In this episode, Dr. Eric chats with certified health coach and functional trainer Vilmos Bond to explore how exercise needs evolve—especially for women over 40 navigating perimenopause and menopause. Drawing from over a decade of experience, Vilmos shares how his approach to functional training goes beyond aesthetics, focusing instead on strength, mobility, and longevity.

The conversation dives into common exercise mistakes, including sticking to repetitive routines, lifting too heavy too soon, and neglecting proper form. Vilmos explains how hormonal shifts impact recovery, cortisol levels, and energy, making it essential to adjust workout intensity and frequency. They also discuss the importance of resistance training for bone density, the pros and cons of high-intensity workouts, and how nutrition and meal timing play a role in overall performance and health.

If you want a clearer, more balanced understanding of how to exercise smarter—not harder—during midlife, you’ll get a lot out of this episode.

Click Here to listen to it on the Save My Thyroid podcast

Dr. Eric Osansky:

I am super excited to chat with Vilmos Bond. We are going to be talking about functional training for women 40 and over. Vilmos Bond is a certified health coach and functional trainer for women over 40 going through perimenopause and menopause. He is also my personal trainer, even though I’m not a woman going through perimenopause or menopause. Most but not all of his clients are women over 40. When I work out, I see the people who are there before and after me. It is mostly women who seem to be over 40. Anyway, this will be another great conversation. Thanks for joining us, Vilmos.

VilmosBond:

Absolutely. I’m happy to be here. Excited about this.

Dr. Eric:

Same here. We usually start off these conversations by getting into the person’s background. How long have you been a functional trainer for? Why did you start focusing on helping women over 40?

Vilmos:

I have been training and coaching women for over 10 years now. I didn’t start off in the women’s space. It was more about everyone. I slowly realized that my people were women. Those were my tribe. It slowly gravitated to that.

My wife is 50 now. As she started to hit her 40s, I realized I had to start doing more for her. That was another trigger that told me I need to start going down this path.As I started working with her and seeing the difference she is making, and some of the things she is accomplishing, it really triggered that I need to start focusing more on women. It naturally went that way.

Dr. Eric:

People know what the term “personal training” is. How does that differ from the term “functional training”?

Vilmos:

That is one of the biggest questions I get all the time. Most people here personal train. They think of personal trainers as the same thing as functional trainers. It’s slightly different. A personal trainer tends to be focused on building muscle. It’s about look. It’s about building strength.

Functional training is a little bit more surgical. It’s more specific to everyday movement. You’re looking at the things you do every single day on your day-to-day activity. It’s about making those movements stronger. As you progress and age, you don’t have certain limitations because you never focused on them. Later on in life, you might end up getting pulled muscles. You can’t bend over and pick up certain things. You start losing strength in your legs. It starts to limit you. Functional training opens all of that back up. You can now do those things with confidence.

Dr. Eric:

You also help people with strength training, too.It goes beyond that.

Vilmos:

Yes, it goes beyond that. It falls into flexibility. It falls into mobility. It’s not just about look. Someone who is really going after functional training, they are not looking at the look of muscles. They are looking for strength, mobility, and being able to move as they get older.

Dr. Eric:

I can vouch for that. I’ve worked with other personal trainers. We do some strength training, but that’s not the focus. It’s not about going as heavy as I can. Some people are interested in that. It makes sense with your clientele that most would not be interested solely on muscle mass but moreso on the functional aspects of training.

I wanted to ask you about the common mistakes people make when exercising. I am 55 now. I have been exercising since I was at least in high school. You have been my trainer now for about two years. Before you, I had a couple of other trainers. For 30-something years, I didn’t have a trainer. I figured I didn’t need one because I knew it all. After working with multiple trainers, it’s a good idea from an injury prevention standpoint. What do you see as some of the common mistakes people make when trying to do things on their own?

Vilmos:

This is the biggest one. They fall into a set routine. They stick to it and never move outside of it. They start losing mobility and some of the functional part of the exercise. A lot of times, people don’t like certain exercise, but that’s the exercise that is beneficial to them moving forward. It takes a really good trainer to identify those things and motivate clients to understand if you don’t do those things, you will pay for it later on.

Working out in a set routine is great. It’s good that you’re moving your body. If you keep cutting out those very important movements, later on, you will find you won’t have certain mobility. You won’t have certain range of motion in your body. Those things hinder you later on in life.

I’m always big on doing a lot of different things. It’s not just pushing, pulling, up, down. It’s more of a circular movement. Keep in mind on a daily basis, you don’t move in a straight line. You move in a circular way. Unless we start training in a circular way, you will have some issues in your day to day. Now your body won’t be used to it.

Dr. Eric:

I was guilty of that. Working out for all those years on my own, my routine for the most part was the same. If I switched to a different gym with different machines, maybe I’d mix things up a little bit. For the most part, the machines are the same from gym to gym.

I definitely have experienced through you so many different machines, not just machines, but free weights, stretching. You definitely mix things up.

Anything else? Another common mistake people make besides that?

Vilmos:

Comparing yourself to others. Especially when they haven’t worked out in a long time, they’ve gone to social media and have seen things, I see a lot of people getting hurt that way. They try to jump into things way too fast instead of taking it one step at a time.

The biggest problem with people not working out is usually, when they get into it, the first two or three different exercises that they are really excited about, they end up having some serious backlash from it because they went way too hard. They don’t like this kind of pain. Now they are backing off and don’t go to the gym for a while. That’s why you have people sign up for gyms and only go three times a year. They don’t make an actual effort to make a game plan. Am I going to wing it? Usually, winging it doesn’t cut it.

Dr. Eric:

Makes sense. That leads into the next conversation with injury prevention. One way to prevent injuries is not to do it on your own ideally, but if you are going to do it on your own, don’t go too heavy too quickly. Go gradually. Lighter in the beginning is better. Get your muscles used to things. What else can people do to prevent themselves from getting injured?

Vilmos:

This is more for women. They go to the gym, and two things usually happen. They’re falling into a routine where they gravitate to walking on the treadmill and doing a bike. They have this mindset of not wanting to get injured, so they don’t know what to do. They stick to that part of it. That’s a different conversation.

Then you have the other side. They look at younger folks doing certain things. Now they’re thinking to themselves, “I can do the same thing.” Keep in mind you haven’t done anything in a long time. You have to have a game plan where you’re starting from scratch. This is more for women. Guys have testosterone, and they see a guy lifting 225, and they know they used to do that when they were 20. They will try it again. That’s another problem.

For women, it’s more about, how can I look at my body, where I’m at right now, and how I can ease myself into it. One thing I notice is women jump too far too fast, and they drive the cortisol level up. They have cascading things going on now, especially if they are going through perimenopause.

My goal is when you are going back into the gym, look at it like this. “I will do squats, no weights. I will try to do some form of upper body.” See how your body reacts first. Then the next time you go, “Okay, I could take it another step.” Slowly, you progress. That is the best way you can do it without getting hurt and to the point where you’re miserable for four days because you’re in such pain.

Dr. Eric:

Posture is really important. I’m a chiropractor who has been doing this a long time. Even when I do dead lifts, you will correct me and tell me to straighten my back, even when I feel like it is already. That’s another reason to get a personal trainer. You can’t really watch yourself while working out. I assume that’s a big issue with the women you work with.

Vilmos:

That goes back to why you need to take things slowly. You want to know if you’re doing something wrong. You’re able to catch it and not lift heavy in that wrong posture. Now you have a different problem.

That’s why it’s always good to have someone with you who can identify. I’ve often noticed that women tend to have one hip more flexible than the other. Maybe they haven’t seen a chiropractor in a while. What happens when they are doing squats is their hip is tilted when they’re squatting. That’s another issue that a lot of people don’t recognize until someone is looking at them from the back going, “Wait a minute. You have one hip tilted as you’re doing squats.”

I see this all the time at the gym. I usually have to correct people and even ask them, “Do you realize you are squatting with your hip tilted?” “No, really?” I usually have to take a picture for them to see what I’m talking about. That’s where the stretching and mobility come into play, to really help to mitigate some of that issue that is going on with your hip.

That’s why it’s very important not to jump into weightlifting and start lifting really heavy, especially when you haven’t done it in forever. That could cause other issues. It’s very important to take it step by step. If you have someone like a trainer who can help you with this, it’s important to seek a trainer.

Dr. Eric:

How frequently do you recommend people to work out, to do resistance exercise? Do you recommend 3-4 days a week? Is every day okay? Is that too excessive?

Vilmos:

That’s too excessive. Especially if someone is going through perimenopause or menopause.

Dr. Eric:

Why?

Vilmos:

Doing excessive workouts drives your cortisol up. Your body is not getting the chance to rest. That is adding more stress to your system. It’s great that you want to do that.

At the same time, you are in a position right now where you don’t want your cortisol going all wacky. All of a sudden, you wake up the next morning with foggy brain. Symptoms are going nuts. The goal is to keep that cortisol down as much as possible. When you’re doing this exercise, and you’re not allowing your body to reset, that is when you are creating more problems later on.

I always recommend if you can space out your workout. If you have to do this Monday, Wednesday, Friday. In between, go on casual walks. Walks do a number on your cortisol; they help bring it down.

Dr. Eric:

When it comes to cardio, do you just recommend walking? Some people do high intensity interval training. More people these days are doing resistance exercise, but there are still classes at the gym.

My perspective is I’m not against HIIT. I do a lot of walking personally. Prior to my Graves’ diagnosis, a lot of people listening to this know I was overtraining with cardio. Doing it too intensely. I don’t know if that’s something you still see these days or if it’s not as common.

Vilmos:

Yes, I still see that today. A lot of times, these are folks who are so used to doing it for years. It’s hard for them to break that habit, even though it’s hurting them. That’s one set of folks.

Then there is another set who go online and research. Everybody is telling them you need to do a class or this or that. They’re pushing the strength training aside for high intensity. They are not connecting the dots that high intensity is what is spiking their cortisol.

I tell folks to spread it out and give their body a chance to relax, to come down from that high that you are putting your system through. Strength training will help build muscle. It will help improve bone density. High intensity training is great for your heart because you’re doing all this movement, but it’s not putting any pressure on that muscle that helps to get your bone density higher.

Folks in those classes complain that their bone density is not moving, and they have been in that class for years. Someone who does strength training twice a week has bone density move six months later. I have seen that with my own clients.

Dr. Eric:

I could ask you what you do as far as cardio goes. I’ll ask you instead what your wife does because your wife is your clientele. Most people listening to this are women. Does your wife do any cardio exercise other than walking? Does she do any other aerobic exercise?

Vilmos:

We do two things. Especially when it’s nice in springtime, around 7pm, we walk for 30-40 minutes. We walk around the park. That’s her cardio pretty much. Every once in a while, we take the bike out, and we do some riding.

As far as our intensity and cardio, we have a hill that we attack every two weeks. That’s our workout.

Dr. Eric:

Sprinting?

Vilmos:

Sprinting up the hill. We don’t do it four days a week. See what I mean? We spread it out. We want to make sure that she does more strength training. In the past, we used to do more of the strength cardio or resistance cardio. As she starts to go through perimenopause, we shifted a lot of that exercise to what we’re doing now. That is the shift that most women resist because they’re so used to that way of working out. They don’t want to shift that. You need someone to help you make that change.

Dr. Eric:

Makes sense. Let’s shift gears and talk about diet. How important is diet and nutrient density?

Vilmos:

Oh my goodness. This is the area that most people have a huge issue with. The internet is a bathroom wall. Anybody can write on it. You can find all kinds of crazy stuff online. What I try to get my clients to understand is think logically. Does it make logical sense? If you see something that tells you you should only eat one time a day, and you are borderline diabetic, you have all these different issues going on, think about it logically. Does it make sense for you to eat once a day? Think of it like that before you start jumping into stuff.

A lot of things you see online are catered to younger folks. Your body is changing. You don’t want to start experimenting on things that are catered to 20-year-olds. You will create more issues.

I look at it like this. Look at your plate. If you can put more protein and fewer carbs, make sure you keep your fruits and vegetables going on a consistent basis. If you don’t want to do anything else, focus on that.

If I tell you youhave to start measuring your food, that would be crazy. You’ve never done it. I am giving you a lot of stress. Let’s focus on looking at the plate and how it looks. Cut out the sugar. Reduce the sugar intake. Reduce the carb intake. Just start there.

Instead of trying to create a science project, where you do all this crazy stuff, it’s too much energy you’re putting out. You can’t maintain it. Just do things that you can maintain. You have a busy lifestyle. Most women have a busy lifestyle. They have all kinds of stuff going on. The last thing I want to tell you is add another job in there where you’re measuring food, checking your carbs, and doing these other things. It’s not something you can sustain.

Dr. Eric:

As far as timing of eating, with exercise, do you always recommend eating before working out? Is it okay not to eat before working out? You see me at the gym. When I train with you, it’s 9am. I know we’re talking about perimenopause for women. When we train, I eat because it’s later. You’ll see me tomorrow at the gym; I’ll be there around 5:30am, and you get there a little bit later. I usually don’t eat because it’s so early. I just get up and drink a little bit of water and bring water with me. Is that okay? Maybe it’s different for men versus women. What are your thoughts about fasting before working out, compared to eating before working out?

Vilmos:

That’s a tricky zone. What works for you does not work for someone else. We’ve seen so many people pass out at the gym. They did not eat before they worked out. About a year ago, we were keeping track of how many people passed out in the morning when they came in to work out. The number was insane.

The reason why it was like that was because these are folks who are used to doing this on an ongoing basis, but they weren’t working out. Now that they start the workout and still try to do the same thing, their body is not ready for that kind of stuff. What happens is we end up having people laid out on the floor. We have to put Gatorade in them.

There are some folks, like yourself, who could come work out in the gym and are fine. Others can’t do that. My advice is to be careful making that kind of switch when you have never done it. I’d rather you have a little something in the morning before you go work out. If you have been doing it for years, some people operate like that and are fine. I would suggest, especially someone over 40 who is now getting into exercise, do that because that could have a serious effect on you while you’re trying to work out.

Dr. Eric:

What would you recommend? Something small like a little bit of protein? Would you recommend carbs before working out?

Vilmos:

If you’re someone who has a sugar issue, I’d recommend having something that would sustain you. Your sugar will drop when you work out too much. If you have a borderline sugar issue, get something in your stomach before you work out.

Dr. Eric:

Let’s talk about bone density. I did a bone density scan. I have low bone density. I found out after I was training with you, so that isn’t the reason I started working with you. I was working with a personal trainer, and I approached you because I didn’t like who I was working with. While under you, I found out I had low bone density.

I don’t know if I told you, but I don’t like squats or deadlifts. I know they’re beneficial, but I never did them in the past.I don’t know if you approach everybody similar to me. With me, since I never did squats although I did other leg exercises, I assume you go light with everybody to start. You start with posture and doing really light.

I’m asking this because from time to time, especially women who are older, those in post-menopause and are in their 60s and 70s, if they have been diagnosed with low bone density, a lot of them are nervous about doing squats or dead lifts, just from the name. What’s your approach?

Vilmos:

You are right. A lot of my clients are in their 70s. I have a client who is 74. I have quite a few between 64-70. Squats and deadlifts are not things they are used to, and they were scared about them. My goal is to get them to trust me to where I can explain to them how they are beneficial for bone density and muscle building, but I will never give them the weight I know will be harmful to them. We are going to start off small.

I had one client who I started with them sitting on a box and getting up. Just to get them comfortable. Then we did that until I gave them more weight from sitting down and getting up. I transitioned to them using a TRX strap. They are squatting with the strap. From there, they got more comfortable. The band is looped. Then they squat through the hole in the band.

It got to the point where they felt comfortable enough to where I could say, you are ready to squat with no weight and just your body. We worked on that for a while until she got into a 90-degree squat. It took some time, a lot of stretching, and a lot more mobility in the hip. Now she squats with the full 45-pound bar and 10 pounds on each side. She is fully comfortable in that.

The thing is a lot of times, we get into the mindset that if a client can’t do something, and they’re resisting it, you just forget it, even if it’s beneficial to them. They move onto something else.

I am a strong believer that if something is beneficial to a person, I will break it down to the lowest denominator and build up from there. I have to build their confidence until I can get them where they need to be.

Most of my 70-year-olds are doing deadlifts; one is doing them with 135 pounds. From where she came to now, that’s a long way. She sought me out. She was recommended by someone else. She came to me and said, “Hey, I notice these ladies can do this, and I can’t do it. I want to know how to do it.” From the lowest denominator, build all the way out. It’s not about throwing X amount of weight and being like, “Let’s go.”

Dr. Eric:

You didn’t do that with me. I could tell you’re more conservative, which is good. I think it’s better than being too aggressive, and then someone gets hurt. Working with you for a couple years, I have never gotten injured, which is a good sign. Unfortunately, I’m sure you see with other personal trainers, especially young, inexperienced ones, people do get injured, which is not fun.

Vilmos:

Correct. I have seen women try to do certain things. “I can do it.” That’s not the right way. You can tell she has no stability in her hip. Her knees are shaky. Her knees are going in when trying to go up and down. Those are signs she is not ready yet. You need to back off and work on some things first before doing something. A lot of trainers don’t see that, and that’s where you tend to have some issues.

Dr. Eric:

What advice do you have for someone who might be thinking, “It might not be a bad idea to work with a personal trainer?” You’re pretty busy, so you might not have availability. A lot of people can’t work with you either way because they live in another part of the country or world. What tips do you have to choose a personal trainer that will do what you do?

Vilmos:

There are two kinds of personal trainers. This is more for women for sure going through menopause and perimenopause. One creates programs and stick to whatever program for a while.

