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Understanding The SIBO-Hashimoto's Connection

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Hear from food & health writer and Hashimoto’s advocate Phoebe Lapine about how small intestinal bacterial overgrowth (SIBO) may be a trigger for Hashimoto’s disease, and what to do.

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The SIBO-Hashimoto's Connection

Hi, everyone. Welcome. We're going to give everyone just a minute to filter in here before we get started. My name is Katie. I am part of the team at Paloma Health and Paloma Health is an end to end medical practice for hypothyroidism and Hashi motos. And today we are sitting down with Phoebe Lapine to talk about the connection between Hashimoto's and SIBO

[00:00:29] phoebe is a wellness expert. She's the Hashimoto's patient and advocate herself. She's a food and health writer. She's a gluten-free chef. She's a culinary instructor. And her work has been featured in all sorts of places like the Huffington post, mindbodygreen, cosmopolitan, O magazine. She's pretty impressive.

[00:00:47] She has a lot of knowledge, so we'll pass it off to her in just a second. Phoebe is the host of a podcast called SIBO made simple, and she just launched a book under the same name, SIBO made simple. So she'll tell us a bit more about her book and what tools are in there. Also our event today is about 45 minutes and we will hear from Phoebe first and then we're going to open it up to live Q and a.

[00:01:09] So go ahead and drop your questions in the chat box at the bottom. And we will get to as many as possible at the end. So Phoebe, I will let you take it from here. It's so nice to be here. I feel like you guys lucky to hear about Paloma in the early stages of your guys's development. And I just absolutely love what you're doing.

[00:01:29] I love the test too. I use them all the time. So I'll give you a little bit of an overview. Usually when I'm talking about this book, I don't start my story so early, but I'll start in the early stages of Hashimoto's. And what I wrote about it in my last book, which was all about. That journey.

[00:01:45]I was diagnosed when I was 22 by my regular GP. And I know I was even lucky at the time to get that diagnosis, but of course, as I think a lot of you will probably identify with, the response was just like, it's nothing to worry about. You'll just have to be on medication for the rest of your life, like having a nice day.

[00:02:04]And that wasn't really something that I was particularly ready. To face. So I did what any super mature 22 year old would do, which is I just pretended the conversation never happened and went on living my life. And, while I was really lucky to get diagnosed, probably pretty early on before I had a full chance to find my rock bottom I managed to find it on my own anyway, working at the time as a chef and caterer in New York and just running myself into the ground.

[00:02:33] And eventually all of those symptoms caught up with me, the crushing fatigue the numbness in the hands and feet, the horrible gut pain and various digestive issues, which we can talk about where Hashimoto's fits into all of that in a bit. But. Eventually, I found a holistic medicine and kind of my food journey and my wellness journey were able to dovetail.

[00:02:58] And even once they did, I felt just like very overwhelmed by, the two sides. The two sides and like the gap that existed in between like conventional medicine, holistic medicine, like conventional medicine was obviously not giving me a whole lot to grasp, food is medicine.

[00:03:15] And then the other side, also about overwhelming, it just felt like there was this laundry list of things I need to do. Things, I need to detox from my home and supplements. I need to take and just, lifestyle overhauls that need to happen. And just basically my come to Jesus moment with all of that culminated in what ended up being my last book called the wellness project.

[00:03:37] And it was a real project that I did. In real time and wrote about it on my site. But I really just tried to take a step back and figure out how to tackle each one of my wellness problem areas. One by one, not with the intention of becoming the healthiest person in the entire world though. I really definitely wanted to get my Hashi motors under control as a result, but, the goal was figuring out like what is actually worth my time, money and energy, because it's impossible to do all of the above all at once.

[00:04:05] And I think. The benefit of there being so many things to choose from in this world of holistic medicine is that you really can find the things that are both. Or either hugely physically impactful or that genuinely bring you some sort of joy or enjoyment. So I crafted this kind of philosophy, which I call healthy hedonism, which is like the Venn diagram, wherever the things that nourish your body, meet the things that feed your spirit.

[00:04:35] And I tell you this all in advance, because it definitely speaks to my approach with SIBO as well. So at the end of my project, my blood work was actually great. I was feeling so much better wrote this book, went out on book tour seven months after that, I started to feel these mysterious, that symptoms creeping back into my life.

