Recently I wrote a series of blog posts discussing the ketogenic diet, Paleo diet, and carnivore diet (I’ve discussed the AIP diet in the past and so I didn’t include it as part of this series).  When I was dealing with Graves’ disease in 2008/2009 I followed a restrictive diet during Thanksgiving and the rest of the holiday season.  And many of my patients with hyperthyroidism/Graves’ disease and hypothyroidism/Hashimoto’s also avoid certain foods during this time of year (as well as other times).  It’s never fun to restrict foods, especially during the holiday season, although keep in mind that even if you’re following one of the diets mentioned above, you can still enjoy the holidays while eating whole, healthy foods.

The truth is that there will always be reasons you can come up with to stray from whatever diet you’re following.  There are birthdays, anniversaries, other holidays (i.e. Valentine’s day), summer cookouts, etc.  No matter what time of year you’re trying to follow a strict diet it isn’t easy.  And I realize that not everyone reading this will be following a specific diet, but the goal of this blog post is to give some encouragement to those who are following a restrictive diet.

Whether you are following a strict diet or plan on indulging more than you probably should, I want to wish you a Happy Thanksgiving!!!

Note: this is the third blog post in a series of diet-related posts. Please check out my previous posts on the ketogenic diet and Paleo diet.

I’d like to begin by letting you know that I currently don’t recommend a carnivore diet to my patients, and while I do eat meat, overall I eat more of a plant-based diet.  That being said, some of the concepts behind a carnivore diet make sense.  The carnivore diet is based on the premise that animal foods are more nutrient-dense and bio-available than plant-based foods, and they also have the smallest amount of toxins.  And I will admit that the latter statement is almost definitely true, as even many proponents of a plant-based diet agree that there are potentially harmful toxins in plant-based foods.

Two examples include lectins and oxalates.  In fact, well-known cardiologist Dr. Steven Gundry recommends more of a plant-based diet, yet he realized that many plants have toxic compounds, which is what led him to write the book “The Plant Paradox”.  However, it’s also important to mention that not all plant-based foods are equivalent, and so while Dr. Gundry’s research shows that grains should probably be avoided, he does recommend certain types of nuts, as well as properly prepared legumes (i.e. pressure cooked).

What is a Carnivore Diet?

A strict carnivore diet involves eating only animal-based foods (i.e. red meat, poultry, organ meat, fish, eggs) while avoiding all plant-based foods (vegetables, fruit, nuts, seeds, grains, legumes).  The main reason why these foods are excluded is to avoid certain toxins, which include lectins, phytates, glycoalkaloids, and oxalates.  In his book “The Carnivore Code”, Dr. Paul Saladino discusses 5 different types of carnivore diets.  His “Tier one” diet involves eating mostly animal-based foods, but allows a small amount of the least toxic plant foods.  In his book he discusses the least and most toxic plant foods, although another excellent book that relates to this is “The Plant Paradox”, written by Dr. Steven Gundry.

I won’t discuss all five of the diets in Dr. Paul’s book, but I’ll mention that his “Tier five” diet excludes all plant-based foods.  Some of the foods he recommends to eat on this “Tier 5” diet include grass-fed muscle meat, connective tissue, seafood, and eggs.  It also involves eating a lot of organ meats.

Why Do People Choose To Follow a Carnivore Diet?

Many people choose to be a vegan or vegetarian because 1) they think that it’s healthier, or 2) they think it’s unethical to eat animals.  I don’t think that most people initially follow a carnivore diet because they think that all plant-based foods are unhealthy, and of course they’re not doing it because they think it’s unethical to eat plants.  The two main reasons are because 1) they are trying to lose weight and nothing else has worked, and 2) they have some type of health condition they’re looking to overcome.

How Can a Carnivore Diet Help with Graves’ Disease and Hashimoto’s?

Although I can’t say that I’ve had patients follow a strict carnivore diet, there are people with different types of autoimmune conditions who have found a carnivore diet to be life changing.   Obviously the same can be said for many other diets that involve eating whole foods, while avoiding refined foods and sugars, fast food, etc.  And while I’m sure there are people who haven’t done well on a Paleo or autoimmune Paleo (AIP) diet yet thrived on a carnivore diet, this is just proof that there is no diet that fits everyone perfectly.

