can help balance the gut microbiome and improve your overall health. He highlights the connection between gut permeability, inflammation, and autoimmune diseases, and delves into the impact of diet on gut diversity. The episode also covers the potential effects of medication on the gut microbiome, the importance of prebiotics, and the role of postbiotics in maintaining gut health. Dr. Hanaway shares insights on the gut-brain axis, fecal transplants, the significance of vagal tone, and practical steps for improving gut health, including the five Rs: Remove, Replace, Reinoculate, Repair, and Rebalance.

Highlight: 

00:00 Introduction to microbiome that can play a role in Hashimoto's

00:31 Understanding Hashimoto's and Gut Health

01:44 The Role of the Gut Microbiome in Autoimmune Diseases

06:52 Medications and Their Impact on Your Gut Health with Hashimoto’s

11:13 How what you eat can shift your gut

16:35 Probiotics, Prebiotics, and Postbiotics Explained

22:19 Fecal Transplants and Postbiotics

31:01 How the Gut-Brain Axis works and Mental Health

38:06 Practical Steps for Improving Gut Health

44:22 How to find certified practitioners

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If you are looking for the only doctor-designed work out program for Hashimoto's: https://www.dremilykiberd.com/thyroid-strong/

Dr.

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Patrick Hanaway, welcome

to Thyroid Strong Podcast.

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I am so excited to have you here.

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I watched so many of your lectures

inside of Institute for Functional

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Medicine, and they were so approachable

and digestible and so informative, so

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I wanted to bring you on to share with

the listeners your wealth of knowledge.

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Thank you so much.

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It's a great pleasure to be able

to reach out to Thyroid Strong and

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your great following that you have.

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the listeners of this podcast have

Hashimotos and oftentimes if they

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have only been maybe just diagnosed

and then given medication, and then

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sometimes they're just sent on their

way, they don't know that our gut health.

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And the health and diversity of

our microbiome inside our gut

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can play a role in Hashimotos.

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Can you connect those two pieces?

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Because some women are like, oh,

I just thought it was my thyroid.

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Why are we talking about my gut?

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Right.

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Well, I might even bring it up a

level from there cuz it's not just the

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microbiome, but it is, the gut has such

an essential role in what's going on

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and I'm sure you're familiar with, Dr.

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Alessio Fasano's work on looking

at intestinal permeability.

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And what we find is that is, so 12 and

a half percent of the population has.

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Hashimotos, something in that nature

or something in, in that range, or at

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least has the, predisposing factors for

it and maybe have, autoantibodies but

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not yet have changes that are going on.

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Of course, there's the whole question

about testing and diagnosis, but

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we're not gonna go into that in

depth cuz you've talked about

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that a number of times previously.

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Yeah.

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So the first thing is, okay,

so this person has some

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kind of autoimmune diseases.

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Autoimmune disease, there

are over a hundred different

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types of autoimmune disease.

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Hashimotos is actually the

most common of all of them.

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that's there.

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And while many p people, including

endocrinologists, think that it's

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just connected to the, thyroid itself,

it's actually a representation of

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an imbalance in the immune system

that has systemic ramifications.

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certainly thyroid imbalances have

systemic ramifications, but we

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also find that people who have an

autoimmune disease, The, number one

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risk factor of an autoimmune disease

is having another autoimmune disease.

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So you're actually at increased risk

for celiac disease and lupus and

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rheumatoid arthritis and Crohn's disease

and many, many other kinds of things.

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So that's important, but that

also tells us, Hmm, there's

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something else going on here.

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And so when we start to look

at, what are common factors?

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One of the things that Dr.

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Fasano has highlighted through his,

discovery of the zul and protein and

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working with intestinal permeability,

is that most autoimmune diseases,

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and we won't say every single one cuz

there are a few exceptions, but most

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autoimmune diseases will have some

degree of permeability in the gut lining.

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And that permeability where

there, where the molecules that

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are in the gut, whether it's.

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Foods, undigested foods, partially

digested foods, bacteria, viruses,

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parasites, toxins, many different kinds of

things that come into our gastrointestinal

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tract are moving through that those open

gates and stimulating the immune system.

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And the immune system is reacting.

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So we know, like with Hashimoto's

thyroiditis, that there's a relationship

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with gluten, and not everybody who

has Hashimotos has issues with gluten,

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but certainly there are a number of

people who will have autoantibodies

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to gluten and have difficulty,

and that will have an impact.

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and whether it's due to some molecular

mimicry at the thyroid peroxidase enzyme,

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the t the quote unquote TPO o antibodies,

we're not entirely clear on that.

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We've, see that there is a relationship

that goes on, so we know that.

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So there's permeability.

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One of the things that has an effect

on permeability is the balance of, is

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there some inflammation or is there

irritation, or is there dysbiosis

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in the gut microbiome itself?

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so is there dysbiosis or

imbalance that term we use?

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Dysbiosis just means imbalance,

and so think about it as there's

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a community in each of us.

