Even if you don’t have SIBO, this episode is a must-listen for all women. We get into the nitty gritty of the relationship between hormones and the gut, how your thyroid factors into the equation, and why conditions like Hashimoto’s and hypothyroidism become such big risk factors for digestive issues like IBS and SIBO.
A big underlying culprit that I talked a bit about in the Rag Time chapter of my book The Wellness Project, but not enough people address, is the pill. Hormonal birth control is a subject that today’s guest is particularly equipped to talk about as it relates to gut health.
Dr. Jolene Brighten is a Functional Medicine Naturopathic Doctor and the founder of Rubus Health, a clinic in Portland Oregon that specializes in women’s hormones. She is a leading expert on the long-term side effects associated with hormonal contraceptives, and even coined the term Post-Birth Control Syndrome. Dr. Brighten is also the author of the upcoming book Beyond the Pill, a 30-day plan to support women on birth control, help them transition off, and eliminate symptoms of post-birth control syndrome.
A quick taste of what we’ll cover:
- How hormonal birth control leads to leaky gut
- Why women are more prone to gut issues
- Why insufficient thyroid hormone contributes to the risk of food poisoning
- An overview of your different thyroid hormones and how they work in the body
- How a SIBO diet dovetails with a diet to support your thyroid
- The things you should and shouldn’t do to treat your SIBO if you’re a woman with hormone imbalances—including Dr. Brighten’s delicious recipe for a night time tonic for adrenal fatigue
- And so much more…
Resources, Mentions and Notes:
- Jolene’s website
- Jolene’s book, Beyond the Pill
- Jolene’s “Why do I poop so much on my period” blog post
- Jolene’s “The Thyroid Gut Connection” blog post
- Jolene’s supplement recommendations:
- The Rag Time chapter of The Wellness Project book
- My Hashimoto’s and thyroid resources
- My post that summarizes a lot of these strategies: How to Find the SIBO Treatment That’s Right For You, Natural or Otherwise
- Join the SIBO Made Simple Facebook Community Page
- My favorite recipes to use collagen in baking and cooking: Pancakes, Soups, Quick breads, Brownies!
This episode is brought to you by Great Lakes Gelatin. Their collagen and gelatin products are sourced from cattle in Argentina and Brazil. They are pasture-raised and grass-fed. And they even offer Convenience Packs for those of us who travel often or are constantly on the go. I like to mix the collagen powder into my morning tea or coffee, or whisk it into soups and stews to help thicken them. I’ve even made a whole host of gluten-free baked goods with collagen in the batter, including pancakes, quick breads and brownies. If you’re looking to fortify and heal your gut, I highly recommend giving Great Lakes’ products a try. Enter SIBOMADESIMPLE at checkout for 20 percent off your first purchase.
HYPOTHYROIDISM AND SIBO
Phoebe Lapine: Okay, so, Jolene. If you want to give the abbreviated spiel to everyone here to tell people how you got into medicine and how you began specializing in women’s medicine, we’d love to hear it.
Dr. Jolene Brighten: Yeah. So, you know, my childhood… I was a sick kid in terms of gastro health. And so it’s kind of crazy because when I went to medical school, I was like, I’m definitely going to specialize in gut health. Well, as it turns out, if you’re going to specialize in hormones, you also have to specialize in gut health. They go hand-in-hand.
But yeah, as a kid, I was actually diagnosed with chronic gastritis before fifth grade, so I was very young. I had chronic gastritis. I had reflux that would keep me up all night. Incredible pain. I was put on proton pump inhibitors before they were even over the counter, so they weren’t studied in children, yet my doctors thought that was the best bet for me. And it took a good amount of time for them to finally diagnose me. It wasn’t until I was almost 18, I was diagnosed with H. Pylori. And that is not a doctor’s fault. That is because the research just wasn’t there yet, and they didn’t know to go looking for it and to do that biopsy.
So, my first endoscopy, which for people listening who don’t know that medical procedure—that’s when they put a tube down your esophagus into your stomach and they view your stomach and they take biopsies and they look at the small intestine as far as they can go, just in the… It’s very initial, just to clarify. You can’t really get down into the small intestine that far, and let alone on a child. I’m grateful they didn’t try for that.
But yeah, so I had that endoscopy and then it was about, you know, another seven years I had another endoscopy. That’s when they found H. Pylori. I went through the full-month round of antibiotics except, whoops! Two weeks into it I developed an allergy to amoxicillin, blew up with hives everywhere, and so then had to go again—another round.
So it was like a total of six weeks on antibiotics, and when I was done, my doctor said to me, “You will always be on a proton pump inhibitor for life. This is your life. Here’s your prescription.” And my doctor was like, “There’s no connection between your diet and what’s going on for you.” Except they started to notice—and here I am, I’m still a teenager—that I’m like, Wait a minute! If I drink orange juice and have pasta with a marinara sauce, I get really bad heartburn. Well, what is that? And I eat a bunch of sugar and carbs and, you know, my esophageal sphincter just does not like that, so that would give me heartburn. And so that’s what launched me into studying nutrition is I started to make this connection that what I ate could either wreck me or make me feel incredible.
And so my very first degree is actually in chemistry. Then I went into nutritional biochemistry, and that eventually led me to naturopathic medicine. I wanted to be in a medicine that respected and honored food as medicine and also looked at, okay, yes we can use pharmaceuticals. Maybe there’s a time and place for pharmaceuticals. But how do we get off of them, and what happens before then?
The funny thing is, I went in and I was like, I’m going to be a gut expert. And then it occurred to me while I was in medical school that so much of women’s medicine is done to them, not with them. If you look at the GYN exam, we insert a speculum and a woman just evacuates her body, so to speak, where she’s like, Okay, I just have to surrender here in these stirrups. And I had an awesome GYN instructor who was like, “Hand a woman a mirror. Make her a participant.” And that really is what fueled me to go into women’s medicine is, I’m like, women are done a great disservice in medicine overall. Their symptoms are dismissed. They’re ignored. And things are just done to them. And they’re not educated about their bodies. And that was true for me.
And in my first year of medical school, I went off the pill after ten years and, you know, I just want to say, I’m not anti-birth control. It was absolutely instrumental—I’m a first-generation college student who went all the way to being a doctor. And for my path and my journey, that was an instrument so that I didn’t become pregnant and I could pursue my passions and my career. I wasn’t as educated about fertility awareness method as I am now, but I went off of birth control and then I developed Post-Birth Control Syndrome. And at that time, my doctor said to me that what I was experiencing wasn’t real, that I actually probably had PCOS all along and just didn’t know it, and that my only thing I could do was go back on the pill, maybe take spironolactone, because for the first time in my life, I had cystic acne and no period.
