Jay Feldman  0:05  
How to heal your adrenals, whether you should use the GAPS diet for autoimmune diseases, and how to improve your digestion without a gallbladder. We'll be digging into these topics in today's episode of the energy balance podcast, a Podcast where we explore health and nutrition from the bioenergetic view, and teach you how to maximize your cellular energy, to maximize your health. Today's episode, we'll be going over what to do if you have adrenal fatigue or adrenal insufficiency, and whether these are really adrenal problems. We'll also be discussing how you can heal your adrenals, how the GAPS diet can help to resolve autoimmune issues, and whether you should consider trying it. How you can improve your digestion, even if you don't have a gallbladder, and how to improve fat digestion and bile flow if you do have a gallbladder but are still struggling with issues in these areas. As always, to check out the show notes for today's episode, where we'll link to the studies and articles and anything else that we reference, you can head over to Jay Feldman wellness.com/podcast, and with that, let's get started.

All right. So Laura asks, What do you think about adrenal insufficiency? And so we'll start out by discussing adrenal sufficiency versus adrenal fatigue. I'm not sure if she was maybe meaning more so adrenal fatigue, but we talk about the differences there, and then dig into what we think about it. And Mike, I'll let you start us off.

Mike  1:32  
Yeah, so I think the best way to start this is she specifically asked about adrenal insufficiency, so we'll run through what that is, and then what we'll do is we'll hone in down on the adrenal fatigue afterward. And so the adrenal insufficiency is, this is a clinical diagnosis. This is actually a pretty severe health issue. And basically what it is is it's a failure of the adrenal gland to produce the important hormones. And so there's a couple hormones. One of them is aldosterone, or it's called a mineral corticoid. Another one is cortisol, which is a glucocorticoid. Then we have the androgens, which is dehydroepiandrosterone, which is DHEA, and then we have the catecholamines, which is epinephrine, and nor epinephrine. And so when you are in in adrenal insufficiency, there's problems with a variety of these different hormones, their production, their release, etc, and it can lead to a variety of pretty severe symptoms, like hypoglycemia, fatigue, weakness, dehydration, low blood sodium levels, altered blood potassium levels, low blood pressure, dizziness and shock, cardiovascular collapse. So basically, you can't maintain your blood pressure. Can't maintain perfusion to your brain into different organs, and so it's a very severe issue, and this is a bit different than adrenal fatigue, which we'll dive into in just a second. Now, with adrenal insufficiency, there can be problems not only at the adrenal gland, but you can also have problems at the pituitary gland or the hypothalamus, and this will differentiate between primary, secondary and tertiary adrenal insufficiency. And it's basically just saying where the problem is, and the reason why is the hypothalamus produces a hormone, corticotropin releasing hormone that acts on the pituitary gland to release ACTH, which is adrenal corticotropin hormone that stimulates the adrenal gland to produce these hormones. And so if the hypothalamus is damaged, or the pituitary is damaged, or the adrenal gland is damaged, the whole system can be dysregulated, and then you can have this, this pretty significant hormonal imbalance. Now, some of the causes that we see with the adrenal insufficiency are related to being on long term glucocorticoid therapy, so taking the synthetic glucocorticoid steroids like cortisone or dexamethasone or something like this, over the long term, and then abruptly withdrawing, because the use of these hormones actually lowers our adrenal function. And when you withdraw or abruptly, the adrenals have been atrophied. They're not producing enough hormone, and you're left without adequate amounts of these, these specific hormones. Another thing you can see is, if you're very injured and you have to go into the ICU and the body's stress systems have been depleted, you can get critical illness related corticosteroid insufficiency, meaning that you're because you're so stressed out, your adrenal glands and your stress systems have failed, and now you don't have the adequate amount of hormone it actually creates crisis. And there's it's associated with worse outcomes, mortality and things like this. Another one is an autoimmune cause, which we would see in Addison's disease, where there's an immune destruction of the adrenal gland, and we've talked about autoimmunity and other episodes, not specifically Addison's disease, but the theory of it in general. And so I would refer possibly to those episodes to start to dig into how you can try to address this under some ways you can support or address the situation. Other components are cancers or tumors that would affect the hypothalamus, the pituitary of the adrenal gland. You also have drug induced dysfunction, which is related to certain drugs like anti fungals, like ketoconazole, that can block the production of glucocorticoids at the adrenal gland, or even anti tubercular drugs, which are able to actually induce the metabolization of. Hormones and lead to lower levels. This is at the liver. You also have head injury. This is actually a big one that causes pituitary and hypothalamic dysfunction, and the head injury can actually lead to a lack of ACTH and CRH, and that adjusts signaling on the pituitary or on the adrenal gland. And then you have congenital and genetic causes here, like changes in amounts of enzymes that produce the glucocorticoids, like the 11 beta HSD enzymes, or even the star protein that helps bring cholesterol and mitochondria. Or you can have malformed adrenal glands, congenerally. So all of these different problems can or all these different circumstances can lead to issues with the adrenal gland specifically. And again, this is very different from something like adrenal fatigue, because most of these problems are very severe. The adrenal insufficiency can be life threatening, and the symptoms that you that you can get from it can be like, pretty life altering, and outside of just having fatigue or increased risk of infections where you see the adrenal fatigue component. So it's very important to delineate between the two. And what I want to say here is, with adrenal insufficiency, it would actually be important that you replace the hormones, especially in states where you're, you know, trending towards adrenal crisis, where you can actually have the shock, like you blood pressure to get too low, to freeze your organs. You're at risk for high for high amounts of infections, or very serious infections because of the lack of function these hormones. So in those circumstances, you the general treatment is around replacing with glucocorticoid based drugs, mineral corticoid based drugs, and things like DHEA, because your body is not producing them. And while these hormones are stress hormones, they are absolutely essential for our function on a regular basis. And it's not to say that they're evil. We don't want them and, you know, we want them as low as possible. It's we don't want them high that is definitively a problem. But we also don't want them so low that we can't maintain a regular function. And adrenal insufficiency is actually an example of this directly. Now moving on to, or, I guess, before I I jump into adrenal fatigue, I don't know if you want to add anything to that perspective. Jay?

Jay Feldman  7:11  
I think that's that's fine as a as a starting place, just clarifying the the difference there. And then we can talk about adrenal fatigue and the Yeah, yeah. And it's, I mean, first, even just in talking about adrenal fatigue, this is not a generally recognized condition, but it is a set of symptoms that does occur. And so, yeah, we can talk about that next. Go ahead.

Mike  7:36  
So the thing that's a good starting place that you brought up Jay and the the idea that adrenal fatigue isn't recognized, and it's kind of for me, it's kind of funny, because a lot of the understanding of stress was built around Dr Hans Selye's work, and this is general adaptation syndrome. And when we look at Dr Hans Selye's work, he talks about the general adaptation syndrome curve, where you have an alarm stage and a resistance stage, and then you get to a fatigue stage. So modern medicine relies on Dr Hans Selye's understandings of stress, but then neglects this fatigue stage, like, Oh, it doesn't exist. Like, you're never, you'll never have fatigue. And the thing is, is, I don't necessarily, so let's talk about adrenal fatigue first before we get into some of the qualms. But you qualms. But the idea of adrenal fatigue is that you've been under such stress that the adrenal gland just burns out, and then that leads to the low cortisol levels and things like this. And I think, well, this may partly be the case, because we see with different individuals that their response to stress can be lowering of these hormones or raising of these hormones. People will respond a bit differently with the chronic long term stress, and then the profile that they present with will also be different versus having fatigue or developing metabolic syndrome or things like this. But the general idea with Adrenal Fatigue is basically chronic long term stress you work through kind of the general adaptation syndrome, and you reach this fatigue stage. And the problem I have with it, though, is not necessarily this idea that it occurs, but like, why it occurs, and what are the solutions to address it? And a lot of times the solutions are like, let's just replace with, with, with glucocorticoid hormones. Like, let's give you some prednisone. Let's give you some adrenal gland extract. And the thing is, that's not taken into consideration with this perspective, is that you or you are under chronic exposure to these hormones in the first place for a period of time, and these hormones have a damaging effect on the mitochondria and the cells in the body in general. And so to say, Oh, look, it's just low let me replace this low hormone so that you can drive stress even further. It just doesn't make any sense, especially, again, if this is insufficiency, different story. But with the idea of adrenal fatigue, the goal would be to just lower the stressor, so bring the stressors down. Bring you know whether that's work stress, whether that's exercise, whether that's keto, whether. That's carnivore, whether that's fasting, whether it's caloric restriction, whatever the thing is, take yourself out of the stress, and then what you do is you, you have to recover. So you, what you want to do is you want to support the hormonal systems. That doesn't mean with more glucocorticoids. There's a variety of other components that would be helpful to actually minimize these effects of the glucocorticoids, like DHEA, like pregnenolone, like thyroid, like androgens, if necessary, depending on what else is going on your in your system, these things, plus the dietary changes, lifestyle changes, stress minimization, light exposure, rest, taking time off, allowing your body to rest, and then giving yourself time and consistency with these things will help to dig you out of the hole, whereas just taking this band aid glucocorticoid will actually probably make the hole worse, as we've talked about in other episodes, the effects of chronic glucocorticoids and catecholamines on the mitochondria is mitochondrial damage, mitochondrial DNA damage. So driving that further is highly problematic, and I think what people start to see is you keep driving that, driving that, driving that, and then you become unresponsive to the hormones. And this is again, because the hormones are just a message to the cell saying, Hey, this is where we're at. This is what we needed you to do. But if the cells basic resources are depleted, if you have a message that says, hey, build a house, but you have no bricks or wood, like, how are you going to even like, how are you going to actually produce the house you can't, even though you have the message, so it's important to resupply the cell, recover the cell, improve mitochondrial function, lower the stress, and I think that's how you kick out of adrenal fatigue. Whereas, again, adrenals insufficiency, different story, different things going on, and that may need to actually be treated with glucocorticoids, mineralocorticoid, DHEA, and things like this.