The problem is that when a woman comes in, two things usually happen. They either wake up that morning with bloating or foggy brain or low energy or some symptoms. It’s hard to maintain that same program you’ve laid out for that person over the next month and use that same approach when she comes in with low energy. That is not fair to her. You are looking to have this woman operate at 100% when she is coming in at 50%.

A trainer like myself, if I have a layout of a plan, my plan is usually we need to work on legs, this, or that. Based on the energy of that client, I modify what type of leg workout we will do. If someone is coming in with low energy, I won’t put her on a deadlift. That is like me trying to tell her, “You can do it,” and she is coming in halfway. Now she is struggling the entire process. That is not a good partnership.

As a trainer, I am supposed to identify where my client is at when she comes in.We greet each other, and I want to see her levels. Where is she at? Does she have something going on in her mind, or other symptoms? At this point, I should be able to identify those things when talking to her.

I notice a lot of trainers don’t do that. They go right into the plan. When women are going through symptoms in perimenopause, they don’t talk about it. They don’t want to say, “Vilmos, today, I have foggy brain.” It makes them feel like they are complaining or copping out.

As a trainer, I want to tell them that I need them to let me know where they are because I can modify the exercise to where you are. I can always bring you a notch higher, but I don’t want to bring you too high if you have things going on.

Looking for the right trainer, sometimes, you have to try and go, “Eh, not the right person.” You have to be able to walk away. “This is not the right trainer for me,” until you can find the right one.

When you do, I have clients who have been with me for years. They will never go to another trainer because if they do, they will leave them quick because most trainers don’t do what I do. They don’t take the clients’ day-to-day in their calculation of how to do things on adaily basis. I strongly believe a great trainer will always do that.

Dr. Eric:

You are definitely a great trainer. That’s why I keep working out with you. We have our Saturday morning timeslot. I’m sure there is so much more we could talk about, but is there anything I should have asked you that I didn’t ask you? Anything else you’d like to say?

Vilmos:

One thing I have noticed with some of the clients that I work with, there are so many things online around perimenopause and menopause. A lot of times, we get caught up in the hype of things. Because of that, the decision-making is all over the place. It tends to hurt them in the long run.

I like to find a trusted source where you can say, “Hey, I want to bounce something off of you. This is what I’m thinking of doing.” Having a group of women who can share information, you may have friends who are going through the same situation you are.

I am a strong believer in connecting women together and sharing information. Something one woman already went through could help another. It could help everybody move together and move forward in the right way, instead of everybody trying everything on their own. That shared experience is big.

Dr. Eric:

You do work with women online. You work with women in person, but you also have some type of program for women who maybe aren’t in the North Carolina area.

Vilmos:

Over the past few years, I have been working with women as far as Australia and Canada. Some of those people don’t even have a gym close by them. I will have them take videos doing an exercise I give them, so I can see what it looks like, make sure the posture is right. If I need to shoot a video to show them what it should look like, I’ll do that to make sure they are doing it correctly and not any which way. I do work with women in different situations.

That is the reason why over the past year or so, I have been putting together an app to bring women together and share information with each other. It has nutrition information. It has workouts. All catered to women going through perimenopause and menopause.

Dr. Eric:

One thing you’ve told me is you are not exclusively online. There are other trainers teaching online, and that’s all they do. You intentionally want to continue 1:1 with people to keep in the flow.

Vilmos:

Absolutely. As a matter of fact, I have clients who came from other trainers online. They were running into problems at the gym when trying to do certain things. A trainer who doesn’t do anything in person, when they call with a question, those guys don’t know how to explain certain things because they don’t do anything in person.

I want to maintain that in-person training because it helps me stay in tune. I know if someone is having an issue with their lats not being engaged, or if they are having pain in a certain part of their hip, I know how to fix that. If someone is having an issue with their hip flexor, I know how to fix it because I have clients right now who are working through that same thing. If you are not doing it in person, you have to look it up to see how to fix it instead of doing it through experience.

Dr. Eric:

Where can people find out more about you, including the app? I also told you I wanted to share your Substack that’s fairly new but still very informative. Anything you want to bring up now?

Vilmos:

On LinkedIn, you could look up Vilmos Bond. Substack, same thing. I try to put a lot of information out there to help people. In the past month or so, it really is starting to gravitate to certain women, and they are taking notice of things I am talking about. My goal is to cut through all the noise and give you the truth.

We are testing the app right now. It’s called ConnectCircle.co. Create a profile and go into the app. Start testing out some things. We are opening the app for people to test and give us feedback. I would love to have feedback. My goal is to make it the best place to get information and for women to connect with each other.

Dr. Eric:

I knew this would be awesome, and it would be a great conversation. I’m sure the listeners learned a lot. Thanks so much, Vilmos, for having this conversation.

Vilmos:

Absolutely, thanks for having me.

Dr. Eric:

You’re welcome. Looking forward to maybe doing it again in the future.

Vilmos:

You got it.

***

Dr. Eric:

That was an excellent conversation with Vilmos, my personal trainer. Really nice guy. He is my personal trainer not just because he’s a nice guy, but because he’s a personal trainer. I did have a couple of trainers before him. It’s not that I didn’t like them, but they were different. They were more into strength training, which Vilmos also does, but he does more than that.

I could do strength training on my own. From a posture standpoint, making sure the posture is correct is important. But with Vilmos, the variety is really great. I have been working with him for two years now, and it’s been great.

We spoke about exercise mistakes. I mentioned poor posture, being a chiropractor, you’d think I’d be perfect with posture. We can’t look at our own posture. Overall, I’m pretty good, but he still makes some adjustments. When you’re lifting really heavy, it just takes a little bit. It doesn’t mean that your posture has to be extreme to get injured.

He mentioned another mistake was people lifting too heavy too fast. When he works with me, he goes a little bit on the lighter side. We go heavy, but he is definitely more conservative. When I’m on my own, I lift heavier. With him, I focus not as much on heavy lifting but learning new things and getting things right. Then I try to replicate it on my own while adding heavier weight.

I asked him about eating before exercising. Is fasting before exercise okay? He mentioned it depends on the person. In a perfect world, it’s probably better to eat before working out. If you will work out like I do early in the morning, which I only do sometimes, I don’t want to eat. I’m not hungry. I don’t want to wait a few hours to work out either. If I work out later, like when we train together, which is on Saturday at 9am, I will eat something before then.

He mentioned how some people will pass out because they haven’t eaten, and they are not used to it. I can’t see I have seen anybody pass out at the gym. Maybe I’ve missed it. He is there a lot more than I am since he is a trainer.

High intensity interval training versus resistance exercise. He and his wife go walking and don’t do any high intensity exercise. He mentioned occasional sprints.

I do some high intensity interval training when I’m on an exercise bike. For the most part, it’s walking. I have a rowing machine, and I’ll use one at the gym sometimes. I can’t say I do a lot of cardio outside of walking. I have a treadmill desk, so these days, I get between 12,000-15,000 steps a day. Most of that is on the treadmill desk. Sometimes, higher than that. I try to get at least 12,000 steps a day. I can’t say I go running or do HIIT, where I’m going all out and then not for a minute or two before going all out again.

Some practitioners do recommend it. There are health benefits from cardiovascular exercise and HIIT. I focus more these days on resistance exercise at the gym.

We spoke about exercise and osteoporosis. If someone has severe osteoporosis, he will go very light with them. He gave an example of an older woman who was concerned about doing deadlifts and squats, and that came from a comment on my Substack, where I had an article on bone density. He mentioned how he had a woman who started slow and is now lifting over 100 pounds. I know someone in the functional medicine space who is 76 and is lifting at least 130 pounds, which is pretty impressive for someone who is in their 70s. Most aren’t doing that or any resistance exercise, even though more people are in general.

Finally, we spoke about hiring a personal trainer. The drawbacks of hiring an online personal trainer are not in the trenches. They are not seeing people. Maybe at one point they did. Same thing like a doctor. A doctor who teaches doesn’t work with patients. I still work 1:1 with people. I have some people on the podcast who for years maybe worked with patients but no longer are working with patients. When you don’t work with people, you don’t keep up with the latest research. You keep on doing what worked in the past out of laziness.

Being that I’m in practice, and I have people asking me questions, which if you are doing things in a group setting, you could keep up with the research. There are people not doing that. All they do is sell supplements and online courses and don’t work with anybody in any context. They are not getting questions. When they create a new online course or write a new book, it might be based on older information. You’d like to think they do new research. Some of them do.

I honestly don’t know if I would work with someone online. Working in person is just different. It’s one thing if you are working with a practitioner online to go over diet and lifestyle. When it comes to weightlifting, it really is beneficial to have someone right next to you. Not that you can’t get benefit from working online, but that is my opinion.

That’s all I’ll chat about here. Hope you found this interview to be valuable. Look forward to catching you in the next episode.

In this episode, Dr. Eric Osansky breaks down the role of functional medicine testing for those dealing with Graves’ disease, Hashimoto’s, and other thyroid conditions. While conventional lab work can help diagnose thyroid disorders, it often falls short in uncovering the root causes behind autoimmunity. Dr. Eric shares his clinical perspective on how deeper testing can help identify underlying triggers and imbalances.

Throughout the episode, he walks through the most commonly recommended tests, including adrenal panels, hormone testing, gut health assessments, and environmental toxin evaluations. He explains when each test may be helpful, the limitations of certain testing methods, and why more testing isn’t always better. Dr. Eric also addresses controversial topics like leaky gut testing, food sensitivity panels, and the balance between testing and foundational lifestyle changes.

If you want a clearer, more balanced understanding of functional medicine testing for thyroid conditions—and how to approach it without overwhelm—you’ll get a lot out of this episode.

Click Here to listen to it on the Save My Thyroid podcast

Dr. Eric Osansky:

Today, we’re going to talk about functional medicine testing for Graves’ and Hashimoto’s.

Blood tests are important. I recommend comprehensive blood testing to pretty much everybody I work with. If you have Graves’ or Hashimoto’s or even a non-autoimmune thyroid condition, doing a blood test alone isn’t enough if you want to find the underlying cause.

If you’re interested in more about blood testing specifically, I would recommend listening to episode #43, where I discuss 10 blood tests I commonly recommend to my thyroid patients. You could check that out by visiting SaveMyThyroid.com/43.

This information about functional medicine testing applies to both those with Graves’ or Hashimoto’s, or if you have the antibodies for both. Even if you have a non-autoimmune thyroid condition such as multinodular goiter or subclinical hyperthyroidism, this information will apply to you. Even with those conditions, you still want to do things to find the underlying cause of the problem.

Let’s talk more about the limits of conventional testing. Conventional testing is typically used to diagnose health conditions. That’s why you go to a medical doctor. Typically, they do some thyroid testing. Maybe if you just go to a primary care doctor, they will run TSH. Maybe they will do a T4, sometimes a full thyroid panel, but rarely. They will usually do the basics.

That’s how you find out that you have a problem, usually through your primary care doctor. Then you might be referred to an endocrinologist to have more comprehensive testing done. Even in this case, it’s not that comprehensive.

When I dealt with Graves’, I went to a primary care doctor. I had a TSH and T4 done. I think it was free T4. They determined I had hyperthyroidism. Eventually, I went to an endocrinologist, who did a little bit more testing, including antibodies, TSIs. That was positive. I was diagnosed with Graves’.

I had other tests, like comprehensive metabolic panel, CBC withdifferential. These blood tests usually are used as part of the diagnosis process. Also to see if there are any underlying problems, like elevated liver enzymes or anemia when it comes to a CBC.

These tests aren’t telling you why autoimmunity is happening in those with Graves’ and Hashimoto’s. If you have a nonautoimmune thyroid condition, these tests aren’t telling you the underlying causes of these conditions either.

There are exceptions. For example, you could do a blood test for EBV. Most medical doctors won’t do this. If you go to a primary caredoctor, they won’t test you for EBV. EBV could be a trigger for Graves’ and Hashimoto’s.

Even in this case, if someone does an EBV panel, there are four markers associated with EBV. If it seems like someone has an active EBV infection, there is a time and place for treating EBV. There are usually other underlying imbalances. Most people who have EBV as a result. It’s more of an immune problem than a virus problem. You still want to do things to find and remove triggers and heal the gut. Most immune system cells are in the gut. It’s really difficult to fix what you don’t identify.

That said, there are other practitioners who don’t test. I had Dr. Evan Hirsch on the podcast. He doesn’t do any testing. As far as functional medicine testing, he just puts people on protocols. Most functional medicine practitioners I know do testing. Some do more testing than others. I’ll talk more about that. Rarely do you come across someone who does not do testing.

You can do a lot through diet and lifestyle. Taking general supplements. Usually, you won’t remove your triggers just by doing that. I do recommend some functional medicine testing. Some of it is based on the health history I conduct. Some of it are tests I commonly recommend.

The first test I will talk about is adrenal testing. Not every practitioner recommends adrenal testing. When I say “practitioner,” I’m talking about natural health care practitioners. If you go to your regular primary care doctor/endocrinologist, they might run a morning cortisol, but they won’t do a full adrenal panel.

Adrenal testing is important because everyone deals with stress. Chronic stress is a factor with a lot of people. I know it was when I dealt with Graves’. By working with so many people over the years, since 2009, I have been working with people with thyroid and autoimmune thyroid conditions. When they fill out their health history, most people are putting stress down as being a factor. Even when they don’t put it down, I’m questioning if it’s really a factor. Maybe it’s not a factor now, but was it a factor when they developed their condition? You want to be aware of the impact stress has on your health.

In my case, I was aware. I was just a little bit in denial. I thought I was doing a good job of managing my stress, even though I wasn’t doing anything to manage stress.

Adrenal testing is a good idea because going back to my Graves’ journey, if I didn’t get an adrenal saliva test, I wouldn’t have realized how bad my adrenals looked, and I wouldn’t have put in the effort to block out time for stress management.

I recommend adrenal testing, whether it’s a saliva test like I did, or in some cases, dried urine testing. Saliva testing measures the cortisol levels throughout the day. Cortisol follows what’s called a circadian rhythm. It should be at the highest levels in the morning and the lowest levels at the end of the day.

Some people have that pattern, but a lot of people don’t. My cortisol levels were in the tank. First two cortisol levels were extremely low. On the other hand, some people have elevated cortisol levels at night or later in the day that might prevent them from falling asleep or sleeping throughout the night.

Saliva testing is great because you can collect it from home. Some tests look at other markers, like the adrenal stress index test looks at not only cortisol but DHEA, which most saliva panels do. This also looks at 17 hydroxy progesterone, secretory IgA, and gliadin.

Dried urine testing, such as the DUTCH test, also looks at the circadian rhythm of cortisol as well as the metabolism of cortisol. If someone has hyperthyroidism, you will typically have increased cortisol metabolism because you have increased cortisol clearance. If someone has hypothyroidism, they will have decreased metabolites, decreased cortisol clearance.

If someone wants to just focus on adrenals, I think it’s fine to look at an adrenal saliva test and not do a DUTCH test. The advantage of the DUTCH test is it also looks at the sex hormones.

Let’s go ahead and talk about sex hormone testing. You can do testing in the blood, looking at the hormones: progesterone, estrogen, testosterone. If you’re a cycling woman, the timing is important. You want to make sure to do it in luteal phase, the second half of the cycle.

Same thing with dried urine testing. If you do what’s called the DUTCH Complete, then the timing is important. On the other hand, the advantage of dried urine testing, and even some saliva panels, is you could do cycling hormone panels. You could collect the sample, whether it’s a saliva sample or dried urine sample different times throughout the cycle.

With the cycling hormone panel, you can look at them throughout the cycle. If someone has a 28-day cycle, you would collect a saliva or dried urine sample every few days, so you could see the patterns. You could see what estrogen and testosterone look like in the second half of the cycle.

DUTCH has other advantages. The big thing is looking at the hormone metabolites, especially estrogen metabolites. A lot of people have problems with estrogen metabolism, which could lead to thyroid nodules, uterine fibroids. It could be a factor with endometriosis. If someone is having some of those issues, they might want to consider doing a DUTCH test. Not always.

I work with people who have thyroid nodules and recommend an adrenal saliva test. It really depends on the situation. If someone has a history of breast cancer, it doesn’t even have to be a personal history, but a family history, where maybe a sibling or their mother had breast cancer. Especially if it was estrogen dependent breast cancer, it’s probably a good idea to do a test such as the DUTCH test and see if you have problems with estrogen metabolism. If you do, you could fix that.

That’s the thing about these tests. The reason we want to test for these is not only to detect the problem, but this way, we have a baseline. If you choose to retest in the future, you could do so.

Getting back to the saliva test that I did when I dealt with Graves’, my cortisol was in the tank, my DHEA was low, my secretory IgA was low, and a few months later, I did a retest, just to see. I was doing a lot to improve my adrenals, but I had no idea if they would look better. I did another saliva test. Sure enough, cortisol looked better, DHEA looked better, 17 hydroxy progesterone looked better. However, my secretory IgA was low and hadn’t improved. I worked on improving that, and a few months later, I did another secretory IgA panel. With the saliva panel, you could test that separately if you want. That thankfully did improve.

Same thing with the DUTCH test. If someone does a DUTCH test, let’s say the adrenals, if they do a DUTCH complete, and the adrenals are not looking great. If someone has low cortisol or DHEA, and they have problems with estrogen metabolism, the 4 hydroxy estrogen metabolite is elevated, which is the- I hate calling it the bad estrogen metabolite as it’s not really good or bad, but you don’t want high levels of 4 hydroxy. You want more of the 2 hydroxy. If the 4 hydroxy is more dominant, that could be problematic.

You could test that. You could do an initial test. If someone has those problems, a number of months later, after you make some modifications, you could do a retest and see if the diet and supplement modifications you made help to improve the test. If it did, great. Now you know. If not, then maybe you need to make some tweaks.

