Gut Health Root Causes: Beyond Elimination Diets (Episode 601)

Full Transcript: Episode 601

Lisa Hendrickson-Jack: This is the Fertility Friday Podcast, episode number 601.

All right. So you’re eating pretty clean. You’ve cut out a whole bunch of foods. Maybe you’ve cut out gluten or dairy. Or maybe there’s a whole list of foods that you are avoiding. But you’re still bloated. You still don’t feel good. You still have digestive issues. If this is something that you’ve experienced or if your clients or client population experiences these issues, you will really appreciate today’s episode with Hannah Aylward. We dive into the root causes of a variety of different digestive issues and we even get into the limitations of elimination diets where they may temporarily help but where they may start to cause more harm than good. So we get into the good, the bad, and ugly today.

Before we dive in, let me tell you a little bit more about Hannah. Hannah Aylward is a certified holistic health coach, functional gut health practitioner, and the founder of HAN. After struggling with her own chronic digestive issues for years, Hannah dove headfirst into the latest in gut research, seeking answers to her bloating and food sensitivities. With her science-backed formula, Hannah has overcome her own digestive issues and helped hundreds of other women around the world do the same. Today, Hannah leads a team of functional practitioners to help clients transform their gut health and overcome their never-ending digestive issues with functional nutrition, targeted supplementation, and advanced lab work. So without further ado, let’s go ahead and jump into today’s episode with Hannah.

Lisa: Well, I’m so excited to be here today with you, Hannah. Welcome to the show.

Hannah Aylward: Thanks so much for having me. I’m excited to jump in.

Lisa: Yeah, I mean we have so much to dig in. I always say I don’t specialize in gut health specifically, but as we were talking even in our pre-chat, a lot of women struggle with these issues. So I feel like we can just dive right in. But actually, you know what, before we dive right in, I would love for you to share a little bit about what brought you to this work for the listeners who aren’t familiar with you and what you do and kind of share with us how you got to this point of really focusing on this area.

Hannah: Yeah. So I really struggled with my own gut and digestive issues for years and it never really made sense. So I was kind of the girl that was like ate healthier than all my friends and I mean I really got into this. I was like in college exploring all of this. I was kind of young and people weren’t even thinking about this stuff then. They were just like having a good time. But I was like having to pack my own snacks and bring them everywhere and taking supplements and really needing to be so mindful about everything that I ate. And it got to the point where I’d find myself skipping lunch because I just wanted to like go out with my girlfriends at night and like wear my high-waisted black jeans, you know? And I think people really, unless you deal with the chronic gut issues, you don’t quite understand just how deeply it impacts like all these areas of your life. But I was eating healthy. I was like living on elimination diets. I mean, I probably lived on an elimination diet for like close to a decade and never ate — I mean, I wouldn’t have touched French fries, never ate gluten, never ate dairy, barely drank any alcohol, and I would still have this like really big belly dissension and bloating. I’d look like six months pregnant after eating an apple. And none of it really made sense. And everything I was reading about gut health was like elimination diet and take out gluten and take out dairy and that will fix everything. So then I started to think, okay, well, if my diet is just perfect, everything will go away. And that can pretty quickly drive you mad and kind of take things over the edge a little bit, which is exactly what happened to me. It did help a little bit. It helped probably 20, 30%, but I was still dealing with these digestive issues. And that’s when I really started to dig deeper into like how digestion even works and what’s going on in the gut microbiome and what is actually contributing to the bloating and the constipation and the burping that I was experiencing, and realized that I had a bunch of like deeper gut issues going on. And after I addressed those, I really was able to like 180 my life. And I started health coaching and I was seeing other women were dealing with very similar things. And oftentimes they would walk out of doctor’s offices crying, right? The doctor would say, “You’re just stressed. Oh, you’re planning a wedding like you’re just stressed.” You know, meanwhile this client has SIBO and like all this other stuff. Like stress of course plays a role, but there’s more to it. So I was just like, “Someone’s got to help. Someone’s got to offer these women another solution.” And it was starting to piss me off. So I was like, I will raise my hand.

Lisa: Famous last words. I can relate. I can relate to this. Yes. I’m needing to step in. I mean, you touched on so much there and I’m sure that there’s so many listeners that can relate and who even tuned in to the episode because we alluded to these things in the title. So maybe share with us. You can use your case as an example or just the jumping off point, but why would somebody be chronically bloated even though they’re eating all these great foods? Like you touched on so many things and like why wasn’t the elimination diet helping? Like what’s really going on?

Hannah: Yes. There are so many reasons to this. So I always like to say don’t blame the food for what the food didn’t do. So it’s like we often think when we have any digestive issue that it is the food that’s causing it. But for example, in my case, I was dealing with low stomach acid after years of chronic stress and undereating and undereating protein. All of those things can contribute to lower stomach acid levels. And then I also was dealing with gut dysbiosis. And dysbiosis is just kind of a fancy term for like an imbalance of your gut bacteria. We can get much more specific with that. I mean, there’s different patterns of dysbiosis. There’s insufficiency dysbiosis. You can have an overproduction of like histamine producing bacteria, more dysbiotic bacteria. There can also be fungal overgrowth in the gut — like these microorganisms, kind of imbalances of these microorganisms within the gut environment that then are causing a lot of reactions to the food. So for example, if someone is finding themselves really bloated after eating foods like apples or watermelon or garlic or onions, these foods are higher in FODMAPs. And FODMAPs are just fermentable carbohydrates that are really good for your gut. They’re good for your gut microbiome, right? They feed your gut bacteria, which is wonderful, but we run into issues when we have an overgrowth of these bacteria. You’ll end up really symptomatic and really bloated and gassy and kind of distended after eating these foods. But the solution is not to just pull those foods out forever and then be terrified to eat an apple ever again. It’s really digging deeper and asking why do I have this overgrowth in the first place? What led to this? And how can I decrease or like eradicate some of this overgrowth so I can tolerate these foods once again? So in my case it was like low stomach acid, dysbiosis. I mean I had done every single diet in the book. My relationship with food was like really poor. My relationship with my body was really poor. I had taken a ton of antibiotics as a little kid. I had like lots of big childhood trauma as a little girl. So it was just kind of this combination of things that led to eventually I can’t tolerate these foods anymore. And I just tried all of the things. I mean, I remember only like steaming all of my foods and not eating any oils and not eating any sugar. And it was like I was just driving myself nuts and you can really start to feel like you are broken. It’s like it’s never going to work for me. It’s always going to be more difficult for me. And that’s why I love kind of bringing this to light and speaking out against like the heavy restriction for a long period of time because it can really just damage your quality of life and then your relationship to food. So there are underlying kind of breakdowns in the gut environment that can contribute to these food reactions. Another example would be — and we see this often in clients especially women — like poor gallbladder liver function, right? So we have like poor bile flow and that can look like after you eat foods that are richer in fats you’re running to the bathroom or you’re really bloated or burpy or maybe after you take fish oil you’re like burping it up a lot or you’re nauseous right because that’s basically fat. So it’s not that fish oil is the problem or that like olive oil is the problem. I mean, these things are really good for you. It’s more so that we need to kind of work on adjusting your bile flow so you can better tolerate these foods and break these things down. So once again, it’s like don’t blame the food for what the food isn’t doing. Assess the gut environment.