Jay Feldman  11:50  
Right. Exactly. That's a great summary and juxtaposition. And so just to zoom out a little bit and talking about what drives this kind of exhaustion stage and what's actually going on more fundamentally, and even even to take a step from that too, the idea that these hormones are low, so we should just replace them. And let's call this, you know, this unique diagnosis of adrenal fatigue that your doctors won't recognize and don't know anything about this. So, you know, it's we're on the forefront of this kind of alternative health world, it's like this is in an extremely allopathic approach, disguised as something that is more holistic, right? This is a situation where you're seeing low adrenal hormones, so let's replace them. And that is, in most cases, the extent of it. And as you're saying, not a good idea. Actually can drive the pathology and make it worse, even though it can help with symptoms. And secondarily, doesn't do anything to get at the underlying issues. And so in terms of talking about the underlying issues, we have to start with what causes this exhaustion. And before that, we had to talk about what causes stress. And we talked about this in detail. You alluded to those episodes talking about like the effects on the mitochondria and what's going on during stress, and the energy relationship with the stress response. So I'll link back to those where we talked about it in more detail. But to keep it kind of more general, here, stress is essentially an energy deficit, right? Our demands are greater than our supply, and we have two sides there, either there can be excess demands, or there can be less supply, or it can be a combination of those two things. And when we have that situation go on on an ongoing basis, we have an ongoing energy deficiency. We dig into deeper and deeper layers of stress. And the adrenal hormones within the adrenal hormones are within the stress hormones. There are layers, right? So first we have glucagon, then we have epinephrine, then we have cortisol, in order of, kind of the depth of the stress response, but on a broader sense, as you get deeper into stress, we shift into deeper and deeper stress mechanisms, and eventually you can get to the place where we've already tried those. We've already tried the cortisol, for example, and it's not working, and it ends up kind of decreasing, and we end up really going into like a deep hibernation state, because our bodies recognize that they don't have the energy available to handle the energy demands. And so instead of trying to continually react to it and respond to it and trying to, quote, fight it or or make up for that deficiency, the body hits a point where it realizes that this is not working. We can't handle it, and we just need to conserve. We just need to conserve and hope that we can kind of weather out the storm. And that's essentially what we're getting at in an adrenal fatigue state. And to call it Adrenal Fatigue is, I think, missing the point right where that is a feature of what goes on. But we're also going to see a lot of other features. We're generally going to see way turned down stress reproductive hormones. We're going to see turn down thyroid hormone production and activity. We're going to see a lot of different pathology going on. And so we can call it adrenal fatigue, if you want. I mean, I don't think it's a great way to characterize it, and part of the reason is because it leads to this idea that we need to focus on the adrenals, that the adrenals are the problem here, when the adrenals are just a part of the stress response. It's not the entire thing, but a part of the stress response that occurs due to the energy deficit, the energy deficiency, and that's where we want to put our focus. And just providing the cortisol or replenishing these adrenal hormones will help short term, in helping you be able to function, but it's coming at a cost anytime that we don't have the energy available, and we're relying on the stress hormones we are taking that fuel and energy from other areas that vitally need it to force ourselves to be able to, let's say, move right, to be able to walk or exercise or whatever it is that we're that we're trying to do. And again, there might be a case where that's our only opt in to work our way out, like we can get in such a vicious circle where you can be so fatigued that you can't eat a good diet effectively, and you can't get in the sun, and it can really become a pretty rough problem, and maybe for a short period of time, you want to use a band aid like a glucocorticoid. But a, it should never be the first thing, and B, it should be only temporary and as minimal as possible. And what we would want to do instead is focus on fixing the underlying energy deficit. And as you said, Mike, one thing that's important is taking ourselves away from the stressors, removing the stressors, removing these demands. And those demands can be everything from exercise to psychological stress, any sort of work, infections, all sorts of different things, all sorts of things in our environment that can increase the utilization of energy, so we want to remove those. But on the other side, we need to improve our energy availability, or improve our energy production, and that's the key thing that is almost never talked about when it comes to adrenal fatigue. And so on that front, this is the thing that we talk about all the time. Of course, we want to be making sure that we're eating adequate calories, we have good macronutrient balance, balanced blood sugar. We're digesting our food well, not being flooded with endotoxin and other bacterial products. Want to make sure we're getting enough calories in and on and on. And I'll refer back to some episodes covering each of those things. And there's a couple of good ones to start, where we just talked about the basic framework of a, quote, bioenergetic diet, which was episodes 100 and 101, and I'll probably start there if, if you're new to this approach, but that's, I would say, of utmost importance when we're dealing with this sort of issue. And that is the way that we will be able to recover from the long term energy debt, the long term energy deficiency or deficit, and be able to get out of the state, and as we were both like as we've said each once. Now using adrenal hormones in the state is something that we generally not recommend unless is necessary. And be very careful with and recognize the cost that comes with it. That doesn't mean that there's never a place for it, but there is a cost to using it, and it's not the ideal method, if we don't need to go that direction. So those are a few things I wanted to mention. Now I do want to say also that if you are dealing with fatigue, if you're dealing with low energy, I've helped tons of people help, help tons of people recover from those sorts of issues, as well as other issues. You know, low metabolism, struggles with weight loss, digestive issues, issues with sleep and on and on, and all of these tend to come together. If we're dealing with adrenal fatigue or low energy symptoms, we tend to see a constellation of these issues. And so if you are looking to resolve those things with clear action steps and strategies alongside personalized guidance. For me, you can head over to Jay Feldman wellness.com/solution, where you can find all the information for the energy balance Solution Program. This program includes customized health coaching, as well as a video library with videos on how you can restore your gut health, regulate your blood sugar, lose weight without destroying your metabolism, rebalance your hormones, get amazing sleep and tons more. It also includes resources like a sample meal plan and supplement guide, as well as a private community. So head over to Jay Feldman wellness.com/solution, to check out all the details about the energy balance Solution Program. And Mike, I'll let you go ahead here and share some more thoughts as far as approaches for adrenal fatigue.

