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Overcoming SIBO: An Interview with Shivan Sarna

On Friday August 27th I interviewed Shivan Sarna, as we chatted about overcoming small intestinal bacterial overgrowth (SIBO), and below is the written transcript. If you would prefer to watch the interview you can access it by Clicking Here [1]:

Here is the transcript:

Dr. Eric:

All right. Well, hello everyone. Happy Friday. Thank you so much for joining us here. So with me I have Shivan Saran and she is author of the book Healing SIBO, which I just finished. I just finished listening to the audio version, so thanks for showing the book and all right, so let’s get to the intro here. So Shivan Sarna is the author again, of Healing SIBO, TV host, the creator of the SIBO SOS Summits and community, the Digestion SOS documentary series, the Gut and Microbiome Rescue Summit, the Lymphatic Rescue Summit as well. A lot of summits.

And Chronic Condition Research a 501(c)(3) nonprofit further research on different medical conditions and after a lifetime of struggling with health issues, Shivan made it her mission to demystify her own health struggles and to share that information with others who are struggling. So her special skill is finding and connecting with the leading expert doctors and connecting those experts with the people that need their help. And her personal mantra is SOS, Save Ourselves, and that’s what she has helped thousands of people do. And thank you so much for being here Shivan.

Shivan:

Thank you so much for having me. Yeah, I love summits, just a note on that because we’re doing the Dental Health Connection Summit right now about biological dentistry, which is so interesting. Topic for another time.

Dr. Eric:

Awesome. You’re the host of that too?

Shivan:

Yes.

Dr. Eric:

Oh, wow. Yeah, you really do have summits on a regular basis.

Shivan:

Yeah, I do. I really love them because they help me and so that’s how I got started. I originally was going to write a book about my SIBO journey, I had all these notes and notebooks, and my best friend said to me, “You’re going to write a book, right? Because you have it right there.” And I was like, “Yeah, I need to really do that.” And I started to write the book and then I realized writing a book is not as easy as one thinks, and since I’m a TV host, I’m a talker and I love summits. And I said, I’m going to do a summit to get the information out. And then Dr. Allison Siebecker, who is a world renowned SIBO expert, who now we’re friends. Thank goodness she was also my doctor and she has siboinfo.com. It’s an amazing free site about SIBO.

So she introduced me to all of these SIBO specialists and helped me connect with them. And then we created the first SIBO SOS Summit. And in the beginning, SOS to me was like someone come and save me, but it turned into save ourselves and the patient advocacy and education. Dr. Siebecker and I have created a SIBO course called SIBO Recovery Roadmap. And here’s why it’s because there is a need, because a lot of gastroenterologists, western trained doctors do not really know how to treat SIBO. And for a long time, it wasn’t even really a seriously considered diagnosis. But there’s an algorithm that Dr. Mark Pimentel created about how to treat and diagnose SIBO, which by the way I’ll define in a second. And then Dr. Steven Sandberg Lewis and Dr. Allison Siebecker added to that. And so that’s what the book is based on.

So you can do it with a practitioner. I always recommend that. But a lot of it, you can DIY there’s also lifestyle aspects to it. But before we do that, what is SIBO? SIBO is small intestine bacterial overgrowth. It is the number one underlying cause of IBS irritable bowel syndrome. And it has a variety of underlying causes itself. So it’s caused by something and it causes other things. And the symptoms of SIBO are bloating, constipation, diarrhea, alternating constipation and diarrhea, things like rosacea.

And restless leg syndrome. I’ve had some of the doctors connect it clinically in their observation to infertility. Malnutrition, overweight, underweight. There’s so many things that SIBO is a part of, but one of the big things that was so shocking to me and it was shocking is that food poisoning is the number one reason why people get IBS and SIBO and it can then… I had food poisoning when I was five and it was when I was in India because my parents traveled and were importers and I got very sick.

