Eric Balcavage: Hey Hey everybody, it's Dr Eric Balcavage.

We're back for another edition of the thyroid Answers podcast.

We have another guest today.

Her name is Anu Simh.

She's a functional health coach with a, I guess we could say, like a specialty in a evaluating gut function, gut physiology, and what goes on within the GI tract, and how that may relate to other health conditions and signs and symptoms.

So welcome to the Thyroid Answers Podcast.

Anu Simh: Such a pleasure.

Eric Balcavage: Before we dive in, can you tell us what led you to focus on gut health as kind of where you landed?

I mean, there's obviously, from a functional health perspective, we look at the big picture, but you really focus on gut health.

Why?

What led you there?

Anu Simh: Well, it's not just gut health.

I just started seeing patterns emerging in my clients, right?

You know typical client who comes to see me?

Maybe there are a couple of typical ones.

One women with normal TSH.

They haven't been that's all they know about their thyroid, but they're struggling with weight gain.

They have like deep, deep fatigue.

They're constipated, your gut motility is compromised, and they don't know what to do.

And then the other client is a woman who's already on medication, probably T4, but still struggling with weight gain, deep fatigue, constipation.

So I don't see the symptoms changing as much, and that seems to happen almost as a pattern in the clients that I see.

And these are women from anywhere from 35 to, you know, 45-50 you know, and they're presenting this over and over again, and it really begs the question, what's what's going on.

So a lot of time they come with this diagnosis, they've forgotten, forgotten it.

Some of them don't even remember that they are on a T4 medication, because it's been so long and, and, and because they they don't really present as over medicated or under medicated.

I don't see that as a huge question that they bring up with your allopathic doctor or your naturopath, or whoever they're seeing at the at the moment.

So that really and so all of these other symptoms are just somehow not connected with the thyroid because they they feel like that's been taken care of.

So I usually see this a lot, and the patterns keep emerging.

And I am a board certified functional health coach.

I do not diagnose, I do not treat.

I just coach to the terrain.

And the terrain is very clear.

These are the patterns emerging.

And I'm I'm thinking how are they all connected?

So my big thing is microbiome connected to the mitochondria.

There's that endosymbiosis.

We know that there they are connected through all the research for my book that was very interesting, and I learned a lot through that.

And of course, the thyroid and other hormones are connected.

And for me, it's the brain as well.

And and I say brain, I mean our nervous system, you know, and the connection to nervous system and mitochondria, all of this emerged as a pattern, and I just coach, coach to that.

So in other words, it's behavior and empowering them with education.

And education is not prescriptive.

It's more an invitation to learning more, because they haven't connected the dots.

They've gone to so many practitioners by then that they have bits and pieces of information, but they're not quite sure how it all fits.

They have a bucket full of supplements and but still, the the symptoms continue.

Eric Balcavage: Yeah, so I want to ask a couple questions off of that, because I think it'll be helpful for the for the listener.

Why do you why do you think there's a disconnection and lack of connection there.

Do you think?

I guess my take would be that the reason people have a disconnect in putting all these pieces together is because it's not the model we grew up in.

We grew up in a reductionist model where it's either you that's a thyroid issue, that's a gut issue.

That's a sex hormone issue, that's an adrenal issue, that's a neurologic issue, that's a neurotransmitter deficiency issue, and we kind of siloed all these systems, and so why would a person connect them in the first place?

If how we all kind of grew up, especially in the US with our with watching TV and listening to doctors and Doctor shows that it's connected when we've siloed it, even in our training, it's siloed.

So what's your How would you link why people are having a hard time seeing a connection between all their systems and all their symptoms?

Anu Simh: I mean, I really have to agree with you on this, because I see that, you know, I see that doctors are not, it's not it's not teamwork.

It's like everyone has an opinion, someone with a thyroid issue who has was also seeing a cardiologist.

Let's say, for example, no one's really, actually having a conversation.

And I'm more of a systems thinker.

I'm always thinking, what else could be going on if that energy is tanking?

Is that a mitochondrial function?

Is it a microbial function?

What is happening?

And that really comes it's very client led in my you know, because every client responds to these questions very differently, and they see their own patterns emerging in a very different way.

But from all of this, I see one thing, they don't think of all these symptoms as a soup that they've created.

It's more like system one.

This is the endocrine system, this is the cardiovascular system, this is the nervous system, but there's no connection between that.

And I try in my coaching to bring that all together and sing asking questions that kind of help them see the connections.

Eric Balcavage: Yeah, I think that's really important, and I think that's really what we should be focused on in functional medicine, because that really is our wheelhouse.

Is, how does this system, the whole body system, connect?

Versus the allopathic profession, which is is very specified, because they're typically treating disease, and so I'm worried about this tissue, this organ, and the disease there, and how do I manage it with drugs or surgery?

They have a different job than we do, in my opinion.

Anu Simh: They do and they don't have the luxury of even asking these questions, because they are in a model where there's the patient is not a participant, you know?

They're just so in and out 15 minutes.

That's all they have.

I blame the model.

I just don't blame the doctors or the MDS, because first of all, the education is very it's, it's caters to that particular system, and ours is more okay.

We're thinking outside.

We've seen this.

We've seen what works.

You have an immediate issue, go to an allopathic Doctor fix the issue.

But if you really want to dig deeper and say, where are these symptoms coming from, and you want answers, then I think function, functional medicine, or even I wouldn't say root cause is, is so interesting.

And, yeah,

Eric Balcavage: I agree to me, it doesn't matter the name and the shingle.

It's the thinking process, because there are very functionally thinking allopathic physicians, but they're limited to their model, and there are very allopathic functioning, or practicing functional practitioners who are really doing the same thing as allopathic medicine.

They're just using a different they're using Hort sexual hormone replacement therapy, they're using supplementation, and they're saying, this is low, I'm going to manage that.

That's how I'm going to manage that.

And to me, that's not truly where our that's not a functionally based practitioner, that is a person practicing potentially functional or integrated medicine, but they have an allopathic approach.

And I think that's where we have to even help educate people to say, Hey, these are the things you're if you go, if you want a functional based approach or true root based approach, these are the kind of things that you should maybe the kind of questions you should be asking your practitioner.

And it's not that.

And people listen to me, and a lot of people come to me because of my discussion on thyroid physiology, but I'm not really trying to fix thyroid physiology, because I don't, think it's broken.

I think it's an adaptive response, but I talk through that lens because that attracts a certain type of person, and then I can deal with them from a functional standpoint.

And I'm guessing you do the same thing, like I've talked through the lens of the gut microbiome and the gut function and gut physiology, but I'm not just a gut specialist, because that's not functional medicine, right?

That is, I need to have a conversation with somebody that is in that's interested in the topic, and then once I get them to me, now I can explain to them, well, you're these are all the things that are influencing your GI symptoms.

So if we can either manage your GI symptoms, or we can address the root cause, but you have to get them there in the first place.

Is that fair?

Anu Simh: I think I 100% agree with that.

Because, you know, when someone says, Oh, you are the gut gut person, I find that an odd comment, because you can't really just focus on one thing, right?

