Bloating: Getting Rid Of Your Food Baby With Functional Medicine - Transcript

Dr. Mark Hyman: If you suffer from bloating, if you have this food baby, if you're really miserable and uncomfortable, there is a way to get through it and fix it. Dr. Elizabeth Boham: If somebody does have an overgrowth of bacteria in the wrong place, sometimes probiotics make that worse. Dr. Mark Hyman: So I'm the average Joe or Jane, and I go to my internal medicine doctor or my GI doctor, and I go, "Hey, doc, I got bloating. And every time I eat, my stomach feels like it's going to explode. I just feel really uncomfortable. What do I do?" And up until fairly recently, it was like, "Well, you have irritable bowel. It's probably psychological. Take some Metamucil and hopefully that'll work. And if that doesn't work, we'll give you some antispasmodics for your stomach so it doesn't spasm. Otherwise, go meditate or take Valium or Prozac." It's not a very satisfying answer for a lot of people. Dr. Elizabeth Boham: A lot of people walk away dissatisfied and they're frustrated and they don't feel good. Like you were mentioning before, it's not always something that's causing death for people, but sometimes it causes significant issues. I have patients who come in and they have such significant bloating that it's stopping them from being able to eat enough nutritious food, so they've had to really their diet or they don't feel like eating so much. And I have some patients, and we'll talk about one later, where they're getting thinner and thinner and they're losing their lean muscle mass, because the amount of bloating they're having is restricting their intake of nutritious food. And that can be really significant for people. I mean, that doesn't happen to everybody, but there are people where they're dealing with it that significantly. Dr. Mark Hyman: No, it's a big issue. Dr. Elizabeth Boham: And it's estimated that 20 to 30% of the population is dealing with bloating on a regular basis. People with irritable bowel syndrome, it's 96%. So people who are struggling with digestive issues or irritable bowels, we've talked about before, that it's something that we really work to define greater than just putting that into a waste paper basket. It's even higher, it's that 96%. So bloating just means that your belly is getting bigger. You have this increase in abdominal girth and it typically, when we're talking about abdominal distention from gas or bloating, what we're going to talk about today, it increases after you eat. So people will feel more bloated after they eat, or they may feel more abdominal fullness or sensation of gas as the day goes on. Dr. Elizabeth Boham: And there's so many reasons behind the causes of bloating, and I think that's really what we want to focus on today, and it's what we really work to get to that underlying root cause in functional medicine. What is that underlying cause for that person? Because there's so many different reasons for bloating and I think that's really critical to focus on and not just saying, "Okay, well take Gas-X, or just take something to suppress the bloating." We really want to figure out, why is it going on? Because that really then can help work on that person's symptoms that are causing them a lot of discomfort. Dr. Mark Hyman: When I was in medical school, we didn't really ever learn about what we call SIBO or SIFO. We didn't learn about that. Did you learn about that? Dr. Elizabeth Boham: No, not in medical school. Dr. Mark Hyman: It's kind of a new insight about irritable bowel, which is, not always, and we're going to go through the causes, but it's often about the overgrowth of bacteria or fungus/yeast in the small bowel. Now you've got like 22 feet of small intestine and about 10, 12 feet of large intestine. The small intestine's generally sterile, but sometimes the poop from the large intestine kind of migrates up, and we'll talk about the reasons for that, and leads to the bacterial overgrowth. So some conventional doctors now are treating people with antibiotics, right? What kind of things are you seeing them do? Dr. Elizabeth Boham: Right. You're talking about SIBO, one of the major causes of bloating is SIBO, small intestinal bacterial over growth. And as you mentioned, there's a lot out of other reasons that people get bloating, but one reason could be because there's the wrong bacteria that have migrated up into the small intestine, as you have mentioned. When that happens, that dysbiotic, or not good bacteria, or the bacteria that shouldn't be there, consumes some foods and then produces gas. So it's consuming foods that- Dr. Mark Hyman: Get fermented. Dr. Elizabeth Boham: ... get fermented, and then you produce a bunch of gas from it. So the combination of certain foods, and not always bad foods, but certain foods that cause this gas when there's the wrong bacteria in the wrong place, can cause a lot of bloating. So SIBO is something we check for all the time. You can check for it with a breath test. Conventional doctors are checking for it as well. Dr. Mark Hyman: Yeah, now they are. Dr. Elizabeth Boham: We check for it all the time. Yep, now they are. There's a few ways you can work on treating that, and we'll delve into that more, but one is getting rid of the bacteria that's in the wrong place. You can do that