SIBO, A Personal Perspective: Rational Wellness Podcast 201

Shivan Sarna discusses a personal perspective on SIBO with Dr. Ben Weitz.

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Podcast Highlights

2:30  Shivan recalls having food poisoning when she was five and then again when she was eight.  She spent a lot of time in the bathroom growing up due to constipation and she was called “Buddha belly” due to abdominal bloating. Then after college she found herself working in a moldy building and she was getting really sick. She went to a Gastroenterologist who told her that she had IBS and prescribed an antidepressant.  Shivan did a SIBO breath test and she was told that the results were negative, but it was actually positive but someone had written positive and then crossed it out and wrote negative.  She finally saw another doctor she calls the digestion detective, who showed her that it was clearly a positive test result.  She became an ideal patient and she sought various treatments, including seeing Dr. Allison Siebecker and going for Ayurevedic, rolfing, steroid shots for firbromyalgia, acupuncture, etc. and she took notes and became knowledgeable about SIBO and IBS.  Then Shivan started the SIBO SOS Summit One and then did SIBO SOS Summit Two and the IBS and SIBO Summit. Shivan also did the documentary Digestion SOS: Rescue and Relief for IBS, SIBO, and Leaky Gut. She also did the Microbiome Rescue Summit and then her book, Healing SIBO: Fix the Real Cause of IBS, Bloating, and Weight Issues in 21 Days, came out.

8:40  Shivan has post-infectious IBS that she learned through taking Dr. Pimentel’s IBS Smart test, which is a blood test that measure antibodies to Cytolethal Distending Toxin and to Vinculin.  The concept that Dr. Pimentel discovered is that after a bout of food poisoning, the bacteria secrete an endotoxin called Cytolethal Distending Toxin. The immune system reacts and creates antibodies to the Cytolethal Distending Toxin and then these antibodies cross react with a structural protein in the intestinal wall called Vinculin, which then damages the motility of the digestive tract. This is the autoimmune component of IBS and SIBO, aka, post-infectious IBS.

11:12  Essentially the IBS Smart Test tells us that IBS is an autoimmune disease.  There is a new breath test from Gemelli Labs called the Trio Smart test that can diagnose SIBO and the type of SIBO based on which gas is found, whether it be hydrogen, hydrogen sulfide, or methane.  Treatments include pharmaceuticals, herbals, or the elemental diet. For hydrogen and hydrogen sulfide the preferred pharmaceutical would be rifaximin, while for methane rifaximin would be combined with Neomycin.  The advantage of rifaximin is that it acts locally in the small intestine and it is not systemic, so it will not devastate your microbiome, which can happen with broad spectrum antibiotics.

13:40  Shivan took rifaximin but had to do multiple two week rounds of it.  She kept relapsing because her migrating motor complex was not working properly, so a key for her recovery was to take a prokinetic drug.  Shivan described the migrating motor complex (MMC) as the sweeping motion of the small intestine, which is like the crumb clearing that occurs when the waiter at a restaurant clears your tablecloth. If you have scleroderma or diverticulitis or endometriosis, these can all inhibit the migrating motor complex.  The collagen condition, Ehlers-Danlos, also negatively affects the MMC.  If the MMC doesn’t clear out the small intestine, then bacteria can overgrow and then the bacteria eat fermentable carbohydrates and it becomes like a microbrewery. It causes bloating, and can lead to nutritional deficiencies, anemia, rosacea, and restless leg syndrome.

16:05  SIBO breath test preparation.  This test requires a 12 hour prep diet followed by a 12 hour fast.  For the diet, there are no veggies. You can have white rice, eggs, chicken without the skin, and black coffee. You don’t want to eat anything that will take a long time to digest and that can cause fermentation. Shivan also suggests for the 12 hour fast to sleep as much of that time as possible.  She suggests to do the test at home instead of at the doctor’s office. It is best to pre-label all of the tubes ahead of time and so you don’t mess it up, it is best not to plan to do anything else during those 3 hours.  It is also helpful to have two timers, like two phones or a timer and a clock.  But this test is important to find out what your levels are and what type of gas you have.

18:43  SIBO can cause brain fog, which Shivan suffered both from doing the breath test and from SIBO.  Dr. Satish Rao has done an interesting study about brain fog and gut issues. (S. Rao, A. Rehman, S. Yu, N.M. de Andino.  Brain fogginess, gas and bloating: a link between SIBO, probiotics and metabolic acidosis. Clinical and Translational Gastroenterology: June 2018 – Volume 9 – Issue 6 – p e162.)

19:52   Does taking probiotics help with SIBO?  Do probiotics, which are bacteria, contribute to the bacterial load in bacterial overgrowth and make the condition worse?  Some practitioners find that prescribing probiotics can be very helpful for patients with gut problems like SIBO/IBS, while other practitioner find that they often cause their patient’s symptoms to flare and get worse.

21:50   Quick Symptom Relief Strategies, which includes strategies for relieving bloating, pain, constipation, diarrhea, acid reflux, etc., including applying castor oil packs by getting good, organic castor oil and apply it to a piece of flannel or an old T-shirt and then place it over your stomach with a piece of parchment paper and a hot water bottle on top. It will stain your sheets and make your night clothes sticky, but it really helps with pain, inflammation, and motility.  It works best if you do it consistently for a while, like five nights in a row.  Activated charcoal can help with diarrhea, but you should take it apart from food and supplements.  There is a form of butyrate–tributyrate–that helps with diarrhea.  Iberogast is a good natural prokinetic, though it is hard to find.  For constipation, you want to drink a lot of water and magnesium can be really helpful.  Abdominal pain can be related to visceral hypersensitivity and curcumin can be helpful.  For abdominal bloating, Atrantil can be helpful, and it helps irradicate SIBO, esp. the methane form.  Peppermint oil and peppermint tea are helpful for pain. Gas-X and Pepto-Bismol can also help with pain.  Also IB Gard is a form of peppermint oil capsules that is sold in drugstores.