You know, like they say that it takes two to tango.

But for me, it's like I've been seeing in my practice, it takes three to tango.

It's the mitochondria, it's the thyroid and and the gut microbiome.

So I can't really just focus on one thing, but need to see the connection between all of these things and how it's affecting us, you know, or any in our prospective client or patient.

And I think, I think it's spot on, you know?

I think it's, it's really about a client led conversation and how they're feeling their body at that.

And that can change too, yeah, that can change, you know, and that's, and we have to be constantly aware of it.

And as far as behavioral changes also,

Eric Balcavage: Yeah, we'll get, we're gonna get into all that.

I do want to ask, I one, it's really two questions to tie into that.

The first comment, when you because this, this is the two people that you say they come to see you a lot, you know, obviously there you might get a lot of people that are have gut related problems, because, you know, that's kind of the window through which you reach people, but when you have people coming in and they have classic hypothyroid signs and symptoms and their TSH is normal, and they've been told they don't have a thyroid condition, I know you don't diagnose but how do you explain that to them?

Do you say, Well, you do have a thyroid condition, or do you just say, No, there's something else that's causing your symptoms?

How do you how do you bridge that conversation?

Anu Simh: Well, they've already been told so much about everything, right?

And it all depends on where the client is.

Are they willing to are they curious?

You know, are they really interested in I do have clients who come and say, Tell me what to do.

They've always been in that model of they want to be told they want, they want a quick fix.

And I usually through my first you know, strategy call.

If the client is in that frame of mind, I usually coach to that.

I tell them why that's in work, and I I, I tell them, this is a therapeutic partnership, and we need to build on that, and that's how we get answers.

It's not as it's not a quick fix.

Having said that, so if a client is willing to dig deeper, then I usually ask them, What do you know about thyroid?

What do you know about low thyroid?

What have you been told?

What's going on?

What do you think is going on?

So, oh, they a lot of times, they will say, Oh, it's not my thyroid.

It's a very nonchalant I've been on medication, and they don't really think it's connected, because, you know, doctors have told them the thyroid medication is perfect, the TSH is perfect, so it's nothing beyond that.

So have you and, and that's when the questioning, really, you know, helps.

You know, are you do you see the connection between your thyroid.

I mean, go back to when you were really struggling with a thyroid, over medication or under medication.

How did you feel?

Really?

The history really helps a lot.

That whole triggering event on when this translated to weight gain or being cold all the time, or constipation.

All of that really is coming from the client.

Eric Balcavage: Yeah, I think for me, I think one of the big things to make sure they understand is, if it's not about your TSH or your lab value, we can manipulate those.

It's about what's happening in the cells and tissues, which we don't really have a great window of.

We can look at a reduced conversion of t4 to t3 and if that wasn't looked at, hey, we can look at that.

We can even look at the free t3 to free t4 ratio, and see that there's under conversion in the tissues, and that's resulting in hypothyroid signs and symptoms.

But I think it's important because people get they're like, my TSH is normal, so I don't have a thyroid problem.

No, your TSH is in the normal range.

But it doesn't mean you don't have thyroid signaling issues and inflammation and dysfunction going on.

It just means the lab value that somebody is looking at is within the range they care about to to medicate you or treat you.

But it doesn't mean you have optimal health.

We that happens all the time where somebody says, You look great, suit, labs look good.

You're all perfectly healthy, and then the next day, they dropped out of a heart attack, like, or, right?

Or they have the I just found out I have cancer.

Anu Simh: So we just need to find what is the weakest link.

You know what's going on.

And I usually tell my clients, it's just not about just the hormone that you're producing or the DTC, just normal.

How are you utilizing it?

How are you clearing it?

All of matters, and that's why I connected to the microbiome.

I connected to the mitochondria.

Show them and say this is so interesting, just this connection between mitochondria and microbiome, the endosymbiosis between the two.

I explained the story behind it and this, and most of it, I usually, I'm very research based, you know, the sense that there's so many things that we can we can cherry pick data.

So I really kind of dig into it and say, Is this something that you'd be interested in learning more about?

And then I leave it to the client.

If the client is interested.

Then we dig deeper,

Eric Balcavage: Perfect.

So let's get, kind of get bigger, big picture with this question, how does our modern lifestyle, processed food, emotional challenges, sleep deprivation, how does this affect somebody's gut biome, and what are the downstream effects?

Or what downstream effects do you see most commonly in your clients, especially related to weight and energy.

Anu Simh: So generally, when they come to me, doctor Eric, they've already been on very restricted diets.

Um, they've kind of cut out so many different food sources and struggling because they're on, like, low calorie just the other day, I had a client who said, I don't think I can eat less than this.

So she was on a 500 calorie diet, and she'd heard somewhere online that that was the way to lose weight.

So what I see the bigger picture is, when you are on such a restrictive diet, your microbiome is taking a beating.

You're not thinking when you're on a restricted diet, oh, I need all of these prebiotic fibers to grow my butyrate to nourish my mitochondria.

That's not happening, right?

So for me, that becomes a beautiful segue into talking about the microbiome and the connection to energy, to thyroid, to other hormones.

So they see that and they they're really uptight.

They come in like this because they're wondering, what else am I going to have to take?

How much, how much, how less should I be eating?

I'm already eating, so little.

What else do I need to do?

So as soon as I say, this is your journey.

This is you make the call.

We'll just look at it together, and we'll figure out what's happening next.

They relax, and then it's only when the nervous system relaxes that any of these other things are going to happen.

So I A lot of times it's like they come in hoping that they will start with losing weight.

And I usually have a conversation, but you've done all of this before.

You've done elimination diets, you've done this.

Where do you want to start?

Oh, be really nice to have a good night's sleep.

Or I am stressed all the time.

These are indications for me that your nervous system is out of whack and maybe just relaxing a little bit in your body and giving them some support there will take us to the next step, whatever that step may be.

For the client, it's usually like they're so tired of living in not living at the ideal weight, that they do want to lose weight, but they are not able to do it because their metabolism is tanked.

They've been on such low calorie diets, the sleep is compromised.

When the sleep is compromised, the microbial diversity is affected.

So it's all this dance that's going on that I just approach it.

I have a overall framework.

I call it mbhr, microbiome brain, brain, meaning nervous system, neurotransmitters, how they are, behavioral changes, all of that, age hormones, all of the hormones that are, I kind of look at that, look at those patterns.

And R stands for reframing the mindset.

So that's where the coaching comes in.

How do I present all of this to the client, you know, in a consumable way that they understand and say, Okay, this can be a goal.

I'm taking this I'm I'm accomplishing this goal, but I have a system to support it.

Eric Balcavage: Okay, but how does so?

I think you said, like disrupted sleep has an can have an impact on the gut microbiome.

Is it fair to say that excessive stress for that individual can disrupt their gut biome?

Anu Simh: 100% I've seen this instrument so a lot of research that being that fight or flight all the time that's us.

I mean, it's every day is like, there's so many tigers we're chasing that a lot of women that's, that's what they're doing.

They're like, really trying to struggle with that.