Now, I come from a big Hispanic family and we all joke that you can just look at a woman and she gets pregnant. Nobody has PCOS. And if anybody is a Latina listening to this, like, Uh-huh, I know this. So, nobody has PCOS in my family. Everybody had babies before the age of 20. I was the first person to make it to 30s and not have a baby. And my periods were so painful, my doctors thought I had endometriosis when I was about 14, and so I knew—my periods came every 28 to 30 days because I dreaded them and I feared them and they lasted more than seven days.
So when my doctor told me that I likely always had PCOS, I didn’t know my body well enough, I was misremembering my period and, you know, he just gave me this run-around, I was like, okay, firstly I’m a freak. I’m totally alone. And I went and leveraged my nutritional biochemistry background—everything I was learning in medical school, which was also telling me I never had PCOS—and was able to heal myself, restore my period, eliminate cystic acne.
And once I got into clinical practice, I came to see that the majority of—if not all—women struggle to come off of hormonal birth control which, as a woman, was validating that I wasn’t alone, and that has been so much of my message. I coined the term “Post-Birth Control Syndrome.” I want to support women if they’re on hormonal birth control or if they’re transitioning off or if they’ve already come off and they have Post-Birth Control System.
But so much of my message is to really convey to women that your story and your symptoms are 100% true and that you’re the only person living in your body, which means that if you say it’s not normal, as a doctor, I have to respect, honor, and listen to that, and as a doctor, it’s not my place to tell you it’s not real. And that’s been done to me. I’ve seen it done to patients. I’ve had so many women come through my office with similar stories, enough to the point where major media outlets are now actually publishing articles about how medicine dismisses women—how there’s a medical gender bias that leaves women, you know, dying. We die of heart attacks because you’re more likely to walk into an ER having a heart attack and have a doctor turn you away because you are not presenting just like a man.
And so, there’s so much we need to change about women’s medicine. It’s not what this podcast is about… We’re going to talk about gut health and hormones. But, you know, it definitely has to be part of the conversation because it’s the same thing, too, with women who have SIBO—how often they get told things like, “Oh, yeah, you’re bloating… That’s just mild. You probably just ate something wrong.” And they get dismissed.
And actually, SIBO and some of those symptoms can actually be a dysfunction of what’s going on with the gallbladder or hypothyroidism. We’re going to get into all of that. And so, while you may have gas and bloating and your doctor’s like, “Whatever, whatever,” it may actually be a little symptom—a little, you think about, if you’re on a boat and you’re stranded, and you shoot off that flare gun to say, “Danger, danger, I need help”—that’s kind of what those SIBO symptoms are doing in women that it might be an early sign that you might be losing your gallbladder or you may have a major hormone imbalance or something else is going on.
And I just want to say that in my story, absolutely as I look back, I can see the whole reason I could never heal my gut for a decade and I had to be so limited with food is because I continued to take the pill and I didn’t know everything that I know now.
Phoebe Lapine: So, I have about 500 follow-up questions, but I’m so glad that you said right up front what you did about women trusting their symptoms. I mean, I know the statistics for IBS, and so many of those gastro symptoms that people experience—especially women—are just chocked up to IBS. And 75% of IBS sufferers are women. I’m not sure if that percentage actually correlates to SIBO—it probably does—but just, you know, right off the top, why do you think that these gut issues disproportionately affect women?
Dr. Brighten: So I want to say this: I think this is really important for everyone to understand is that while medicine will compartmentalize your systems because it’s an easy way to study it and it’s an easier way to treat it… And so we’ve got an endocrinologist, we’ve got a gastroenterologist… But you know who does not care about the compartmentalization of your systems? Your body! Your body doesn’t care how medicine wants to divide it up, because it is all connected.
And you know, if we look at small intestinal bacterial overgrowth or irritable bowel system—so, SIBO or IBS—we can absolutely see there is a connection to the nervous system in all of this. I mean, that’s so much of what’s the crux of SIBO, right, is the migrating motor complex, the little street sweeper of your gut.
Lapine: [Laughs] I haven’t heard that yet! That’s cute.
Dr. Brighten: I come up with all kinds of funny analogies just to make it interesting. [Laughs]
Lapine: That’s very important. We appreciate that on SIBO Made Simple.
Dr. Brighten: So, you know, with that—those things, those are absolutely connected to nervous system and hormones go hand-in-hand. The majority of people with hypothyroidism are women. It’s just growing. I mean, we’re seeing hyperthyroidism just growing and growing exponentially in women, and so something I also commonly see is that women will have IBS or SIBO symptoms, and it really is rooted in a thyroid dysfunction. And if you’re hypothyroid, that can lead to you developing SIBO. And then if you have SIBO, that can make things worse for your thyroid because you need a healthy gut to convert your T4 to T3—inactive thyroid hormone to active thyroid hormone. You also need a healthy liver to do that, and so your liver’s processing SIBO gasses and getting all hot and bothered when you have SIBO, and so that also impacts it.
Now, we can also talk about estrogen dominance. When you’re estrogen dominant, you’re at higher risk of losing your gallbladder. This is why hormonal birth control like the pill also puts you at higher risk of losing your gallbladder. So if you have estrogen dominance, which, like, all of us have had at some point in our life because our environment is so full of all of these chemicals called xenoestrogens that dock onto our receptors and irritate the heck of out of our system… But if you have gallbladder dysfunction and you don’t make bile acid—it’s not getting in there—bile acid is actually toxic to those organisms.
So, let me clarify that the organisms in small intestinal bacterial overgrowth—they’re really, really good organisms. They’re awesome living in your gut, when they’re in your large intestine, and they’re never supposed to be in your small intestine. So, I really want to say, you know, it’s very much my perspective that the organisms are not our enemy here. There’s a root cause to the dysfunction that led to them heading north in your gut and, you know, the way it’s supposed to work is that you eat carbohydrates and then there are carbohydrates you don’t digest so you get first dibs on your carbs. Then the undigested fiber makes its way to the large intestine and feeds your good gut bugs. You’re basically being a little farmer with that and making sure you cultivate those gut bugs.
But if you think about it, there’s dysfunction with hypothyroidism, and so you’re constipated and those organisms head north. Well, what do they love? They love carbs, and so how could you blame them for doing everything they can—like disrupting your pancreatic enzymes and disrupting your bile acid—so that they can get at your carbs first, and they’re very, very good at that.
