Many people with Hashimoto’s feel significantly better when they remove reactive foods, replenish nutrient depletions with restorative foods and supplements, and support the gut with probiotics. But what if those steps alone don’t work? You’ll have to dig a bit deeper.
It took more than the implementation of the strategies above for me to resolve all my symptoms related to Hashimoto’s. In fact, in some cases, my attempts to produce healing led to the development of additional, different symptoms altogether. Searching for the solution that will work for you can sometimes feel like trying to find a needle in a haystack, but the right combination of protocols for you is out there.
When symptoms don’t subside in response to what might be considered the standard approach in functional medicine — removing, replenishing, and repairing — there is a good chance that you have an unaddressed infection.
Many people with hypothyroidism may have SIBO, or small intestinal bacterial overgrowth. While this is not technically an infection, SIBO does have a bacterial component and can be a trigger or exacerbating factor for Hashimoto’s!
In fact, a 2007 study found that about 50 percent of people with hypothyroidism have SIBO, while a 2017 study found that levothyroxine use can contribute to the development of SIBO! (1,2)
In this article, we’ll explore:
- What SIBO is and what causes it
- How to test for SIBO
- Determining which SIBO treatment option is right for you
- How to prevent a SIBO recurrence
What Is SIBO?
“SIBO” is an acronym for small intestinal bacterial overgrowth. Our small intestine is meant to be relatively clear of bacteria, while the large intestine houses most of our bacterial friends and foes. In some cases, bacteria from the large intestine may make their way up and overgrow into the small intestine. (3) Too much of any bacteria, good or bad, can lead to SIBO. The key is to keep the bacteria in the large intestine, where it belongs, and out of the small intestine.
Once you have SIBO, it can lead to intestinal permeability and contribute to a long list of digestive symptoms, including acid reflux, belching, bloating, and irritable bowel syndrome (diarrhea, constipation, or mixed type). (4) SIBO often presents with bloating after eating, and is associated with the annoying “I woke up with a flat stomach and now I look pregnant syndrome.” (This is caused by bacteria in the small intestine creating too much gas.)
Conditions like irritable bowel syndrome (IBS), hypothyroidism, fibromyalgia, and restless leg syndrome have all been tied to SIBO. (5-8)
SIBO can also cause a depletion of vitamin B12 and iron, as well as lessen levels of digestive enzymes like lactase (digests lactose in dairy) and amylase (digests starch), making it more difficult to digest many foods. (9)
If you’ve noticed that fibrous foods, fermented foods, histamine-containing foods, prebiotics, cruciferous veggies, and/or the use of probiotics seem to cause a flare-up in your digestive symptoms, there’s a good chance you have an overgrowth of bacteria in your small intestines. That is because these foods feed the bacteria in your intestines and cause them to multiply, contributing to the overgrowth. (For this reason, most probiotics, with the exception of one, are not recommended for those with SIBO. I’ll discuss this in further detail in a minute.)
Also, if you’ve found that using antibiotics or antimicrobial herbs, even when used for unrelated reasons, makes you feel better, this could also indicate the presence of SIBO. Substances with antimicrobial properties can suppress the bacteria, leading to temporary relief of symptoms. (3)
Additionally, I’ve found that people who feel better when fasting and skipping meals and have the flattest stomachs when they first wake up (but tend to look “pregnant” in the evenings), are more likely to have SIBO, as fasting, skipping meals and of course our lack of eating at night will prevent the bacteria from gorging on our food, producing gas, and replicating.
What Causes SIBO?
A SIBO overgrowth can be caused by issues such as low stomach acid (sometimes due to H. pylori), antibiotic use, the use of acid-suppressing medications (Pepcid, Protonix, Nexium, Prilosec, and Omeprazole are some potential names), slowed gut transit (where food moves along the gastrointestinal tract too slowly), and food poisoning, among others. (3,10) All of these things can suppress digestion and slow the passage of food through the intestinal tract, giving bacteria time to “set up shop” and colonize the small intestines.
Hypothyroidism in itself may contribute to SIBO because of its propensity to slow down gut motility. A 2017 study also tied the use of levothyroxine to SIBO — however, I’m not sure if this is a chicken or egg thing… (2)
SIBO can be a root cause, consequence, or exacerbating factor of Hashimoto’s. I have seen people with Hashimoto’s resolve symptoms like IBS, restless leg syndrome, low ferritin, and low B12 levels by treating SIBO. In some cases, I’ve also seen thyroid antibodies reduced — and even go away — with SIBO treatment.
How to Test for SIBO
While yeast overgrowth and most causes of gut infections can be detected in a stool test, SIBO is best revealed via a breath test. This is because the breath allows us to determine the presence of gas-producing bacteria. The gas is emitted because of fermenting bacteria, which will usually produce measurable levels of hydrogen and methane.
Because SIBO is a hot new topic in the gut world, more and more progressive conventional medicine doctors may be willing to test you for it — although you may have to be proactive and ask for the test yourself. Functional medicine practitioners, gastroenterologists, and major Academic Treatment Centers will have access to advanced diagnostic tests, possibly administered using a breath-testing machine.