So even just calming the nervous system, really helping them.

Because when the nervous system is so uptight, the mitochondria gives gets a signal to shut down, it goes into repair mode.

So I tell them, look, listen, this is the connection.

And without not going becoming too nerdy or sciency for them, I show them the connection between mitochondria and the nervous system.

Thyroid and the nervous system.

You know, the stress is such a big part of what we are going through right now, and and we're so divided as people that is causing stress, it's crazy.

Eric Balcavage: Yeah, so I, for the listeners this, the key is, and I talk about this all the time, we typically operate in one of two states.

We're either in homeostasis, which is a state where I make enough energy to run all the systems in my body under my current stress load, and that could be a lot of stress, but you're it's managing.

So that's homeostasis.

And if you have chronic signs, symptoms, gut dysfunction, you're The other state is Allostatic regulation, and this is kind of what she was referring to, is that, hey, when there's more stress on the system, that starts to create danger signals, signals in the physiology and your mitochondria, which are these engines inside your cells, are the danger sensor.

And so when there's danger cues being picked up by the mitochondria, from organisms, from toxins, from inflammatory chemicals, from disrupted sleep patterns, from disrupted oxygen getting to the tissues that activates this cell danger response, and that's going to result in up regulation of your fight or flight system.

It's going to result in down regulation of the parasympathetic system, which is the gut is a huge part of that parasympathetic nervous system, and you are going to have down regulation of mitochondria.

It's not dysfunction, it's adaptation, and the big hormone that helps regulate this cell danger response is the decreased conversion of t4 to t3.

So with lower t3 in the cell, we can slow down the less important systems in that framework, and shift the limited energy to more of the cell defense mechanisms releasing inflammation, and we're going to have unfortunately, signs and symptoms.

That's our body telling us we're in danger.

We've We've spent a lot of time compromising it.

Anu Simh: Beautifully said, and the mitochondria, I mean really response.

I mean, it's affected by oxidative stress.

So I see that, you know, through food, through toxins, all of that happening in our systems.

And you said it perfectly, and, and, of course, enterohepav pathways and T 43 conversion.

So when clients even hear that, oh, that's happening in the gut or the liver and, and the connections, it just becomes a little bit easier to understand, you know, than just a TSH,

Eric Balcavage: yeah, It's not just TSH.

It's not just your gut.

I think that one of the most important things that I want to get across the patients is, I don't care what the conditions are.

You're not broken in most cases.

Okay, you may.

You can get to a broken state, but a lot of people that are coming to us have been they're either getting their broken state managed somewhere else, or they've been told they don't have a disease that needs to be cut out or drugged, but they still are kind of stuck in what I call purgatory, that kind of in between state from optimal health to illness.

But do you see?

I'm sure you see people who have been to other functional health providers, who've done gut protocols and dietary strategies.

And while they may work short term for them, they don't last.

What do you think is the big factor there that limits some of those well intentioned strategies from working Do you think it's the actual state of the individual?

Anu Simh: I think it's both.

But I think a lot of it is not treating a symptom.

Even you can be functional.

You can call yourself a functional practitioner, do all of the right things, get them all of the ox bile in the world.

But if you're not really coaching behavior, which a lot of doctors obviously don't have the time for, the end result is kind of as well.

So what I'm saying is that in every practice, there's room for practitioners, there's room for coaches, there's room for MDS, there's room for, you know, naturopaths, there's room for all of this.

But ultimately, boils down to the client, and what the client is, how the client is responding.

I'll give you an example, you know, a client came to me with several supplements for her conservation.

She'd gone through the four abs, you know, the naturopath, I told her to, you know, eat more fiber, eat beef, it, you know, have more fruit, or, you know, things like that.

Unknown: But there was, and then there was, like, a protocol, you know, like, this is how you you increase all of this.

But it's very confusing sometimes to the client, like, Okay, I have this, I have this prebiotic fiber.

I feel worse because I have more symptoms from it.

I'm bloated, gassy, so it becomes so convoluted, you know?

I mean, it's not a it's not an easy answer.

You know, for someone who's been struggling with, let's say, gut issues, to just give them a protocol, it just has to come from really understanding where the client or the patient is, and really taking one step at a time and asking, what is the next thing you want to add into your protocol, or into what do you see as the next thing that would help you and give them choices?

If I tell them that, butyrate is this multitasker.

It's shown to activate AMPK.

It's cellular energy, you know thing, but and then just leave it at that and give them a few choices.

It may or may not happen.

Anu Simh: But if i i say there are many choices here, as far as prebiotic fibers, it's false.

It's Goss, it's all of these patterns, lactulose what is it that you would like to start with, and what makes sense and really describe each one.

Then the autonomy, er taking the next decision lies with the client, and I do not explain it, except that it works every single time, because they feel so much more in charge that they relax in the body.

The nervous system is a little bit more.

You know, they're able to handle it a little bit.

I don't know if I'm making sense of it, but that's how I see it, not rather than just giving them something prescriptive, yeah.

Eric Balcavage: Well, I think the challenge is, for some time for people, is they the if they have a GI issue, the thought process is, you do this 30 day or 60 day gut protocol, and that's worked on this client and this client.

So it should work on you because of as a clinician, we've used it a lot of times.

I think part of what you were saying before is you gotta work with habits and behaviors.

And I agree with that.

Part of it, it's huge.

And what I would what I would add to that, to what you were saying is, if we don't change habits and behaviors, and our patient is still in a higher level of stress or threat or that cell stress response, we can provide a strategy that, on paper, seems appropriate, low stomach acid.

We can probably poor bile physiology.

Going to provide biome they have low short chain fatty acids, so I'm going to give them fiber and probiotics and maybe some butyrate temporarily.

But if they're in the same state, and they still have disrupted sleep and bad relationships, and they hate their job and they've got a whole bunch of other stressors that are keeping in them, them in that fight or flight state, a well intentioned protocol that does make sense on paper is likely going to be short term symptom changing at best, but it won't improve long term.

And so I think that's what I was that's what I was kind of leaning towards when you were talking about habits and behaviors, because if that is what you're saying, I fully think that that's one of the most important reasons that people start to fail, especially with gut protocols, because they change their food.

I've gone gluten free, I've gone dairy free, I've gone grain free, oxalate free, all this stuff free.

They've gone fun free, right?

But their state, their nervous system, state, has not changed, so they're still not going to produce acids and enzymes and have a healthy gut, right?

Anu Simh: And that's the problem.

You see?

I mean, if I tell them, Do this, do this, I'm giving them a bunch of directive, kind of prescriptive things, but really not paying attention to how is the nervous system?

I see that overwhelm.

I see that, oh my gosh.

One more thing on my plate.

I have to remember to take this supplement.

I have to do this.

I have to do that.

But they're not seeing they're not connecting the dots.

But instead, if, for example, I'll give you an example of a client who he is a CEO, and just really, I, you know, a high end job and just a lot of stress, doing really well in his whatever it is that he's doing, but his family life has taken a significant beating.

You know, he comes home so exhausted, it's not able to connect with this child.

It's not connecting with his wife.