And so, why are women more susceptible to this? One, we take on a lot of stress in this world. We are the caretakers of the human race. We are constantly putting people—everyone—before ourselves. So there’s that self-care piece of like, we’re eating on the run and we’re doing all these things to support other people. But like, there’s also what plays in the background is that, compared to our male counterparts, we are disproportionately under an enormous amount of stress, just in that we are vulnerable creatures walking around this earth. If a man wants to attack us in some way, we’ve got to be running that little safety in the background at all times. I think there are a lot of things going on political right now where we’re seeing women being like, Yeah, I actually do feel that extra bit of stress. So, there are a lot of things kind of going on in terms of the stress component, which, that’ll wreck anyone’s gut. A lot of us store our stress in our gut.
And then there are the hormone imbalances that come from all that. And then there’s the piece that, like, a hundred million of us are on hormonal birth control. And so, if you’re on hormonal birth control, that can cause dysbiosis of the gut. There are great researchers, experts, microbiologists who’ve actually shared with me how they have seen that the diversity of microbes drops when women are on hormonal birth control. It also induces intestinal hyperpermeability, more commonly known as leaky gut, and that’s just scratching the surface of the dysfunction that it causes that can leave you susceptible to IBS or SIBO. I know that’s, like, so much information. [Laughs]
Lapine: No, but it’s important because there are so many factors. I think the fact that—as you mentioned—that there are so many comorbid concurrent risk factor diseases that already impact women way more than men with SIBO is such a huge thing to consider. So, specifically with thyroid issues and Hashimoto’s, you mentioned constipation. Is that the big symptom regardless of SIBO to watch out for, and if so, why is that happening?
Dr. Brighten: Oh, I love this topic. We could actually talk about this for, like, three hours. I have Hashimoto’s myself as a result of giving birth to my son. I developed post-partum thyroiditis, so I’m very intimate with this condition. I also studied under Datis Kharrazian. One of my best friends is Dr. Izabella Wentz. So thyroid is, like, totally my jam. So let’s break this down.
Let me start from the top. TSH: that is thyroid-stimulating hormone. That is what your brain says to your thyroid. That is what most doctors measure, and that’s not enough. Right? They’re measuring a brain hormone to understand the function of a gland. Now, the other test that you would want to have done is a free T4, and that is what your thyroid produces.
So, your thyroid produces T4 and a little bit of T3. T4 is inactive. That means you don’t use it. You can’t use it at the cellular level and you have to convert it to T3. And you do this throughout your entire body, but the gut and the liver are major conversion sites of getting T4 into T3. Now, T3 is our active hormone. It’s our mood; it’s our metabolism; it’s our menses, so we have a regular menstrual cycle, we’re fertile when our T3 is right, we grow hair.
And some of the symptoms of hypothyroidism—so, certainly you can have constipation, but I’ve also seen patients with alternating constipation and diarrhea, because if you have the Hashi’s flare, that can actually cause the diarrhea and you start spilling all kinds of thyroid hormone. I see the majority of my thyroid patients do have small intestinal bacterial overgrowth, and the reasons for this, as I hypothesize, is that, one, without T3, you don’t move your gut. So, your migrating motor complex can try all at once, but you got to have that T3 to move your gut. You need that T3 in order to just poop every day. And if you’re not pooping every day, know that you’re not getting your estrogen out. And if you’re not getting your estrogen out, well, estrogen—she’s awesome, but she’s also a bit of a diva, and she comes around and bullies everybody off of receptors, and so estrogen dominance can also lead to that thyroid dysfunction as well. And so, it’s tricky because just because you’re not pooping, then your estrogen can build up, or you have dysbiosis, you get reconjugation, reactivation of your estrogen… Estrogen comes in… Now you can’t use your thyroid hormone that you are making as well.
Now, the other piece of it is that without optimal thyroid hormone, we don’t make our hydrochloric acid, so this is why it is very common to see in hyperthyroidism or Hashimoto’s—let me explain that, actually. Hashimoto’s is the autoimmune disease that causes hypothyroidism. It’s the number one leading cause of hypothyroidism within the United States, and it’s estimated—I mean, there’ve been some estimates that are like well over 95% of people with hypothyroidism, it is due to Hashimoto’s, which is an autoimmune attack on the thyroid.
So I just wanted to explain that piece, because I’m kind of using them interchangeably, and you can have hypothyroidism due to nutrient depletions, due to being on hormonal birth control. There can be other reasons, but the number one cause in the United States is Hashimoto’s, and you need an anti-TPO and an antithyroglobulin and a body test to understand if that’s true for you, and also to understand that there have been studies that have said up to 10% of people are zero negative. That means that you may have Hashimoto’s and we can’t actually detect it on a blood test because your immune system may not be robust enough for whatever reason. And so, understand that if you live in the United States and you’re hypothyroid, odds are, it is due to Hashimoto’s.
Now, this is important because it is very common in hypothyroidism to see low-mineral status. So, low-B12 as well, because you don’t have enough hydrochloric acid. You need the thyroid hormone to stimulate the parietal cells of the stomach to make the hydrochloric acid. They also make intrinsic factor, which is the only way you absorb your B12, which is why people with Hashimoto’s can start having brain fog. Well, guess what? If you don’t absorb your B12, well, the migrating motor complex is neuronal tissue. It can’t function either in your gut. So, you know, this is very common to see in Hashimoto’s. It’s also very common to see atrophic gastritis or an autoimmune inflammation of the stomach as well, which we will then see that dysfunction. And then, you can certainly have antiparietal cell antibodies and develop pernicious anemia, which is an autoimmune-mediated B12 deficiency.
Now, the other piece to get to the gallbladder piece is that without adequate thyroid hormone, we don’t get adequate gallbladder function. Your liver makes bile, your gallbladder stores it, and then that thyroid basically helps squeeze that little gallbladder to contract so that it puts that bile into your system. Without that bile, you don’t absorb your fat-soluble vitamins.
All of these things I just described, that will also make you nutrient deficient, and if you’re nutrient deficient, your thyroid can’t function optimally. And we need things like zinc and selenium, you know, just talking about minerals… We need B vitamins in order to synthesize thyroid hormone, to convert thyroid hormone, and to use it at the cellular level.
So, it gets pretty complicated, which I think is really fun. I mean, that’s my favorite part about medicine is that, I’m like, I would hate to be in a different philosophy of medicine that only focuses on one little thing. I love all the puzzle pieces, putting it together, and figuring out what’s true for the person sitting in front of me.