[00:04:54] And, I'd done a ton of research over the course of that project. And I really thought that I knew everything there was to know about gut health. I was just, crushing probiotics, eating all these fermented foods and inulin, rich vegetables. And as my symptoms started to creep up on me, just like bloating after every meal, I was burping a lot during meals and just, on the cycle of constipation diarrhea.

[00:05:20]But I just doubled down. I just started tried drinking, Mark and Boucher and taking my probiotics and doing all the things that these microbiome specialists had told me to do. I ended up back at my doctor's office. He gave me a test for SIBO spoiler alert. It was something called seatbelt. And that honestly turned everything.

[00:05:39] I thought I had known about that house on its head, because it was this fascinating. I thought at the time niche condition within gut health, where kind of the treatment management to men and management is to do the polar opposite of what I had learned over the course of my wellness project. So I will just get quickly into kind of the one Oh one on SIBO for those of you.

[00:06:05] Who do not know what it is. Hopefully probably just reading the description of this chat, you know what it is, but we'll dive into a little bit more specific. So small stands for small intestinal bacterial overgrowth. And I think one of the tough things about the way that kind of. Things about our microbiome are trickled down into like wellness speak.

[00:06:28] Is that you hear a lot about your good gut bacteria and you don't realize that, people are really just referring to what's in your large intestine. That's where the majority. Of your quote unquote, good back, good gut bacteria, every, any kind live. Every digestive organ has its own ecosystem, its own microbiome, but the small intestine in particular is not a place where you're supposed to have any bacteria at all.

[00:06:53] It just doesn't have a role and it's really not designed to withstand any bacteria. In fact, When our digestion is working like a well-oiled machine, we have all of these anti-microbial substances to ensure that bacteria that just naturally comes in through the nose and mouth never makes its way to the small intestine.

[00:07:12] And even if it does then can never colonize and stay for good. So we will get into a few of the root causes of SIBO and why some of those mechanisms white might break down. But first I just want to talk about the symptoms. There's something called the low FODMAP diet that I had heard about in my research.

[00:07:31] And again, it was a point of confusion for me because it was basically. All of the things that, microbiome specialist tell you to eat the fermented foods, the inulin, rich vegetables, the little goobs, the fibrous, beans and whatnot. Those were all on the no list with a low FODMAP diet.

[00:07:47] And it always confused me until I discovered see about, I started to learn more about SIBO. And if you do have an overgrowth of any type of bacteria can be good or bad, it makes perfect sense. That these things that constitute your bacteria, his favorite food would just make you miserable. So in your small intestine, That's where you absorb all your nutrients, it's where you digest.

[00:08:12] So again, bacteria, it does not have a role. In fact, when it's there, it is competing for the food at your table. And when it eats this list of favorite foods, a lot of which include the carbohydrates in the FODMAP acronym, they eat it and they release gas. Different types of gas spec, depending on what's overgrowing, but that gas is what causes those uncomfortable IBS symptoms.

[00:08:35] And it's thought that SIBO, which by the way, is not a disease in and of itself. It's just a condition and kind of a sign that things have gone awry and your digestive system, but SIBO is said to be the root cause of. Over 60% of IBS cases. And by the way, the low FODMAP diet is one of the most data-backed approaches for limiting the symptoms of IBS.

[00:09:00]So that makes perfect sense. If you take away some of these foods that are creating, that your bacteria are feasting on and therefore creating gas, you're going to limit the gas and some of the uncomfortable symptoms. And so back into what those symptoms are. The burping to me made a whole lot more sense, because again, your bacteria's a lot further away from their usual exit ramp.

[00:09:22] So it flatlands through both ends, but more likely, just really trying to. Find a way out, whatever way possible. And also just really like uncomfortably getting trapped below your ribs. SIBO, I think, in terms of differentiating it from just regular old IBS, that may be a cause of something else.

[00:09:42] It's a frequency game. So if you're uncomfortable, every time you eat, that's going to be more in the SIBO camp. And if it feels right. Further up and an inner tube underneath your ribs. That's more SIBO, not like it's not like bloating, like ladies you would get before your period. So in addition to the four hallmark IBS symptoms that I've ticked off slowly, other things that fall more into kind of the auto-immune spectrum is when that gas is just stuck in your small intestine.