32:16  SIBO diet.  Shivan used the SIBO specific food guide developed by Dr. Allison Siebecker, which is her version of the low FODMAP diet. You want to eat in a manner that will reduce your fermentable load.  You have to understand that while diet can help to avoid feeding the bacteria and this can make you feel better, diet alone cannot cure SIBO.  To this day, even though she feels much better with her SIBO, she still cannot tolerate garlic or onions and she eats gluten free.  You can get green onions and just eat the green part, so it is like eating an onion without eating an onion.

37:30  Shivan used antimicrobial herbs, including oil of oregano, allicin in the form of Allimax or Allimed. She used CandiBactin-AR and BR from Metagenics. She also tried the Elemental diet and she tried both Integrative’s and Dr. Ruscio’s version of it. Shivan continues to take a prokinetic and she cannot really tolerate most of the natural ones because most of them contain ginger and she gets reflux from eating ginger. She takes Motegrity, which used to be called Resolor.  You also have to make sure to space your meals out so you have 4 or 5 hours between meals to stimulate your migrating motor complex to work.  Shivan also found it helpful to use the biofilm busting agent that was developed by Dr. Paul Anderson at Priority One.


Shivan Sarna, who was originally a patient, but Shivan has now become an expert at IBS and SIBO as a result of her experiences as a patient and due to her being the creator and the primary interviewer for the docuseries Digestion SOS: Rescue and Relief for IBS, SIBO, and Leaky Gut, as well as the SIBO SOS Summits. Shivan has now just published a book, Healing SIBO: Fix the Real Cause of IBS, Bloating, and Weight Issues in 21 Days.  

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.


Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.  Hello, Rational Wellness Podcasters.

                            Today our topic is SIBO, small intestinal bacterial overgrowth, with Shivan Sarna. Now, we’ve certainly discussed SIBO quite a number of times. However, there’s always different perspectives, and today we’re going to get a little bit of a patient’s perspective, along with additional scientific information that she’s gleaned both from her own experiences, as well as being the primary interviewer and creator for the docuseries Digestion SOS: Rescue and Relief for IBS, SIBO, and Leaky Gut, as well as the SIBO SOS Summit.  And now Shivan has published a book, Healing SIBO. It’s a very readable, helpful book for anybody dealing with SIBO. And so, what is SIBO? SIBO is small intestinal bacterial overgrowth, and it is the most common cause of irritable bowel syndrome, IBS, which is the most common digestive disorder.  IBS is characterized by one or more of the following symptoms: abdominal pain, gas, bloating, diarrhea, constipation, sometimes alternating, nausea, and the urgent need to defecate, as well as a whole bunch of other symptoms. Sometimes skin issues, sometimes brain fog, et cetera. And so, Shivan Sarna, thank you so much for joining us today.

Shivan:                 Oh my gosh, thank you so much. I’m a long time listener and a huge fan. I appreciate it. I got to get the word out, man, so thank you for letting me talk about constipation, diarrhea, and bloating on your show.

Dr. Weitz:            Yeah. Hopefully, we won’t have constipation of the mouth. Maybe you can tell us about your personal journey with digestive disorders and SIBO.

Shivan:                 Before I tell my story, I always say I’m going to tell the story in a way that hopefully will help someone else. Not just like, “Ooh, what’s my story?” Because I usually … As an interviewer, I’m like, “Oh, is anyone going to listen to the story? What’s in it for you? I’m going to tell you.”  I had food poisoning when I was five. Then I had food poisoning when I was eight. Trip to India. Trip to a farm. And I was never the same afterwards. And the reason I know that, it’s not that I have these overly vivid memories of that time in my life, although I do remember the episodes. My father’s from India. My mom’s from Upstate New York.   And my dad, familiar with Ayurvedic basics, was like, “I don’t think Shivan’s going to the bathroom enough,” to my mom. And my mom made inquiries to me, the five-year-old. And that was the first time ever experienced shame. Like, “Really, am I doing something wrong? Get out of my beeswax. I’m five.”    But that was a big, like, “Is something wrong with me?” And they had a poster in the bathroom with this long quote on it and it’s the first thing I ever memorized, because I spent so much time in the bathroom. So, that’s the beginning. I grew up and we called it “Buddha belly,” with all respect to Buddha. And I’m skinny everywhere else, but I have this bloated belly, and-

Dr. Weitz:            So we’re going to talk about the spiritual aspect of SIBO.

Shivan:                 Oh, absolutely. Oh, honey. There is no doubt about it. It has taken me there. Lot of praying. Praying, expressing gratitude. It all blends together in my world.

Dr. Weitz:            There you go.

Shivan:                 So, I went to college and my girlfriends in the sorority house, they clearly didn’t have the same patterns that I had. I had been drawn into health food starting at age 15 with food combining, if you remember that. And just, I was different, which I’m used to. It’s fine, but there was something going on.  And then fast forward, I have this big career. I work in a moldy building that I didn’t know was moldy for 20 years, and I’m getting really, really sick. And people are asking me if I’m pregnant on Facebook, which I am not.  And that’s devastating for somebody who’s supposed to be an aspirational TV host. But I’m also really not feeling well. So, I finally go to a gastroenterologist, and the gastroenterologist is like, “Well, you probably have IBS. Run three miles. Here’s an antidepressant.”   And I thought, “Are you trying to tell me it’s all in my head? And I don’t have the energy to run a block, much less three miles.” So, I had this other girlfriend at work, and she was another weirdo, because we were gluten free, and we were weird. Fine. That’s fine.  And she told me … I saw her randomly and she’s like, “Oh my gosh. I’m doing this really crazy antibiotic, and I had to do this test where I breathe into this test tube. Got to go. Talk to you later. Bye.” And I was like, “What? Wait a minute.”   So, I got the information. She was not … She was wonderful, but did not know what the heck she was talking about. She was just doing what her doctor said. I did a SIBO breath test. Same thing, didn’t know what I was talking about. I was just like, “Whatever. Maybe it’ll help me. I don’t know. I’m desperate.”   And I got the wrong information, in that someone said it was negative, when actually, it was positive, and I lost 18 months. And when you’re chronically uncomfortable and you’re trying to figure out your diagnoses, you’re like, “Oh, don’t have that. Great.”   I begged for a colonoscopy on the last appointment before Christmas break. They were closing the outpatient clinic down, basically, as I was recovering. “Oh. No, I don’t have cancer.” Which is great, thank you. But, “Oh, don’t have cancer. What is it? What is it? What is it?”  So, it was difficult because I actually did have SIBO, but for 18 months of intense questing, didn’t know that was it. Finally went to a doctor who I call “the digestive detective,” and he’s like, “I want to see the results. I want to see that graph.”