Mike  18:58  
I mean, for me, the the general the general premise, even if somebody was dealing with like hypothyroidism, whether or they're hypogonadal, is, first get the foundations under control, and then if the foundations, you know, because it's low hanging fruit, to fix your diet, start to organize sleep, start to adjust micronutrients, start to adjust stress levels, flight exposure, and these, these different elements, these things are low hanging fruit. And when you get those in place, a lot of times, people start to feel significantly better overall, without having to go straight to the glucocorticoids or straight to the thyroid hormone. And so I try to do this first. Then if the needle is not moving, it's like, okay, then say it's hypothyroidism. Let's see if adding some thyroid can help to move the needle further improve symptoms and like, get resolution of what's going on. And then later on, if you either you stay with it because you find that it's helpful, or you want to come off and see what the. Responses, then, sure that would be the way to go. But with adrenal with the adrenal fatigue, most people that I've worked with that have showed up with adrenal fatigue. They've had low cortisol values. And usually these are people, again, they're coming from low carb backgrounds, tons of exercise, doing the fasting thing, really low calorie intake for their level of activity. And then after, you know, some people it's a couple months. Some people it's a couple years, completely burnt out. All their hormonal systems are fried. Their hormonal panels are all types and weird. Things are not right. Things are completely off. And at that point it's like, Okay, again, let's fix the foundation. A lot of times I fix the foundation, and and it they start to get, you know, 40% 50% 60% 70% better, just with that. And then I will start to say, Okay, let's add some of these things on board, and the appropriate amounts and appropriate dosage. And with the adrenal fatigue, it hasn't even been using the adrenal hormones it had, or in the sense of the glucocorticoids or mineral corticoids, most times it's been, you know, working with a practitioner, a doctor with them to talk about if they have very low testosterone as well. Because you see this using that for a period of time to help them move the needle. If their thyroid values are pretty working with a doctor to help them to get the thyroid values dialed in. And you start to see using things like pregnenolone, using things like DHEA to move the needle without having, and with women progesterone, without having to rely on the glucocorticoids. And I, with almost every single person I've worked with with adrenal fatigue, I have not had to use glucocorticoids at all. I've used these other components with quite a bit of success. The other things I had to, you know, you start to minimize exercise. Take a break from it. You start to make sure that they're eating enough regularly. And something I want to mention here, and this is what I see very, very often. A lot of these people that I'm working with who have come from this adrenal like, been dealing with adrenal fatigue. They've worked with like, four or five, six other practitioners to try to get things under control. And a lot of times the strategy is like, let me throw subs at it. Let me throw hormones at it. Let me throw like, prednisone or adrenal extract or whatever the thing is. And a lot of times it's, it's short lived leading result that doesn't really make a long term impact. And the person starts to get, like, burnt out on trying all these different interventions and not getting an effect. And so the reason why I think people are seeing this problem is because the practitioner, again, are treating things in this allopathic model of, oh, it's low. Let's replace instead of understanding why it's low, what are the effects of these individual hormones over the long term? What is the risk versus reward of these hormones, and then how do we correct this underlying, foundational components First, to get things moving in the right direction? And that's like, that is not, does not often not there. I mean, I have people, they'll come up with their Dutch test, and they'll come up with their their their oat tests. And again, I'm not even prescribing these or recommending these. These these are from the other practitioners. And then it's like, they're looking at the test, and it's like, well, your your mitochondrial markers are off, and your, your hormone pathways are off. And it's like, we need to reductionistically, go in and address these, instead of putting it in context and being like, Okay, well, you've been running this really low calorie, low carb diet for a period of time. Like, of course, your mitochondrial markers are going to be off. Like, what this is what I would expect to see in these values. I would expect to see your cortisol rhythm is skewed with the things that you're doing. And so it's like, you need to stop doing those things first. I can't fix like, a, like, 1000 calorie a day diet with cardio like that. There's no amount of supplementation that I'm going to do that's going to correct that. We need to fix the foundational piece first. And that's something I see time and time again for a variety of different things. People coming to me with fatty liver, eating 180 grams of fat a day, and and and carbs on top of that. And then you're going to the practitioner, and the practitioner is giving you choline and betaine and taurine and glycine and B vitamins and and all these different supplements. And it's like, Yes, this is great, but you're still eating 180 grams of fat a day. So until you correct these foundational things, these, these, I know they seem simple, but they're key, the these, these, these lifestyle components then it's not going to work. So you need to figure this out first, get this dialed in, and then you can move to these higher level strategies and work in that fashion to get the outcome. And that's for me, that's the process I'm working through, and that's where I'm seeing the success, versus just like, oh, cortisol low, here's some cortisol DHEA. Low, here's some DHEA. And the other thing is one last piece I want to mention here. It's a little bit tangential to this, this trend, but I just remembered it as I'm going through this process, during aging process, what you could characterize the aging as, like just stress over time, the adrenal gland doesn't. Actually lose its ability to produce cortisol. So there's different portions of the adrenal gland, so you have the zona reticularis, and then you have this zona faciculata. So essentially, during the aging process, the zona reticularis produces DHEA, and that portion degrades. But the zona faciculata, which produces glucocorticoids, and then also the zona glomerulosa, which produces the mineral corticoids. Those parts of the adrenal gland don't actually ate like degrade over time. You don't lose them. So the aging process is characterized. And a lot of the if you even look at the synthetic glucocorticoid drugs, they cause muscle loss, they cause central adiposity, they cause metabolic dysfunction. All of these things that we see associated with this aging process are characterized by an glucocorticoid that is unopposed by things like DHEA and the androgens and so other thing you want to look at here is, what is your cortisol to DHEA s ratio? What is your cortisol to testosterone ratio? Because it's not about the total amounts all the time. It's a lot of times about the ratios. And understanding cortisol, the DHEAS, is telling me where my adrenal function is and telling me what's going on with the androgen production from the adrenal gland. My cortisol to testosterone ratio is telling me what's going on with my anabolism and catabolism across the body, and then, so that's this. This is another reason that it's like, it's not just like, low cortisol, it's burnout in general. And then at the same time, it's also, we see the effects of cortisol on the body are actually not good over the long term, so we don't want to be optimizing towards that. And the same thing for the mineralocorticoids. So it's like, again, I think with the adrenal fatigue, it's the fundamental burnout and and chronic stress. And it's not just because glucocorticoids are low. That's a very reductionistic perspective, especially knowing the effects of the glucocorticoids, and that's why correcting the foundation is key, instead of just replacing.

Jay Feldman  26:58  
Right. and as you're getting up with those ratios we're generally seeing low in terms of the androgens and other reproductive hormones, low in terms of things like thyroid hormone alongside potentially low cortisol, even in the state and and again, we're, as you're saying, we're kind of choosing, or by most people who are diagnosing this, so to speak, are choosing to just focus on the adrenals at the cost of these other things. And coming back to the kind of approach to this. So just to be clear, there's some sometimes people use something like prednisone, which I think is more well known that like this is a glucocorticoid, but a lot of times desiccated adrenal will be given, which it's important to recognize that this has those stress hormones in there. And is, is just like giving something like prednisone, of course, not as strong. And so you'd want to be looking at any of those products, even if they're considered to be natural, it's still the same stress hormones. There's also licorice is often given, which has a compound in it called glycerin acid, which increases cortisol the there's also an available form of the licorice called DGL, which has that glycyrrhizic acid removed, which doesn't have that effect. But in this case, oftentimes the regular licorice is given and and so there's a number of different kind of even natural supplements that are given to increase the stress hormones, which is having the same effect. Whether it's natural artificial, is not important here. What's important is the fact that you are increasing a system that has been turned down in an adaptive way to protect yourself. So we want to be very careful about doing that. And you were saying, Mike, you know, with looking at the ratios of the different markers, and considering that there's generally clear hypothyroidism here, clear, you know, hypogonadism here, we can look to support those as well. And I would definitely want to support those before the stress hormones. But as you also highlighted, and I just want to make sure this is very clear, it's really, really important to get the foundations in place first, make sure you are doing everything you can to support having adequate energy, you know, supply and production before adding those in. Because if you don't, and you're still in that low energy state, and you add testosterone or you add thyroid hormones, you're still going to end up driving a lot of stress, and still going to be forcing yourself to direct energy toward dealing with the current stressors, at the expense of vital function, at the expense of other organ systems that are currently trying to be spared. Right? That's the whole point of turning everything down. That's that kind of hibernation state. So we still want to be really careful with those two and make sure that we're if we are going to use those, it's done at the right time. So I wanted to make sure that that was clear. And then also, I have seen some people suggest that there's no such thing as adrenal fatigue. It's just hypothyroidism. And as we're saying here, normally those things go hand in hand, right? There's often you kind of need to have turned down thyroid to get to a point where you're in adrenal fatigue. It's basically a requirement. But again, two things to mention. One, this is kind of a step further potential, or at least a version of hypothyroidism. And you can have hypothyroidism without the quote, adrenal fatigue presentation. But also, you. As I was just saying, that does not mean we just throw thyroid hormones into the mix. We want to make sure that we're treating the whole system, you know, considering that there is hypothyroidism present, we want to be very careful about using that, like using thyroid hormones. And we had a pretty extensive series talking about hypothyroidism as well that I'll link to for more information on that.

Mike  30:19  
I want to just bring one point here that I think is often missed with all these things. And you highlighted it earlier, Jay, where you're talking about the central piece here is energy. It is energy supply and demand, so the solution to these things is not bringing more hormones on board that cannibalize your tissues to provide the energy it is providing the exogenous energy and lowering the demand, because the problem is oftentimes in either an excess demand or not enough supply, or a combination of both. And so we really, this is why, you know, a lot of people gloss over the importance of diet in some of these things. Like, it's like, oh, like, you know, do keto, do carnivore, do Mediterranean diet? It's like that. And it's like, actually, some of the most fundamental, most important pieces to actually dial in is the diet, because a lot of the hormonal systems are completely organized around energy supply and fuel supply and things like this. And so it's like when you if you want to fix underlying logistical problems in the body that are centered around energy and supply and demand, you need to change energy supply and demand. You don't want to add more backup pathways. You want to fundamentally fix the underlying problem, which is why I think fixing the what's going on with the diet is so important. And the other thing is, if you're going to throw thyroid and testosterone or some of these different components, pregnenolone, DHEA, whatever it is, on a super stress system, and not fix the underlying supply and demand, you're going to shunt those things and convert them into compounds that you do not want, whether that is estradiol, whether that's glucocorticoids, whether It's any of these different components, because the stress hormones themselves and the state is basically directing the hormones and these signaling molecules down the different pathways, depending upon what you have going on. Now this doesn't mean I know there's this whole pregnenolone seal thing. So I'm not saying that, that you just take pregnancy straight goes to cortisol. What I am saying, though, is that if you you can get pretty gnarly symptoms. For example, using thyroid, if you don't have enough energy on board, you get palpitations, you get anxiety. And there's reasons why. I've talked about this before. With the sympathetic nervous system or with testosterone, I see a lot of guys like, oh, I have these symptoms. I'm not feeling good, TRT. And then they get on TRT, and it's like, wow, your estrogen is really high. And then they go on the aromatase inhibitor, and they they like, have this, this up and down all the time with their aromatase inhibitor and their testosterone to figure out their estrogen. And it's like, or you maybe just fix the underlying reasons that's causing you to aromatase appropriately. And also, sometimes how these testosterone is administered, drives estrogen production, but this is what we're seeing, is if the state is bad, if the context of the body is bad, and you throw things into it and you're not fixing that context, that can be a part of fixing context. But if you're not fixing that overall context, you can get unintended consequences that can make things worse. And I've seen this happen with guys who have gone on hormones, the doctor put them on HCG and DHEA when they're super stressed out, and then it's like, wow, look how high this estrogen gets. And now the guy is having pretty severe emotional breakdowns and psychological symptoms, because estrogen is through the roof. And it's like, you made it worse, because you fundamentally the individual, the guy just wanted help, but the practitioner, fundamentally doesn't, didn't understand why his stuff was low and how to go about it, and then it causes problems. I've seen this HCG thing multiple times, or the Clomid stuff, or the DHEA high dose, or the adrenal like I have clients I work with, they get prednisone because they were adrenal fatigue and it made them worse. It drove, drove the stress worse. They gave them mania, they got insomnia, all these types of problems because, again, it's driving the same problems, and that's why the context and the energy supply piece being central is so key.