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We have between 150 and 200

different bacterial org families

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of organisms, species of organisms.

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Overall, there's trillions and

trillions of organisms that are there,

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but they form a community and in that

community they work and act together

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to be able to perform the functions.

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So I'm just gonna go brief side note here.

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Yeah.

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Functions as in functional medicine

and we talk about functions, what we're

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talking about, there are the functions

of do I assimilate and get what I need?

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Do I have a mechanism to get

rid of that which I don't need?

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Do I have a mechanism for energy

production, for communication,

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transportation, infrastructure

and defense and repair?

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Those are the functions.

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Those all have to happen even

within the gut, within this

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community that is living there.

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One of my teachers at Washington

University when I was there became the

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head of the Human Microbiome Project,

and he has said that the human gut is

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the most complex ecosystem that has

ever been discovered, and there are 8

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billion of them on this planet, right?

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We're all different in that way.

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So you think, wow, that's really,

there's a lot going on there.

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And the microbiome.

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If, the functions aren't being performed

properly, it will lead to permeability,

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it will lead to inflammation, it will

lead to maldigestion, it will lead

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to immune dysregulation, also will

lead to changes in the, products, the

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chemicals that are produced will change

the way we feel, Anxiety, depression.

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So there's a lot going on there.

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And it has an impact directly

on the thyroid as well.

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And so when we see Hashimoto thyroiditis,

we have to first think the gut and think

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about permeability and the microbiome.

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We can go into depth

on any of those things.

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They said a whole bunch of stuff there.

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Yeah.

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So there you mentioned some

of the things that can affect

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our microbiome as well as the.

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Permeability of the gut lining.

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Mm-hmm.

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I think one of the things that women

don't know is that certain medications

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can change the gut microbiome.

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Can you share, cuz I can't speak

to medication as a chiropractor,

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but I would love to tap into your

wealth of knowledge in terms of Okay.

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You know, a lot of women think, oh, I'm

just taking this medication for a certain

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condition, not knowing that it could

potentially change our gut microbiome.

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Well, I talked about the things

that the microbiome changes

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will affect in the body.

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What changes the microbiome will,

the first piece is going to be

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food, and I just have to note

that and we'll come back to that.

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But the diversity of our foods, the

number of different colors and types of

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vegetables and things we eat will directly

affect the diversity of our microbiome.

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And we want a diverse microbiome.

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Now the diversity in my microbiome,

yours are gonna be different, but

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as long as the functions happen.

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And then there are a number of other

things that if we eat foods that aren't

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organic and we get exposed to toxins, that

will have an effect on the gut microbiome.

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If we eat foods or have medications

that have particular additives in them,

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that will change the gut microbiome.

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we find that a number of medications

will have gluten in them.

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we don't even know that, but you google

it online, you say medications with

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gluten and you can get medications

that do not have gluten in them.

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And you're like, why would

there be gluten in medications?

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But, you know, a number of 'em are

made, with fillers or things that

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have various kinds of, gluten or

wheat-based, components in them.

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but you can find ones that don't then.

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Then of course, the anti-inflammatory

medications, the NSAIDs, the non-steroidal

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anti-inflammatory and anti-inflammatories.

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And whether we're talking about

ibuprofen or acetaminophen or aspirin

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or nain or an naproxen or, Long list.

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Yeah.

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All are going to have

a fundamental impact.

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They actually cause some degree of

low-grade I irritation in the gut.

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We know that, right?

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That's like, oh, you could get

ulcers, you could get bleeding.

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They actually cause permeability, that

permeability that we talked about earlier.

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And they cause changes

in the gut microbiome.

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Things like steroids of course,

will have that kind of effect.

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various hormones will have effects on

shifting the distribution, composition

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and distribution of the gut microbiome.

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And so we've kind of gone through a

number of different classes there.

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Now, the larger classes around

antidepressants, anti-anxiety drugs,

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and statins, those are things that

there appears to be a shift when

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they're given in the microbiome itself.

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Whether that shift is sufficient to

actually lead to an inflammatory process,

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or systemic effects that part's unknown.

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The things I've talked about up

to this point in time, those are,

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clearly known and documented.

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but having awareness that there is going

to be a shift the simplest way frankly,

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to understand, well, am I doing okay?

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how do I tell if I'm doing okay or not?

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Is to just basically look at, how many

bowel movements are you having a day?

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One or two is the best answer to that.

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anymore, any less.

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Generally gonna be

problematic in different ways.

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And are they formed?

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there's something called the Bristol

Stool Scale, and it rates your poop

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from being, runny to, to super hard.

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from one to seven, and

you wanna be at four.

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you wanna have it just be like a nice,

as my friend Patch Adams used to talk

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about a footlong floater, you want

little gross, but, you want to have

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a well-formed stool and that's key.

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Yeah.

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so anyways, I'm kind of jumping ahead.

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Yeah.

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But people would ask that question, well,

how will I know if things are IMB or not?

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Is 70% of Americans will have

an imbalance in their, will

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have dysbiosis in their guts.