Dr. Weitz:            Yeah, there’s a lot of differences in interpretation.

Shivan:                 Well, there it was. Someone had written “positive,” crossed it out, and wrote “negative.” And when you look at the graph, if you’re even mildly familiar with this, it’s so blazingly obvious that it was a positive result. So, that made me really mad and sad.   And my husband was getting his CPA as a grown-up, and so he was studying a lot. And I became, for the first time since the ’80s, someone who had a little bit of time on her hands. So I sat there in front of my computer and did Dr. Google, and took all my notes, and the typical chronic condition patient journey.  And I would go to all my doctor’s appointment. Ayurvedic, Rolfing, steroid shots for fibromyalgia, acupuncture, you name it. And every time I’d sit down, I’m like, “Here are all my notes.” I was super like, nerd patient. And they’d look at me and they’d be like, “You know, you really need to write a book.”   My spiritual teacher: “You know, you really need to write a book.” So I’m sitting there and I’m like, “Listen, God. I really need to tell the world about what I’m discovering, and if I figure it out, I will tell the world.”   What happened was, I was trying to write the book. It’s not that easy. I’m a TV person. I can definitely do an online summit. I can do video. I can do interviews. So, I started with the SIBO SOS Summit One, which Dr. Allison Siebecker was so pivotal in, because she introduced me to all of her colleagues.   And then, I did SIBO SOS Summit Two. I did the IBS and SIBO SOS Summit. I did the documentary you referred to, Digestion SOS: Rescue and Relief for IBS, SIBO, and Leaky Gut. Looks better on paper than mouthed. And then I’ve done the Microbiome Rescue Summit, and then the book came out, because I took everything I learned from these summits as well, and put it into the book.    So, that’s how I got here. I do have post-infectious IBS. I learned that from Dr. Pimentel’s blood test, which I know your listeners … Go back and listen to Dr. Mark Pimentel’s session, if you haven’t listened to it. So I know I have the antibodies, which we’ll explain, and therefore I’m very religious with the prokinetic, which we’ll also explain. And so, another message is, if you have a chronic condition that goes untreated, you can feel horrible. If you have a chronic condition that is treated, you can feel 100% better. And that’s what I do.

Dr. Weitz:            Right. So, for those listening who don’t understand about the autoimmune component, how you could take a blood test and tell you that you have SIBO, is that Dr. Pimentel discovered that one of the most common causes of SIBO is that somebody gets food poisoning, and the bacteria that causes the food poisoning causes an immune reaction.  And the immune system reacts against a toxin that that bacteria secretes, called “cytolethal distending toxin,” and then those antibodies, again, cytolethal distending toxin, then also react against a structural protein in the intestinal wall called “vinculin.”  And so, there’s a blood test that Dr. Pimentel developed, that measures antibodies to cytolethal distending toxin and vinculin. And so, when this test is positive, it shows … and then what happens as a result of the immune system, the antibodies attacking the vinculin, it affects the migrating motor complex and the motility of the small intestine, and that allows the bacteria to build up. And so, this blood test will tell you that you have these antibodies, and that’s how your SIBO developed.

Shivan:                 So, officially, if you have post-infectious IBS, like if you talk to the guys at the lab, they will not say that it’s a SIBO test, right?  Because the SIBO breath test, which Gemelli Labs, also from Dr. Pimentel, does. But it tells you have post-infectious IBS, which is SIBO, which is … but it’s not a SIBO, officially, according to all the medical people. It’s not.

Dr. Weitz:            Right. [crosstalk 00:11:07]

Shivan:                 Yeah. But I’m really glad I did it, because now I know my underlying cause.

Dr. Weitz:            Yeah. And one of the most fascinating things about that test is, it tells us that IBS, which is the most common digestive condition, is actually an autoimmune condition. So, how should patients think, who have IBS and they go to a conventional gastrointestinal doctor, and they’re told to just take some drug to treat the symptoms, like you were told to take a antidepressant?  Or maybe they have diarrhea and they’re given a drug to control the diarrhea, or maybe they even got diagnosed with SIBO and were given two weeks of an antibiotic known as rifaximin, and then they’re still not better? What should SIBO patients think about that situation?

Shivan:                 Well, first of all, there is a breath test for SIBO that you can take, that will tell you what kind of SIBO you have. Do you have hydrogen-dominant? Do you have methane-dominant? “IMO” for short. Or do you have hydrogen sulfide? And that’s called “Trio Smart” from Gemelli Labs, and also Aerodiagnostics does a beautiful job with breath testing.   So, you find out what your levels are, right? And what kind of gas you have: hydrogen, hydrogen sulfide, or methane. Then that will dictate the treatment, and there are three major treatments. One is pharmaceuticals. One is herbals, and one is the elemental diet. And that rifaximin that you were just talking about is the antibiotic that Dr. Pimentel discovered works in the small intestine, stays in the small intestine.  It’s actually the one given for traveler’s diarrhea. So, since e. Coli is the cause of much of the SIBO out there, that makes sense. And then if you have the methane-dominant, it’s combined with Neomycin, and then if you want to do … and there’s some other variations, but those are the main ones.   And you need to realize that, after you do that round, it’s not like normal antibiotics, where like, “I was sick. I took the antibiotic. I’m well.” You may have to do multiple rounds, but the studies show that to rifaximin, the resistance … I would say the clinical experience, at the very least, the resistance is not like with other antibiotics. It also stays in the small intestine, so it’s not like a nuclear bomb goes off in your microbiome, whereas Neomycin, it is bigger.