Maybe it’s improved, but just like my situation, where the saliva test looks a lot better but not perfect, I made some adjustments. In my case, with secretory IgA, I made some dietary adjustments. That did seem to help.

Let’s switch gears and talk about gastrointestinal (GI) testing. If you have Graves’ or Hashimoto’s, you might already know that you can’t have a healthy immune system without having a healthy gut. Most of the immune system cells are located in the GI tract.

I can’t say I recommend gut testing for everybody, but I have recommended over the years a lot of comprehensive stool panels and other types of tests, like SIBO testing. It depends on the person.

I do give people a choice. If someone works with me, maybe I just think that they need comprehensive blood testing, saliva testing. I like hair mineral analysis testing, too. Maybe I start off with those. I might give them the option of doing comprehensive stool testing, and they may or may not choose it.

Even though you can’t always go by symptoms, if someone has a lot of GI/digestive symptoms, I do recommend some type of digestive test. Unless food is the culprit, meaning that sometimes, if someone is not eating a great diet, maybe change your diet, which I will recommend. See if that resolves the GI symptoms.

It does depend on the person. I do like comprehensive stool panels. I have done a lot of GI Maps. I have done GI Effects. There are others I’ve done. Typically, they are not just looking at good or commensal bacteria but opportunistic and pathogenic bacteria. Opportunistic means that it’s normally in your GI tract, in the large intestine, but you don’t want it to get out of hand.

Sometimes, you’ll see things like streptococcus, staphylococcus, elevated klebsiella, pseudomonas. Sometimes, these could be pathogenic. Others like H-pylori, which has some controversy, but it can be a potential trigger for Graves’ and Hashimoto’s. if I see H-pylori, I will recommend a natural protocol.

Controversy with parasites as well in some cases. I’ve had people on the podcast who say that not all parasites are bad. You don’t always want to treat for parasites. There are people who treat everybody for parasites.

Stool testing is not perfect. You need to keep that in mind, especially when it comes to parasites. That is one justification for treating everybody with parasites. You can’t 100% rely on stool testing. That being said, it’s not perfect.

Usually when I’m doing a stool test, it’s not just for parasites. We are looking for other things, too. If it picks up a parasite, at least we have an answer. Let’s say someone tests positive for Blastocystis hominis. I have had some on the podcast, Dr. Jason Hawrelak, Dr. Nirala Jacobi, who don’t recommend always treating Blastocystis hominis. If I see it, I will recommend a treatment for it. Again, it will be more of a natural protocol. This way, if we treat it, a few months later, if you want to, you can retest.

Same thing with H-pylori. If you’re following a protocol for H-pylori, I recommend retesting to make sure it’s gone.

If you test negative for parasites, and someone is having a lot of GI issues, and you do a lot of things and nothing seems to be helping, sometimes I will treat for parasites, even if it’s negative on a stool test. You should be open-minded. I like testing, but I realize that it’s not perfect.

Same thing with yeast. Yeast, such as candida overgrowth, a lot of stool panels will test for yeast, but it’s not the best test. A lot of times, it will be negative, but it doesn’t necessarily rule out yeast overgrowth.

Stool tests look at inflammation markers like calprotectin, other markers like pancreatic elastase. Some look at short chain fatty acids like butyrate. They’re not perfect, but I think they could be really helpful in many cases. That’s my opinion on comprehensive stool tests.

Stool tests are different. If you go to a regular lab, they will usually just do a very basic stool test. It’s important to mention because someone might go to a doctor. They might go to a functional medicine practitioner, who recommends a GI Map or GI Effects. These could be expensive when paying out of pocket, hundreds of dollars.

Someone might go to a primary care doctor and request a stool panel that’s covered by insurance. The primary care doctor may or may not order a test. If you’re not having any GI symptoms, they probably won’t. Even if you’re having GI symptoms, regardless, whether you are or are not, if you order the test, it’s usually verybasic. It looks at bacteria and viruses that cause diarrhea, maybe some parasites. It’s not the same as a comprehensive stool panel.

If you’re having chronic diarrhea, it’s not a bad idea to start off with one of those tests, especially if covered by your health insurance. If it’s negative, it doesn’t mean you don’t have anything going on in the gut. It doesn’t mean you can’t potentially have a gut infection.

Even when looking at functional medicine stool panels, like GI Effects, GI Map, there are differences between the two. They both use PCR, where you don’t have to detect the parasite under a microscope. It’s looking at DNA. The GI Effects looks at PCR and microscopy, where you look at it under the microscope.

I recommend a GI Map because it’s the most comprehensive test I know for H-pylori. I know there are other tests out there, like the Gut Zoomer. These are just the two that I use the most, moreso the GI Map. GI Effects, I like, but H-pylori is an add-on. It’s not as comprehensive as a GI Map.

There is good and bad about both tests. If GI Effects ever changes their H-pylori, I would probably switch to GI Effects. It’s better with parasites because it not only looks at parasites via PCR but also through a microscope, too. Like I said, they both have pros and cons.

Still talking about gut testing. This isn’t necessarily related to a comprehensive stool panel, but organic acids testing, which is a great test. There are a number of different companies that offer organic acids testing. You could get it through a regular lab. In the U.S., LabCorps, Quest Diagnostics have them. They are very basic. They won’t be the same as going through companies like Mosaic Diagnostics, Genova Diagnostics. Thereare others that offer this.

They’re great tests for looking at yeast and fungi. The one from Mosaic Diagnostics looks at some potentially pathogenic strains of Clostridia, which could cause problems. They look at mitochondria, nutrients. It’s not just looking at things potentially related to the gut. Really good test.

I can’t say I recommend it toeverybody. I’m not one that recommends 5, 6, 7 tests to every single person. It depends on the person I’m working with, just because tests are expensive. If I think someone needs them, I will recommend them, but I won’t do soacross the board. If someone wants those tests, they can overrule me and get those tests. That’s just my approach.

Let’s talk about leaky gut testing. Every now and then, someone will ask me about doing a test for a leaky gut. I used to do a lot of leaky gut testing years ago. I used a company, Cyrex Labs, their Array #2, which is their intestinal permeability test. Most people were positive.

I stopped doing it for a few reasons. One is it’s an extra expense, a couple hundred dollars. I felt that if most people are testing positive, maybe I should just assume everybody has it.

There’s the triad of autoimmunity. Especially with Graves’ and Hashimoto’s patients, with the triad of autoimmunity, you have a genetic predisposition, exposure to one or more environmental triggers, and that increased intestinal permeability, which is the medical term for a leaky gut. According to that triad, if you have Graves’ or Hashimoto’s, you have a leaky gut. Most people tested positive for a leaky gut.

In addition, it’s not telling you what caused the leaky gut. I eventually stopped having people test for that and save a couple hundred dollars. They’re not perfect.

You could do other types of testing, like testing for zonulin on a stool test, like the GI Map. It’s an extra expense. The problem with zonulin is if it’s positive, you probably have a leaky gut. If it’s negative, it doesn’t rule out a leaky gut.

There are more classic tests like the lactulose mannitol test. There are different leaky gut options to determine if someone has a leaky gut. like I said, unless someone insists on doing that test, I usually don’t recommend it. I recommend taking the money and putting it toward another test instead.

As I mentioned, when I did the test, most people tested positive. If they were negative, I’d question them. Are they really negative? Should we still treat them for a leaky gut? If that was the case, if 95% of people were positive, even the 5% that were negative, I still wanted to treat the gut. What’s the purpose of doing the test?

The one benefit of doing it is to have a baseline. You could retest. That was kind of cool, where someone tests positive for a leaky gut, and then toward the end, you could always retest.

That’s also a common question. How do I know if the gut has been healed? If someone has Graves’ or Hashimoto’s, if their thyroid is normal, if their antibodies are normal, if they’re not having gut symptoms, I typically make the assumption that the gut is healed.

When I dealt with Graves’, I didn’t do any leaky gut testing. That marker, secretory IgA, I will say it’s not a specific leaky gut marker. When it’s low, it usually means there’s a leaky gut. You could look at that. That’s what I did at times. Some saliva test panels and comprehensive stool panels. If it’s low, then we usually want to do things to normalize it. I can’t say I order a specific leaky gut panel.

Next, let’s talk about environmental toxins and toxicants. These can trigger autoimmune conditions such as Graves’ and Hashimoto’s. They could also in some cases increase intestinal permeability, cause a leaky gut. Things like mycotoxins, microplastics, glyphosate can disrupt the gut microbiome. Doesn’t mean we need to test for all of these. I can’t say I go crazy withthe toxins tests because we’re exposed to so many toxins and toxicants. You can’t do all these tests.

I like to do hair mineral analysis testing. Hair testing is not a perfect test, but it looks at heavy metals. Some doctors do what’s called provoked urine testing to look at heavy metals. Urinary mycotoxins testing. There are a number of companies that do this now. I like urinary mycotoxins testing in some cases. Mosaic Diagnostics, Real Time Laboratories. There is a company, Vibrant Wellness, that has a total tox test that includes urinary mycotoxins and also other toxins such as heavy metals and different types of toxins and toxicants.

There is also a company, Cyrex Labs, which has what’s called Array #11. This is their chemical sensitivity test that looks at the immune system response to different toxins and toxicants. I don’t want to get into this here, but there is the argument, and it’s a really good one, that it’s not just about the toxin levels.

We all have a toxic burden; we’re all exposed to toxins. It’s really about how your immune system responds to these toxins. I can’t say I recommend this test to most people, but if someone is not progressing as expected, if their antibodies aren’t decreasing and normalizing over time, then it is something to consider.

It can help see if your immune system is reacting to any toxins or toxicants. There is what’s called a loss of chemical tolerance, which is a factor with different autoimmune conditions. This usually relates to the gut microbiome. We won’t completely eliminate our exposure to toxins and toxicants, but we can do things to improve the health of our gut. We spoke about leaky gut. That’s a big part of it. It goes beyond that as well.

You definitely want to do things to reduce your toxic burden. Of course, you can do that even without doing these tests. Some of these tests can be quite expensive. Usually, that’s what I do initially rather than have some people spend a lot of money on tests. I do hair testing, but that’s not just looking at heavy metals; that’s looking at things like minerals, too. Try to do as much as you can in your own home to reduce your toxic burden.

Nutrient deficiencies. Nutrients are important of course. There are a lot of important nutrients when it comes to thyroid health and autoimmune thyroid conditions. Selenium. A lot of people are deficient in iron, magnesium, Vitamin D, Vitamin B12, omega 3 fatty acids. Some of these, we can just do at regular labs, like an iron panel. We can do a 25 hydroxy Vitamin D. Some of these, we look elsewhere.

You could do blood testing, but there are other companies like Genova Diagnostics, which has a NutrEval. It’s a comprehensive test that looks at vitamins, minerals, amino acids.

Hair mineral analysis looks at minerals. Hair testing is different though. It’s not perfect, and it’s not just looking at deficiencies. Most people on a hair test will be low for iron, but I wouldn’t rely on a hair test to determine if someone has an iron deficiency. I would recommend doing a full iron panel through the blood and not relying on the hair test. Like I said, there are other companies. Even NutrEval, I forget if it looks for iron, but if it does, it doesn’t look for iron saturation or ferritin.

Food sensitivity testing. I can’t say I’m a huge fan of food sensitivity testing. I usually recommend an elimination diet, like an AIP-type diet or paleo-type diet. IgG testing is very popular here. I can’t say I never do it. Usually, it’s another test where if someone is hitting a roadblock in their recovery, I might consider doing that.

If I recommend it, I usually will recommend either mediator release testing (MRT) or Cyrex Labs’ Array #10. There are other companies, too, but you have to be careful. Some food sensitivity tests, you can get on your own. I won’t name specific names here, but they’re very inexpensive, and you get what you pay for here. If you’re spending $80-100 on a food sensitivity test, I don’t know if I would rely on it.

Quickly, iodine testing. I decided to talk about this briefly. I don’t really consider this functional medicine testing, but it’s a common question. I won’t get into iodine here as far as should you take iodine; I have other episodes where I talk about that.

I will say I am more cautious now than I was in the past when it comes to iodine. I am not anti-iodine. Iodine is an important mineral. In some cases, it can cause problems.

If I do recommend iodine testing, it’s urinary testing. There is a company, Hakala Labs, that I like. They offer a spot urine test or a 24-hour iodine loading test, which does require you to take a large dose of iodine prior to that. I am not recommending that. Many people will be fine, but other people might not be fine. I just wanted to bring it up because some people might wonder about iodine testing.

Also, I wanted to bring it up because some people will get iodine tested in the blood, which is not the best way to look at iodine. If it’s low in the blood, maybe you’re low. If it looks good in the blood, it doesn’t always rule out a deficiency.

Those are the main tests I wanted to discuss. It’s not all inclusive. There are others. Those are some of the more common ones that I recommend. I’m more on the conservative side. It does depend on the person.

When I dealt with Graves’, I just did an adrenal saliva test, I did hair mineral analysis testing, and I did a blood test. I did retest the saliva test as I mentioned. Some people do need a comprehensive stool test. Some people need organic acids tests. Some people need urinary mycotoxins tests. It really depends on the person, their health history.

Like I said, it’s ultimately up to the person. If someone has been dealing with Graves’ for a long time, and they have worked with different practitioners, maybe they have done different tests or have done a bunch of tests. If they haven’t done much testing though, then they might want to do more testing than the average person, compared to someone who is newer with Graves’. It is ultimately up to the person.

If I recommend conservative testing, and someone wants to do more comprehensive testing, I am fine with that. Of course, if I recommend comprehensive testing, and someone can only afford conservative testing, that’s fine, too.

In a perfect world, everybody would do every single test, or not every single test, but you know what I mean. If you’re paying out of pocket, that’s quite expensive. I’ve found over the years, most people don’t need to do all those tests. 2-3 tests, many people are fine with, and we can always do more testing. If someone really wants to do more testing initially, that’s perfectly fine.

I wanted to briefly discuss some of the biggest mistakes people make with testing. #1 is what I just mentioned: doing too many tests at once. Actually, I take that back. The biggest mistake is not doing functional medicine testing in the first place, trying to change your diet and take lots of supplements.

Another mistake would be doing too many at once, spending too much money when it’s not necessary.

In this day and age, people can order tests on their own. That’s another mistake. Not necessarily ordering tests on your own but ordering it and trying to figure it out on your own.

Using AI to try to figure it out also. I would be careful because AI is pulling from so many different sources.

Another big mistake is relying too much on the testing and ignoring the foundations. I definitely recommend diet changes, blocking out time for stress management, getting proper sleep. Sometimes, you need to do some of those tests to help, like stress and adrenals go hand in hand. Adrenal imbalances can also cause sleep issues.

That is pretty much all I want to discuss here. Again, testing is beneficial. I am so glad I did testing when I dealt with Graves’. Over the years, I have recommended functional medicine testing to pretty much everybody I work with. Not everybody chooses to get tested, but most people do. They at least get some testing done.

Like I said, I am more on the conservative side. If you really want to find and remove your triggers, testing is a good idea. Yes, you can guess, and some practitioners, like Dr. Evan Hirsch, I don’t like to say he guesses, but if you’re not testing, that’s essentially what you’re doing. I’m sure he gets great results, but I like to test and see what imbalances someone has.

If we do 2-3 tests, and let’s say only one test is showing anything, I don’t see it as a waste of those other tests. We’re ruling out information. If we’re doing a few tests, usually we’re seeing multiple triggers. It’s not like there’s only a single trigger.

When we do adrenal saliva testing, hair testing, comprehensive blood testing, usually we’re seeing a number of different things. Maybe not all of them are triggers; maybe some of them are not related to your Graves’ or Hashimoto’s or non-autoimmune thyroid condition, but you still probably want to fix it if you see something out of balance.

I will say this. I am offering here for free a Beyond Thyroid Testing Checklist. You want to do thyroid tests and comprehensive blood tests, but you also want to do more than that. If you want some of this in writing as well, just so you have a handy checklist, visit SaveMyThyroid.com/TestingChecklist.

As usual, I hope you found this information I presented to be valuable. Of course, I look forward to catching you in the next episode.

***

I will expand a little bit on the episode here. Testing versus guessing. I brought up how Dr. Evan Hirsch doesn’t do functional medicine testing. There are others who don’t do functional medicine testing.

As I mentioned during the episode, most of the natural health care practitioners who I know do testing. Again, they might be like me and do more conservative testing, even though there are times when I do comprehensive testing. There are practitioners who recommend comprehensive testing for everyone. They’ll recommend five functional medicine tests. Approaches are different.

I do think that if you can afford to do testing, it’s better to test rather than guess. There is a time and place for some guesswork because the tests aren’t perfect. Even though they’re not perfect, the tests are pretty good. If they were greatly inaccurate, it would be fair to question whether or not you should do testing. I think they’re valuable.

The GI Map, for example, is not perfect with parasites, but it’s not just looking at parasites. If it was just a parasite test, I could understand maybe not doing the GI Map. It’s great for H-pylori. It’s really good for opportunistic bacteria and other markers. Again, it does pick up parasites sometimes. It’s not like it never does.

With the PCR testing, there are limitations. You can’t test all parasites with PCR testing. If it’s negative, you could have a false negative, but it’s also possible that you have parasites that aren’t present on the GI Map.

Saliva versus DUTCH testing. I spoke about this a little bit. If you’re just focusing on adrenals, I think it’s perfectly fine to do saliva testing. DUTCH also has an option to do saliva testing. It’s a dried urine test, but you could do saliva testing for adrenals with DUTCH.

If you’re looking not only to evaluate adrenals but also the sex hormones and how you’re metabolizing sex hormones, especially estrogen, it could be valuable.

Secretory IgA versus leaky gut testing. I mentioned how in 2008, I wasn’t really familiar with leaky gut testing. It wasn’t as popular then as it is now. You could add zonulin to stool tests. Cyrex Labs wasn’t around in 2008, I don’t think. If they were, I wasn’t familiar with them.