Then I came home, I got well, then I came home and went on a field trip to upstate New York. And I was a city slicker, little kid and I was eight and we were milking the cows, the teacher looked away and we took the milk right out of the utter we were being a little, like having fun. And I got so sick. Oh my gosh, I got so sick. So who knows what the exact bacterial source was, but I was never the same after that. So for people who’ve had travelers diarrhea, for people who’ve had like a bout of the stomach flu. These could be underlying causes and I’ll explain why. The thing and maybe this has happened to you, doctor, where you’ve had dinner with everybody and we all ate the same salad okay or whatever, even at someone’s home.

And then lo and behold, Joe gets food poisoning, but no one else gets food poisoning at the same table, at the same food that everyone else ate. And it’s like, well, it couldn’t be food poisoning because we ate it too and we’re fine. Ah, the more you’re exposed to food poisoning E. coli and the other foodborne illness, foodborne bacteria that are pathogenic the easier it is to get it. So you’re more prone to having it in the future. So my husband and I just did this, we got some nachos at a restaurant the next day he felt a little bit weird, a little bit off and I felt terrible. So his immune system is stronger than mine when it comes to the gut. And so that’s just a perfect example.

So small intestine, bacterial overgrowth is with SIBO is, and the reason why this food poisoning causes these implications down the road is because of motility. And the impact in this particular case is when the bacteria of the food poisoning that I was talking about, causes a confusion within the digestive tract of the small intestine that impacts the MMC, which is the migrating motor complex, which Dr. Mark Pimentel refers to as the sweeping motion, the crumb mover, this debris of bacteria that when it doesn’t move out overgrows and then that’s where you’re becoming like a mini micro brewery and it’s a fermentation. So that’s what leads to the bloating. The food particles are being consumed by an overgrowth of bacteria that are in the wrong location, not necessarily related to the fact that you had food poisoning years ago.

It’s not necessarily the same bacteria still there, but it could be the same kind, but that bacteria that normally would be swept out by the MMC or the migrating motor complex is still there, is eating your food, is fermenting that food and releasing gas, and then it leads to all of those other symptoms. So when the migrating motor complex is impaired and doesn’t have that sweeping motion, which can be done because of the confusion of the molecular mimicry that’s happening, because it is confused by the antibodies that were created by the food poisoning episode, that’s when SIBO often occurs.

Dr. Eric:

So it is an autoimmune process from what I understand, correct?

Shivan:

So it’s not like lupus or psoriasis is an autoimmune disease, but it is as you just described it an autoimmune almost like consequence.

Dr. Eric:

And so food poisoning just to confirm it a common cause of SIBO, but it’s not the only cause. Correct?

Shivan:

Right. I’m so glad you just said that, because other underlying causes can be adhesions, which is a big one and an adhesion is an internal collection of, I call it like just internal scar tissue. It’s collagen that grabs to hold your body together after surgery, after an injury, you’ve been kicked in the belly by a horse the body freaks out and it grabs the collagen and holds you together. The cesarean section what’s that scar tissue doing? It is holding you together, but it’s also those adhesions can be a barrier to healing and a lot of different things, a lot of scar therapy going on these days, like never before.

But internally, if you have endometriosis, if you have scleroderma, a lot of other things you can have this adhesion and it can literally pull the tissue of the small intestine, for example, into a way that let’s say your migrating motor complex may not be impaired from food poisoning, but the tube that is the small intestine could be, look over here instead of where it’s supposed to be because of an adhesion pulling it. And that can impact the ability to sweep out the debris from the small intestines. So there’s a physicality that’s possible as well.

Dr. Eric:

Okay. And what do you do if you have adhesions? Maybe see a visceral therapist, someone who does visceral manipulation.

Shivan:

Larry Warun and the Warun method and Belinda Warun with clear patch… They’ve created Clear Passage and they have a very special technique for body work that is different than visceral manipulation, but we’ll talk about that. And they started by helping people remove bowel blockages as well as opening fallopian tubes and helping with fertility through this body work, the abdomen. There’s also the Mayan belly. I call it the Mayan belly rub. That’s not the official name. It’s Arvigo I think is the terminology. And it’s a Mayan technique that helped women with fertility that can help with adhesions, but visceral manipulation, which is training is very specialized by the Burwin Institute and by Upledger, the Cranial Sacral outfits they teach visceral manipulation, which is internal organ manipulation. And I know a lot of people have great success.