Dr. Weitz:            You took rifaximin, right?

Shivan:                 Oh, yeah. Oh, yeah. I’ve done it all.

Dr. Weitz:            What was your experience with it?

Shivan:                 Well, so to your point, I was not told that I would have to do multiple rounds. So I took it and wasn’t better, and I was like, “What the hey?” Like, “Wait a minute. This isn’t normal.” So I took it and then re-tested, and saw that it helped, so then I did a couple multiple rounds.  This whole time, though, I was not told to do a prokinetic.  So, I was relapsing because I wasn’t still moving my migrating motor complex.  So, in a prokinetic-

Dr. Weitz:            Maybe you can explain what the migrating motor complex is?

Shivan:                Yeah. Sure. You know… 

Dr. Weitz:            I know, I know.

Shivan:                 You [crosstalk 00:14:22]. The migrating motor complex is that sweeping motion of the small intestine. They call it the “crumb-clearing” … like, think of a waiter in a white tablecloth restaurant who comes around with that little crumb clearer. Fancy, fancy. That’s not my analogy, but I do love that one.  And it sweeps out the debris from the small intestine, and if you have adhesions, if you have scleroderma, if you have endometriosis, diverticulitis, those all can impact the migrating motor complex, along with the antibodies that you were just talking about.  And if it’s adhesions or endometriosis, it’s because literally, it can be pulling the small intestine out of a particular place in the body. Ehlers-Danlos, the collagen condition as well. So, your migrating motor complex actually might work from a mechanical, chemical perspective. But the physicality of the placement of the intestines could be inhibiting that motion.

                                Or if you’re like me and you have post-infectious IBS, then you have that mechanical chemical thing going on. So, when you don’t sweep the debris out, the food in the small intestine can overgrow, thus small intestinal bacterial overgrowth, because … not the food. The bacteria eats the food in the small intestine, and that is what overgrows, and become like a micro brewery.   And it ferments your food, all that bacteria overgrowing, and that’s why the bloating comes, and it can rob you of your nutrition. It can lead to imbalances of anemia, rosacea, restless leg syndrome. I’ve spoken to some of these doctors and they theorize, some of them, that it may even impact fertility, which I found fascinating.

Dr. Weitz:            Interesting. So, do you have any suggestions, you mentioned a breath test, for patients who are getting ready to take the SIBO breath test, from a patient’s perspectives?

Shivan:                 Yeah. No, I’m a vegetarian, so it’s even more intense because you have to do a 12-hour prep diet, followed by a 12-hour fast. And so, they suggest that, for the 12-hour fast, you sleep-

Dr. Weitz:            You don’t have any vegetables?

Shivan:                 Oh. Well, during the diet, it’s no veggies … Well, it’s rice. You could do white rice. You can do eggs. You can do chicken without the skin. You can do black coffee. It’s super, super limited. And the reason is, is because they’re trying to get you to not ferment your food.   And even though rice is a carbohydrate, it stays higher up in the intestine and gets digested fairly quickly, so it doesn’t really get a chance to ferment in the low intestine. So, I suggest doing the prep diet, being very strict on it.

                                Then I suggest sleeping for as long as possible the next day for that 12 hours. I’m not saying sleep for 12 hours, but if you can sleep for eight hours, then you only have a four-hour window until it’s time to take the breath test.   And you could take it in the office of a doctor who gives them, but you can also do it at home. And I prefer that, because I can … especially now, do it at home. But I tend to not do well with lactulose, which is the sugar that you drink prior to breathing into the test tubes. The body doesn’t digest it, but the bacteria love it.   And then, you breathe into these test tubes every 20 minutes for two or three hours. It depends on whichever test you’re doing, by the manufacturer and the lab. But I tend to get a lot of brain fog when I drink lactulose, so I have messed the test up, simply by going, “Did I just breathe into this test tube? Is this test tube eight or is this test tube nine?”   So, pre-label everything. Have two timers, like two phones or a timer and a clock, and try not to get too distracted, because keeping track after a while … and it looks … not nothing, but it looks like, “Oh, I can handle this.”    Now, Dr. Siebecker will run an errand, go to the grocery store and do a SIBO breath test no problem. I’m like, “Okay. I’m locked and loaded. For the next three hours, no one bother me.” So, everybody’s different. But it is a little bit of a project but it’s totally worth it to find out what your levels are and what type of gas you have.

Dr. Weitz:            Right. And so, you have some issues with brain fog from lactulose. Do you get that from your SIBO as well?

Shivan:                 I do. I did have really bad brain fog from … I do believe it was my SIBO, combined with my mold. At one point, I couldn’t … It was one day, I should say. I mean, it’s been fluctuating, but the worst brain fog I ever had was, I couldn’t speak. And that was extremely scary since I talk for a living.   And it was on a weekend, so I was able to actually recover. But I couldn’t speak. And it’s fine to lose a word every now and then, but I literally could not find a couple of words. Not to mention the mechanical, putting my lips together and breathing, speaking. It was bad. It was bad.  So, that was the worst case scenario. But brain fog is real. And Dr. Satish Rao has done a very interesting study about brain fog and these gut issues, which was not without controversy, but I think was quite compelling.

Dr. Weitz:            Are taking probiotics good or bad for SIBOs? Some practitioners say if you take any bacteria, it’ll only add to the bacteria you’re trying to eliminate. There are some practitioners, like Dr. Ruscio, who feels that probiotics, after you institute a diet, should be your first intervention, and that alone can take care of the SIBO. What do you think about probiotics and SIBO?