Jay Feldman  34:17  
Right. Yeah, exactly. And just to clarify two quick things, we're gonna move on to the next question. First was you were talking about like the conversion of the hormones to the stress hormones, but the real concern is just the increased production of those stress hormones, you know. And don't want to get too far on this tangent, but as you said, we can provide thyroid hormones, which are not precursors to adrenaline or cortisol or estrogen, but still have increases in those things. If the if we don't have the energy supply to make up for that demand that creates signals that drives the stress hormone production, same thing if we're talking about testosterone or pregenolone. It's not a concern necessarily that they will directly be converted. But rather, if you are adding those things, add energy demands, and if we don't. Have the supply there. If we're not actually Freeman fixed anything on that front, we will increase the production of the of the stress hormones, potentially directly from them. But that's not even the point. The point is, like it can be produced elsewhere from other hormones. It's, it's just that production that's driven by the signal of the energy deficit. That's, that's the the real focus, and again, not going too down, too far down the path, but the hormones, like pregnenolone, actually help to prevent the production of the stress hormones, but an energy deficit will override that signal. So that's the kind of balance there. Yes. And then the last clarification I wanted to make, you mentioned exogenous energy, and you were kind of alluding to, like calorie intake, making sure we're getting enough fuel in which is 100% important. We want to make sure we're doing that. And then we need to make sure we're also improving the things that allow for us to endogenously produce energy from the substrate, from the potential energy in that food. And there can be a lot of issues there, which we talk about all the time. So those are the kind of areas we want to be putting our focus far before we're thinking about providing some some hormonal supplementation.

Mike  36:04  
Yep, yep. 100%

Jay Feldman  36:07  
Alright. Next question from Victor, who says you should do a podcast about the GAPS diet, it has cured a lot of people from autoimmune diseases, so we have answered kind of very parallel questions about things like low carb diets and ketogenic diets being able to cure autoimmune conditions and and I've shared our thoughts on that, so I'll link back to those episodes. But one thing that we've talked about both in autoimmune series, we talked about it in in these other episodes talking about autoimmune conditions, is that one factor that's central, one feature that's central in terms of driving an autoimmune state is bacterial problems or microbial problems at the gut and the production of various toxic products and compounds that can then lead to an autoimmune state, normally not in and of itself or not alone, but in a larger context. And so with that in mind, there's a lot of different ways that you might want to go about, or that you might be able to go about trying to improve that situation. And the gaps. Diet is essentially one of them. It's essentially oriented toward trying to heal up the gut so that you can resolve issues that would stem from that, and it essentially involves a pretty extreme elimination and then reintroduction diet. And the premise here, as we as we're kind of saying, makes sense, like there is logic to the idea that the gut is a central issue for tons of different things we might be experiencing, and a lot of foods that we eat could be further contributing to that pathology by feeding harmful bacteria or fungi, you know, other microbes that are then producing toxic things and causing issues. And so reducing the feeding of those microbes can be really helpful, and then trying to heal up and fix the microbiome and other aspects of digestion, although in this case, it's really just microbiome focused can provide a lot of benefit. And from that standpoint, there is logic here, but there are a lot of different ways we can do that. We've talked about low carb in the past as a way to do that that also happens to come up with a lot of stress due to the lack of carbohydrates, and in this case, with the GAPS diet, it is potentially a way to help provide some relief, but we would say not a very, not an ideal one. I think it falls short in a couple different ways. One is the negatives to the actual foods that they're suggesting introducing, reintroducing, the negatives to the lack of foods or the foods that they don't recommend including, and then the orientation of the approach of kind of just as simple elimination and reintroduction, which I think doesn't in many cases, doesn't solve the issue. Doesn't solve the microbial issue, which can come back pretty effectively or dramatically, and also doesn't impact all of the other possible things that could be going wrong digestively, one of the ones we'll be talking about next in terms of lack of vile flow, poor stomach acid, slow motility, and other things like that, which, of course, can have microbial underpinnings, but can also be relatively independent of that. And so that's kind of like the broad picture here, and we can go into some of the specifics of things that they suggest that we really disagree with, but I would say, big picture wise, there are much better ways to fix up to improve your gut health without the significant amount of negatives that would come with this sort of approach. Now we've talked about these quite a bit. There's, you know, we've had several episodes talking about gut health and digestion and eating digestible foods. We've had episodes talking about different forms of probiotics, antimicrobials. I'll link back to all these things, and they're going to be directly relevant to some of the specific issues we have with the GAPS diet. So I'll let you. You start with those.