I’ve had success with that, but you have to go to someone who’s really devoted to it, really committed to it. It’s like an obsession for them. Please don’t think that you’re going to have your adhesions resolved by someone who’s gone to only a weekend seminar. Who’s also a wonderful massage therapist, but doesn’t have this very specialized technique like dialed in. And I say that about also CranialSacral Therapy in general, it is a very specialized technique. And if you find someone who is good at it, treasure them because they can change your life for the better.

Dr. Eric:

When I was listening to the audio version of your book, I think you mentioned a website. I don’t know if you have that off the top of your head-

Shivan:

For the visceral manipulation?

Dr. Eric:

Correct.

Shivan:

I just looked at it the other day, just type in Upledger, like literally how it sounds as well as B-A-R-R-A-L they have a shared directory. And then when you go to the directory, you can type in by zip code and state, I think. And what you want to find is someone who has the initials VM as in visceral manipulation in their training, and you can actually search by training. So you can backward engineer that as well.

Dr. Eric:

All right. Wonderful. How about low stomach acid, can low stomach acid also play a role in small intestinal bacteria overgrowth?

Shivan:

There’s a little bit of controversy around that, but I think intuitively and clinically, a lot of people feel that is part of it because of use of PPIs or just it’s a natural occurrence within the patient. If you think about what stomach acid does as helping digest the food, but it also kills bacteria. I think that my seven years on nexium was definitely a contributing factor. And so it comes down to some terminology where it’s underlying cause, contributing factor, thyroid…right? We’ll talk about the thyroid, stress contributing factor, use of antibiotics. I’m not going to say abuse, but overuse of antibiotics can be an underlying cause. And then you combine that with that food poisoning I had it in that country I was in on vacation a decade or two ago. So it starts to have a bucket that can fill up. It can be just one thing, but I do think there are a lot of contributing factors and I do think that stomach acid and bile play a role in it as well.

Dr. Eric:

All right. And you mentioned thyroid, so…

Shivan:

Talk to me about that.

Dr. Eric:

Yeah. Let’s talk a little bit about thyroid health and SIBO. I see it with both my hypothyroid patients and hyperthyroid patients and the literature just in general, you see it more associated with hypothyroidism and maybe because hypothyroidism is more common than hyperthyroidism but I’ve seen a number of hyperthyroid patients with SIBO. Now from a hypothyroid perspective, it makes sense as hypothyroidism can potentially also slow down that migrating motor complex when it comes to decrease in stomach acid, that’s again, according to the literature more common with hypothyroidism but I have hyperthyroid patients who seem like they might be deficient in stomach acid, maybe because they have a gut infection such as H. pylori, but then also there’s that immune gut connection, because most cases of hypothyroidism are Hashimotos and most cases of hypothyroidism are Grave disease.

And I’m not saying that SIBO is a trigger. I don’t think there’s any evidence that SIBO could trigger Graves or trigger Hashimoto’s, but there’s what’s called that triad of autoimmunity. And part of that triad of autoimmunity is an increase in intestinal permeability, which is a leaky gut, which SIBO potentially can lead to. And so I think it’s safe to say that even if SIBO doesn’t cause Graves or Hashimoto’s or other autoimmune conditions, if you have SIBO, it might be very difficult to get into remission if you have thyroid autoimmunity or a different autoimmune condition, would you agree with that?

Shivan:

I do agree with that. And that’s why it’s so important to make sure people are on a prokinetic helping to coordinate the migrating motor complex after treatment that’s really, really important. And just a note about that is just a baseline I want to just announce is that diet is specialized in SIBO but it doesn’t treat it, it controls the symptoms. Which is great because you can really control how you feel. You can feel much better, very quickly, but there is a little bit of a myth I like to bust, which is that diet doesn’t cure SIBO it controls the symptoms and with low FODMAP and with the SIBO specific food guide, which is what Dr. Siebecker created and pulled from low FODMAP and SCD and GAPS diet, and put it all together in one food guide.

