(844) 863-6700So many of us know this feeling: we are doing the workouts, trying to eat “healthy,” pushing through work, parenting, stress, and the endless to-do list, and somehow we still hit that wall. The 3 p.m. crash. The bloating that makes no sense. The brain fog. The anxiety. The sense that our body is not working with us. Dr. Amy Shah joins Dr. Thais Aliabadi and Mary Alice Haney to discuss why this matters so much.
Dr. Shah is double board-certified in allergy, immunology, and internal medicine, and her message is refreshingly practical: if we want better hormones, steadier energy, a calmer brain, and less inflammation, we have to start paying attention to the gut.
This is not about chasing the newest supplement trend or building an entire fridge full of wellness products. It is about understanding that our gut microbiome influences hormone signaling, metabolism, immune function, mood, cravings, and even brain health. And when the gut is neglected, the body starts speaking up through symptoms.
Table of Contents
- How did your own health journey lead you into gut health and lifestyle medicine?
- Why does gut health matter so much for women?
- What should we actually eat to support gut health?
- What is the 30-30-3 rule, and why is it so effective?
- Where do prebiotics fit in, and how are they different from probiotics?
- Can apple cider vinegar really help?
- How are gut issues connected to hormones like PCOS and endometriosis?
- What is SIBO, and when should we think about it?
- Do antibiotics always damage the gut, and what can we do about it?
- Do foods need to be organic to be worth eating?
- Why did magnesium come up in a gut health conversation?
- What is the simplest habit for brain and gut health that most of us overlook?
- What are the top five habits you recommend for women?
- What are your top five foods?
- FAQ
- What we want every woman to remember
How did your own health journey lead you into gut health and lifestyle medicine?
What changed everything for you personally?
Dr. Shah shared that her turning point came during a period of total overwhelm. She was a busy physician, a mom of two young children, and a newly made partner in her practice. Like so many women, she was saying yes to everything while internally running on stress hormones.
One day, after being asked to stay late for a partner meeting, she felt the pressure build. She needed to pick up her children, was already running behind, and was mentally racing all day. After the meeting, she got into her car, rushed to make up time, and ended up in a major multi-car accident.
Thankfully, it was not catastrophic. But it became the wake-up call.
In that moment, she realized she did not like how she felt in her body or how she was moving through life. She began rebuilding from the inside out with very basic lifestyle changes: eating better, getting sunlight, walking more, and reconnecting with what she already knew scientifically about the gut-brain-hormone connection.
That personal reset eventually became the work she is known for today.
Why does gut health matter so much for women?
What is the gut really doing behind the scenes?
One of the most important ideas from this conversation is that the gut is not just about digestion. The gut is an entire ecosystem of organisms that helps regulate how the body functions.
According to Dr. Shah, this microbiome helps shape:
Hormone balance
Brain health and mood
Metabolism and blood sugar regulation
Immune function
Inflammation
Longevity
When we start to think of the body this way, a lot of symptoms stop looking random. Bloating, cravings, fatigue, anxiety, poor stress tolerance, and hormone disruption are often connected rather than isolated.
That is also why gut health comes up again and again in conditions like IBS, SIBO, PCOS, endometriosis, insulin resistance, and perimenopause. These systems constantly talk to one another.
What are the biggest things harming the gut microbiome?
Dr. Shah pointed to two major issues.
First, overuse of antibiotics. Antibiotics are sometimes absolutely necessary, but they are often used too casually. They do not just kill the bacteria we are targeting. They also wipe out beneficial bacteria along the way.
Second, our gut bacteria are underfed. This is such a simple but powerful concept. The microbes in our gut need food too, and their primary fuel is fiber.
When we eat whole foods rich in fiber, our bodies absorb the nutrients, and the bacteria are left with the fiber to ferment and use. But when we eat mostly ultra-processed food, the calories get absorbed quickly, and there is almost nothing left to feed the microbiome.
That leaves the gut ecosystem depleted.
What should we actually eat to support gut health?
If someone wants a simple starting point, what foods matter most?
Dr. Shah kept this part practical. If we need five easy foods to focus on, she recommends starting with high-fiber staples that are easy to repeat.