Mike  40:01  
I think there's quite a few problems with the gap side in my mind, personally, especially because I tried it at one point, and I have many clients who tried it. And the biggest problem up front is that it's a single strategy solution, and it's just elimination of foods. And in my experience, number one, elimination is a slippery slope. And number two, the foods that that are recommended in a GAPS diet I have problems with. And number three, it fundamentally lacks an understanding of multiple important components around setting up a diet, including macros, calories, food selection and things like this that are heavily, heavily problematic. And I actually don't think this is a good way to go about an unlimited elimination diet at all, personally. So the first thing, first is you get, you get put on just kind of like a broth. And so when I did this, and I have clients who do this, like, you can't eat enough, like it's hard to eat enough. You don't have a lot of food options. It's, it's almost worse than carnivore, because at least at carnivore, you get to have some fat, juicy rib eyes with a nice piece of fat on the edge. And it's like, all right, I can kind of go, I can kind of go with this. But it's like, with the gap side, it's like, sauerkraut and and, and some broth just that and not going to cut it. So there's the caloric problem overall, and this is fundamentally an issue, because the intestine is a high energy system, and so when you don't have enough food or coming into the system, enough energy for the system, that causes problems. I've seen people develop problems digestedly, just for me on low calorie diets. The next thing is the intestine has a high requirement for things like amino acids, which is hard to get enough with but just broth. The next thing after that is nutrients. So the intestines require quite a bit of nutrient density, or quite a bit of nutrients, P, vitamins, things like this, to function appropriately. And if that's your problem, eliminating foods is not going to be the solution here. So it's like, why are you actually having these digestive issues? And so that's another thing, is, like, is it a vitamin deficiency? Because I have people I work with B vitamin deficiencies are definitively a problem, and they're digestive issues, and they can go do the gap site. And also, you know that for autoimmunity as well, there could be other things going on, but they could go do the gap side, and it doesn't solve the problem, because they're not fundamentally addressing what that problem is. They're just on an elimination diet, and so that there's things like that, there could be underlying causes for these things. That's not just the gut. It's important to figure those things out. The GAPS side is too restrictive, so it makes it hard to get macro and micronutrients and calories, and then even some of the foods in it I have problems with, like, I don't think that what I don't think that broth by itself, is going to fix people's gut. I don't think that sauerkraut or homemade fermented yogurt products are really going to solve the problem, either. And I think for people that I know have gut issues, those are not the first options that I'm reintroducing for them, because I think most people tend to have problems with them. The next thing is eggs are, which are some of the first added foods in here, I also think are problematic, and I those are also not the first option that I'm adding in. If you have pretty significant digestive issues. Do I think eggs are a good food? Yes, but if you're dealing with digestive issues, a lot of times, the eggs may be, like, pretty problematic. So I wouldn't, I wouldn't start with these foods on the elimination diet. And then the next piece is the types of fats that are recommended here, or even the carb sources, like, there's this talk about these pancakes that are made with nut butters, so almond, walnut, peanut, and then eggs, and then squash. The worst option that I can think of to add in for initially, for people having digestive issues, is peanuts, one of the worst things to recommend, off the bat, not to mention the other nuts can be problematic. And this isn't even taking into consideration the idea that we're going to bring in a bunch of high omega six fatty acid sources, which we know the Omega-6 can cause intestinal inflammation in people, especially if they have the issues going on. So there's multiple problems with this elimination diet for this, this purpose. And I think, if anything, the if you want to go on an elimination diet to try to shift the gut microbiome, the solutions that I would say, would be have protein sources. That's probably some lean protein sources that you can eliminate. The most problematic ones, you're looking at seafood, you're looking at chicken and beef as the options to start with, unless you have kind of an allergy and to like shellfish or something, then do just fish, or if it's a fish allery, then do beef and chicken. Most people tolerate those foods without much issue. The next thing after that is have easily digested carbohydrate sources available, whether that's white rice or well cooked potatoes, or whether that's fruit juices or things like this, or if you have to put in a little bit of maple syrup or something like that, just in the beginning when you're on the elimination fine. And then the fat sources that I would look to would probably be to look to sources that aren't nuts. To start, I'd be looking to try out things like olive oil, which is less likely to bother the gut, or macadamia oil, so you don't have all the heavy fibers, or maybe something like avocados, maybe the egg yolks, but the egg yolks can be hit or miss depending on the person's response to them. I've seen a lot of people not do well with them with autoimmune conditions. That doesn't mean they're bad. A lot of people do great with them, but those are, those are more of a problematic food. So I would be looking for like an easy oil and easily digested starch or sugar and an easily digested animal protein source. And if you're going to look to fibers, sure, I agree with the squashes, maybe cooked carrots, something that's easy and digestive tract. So you're still able to get enough calories, you're still able to get enough nutrient density, you're still able to get enough macronutrients overall. And these foods, I think are way less likely to cause problems in the digestive tract. So when I'm looking at the GAPS diet, I don't think it's a good elimination strategy. I've run it, and I know clients who've run it and had a bad time with it, do I think the broth can be helpful, or collagen to seal the gut, sure, but basing the diet entirely around broth in the beginning, I think it's a bad idea, especially people who are already, you know, a lot of people are dealing with these gut issues are already not eating enough because they have gut issues. So like, let's make that worse. The other thing I've seen is, when you have elimination get too restrictive and too extreme, it actually makes things worse. So people who tend to go on carnivore diets become more intolerant to foods by the time they're done with carnivore than when they started carnivore, and that's because of the shift to microbiome and the problems there. So I think the elimination slippery slope, not having enough calories, macronutrients, micronutrients, problematic. There's a way better way to set up this elimination diet to minimize things here that I think are very problematic for people with gut issues and autoimmune diseases like like fermented sauerkraut, say, of Hashimotos. You're going to go on sauerkraut, it's a pretty bad idea. Say, you're going to say you're dealing with any of these other types of the autoimmune issues, and you're going to add in a bunch of dairy initially as one of the best options, I would say, probably not my first choice. I would start with the other thing. So these are the major problems I'm seeing with the with the GAPS diet, and I personally wouldn't recommend it, and I think there's way better ways to eliminate to have an elimination diet and build out from there, incorporating many more factors. I also think again, elimination diet is one strategy. You have hormonal adjustment, you have microbiome adjustment, you have an elimination perspective, and then you also have micronutrient adjustment and inflammation adjustment and lifestyle adjustment. So it's like there's multiple things to do besides just like, Oh, I just need to go on this really restrictive, hard to maintain elimination diet that can probably add things that are going to make my digestion worse.

Jay Feldman  47:29  
Yeah, there's a major difference between, quote, eliminating foods versus an elimination diet. And as you were saying, you know, you were talking about different macros and types of foods, there are certain things that are going to be more easily to easier to digest, harder to digest, depending on what our digestive issues are. If we're dealing with a bacterial overgrowth, we shouldn't be assuming that we should eliminate, quote, unquote, the same foods as if we're dealing with low stomach acid or poor bioflow. And so for some people, saturated fats are going to be great and we don't need to worry about shifting toward monounsaturated. And for someone else, we need to be way more careful with our carb sources and and for some people, eggs might be an issue. And for someone who's not dealing with anything that would maybe suggest that not dealing with any issues with with bile, let's say it's much less likely and that, yeah, I think the perspective of an elimination diet in its in and of itself, is problematic, as opposed to the context and holistic understanding of what is going on in this individual digestively, what's going on with your digestive health. Then let's make, let's implement strategies based on that. Like, let's just it's the most logical thing, like, just look at what's happening and then do something in response to that. Why would you just take some pre made diet and apply that to your circumstance that might have nothing to do with it, just because you also have an autoimmune condition or you are also dealing with some psychological issue that, like some psychological symptom or like, it's It's ridiculous. It's so, so ridiculous. And we talked about this in terms of the kind of mental health side, psychological health side when it comes to elimination diets as well, or low carb diet. So I'll link back to that episode too. But yeah, that's that's the kind of big picture issues. And then, as you said, there's so many specific things that I think are really concerning with this approach. So for one, a low calorie approach means a high cortisol approach, a high stress approach. That is a terrible idea when it comes to improving gut health. Like a purely, first off, a purely protein based diet and a purely low calorie protein based diet is a really, really bad idea when you're trying to improve anything that isn't solved by increasing stress, which is everything you know like that is a guarantee to increase stress hormones, and that's not something we generally want to do. We'll definitely impair digestion and gut health and create problems, maybe if there weren't even problems there, and also contribute to a hypothyroid state. And when we're talking about hypothyroidism and the relationship with motility, stomach acid, microbial issues, bile flow. Yeah, there's a really clear link there. And so we want to be doing the opposite of that in many ways. And so that's kind of the first part, as you were saying, too. The introduction of probiotic foods is something I'd be really careful with. We talked about concerns with probiotics themselves, and probiotic foods carry the same concerns, which is that if you have a non optimal gut, like if your gut health is not in great shape, you don't have the healthy microbes to keep the harmful ones from overgrowing. You maybe don't have good digestion and motility and movement, you can create overgrowth with the exact types of bacteria that you're introducing to that system. And that's been shown to happen with probiotics, that will actually cause SIBO with the exact strains that are being introduced. And we've talked about this a couple about this a couple different times, so I'll link back to those episodes, but that's something to be really careful with when it comes to introducing the probiotic foods, not to mention some of the specifics, which is, if you're making it yourself, you're kind of rolling the dice as to what types of bacteria are going to be in there. And again, it might turn out fine. It might not. That doesn't mean don't eat these things, but it's something to be cautious about. And then, yes, in terms of some of the specifics here, I don't even it really doesn't make a lot of sense to me, is in terms of the order of operations here, or the types of things that are being introduced, you were talking about nuts, and one of the first solid foods that they have you introduce after the eggs, and like some of the stews and things like that, is is these nut butter based, based foods. And I can't tell you how many times I've seen people come to me and say, I stopped eating nuts because of the concerns with the PUFA digestion that you mentioned, and I feel so much better like that one change makes such a big difference. Not to mention, of course, the fact that, other than a couple of of exceptions, like macadamia and coconut. Most nuts are super high in PUFA and generally are best avoided for that reason. But from a digestive standpoint, I mean, at the very least, I would say they should be the last thing, but, or one of the last things,

Mike  51:54  
I agree,

Jay Feldman  51:55  
if even at all you know. So, yeah, just in terms of the specific suggestions here, I think they don't make a lot of sense from our perspective, and then in terms of the broader picture as well.

Mike  52:08  
I the only thing I'll add is like, I think the general idea, I think the general idea that the there's an interplay between the gut and your psychology, and there's an interplay between the gut and autoimmunity. Like that premise was super like when I was going through it like that was very interesting and helpful at that to understand and put together and start to see the relationship. It's just when it comes to the implementation, I just, I don't like, I don't think if the implementation here is good, as we kind of laid out. And I think the really important point that you mentioned, Jay is like, let's hone in on what your problem is. Let's figure out what is driving your issue, instead of just shotgun like, oh, I have a gut issue. I don't exactly know what is like. Let me go on this extremely restrictive elimination diet and then have this arbitrary introduction system. It's like, or, if you have a if you have a problem, if you have a bio problem, like, what we're going to talk about here, let's address that, right? Like, let's hone in on what the specific problem is, instead of just put random interventions into place and go from there. And for me, that's, that's when I'm working with individual like, that's what I'm looking to do, is like, where is the specific where do we have the highest leverage point? If I can affect this one point here or these two or three points here, can I really move the needle for you, instead of just, like, overhauling the crap out of everything and maybe some things don't need to be adjusted. It's like, there a lot of times there's like, these very specific issues that can be solved, that are even just like, they're not. They don't have to be complex. They don't have to be like, super in depth. They can be like, specific issues in the diet. Like, again, you're coming you're eating tons of sauerkraut and fermented dairy products and nuts and seeds, and you're bloated and gas. You have terrible digestion all the time. It's like, let's just take those out instead of, like, Okay, you're only gonna have broth for the next week. That is that the solution doesn't fit what the problem is, and not to mention when you're saying you raise the stress hormones by with the high cortisol, because you're lowering your intake so much, the stress hormones, cortisol and corticotropin releasing hormone and ACTH, are directly involved in pathogenesis of autoimmune diseases. They worsen immunity. They shift the immune balance in a negative fashion and skew th one, th two balance and things like this, and shift towards more humoral immunity versus versus things like cell mediated immunity and whatnot. And that's and key point in a lot of these autoimmune diseases. So let's worsen our hormonal profile and our energy state to drive this like, the like, go on this elimination diet that may worsen this problem, that we have to try to fix the problem. It's like, we need to be careful of our risk versus reward strategies that we're putting in place to solve these different issues. And so, yeah, that's, I think, the general premise of it, like the underlying ideas that like your. Gut interplays your psychology and the autoimmune diseases, and we want to seal the gut lining, Sure, great idea. But how we're going to go about that? I don't think it's going to be the GAPS diet.