Lisa: Well, and you mentioned a couple of things. You mentioned childhood trauma, you mentioned undereating, low stomach acid, stress, different things. So what would be some of the potential contributing factors? I’m guessing that something like this doesn’t just happen overnight, but then again, some people go on a trip somewhere and then it does happen overnight. So maybe share with us what some of the risk factors are or some of the commonalities that keep coming up that you’ve seen in your clients.

Hannah: Yeah, chronic stress is a big one. And I know it’s like I’m almost hesitant to say that because everyone’s like, “Yeah, I know. I’m stressed, you’re stressed. We get it.” But it’s like I do think that women in general tend to have a more kind of interesting complex relationship with food and our go-to — or at least I was very much primed to restrict. It’s like restrict, pull back, not to nourish. It’s not like add more in to nourish. It’s like pull out to be smaller or whatever. I mean, I like used to count out my almonds, you know, like that was what I grew up doing and like reading Jennifer Aniston’s thing in like Self magazine or whatever — no knock to Jennifer Aniston, but you know what I mean. It’s just like the thought process is to like pull out and restrict versus, oh, I actually need enough vitamin A for my gut lining and my thyroid. We’re not thinking like that. We’re thinking about taking things out. So that is a stressor. I mean, undereating is a stressor. Over-exercising is a stressor. Not hitting your nutrient needs is a stressor. That’s why we want to be careful with these really restrictive diets too when we’re just like pulling out carbs or we’re pulling out fibers or whatever it might be. And then chronic stress — I like to put stress kind of as this overarching category that we can break down into like smaller categories. So we’ve got physical stressors: undereating, over-exercising, not hitting your nutrient needs, poor sleep quality. We see a lot of like nurses that work overnights — like that circadian rhythm disruption I think is a really big stressor. And then we also have, really in that physical bucket, like other medications, antibiotic use, birth control use, proton pump inhibitor use, things like that. And even NSAIDs — like it says on the back of the bottle, you don’t want to take too much ibuprofen or it can damage your stomach lining. So that over years and years can cause an issue. And then we have these mental and emotional stressors like trauma, childhood trauma. My parents went through like a really big divorce that was like just awful and stirred our whole lives up for years and it got really bad. So like that’s a big stressor on a child and an adult. Big financial stressors. The loss of a loved one, especially if you’re caring for this loved one and like expending so much energy. I mean all of these things put the body under stress. Then that will impact your sleep and that will impact your movement and it’ll impact your diet. And then we have these environmental stressors like mycotoxin exposure or mold — living in a moldy building, maybe a lot of like heavy metal exposure in the water that you’re drinking. We actually are seeing quite a bit of that in clients right now which is really interesting. Never something I got into before. I didn’t really mess with heavy metals and now we’re like really seeing a lot of it, and different like kind of chemical exposures, you know, like high levels of endocrine disruptors, things like that. So we can kind of put them into different buckets, but all of these things will negatively impact the gut microbiome. I would say the trend in our clients — yes, we definitely have the cases where it’s like I traveled, my gut was never the same. They picked up a parasite or two, they picked up a Helicobacter pylori infection. That’s totally possible. Or I took this antibiotic and I was never the same. That can definitely happen because that will increase your risk for like candidiasis or that fungal overgrowth in the gut that can then cause a lot of issues. But most commonly, it’s kind of slow breakdown over time. Like, oh yeah, I had to take this antibiotic and then I had this really stressful time and then I had a whole year where I wasn’t even eating lunch because I was just trying to survive and then I got on birth control for a few years. Like that pattern. And then it’s, oh, one day I woke up and my gut issues were worse than they ever were before. But if I’m really honest with myself, it wasn’t great for a couple years.

Lisa: I feel like you painted such a full picture because I mean obviously this issue is so complex, right? And it’s like the straw that broke the camel’s back scenario where there’s just so much stuff going on. Sometimes it’s hard to pinpoint exactly what the thing is. In your examples, there are times when you can kind of pinpoint that exact time or thing that really tipped it over. But even in your example of it, that might have just been the straw that broke the camel’s back. That one thing that after all of those times, that one time you used antibiotics really pushed it over the edge. So there’s a lot we could dig into here. I did want to single out — I would love to hear what you have to say about hormonal contraceptives. I talk a lot about those and there’s a lot of research about hormonal contraceptives and there’s a lot of research about how it can negatively impact gut health. So I’d love for you to share a little bit about that.

Hannah: Yeah, absolutely. I mean, I believe it was March of 2025, new research came out — I’d have to like fact check that, but I believe that was the case — really showing that it disrupts the gut microbiome, which like, we knew, you know, like I knew, but it’s nice to see that research. And then, you know, there was research, I don’t know if it was like a year or two ago at this point, that showed that even the IUDs, the hormonal IUDs — I mean, the hormones don’t stay in that area, right? They spread. Of course, they don’t say, right? I’m like, we already knew that, but you know what I mean. And then, honestly, I’d love to get your two cents on this. I mean, my understanding — and I always check this with my team — I’m like, “My thought is right here, right?” But if we’re suppressing ovulation like over and over and over again, and we’re not getting that optimal like progesterone production, I mean, we’re going to lean more estrogen dominant, and then that is going to impact our gut health, and that will also impact our bile, like our liver and gallbladder function, which can then cause more gut and digestive issues. And I mean, feel free to chime in there. Am I right thinking that?