I mentioned how I did a saliva test that looked at secretory IgA, which was depressed when I did my first saliva test. I retested a few months later, and my adrenals improved, but secretory IgA was low. Eventually, it normalized. Secretory IgA is also uncertain. Comprehensive stool panel is as well. It’s not a specific leaky gut test. Usually, if secretory IgA is low, the person will have a leaky gut.

Stool testing versus SIBO testing. I didn’t talk much about SIBO breath testing. I mentioned it briefly. When do you determine if you should do a comprehensive stool test or a SIBO breath test? If you decide to do gut testing in the first place. It’s not like I have everybody do gut testing.

If someone is having a lot of gas, bloating, with certain foods, especially higher FODMAP foods, fermented foods, higher fiber foods, then that probably is more of an indication that you should do a SIBO breath test. If you have other gastrointestinal symptoms, then maybe do a comprehensive stool test.

If you’re not having symptoms, like if someone starts out with adrenal saliva testing, hair mineral analysis, comprehensive blood testing, and they just hit a roadblock in their recovery after a few months, and we’re thinking about doing other tests, but they’re not having any GI symptoms, I would say maybe a comprehensive stool test.

Usually, with SIBO, you will have some symptoms. With H-pylori, parasites even, you won’t always have symptoms. In that case, I would probably lean more toward a comprehensive stool test, like GI Map or GI Effects.

Nutrient testing. I mentioned the NutrEval. I should mention that I don’t have most people do the NutrEval. It’s a really good test. It’s a pricey test. I usually test some nutrients through the blood. I look at hair mineral analysis for some of the minerals. I can’t say I test all of the nutrients through regular labs. Organic acids tests have limitations. It’s an option in some cases to consider.

Recently, I have recommended a little bit more frequently. Still not for everyone. Not even the majority of people who I work with at this point.

Function Health. I didn’t mention Function at all. This involves comprehensive blood testing. I wanted to bring it up here because recently, I joined Function Health. I don’t know if you’ve heard of them, but Function Health is through Dr. Mark Hindman.

For a reasonable price, you get one comprehensive blood test every year. You can get a second one that’s okay, not nearly as comprehensive as the first one although you can add to it. If you have some findings on the first one, and if those markers aren’t included on the second one, you can always add them. Depending on the tests, some of them are reasonable, and some are pricey.

I think for comprehensive blood testing, if you’re paying out of pocket, whatever you can get covered by health insurance, but if you have ahigh deductible or no health insurance or poor health insurance, where you have limited coverage.

We have decent health insurance. My wife is a teacher who works for the state, so we have health insurance. You know how the medical system works. I still went with Function Health.

I have been happy with it so far. I did my first test in December. We’ll have a follow-up test sometime in June or July.

If you join, I didn’t realize until recently they give a referral link. If you know someone who mentioned Function Health, use their referral link. Don’t use mine. If you don’t know anybody, you can get $25 off. I also get a $25 credit. SaveMyThyroid.com/FunctionHealth. If you visit that, you’ll get redirected to my referral link and get $25 off Function Health. If someone else has mentioned it to you, I would ask them, just to be fair, just to get their referral link. I’m pretty sure everybody has a referral link. It’s not just because I’m a practitioner.

Feel free to do some research before you join. I learned about Function Health through my patients. I had a few patients go through it, and they told me the price. As of recording this, it is $365. They market it at $1/day. To me, that’s affordable for everything you receive.

You can always visit their website and see what it includes. If you visit the referral link, it will take you to the website, so you can look at what tests are included.

Thanks again for tuning in! Hope you found the episode to be valuable. Look forward to catching you in the next one.

 

In this episode, Dr. Eric sits down with gut health expert Lindsey Parsons to explore the deeper root causes behind SIBO—especially post-infectious IBS. Lindsey shares her personal journey from food poisoning to chronic gut issues and autoimmune conditions, eventually leading her to specialize in helping others heal complex digestive disorders.

They dive into what really drives recurrent SIBO, explaining how an autoimmune response triggered by food poisoning can damage the migrating motor complex, leading to ongoing bacterial overgrowth. Lindsey breaks down the differences between hydrogen and methane SIBO, the role of fungal overgrowth (SIFO), and why many traditional approaches fail to provide lasting results. The conversation also covers testing options like the IBS Smart test, limitations of breath testing, and how to better assess the gut microbiome.

You’ll also learn about effective treatment strategies, including when to use antibiotics versus herbal antimicrobials, the emerging use of MSM, the controversy around berberine, and the critical role of prokinetics in long-term management. If you want a clearer, more balanced understanding of why SIBO keeps coming back and how to manage it effectively, you’ll get a lot out of this episode.

Click Here to listen to it on the Save My Thyroid podcast

Dr. Eric Osansky:

I am superexcited to chat with Lindsey Parsons. We are going to be talking about SIBO and post infectious IBS. Lindsey Parsons is a certified health coach working out of Tucson, AZ. She specializes in helping clients heal gut issues and reverse autoimmune diseases naturally. She also hosts a podcast, The Perfect Stool: Understanding and Healing the Gut Microbiome. Prior to starting her health coaching career, Lindsey cofounded and ran a nonprofit advocating for healthier food in the Montgomery County public schools in Maryland. Welcome, Lindsey.

LindseyParsons:

Thank you so much.

Dr. Eric:

Great to have you here. Really excited for this conversation. Let’s start out with your background. Why do you focus on infectious IBS? I know it has something to do with your personal health journey, so maybe you could elaborate and talk a little bit about this.

Lindsey:

Sure. My health journey started somewhere in my early 20s when I moved to Costa Rica. I had a bad food poisoning incident. There were a couple incidents. I got some kind of parasite one year, and then I was back after that and lived there for a year and a half. I got food poisoning from mayonnaise. It was entirely my fault. I left it out of the fridge for several days and then ate it, trying to keep it cold. I made tuna salad. Typical food poisoning event.

When these typical food poisoning events happen, 9/10 people will be fine and recover, and 1/10 people will get post infectious IBS, which is what I got. I didn’t know that for many years. What followed was slowly but surely, more and more bloating when I ate. More loose stool. Never a lot of diarrhea kind of thing, but when I had a bowel movement, it was loose. I started using those wipes, which clogged up the plumbing multiple times in many houses.

Fast forward. At some point, I saw a gastroenterologist, who didn’t have much to say about what was going on. Didn’t think that was terribly out of the ordinary. Around 2014, I’m in my mid-30s. I’m diagnosed with Hashimoto’s thyroiditis, pernicious anemia, inability to digest B12, and a platelet autoimmune disease called ITP. They subsequently removed that diagnosis and said they changed the criteria, so maybe I never had it.

My antibodies aren’t terribly high with Hashimoto’s, and they saw I had nodules on my thyroid. They then saw the damage from the Hashimoto’s and diagnosed me. I wasn’t far enough along to have to go on thyroid hormone.

I ended up seeing an endocrinologist. “We’re just going to wait and see what happens. Eventually, your thyroid will stop functioning, and we will supplement. Eventually, we will have to have it removed, and that will be that.” Are you crazy? I am going to wait for my body to destroy my thyroid? What kind of an idiot would do that?

I did some research. I knew there was gut stuff going on. At this point, I had heard about FMT. I did one on myself. Very unadvisedly without testing for pathogens or anything. Just thought, what the heck. I had suffered for many years and thought maybe I could fix all these things. My B12 level did shoot up temporarily, but it didn’t stay that way. I have always had to take sublingual B12, even though a B12 shot did normalize my antibodies for pernicious anemia.

Eventually, I was diagnosed by a functional medicine doctor with SIBO. I think that had been the first time I had heard about it. Maybe I read a book about it. I got a breath test that was marginally positive and went through herbal treatment; rifaximin, which is the typical antibiotic that they give for SIBO; and improved enough for a time. Then it just kept coming back.

That is the pattern with people who have post infectious IBS. The problem is not an overgrowth of bacteria. Yes, that’s the problem, but that’s not the root cause of the problem. That is an autoimmune attack on your migrating motor complex (MMC). I had recurrent SIBO and learned to manage it with antimicrobials.

I eventually became a health coach and learned more about this. I started specializing in gut health and learned a lot more about it. I understood a lot better. I probably had some candida along the way in there. Various other sundry things. I had endometriosis and infertility and some of these other things that happened where you have all sorts of problems in your gut and thyroid. That was my journey.

Dr. Eric:

Sounds like you have been through a lot between the post infectious IBS, the Hashimoto’s, pernicious anemia, some other health conditions. These days, you’re doing a lot better.

With Hashimoto’s, you said you haven’t been on thyroid hormone replacement at all?

Lindsey:

Never. Once I corrected what was going on in my gut, and I went off gluten and dairy, for a time, I went off soy. Then the Hashimoto’s never advanced. I wouldn’t say I have optimal thyroid function, but I’m still totally within optimal TSH at least.

Dr. Eric:

Remind me, you were diagnosed with Hashimoto’s prior to being diagnosed with post infectious IBS?

Lindsey:

I believe so. It was a year or two before. Post infectious IBS, I have never officially been diagnosed, but I took the IBS-Smart test, and it was positive for vinculin antibodies.

Dr. Eric:

Okay. We’ll talk more about that. Not all cases of SIBO are post infectious IBS, correct?

Lindsey:

Correct. Some people have other reasons for SIBO. Maybe they took some antibiotics, and the balance of bacteria just got off. Some people, it’s fungal. Some people, it’s actually SIFO. It’s candida in the gut. Some people have adhesions that might be slowing their motility. There are people with Ehler’s Danlos Syndrome that have motility issues. Sometimes, it’s stress related or thyroid related. There are kinds of dysbiosis that are not SIBO per se.

SIBO itself almost always presents with bloating or gas. Some people for whatever reason don’t bloat, but it’s pretty rare. Most people with SIBO are bloating. Every time they eat, they are roughly getting worse throughout the day.

Not all SIBO is post infectious IBS. Only the kind that keeps recurring. Then it’s worth testing and finding out if it’s post infectious IBS.

Right now, you can do the IBS-Smart Test, which does the vinculin and the CdtB antibodies, which are a distending toxin B that is on the cell wall of gram negative bacteria, particularly salmonella, E.coli, campylobacter.

In an episode of food poisoning, your body will mount a defense to that CdtB, which it should do. For some people, it also sees the vinculin, which is a protein involved in the MMC, which does these cleaning waves of our gut every 2-3 hours after we eat roughly. The cleaning waves won’t happen if your body mistakes this vinculin protein for the CdtB protein and starts attacking it.

Then you get a disrupted wave. It maybeback flows, or it doesn’t go smoothly. It allows for the bacteria to gather in the small intestine. Then you get these overgrowths typically of either klebsiella or E.coli, the loose stool presentation, which is IMO overgrowth, which is more of a dysbiosis that may or may not have been caused by the same reason but mostly not post infectious.

This is usually related to antibiotic use or dysbiosis that accumulates over time, where people end up with high levels of methanogens, which are not bacteria. They are archaea. It’s a dysbiosis that is probably not caused by post infectious IBS, but sometimes.

Sometimes, you can have both. You often do have both because hydrogen producers, which is the SIBO-D type presentation, those hydrogen producers feed methane producers. Sometimes, it starts with hydrogen overgrowth and feeds into methane. Those guys start overgrowing and taking over. Then people are really miserable because they are constipated and bloated. That doubles back on itself and makes them even more miserable.

Dr. Eric:

Backtracking. For those who might not be following, SIBO. You have the MMC, which is the cleansing wave. You want the cleansing wave to sweep out the bacteria from the small intestine. There could be numerous factors that negatively affect the MMC, but when you have post infectious IBS, you’re getting an autoimmune process that is affecting the MMC, which is as of now not reversible.

If someone does a health history, if they come in presenting with gas, bloating, or maybe they have already been diagnosed with SIBO, but they have undergone different treatments, whether it’s rifaximin or herbal antimicrobials or the Elemental Diet, and it keeps on coming back, maybe you suspect that it might be potentially post infectious IBS.

You might run a test such as the IBS-Smart that looks at these antibodies. If that IBS-Smart is positive, then that probably confirms that the person does have post infectious IBS. There is not a cure for this, but you can treat it. We will talk about prokinetics, which a person can take to maintain a state of wellness, where they are not experiencing the gas and bloating continuously.

Lindsey:

Yeah. I did leave one thing out, which was the other test that tests this. It’s by Vibrant. They do a Candida + IBS Profile. That includes those same antibodies for IBS, but then they also do some candida antibodies. Those are the two options in the U.S. I know that there is a place called Colab, where you can access the IBS-Smart from abroad if a doctor orders it for you.

Dr. Eric:

With the candida antibodies, as far as I understand, there is no specific test for SIFO. You can do certain tests for antibodies. You can look at organic acids tests, but there is nothing that really pinpoints the fungal overgrowth in the small intestine. Correct?

Lindsey:

The best marker for that would be arabinitol in an organic acids test. That would be the Genova Metabolomix, or NutrEval has that marker.

Some other tests have arabinose, which is a less specific marker. It often points to candida. If it’s in the small intestine, and if it’s invasive and forming high fat and sending metabolites to the urine.

You might see candida on a stool test, but I almost never see them both on a stool test and an organic acids test. They often seem opposing. If I see it in a stool test, it’s more likely in the large intestine.

Dr. Eric:

I’m sure a lot of people know that IBS-D, methane, hydrogen. If it’s hydrogen dominant, they are more likely to have loose stools, diarrhea, IBS-D (diarrhea). If it’s more methane dominant, they are more likely to have constipation and less likely to have post infectious IBS.

Lindsey:

Yeah. Maybe 10-20% of those people might. Of all the people who have IBS, probably 70-80% actually have SIBO.

Dr. Eric:

Not all cases of IBS are caused by SIBO, but 70-80%. Most conventional doctors still don’t understand that.

Lindsey:

No.

Dr. Eric:

If you have those symptoms, most of themwon’t even test for SIBO.

Lindsey:

I asked a doctor, too. I was trying to get some rifaximin because I wanted a good cleanout. I went to see a gastroenterologist, and he gave me a SIBO test. They sent incorrect instructions on the substrate. They only had me take a small quantity.

What I ended up doing was taking fructose because glucose was an inferior substrate. Ideally, you have lactulose; that’s the best one. For me, the second best choice is fructose, but that’s not officially used. I think I used too small of an amount. No, maybe I did take their glucose. The test came back negative, but I managed my SIBO, and it was going to come back negative anyway. I couldn’t get the prescription.

Dr. Eric:

Most labs use lactulose. I know there used to be a company, BioHealth, that is not in business anymore, but they offered the glucose and lactulose. There are other companies that currently do that, which offer lactulose and glucose. You have to request it.

Lindsey:

Whomever orders the test chooses which substrate to use. Have you heard of FoodMarble?

Dr. Eric:

I think so.

Lindsey:

It’s a handheld device that you can own to test-

Dr. Eric:

Yeah. I heard you during one of your solo podcast episodes in preparation for this, and you mentioned it. Dr. William Davis, I don’t know if it’s the same device, but in his book SuperGut. I know he has Wheat Belly, not that book. But his most recent book, he was talking about another device to measure in place of the breath test. Is that the FoodMarble? Is that a different device?

Lindsey:

Probably. I don’t know of any other devices you can buy. I like the device for IMO because they tend to have more trouble eradicating it, even in one round of antimicrobials, so it’s good for testing and retesting. It maybe costs $250 compared to getting a commercial test for $200. This way, you can test and retest.

Dr. Eric:

Do you think it’s just as good as a SIBO breath test?

Lindsey:

It’s not calibrated every time you use it. But I think it’s good enough. You’ll see the signal if it’s there, let’s put it that way.

Dr. Eric:

Interesting. Maybe it was the FoodMarble. It rings a bell. Maybe it was just because I heard you say it during the interview, but he mentioned a similar device. Maybe it is the same device in the book. Then I forgot where, but others mentioned where they didn’t feel like it was accurate. I don’t think it was practitioners who really focused on SIBO like you do since that’s really your specialty. That’s interesting. I might have to look into that. The SIBO breath test also is not perfect.

Lindsey:

No. In fact, I rarely use SIBO breath testing. If I hear someone who has extreme bloating after they eat, and then I look at their gut, and I can see what’s in there, do they have an overgrowth of E. coli or klebsiella? Do they have a lot of gram-negative bacteria?

Usually, you can tell what’s going on based on the gut microbiome. If they’re constipated, do they have excess methanogens? Do they have methanogens present? Between symptoms and the stool test, I feel like that’s a better view. If there is a parasite or if you are getting organic acids, if you happen to see candida on the stool test, there are more opportunities to see more of what’s going on. Occasionally, you do get a random parasite that people have.

The gut test I use the most right now is either the Tiny Health PRO or the Gut Zoomer from Vibrant. On the Vibrant test, which I use the most, you are seeing bile acids, short chain fatty acids, gluten antibodies, active antibodies, five or six inflammation markers. You’re seeing a lot. You can see if there is potentially IBD and the whole microbiome, what’s overgrown, what’s not. It gives a good view of what’s going on in the gut.

Dr. Eric:

What is the first one you said? Tiny Health PRO?

Lindsey:

That was originally developed for mothers and babies to see how their microbiomes are doing. They do an adult version. The PRO adds on the gut health markers, so you have pancreatic elastase, secretory IgA, short chain fatty acids, beta glucuronidase, calprotectin, lactoferrin. All thosemeasures plus a genomic sequencing of the microbiome. There, you really know what is the dominant microorganism in this ecosystem? What is the second most dominant? Third most dominant? What’s really overgrown? What’s pathogenic? It’s probably the best in terms of actually knowing what’s going on in the microbiome.