So, that’s just a few of the ways that thyroid dysfunction can affect the gut and then lead to small intestinal bacterial overgrowth. And then you get those bugs in your small intestine. You’re having gas, bloating, you’re inflamed, now you’re not converting that thyroid hormone, you’re not absorbing your nutrients as readily… And I’m sure that you’ve seen this—I personally have had SIBO myself, you know, but with that, I just wanted to say, people start reducing more and more because every time they eat, they’re bloated, they feel worse, now they’re getting even less nutrients in. And so, we’ve got a really big issue in terms of just normal thyroid function, not to mention, all of the other hormones.
And if your adrenals and your thyroid aren’t right, your sex hormones will never be right, so take that one away. Because that’s the other thing is like, with SIBO and hypothyroidism and Hashimoto’s and all that, you start getting inflamed. Now your adrenals have to work overtime. Your body says the environment’s not safe and it says, “Stop ovulating. Shut down progesterone production,” which is what makes you feel chilled-out, calm, and in love with your life, and instead, “hit the gas pedal on cortisol so we can save ourselves from the inflammation in our environment.”
Lapine: So, I’m so glad that you spelled it out for people who maybe aren’t already part of the Hashi Posse about the difference between—
Dr. Brighten: Hashi Posse! [Laughs]
Lapine: So, in terms of SIBO itself, obviously there’s a lot that can go wrong, as you said, when your thyroid’s not functioning optimally. What are the pieces that are specific to the autoimmunity? Do you see as high a percentage of people with SIBO that have just plain hypothyroidism as Hashimoto’s, or is it increased just with the TPO in the game?
Dr. Brighten: Yeah, so that’s the tricky thing is that I make this statement… We have to recognize that I see sick people. Sick people come to me and people know I have Hashimoto’s and I lecture a lot on Hashimoto’s, and so I get a lot of Hashimoto’s patients, and so there’s a bit of a bias there just based on the patient population that comes in. But we know—so the most classical form, as described by Mark Pimintel’s research and some of these other fantastic doctors, is the transient autoimmunity that can happen with the migrating motor complex, which I guess that actually leads into my SIBO story.
So, it’s funny because my husband was belching. He was having some bloating. He was having digestive issues. And I was like, “You have SIBO. You need to do this test.”
Lapine: The burping is always a dead giveaway, I feel. [Laughs]
Dr. Brighten: Yeah, right? I was like, “Your breath is really bad. I can’t make out. Sorry.” [Laughs] “So, like, you gotta do this test.”
And he’s like, “A three-hour test? Like, fasting and you gotta eat, like…” You think it’s gonna be fun to do the prep diet, because you’re like, “Oh, I get to eat—”
Dr. Brighten: It’s not fun! You get sick of it.
So he’s like, “I’m only doing this if you do this.”
And I’m like, “Fine, whatever, I’ll do this.”
I had no gastrointestinal symptoms. We do the test. My gasses are like ten times his. Like, through the roof. They’re some of the highest gasses I’ve ever seen. I’m like, “Oh my God, I have SIBO. I have SIBO! Okay.”
So, how did I get SIBO? Well, I was actually on a plane going to Paleo f(x). Ironically, Chris Kresser was sitting right behind me. Dr. Ruscio was sitting across from me on this plane, and Michelle Tam from Nom Nom Paleo was on there as well. And I had gotten a beverage in the airport and it was this unpasteurized juice, and I was like, “Fantastic. I’m gonna have this unpasteurized juice. Gonna load up on nutrients.” And, sipping on it, I fell asleep on the plane listening to Sean Croxton’s podcast, and I’m like, “Oh my God, I’m gonna throw up on this plane right now.” Mind you, I’m on here with a bunch of other health influencers. Yes, they’re friends, but it’s also like, these are colleagues, and I’m going to vomit on the plane.
And so, the lady sitting next to me was actually really rude, and I was like, “I have to get up right now.”
And she’s like, “We all have to get up and go to the bathroom,” and starts giving me attitude.
I pull the puke bag out from the thing.
I’m like, “What I have to do will not fit in this, okay? You don’t understand.”
She smacks her husband and she’s like, “Get up now.”
I bolt. Run to the back of the plane. I lost it all. Oh my gosh, and everybody could hear me on the plane. Like, that’s how bad and violent it was. And I come out, and then I ask the flight attendant for, like, all the ginger ale she has. I’m double-fisting ginger ale, and then here comes Michelle Tam. It’s funny because here I am slamming as much high-fructose corn syrup as I can while I’m going to Paleo f(x)—like, a paleo conference!
Lapine: [Laughs] Beautiful. The ironies of the world.
Dr. Brighten: Totally. And I go back to my seat, and then I open up the bottle and look at the cap and there’s mold in the cap.
Dr. Brighten: Like, it was growing stuff on it. It was mold or bacteria. I didn’t culture it, but it was not right, and I didn’t see it, and I’m like, crap. So, I had food poisoning, and then, several months later, I did this test, and sure enough I had SIBO. It was after the test I started having bloating, and I was actually just sharing this—I was telling you before we started recording—my friend, Dr. Ken Brown—I was sharing with him, like, I knew I had SIBO when I ate, like, one too many cherries—it was cherry season—and then I was writhing in pain in the bed, bloating, to the point where my husband was like, “I’m gonna call an ambulance. I have never seen you like this—sweating, in so much pain.” And now it’s something like—I share that story because that is like how much SIBO can mess you up.
Lapine: So you did have the symptoms! You did have the symptoms, you just didn’t…
Dr. Brighten: Not until after I took the test. So, after I took the lactulose breath test—and this happens in some patients—so I actually was having some funky rashes. That’s how my SIBO was showing up. And that’s to say, it’s not always gastrointestinal, and that’s why I actually advocate to test in the majority of people because, you know, I find it in people, and I found it in myself. I never had any of those symptoms. After I took the test, then cherries triggered me, and cherries were my only trigger. Like, super bizarre, right? Onions, garlic, broccoli…none of that was a trigger.
Lapine: Interesting. And can you explain to people why the lactulose breath test may have triggered more symptoms that were just dormant?
Dr. Brighten: Yeah! Because I fed those organisms like crazy. So the lactulose breath test, you drink that sugary beverage, and it’s meant to feed those organisms so that they put off gasses, and you can measure it. And so, I was eating a paleo diet and, mind you, I was eating FODMAP foods, but I wasn’t eating refined carbs and things like that. But you can do a lactulose breath test, and that can absolutely trigger the symptoms, because you just got all those organisms hot and bothered. They get super, super excited. They’re like, “Yay!”