And so when I coach someone like him, first thing, I remember him constantly complaining about this.

You know, I do so much, I'm making a lot of money, but my my family doesn't see this.

They don't see that I'm working so hard, because all they see is, oh, you've come home tired.

You're not there for it's emotionally.

The wife might say that the child said, Daddy, you don't have time to play with me.

But dad is so exhausted, he's tanked.

He has no nothing more to give.

And how do I coach someone like that?

I can't say, Stop working so hard.

Give up your dream job or this thing, this purposeful job that you have, that you really have worked so hard for.

Instead, I say, Okay, what happens between you going between leaving work and going home, is there anything that you can do to kind of just kind of pack that CEO in and bring out the dad and the husband, you know?

And then so he this, this particular client came to mind because he said, Well, I know every day I drive past, you know, in La Jolla, drive past, you know, I see the ocean.

And I always think, Gosh, how beautiful.

But I have never really had the time to stop and enjoy the ocean.

Because he's rushing home to be that parent, to be that husband, right?

Because he's already worked so many crazy hours.

So I said, What if you took just a few minutes for yourself?

It sounds like you're doing a lot of work.

You have to come home, shift gears, put on a different hat.

What if you just took a few minutes to enjoy that?

Enjoy the view?

Would that help you just relax in your body?

And then we started coaching around that, and so we started using it as a goal.

So we did that for about a week.

And the next time he came in and said, it was amazing, my my son started responding to me.

My wife said, what's going on, honey?

You're a different person.

Just that few minutes for himself where he could shift here, and I taught him some humming and deep reading just to relax.

And it seems so small, but it's in these small shifts, big changes happen, and we're always looking at big changes, we want to give our clients, our patients, this big victory if we weren't able to, because it's really about meeting them where they are, and that little thing led to so many other changes.

And I don't know, without that, if I, I wouldn't, may not have had the success I I did have this client because he was pretty wound up.

Eric Balcavage: yeah, and I think that's critically important, and I think that what's what makes the difference sometimes, for clients who've tried a lot of different strategies and they haven't worked or lasted, it's because their state hasn't really changed, and what you're doing and trying To focus on sleep and their emotional fitness and how they perceive their environment, from am I perceiving that as danger, as threat, and continually winding up the limbic system, sympathetic nervous system and down regulating the parasympathetics.

We can get a lot further with gut improving, gut health and gut physiology, if we address the habits, the behaviors that are contributing to the excessive load and raise somebody's level of what I call fitness in their emotional fitness, in their personal care fitness in their mindset fitness.

I'm sure that person was living even though he's highly successful in one avenue of his life that came at the cost of reduced self care, reduced relationships, and that in itself, creates internal and anguish and internal conflict and danger in winding it up.

And so do you think that that's one of the kind of the hallmarks to why you've you make it maybe a higher level of success in helping somebody reset their gut physiology, their gut biome and their health in general.

Because it's not just about which probiotic I take or which gut repair formula it is.

Sometimes people are like, well, that one probably didn't work, and I'll try a different one.

I'm like, one.

I'm like, if you've done two or three gut protocols, it's not about your gut, it's about something more.

But I do agree with you that not everybody on day one is ready to talk about what's going on consciously and subconsciously in their mind and what's creating the conflict.

They're like, No.

Don't have any problems.

I'm good.

I'm good, yeah, just fix my gut.

Anu Simh: My God, men are notorious for it, you know, and I don't want to just make it gender based, but I women are really more apt to share things and a lot, and men is in my experience, in my practice, it takes a bit of time, and a lot of times the male clients I get are from my female clients.

They they push their husbands my way.

Go go see her.

Go see her.

And they're not ready.

And if a client is not ready, they're not in that stage of change where they're not even they're not even contemplating change.

There's nothing much as a coach or a doctor, you know that you can really do you just listen and be the best.

You just listen.

You just actively listen and look for those clues.

What?

What is he really saying?

I had this one client who came to me, his wife was really tired of smoking, says, What the heck.

You know, he's still smoking, and she was, like, an avid everything about health.

She couldn't really understand it.

And he was like, not at all keen to have the conversation.

I haven't seen any problem with it.

The smoking relaxes me.

I want to continue smoking.

What am I going to do?

I'm going to help him with smoking cessation when he's not even approaching the subject.

So we started talking about other things.

I said, what makes you happy?

What do you enjoy?

So he brought up golf.

And I said, Wow, you like golf.

How's your game?

So we started talking about about golf, and he never made the connection between smoking and golf.

And he was also, he had also gained a lot of weight.

So I said, Would you, would you?

It sounds to me that you really want to to up your game.

And he said, Yeah, that's my one goal.

I really want up my game.

So all the coaching was around golf, and his how he showed up for the game, rather than telling him, you've gotta stop smoking, you need these supplements, or you need this food.

So within about a month, he was he dropped about five to 10 pounds, then drop weight very easily, and and he's feeling a little bit better, you know, as far as this game and this went on and on.

We had many conversations, and within about three to four months, he said, Yeah, I think I want to stop smoking.

I didn't suggest it.

He suggest, and I think that's about behavior change, that it all has to come from the client or the patient, we can only be that guide by the side, whether you're a doctor or a coach, you can't do anything more than that.

It's just the information has to be at the right moment.

I think

Eric Balcavage: What is it when you're talking to somebody who's comes to you with chronic will keep the focus, you know, chronic gut issues that lend you to say, You know what this is, less about their diet and more about their life, their lifestyle, their habits, their behaviors and their thought processes.

What are the things like, if somebody's listening to this conversation and saying, Well, I think I just have a gut problem.

I don't think it's caused.

I think it's just my gut and maybe just the food I eat.

What?

What are the key things that you hear when you're when you're having that conversation, when you're doing that active listening that helps you key in, that there's something more here than just bad nutrition.

Anu Simh: Well, again, that comes from that active listening and looking for clues, right?

You know, client comes in, and I usually do an intake form, I get a lot of information.

We talk, and I see that.

I see how they're even the demeanor, you know, are they just moving around?

They were looking around.

They're not able to focus.

They don't even have to say that they're anxious.

They present as an anxious person.

And there's a big difference being calm and you know, being in your being present to the conversation or the person in front of you, then, then a person who is not so that right away gives me some clues, and I kind of dig deeper into that.

Saying, how are you feeling?

You know, just finding out more about the system.

What does stress look like?

Questions like that, and if they want to go, there we go, there.

They're like, more like, No, I think it's my gut.

Then we have a conversation about the gut.

Eric Balcavage: I think, I think that's great.

I think that's one of the things that we need to do.

And we'll close this kind of this section of the podcast, and just kind of summarize it that you.

Your habits, your behaviors, your beliefs, your thought processes all influence your overall health, your gut physiology, your thyroid physiology, all of this system.

So my recommendation, and I think it would probably align with yours, before we start treating this system and what we see as a sign or a symptom or a diagnosis, we need to start asking better questions, what's the state my individuals in, and what's causing them to be in this state?

And how do I address that?

Because if you never address what's keeping them in that stress state, you're likely not going to have any long term success.