Dr. Eric:

Not familiar with that test. Might have to look into that.

Klebsiella, for example. If it shows up on the Gut Zoomer or GI Map or GI Effects, even though that’s a large intestine test, it might still correlate with the small intestine, is what you’re saying.

Lindsey:

Let’s put it this way. If someone has an overgrowth of klebsiella, and they have SIBO and histamine reactions, it’s all pretty good correlations. That’s what you’re dealing with. Klebsiella is a histamine producing bacteria. It might not be overgrown, but if it’s present, and they have all these other things, we know what’s in there.

Not everybody has klebsiella; only a relatively small portion of people do. Everyone has some E. coli. That one is tougher. Sometimes, you see a pathogenic E. coli. Then you know this is probably an E. coli presentation. If there is no histamine reaction, and it’s SIBO, it’s probably E. coli that’s overgrown. The research of Mark Pimentel shows us those are the two primary organisms overgrown in SIBO. Everything is overgrowing; it’s these ones that are taking over.

Dr. Eric:

Getting back to food poisoning. There might be some people listening who have a lot of gas and bloating, but they don’t remember having any food poisoning. That doesn’t necessarily rule out post infectious IBS. Maybe they had food poisoning, but they didn’t remember. Sometimes, it’s obvious. Sometimes, it’s not so obvious.

Lindsey:

Sometimes, people don’t remember. Maybe you thought it was viral. Maybe it was viral, and that’s where it came from. Sometimes, people had diarrhea to begin with, and then it got worse for a week or a few days. The distinction wasn’t super clear.

If you have recurrent SIBO, I think it’s worth doing the IBS-Smart to find out if you have the antibodies. You will manage it differently. You will know up front this will not go away with a good round of antibiotics or antimicrobials. This will keep coming back. How do you manage this?

Dr. Eric:

With gas and bloating as common symptoms, do you find that most people experience just when eating certain foods, like high FODMAP foods? Does it vary? For some people, it doesn’t make a difference what they’re eating.

Lindsey:

The research has shown that if you avoid wheat and dairy, because wheat is a FODMAP, you will probably eliminate most of the FODMAPs because that’s where the bulk of the FODMAPsin our diet are. I notice if I eat too much avocado or asparagus, I will get bloated. If I eat dairy, it’s like death. I’m miserable. I’m also lactose intolerant. Of course, I’m taking a lactase enzyme when I’m eating dairy. Dairy is the absolute worst one.

Something with low wheat, I can eat a slice of sourdough bread, and that won’t bother me. I am not doing that because I am glutensensitive.

Yes, you can eat low FODMAPs, but I wouldn’t recommend it. It is a limited diet. You will miss out on a lot of fibers you need. Ultimately, you won’t end up with the microbiome you want to stop that recurrence of E.coli. I have taken anew approach most recently to dealing with recurrent SIBO or IMO, which is about using targeted fibers to try and remake the microbiome, so E.coli can’t regrow in heavy numbers. You will have the protective effects of all these good butyrate producing bacteria and trying to have the ones be most dominant in your colon.

Dr. Eric:

Cautious of doing low FODMAP, especially long term. I agree that can have negative effects on the gut microbiome. Unlike the Elemental Diet, which is an actual treatment, the low FODMAP diet is trying to manage symptoms and not doing anything to eradicate.

Lindsey:

It won’t get rid of it, no. You’ll feel better on it, but you can’t eat garlic and onions. Good luck going to a restaurant. I’ll have the plain lettuce salad with steak on top. That’s it. I’ll take olive oil and vinegar. That’s it. That’s all you can order at a restaurant if you can’t eat garlic. To me, it’s not a way to live.

Dr. Eric:

I agree. In some cases, maybe temporary while you’re treating it, if someone’s symptoms are severe.

Lindsey:

If they’re miserable. But the problem is people go on low FODMAPs. They’re reacting to this and that. The whole time, they’re thinking it’s the food. It’s not the food; it’s the bacteria. It’s not about the food.

Dr. Eric:

Are signs like weight loss more common compared to weight gain?

Lindsey:

I don’t often see weight loss with SIBO. Sometimes, you get reflux because you get that upward pressure from the bloating and such. Some people will have signs of reflux or silent reflux. That was one of my signs before I quit dairy. Having a perpetual cough after I ate. A little bit hoarse throat, which I still have. Gas, bloating, loose stool, those are very common SIBO symptoms. Sometimes, people have pain.

We haven’t talked about hydrogen sulfide SIBO, which is a different beast. That can happen if your sulfate reducing bacteria get overgrown. That one is particularly miserable. Usually, that’s the one where you’re having 6-10 urgent diarrhea episodes a day.

Dr. Eric:

Is that the Trio-Smart that looks at hydrogen sulfide?

Lindsey:

It does. I have sent people for Trio-Smarts, and 3-4 of the samples are invalid. It doesn’t work that well. It sometimes fails to diagnose when all the symptoms agree with it. People can’t tolerate garlic or onions or broccoli or Brussels sprouts or high fat foods. All the signs. They’re having urgent diarrhea. They get a negative test. No. They have this. You can tell.

Dr. Eric:

Like you said, you rarely do breath testing. You do a comprehensive stool panel by Vibrant Wellness, the Gut Zoomer. Did you say with most people, you give them the FoodMarble device?

Lindsey:

No, mostly people who if they know they have intestinal methanogen overgrowth, and I know they will keep retesting to see where they are, to see where the symptoms are.

It also depends. Have they already had a test or not? Do they need to test for the first time, and they will need at least one test and retest, so it economically makes more sense. It depends on the client.

There is also cost questions. Is there a suspicion of SIFO? If there is, maybe I need to do both a stool test and organic acids test. Is there suspicion of mycotoxins? If so, then there are deals with multiple tests with Vibrant, so it all depends on the person.

Dr. Eric:

To reinforce what you said earlier, if you are suspecting SIFO, you prefer Genova Organics because it looks at arabinitol, compared to Mosaic, which looks at arabinose.

Lindsey:

I do prefer that. I don’t necessarily already order that because of the practicalities of cost. If there is a deal where they can get three tests for $800, I will send them to that instead of having them spend $1,200 on three tests.

Dr. Eric:

Treatment. Before we get to the prokinetics with post infectious IBS, do you prefer the rifaximin, Xifaxan, herbal antimicrobials? There is the Elemental Diet. I think those are the only three options, right?

Lindsey:

Yeah. If people can get ahold of rifaximin, I don’t object to it. The research shows that it attacks in particular these overgrown organisms and does not disrupt the microbiome. That is what the research says. People’s experience might not be the same. In general, that’s what the research is showing.

Assuming they can’t get hold of it, or they don’t have a doctor who will diagnose it, then I usually recommend herbal things.

One thing I do not ever use is berberine. There was a big study that showed it decreases bifidum, a bunch of good butyrate producers. That’s something I won’t touch unless it’s absolute last resort.

I’m either using high dose allicin, or I like a protocol with MSM.

Dr. Eric:

I was going to ask you about MSM. I had a patient who couldn’t tolerate the antimicrobials, not berberine, which I’m sure you’re familiar with, the study that showed the biotics research and the Metagenics products. She couldn’t tolerate the herbal antimicrobials. The Elemental Diet didn’t work. She was trying a protocol with the MSM. I wasn’t as familiar with it. I have learned a lot from Dr. Allison Siebecker and Dr. NiralaJacobi, and I don’t remember them bringing that up. Can you talk about it?

Lindsey:

I wish I could attribute the person who talked about the protocol. I believe it was on Nirala Jacobi’s podcast.

The protocol begins with 1/8 teaspoon of MSM, which is a bitter powder. It’s a sulfur source. Cheap as dirt. You just double every day until you get to 32g. Hold there until the bloating is gone.

The doctor who recommended this protocol said that it was very effective. She didn’t care what kind of SIBO it was. She wasn’t even testing. She would give it to anybody, even if she thought it was hydrogen sulfide. I tend to stay away from sulfur when dealing with hydrogen sulfide, but she recommended that protocol.

I thought I wasn’t going to recommend it based on somebody saying something on a podcast, but I tried it on myself. I got up to 16g a day, half a tablespoon three times a day. My bloating was completely gone. I felt as good as I’d felt in forever.

I decided to keep the MSM around and use a little bit to kill a little bit of bacteria. Is this going to kill my beneficial microbes? Over the course of time, while I was using that, I used that and then used it as a maintenance, half a teaspoon a day or more if I started to feel more bloaty.

I discovered on my stool test that my beneficial microbes were not depleted. I was in good shape. I have since recommended some clients do it, and same thing. Came back in concert with a gut shake that has good fibers to promote butyrate producers. All the good bacteria had increased. None of the beneficial ones were depleted.

I think part of the reason is it’s a powder that dissolves really quickly in water. It’s definitely hitting the small intestine, not making it to the colon, I don’t think.

Dr. Eric:

Hmm. You mentioned berberine. Some controversy with berberine. I had Dr. Jason Hawrelak on the podcast. We had a little bit of a debate because he is the one I learned that about berberine. He was my instructor when I went through my master’s in nutrition back in 2013. Around 2018, I took a gut microbiome course through him. I forgot when I first heard about berberine.

There are so many positive studies recently looking at berberine and talking about the benefits of the gut microbiome. It’s conflicting. I know the study he mentioned, and you mentioned an older study. There are newer studies. If you type in “berberine for the gut microbiome,” most of what you see on PubMed is positive.

Dr. Allison Siebecker and Nirala Jacobi, too, use berberine. They also use oregano. Oregano for sure can affect some of the good bugs. Either way, when it comes to SIBO, some look at it as risk versus benefits. Even if it affects some of the good microbes, if it’s doing what it needs to do for SIBO, you could replenish the gut microbiome. There are a lot of different perspectives on berberine on the gut microbiome.

Lindsey:

I’m not deep in the research, so I rely on people like Jason Hawrelak and Brad Leech, who is his colleague, to filter that stuff. I did take that study and ran it through AI and asked it to summarize for me. Which go up, and which go down? Not only did it say that it pushed down the beneficial microbes, but it pushed up a variety of pathogenic microbes. In that study, it was not even helping with the stuff you’re trying to push down. I admit that I am not that familiar with the more recent research if there is something showing otherwise.

Either way, if I have a tool that is not that, that won’t be potentially harmful, I will use that tool first. As I said, you sometimes get to the point where you run out of options. Go to something that has some berberine in it, but not the only thing it has.

Also, with mycotoxins, I’m using that because there is not a lot of great herbal options. If people can’t get prescriptions, you have to find something to help them.

Dr. Eric:

The ones I mentioned have some berberine. Dr. Siebecker, when she worked with patients, I know she worked with really tough cases. She mentioned she would use really high doses of berberine in some cases. She was saying a lot of people can’t tolerate the high doses, but sometimes she would recommend 2,000-3,000mg, which is pretty high. Some people can’t tolerate 500-1,000mg.

How about Neem? Do you use that at all?

Lindsey:

I have used it in the past. I am trying to stay away from the more powerful stuff at this point. I would say the primary things I’m using now are the allicin. Sometimes, you’re getting SIFO presentation, too, so it might be that you’re using something for both the SIFO and the SIBO or IMO. Maybe you’re using the allicin to hit both of those. Then you’re adding the caprylic acid. Biofilm disrupts the GI phase 2. I always forget how to combine the words; it’s like GI phase 2 advanced something.

Dr. Eric:

Dr. Paul Anderson?

Lindsey:

Yeah. There is the SFI Health, Ther-Biotic Interfase. Some of those products.

Dr. Eric:

You use allicin not just for methane dominant SIBO, but even if it’s hydrogen dominant?

Lindsey:

I mostly use diet changes and some form of bismuth if possible for the hydrogen sulfide.

Dr. Eric:

With diet changes, do you recommend the Elemental Diet?

Lindsey:

That’s a last resort. That would probably only come into play for very resistant IMO. I’ve found that sometimes people can’t have enough antimicrobials. It’s not busting up the bloating. The constipation, you can usually get moving, but the bloating seems to be really resistant. That would be the one case where I have resorted to the Elemental Diet.

People don’t want to spend the money. They are not eating for three weeks, but three weeks of not eating, for some people, I had one guy who did it four times. It was totally his own choice to do it four times. He had a combo of gastritis and IMO, and that was the perfect thing for him because he couldn’t take a lot of stuff. He was so sensitive because of the gastritis. It was the perfect thing. He kept doing it over and over again, and he was completely clear of all symptoms of everything.

Dr. Eric:

Hmm. I know Dr. Siebecker, in the past, has said that could be more effective than the herbs.

Lindsey:

No doubt. Not a lot of people are buying it.

Dr. Eric:

I agree.

Lindsey:

No, thank you.

Dr. Eric:

Most people don’t want to do it, both costwise, and I find they don’t want to follow a liquid diet for 2-3 weeks.

Lindsey:

Exactly.

Dr. Eric:

Let’s talk about prokinetics. What are they? When would someone consider taking them? What are the top prokinetics you recommend?

Lindsey:

Prokinetics are something that helps move the small intestine. One of the most recommended and well-known ones is also used for constipation at higher doses, which is prucalopride. The brand name is Motegrity in the U.S.

That’s the one I currently take actually. I take a quarter of 1mg. For people who tend toward the IBS-D, too much of that is definitely way too much. I started taking that about six months ago. I had tried all of the other prokinetics. Iberogast is probably my second favorite after that.

They help the MMC overnight. When I go to sleep, I am probably still digesting for many hours. At least this helps me start to clear some things out of my small intestine. Every night, I get a good reset. I had a wave of diarrhea and problems, and I wasn’t sure what was going on. I stopped the thing that was adding to my motility. Sure enough, within 3-4 days, my bloating came back pretty bad. It was a really good trial of seeing is this as effective as I think it is?

But iberogast would probably be my second favorite because it’s a little antimicrobial, and it’s bile promoting. You take 30-60 drops before bed. They also just came out with apill form, which I haven’t tried. I’m not sure whether the dosing would be 1 or 2. That would be the dosing equivalent.

Any form of ginger. You could just take normal ginger if you wanted to go super cheap, but you might get that burning feeling in your chest. If you are taking it before bed, you might need a lot of water because sometimes it gets stuck, and you have an hour of feeling kind of gross. There is a number of products that have some form of slightly altered ginger, so it’s not quite as burny.

There is GI motility complex. There is something that has tryptophan in them, and that’s particularly good if you are on the constipation side. MotilPro, that’s Pure Encapsulations. There are a few newer ones that are based on other products, like d-Limonene. I tried plain d-Limonene, which didn’t work for me. There is one called MMC Restore. I think that’s Gaia Pro’s product. There is a variety of them.

Honestly, if you have post infectious IBS, I would say try and get ahold of prucalopride. There is also low dose azithromycin by prescription. Some people use low dose naltrexone (LDN) as a prokinetic. I take that, too, more trying to suppress any autoimmunity.

Incidentally, I did retest my antibodies, and I did two things. I did LDN for about nine months to a year. Then I also did two rounds of the prolonged fasting mimicking diet and retested my antibodies. They were negative for vinculin. This is after 30 years of this.

That being said, the SIBO is still there. They might be negative, but I still get bloating. I still have to keep managing it. I’m not sure it’s really gone.

Dr. Eric:

The prucalopride helps the best in your situation.

Lindsey:

In my experience, yeah.

Dr. Eric:

The iberogast is #2 in your experience. The LDN, you’re taking but moreso for the autoimmune component. What dose are you taking of LDN?

Lindsey:

4.5mg.

Dr. Eric:

How long have you been on that for?

Lindsey:

Probably at least a year at this point. I think I just passed a year.

Dr. Eric:

Anything else that I should have asked you that I didn’t ask you? We definitely covered a lot when it comes to post infectious IBS and SIBO. We spoke about some of the signs, symptoms, treatment, testing, prokinetics. Anything really urgent I’m missing?

Lindsey:

Maybe a little bit more about fiber. Say you go on a whole regime of killing off bacteria. You go through your rifaximin. You really want to build back the microbiome.

I look at gut reports day in and day out. All I do is look at people’s gut reports. Every single person has the same problems. They have low butyrate, low short chain fatty acids in total, too much proteobacteria, and some amount of dysbiosis. Which particular pathogen decided to take over is different for each person. At the end of the day, the base problem for every single person is they have low butyrate producers.

I am really careful now that after I finish people with anything antimicrobial, I also recommend a gut shake that includes very high levels of fiber, 40g of fiber in a shake. We are talking about apple pectin, psyllium husk, flaxseeds, resistant starch for people who are on the IBS-D side, immulin for people on the constipation side, and rice bran. I am putting them on a fiber shake, all of these fibers. Often glutamine for their leaky gut and some zinc carnosine for the leaky gut.

I am trying to help them rebuild a microbiome that is going to keep them healthy. It’s a bloaty, gassy mess for the first month or so. After that, things settle in.

Dr. Eric:

I was going to ask that. In the early stages of treatment, they’re not tolerating that well.

Lindsey:

I have gone through it myself, so I know what it’s like. It’s a bloaty, gassy mess for about a month. Then you settle in, and your microbiome is getting back into good shape and good order. I have yet to do my own stool test retest after a heavy protocol. But I do my own shake once a day. That’s for rebuilding and trying to prevent relapse.

Dr. Eric:

That’s awesome. You’re continuously doing things to help build your gut microbiome, taking prokinetics to help with the MMC. The prolonged fasting helped with vinculin antibodies, but still having the SIBO symptoms, so it didn’t completely get everything in remission. It potentially has some benefits. Do you still plan on doing the prolonged fast once or twice a year?

Lindsey:

I still have one more. I am meant to do three before I do my next IBS-Smart retest. I have to go off of LDN first. I haven’t willed myself to take another one since I had those negative antibodies.

