Case Study: How We Helped Heal a Patient’s Hypothyroidism

How Dr. Hannah Hamlin guided a patient from a questionable hypothyroid diagnosis to symptom relief using diet, mental health, and simple lifestyle changes.

For a patient of our clinic’s own Dr. Hannah Hamlin, she received two diagnoses from previous practitioners: colitis and hypothyroidism. While the colitis was evident from endoscopic imaging, her hypothyroidism was questionable, especially with her thyroid lab results being in the normal range. Dr. Hamlin followed our clinic’s approach of looking at her symptoms, medical history, previous response to treatment, and lab values to determine the right course of treatment.

In the episode, she shares how her patient’s symptoms of diarrhea, fecal incontinence, orthostatic hypertension, anxiety, PMS, and more dramatically decreased when implementing dietary and lifestyle changes necessary to healing the mind and body. Tune in to hear the patient’s full story and how to establish a healthy mindset for a healthy you.

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Intro:

Welcome to Dr. Ruscio, DC Radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. The following discussion is for educational purposes only, and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now, let’s head to the show.

Dr. Ruscio, DC:

Hey everyone. Today I spoke with Dr. Hannah Hamlin, one of the amazing doctors on our clinical team. We discuss a couple things. We discuss a case study of colitis (lining of the gut being inflamed), in this case, what’s known as lymphocytic colitis, wherein the immune cells are infiltrating and inflaming the lining of the colon, who was also incorrectly told that she was hypothyroid. And we kind of talked through “what does this look like? What did we do? What helped her?” So, gut-thyroid interplay and how all of these other symptoms that we should be paying attention to, like anxiety, like insomnia, can improve when we tend appropriately to someone’s gut health. So we share that case study from our office. We also talk about the importance of mindset, and how, for some people, previous traumatic events, namely in childhood, can lead to either IBS, anxiety, or both, later in life.

Dr. Ruscio, DC:

And we tie this into why it’s so important to not over-test, to not incorrectly diagnose, and I guess not to get swept up in all of the bells and whistles of things that could be wrong with you because XYZ test said so practice that is so commonplace in functional healthcare, because those things feed what can be this hypersensitivity to stress. And we briefly cover a study that looked at how time in nature impacts activation of the amygdala. So we really kind of hit a broad swath of topics, but we can encapsulate this under: Make sure you improve someone’s gut health if there is a problem there. Be careful regarding the over and excess diagnosis of thyroid problems in the field, and be attentive to the language that you use and how you frame healthcare. Because for some sensitive people, and by sensitive I mean they can be a bit over-reactive to stress due to prior life events, handling the conversation the right way can help those people, and handling it incorrectly can actually make them worse.

Dr. Ruscio, DC:

And that’s the overview that Dr. Hamlin and I discussed today. And remember that if you are in need of help, we have such a great clinical team. Anyone at the clinic would be more than happy to help you. So, if you are in need, again, please feel free to reach out any time. Alrighty. And with that, we will now go to the conversation with Dr. Hannah Hamlin.

Dr. Ruscio, DC:

Hey everyone, welcome back to Dr. Ruscio, DC Radio. This is Dr. Michael Ruscio, DC joined today again by Dr. Hannah Hamlin from the clinic, and we are going to be talking about a case study of lymphocytic colitis plus incorrect thyroid diagnosis, and then a little bit about adverse childhood events and how this can lead to digestive symptoms. So Hannah, welcome back. I’m looking forward to unpacking some of these topics.

Dr. Hannah Hamlin:

Thanks. I’m happy to be here.

A case study on the importance of fundamentals

Dr. Ruscio, DC:

Yeah, it’s nice for me to be able to connect with some of the doctors on our clinical team, just so that our audience knows that it’s not just me in the clinic and that we have an awesome, empathetic, intelligent, and dedicated team of doctors all working together. And you did a really nice case study that so nicely portrays a lot of the items that we really try to bring to the forefront of the conversation, which involve… GI care is quite important, it doesn’t have to be exotic, and the fundamentals work very well. Plus, oftentimes people are <laugh>, kind of force-fed thyroid medication. And, you know, this case study that you wrote up for, I think it was the July Future of Functional Health Review, was a nice portrayal of that. Do you maybe want to give us the summary? We’ll start zoomed out and then we can share some of the details?