Dr. Brighten: The reason why I share this story is because I had food poisoning, and that’s one of the most classical ways… They’ve done research on IBS and the military and found that people with post-traumatic stress disorder, people who were in active war areas—so, being shot at—they didn’t have a higher level of IBS diagnosis. No. In fact, what the research showed is having a history of food poisoning put you at a higher risk of it. So we’ve always been told that IBS is psychological. I do believe there is a stress component to IBS, but I don’t think it does anyone any favors to stop there and stop asking why.
Dr. Brighten: And so, what happens is that you get food poisoning. So, salmonella—potato salads in the summer. That’s, like, one of the most classical ways we get food poisoning. You know, salmonella, shigella, one of these bad guys—if you get too much of them—will release cytolethal distending toxin, and that’s as bad as it sounds, and your body being really smart’s like, “Whoa, we’ve got to neutralize that.” So your body makes antibodies to that.
But the tricky thing is there’s an amino acid sequence, and that toxin that also looks like vinculin, and vinculin is a protein on the migrating motor complex, and so that food poisoning can trigger a transient autoimmunity. And so now your immune system begins attacking the migrating motor complex. Why we say it’s transient is because you can heal from that, and as we know, with autoimmunity, you can put it into remission. What I see is that if you already have autoimmunity, you’re already programmed to go there and to do that autoimmune dance. But the other piece of that is that if you’re hypothyroid, you have inadequate thyroid hormone, you have slower gut motility, then you’re going to be at higher risk of getting food poisoning, which is also why if you’ve ever had SIBO, you’re at higher risk of getting food poisoning.
So, you’ve had SIBO. I’ve had SIBO. We’re not good examples. But let’s say we’ve got someone who’s never had SIBO and then there’s me who’s had SIBO and we both eat the same exact meal and we both get the same exact exposure to, say, salmonella excess. Well, they have hydrochloric acid. They have a bile acid. Things are functioning and their gut motility is intact, so it moves through quicker and they can handle it. My gut is a little bit slower. Like, maybe I don’t have enough hydrochloric acid. There are other things that make me susceptible. Now I’m more likely to have a relapse in SIBO and have that triggered again, which is why all of my patients, if they have ever had SIBO, we put together a whole plan if they’re going to travel overseas. So, that’s not to say—I mean, food poisoning happens in America, too—but like if you’re going to be in Mexico or Bali…
Lapine: I’m literally going to Mexico tomorrow. Please tell me what I should do. [Laughs]
Dr. Brighten: Some doctors will give antibiotics. I usually use—I have a product called Gutclear. So I like to use that with my patients because it’s a more broad spectrum, so it’s actually good for bacteria, yeast, and parasites. It’s formulated in that way.
And then I prefer megaspore biotic, but the other thing is when you’re in Mexico, it’s going to be hot and you might not have a refrigerator and you don’t have to worry about that, because these are spore-forming organisms. They survive the hydrochloric acid and they are shown to promote diversity in your gut, which means that getting more good guys in your gut—they will throw down and fight on invaders with you. And so, that’s just a couple of things that I recommend. And what I’ll have people do is, I’m like, “Listen. If you think that you have eaten a meal that’s sketchy, go ahead and take that Gutclear. Go ahead and take it with that meal.” Otherwise, you’re taking it between meals, and then you’re taking the megaspore with your meals.
With some people, depending on what’s going on, I’ll be like, “You’re taking a megaspore with every single meal,” and so that might be three to four caps in a day just to safeguard them. It’s really important that people understand you can do antimicrobials, but also that those good guys in your gut, they’ll also throw down for you and they’ll protect you from contracting these things. And then the other thing I would say is getting a digestive enzyme.
So, I have a product called Digest, and why I like this is because it had pancreatic enzymes and then it also has in it bile acid and hydrochloric acid. So the hydrochloric acid’s going to help—and for everybody listening, if you don’t have hydrochloric acid and you don’t get the party started up top, then nothing works right downstream. And so, that is antimicrobial in itself, and it actually helps your gallbladder and your pancreas function more optimally. And then the bile acid is actually toxic to organisms that shouldn’t be living in your small intestine, and so that’s the other piece is that we can actually leverage what your body has designed to do so that those organisms stay in the large intestine.
Lapine: This actually goes back to one of my first follow-up questions from your bio, but I’m curious how you taking proton pump inhibitors for so long—if you think that had any role in your issues later in life?
Dr. Brighten: I was so noncompliant. [Laughs]
Dr. Brighten: So let me say that when you tell a teenager, “Hi, you’re going to have to take this pharmaceutical every day for the rest of your life…” Like, I was taking the pill. That was enough. I was not going to be compliant with that.
The other thing I noticed is that when I was on—well, I actually have never shared this before. I’m going to share it now. I was on those proton pump inhibitors and I was super spacey. I would be in my car driving and be like, “Wait, where was I going?” It was scary.
But I also was dating this guy. He was not good to me. I remember my friend saying to me, “I feel like when you stop taking that drug, you’re going to stop dating that guy.”
Dr. Brighten: And mind you, I was also on birth control, which also makes you pick bad boyfriends. And so, there was all of that, and sure enough, when I got off of it, I was like, “What! Peace out, buddy!” I broke up with that guy, and what it was was I just stopped taking it. I just was like, “I’m sick of taking this.”
I did get rebound heartburn with all of that, but it’s interesting now because when I talked to my doctor about that and I was like, “I feel spacey. I feel like my head’s disconnected from my body.”
And he was like, “Yeah, that’s not a thing.”
And now seeing, like, here we are, decades later. This is like 20 years later. Oh, hold on, yeah, they do have an impact on neurological health. But it was scary—almost like dementia symptoms where I couldn’t remember things. So I was just really noncompliant. That’s really what ended up happening. And I do believe had I stayed on it, absolutely it would have messed me up even more. I probably would have been hypothyroid way sooner, too.
Lapine: So just to explain to people who may not know—so proton pump inhibitors are essentially just suppressing stomach acid, correct?