[00:10:16] And when there are bacteria in there, they can chew through, eat through right. You're very thin mucus lining. You have a much thicker mucus lining in your large intestine again, cause it's designed to withstand bacteria and when they chew through or eat through they become in contact with your immune system.

[00:10:33] And that's when a lot of inflammation happens. It's when you can damage the integrity of your tight junctions leading to leaky gut. And then it's when you know, small pieces of bacteria in small pieces of food can make it into your bloodstream and cause systemic inflammation and. We'll get it again into kind of the buckets for root causes of SIBO, but auto-immune diseases in general Hashimoto's and beyond are just a big risk factor for seatbelt.

[00:10:59] And then I think it goes the other way too. It's unclear with the research where it stands today. What the chicken or the egg. Relationship is, but it again is another like very overlapping Venn diagram, autoimmune diseases and SIBO. So in that column of kind of auto-immune symptoms, you're going to get brain fog.

[00:11:18] You're going to get strange rashes, joint pain certainly nutrient deficiencies. Cause again, like there's something. Literally eating your meals weight loss, or weight gain, depending on what type of bacteria overgrowing, cause certain types of bacteria can actually metabolize your food differently and cause you to put on weight.

[00:11:38]And then of course, since, The majority of your serotonin is produced in your gut, it can be hugely impactful for your mood. So either anxiety or depression it really runs the gamut. I have a whole checklist in my book to just parse out your symptoms and then also parse out the root causes.

[00:11:54]So let's talk about the root causes, cause I think they're really important. And then I'll get into specifically where Hashimoto's. It fits in. And I know I so bad at multitasking, but I can see questions coming in that I cannot divert my attention to read right now, but I'm sure they have to do with Hashimoto's and we will for sure tackle that.

[00:12:13] Okay. There are three main buckets for why someone would develop seatbelt. They fall into the category of motility, which has to do with something called the migrating motor complex, which is again, not something that ever came up when I was doing just my basic gut health research around what, but it is this street sweeper mechanism.

[00:12:35] That's responsible for cleaning up back your meals. So essentially just make sure that all of the debris. And things that are going to be shuffled down to the large intestine actually make their way through this incredibly long winding path. That is your small intestine. The surface area is larger than a football field.

[00:12:55] It's crazy. It is got tons of nooks and crannies that where when given the opportunity will allow bacteria to pull off the road and build a little shanty tab. But the MMC migrating motor complex in theory protects against that. And. Most of the research has been dedicated to the why behind SIBO has discovered that the breakdown of the migrating motor complex is one of the biggest reasons that SIBO can occur.

[00:13:23] And that can be a whole host of different things, lifestyle and disease that can cause. The migrating motor complex to go off the rails. One of the most common reasons is just a simple acute case of food poisoning. And I think that's really interesting too, because personally, I think my Hashimoto's was sparked by a case of food poisoning a really long time ago.

[00:13:47]Seba, I think similarly to autoimmune disease is like a lot of things adding up over time. For auto-immune disease. I've always thought about it the way one of my practitioners put it, which is that you're just like slowly putting, Tinder into a box. Eventually there's one event that kind of lights the match and lights, the whole thing on fire.

[00:14:09] But it's often just like a slow building of, I don't know, toxic burden, deficiencies. What have you, that could cause you know, One of your genetically disposed immune diseases to click on SIBO. It's a little bit more concrete cause we know exactly what is clicking on and off. And in this bucket, we're talking about the migrating motor complex.

[00:14:31]So with food poisoning, There are few things that need to go wrong in order for you to even react in an aggressive way to food poisoning. But if the pathogen makes its way to your small intestine, that's when your immune system comes to arms and they fight it. But in the process, there's actually an acute case of auto-immunity that can happen where upon which they release these toxins to fight your bacteria and that damages the nerve cells of the migrating motor complex.

[00:15:01]Some people. Have that acute case of a stomach bug and be a stomach bug too, or food poisoning and feel totally fine within a few days, that's the norm. But then because of the migrating motor complex being damaged and taking time to repair. You're allowing a slow buildup of stuff in your small intestines.