Lisa: Well, so one of the side effects — maybe the lesser known side effects — is this gallbladder issues. So I’ve interviewed at least two women. So I’ve had multiple clients for whom this happened. I interviewed Lucy Frink like a couple years ago and she shared her story of having these gallbladder attacks. And she didn’t know it was related to contraceptives — I think if I remember correctly, it’s been a while — until after she had it removed. And then it wasn’t until afterwards that someone pointed out or she saw the side effect profile, and having gallbladder issues is one of them. So that’s interesting that that’s a connection you’re making because that is a known side effect of contraceptives. And there’s studies that kind of show that if a person had like a history of Crohn’s disease or their family and things like that, that then being on the contraceptive makes them more likely to have these symptoms. And then there’s the interesting things that will happen to some people but not others where they’ll go on the pill and then they’ll just yeast infection and then BV and then yeast and then BV and once they come off of it, it just stops, but they are going back to their doctors getting drugs for one, drugs for the other, and they’re just kind of swinging back and forth, but it all started when they went on the contraceptive. So we know that it does disrupt the microbiome. I would be really interested to look into some research to kind of get more of like the how and why. But yeah, it’s just so fascinating.

Hannah: Yeah, exactly. There is research to show that it can increase your risk for irritable bowel disease. It just causes that inflammation of the gut barrier, right? Which is not a surprise. So I always say — I mean if you are diagnosed with irritable bowel disease shortly after or like within a year of getting on birth control, I mean, definitely talk to your doctor about it and see what other options are there. Of course we know there are lots of options, but have that conversation. I definitely think it’s worth exploring. I will say — I mean, I don’t have data to back this — but what we see very commonly is it causing candida overgrowth in the gut. I would say there’s definitely a connection there. I don’t think there’s any like scientific literature that states exactly that, but when we’re working with clients, I’m like, what are these patterns? I mean, we’ve seen so many people at this point — I feel like it does start to cause that fungal overgrowth in the gut. We also know, I mean, obviously hormonal contraceptives deplete certain nutrients — especially nutrients that are very important when it comes to gut health and gut function — B vitamins, magnesium, right? So there are many different kind of mechanisms through which it negatively impacts our gut health, and yeah, it doesn’t impact everyone the exact same way, but it is something we always take into consideration.

Lisa: Well, and one other drug that you mentioned — I mean, you mentioned proton pump inhibitors and ibuprofen. And given my work, a lot of women may have period pain and they may have to be relying on NSAIDs like ibuprofen or naproxen for years and I’ve seen that just absolutely wreck women’s guts. So I’d love for you to just speak a little bit on that. Obviously, in the context, that’s not necessarily the whole picture. There’s a lot of other factors as you talked about, but it is fascinating to me that ibuprofen and other NSAIDs can cause such devastating gut issues when taken consistently over time.

Hannah: Absolutely. Yeah. I mean, and it says it right on the bottle, right? It’s like don’t take too much of this in 24 hours or it will cause — I won’t take it as far as like gastritis, but I mean, it will cause like inflammation of the stomach lining specifically. Always take it with food when you’re taking it. Like never take it on an empty stomach — that’s going to help protect your gut from these medications. And I would definitely urge people to explore more natural alternatives where they can. And I get it. I mean, when I have period cramps, nothing kicks them down like an Advil. So I understand. But, you know, even if you can decrease that amount where you’re taking one every 8 hours or 6 hours versus two every six hours, always taking it with food. And then you can also bring in some like gut lining support even in the meantime. I mean, talk to your practitioner about all of that, but even some like mucilaginous herbs can be supportive. So like marshmallow or slippery elm or even aloe vera juice to just like help support that stomach lining and gut lining if you do need to take something like that. But other things — I mean, I’m sure you have all the tricks — but like magnesium, increasing your magnesium dose in your luteal phase, or omega-3s, or exploring the deeper cause of some of these bad period cramps is well worth your time, I would say.

Lisa: Yeah. And I mean that’s a whole conversation so we won’t let that totally sidetrack it. I mean in Real Food for Fertility we talk a little bit about some of the anti-inflammatory options and the one thing I always say is I’ve experienced really severe period pain and we’re not saying never take it, but I think it’s really important to recognize that, especially when it’s a chronic issue, because that’s really the problem — like when it’s chronic and you’re having to take it on a regular basis all the time. I don’t know that everybody’s aware of how significant of an issue that can contribute to gut health. So you talked a little bit about the various symptoms, the discomfort, and I have a few questions around that, and I think you painted a picture of like how uncomfortable this can be. I would love for you to talk about what does a healthy gut look like and feel like, and even healthy bowel movements, healthy digestion. And we talked a little bit about this before we hit record, but I’ve worked with a lot of clients for whom this is kind of their norm. Like, they really can’t remember — it’s been several years since they had normal gut function. And so this has become what they feel is normal. And I think sometimes — I can think of a few clients — how often do you have a bowel movement? Like, oh, you know, once a week. But they said it like that was just how it’s supposed to be. And so I’d love for you to paint us a picture of what healthy gut function looks like.