Dr. Brighten: Yeah. And the funny thing about it is that most people have heartburn because they don’t have enough hydrochloric acid…
Dr. Brighten: …So it’s just silly, right? Because hydrochloric acid—so for people who are like, “Wait, what’d you say?” Hydrochloric acid stimulates the esophageal sphincter—which is basically the gatekeeper between your esophagus and your stomach—to close. And so, when your stomach acid is low, it doesn’t close, and then some of that acid can spill up, which makes some of these conventional docs say, “Oh, the problem is you have way too much acid,” which is a very simplistic viewpoint. When in reality, most of the time it’s that, no, it’s because you don’t have enough hydrochloric acid and, you know, if you have gastritis and you take hydrochloric acid, it’s going to burn. So just know that if you have inflammation of your stomach.
But one test you can do is you can actually take—and it just really depends—you can take a couple teaspoons or up to a couple tablespoons of apple cider vinegar in the little bit of water before your meal. If you don’t have heartburn and it helps, it’s because that’s stimulating your hydrochloric acid, and so your answer is you need to increase hydrochloric acid production.
And then we have to ask, why? Why are you not making enough hydrochloric acid? Is it because you’re not smelling your food? You’re not eating it in a relaxed environment? (Because that has a bearing.) Is it because you’re hypothyroid? Is it because you have an autoimmune condition attacking your parietal cells? What is actually going on for you that your body’s not functioning the way it was designed? And that is, to me as a physician, the very first question we should ask before we pass someone a pill of any kind. Even supplements, we should be asking that question. That’s not to say that using supplements or using pharmaceuticals is bad, but it is to say that using these kinds of things without a question of why is just a Band-Aid solution.
And we started at the top of this conversation, these things that are sometimes just minor inconveniences… It feels like, oh, I have a little bit of heartburn—sometimes people just pass it off, but they can actually be signs that something deeper is brewing. So, I’ve seen patients who have been put on proton pump inhibitors—so, shutting down their hydrochloric acid production—and I’m like, well, why? You’ve been on this for a long time and these are not approved to be used for long periods of time, let alone when they were being used on me—they were never even studied in children. So that kind of makes me shudder.
Lapine: Good thing you were noncompliant! [Laughs]
Dr. Brighten: Yeah, right? I know! Well, they tried to put me on these things when I was, like, ten, and I was definitely noncompliant. But I’ve seen people with just a lot of dysfunction that’s stemmed out of using that proton pump inhibitor without anybody really asking why.
Lapine: And explain, for those who don’t even know the connection, why you need stomach acid in order to have good gut health—in order to prevent dysbiosis.
Dr. Brighten: Yes. So you eat and you always are getting exposed to all these organisms when you eat, especially if you have children. I have a five-year-old and, man, when he was a baby, I’m like, “Can you just keep your hands out of my mouth, man?” Because anybody who’s ever breastfed is like, “Yeah, I know what you’re talking about. They just stick their hands in your mouth and you think it’s cute and you’re also like, ew, wait a minute…”
So, hydrochloric acid is antimicrobial, so it’s your first defender, but it’s also—everything is an intricate symphony within your body. What I mean by that is there are instruments that must be in tune and they must play. I usually explain this with hormones, but if you’ve ever listened to music, if one instrument was out of tune, it throws off the whole piece. Everybody starts to try to compensate, and now we have dysfunction.
And so, with that, you have to have that TH—that acidic pH. So you eat the food. This little acidic bolus of food is going to come through, and it comes down, and it’s that acidity that is going to trigger the pancreas to work correctly. And so every organ really depends on that pH change within the intestines to start to do their job correctly. So if you do not sit down, be calm, see your food and smell your food, you stand no chance in optimizing digestion because it really starts with our senses. You want to smell it, you want to taste it, you want to be in the moment with it. It’s like the best act of mindfulness. You don’t have to be a yogi. You can just be present with your food and you’re winning, okay? So, guys, this is a really easy tip. And then you gotta chew well, and most of us don’t chew well. And I am gonna own that there are days I do not chew well. And I have a five-year-old, so I know, like, mamas, what do we do? We’re like, “Oh my gosh, shove the food in my mouth. Run after my kid while I’m chewing.” That is terrible for your digestion.
If you are in sympathetic state—so, let me explain. You got two aspects of your nervous system. We’re going to keep this simple. We’ve got rest and digest—parasympathetic activity. Exactly what it sounds like. If you’re not chill and calm while you eat your food, then you’re going to take that blood that should be going to your gut and letting your gut function and you’re going to put it out to your muscles as you go into that sympathetic state.
So now we are in fight, flight, or freeze. And if you’re in the sympathetic state, which a lot of us are—so that’s what I was talking about. If you feel like you’re in a dangerous environment, your body chooses survival all the time—now you are in that fight or flight, you’re not going to digest optimally, and that’s why that is so important. And so if you are someone who is struggling with your hydrochloric acid, with any of these things, know that you have so much power just in how you step up to your plate—not baseball—stepping up to your plate of food. You have so much power in that, to really optimize your digestion.
Lapine: That’s so important. Thank you for giving some people some agency in all of this, because it definitely feels like there are a lot of pieces of the puzzle that we can’t necessarily control.
That’s a good segue to talking about diet, which, besides—I’m glad you talked about the “how” of eating, but I feel like people, especially with SIBO, really hone in on the “what.” So, in your experience, how do we kind of reconcile the best SIBO diets with the best thyroid diets, since SIBO tends to be very anti-carb and I know that’s not always so great for us Hashi Posse members?
Dr. Brighten: Yeah. So this is a great question. The first thing I’m going to say is that you cannot be on a low FODMAP for any of these restrictive diets too long. And I just get really troubled when I have someone come in and they’re like, “I’ve been on the low-FODMAP diet for two and a half years.” And I’m like, “Well, that’s about two years too long.” If the treatment’s working, the goal in my clinical practice is that we get people always—I don’t care what your condition is—the goal is as much food as you can tolerate. Now, gluten aside, because that is not a Hashimoto’s gal’s friend. That’s, like, nobody’s friend these days. I’m sad about it because I know it’s delicious, guys. But yeah, no gluten.
But, you know, in terms of that, I see a lot of doctors who are like, “Just go on the low-FODMAP diet for the rest of your life.” Well, without cruciferous vegetables, we have a very hard time running liver detox pathways. That can get us into big trouble in our environment, and that’s just one example. Plus, there are all the nutrients you’re missing out on. So, you know, you start to have a lopsided diet. Now we are ending up with nutrient deficiencies.
When you have diversity, you have diversity flora in your large intestine—yay, that is a very healthy gut. But you also send the signal to your body that the environment’s safe, and any time you can tell the body the environment’s safe, the hormones are going to sing. They’re going to be way better.