Shivan:                 So, I’m definitely a big fan of Dr. Ruscio’s, and I’ve heard his … I’ve interviewed him about this topic, about the rotation and the different types of probiotics. I think it’s fantastic. I mean, if you’re sitting there going, “I’ve tried everything.” First of all, Dr. Siebecker always says, “Have you really tried everything?”    But anyway, if you feel like you’ve tried everything, I would definitely read Dr. Ruscio’s book and go to his website for his blog posts about it, about the rotation of these three types of probiotics, to see if it helps. He has incredible clinical results with it.   Classically, people are very split down the middle. Why would you take a probiotic and add more bacteria when you already have an overgrowth of bacteria? But if you sit and think about it, is that bacteria making it to the small intestine from the probiotic? Is that probiotic full of a gatekeeper-style probiotic that will actually help to balance the diversity, and actually help to get rid of the bad guys in an overgrowth?  So, I think it’s very personal as the microbiome is, and I think if you feel like you’ve tried everything, it’s worth a try. But so, I don’t have an answer for you that’s clear-cut and like, “Yes, this always works,” because it doesn’t. It’s very personal. I know people that it has been like a miracle for, and I know people that it’s been really uncomfortable for.

Dr. Weitz:            You have a chapter in your book on quick symptom relief strategies, and I thought some of those were really interesting. Maybe you can talk about some of these quick symptom relief strategies for … You have ones for bloating, pain, constipation, diarrhea, acid reflux.

Shivan:                 So, remember, I’m the patient, right? And I’ve interviewed all these experts, and so this is based on Dr. Allison Siebecker’s symptomatic relief guide. And-

Dr. Weitz:            Right. Now, one of them that you talked about was applying castor oil, and you put that directly over your stomach. Tell me about that.

Shivan:                 Love it. Love it.

Dr. Weitz:            Okay, so how do you do it, exactly?

Shivan:                 Okay, so there are a couple of techniques. So, you get the organic, good castor oil that’s in a dark glass bottle, and you take a … This is an old school naturopathic technique, right? You take a piece of flannel. I know some people who only do organic flannel, whatever. I have seen people use a T-shirt before.  This is before you go to bed, right? And you put the castor oil on, and you put the flannel on. Maybe you put a piece of parchment or wax paper on, and then you put a hot water bottle. Some people put heating pads. They’re going, “Oh, the EMFs,” whatever. So you have to decide.  But then you just keep it on for as long as possible. It will stain your sheets. It will make your night clothes sticky, so I put on a … To be very personal, I take my husband’s boxer briefs. I wear them that night, and I take an old T-shirt of his, and I put it on underneath and kind of tuck it in and around, and it works great. This is not something to wear with your pretty nighties.  And basically, the castor oil, which is, in my opinion, not a great idea to consume, it’s an old school, very, very strong laxative. There are so many other options.

Dr. Weitz:            Yeah. Remember, castor beans are where the poison ricin comes from.

Shivan:                 Exactly. Let’s not go crazy here, people. There are too many other options. But it reduces inflammation. It helps with motility. It helps balance things. So I know people with diarrhea that have done really well with them. I know people with constipation. Just even the bloating. It’s very soothing.  I also … I have a Facebook group with 18,000 people in it. So when I’m talking about, “I’ve seen people do this and I’ve seen people do that,” the SIBO SOS Facebook community is what I’m referring to. Not to mention all the emails I get.   But I’ve heard people say like, “I tried it for two nights and didn’t notice it.” Give it like five nights in a row, and I mean, chances are you’re really going to notice something good. It’s pretty magic from that perspective. So, that’s very soothing. Very, very soothing. And I think we need to be soothed. I think we need to be comforted.

Dr. Weitz:            Yeah. What are some of the other relief strategies?

Shivan:                 Some of the other relief strategies include, if you have diarrhea, activated charcoal which is sold everywhere. If you feel like you ate something that was, “Did I just get food poisoning?” That’s really handy, and it does tend to constipate, so Dr. Siebecker suggests that you take it with magnesium if you’re worried about that. Although it does also absorb nutrients, so maybe wait a little bit, then take the magnesium. You don’t want to take it with food.  We see charcoal showing up as an odor remover, as a teeth whitener, which I don’t suggest. I’m doing a dental summit, so I know, don’t do that. I mean, it can be totally life-changing for people. So charcoal if you have diarrhea. I also just talked to Steve Wright, I don’t know if you know him, from SCD Lifestyles?

Dr. Weitz:            Oh, I’ve heard him. I’ve never met him. Yup.

Shivan:                 Lovely guy. Really smart guy. And he just talked to me about Tributyrin-X, basically tributyrate, for diarrhea, and that works like a champ as well, so I thought that was really interesting, that particular-

Dr. Weitz:            Tributyrate? Is that similar to butyrate?

Shivan:                 Yes. Yes, but they’re different forms of butyrate, so this is the tri. But yeah. He’s had great success with that. Some of the other things are Iberogast, which is hard to find with American English writing on the box. You can get it on Amazon, and it looks like it might be an Eastern European language. I don’t know if it’s Russian or what.  But that is a natural prokinetic, and interestingly enough, will help people if they’re nauseous, help people if you have diarrhea, constipation. It’s really interesting. It is not to be taken if you are on opioids, so that’s just a little disclaimer.  But that’s been also pretty miraculous for a lot of people, and you can play with how many drops that you take. I personally don’t like the taste of it. I’m a super taster, so I was doing our course, the SIBO Recovery Road Map with Dr. Siebecker, that we created together. And we were taping that day and I was like … I’d just come back from work. I’d just been in the mold. I didn’t really feel well.  And we had all these products out in front of us, and I’m like … She’s talking to me about Iberogast and I’m like, “You know I hate the taste.” She’s like, “Yeah, but you don’t feel well to begin with.” I’m like, “I know. It’s terrible. I feel terrible.” So, we caught me on tape taking it, and then how I reacted within an hour, and it did the trick. It really did the trick, so that’s my personal testimonial for that.