with medication, like antibiotics, like you mentioned, you can do that with herbal substances that lower the bacteria in the wrong place, and you can also change the diet for a period of time that takes away the food that's feeding this wrong bacteria, that's allowing it to overgrow. Dr. Mark Hyman: That's good. So conventional doctors are getting the point a lot about SIBO and they're using antibiotics and then they'll use different diets to restrict the fermentation of the foods, but they really don't have a comprehensive 360 approach, from my perspective. They don't deal with the overall ecosystem of the gut, they don't look at all the other food sensitivities, they don't look at how to repair and rebuild the gut after the problem is taken care with antibiotics, they don't often treat yeast or SIFO, which is often coexisting with the SIBO, and then they end up having recurrent bloating. So it'll maybe get better for a few weeks or a month, and then it comes back. Dr. Mark Hyman: So functional medicine has a very different perspective. We understand the problem, but then we also understand how to navigate like medical detectives to the cause. What I think it's challenging with SIBO is it's such a persistent and uncomfortable thing, and there's not a lot of insight about what really happened. So I would love if you'd take us through, what are all the types of reasons people can start to develop SIBO and all this, and develop this fermentation process. Because, by the way, the thing that struck me was such a big insight was humans don't make gas. It's the bacteria eating the food that you eat that make the gas. So if you have gas or bloating, and you have distention and air in there, it's not you making it, it's the bugs and it's an imbalance in your relationship with your bugs. So you got to get in harmony with your bugs basically. So take us through, Liz, what are the common reason why we get this bloating and dysbiosis and imbalances in the bacteria? Dr. Elizabeth Boham: I mean, one of the biggest reasons that we see that people get dysbiosis, imbalances in their gut bacteria, are antibiotics. I mean, when we overprescribe antibiotics or people have been on large courses of antibiotics for certain reasons, chronic infections or they got on too many antibiotics when they were younger, what happens is it can result in this imbalance in the good and bad bacteria in our system. It can get rid of some of the good bacteria and fungus, yeast, and things that keep that ecosystem in better balance. So too many antibiotics, too many antibiotics in our food supply. We know that things like stress has a huge impact because stress in our life impacts our motility and how well things move through our system. So we know that people get bloating, this isn't just SIBO, but bloating, because of ... Sometimes if they're they're eating too quickly, they're not digesting their food properly, so they are swallowing air or eating too quickly. Dr. Mark Hyman: Probably that's what I do. I eat fast. That may explain some of my issues. Yeah. And there's more, right? Dr. Elizabeth Boham: Moving onto the next. Right, right. Then there's things like lactose intolerance, which is ... Lactose intolerance is so common, that's the decrease in that lactase enzyme that's in our intestines that breaks down lactose, and when we don't have enough of that lactase enzyme, then we can't digest our lactose very well, which is in dairy. So we've done a lot of different podcasts on dairy and all the issues, but what we know is that for everybody, by the time they reach a hundred, they become lactose intolerant. So everybody in the whole world is that way, and some people become lactose intolerant at- Dr. Mark Hyman: So no cheese after a hundred? Dr. Elizabeth Boham: Some people become lactose intolerant at age two, some people at 50. Dr. Mark Hyman: I was just in Sardinia and I saw these little 100-year-old people eating a lot of goat cheese and sheep cheese and they were doing good. Dr. Elizabeth Boham: Well, and what do we know about, when we say lactose intolerant, it's important to recognize it's a spectrum. So what does it mean to be lactose intolerant? It means you're not as tolerant to digesting as much of the lactose. And that's what gets people so confused all the time about foods and food sensitivities. They're like, "Well, I ate that yesterday and I was fine, but then today I'm really struggling." It's really because of the volume. Many times you can get away with a certain amount of lactose, and then other times, if you have two servings or whatever, then it pushes your body over the edge because you don't have enough of that enzyme to digest it. So it's a spectrum. And that's what we see all of the time. Dr. Elizabeth Boham: It's also important to recognize there's other things that can cause bloating, things like constipation can cause bloating. We know not having good motility, maybe because of autoimmune processes or just gastroparesis- Dr. Mark Hyman: Diabetes. Dr. Elizabeth Boham: ... not good motility. Exactly. If your bloating is all the time, or if it's not getting better, you really want to get evaluated because there are some cancers that can cause bloating and GYN issues, gynecological cancers. So there's more things that can cause bloating. It's important that we pay attention