And so, in my practice, we typically use the low-FODMAP diet, and when I approach treating SIBO, we are more successful if we just let people eat whatever they want to eat while we’re going through the antimicrobial phase. So, we go through the antimicrobial phase and there might be food sensitivities that we have to avoid. So maybe it’s like I can’t eat soy, gluten, dairy—some of these things.
But in terms of the FODMAP piece or any of these other diets, we just let people have free range. Eat what you feel comfortable eating because we want to feed them. Most of my patients want to do an herbal antimicrobial approach. And so what we’ll do—and that needs to be at least a month typically—is that we’ll go three weeks, eat whatever you want, and then at week four, we’re going to start the low- FODMAP diet. And why I do it that way is because I’ve done the low-FODMAP diet… Have you done the low-FODMAP diet?
Lapine: Oh yeah.
Dr. Brighten: Yeah. You’re going to mess it up the first week. Like, you’re going to mess it up because it’s so complicated.
Dr. Brighten: And then you don’t have to stress about it because you’re on these antimicrobials for that week. And then we were like, okay, you’re going to start that week, you’re going to have some hiccups, and we’re going to get it right, and we’re going to be on that, and it’s going to be anywhere from four to just 12 weeks. It really just depends on what’s going on, but I like to get people off of that as soon as possible.
So, let me explain. We do the antimicrobial, then we go into a gut repair phase where we’re repairing the intestinal lining, helping seal everything up, reestablish function… There are supplements involved, yes. There are a lot of lifestyle practices. You got to be stimulating that vagal nerve.
So, with that, I want people to come off. The reason is because I’ve seen that not every high-FODMAP or moderate-FODMAP food is a trigger for everyone and the question we are asking is, what is true for you? And so, you know, I will say onions, garlic, and apples—those tend to be the hardest for people to get back to. Sometimes it’s avocado, though. Sometimes it’s, I can eat broccoli but it’s the cauliflower that gets me.
And so, we want to understand what’s true for you, and anything that aggravates, we go ahead and leave that piece out, but we start bringing in the variety. Psychologically speaking, I think that is why I’m also behind this approach because I think that—I see this all the time in health—it just gets so rigid, so convoluted, and then people are developing eating disorders. I’m not saying you’re anorexic or you’re bulimic, but you have an inappropriate relationship with food. And if you come to your plate every time and you look at it as, This food is the enemy. I should be scared of it, you’re going to have symptoms, because your mind is that powerful.
Lapine: Totally. So when you do that four plus weeks of low-FODMAP diet post antimicrobials, is your goal there using the low-FODMAP approach as a means of healing? Is it to just mitigate any effects of lasting bacteria that are straggling around and kind of doing a part two semi-starve? Tell me just a little bit more about this strategy.
Dr. Brighten: I really hate war analogies, guys, so if you get offended by it, I’m with you, but I think it works really, really well, and it’s the best language I have. So my approach is, we’re going to go in and we’re going to cut down the troops—the number of the troops. These organisms are not “bad,” so we don’t need to blast them all out of your gut. I’ve definitely talked to clinicians and they’re like, “I go in and I kill everything,” and I’m like, “But your large intestine’s really important. Do you know that? Do you wonder why your patient has anxiety after your start treating SIBO?” That can happen. So, with that, we’re going to cut down the numbers. So, we’re going to cut down the number of the troops.
Then, as we roll out of the antimicrobial phase, we start healing, and we’re going to starve them now. Now they have no choice but to retreat to the large intestine where they belong, so that’s the philosophy with that, is that we’re going to withhold food from them. Another thing that I’ll do, and it just depends on, like if you’re someone with severe adrenal issues going on, this may not work for you, and that’s why I take a really individualized approach, is that we do intermittent fasting.
So we shut down—I’m like, you have to have a minimum of 12 hours of fasting. We go into the repair phase. And you have to get good sleep, because the migrating motor complex—so that street sweeper we were talking about—that’s going to sweep about four times on average, so take everybody from the small intestine down to the large intestine.
And then, first thing in the morning when we break that fast, we’re going to avoid the high-FODMAP and moderate-FODMAP foods. We’re actually going to avoid all carbs and we’re going to eat more of a ketogenic breakfast, and that’s going to be in a fasting range, and that’s because—so one, we’ve got the migrating motor complex. It sweeps things through. Fasting can actually optimize your microbiome health overall. And then feeding only fat and protein in the morning, you’re starving them, and then carbs show up later in the day, you’re telling them, “Hey, hey, get back to that large intestine. I got you and I’m gonna take care of you. But if you’re up here in the small intestine, you’re not going to get what you need.”
Now the other thing is that fat is actually a prokinetic. So, if you’re someone with constipation, that can stimulate things to move through the digestive track. That doesn’t mean if you have diarrhea—I haven’t seen it work that way in terms of like, if you have diarrhea, eating fat’s going to cause you to have more diarrhea. But it is beneficial with people who have constipation.
And so, again, to kind of recap, we’re first going to do antimicrobials. Cut down the troops. Then we’re going to starve them out so they have no choice but to retreat to their home base, which is the large intestine. Does that all make sense?
Lapine: Oh, it makes perfect sense to me, and part of the SIBO Made Simple way. I’m going to distill it all at the end of the episode for people in case anyone missed anything. But one thing I want to ask you about since you brought it up—the intermittent fasting—is there anything to watch out for for women in general and, you know, knowing that a lot of women do suffer from adrenal fatigue since, as we discussed, we’re all chronically stressed?
Dr. Brighten: Yeah. So that’s a very big conversation that we could get into, but I will say this one thing, which is that anybody listening can identify if it’s not right for them. If you were a woman who has difficulty staying asleep—you wake up in the middle of the night, you feel hot, you’re sweaty… And I’ve seen this; you’re like, “I’m 22! I’m having hot flashes!”
You’re not going into menopause. It is likely your cortisol is spiking, and the reason for that is that your blood sugar is dropping. And so, fasting is going to be more difficult for you because your blood sugar drops, then your cortisol spikes, then you get all hot and sweaty, and it does that because when cortisol goes up, it stimulates the glycogen—the storage form of sugar in your liver—to be released.
Then your blood sugar goes up. And it’s basically like your brain is like, “We’re starving!” And your body’s like, “Nooo!” And it’s a very, very important mechanism so that you stay surviving. This is a good thing, but it is a sign that you have blood sugar dysregulation, which is something that is likely due to adrenal dysfunction. And as I said, if you don’t sleep, that migrating motor complex doesn’t work, plus you’re going to be tired the next day. You’re going to be in hormonal chaos as well.