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so it's a really high, percentage.

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That's a very high percentage.

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Do you think it's because of just some

of the things that you mentioned that

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we're exposed to or maybe, shifting

shifts in our eating patterns?

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cause I know you do take like a food

first approach, like 70% is really high.

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Almost everyone should be working

on their gut health Right, exactly.

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In some capacity.

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Exactly.

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Well, and that's one of the things, when

we're talking a little bit earlier, it is

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like when someone who I'm working with,

Isn't doing well, they're not improving.

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I keep going back to those

principles, food first and

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what's going on with the gut.

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Like, I want to get

that into balance first.

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and what I found in my practice, even

early on where I was really emphasizing

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the food, but then I was finding, oh

wow, these people actually aren't able

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to digest and assimilate the food.

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They had too much imbalance going on

that I needed to work to be able to

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use what we commonly talk about as like

a five hour program of remove what's

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not working and replace what you need

support and rebalance the gut microbiome.

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And we can talk about that,

with these terms of prebiotics,

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probiotics, and postbiotics.

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And then working on

being able to, help to.

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Reinoculate, or repopulate cuz

you're not really inno inoculating,

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but repopulating the gut.

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I wanna ask you this question though.

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So I took this from your lecture

and I love this and I don't

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think many people know this.

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Changes in diet can cause large shifts

in the microbiome in just 24 hours,

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which is profound.

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Cause I think a lot of people think,

and we'll touch upon this kind of like,

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prebiotic, probiotic and postbiotics.

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But I think a lot of people think, oh,

it's gonna be this long journey of like

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rebuilding gut health and, but you could

literally start to make large shifts

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in your microbiome within 24 hours.

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how does that happen?

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Yeah, so it's repair, but repair.

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Ah, I know you remember.

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so we thought 20 years ago that there

was a core microbiome that everyone

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had and that it was just trying

to help get people back to that.

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It's through the techniques of the

more recent molecular techniques,

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which I could talk about at

length, but nobody really cares.

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They're just like, we've

figured out that there's a huge

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difference amongst all of us.

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and so we also found a.

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When they were testing kids

and adults and following people

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longitudinally, with earlier kinds of

approaches, they find found that the

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gut microbiome was pretty similar.

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If you keep eating the same

foods, if you change your diet,

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you can actually change it.

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Dr.

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Mez, most of us have heard of him

and he did a little experiment

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with using a smoothie, and he was

able to begin showing changes.

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In a day in 24 hours with very

significant changes at, or three days

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period of time, in three days, you could

fundamentally change the gut microbiome.

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And we'd seen this in mice, but we

hadn't actually seen it in adults.

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And it was like, oh, it'll

take about a month for it.

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And he showed like, oh no, it

actually starts happening in 24

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hours and you're at a significant

shift at three days period of time.

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And then there's some further studies

that have gone on and, and used like

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a vegetarian diet, group that just a

vegetarian diet and then, had a washout

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period, and then just a carnivorous diet

where it was just like meat and cheese

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and they could show shifts again in the

microbiome within 24 hours period of time.

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So it kind of goes to what you eat and

what's in your gut is what you eat.

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Do you know if in that study that you

mentioned, if there was a difference

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in diversity, because I know there

was, huge shift in diversity that

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happened at that point in time as well.

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Yeah.

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And, and so that's why, I really

emphasize, the ability to, if you're gonna

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use a smoothie, doing something that's

got lots of different kinds of vegetables

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or s sprouted vegetables in it, as a way

of, of being able to have a simple way

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to do it if you're not, looking at your

plate and you should have five different

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colors of fruits and vegetables, when you

sit down to have at least your main meal.

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But the other thing that's interesting,

and my friend Deanna Minnick kind

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of pointed this out and did this

really fun, online program about it.

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I think I have a diversity of fruits

and vegetables in my diet and I looked

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down and I see lots of different

colors, but she said how many different.

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Vegetables you eat in a week period of

time, I can go through, it's like, okay,

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so kale, cauliflower, broccoli, mushrooms,

basil and avocado that can go through.

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But there's about 12 to 15

things that I eat all the time.

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and then I started looking at, because

she said you should try to have 30

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different kinds of vegetables every week.

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30 and all of a sudden you're like, wow,

I gotta go shop at the Chinese market.

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I gotta get some things

I haven't tried before.

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I gotta learn how to cook them.

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I gotta be more diverse.

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I gotta bring other things in.

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And she did an online thing of how many

different vegetables could people eat?

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and my recollection is that the

winner was a woman and her 12 year old

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daughter who was really compelled and

they had 149 different vegetables that

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they ate in a week period of time.

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That's pretty impressive.

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That's impressive.

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Yeah.

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Yeah.

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I didn't even know there was

like 149 in season at one time.

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I wanted to speak to, a lot of

people know about a probiotic, right?

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That's kind of like general public knows.

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Not a lot of the general public knows

about prebiotics or postbiotics and why

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they are important for our gut microbiome.