Otherwise, you can order a SIBO breath test kit that uses lactulose (to stimulate the bacteria) to release their gasses. The 3 Hour SIBO Lactulose breath test checks levels of bacteria in the small intestines. You can order this test through my Rupa Health, Direct Labs, or MyMedLab channels.
It’s important to find out if you have SIBO, as treating a bacterial overgrowth may not only greatly improve digestion, it may also result in remission from Hashimoto’s in some cases.
SIBO Treatment Options
There are several protocols that can be used in the eradication of SIBO, including a pharmacologic approach, which relies on antibiotics, and an herbal approach that focuses on the use of antimicrobial herbs. (11,12)
It’s important to realize that there is no “one-size-fits-all” cure for SIBO, and what works well for one person may not work for the next. Some people may need to undergo several rounds of treatment in order to eliminate the bacterial overgrowth and find relief from symptoms, while others may need to tackle the problem by using more than one intervention — for instance, by incorporating some dietary changes and using antimicrobials.
Pharmacologic Approach
According to Dr. Allison Siebecker, creator of the informative website SIBOinfo.com, the antibiotics metronidazole, rifaximin (Xifaxan™), and neomycin have been used to treat small intestinal bacterial overgrowth because of their ability to stay in the intestines, which prevents them from causing systemic adverse events. Most of my clients who have used this approach have reported positive results, though it’s important to note that not all insurance companies cover Rifaximin — and the out-of-pocket cost may be high.
I typically recommend the following dosages. However, I encourage you to consult with a practitioner in your area, as they will be familiar with your health history:
- For hydrogen-producing bacteria: 1200 mg of Rifaximin daily, for 14 days
- For methane-producing bacteria (which are more likely to cause constipation): 1600 mg of Rifaximin per day, for 10 days; combined with neomycin (1000 mg per day, for 10 days) or metronidazole (750 mg per day, for 10 days)
Herbal and Alternative Approach
Many people have found herbal antimicrobials to be as effective — or more effective — than their pharmacological counterparts. In fact, one recent study showed that herbal treatments (consisting of oil of oregano and berberine-based herbal blends) had a 46 percent success rate, while 34 percent of the participants using Rifaximin experienced a resolution of their SIBO. (12) Furthermore, those on Rifaximin experienced symptoms such as anaphylaxis, hives, diarrhea, and Clostridium difficile bacterial overgrowth, while only one participant using the herbal remedy experienced diarrhea.
In general, the anti-bacterial compounds derived from plant sources tend to spare the healthy gut bacteria more so than pharmacological antibiotics, which may decrease the risk of diarrhea and other digestive complications. Additionally, combining herbs can produce a synergistic effect on microbes and reduce the likelihood of resistant bacteria, which is a common problem with prescribed antibiotics. (13)
Other benefits of using herbal treatments include reduced cost, no prescription needed, and fewer side effects. On the other hand, an herbal treatment course usually lasts at least four to eight weeks, whereas prescription antibiotics usually show improvement within one to two weeks.
There are several different herbal antibiotics that have proven effective in the treatment of SIBO. Keep in mind that different herbal combinations are usually chosen based on the gasses produced in your gut, and the symptoms you are experiencing. For example, herbs that work on methane-producing organisms, such as Allimed and Atrantil, are usually chosen for methane-producing SIBO bacteria.
Herbs for SIBO treatment include:
- Garlic extract (allicin) (14)
- Oregano oil (12)
- Berberine (12)
- Neem (15)
- Pomegranate husk (16)
- Clove (14)
- Thyme (12)
- Atrantil (17)
Some of the protocols that I have seen the most success with for SIBO are focused on using berberine with oil of oregano for 60 days, with an addition of garlic extract in the case of methane-producing bacteria. I’ve provided a few of my favorite options for berberine, oil of oregano, and garlic extract, so that you can select the one that works best for you. 🙂
Berberine-containing brand options and dosing:
- Rootcology Berberine: one capsule, three times per day for 60 days
- Candibactin-BR (an herbal formulation containing berberine): two capsules, three times per day for 60 days
- Integrative Therapeutics Berberine: one capsule, three times per day for 60 days
Oil of oregano-containing brand options and dosing:
- Rootcology Oil of Oregano: two capsules, three times per day for 60 days
- Designs for Health Oil of Oregano: two capsules, three times per day for 60 days
- Candibactin AR: one capsule, three times per day for 60 days
Garlic extract-containing brand options and dosing (add on for methane-producing bacteria):
- Rootcology’s Garlic Oil: two capsules, 3 times per day for 60 days
- Allicillin (garlic extract): two capsules, 3 times per day for 60 days
These are my recommended dosages, but please consult with your functional medicine practitioner to determine the dosage that is appropriate for you.
In addition to taking antibiotics (herbal or pharmacological), I usually recommend taking the beneficial yeast S. boulardii. While most people will need to avoid probiotics while working to eradicate SIBO, S. boulardii doesn’t colonize the intestines as most other probiotics do. Thus, it doesn’t contribute to the overgrowth of bacteria in the gut. Instead, S. boulardii helps to clear out the existing bacteria in the small intestine, and speeds up the process of clearing the gut infection. (18) I recommend starting out slowly and building up to a therapeutic dosage of as much as 4000 mg of a supplement such as Rootcology S. Boulardii per day.