Her go-to categories include:
Berries, including blueberries, blackberries, and raspberries
Avocados
Fruits with skin, especially apples and kiwi
Oats
Leafy greens, especially more fibrous greens like kale
Nuts and seeds, with walnuts getting special mention because of their omega-3 content
Kiwi was one of the more memorable examples. If eaten with the skin, the fiber content jumps significantly. It is a small habit, but a useful one.
Leafy greens also got a big endorsement because they offer a lot of fiber without a heavy calorie load. That makes them a high-value food for both gut health and metabolic support.
If brain support is one of your goals, too, many of these same foods overlap with the best brain foods, which is part of why this approach is so effective. The same foods help multiple systems at once.
What is the 30-30-3 rule, and why is it so effective?
Can you explain the framework simply?
Dr. Shah’s signature framework is easy to remember and surprisingly comprehensive. She calls it 30-30-3:
30 grams of protein at the first meal of the day
30 grams of fiber throughout the day
3 probiotic foods every day
That is it. Three targets.
If we can consistently hit those three markers, we cover a huge amount of ground for blood sugar balance, cravings, satiety, lean muscle support, microbiome nourishment, and digestive resilience.
Why start the day with 30 grams of protein?
The first meal sets the tone for the rest of the day. Starting with enough protein can help reduce cravings, stabilize blood sugar, support lean muscle, and improve decision-making later on.
Instead of beginning with something that causes a quick spike and crash, Dr. Shah recommends a protein-forward breakfast. Some examples she gave:
Egg scramble with vegetables and cottage cheese
Greek yogurt parfait with berries
Tofu scramble
Smoothie with a quality protein powder
She made a point that food first is best. Protein powders can be useful, especially when life gets hectic, but they are still processed products. When using one, she recommends choosing a brand that is third-party tested, especially plant proteins that can carry concerns about heavy metals.
She prefers whey when tolerated, especially micro-filtered whey, because it is closer to the source and often easier for people with lactose sensitivity.
What counts toward the 30 grams of fiber?
This is where the berries, avocados, greens, apples, kiwi, seeds, nuts, and other whole plant foods come in. Rather than trying to hit a giant number all at once, the goal is to include fiber at each meal.
That could look like:
Berries in the morning
Avocado or salad at lunch
Leafy greens and vegetables at dinner
Nuts or seeds added throughout the day
Dr. Shah did mention inulin fiber as an optional supplement, but again, the preference was to get there through food if possible.
What are the 3 probiotic foods?
Probiotic foods are fermented foods that introduce beneficial bacteria or bacterial byproducts into the gut environment. Her examples included:
Greek yogurt
Probiotic cottage cheese
Kefir
Kimchi
Sauerkraut
Miso
Tempeh
Kombucha, with attention to sugar content
Raw apple cider vinegar with the mother
The idea is not to eat the same one three times. Variety matters because different fermented foods offer different bacterial strains and benefits.
Where do prebiotics fit in, and how are they different from probiotics?
Do we need both?
Yes, and this distinction matters.
Prebiotics are the foods that feed our gut bacteria. This is essentially the fiber-rich plant matter that beneficial microbes use as fuel.
Probiotics are bacteria themselves, usually coming from fermented foods or supplements.
Dr. Shah’s message was very clear here: feeding the microbiome is more important than obsessing over probiotic supplements. If the gut environment is not healthy, added bacteria often will not stay.
Prebiotic-rich foods she highlighted include:
Asparagus
Leeks
Jicama
Artichokes
But the broader point is that most fiber-rich whole foods are supportive. We do not need to build an exotic grocery list. We need to consistently feed the bacteria we already have.
What about probiotic supplements?
This is where Dr. Shah offered a very balanced take. She did not dismiss them completely, but she emphasized that many probiotic products are overhyped. The stomach is very good at destroying bacteria before it reaches the colon. That is one reason quality matters so much.
If someone is going to use a probiotic supplement, she recommends a brand with evidence that the strains remain viable and can survive the journey to the gut. She mentioned Metagenics as one example of a more carefully formulated option.
She also mentioned a newer probiotic interest, Akkermansia, including products from Pendulum, because of emerging interest in its role in metabolic health and support of the body’s natural GLP-1 activity.