Dr. Hannah Hamlin:

Yeah, absolutely. So I think that kind of getting started with just general presentation is a good way to follow the flow of the case. So this patient came to me earlier last year with multiple symptom complaints, not just in the GI tract but kind of multiple areas. And so she had daily diarrhea, with actual kind of total fecal incontinence. So really severe, it had impacted her quality of life to the point where it’s just challenging to leave home, kind of not being able to predict her bowel movement frequency. She had abdominal pain with that, and bloating, she was having some sleep disturbance, and kind of this new symptom of orthostatic hypertension where she was getting lightheaded when standing up quickly. And that was significantly worse on the days where she was having more severe diarrhea. Likely just with the associated dehydration component. She also had some baseline anxiety that had been going on for her since her early years, and then some PMS symptoms that came with painful periods.

Dr. Ruscio, DC:

And this is a pretty typical, I would say, presentation that we see. And I think any clinician working with gut symptoms, you’ll see, sure, diarrhea, abdominal pain, bloating. But, as I learned, if there’s a problem in your gut, it can tank your sleep and cause issues with mood, and in this case I’m assuming there’s some carryover and influence on her PMS. So yeah, just kind of a normal constellation of symptoms that we see. Alright, where do you go from here? You’re taking this in, and what thoughts do you have, and where are you going next?

Dr. Hannah Hamlin:

Yeah, so, you know, I think that… I completely agree. This is a very common picture that we have coming into the clinic. And typically the next piece for me is really understanding the patient’s story. Kind of looking at the progression of… when did these symptoms start, how long have they been going on? And understanding the impact on quality of life for the patient is huge. So for this particular patient, she grew up with chronic constipation and some anxiety that started in childhood, and in kind of the midlife age range had her gallbladder removed. She had significantly worsening symptoms after that. That’s kind of when the diarrhea had started for her, and the abdominal cramping, and it just tended to kind of get worse yearly after that. And I saw her kind of about 10 years after this happened. So she had had about 10 years of this type of abdominal symptoms that was worsening up until a few months prior to seeing us.

Dr. Hannah Hamlin:

Closer to coming into our clinic, she had had the diarrhea worsen to that fecal incontinence piece, which had created the kind of feeling stuck at home, quality of life component, and that’s when she came to us.

Treating diarrhea upstream

Dr. Ruscio, DC:

Right. And we’ll get to this in a moment in more detail, but I do want to just foreshadow the fact that we are finding that diarrhea responds very, very well to what we do in the clinic. And this includes even in cases of what we’re going to presume here is bile acid malabsorption, right. We didn’t do the full workup to technically make that diagnosis, but certainly with the cholecystectomy history and then symptoms of diarrhea starting after that, that’s as textbook as you get.

Dr. Ruscio, DC:

And we’ve discussed on the podcast in the past that there’s different ways that we can look at intervention. One could be treating the symptom: I have diarrhea, let’s treat that with cholestyramine, let’s say, or some kind of binder. And that’s okay. But at the clinic, we’re intervening upstream, and we’re trying to repair the lining of the intestine. And for our audience, remember that it’s at the terminal or the end of the ileum, end of the small intestine, that that bile gets reabsorbed. And if it gets reabsorbed by a healthy intestinal lining, it does not then make its way into the colon where it causes that diarrhea. So I just want to kind of plant that foreshadow and frame that context for our audience.

An improper thyroid diagnosis

Dr. Hannah Hamlin:

Yeah, I think that’s an important piece, and I agree with the diarrhea being a common thing that does respond quite well. And so with that, this particular patient had been diagnosed by her local gastroenterologist with microscopic lymphocytic colitis that was found on colonoscopy with biopsy. So that was kind of the working diagnosis when she came into our clinic. Just a note, she had also been diagnosed with hypothyroidism a few years prior with her functional and integrative doc that was local to her.

Dr. Ruscio, DC:

And that’s a key note <laugh>. And part of the reason why we know that it was the functional/integrative doctor that made the diagnosis is because we track this now as part of our intake, because the misdiagnosis is so common in this community. And it’s not something that, you know, it’s not meant to be a disparagement of the community, but I guess for our audience, just please appreciate that it is so commonly an accurate predictor of incorrect diagnosis that we put it into our paperwork. So <laugh>, you know, I think that really speaks volumes to how much we as a community of integrative and functional providers need to be a little bit more discerning with that diagnosis.

Dr. Hannah Hamlin:

Yeah, absolutely. And I think that understanding what happened with the lab work at diagnosis is also helpful. If it’s subclinical versus autoimmune versus another etiology, that can tell us kind of what are the options moving forward for that patient. And so I agree, I’m glad that we… I think universally, all the clinicians at the clinic ask that to patients coming in.

Dr. Ruscio, DC:

Absolutely. And what did you take away from her prior use of thyroid hormone, her prior testing? And you know, it’s always a balance with case studies because we don’t want to go so into the details where people gloss over. But was there anything from reviewing her prior testing that really kind of stuck out to you?

