To download a copy of the Transcript – Click here.

TRANSCRIPT: Healing SIBO | 21-Day Plan to Banish Bloat, Fix Your Gut, and Balance Your Weight – Shivan Sarna with Dr. Christine Schaffner

Dr. Christine Schaffner: Hi everyone. Welcome to the Spectrum of Health Podcast. I’m Dr. Christine Schaffner, and today I’m speaking with my dear friend, Shivan Sarna. We’re going to be talking about her new book, Healing SIBO: The 21-Day Plan to Banish Bloat, Fix Your Gut, and Balance Your Weight. So a little bit about Shivan. Shivan Sarna is an author, TV host, entrepreneur, podcaster, and health advocate. She’s the creator of SIBO SOS, the Digestion SOS documentary series, The Gut and Microbiome Rescue Summit, and The Lymphatic Rescue Summit. 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 were struggling.

0:00:42.1 CS: Her special skill is finding and connecting with leading expert doctors and connecting those experts with the people who need their help. Her personal mantra is SOS, save ourselves, and that’s what she’s helped thousands of people do. I hope you enjoy the podcast today.

0:01:12.9 Shivan Sarna: Oh my gosh, I’m honored to be with you. Thank you so much. I really appreciate all your work. Anyway, let’s talk SIBO, doc.

0:01:21.4 CS: I know. It’s been so fun. We’ve done so many interviews over the years, and it’s really awesome to share your information with my podcast community. You really have become, in my opinion, a SIBO expert, and you really became that from your own personal journey. You really had to become an expert in order to heal yourself, and it seems that the journey has put you on this path to be an education machine, sharing the news about SIBO. Can you tell us a little bit about how you got into this work?

0:01:55.5 SS: I will. I’m going to briefly tell my story, but I’m going to try to make it educational so you guys that are listening aren’t just like yeah, yawn, whatever. I want to make it instructional. So basically, I had food poisoning when I was five from a trip to India. My parents are importers, and I went on a trip with them and drank water buffalo milk that probably wasn’t pasteurized, who knows? But I got very sick. And then I came home and went on a field trip to upstate New York, I was a city slicker New York City girl, and we milked the cows and we were being really cute and unsupervised for a minute, and we drank some of the milk out of the bucket. I got really sick, but that was probably the triggering event because this is the big deal, everybody.

0:02:44.1 SS: The big announcement is that it is now shown that most IBS is from food poisoning even from decades ago. The big announcement that I’ve been saying for years, thank you, Dr. Mark Pimentel, of Cedar Sinai, the big event and announcement is that IBS is SIBO. SIBO is the number one underlying cause of IBS. IBS is this diagnosis of exclusion. You don’t have IBD, thank God. You don’t have Crohn’s, thank God. You don’t have whatever else. Most doctors aren’t testing for parasites, so that actually can’t be excluded because you haven’t had that test, but SIBO is a small intestine bacterial overgrowth. This is when the microbiome’s delicious bacteria end up in the small intestine and do not get swept out by a function of your small intestine called the migrating motor complex, or MMC for short.

0:03:37.7 SS: And when that doesn’t happen, the bacteria can stay in there and overgrow and eat your food and fart out either hydrogen gas, hydrogen sulfide gas, or methane gas, leading to bloating, constipation, diarrhea, alternating constipation or diarrhea, rosacea, restless leg, anemia, B12 inconsistencies–that is SIBO. And because of my food poisoning, I’ve been tested, and I’ll tell you about the test, because there is actually a test for IBS, post-infectious IBS, after the food poisoning infection IBS and SIBO breath testing. I was just uncomfortable for most of my life. I was in a mold-exposed situation. Things started to deteriorate. Fast forward to five years ago, I finally went to a gastroenterologist. He didn’t even suggest a SIBO breath test.

0:04:29.1 SS: I had a girlfriend tell me about it, as girlfriends do. We need to do that more. I got a negative diagnosis on that test, but when I looked at the test when finally, finally, after 18 months, I got the report itself, the word negative was crossed out and positive was written. So someone had misread it, and so I’d lost 18 months, and a lot of money, time, and energy. I finally did another breath test, got the proper diagnosis, and then started to get treatment. There are three kinds of treatment primarily which I’ll go over briefly. I was collecting all my data like a good patient does, working with the doctors and tracking and doing food allergy testing and steroid shots for my fibromyalgia and my chronic inflammation, I spent thousands of dollars on bodywork, and basically, the doctors and my therapists of all shapes and sizes were like, “Oh, you really should write a book,” and my spiritual teacher Linda was like, “You know you have to write this book, right?”