I also use SBI powder any time I see there is a gut pathogen. If I see a pathogenic E. coli or an unknown diarrhea of any sort, or if I see C. diff in there, SBI powder. The perfect stool supplement company, too. I sell two products, the SBI powder and Tributyrin Max, which is a tributyrin, a better absorbed form of butyrate. I use that a lot with people to help turn around too much proteobacteria, too much oxygen in the colon. Try and promote butyrate producers.

The other thing I use is pomegranate husk. That is also good at wiping out the bad bacteria and promoting the good bacteria selectively.

Dr. Eric:

I forget who said this, but someone mentioned pomegranate as well. You shared a lot of really good information. This is really helpful, even if they’re not dealing with post infectious IBS, but SIBO in general. A lot of these things could also be beneficial even if someone just has GI issues without SIBO. A lot of the things could be really important regardless.

Lindsey:

If someone has random GI issues, especially on the loose side, even on the constipated side, sometimes SBI powder alone is enough to resolve their issues.

Dr. Eric:

A lot of people are low on butyrate, like you mentioned. Fiber as well.

Lindsey:

Literally every single stool test I see. I don’t have to look at the test; I know what the answer is already.

Dr. Eric:

I like the GI Map. Genova looks at those markers. I don’t know if they do. I think they do. GI Map doesn’t look at-

Lindsey:

I stopped using it entirely. To me, it’s almost useless at this point. Without the short chain fatty acids. Not to mention I get the gluten sensitivity markers and bile acids.

Dr. Eric:

It does look at that. I assume most people have the low butyrate and need some support. There are so many different tests out there. We all have our favorites. They’re not perfect, but we all fall in love with our own tests.

I’m familiar with some of the Vibrant Wellness tests. I know they’re a good company. Genova is a good company. There are a number of good companies out there. There are companies I won’t name where I have tried them, and I don’t care for them. They’re all trying to help.

Lindsey:

Accuracy is one question. How much information you get is another question.

Dr. Eric:

This was wonderful. Lindsey, if you could tell people where to find you. Mention your podcast, your website, anything else that you would like to discuss.

Lindsey:

My website is HighDesertHealthCoaching.com. My business is called High Desert Health. My supplements are PerfectStool.com. My podcast is The Perfect Stool: Understanding Healing the Gut Microbiome.

Dr. Eric:

You also shared the link to a quiz. Thank you so much. This was great. We’ve had a few people talk about SIBO. This is really the first one where there is an emphasis on post infectious IBS. As a result, more discussion on the prokinetics. I’m almost certain the first one to talk about MSM when it comes to SIBO as well. You definitely gave some newer information that people can’t find on the other interviews. Thank you so much. Really appreciate this.

Lindsey:

Thank you for having me. It was a pleasure.

***

Dr. Eric:

That was an excellent conversation with Lindsey on post infectious IBS. Recently, I interviewed Dr. Izabella Wentz, who released her new book on IBS. This conversation wasdefinitely a lot different than my conversation with Dr. Izabella. Really more basic, getting into a lot of the basics.

Food poisoning and SIBO. Food poisoning can damage the MMC, which is the cleansing wave of the small intestine. It is one potential cause of SIBO. When I interviewed Dr. Izabella, we spoke about the relationship between IBS and autoimmunity, but we didn’t talk about this specifically. If she brought it up, I would have, but I knew I would be talking about it with Lindsey in this conversation.

I learned a number of years ago from Dr. Allison Siebecker and Dr. Mark Pimentel about that relationship with food poisoning. If you have a history of food poisoning, it doesn’t mean that it definitely will have caused SIBO. But if you have a history of food poisoning, it might be a factor.

The IBS-Smart is a test that looks at those antibodies associated with this autoimmune process regarding the MMC and post infectious IBS. If you’re suspecting this might be a problem, you could do the IBS-Smart.

The FoodMarble. I did do some research. Dr. William Davis, the book is Super Gut. I havenot read the book but have listened to it. It was a pretty good book. He does recommend what’s called the Aire Device from FoodMarble. It sounds like it’s the same one that Lindsey was mentioning.

I’ve had at least one if not a couple of people read that book and get the device with mixed results. I think Lindsey admitted it’s not as good as the SIBO breath test, but it’s more cost effective, more convenient. Something to consider. Something I maybe need to bring up to some people, if we’re thinking about something severe, like post infectious IBS. Even other cases of SIBO, maybe.

Testing for SIFO. She mentioned she likes D arabinitol, which is a marker on Genova’s organics test or their NutrEval. I haven’t heard from anyone else yet that that is a good marker for SIFO specifically. I’ll need to do some research on that.

If I do a regular organic acid test from Mosaic Diagnostics, and I see yeast markers, including arabinose, I realize it’s not specific for SIBO. if someone is having excessive bloating and gas, and that shows up on the organic acids test, a lot of fungal markers. It’s not conclusive, but I don’t think D arabinitol is as well.

MSM as a treatment for SIBO. Recently, I had a patient who was trying MSM. I chatted with Lindsey about this. At that point, I didn’t hear, or maybe I did hear years back, but it’s not something that’s popular for SIBO. Maybe I heard of it and forgot. I didn’t think it was effective, and it wasn’t effective, but Lindsey said she didn’t follow the protocol correctly. I’m not sure. I’ll need to send this episode to that patient to listen to. Maybe she did follow the protocol.

There is no protocol that works for everybody with SIBO, whether it’s antimicrobials, herbal antimicrobials, rifaximin, or the Elemental Diet. They can be very effective, but everybody is different.

The berberine controversy. Maybe I need to do more research on it. I did a little bit of research. I did use a little bit of AI and asked ChatGPT to do some research. I looked at some of the published journals, not just basic research on blogs. ChatGPT’s conclusion was it’s pretty much beneficial. It wasn’t too concerned about the negative effects of berberine on the gut microbiome. The evidence is more in favor of it being beneficial to the gut microbiome.

There is a single study showing it could have some negative effects on lactobacillus and some other bacteria. Lindsey said it could increase harmful pathogens, but I don’t know if I’ve seen that. I’d like to see that.

I took a non-biased approach when it came to doing the searching and cheating using ChatGPT for this. Overall, the consensus was that it was beneficial. I put in ChatGPT that there is some evidence in the published research that berberine can have negative effects on the gut microbiome.

Prokinetics help with motility. If someone has post infectious IBS, there is an autoimmune process. You won’t completely get rid of SIBO, just because you won’t reverse the autoimmunity. You will probably have to take prokinetics to help with motility. She mentioned prucalopride, or Motegrity in the U.S. It’s a medication, not crazy about that. It does work.

Iberogast, which I do like. It’s an herbal formulation. There is also MotilPro, which is a combination of ginger, 5HTP. There’s LDN, low dose erythromycin. The top two are Motegrity and iberogast.

Finally, the prolonged fasting mimicking diet. She mentioned how she did this test and was negative for vinculin but still had other antibodies. She still had symptoms. She is going to try it again and see how that helps. Something to consider. I am familiar with the prolonged fasting mimicking diet. I personally never did that specific fast, but fasting mimicking.

Really great conversation. She spoke about other things as well. You could tell that Lindsey is very knowledgeable when it comes to post infectious IBS.

Again, as usual, I hope you found our conversation to be valuable. Thank you so much for listening. I look forward to catching you in the next episode.

In this episode, Dr. Eric Osansky tackles a challenge many people with hyperthyroidism face: helping friends and family truly understand their condition and treatment choices. Whether you’re dealing with Graves’ disease or another form of hyperthyroidism, explaining what’s happening in your body—and why you’re taking a natural approach—can feel overwhelming.

You’ll learn how to navigate tough conversations about treatment choices, including medication, diet changes, and natural healing approaches. Dr. Eric shares practical ways to set boundaries, communicate your needs, and handle skepticism—while staying focused on your healing journey. If you want a clearer, more balanced understanding of how to advocate for yourself and explain hyperthyroidism with confidence, you’ll get a lot out of this episode.

Click Here to listen to it on the Save My Thyroid podcast

Dr. Eric Osansky:

Hyperthyroidism isn’t something that most people are familiar with. Think back before your diagnosis. Chances are, you probably didn’t know anything about hyperthyroidism. If someone was in your shoes, you probably wouldn’t understand what they were going through.

When someone chooses to take a natural approach, it’s not uncommon for friends and family members to question the person’s decision. After all, shouldn’t your endocrinologist know what’s best for you? Of course, it’s easy for them to have this perspective when they are not the ones being pressured to receive radioactive iodine or thyroid surgery.

The goal of this episode is to help you communicate your hyperthyroid condition clearly and confidently and help your family and friends better understand why you are choosing to save your thyroid.

Let’s start off by discussing what hyperthyroidism actually is. This is what you would convey to your family and friends. You could explain to them that the thyroid gland regulates metabolism and energy. In hyperthyroidism, the thyroid becomes overactive.

If you want to, you could even compare hyper versus hypothyroidism. Hypothyroidism is a lot more common. There is a chance maybe one of your family members or friends has hypothyroidism. With hypothyroidism, the thyroid hormone levels are low. Typically, that will lower metabolism. In hyperthyroidism, it speeds everything up. Everything is overactive. Essentially, the body runs too fast. It’s like your body’s engine is stuck in overdrive.

You could go on to explain some of the common symptoms associated with hyperthyroidism. You might not have all of these, so feel free to be specific to your symptoms. Some of the more common symptoms: rapid heart rate, which I definitely dealt with when I had Graves’ heart palpitations; anxiety; fatigue.

Fatigue, wired versus tired. You might not want to explain this part. Hyperthyroidism puts a lot of stresson the mitochondria, which are the energy powerhouses of the cells. Or you can. It’s up to you. Fatigue is also common. Some people, especially in this day and age, where they might look things up on Google or ChatGPT and say, “With hyperthyroidism, fatigue is not really a classic symptom.” As I mentioned, it does put a lot of stress on the body, the mitochondria, so it’s not uncommon to experience fatigue.

Quite frankly, when I dealt with Graves’, I felt more wired than tired. Everyone is different.

Weight changes. This is different. When I dealt with Graves’, I lost 42 pounds. I lost a lot of weight. Many of my patients lose weight. It’s not uncommon for people to gain weight, too. This is where it might become confusing. If they look up hyperthyroidism, and you’re not losing weight, they might not understand. I do have some episodes on the podcast that you could show them.

Sleep problems are very common. Just because of the elevation in thyroid hormone.Sometimes, it causes heat intolerance, which can also cause sleep problems.

Increased bowel movements. Hair loss. There are a number of symptoms. Feel free to explain them. Even though they can look it up, chances are they won’t take the initiative to do so.

If you have Graves’, then you probably want to tell them that Graves’ is the most common cause of hyperthyroidism. It’s more of an immune system condition. It’s actually an autoimmune condition. A lot of people are familiar with autoimmunity these days. You could mention that it’s where the immune system attacks the thyroid, specifically the TSH receptors of the thyroid gland, which results in too much thyroid hormone.

If you have a different hyperthyroid condition, try your best to explain this. If you have toxic multinodular goiter, that involves swelling of the thyroid, which is a goiter. You could also let them know that it involves multiple thyroid nodules. I don’t think you have to get into detail about thyroid nodules. You could tell them they are little bumps on the thyroid, little growths, in an easy-to-understand way. Essentially, it’s an enlargement of the thyroid gland, or thyroid swelling, and multiple bumps on the thyroid.

With toxic multinodular goiter, you have too much thyroid hormone. I would focus more on the hyperthyroidism part than the goiter and the nodules.

There are others, like subclinical hyperthyroidism. Most of the concern will be with Graves’ and toxic multinodular goiter. Subacute thyroiditis is very prominent, but it’s temporary. Usually, the person will eventually become hypothyroid.

Let’s talk about focusing more on Graves’. Most people listening to this have Graves’. Not everybody. With Graves’, you want to talk about that immune system. You don’t get into cytokines and all these other things, which you might not even be familiar with either. I don’t expect everybody listening to this to know the nuts and bolts when it comes to the immune system. It involves immune system dysregulation.

You could talk about some of the triggers briefly. I mention the four main categories of triggers are food, stress, toxins/toxicants, and infections. The goal is to find and remove those triggers. The symptoms could fluctuate, and they vary. You could look up hyperthyroidism online, and your symptoms may not match all the symptoms online. Everybody is different.

The point is, by talking to them about the triggers, they will understand it takes time. Healing takes time. Your goal is not just to put a band-aid on this; your goal is not just to take the medication. Maybe you’re choosing to take antithyroid medication or beta blockers, but you want to do more than that. You want to heal.

When it comes to symptoms, as I mentioned, symptoms can differ, and they can be confusing. Feeling exhausted, with that wired but tired feeling. Voracious appetite, they might be seeing you eat all the time, but you might also be losing weight. Not everyone does. If you are losing weight, yet you are eating all the time, again, it’s the increased metabolism. Anxiety that is more than psychological, that is also important.

Letting them know that many of your symptoms are physical, not just emotional. There aredefinitely psychological aspects with Graves’, but there are also the physiological aspects. Even things like Graves’ rage, there is a physical component. It’s not all emotional or psychological.

It’s important to convey this to your friends and family, so they understand it’s not just stress. That is of course a factor. You may be feeling chronically stressed. Stress can be a factor in causing hyperthyroidism. When you’re dealing with these conditions, you may be even more stressed out. This is going beyond just stress. There is that physiological component.

Healing, as I just mentioned, takes time. If someone takes antithyroid medication, that could work quickly. Within a few days or weeks, they might feel a lot better. There are side effects that are common, which not everybody experiences. If someone is taking antithyroid medication, you might expect in many cases to get quick results.

If you are taking a more natural symptom management approach, like taking bugleweed, motherwort, or L-carnitine, it could take more time. You might have to explain to them that the medications are harsh on the body.

If you’re listening to this and taking medication, I work with a lot of people who take the meds. I even though I personally didn’t take the meds, I have nothing against the meds. I am giving both sides of the story.

If you are taking medication, and it’s helping, let them know. This might offer them some comfort. Yes, you are not doing everything naturally; you’re trying some things conventionally.

If you’re like me, where you are not taking any medication, then explain to them that the reason you decided not to take the medication is because first of all, side effects are very common with antithyroid medication, and you could describe some of those. It could put stress on the liver, lower white blood cell counts, affect the gut microbiome. They could search online as well. You’re not making this up.

Also, you have known people like yourself and others who have successfully managed their symptoms naturally through herbal medicine. L-carnitine is not an herb. You could say natural agents (bugleweed, lemon balm, motherwort). They might not understand if it’s a few weeks into the treatment, and you’re still showing many of the signs and symptoms. You need to let them know, especially if you’re taking a full natural approach and not taking medication, that it could take some time.

You could let them know that, assuming you have Graves’, it involves the immune system. Even if you don’t have Graves’, you have to focus on improving adrenals. You need to improve gut health and nutrient deficiencies. You need to find and remove triggers.

Like I said, if you’re taking medication such as methimazole or PTU or beta blockers, let them know that. They might feel more comfortable that you’re taking medication. It depends. I work with people whose family members might be on the first consultation call with them, and they’re all supportive. It’s not like family are never supportive. If you have a spouse or other family who aren’t supportive, and you are taking medication, they probably will be happy that you’re doing so.

If they are more naturally mindset, they might not be supportive. But it is your body. It is your decision. You could cut to the chase and say, “It’s my body. It’s my decision.” But I think it’s important to help them understand, to try to decrease tension.

Let them know that whatever approach you’re taking from a symptom management perspective, whether it’s medication or natural agents, you’re doing things to help control the thyroid hormone levels, reduce cardiovascular symptoms. Managing the symptoms is different from addressing the cause of the problem.

Then there is diet. For a lot of people, this is a big factor. For example, if someone is working with me, and their spouse is not fully on board, they might question why you need to follow a restrictive diet. Nobody likes restrictive diets. I don’t even like that term. It’s an elimination diet. We’re eliminating certain things or restricting certain things, but the foods you are allowed to eat, you can eat a good amount of these foods. I don’t like that term, “restrictive diet,” but it can be restrictive.

Like I said, diet can be more difficult to communicate to some people. When you’re avoiding foods that are healthy, eggs are not part of an AIP diet. If you’ve read my book The Hyperthyroid Healing Diet, the level 3 diet, which is a modified AIP diet. Eggs are excluded, not because they’re unhealthy. You might need to mention that eggs are healthy. Tomatoes have some health benefits. But eggs are a common allergen, and tomatoes have compounds that could in some people be inflammatory, especially with autoimmune conditions.

Especially if you have Graves’, you might want to point this out. Most people do fine with both eggs and tomatoes. With certain autoimmune conditions, these foods sometimes can increase inflammation. You can say they negatively affect the gut. Whatever is easy for you to communicate.

Like I said, it’s challenging. In some cases, when a significant other isn’t supportive, the person I am working with may end up making two meals, which can be stressful. I’ll talk more about that.

Feel free to let them know about my book The Hyperthyroid Healing Diet. If they’re not on board, they probably won’t want to read it, but it might offer them some reassurance that there is a book on it. If you have a physical copy, it’s pretty thick. It’s not like it’s short; it’s close to 500 pages. It’s quite comprehensive.

When it comes to limitations, everybody is different. When I dealt with Graves’, I felt like I, for the most part, could do what I had to do. I didn’t feel like I couldn’t do my daily tasks. For some people, energy levels are dramatically affected. They might not be able to go to work and do whatever job you’re doing. You could let them know some days you have energy, other days you don’t. Stress associated with your job really flares things up, worsens your symptoms. You need more sleep, which is important for recovery.

You want to communicate all these things. You might think it’s common sense, but they might not understand. They might not understand even when you communicate this. You need to make the effort. You need to explain that healing often requires lifestyle changes. Obviously, diet changes; stress management; getting proper sleep.