Hannah: Yes, absolutely. And that gets me thinking because I remember pretty early on in my career, I asked one of my clients how her menstrual cycles were and she was like, “They were fine. They’re fine.” She’s like, “I just take — I think it was like three Advil every six hours or something.” And I was like, “What?” I’m like, “No, no, no. That’s not fine.” Maybe one on day one, but I was like, “Whoa, that’s a lot.” So yes — I mean, people’s like perception of these things can be just interesting and depends on what they’re used to. But healthy gut function overall — I mean, I would say you’re not thinking about your digestion all the time. You’re not thinking about your gut all the time. You’re just kind of eating food. You’re not afraid of a bunch of foods. You’re not scared to eat out at restaurants. You’re not scared to travel because you won’t poop for 7 to 10 days. I’ve been there. It’s horrible. It ruins your whole vacation. It’s like you’re more stressed than you are enjoying yourself. You’re not planning extra outfits based on how your stomach might respond. So you’ve got your like fun dress that you want to wear and then you’ve got like a billowy thing based on like how your tummy feels. And that has nothing to do with like fat composition — that’s like bloat and pain and discomfort, which I deeply get too. But a healthy bowel movement — I mean, I say one to three times a day. People don’t all agree on this, but I would say if you’re going once per day, that’s pretty good. I don’t think everyone needs to be going three times a day, but like one to two times a day, I think, would be ideal. I mean, once a week — definitely not enough. And of course, I mean, that’s going to like increase circulating estrogen. There’s even some research showing a correlation between constipation and acne. And I mean, you’ve got this excess estrogen and toxins just like hanging out in your stool being reabsorbed back into the body. I wish people took it more seriously, honestly, because I do think it’s a really big — not to freak people out, but it is a more serious problem. I mean, if you’re not going to the bathroom regularly, like this is one of the first things we want to get you doing — you can’t expect to have pain-free periods if you’re never eliminating this estrogen. So I would say, once again, one to three times per day, not a ton of bloating after eating. If you feel like your belly kind of like expands a little bit, that makes sense, right? Like the food’s got to go somewhere. But if you are feeling like gassy, burping, I need to unbutton my pants, or you’re really full after a couple of bites — a lot of our clients will report that they get very full very quickly, or they feel like if they say it feels like there’s a rock in my stomach, like there’s just like a brick sitting in my stomach — big sign of like maldigestion. So those are some big things to look out for when it comes to your poop or your stool. I mean, we don’t want like rabbit pellets. I know a lot of women struggle with that. We want like healthy — kind of like a sausage. I know it’s super cute, but like a sausage. It shouldn’t be floating. It should sink to the bottom of the bowl. It shouldn’t really stick. So it shouldn’t be like you’re leaving a lot of like marks in the toilet bowl. You shouldn’t have to wipe 30 times before you get off the toilet either. So it should kind of like come out, be all together in one form, and then you go on your way. It really — like you don’t think about it much. I think that’s probably a good sign. We shouldn’t be running to the bathroom multiple times a day. It shouldn’t be really liquidy. All of those can signal that there are other things going on. It should be kind of dark brown in color. If it’s black, if it’s really light or green even, like with a green tint, that can signal that there’s other things going on. So you should also feel like you can tolerate most foods, you know. And of course, I would say having a couple — one to two, maybe three things — where you’re like, I don’t really feel so great when I eat that. Not a huge deal. Listen to your body. But if you’re like, “Oh my gosh, I can’t eat that and then I can’t eat that and then I think this causes my bloating and then I can’t eat that” — that’s a lot of our clients. We’ll see people, some women coming in and they can eat 10 foods, like they’re safe foods. That’s a big sign that something else is going on.

Lisa: Well, and I feel like all the things that you described, there’s probably a lot of listeners — I mean, a couple of those things made me think. So I’m sure there’s a lot of people that have at least one or more of what you described. It was helpful to kind of hear like what normal is. I think that’s so important. Obviously, we’re on the same wavelength. I like to also describe what’s normal for periods and menstrual cycles because we’ve just kind of been trained to kind of just take it — like a lot of things that we really shouldn’t be doing. And as you mentioned, you shared earlier that many women might be going to their practitioners about this and kind of being laughed out of the office or just, oh, you’re fine, and kind of brushed off when, you know, this could be a sign of a more significant issue. So maybe one question for you — because you said we should be taking this more seriously and we’re not always thinking of this as a serious issue — why is it a serious issue? So maybe like kind of tell us like what could this mean? And also share with us like what could be going on? Because one of the first things you said is that it’s not really the food that’s causing the problem.

Hannah: Yeah. I mean, when it comes to something like kind of extremes in bowel movements — whether that’s like chronic diarrhea or chronic constipation where you’re not going for multiple days at a time — on a more serious scale, I mean, it can be something more serious, right? There could be like an internal blockage. There could be a tumor. I mean, there could be a more serious reason why we’re having issues — and there’s either like things are kind of rushing out in a liquid form because they can’t come out in a normal way because there’s like an obstruction, or you just can’t go at all because there’s something in there. So I mean, that’s like more severe. That’s really not who we see most of the time. Of course, it could be even irritable bowel disease, which is also more severe. We will see a lot of women with that. And there’s still so much that we can do. I mean, when we’re looking at irritable bowel disease, whether it’s ulcerative colitis or Crohn’s, there’s very commonly like a dysbiosis component to that. So your gut bacteria are kind of out of balance contributing to some of this inflammation. We can work to support that, enhance nutrient absorption, because that will be a big issue too. So gosh, there’s so many ways I could take this, but if things are running through you too quickly, you’re not going to be able to absorb the nutrients from your food efficiently, which will then impact everything. I mean, there’s nothing that it won’t impact — your skin, your energy, your fertility, your hormones, everything’s going to be impacted from there. And then if you can’t eliminate — on a very like basic level, we excrete toxins via our sweat, our urine, and our stool. So if you’re not able to move these toxins and excess hormones and even like mycotoxins — like mold toxins — out of the body, this is the body’s like natural kind of dumping process. So over time that will cause more issues. It can cause acne. It can cause thyroid stuff, or contribute to, I should say. I mean, it can contribute to more bloating. You’re going to be bloated if you’re constipated. So I do think like sometimes they can signal, hey, something much bigger is going on here. And if your stool is like weird and you’re running to the bathroom and it’s kind of floating, that could be a liver gallbladder issue. And like let’s do some work there so we don’t have to remove that. So we don’t have to be rushed in for surgery. So it’s like, it is good to pay attention to these things because your body is trying to communicate with you, hopefully before things do get more serious.

Lisa: I think that’s a good reminder because I know — like I can think of some personal friends that I know for whom the stopping of going to the bathroom meant an actual obstruction. And that was a legitimately horrific experience, right? Because then you have to — so it is a good reminder that sometimes it can be more serious. Obviously that’s not always and usually the case. But I think sometimes we’re thinking of the parallels here — I know because sometimes when I’m asked about certain types of menstrual issues like irregular bleeding and stuff like that, people don’t think that it could be a sign of uterine cancer. But in rare cases it literally is. And so we do need to be aware that yes, it could mean something more significant. But either way, we want to rule that stuff out and figure out what’s really going on. So I’m sure that there’s a range of why this could happen. So maybe walk us through — because we mentioned it’s not always a food — and you’ve touched on some of the issues that it could be. So maybe walk us through like what is the reason, from something like SIBO which can cause so much discomfort, to IBS? But like just walk us through for someone for whom they might be having some of these symptoms and maybe this is new information and they’re kind of like, well, why?