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Let's first talk about probiotics,

because probiotics, we know, we take them.

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These are, bacteria that are, created to,

be similar to what's in our gut and to

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help bring balance back to the system.

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But what we found is is that

the probiotics act as tourists.

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They move through, they

cause changes in the economy.

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I live in Asheville, North Carolina,

which has become a great tourist place,

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and it's kind of like the town I moved

to 27 years ago is fundamentally changed

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because there's so many tourists and

it's like you, over-rely on tourists.

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You don't want that.

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Probiotics can be very useful,

just like antibiotics when they're

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targeted a specific probiotic.

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And even a strain at a specific

dosage for a specific period of

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time for a specific condition.

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So that's great.

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Now, a lot of people are saying,

oh, I take probiotics to help

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my overall health and wellbeing.

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That's not actually

ever been demonstrated.

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what we find is that the probiotics,

even if someone is using a nice,

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well-balanced probiotic formulation

with multiple different components,

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you should shift it up every six

months if you're going to do that.

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Now, what's more important

are the prebiotics.

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The prebiotics are gonna be the foods

that feed your bacteria in your God

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to bring them back into balance.

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And so there are prebiotics.

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things like inulin and

fr oligosaccharides.

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I particularly like Acacia root

can use potato starch as an agent.

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those are both relatively inexpensive

and easily accessible as powders.

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and then there's some other, fancier

named Xlo oligosaccharides and,

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ara, galactans and things like that.

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But the prebiotics are helping

the beneficial bacteria to grow.

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And then what you also wanna bring

with that is you want to bring in

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what are the foods that are going

to help direct the populations,

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the right populations to grow.

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And interestingly enough, the data shows

us that the best foods to eat are berries.

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And, the berries that have a red

and black skin on them are gonna

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be the best, red, blacker blue.

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And so it's cranberries, blueberries,

raspberries, black raspberries,

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pomegranate, cherries, all of those.

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And it's in the skin actually

that has the flavonoids that help

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the beneficial bacteria to grow.

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So people will say, gosh, I've

heard of this thing called amania.

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Yes.

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and there's there's a product out there

ACR mania has been associated with

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decreased inflammation, but there's lots

of different bacteria that will have

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an anti-inflammatory quality to them.

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And so just taking the one thing is a

probiotic and it's a tourist that goes on,

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but if you take a combination of something

like a Keisha root with blueberries and

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blackberries and pomegranate, you actually

grow amania and you can do that for

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like, 15 bucks a month and eat berries,

as opposed to, taking a probiotic that

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may cost a hundred bucks a month and

has not been shown that when you take

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the akkermansia, as soon as you stop,

you don't have Akkermansia anymore.

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Mm-hmm.

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It's only good while it's there.

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Whereas if you're eating the foods,

you'll continue to help it to grow.

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So it's an example.

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So there's prebiotics

where my emphasis is now.

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Probiotics are when

there's a true imbalance.

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If there was a probiotic for, Hashimoto

thyroiditis, I would tell you immediately,

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I'd say This dose, this strain.

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there's no data there.

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There are things for irritable

bowel syndrome and especially.

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that aspect that's, mixed in nature.

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There are probiotics for

inflammatory bowel disease.

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There are probiotics for interstitial

cystitis and urinary tract infections.

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These have been studied

and we can dial that in.

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but for Hashimotos or for other autoimmune

diseases, we do not have that yet.

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we may find some that really act as

specific agents, but we don't yet.

344

So then we go to, well, what's

this other term that you said?

345

I've never heard that before.

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Postbiotics.

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What does that mean?

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Recall that I said we want to have

the functions of the gut to be working

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all in balance with each other.

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And I talked about those seven functions.

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The way in which that happens, the

diversity of many different people's

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balanced gut microbiome, whether it's

a microbiome in Singapore or in Paris

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or in Sao Paulo, there's diversity in

balance and we can tell there's balance

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because the functions are working

properly and the functions happen

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through the production of postbiotics.

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It's what the bacteria make.

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And we now begin to see that,

those things can affect the

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mitochondria and energy production.

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Those things can affect the

balance of the immune system.

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Those postbiotics can affect the

gut-brain access and lead to changes

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in feelings of depression or anxiety or

improvement of those kinds of things.

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So it's the postbiotics, which is

probably where You've heard some of

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your people have heard about fecal

transplants, and that it's probably

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through the postbiotics that the

fecal transplants are having their

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beneficial effect on the person overall

of bringing them back into balance.

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So there's a lot going

on in the conversation.

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Yeah.

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Fecal transplant is not the first

step or the first probably 20 steps.

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I've, for people who I know who

have gotten a fecal transplant,

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it's usually like the last resort.

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And from what I understand,

not always successful.

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No, and where you get it from.

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And there are people

who are, do it yourself.

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Ooh.

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where they get it well, where they

get it from someone that they know

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and they create it themselves.

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It's not actually legal in the

United States to do a fecal

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transplant at this point in time.

