Hashimotos and SIBO (Part

1 of 2)
a couple of years ago /

FREE Hashimoto's Diet Related Health Challenges /

By Marc Ryan

Diet Matters with Hashimotos

For many people who struggle with Hashimotos, diet is a huge issue.

Yet, many doctors ignore the role of diet in the initiation, and progression of
this and other autoimmune diseases.

But, if you have Hashimotos, and you are like a lot of people weve worked
with, then you know that what you eat has a huge impact on your health
and how you feel.

This just makes sense. Where is your immune system in your body?

Over 70% is found in and around your digestive tract. This is where it lives.

What you eat has a profound impact on autoimmune diseases like

Hashimotos.

In this series of posts, well examine a key factor in healing your

Hashimotos by looking into something that is really common but often
overlooked.

SIBO or small intestine bacterial overgrowth.

I recently attended a lecture taught by my teacher and mentor, Dr. Datis
Kharrazian.

Dr. Kharrazian is a relentless researcher.

He is always exploring other peoples research and doing his own in order
to help us understand why people are getting sick and how we can fix it.

In a recent lecture that I attended called The Neuroendocrine Immunology

of Small Intestine Bacterial Overgrowth, he shared a lot of really valuable
information on many aspects of SIBO that new research has revealed.

Why SIBO Matters to Someone with Hashimotos

Determining whether not you have SIBO can be really, really important for
people with Hashimotos because of the role that the small intestines play in
thyroid hormone conversion and absorption.
When you have Hashimotos and hypothyroidism this leads to problems
with motor functions in the small intestine.

There are thyroid hormone receptors all over the gut. The vagus nerve fires
into the gut.

If they arent getting enough thyroid hormone, things dont move as well
through there and that leads to overgrowth of bacteria.

And too much of this bacteria can interfere with levothyroxine absorption.

This is why some people take Synthroid, Armour, Cytomel, Naturethroid or

another thyroid replacement hormone and it doesnt feel like its working.

Thats because it isnt.

With SIBO you cant absorb thyroid hormone very well.

And autoimmunity shuts down T3 receptors.

Again, thyroid hormone doesnt work if it cant bind to receptors and cant
be absorbed.

So, even though you are taking thyroid hormone, it isnt working you have
all the symptoms like fatigue, brain fog and memory issues, weight gain,
hair loss, depression, etc.

The Small Intestine is Ground Zero for Autoimmunity

Many researchers also believe that autoimmune disease originates in the
intestines.

A leaky gut or damaged intestine has been found in every autoimmune

disease that has been tested including rheumatoid arthritis, ankylosing
spondylitis, inflammatory bowel disease (Crohns disease and ulcerative
colitis), celiac disease, multiple sclerosis, type I diabetes and, yes,
Hashimotos.

In the small intestine this damage leads to immune system stimulation, the
wrong types of things in the blood stream and, ultimately, a systemic
problem that results in the loss of self-tolerance.

This means that the immune system gets so overwhelmed it cant tell what
is our tissue and what is a bad guy that must be attacked.

Which Came First Leaky Gut or SIBO?

There are many causes of the breakdown of the intestines.

These include NSAID use, alcohol, gluten and other dietary proteins,
bacterial overgrowth, environmental toxins and more.

And once this breaks down it alters the whole ecosystem of the gut.

Its hard to know which came first.

And at the end of the day, it doesnt really matter.

What matters is what causes it and what we can do to heal it.

Symptoms of SIBO
SIBO has a number of possible symptoms, but mostly these involve
bloating, gas, diarrhea and/or constipation.

The hallmark symptom is bloating and discomfort after eating certain foods.

Basically heres what happens.

The wrong type of bacteria end up getting into the small intestine. The
migrate from the large intestine and take over.

They feed on certain types of foods like sugars, galactans, fructans and
starch.