[00:15:21] And then a month later you might be like, Oh my God I'm starting to feel bloated all the time. You might feel an onset of symptoms and that's a classic SIBO case from that root cause. But there are, again, other things that need to go wrong that could contribute to even that one root cause.

[00:15:38]I will just say quickly that the migrating motor complex is directly related to something like Hashimoto's other things that can. Mess up the migrating motor complex stress in studies shows that it really limits your motility. So that's interesting. And then, a lot of the autoimmune diseases like IBD and celiac that just damage the integrity of the gut can.

[00:16:02] Lead to slowed motility and have a huge overlap with SIBO. Okay. Quickly get through the other buckets. Cause I've run a, from my 20 minutes already, even though we haven't even touched on how she murders. Okay. Second bucket would be structural issues. There can actually be kinking of the intestines.

[00:16:19] That's not the norm, but that could be something, but anything that kind of prevents things from running smoothly. A lot of people get some sort of abdominal surgery, even if it's laparoscopic and without knowing it. There's some sort of internal scar tissue that forms that maybe will prevent your organs from being able to move as freely as they once did.

[00:16:39] And again, your small intestines so long, so winding, even a little bit of pressure or a narrowing in a place could potentially cause some sort of buildup. Other structural things, I think endometriosis falls into that category. Again, grow any sort of growth outside the uterus is going to create constrictions.

[00:16:57] Then there's a lot of laparoscopic surgery that is, part of treatment for endometriosis and just a lot of inflammation again, that could potentially look at the migrating motor complex. Third bucket is interesting because. I think most people will have something in this bucket that will well, okay.

[00:17:17] So if you think about it structurally or this migrating motor complex thing, this bacteria, isn't supposed to make it to your small intestine and not be killed. You're supposed to have stomach acid for that. You're supposed to have pancreatic enzymes and bile that creates a harsh environment where bacteria are not supposed to thrive.

[00:17:37] And of course you're supposed to have. Your immune system there to detect when there is something that is other and protect you against it. So bucket number three is the bacteria are not killed. So a few of the things I just mentioned, low stomach acid, any sort of immunosuppressants, or, as a condition that will naturally lower your immune system.

[00:17:57]That's all in the third bucket and there's so much with the gut brain connection too, that kind of falls into structural damage to the vagus nerve. An interesting example that I like to give is if you have some sort of accident, let's say you are in a fender bender, get whiplash, or, damage to your spine, or have a mild brain injury that is also very much associated with SIBO.

[00:18:21] But then in addition to what that can do to. You're migrating motor complex. And again, the communication between your brain and your gut is maybe you're then put on medication opioids and CEDS and antibiotics. All of these things are risk factors for your migrating motor complex, not working properly then though there's the insidious way that.

[00:18:44] Maybe your body healed after the fact, maybe you'd never saw the proper body worker and your alignment was just often away that your intestines just weren't functioning properly anymore. A lot of people, with that particular example could have root causes in all three buckets, just from that one event.

[00:19:02]Okay, so quickly before we move on, I'll just touch on the root cause of Hashimoto's because it's a particularly interesting one, I think in terms of CBELL and just in understanding SIBO, I feel like I learned a lot more about what was going wrong with my Hashimoto's. As many of you probably know by now there's the T4 hormone and then T3 and T4 is inactive and we need to convert it to T3 in our gut in order to maintain our energy reserves.

[00:19:34] So T3 has a lot of other functions as well. T3 in particular, we need to produce. Adequate stomach acid. We need it to produce intrinsic factor, which is how we absorb our B12. And then if we're not observing our B12, that affects the migrating motor complex. So it can be this kind of vicious cycle, because if we have a damaged gut, we're going to have trouble with that initial conversion.

[00:19:59] But then if we don't have enough of the hormone, we're going to have a damaged gut and a higher risk of SIBO specifically along, those. Lines have low stomach acid. And also like you're going to have insufficient pancreatic enzymes and your gallbladder is going to have a harder time secreting bile.

[00:20:19] So it really is a vicious cycle. And then of course, a lot of, like brain fog and constipation are side effects of Hashimoto's. And if you're not pooping every day and Spelling excess hormones that can create extra estrogen dominance, which then makes it harder for you to convert your thyroid hormones.