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there are some new postbiotics

formulations that come from

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basically fecal transplants where

all the bacteria have been killed.

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And so it creates a

postbiotics, but what was it?

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But you want to get it from a healthy

cohort, a healthy group of people.

383

So I wanna share just a brief story where.

384

A colleague of mine, Dr.

385

Tom Salt and I were talking in 2000

8, 9 10, about, starting a program

386

with fecal transplants for people.

387

And, I had gone to Australia and

learned how to do it from Dr.

388

Ted Barra, who's the most

well-known person in this area.

389

And then I was talking to a colleague,

at the group in, Cork Ireland, who

390

have some of the best GI doctors in

terms of the microbiome in the world.

391

And Dr.

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Fergus Shanahan, said to me,

Patrick, you understand that

393

changes in the gut microbiome

can have an effect on, of course.

394

Clostridium difficile, but also on heart

disease, on cognition, in Alzheimer's,

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on liver disease, on osteoporosis, on

inflammatory bowel disease, on mood

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disorders of anxiety and depression.

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I'm like, yeah.

398

And he said, so if you are taking a fecal

transplant from someone and you don't

399

understand what it's going to do, you give

it to them, and that person who wasn't

400

necessarily on a track for developing

some cognitive problems or some behavioral

401

problems or heart disease ends up moving

in that direction and we just don't know.

402

do you want to do that?

403

Do you want to take on that risk?

404

Certainly if you have someone who's got

this infection called C difficile that

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it's approved for, these people are,

are really sick and you can die from it.

406

And so you need to do something

and it's 98% effective.

407

So it makes sense in that setting.

408

But if you've got someone with infl,

with irritable bowel syndrome or

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Hashimotos thyroiditis or depression,

and they think that they're going to get,

410

benefit from a fecal transplant, well

they may in that domain, but they may

411

develop some other kinds of problems.

412

And there are ways that we can

work to heal the lining of the gut.

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through focusing on the diversity of the

microbiome, repairing the permeability

414

damages that are going on, replacing the

digestive enzymes and things that are

415

missing, removing the foods in general

that are going to be processed foods.

416

I mean, that's job one, get rid of the

processed foods and, then moving towards

417

balance in that way and that doesn't have

any risk associated with it of long-term

418

problems caused by the treatment.

419

Yeah.

420

I had a friend get a fecal transplant and

a month later she had, her appendix burst.

421

She had surgery and I was like, oh,

that's like a weird correlation.

422

And then she needed a

bunch of antibiotics, after

423

getting a fecal transplant.

424

Right.

425

Which was kind of a bummer.

426

Right.

427

and so I mean, there are ways, there

are some, clinics in the uk, in The

428

Bahamas, um, that have done these and

that use a very healthy cohort of people,

429

who are eating organic and they're

young and they're healthy and they've

430

been qualified and they don't have

any kinds of parasites or imbalances.

431

And I think that's a

reasonable way to do that.

432

But even in the patients I've had who

have gone to have that done, it's about

433

50% of them get significantly better.

434

And if 50% don't, and as a pretty big

ask now, I had one patient who did a.

435

Do it fecal transplant, from her

husband, and she got improvement.

436

But, she continued to have problems.

437

She started taking this, postbiotics,

kind of blend, and she got really

438

significant improvement from it.

439

So, I believe that there's ways that

we can work with the concept without

440

actually doing a full fecal transplant.

441

And then there's poop pills

that are coming out now.

442

One was just approved by the f D A

last week, and it's not really poop.

443

It's, basically a combination of bacteria

that have been derived, um, and have been

444

demonstrated to help with c diff, this

clostridium difficile, this bad infection.

445

but that's just where the data is on that.

446

there's some fascinating, research on.

447

Fecal transplant with autoimmune

disease, with autism, with mood

448

disorders, and with liver diseases.

449

There's some really cool stuff.

450

So we know that changing the microbiome

will change the overall physiology

451

of what's going on for people.

452

It's just there's ways to do with

food that are much simpler and easier.

453

In terms of the five Rs, the

first one is remove, right?

454

And it's not only maybe removing

certain foods for potentially a period

455

of time, but then also addressing

underlying, infections or maybe

456

bacterial overgrowth or fungal overgrowth

that could be happening in the gut.

457

Mm-hmm.

458

How does someone who maybe has

just kind of gone like, okay, I

459

have medication for my thyroid.

460

How, can I even start to discover.

461

maybe I have a gut infection.

462

What would it be, working with

someone and taking a thorough history?

463

Would it be doing a stool sample?

464

I know there's a lot of different

labs that do different stool testing.

465

to start to kind of like walk that

path of, okay, now we first is remove.

466

So in, the remove stage, I'm taking the

history to find out when did this begin?

467

And if it's something that occurred

after, doses of antibiotics or something

468

that occurred after travel or something

that had more of like a, real defined

469

point source, it's like, oh, this

day, this is when it happened, then I

470

for sure go and, and wanna do a stool

test to be able to say, is it possibly

471

an infection that's going on there?