That’s very liberating because you can control more about your symptoms and how you feel, and it’s a low fermentation diet, or I should say food list. But the thing is that with people, I think it off track and this happened to me is that when you’re diagnosed with IBS, you are told here’s a sheet about low FODMAP, which is these specific carbohydrates that are going to be lower in these foods that should help with symptoms of IBS. And then you’re sent on your merry way. And then there’s all these wonderful, brilliant food bloggers and foodies and cookbook writers who then take you down this beautiful rabbit hole of just low FODMAP, but you’re not dealing with the underlying cause, you’re not reducing the bacterial load and not everyone who has IBS has SIBO, but the vast majority is.

And so I want to tell everyone, if you’re just stopping at low FODMAP diet, as I did for a really long time, know that there is a whole world of treatment to get to your underlying cause. And this is really important. I know you must see this in your practice all the time is managing it so that even if you can’t resolve that underlying cause because you had a cesarean and you can’t get rid of all those adhesions whatever, the ability to live with a chronic condition and have it treated can help you to live a much more comfortable, 100% better life than an untreated condition. So we have to adjust sometimes about having a cure versus feeling so much better and being like, yeah, I got SIBO. But I manage it. And I used to have a special… I stay away from onions and garlic and apples and certain foods that are higher FODMAP.

And I take my prokinetic every night to help with the migrating motor complex. So everything’s getting swept out and I do some magnesium maybe and life is good versus I hate it. I feel miserable all the time. I ate an Italian dish with a lot of garlic in it and I thought I was going to die, it is much more manageable. And I just want to tell everyone chronic conditions when manage can be life changing. So don’t get stuck on only talking about a cure because it’s a big mind shift change.

Dr. Eric:

Yeah. Thank you for mentioning that. And so prokinetics, as you mentioned, they stimulate that migrating motor complex to help keep a state of, I don’t know if you could say wellness, but just really preventing the SIBO from getting worse and what are some of the different prokinetics out there and I’d be curious to know which one that you take?

Shivan:

So I take something called Resotran, what’s it called in the United States? Motegrity. Resotran is the Canadian name for it. It’s prucalopride and it wasn’t allowed in the States for a long time. And I got mine from Canada and it coordinates the migrating motor complex, so it’s not a laxative. And so there’s a myth I just saw it in our big SIBO SOS Facebook group, I have IBS-C… Excuse me, I have IBS-D, IBS with diarrhea, I have SIBO my doctor says, why would I want to do a prokinetic? And logically, I can see why someone would say that. But prokinetics are not laxatives. They coordinate the migrating motor complex in the digestive process. So in actuality, even if you have diarrhea type, you should still after treatment do a prokinetic.

Dr. Eric:

Thanks for mentioning that. Whether you have IBS-C or IBS-D then you still would want to take a prokinetic after treating SIBO. And with the treatment so again, there are three types of treatments for SIBO, correct?

Shivan:

Correct. There is the and you’ll see it on page 111 of the book and the chapters devoted to it. There is the most effective, which I’d like to start with first, which is the elemental diet, which is a liquid diet that is historically disgusting tasting, taste like vomit because it is made of amino acids. Good news is Dr. Michael Ruscio and integrative therapeutics…they have a couple more, have made formulations that are actually much tastier and so you’re not going to throw up by even thinking about drinking this stuff. And you do that for 17 to 21 days and retest well, 14 to 17 to 21 that range there. And you just consume your calories from the elemental diet. And it is quite severe because you’re not doing any food, because you’re only feeding your body, not the bacteria that’s hanging out overgrowing in the small intestines.

So it’s a different technique of actually starving that bacteria versus actively killing it with an agent. It’s the most effective, it’s the most difficult let’s face it. And it’s not inexpensive. It’s not like crazy expensive, but it’s not inexpensive. Then there are herbals, which are the antimicrobials, which are things like allicin, which is the active ingredient in garlic. You don’t want to eat the garlic. You want to have the allicin. I like allimed and allimax, oregano oil, Metagenics CandiBactin-AR and Metagenics CandiBactin-BR are some formulations that have been studied to be effective. The thing with antimicrobials is that the treatment is usually four weeks versus two weeks. That’s what the studies showed. And then it might be slightly more effective than the pharmaceutical, but it’s less expensive depending. Okay. It depends, does your insurance I pay for the drug I’m about to talk about?