An autoimmune Paleo diet involves avoiding most of the plant-based foods that are harsher on the gut and can potentially result in inflammation.  But without question there are people who don’t do well with the “allowed” plant-based foods, and thus they might do better on a carnivore diet.  It’s also worth mentioning that many of the AIP allowed foods are high in oxalates (i.e. spinach, sweet potatoes), which in some cases can cause pain, kidney stones, and other health issues. This doesn’t mean that you can never eat these foods, although it probably is a good idea to minimize your consumption of them.  For example, if you’re stuffing your smoothies with spinach like I used to do then you might want to reduce the amount of spinach you eat.

Can a Carnivore Diet Disrupt the Gut Microbiome?

In my recent blog post entitled “Can a Ketogenic Diet Benefit Those with Graves’ and Hashimoto’s?“, I discussed whether or not a ketogenic diet can negatively affect the gut microbiome.  I brought up a few different studies, and concluded that more research needs to be done, and to play it safe it might be a good idea to supplement with prebiotics when following such a diet.

Although there is no research I’m aware of that looks at the gut microbiome of people following a strict carnivore diet, one randomized controlled trial compared a vegan diet vs. a meat-rich diet, and after 4 weeks it showed that overall the gut microbiota was not remarkably altered between both diets (1).  So most of the participants showed a similar microbiota composition at the start and the end of the trial, which is encouraging for those who choose to eat mostly animal-based foods.  But of course four weeks is a short period of time.

One of the main concerns with avoiding plant-based foods is that there won’t be dietary fibers to support the flora of the gut.  Once again, this is disputed by advocates of the carnivore diet, as they claim that the body will adapt.  I’m not arguing this, but I still think more research needs to be done before we can conclude that a 100% animal-based diet won’t have any negative consequences on the gut microbiome when followed for a prolonged period of time (i.e. at least one year in duration).

Can a Carnivore Diet Cause Nutrient Deficiencies?

Advocates of the carnivore diet claim that eating a strict carnivore diet won’t result in nutrient deficiencies as long as you eat a variety of organ meats.  Although I can’t say I eat organ meats, I agree that they are very nutrient dense.  That being said, because of the lack of research demonstrating whether eating a diet consisting of 100% animal-based foods will result in nutrient deficiencies, even if one chooses to predominantly eat animal-based foods, I still think it would be wise to eat some plant-based foods as well.

Can a Carnivore Diet Increase Cardiovascular Risk?

While in the past there were some concerns about eggs increasing cardiovascular risk by raising cholesterol levels, this has been debunked (2) (3).  Currently most of the concerns with animal-based foods are with red meat, as there are numerous studies that show a relationship between red meat consumption and heart disease (4) (5).  While this might be attributed to eating unhealthy forms of red meat, one also needs to take into consideration that many people who eat “unhealthy” forms of red meat on a regular basis also incorporate other unhealthy habits.  For example, someone who eats non-organic, grain-fed beef probably is more likely to eat other lower quality foods than someone who regularly consumes grass fed/grass finished beef.

In 2015 I released an article entitled “Is Red Meat Harmful For Those With Graves Disease and Hashimoto’s Thyroidits?“.  In this article I argued that eating healthier forms of red meat (i.e. 100% grass fed beef) probably doesn’t carry the same health risks as unhealthier forms.  That being said, I can’t say that I eat red meat on a daily basis, but I’m not necessarily avoiding it on a regular basis, as I do eat it a few times per week.

Can other sources of animal-based foods increase cardiovascular risk? 

It’s important to mention that while most people who follow a carnivore diet probably eat red meat, those who follow this diet probably should eat other types of meat as well.  And the research seems to show a decreased cardiovascular risk when eating other forms of animal-based foods.  This includes poultry and fish (6) (7) (8).  Once again, none of these studies takes into account healthier forms of red meat.

Did Our Ancestors Follow a Carnivore Diet?

Although it does appear that some ancestral groups ate large amounts of animal-based foods, they didn’t exclusively eat this way.  They did eat some plant-based foods at times, and so while I do recommend more of a plant-based diet to my patients, if you eat a lot of meat I would still recommend to eat some vegetables.  You just want to try to avoid the least toxic plant-based foods while trying to restore your health.

Is It Safe To Follow a Strict Carnivore Diet Long Term?