In reality, SIBO should be considered with abdominal discomfort after

eating any of the following things:

Starches
Sugars/fructose
Fructans
Prebiotics
Probiotics
Fiber supplements
Rice or pea powder from metabolic powders
Galactans

You may notice that many of the foods listed here can also aggravate
candida. And sometimes candida is blamed for what is actually SIBO.

5 Main Causes of SIBO

The causes of SIBO matter because when we understand the causes, we
can figure out how to fix them.

These include:

1. Too little stomach acid.

Hashimotos and hypothyroidism leads to lower production of gastrin and
stomach acid. This is super common.

And ironically, many people develop GERD or acid reflux and are
prescribed proton pump inhibitors and antacids that just make everything
worse.
(Weve discussed this in depth in this post)
2. An immune suppressed gut.
Many factors can lead to immune suppression in the gut. 2 important ones
are long term corticosteroid treatment and chronic stress.

In either case, lots of cortisol or corticosteroids cause the immune system to

shut down and allows the party to get out of control.

With Hashimotos the body is under a great deal of physiological stress, all
the time. So extra emotional stress and abnormally stressful events often
result in people getting a lot sicker.

This is one of the reasons why.

3. Injury to the gut nervous system (known as the ENS or enteric

nervous system)
The gut has been called the bodys second brain because it has its own
nervous system and produces many of the neurotransmitters that are also
produced in the brain.

Well, just like our other brain this can degenerate and break down with age
and with diseases like chronic celiac disease, sceleroderma and IBS.

And just like neurodegeneration in the brain, this can be permanent. But
also, just like the brain this second brain has remarkable plasticity and it
can relearn things and rewire itself, too.

The gut brain and our main brain are both loaded with thyroid hormone
receptors. With Hashimotos and hypothyroidism, there is often too little
thyroid hormone or its not getting absorbed properly.

This can result in damage to the enteric nervous system (the gut brain).

4. Problems with the Vagus nerve

The Vagus nerve is a central highway for communication between the brain
and the gut. When the vagus nerve stops firing into the gut this slows down
everything.

This is a major cause of slower motility and constipation.

Thyroid hormone has a direct affect on movement through the entire

gastrointestinal tract.

Thyroid hormones increase intestinal neurotransmitters, increase blood flow

to the intestines and support the repair and regeneration of the intestines.

Hypothyroidism can slow movement through the esophagus, can affect

muscle function in this area and can affect the nerves that cause
movement.

Hypothyroidism also has an affect on the vagus nerve and this can lead
both directly and indirectly to slowing movement through the intestines.

5. Anatomical or structural changes to the small intestines or

illeosecal valve
Surgery to the gut (like appendectomy or resection), diverticulitis and
scarring due to inflammatory bowel disease can all lead to this.

Hypothyroidism can lead to the loss of control of the ileosecal valve that is
the doorway between the large and small intestine.

When this stops working as it should it lets lots of critters from the large
intestine into the small intestine.

SIBO Has Degrees of Severity

Just like Hashimotos, SIBO has different degrees of severity. These are
important because the more serious it is the more work you may have to do
to resolve it.
I. Asymptomatic:
Abnormal small intestine bacterial overgrowth tests and mild or no
symptoms.

Bloating after meals.

II. Moderate Symptoms:

Bloating with malnutrition and constipation.

Bloating with nutritional deficiencies.

III. Severe Symptoms:

Bloating with anemia, low albumin, low cholesterol

Bloating with weight loss, chronic diarrhea and malabsorption

If you are a person who has trouble taking supplements because you just
react to everything, then you may fall into the more severe symptoms
category.

Who Has SIBO?

Heres an overview from the Journal of Clinical Gastroenterology on the
prevalence of SIBO in other conditions:

15% of the elderly

33% of people with chronic diarrhea
34% of people with chronic pancreatitis
53% of people using antacid medication
66% of patients with celiac disease with persistent symptoms.
78% of people with IBS
90% of alcoholics
What really stands out for me there are 2 of those statistics.
More than half the people on antacid medication and 9 out of 10
alcoholics suffer from SIBO.
That shows you how destructive alcohol can be to the small intestines.