[00:20:39] It's just, again, a real vicious cycle that we can get into more specific stuff, but it's three 25. So I want to make sure that we have time for your questions. And I do think that I'll give a few pointers before we get onto that. Just for. You'd have some practical tips to take home. So I, first of all, I think that this is a mistake I made that I told you about.

[00:21:01] I don't think that thyroid medication is. A failure is something to be ashamed of. In fact, if you do consider this vicious cycle, I think it can be something that's an incredibly useful crutch to get you onto a higher playing field. Because knowing about this cycle, I really do see how I got myself down to rock bottom.

[00:21:20] Even if I wasn't diagnosed necessarily with SIBO you just need a step up or a helping hand somewhere. Otherwise, these deficiencies just start to perpetuate one another. So I'd say that. And then second of all, how she motives folks, we are going to be, especially if you're not getting adequate hormone, a bit more susceptible to food poisoning.

[00:21:42] We know that food poisonings, one of the most common reasons that people get SIBO. So that's just something to keep in mind in terms of traveling smarts, taking. Digestive enzymes or, some sort of stomach acid supplements, HCL with pepsin, whatnot, or just being a little bit careful when you're.

[00:22:00] Eating abroad back when we travel again or, are eating raw food at home. It's just something to keep in mind. I give the tip in my book of eat like a pregnant person. It doesn't mean you have to do that all the time, but it is something that I think about a little bit more. And I'm just a little bit more cognizant of that.

[00:22:18] I'm just someone that is always going to be a little bit more prone to food poisoning. Then, of course, they're just the things that you can do to aid your digestive system to work the way it was meant to work. Chew your food. That's a really good one. Cooked foods tend to be so much easier for a weak digestive system to deal with, especially pureed foods.

[00:22:38]As much work as you can do for your food before it gets to your small intestine, the better. I always say, and it's like kind of one of my main principles of the book is that it's much more important. Not what you're eating, but how you're eating it. Meal spacing is another one, not necessarily intermittent fasting, but one thing to know about the migrating motor complex is that it only kicks in during a fasting state of 90 minutes or more.

[00:23:03] So even if you're eating super healthy snacks, even if you're eating your Brazil nuts, things that are in theory, really good for Hashimoto's and thyroid health. If you're doing that every day, 20 minutes, your natural digestive processes never have time to kick into gear. So I think allowing four to five hours between your meals, maybe that means you have to eat larger meals to tide you over or manage your blood sugar and away and add certain types of fiber.

[00:23:31] Great, but leaving that downtime for your digestive system to kick into gear for the MITRE migrating motor complex to clean up after me after the meal is so important and also eating a little bit earlier at night to give it time to kick in before you go horizontal, another big pointer Then the last piece that I'll bring up because it's something that, again, I didn't really know about when I was just dealing with Hashimoto's is something called a prokinetic.

[00:23:58] So this is either a prescription medication or a natural alternative that can stimulate the migrating motor complex. Most of them are advised to be taken at night overnight again, to help, Get the last of that debris through your system. But there are a few prescriptions that you can talk to your doctor about if you want to, again, knowing that Hashimoto's may be a root cause or something that can put you at a higher risk factor for SIBO.

[00:24:24] Certainly if you've had food poisoning and you feel like that's part of your SIBO picture, it could be something to talk to your doctor about. And then there's another natural option or a few natural options that have really high concentrations of ginger that do the same thing. Naturally just.

[00:24:39] Stimulate the migrating motor complex. They're not the same things as laxatives. Personally, I'm on one. And I do feel like it makes me more regular, but in the way it works, that's not the actual mechanism that it's, I'm dealing with. It stays in the small intestine. So that's, I have a lot more to share that I took notes on, but I'm over.

[00:25:00] So why don't we get to questions and hopefully I can tick off a few of these other things while we're chatting. Yeah, that's great. And thanks for sharing. I know you apologize for going over time, but I think it's great. Like the more information the better, and we still have 15 minutes here. We've got lots of questions.