Unfortunately I wasn’t able to find any long term studies involving people following a 100% carnivore diet.  On a short term basis it probably is fine to follow this.  But on a long term basis it is unknown.  I’m sure if you visit some of the carnivore diet Facebook groups there will be people who have followed this diet for many months, and probably some for years and who seem to be in a good state of health.  And if this describes you then please feel free to share your experience in the comments section below.

Have YOU Followed a Carnivore Diet?

If you have followed a carnivore diet, or are currently following one, then I’d love to hear from you! Whether you have followed a carnivore diet for a few weeks, months, or years, please share your experience in the comments section below.  If you followed a carnivore diet and it greatly improved your health please let me know! And if you followed a carnivore diet and you didn’t notice any improvements I’d also like to know!

Note: this is the second blog post in a series of diet-related posts. Please check out my previous post on the ketogenic diet.

In the last blog post I discussed the ketogenic diet, and I figured I’d go ahead and discuss the Paleo diet in this post.  In the past I’ve discussed the autoimmune Paleo (AIP) diet, and although the Paleo diet isn’t as restrictive as an AIP diet, this doesn’t mean that it can’t benefit people with autoimmune conditions such as Graves’ disease and Hashimoto’s.  In fact, it can be a great option for those who find an AIP diet to be too restrictive.

In this blog post I’ll mention how the Paleo diet is followed by many people looking to lose weight.  However, this isn’t the main reason I recommend this diet, and in fact, some people with hyperthyroidism are looking to gain weight.  Even when this is the case, following a Paleo diet can be a good option to consider, as the goal isn’t to restrict calories, but instead is to eat an abundance of whole healthy nutrient dense foods.

What is The Paleo Diet?

The Paleo diet is based on the diet that our Paleolithic ancestors followed.  As Dr. Loren Cordain mentioned in his book “The Paleo Diet”, there was no single Paleo diet, as our ancient ancestors made the most of their environment. In other words, they ate what was readily available.

Whereas the ketogenic diet is a high fat, low carbohydrate, low to moderate protein diet, the Paleo diet is a high protein, low carbohydrate, moderate fat diet.  Although I mention “low carbohydrate”, a Paleo diet usually isn’t as extreme as the ketogenic diet, which is a big reason why the ketogenic diet can be more effective for people looking to lose weight. That being said, many people who follow a Paleo diet for weight loss purposes also successfully shed unwanted pounds.

Why Do People Follow a Paleo Diet?         

Just as is the case with most other diets, many people choose to follow a Paleo diet to lose weight.  In the previous blog post I discussed how many people follow a ketogenic diet for the same purpose, but unlike a ketogenic diet, a Paleo diet is usually more sustainable long-term.  Of course not everyone follows this diet just to lose weight, as some follow it to improve and/or maintain other aspects of their health.  This is especially true for those with chronic health conditions, as many times it takes a life-changing event for people to start eating well.

Quite frankly, this described myself when I was diagnosed with Graves’ disease.  While I arguably didn’t eat as poorly as the average person, there definitely was a lot of room for improvement.  And after I was diagnosed with Graves’ disease I followed a Paleo diet initially, as back in 2008 the autoimmune Paleo diet didn’t exist, although there were similar “gut-healing” diets.  But even though I followed a Paleo diet to start off with, I didn’t really eat eggs, and I wasn’t a big fan of most of the nightshades (other than white potatoes, which I was avoiding).

However, I didn’t give up nuts and seeds, as I figured they were a nice healthy snack (which they are).  But when I hit a roadblock in my recovery I decided to give up nuts and seeds for a few months, and I do think it made a difference.  Perhaps if I properly prepared the nuts (i.e. soaked and sprouted them) I wouldn’t have had to stop eating them, and the same might be true of others reading this who have Graves’ disease or Hashimoto’s.

What Foods Are Allowed on a Paleo Diet?

When eating a Paleo diet there is no limit on the amount of lean meats, poultry, fish, seafood, fresh fruits, and vegetables (with the exception of starchy tubers) you can eat.  Eggs are also allowed, although not recommended to eat daily.  And nuts and seeds are also allowed in small amounts.  I’ll discuss why these should be limited shortly.

For those who eat meat, I of course would recommend to eat healthier forms of meat (i.e. organic, 100% grass fed, pasture raised).  And while I don’t agree that seafood should be eaten on a daily basis, if you do eat seafood you also want to choose healthier forms (i.e. wild vs. farm-raised salmon).  If you eat eggs they should be organic and/or pasture-raised.