Still, her larger point held: no probiotic can make up for poor sleep, high stress, low-fiber eating, or a diet full of ultra-processed food.
Can apple cider vinegar really help?
Why did it come up so often in this conversation?
Apple cider vinegar was discussed as both a probiotic-supportive food and a blood sugar management tool. The key detail is to use the raw version with the mother, meaning the cloudy fermented material that settles at the bottom.
That “mother” contains the naturally occurring compounds and fermentation byproducts that are filtered out of more processed versions.
Ways to use it:
Add it to salad dressing
Mix it in water
Use it as one of the day’s probiotic food servings
It is not magic, but it can be a very simple habit that supports blood sugar steadiness and digestive health.
How are gut issues connected to hormones like PCOS and endometriosis?
Why do these conditions so often come with bloating and digestive symptoms?
This was one of the most important sections of the conversation, especially for women who have been told they “just have IBS” when the real story is more complicated.
Dr. Aliabadi pointed out that in women with endometriosis and PCOS, gut symptoms are extremely common. Many have bloating, pain, bowel changes, fatigue, nausea, and brain fog. Some go through colonoscopies and extensive GI workups when part of the problem is pelvic inflammation or hormone-driven dysbiosis.
Dr. Shah agreed that inflammation is often the link.
With endometriosis, pelvic inflammation can contribute to gut irritation and increased intestinal permeability. With PCOS, insulin resistance can disrupt gut motility and increase inflammation, which in turn can worsen androgen excess and hormonal imbalance.
It becomes a vicious cycle:
Hormonal dysfunction worsens the gut environment
Gut dysfunction raises inflammation
Inflammation worsens hormonal dysfunction
That is why these conditions should never be treated as isolated systems. Gut health and hormone health have to be addressed together.
For more on the metabolic and nutrition side of PCOS, Dr. Aliabadi’s guide to PCOS diet and exercise is a helpful companion resource. And for women dealing with pelvic pain, bloating, and bowel symptoms that overlap with GI complaints, her endometriosis resource is worth reading: endometriosis symptoms and treatment.
What is SIBO, and when should we think about it?
What symptoms can point toward SIBO?
SIBO stands for small intestinal bacterial overgrowth. It can cause symptoms that feel frustratingly nonspecific, which is part of why so many people go undiagnosed or get bounced between explanations.
Symptoms discussed included:
Bloating
Fatigue
Brain fog
Nausea
Weight gain
General digestive discomfort
Both doctors noted how common SIBO is, particularly in women with conditions like thyroid disease, PCOS, and especially endometriosis.
What is the role of a low-FODMAP diet?
For people with significant gut irritation, Dr. Shah described the low-FODMAP diet as a temporary elimination approach. It reduces certain fermentable carbohydrates that can worsen symptoms and allow inflammation to calm down.
But this is not meant to be permanent. It is restrictive, difficult to maintain, and cuts out many otherwise healthy foods. The goal is to use it strategically, reduce inflammation, and then gradually reintroduce foods.
She also made an important point: if someone has serious gut dysfunction, they may not tolerate high amounts of fiber right away. Going from 5 grams of fiber a day to 30 overnight can backfire.
Her example was perfect: a big bowl of raw broccoli might sound healthy, but if your gut is not ready for it, you are going to know very quickly.
Do antibiotics always damage the gut, and what can we do about it?
What happens to the microbiome when we take antibiotics?
Antibiotics can be necessary and life-saving, but they are disruptive. They do not discriminate neatly between harmful bacteria and helpful bacteria. That means every course of antibiotics can alter the gut ecosystem.
When discussing treatments like rifaximin for SIBO, Dr. Shah acknowledged the tradeoff: yes, even targeted antibiotic therapy can affect the microbiome. That does not mean it should never be used. It means that after treatment, rebuilding matters.
Is taking probiotics during antibiotics the answer?
Not necessarily.
Dr. Shah said the evidence is not as straightforward as many people think. In some situations, taking probiotics alongside antibiotics may not help much, and in a few cases, it may even interfere with the recovery process. More research is needed.