[00:25:16]So we'll try to get through as many as possible. The first one is about like, how do you know you have SIBO? We've mentioned a lot of symptoms. You mentioned a test that your doctor ran. Can you tell us more about that? And in the same vein, can you. Talk a little bit about like how you approached it with your doctors.

[00:25:32] It's something that they brought up or how did you start a conversation about this? Yeah, so I'm so lucky. My doctor is very savvy and when I described my symptoms, he liked thought immediately to get a SIBO breath test. So that is the main test for SIBO. It's a breath test. There are a few stool tests that.

[00:25:52] Some doctors may say to you, okay, you have markers for SIBO, but nothing is conclusive unless it's a breath test. So the way it works, I think is really interesting. You essentially have to prep for about 24 hours before, and you. Drink a sugar solution the morning of, and then breathe into a tube every 15 to 20 minutes.

[00:26:16] And essentially the sugar solution is going to see where there are bacteria along the way. So they're testing for certain gases in your breath that can only be coming from these bacteria. So in theory, the first two hours, you're not supposed to get much of a reading at all. Once you get to the. Three hour Mark.

[00:26:37] You're going to be in the large intestine and you should see some sort of spikes. So there it's unfortunately not a precise science right now. There are different labs have different criteria for diagnosis. You can view with SIBO different gas, threshold, or combinations, but. I do still think that it is worth getting a test because it can tell you what type of SIBO you have, whether it's hydrogen dominant or methane dominant or hydrogen sulfide dominance, it's all very confusing.

[00:27:06] But I swear to you, it's outlined very well in the book to make it easier for you to understand. But that dictates your treatment. You always want to make sure you know exactly what you're trying to target, what you're trying to eradicate before just going on a crazy killing spree. So yeah, you can talk to your doctor about a SIBO breath test, certain labs.

[00:27:25] You could order directly yourself depending on what state you're in. I'm in New York and we're a fascist state. I dunno, I was hopefully. Yeah. I always all my tests out of you when I'm like staying with my family and Massachusetts. So yeah. You can look into that with your doctor, for sure. Just ask for a breath test.

[00:27:47] Stool test is only the large intestine, so that's not actually telling you much. To follow up on that, so I imagine most of the people that are joining us today have Hashimoto's or hypothyroidism or suspect thyroid issues. You've mentioned a number of different root causes of SIBO. The question is like, how can I tell what caused it for sure.

[00:28:08] And I'm going to add on, does it matter for treatment or to solve it? Yeah, it does matter because. A lot of the time, people will, a lot of the times SIBO can be chronic, but it's not because SIBO is just chronic in nature. It's because again, if you had like a structural issue that you do not, figure out a way to protect against or to overcome, or even in migrating motor complex is, whatever it is, if you don't overcome that root cause then of course, SIBO is going to come back.

[00:28:35]Your digestive system is just not working properly. Honestly, there's a very long list and there's a checklist in the book, but most people know enough about their health now that you can go through and just be like, Oh yeah, like I had a car accident like 10 years ago. Oh yeah. I had like food poisoning.

[00:28:51] I forgot about that. Oh yeah. Like I have thyroid issues. You may not necessarily uncover all of them, but you can at least begin thinking. Like more holistically about all the things that could go wrong. Hopefully not making you paranoid, but just, in troubleshooting. And figuring out, do I have low stomach acid, maybe I'll just take for a week, a few PEPs in before my meals and see if, it makes my digestive feel any better.

[00:29:13]A lot of people who have reflux and GERD, it's actually from too little stomach acid, not too much. It's just your body trying to overcompensate and overturn and create more. Yeah, I do think that any practitioner you work with hopefully will have an eye towards helping you uncover those root causes and protect against them.

[00:29:33]Like a prokinetic, like I mentioned is a really good way to protect against, immune disease that is not going away, that may, limit your NMC function. And there's another test by the way to figure out if you have this auto-immune post food poisoning reaction, it's called post-infectious IBS.

[00:29:50] And that test could confirm whether or not you still have these kinds of antibodies in your system from that particular occurrence. And that can tell you that. Yes, it's probably a good idea to take appropriate out or something to guard against that. But you know what, honestly, not everyone invests in these tests.