Jay Feldman  55:11  
Yeah, yeah. And you mentioned about the relationship between stress hormones and autoimmunity, which we did touch on in that autoimmunity series, so I'll link back to that. But also with mental health, right? A lot of cortisol is not a good not a good idea, or any sort of like, if we're talking adding a lot of adrenaline and cortisol, and dealing with anxiety, dealing with low mood, depression, any sort of other issue. I mean, that's something I'd be very concerned about. So,

Mike  55:37  
yeah, yep, yeah.

Jay Feldman  55:40  
Alright. So on a similar digestive note, Angela says, I know from listening to Mike that he has no gallbladder. What does Mike do for gallbladder support? I've been struggling now for 10 years with bloating, an upset stomach. I changed up my diet after intermittent fasting and low carb for 10 years. I'm finally finding my bloat subsiding. But when it comes to fats, I need help and guidance. So of course, I'll let you speak a little bit on this mic, as you have some direct experience. But I've worked with a lot of clients without gallbladders too. I mean, it's, it's a really common issue. And even if you do have a gallbladder, you still might have issues with bioflow and production and fat digestion too. And that's something that, you know, I've seen quite a bit. It's very common. And so there's a few things I want to touch on first. The first thing is, anytime we're dealing with a digestive issue and we want to treat, or not even treat, but evaluate what's going on and then create an intervention based on that, the first thing to do would be to make tweaks in the areas that we're struggling. So if we are struggling with a bacterial issue and feeding the microbes is causing gas and bloating and things like that, then we might want to reduce the things that feed them. And in this case, if we're having trouble with fat digestion, we might want to shift toward easier to digest fats, so more of the monounsaturated fats over the saturated ones. And we might also want to just reduce our fat intake to an extent, and that can help as well. Here at the same time we would want to then support that area. And so when we don't have so the gallbladder is basically where we're storing bile that that gets released when we consume foods with fat, and that bile helps for the fat digestion and also has a lot of other important functions in terms of keeping the small intestine clear of microbes and helping to prevent SIBO. And so if we have gone to a place where our gallbladder had to be removed. Normally, there's a lot of digestive issues that had already gone on, maybe a lot of liver issues and bioflow issues to begin with, maybe some microbial problems as well. So normally, it's not something that has happened independent of these other issues. So we want to make sure we're considering the whole constellation of possibilities that could be going on when it comes to gut health, but then we definitely want to provide some extra support in terms in terms of our fat digestion and a couple of things that I'll often suggest and find that help. In addition to changing up the fat sources, if needed, toward more of the monounsaturated fats and maybe a bit less fat intake, especially for coming from low carb one other thing that can help quite a bit is having some foods with fiber, some fiber, you know, whether we're talking whole fruits or some cooked vegetables or cooked root vegetables alongside our meals. That can help as well, assuming that it's not feeding bacteria or feeding a microbial issue, which we would then need to evaluate kind of separately and maybe hold off on that part. And then using some things like taurine can be really helpful for supporting that bile flow and for making sure that enough bio is getting released with the meals to help digest the fat. Sometimes I've also normally towards my starting place. But then things like ox Bile or TUDCA, which the TUDCA is basically taurine that's bound with with bile acids, and those can help as well. So those would be things that I might consider, but there's a lot. There's probably more things that I would be considering here than just the fat digestion. So we'd want to make sure to just keep a close eye on overall digestive health as well, and liver health too, for sure, because if we've had issues with bile flow, that is often going to mean that we can't excrete things through our through that system, which we need to do from the liver, which can mean an overburden liver with endotoxin and estrogen and various other things that we're typically clearing out through the bile.

Mike  59:13  
Yeah. So no Gallbladder, gang. It's actually, it's not great. Like, I think that was if I had a singular regret in my life, it would, probably would have been getting my gallbladder taken out. Now, there's a silver lining, because, because I've had such issues after they took it out, I've had to really learn digestive physiology and and gut health and microbiome and all type of stuff pretty well, but it is a bit of a struggle when they take out the gallbladder. And so there's a couple issues that you run into when you remove the gallbladder. And I guess you could do within gallbladder gang, you know, the gallbladder squad, there's different there's different groups that you can fall into different camps. And so the camps would be, you have too much bile acids now, so your bile dumping. So you eat a big meal, and you just, you just like, you just your liver, just like, free all the bile. And then what that usually causes pretty bad, acidic, painful diarrhea, which I know personally. So anyone who's in the gallbladder, I get it the next one is not enough bile. So your your bile, you're not, you're you're kind of just leaking bile slowly all the time. And depending on what you're doing with your diet, you're not producing enough. And then you get the exact opposite, which is a very nice slow digestion and constipation. And that kind of also sucks. And you could actually fluctuate between the two depending upon how you set up your diet, because then we'll talk about the setup there. The next one that really sucks is some people get bile reflux into their stomach, and so they get these GERD symptoms and stomach discomfort and stuff after eating that's from the bile specifically, like refluxing back into the stomach. And then the other thing you can start to see for some people is that they start to get dysfunction around some of their bile ducts after they take out the gallbladder, and that creates like right upper quadrant pain and kind of gnarly digestive symptoms as well. And what the most unfortunate point of this is that the surgeon who takes out your gallbladder oftentimes doesn't tell you that this is what's going to happen. And a lot of people go to get their gallbladder taken out, it's a very routine surgery. At this point, it's like, oh, I have this pain, and I've been having it after I eat, and it's like, the surgeons like, oh yeah, we just have to take it out, and after that, you'll be better. And then they take it out, and it's like, no, I'm actually worse now. So I don't have the same gallstone pain, but now I have way worse digestive symptoms, and it's like, and that you don't get told that there's no discussion of that. The surgeon who took mine out told me that my bile ducts will form a pouch that will now hold my bile. And it's like, that is 100% BS. That is not what has happened to me since they took out my gallbladder. And so I feel for people. But there's these different camps that you can fall into. Looks like you want to say something, Jay, so I didn't let you jump in there really quick.

Jay Feldman  1:02:08  
I was just, just like many surgeries, it's this idea that you can live without it, so there is no consequence that. And it's like, from a doctor perspective, a mainstream medical perspective, yes, you can remove it and then not need to be hospitalized immediately or for the rest of your life, like it is not something that is going to be fatal if you don't deal with it. But that doesn't mean that there's not a consequence. And the reality instead is that for a lot of people, it can be lifelong, especially if they aren't taught how to effectively manage it. And it's awful. It's it's really awful,

Mike  1:02:39  
yeah. So to be fair, if you have a gallbladder problem and you have a stone that blocks the duct and it gives you, like, an infection in your gallbladder and it's gonna rupture in your abdomen, have it like, go get it fixed, because that's risking death and serious infection, versus just like, You know, if you have a gallbladder problem and you just having pain periodically because you have hormonal problems or hypothyroidism or or gut dysbiosis, and you have some gallstones and things like this, and it's just making you uncomfortable in that circumstance, there's fixes for that. You can correct that, versus the person you get. You know, there's their septic because their gallbladder is bad. So if you're septic, it's a life threatening emergency. If you're not septic, and it's a routine thing and the doctor is talking you into it and this type of stuff, just know, you know you do whatever you want to do, but just know that there is very likely going to be consequences digestively For the rest of your life. When they take out your gallbladder, some people seem to be completely fine, but other people seem to develop issues. Unfortunately, I was not one of the completely fine people's pretty much wrecked my digestion for years. Okay? So we have the different types, right?

Jay Feldman  1:03:52  
Just Just real quick, also to interject, when it comes to the removal, and this is, this applies for both gallbladder and appendix, of course, if it's ruptured, if there's, like, a serious life threatening situation and you need to get it removed, you need to get it removed. But oftentimes these surgeries are suggested as like a first line approach when something as simple as antibiotics can prevent the need for surgery entirely and fully resolve the issue. So and that's the case for for the gallbladder inflammation as well that can occur with the gallstones, with gall stone, like with gallbladder disease and inflammation, antibiotics can be really effective because there's often an infectious endotoxin based component as well. And normally that's not something that's suggested, whether it's appendicitis or or for the gallbladder. So just wanted to throw that out there as well.

Mike  1:04:41  
Yeah, there's, there could be other options. It just if it's life threatening, then, you know, maybe worth. It's death likely worthwhile to go that route.