They're not going to have long term success, and everybody's going to be frustrated.

Anu Simh: And they know that, you know, because they might say, oh my gosh, I went to this practitioner.

All I got was, supplements, or I just got so many protocols.

It didn't really help me, and it's because they didn't take the time to understand the patient or the client.

So in my practice, I spend about the first two to three hours really getting to know, getting a real screenshot of who my my client is, without that, without understanding the story, your back story, what is some of the triggering events in your life?

What is the suit that they've created called body, very hard for me to come up with anything substantial or sustainable for this client.

Eric Balcavage: Okay, so we're gonna, we're gonna put a lid on that conversation.

It's almost hard to go to this next piece, because we just talked about how habits, behaviors and and mindset and your state really has an impact on dysfunction.

But we'll shift gears and assume that we're working on our state, we're reducing the overall stress load, and now we want to start to nurture a healthier GI tract.

So let's talk first about food.

There is lots of opinions about what's the healthiest food to eat.

And you hear, you may have a different opinion, but I'm just going to say you hear nonsense.

Like, if you have this condition, you need this type of diet.

If you have this condition, you need this type of a diet and and, like, there's a thyroid specific diet, there's a adrenal specific diet.

I think all of that is nonsense.

I think there's things that we say because it's sexy to bring people in and attract eyeballs, but ultimately, I think a lot of those things, any dietary change, in my opinion, is going to create a change in somebody's physiology.

It's going to create a change in the biome that can make them feel better or worse.

But ultimately, if we had to give somebody who's just saying, but I need to know, there's keto over here, there's carnivore over here, there's vegan, there's vegetarian, there's Mediterranean, there's paleo, there's AI, AIP, like for you, when you think about what is the standard overall diet that somebody should be focused on if they want to be healthy.

Where do you land on that?

Anu Simh: It's a great question, and it's a complicated and the answer is very nuanced, because it always is with nutrition.

It's not easy.

Nutrition is complicated, and because it really is about food, and food is so personal, food is bioindividual.

Food is social.

So many aspects to food, and it's very hard to just I find labels very like, like cages, right?

It's like, when people say I'm carnivore or vegan or something like that, it puts them in this box.

And even if that little cage is not it's it's trapping them.

It's really, kind of really suffocating them.

They want to be in that cage because they're so at this point it becomes personal.

It's about that's the whole mentality of, you know, really belonging to something, and saying, I believe so far, so much into it.

I'm not willing to look at science.

I'm not looking at anecdotes in my own life to even change it.

So I find that very challenging, because, yes, my clients will come and say, I really had a lot of luck with being keto or carnivore or vegan, and then my underlying question is, so why are you here?

You know what's going on so, but if I, if I were to make some rules around food, it would be simply the eat for your body.

Don't listen to an influencer or doctor or even me and say this is what they believe in.

Find out up make a lot of experimental goals.

How does How do you react to food?

How food can be poisoned?

Food can be medicine.

There's a wide gamut of things.

And inside of that, there are single nutrients that affect people in different ways.

But if you look at food collectively, I think the only things I can come up with is like, make sure that you eat adequate protein.

And that is a that's a pretty loaded question.

Depends on where you are in your journey, or you menopausal, post menopausal.

Are you?

Are you an older person?

Do you need more?

Are you exercising?

Or you're a couch potato?

Totally different.

I think for me, I feel like, choose your protein, do what you have to the big thing I've I focus on, based on all the research that I went into for the book, eat your fiber.

You know, that's something that I've come to a conclusion, that it does help to have these beauty producers, have some, you know, something to feed your microbiome, because you're feeding yourself and you're most of us are not protein deficient.

We're not, you know.

And again, the whole thing about fats is another pretty loaded question.

How is your cardiovascular system?

Where's your Apo B, or do you have an genetic marker, like LPa.

So it's it's hard to really kind of just kind of pinpoint and say, This is the best diet.

It's totally dependent on the client.

The only thing I would say to them is make sure you have a bit of everything.

So when you're looking at your plate, you have protein, your good fats, and you have a microbiome, accessible carbohydrate to support your microbes.

That's pretty much where I land, you know, and I don't if someone wants more than that.

Of course, I have a protocol, I have a lot of ideas, and I have a bunch of meal plans.

But it all starts with, what do you want in your life?

What?

What do you see as sustainable?

I had a client who came to me with, I mean, he was miserable because he was his his exercise coach had put him on a high protein diet because the guy, South Asian wasn't gaining any muscle.

They said protein is the key.

Man.

You need to eat a lot of protein.

So the poor guy went from being vegetarian, no animal protein, to tons of meat, red meat and all kinds of animal protein.

And he his stuff was just a mess.

And so coaching to the terrain, coaching to the client, really makes a lot of sense, even with nutrition, especially with nutrition, I think,

Eric Balcavage: I agree with that part of it, but I think for the average person who's saying, Alright, I don't even know where to start to say, well, eat.

What's going to make you feel good?

That may be a very processed food diet, and that may make them feel good emotionally, but it doesn't necessarily make them feel good physiologically.

Anu Simh: Oh, of course.

Doctor Eric, what I'm saying is that, yes, you know, I usually will say, Listen, in my practice, we usually try to see why you're having these problems, and you may have as and have you gone through something called elimination?

Have you eliminated certain triggers?

And the usual triggers that we see in the Western world, in the standard American diet, are things like gluten or dairy stuff, you know, and it's an individual response.

Have you done that?

And sometimes they will say yes, but I don't know what came off of it.

So we really focus on the answers.

How does gluten affect you?

How does dairy affect you?

How does corn affect you?

Anything that they say is really coming up as a red flag, and that can be the first step.

But at the same time, I'm more interested in not just taking things out.

How do we feed you?

Really starving that you know you've been on restrictive diets for so long.

You've eliminated so many things because you've been told to, or, like in my own story, I had a gut issue.

I I grew up eating a lot of veggies and fruits and things like that, but I I was at a point where I had to kind of really cut out a lot of these things, because I wasn't, I wasn't responding to them.

And that came from many, many years of being on a standard American diet, thinking that was the way to go, no, because it was fast, it was convenient.

So I see myself in a lot of my my my clients, you know, they are rushing to work.

They're eating something in a package, you know, brown boxed whatever, and it's not giving them prebiotic help, or the getting the microbiome ready and geared up for doing things that they they should be doing for us, as our forever guests, as our symbiotic partners.

Eric Balcavage: Yeah.

I mean, I think one of the biggest challenges for a lot of people when they've been on lots of different diets.

They've tried carnivore, keto, and it helped for a while, but it doesn't last, and then they're confused as to, what can I eat?

I think they're the place even before you meet a me, maybe a new is just return to a whole food based diet and see how you tolerate that eat as close to the way foods come from nature as minimally processed as as possible.

And that's a great start.

And then I think it is important to consider where your calories are, what your macros are.

And there's plenty of like general calculators that you can put in and get your your put your age in your weight, your height, your activity level, and get a general feel, because you you you have to make sure you're eating for your your close to your burn rate.

So if your burn rate is really low, then you don't need, you know, 1000 times more calories.