0:05:32.7 SS: So I started writing the book and it was not as easy as I thought it was going to be. I was talking to Dr. Allison Siebecker who’s a world-renown SIBO expert because I had her as my doctor through telemedicine, which I was totally opposed to at the beginning, but I realized that if you were talking through telemedicine to the right person, it could be a 1000% more efficient than an in-person visit with a doctor who is not a specialist. I said, “Listen, I’m going to do a summit,” because I was attending these summits and I was like, “Oh, online learning, this is great.” I was lit up from summits because I just thought they were so cool. I had bought five of them from these random people, and of course, from Sean Croxton who led the way for summits in this health space, bless you, Sean. I said to her, “I’m going to do this and can I interview you?” I was kind of scared.

0:06:19.1 SS: She was the first person I was asking. She was like, “Not only can you interview me, I want to help you,” and she introduced me to her colleagues, a cache of them in Portland, Oregon. Seattle is a hotbed for healers as well. So I did the first SIBO SOS Summit. ‘SOS’ was about “Help, someone save me,” but now it’s come to mean ‘save ourselves,’ when you work with the right practitioner and you get the right information and it is treatable. It is fixable, and I’m here to tell the world about it. So thanks for having me. Long story short.

0:06:47.9 CS: What a journey, right? It’s just amazing, the people you connected with, not only for you to gain that knowledge to help yourself, but to help other people, which I so admire. I’ve only been practicing, Shivan, for about 10 and a half years, and I feel like SIBO has been there since day one of practicing, but definitely there’s been an explosion of information and knowledge over the past maybe five years. This is so much more common, I think than people realize. You mentioned that typically there can be this infectious trigger, and that’s in the realm that I often see, that there’s often an insult, either infectious or in combination with environmental factors, to our microbiomes in our body. That can create symptoms such as SIBO. So walk us through, in your research and in your experience, are there any other triggers or any other reasons why this is so prevalent?

0:07:49.5 SS: Thank you so much; that’s perfect. Adhesions are another underlying cause for SIBO. SIBO is caused by something else, and then SIBO causes stuff. So adhesions, what could that be? I’ve never had abdominal surgery, but I did have a seat belt jam into me in a fender bender back in ’91. I got some bodywork, and she was like, “Oh, you have a lot of adhesions here.” So that can literally move the intestines. What’s an adhesion? It’s an internal scar that’s actually there to hold you together, but it’s stronger than steel, and it can move your intestines to the point of where your migrating motor complex may work, but it’s like plumbing that’s kinked and not going in the right direction. Endometriosis can be an underlying cause for the same kind of pulling reasons. Our friend Dr. Jessica Drummond is a specialist in that, go google her, if you have endometriosis and this is resonating with you.

0:08:41.0 SS: Opioid use, there you are, and I’m not even talking about the epidemic of addiction on the planet, that is a problem. But you go for some dental surgery, they give you pain medication combined with a few antibiotics. Why not? But the pain medication slows your body down so much that post-opioid constipation is a thing in itself, but it also can lead to SIBO, because the petri dish of your small intestine could be inoculated with some of the bacteria from your large intestine and the migrating complex isn’t working because you’re on an opioid, even if for only a couple of days. I’ve confirmed this with Dr. Pimentel, who is I think the person who is going to find the cure for this in our lifetimes–the overgrowth can happen. Now, that’s really a problem because you’re not the same after dental surgery, or a little nip and tuck or whatever when you’ve just had a couple of opioid painkillers, so you’ve got to make sure if you’re getting any anesthesia, everybody, make sure you are taking something to move your intestines afterward, like some ginger, something that is a pro-kinetic, because that is actually not just a laxative, but it moves the migrating motor complex into action.

0:09:56.9 CS: Great points. Have you seen also in your research the connection between the vagus nerve and SIBO? What kind of things have you learned over the years? The connection with, maybe, a vagus nerve that’s not communicating well? Or the gut telling the vagus nerve via the pathways back to the brain that there’s a lot going on? What have you seen with the connection between the vagus nerve and SIBO?

0:10:22.6 SS: I am really glad you mentioned that because I tend not to talk about it as much because the other is so juicy. The vagus nerve…your fight- and-flight, your central nervous system is communicating, back and forth, back and forth. So, much from the gut to the brain is the newest information. And when that’s not online and balanced, it’s just like a shutdown; it’s just like you’re in constant flight and it’s not working. Think about if you were running away from a tiger. Your body would be like, “You know what? I’m not going to digest food right now because I’m going to use that energy to move my quadriceps and run really fast.” So when that’s not working, that whole migrating motor complex can go offline.