Her bigger focus was on supportive care:
Sleep well
Eat real, minimally processed foods
Reduce added sugar and junk food
Exercise regularly
Get sunlight during the day and darkness at night
Use local antibiotics rather than systemic ones when medically appropriate
In other words, if antibiotics are the storm, lifestyle is what helps restore the landscape afterward.
Do foods need to be organic to be worth eating?
Has your thinking on organic changed?
Yes, and this part felt especially practical.
Dr. Shah said she has changed her position over time. While organic can be great when available and affordable, she no longer treats it as the line between healthy and unhealthy eating.
Her reasoning was simple:
Organic certification does not mean pesticide-free
Some farmers use excellent practices, but cannot afford certification
Skipping fruits and vegetables because they are not organic is worse than eating conventional produce
That means if we are at a restaurant, traveling, or shopping on a budget, we should still eat the salad, the berries, the vegetables, and the fruit. The goal is not perfection. The goal is to actually nourish the body.
What is the best way to wash produce?
Her produce-washing tip was wonderfully doable: soak fruits and vegetables in water with two tablespoons of baking soda for about 15 minutes, then drain and rinse. Rubbing produce as you wash it also helps remove surface residue.
She noted this can remove a large percentage of pesticides, even on foods like lettuce.
Why did magnesium come up in a gut health conversation?
What makes magnesium so important for women?
Because it touches so many of the same systems.
Dr. Shah described magnesium as one of her favorite tools for women, especially for PMS, stress, sleep, and brain health. She began using it years ago for premenstrual symptoms after an OBGYN friend suggested it, and later became even more interested after seeing data connecting higher magnesium intake to better brain health, especially in women.
Magnesium-rich foods overlap heavily with the gut-supportive foods discussed earlier:
Leafy greens
Nuts and seeds
Dark chocolate
Pumpkin seeds in particular
That is part of why her framework works so well. One set of foods supports multiple systems at once.
What form of magnesium is best?
For general support, Dr. Shah likes magnesium glycinate. It is magnesium bound to glycine, and she noted it may help with relaxation, lowering cortisol, and sleep support.
Dr. Aliabadi added that magnesium threonate is particularly interesting because it crosses the blood-brain barrier and may be especially helpful for women dealing with anxiety, stress, and racing thoughts. She often recommends taking magnesium at night.
They also discussed magnesium citrate, which can be useful for constipation, especially while traveling.
The broader takeaway was this: if we suspect we are low in magnesium, we should improve the diet first, then consider supplementing thoughtfully.
What is the simplest habit for brain and gut health that most of us overlook?
Why is walking so powerful?
Walking got one of the strongest endorsements in the conversation.
Dr. Shah called it one of the laziest and most effective ways to improve brain health, and she meant that as praise. She cited research showing that walking regularly, even around 40 minutes three times a week, can support growth in the hippocampus, a region of the brain involved in learning and memory.
As we age, the brain naturally shrinks. Movement signals the brain to make new connections.
And it is not just the walk itself. If we go outside, we also get sunlight, stress relief, circadian support, and often a better mood.
For busy women, she recommended something incredibly realistic: take phone calls outside. If there is a no-show, a break, or even a few spare minutes, go out and walk. Make movement a reflex instead of waiting for the perfect workout window.
If sleep is one of the barriers making everything harder, this ties in beautifully with the basics of getting a good night’s sleep. Daytime movement and bright light exposure can make a real difference in nighttime rest.
What are the top five habits you recommend for women?
If you had to narrow it down, what would make the biggest difference?
Dr. Shah’s top five were wonderfully clear:
Use the 30-30-3 framework
Prioritize magnesium
Get omega-3s through food or supplementation
Support vitamin D levels
Exercise regularly, especially walking and strength training
She also emphasized that for women over 35, weight training two to three times a week becomes especially important for muscle, metabolism, and long-term health.
What are your top five foods?
If we want a short grocery list, what makes the cut?
Dr. Shah’s top five foods were:
Blueberries for fiber and anthocyanins that support brain health
Eggs for protein and choline from the yolkNuts and seeds, especially walnuts, almonds, Brazil nuts, and pumpkin seedsLeafy greens because they are among the most nutrient-dense foods we can eat
Probiotic foods because most of us need more fermented foods in our routine
It is hard not to notice how much overlap there is between these foods and the larger gut-health strategy. That is a good sign. A sustainable plan is one where the same habits keep solving multiple problems.