If your burn rates really high, and you're in a 500 calorie deficit, that is not going to help you, that is creating more stress.

Yeah.

Sure.

And you're right about processed foods, because I think one of the big changes, and I mean, why we're having this rampant obesity, I have to, we have to look at food and our food sources, and it's largely the ultra processed, hyper palatable foods that we've all gotten so accustomed to.

And it's so hard from a brain perspective, from that food chapter, and from having that insatiable hunger for these foods to really just kind of cut, cut off and say no to them.

I usually give them a food addiction scale.

I think that, I think was a hill that came out with it, and that kind of tells me right away how, how addicted are they to these processed foods, flour, sugar, things like that.

And gives me an idea like how the conversation should go.

I mean, if it's kind of like at the some, some say yes to every single thing you know, can you ever think of a day without processed stuff, you know, like the donut or something, oh my gosh, I go looking for it or I I need ice cream at the end of the day.

Those are real good ways for us to figure out how, how, how much they are influenced by processed foods and hyper palatable foods.

And for someone like that, I don't know, I have clients on GLP, and they the food chatter seems to really kind of diminish and but at the same time, they work with me because they want behavioral changes.

They don't want to be on a drug for a lifestyle disease all their lives, but I see that chatter coming down.

I mean, all I can tell you is what I see in the practice scene.

And of course, as as a coach, I mean, it's always like, gosh, another medication, you know, like, they're already on so many other things, Metformin, they're on high blood pressure medication, without really understanding how all of these medications be the beta blocker or platform all of that is changing this body.

Yeah, yeah, you mentioned it, so I'll make some comments on it and maybe get some feedback on it.

You say you see some benefits when people are on the GLP one drugs.

And obviously we can, we can see some of those because of the way GLP has an effect on the neurochemistry, on glucose regulation.

But there's also some potential, really significant challenges that come with it.

But it, we have to ask that question, and I don't know if you how you bridge that with your clients, because when people ask me about GLP one medications, I'm like, Look, you could do anything you want to do, if that's what your goal is.

If you're trying to do it, because you have to get an address for your wedding in two weeks, and if it helps you and that makes you happy, then you can do that.

But the big question here is, if the GLP one drug helps you, that means you're not generating appropriate levels of GLP one or the signaling mechanisms aren't working.

A medic, a medical provider, can provide that GLP one drug, and it may have a positive effect that gets you closer to whatever your goal is, but taking the GLP one drug ultimately does not address the real issue that's going on inside that person.

They've got dysbiosis, they've got altered signaling, they've got DL decreased GLP one.

And for the listener that GLP one drug can create lots of changes, but you make it if you have a healthy gut.

IO and a healthy GI tract.

You make it, your body didn't forget how to make it.

So that's the real issue here.

And I think that's where you know, it's easier to take a to take a GLP, one drug, than to change habits behaviors.

But

Anu Simh: Metabolic inflexibility.

I mean, that's not going to change.

What we've seen from studies is, the minute you stop taking the drug, the weight comes back and then some,

Eric Balcavage: Because the broken physiology, or the adaptive physiology, is still there.

There's still dysbiosis, right?

Anu Simh: But instead, if I'm able to coach the client to better habits, teach them the importance of these vegetal greens or fibers that can mimic that GLP.

They're learning the how to eat for their body rather than and for your microbiome, and seeing that connection, that when they finally are ready to wean off the drug, they have something, a system in place that really helps them deal with the aftermath of taking the drug, because it can be like this, and that is just very sad, because some of these women and men, Dr Eric, they're not looking to lose 20 pounds.

They're looking to lose about 100 pounds.

100 pounds is a lot of weight to lose, and I, that's where I that's so it's a very measured answer.

It's a it's a little bit, I have a lot of trepidation even saying that I'm okay with it.

I'm not okay with it.

It's just that when a client says that they they want to take it because they see the superficial benefits, or being on a drug like that, you know, because they see their friend losing tons of weight without having to go on, you know, just this juice fast or something like that.

It's a very attractive, it's very attractive if people things, people are saying, This is great, it's very hard to compete with that, is what I've said.

Eric Balcavage: Yeah, well, our job is still not to be the boss.

Our job is to is to be the coach, right?

And so I think if we, if we had the ability to have a functional health coach in every practice that prescribe GLP one drugs, and say, Okay, this you're coming in, you're asking for this GLP one drug.

Let me explain to you the pros and the cons, and let me explain to you the options.

Ultimately, you should be able to make this GLP one drug, but you're not, because of these reasons, and we can provide the medication that you want with no education and assistance, and you just take the drug.

And when you're done, you're done, but be aware that there's side effects that come with it, reduction of bowel movement motility that can create some significant issues, gallbladder problems, micronutrient deficiencies, there's a whole host of awesome yeah, right, right.

So if you're going to take it, I want you to know that we can just prescribe it, and you can walk out the door and nobody bugs you.

Or we can also provide life lifestyle strategies along with that, so that way you understand how you need to can eat while you're taking this.

You're it's going to have an you have to be focused on what your protein intake is with this and some of the other factors with it.

And we can help educate you as to what probably caused you to have the obesity and the decreased GLP one production, so that as you learn those things and you make the appropriate changes in your diet and your lifestyle, and we use some things to help change your gut biome, you a won't need the medication, and when you come off you won't have the typical rebound effect that a lot of people do, where They've lost weight, but they've lost a lot of muscle mass, now they return regular eating, back, whatever that is for them, with less actual muscle mass and still a chaotic and dysbiotic bow.

And you're going to be you're going to gain weight and it and it'll be even harder to lose the second time if we gave them that option.

And maybe it is, I don't spend much time in a practice,

Anu Simh: But it's that would be the ideal situation, right?

That is what is going to help us as a nation, change from this, you know, this metabolic mess that we find ourselves in, to really kind of changing and for our children.

I, I am so bothered by it at so many stages, with just kids being so obese, kids having type two, which is an adult onset, is no longer adult onset.

Blood sugars rampant.

I come from a country where I, when I left my country, India.

I, I don't think I ever saw obese people, you know, it wasn't, it wasn't the norm.

I came to America and so, oh my gosh, there are obese people, you know?

I didn't even it.

Didn't even was in an art, you know what I grew up with.

Now, it is just shocking to see obesity being so rampant in cities.

Insulin resistance is rising every single day, people on medications, it's same thing.

Everybody is on the standard American diet.

You know, it's the or the Western diet, and you have to connect that Western diet with the microbiome, with the Mito, mitochondrial dysfunction, with the hormonal imbalances, all of that really work together, not just one thing, but I start with the microbiome, because it's connected to food, and it's an easier step into it for for coaching purposes.

Eric Balcavage: Yeah, it's a shame.

I think, you know, we, we have two industries that have two different jobs, the allopathic approach and the functional approach.

And we've looked at these as competing entities for for way too long.

And what we really need to do is build that bridge so that if you're in crisis, we have the tools to do that.

But if you have a disease or a condition, and we manage the crisis effect, or you're you're not in a need yet for crisis management, there's an option for people just to say, Well, you're not bad enough yet to come back later.