Dr. Hannah Hamlin:

Yeah, so looking at her initial diagnostic labs for when she was diagnosed with hypothyroidism, she had a TSH that was at around 0.6, so not hugely elevated, which is kind of helpful to understand. T4 and T3 were also within normal range. And so it didn’t really scream that her thyroid was hugely out of place when she started the medication. She was also started on an incredibly low dose of thyroid medication and had maintained that dose, without a huge change in her thyroid levels as they had been kind of followed up many times. And so it was interesting to see for this particular patient that not only did the thyroid hormone not seem to adjust her thyroid levels, but that her thyroid levels weren’t hugely out of range when she started it.

Dr. Ruscio, DC:

Yeah. I mean she was in range, right. But I guess this is all about whose ranges we’re looking at. I’m assuming it was the free T4, or maybe the free T3, that the provider was taking issue with. But I mean this is what’s so frustrating, I think Hannah, to you and I and us at the clinic, where the lab work that diagnosed hypothyroid, this person clearly did not have hypothyroid. Maybe you could say there were some issues with the nuances of conversion, but again, for our audience, it’s really unfortunate when someone gets put on medication that is oftentimes assumed to be lifelong, when the thyroid function is okay. And, you know, maybe you’re seeing some minor perturbations of T3… and also, like you said, Hannah <laugh>, the dose goes up and… because I’m looking at some of the notes from your writeup here, and there’s not really much of a change.

Dr. Ruscio, DC:

Her TSH goes a little bit lower, but her other values don’t, especially her free T4 doesn’t really budge. And this is, I think, a good flag for individuals to keep in mind. What I’ve seen, and I’m assuming you’ve seen the same thing, Hannah… I can only speak in terms of the charts I’ve looked at for my own patients, but I think we’re all in agreement that when someone doesn’t need hormone and then they’re given hormone, it doesn’t tend to do what you want it to do. And that’s where you have these “well, we increased the dose”, yet the level still didn’t budge a whole lot. But let me check in with you, I guess a good chance for me to ask you, are you seeing that same thing in some of these cases?

Dr. Hannah Hamlin:

Yeah. Yeah, I am. And it’s interesting, I think to your point, you know, when someone is not feeling well, and usually fatigue comes with this type of or slew of symptoms that we see, I can see how it would be tempting to want to start someone on thyroid hormone, just wanting to help them feel better and gove them more energy. And it’s clear that this person probably didn’t qualify based on the literature that we’re reading and we’re finding and following so closely at our clinic, but also didn’t seem to respond from a lab work perspective or a symptom perspective. And so yeah, I agree. This is something I’m seeing commonly.

Dr. Ruscio, DC:

Yeah. So again, just for our audience, you know, this is why we talk about this topic in particular a lot, because, and like I’ve said before in the podcast, we’re seeing a case like this roughly once per week probably. Sometimes, you know, more often. It does depend, I think some of these things go in ebbs and flows, but certainly seeing this way more than I feel like we should, Hannah, right? Like, this shouldn’t be something that’s a commonplace observation.

Dr. Hannah Hamlin:

Yeah. And I think it kind of can distract from the true root cause of the problem. I mean this patient had diarrhea and was obviously malabsorbing by the frequency and severity of it. And so there were clear other kind of ways to look for the root cause of that fatigue, that maybe got pushed back a little bit further because we stopped and looked at the thyroid more than we needed to.

Dr. Ruscio, DC:

Yeah. And that’s another reason why it’s just so important to not jump to thyroid when there’s, you know, clearly a little bit of a mess in the GI. And speaking of which, you know, what else are you thinking of? Let’s keep going with your train of thought.

Dr. Hannah Hamlin:

So, you know, this patient had tried many different diets and been on previous treatments before coming to me. And she had found some improvement of general GI symptoms with a Paleo-like diet, and really seen some improvement with intermittent fasting too. So she knew that those were tools she could lean into, but she was still having the daily severe symptoms, and so it wasn’t moving the needle enough for her. She also had been prescribed cholestyramine by her local gastroenterologist, and that helped in the beginning, but stopped working after a few months for her. And so she felt like she was a little bit at a loss for what to do next.

Dr. Ruscio, DC:

Yep, makes sense. And as you’re analyzing this, where are you going next, you know, in terms of treatment recommendations, or do you want to give any other high level remarks? I just kind of want to let you lead here, and I don’t want to get in the way of your thought process, so please feel free.