FAQs
What is the fastest way to improve gut health?
Start with the basics, Dr. Shah emphasized: eat more fiber-rich whole foods, get 30 grams of protein at your first meal, include three probiotic foods daily, sleep well, walk regularly, and reduce ultra-processed foods. Gut health improves fastest when diet and lifestyle work together.
How much fiber should we aim for each day?
Dr. Shah recommends aiming for 30 grams of fiber per day. If you are currently eating very little fiber, increase gradually. Jumping from a very low intake to a high intake too quickly can cause gas, bloating, and digestive discomfort.
What are the best probiotic foods to eat daily?
Good options include Greek yogurt, probiotic cottage cheese, kefir, kimchi, sauerkraut, miso, tempeh, kombucha, and raw apple cider vinegar with the mother. Variety matters because different foods provide different strains and benefits.
Do we really need probiotic supplements?
Not always. Dr. Shah’s view is that feeding the microbiome with fiber and whole foods is more important than relying on supplements. Some probiotics can be useful, but many are of poor quality or may not survive digestion well enough to help.
What is the difference between prebiotics and probiotics?
Prebiotics are the foods that nourish gut bacteria, usually fiber-rich foods like asparagus, leeks, jicama, artichokes, berries, greens, and other plants. Probiotics are bacteria found in fermented foods or supplements.
Can gut problems affect hormones like PCOS and endometriosis?
Yes. The conversation highlighted that inflammation, insulin resistance, and hormone disruption can all affect the gut, and gut dysfunction can feed back into worsening hormones. That is why symptoms like bloating, brain fog, fatigue, and digestive discomfort are so common in PCOS and endometriosis.
What should we do if high-fiber foods make us feel worse?
That can happen, especially in people with significant gut irritation or SIBO. In that case, a more temporary and strategic approach may be needed, sometimes including an elimination plan like low-FODMAP under medical guidance. The goal is not to avoid fiber forever, but to calm inflammation and rebuild tolerance.
Is organic produce necessary for good gut health?
No. Organic can be a great choice when available and affordable, but Dr. Shah emphasized that eating fruits and vegetables matters more than avoiding produce that is not organic. Washing produce well, including soaking it in baking soda water, can help reduce surface pesticides.
What magnesium should we take for stress and sleep?
Magnesium glycinate was the main recommendation for general support, relaxation, and sleep. Magnesium threonate was also discussed for its brain-related benefits, especially for anxiety and stress. Magnesium citrate may help more with constipation.
What is one habit almost everyone can start today?
Walk more. Dr. Shah highlighted walking as one of the easiest ways to support brain health, stress regulation, and overall wellness. Even short outdoor walks during calls or breaks can make a meaningful difference.
What we want every woman to remember
If you feel bloated, tired, anxious, or inflamed, where should you start?
Start with the gut, but do not make it complicated.
You do not need a dozen supplements or a rigid food plan. You need enough protein to stabilize the day, enough fiber to feed the microbiome, enough fermented foods to diversify support, and enough sleep, movement, and sunlight to let the whole system work.
That is what made this conversation so useful. It brought gut health out of the world of wellness confusion and back into everyday choices.
If we need five things, try to eat these five things. If we need one framework, remember 30-30-3. If we need one encouraging reminder, let it be this: our body is always trying to work for us. Sometimes it just needs the right support.
Concerned About Your Health? Talk to Dr. Aliabadi
Dr. Aliabadi is an expert OB/GYN who is knowledgeable in all aspects of women’s health and well-being. Dr. Aliabadi and her caring, supportive staff are available to support you through PCOS, endometriosis, menopause, childbirth, infertility, or routine gynecological care. We invite you to establish care with Dr. Aliabadi. Call us at (844) 863-6700 or
This article was created from the video The Real Reason You’re Bloated, Tired, & Anxious (It Starts in Your Gut!) | SHE MD for Dr. Thais Aliabadi’s website.