But you can get this on Amazon, these herbals, these antimicrobials, and you have a variety to choose from. So after you do a treatment, if you’re like, “Oh, I’m going to try another one.” That’s cool. But then the antibiotics are Rifaximin. If you have the hydrogen kind, the gas being produced by the overgrowth of the bacteria being hydrogen producers or you could do Neomycin and Rifaximin and that’s if you have the methane producers. And then there’s another third gas that they’ve been able to test now with trio-smart, which was the breath test created by Dr. Mark Pimentel which is the hydrogen sulfide, which is a little bit of a different treatment.

But Rifaximin, I’m sure you have people all the time who are like, “I don’t want to do an antibiotic. No, whatever you do, no.” But Rifaximin is a very interesting antibiotic. It stays in the small intestine versus milking your entire microbiome. It is what they give people for travelers diarrhea. And it can be very expensive or I have happened to have been blessed with decent insurance and I was able to buy mine for $10. So it just really depends. Salix is the company that owns it and they do have coupons on their site, you can ask about those. And then if you are always using that Rifaximin with the antibiotics and then there’s neomycin and there’s also Flagyl that can be used. So there are a couple of other ones that are combined with the Rifaximin, if you do have the methane production overgrowth.

Dr. Eric:

All right. Yeah, Rifaximin I know is pretty expensive if you don’t have health insurance.

Shivan:

It can be. People can get it from Canada. There’s some people who also found decent sources in India but I would say keep pushing, call the company, see if you can get a coupon. There are ways to at least try to get a better price.

Dr. Eric:

Good to know. And so just to summarize the three types of treatment for SIBO, elemental diet, herbs, and antibiotics, but not typical antibiotics as there’s Rifaxamin or Xifaxan, which just affects the small intestine. And then the treatment will differ if someone has high methane, let’s say on a SIBO breath test, then they would need to take not only Rifaxamin, but maybe neomyacin and same thing if they were to take the herbs, they might have to add allicin to that. So it is more complex potentially if someone has high methane and I guess one other thing too, you said as far as four weeks for the herbs, two weeks for the antibiotics, but some people do need multiple rounds, so they might need to go a few months with the herbs or even a few months with the antibiotics, correct?

Shivan:

That’s true. That is correct. And that’s why Dr. Siebecker really wants people to retest after that first treatment round, because what you’re going to be doing is dropping the parts per million of the presence of the gases. The first time I took my antibiotics, I was like, why am I not better? Well, I wasn’t fixed because I still had levels of gas to go down. It’s just not often a one shot and that’s very unusual we’re not used to that. We’re used to taking a pill, getting better within two weeks and moving on. So it’s about reducing the bacterial load, which can take multiple rounds.

Dr. Eric:

So she recommends a breath test after every round. Is that correct? I don’t know if she’s still does that.

Shivan:

She does, unless you’re 90% better. And then there’s if you have an initial test and it’s positive and you do the treatment, if you can’t afford to do the second test there are ways to work around that but if possible, do the second test, so you can see if the treatment worked and how well it worked.

Dr. Eric:

I mean, I do like the breath test. Are false results, such as false negatives possible? So if someone is suspecting SIBO and let’s say they do the breath test and it comes back negative, I know there’s also SIFO. So someone might have small intestinal fungal overgrowth, so that’s a possibility but is it also possible they might have SIBO but the breath test doesn’t come back positive?

Shivan:

So that’s a great question. So there are things that mimic SIBO, and this is all part of the complicated diagnosis. SIFO and candida mimic SIBO symptoms as do parasites. So this is very, very common. And that’s why testing is so important because if you’re going to treat parasites it’s very different than treating SIBO. So if you have not done the test prep properly, and it includes a 12 hour special diet of just very reduced types of food, because you’re trying not to feed the bacteria too much during that time. And then 12 hours of fasting. So it’s a 24 hour period. And a lot of people do the special diet for 12 hours and then sleep and then do the test in the morning have their overnight, and then do the test in the morning.