Dr. Hannah Hamlin:

Yeah, so next, I really focused in on: what are the most likely root causes of this for her? We saw those local inflammatory changes at the biopsy level, so we knew that the inflammation was present in the location of the GI tract, but really what was the root cause? What was the why behind that? So as I was thinking through differential diagnosis, one of the things that had really stuck out to me was that she just was not sleeping well, and this chronic loss of sleep could have been a contributing factor with increased cortisol and stress. So that was kind of the low hanging fruit of recommendations to give. The other piece was this kind of low grade anxiety. She did endorse to me that she noticed on days where she was having more stress in her life that her diarrhea symptoms were significantly worse. And that was kind of a trend that she had noticed. And so my thought process was: what kind of things could we lean into in that direction? Then the big piece is really considering the possibility of dysbiosis (or an imbalance of kind of the beneficial and less beneficial bacteria in the GI tract) and thinking what can we do? What would be obvious next steps to work on for optimization in that area?

Dr. Ruscio, DC:

Yeah. So all of these core essentials that are really intervening upstream, and I appreciate the way that you’re framing that, which is, you know, how can we think about these symptoms not so as to treat the symptoms, but rather what do they tell us in terms of what could be going on upstream? So yep, this is great, the right way of framing this.

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Initial treatment & testing recommendations

Dr. Ruscio, DC:

Where did you go or what did you recommend for her initial treatment and/or testing recommendations?

Dr. Hannah Hamlin:

Yeah, so we started off with doing a GI-MAP by Diagnostic Solutions. And we’re doing, I feel like less and less of these now, just not needing to, because we’re getting better at learning the patient’s story. But for this patient, her symptoms were significant, impacting her quality of life, and really, you know, quite severe. So I thought, let’s take a deeper dive in the beginning so that we can understand what’s going on.

Dr. Ruscio, DC:

Let me interject one thing here just for our audience, because with these case studies, you know, this was published in July and that case study was from a few months before that. So because the clinic is constantly thinking through what we’re doing and evolving things, it is important to just echo what you said, Hannah, which is we’re doing much less, and we kind of officially made this decision maybe two months ago, much less stool testing and SIBO breath testing, because we’re just not finding it influential enough in the treatment. So, you know, it’s always hard to say what you would’ve done if you were seeing this patient today, but I think we could safely say the probability of us doing a stool test out of the gate would be a lot lower. And that’s important because I always wince a little bit when we recommend… or we’re not necessarily recommending or advocating for the test on the podcast, but I think just by us saying a test name, it leads some people to say, “Ooh, I gotta go out and do that test.” And I just want to, you know, echo for our audience one more time: please do not make the mistake of thinking a stool test is going to tell you how to fix all of your GI problems. We’re doing much less of those now, because we’re just not finding that to be the case. So anyway, I just want to make that one, I guess PSA, Hannah.

Dr. Hannah Hamlin:

Yeah, no, I love that you emphasize that, and I’ll say reducing the amount of stool testing that I’m doing, I don’t find that the results that we’re getting at that first follow up are changing much. I think we’re, you know, getting the same results. It’s just that we’re learning and growing and I love that we have the ability to change our practice as we learn more from the literature and kind of find better flows of things. And so I love that that’s a testament to, I think, really growing.

Dr. Ruscio, DC:

Yeah. And trying to really stay true to the cost-effective nature of care that we espouse.

Dr. Hannah Hamlin:

Yeah, absolutely. That’s so important.

Dr. Ruscio, DC:

Alright, so let’s keep rolling through this.

Dr. Hannah Hamlin:

So what we did as far as recommendations while we were waiting on the stool test results was we really looked at: how can we calm down her inflammation quite quickly? And so I recommended a 2-4 day elemental reset, and we used the Elemental Heal powder on our website, and she did that as an exclusive meal replacement for 2-4 days, replacing all of her calories. After that recommendation, I suggested that she move her way into a Paleo low FODMAP diet to continue to calm down inflammation, Isee if we can kind of reduce her symptoms until our next follow up. Now this wasn’t a long-term nutrition recommendation, but it can be used in a temporary chapter to really kind of help mitigate symptoms, and that was the goal. That if she found that those FODMAPs were flaring her symptoms, it’s important to kind of reduce them at about 80% compliance just so that we’re not continuing to kind of rock the boat with the local inflammation and we can really work on healing.

Dr. Ruscio, DC:

Yup, great. And I love the fact that you said 80% compliance. I’ll just reiterate that for our audience: 80%, 80%, 80%. You know, don’t make your life too hard aiming for 100% compliance because it’s just so difficult. It can be stressful. So give yourself that 20% license.

Dr. Hannah Hamlin:

Yeah, I think universally that’s the most common recommendation is that that last 20% just doesn’t move the needle enough to I think justify the stress that can come with the social impact.

Dr. Ruscio, DC:

Yep, totally.