Jay Feldman  1:04:49  
Yeah, at that point it's still, that's a pretty easy decision. If it's life threatening.

Mike  1:04:53  
If it's not life threatening, like for the biggest thing is rupture, where it breaks open and you leak contents in your abdomen, which should be sterile, your peritoneal cavity. And then what happens is you get peritonitis, which is infection of the peritoneum from the bacteria, and there's a high risk of mortality from that with sepsis, which is just like, yeah, it's a no brainer, but, like, a routine, like, Yeah, can I get this gallbladder done by, like, you know, before Christmas, because I'm going on vacation, like that type of thing, I think is I would start to question that, because I because I do think there's downsides. And so we have the different types, too much, bile acids, not enough bile acids. We talked about the bile reflux in the stomach. The other one is bile malabsorption, where essentially you're and this can happen to people who even have gallbladders, but the part of their intestine, I think it's in the ileum, where they're reabsorbing the bile acids. That's not working well for a variety of reasons. Usually can get this, this where people with IBS can experience, after you have an infection, I think it maybe there's still latent infection in that area. And then basically you also get the bile dumping system symptoms. But you can have this happen with the bile acid without the gallbladder as well. And so each of these requires a different strategy. If you are bile dumping and you're not absorbing bile acids, if you want to have a really bad time, then you will take ox bile and TUDCA and I've done this to myself. And it's, it's, like it to be 100% honest, it really sucks, like it's extremely painful to run the because when the bile acids get into the colon, they irritate the colon pretty badly. They cause a serotonergic response, and they cause microbiome disruption. They're basically like a detergent on the colon. So in the small intestine, because they're great, they're fine in the colon, bad news, so you don't really want tons of bile acids in there. So in that case, you do not want to take taurine, glycine, TUDCA or ox bile it'll be like a one way trip to the toilet for the entire next day. It's not worth it. But if you're dealing with the constipation side of things, because you're not producing enough bile acid now, then what you can do is you can use taurine plus glycine plus vitamin C has some cholesterol on your diet, maybe from egg yolks, because those things are the components that are needed to build bile acids. The bile acids are made from cholesterol. Vitamin C is in comport an important co factor in producing bile acids. And then taurine and glycine are important for conjugating bile acids, which allows them to actually work effectively. They bond the taurine and glycine to this steroid molecule, the bile acid, which is made from cholesterol, and allows it to basically have a polar effect. So polar meaning one, one charge is positive, or there's there's differing charges on either side, which allows it to interact with fats and allows it to interact with water to emulsify the fats up. So if you're having low bile acid, then you can use those things and see if you can increase your own production without necessarily having to take bile acids. If that doesn't help, then you and you're still having trouble with fat digestion, then you can add in bile acids. And you do not want to take them away for meals. You want to take them with meals, because the goal the bile acids would usually be ejected from the gallbladder during a meal with a with a fat bolus that stimulates cholecystokinin. And so it's important that you take it with a meal. If you take it away from a meal, you are running the risk of giving yourself a really bad time digestively, especially because the bile acids are like, again, they have a detergent effect. So you don't really want them in your stomach without food, and you don't want them to run through your small intestine and not re and get into the colon and cause problems. So take them with a meal. So that's the that's the first piece with the bile acids. You're gonna use it, TUDCA, ox bile fine. And then you will. You could also do Victorian glycine, vitamin C and asthma cholesterol in the diet to produce the bile acids. Another component, very briefly, with tudka. If you are going to use TUDCA, you cannot drink. You cannot drink alcohol. The TUDCA can worsen alcohol induced liver dysfunction. So avoid like when you're on TUDCA, don't have any alcohol at all when you can stop, when you stop alcohol, you can bring TUDCA on board, and it can help improve your liver function from the alcoholic damage. But if you have TUDCA before you drink, it'll worsen the alcohol damage in your liver. So you need to be careful with that. Now, if you are not producing the other thing is, you can be not producing enough bile acids if your diet is too low in fat. And so if you increase the fat intake in your diet, that can help to stimulate bile flow during the meals, and that can also help minimize the constipation symptom. And the reason you're getting constipation when you have low bile acids, the bile acids trigger motility in the intestine. So that's extremely important. The other thing is, if you don't have enough bile acids and you have the constipation, you basically cause issues in the small intestine, because one, you have the slow transit, and then two, the bile acids trigger receptor in the intestine, called the farnazoid X receptor, and farness weight receptor increases intestinal defense. And so if you don't have the bile acid signaling you have it, can worsen your intestinal defense. Allow more of the overgrowth, plus the bile acids kill bacteria in the small intestine as well. It's one of the main defenses. So not having enough of that, can see, cause some serious issues for the intestine. Now that's for the low the low bile acid, constipation. You could take the taurine, glycine, vitamin C, cholesterol, you can use Ted Cox bile. And you can also increase fat intake in your diet, and that in meals, specifically, you're maybe 2030, grams per meal, maybe a little bit more, depending on how much you need to have in a day. But those things can help move the needle. If bile acids are too low. Now, if you are having malabsorption or too much bile acids in this circumstance, again, no taurine, glycine, not high dose vitamin C, definitely not high dose Todd, car, ox bile, or test them out and see what your response is. And then what you also want to do is you want to be careful with the amount of fat you're having in your diet and in a meal, specifically, and you do not want to fluctuate the amounts too much. Because for me, if I say I eat 20 grams of fat for breakfast every single day, and then now I go to 40 grams of fat, I'm going to start dumping bile, because my small intestine, my ilium, at my theory, at least on it, is not used to absorbing that much bile now and that much fat, because the system had, for me, I have a day or two lag to for adjustment if I change my fat intake. So you want consistent fat intake in your meals, I usually shoot for around 20 grams, 10 to 10 to 30 grams. For me, I'm about 20 other people can go in between there, and that'll help to control what's going on with the amount of bile that gets shot out with the meal. The other thing that you one thing that you mentioned Jay, is having the specific types of fats. So the taurine conjugated bile acids are more polar than the glycine conjugated bile acids, they have a better detergent effect. And when you essentially

have a higher saturated fat diet, the saturated fats are much more lipophilic. They don't do their hydrophobic. They don't mix well with water, like the oil fats do, the monounsaturated polys do. And so you need more taurine conjugated bile acids to absorb them. And so you start your body adjusts and produce more taurine conjugated bile acids. Well, this causes a really nice detergent effect on your colon if you're not absorbing it, and can really irritate and worsen the symptoms. So in that case, you're going to want to shift towards monounsaturated fats, so that if you get bile acid diarrhea, it's way less irritating to your system. And I also it seems to be like create way less bile acid diarrhea as well. So switching more towards monos is a good idea. If you're having this problem, you could still have saturated fats, but some of them, like stearic acid, are actually one of the worst in terms of triggering the diarrhea response. The other thing with the if you're having the bile acid malabsorption, because it causes dysbiosis in the intestine, it's gonna be really important to have fiber like really, really important, because the fiber soaks up and binds up the bile acids to some extent, and protects it from irritating the crap out of the colon and causing all these problems. The other thing is, if you don't have a bile a gallbladder, you're not secreting your bile acid in these big dumps, you're constantly recirculating it all the time, and you that may impair detox a bit. So you're also going to want to have fiber to bind up those bile acids and pull out and detox different types of things. And so for me, what I found is I actually really need fiber in my diet on a regular basis, or I get severe issues in my colon, specifically small intestine, no problem. But in the colon, it starts to cause irritation. So it's important to have the fiber present for the detox for these different components, but so these would be the major ways that I would look to actually address this, these two different areas, whether too much or too little, or the malabsorption, in terms of the reflux into the stomach. This one is a little harder to address, and it's really unfortunate because it's extremely uncomfortable. I've had this happen to me a couple times, and it really irritates my stomach. But basically what, what winds up happening is, number one, when I drink, when it happens, I drink a decent amount of water, and it helps to, like, kind of clear things out and minimize the pain. Number two, when I have my meals, the fiber helps to move things out and kind of protect my stomach, and then being careful with the types of fats, how much fats and things that I have on a regular basis is is important for managing that type of symptom. And so it really is about setting up every meal with an appropriate amount of fat, protein, carbs and fibers so that you're not over stimulating your your your bile production, or having too much of the reflux symptoms, or getting the irritation to the stomach, in terms of healing the stomach, if that is happening from the irritation, I would look to use things if you tolerate well the collagen is hit or miss, because it could be very high in glycine, which can trigger the bile flow, but you can have. Some collagen. You could also do something like a zinc carnosine to protect the stomach. Could also buffer it with a little bit of calcium, magnesium. Those things can help prevent the irritation. The calcium also can bind up some of the bile acids, so that can be helpful as well. So these the other thing I'll mention too, if you're having too much bile flow as well, you're going to want to go on a lower fat diet in general, like the high fat stuff's not gonna work, but you if you go too low, you can actually cause worse problems, like the constipation. So the lowest I would go is about 20% calories of fat, and probably stay around 25 so these are, for me, these are things that I do all the time, because if not, I'm gonna be run into the bathroom many times a day with bile acid diarrhea. The last component I'll mention here, and this is something that's not talked about inside. It's not talked about by the doctors or people who talk about gallbladder removals. Bile acids are really important signaling molecules throughout the body for metabolism, for thyroid function, for detox. There's a the farthest weight X receptor, is a nuclear receptor, one of the major ones that's triggered by bile acids. And when you start to screw around with the circulation of bile acids from the intestine, in the liver, when you take out the gallbladder, there's a whole bunch of signaling pathways that get messed up, and that can cause people to develop issues with some of their metabolic processes because of this. And so it is. It can become quite, quite problematic. A lot of people find they gain weight or or can't or lose weight because they're gaining they're not able to hold food down. And I think some of that is also related to the signaling processes. I'm still trying to figure out how to correct all that type of stuff with different compounds and whatnot. It's quite it's actually quite a, how do I want to say it like complex, because you have multiple overlapping signaling molecules, then you have the microbiome adjusting signaling on top of that. So it really becomes a, like a bit of a complicated issue. And it is unfortunate that, you know, we have people saying, Oh, just take out your gallbladder. It's vestigial, and then not actually doing any research to see all the effects and negative of downstream consequences of removing this organ overall. So that would be my take on it. I deal with this every day of my life since I had the surgery. And so there is a bunch more nuance into into addressing and adjusting it. And I do work with many people who have gallbladder issues to help solve this. And unfortunately, a lot of them is mostly postmenopausal women. That is the age group that tends to get gallbladder problems, and it does really mess up their digestion as well.