Hannah: Yeah. So I will say when we’re looking at root causes, it’s often more than one thing. You probably find that too. I mean, because once one thing goes, something else goes, right? So it’s like once you have low stomach acid, you’re almost guaranteed to have bacterial imbalances because the stomach acid helps to maintain the gut environment. So how can I put this simply? If we think about digestion, it’s really north to south. So it starts in the brain and it goes all the way down. Oftentimes when we’re talking about the gut microbiome, people think probiotics and they think, I’ll just throw probiotics into it. And probiotics — what we’re hoping is that they go into the large intestine or the colon. But I mean, I think what oftentimes we forget is that there’s all this stuff up the chain that has to kind of go well before we even get to the large intestine, you know? So it’s like your nervous system — I mean, digestion is really a nervous system regulated process. So you have to be in that kind of parasympathetic state to optimally digest your food. So I mean, even that could be a root cause — someone who’s always on, who’s running on stress hormones, who’s never kind of relaxing or who has a lot of trauma and that’s kind of leaving them in that state. So that could be a cause. And then what that will also cause is something like low stomach acid, which will then influence your enzyme secretion and your bile flow. So stomach acid is kind of like the conductor in the orchestra. It signals for the other digestive juices to kind of like work their magic. So any issue there is going to negatively impact the rest of it, which will then impact the more like microbiome piece — or those microorganisms, those like trillions of bacteria. So any kind of imbalance in any of these things can cause these chronic digestive issues. And then we see like a lot of dysbiosis — or just like imbalances of gut bacteria — really causing a lot of bloating. The biggest difference between just regular dysbiosis and like SIBO or small intestinal bacterial overgrowth — they’re kind of the same thing, but most people when they’re talking about dysbiosis are talking about an imbalance in the large intestine, versus SIBO is really that overgrowth in the small intestine. And it can even be an overgrowth of your good gut bacteria. It doesn’t have to be these bad gut bacteria. It’s kind of just like they’re overgrowing in the wrong place. So all of these things can lead to constipation and or diarrhea. SIBO specifically, they say methane is more constipation and hydrogen is more diarrhea. But to be completely honest, I’m like there’s no telling. Like we see it flipped. We see that half the time and we see it the other way half of the time. So these different bacterial balances and kind of like maldigestion patterns — like low stomach acid, low enzyme secretion, poor bile flow — all of those things will cause different reactions to foods. And then something that’s kind of like making the rounds right now is this histamine piece. And when estrogen is higher, that kind of pushes histamine as well. They kind of like work together. That can cause a lot of different food sensitivities and reactions for people too. And also like diarrhea, headaches, lots of sensitivities, right? People are very reactive when they’re dealing with that. A lot of these histamine issues are stemming from the gut itself. So yes, we can have genetic predispositions. There’s kind of a lot that goes into the histamine piece, but you can literally have an overgrowth of these histamine producing bacteria, which we see all the time. Like we had a client who — what’s so funny is her test results, actually her levels were quite low. They were present, but they were low. And I’m like, if I see them present, I still want to bring those levels down. So we worked on bringing those levels of her histamine producing bacteria down. And like, she couldn’t eat fermented foods. She couldn’t eat aged cheeses. She couldn’t eat any of that kind of stuff for like 10 years. And once we worked on that, she was like, “Oh my gosh, I’m eating pickles. I’m eating olives. I’m eating all this stuff again without any pain.” And she had endometriosis too. So there’s still so much that can be done when we look at kind of this — I call it the gut environment. So it’s like your microorganisms plus your digestive juices, and then of course your gut barrier or that gut lining. Most people are familiar with the term like leaky gut. That’s a whole conversation. But any degradation of that gut barrier can definitely lead to bloating, gas, constipation, food sensitivities for sure — like lots of reactions as well. So all of these things aren’t really food, right? We can use food to repair some of them. Targeted nutrition. Of course, you always want to maintain like a nice healthy supportive diet for a million different reasons. The food that you eat directly impacts your gut microbiome and quite quickly as well. However, once we have say a low stomach acid issue, I mean, you’re going to be burping after anything you eat. You’re probably going to have low B12. You’re probably going to have low iron, and you may have undigested food in your stool, and you may be constipated. And that’s not going to be fixed by taking out gluten.

Lisa: You said a lot there. That was like taking notes. So there’s a couple things I want to ask about. This is a fascinating conversation. Obviously, histamines are a big topic. And I even saw like a post yesterday — I didn’t pay too much attention to it, but it came to mind, so I’ll probably get it wrong, but it was kind of like stop eating these foods, and it listed all these foods like, don’t let anybody tell you these foods are healthy. It was kind of like this. So the way that I am, the way that my brain works — because you know about the menstrual cycle, obviously that’s what I do and everything — I often have this theory and it’s like you have your menstrual cycle, we all have our own proclivities, and you found something that works for you. So maybe like you did something for your — and I’ll bring it back to the histamines — you did something for your menstrual cycle that works for you and then all of a sudden now you’re putting it on billboards, you’re posting about it because you feel like every woman should do what you did because that worked for you. So I don’t know — with that context, is that what’s going on here with a post like that that’s like, never eat these foods? Because what you said was that the underlying issue wasn’t the food. And then when you addressed — you said it in better words — but the histamine-producing bacteria, when you leveled the playing field and got that back in balance, she could then eat those foods. So now I’m dying to hear what you have to say.