I have seen many people clear their SIBO through a simple course of oil of oregano, berberine, and S. boulardii, and often recommend this line of treatment to my clients.
Dietary Treatments for SIBO
Some people have had success using specific dietary approaches, such as the elemental diet, the Specific Carbohydrate Diet, the low FODMAPS diet, or the GAPS diet, to reduce the bacterial overgrowth. However, many people will find that these dietary approaches work best when combined with one of the antimicrobial treatments mentioned above.
Even if you don’t choose to take a dietary approach, it is recommended during the treatment of SIBO (or suspected SIBO) that you limit starchy foods, fiber, and the use of probiotics that contain prebiotics like fructooligosaccharides (FOS), inulin, and Arabic gum, as well as foods with high amounts of prebiotics (this is similar to the low FODMAPS diet, see below).
Foods with high prebiotic content to avoid include chicory root, Jerusalem artichoke, dandelion, garlic, leek, onion, and asparagus.
Peppermint oil has been found to be helpful for SIBO as well. (19) (Please work with a professional who knows how to safely prescribe essential oils, before ingesting peppermint oil.) However, most brands of peppermint oil contain soy, so drinking peppermint tea may be a better alternative.
Elemental Diet
The elemental diet is a liquid diet that is free of non-digestible substances such as fiber, complex carbohydrates, and protein structures. It contains our essential macronutrients in a state that requires little to no digestion, and results in complete absorption. (20) In doing so, it does not provide any food for pathogenic bacteria to feed on, thus starving them.
It has been traditionally used for rehabilitation of severely malnourished individuals (like in the case of anorexia), people with bowel inflammation, and those experiencing diarrhea.
The elemental diet is also considered a “low-residue” diet, which means that it is composed of free-form amino acids and fat in liquid form. Amino acids, glucose, fat, and vitamin/mineral supplements (in liquid form) are utilized instead of food. Because it results in a reduced secretion of pancreatic and gastric juices, this diet gives the stomach and pancreas a rest from digestive activity, and allows for healing and reduction of inflammation to take place.
Additionally, free-form amino acids allow for the body’s own protein (muscle tissue) to be spared during the diet, helping the rest of the body heal quicker.
An elemental diet may be incredibly beneficial in kick-starting the thyroid healing process. This diet causes a rapid shift in bacterial flora within one to two weeks. (21)
SIBO is thought to be a primary cause of IBS, and clinical trials have shown that this diet is effective in reducing SIBO within two weeks in people with IBS, resulting in a substantial improvement of symptoms in as many as 80 percent of people. (22)
Of course, there are some drawbacks to the diet. First, the amino acid supplements are expensive and taste pretty disgusting, if not properly prepared. Many people report feeling nauseated after drinking the solution, and aspiration has resulted when people lie down too quickly following ingestion. Furthermore, commercially available formulas (e.g. Vivanox®) contain a lot of artificial ingredients that people with Hashimoto’s may not tolerate. They also include a lot of carbohydrates, which can cause high blood sugar and harm adrenal function.
In recent times, the company Integrative Therapeutics came up with a cleaner version of the elemental diet — the Physician’s Elemental Diet. This formulation has become my go-to recommendation for people with Hashimoto’s who are interested in the elemental diet. Please note, Integrative Therapeutics has removed distribution of this formula from retail channels, as it is an FDA-regulated medical food. As always, I do recommend working with your personal health care provider to ensure this (or any other) intervention is appropriate for you. However, if you and your practitioner are having trouble obtaining this elemental formula, Dr. Siebecker’s homemade Elemental Diet may be a suitable alternative.
A modified homemade elemental diet is also available in the Companion Guide to my book, which you can download at thyroidpharmacist.com/guide. As this diet requires the purchase of expensive amino acids, however, it can be quite pricey.
Some critics of the elemental diet also noticed that symptoms sometimes return after a period of time ranging from months to years. I think this is likely because people go back to their high sugar/carbohydrate diets too soon. However, if an elemental diet was followed by a grain-free FODMAPS diet, Specific Carbohydrate Diet (SCD), or a similar diet, this could result in permanent remission.
I do not recommend attempting the elemental diet for those with compromised adrenal function and/or other types of infections, such as parasitic infections. Elemental diets should be used under the supervision of a health care professional and in the case of confirmed SIBO.
Specific Carbohydrate Diet/GAPS Diet
The Specific Carbohydrate Diet (SCD) and the Gut and Psychology Syndrome (GAPS) Diet are other diets that have been found to be helpful for SIBO. (23,24) It eliminates grains, sugars, and starches — and only allows carbohydrates to be eaten in the form of fruits, honey, and certain kinds of specifically fermented yogurts.
The SCD diet is very similar to the Autoimmune Paleo Diet (AIP) well-known in the Hashimoto’s community, with the exception that it does not allow sweet potatoes due to their starchy content, and unless customized, allows other foods like nuts, seeds, and nightshades that are not AIP-approved.
I love the website SCDlifestyle.com if you’re looking for more information on the SCD approach.