472

And, there's it, these kinds of

stool tests, the ones that are more

473

comprehensive are not the ones done

through Quest and LabCorp, but done

474

through other specialty laboratories

like the one that I used to be

475

the chief medical officer at, and.

476

In that process, they're gonna look

for parasites, they're going to

477

look for worms, they're gonna look

for, various kinds of potentially

478

pathogenic bacteria that are there.

479

they're gonna look for an

overgrowth of yeast or fungus to

480

be able to see what's going on.

481

And they're also going to

assess well, what kinds of, anti

482

bacterias or antimicrobial herbs

are these things sensitive to?

483

And so, you can measure certain aspects of

the immune system that will say, something

484

called immunoglobulin that when it's

really high, it's like there's something

485

going on that the immune system is saying,

Hey, I'm feeling attacked and I need to.

486

To go after this.

487

So there's ways to be able to look

at that testing to say, yeah, there's

488

something that needs to be done in

terms of an infection, that needs

489

to be brought back into balance.

490

And, while we can use foods and

things like that, if you've got the

491

irritant continuing to be there,

it's hard to get back into balance.

492

And so yeah, it's removing foods and like

in the case of Hashimotos thyroiditis

493

for sure, removing gluten and removing

processed foods and doing that and

494

something like a whole 30 diet, a food

plan is a great kind of off-the-shelf

495

food plan that you can gain access to.

496

so that's the remove part of it.

497

Yeah.

498

You mentioned earlier this gut-brain

access, And I wanna bring this up

499

because a lot of women with Hashimotos

will struggle with depression,

500

anxiety, and then also brain fog.

501

Mm-hmm.

502

And.

503

Maybe we'll kind of go the tr uh,

route of, oh, well, maybe I should go

504

to therapy, or maybe I should work out

more to try and boost my endorphins.

505

And they don't know that there is this

connection of the gut to the brain,

506

and maybe this should tap into that.

507

Yeah.

508

Yeah, there's a whole field, that was

developed by, Danana and Cryer in Cork

509

Ireland called Psychobiotics, where

they've been looking deeply at this area.

510

It's still in its infancy in

terms of is there a clear organism

511

that's going to be really helpful.

512

And, the one I favor at this point in

time is something called Zen Biome.

513

it's made by Microbiome Labs.

514

I don't have any affiliation with

them, but the specific organism,

515

that's in there has been shown to be

really quite helpful for dealing with,

516

depression, anxiety, kind of neuro

imbalances in the gut brain axis.

517

And people say, well, Really?

518

What, do you tell, like,

how does that happen?

519

does the poop go into your brain?

520

Is, like, no, no, no.

521

There's pathways, both through the

nerves as well as through the blood.

522

where sometimes, people may not know,

but 95% of the serotonin in your

523

body, you've heard of serotonin.

524

your.

525

Audience is sort of serotonin because

it's like this is what many of these

526

antidepressant drugs are, based upon.

527

They're, reuptake inhibitors.

528

You don't have enough serotonin but

95% of it's produced in the gut.

529

it moves up into the brain.

530

there are also other kinds

of neurotransmitters.

531

There are anti-inflammatories and

pro-inflammatory agents that can move up.

532

They can move through the blood, they

can move through the vagus nerve, and

533

they actually aggregate in a certain

area, called the insular cortex.

534

Now, I won't get too, too detailed.

535

I told you, I, I wouldn't, but

I, I love this stuff because it's

536

like what our gut feelings are.

537

Actually, they're our gut feelings.

538

They're like, what's happening in our

gut is having an effect on how we feel.

539

You know?

540

and it's that direct.

541

So yeah, there are agents now that we are

beginning to learn can have an effect.

542

now here I'm back on probiotics and

you can say, wait, he said before,

543

he doesn't focus on probiotics.

544

But if I'm working on a specific

problem, a specific issue that's there,

545

then I'm gonna use that as an agent

for a specific period of time at a

546

specific dose to try to affect change.

547

Knowing that my goal all along is

to change the diet and to change

548

to the relationship, to stress.

549

I'm gonna kind of go off topic

from here, but there's data now.

550

So the vagus nerve.

551

in your training, you know

a lot about the vagus nerve.

552

Yeah.

553

But the vagus nerve is not like Las Vegas.

554

It's, it's V A G U S and it's the

wandering nerve and the wandering

555

nerve that comes down and comes

down the back of our throat.

556

And it, it affects our

production of digestive enzymes.

557

It affects our stomach, it affects

motility, it affects our breathing,

558

it affects our heart rate.

559

It affects the rate of

motility of the gut.

560

And there are different

branches of the vagus nerve.

561

They go front and back,

anterior end dorsal.

562

And there are Different

effects that go on now.

563

One of the things that I've been learning

recently, and I've been interested in

564

the vagus nerve for a long time, but

I've found that if your vagus nerve

565

isn't working properly because you're

overly stressed, you're in fight or

566

flight response instead of in more

of a chill parasympathetic tone.

567

So you have parasympathetic

chill sympathetic.