Dr. Hannah Hamlin:

The other things that we recommended were the low hanging fruit of the lifestyle changes, things that maybe could kind of move the needle on optimization further as she was going through this healing chapter. And so she already was doing a great job on exercise and sauna, but really that stress piece seemed to be a big thing. And so I recommended that she try 10 minutes of meditation a day, just to see if that could kind of help reduce things. And so that was part of the initial recommendations. And then the supplement that I recommended was our Triple Probiotic Therapy and our Gut Healing Nutrients, and really to kind of lead out of the gate with both was, again, just due to the severity of her symptoms, but the Triple Probiotic Therapy was something that made sense due to the inflammatory changes that they saw in colonoscopy.

What happened next

Dr. Ruscio, DC:

Sure, sure. Okay. And we give her a number of weeks on this protocol. How did she respond?

Dr. Hannah Hamlin:

Yeah, so about six to seven weeks later, that’s when she followed up, and she answered her pre-appointment questionnaire at 90% improvement. And I was honestly just really excited about that, and kind of shocked before I called her to check in and start our appointment together. And so I thought, gosh, I mean, that sounds wonderful. But really it was 90% improvement in the way that she felt for her overall life. And she saw that her symptoms like the diarrhea had decreased significantly, but overall she had lost the incontinence piece, which really kind of gave her her life back and the ability to leave the house without so much concern.

Dr. Ruscio, DC:

Absolutely. Yeah. Yeah, that’s a big one.

Dr. Hannah Hamlin:

So she found that overall, the biggest things that had kind of changed were the significance of the diarrhea, the severity of it, which had decreased, the dizziness on standing, which really helped. Her sleep had also improved. She said that she was still awakening, but it was easier to fall back asleep and she found that the meditation significantly helped with her anxiety, and so she liked that and wanted to continue it.

Dr. Ruscio, DC:

Love it, love it.

Dr. Hannah Hamlin:

She also mentioned that she checked in with her local providers and had stopped her thyroid medication and didn’t notice a change in her symptoms with stopping. So she was happy to continue without needing to take that medication daily.

Dr. Ruscio, DC:

That’s fantastic. Okay. And so now we are in possession of an easier to live life, right. She doesn’t have to be staying home. Gosh. And that has to be so hard, for an extended period of time just feeling like you can’t leave home because of incontinence. So life is improved off of a medication, and where are you going next? What are you thinking?

Dr. Hannah Hamlin:

Yeah, so next, you know, we looked at the stool test results and found some imbalances there that suggested it would make sense to move forward with some antimicrobials and really kind of looking into what could we do to help kind of further optimize the microbiome. We continued the Triple Probiotic Therapy since that had worked so well for her, and continued the Paleo low FODMAP diet. She did notice that there were some FODMAPs that were causing worsening in the abdominal cramping. And so she endorsed that she wanted to continue eating that way until we could expand her diet without the symptoms worsening. So the next thing that we led into was herbal antimicrobials, and kind of waiting to follow up and see how she did from there.

Dr. Ruscio, DC:

Awesome. Awesome. And have you followed up with her again since then? Or was that the last visit you had with her?

Dr. Hannah Hamlin:

That was the last visit that we had. And on that last visit we also discussed the option of leaning in a little bit more to limbic retraining through the Gupta Program, and she was interested in learning a little bit more about that, just since she had really felt that the meditation helped her so much. We find often here, and I think Michael, you taught me this, is when something’s working, if you can lean into it a little bit more often, you can get more benefit. And so we’ll often do, you know, increasing doses of probiotics that are already working, or leaning more into this. And so that was the thought with the limbic retraining recommendation was the meditation helped so much, let’s lean more into that approach.

Less treatment & testing, better results?

Dr. Ruscio, DC:

Yeah, love it. And I feel like collectively we’re using antimicrobial therapy less than we used to. And I feel that’s because, like you said, we will have someone increase their dose of probiotics, we’re getting better with lifestyle, we’re getting better, I think even further yet still, with the psychological piece of things. And maybe part of this is because we’re ordering less labs, so patients have less words in scary red font that they have to look at that kind of, you know, makes them nervous psychologically. But certainly… it’s funny, Nick Hedberg sent me sort of a satirical image, and he called it the Hedberg Ruscio Index <laugh> or the Hedberg Ruscio Rule, which is there’s an inverse relationship between the number of tests ordered and the clinician’s competency. And so I think that we’re following that trend in the correct direction where the better we get as a clinical team, the less testing that we’re ordering, the less treatment that we’re doing, and the better the results that we’re getting.