Low FODMAPs Diet
The low FODMAPs diet is considered an effective nutritional therapy for certain digestive disorders, including SIBO. (23) By removing foods high in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (short-chain carbohydrates), this diet essentially cuts off the food supply to the bacteria that may be running amok in your intestines. This can help eliminate SIBO by multiplying the flora we need for absorption and, potentially, starving the pathogenic flora by avoiding the foods that are fermented by pathogens.
Certain foods —specifically onions, garlic, and beans — will always be malabsorbed in all individuals, whether they have IBS or not. (25) These three foods also cause gas production in all individuals. However, when pathogenic bacteria are present, toxic byproducts are produced, causing more severe symptoms.
A 2012 study showed that 75 percent of individuals with IBS who follow a low FODMAP diet have been found to see an improvement in symptoms. (26)
The low FODMAP diet allows some fruits, but advises against eating too many of them. Bananas, blueberries, boysenberries, cranberries, grapes, grapefruit, honeydew melon, kiwi, lemons, limes, oranges, raspberries, and strawberries are allowed. Vegetables included on the low FODMAP diet are carrots, celery, endives, ginger, green beans, lettuce, olives, parsnips, potatoes, pumpkin, red bell peppers, spinach, squash, sweet potatoes, tomatoes, turnips, and zucchini, as well as most herbs.
Gluten-free cereals and grains, such as rice, oats, polenta, quinoa, psyllium, sorghum, tapioca, and arrowroot are allowed.
Most dairy products are not permitted unless they are lactose-free. Sweeteners such as sugar and maple syrup are allowed, but not in large quantities.
You’ll notice that meats and eggs are not restricted on the low FODMAP diet, as they do not contain fermentable carbohydrates.
Here’s a graphic with an overview of high FODMAP foods, that you can save and refer to later:
For those following another type of diet, such as the Paleo or gluten-free diets, modifications can be made to the low FODMAP diet to meet your specifications. Examples of how you may want to modify your diet include:
- Gluten-free: Eliminate all gluten-containing grains (wheat, barley, and rye in all variations).
- Dairy-free: Eliminate all sources of dairy, including lactose-free dairy products.
- Paleo: Eliminate all grain, dairy, legumes, and processed food products. Focus on meats and low FODMAP vegetables/fruits.
- Autoimmune Paleo: Avoid all processed foods, grains, legumes, dairy, eggs, soy, sugar, food additives, alcohol, and most nuts and seeds. Focus on pasture-raised meats, and low FODMAP fruits and vegetables.
For more information on how to implement a low FODMAP diet, please see my full article.
The Importance of Retesting and Tips for Preventing SIBO Relapse
Regardless of the method you choose to combat SIBO, it’s important to retest for SIBO 5-14 days after the completion of your treatment protocol to determine if, in fact, the SIBO has been appropriately treated, or whether it may be growing back.
One way to keep the bacteria from growing back is to ensure that you have sufficient stomach acid to properly digest and absorb the food you consume. (27) This is especially important for those with thyroid conditions to look into, as many people with Hashimoto’s may have low stomach acid. (28)
In my clinical experience, many people with low stomach acid find betaine with pepsin helpful. However, it’s important to note that low stomach acid may often be caused by H. pylori. After studying gut health for almost a decade, I have come to realize that this important pathogen can be behind “treatment-resistant SIBO.”
Another important factor in keeping bacteria overgrowth from returning is making sure that your bowels are able to move food through the intestines properly. We call this process gut motility. When food sits in the intestinal tract for too long, as is the case with constipation (often experienced by those with hypothyroidism), bacterial overgrowth is more likely to occur. (29)
Prokinetics are agents that work to stimulate the intestinal tract so that it can move food along effectively and prevent bacteria from “snacking” on the food as it passes. These can include herbal treatments, medications, and physical devices. Many people will find that these agents are an important part of their strategy to keep SIBO from recurring.
Prokinetics and substances that may help with bowel motility include:
- Low dose naltrexone
- Motilpro by Pure Encapsulations
- Low dose erythromycin
- Iberogast
- Thyroid medication
- Vagus Nerve Stimulation (VNS)
- Carnitine
- Magnesium citrate
- Aloe
Picking the Right Protocol for You
I advise you to discuss these potential protocols with your practitioner and let them help identify the best starting point for you based on your health history. While it may take some time, eradicating SIBO can allow for your gut to heal and, ultimately, resolve the intestinal permeability that may have been your Hashimoto’s trigger.
The first step is to get tested for SIBO and then make a plan to decide which diet, antimicrobial, and preventative options are right for you.
SIBO can be challenging to conquer, and may take some time and persistence on your part. However, I have seen many people overcome their infections and experience huge relief from their symptoms, and I know the same is possible for you. I’m rooting for you!
Have you already been tested for SIBO? What methods have you tried to treat it?
I love interacting with my readers on social media, and I encourage you to join my Facebook, Instagram, TikTok, and Pinterest community pages to stay on top of thyroid health updates and meet others who are following similar health journeys. For recipes, a FREE Thyroid Diet start guide, notifications about upcoming events, and the Nutrient Depletions and Digestion chapter from my first book for free, be sure to sign up for my email list!