So here is a bulleted list of foods that are allowed on a Paleo diet:

• Lean meats and poultry
• Fish
• Fresh fruits
• Vegetables
• Eggs
• Nuts and seeds
• Healthy oils
• Spices
• Honey

Why Should You Limit Eggs and Nuts?

First of all, not all advocates of the Paleo diet recommend to limit eggs and nuts.  Also keep in mind that eggs and nuts are excluded from an autoimmune Paleo diet because they include compounds that can be harsh on the gut.  But this isn’t the main reason why some recommend to minimize the consumption of these foods when following a Paleo diet.

In his book “The Paleo Diet”, Dr. Cordain gives a few reasons why eggs should be limited to a few times per week.  One reason is because they weren’t available all of the time to our Paleolithic ancestors.  He also mentions that eating too many eggs can promote weight gain and increase blood cholesterol levels. I honestly don’t think the latter reason is a concern with eating an egg or two per day…especially when it comes to affecting cholesterol levels.

As for nuts and seeds, the main reason why it’s recommend to minimize your consumption of them on a Paleo diet is because most nuts and seeds have a high omega 6 to omega 3 ratio.  Some nuts aren’t as high as others, as walnuts and macadamia nuts have a lower omega 6 to omega 3 ratio when compared to other nuts and seeds, including cashews, almonds, Brazil nuts, and sunflower seeds.  Dr. Cordain has a nice chart in his “Paleo Diet” book that lists the different ratios.  It’s also worth mentioning that nuts are higher in oxalates than other foods.

What Foods Should Be Avoided?

Just as is the case with any healthy diet, you of course want to avoid eating refined foods and sugars, along with unhealthy oils (i.e canola oil).  You also want to avoid grains and legumes due to the lectins, which can be harsh on the gut and in some cases result in inflammation.

Here is a bulleted list of the foods you should avoid when following a Paleo diet:

• Refined foods and sugars
• Dairy
• Grains
• Legumes
• Unhealthy oils
• Soda and sweetened beverages
• High amounts of salt

Can You Eat a Plant-Based Paleo Diet?

Although many advocates of the Paleo diet recommend to eat a lot of animal protein, some recommend to eat plenty of vegetables.  This includes Dr. Cordain, as while he does recommend for people to eat a lot of animal protein in his book, he also recommends eating plenty of fruits and vegetables.  In his book he mentioned that ancient Paleolithic groups ate an average of 55-60% animal foods as part of their daily caloric intake, although some ate a much higher percentage.

If you’re a vegan or vegetarian you might have stopped reading at this point, but I will say that in my opinion, people who follow a Paleo (or AIP) diet don’t need to eat a lot of meat.  The problem is that many people don’t eat enough vegetables and healthy fats (i.e. avocados), which is one reason why they are hungry throughout the day.  Of course there are other reasons, as many people with hyperthyroidism have a voracious appetite, and as a result they don’t feel satisfied unless if they eat larger amounts of meat.  If someone wants to eat more meat while following a Paleo or AIP diet that’s fine, but I just want to let you know that it’s not necessary.

When I dealt with Graves’ disease I ate a good amount of meat, but I also didn’t eat as many vegetables as I do today.  These days I eat plenty of vegetables (many as part of a smoothie), and I eat a small amount of meat on most days.

Does a Paleo Diet Negatively Affect The Gut Microbiome?

In my ketogenic diet blog post I discussed a few studies which showed the effects of this diet on the gut microbiome.  I concluded that more research needs to be done, and those who follow a ketogenic diet might want to consider supplementing with prebiotics, just to be on the safe side.  I came across a couple of studies on the effects of a Paleo diet on the gut microbiome (1) (2).

One of these studies showed that long-term adherence to the Paleo diet is associated with a different gut microbiota, and that a variety of fiber components, including whole grain sources may be required to maintain gut and cardiovascular health (1).  The other study concluded that “the consumption of Microbiota-Accessible Carbohydrates from plant-based foods–but not grains–at the expense of refined sugars, and the minimization of the intake of processed foods, both hallmarks of the Paleo diet, could indeed act synergistically in maintaining a eubiotic level of gut microbiome diversity.”(2).  However, they do advise that caution be taken in adhering to this diet in the long term.

How Long Should One Follow a Paleo Diet For?