[00:30:07] I didn't, I just went straight on the prokinetic and it worked for me. That's awesome. If you had mentioned your book a bit, and I do want to ask you to tell us a bit more about your book, like what tools are in there? Do you have favorite recipes, but I want to ask a couple of questions that I've seen come in about diets, which like you've got a ton of recipes in there that are good for SIBOE.

[00:30:27]Someone's mentioned that they there's foods on the low FODMAP diet that they've discovered they can't eat because of Hashimoto's. They already feel limited because. Of what they can and can't eat for Hashimoto's. There was a question about the AIP diet. Can you talk a little bit about Just w what to do to reconcile this and eat for both.

[00:30:44] Yeah. So actually I think what makes my book different? There are definitely a lot of low-FODMAP cookbooks out there, but this one's also allergen-free so not completely allergen-free, but dairy free, gluten free soy free corn free is not fully AIP. Personally, I don't think that's necessary for most Hashimoto's people.

[00:31:02]Just. Lot of the nutritions that I've talked to there was, I don't know where Paloma stands on that, but, I don't think it's always necessary for everyone to go that extreme. Taking out some of the major allergens while you're healing, your gut, I do think is super important. And again, because of the connection to leaky gut SIBO can cause food sensitivities.

[00:31:20] I forgot to even mention that long list of symptoms. But that's something that could be temporary. Once you fix your gut or heal your SIBO or whatnot. But in that process, I do think it's so important to call out the immune system and just limit the inflammation by taking out some of the things that could be potentially Sensitivities of yours on the allergen front.

[00:31:40] So low FODMAP, high FODMAP ingredients. You're not actually allergic to, you're just having trouble digesting them. And you're experiencing symptoms. If there are bacteria, overgrowing that are directly related to that food, but they don't last longer than your digestive cycle. Whereas something that you're having a true, like allergen reaction to is more systemic and it's calling your immune system.

[00:32:05] Up in arms and the symptoms again, can be a little bit more insidious. Rheumatoid arthritis folks, will feel it in their joints. Hashimoto's people may just be like tired and brain foggy and just feeling, just off I call it thyroid. I'm like I'm feeling fat righty. In terms of marrying those two, I know it can be incredibly limiting.

[00:32:23]I wouldn't necessarily point you away from AIP if it's something that's working for you. But I do think that the recipes in the book, you can find a lot of options and a happy medium for you. Just maybe eating vegetables that you've never cooked before yourself at home. Do you have a, do you have a favorite recipe in the book?

[00:32:40] Is that like saying to pick your favorite child? It seems to be, yes, it seems to be the question I'm getting asked every single day and I just choose a different one each time pointed you towards a few of them. So there is, let me see if I can flip to it. I have a bunch of great sheet pan meals, cause I'm all about the accessible stuff.

[00:33:00] Oh, this one's good for mediators. I do love this beef nega Maki, stir fry with watercress and a low FODMAP serving of green beans. I tried to keep the book really global and exciting. So this is a tumeric deal. Catfish. She panic. Make it with any fish though. It's inspired by this Vietnamese dish.

[00:33:19] That's really yummy. It's got Bach. Choi's the bed. It's really simple. It's just got a lot of ginger, fresh ginger and tumeric. Lots of anti-inflammatory things like that. Little fish sauce. Yeah, it's delicious also. I'd say What's cool about the book is that I went really deep and the dietary restriction key AIP I did not solve for, but there is a paleo marker for these and SED, which is the specific carbohydrate diet that's oftentimes layered in for SIBO on top of low FODMAP, which is again, somewhat AIP, like pretty restrictive, but that's all marked for the book.

[00:33:54] And then I also marked for Histamine. It's a big overlapping issue for a lot of auto-immune folks and SIBO folks. So it marks out what you need to do to adjust the recipe, to be low histamine or yeast and candida friendly or low sulfur for those with hydrogen sulfide, SIBO. It's unfortunately, there's no one diet for everyone.

[00:34:14] And I'll say like with specific with SIBO specifically, there's a lot of misconceptions around diet. There are people who heal their SIBO. Or eradicate their SIBO say without making a single change to their diet, it's not necessary to make sure that you're killing the bacteria any better, but it is the best tool we have for limiting our symptoms.