And, the fact is that alcohol degenerates the enteric nervous system of the
gut very aggressively.

How Do You Test for SIBO?

In the conventional medical model there are 2 types of testing for SIBO.

Both are flawed and not definitive.

1. Direct: Endoscopic Aspiration and Culture

This is a direct endoscopic aspiration and culture of the small intestine.

This requires a gastroenterologist, its expensive, its invasive (they have to

go in and get a sample).

The problem with this is that many of the bacteria removed from the small
intestine cant be analyzed because they dont survive in culture.

Samples must be handled properly for accurate results.

To recap: Its expensive, its invasive and sometimes tests dont reveal all
the bacteria involved.

2. Indirect: Breath Testing for Hydrogen and Methane

This type of testing involves breath testing for hydrogen and methane.

This test can be inaccurate if someone has recently had antibiotics.

It may not be useful in determining all species of bacteria.

The optimal window for timing for collection is different for different people
because transit time is different for different people.

To recap: You may get false negatives due to different transit times or
antibiotic use.

Actually, the best test for SIBO is a trial diet and/or a stool test that
looks for invasive species.
In our next post, well look at this diet and how to treat all 5 different
causes of SIBO and the various levels of seriousness.
References:
http://www.discoverymedicine.com/Kouki-Mori/2012/11/27/does-the-gut-
microbiota-trigger-hashimotos-thyroiditis/
http://www.ncbi.nlm.nih.gov/pubmed/17698907 SIBO and hypothyroidism
-antibiotic therapy didnt affect thyroid hormone levels
http://www.ijem.in/article.asp?issn=2230-
8210;year=2014;volume=18;issue=3;spage=307;epage=309;aulast=Patil
Link between SIBO and hypothyroidism
http://journals.lww.com/theendocrinologist/abstract/1995/05000/absorption_
of_oral_thyroxine.9.aspx
It is markedly decreased in conditions in which there is a decrease in the
effective small intestinal absorptive surface, including short bowel
syndromes sprue, and other malabsorptive conditions.

http://www.europeanreview.org/wp/wp-content/uploads/451-4561.pdf
Levothyroxine absorption in health and disease
http://gutcritters.com/thyroid-function-and-gastrointestinal-distress/ LPS
and thyroid receptors
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/ SIBO Study
http://www.ncbi.nlm.nih.gov/pubmed/12388159?dopt=Abstract Infection
leads to poor thyroid hormone absorption
http://www.ncbi.nlm.nih.gov/pubmed/18372241 LPS reduced T3
http://chriskresser.com/inflammation-strikes-again Low T3 Syndrome
http://www.discoverymedicine.com/Kouki-Mori/2012/11/27/does-the-gut-
microbiota-trigger-hashimotos-thyroiditis/
http://www.naturalendocrinesolutions.com/articles/sibo-thyroid-health/
http://neurosciencestuff.tumblr.com/post/38271759345/gut-instincts-the-
secrets-of-your-second-brain Great article on the enteric nervous system
http://www.ncbi.nlm.nih.gov/pubmed/16336493 : glial cels in the gut cause
neurodegeneration
http://www.jneuroinflammation.com/content/7/1/37 : neurodegeneration in
IBD
http://ajpgi.physiology.org/content/ajpgi/303/8/G887.full.pdf : enteric glia
cells are protective, damage to them leads to neurodegeneration
Prevalence of small intestine bacterial overgrowth diagnosed by
quantitative culture of intestinal aspirate in celiac disease. J Clin
Gastroenterol, 2009 Feb; 43 (2): 157-161

The Neuroendocrine Immunology of Small Intestine Bacterial Overgrowth,

lecture notes, Dr. Datis Kharrazian, November 2014.

The Paleo Approach, Sarah Ballantyne, PhD, Victory Belt Publishing 2013