We need to be able to have that bridge where that your that GP says, Look, you're gaining weight.

Your obesity isn't the cause of disease.

Obesity is the effect of chronic low grade inflammation.

Yeah.

And so if you want to lose weight, you got to fix your chronic low grade inflammatory process going on.

I don't have a tool to fix it for you, that is diet, lifestyle and management, but there are, here's the functional medicine practitioner, functional medicine coach, who can help you with those diet, lifestyle things, it and so you don't have to come back to me for a crisis treatment, but I'm here if you need me, but that's the option.

We're either going to be loading you with drugs into perpetuity, or we can get busy trying to address the root issues and let it to the person, but I don't, unfortunately, people think it's one or the other, and the clinicians, I think sometimes think like negatively of the other profession, because, and they're like,

Anu Simh: There's no room, like I was, we were on our podcast, we had an very an acupuncturist.

He said, I have no place in this model, so I have to find my own place in the sense that in the allopathic world, oh yeah, an acupuncturist is not I mean, they may just say, oh, some people, well, who knows something about acupuncture?

May say, Yeah, you know, go see an acupuncturist or a chiropractor or something like that.

But most people have a very black and white approach to that.

Oh, chiropractors, they don't know anything.

Or acupuncturist, that's all Eastern medicine, Ayurveda.

But who's really thinking of asking the client what he or she wants?

Right?

Maybe they are, are Asian.

Maybe they need to go to an Asian practitioner who understands their metaphors and and their, you know, lifestyle way better.

So a lot of it becomes, even though we are melting pot, it becomes a cultural issue.

You know, food is so cultural.

So really speaking to their language makes such it's more impactful.

I think, rather than just saying, Oh, you need to go on a Mediterranean diet, and you say that to someone who's doesn't know what that is or cannot connect, that's really not achieving anything.

And that's the same thing that's happening with the medical model as well.

Eric Balcavage: Yeah, and that, and that may you know, for the same you know, somebody who's from a different area of the world, what's your culture?

What do they eat?

Let's eat a healthy version of your cultural diet, right?

Versus a maybe processed version of your cultural diet that could be more beneficial for them.

Anu Simh: Italian.

Stop eating pasta.

Eric Balcavage: You can, but they may not listen.

Anu Simh: So how do you eat the pasta?

Right?

I mean, that's what I coach them to for blood sugar balance.

I mean, if you are going to eat pasta, why not choose a pasta that has a little bit more fiber in it, or add all of these bitter beans that trigger those bitter receptors, and then maybe having some adequate protein so you insulin, your blood sugar spike is not as profound.

That is the best we can do, as you know, as doctors or because.

You can't give them an ultimatum like that is going to kill you.

Don't eat that.

You can say that.

But what?

What are the chances it's going to be sustained?

Eric Balcavage: Yeah?

Yeah.

I think learning how to eat from that, from sitting down, relaxing, chewing your food, not drinking a lot of fluid, how you prepare your food so it's so that it manages blood sugar and has the best effect.

Those are all things that I don't a lot of us didn't learn, and nobody's taught us.

We just throw stuff together, right?

And

Anu Simh: I mean, I, I, you know, my grandfather was a physicist, doctor Eric, and he was also a renaissance man.

Was always experimenting with food and Ayurveda and connecting it to science and and he was the first person I saw really sitting down and and chewing his food.

And he said, I know, chew your food about 32 times.

I said, Grandpa, where did you get that from?

And he had heard, I think his name was Harold Fletcher.

You know, he was this American Hippie kind of person who was would kind of propose the idea that we need to really Chew it well.

And then he came with the 32 you know, twos, but my grandfather that time was actually testing it out, and he said, I remember my digestion is better.

I'm not sitting in the toilet, as much as I used to my you know, he connected, started connecting the dots, and he started telling everybody about it, saying there's some truth to this.

Slow down.

Enjoy your food.

Listen to that.

Where does digestion really begin?

It begins when you see the food, you smell the food.

What's happening in your mouth?

Psych, IgA, all of that.

You know, it's that's a lot of there's a lot of truths to that, and just getting that ancient wisdom and connecting to modern science is something that I absolutely love doing, because I see value in all of this.

Eric Balcavage: Yeah, we could talk more about that, but I want to move on to another topic.

So I wanted, I want to get your opinion, like, in where in your model, where do you see the use of probiotics?

Probiotic foods, prebiotic foods.

How do you where do you see them?

There's so many probiotics on the market, there's a lot of disinformation regarding probiotics.

I've had discussions with people about, and we've talked about on the podcast some of the kind of the warnings, things to look for when you're when you're purchasing a probiotic.

But where does where does the probiotic conversation and fermented foods fit in your model of healing?

Anu Simh: Great question.

In the book, I propose a simple diet.

I call it the flourish diet.

I'm always being fascinated with the idea of flourishing.

So I believe that to flourish from within is the best place to start.

You know, because if you're not flourishing from within, all of the things that we want to do in our life, you know, be it an ED guy or, you know, purpose in life is for not because we're not feeling well in our bodies.

And connect that to eating and feeding our microbiome, and feeding our bodies and and taking that further, we have a foundation layer.

Foundation layer comes from all these diverse prebiotic fibers.

The prebiotic fibers feed the gut bacteria, and it's very easy to say, just take this supplement or a probiotic.

But it really depends on the client and what the client if the client has a problem, let's see the the media's darling, akermansia.

You know, everyone's talking about it.

So a lot of my clients will will say, Should I be taking akermansia Well, first of all, why do you need that?

You know, what are you?

What do you know about a akermansion?

Well, I feel like if I take that, I'll drop the weight.

So I talked to them in that context about transient microbes.

And you know, what kind of benefit a probiotic will give the body when it's when it when you're taking it.

What sees this to happen?

Do they attach to the you know, to your lining and and and just education around probiotics?

The biggest confusion around probiotics is around food probiotics and and supplements.

They they buy any shiny new object, a yogurt that looks really yummy and you know, but looking at the label, looking at if it says contains probiotic culture solutions, to my client, don't bother, because if they haven't taken the time to even tell you what kind of probiotic strains are.

In the yogurt.

Why do you want to spend your hard earned money on it?

Instead?

Look for yogurt that has very specifically a strain that's mentioned.

So let's say, give me that is 212 or lactic suicide, dry or all well studied, you know, strains, and then you can make do your own research, go to PubMed, research it, and see what the connection is.

Do you really need that?

You know, a lot of times they'll take something.

It makes them feel worse, for instance.

And so I always start to answer your question.

I start with food.

Yeah, I feel like feeding the microbiome is better.

And it's, it's cheaper, it's, it's sustainable, and it, it really helps.

It's easy to grow, butyrate producers, you know, faculty bacterium from HCA, or superior or ubacumen, just by eating the right kinds of good probiotic, probiotic, fabulous.

So that's where I started conversation,

Eric Balcavage: And that's where you know, we weren't designed to get a capsule with 50,000 colonizing units in it, or or 50 million colonizing units in it.

That's not really how the physiology was designed.

It was designed to get it from food, from fiber, the combination of those things.

