The Case:  Alison has Hypothyroidism and Hashimoto’s and also experiences tons of digestion issues.  She often feels gassy and bloated and has trouble going to the bathroom. She’s tried taking all types of probiotics, eating super nutritious fermented foods, and done several colon cleanses, but nothing helped.    The Investigation When I met Alison, she explained that she had taken gut-support vitamins and eaten a healthy diet. However, I could see right away that she was missing a few big clues in solving her health mystery.    Gluten, Gut Health, and Hashimoto’s I’ve talked a lot about the connection between Hashimoto’s and our gut on the podcast in the past. I knew that this was at the core of solving Alison’s issues. To discuss it further, I invited Dr. Vincent Pedre, aka America's Gut Doctor, to the show.  Dr. Pedre is an internist and the author of the upcoming book The Gutsmart Protocol.  One of the first things he brings up is the connection between Hashimoto’s and gut health as well as gluten. We’ve talked a lot about this connection on the Health Mysteries Solved podcast - including my own journey with Hashimoto’s and gluten. Dr. Pedre shared the work of Alessio Fasano, who studied the effects of gluten on the gut and how gluten can trigger autoimmunity. He discovered that gluten triggers the release of a protein called Zonulin, which increases gut permeability. This leads to leaky gut, which can eventually result in autoimmunity. Dr. Pedre also explained that there are three key factors in the development of autoimmune diseases: genetic predisposition, environmental triggers (such as gluten), and leaky gut. He went on to explain that one of the enzymes that helps break down gluten, called tissue transglutaminase, can create a chimeric molecule that can be recognized by the body's immune system as an invader. This can lead to an antibody response and cross-reactivity, especially with the thyroid where tissue transglutaminase is found in high concentration. The Power of a Food Journal One of the best ways to solve a health mystery involving gut health is to keep track of everything that is being eaten. Dr. Pedre uses this technique to help him diagnose issues but also finds that the activity really helps patients better understand their own triggers. So often we are unaware of all of the things we put in our mouth - especially when we don’t know all of the ingredients in the food we eat. Dr. Pedre shared a powerful story about one of his patients having a complete epiphany after keeping a food journal for just a few days. This mindful practice helps us better connect with our eating and be better advocates for our own health. It reminds us that everything we eat is feeding our microbiome.  Balancing the Microbiome is Complex  Many people think that the answer to balancing the microbiome is to take a probiotic, but Dr. Pedre explains that it’s far more complex than that. And, because our microbiome controls so many aspects of our health, it’s imperative that we keep it balanced.  He explains that, while probiotics are helpful, they are just a small part of the bigger picture. His approach has changed over the years - he used to be quite aggressive in attacking the bad bugs but now he has a more holistic approach. This means looking at the person as a whole, their history, reactions to different things, and taking a gut-body-mind-spirit approach to healing. We’ve discussed this many times on the show (if you want a good overview, check out episode 112). The gut health issue is just a portal into something much bigger and it's important to approach it holistically. One of the keys to a holistic approach is to understand what is actually going on. Dr. Pedre will sometimes use stool testing but warns that it can be misleading. Instead, he looks at different types of gut issues, which I love because it has been such a successful way for me to help people with thyroid conditions. We both agree that a one-size-fits-al