0:11:04.5 SS: We just did a master class summit, Dr. Siebecker had had this in her mind for a couple of years because she is actually the first person to do a SIBO conference. I’ve done the SIBO SOS Summit 1 and 2 and the Microbiome Rescue Summit, as well as the Digestion SOS Rescue and Relief documentary, and we have courses and all that. The newest one is the masterclass summit called Next Steps for Treating Tough SIBO. What she did is, she was seeing these tough cases and the antibiotics weren’t working. They certainly do work for a lot of people with the herbals and the elemental diet, and that’s why we called it Next Steps. So there is brain reprogramming, there is DNRS, there is Dr. Gupta’s program, Annie Hopper’s program where you can reprogram your central nervous system so you can get that communication back online. Have you seen success with that, doctor?

0:12:00.0 CS: Yes, I’m so glad you brought that up. We get into these patterns, and our brain can be wired because of trauma and stress into this kind of cycle, and there are tools for retraining, like DNRS, the Gupta method. I have some patients that really have really changed and transformed, especially the patients who are highly reactive or highly sensitive, and the patients who might have exposure to perfume and faint or just that type of severity of triggers, so I find that that can be really helpful. And then, we have to eat every day–our digestion is so connected to how we feel, and so there’s so many potentially traumas and things that happen over the course of not feel- ing well for so long and becoming afraid of food, and there can be a really paralyzed state because of how bad people feel for so long. So I think that’s great that you’re mentioning that, and I think they work in neuroplasticity and this type of work is emerging, and it’s innovative, and integrating that into whatever physical plans you commit to I think can really help you recover and resolve, and do not have these recurrent bouts of SIBO as well.

0:13:21.2 SS: I think also, Dr. Kharrazian’s suggestions of gargling, singing loudly, using tongue depressors to stimulate the gag reflex to stimulate the vagus nerve. It can’t hurt, it might help, why not? There’s no downside to all of that.

0:13:40.8 SS: I know you and I have talked about this briefly, but about the possibility that the oral microbiome might be really feeding the mechanisms as well? That’s another frontier that I’m very excited about sharing with people. I’m doing a biological dentistry summit coming up as well.

0:13:58.8 CS: Yes, and that’s, I think, one of the most overlooked areas that are interfering with the body’s ability to self-regulate, and it’s such important work. I’m so glad that you’re going to spread the word on that too, and that it’s the microbiome and the infections in the jaw that can also affect the vagus nerve and all of that. I think that’s a really important place to look if people have been stuck. So Shivan, if someone has SIBO, what do we do? How do we fix them?

0:14:27.4 SS: Right, how do we fix them? First of all, test, because when you test you know, and then you can treat. You can treat effectively because SIBO mimics Candida, SIBO mimics parasites. Bloating, constipation, and diarrhea alternating is so frustrating, and it’s very easy to just go, “Oh my gosh, Shivan, you’re talking about SIBO, and that’s me, that’s me. That’s it, I’ve got it. Oh, I finally figured it out,” because believe me, I’ve been there. I have been thrilled when I thought I had something, which is very strange to say, but you’re so relieved you have a name for it, right?

0:15:03.7 CS: Definitely. Right.

0:15:05.1 SS: We need to figure out a term for that, ‘diagnosis delight,’ but it’s not always right. Anyway, there’s a breath test that you do. It’s a special protocol where you diet for 12 hours in a special, very limited way, and then you fast for 12 hours, and then you take a lactulose solution, you drink it, and then you blow into these test tubes every 20 minutes for three hours. That’s the lactulose breath test. Aerodiagnostic Labs out of Massachusetts are wonderful. They work with your insurance, Medicare pays for it, but also a new development is Dr. Mark Pimentel’s Gemelli Labs, and that is the trio-smart breath test, which is the first one that measures all three gases: Hydrogen sulfide, hydrogen, and methane.

0:15:52.9 SS: So, just touching on this, but you would get your doctor to fill out the requisition form and get them to send you the test kit at home, which is very convenient especially in days of COVID. So you can be tested, then make sure you’re getting the test interpreted properly, make sure you get the results, not just like, “You’re negative or positive,” because you want to know how high your gas levels are because the bacteria overgrowing in your small intestine are excreting these gases, and when you drink this lactulose solution, and then you test through these test tubes, whatever they’re excreting is going to be shown by how high your gas levels are, which is a reflection of how much bacterial overgrowth you have.