Since getting into remission from Graves’ disease this is the diet that I follow most of the time, although I can’t say that I follow it strictly 100% of the time.  Occasionally I do eat dairy and grains.  And so I guess you can say that I follow a “modified” Paleo diet.  After presenting the research above related to the impact of the Paleo diet on the gut microbiome, some might be concerned about strictly following this diet on a long term basis.  I think if someone eats plenty of high fiber vegetables then there is minimal risk of following this diet for many months or years, as we don’t need to eat grains and legumes (or dairy) to thrive and survive.  That being said, if you’re concerned you can certainly try to eat some of these foods on an occasional basis, which is what I do.

Have YOU Followed a Paleo Diet?

If you have followed a Paleo diet, or are currently following one now, I’d love to hear from you!  How did you feel when following such a diet? Did you notice any positive changes in your thyroid panel results, or any other markers? If you happened to have had a negative experience with the Paleo diet of course please let me know as well, as the goal is to try to get both perspectives.

I commonly recommend an autoimmune Paleo diet to my patients with Graves’ disease and Hashimoto’s, but I’d like to dedicate a few blog posts to some of the other common diets, and to determine if they might also be a good fit in some people with thyroid and autoimmune thyroid conditions.  In this blog post I’ll be discussing the ketogenic diet, as it is one of the most well known diets.  And while many people use a ketogenic diet as a way of losing weight, I’m going to discuss some of the other health benefits of this diet, as well as if it’s a diet that should be considered for those with hyperthyroidism/Graves’ disease and hypothyroidism/Hashimoto’s.

What is a Ketogenic Diet?          

A ketogenic diet is essentially a high fat, low carbohydrate diet. When following such a diet the person will typically consume 20 to 50 grams of carbohydrates per day.  It usually consists of 70% fat, 20% protein, and 10% carbohydrates, although there is also a variation called the “high-protein ketogenic diet”, where the ratio is around 60% fat and 30-35% protein.  Following a ketogenic diet will cause the glucose reserves to decrease, and ketones are used as an alternative source of energy, and this is referred to as ketosis.  The two main types of ketones are acetoacetate and β-hydroxybutyrate.  These are produced in the liver through the process of ketogenesis.  It’s worth mentioning that a lot of this takes place in the mitochondria of liver cells.

Why Do People Follow a Ketogenic Diet?

Most people who follow a ketogenic diet do so because it can be very effective in helping them to lose weight.  While losing weight is probably the number one reason why most people choose to follow a ketogenic diet, it was originally used to help in cases of pediatric epilepsy.  However, the ketogenic diet became less popular once antiepileptic agents were developed.  As I’ll discuss below, the ketogenic diet can help with numerous health conditions.

Unfortunately people who follow a ketogenic diet don’t always pay attention to the quality of the food they eat.  So while it is very possible to follow a healthy ketogenic diet, it’s also possible to eat an unhealthy ketogenic diet.  But this is the case with just about any other diet, as for example, many vegans and vegetarians don’t eat good quality foods.  Similarly, while the Paleo diet is considered to be healthy, it’s possible to eat an unhealthy Paleo diet (i.e. eating fast food burgers without the bun instead of organic grass fed beef).  The same is true with an autoimmune Paleo (AIP) diet, as while I’d like to think that most people who follow this diet are paying attention to the quality of the food they eat, this isn’t always the case.

On a side note, I’m not suggesting that someone has to eat a 100% organic diet for it to be considered healthy.  Whatever diet you follow, the number one goal should be to eat whole, healthy foods, while avoiding refined foods and sugars, unhealthy oils, etc.  But I would try to eat organic whenever possible, especially when it comes to vegetables, fruits, and meat/poultry.

What Does The Research Show?

There is a lot of research on the ketogenic diet, and here are some of the health conditions it can potentially help with:

• Might lower cardiovascular disease risk
• Improves lipid panel markers
• Can benefit those with cancer
• Can help with obesity
• Can benefit those with type 1 and type 2 diabetes
• Can help with fatty liver
• Has neuroprotective effects
• May help with obstructive sleep apnea

So you can see that it’s not just about weight loss, although obesity does go hand in hand with some of these other conditions.  On the list above it mentions how following a ketogenic diet can improve lipid panel markers, although I will say that in some people, eating higher amounts of saturated fats can cause elevations in total cholesterol and LDL.  This includes healthier saturated fats such as coconut oil.  This is especially true when someone has the APOE4 genotype (1) (2).