to all of those when we're get a really good history and timeline from our patients. Dr. Mark Hyman: I agree. I mean, I think there's certain things we see commonly, like the bacterial overgrowth, it's often because of people taking antibiotics or other drugs. In fact, one of the things that people really don't realize is that the acid blocking drugs, which are the third leading class of drugs sold in America, these are like Prilosec, Protonix, Nexium, Aciphex, all those drugs, they're given all like candy and they cause bacterial overgrowth and they cause fungal overgrowth, because they change the pH, they change the environment. So while you may not have heartburn, you end up getting irritable bowel. That's one of the side effects of these drugs. So I think it's important for people taking those to realize they're not lifelong drugs, there's ways to fix the underlying problem. Dr. Mark Hyman: The other thing that I found often is these sugar alcohols that are now in all these ["healthy" 00:12:09] products that are highly fermentable, non-digestible, sugar alcohols, like erythritol, xylitol, sorbitol, maltitol, and they are in a lot of these foods. Some people do fine with them, some people don't, but I know if I have a ... Way back when, I think it was like 20 years ago, when this stuff was just coming out, someone gave me this sugar-free chocolate bar, which is full of maltitol, and I ate the thing at Canyon Ranch and I literally couldn't see patients the whole afternoon because my stomach just was going crazy. Dr. Elizabeth Boham: Yeah, you were doubled over in pain, right? Dr. Mark Hyman: Oh my God. Other things that I found clinically, and I wonder if you found this too, [inaudible 00:12:50], but certainly it's like tick infections, like babesiosis and others, can cause motility issues in the gut, or heavy metals. So I often, if you don't get better initially, I start to look for other factors. So these are really common problems and 10% of all loss of productivity in corporate healthcare is from irritable bowel. So it's a huge economic burden on society and it's the number one reason for visits to the doctor for anything. Dr. Elizabeth Boham: I mean, it's so important about the additives in foods and sometimes people, that's something you really have to delve in deep with people on, and look about, okay, what bars are you eating? Even certain shakes that have, like you said, some of the sugar alcohols in them. Chewing gum, people always forget about chewing gum and how much that can cause bloating because of some of the sugar alcohols in them. So you've got to pull those away just to help people feel better. Dr. Mark Hyman: Absolutely. I think it's a bit of a detective job, and a lot of processed foods has emulsifiers and thickeners that tend to cause leaky gut and other issues. So there's just so much opportunity by focusing on a very detailed history to figure out what are the culprits and if you're eating anything that's not real food. It could be a thing like fructose is a big factor, a lot of high fructose corn syrup and stuff, and people have fructose intolerance. So there's a lot of issues that we can really deal with. Dr. Mark Hyman: So take us now, those are the causes, and those are the things we tend to think about and test for. We test for gluten, we test for food sensitivities, we test for a lot of things. What would be an approach that we would take typically to deal with these people with the food baby, bloating thing? And let's just say it's the typical kind, no cancer, Lyme disease. Dr. Elizabeth Boham: Right. Right, right. I mean, exactly. So you mentioned about the Lyme disease. That's really, I think, important when people are not getting better, when they're being treated so many times and they're not getting better. Yes, so we often will test for dysbiosis. So we're testing for SIBO, but we also do stool testing that is fascinating just some of the revelations we're having and improvements in stool testing. We can look at levels of good and bad bacteria and balances in good and bad bacteria, and work to shift those as well, which can be really helpful. Dr. Elizabeth Boham: One of the first things we always start with, of course, is dietary changes. So we'll either put somebody, depending on their history, their story, and where they are in their level of motivation, we either put them on a dairy-free diet or we put them on a gluten dairy-free diet or we might put them on a low-FODMAPs diet. So FODMAPs, maybe people have heard about FODMAPs, and so it's important for us to just delve into that a little bit, but FODMAPs are- Dr. Mark Hyman: Yeah, what is that? What does that mean? What does that mean? Dr. Elizabeth Boham: Yeah, so FODMAPs foods are fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols. So these are these carbohydrates that are not completely absorbed for some reason, either because of some maldigestion or just because they're harder to absorb carbohydrates, and then when there's the wrong bacteria in the wrong place, they consume those carbohydrates and produce gas. So the oligosaccharides, those are things like wheat and rye and onions and garlic and legumes. Disaccharides are things like lactose and dairy. Monosaccharides are things like fructose, like high fructose corn syrup, like you mentioned, honey