References
- Lauritano E, Bilotta A, Gabrielli M et al. Association between Hypothyroidism and Small Intestinal Bacterial Overgrowth. The Journal of Clinical Endocrinology & Metabolism. 2007;92(11):4180-4184. doi:10.1210/jc.2007-0606.
- Brechmann T, Sperlbaum A, Schmiegel W. Levothyroxine therapy and impaired clearance are the strongest contributors to small intestinal bacterial overgrowth: Results of a retrospective cohort study. World Journal of Gastroenterology. 2017;23(5):842. doi:10.3748/wjg.v23.i5.842.
- Quigley EMM. The Spectrum of Small Intestinal Bacterial Overgrowth (SIBO). Curr Gastroenterol Rep. 2019;21(1):3. Published 2019 Jan 15. doi:10.1007/s11894-019-0671-z
- Park JH, Park DI, Kim HJ, et al. The Relationship between Small-Intestinal Bacterial Overgrowth and Intestinal Permeability in Patients with Irritable Bowel Syndrome. Gut Liver. 2009;3(3):174-179. doi:10.5009/gnl.2009.3.3.174
- Giamarellos-Bourboulis E, Pyleris E, Barbatzas C, Pistiki A, Pimentel M. Small intestinal bacterial overgrowth is associated with irritable bowel syndrome and is independent of proton pump inhibitor usage. BMC Gastroenterology. 2016;16(1). doi:10.1186/s12876-016-0484-6.
- Patil A. Link between hypothyroidism and small intestinal bacterial overgrowth. Indian Journal of Endocrinology and Metabolism. 2014;18(3):307. doi:10.4103/2230-8210.131155.
- Erdrich S, Hawrelak JA, Myers SP, Harnett JE. Determining the association between fibromyalgia, the gut microbiome and its biomarkers: A systematic review. BMC Musculoskelet Disord. 2020;21(1):181. Published 2020 Mar 20. doi:10.1186/s12891-020-03201-9
- Weinstock LB, Walters AS. Restless legs syndrome is associated with irritable bowel syndrome and small intestinal bacterial overgrowth. Sleep Med. 2011;12(6):610-613. doi:10.1016/j.sleep.2011.03.007
- Dukowicz AC, Lacy BE, Levine GM. Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterol Hepatol (N Y). 2007;3(2):112-122.
- Sachdev AH, Pimentel M. Gastrointestinal bacterial overgrowth: pathogenesis and clinical significance. Ther Adv Chronic Dis. 2013;4(5):223-231. doi:10.1177/2040622313496126
- Rezaie A, Pimentel M, Rao S. How to Test and Treat Small Intestinal Bacterial Overgrowth: an Evidence-Based Approach. Current Gastroenterology Reports. 2016;18(2). doi:10.1007/s11894-015-0482-9.
- Chedid V, Dhalla S, Clarke JO, Chander Roland B, Dunbar KB, Koh J, et al. Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth. Glob Adv Health Med. 2014 May; 3(3): 16–24. doi: 10.7453/gahmj.2014.019.
- Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T. 2015;40(4):277-283.
- Ren X, Di Z, Zhang Z, et al. Chinese herbal medicine for the treatment of small intestinal bacterial overgrowth (SIBO): A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2020;99(51):e23737. doi:10.1097/MD.0000000000023737
- Kumar VS, Navaratnam V. Neem (Azadirachta indica): prehistory to contemporary medicinal uses to humankind. Asian Pac J Trop Biomed. 2013;3(7):505-514. doi:10.1016/S2221-1691(13)60105-7
- Howell AB, D’Souza DH. The pomegranate: effects on bacteria and viruses that influence human health. Evid Based Complement Alternat Med. 2013;2013:606212. doi:10.1155/2013/606212
- Brown K, Scott-Hoy B, Jennings LW. Response of irritable bowel syndrome with constipation patients administered a combined quebracho/conker tree/M. balsamea Willd extract. World J Gastrointest Pharmacol Ther. 2016;7(3):463-468. doi:10.4292/wjgpt.v7.i3.463
- García-Collinot G, Madrigal-Santillán EO, Martínez-Bencomo MA, et al. Effectiveness of Saccharomyces boulardii and Metronidazole for Small Intestinal Bacterial Overgrowth in Systemic Sclerosis. Dig Dis Sci. 2020;65(4):1134-1143. doi:10.1007/s10620-019-05830-0
- Logan AC, Beaulne TM. The treatment of small intestinal bacterial overgrowth with enteric-coated peppermint oil: a case report. Altern Med Rev. 2002;7(5):410-417.
- Russell RI. Intestinal adaptation to an elemental diet. Proc Nutr Soc. 1985;44(1):87-93. doi:10.1079/pns19850014
- Andoh A, Inoue R, Kawada Y, et al. Elemental diet induces alterations of the gut microbial community in mice. J Clin Biochem Nutr. 2019;65(2):118-124. doi:10.3164/jcbn.19-8
- Pimentel M, Constantino T, Kong Y, Bajwa M, Rezaei A, Park S. A 14-Day Elemental Diet Is Highly Effective in Normalizing the Lactulose Breath Test. Digestive Diseases and Sciences. 2004;49(1):73-77. doi:10.1023/b:ddas.0000011605.43979.e1.
