SIBO/IMO: Gut Condition Affecting Millions

Tom Moorcroft, DO

Hey everyone, welcome back to this episode of the Reversing Mast Cell Activation Syndrome and Histamine Intolerance Summit. I’m your, co-host Dr. Tom Moorcroft, and I’m really so pleased that you’re joining us today. And I am so stoked because I get to interview and bring to you Shivan Sarna, who is the author of “Healing SIBO,” a TV host, a creator of SIBO SOS summits, and community, and a whole bunch of other sort of digestive health, gut microbiome, summits, and docu-series. And what’s really cool is that Shivan noticed that chronic conditions weren’t always being addressed properly. So she created the chronic condition research 501C3 nonprofit so that she could research some of these underfunded medical conditions and really bring light to them. And this really came after a lifetime struggle with health issues, which I know we’re gonna dive into. And the part that jumps out at me when I look at her bio and talk to her is her personal mantra is SOS save ourselves. And that’s really what she’s helped thousands of people do, and that’s what we’re gonna talk about today. And anytime that I get to talk with someone who wants to help other people take full responsibility for their own health, and also give them the tools with which to do it, I’m stoked, so Shivan thanks for joining us today.

Shivan Sarna

Thank you very, very much. I’m glad we’re getting word out about MCAS so important.

Tom Moorcroft, DO

It is, so when I hear your name, I think about SIBO and other things similar to that, but how did that all start? Like, one of the things I’m so interested in is what your personal, what brought you here from your personal life? And I love your cute kitty cat in the background too. I got one of those over here.

Shivan Sarna

That’s Petunia, we’ll see what happens if she eats the fake orchid or not, and then has a mass cell activation problem. Anyway, I will not let that happen, so quickly with hopefully a little bit of an inspirational twist to my story to help somebody else is that I went to India when I was five with my parents and I got food poisoning and I was never really like the same afterwards, and wasn’t quite right, and wasn’t going to the bathroom every day, and my father who’s the Indian noticed and sure enough, I basically from that food poisoning episode, and then another one, when I went on a field trip in upstate New York and we milked cows and we snuck a sip of the unpasteurized milk and all the little kids got really sick, yeah. I just, I had a lot of food poisoning and food poisoning is the number one underlying cause of IBS. 

And this is shown by Dr. Mark Pimentel, of Cedars-Sinai mast program. He has been working on a blood test and actually has produced a blood test for IBS called IBS-smart test, which shows that you have antibodies from that food poisoning that is hurting your migrating motor complex, MMC, which is the sweeping motion of the small intestine. And what happens is, is that bacteria and methanogens, which are similar to bacteria, can overgrow in the small intestine and therefore produce gas of either methane, hydrogen, or hydrogen sulfide, which leads to SIBO or intestinal methanogen overgrowth, IMO. And they hear the symptoms, bloating, bloating, more bloating because all those little microbes are farting out those gases I just described leading to what, bloating, and then also constipation or diarrhea, alternating constipation or diarrhea. So one or the other or mixed. So basically I got food poisoning. I got SIBO, IBS, didn’t treat it or know about it or do anything about it until I was a grown adult, very much an adult, like as in back in 2016, I finally went to my first gastroenterologist because I was also in a moldy building. I also had old Lyme, old EBV,

Tom Moorcroft, DO

Oh boy.

Shivan Sarna

Mold made it blossom. And this gastroenterologist told me to run three miles. We lovingly call him in my book “Healing SIBO” Dr. Run three miles. And he gave me a, you know, antidepressant, which really he was trying to like help my neurotransmitters in my gut move. But he didn’t explain that to me. So I just left thinking, he thought I was nuts, nothing wrong with that, but he wasn’t a good communicator as many gastroenterologists aren’t, but some are, so bottom line is I was, I had this condition. I went through life, I went through college, I went through my first careers. I was in a moldy building for 20 years. It made it worse and it forced me to finally deal with it. Otherwise it had been fairly manageable. And when the mold sort of filled the bucket and overflowed, I just, I was really, really sick. I was losing my hair, I could barely get outta bed. I had such brain fog, I was stuttering, which is a freaking nightmare if you were a TV host, I’ll tell you that right now.