Ideally, you want to get support from your family members and friends, especially family members. Anyone who lives in the household, you could let them know that they need to be patient with your recovery. Understand fatigue. Help reduce your stress, not increase it. Respecting any dietary changes you make.

You could tell them it’s not helpful if they minimize the symptoms you have, saying, “You look fine. It doesn’t look like anything’s wrong with you.” That’s the case with many autoimmune conditions or other health conditions. At least, initially, many people do look fine.

In my case, when I lost 42 pounds, I didn’t look fine, but it did take time for me to reach that point. Not everybody will lose weight to begin with, let alone that much weight. Some people look normal.

Obviously, if someone has thyroid eye disease with Graves’, and it’s moderate to severe, then you know something’s wrong, and it’s not just a psychological thing.

You could obviously show people your lab results if you want to. If it’s a significant other, they may see them anyway. They may go to the doctor’s appointment with you, which might not be a good thing.

Most endocrinologists aren’t going to be supportive of natural treatment options. You will need to explain that is the training they have in medical school. There are functional medicine practitioners and natural health care practitioners who open their minds and realize that there is a cause of the problem.

Getting back to what’s not helpful, mocking dietary choices, making the spouse or significant other cook two separate meals every single night for dinner.

Set boundaries when necessary. You need to do what’s necessary to heal. Protect your energy. Avoid unnecessary debates with your family and friends. Ultimately, it does come down to it’s your body, so it’s your decision.

You might not want to start with that. You might not want to be confrontational, but if you do everything you can to communicate this to them, and they still don’t understand, then you might just need to draw the line still and do what’s necessary to focus on your healing.

Let them know, “I appreciate your concern. This is something I truly believe in. We have a thyroid gland for a reason. I’m going to do everything I can to save my thyroid, and I am working with this other practitioner.”

If you go to an endocrinologist initially, and your significant other is with you, and your endocrinologist says, “It’s Graves’. There is no cure for it other than removing your thyroid or getting radioactive iodine. If you don’t do that, you’re at risk of thyroid storm, going to the ER.” They will use these scare tactics.

Not to say there is not risk. We know there is risk. They won’t bring up the risks of radioactive iodine or thyroid surgery though. Not that they don’t know, but they may not know if they don’t look it up. The endocrinologist won’t bring it up. Youcould bring it up to the endocrinologist.

The truth is the endocrinologist will be defensive. “The risks are low. It’s definitely more risky to deal with the hyperthyroidism.” Again, they are an authority figure to most people. If your family or friends are more medically oriented,they will buy into what the endocrinologist says.

You have to stand up for yourself if that’s the case and let them know, “I understand you care about me. I could always get the radioactive iodine or the surgery. Once I make that decision, there is no turning back.” The thyroid gland is very important. “Sure, I could get my thyroid removed and be on thyroid hormone permanently,” but the research clearly shows that if someone has one autoimmune condition, there is a greater likelihood of developing other autoimmune conditions in the future.

If you have a non-autoimmune thyroid condition, you could still say, “This is not addressing the cause of the problem. Yes, I could get my thyroid removed, but I’m still at risk of having other health issues. If I develop toxic multinodular goiter, and I am not doing anything to improve my health. If I do things to improve my health, by following a natural treatment protocol, and things don’t get better, I could always get radioactive iodine or surgery. I will do things to manage my symptoms in the meantime. Again, I want to be able to live with my decision if I go that route.”

Hopefully, you’re listening to this because you want to save your thyroid. Explain to them that you’re not completely opposed, maybe even if you are. When I dealt with Graves’, I didn’t even think about surgery or radioactive iodine. I was open to taking medication. I’m not saying under no circumstances I wouldn’t have received thyroid surgery, but I was trying to do everything to avoid surgery and radioactive iodine.

I will start wrapping this up by reminding you that there are resources that are not only for you but for others. There is this podcast. You could have themlisten to this episode if you want to. You could talk to them, but if you’re still arguing, maybe have them listen to this. Maybe have them listen to some other episodes about healing. That is what the podcast is about.

There are also books out there, including mine, about addressing hyperthyroidism naturally. They know it is possible. You could visit my website and show them some testimonials I have on there. If they’d rather read than listen, but they don’t want to read the book, I also have my new Healing Graves’ Naturally newsletter on Substack. You can refer them to that. A lot of the articles will help those with other thyroid conditions besides Graves’.

Remember, you’re not alone. I understand it can be challenging to explain hyperthyroidism and why you chose to take a natural approach to others, which is why I decided to put together this episode.

Some people don’t want to hear it. They were brought up with that medical mindset. No matter what you say, they will take the side of the endocrinologist. In that case, all you can do is stand up for yourself. Education and communication are important and can improve understanding. Some people will sway them, or at least make them understand and respect your decision. If not, you need to do what you need to do to save your thyroid.

In the case of family, this might be difficult. In the case of friends, if it comes down to it, and you have one or two close friends who are not on board and really making you feel bad about your decision, you might need to take a break. I am not saying to end the friendship; that’s up to you. But maybe you need a break. Even family, if it’s not someone in the household, maybe you distance yourself a little bit while healing.

You want to have that positive mindset. You don’t want to have the negativity every single day. You don’t want someone telling you you need to do radioactive iodine or surgery every day. If you’re managing your symptoms naturally, you need to take the medication. You don’t want to have someone telling you this day in, day out, or even a few days a week, if you are trying to take a natural approach.

Hopefully, you found this episode to be valuable. Appreciate you listening as usual. Of course, I look forward to catching you in the next episode.

***

Explaining Graves’ and other types of hyperthyroidism, you don’t have to get into great detail. Especially with Graves’, you need to let them know that it is an autoimmune condition, which more and more people are becoming familiar with, just because they are so common.

If you have a different type of hyperthyroid condition, you can get into the basics. Tell them that you have an enlarged thyroid gland with multiple nodules.

It’s about addressing the cause of the problem. The issue with conventional medicine is that with Graves’, when you go to an endocrinologist, they don’t do anything for the immune system component. You want to make sure you communicate this to your friends and family.

Explaining common triggers. Talking about how there are underlying causes for this. Let’s say your significant other needs some convincing, and you bring them to the endocrinologist. The endocrinologist is going to say that there is no underlying cause that we know of. It might be a challenge to convince your significant other, family, or friend that there is an underlying cause.

Maybe it’s by having them listen to my podcast or read my book. There are other sources out there, too. I’m not the only one talking about hyperthyroidism. Admittedly, there are not as many practitioners talking about hyperthyroidism as there are with hypothyroidism.

Explaining side effects of other treatments. Antithyroid medication has a time and place, but side effects are common. A lot of people who work with me take antithyroid medication, so I’m not against it. If you do take it, that’s fine. Tell them that you’re taking the medication to be safe while addressing the cause of the problem.

If you’re taking a natural symptom management approach like bugleweed or higher amounts of L-carnitine, show them the research. I have podcast episodes that talk about bugleweed and L-carnitine.

Radioactive iodine and thyroid surgery are extreme procedures. They know this, but you might need toremind them that you could always get the surgery or the radioactive iodine. There are side effects associated with these, so you want to try your best to avoid these.

If it’s Graves’ and autoimmune, you could tell them that if you have one autoimmune condition, you’re at greater risk of developing other autoimmune conditions in the future, according to the research. Radioactive iodine and thyroid surgery do nothing for that autoimmune component.

Explaining the diet you choose to follow. This could be very challenging. I discussed this in the episode. They probably won’t read my book, which by the way, I checked, it’s actually closer to 400 pages, not 500. You could have them listen to the podcast.

To us, it makes sense. Diet is important. For some people, it doesn’t make sense. Ultimately, it’s up to you to follow the diet, to block out time for stress management, to get sufficient sleep, regardless of whether your friends and family are supportive. That being said, I would try your best to explain the importance. Maybe show them some of the resources.

Finally, letting them know that even though you plan on doing everything you can to save your thyroid, conventional treatment is always an option. Once again, maybe you’re already taking antithyroid medication. If your endocrinologist is pressuring you to get radioactive iodine or thyroid surgery, and your friends and family are also thinking about that for you as the main options, tell them, once you get these procedures, there is no turning back. You want to be comfortable with your decision.

This is your body. It’s easy for them to say to get the radioactive iodine or surgery when it’s not them who’s getting it. Tell them, “I am considering it.” When I dealt with Graves’, I was not considering it. But if it eases some tension, you could say you are considering it. Right now, you are going to do everything you can to save your thyroid.

I really hope you found this episode to be valuable, especially if you are having difficulties explaining hyperthyroidism to your friends and family. Explaining you are choosing to save your thyroid, to take that natural treatment approach to address the underlying cause of the problem.

As usual, I look forward to catching you in the next episode.

In this Q&A episode, Dr. Eric dives into the powerful connection between gut health and thyroid function. Recorded during a Substack livestream for his Healing Graves’ Naturally newsletter, he begins by explaining why the gut is such a central player in thyroid autoimmunity. With most immune system cells residing in the gut and about 20% of thyroid hormone conversion occurring in the gut microbiome, maintaining gut health is critical for those dealing with Graves’ disease, Hashimoto’s, or other thyroid conditions.

Throughout the episode, Dr. Eric answers listener questions about gut testing, including when to use comprehensive stool tests, SIBO breath tests, or organic acids testing. He also discusses leaky gut testing, parasites, H. pylori treatment options, histamine intolerance, and how gut imbalances can contribute to symptoms like bloating, gas, and constipation. He explains how diet, stress management, and proper digestive support can play a role in restoring gut balance.

Listeners will also learn about natural approaches to supporting stomach acid levels, the role of fiber in producing beneficial compounds like butyrate, and whether sweeteners like stevia or monk fruit affect the gut microbiome. If you want a clearer, more balanced understanding of the gut-thyroid connection and practical answers to common gut health questions, you’ll get a lot out of this episode.

Click Here to listen to it on the Save My Thyroid podcast

Dr. Eric Osansky:

Welcome, everyone. Thanks for joining me. We are going to chat about the gut and the thyroid. This will be a great live call. Obviously, this is live now, but this is going to be a future podcast episode. I am recording this on February 11, so sometime in March, this will be uploaded to the podcast and YouTube.

For those in the future who are listening to this on my podcast, this livestream is on Substack. I have a new Healing Graves’ newsletter, which is why I have been doing some livestreams in the month of February.

What I am going to do first is talk a little bit about the gut and the thyroid. Then I will go ahead and answer some questions that were emailed to me. Then we’ll go ahead and address the live questions. Thanks for joining me.

Let’s talk about the gut and the thyroid. How does the gut relate to the thyroid? First, most of the immune system cells are located in the gut. Most thyroid conditions are autoimmune in nature. Not all of them, but approximately 90% of people with hyperthyroidism have Graves’, and approximately 90% of people with hypothyroidism have Hashimoto’s. Since most of the immune system cells are located in the gut, you need a healthy gut to have a healthy immune system.

In the very first newsletter, I spoke about the triad of autoimmunity, also known as the three-legged stool of autoimmunity. There are three factors necessary for autoimmunity to develop. One is a genetic predisposition. Two is exposure to one or more environmental triggers. Three is an increase in intestinal permeability, which is the medical term for a leaky gut. That leaky gut component is another way that the gut relates to the thyroid health.

Also, T4 is produced by the thyroid gland. The thyroid gland does produce some T3. Those are the main thyroid hormones, T4 and T3. There is also T1 and T2, but we’re still learning about those, and we can’t test for those at a lab. We can only test for T4 and T3.

Most of T3 is actively produced by the conversion of T4 into T3. Approximately 60% of the conversion takes place in the liver, and approximately 20% of this conversion takes place in the gut microbiome. If you don’t have a healthy gut microbiome, that can negatively affect the conversion of T4 to T3.

We also have to consider that a healthy gut is necessary for optimaldigestion and absorption of nutrients, some of which are important for thyroid health.

Those are four different ways in which the gut plays an important role in thyroid health. Before getting to the questions, of course the focus this month has been on my new newsletter, which is Healing Graves’ Naturally on Substack.

I do have another newsletter that has been out for over a year now, Healthy Gut, Healthy Thyroid. If you are interested in learning more about the gut, I don’t want to overwhelm people with too many newsletters, but at SaveMyThyroid.com/Newsletter, you can check that one out, too.

I was releasing one newsletter every week. Now, it’s more like once every other week. I have a difficult time keeping up with everything and wanted to come out with this Substack focusing on Graves’. Healing Graves’ Naturally right now will be every single week, Friday at 10:45am. Healthy Gut, Healthy Thyroid is released on Sunday morning.

Let’s dive into the first question: What are the top tests you recommend to evaluate someone’s gut health?

Great question, Daphne. I would say it does depend on the person. I can’t say I recommend the same gut test to everybody. The most common gut related test I recommend is a comprehensive stool panel. I have been using mainly the GI Map for a number of years. I’ve used other companies. GI Effects is a really good one. There are a few others.

The GI Map is the one I’ve used the most. That’s a comprehensive stool test that focuses on the large intestine. It looks at things like H-pylori, parasites, opportunistic bacteria, markers related to gut inflammation.

There is also SIBO testing. That’s a breath test. If someone is having a lot of gas and bloating, especially when eating certain foods, it doesn’t guarantee it’s SIBO. It could be something else. I very well might recommend a SIBO test over a comprehensive stool test in that situation.

There is also organic acids testing, which is not specific for the gut, but the first page of the organic acids test from Mosaic Diagnostics looks at fungi, yeast, bacteria. It looks at the classic candida marker, which is arabinose. It looks at Clostridia. Some stool tests look at Clostridia, too, but it doesn’t differentiate between commensal or harmful, good or harmful strains of Clostridia. Great Plains, or Mosaic, it used to be called Great Plains for a number of years, but now it’s Mosaic. They test for the more harmful or pathogenic strains of Clostridia.

Those would be three of the top tests. Not to say I recommend all of those if someone is having a gut issue. Usually, I’ll start with one. Sometimes, I’ll do a stool test and a SIBO test. Sometimes, I’ll do a stool test and an organic acids test. Many times, I’ll just start with the GI Map, for example.

If you had to choose one test to determine whether someone has a leaky gut, which one would it be?

I don’t do a lot of leaky gut testing these days. I used to do a lot of leaky gut testing. My go-to test at the time was the Array #2 from Cyrex Labs. That’s their intestinal permeability test. It’s a blood test.

These days, I know a lot of practitioners recommend zonulin, which you can add to a GI Map, for example.

There is the classic test for evaluating whether someone has a leakygut test, which is the lactulose mannitol test, a urine test. If someone has higher lactulose levels, that typically indicates a leaky gut.

I don’t do a lot of leaky gut testing these days for a few reasons. One is it’s not telling us what’s causing the leaky gut.

Also, I found when I did the testing, most people had a leaky gut. Most people had positive findings. Additionally, if someone has a negative finding, I still would question is it really negative, or do they actually have a leaky gut? According to the triad of autoimmunity, if someone has Graves’ or Hashimoto’s, they should have that leaky gut component.

Now, unless someone really wants to do a leaky gut test, ultimately, it’s up to the person I’m working with. Most of the time, I’ll say let’s spend the money elsewhere. The test from Cyrex Labs is a couple of hundred dollars. If you add zonulin to a GI Map, it’s not as expensive, but it’s still an extra expense.

If zonulin is elevated, then the person probably has a leaky gut. If it’s negative, it doesn’t rule out a leaky gut. I do see a lot of negatives when people do zonulin, whether it’s through me or another practitioner.

If I had to choose one, it would still be the Array #2 from Cyrex Labs.

I have been experiencing a lot of bloating and gas recently. I did a GI Map, which didn’t show any parasites or anything significant. I have heard you say that stool testing is imperfect for parasites. In my situation, would you assume that there are parasites and treat them?

You’re experiencing bloating and gas. You did a GI Map. Parasites were negative. Nothing else showed up, or at least nothing significant. Stool testing is definitely not perfect for parasites.Similar to what I just mentioned for leaky gut testing. They’re not exactly the same.

If you test positive for parasites, you probably have parasites. If it’s negative, it could be a false negative. If someone tests negative for parasites, and they have bloating and gas, I am not automatically going to treat them for parasites. It depends.

Bloating and gas could be related to other conditions, like SIBO. Maybe we would do a SIBO test. Maybe we would have started with the SIBO test if they were having bloating and gas when eating foods higher in FODMAPs, like fermented foods, higher fiber foods.

I am not opposed to treating parasites. If we have done testing, and the person has eliminated certain foods, and they are still having gut issues, there is the possibility of parasites. It could also be something else as well.

In your situation, I wouldn’t necessarily jump to the parasite treatment. I would say maybe do a SIBO breath test. I understand it can get costly. I am more conservative with testing. I do like to test and try to find the answer rather than to guess. Every now and then, we do need to guess, if everything looks negative, and diet and lifestyle is not changing the gut symptoms. The tests aren’t perfect.

It is said that Crohn’s and thyroid disease are related. How do you start curing them? What would be the first step you would take?

I am assuming that this person was already diagnosed with Crohn’s, so you know you have Crohn’s.

The first step would be diet, having someone eat a healthy, clean diet. For those who have read my book The Hyperthyroid Healing Diet, I have three diets in there. Level 3 is a modified AIP diet. Level2 is a modified paleo diet, and level 1 is a modified Plant Paradox diet, which is by Dr. Steven Gundry.

In this situation, if it was Crohn’s or ulcerative colitis, which is another type of IBD, I would recommend, especially if someone had Crohn’s and Graves’, a level 3 diet, a type of AIP diet. Even a paleo-type diet is good and could greatly help.

I would start with diet and lifestyle. Diet is number one. Stress management and sleep, too. In this case, I would probably do some gut testing, maybe a comprehensive stool panel, unless the person was experiencing other symptoms that led me to believe they had SIBO or something else going on.