Dr. Ruscio, DC:

And I just can’t say that enough, because I think one of the challenges for new clinicians, which I totally felt, and I was absolutely there at one point myself, is you want to help so bad that you don’t want to potentially not issue a support that could help the person. So you give this and that and the other thing and the other thing and the other thing, and you know, the psychology, and I remember this, is “well, you know, they’re kind of tired, and I know I didn’t give anything for their adrenals, and I just, I really want them not to be tired.” And I get that. But, you know, the reason why I sometimes admittedly beat this horse to death is so that patients and clinicians can appreciate that less is really more, and the minimal effective protocol is what we want to aim for.

Dr. Hannah Hamlin:

Yeah. I completely agree. I know Dr. Mather had mentioned on one of our calls this past week that sometimes even the frequency at which we have to do things to optimize our health or do things to try and mitigate our symptoms can be reminders that there’s something imbalanced that then almost creates a situation where we’re thinking about it more. You know, the more special we have to eat, or the more supplements we have to take at specific times, it can create this space where we feel like a sick person often. And we have all these reminders built into our day about it. And that’s not conducive for optimal healing. You know, I think that it can be that sometimes over focusing on it just doesn’t help. So I agree with the labs, but I think also that the simplified piece is helpful, and it also just leans into that direction of… the body is kind of self-healing once we take away some of those factors that are, you know, preventing it from doing that. We don’t have to check all our balances and micromanage everything, that it can do a lot on its own if we give it the right support.

Dr. Ruscio, DC:

Yeah, great points. And also, I just want to echo that recommendation from Joe. And this is something that we’ve been having a back and forth on, and we’ve actually discussed this on the podcast before, going even back to probiotics. Does it really matter if they’re with food or on an empty stomach? I don’t think so. I haven’t seen any credible evidence that suggests one way or the other. And I also picture in my head some of the dosing tables patients have come in with and it’s literally an Excel sheet <laugh>. And this is part of what Dan Kalish used to teach, I’m assuming things have updated since then, and I think these things were done with good intention, but then you see how it negatively impacts patient psychology like you’re suggesting Hannah, which is, “I’m really sick, I have to take, you know, eight doses of stuff per day because my body is so broken.”

Dr. Ruscio, DC:

And in some of these tables, it would be first thing in the morning, you know, so this is like your potential for dosages. First thing in the morning, before breakfast, with breakfast, afternoon, lunch, mid-afternoon, empty stomach, dinner, evening, before bed. That’s nine points of dosing. And clinicians, we’re thinking, and again, trying to help, right. But I think we need to be better collectively as a community in saying “whoa”, like, we get that this is intended to help people, but it’s actually making some people worse. Because again, as you’re suggesting, Hannah, it’s such a great point, that that has this psychological weight that it carries. Like, “my body is so messed up that I’ve got to constantly be like feeding it these different supplements and supports.” Whereas we could say, yeah, take it once per day, ideally twice <laugh> , and then go and like live your life, and don’t walk around with your table in your purse that you’re checking like 15 times per day to make sure that you don’t miss a dose.

Dr. Hannah Hamlin:

Yeah, absolutely. And I think what we focus on is what grows in our minds, you know, and I think that if we’re focusing on joy, and I love that you said that, you know, go out and live your life and have fun. Those things are important to lean into. And so that’s part of the healing process, is really being intentional about what you’re focusing on.

Adverse Childhood Experiences & IBS

Dr. Ruscio, DC:

Yes. Because we only have so much focus and so much time in a day. And you know, this is a nice tie-in with the research overview that accompanied your writeup. So outside of the case study, there were also some research reviews looking at the association between Adverse Childhood Experiences, anxiety, and IBS. What points there do you think are worth reiterating or sharing?

Dr. Hannah Hamlin:

Gosh, you know, the adverse childhood experiences studies are massive and just really insightful, and they’re kind of these studies I’ve been so interested in as I’ve grown as a clinician. It really highlights the connection between the mental, psychosocial aspect of health, and the physical symptoms that we have. And so one of the studies that really stood out to me that I think is very applicable for the type of care that we practice was looking at the connection between adverse childhood experiences, anxiety, and IBS. And what it found was that there was a clear correlation between having this score of Adverse Childhood Experiences (which is a general kind of questionnaire that is used to identify emotionally challenging situations including emotional neglect, physical abuse, sexual abuse) in people, looking at how many of these items they experienced in childhood, which creates this score that we’re using in data to analyze, and looking at the types of diseases or the types of diagnoses that they have in adulthood.