Dr. Weitz:            What about for constipation?

Shivan:                 So, that does work for constipation too, but certainly, making sure you’re drinking enough water. I’m not going to say, “Do fiber,” because if you have SIBO, the bacteria feeds on fibers. So that’s why, in my book, it’s a vegetarian set of recipes, because you can always add any kind of protein you want.  But when you are doing recipes and eating for SIBO, it’s hard if you want vegetables. Of course, we all want veggies. And so, if you are constipated, I’m not going to say, “Do fiber.” I am going to say that Dr. Siebecker talks about … Let’s see. I’m going to try to remember here.

Dr. Weitz:            Well, magnesium, of course.

Shivan:                 Oh my gosh. Magnesium, of course. Magnesium is her go-to. Most people, she says, don’t do enough. Right? So we think, “Gosh, I’m doing 600 milligrams. That seems like a lot.” And for somebody, it is. But maybe for you, it’s not. So, she likes the Vitamin Shoppe’s magnesium. I like it, but my husband has it around the house, so I usually just take that, but magnesium is like magic for a lot of people with constipation.

Dr. Weitz:            And what about any other hints for pain? You had a couple of interesting ones in there.

Shivan:                 For pain, it’s definitely something that … So, I just want to talk about pain for a second, from the perspective of people with IBS. You may have visceral hypersensitivity. And visceral hypersensitivity is pretty much what it sounds: visceral, the belly/abdominal area, and hypersensitivity. What hurts you might not hurt somebody else.  It could feel over the top for you. Like, “Oh my gosh, I feel like I’ve got a knife in my belly.” Other people could eat the same thing or have the same experience and they’re like, “Oh, I’m fine. It’s no big deal.” So, in your practice, how do you handle visceral hypersensitivity?

Dr. Weitz:            Curcumin is an interesting nutrient that’s been shown to be beneficial.

Shivan:                Oh, we love. Love. Okay, do you do the pepper or no pepper?

Dr. Weitz:            No pepper. I don’t like the pepper.

Shivan:                I don’t like the pepper either!

Dr. Weitz:            Patients hate it, especially if you want to do a high dosage. The pepper’ll just irritate their gut, so we use the one blended with phosphatidylcholine, the Meriva form.

Shivan:                Oh, yeah. Nice. Nice.

Dr. Weitz:            Yeah.

Shivan:                So just real quick, this is the section on the symptoms, like you were talking about. There’s a section on bloating. Oh, Atrantil, I have to give a shout-out to. If you have methane-dominant, methanogen overgrowth, Atrantil is worth looking at.

Dr. Weitz:            Yeah, we use that. Dr. Ken Brown, yeah.

Shivan:                He’s awesome. Awesome. So, peppermint oil and peppermint tea is also great for pain. It helps things move, but not in a laxative way. Also, some of the pain, I think is … depends, obviously, but from gas. And Gas-X helps to break the big gas bubbles into smaller bubbles, so it doesn’t feel as much pressure.  And also, Pepto-Bismol is around for a reason, for a really long time. There is a brand from Target. I can’t remember the name of it right now. I think it’s in here, but it’s the in-house brand of Target. They have the safest for SIBO-

Dr. Weitz:            We just can’t do that. I just can’t … Artificial sweeteners and artificial colors, and …

Shivan:                Yeah. Oh, the color. Oh, yeah. The nature pink. What? I’m not saying it’s natural. I’m not saying it’s natural.

Dr. Weitz:            I know, I know.

Shivan:                I’m saying, in desperate times, sometimes, desperate measures.  This is full of natural [crosstalk 00:31:35]

Dr. Weitz:            I notice in your book, you talked about, if they’re having abdominal pain, that if they use … If the pain is in the upper part of the abdominal cavity, that peppermint tea might be better, whereas if it’s lower down, enteric coated peppermint capsules might be better.

Shivan:                Because of the enteric coating, it’s going to make it further down.

Dr. Weitz:            Right. Yup, yup.

Shivan:                The IB Gard, I think is what it’s called. And that’s been studied, and you can get it at all your local drugstores, so that’s a Godsend too. And it’s something like … It’s not going to hurt. It might help, right? So, very low risk. Very low risk.

Dr. Weitz:            So, let’s go to diet. Which version of the SIBO … There’s multiple SIBO diets out there. The one that’s talked about today the most is the low FODMAP diet. And you mentioned the specific carbohydrate diet. There’s one diet where you actually count up the points for the amount of fermentability.

Shivan:                Fast tract diet, Dr. Norm Robillard. Yeah.

Dr. Weitz:            Exactly, so there’s that one, and then there’s Nirala Jacobi’s got her version in phases, and …

Shivan:                Bi-phasic diet, which is based on …

Dr. Weitz:            Bi-phasic diet.

Shivan:                Which is based on Dr. Allison Siebecker’s SIBO specific food guide, which is kind of all of them combined.

Dr. Weitz:            Right. And Pimentel likes the Cedars-Sinai white bread, white rice diet, of low fiber diet.

Shivan:                Diet Coke.

Dr. Weitz:            And then, Allison Siebecker has her version of it. So, what did you find best for you?