I commonly recommend prebiotics, probiotics for some conditions. Prebiotics can make things worse for SIBO sometimes. For Crohn’s, usually not, but everybody is different.

The first step would be to clean up the diet and focus on diet and lifestyle.

At what point do you stop usingbutane HCL with pepsin? How do you know if you need it any longer or not? My numbers are optimal, except for my TSI, which is now down to 187. I was and still am very strict with my diet. Making changes as you suggested in your thyroid diet book. When I stopped using it, there were nights where I felt like I had heartburn, according to people who have described it. Very uncomfortable when I bent over to pick things up. I went back on it, and all that stopped. Is it trial and error for going offof it? Is it something you stay on? Any issues with long-term use?

Ideally, you don’t want to be on it permanently. If someone had to be on it long-term, it’s fine. But you want to try to address the cause of the stomach acid. Chronic stress is a big factor when it comes to low stomach acid. Low thyroid, which is not the case with you, could also affect stomach acid. Sometimes, there are autoimmune conditions affecting stomach acid.

Ideally, you want to try to address the cause, so you can rely less and less on butane HCl with pepsin. It’s great that it’s helping with those digestive symptoms, but if you stop it, and those symptoms come back, that is suggesting that they still haven’t been resolved.

It is kind of trial and error over time, getting to the point where you need less and less. I don’t know how many you’re taking. If someone is taking more than one capsule per meal—you always want to take this with meals high in protein—then you reduce it gradually. Going from three capsules to two capsules and see how you feel. Gradually decrease until the point where you don’t need it. If you’re still experiencing symptoms, like you can’t get off it, it would still seem like there is something underlying that needs to be addressed.

I guess you could say it is kind of trial and error. There is not a great test to determine if you have low stomach acid. There is a butane HCl challenge, which means that when you have adequate stomach acid, you probably don’t need butane HCl. You might actually get heartburn by taking it.

That’s another sign, too. If someone is taking one capsule 2-3 times a day with meals high in protein, and they are feeling great, and then all of a sudden, they start feeling some heartburn when taking butane HCl, that’s a good sign. That means your body is starting to produce stomach acid on its own. That would be an indication you don’t need to take butane HCl.

What approach do you take when someone is dealing with a histamine intolerance?

I won’t go into great detail here for those who are not familiar with histamine intolerance. I do have some episodes on my podcast about this.

Histamine intolerance, the gut definitely plays a big role. Potentially do some gut testing. Maybe a GI Map or a SIBO breath test.

There is also some genetics behind it. There are certain enzymes associated with problems with histamine. The most well-known enzyme is DAO, diamine oxidase. Some people have genetic variations that might make it more challenging for them to break down histamine. Certain supplements like quercetin or a DAO supplement can sometimes help. Sometimes, I’ll do that in combination with a lower histamine diet.

If there is a lot of gut dysbiosis, which essentially are gut imbalances, we want to address the gut and do things to heal the gut. That can play a role in histamine intolerance.

Like I said, for more information, check out my podcast. I have at least one if not a couple of solo episodes on it. I also have some guest experts talking about histamine intolerance.

We have another parasite question. I kind of answered it, but it’s asked in a different way. I have heard we all have parasites. If this is true, does it make sense to do a parasite cleanse once or twice per year?

I am not a big fanof randomly treating parasites. I do like to test and see if someone has parasites. I have had people on the podcast just treat everybody for parasites, and I have had others who don’t treat everybody for parasites, which is the approach I take. I can’t say I treat every single person for parasites.

I don’t do a parasite cleanse once or twice a year. When I dealt with Graves’, I didn’t need to do a parasite cleanse in order to get into remission. Parasites in my opinion aren’t the trigger in all people. In some people, they definitely can be.

Even though testing is not perfect, I do like to test. If we do a test, and it’s positive for parasites, then we got that baseline. After a few months, ideally, we want to test.

Maybe we don’t have to test. If the person has Graves’, and their antibodies normalize, gradually decreasing and normalize, maybe we don’t need to retest. Let’s say the person has some GI symptoms, and they don’t resolve, maybe we want to retest, just to make sure the parasite is still there. Maybe the parasite is still there, and we need to treat it further. Or maybe it’s not there, and we need to do additional testing.

It could be a challenge. You might retest, and it might be gone. Is it gone because it’s really gone? Is it gone because it’s a false negative? We could go back and forth and say because of that, we should randomly treat. My approach is to test and see what we find.

The GI Map is looking at more than just parasites. There are companies like Parawellnessthat are specific for parasites. They don’t look at anything else.

I usually don’t recommend Parawellness right off the bat because I like a test that looks at other things, not just parasites. There have been times where we have done a GI Map and a SIBO test and other tests, and nothing is showing up.

I mention Parawellness, which I found out about from one of my podcast guests, Dr. Ami Kapadia, who spoke about different things related to the gut, including Parawellness. The company has been around for a while. I have used it on a few patients, and I think it does a better job of detecting parasites than many other stool tests. Again, that’s all it’s looking at.

Do you have any solutions for constipation? I move my bowels most days, not every day. I don’t feel like I’m fully evacuating.

I think I might have an episode on the podcast about constipation, but I’m not sure. If so, it’s probably a solo episode. I don’t know if I’ve interviewed anybody specifically to talk about constipation. On my other website, NaturalEndocrineSolutions.com, if you do a search for constipation, I have an article on chronic constipation.

You of course want to make sure of the basics. You’re eating healthy, staying well hydrated. Regular movement is important.

I have always been more sluggish in my bowel movements. I used to be constipated when I was in my 20s (I’m now 55). I was having two bowel movements per week, sometimes just one. Diet definitely has helped. Eating better. Staying hydrated.

But regular movement, doing a lot of walking also helps with gut motility. If someone is sitting all the time, and I do my fair share of sitting, but I also have the luxury of working remotely most of the time. I do have an office, but I usually work from my home office. I have a treadmill with the desk on it, so on my breaks, I will often be walking and working at the same time. I do get a lot of steps per day.

Also, SIBO, depending on the type, could cause diarrhea or constipation. If someone has methane dominant SIBO, that could lead to constipation. In some cases, we might want to do a SIBO test and see what that shows.

Those are some potential causes. Not to say with someone with hyperthyroidism can’t experience constipation, but if someone with hyperthyroidism is taking antithyroid medication, and that is slowing down their thyroid, that could cause constipation.

Ideally, you want to try to figure out the cause of the problem. There is a time and place for supplements. Magnesium is something a lot of people take. Magnesium citrate in this case before going to bed. Triphala is an herb that some people take that could be beneficial.

There is a time and place for supplementation, but you want to make some of the changes I mentioned. Make sure you’re eating well, staying well hydrated, regularly moving. If you have something underlying, such as SIBO, you want to address that.

I know that artificial sweeteners can disrupt the gut microbiome, but how about natural sweeteners, such as monk fruit and stevia?

Monk fruit, I don’t know of any studies showing that could disrupt the gut microbiome. I think monk fruit is okay.

Stevia, there is one older study showing that it can have a negative effect on Lactobacillus. I don’t consume stevia like I used to. I used to add stevia to my green tea and herbal teas. I can’t say I do that anymore. If there is stevia in a protein powder, I’m not nervous about it. There is not a lot of evidence of stevia having a negative impact on the gut microbiome.

It is a contraceptive. If someone is trying to get pregnant, they might not want to take anything that has stevia, especially adding stevia to anything. That’s something to keep in mind.

There is not a lot of strong evidence that it affects the gut microbiome. That being said, it’s not something that I regularly add. I don’t add at all these days; in the past, I did.

If it’s an ingredient in something, even that, I can’t say I regularly have powders and other things. These days, there is plenty of powders that are unflavored. If you’re a smoothie person like me, you can add berries to make it a little bit sweeter. You could also add monkfruit separately.

Again, there is definitely more evidence with artificial sweeteners having negative effects on the gut microbiome.

I know you prefer a natural approach for H-pylori. When do you think that taking antibiotics is a good idea? I know antibiotics also kill the good bacteria, but I have been working with a naturopath and still have H-pylori after treating it for three months.

It’s a catch-22. You’re right. The antibiotics can disrupt the gut microbiome, but it could take a lot longer to get rid of H-pylori treating it naturally through herbs or triple probiotic therapy. I had Dr. Nikolas Hedberg, who was one of my first guests on my podcast four years ago, who spoke about triple probiotic therapy for H-pylori.

It can be challenging to treat H-pylori naturally. That is what I still recommend. In this situation, you’re not asking about starting off with natural versus antibiotics. If someone has been following a protocol like you for a few months, and H-pylori is still present, is it time to make the switch to antibiotics? Should you continue with the natural approach?

Ultimately, it’s up to the person. Usually, what I do is recommend a two-month protocol for H-pylori and then retest. If it’s still there, it’s up to the person. But if the person is treating it for another two months, which I know is a long time, and it could be pricey with the supplements.

Again, Ireally would try to avoid antibiotics if at all possible. They don’t just use one antibiotic with H-pylori; they use two. It’s a quadruple therapy. Two antibiotics, a proton pump inhibitor, which is a triple therapy. Sometimes, I’ll add bismuth.

Ultimately, it’s your decision. I have had patients who took antibiotics. I have had patients who took antibiotics initially. They did not follow a natural protocol. They looked to eradicate it and rebuilt the gut microbiome.

The thing is, the antibiotics are more effective than the herbs, but they are not 100% effective. I have had people over the years take two antibiotics, and H-pylori is still there. That’s another dilemma. Do theydo another round of antibiotics, or do they switch to the natural method?

I will say the GI Map, one advantage there, if someone tests positive for H-pylori, they will tell you what antibiotics you’re resistant to. This way, you could show it to the prescribing doctor if you take antibiotics and make sure you’re not taking antibiotics you’re resistant to.

Does healing the gut help with TED?

Absolutely. Thyroid eye disease (TED), like Graves’, is an autoimmune condition. It’s where the immune system attacks the tissues of the eyes. Remember, a healthy gut is a healthy immune system. You still have to find and remove triggers. I’m not saying if all you do is heal the gut, it will resolve TED. If you have an unhealthy gut, and you have TED, you really do need to optimize the health of your gut.

I know that gluten can cause a leaky gut, but why are gluten-free grains excluded from your level 2 and level 3 diets? It would be nice to have some gluten-free bread once in a while.

A lot of people love their bread. When healing, I would try to avoid grains, just because even gluten-free grains can be harsh on the gut. Ultimately, it’s up to the person.

My level 1 diet, I do allow a small amount of grains. Even then, I ideally say avoid grains. Certain grains, like white basmati rice, is one of the few grains that are allowed on that diet. It’s a modified Plant Paradox diet.

There is a bread called paca, which I have only seen at Whole Foods. Other places might have it. They have a bread that is organic, gluten-free sourdough. The two ingredients are buckwheat and sea salt. If someone is going to insists on eating bread, I’d say probably to eat that. Again, ideally, I would say avoid bread while healing.

The reason is they still also are harsh on the gut. That’s why they’re excluded, not just from level 2 or level 3, but regular AIP and paleo diets. The level 2 and 3 diets aren’t completely made up by me. They’re modifications of AIP and paleo, which already exclude all grains, including gluten-free grains.

When should someone choose to see a gastroenterologist for their gut instead of a functional medicine doctor? Are there any conventional GI doctors that also recommend functional medicine testing?

I’m sure there are conventional gastroenterologists who recommend functional medicine testing. I don’t know if they would be able to say they are conventional if they recommend functional medicine testing. They are medical doctors, and maybe they also went through Institute for Functional Medicine certification, so they combine conventional and alternative treatments.

I mean, as far as when should you see a gastroenterologist instead of a functional medicine doctor, usually, I’m going to recommend starting with diet and lifestyle changes. If those aren’t improving the gut, and a lot of people, when they work with me, they have already done things with diet already.

Usually, when you go to a GI doctor, you will get an endoscopy and a colonoscopy. There are times and places for those, but they are invasive. I’d rather someone do a comprehensive stool test or an organic acids test if they need a SIBO breath test, do that. Unfortunately, most GIs don’t do those tests. Some GIs will do SIBO breath testing, but not all of them.

Try to do things naturally. Ultimately, it’s up to the person. In my Healthy Gut, Healthy Thyroid newsletter, I have an article where I focus on colonoscopies. I talk a little bit about endoscopies, too. There is a time and place for them, but usually, I would recommend a more conservative approach first. Ultimately, it’s up to the person.

The final emailed question, and then I will look for any live questions related to the gut and thyroid: Can mold have a negative effect on the gut?

Yes. You can have mold colonize the gut. Remember, mold is a fungus, just like yeast. There is not a great test for this, but organic acids testing looks at some mold markers. That would be the test that I would look at.

If it’s negative, it doesn’t necessarily rule out mold colonization of the gut. If certain markers are positive on an organic acids test, especially the one from Mosaic. There are other ones, like Genovva has an Organics test, which is their organic acids test. Nutroval has some organic acid markers. In this case, if we’re looking at mold colonizing the gut, I would rely on the organic acids test from Mosaic Diagnostics.

Beyond butter, are there any other ways or foods to consume to help with butyrate or produce it?

Fiber-rich foods are going to help you produce butyrate. If you’re following a level 3 diet, then fiber-rich vegetables, cruciferous vegetables for example, asparagus. There are butyrate supplements as well. I would say try to do as much as you can through food sources.

What would be driving almost zero zinc in my system?

I’m answering this because she says she has ulcerative colitis, which of course relates to the gut, for 26 years and Graves’ for four months.

The ulcerative colitis definitely could affect digestion and absorption. You need healthy stomach acid levels for the breakdown of minerals. Maybe it’s related to the ulcerative colitis. Maybe it’s related to minerals. I’m not sure if you also tested for H-pylori, which suppresses stomach acid. Not just zinc, but it could cause deficiencies in other minerals.

You mentioned almost zero zinc. You might also want to do other tests. I don’t know if you just did a serum zinc. There is also RBC zinc, red blood cell zinc, which is more intracellular. That is another option, to do a different type of zinc test.

Can you make a stream devoted to heart palpitations?

Maybe. I don’t know how much interest there will be. How many questions there would be just on heart palpitations. The reason why I came up with a separate Q&A on bugleweed is there are so many questions I receive all the time about bugleweed. What should I take? How much should I take? How long should I take it? What if it doesn’t work?

With antibodies and the gut, there are also so many questions. With heart palpitations, I don’t know if I could have a whole Q&A session.

This is all to celebrate the release of my Healing Graves’ newsletter. Last week, I did a general Q&A to kick things off. Then I decided to have a couple of themed Q&As, which I could also use as future podcast episodes. I can’t say I will do these regularly on Substack, but there may be an opportunity for one more general Q&A, where people could ask about copper and heart palpitations, etc. Then I will probably take a break from these for a little bit.

How do you increase stomach acid?

It depends on the cause of the stomach acid. Someone said they are taking butane HCl. You could take bitter herbs. Those are options.

Do you have chronic stress? Chronic stress is a big factor when it comes to low stomach acid. H-pylori can cause low stomach acid. If someone has Hashimoto’s, or someone with hyperthyroidism taking antithyroid medication, because low thyroid can cause low stomach acid. Autoimmune conditions can affect parietal cells; that is a completely different issue.

If it’s due to chronic stress or H-pylori, we want to address the stress. We won’t completely eliminate the stress, but try to minimize stressors by improving our perception of stress and blocking out time on a daily basis for stress management.

Improving health of the parasympathetic nervous system, maybe doing some Vagus nerve exercises such as vigorous gargling, humming, singing out loud, taking cold showers or doing cold plunges.

If someone has H-pylori, you want to test for that first to see if you have it. If you do, follow a natural protocol, or like I said earlier when someone asked a question about this, there is a time and place for antibiotics.

Could dandelion tea or extract help with gut health?

Maybe. It’s more for liver support. There is a connection between liver and gut. I really like herbal teas. I can’t say dandelion is my favorite herbal tea tastewise, but from a health perspective, it’s really good. It won’t hurt for gut health.

I would choose ginger tea over dandelion tea to benefit gut health.

We can kind of relate this to the gut: Are there any nuts and seeds you recommend for hyperthyroid healing?

I don’t know if you know my story, but when I dealt with Graves’, I was eating more of a paleo diet. Back in 2008, there wasn’t an AIP-type diet. I hit a roadblock in my recovery. There is a marker, secretory IgA, which lines the mucosal surfaces of the body, including the GI tract. That was on the saliva test I did.

My adrenals were low, my cortisol was low, my DHEA was low, and my secretory IgA was low. I was working on improving my adrenal health, and I did a retest. My cortisol, DHEA, and adrenal levels were better, but my secretory IgA was still depressed.

I was eating mainly nuts. I forget, it’s been so long, but I don’t know if I was eating seeds. I was eating almonds and cashews, etc. I took a break from nuts for a few months and retested secretory IgA, and it was normal. They are excluded from AIP because nuts and seeds can be harsh on the gut.

In the book The Plant Paradox, Dr. Steven Gundry talks about certain nuts and seeds that are more gut friendly. Of course, properly preparing them, like soaking, sprouting them will help.

Almonds and cashews are two of the harsher nuts. Those are two of the main ones I was eating, especially cashews, because I love them. Walnuts, pecans, pistachios, macadamia nuts seem to be more friendly and less harsh on the gut. I don’t know if they will assist with hyperthyroid healing directly.

If I were to go back in time to 2008, maybe if I ate those nuts, everything would have been okay. I can’t say 100% that was what caused the secretory IgA to increase, but that is the only change I made. It could have been a coincidence.

If you haven’t read my book The Hyperthyroid Healing Diet, it’s really comprehensive.

I think that’s it with questions. Thank you so much for your support. For those listening to the podcast in the future, thanks as usual for subscribing to the podcast.