Regarding neuroprotective effects, multiple sclerosis is an autoimmune condition that involves neurodegeneration, and there is evidence that the ketogenic diet can help people with progressive multiple sclerosis (3).  This may be due to the ketone bodies, as apparently they play a neuroprotective role in animal models of neurodegeneration (4) (5).  This also may be the reason why the ketogenic diet can benefit people with Alzheimer’s disease (6) (7).

Is the Ketogenic Diet Safe To Follow For Those with Thyroid and Autoimmune Thyroid Conditions?

A few studies have shown that a ketogenic diet can result in lower thyroid hormone levels (T3 and T4). One study involved 120 patients who followed a ketogenic diet for an entire year (8).  The results of the study showed that the ketogenic diet causes thyroid malfunction and L-thyroxine treatment may be required. Another study looked at the effects of a modified Atkins diet on thyroid function, and the results showed that after 12 weeks on the diet there was a significant reduction in total T3 and free T3 levels, but oddly a significant increase in free T4 levels (9).

Based on these studies, those with hypothyroidism/Hashimoto’s might want to be cautious about following a ketogenic diet.  On the other hand, it would be interesting to see if following a ketogenic diet would benefit people with hyperthyroidism/Graves’ disease.  In other words, would following a ketogenic diet help to lower thyroid hormone levels in people with hyperthyroidism?  One of the dilemmas is that many people with hyperthyroidism lose a lot of weight, and a ketogenic diet might contribute to this.  For example, when I dealt with Graves’ disease I lost 42 pounds, and so I’m not sure if a ketogenic diet would have been a good option for me.  On the other hand, some people with hyperthyroidism struggle to lose weight, and in this situation a ketogenic might be an option to consider.  This is especially true if they prefer not to take antithyroid medication.

Does a Ketogenic Diet Negatively Affect The Gut Microbiome?

A few different studies have looked at the effect of the ketogenic diet on the gut microbiome.  The concern is that in order to have a diverse microbiome you need plenty of dietary fibers, and many people who follow a ketogenic diet don’t eat as many foods rich in dietary fiber since these are a source of carbohydrates.  One way to get around this is to supplement with prebiotics, including inulin, fructooligosaccharides, and galactooligosaccharides.

But is supplementing with prebiotics absolutely necessary?  Well, one study looked at the effects of a ketogenic diet on the gut microbiome in people with multiple sclerosis (10).  This was a very small study, as ten patients followed a ketogenic diet for 6 months, and in the short term, bacterial concentrations and diversity decreased, but then they started to increase at week 12 and after 23-24 weeks actually exceeded the baseline values.

Another small study looked at the short-term impact of the ketogenic diet on the gut microbiota (11).  The results of the study showed that there were no statistically significant differences at 3 months in Firmicutes and Bacteroidetes.  However, there was a statistically significant increase in a bacterial group that has been linked to increasing inflammation.

Yet another study looked at the impact of low-FODMAPs, gluten-free, and ketogenic diets on the gut microbiota (12).  The authors concluded that the low-FODMAP and gluten free diet might have a greater impact on the diversity of the microbiome, and with the ketogenic diet the picture isn’t entirely clear.  I think that more research needs to be done, and for those who choose to follow a ketogenic diet, just to play it safe I would consider supplementing with prebiotics.

How Long Should One Follow a Ketogenic Diet For?

A ketogenic diet will usually be followed for at least a few weeks, and while some will follow the diet for 6 to 12 months, many find it difficult to stick with the diet past 6 months.  But of course this is also the case with other restrictive diets.  I don’t look at a ketogenic diet as being a long-term diet, just as I don’t look at the autoimmune Paleo diet to be a long term diet.  That being said, including components of the ketogenic diet into your regular diet routine is probably a good idea.  For example, while you might choose to eat more than 50 grams of carbohydrates per day, it probably isn’t a good idea to exceed more than 200 grams per day on a regular basis, which many people do.  It’s also wise to eat a good amount of healthy fats.

Have You Followed a Ketogenic Diet?

If you have followed a ketogenic diet I’d love to hear from you!  If you have hypothyroidism/Hashimoto’s and followed a ketogenic diet please let me know! Or if you followed it while dealing with hyperthyroidism please let me know.  And even if you followed it before developing a thyroid condition let me know! Thank you for sharing your experience with everyone.

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:

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.