568

Flight, freeze appease.

569

And if you're, in that zone, then

your vagus nerve isn't working very

570

well, you're not actually gonna be

able to digest your food properly.

571

You're not necessarily gonna

have, even the supplements you're

572

taking be able to be incorporated

effectively in what's going on.

573

and the vagus nerve is used as

also a conduit both to the brain

574

and back from the brain about

what's happening in the microbiome.

575

it's a loop system, that is giving

feedback to what's happening in your gut

576

is affecting your feelings, is affecting

your overall habituated behaviors of

577

fight or flight or, freeze appease.

578

So how do we get into, a deeper

tone, a deeper balance point, and,

579

And I'm, want say one more thing

about that because it's typical

580

things like yoga, slow down, take

a walk, be in nature, say prayers,

581

meditate, knit, all these things.

582

Help sitting in front of a TV and watching

a movie love, that's not gonna help.

583

it's gotta be active and then there's

now external vagal nerve stimulators

584

that actually can help with that as well.

585

Then one would say, well, I'm pretty

chill, I mean, my friends say I'm a pretty

586

chill guy, so I must not have a problem.

587

I really like measuring

heart rate variability.

588

So heart rate variability is a

way to be able to say, where am I?

589

Because when we're young, in our

teens and early twenties, our

590

heart rate has a variability.

591

It doesn't just go dumb,

dumb, dumb, like a metronome.

592

There's a little bit of variation.

593

So when we're young, that variation is

as much of a hundred milliseconds, a 10th

594

of a second variation, and that's telling

us that we've got really good vagal tone.

595

We've got really good balance

between our parasympathetic

596

and sympathetic nervous system.

597

Now, when you get to be in your

sixties like I am with aging, the

598

normal is that rate, we become

less flexible, more restricted,

599

and that beat to beat variation

is between 10 and 20 milliseconds.

600

It's like 10 90% less,

601

But you can, and you can measure it.

602

You can measure it using a tool

like this aura ring that I have on

603

my hand right here on my finger.

604

You can use it by measuring

other kinds of tools.

605

There's even new tools that are gonna

be coming out that will be able to

606

use the camera from your cell phone

to look at you and tell you what

607

your heart rate variability is.

608

So there's, it's an important

thing to understand and where

609

am I and what will help me.

610

you've maybe heard some of my own

journeys, but I found that while being

611

in nature actually made the biggest

shift for me, to be able to do that.

612

And so that's what works best for me.

613

The other things are helpful, but, finding

out what works best so that there's,

614

it decreases intestinal permeability.

615

It changes the gut microbiome.

616

So between stress and food, those

are your two biggest things that

617

you can So if because you always

hear like, oh, trust your gut.

618

What does your gut say?

619

And I'm like, well, I

might have gut dysbiosis.

620

I don't know what my gut says.

621

My intuition might be off.

622

Yeah.

623

And you can actually

measure, what's going on.

624

there's stool testing that will

help to be able to see is it

625

imbalance or is it, out of balance?

626

And one of the things, I'm gonna talk

clinically for a moment, one of the things

627

I've learned is that what I wanna do with

the people who come to see me is I wanna

628

get 'em on a better diet right away.

629

I wanna get 'em off of processed

foods and I want to, help them.

630

Usually I stop gluten at least

for a trial and then add it back.

631

And so it's a four, six week process.

632

Then I see if they're still not

feeling well, then I test the gut

633

because I, already know like, well the

main drivers are gonna be there, so

634

let's see if things are in balance.

635

Are you in balance?

636

if your food and nutrients and

things are moving in a good way.

637

And then I I think a lot of women,

like to default to food sensitivity

638

testing to kind of determine what they

should eat and what they shouldn't eat.

639

And I think, it's not the right approach.

640

Can you share why I, cuz I think,

I get a lot of messages like.

641

What food sensitivity testing,

and I was like, maybe none.

642

Maybe there's a better way.

643

Well, I'm, I think I'm a little

controversial in this area and

644

as I said, I worked for a lab

that did this kind of testing and

645

so I'm really familiar with it.

646

but I was never supportive of it

because what happens is that if you have

647

permeability, you will have reactivity

to the foods that you're eating.

648

And if you switch the foods that you're

eating and you have permeability,

649

now you'll have a reaction to

the new foods that you're eating.

650

Mm-hmm.

651

So there, are some aspects

where some people are uniquely

652

responsive and are reactive to

specific food groups, whether it's.

653

Corn, dairy or, beef or gluten.

654

but that's why I work with a food

challenge, an elimination diet to

655

remove those things initially, and

then, and then start adding back

656

after three to four weeks period

of time and see how do I feel?

657

Yeah.

658

because is, There's no

validation of i g G food testing.

659

Now I hear, I'm talking about allergy

testing, cuz there that's important.

660

And the IgE E food allergy testing

can be really useful if you have a

661

specific thing that you are reacting to.

662

but the IgG G testing, it's just

not re reproducible, across labs

663

or over time because it's more

of a reflection of permeability.