Hannah: Yes. I mean I can imagine this post was just like eliminate high histamine foods like aged meats and cheeses and fermented things. And this is also where it gets really confusing for people because collagen and bone broth and sauerkraut — all of these things are higher in histamine, lemon, right? So people are like doing all this good gut healthy stuff, right? And then they’re just like, “What the heck? I’m having all these issues.” Green smoothies that are packed with like spinach and lemon and things like that. So there’s just a lot of nuance to all of this. If someone is very symptomatic and reactive, we may trial lowering histamines in the diet only temporarily while we work on all of the underlying issues. Following a low histamine diet for a long period of time, it’s going to be very restrictive. And I totally understand wanting to do some of that because you’re like, I’ll do anything that will give me any kind of relief. And I get that and I’ve been there. I mean, the amount of like cleanses and detoxes and things that I have tried in my day — I would have done anything just to like be able to live my life. So I do get it, but we always want to look at why are you having the issue breaking down histamine in the first place? So I kind of describe it as like a bucket. Like, you have this like histamine bucket that’s overflowing. Why can’t you degrade the histamine quickly enough? Because we’re all exposed to histamines all the time — like in the air, in pollen, in dander. I mean, we’re all getting exposure in lemon and spinach and these healthy foods that we’re all eating. It’s not really the food’s fault. It’s more like — why can’t we break it down efficiently? And that really comes down to, are we producing too much, which can happen? Or do we have issues actually clearing it — like our enzymes that actually break it down, like DAO and HNMT, are those not operating efficiently, which largely comes from like gut and liver issues? And there can be genetic kind of mutations that make this harder for some people. Yes, there’s this whole piece of like COVID and long COVID and all of that that really jacked up people’s like histamine. I mean, we are seeing it more than ever before. We are seeing like people are more sensitive than ever before. They’re kind of sicker than ever before. I mean, our approach that we would take when I first got started versus what we do now — it’s not exactly the same. The methodology is the same, the concept, but it’s like we’ve got to move people forward more slowly and all of that because they’re just more reactive. I do think that the chronic just stress and like trauma of everything COVID, plus the actual implications of the virus and how that impacted people did play a big role. But my point is like there’s underlying reasons why you would need to cut out those foods in the first place. That’s what I always want to work on with people. If lowering the amount of histamine in the food that you’re eating is bringing you some relief, I think that’s great data for you to have on your own body. But don’t stop there. Let’s go a couple layers deeper.

Lisa: Well, and I know it’s a big topic, so I just want to ask one other question along these lines and then I have another question that I want to ask about food restrictions. I want to get into that a little bit. So we do know that there’s a link then between estrogen production and histamines. I’d love for you to go into that, and also maybe you could talk a little bit about like everything is connected. So we did talk a little bit about how digestion even plays a role in eliminating. So I feel like it’s a big topic but I’d love to hear your thoughts.

Hannah: Yeah. So what I look for in clients — what we look for — and this is why tracking a cycle can be so helpful for a million reasons, but one of them is, you know, if we’re noticing that women are feeling worse at ovulation, right, when that estrogen’s kind of like hitting its peak before it’s going to drop — that’s a big sign that there a) could be estrogen dominance, but b) that there’s a histamine issue at play, because as that estrogen’s rising, then that histamine is going to go up with it. And then people or women that are like, I’m supposed to feel good at ovulation and I’m supposed to have the most energy and I’m supposed to feel excited and juicy and all of that — I’m feeling terrible. That’s kind of a sign that we want to dig deeper into that. So estrogen, yes, it can increase histamine. Estrogen dominance can be an underlying root cause. Of course, estrogen dominance has underlying root causes that we always want to work on. And then progesterone is also like a mast cell stabilizer. So any estrogen dominance and then coupled with lower progesterone levels, we’re going to get more of that kind of like histamine response, as I call it.

Lisa: Well, and along the lines of what you were saying, like is it the food, right? Or is estrogen inherently a problem because we all make it. So why is it that some women then have these reactions and other women don’t?

Hannah: Yeah, that’s a good question. Probably because they have lower progesterone. And also maybe they need some additional liver support, some estrogen kind of clearance support. Maybe they’re not going to the bathroom regularly.

Lisa: Yeah, I think there’s a lot to dig into there — like with that topic of why it would impact some women more than others. What are your thoughts on that? I mean, I would imagine that if you were to really analyze the menstrual cycle and take a look at how well you’re clearing it, the types of food that you’re eating — I feel like nothing is happening in isolation. I feel like you’d be able to see some clues. And certainly, progesterone has a really significant role at countering the impacts of estrogen. I mean, I would be curious to kind of really dig in because people like to say these things. And my initial thought is that estrogen inherently can’t — it’s like you’re allergic to your own estrogen. Like that’s a really simplified way of saying it, right? It’s like I would imagine that it would be similar to what you’re saying about the food where it’s not the estrogen that’s necessarily the problem, but it’s the other factors of how you’re clearing it. Are you breaking it down properly? How is it breaking down? Is it breaking down into favorable metabolites or not? And how is your body clearing it? Then, you know, what’s going on with your cycle? And when is ovulation happening? And are you even eating? Right. So there’s a lot of things that I would be curious to ask about.

And that brings me to — as we kind of start wrapping up — you’ve talked a lot about this already, but I mean, one of the things along the same lines of like is it the food? I also saw a lot of that, especially within the last 10 years, of when a person has different food sensitivities, they’re identifying that certain foods are causing bloating or causing constipation or all of those kinds of things, then the solution is just to kind of cut it out. And I remember a long time — I don’t know if it’s still in vogue — but there was a lot of discussion around low FODMAP diets and this type of diet and that kind of diet. And I remember thinking like, look at the list of FODMAPs. Like if you’re going to live your whole life without eating any of these foods that we love. And even the histamine approach when it was like, don’t let people tell you to not eat these foods. I’m just like, so you’re just never going to have bone broth again, right? So tell us your thoughts about that. Like talk us off the ledge.