[00:34:36] And the more we can limit our symptoms and limit the gas the better our gut will be able to heal in the moment. Then on top of that, the more we can call off our immune system by limiting allergens, that again will help us heal. So I do think it's hard. To reach a healing phase without making any changes to the gut, but at least during treatment you can have no diet and that's fine.

[00:34:57] You just may be a little bit miserable. You may have worse symptoms of die off from the treatment itself. That's super helpful. And I got one last question for you and then we'll wrap up here, but one question is, should we be taking probiotics? And do you have any recommendations for brands or types that you like.

[00:35:15] Yeah. So probiotics are tricky with SIBO because most conventional, probiotics and I was like conventional, like in a bad way, the majority of probiotics are in the category of lacto bifido bladders, which is the type of bacteria that tends to be overgrowing and SIBO. So most practitioners do not recommend actually taking probiotics.

[00:35:35] During treatment, I'm only starting to take them once the SIBO is confirmed to have been eradicated so that you can start, retooling and rebalancing your gut. However, there is a great podcast episode. I podcasts Evo made simple. I think it's episode six with Dr. Jason. Hi, relax. If there are certain probiotics that can stimulate them, migrating motor complex can have kind of a.

[00:36:03] Specific actions that we want to heal SIBO. So there are practitioners who are very savvy in those things who do use probiotics as part of a treatment, but it's not something that like anyone should just play around with. It's better to just steer clear until you've gotten that under control. But the one specific brand that is good for the motility that now when I'm just trying to heal my gut I had to go on a few rounds of antibiotics for dental work this fall.

[00:36:31] And I, just knowing that the antibiotics were probably gonna mess with my MMC. I didn't want to just take any old probiotic off the back of that. So I took this one specific brand called bio Gaya that has the one specific strain. That's good for motility. Awesome. Maybe this has all been super helpful.

[00:36:53] Like a lot of information that I think people are probably gonna want to go if will, what that means, learn more about this. Where can people find you if they want to learn more from you? So they can find me at my website, feed me phoebe.com. You can find the podcast there and also some free info about SIBO, if you want to just read through it and figure that out.

[00:37:13] Also some free recipes, a lot of low FODMAP recipes. I'm just trying to pull in the book that. By the way, like SIBO is a different language. So it's like the first part of the book is a key list of like glossary of terms to learn how to speak SIBO. So if you guys are going to leave here and go Google and you're interested in learning more and consider getting the book, it'll literally take you through like soup to nuts, everything you need to know.

[00:37:36]And. If you do a SIBO made symbol.com, you can find the links to buy. And then also there's a free gut heal boot camp for another week or two. That's like the early bird pre-order bonus. And that's just a fun five day email sequence in your inbox with some really actionable tips and then really great Facebook group.

[00:37:56] We're doing a live session right now. So it's going on currently and it's just been an incredible. Space to share another lot of people in there who are like so grateful because they have no one in their group of friends or family that know what it's like to go through all of this auto-immune stuff and get stuff and not being able to eat certain things.

[00:38:15] And. Feel great afterwards. So yeah, it's a supportive group beyond Paloma. If you need another pack to associate with actually a great segue, we are hosting a campaign for January's thyroid awareness month. It's a video campaign and we are inviting patients who have hypothyroidism or Hasimoto's.

[00:38:35] Or loved ones that people who live with this condition to share part of their thyroid story via video. And our hope is to help raise awareness of thyroid conditions and help people who are living with our conditions feel less alone. So if you're interested in sharing your thyroid story, you can head to thyroid awareness.capsule.video.

[00:38:54] And when you submit. A video, you are entered to win a thyroid support bundle. I'm not going to list everything that's in that bundle here, but one of the things that's in the bundle is a copy of Phoebe's SIBO made simple book. I will make sure that when we send out the replay, you also have the links to this campaign, to Phoebe sites so that you can learn more from her.

[00:39:16]I want to thank Phoebe for joining us and sharing all of her knowledge and wisdom and personal experience with us. I think this has been super valuable and thank you, each of you who's joined us this afternoon. I know it's time out of your day and I hope this was valuable to you and that you have a good takeaway to support your Hashimotos, your thyroid health, your gut health, and so forth.

[00:39:36] So thank you all very much and we'll see you soon. Pleasure. Thank you all.

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