- Vincenzi M, Del Ciondolo I, Pasquini E, Gennai K, Paolini B. Effects of a Low FODMAP Diet and Specific Carbohydrate Diet on Symptoms and Nutritional Adequacy of Patients with Irritable Bowel Syndrome: Preliminary Results of a Single-blinded Randomized Trial. J Transl Int Med. 2017;5(2):120-126. Published 2017 Jun 30. doi:10.1515/jtim-2017-0004
- Sibo diets – gaps diet and SCD. IBS Diets. https://www.ibsdiets.org/ibs/sibo-diets-gaps-diet-and-scd. Accessed August 25, 2022.
- Barrett JS, Gibson PR. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals?. Therap Adv Gastroenterol. 2012;5(4):261-268. doi:10.1177/1756283X11436241
- Magge S, Lembo A. Low-FODMAP Diet for Treatment of Irritable Bowel Syndrome. Gastroenterol Hepatol (N Y). 2012;8(11):739–745.
- Ramsay PT, Carr A. Gastric acid and digestive physiology. Surg Clin North Am. 2011;91(5):977-982. doi:10.1016/j.suc.2011.06.010
- Cellini M, Santaguida MG, Virili C, et al. Hashimoto’s Thyroiditis and Autoimmune Gastritis. Front Endocrinol (Lausanne). 2017;8:92. Published 2017 Apr 26. doi:10.3389/fendo.2017.00092
- Ghoshal UC, Srivastava D, Verma A, Misra A. Slow transit constipation associated with excess methane production and its improvement following rifaximin therapy: a case report. J Neurogastroenterol Motil. 2011;17(2):185-188. doi:10.5056/jnm.2011.17.2.185
Note: Originally published in February 2020, this article has been revised and updated for accuracy and thoroughness.
Do you recommend the elemental diet if you also have tested positive for a yeast overgrowth? If you do, what herbs do you recommend with the elemental diet? I have been fighting SIBO for over two years but my functional medicine practioner does not want me to do elemental because I have a yeast overgrowth but after multiple rounds of rifaximin candibactin at/br, allimed, lauricidin, atrantil…and lots of money and time. The elemental is my only option. Please let me know your thoughts …thank you!
Jennifer – thank you for following this page. The way that you want to address infections is by starting with the highest infection in your body first. H. pylori is typically found in the stomach (it can also be in the upper part of the small intestine), so that’s going to be the first infection you want to treat. A lot of times, when you treat H. pylori, the SIBO will go away as well. Next would be the parasite. If, after the H.pylori and parasite protocols you still have SIBO, you would treat it at this time. The yeast would be addressed last, if needed. Sometimes when you use the parasite protocol along with the SIBO protocols, the yeast issue is taken care of as well. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition.
Hashimoto’s Protocol
thyroidpharmacist.com/protocol
Hashimoto’s Root Cause
http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20
Thank you for this Isabella. I was looking for answers to my questions and found it in your response.
Your books, articles are amazing and help so many of us. Thank you!
Anna – you are very welcome! ❤️
Would it be possible for your computer techs to figure out a way people could print only the article and not all the extra nonsense on the page (pictures, etc)??? I’ve noticed that some sites have a button at the end of article that says print and can get just article. ( I’ve stopped printing because when one little article uses all the paper and ink because of all the nonsense surrounding it, that is not doable.) I can’t read a lot while looking at computer because the light is very uncomfortable. Sometimes would like to read your articles, but they are too long to do that on the computer.
Diane – thank you for following this page and for the feedback. I will have my team look into this! 🙂
Diane – thank you for the feedback. If you scroll to the end of the article you will find a printer icon and when you click on it a window comes up so you can print without all the images. I hope that helps! 🙂
You posted an article recently that dealt with thiamine testing and supplementing. I cannot find it! Could you please let me know where I can find it?
Thanks so much!
Mary R. Brinkley
Mary – thank you for following this page. Here is an article you might find helpful.
THIAMINE AND THYROID FATIGUE
https://thyroidpharmacist.com/articles/thiamine-and-thyroid-fatigue
Hello good day. Can u email me the link so i can purchase ALl the supplements please?
Ann – Thank you for your interest in my new supplement line Rootcology! Here is a link to the site.
https://www.rootcology.com/collections/supplements
Regarding the herbal protocol: all of the three options must be taken together or we can combine either candibactin or oil of oregano with allicitin?
Thank you
Gabriela – thank you for following this page. For questions pertaining to the protocols or side effects please contact my team at info@thyroidpharmacist.com and they will be happy to help you. 🙂
Dr. Wentz,
I have performed two one hour breath test for SIBO and they both came back negative but my GP is convinced I have SIBO. Should I do a 3 hour breath test? All my symptoms have been erradicated except the extreme bloating which is very painful. My doctor recommended a three day cleanse to see if my intestine would clam down.
Also, shouldn’t I assume I have Hashimoto’s if I have hypothyroidism? I was on the AIP diet before getting my antibodies tested and it came back negative but I do have hypothyroidism. Thank you.
Natalie – thank you for following this page. Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically, is ‘dead’, or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target. We need to re-balance the immune system to prevent this (sometimes the autoimmunity can be reversed as well). The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition.