664

And the other big thing, and I'm sure

you've seen this in practice, I see people

665

walking around carrying cards and things

and saying, oh, I can't eat all these.

666

I have this test.

667

I can't eat all these foods.

668

And has developed something that the term,

that has emerged is orthorexia nervosa.

669

and that is, why my immunology friends

and rheumatology friends really don't

670

really speak strongly against this

kind of testing because it gives

671

a false notion and it limits the

diversity of foods that people eat.

672

Not a good thing.

673

Which then in turn limits potentially

the diversity in our gut microbiome.

674

Right?

675

Exactly.

676

Yeah, exactly.

677

Yeah.

678

And we see this with people who are

eating like a sibo, low FODMAPs diet also.

679

I mean, if people have small

intestinal bacterial overgrowth, yes.

680

It's a real thing.

681

Yes.

682

There's bloating there.

683

Yes.

684

Eating a diet that does not contain, a lot

of these, what are called FODMAPs, fructo,

685

Olivo, monosaccharides, and polyols.

686

You don't have to remember that, but,

They come from lots of vegetables.

687

What's useful in the short term to help

be able to get, gain some balance back,

688

but it's not useful in the long term.

689

But I see a lot of people who

stay on that diet, and it's,

690

it's not a good long-term diet.

691

For, people who do introduce

an increase in vegetables and a

692

diversity, and they might have some

bloating or maybe indigestion, what

693

do you recommend for those people?

694

Because they're like, I wanna

take a food first approach.

695

And then they start to, maybe it

doesn't sit well with them at first.

696

there's a couple different things.

697

One of 'em is like with a lot of the

prebiotics that I mentioned, if you

698

actually don't have a balance in your

gut and you take a prebiotic like inulin

699

or fructooligosaccharides, f o s, they

call it, that's gonna cause more of

700

a non-specific growth of everything.

701

And if you're outta balance, You're gonna

kind of accentuate that, So starting

702

slow with it and going with a low dose

of a, of a prebiotic, and then beginning

703

to look at it, journaling like, well,

what foods do I notice are a problem?

704

and they tend to fall in categories.

705

So sometimes it's, it's more

like the, the Allisons, like the

706

garlic and the onions and the

shallots and things of that nature.

707

For other people, it may be more of

the nightshades that cause imbalances.

708

And so work to say, how do

I begin to parse this out by

709

the foods that I'm eating?

710

and the other thing is that

when you change your diet,

711

it is totally expected, dude.

712

You're gonna have some shifts.

713

In the gut in the first week

period of time, and you wanna kind

714

of move through seven to 10 days

to say, well, where am I at now?

715

Now if you're still having bloating

and problems at that point in time,

716

then you gotta do what I just said,

start to look at which food is it.

717

but give it seven to 10 days on the front

end because that's when the, shifts are

718

occurring and you're trying to find what

the new balance is to be able to do that.

719

and as I said earlier, and, as you

work with those things, if after a

720

four to six week period of time you're

still having significant issues, then

721

that's a time to be able to do testing.

722

Such a great mindset shift, right?

723

Cause I think some people think, oh,

I've been doing this for two days.

724

why isn't my bloating better?

725

so I think that's a great reframe.

726

drhanaway, thank you so much for

all the information you've shared.

727

Where can people find you and

where can people work with you?

728

Well, I'm laughing because, I'm not

taking new patients at this time that my

729

career is focused on being able to educate

providers through the Institute for

730

Functional Medicine at this point in time.

731

And, it's a passion to

teach and I love to do it.

732

So where I encourage people

to go is if fm.org/find

733

a practitioner or if you just

go to the main page on the upper

734

right hand side, there's a find a

practitioner, and these are people

735

who have been through the training.

736

if you find someone who's an I F

M, certified practitioner, they've

737

gone through, they've been tested,

they understand what's going

738

on, and you can search by your

zip code or by your state and.

739

set a distance area.

740

We've got, thousands of practitioners

who are trained now and tens of thousands

741

of practitioners who have, begun to

learn the process that's occurring.

742

So I feel really, pleased that we

have, been able to do training get

743

people in into your neighborhood.

744

And I send people to that link all the

time cuz I have, women are like, where

745

do I find someone in North Dakota?

746

And I'm like, well go to if f m Yeah.

747

Check for practitioners.

748

Yeah.

749

Mm-hmm.

750

Yeah.

751

Well, thank you so much.

752

I have taken a bunch of notes and

I'm sure the listeners have as well.

753

So thank you for sharing your wealth

of knowledge and I really loved our

754

conversation and thank you for being on.

755

Oh, you bet.

756

Thank you so much.

757

And thank you for the work that you're

doing to empower women, and help them

758

to recognize that, when we're outta

balance, it's just a call to be able

759

to help find what's going on in my life

and how do I move back into balance.

760

And then you're sharing that and

helping people to be on that journey

761

of healing to become a whole.

762

I really appreciate it.

763

Yeah, thank you.