and apples. The polyols, those are things like sorbitol and mannitol, the artificial sweeteners, and some fruits contain some of these polyols. Dr. Elizabeth Boham: So one of the first things we do is say, "Okay, maybe we should try a low-FODMAPs diet for a period of time." So there are some foods on this list that are good, healthy foods that you don't want to stay off of forever. So it's usually, with a low-FODMAPs diet, it's for a period of time that you're taking people off of these carbohydrates that are fermentable, and then over time working to reintroduce the healthy ones for that person. Monash University has a really good website, lots of good resources on FODMAPs foods, but in general, you pull away things like wheat and rye and onions and leaks and cauliflower and apples and dried fruits and sugars and high fructose corn syrups and legumes, and you do that for a period of time. Not everybody needs to go to that level, and for many people it's important that they work with somebody who's a nutritionist or somebody who can help them navigate the world with this, because, like I was mentioning earlier, you got to figure out what you're able to eat. Dr. Mark Hyman: So let's talk about some of the other approaches besides the dietary restrictions that we would take. We might get of [inaudible 00:18:12], get off grains, get off beans, get off sugars, get off all the things that you mentioned. What do you do for the bad bugs? How do you reset the gut? How do you rebuild the gut? Dr. Elizabeth Boham: Oh, great question. So depending on what's going on in terms of dysbiosis, dysbiosis just means imbalance in good and bad bacteria and yeast, and depending on what we find is going on, we will treat that. So we can treat that with a prescription medication. So sometimes we'll use an antibiotic. I know that sounds kind of crazy because you're like- Dr. Mark Hyman: Counterintuitive. Dr. Elizabeth Boham: Yeah, we're like, "Wait, we know antibiotics cause dysbiosis." True, but sometimes if people, depending on their level of symptoms, we can improve symptoms with a short course of a non-absorbed antibiotic. So sometimes we'll use an antibiotic for a period of time and then we'll use an antifungal medication and then there are times- Dr. Mark Hyman: Because you always follow the antibiotic with antifungal? Dr. Elizabeth Boham: Yeah. I mean, I often do. Again, it depends on what I find with the testing we do through stool testing and breath testing and their clinical situation. So I often will follow with an antifungal or I'll follow an herbal medication that includes ... There are many different herbs that they have effect at both treating bacteria and yeasts. So we can use some herbal regimens. There's a lot of good ones out there that will treat both bacteria and yeast overgrowth. And that's one of the nice things about herbal regimens, I find, is that when you're resetting the bacteria in the gut and the yeast in the gut, is they may be a little slower to act, but they sometimes are really effective long-term. So there's a few herbal regimens that we use very often and some have been really well studied. Dr. Elizabeth Boham: We also do things that help the body with digesting your food. So whether that's something that increases acid in the stomach, like betaine HCL or a digestive enzyme, there's digestive enzymes that are plant-based digestive enzymes and then there are other digestive enzymes that comes from ... They're porcine, they're glandular digestive enzymes- Dr. Mark Hyman: From pig, yeah. Dr. Elizabeth Boham: Those things help with breaking down your food, your protein, your carbohydrates. They help with breaking them down so that they're easier to absorb into the body and less likely to feed the dysbiotic bacteria that we were talking about. Dr. Mark Hyman: That's great. Dr. Elizabeth Boham: So that's also really helpful. Dr. Mark Hyman: So I think the unique thing about functional medicine is that you not only just get rid of the bugs, but you focus on resetting the whole gut, whether it's an antibiotic, an antifungal, and herbs, and I would love you to talk about what herbs, or then you add in enzymes and other pre- and probiotics and repair components for the gut. That's what really helps people get better, right? Dr. Elizabeth Boham: Yeah, absolutely. Dr. Mark Hyman: So tell us about the cases, you had a 35-year-old guy, had quite a remarkable story. Dr. Elizabeth Boham: Yeah. So there's this gentleman, he was 35, and he came in to see us and he was really frustrated with his bloating. What he said is that he felt fine in the morning and then as the day went on, he became more and more distended. He became more bloated in his belly and distended. So it's really important, as I said, that we get really detailed clues as to his history. What really helps many times is when people take that really detailed history and they think about their own timeline. When did this start? How long has it been going on? Trying to help get the clues as to what triggered this to occur for them. Dr. Elizabeth Boham: So we knew that as a child, he had ear infections, so he was on multiple rounds of antibiotics, but then two years ago he developed a pneumonia. He ended up, the first round of antibiotics wasn't helpful at getting rid of his pneumonia and he needed a