0:16:33.4 SS: In terms of treatment, you can do antibiotics that have been shown to be quite effective. Rifaximin, if you have hydrogen. Rifaximin and Neomycin, if you have the methane kind. Hydrogen sulfide is a little bit more complicated, they’re still working on that, but there are some solutions. And then there’s also the herbal protocol that I know you’re a huge fan of, and that is shown to be actually slightly more effective, though you have to do it for longer. That includes things like oregano oil, CandiBactin AR and BR, and allicin, which is the garlic extract. You can eat a piece of garlic and you’ll probably not feel well if you have SIBO, but if you do this, it does help as an antimicrobial. And then there’s also the elemental diet, which is a liquid diet, which sounds insane, but it is amino acids that were originally designed for feeding tubes that tasted disgusting.

0:17:28.9 S3: They’ve made tastier versions now for people who are looking for a gut reset, and you do it for two weeks to 17 days, then get re-tested on that last day, so you know if you have to continue a little bit. That’s called the elemental diet. Dr. Michael Ruscio has one called Elemental Heal. It’s a partial elemental as well as a real elemental. Integrative Therapeutics has one, which you can get through a practitioner, and there are a couple more that have kind of emerged. Dr. Siebecker’s site, siboinfo.com, has a list of them.

0:18:00.9 CS: That’s great. So, testing, and then we can individualize a treatment plan depending on the gas and the type of bacteria that’s migrated its way into the small intestine. We kind of already alluded to it, and you cover it in your book, how people get through those treatments and they still feel like they’re having symptoms, or they feel like they’re getting better, but then it comes back. How do you suggest people navigate that?

0:18:26.6 SS: I’m so glad you asked that. Here’s the chart.

0:18:28.7 CS: I figured you had a chart about this.

0:18:32.1 SS: This is what I nicknamed the SIBO Recovery Road Map. At the top is, “So You Think You Have SIBO?” And then it takes you through the different steps. If you go to sibosos.com, you can actually download a copy of this for free. It’s an algorithm that Dr. Mark Pimentel created, then Dr. Sie- becker and Dr. Sandberg-Lewis added to it, and then I even added to it as well. It takes you through steps of, “Okay, so you did a treatment, you did a re-test, you’re better, but not totally well, what to do then.” So there is actually a formula for it. The other thing is, each round of your antibiotics or treatments may only take you down a certain amount, you have to keep reducing the bacterial load, which is unusual. Re-treating feels unusual when you’ve done an antibiotic. It’s usually one and done. But in this case, you may have to do multiple rounds.

0:19:27.2 SS: The other thing is, if you want to find out your underlying cause, which of course you’ll have to do, really, keep searching, and you want to know if it is from food poisoning. There is a blood test that Dr. Pimen- tel created called the IBS Smart Test. It’s at ibssmarttest.com. It shows if you have antibodies from food poisoning, even decades later, that are impacting your migrating motor complex. That was very valuable for me because it wasn’t all in my head. I was able to do a connect-the-dot psychologically and logically, and then also, and this is part of the protocol in the chart, I’ve been very consistent with my prokinetic, which we touched on, which is what helps the migrating motor complex sweep out that debris, and because of that, I feel 100% better.

0:20:19.3 SS: If you have a chronic condition that is untreated, obviously, you can feel terrible, right? If you have a chronic condition that is treated, maybe not cured but treated, you can feel 100% better. That’s a sub-message I want to get out. Hey, who doesn’t want to be cured? Of course, but the whole idea of, “Look, maybe I can’t fix these antibodies, so I’m going to manage the condition, and I feel great”–that works.

0:20:50.3 CS: I think it’s a great point. Look at all that Dr. Pimentel’s figured out, look at all of these wonderful minds who continue to put research behind this, and figure this out clinically, so that medicine evolves. Just because we don’t have the treatment today, it doesn’t mean we’re not going to have it in a few years. Again, if you are able to manage your health and feel better, absolutely. People will do anything to be able to maintain that. Shivan, what about prokinetics, what do you like for prokinetics?

0:21:22.3 SS: There’s something that you can get on Amazon called Iberogast, and it is a German formulation, and right now on Amazon it has Russian writing on it, but I bought that version, it’s been fine. Do you know another source?

0:21:36.5 CS: Yes, we actually have used that over the years and provided that for patients. It comes from Europe, and it’s a wonderful bitter formula. I love Iberogast. Are there any other ones you use?