Jay Feldman  1:17:36  
Yeah, yeah. A lot of great points there. And just a couple of things I want to wanted to come back to and highlight real briefly. So one is the some other things that could relate here that we would want to consider, let's say, in the case that we have a lack of bioflow and we're dealing with that side of the symptoms, hypothyroidism is something that can drive that independently. And so that's something you might want to consider. You had talked about some of the different precursors as well, and so we're talking about cholesterol. And of course, cholesterol that we're just getting from our diet is great. We're also generally pretty good at producing cholesterol if we're having enough, normally, fats as the precursor. And so that's something to consider as well. We We can try to get the cholesterol from our diet, or we can just make sure we're getting enough fat for that. So there's a couple of things to mention there, and then also the impact of microbes, right? Or other things that are creating inflammation the intestines, which just adds that. Can add another variable here that contributes to these other possible issues. And so this, like it adds an element of complexity when it comes to addressing the gut issues, and that has to be addressed. But also we want to make sure that we're not also considering the the influence of some of these other digestive issues that can then lead to something like the bile acid. I mean, either lack of flow or other things contributing to constipation, malabsorption and things like that. So yeah,

Mike  1:19:07  
and if, if somebody is dealing with gallstones a lot of times, like when I developed gallbladder issues, number one, I didn't have gallstones. A lot of people don't, but a lot of people are developing gallstones. Can be developing them, particularly in post menopausal women or the the the group inside. So like when I was in my my nurse practitioner, course, right when they look at gallbladder components, the group that they usually associate with the highest risk, they say is it's the four F's. And to be fair, some of that like, it's not like a nice characterization, but it is like the demographic that is dealing with it the most. And it's, it's women so fair. So it's female, female fair, fat and 40, because this the group that is often dealing with these symptoms, and it's related to a. Lot of times the gallbladder flow is related to problems with estrogen signaling. So if you have a woman who's in her 40s, so she's coming close to menopause, and she's overweight, so she has a lot of fat tissue producing aromatase, and then it's a female, you basically are setting up the stage for maybe an estrogen dominant state that adjusts liver process pretty directly and can lead to issues with the gallbladder also this group of women, the fair usually relating to Caucasian women, you tend to see a higher amount of hypothyroidism in this group as well. And the hypothyroidism drives the gallbladder dysfunction. So if you're dealing with that problem, the solution is to correct those underlying issues, and you then you could still use things like Ted, covid time that could help to degrade some of gallstones, if you've developed them, shift up the diet so that you're not still producing gallstones. There's different components that can cause a super saturation of cholesterol is a lot. That's a whole other can of worms. I don't want to go too far into that, but there's a those things be corrected, and then you can start to see a change and minimization of what's going on with the gallbladder and the gallstones and issues overall. For me, my gallbladder problems were secondary to doing the plant based diet and juicing large amounts of kale and green vegetables and making myself extremely hypothyroid. And then after that, I developed liver and gallbladder issues that the doctors were unable to figure out because they didn't even ask me anything about my lifestyle or even look at my thyroid function or consider my hormonal function. It was just like, Oh no, you have GERD. Oh no, it's not GERD. Here's the surgeon, because I don't have any other recommendation for you. So I went to a GP general practitioner who referred me to a GI doc who was useless, absolutely useless. The only thing he wanted to prescribe was a PPI proton pump inhibitor. When I'm telling him I don't have acid reflux, I have abdominal pain. And then he didn't he didn't want to explore it further. So he sent me to after he scoped me, didn't see any problems. It's a very common experience for people. You're not going to find a structural issue a lot of times, especially on the scope so then he sent me to the surgeon, because he was annoyed for me keep coming into visits, and then the surgeons like, yeah, it's your gallbladder to take it out. And when they went in, I didn't have a single stone. I just had an inflamed gallbladder, and portions of my intestines were inflamed around where the gallbladder was inflamed. Why is this happening? I went on a plant based diet. I was hypothyroid, wasn't eating enough, like, having pretty bad digestive symptoms, and eventually the system just broke, and it was my goal. Like, the solution for modern medicine was, like, this cable, leave me alone. We'll just, like, give them a surgery so you can get them off my back. And that was for me. Like, now I know that I was, like, obviously, extremely frustrated, but I was doing things that initially caused the problem, and those are things important, because even if you take out the gallbladder, if those are not fixed, you will still have problems. I still had digestive problems when I was done, until I shift my diet, and then now I just introduced an entirely new problem and didn't solve the original problem. And now, and now, I still am dealing with this permanent problem that they took out my gallbladder decade, a decade or more later, and it's going to probably go like that perpetually for the rest of my life, because of because of this setup. And for me, like there's a period of time I was very upset at the doctors for what they did, because I feel like I got maimed to some extent. But at the same time, I made the decision to go forward with this, and I initially caused the problem overall, and so I take responsibility for it, and now, like, I figured out solutions around it, how to solve it and understand the digestive stuff better. Because before I figured out, I was like, Oh, it was really my gallbladder as a problem. I was thinking microbiome. I was thinking IBS, I was thinking Crohn's, ulcerative colitis, all these types of things. So I did a lot of research in all these areas to figure out what's going on with the intestine, and now I got a good knowledge base out of it, but yeah, I still struggle with some digestive issues at times, because they physically removed an essential part of my digestive process, because it's vestigial.

Jay Feldman  1:24:07  
Yeah, yeah, obviously, quite an experience. Yeah,

Mike  1:24:11  
it gets me heated every time, because this is so frustrating,

Jay Feldman  1:24:15  
yeah, yeah, seriously, understandably so yeah. And one thing I just wanted to go back to real quick, and then we'll, we'll wrap up. But just that, the role of estrogen here is pretty clear, and in the population you described as well, where estrogen can impair bile flow, can lead to change of the bile composition. It can lead to obstruction, can lead to all sorts of problems at the liver, and then you get the kind of positive feedback, or vicious circle, where then you have problems excreting and clearing estrogen. So yeah, definitely a major, huge factor here to also,

Mike  1:24:53  
if you go on the research, it's like, pretty obvious that estrogen is, like, one of the huge components of this.

Jay Feldman  1:25:01  
Yeah, so, yeah, awesome. All right, anything else? Mike, no, that

Mike  1:25:04  
was it. I got it all out. I vented.

Jay Feldman  1:25:10  
Sounds good. Can you let the listeners know where they can find you? Yeah, so

Mike  1:25:14  
they can find me here in energy balance and at my website. Mike, fave.com,

Jay Feldman  1:25:20  
awesome. All right, and if you guys enjoyed this episode, please leave a like or comment. If you're watching on YouTube and if you're listening elsewhere, please leave a review or five star rating. All of those things really do a lot to help support the podcast, and are very much appreciated. To check out these show notes, where we'll link to the articles and studies episodes, anything else that we referenced throughout today's episode, you can head over to Jay Feldman wellness.com/podcast, if you are dealing with various low energy symptoms. These could be gutter digestion symptoms, hormonal imbalance, chronic cravings and hunger, low energy or fatigue, joint pain, poor sleep, brain fog or low energy conditions, whether these are autoimmune conditions, hypertension, insulin resistance, high cholesterol, or any other related conditions, then I'd recommend you head over to Jay Feldman wellness.com/energy where you can sign up for a free energy balance mini course where I'll walk you through how you can adjust your diet and lifestyle to maximize your cellular energy and resolve these low energy symptoms and conditions. So again, you can head over to Jay Feldman, wellness.com/energy, to sign up for that free energy balance mini course, and with that, I'll see you on the next episode. You.