Tom Moorcroft, DO

Pretty significant, right?

Shivan Sarna

Yeah, my psoriasis went crazy, blah, blah, blah. So that’s a little bit of my story. And what I said to the universe was, okay, this is stupid. I have some time on my hands, I have good insurance. I have a brain and I have a computer. So let’s figure this out. I went to Dr. Google, couldn’t find answers, did find out about the low FODMAP diet, which we’ll briefly touch on, and just really fell down a lot of rabbit holes. And I was like, still saying, this is stupid, ’cause I’m not finding people who know about it. And then I was like, okay, you know what, whenever I find out, I’m gonna tell other people, which is like how these things happen. And I met Dr. Allison Siebecker, who now we are colleagues and friends and also content creators together. And she is a truly a SIBO specialist. And she introduced me to her colleagues. And I was really consuming a lot of summit material at that time when summits weren’t as like big and available. And I said, I need to write a book about this. And then I was like, wait a minute, I’m a talker. I’m a TV lady, I wanna do a summit ’cause like I can do that. ‘Cause writing the book’s actually really hard. And so I asked her if, she was the first person I asked to do an interview, I was so nervous.

Tom Moorcroft, DO

So cool.

Shivan Sarna

And then she’s like, not only will I do an interview with you, I will help you. I will introduce you to my colleagues. And that’s how, you know, 10 summits ago, it started and it’s been beautiful because I did find people who knew what they were talking about. And I have been able to get their information out to millions of people around the world. And that’s very exciting. And also I have improved so much, depending on your underlying cause will depend on how you treat. But most importantly, the type of SIBO, IMO that you have will depend, will dictate how you treat and the thing about food and the thing about diet and the thing about FODMAPs, which are a form of carbohydrates that are easily fermentable, is that food controls your symptoms. It does not resolve your underlying cause, it does not even resolve the overgrowth of the bacteria or methanogens. It simply controls your symptoms, which is fantastic. Amazing, but if you only stop at FODMAPs, you will be doing yourself a disservice because you will not be reducing the overgrowth through the three main treatments. And you will also not probably search for your underlying cause and you might get really frustrated with food.

Tom Moorcroft, DO

So you’ve talked a lot like this is like, so like music to my ears, ’cause you know, in my background with Lyme, babesia and heavy metals, it was like, you just search everywhere and you meet no one who knows what they’re doing. And then all of a sudden, everybody knows what they’re doing. So a couple of things that I kind of gleaned from you and is everybody seems to be an expert. Like if people are looking for an expert, like how do they even know? Or like what are the main things they should be looking for for like the key words that are, yeah, I should work here or maybe this is just another person putting up a shingle ’cause I think that we’re all looking so many places, you know.

Shivan Sarna

I understand what you’re saying because there, like I said, there are a lot of rabbit holes. I think that Google that person’s name. How often does it come up? But does that mean that they’re an expert? It doesn’t, it means they’ve done pretty good job with the PR.

Tom Moorcroft, DO

Yeah, SEO wizard.

Shivan Sarna

Right, and that being said, let’s say, I know a lot of doctors and practitioners who are in their clinics, in the lab, in their exam rooms, working their butts off, they know what they’re doing. They’re not famous, no way. They’re not famous at all. That’s one of the reasons why I love summits is because I get to reveal unfamous people to the world.

Tom Moorcroft, DO

For real, right.

Shivan Sarna

So I would ask some questions. I would say, do you work with people with SIBO and IMO? Do you do the SIBO breath test? What kind of substrate do you like? Lactulose, glucose, Fructose, some questions. Bottom line is, is SOS. You have to save yourself. So you have to be your own advocate. You have to have your own education. You don’t need to be a genius. You just need to have enough to move you forward to the next right step. So this is about one foot in front of the other and you don’t wanna make costly mistakes with time, energy, and money and being with the wrong person. I totally get it. So don’t move too fast. Go into some Facebook groups, we have one at SIBO SOS, Facebook community at virtual community, whatever SIBO SOS with 24,000 people in there talking about this, ask around. If you’re trying to find a gastroenterologist call the front desk, does this person do SIBO breath tests. 