Hannah: I have so many thoughts about it. And the reason why I speak to this so much is because I wish I knew this and really believed it earlier because I did more damage to my relationship with food and had this weird — I don’t know, I think you go through this phase when you first get into like nutrition research and education where you’re just like, food is so powerful and it can fix everything and this is amazing. And it is so powerful. And there just can be other things going on. And I don’t know, there’s just so much more to this story. So when it comes to a low FODMAP diet, I mean, we only bring this in if it is like so necessary — a) if it’s genuinely bringing someone some symptom relief, right? So if they are actually feeling a bit better on it, but basically just so they can get through the day while we address why they’re reacting to the FODMAPs in the first place. So it’s never a solution for us. And I believe that when the low FODMAP diet was even introduced, I mean, my understanding was that it’s not supposed to be used forever. I mean, you’re supposed to trial a whole reintroduction period with it, which a lot of people don’t do. However, I’m like, when you take out the FODMAPs, you do nothing else and you just reintroduce them, you’re probably not going to tolerate most of them well without optimizing digestion or shifting the gut microbiome at all. Same with histamine, right? So that doesn’t really make much sense to me. But taking them out forever is not a long-term solution. And when we start to take out all of these foods and then we’re reducing this bacterial diversity, we’re pulling all these fibers — that’s going to lead to more issues. I mean, you can develop more intense sensitivities and more of like almost even like allergic responses when we start pulling out all of these foods from the diet. You’re not going to like create allergies for yourself. But I mean, I would be mindful of pulling out a ton of foods for a long period of time. The issue is not really the FODMAPs. Now, if you can eat the rest of them and you’re like, garlic just really ticks me off, then like, so be it. Minimize the garlic. But if you’re like, “I can’t eat more than two pieces of broccoli,” it’s like, “Okay, something else has got to be going on.” And I mean, we’ve been eating these foods for so long. There has to be another reason. And when people get into all of this discussion about oxalates or lectins, my eyes just get such a big eye roll because I’m just like, no. And there’s so much, especially on social media, that just like pushes these like food fears. I saw this post the other day and it was like, fruit is making you fat, and I was just like, we’ve lost the plot. I mean, we’ve completely lost the plot. Most people are going to benefit from eating more fruit. I mean, this is not helpful. Like fearing people out of eating these foods or like bell peppers because they’re a nightshade — it’s just not helpful for anyone. Your average person is going to benefit from eating more whole foods. And oatmeal is not the cause of the obesity epidemic. So the heavy restriction — getting back to more gut specifics — it’s still not addressing the root cause of the issue. So if you are reacting to these higher histamine foods, we always want to get down to why that is. Same with FODMAPs. Same even if it’s lectins or whatever — it’s probably not the lectins. Or if it’s like proteins, if you’re like, “Oh gosh, every time I eat animal protein, I feel really sick” — well, that’s probably a low stomach acid issue because stomach acid breaks down protein. So we always want to dig into the deeper why so you can live your life more freely, you know, and maintain a good healthy whole foods-based diet and all of that. But I never want clients fearing like going out for date night and like having to order their salmon with no oil and know this — and it’s just like there’s very few cases that really need to do that.

Lisa: I feel like that paints an interesting picture. My takeaway is kind of like, this is a symptom.

Hannah: Yes.

Lisa: And we should be looking at why that’s happening instead of demonizing all of the foods all of the time and signing up for a life — like a whole life of not eating certain things. And I feel like that’s a more balanced approach because we’re looking for a long-term solution where you can actually eat food because it is important to eat food and to be able to have a variety of different sources of nutrition so that you can have a well-balanced macronutrient profile. It does make a lot of sense. That should be the goal — not just to figure out what I can’t eat and never eat again.

Hannah: Exactly. And then all these FODMAP foods — like when you look at the list of high FODMAP foods, I mean, there’s tons of them are healthy whole foods. It’s like broccoli, it’s like onions, apples, watermelon. I mean, come on. We don’t want you never eating those things. I mean, I don’t want you never eating those things.

Lisa: Yeah. No, that makes a lot of sense. Well, so one question that I had is kind of like, what are some of the basic things that we can do? And I feel like you alluded to some of those things when you talked about stress and you talked about the person that’s really high-strung. It made me think of like sitting down at a table with your family and chewing your food and like enjoying that or relaxing and even how that could have an impact. So what are some of the basic things that all of us can do to improve digestion? And then the second part of that is like if those basic things aren’t working, like how do we know when we need to then reach out for support and look into deeper testing?

Hannah: Yes, absolutely. So a couple things you can do is what you pointed out. I mean, really get present with your food. You can even practice gratitude for your food. Pray. I mean, any of those things, whatever works for you. Take a few deep belly breaths before you eat and try to really shift your nervous system out of that sympathetic dominant state into that parasympathetic state. That’s when we are producing adequate digestive juices. I mean, it’s like you can take HCL and throw supplements at it or you can try to let your body do this on its own. Sometimes we need both and that’s fine, but it’s like how can we work on supporting your body on doing that on its own, right? So deep belly breathing — I like to say like six deep belly breaths before a meal, chewing each bite to applesauce consistency, closing the computer, putting the phone down. I mean, right now — and I am not immune to this, right? Like, we are so hyperconnected. I mean there’s like a podcast on and our phone’s there and we have something pulled up on the computer and the phone and we’ve got the TV on and we’re texting — it’s like it’s never-ending information. And then sometimes on the phone now — I mean, with the algorithms, you don’t even know what you’re going to see next. It’s not even people you follow. You get fed all this other stuff now. It’s like you can barely even curate it. So it’s constant stimulation. That’s my point. I mean, so anytime you can just quiet it all down and turn it all down a notch, that will literally positively impact your digestive function. And we have something called the cephalic phase of digestion where our body starts to produce these digestive juices before we even take a bite based on what we’re smelling, how we’re engaging in the food, if we’re excited to eat the food. And I give the example of like when you walk into an Italian food restaurant and you smell the garlic and like the sauce and you’re like, “Oh, I’m hungry.” Right? Your belly will even growl a little bit. You’ll like feel that. And that — you haven’t eaten anything, right? You’re just like, you’re smelling it, you’re engaging in the food. And we’ve gotten so far removed from that in a world where we just like order like Uber Eats or whatever and we don’t even cook our own food anymore. So it’s cooking your food at home, being present with your food. I mean, saying grace or saying a gratitude or anything like that, taking a couple deep belly breaths is a great thing to start. After that, I mean, there’s so many tips I could give, but I would say try to actually increase the diversity in the plants that you eat. So the American Gut Project really showed that like 30 plus different plants per week is ideal to support that gut bacterial diversity, which kind of leads to like gut resiliency. So 30 different plant foods — these things contain fibers, different plant fibers, which is really important for the gut microbiome. 30 sounds like a lot, but it’s not when you really break it down. So I mean, for an example, if you’re making a smoothie in the morning and you’re adding in like almond butter and chia seeds and flax seeds and spinach and ginger — I mean, you already have a bunch right there. So it’s not just fruits and veggies, right? It’s like nuts and seeds, it’s gluten-free grains, it’s herbs and spices. These are super underutilized. Like, add fresh herbs and spices into your diet into soups, stews, sautees — like anything like that is a great place to start. And then I really love people to focus on adding in more polyphenol-rich foods as well. So these are really supportive of the gut microbiome. The gut microbiome — these bacteria eat up these polyphenol-rich foods and we start to produce these things called short-chain fatty acids, which are really important for decreasing inflammation and supporting metabolic function and enhancing the gut barrier. And there’s so much cool stuff there and so much cool research — like those with IBD have lower levels of these short-chain fatty acid producing like bacteria and things like that. And these keystone gut bacteria that support that mucosal barrier. So adding in polyphenol-rich foods — which are foods that stain. So foods that you put on your cutting board, they like stain your cutting board. They’re like a pain, right? So like beets and raspberries and turmeric — right, you’re like, I can’t get this color, it stains my fingers, right? These are loaded with polyphenols. So adding some of those in can be really beneficial for your overall gut health as well.