second round of antibiotics. So we also need to delve into this risk for pneumonia here and everything, but it was those recurrent rounds of antibiotics, at that point, since that point, he's struggling with bloating. So at that point, he started saying, "Okay, now every time I was eating, I was getting more bloated." And prior to that, he could eat whatever he wanted. He really didn't have to be careful with his diet at all. Dr. Elizabeth Boham: Now, he noticed if he ate too much dairy, he would get bloating and diarrhea. We did do a SIBO test and it was negative, but while we were waiting for his stool test to come back, we just decided, "Okay, let's pull away gluten and dairy." He wasn't really ready to go on a full low-FODMAPs diet and I didn't even know if it was really necessary for him right away. So we said, "Okay, let's pull away gluten and dairy." And when we did, he had significant improvement in his symptoms, but not complete improvement. He felt better, but he still was getting some bloating depending on what he ate. So the stool test came back and it was really interesting, it showed a dysbiosis, it showed an overgrowth of many different bacterias and some yeasts. So we then treated him with an herbal regimen. Dr. Elizabeth Boham: So we used something that had a combination of different herbs, oregano, berberine, it was a combination product, and he took it for six weeks and he found that extremely helpful. We did add in probiotics. We did wait to add in probiotics till we were done with his herbal regimen, but once we did add in a general probiotic, and there's so much to discuss with probiotics, but he found that to be really helpful. Now he's back to ... I mean, he really is careful with dairy and has a really good, healthy diet, but he's really much more comfortable all the time now. Dr. Mark Hyman: Well, let's talk about that. I mean, the probiotics can be problematic. A lot of people with irritable bowel, they go, "Oh, I'm going to take probiotics," and they go to the drug store, they go to the health food store and they get the probiotics, and they take them and often they get worse. Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: Can you explain that there's an important order to doing things and that what would be beneficial at one point might be harmful at another point? Dr. Elizabeth Boham: I think that's absolutely true. Order is really important. If somebody does have an overgrowth of bacteria in the wrong place, sometimes probiotics make that worse. If you take a probiotic and feel more bloated, or your digestion feels worse, not better, then that's the wrong probiotic or could be the right probiotic, but at the wrong time. So it's really important that you're either working with somebody who knows how to recommend what order of things to do it in, or just knowing that if it doesn't feel right to you, put it on hold. There's lots of different brands of probiotics out there, and quality of probiotics out there. Some probiotics have dairy in them, and so for people who are dairy sensitive, they don't work and other ones don't. There are also some strains of probiotics that can, in and of themself, depending on the milieu, increase the amount of bloating for certain people. Dr. Elizabeth Boham: So there are it's hard to give a general recommendation. It's hard for me to say, "Well, take one," because it doesn't work for everyone, but just know that if you try one and it makes you feel worse, put it aside and it may be that it's just not the right one for you or it's one to try at a later date, after you've gotten rid of the dysbiotic bacteria. Some people get a probiotic and they feel better right away, and then that's great. Dr. Mark Hyman: Wow. Yeah, it's complicated. So if you're struggling with this, don't lose heart, there's a lot of things. I mean, you [inaudible 00:26:55] mention histamine intolerance. There's just a lot of things that cause problems, which we've covered a lot on the podcast, but the key is that if you suffer from bloating, if you have this food baby, if you're really miserable and uncomfortable, all that, there is a way to get through it and fix it. Dr. Mark Hyman: Do you want to know my secret for living a long and happy and healthy life? Well, all I have to do is check out my weekly newsletter Mark's Picks, where I share my favorite tips for health, longevity, wellbeing, and lots more. Check it out at the link below. Dr. Mark Hyman: You also, I think, had one other case of a woman who was 25 and was also struggling. Dr. Elizabeth Boham: Yeah, I mean she was also- Dr. Mark Hyman: Kind of classic history- Dr. Elizabeth Boham: Mm-hmm (affirmative). Lots of antibiotics for ... She had acne, so she was on lots of antibiotics between the ages of 17 and 22. This is what we were talking about before, her bloating was so significant at this point that it was preventing her from doing things. She wasn't getting out during the day, she wasn't seeing friends all the time, she also couldn't eat as much. And just with her body type, if she wasn't eating enough calories or enough protein, she was starting to lose weight and she was getting underweight. She was also losing lean muscle mass. This then creates this vicious cycle because if you don't have enough nutrients coming in, then the body can't heal. I always