Hold on, I’ll be right back, wait a minute, please hold. Hi, I asked the nurse and she isn’t sure. Okay, that is not your practitioner. I call, I asked the doctor, he said he doesn’t believe in SIBO, not your practitioner. So here’s a way to reverse engineer it. Call the labs like Aerodiagnostics QuinTron which makes the machinery for the SIBO breath test. Tell them you’re looking to do a SIBO breath test. Can they tell you a doctor in the area that runs them? Don’t be afraid of telemedicine. Telemedicine is a miracle. One hour with a practitioner who’s a specialist can save you a year and thousands and thousands of dollars. So those are some suggestions I have. You can do some SIBO breath testing on your own. Trio-smart at Gemelli labs, you can get ahold of them and for like a minor fee, fill out a questionnaire, find out if you’re a candidate, they will send you the script for the lactulose, and you can run the test. If you’re in New York state, no, but there, there are ways around it, which is one of the things that we do as a primary educational resource is help people.

Tom Moorcroft, DO

It’s so good to have access to it, right. And ’cause I know I looked in my healing journey forever to find the people to help me. And just like you said, eventually for me it was like it was SOS. And then once I did all the groundwork magically, the doctors that actually knew what they were doing were on my doorstep. It was amazing. And the thing they found, and this is a question I have too, ’cause you brought it up a couple times, is they really dug into that underlying cause that the other folks hadn’t previously, are there particular underlying causes that folks should be looking for for SIBO and IMO?

Shivan Sarna

Yes, and they are things like food poisoning. Even if you say, oh I’ve never had food poisoning, did you have stomach flu? Did you have diarrhea for 24 hours? And then you weren’t really quite the same after have you had surgery were on opioids and gosh, that constipation never really went away. I’ve not been the same since because that, the deep anesthesia plus opioids for pain meds slow the migrating motor complex enough so that overgrowth could occur. Scleroderma, endometriosis, adhesion, caesarian sections, internal scars, Lyme disease. Gosh, what else? MS. Alcoholism.

Tom Moorcroft, DO

Mold.

Shivan Sarna

Food poisoning, mold. And you know, a lot of things are contributing factors. So is your SIBO bad because of mold? Did it cause the SIBO for me it was the food poisoning. Did the mold make it worse and very unresolvable for a really long time? That is correct. So hormones, thyroid imbalances affect your motility. Like what’s impacting your microbiome and what’s impacting your motility. Those are some things to look at, get the IBS-smart test. Now they do not have a cure yet for to help those antibodies. But there are treatments for SIBO that can help lower your gas levels that combined with a prokinetic taken after your treatment, and maybe you have to do multiple rounds of treatment, will stimulate and make a symphony of your migrating motor complex. So that overgrowth can’t occur or doesn’t occur as much as it did, so.

Tom Moorcroft, DO

Yeah, it was interesting. ‘Cause earlier we were talking about like, you know, the work that you’re doing with chronic conditions and fascia and the summit and everything. And for me as an osteopath, I’m like the first thing I think of when you talk about like the hospital and anesthesia and stuff is like any of these procedures where they blow up your belly and stuff. We have this high likelihood of postoperative ileus, which is a fancy way of just saying your gut’s not moving. There’s poor motility afterwards, but it’s almost in shock, and it sounds like anything that can slow down the pace of things moving through your gut could potentially either create the situation where SIBO could happen or where it could worsen.

