 Hi, this is Dr. Ruscio and let's discuss the SIBO thyroid connection. This story really begins in 2017 when a group of researchers were trying to better understand what conditions are most tightly associated to SIBO or small intestinal bacterial overgrowth. So they examined about 1,800 patients and they were surprised to see that hypothyroidism was actually the condition most highly associated with small intestinal bacterial overgrowth. They were expecting that some type of intestinal surgery or perhaps use of acid lowering medications would be what underlined or what most closely associated to SIBO, but in fact it was hypothyroidism. It's a very unexpected finding and this kind of sets the stage for a finding from a year later, 2018. A group of pollutist researchers were looking at SIBO patients and they found that SIBO patients had a higher likelihood of thyroid autoimmunity than did healthy controls and remember that thyroid autoimmunity is the most common cause of hypothyroidism. And then one year later, really the most seminal finding here, a group of researchers wanted to better understand why do some patients who are on thyroid medication still have fatigue and have an inability to stabilize their TSH levels? So they took a group of 16 individuals who are being treated with thyroid hormone as levothyroxin and still had fatigue and were still struggling with dialing in their dose and they gave 30 of them probiotics and the other 30 they gave up the SIBO so as to ensure any findings from this study would not be from the SIBO effect. And the results here were fairly shocking again. TSH levels in the probiotic group decreased, levothyroxin dose required also decreased in the probiotic group and fatigue scores improved in the probiotic group all significantly whereas none of these changes were observed in the SIBO group. So again, really interesting and actually hopeful findings here and likely what was happening, you know, why these patients saw their TSH come down, their dose required reduced and their fatigue improved was for a few underlying mechanisms. One, the anti SIBO effects of probiotics has been demonstrated now in over 18 clinical trials that probiotics can combat SIBO. Well, at the same time, probiotics have an anti inflammatory impact that they ensue in the gut and then also very important to clarify that likely the improved gut health led to improved absorption of that capsule of levothyroxin these patients were taking every day, thus leading to an improvement in their symptoms and a reduction in the dose required in that 30 individual group who were taking the probiotics. So some very interesting findings regarding SIBO and thyroid and their connectivity that have been published over the past few years and articulating the principle that probiotics are a simple and safe support that may also improve thyroid function.