Shivan:                For me, I did the SIBO specific food guide, and that’s in the book. Allison very graciously let me use her work in the book, and it’s based on all of those things combined, to way oversimplify it. And it’s very portion-specific, so you have to be careful not to get too focused on the portions, or I think we can go a little bit overboard.  And also, on the one hand, it’s careful. Like, “Oh, I can only have this many grams of this, or half a cup of this.” And then we get really, really uptight about it. On the other hand, this is what happened to me in the beginning. Like, “Oh my gosh, I can eat zucchini.” And I would eat five zucchinis in a day.  That’s the other end of the spectrum, so you have to be aware of those portions. But you’re trying to reduce your fermentable load, so that the bacteria doesn’t go crazy on these carbohydrates that are more easily fermented than others.    So, this is so important. The diet does not cure SIBO. The diet controls the symptoms. That’s really important. There is a lot of mythology around that the diet is going to cure SIBO, and it doesn’t. It will make you feel better. It definitely controls the symptoms.    You could feel better in a couple of days by fixing your diet, by being on the SIBO specific food guide, or some of these other carefully calibrated, low fermentation carbohydrate diets. So, that is a huge point in the book. But also, I have 40 recipes, vegetarian. Again, if you’re a vegetarian, it’s much harder if you have SIBO. And so, I wasn’t going to make it like, for the easiest common denominator. I was going to make it for the most difficult common denominator. And then you can always add whatever protein you want.

Dr. Weitz:            So, how long do you have to stay on this kind of diet? And do you still have restrictions in your diet?

Shivan:                So, do not give me garlic. It’s not going to work. It’s not happening. I stopped liking it. It doesn’t work for me. It makes me sick. I hate it. I love the smell and I’ll put it in some garlic-infused oil. That’s fine, and it’s occasional.   So, how long should you be on the diet? So ideally, you’re on the diet while you’re trying to get your treatment under control. This is not a long-term fix, because the biodiversity of the microbiome will be impacted. It’s not going to be devastated.  If you’re doing it for eight weeks, you can rebuild it. Your microbiome is changing all the time. Ideally, you’re trying to do, even within these foods … In the back of the book, there’s this chart. There’s a lot of diverse foods in there. It’s not like you’re eating three foods. You can do bok choy and all kinds of fruits and vegetables and cabbage and green beans.  I mean, it’s not like you’re going hungry, and it’s not like you couldn’t even really, maybe eat some foods you didn’t usually eat to diversify your microbiome. But it shouldn’t be forever. I know people who’ve been on it for five years. That’s too long. It’s really too long. You need to diversify.

Dr. Weitz:            So, other than garlic, where are you in terms of food restriction?

Shivan:                 I’m, by choice, gluten free. I don’t do onions. Really, it’s onions and garlics. I used to not be able to do apples, which are notoriously high in FODMAPs, and something I literally said to myself, “I’ll eat an apple. It’s good for me. It’ll keep the doctor away, right?” And then was like, more bloated. This was way back. So, I can eat almost anything now. I just don’t do garlic and onions. That’s me. Everybody’s different.

Dr. Weitz:            I noticed in one of your recipes, you were talking about taking a green onion and just not eating the white part. So, it’s kind of a way of sort of getting an onion without getting an onion.

Shivan:                 Exactly. So, the green part of scallions is-

Dr. Weitz:            “How to get an onion without getting an onion.”

Shivan:                 Yeah, that’s the way to do it. That’s the way to do it.

Dr. Weitz:            So, let’s see. What else do we want to talk about? Did you do antimicrobial herbs? And which ones did you find helpful for you?

Shivan:                 So, I did the pharmaceuticals. Then I did the antimicrobial herbs. I did oil of oregano. I did the allicin, like Allimed, or Allimax. And Allimed is stronger, even though “Allimax” makes it seem like it’s stronger. And I also … This was on a rotational basis. I did CandiBactin-AR and BR, which is what was studied compared to the rifaximin, and was found to be a little bit more effective, but you have to do it for a month versus two weeks.  I’ve pretty much done it all. I’ve done the elemental diet as well, and that was okay for me. I didn’t last the whole time, which is supposed to be anywhere between 14 and 17 days. My lifestyle at the time … You have to really be prepared mentally, because it’s only liquid diet for that time, and-

Dr. Weitz:            Really hard.

Shivan:                 It is hard, and a lot of people say, “Oh, I wish I had this to begin with,” because it’s so effective. It is the most effective treatment, but it is hard. And I couldn’t take 17 days off to do it. And if you do the high performance job that I have, of doing live television, you can’t mess around. You have to feel good when you go out there. There is no messing around.  So, I played with it. I also have used it as a meal replacement on occasion, and it’s a great gut reset. This is a diet that is originally a liquid diet that was for feeding tubes, and it’s made up of amino acids that are quickly absorbed into your body, almost like instantly digested, and it feeds you but it doesn’t feed the bacteria, so you’re starving the bacteria instead of killing it through a killing agent like an antibiotic.  They used to taste disgusting. Disgusting. And people, speaking of desperate times, were so desperate to change the flavor that it became sort of famous that people put Crystal Lite to fix the flavor, and it still didn’t fix it.  But Dr. Ruscio and Integrative Therapeutics, they’ve made a much, much better-tasting set of elemental diets that you can pick from, like chocolate and vanilla, and they taste like really sweet milkshakes, like really sweet. But I mean, it’s so much better by comparison.

Dr. Weitz:            I think that’s Ruscio’s version, not Integrative’s. Theirs is just one flavor.

Shivan:                Yeah, it’s vanilla. Right. He’s got more variety. I like his taste better, but maybe you’ll like the Integrative Therapeutics better. Who knows? But you have to make you’re doing enough calories so you don’t lose weight.

Dr. Weitz:            Right. Prokinetics. Do you continue to use a prokinetic? Is it a natural one or a prescription one? Have you tried the natural ones?

Shivan:                I can’t do ginger, because I tend to have a little reflux with my lower esophageal sphincter, so I get the ginger burn. Or you get it once and you never even want to try it again. But other people love ginger. It is a natural prokinetic which is what we talked about earlier, of moving the migrating motor complex so that it sweeps the bacteria out of the small intestine so it doesn’t overgrow.  It’s what helps prevent relapse. There are prescriptions that are … like Motegrity, which was called “Resolor,” which was usually only available in Canada, and now it is available in the States. There’s MotilPro, which is also natural. It has a lot of ginger in it.  There’s one called … It used to be called “Zelnorm,” and it was taken off the market, and it’s back on the market. And I cannot remember the name of it to save my life right now.