Shivan Sarna

Yeah, I mean that, that’s all true. However, if you let’s say you don’t have an ileocecal valve. Okay, which is the valve between the small and the large intestine, and the backwash of large intestine bacteria goes into the small intestine. And that can happen if it’s stuck, and, but if you don’t have an ileocecal valve, some people don’t from surgical procedures and like number one, you may have adhesions with adhesions, which are those internal scars, which can pull the tissue out of place. Ehlers-Danlos is another underlying cause, which is a collagen disorder of laxity through the body and organs. But if you have a really strong migrating motor complex, not impaired by food poisoning, then potentially you wouldn’t have to get SIBO. It could be sweeping that, it sloshes in you sweep it out. So I’ve actually asked Dr. Mark Pimentel this question like exactly that if you are taking a prokinetic or you have a strong migrating motor complex, theoretically and practically, could you avoid having SIBO. And he was like, yes, you could. So he even said that if you did prokinetics you could actually resolve SIBO, but that’s not the usual way of going about it. It’s usually one of three treatments, which is either the elemental diet, which is a liquid diet for 17 days. And it is not your typical protein powder. It’s amino acids, it is disgusting tasting. Although now they have better flavors.

Tom Moorcroft, DO

So true Right.

Shivan Sarna

Right, I mean, it’s truly gross, but it is, there are new formulas like Dr. Michael Ruscio’s formula, integrative therapeutics that are much, much better. And then there is antibiotics as rifaximin, plus neomycin or just rifaximin, depending on the kind that you have. Some people are adding bismuth subnitrate, or Pepto Bismol to that combination for hydrogen sulfide and then the third option. And it’s, you can also mix and match these not within the two week to the month that you’re doing the treatment, but like ABC in order and or play around with what order works for you. And then the other one is herbs, and those would be done for a month. Whereas the antibiotics would be done for two weeks. One thing about the antibiotic rifaximin is it does stay in your small intestine, and so that is really cool, it doesn’t nuke your entire microbiome, neomycin does however, getting that reduction of the gas levels because of reducing the overgrowth for some people’s totally worth it. What I also just recently in July asked Dr. Pimentel was look, if you do take, ’cause he’s identified the bad players of the microbiome that take over. And I used to think it was location location that you had just the overgrowth, but it’s not that it partially that, but it’s not just that it is actually that specific bad players are there that are part of the normal microbiome, but get out of control, like weeds in a garden. And then they, as gatekeepers hurt the rest of the microbiome. So once those are in check, I was like, well how fast did the microbiome come back? He’s like weeks.

Tom Moorcroft, DO

That’s pretty rad.

Shivan Sarna

Food intolerances also go away. Once your IBS and SIBO are resolved. In many cases like I had SIBO, I got it treated. Now I can eat an apple. I had SIBO, I got it treated, I had to do three rounds. I retested I’m now Okay. My gut’s feeling much, much better, and now I can eat some Italian food with garlic. I mean it does happen all the time. So I just wanna send that as a message to hope for people who feel like they’ve tried everything and they’re not well yet. But the question to really ask is have you tried really everything and done it in the right order?

Tom Moorcroft, DO

Well, I think that’s so important to talk about because I know a lot of people are like, oh like I actually just had someone follow up with me the other day. Like we treated her SIBO a year and a half ago. And then I gave her a follow up, like a follow up plan, like next step, you know, like the antibiotics followed by the herbs. And then like a year plus later comes back and like, I haven’t heard from her and she’s like, I’m still having the same stuff, but it wasn’t like there wasn’t that follow through of the whole protocol. So what’s it look like for people? I mean, is it like, ’cause you just mentioned two weeks a month, 17 days. I mean, can somebody can the average person.

Shivan Sarna

There is a protocol that was developed by Dr. Pimentel and then added by Dr. Siebecker and Dr. Steven Sandberg-Lewis, I even contributed part of it just a little bit, but still I’ll take credit.

Tom Moorcroft, DO

You’re in there.

Shivan Sarna

I was like, oh, look at that. Basically it’s do test to determine if you have SIBO and then while you’re doing the diet the whole time, and then, I’m visualizing the algorithm, and then do one of three treatments that I just described, herbs, antibiotics or the elemental diet. Retest so you can see if it worked, and then if it worked and you’re feeling 90% better get on with your life and take a prokinetic which moves the migrating motor complex, gently. And if you need to, let’s say the gas levels came down a little bit. You wanna do that treatment again? Or you’re like, you know what, I feel like doing herbs now, or I’m screw it, I’m just gonna do the elemental diet. Then you do that again. 