But we, you know, I get it.

It's sexy.

And people say stuff.

There's other things.

There's other challenges with probiotics, especially when we start to see combinations of probiotics put together that don't play well together in a capsule.

Anu Simh: Thing, you know, you could have one strain, like yesterday, I was talking to someone who said 299, feet, you know.

And but it wasn't just that, which, in it, by itself, is being studied really well, but they had added a whole bunch of other things to make it their product, that connection, that symbiosis, right there.

Do we know if it works?

Do we know if that that thing is going to work?

No, we don't.

So I said, well, the bottom line is, we don't know.

You know, we just know about this particular strain.

But together, this marriage, is that working?

We don't know.

So do you want to take it, you know?

Eric Balcavage: Yeah, I've had Jeff Thurston on he, he's, uh, he's the owner of master supplements, and he's been making probiotics.

He's like, you know, there's this world behind there, and he's a little bit resistant sometimes to really dig in and say things out loud.

But he says that, like a lot of these things, just you put them together, and we put them together because they're the sexy probiotic at the moment, we put them in a capsule, but we know that they don't, they don't play well together in in there.

So you're there, essentially you're getting in an effort to get this sexy looking combination of of probiotic bacteria you may not have much in there by the time it gets in.

And the other pieces is that getting if you if you really have healthy gut physiology, your saliva is killing some of the bacteria, your stomach acids killing some of the bacteria, your bile, your pancreatic enzymes,

Anu Simh: Yes at every level, we have so many parameters, like, Stop, you know, like, it's a gatekeepers, you know, for what's happening.

But if entry lands in the COVID, I mean that I see a lot that holds SIBO, you know, issue and and that's where the problems really start for people.

When they end up with something like SIBO, they really cut out a lot of these trigger trigger foods.

And a lot of them are these high fought map foods.

And they've been off of these high FODMAPS foods for for a long time, and they don't know how they're going to respond to it, and really get nervous about adding it back, you know?

So I do see that a lot.

And then in there the MMC, there's fasting that can really help.

There's so many, so many things that that can help, not just getting them getting rid of a bunch of bacteria that have translocated to the wrong you know, that's not the only thing.

It's the aftermath of that.

How do you coach them to start eating the foods that they are so afraid of eating?

Eric Balcavage: Yeah, and yeah.

I think you have to coach two things, right?

Because the SIBO is always the result of and what happens, typically in traditional SIBO is they treat and then they know they're going to wind up treating 90 to 120 days later, because it tends to reoccur.

And part of the reason it reoccurs is the state of the individual.

They're in a sympathetic DOM.

And it states so stomach acid is down regulated.

Bile physiology is downregulated.

Pancreatic enzymes down regulated.

Now we've lost the innate immune system in the GI tract to be functional, to be as functional as it should be.

And now bacteria from our oral cavity or food gets into that, into the small bowel, and it's like, hey, there's nobody here to manage like it's a party, and it can hang out there, and they get first crack at that food that's coming in, and can ferment it.

And people do exactly what you say.

They go on a SIBO based diet, and they do antimicrobials.

And I'm like, but if you're not, what about your stomach acid production?

And what about physiology?

Anu Simh: I really have an opinion about if I have an opinion, it's about that.

It's about, if you take, like, let's say, a stool test that's going after these pathogenic bacteria, how many pathogens are you going to fight instead?

What if we did grow a lot of the beneficial bacteria to fight the battles for us is, I feel like a lot of studies are kind of pointing to in that direction, and I find that a little bit more doable than just saying, We kill this bacteria, kill that bacteria.

I mean, like, it doesn't make sense, and it's easier for the client to rather than just chasing, unless it's something huge, right?

Yeah, right, or someone has Giardia, or, you know, things like that,

Eric Balcavage: Most of the problems are an imbalance of the commensal bacteria in the first place.

They're not pathogenic issues.

And the argument

Anu Simh: It is like 1% Yeah, something very small, yeah.

Eric Balcavage: And the argument I make, even from a pathogenic standpoint, is if you already have a healthy gut biome and healthy defenses, even if you get a pat more pathogenically, an organism that's more likely to create a pathology if you have a we've never test how many people have been exposed to one and dealt with it.

We always see the people that didn't have the capacity to manage and deal with it, but we have systems in place to deal with the a lot of these things coming in.

So if you're in a healthier state and you pick up a bug, somehow you're many times, your body's going to be able to deal with it.

Yeah, you may get some level of sickness or illness short term, and then it goes and your body recovers.

It's the person,

Anu Simh: You are right about the immune system, right?

I mean, and then connecting it to a Brazilian microbiome, a resilient microbiome, by definition, is a microbiome that can bounce back after an illness, after a trip to Mexico and after round of antibiotics.

And the immune system plays a huge part.

And the microbiome is like the training ground, these beneficial bacteria the training ground for the immune system.

So it's so connected, so we can't really look at it from a single lens, you know, just us.

Eric Balcavage: Absolutely it is.

It's a complex topic, but it's good to to keep nuancing the conversation a little bit, and we didn't in this conversation.

We didn't get into strategy and like what products or anything, I usually shy away from that to begin with, but I think we covered what's really important, which is a in general, we should eat a whole food based diet as kind of a general idea.

And then two, we really have to be focused on the state we're in, because that changes the biome.

And we need to start nurturing.

We got to look at our habits and our behaviors and say, Okay, what are the things that are the that I have, that I have the lowest level of health in and how can I incrementally start to improve those things, which then produces less stress on the physiology, which then allows for a healthy, healthier digestive capacity, healthier gut biome, and that's how we get healthy.

That's how we stay healthy, versus what's the best gut protocol, and what's the best way?

What's the best fad diet I can do that's going to create change?

Fad diets can create change.

They can change the biome like pretty quickly, but that doesn't mean it's a long term benefit in most cases.

So let's wrap this up, because we're kind of at the end of that time frame.

But tell people a little bit about you, what you do, your book and your podcast.

Anu Simh: So I am a board certified functional health coach.

That really means that I take people from where they are to where they want to go, and it's largely women who are busy, women who are struggling with, struggling with living at the ideal weight.

They have a lot of the thyroid symptoms, you know, gut issues, you know, and I connected, and I use my Protocol, or I didn't even want to call it a protocol.

It's just an a system that helps them dig deeper in.

Into the microbiome, brain, nervous system, regulation, hormones, and I coach them.

And we all of this through helping them see behavioral changes.

My business and my philosophy is nine arms of wellness.

You know, I just really don't think it's a single prong approach.

It's all of these arms that really help us take us to optimal wellness.

And my website is nine arms of wellness com.

My Instagram is nine arms of wellness as well.

And my book is called flourish from within, and it's going to be out end of the month, and it's available where all books are sold, and it's also going to be on my website.

Eric Balcavage: Fantastic.

Well, thanks so much for coming on the thyroid Answers podcast, and I'm I'm looking forward to maybe another conversation in the future.

Anu Simh: Thank you so much, and I'm looking forward to having you on ours on that message.

Eric Balcavage: Awesome.

I'm looking forward to it too.