0:21:49.8 SS: Fortunately, there’s a slew. There’s also anything with ginger in it, like MotilPro, and there is also just plain straight-up ginger, but if you have esophageal reflux and your lower esophageal sphincter tends to open as mine does, I got ginger burn and that was very uncomfortable. So things with ginger don’t work for me personally, but I know it works beautifully for other people. Then also there are prescriptions like Motegrity, which has just been re-approved or just approved in the US, and that works like a champ. For me, low-dose naltrexone is actually a very mild prokinetic. I have a lot of the doctors that I’ve talked to that combine prokinetics or rotate them, which is interesting, but low-dose naltrexone is a miracle unto itself for other things. So if you’re on the fence to do it, maybe you do it because it’s also a mild prokinetic, but also take ginger, the Iberogast, Motegrity, Zelnorm. Zelnorm was an IBS drug that got taken off the market, it is now back on the market, and I am having a brain blank about what it is called now. Do you remember?

0:23:02.6 CS: Tegaserod?
0:23:06.6 SS: Right. Tegaserod or something like that.
0:23:14.1 CS: I haven’t used that one. That’s why I didn’t know that.

0:23:16.6 SS: Yes, that’s a good one. It’s definitely a good one. You want to start slow with that. It’s an IBS drug as well. So if you’re constipated, it can help things move along. There is Prokine by Vita Aid, MotilPro by Pure Encapsulations, Motility Activator by Integrative Therapeutics, GI Motility Complex, ENZYME SCIENCE, SIBO-MMC Priority One, and then Bio.Me Kinetic from Invivo in the UK. Those are just some.

0:23:43.3 CS: Awesome, awesome. And what works for someone doesn’t work for another, so that’s so awesome to have that list of tools because there’s going to be something or some combination that’s going to help you get your gut moving. That has everything to do with how you feel on a regular basis, especially if you have SIBO. So, Shivan, anything else then? You’ve laid out this beautiful plan, all of this research, all of this experience. As we wrap up, looking at your journey with your health and with all that you’ve learned if you could give somebody who has just diagnosed with SIBO some words of wisdom, what would you share?

0:24:24.5 SS: There is hope, do not give up. There’s a grieving process that I think happens for anyone with a chronic condition when they’re cycling around things that didn’t work, you’ve spent money, you’ve done tests… That wasn’t it. Nothing happened. Nothing helped. You feel like it’s never going to get better, but that’s where really you have to dig deep and do that inch by inch it’s a cinch. Follow your intuition, there are answers, and remember, even if you’re just managing it, you can feel 100% better. One surprise for me is that the migrating motor complex moves every 90 minutes, so the whole idea of small meals throughout the day was changed, tipped on its head for me, so meal-spacing versus intermittent fasting. What if intermittent fasting actually works so beautifully also because the migrating motor complex got a chance to function?

0:25:15.6 CS: I think that’s right. That’s true.

0:25:16.3 SS: Right? Part of it. So the migrating motor complex won’t work when you have food in your stomach or you’ve consumed calories. It will only work when you’re not in a full state or you’re not consuming calories, so give yourself maybe four or five hours between meals, if possible. Obviously, if you have other issues, talk to your doctor and all that, but that was a big ‘aha’ for me.

0:25:38.1 CS: I can’t thank you enough for the work that you do. It’s always so fun connecting with you, you’re prolific with all the material that you’re put- ting out. You have your book, where can people buy your book? And then you have your website with all this awesome information, so tell us everything.

0:25:53.6 SS: You’re so sweet. Healing SIBO is available where all fine books are sold. Certainly, it’s on Amazon, it just came out February 2nd,

2021. There are 40 recipes in the back that I’ve been remaking like, I knew I tested these, but I’m just going to make them again and see. They’re delish. I was secretly relieved and like, you did them the first time, they were great. Anyway, we have a great community called the SIBO SOS virtual community on Facebook with 18,000 members at this time. SIBOSOS.com lets you know about the SIBO recovery road map course that we have, taking you step-by-step through everything. But in terms of a first move, 20 bucks on this book. I wrote the book because this is the book I wish I had when I first started figuring it out. Thank you for having me, Dr. Schaffner, I really appreciate it.

0:26:45.3 CS: Of course, and congratulations, that book is your baby, your work of art, and I really appreciate you putting all of that information together and putting it out to the world, so thank you, thank you, thank you.

0:26:56.2 SS: Thank you.

0:27:00.1 CS: Hi, everyone, I hope you enjoyed my conversation today with Shivan Sarna, and please check out her book, Healing SIBO. It can be found on Amazon and all those great websites that sell books, and please check out her website, SIBOSOS.com, she has so many resources and educational classes for you to really dive in and figure out what is going to be the healing path for you. Enjoy finding out more about Shivan’s work and thank you for listening.