And so, with that, these are people that I will instead, what we’ll do, is I will have them—and I actually, so my book, Beyond the Pill, I have an entire gut chapter where I talk about the hormonal birth control and the connection to SIBO and to a lot of this gut dysfunction. I put the whole recipe in there of this, what I call, “upgraded golden milk,” which is where I have people at night drink a beverage that has turmeric in it—so, anti-inflammatory, your gut loves that—and then we add fats into it as well. So like, coconut oil and butter or ghee. It just depends on what your sensitivities are. And then sometimes we put collagen in that as well. And what that does is that fat—that bolus of fat—will stimulate the migrating motor complex, will keep things moving through the intestine, but it will also give you some fuel so that you can sleep through the night.
So, that was a great clarifying question. I hope that helps women understand how to differentiate that, and I do think… I was somebody, it wasn’t until I really loved up those adrenals and that thyroid right. Now I do. I do 12- to 14-hour fasts every day, and that’s just how I feel optimal.
Lapine: Amazing. And so, for those who are fearing going no-carb, having it in the afternoon… I mean, that to me sounds like a really good compromise. Do you find that that actually helps women who maybe, I don’t know, I guess our energy reserves are feeling a little bit insecure without any carbs at all?
Dr. Brighten: Yeah, so that’s a great question. I actually find that people who do a loaded-carb breakfast in the morning, they tend to crash. They crash at like 10 to 12 o’clock, or sometimes 2 o’clock in the afternoon. And you’re not doing it—this is not for life. You’re doing this… We’ll do it anywhere from 14 to 30 days where they are only eating fat and protein in the morning.
I want to clarify that if you’re a woman with polycystic ovarian syndrome, you’re better to go higher fat than higher protein because of how it stimulates insulin. It’s the same thing if you have insulin resistance—higher fat than higher protein, because protein will stimulate insulin to go up. And so it actually can help hormones as well, and fat’s how we build our hormones.
And in some of these people, we’ll do something where it’s like, well, let’s do a cup of cooked spinach or wilted spinach where you massage some kind of acid like a vinegar on it, because that’s still really lower carb, but sometimes they’re like, “I just feel like I need that little bit of fiber.” So I just want to say it can be very individualized and you might have to play with it.
And it doesn’t have to be totally in the afternoons. Let’s say you eat at 8 o’clock in the morning. Maybe at 11 o’clock in the day you’re going to have a little bit of carbs with whatever you’re eating. If you have SIBO, you’re better off to go a four-hour period between meals, but if you are a woman with hormone imbalances, that can be tricky.
Also, understand that there are a lot of really smart people in the SIBO world, but the majority of them are men, and there are a lot of studies on men, and these are some of my besties—I love these people—but you know, they’re men! We’re getting studies and trials that are on men and that… we’re not men! And we’re not smaller versions of men. We’re not just, like, a different model. We are women. We have cycles. We are very distinct. And so it’s something that like, you tracking your data, you being in tune with your body—that is so powerful in being able to heal yourself. And so, I just really want everyone to recognize that, especially in the keto conversation—it’s men! Men are driving this conversation; the studies are on men; it doesn’t apply to women. It’s not the same.
Lapine: No, I’m so glad you said that. And, you know, we’re going to wrap up because I want to be respectful of your time, but on that note, is there anything else you want to say about what women facing a SIBO diagnosis should do retreatments that maybe isn’t talked about enough as a gender-specific tactic, or something not to do?
Dr. Brighten: You must get your thyroid tested. I can’t tell you… I have seen patients who come to me, and this is scary to me… They’re on their 12th round of rifaximin, and that’s the definition of insanity. I actually wrote a whole blog called “Healing Hashimoto’s.” Doing the same thing over and over and expecting a different outcome. That’s the definition of insanity, defined by Albert Einstein, who we can all recognize is a legit genius. Dr. Jolene Brighten did not define this. And I will test them, and their TSH—I had one woman, 12 rounds of rifaximin—her TSH was 18.
Dr. Brighten: Wow! Your TSH shouldn’t be above 2.5, ladies. Her issue was she was hypothyroid, and so she kept getting treated for SIBO, and I was like, well, you’re not pooping and you have SIBO because you’re hypothyroid.
So, in terms of that, advocate for yourself. I gave you the full thyroid panel in this conversation. You want to do other hormone testing as well, and you want to look at that. You are a complex biological system. You are way more complex than your male counterpart. And track your symptoms in relation to your menstrual cycle, because if you are finding that you have diarrhea and it’s coming up a couple days before your period and during your period, I have some gastroenterologists say, “Oh, you have IBS.” Ladies, head over to my blog. I wrote a whole blog on, why do I poop so much before my period, during my period? It’s because of prostaglandins. I would bet money you also have really painful periods. That is a prostaglandin issue. That is not a gastrointestinal issue. That’s because you cycle and you shed your endometrium. That’s a period. And that’s what’s going on with that.
And then, it might be that like, oh, the week before my period? Well, I notice anywhere from day 21 on of my cycle, I get really constipated. You might have too much progesterone. Progesterone is going to… it’s a smooth muscle relaxant, so you’re not pooping because you have all that progesterone, and now you have estrogen dominance going on, and now that’s affecting your thyroid and affecting your gallbladder.
And so, track your cycle and track your symptoms with your cycle because it may not be that you actually have a gastrointestinal issue. It may be those are symptoms that are side effects of what’s actually going with your hormones. It’s a natural occurrence through your menstrual cycle, but things are a little bit off-kilter, and there are very easy things that you can do to start to balance that, and I know that we’re wrapping up here, so I’d say head over to DrBrighten.com. I’ve got all of this, like, how the gut is connected to your thyroid, how the gut is connected to your hormones, why you poop so much before your period, why are you getting constipated with that… So that you can understand that your gut isn’t the end of the story, and it’s very, very intimately tied to your hormones.
Lapine: Thank you so much, Jolene, especially for telling everyone how they can find you. I will link to some of the specific resources you mentioned in the show notes, and I hope that everyone goes and checks out your book Beyond the Pill, because I know that it’s going to be hugely relevant to a lot of women listening today who have thyroid issues and SIBO and just the whole enchilada of fun. .
Dr. Brighten: Awesome!
Disclaimer: The information shared in this podcast is not meant to provide medical advice, professional diagnosis, or treatment. The information discussed is for educational purposes only and is not a substitute for medical or professional care.