Dr. Hannah Hamlin:

So years and years later, we find that there are really fascinating correlations. So this specific kind of breakout of that data looks at IBS. And it did find that people who have IBS tend to have increased Adverse Childhood Experience scores, and more general anxiety than the average population. And it’s really interesting to see that correlation. I think often that that can sometimes come across as this kind of self blaming idea, as in, “oh, they had a hard experience, they’re more emotional, maybe they’re making these symptoms up.” And that’s absolutely not what these studies are proving, they’re quite showing the opposite. And that’s that when we have these traumas or triggers that happen in childhood, it can change the way that we are developing our nervous system, and we can have a different threshold at which we’re causing that kind of sympathetic dominance or that fight or flight nervous system to get triggered and signal those physical changes. So we’re seeing physical changes here. That to me is what’s most exciting.

Dr. Ruscio, DC:

Yes. And it’s so important to make that delineation. This is not the clinician saying “it’s all in your head”.But there could be something in the brain that’s affecting the gut. So there’s a legitimate thing that can be supported. And again, I feel it’s crucial for us to make that delineation so that people don’t think you’re just being sloughed off and essentially told that you’re crazy. And we do know, from another kind of parallel body of research that to my knowledge is fairly robust, that patients with IBS have higher scores of anxiety and depression. This adds a layer to it that some of the anxiety and depression might not be from gut to brain, but instead is from brain to gut, presumably from the traumatic childhood experiences. And what’s interesting about this, building on our prior conversations, it’s nice how these puzzle pieces sometimes fit together so tightly <laugh>, so someone with a prior traumatic childhood event is going to be more sensitive, let’s say to stress, or more hyper-reactive to stress. And picture that person in a functional health office that says things like “if you have one bite of gluten, it’s going to upregulate inflammation in your intestines for six months. And this lab test…”

Dr. Ruscio, DC:

Like we talked about in that wonderful video conversation with Danielle whose doctor said, from a dysbiosis finding, “you’re really sick.” These things are the worst thing we could do for someone like this. But instead, meditation, or limbic retraining, or even walking in nature. In fact, credit to Scott and his great job overseeing the FFMR+ research feed, he plucked a nice study recently that took a group of people, and at baseline they were all shown pictures of people making terrified faces essentially. And they did MRIs and they looked at the amount of amygdala activation. Then, everyone went for a walk. Half of the people went for a walk in nature. Half of the people went for a walk in an urban environment. They came back to the lab, were again exposed to these terrified faces of individuals (pictures of faces), followed up with another MRI, and the amount of amygdala activation, which is where fear and the limbic system is centered essentially, dropped precipitously in those who went for a walk in nature, and it actually went up slightly in those who went for a walk in an urban environment.

Dr. Ruscio, DC:

So what this tells us is these simple things that we advocate for, like you said Hannah, potentially going for a walk in nature or meditation, these can literally help to correct the imbalances in the brain that might be leading to IBS, that might be leading to anxiety and depression. And so just so important for us to continually surface these findings and how they correlate, because it all does matter in terms of the interactions that you have with patients, the language that you use, and this can be something to help an individual or to harm them.

Dr. Hannah Hamlin:

Yeah, I love that study that Scott pulled, I think that’s so helpful at just looking at… how can we structure our lives to set us up for success, too? You know, not just optimization and illness, but looking at just overall, you know, how do we create these habits that help us optimize quality of life?

Dr. Ruscio, DC:

Yes, 100%.

Closing thoughts

Dr. Ruscio, DC:

Anything else from this study or some of the related ones that you went through that you want to share?

Dr. Hannah Hamlin:

Well, I think reiterating that it’s not something that the patient is choosing or I think even can consciously turn off all the way. Often these sensitivities to these physical symptoms that are changed if someone’s experienced Adverse Childhood Events, it’s really more this kind of subconscious loop. And that’s what I love so much about the Gupta Program that we talk about on here often, and the limbic retraining and the other courses available, is this idea that if we can look at: how do we optimize that patient’s IBS, for example? From these studies, it’s yes, looking at the the dysbiosis is important, and yes, understanding the nuance of how to eat in a way that’s supportive for overall health and inflammation is important. But I think that really leaning into: how much are those subconscious loops playing into this?

Dr. Hannah Hamlin:

And for some people, it might be more than others. And I think what I’m starting to think more and more just from seeing patients with these types of challenges is that it’s almost not “is this a part of their story or not?”, but it’s “how much?” You know, I think for everybody that there’s got to be at least some event. To some amount, we all grow up, and life happens, and different things, and we learn, you know, this idea of good and bad in our head and it can create all of this sensitivity. But I think for some people, it’s a lot more a part of their healing story than others. And it’s really identifying, who’s the right person to lean into that. But I do think it affects everyone. I don’t think it’s just some people.