talk to people about that. People are always restricting foods, which elimination diets can be so helpful, but sometimes if we're eliminating, eliminating, eliminating, and then not getting in enough nutrition, then the body can't heal. And this is what was happening with her. She was eliminating so much that she was wasting, her lean muscle mass was decreasing, she was feeling more weak. Dr. Mark Hyman: Because if you feel bad when you eat, you don't want to eat. So you start to lose weight, you lose muscle- Dr. Elizabeth Boham: Exactly. So she was just not eating. And she was more constipated. We did a SIBO test on her. It was positive. It was positive for both methane and hydrogen SIBO, but much more positive for the methane-positive SIBO. And what we know- Dr. Mark Hyman: Yeah, talk about that. So we do this testing, which is you just drink this liquid that tends to cause the fermentation, and then you breathe into this bag, and you can tell whether it's hydrogen or methane, and each are different and they actually respond to different treatments. So it's important to know which type of gas you're producing, because that means it's different bacteria, and so you need different drugs or different herbs for different bacteria. Dr. Elizabeth Boham: That's so true. That's so true. So what we know is that the methane producing bacteria are more likely to cause constipation. They're more likely to impact the motility in the digestive system and cause more constipation. So the hydrogen producing bacteria, are more likely to cause diarrhea. Now that's not always the case. Like sometimes people, their testing looks one way and it doesn't always match up, but in general, we see the methanobacteria, the methane-producing bacteria, more likely causing a constipation picture and bloating. So you're right. So sometimes the medication, there's a typical prescription medication that's used for SIBO called Xifaxin, but when you find the methane-producing, it typically works better when you use it with neomycin together, you use both together. Dr. Elizabeth Boham: She also did well when we put her on that low-FODMAPs diet. We really pulled away. She needed a nutritionist on board because, as we were mentioning, she was becoming underweight. So she really needed somebody to guide her through. And as you know, at The UltraWellness Center, we've got all our nutritionists working with all our patients, which is wonderful. So her nutritionist was really helpful to guide her through the pulling away of the foods that were making her feel worse, but then getting her the nutrition she needed and then slowly transitioning over time, so she could add back in those healthy higher FODMAPs foods, like the onions and cauliflower and fruits that we want to be able to add back in when possible. Dr. Elizabeth Boham: So after we treated her and got rid of that dysbiosis, she started to feel so much better and, nutritionally, she responded well. She was able to digest and absorb her food better, which is really important because when there's that imbalance going on, you're not digesting well, you're not absorbing well, she was getting weaker. So she was able to digest and absorb better and she was nutritionally getting stronger and healthier and her gut was healing, and we could add back in those good, healthy, higher FODMAPs foods that she was able to tolerate. Dr. Mark Hyman: I mean, it's quite amazing how many people really struggle with this and how hard it is for people to overcome this and how traditional doctors really aren't that great at addressing this and that there really is a new way to do this, more comprehensive way, using the approach of functional medicine and getting people the kind of support they need to rebuild their whole gut. Because it's not just about taking the antibiotics and that's it, it's really about a whole gut healing and repair approach that's with functional medicine, and also the right kinds of testing and everything. So I think it's super important to understand for people listening that this is not something you have to live with your whole life, this is not just who you are. That it's really, really important to actually dig in and figure it out and get to the bottom of it. Dr. Elizabeth Boham: You made such a great point there, Mark, about the comprehensive approach, and I think that's what we need more of in healthcare. It's really important in this situation that people get all of that comprehensive care with having a nutritionist on board, somebody they can check in with regularly, that's really following up with how they're doing and really digging in and finding that underlying root cause for them. It's so much more successful than that knee jerk approach. Dr. Mark Hyman: Completely, completely important. Wow, well, I think for those listening, if you've experienced bloating and if you know what I'm talking about or what we're talking about, then it's important for you to take this seriously, because it's not just something that is annoying, it actually indicates that your overall microbiome is out of balance and your health of your microbiome determines your health and longevity. So it is annoying, but it's also more than that, and so really working with the right practitioner, getting the right kinds of testing and diagnostics is so important.