Retest do your prokinetic, while you’re doing the diet the whole time. So there are, there’s a very specific validated combination of things to do. And one of the big myths that is very frustrating is for people who say it comes back all the time, it does come back all the time. But a lot of people are also not doing prokinetics. If you do not do that prokinetic it will probably come back. Especially if you have an unresolved underlying cause, but there is definitely a protocol to it. Many people are not doing it in the right order. They are, they’re wasting a lot of time, energy and money by getting sidetracked. If you have a very tough case, mold, lime, heavy metals, it is great to do a pre-tox right to make sure your emunctories your drainage is open. You’re pooping your, you know, regular stuff out. That would be great because once you do, you know, the killing part of the reducing of the bacteria, you know, you don’t want that stuff getting stagnated in your body. However, there are so many people who do not pay attention to that and still have resolved their SIBO.

Tom Moorcroft, DO

So there’s a lot of hope.

Shivan Sarna

There’s so much hope. A lot of times people are like, I have to be gluten free. I have to be sugar free. I have to be dairy free, which I am all for. If that is you, that is fantastic there, you know? Great. Do you need to do that to resolve your SIBO? No, you do not. Okay. Like the cases of traditional gastroenterologists who are not talking about anything with diet and emunctories and drainage who resolve their patients SIBO all the time is enough to give you hope so don’t over complicate it. And that being said, if you do have a complicated case, which I get, hello, mold 20 years, I get that you need, you do need to address that, but you gotta walk that line of simplicity, complexity, and doing it right in the right order. And not over complicating it, give it it’s due, but don’t over complicate it.

Tom Moorcroft, DO

Right, and it’s like, I’m just thinking about like my own SOS. I learned the simplicity was like the simple little things actually work. And that was the part my doctors didn’t teach me. And I think what I really love hearing Shivan is that you’re saying like, it’s not just about smashing the conventional doctors and they don’t know how to do it, ’cause you just said they actually do fix it.

Shivan Sarna

Some can. Now some people like I literally just talked to someone who said her gastroenterologist didn’t believe in SIBO. I’m like, so whatever.

Tom Moorcroft, DO

Well I have people who the doctors don’t believe in Lyme? I’m like, how do you not believe in Lyme? It’s a freak, I mean, it’s a spirochete organism that we can find, I mean, it’s like a thing, right? I mean, come on.

Shivan Sarna

And it’s not a religion, so you don’t need to believe it. You just need to know it anyway.

Tom Moorcroft, DO

Right, right.

Shivan Sarna

Don’t get me started. So some traditional doctors absolutely do know what they are involved and others don’t. They weren’t taught this in school, they were not taught this in school. So like Dr. Siebecker has a course for pros called the SIBO pro course, which were super thrilled that like so many people are getting so much help from it. And you know, she teaches at the natural medicine school in Portland, Oregon, and this takes you even further. So there are resources and there is a lot of hope and I just don’t give up, don’t give up. The other thing is do test to find out if you do have SIBO again the symptoms are bloating, constipation, diarrhea, alternative constipation, diarrhea, MCAS, histamine intolerance. That is part of the constellation. But SIBO also mimics other things like parasites, like Candida, in serious cases, ovarian cancer can cause bloating, right? So really find out if you have it get tested. I love Aerodiagnostics labs. I love Gemelli labs and Trio-smart. Oo, she’s like a fish. She’s like a fish she’s just wiggle worming.

Tom Moorcroft, DO

Right, so cute.

Shivan Sarna

She’s like one big muscle anyway. And find out if you really do have SIBO and treat that. So you’re not spinning your wheels.

Tom Moorcroft, DO

Well, I think it’s so important to know to get the test. And then like you said, this magic word, that’s like hallelujah in my ears is retest. It’s like a lot of people are like, oh, I’m gonna have it forever, or, oh, it’s fixed. And it’s like, you can actually have multiple things. And like, I just really wanna drive home for people that testing and retesting is critical because you can have something and then fix it and something else can come up. And my goodness, if ovarian cancer can cause a similar symptom as SIBO, that’s a pretty significant difference in outcome.