Dr. Ruscio, DC:

Agreed. Yeah. It’s a spectrum. And this is one area that I’m really proud of the work that we’re doing at the clinic and being able to identify those people. And then just having our clinic model set up in such a way where we’re very intentional with our language and everything else. Like I’ve talked about before, we’ll interrupt patients when they say “my SIBO” or “my this”, and we’ll try to interrupt some of those patterns. Like I’ve said on the podcast before, sorry if this is trite, but if you sprained your ankle three years ago, you wouldn’t be saying “my sprained ankle” still, you would’ve moved on. And we don’t tend to do that with certain lab markers. So we help firstly debunk some of the BS lab markers and diagnoses people walk in with, and there it’s like, let’s shrug 20 pounds of emotional weight right there.

Dr. Ruscio, DC:

And we have an empowering way that we frame these things. And there’s another 20 pounds of emotional weight we can shrug, in maybe saying, “yeah, I know you read that SIBO never goes away, but we don’t see that, in fact, people do really well with SIBO”, right? There’s another 20 pounds. And so all these things add up, and for some people they matter. For some people, I’d say for someone like myself, I’m more of a “yeah yeah, whatever, just what’ve I gotta do”, and I’ll go do it. I’m a type A, I want to get it done, I want to move on, but that’s not everyone. And so for me, this language isn’t necessarily helpful, it’s not gonna hurt. But for other people who are much more amenable to, you know, that reading in between the lines of the language, this stuff really adds up, 100%.

Dr. Hannah Hamlin:

Yeah, I love that point. And I think I was probably on the other end of the spectrum than you at some point, Michael, where that type of vocabulary really impacted me. And I know on our last podcast I talked about kind of growing up with type one diabetes, but often getting called a “diabetic” really is an identifying marker. And I remember being at a conference once where this speaker was discussing living with type one diabetes and said, “who would you be without diabetes? “And I remember at that time being so caught up in my illness, and really trying to optimize my blood sugar, and setting up my entire life schedule to try and, you know, do things the right way, and thinking, oh gosh, I don’t know who I would be without this. And that was a huge turning point in my healing journey was really understanding, I have to separate myself from this, and I have to be me and just figure out how to do the blood sugar stuff on the side. And so I love that our whole clinic is structured around really being sensitive for that type of piece because you can get so deep in the weeds where it’s hard to see out, and you so identify with your symptoms. So I really love that about the way that we do things here.

Dr. Ruscio, DC:

And especially also if, you know, <laugh>, if someone’s coming to a clinician as their lifeline, the clinician can either pull them out of the despair or make it worse. <laugh>, right? This is where like that doom and gloom would literally be like taking someone who’s drowning, reaching up and like putting your foot in their head and just pushing them deeper into the water.

Dr. Hannah Hamlin:

Yeah. I think that that framing is so, so important. And you’re right, it is the lifeline for a lot of people that show up to our clinic is that they’ve tried a lot of things and they’re really worried, you know, and so the way that we come in overly concerned about where they are, or really taking them seriously, but also being clear that there’s a way to move forward that has good statistical outcomes, you know, that can change the way that they think about their life and their outcomes every day between that and the next time we need them.

Dr. Ruscio, DC:

Yes. And this is why I’m so excited about the fact that we’re integrating more exercise recommendations into what we’re doing, and we’re just kind of getting the ball rolling on this. I mean, we’ve always made some recommendations, but I’ve been working on a number of things, and we’ll be building those more into our protocols as I have some of the parameters, you know, very fully dialed in. And I think for some people and you know, in case you’re someone listening to this who feels like you are a bit hyper reactive to stress or you tend toward anxiety, the literature is pretty overwhelming in terms of how helpful exercise is, not only for anxiety, but for death from any cause. And so it’s like, man, what a wonderful two for one we essentially get, wherein you will have less anxiety, and you will also have a lower chance of death by cardiovascular disease, stroke, Alzheimer’s, cancer. So let’s make sure we don’t miss that one thing. And I guess what we’re doing, I’m so excited, because we’re doing less of the testing that’s not helpful, saving money, reducing psychological burden, and more of what will help people (exercise): better outcomes at a lower cost. And that’s just the constant end I think we’re trying to get to, which is the best outcomes for the lowest cost.

Dr. Hannah Hamlin:

Yeah. Absolutely.

Dr. Ruscio, DC:

Cool. Well, Hannah, anything else that you want to leave people with before we call it?

Dr. Hannah Hamlin:

No, I think we covered a lot today, and as always, I’m excited to be working with you and just really happy about the results that we’re seeing for patients. It’s so encouraging to have these kinds of conversations and reflect on the good work that we’re doing. So thank you.

Dr. Ruscio, DC:

Yes, 100%. And thank you for being such a dedicated member of our team. And thank you everyone for listening. Hopefully this is helpful, and we will talk to you all next time. Bye.

Outro:

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