So I had a false negative, but when you looked at the test, the test was positive. The test was accurate, the interpretation was negative. So that’s part of that. I’m hoping that facility in Tampa has fixed their knowledge base, I’m assuming they have. This was years and years and years ago. You have to check, when did the lab last calibrate their machines? The equipment is very, very sensitive. Some doctors have it in their office. Sometimes you can get the script and do the test at home, which is nice, because it’s a three hour breath test. So it just depends on the circumstances. I think that the days of false negatives are much reduced, but again, the patient also plays a role in if the test prep isn’t correct that can impact easily the outcome. Like one of them, I chewed some gum that morning and that can impact the results of a test.

Dr. Eric:

Wow. Good to know. So the test prep plays a role and then I think most of the labs now will do it for three hours, but in the past, some of them would only require a two hour test, which also could lead to some false negatives?

Shivan:

Yes. So try to get the three hour, that’s my personal opinion based on everything I know. Not everyone does that. And so if your doctor’s really a SIBO specialist and they prefer the two hour test, then go with that. If they’re an expert in the world, but I think most people are going with three hours.

Dr. Eric:

Well, thanks for that. And as also in your book, you mention I think it’s called the IBS-smart. Is that the same as, I know there was the IBS check?

Shivan:

Yeah, IBS this is the newest iteration of the antibodies that I talked about in the beginning of the blood test to see if you had the antibodies created from food poisoning, and it’s called IBS-smart test. Yes. And it is also developed by Dr. Mark Pimentel. This is from Gemelli Labs. And what’s cool about the IBS-smart test is you do need a doctor’s prescription, but they have it set up so that if you fill out a questionnaire, they have a doctor in-house, they can write you that script, send you the test, you get it from the phlebotomist. There are a lot of traveling ones right now. There’s also in the United States, in certain states, Any Lab Tests Now that you can get the blood draw and then they will send the test in. And then you can find out if you have the antibodies, which really means you need to be taking that prokinetic because you will now know what your underlying cause is. And that’s super, super helpful.

Dr. Eric:

All right. Well thanks for sharing.

Shivan:

Thank you.

Dr. Eric:

So I want to leave a few minutes for questions because I know you got to run soon. So where can people find out more about you? Obviously we want everyone to go out and get your book Healing SIBO which they could find on Amazon or they could also visit healingsibo.com.

Shivan:

Come to sibosos.com because it’s there and it’s a link to your major book sellers. It’s $17.99 right now on Amazon. It’s usually around 20 bucks. So listen, this is going to save so much time, energy and money. This is truly the book that I wish I had, when I first got, even heard the word SIBO it would’ve saved me years. It would’ve saved me years of suffering. It would’ve saved me thousands of dollars and seriously I put my heart and soul into it. There are over 40 recipes that are part of the SIBO specific food guide. Dr. Siebecker read every single word, she wrote the foreword. Seriously, it’s one of the best investments you can make. I love my summits that I’ve done in 40 hours of info about SIBO and a 10 hour documentary about SIBO and leaky gut and IBS. But if you’re like, I need one thing that’s quick and easy and inexpensive to help guide me, get the book.

Dr. Eric:

Yeah, I agree. Again, I listened to the audio version and it’s only about four and a half hours, but it packed with so much information. I almost prefer that than listening to a 10 hour or a 12 hour audio book where they beat around the bush and don’t get to the point. So it’s just packed with so much information. So yeah, definitely either get the book to read or listen to the audio book or you can do both. Thank you so much Shivan for doing this interview. I appreciate it. And again, I recommend her book highly.

Shivan:

Thank you.

Dr. Eric:

Yeah. And let’s go ahead and see what questions people have and…

Shivan:

Oh, doctor also the SIBO SOS Facebook group is a great resource and my website sibosos.com is where you can find our courses and the summits and master classes about it. So those are the resources.