Lisa: Amazing. I mean, I could talk to you for another two hours. Like I have enough questions, but I’m going to like spare you that. But I really appreciate your approach — how you took us through all of this. I think it was a really great discussion and I really think we touched on just kind of painting a picture like it doesn’t have to be this way. I feel like there’s a way — like yes, these are significant issues, but with the right support and the right strategies, it doesn’t have to be this lifelong thing. Although we didn’t touch on some of the other kind of chronic issues — maybe we could do something like that at a separate podcast — issues related to gluten or related to Crohn’s or colitis or some of the other issues that are a little bit more wide-reaching. But with that said, I’d love to invite you to share a little bit about — well, actually, before I do that, let me let you kind of jump in if you have any last words or last thoughts for the listeners who did tune in, maybe because they are struggling with some of these issues.

Hannah: Yeah, it’s probably similar to something you would say, which is you don’t need to accept feeling like crap, you know? And yes, I think life hits us and sometimes we’re tired and we can’t do it all perfectly and all of that is just like deeply human. And also, I do think women have very much normalized just feeling like crap and like always being exhausted and not pooping and having really painful periods or whatever it might be. And there’s just so much more available to you. And even if you’ve been told everything looks normal and you’ve gone for a colonoscopy — and that’s their first go-to, not first, but maybe like third go-to — that’s great. It’s great that it came back normal. That’s wonderful because there’s nothing more severe going on. And also all this other stuff could be going on. So like we can help you feel so much better. If you genuinely feel like something is off in your body, listen to that and don’t take “everything looks normal” as like the end all be all. I would just explore deeper help.

Lisa: Yeah. Everything is fine and normal and just go take a nap or whatever. Famous last words. You know what I mean? Trust your intuition. It’s there for a reason.

Hannah: Yep.

Lisa: All right. So where can people go to learn more about you, what you do? I’m sure there were a lot of listeners who were inspired to like lean into that like it doesn’t have to be this way and like help me. So let us know — where are all the places?

Hannah: Yes. So I have a podcast as well. It’s called the Nutrient Dense Podcast. Your episode will be coming out soon. We can’t wait. It was such a fantastic episode. So the Nutrient Dense Podcast — we launched it this year. It’s been really fun. I like deep dive into lots of topics — like if the histamine thing resonated, if the gut estrogen topic or the food sensitivities, leaky gut — I have episodes on all of this stuff. So go binge the podcast. You’ll learn so much. And then you can always follow me on Instagram. I’m pretty active there. It’s at Hannah Aylward HHC. And then our website’s just hannahAylward.com. And if anyone is really resonating with this and wants to kind of dig deeper, we have like a gut health root cause quiz that I developed really based on our digestive health assessment that we give all of our clients, because we can see a lot in kind of patterns. Testing is super, super valuable. But if you’re presenting with like five of these seven things, you likely have low stomach acid. So the quiz is based on that. So you can really like take that quiz — it’s like 2 minutes — and you’ll get next steps and education, and I built out like a whole PDF for you guys with that. So for anyone that feels like they’re struggling with the gut issues, we’ll make sure to get you that quiz.

Lisa: Awesome. And do you have a link for that if you want to share?

Hannah: Yes, it is — go to hannahAylward.com. I think it’s just like /gut-health-quiz, but we’ll get it to you.

Lisa: Awesome. Amazing. And anything exciting happening in your world these days?

Hannah: Oh my gosh. We are entering Q4 currently and Q4 is — I’m done with the other things. I’m done with the big things for the year. I feel like once it hits October, it’s like the holidays and then the New Year’s. So I don’t know if you feel that way. I’m like, “Oh gosh, October’s here.” Like the year is ending. So I’m just organizing and picking up pieces at this point from the whole busy, busy year that we’ve had.

Lisa: Amazing. Well, yes, looking forward to that. I do like the fall. My birthday, my son’s birthdays in the fall. Actually, half my family’s birthdays in November, so let’s just call it what it is. But yeah, moving into that time of year. Hannah, it has been such a treat to have you. Loved this conversation. Really excited to share it with the audience and hoping that some of our listeners will have a lot less bloating and pain and discomfort and more bowel movements — you know what I mean? Like the good ones, with the sausage and stuff like that.

Hannah: Yes. Thank you so much for having me.

Lisa: Thank you for listening. If you enjoyed today’s show, please share it with a friend. You’ll find the show notes page over at fertilityfriday.com/601.

I hope that you enjoyed today’s conversation with Hannah. It was really fun and fascinating to hear her perspective on things. And as I said at the top of the episode, it’s always helpful to really dig into the root of what’s really going on. And when you understand the root of what’s going on, it certainly informs what practices that you’re going to do to try to improve it and for how long. And avoiding certain foods can sometimes snowball into avoiding like every food. And we still have to eat and we still have to be able to access that nutrition. So I really love that she highlights some of the limitations of some of those common strategies that really provide short-term relief but may not be addressing that underlying root cause. Hannah’s work really highlights why it’s important when seeking support for specific issues to really be finding practitioners who specialize — practitioners for whom this is what they do all day long — and also applying the science to back up the strategies that they’re using. And that’s exactly what we do in FAM and our Fertility Awareness Mastery Mentorship. With that said, I hope you have a wonderful weekend whenever you’re tuning into the show. And of course, as always, until next time, happy charting.