Shivan Sarna

Yeah. I mean, it’s, it has happened. It has happened, So I mean, it’s not super common, but that doesn’t matter. I think it’s worth investigating. And when you test, you know, and when you know it is a weird feeling to have a diagnosis and be relieved, very strange. I know I’ve had it myself and yet it’s empowering because when there are answers and it’s not an incurable disease, you can take action. Now, some people have an underlying cause that’s not gonna be resolved, but you can manage it. And this is a huge thing that’s part of my whole message, which is that a managed chronic condition can have you feeling a hundred percent better, than an unmanaged chronic condition. So you manage your SIBO. You can feel a hundred percent better than unmanaged SIBO and get your life back.

Tom Moorcroft, DO

Oh, I love it so much hope in all of that. So I was gonna ask you if you had anything you wanted to kind of wrap everything together with, but I mean, that’s kind of like seals it up and slam dunks it. I mean, it’s so good. Shivan, I’m so thankful for the opportunity to have this conversation and provide this education and this hope for all of our folks who are listening. So I’d love to just give you a moment to be able to share with people where they can find you, if they’re interested in learning more about what you’re doing. And because I think you’re probably motivating a lot of people right now, ’cause it’s like. Hey, maybe it won’t go away, but I can actually manage this and lead an amazing life and-

Shivan Sarna

Absolutely and feel so much better. And you can not freak out that you have to go to a social engagement or whatever, what to eat at the restaurant. So my website is sibosos.com. Dr. Siebecker’s is siboinfo.com. The SIBO pro course I think is sibopro.com. I don’t know, go look at her website and mine, it has it. And then also the Facebook group, SIBO SOS community, and we also have a course called the SIBO Recovery Roadmap, which is a course designed for patients that both Dr. Siebecker and I teach. And it has helped thousands of people to really know what to do next, get ahold of the testing companies, like really holds your hand On paper SIBO Recovery Roadmap looks good, to say it, it’s ridiculous, that is the name of it, and it really, you know, there is hope and just stay the course and SIBO also causes anxiety, so give yourself a break, yeah.

Tom Moorcroft, DO

Right, and so much of this just drive just really, you know, puts you in that mental over drive, and you know, we’ve talked so much in the summit about like the connection between the gut and the vagus and the brain and anxiety and memory. So all those other things really SIBO can be impacted by or impact. So these are, this is a sort of Charlotte’s web of the whole thing that we’re helping to unravel here in the summit. And I wanna say a personal thank you because I’ve, you know, between the information I’ve learned from, you know, following your work and following the work of Dr. Siebecker. Like when I first started, I knew SIBO was a thing because I started to see it, but I didn’t know where to go and having that information, even as a board certified physician, I wasn’t, like you said, I wasn’t taught this. And so just a sincere thank you for me, and I know all my patients, because the work that you’re doing is actually helped trained me to actually make a difference and know that we should be talking right now. So, so good, and thank you for joining us.

Shivan Sarna

Oh, very heartwarming to hear that. Thank you, mission accomplished and still going strong. And we’re trying to really get the word out around the globe. We’ve had some folks from China as well as the middle east. And I get, I love sharing this information with everyone in the United States and Canada and the UK. And then when we reach some of those harder to reach locations with social media, et cetera, I get really turned on, so please spread the word. Thank you so much.

Tom Moorcroft, DO

Oh, you’re so welcome. And yeah, everyone definitely share the word because you know, again, if you think about food poisoning as one of the biggest triggers, how much of that is happening in places outside of the US, where we can make a huge difference in everyone and think about their Mast Cell Activation Syndrome. It could, you know, there’s that back and forth balance. And this could be the big trigger that makes a huge difference in not only your life, but someone else’s. So please share. Again, Shivan Sarna, thank you so much for joining us and everyone, thank you for joining us for this episode of the reversing Mast Cell Activation Syndrome and histamine intolerance summit. And we’ll see you in our next interview.