Dr. Eric:

So what’s that website again, sibosos.com?

Shivan:

sibosos.com. And then we have a Facebook group with 20,000 people and they’re all helping each other about SIBO too. And then Dr. Siebecker’s website is siboinfo.com.

Dr. Eric:

Yeah. Her website is also awesome.

Shivan:

I know.

Dr. Eric:

Thanks for sharing that. And thanks for sharing your Facebook group information. All right. So the first question… and again, we have about 10 minutes just to let everyone know, because Shivan has to run here, but we’ll get to as many as we can. So this is a long one here, so hi, Dr. Eric this is the first time I’ve been able to catch this. This is not actually about SIBO. Actually let’s do this, just before we get to that, see if there’s any SIBO questions while we have Shivan here. So Moni, thank you all for this information. I have both Graves and SIBO. Done much research on both and there was always much to learn. All right. Thanks, Moni. Appreciate it.

Shivan:

Thank you.

Dr. Eric:

And then, so do we know the bacteria that causes SIBO? So there’s not a specific bacteria that causes SIBO and also it’s important to, I don’t know if it was mentioned that again SIBO is not an infection, not that this person is suggesting it’s an infection, as it’s just bacteria in the wrong place. You have too much bacteria in the small intestine, but again, there could be different bacteria that lead to SIBO, correct?

Shivan:

That’s very True, but here’s what’s very interesting and super cool and really breaking news is Dr. Mark Pimentel and Dr. Ali Rezaie at Cedar-Sinai actually have started to map the small intestine microbiome. Fascinating. And they do know some of the bacteria that is causing SIBO now. E. coli, I can’t do the list because I don’t want to get it wrong, but it’s fascinating they have been able to identify some of the bacteria and have in papers released that information. But it hasn’t changed the treatment. So that’s the key. It hasn’t changed the treatment as of yet.

Dr. Eric:

Okay. Thanks for sharing that. And oh, okay. I meant do we know? So let’s see. Moni I missed the beginning. Will the information on the connections between SIBO and thyroid be in a transcript form later? Yeah. This is being recorded. It’ll be on Facebook. And then yes, what I do is with these live interviews, I do actually transcribe them and eventually put them on my website. So yes, she’ll be able to see that, to read the transcript as well. All right and Karen, this is fascinating. You’re a great inspiration, Shivan. Thanks for the most informative interview.

Shivan:

Oh, thanks Karen. You’re welcome. I’m so glad you’re here learning about it because I wish that I had stumbled across or tuned into this information so many years ago and I want to make sure everyone knows that this is a condition that is treatable and that you’re not crazy and that feeling like you look like you’re six months pregnant when you’re not and you’re bloated, guys too. It’s treatable and it’s not just the low FODMAP diet and some of the low FODMAP people will say, stop, what do they call? Like pathogenizing IBS. I’m like, “Well the science is saying that it is from… The post-infectious IBS, is what it is from food poisoning and it is the primary cause, so quit not pathogenizing it please. Thank you. Amen.”

Dr. Eric:

With the food poisoning too, , there are people that will, I guess, swear that they didn’t have food poisoning. But honestly, sometimes you might not remember if you had it like 20 years ago. I mean, I’m pretty sure I’ve had it, not SIBO, but I’ve had food poisoning. Again, it’s not like something that’s really clear where I remember. I mean, for some people I’m sure it is, when they know they have it, but then others, maybe it wasn’t too bad but it still was severe enough where maybe it was a potential cause of SIBO or IBS.

Shivan:

Yeah. I mean that stomach flu, that time you threw up, maybe it was mild. And there are people who have food poisoning that are not going to have post-infectious IBS. Their immune system functions in a different way. They don’t have the antibodies. They haven’t had multiple exposures to that bacteria, so their body didn’t respond that way. That’s the thing. If you do have it, you need to investigate and look backwards and see. The other thing that can be an underlying cause of SIBO that I didn’t mention but I wanted to is opioid use.

