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After 20 years of balancing hormones in women, I consider the gut as the key change agent, the missing piece to the puzzle of how to feel most vital and restored hormonally. As Hippocrates put it, “All disease begins in your gut.” Another ways to put it: If your gut ain't happy, your hormones ain't happy. Your thyroid is a good example. Our zeal in the 1980s and 90s for low-fat diets hurt our thyroids significantly. Low-fat eating leads to high insulin and leptin. Dean Ornish determined it was a good thing to eat foods low in fat after a heart attack, and we all took the bait! Dean got me started on eating pasta and chicken breast (no skin!) with no oil. I aimed for a fat content of <10% in my foods. But ultimately, low fat leads to slow metabolism, lower body temperature and conservation of vital nutrients. Over time, low-fat diets result in an underactive thyroid. Low-carb is not much better. Fast-forward to Atkins and South Beach diets and suddenly everyone avoids carbs like the plague and overeats meat. Excess protein lowers conversion of T4 to active thyroid hormone, T3. But aside from my musings on how our food harms our thyroid, let’s get action-oriented about assessing where you are right now. Bloated? Gas? Irritable bowel? Constipation? Those are divine messages to listen up to your gut. Step 1: Manage Your Transit Time. Ideally, it takes 12-24 hours for food to pass through from your mouth to your toilet. You can calculate your transit time by eating a serving of red beets and tracking how long it takes for the beets to show up in your stool. If you time is too fast, you are probably not absorbing the nutrients you need. If you transit time is too slow, you may have increased likelihood of gut infections such as from yeast and bacteria, leading to poor nutrient absorption and greater chance of food intolerances. Like with most things, we need to find your sweet spot with transit time – not too fast, not too slow. Think Goldilocks: let’s get it just right for you. Step 2: Assess for Leaky Gut. Leaky gut was described well by Howard Liebowitz, MD, a physician in Santa Monica, CA: “Leaky gut is a syndrome where the cells that line the digestive tract are like the bathroom tiles on the wall, and the grout between the bathroom tiles on the wall, and the grout between the bathroom tiles are like the spaces between the cells. When there is inflammation in the digestive tract, the cells swell up, and when they swell up, they get puffy and tend to pull away from each other. When the spaces between the cells open up, then microscopic particles (proteins, usually) leak out from the inside of the digestive tract and get into the bloodstream, where they’re not supposed to be because they haven’t been completely processed. That’s leaky gut syndrome. When these proteins leak out, they are free to go anywhere and they end up lodging into all sorts of tissues. The thyroid is very susceptible because it is so engorged with blood and so much circulation goes through that thyroid. The thyroid doesn’t have a filtering mechanism, so these proteins get lodged into the thyroid. The proteins are foreign and not supposed to be where they are in the blood; they get attacked by the immune system of the body, and that’s how you end up with autoimmune phenomena. Plus the thyroid gets damaged and the patient ends up with a nonfunctioning or low-functioning gland.” How does leaky gut start? From stress (high cortisol), excess alcohol, sugar, drugs, use of antibiotics. The list is long. You can test for it with a lactulose/mannitol cocktail one of the newer options on the market. Step 3: Ferret Out Food Your Gut Dislikes. I’ve posted previously on food intolerances and allergies and how they link to an exaggerated immune response, and conditions such as Graves and Hashimoto’s Thyroiditis. If you persist in eating foods to which you are intolerant, you put yourself at greater risk for autoimmune and thyroid problems. Food intolerance also contribute to blood sugar instability, sugar cravings and sometimes weight gain. Two options here: either follow an elimination diet such as the Gottfried Cleanse (see my website) or test yourself for food intolerances in the blood. The most common intolerances include gluten, dairy, eggs, corn and yeast. Step 4: Tame the Blood Sugar Beast. Find out if you have a problem with your blood sugar. Easy ways to test for this include getting a fasting glucose (and possibly a fasting insulin level). Even though I’m lean, I found that I had an elevating fasting glucose at age 38 because of my adrenal dysregulation. For me, I would have wild sugar cravings and episodes of hypoglycemia. No wonder I was irritable! Another way to assess your tolerance for sugar or carbohydrates is to follow a simple rule: if you are sleepy after eating, you probably ate too much carbohydrate. I’m not recommending that you avoid carbohydrates as a food group – I advise that you collect the data on the right amount for you and your body. Step 5: Get Your Probiotics On. Twenty percent of your thyroid production is dependent on healthy bacteria in your gut. Most of us are chronically low in good, protective bacteria and need more. You know the usual reasons – our overuse of antibiotics, our tendency toward too much stress This is just a start and by no means a complete list. I haven’t even gotten to stomach acid, digestive enzyme and pathogens, such as parasites, yeast and what happens when you have more bad bacteria than good. But hopefully this post will give you food for thought, a start to happy intestines.