Hashimoto’s Protocol
thyroidpharmacist.com/protocol
Hashimoto’s Root Cause
http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20
This is so informative and at the perfect time for me. I don’t have ins like symptoms but do have extreme bloating that will last weeks (or months) from something I ate. I’m about to do the sibo breathe test (lactilose) from Genova. Do you have any natural tips to help with constipation? It says any supplements that assist in this regard are to be avoided for the week prior to the test.
I have candida, salicylate sensitivity as well as hashimotos so I’m concerned about doing the elemental diet. My adrenals are already pretty shot, and have high cortisol. I avoid carbohydrates, sugar (even fruit) as much as possible. Might you have any thoughts of what to try?
Sorry one last question. If you are going to have a planned ‘cheat’ on vacation and want to have a cocktail. Is there something else to mediate symptoms besides or concurrent with taking charcoal pills?
Thank you for your time and most helpful information.
Brooke – thank you for following this page. The way that you want to address infections is by starting with the highest infection in your body first. H. pylori is typically found in the stomach (it can also be in the upper part of the small intestine), so that’s going to be the first infection you want to treat. A lot of times, when you treat H. pylori, the SIBO will go away as well. Next would be the parasite. If, after the H.pylori and parasite protocols you still have SIBO, you would treat it at this time. The yeast would be addressed last, if needed. Sometimes when you use the parasite protocol along with the SIBO protocols, the yeast issue is taken care of as well. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition.
Hashimoto’s Protocol
thyroidpharmacist.com/protocol
Hashimoto’s Root Cause
http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20
Dear dr. Wentz,
I have a ton of gurgling going on in my stomach all the time. As I sleep when I wake up. My general saying is if I could live without food I probably would. The problem is I know I also have several Got Bugs including yeast and I’m not sure the best approach for treating possible sibo if I have yeast because it seems like there might be some dietary contraindications. Right now I am taking grapefruit seed extract and a few other things to help get rid of the yeast in my gut. But I also think I need to be tested for the sibo because I feel terrible in my gut all the time. Yes I have a dr. That I will be talking to who is naturopathic doctor. Any suggestions on the combination of things I said try to get rid of this horrible gut-wrenching problem?
Celia – thank you for following this page. The way that you want to address infections is by starting with the highest infection in your body first. H. pylori is typically found in the stomach (it can also be in the upper part of the small intestine), so that’s going to be the first infection you want to treat. A lot of times, when you treat H. pylori, the SIBO will go away as well. Next would be the parasite. If, after the H.pylori and parasite protocols you still have SIBO, you would treat it at this time. The yeast would be addressed last, if needed. Sometimes when you use the parasite protocol along with the SIBO protocols, the yeast issue is taken care of as well. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition.
Hashimoto’s Protocol
thyroidpharmacist.com/protocol
Hashimoto’s Root Cause
http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20
Hello Dr. Wentz! I just bought your new book and am feeling hopeful for what lies ahead. I wanted to share, just briefly my success with VSL #3 and I know you mention it in your new book, but saw no mention on this page for Gut issues. VSL # 3 has had an incredibly positive impact and such that when it started working after about 3 days, it dawned on me how I was in so much pain all the time. I had come to accept it, but of course miserable. It is pricey, but worth having a happy tummy. I simply cannot live without it! I try to tell all my Hashimoto friends about it. My only suggestion is that it is purchased directly from a pharmacy, say Walgreens, instead of Amazon; I have read many reviews about the product being delivered warm. (It needs refrigeration)….thank you for sharing this!
Marne – thank you for following this page. Here is an article you might find helpful.
THE FOUR BEST PROBIOTICS FOR HASHIMOTO’S
https://thyroidpharmacist.com/articles/the-four-best-probiotics-for-hashimotos
Hello Dr. Wentz,
Thank you for this article and its valuable information. I was wondering: when you say ‘eat gluten free’, is it allowed to eat for example oatmeal gluten free version? I find it extremely hard to imagine my diet without bread of oatmeal to be honest….
I was just diognosed with Hashimoto’s and I was put on T4 hormones.. just recently found out! I also suffer from Lyme Disease…
Can you give advice in what to do now? What kind of tests should I opt for? I just don’t know where to start.. I am searching for a specialist though.. but it is just too much.. I am still in shock to be honest.
Thanks again for your dedication!
Greetings from Amsterdam
Sara – thank you for following this page. I highly recommend that you work with a functional medicine clinician. It’s an entire medical specialty dedicated to finding and treating underlying causes and prevention of serious chronic disease rather than disease symptoms.
FUNCTIONAL MEDICINE APPROACH TO THE THYROID
https://thyroidpharmacist.com/articles/functional-medicine-approach-to-the-thyroid
CLINICIAN DATABASE
http://www.thyroidpharmacistconsulting.com/clinician-database.html
FIND A FUNCTIONAL MEDICINE CLINICIAN
https://ifm.org/find-a-practitioner/
Hello,
I have Hashimoto and SIBO. I have had 3 rounds of antibiotics and my next test is sept. 12th I am hoping this time it’s gone. I am reading your book Hashimoto proticol and i seriously have so many questions but one of them is do I wait till the SIBO is gone before startling the 90 day plan and all the suppliments . I’m nervous to take so many supplements.