So if you have deep anesthesia, your body’s in that altered quiet state, depressed state, then you’re on pain meds. Your migrating motor complex is probably not doing a lot of motion. They’re literally drugs for opioid cause constipation. So for me, when I’ve ever had surgery, which hasn’t been often, thank God, but I made sure I really reduced the food load. So the bacteria didn’t have a lot to eat, but then afterwards I got on a prokinetic and really made sure things were moving.

Dr. Eric:

All right. Now, thanks for sharing that too. And then parasites yuck. How do that you have them? So I mean, testing wise, I guess. And do you speak about this in your book too, like doing a comprehensive metabolic panel and I think you mentioned, is it parawellness.com?

Shivan:

It’s Parawellness in Colorado. It’s an interesting situation. He’s a parasitologist who worked in the military for I’m sure very long time. And he has a lab/study, which allows him to get around certain things and you can pay them like 300 bucks which is not nothing, I know that. And he will look at a thousand, 1500 views of your stool to see if he sees anything. So you could go to LabCorp, Quest great at other things, but not great for the ova and para testing typically. If you do go to Quest or LabCorp and it comes back that yes, you do have a parasite. You do, if you don’t, it doesn’t mean you don’t. Okay. If your test comes back negative from the mainstream labs, it doesn’t mean you don’t. So Parawellness is one I really like, I know also people are really liking GI-MAP right now as well for-

Dr. Eric:

Yeah. That’s what I do. GI-MAP’s good. Genova’s pretty good they have their GI effects as well. So there’s a few labs. But false negatives are still a possibility really with any lab.

Shivan:

Sure. Of course.

Dr. Eric:

All right, so I’m going to to try to answer this quickly and this might be the last question. And if I can’t answer it quickly, I’ll be live next week just doing some Q and A. “So during a time of extreme stress, all the hyper symptoms began at the beginning of June. My blood has been done a few times since then. My question is, why do you think my TSH has always been optimal 1.57 to 1.96 while T4 has always been 20.4 to 23.7?  My symptoms were horrendous even at 20.7. I was so healthy before this never had pain. Now that’s all I have.”

So this sounds like thyroid hormone resistance. I don’t know if Shivan ever heard of that, but that’s when TSH actually will look good or maybe sometimes on a higher end, but T4 is high. So it’s almost like insulin resistance. Where you have too much insulin that’s not getting into the cell. So T4, in this case you have a higher amount of T4, but it’s similar. It has to do more with the receptor. And again, I do have an article on this on my website, naturalendocrinesolutions.com. But this is what it sounds like. So I would definitely check out the article, but again, I will be on next week if there are any questions that are not related to SIBO.

Shivan:

Thanks doc.

Dr. Eric:

Yes. Thank you. Thanks again. And there it is. There’s the book that you want to check out Healing SIBO and so again, Amazon or can you say one more time, those websites?

Shivan:

It’s go to sibosos.com. You can find it there. It’s clickable to Barnes & Noble, Amazon all your major book sellers and the audio book is done by an award winning actor. She did the vice president’s book, interestingly enough. I thought she did a really a job. Did you enjoy her narration?

Dr. Eric:

Yeah, I agree. I thought she did a real good job. So, again, listen to the audio book or read the book and I think if you’re dealing with SIBO, I don’t know. I mean maybe both but I would say maybe read it because when I’m…

Shivan:

It’s nice to highlight.

Dr. Eric:

Exactly.

Shivan:

It’s nice to highlight. And the studies we used are on a website that is clickable. So I think it’s clickable. I’m quite sure it’s clickable. So it can take you to the study. That was the goal. But if they didn’t, they’re there and you can just cut and paste. And someone on Amazon was like, “There are no references in the book.” I’m like, “Yeah, because I made it more convenient for you. Go to the website, click it, cut and paste and go to the study.” So, I didn’t waste your paper with something that you’re never going to type in anyway. Take care. Thanks so much.

Dr. Eric:

All right. Thank you. Have a great day Shivan. Thanks again for doing this. Appreciate it.

Shivan:

Thank you, it’s an honor to be here. Bye.