Dr. Weitz:            I think it’s called “Prucalopride.” No?

Shivan:                Yup. Well, Prucalopride is the Resolor, which is now Motegrity.

Dr. Weitz:            Oh, okay. Okay.

Shivan:                Tegaserod. I think it’s called “tegaserod,” or something similar to that. That is another prokinetic. You could literally type in “Zelnorm” and you’ll find the new name for the prokinetic. These are IBS medications sometimes.

Dr. Weitz:            Right. So, do you continue to take a prokinetic?

Shivan:                I do. Oh, yeah. I definitely do.

Dr. Weitz:            Which one do you take?

Shivan:                I still have those antibodies, so I definitely still take it, and that’s-

Dr. Weitz:            Which one do you take?

Shivan:                I take Motegrity, which was Resolor in Canada.

Dr. Weitz:            Okay.

Shivan:                Love the stuff. Love it. I never thought I’d say that about a prescription medication, but I’m like, “I love it.” Does the trick. And it doesn’t necessarily cause a laxative type reaction, so prokinetics are not laxatives. You may have a laxative experience, but it’s not the goal. The goal is to keep the migrating motor complex going.

Dr. Weitz:            Right. So, you have the motility that occurs when you’re eating, that pushes the food down, and then you have these cleansing waves that happen in between eating when you haven’t eaten for three or four hours, and that’s what you’re really trying to stimulate.

Shivan:                Yeah, and I’m glad you just said that. Meal spacing is super important. You want to not eat small meals throughout the day, unless your doctor’s advised that because of your blood sugar scenario. But to get the migrating motor complex moving, you need to not consume calories for about four to five hours, because the migrating motor complex will not work when you have that full mode of the body and calories indicate that, so you need to have, like … A lot of people take their prokinetic at night. I do, because you’re not taking calories in at night.

Dr. Weitz:            Right. You mentioned biofilms, and that being an issue with trying to get rid of the bacteria. Did you find anything that was effective in breaking up biofilms on your journey?

Shivan:                So, I’ve had the pleasure of interviewing Dr. Paul Anderson multiple times, and his combination, he’s got a formula at Priority One, and then he has a prescription biofilm buster. That has proven to be really helpful for me, and if anybody doesn’t know what a bio-

Dr. Weitz:            Do you use the Priority One one, or the prescription one?

Shivan:                I’ve used them both. I’ve used them both. They were both great for me. If people have long-term SIBO and they have not been able to reduce the bacterial load, I do suggest reading up on how a biofilm buster can help you, because maybe that biofilm is keeping that bacteria overgrown in a lockdown position … not to be medical, because that’s not a medical term, but in a state where it isn’t breaking up and releasing, so it’s not behaving as it normally would, if a biofilm wasn’t there.   And we have biofilms everywhere, right? The skin, the mouth, the genital area. Yeah, the intestines. So, it’s like … I call it “mucus” in my head. I just think of that as a biofilm, and it keeps pathogens trapped in it, and it’s very elaborate in the way that it likes to survive. It’s quite interesting.

Dr. Weitz:            Right. Yeah, I think we’re all aware of the fact that bacteria often have biofilms, and that could be a problem in getting rid of them. The problem is, is a lot of the strategies we try, the products on the market all seem to be somewhat disappointing, so maybe we’ll have to look into the Paul Anderson formulas a little more.

Shivan:                Oh, yeah. I think people have a lot of success with those. A lot of success. And if you have been trying for a long time to get rid of SIBO and you just can’t beat it, and you haven’t done a biofilm buster, I would definitely suggest doing that in conjunction, very carefully timed with your treatment.

Dr. Weitz:            Right. So, how can our listeners and viewers get ahold of your book? Where is it available?

Shivan:                Well, I’m so glad you asked, darling. Thank you. It’s on Amazon and …

Dr. Weitz:            Barnes and Noble.

Shivan:                Barnes and Noble, and where all books are sold. We’ve just gotten it into the UK, and a couple of other overseas markets, at the very least, in Kindle. And yeah. I mean, this is what I wish I had known five years ago when I started my figuring out about SIBO. It is loaded with information.   Some of the feedback, which I so appreciate, has been like, “It’s an easy read.” It’s something that they’re highlighting. On page 111, there is a map. We call it the “SIBO recovery road map.” It is the algorithm that Dr. Pimentel originally created, that then Dr. Allison Siebecker and Dr. Steven Sandberg-Lewis added to.   And it literally takes you step by step through what to do. Like, “Test, symptom relief, diet. Then do your three-hour lactulose breath test. Choose a treatment: elemental, herbal or antibiotics. Afterwards, test again. And if you’re well, manage. If you’re not well, treat again.” And it just takes you through the whole cycle so you don’t have to keep memorizing everything I was just talking about.   So, that’s in there, and that’s also what the core SIBO recovery road map is based on as well, is that algorithm. So, sibosos.com is my website. And our SIBO SOS Facebook community, we’d love to have everybody there. And that’s how you can get ahold of me.

Dr. Weitz:            Awesome. Thank you.

Shivan:                Thank you so much. Keep up the great work. We love your work, and getting us all educated. Appreciate you.

Dr. Weitz:            Excellent, excellent. Thank you so much.

Dr. Weitz:            Well, thank you, listeners for making it all the way through this episode of the Rational Wellness Podcast. Please take a few minutes and go to Apple Podcasts and give us a five star ratings and review. That would really help us, so more people can find us in their listing of health podcasts.

                                I’d also like to let everybody know that I now have a few openings for new clients for nutritional consultations. If you’re interested, please call my office in Santa Monica at 310-395-3111. That’s 310-395-3111. And take one of the few openings we have now for a individual consultation for nutrition with Dr. Ben Weitz. Thank you, and see you next week.


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