Thank you for helping others also through your experience I was starting to think I was going crazy.
Debbie
Deborah – thank you for following this page. For questions pertaining to the Protocols please contact my team at info@thyroidpharmacist.com and they will be happy to help you.
Hi
I had a negative test for SIBO with glucose (not lactulose). Tested early in the morning I felt quite ok till lunchtime, but afterwards a felt very sick with headache and exhaustion which made me think that I had SIBO all the same, but in the lower parts of the small intestine. In Switzerland it is very difficult to find a physician testing with lactulose and even more difficult to find somebody who is treating it as you recommend.
So I started the Treatment on my own (Candibactin-BR
Oil of oregano, Allicillin). After a few days I began to feel nauseatic and since then have diarrhea. Is it possible with this medication?
A part from this I follow the Autoimmune-Paleo-Diet.
Thank you and greetings
catherine
Catherine – Thank you for following this page. Please, understand that due to liability issues, I am unable to answer specific medical questions, but I highly recommend that you work with a functional medicine clinician. It’s an entire medical specialty dedicated to finding and treating underlying causes and prevention of serious chronic disease rather than disease symptoms.
FUNCTIONAL MEDICINE APPROACH TO THE THYROID
https://thyroidpharmacist.com/articles/functional-medicine-approach-to-the-thyroid
CLINICIAN DATABASE
http://www.thyroidpharmacistconsulting.com/clinician-database.html
FIND A FUNCTIONAL MEDICINE CLINICIAN
https://ifm.org/find-a-practitioner/
Hi Izabella,
After reading your book and digging deeper into possible root causes I have tested positive for H Pylori, Blasto & SIBO. I’ve seen your answer above to Celia who is in a similar position so I’m confident in the order I should treat these but I’m finding it hard to find anyone to say the natural protocols worked for them. I know you tested positive for these 3 in your journey and I was hoping you would outline which of your protocols you followed and for how long etc.
Thank you!
Renae – thank you for following this page. I am so happy you are taking charge of your health. Here are some articles you might find helpful.
MY HASHIMOTO’S AND HYPOTHYROIDISM JOURNEY
https://thyroidpharmacist.com/articles/my-hashimotos-and-hypothyroidism-journey
SIBO
https://thyroidpharmacist.com/articles/sibo-prevent-remission-hashimotos/
THE COMMON ROOT CAUSE OF HASHIMOTO’S, HIVES AND IBS
https://thyroidpharmacist.com/articles/the-common-root-cause-of-hashimotos-hives-and-ibs
Dear doctor, I think I have sibo but there is no proper test for this in my country Iran. My practitioner prescribed metronidazole. Does this medicament work in case of diarrhea?
We don’t find rifaximin here!
Thank you
Mahshid – I wish I could give you more direct advice but, each person will react differently. I would advise you to ask your personal pharmacist or a trusted clinician who’s care you are under. I am not able to respond directly to these types of questions here.
I also have earache.I’m not able to eat foods nor vegtables, any thing but lamb meet and gluten free toast! This has happened to me after taking levothyroxin!!! I feel pain in my right ovary! I’m really worried because of this condition. Loperamide made it worse!!
What’s your suggestion?
Warm regards…
Mahshid – I highly recommend that you work with a functional medicine clinician. It’s an entire medical specialty dedicated to finding and treating underlying causes and prevention of serious chronic disease rather than disease symptoms.
The UK does not have a big FM community but it is possible to work with an overseas FM practitioner remotely via Skype. You may have to go to London to see someone. Have you joined any UK groups and asked for help? There are 70 UK practitioners on the Functionalmedicine.org link
http://www.thyroidpharmacistconsulting.com/europe1.html.
https://www.functionalmedicine.org/practitioner_search.aspx?id=117#results
Thank you Izabella?
Good morning –
I have had Hashimotos for 5.5 years and in the last year developed SIBO. I also have adrenal fatigue which had been improving but then went south with the development of SIBO. I am following an herbal SIBO protocol and am on a strict food limitation diet following Dr. Siebecker’s 2014 food chart. My issue is that due to the adrenal fatigue I had been told to eat every 2.5-3 hours and with the SIBO diet it says to eat every 4-5 hours to let the food pass completely thru. Consequently, I sometimes feel light-headed and nauseous. I don’t want to damage my adrenals and that system further, but I need to get rid of the SIBO or nothing will ever heal. I’ve also stopped most supplements as they contain ingredients which are forbidden on this diet. I am frustrated and more tired than ever. To top it off, the doctor I’ve been working with for years has suffered severe illness and is slipping mentally and I have no idea where to turn for GOOD, knowledgeable advice. Please, can you help me?
Saraphine – thank you for reaching out. Please understand I am not able to respond directly to these types of questions here. I highly recommend that you work with a functional medicine clinician. It’s an entire medical specialty dedicated to finding and treating underlying causes and prevention of serious chronic disease rather than disease symptoms.
FUNCTIONAL MEDICINE APPROACH TO THE THYROID
https://thyroidpharmacist.com/articles/functional-medicine-approach-to-the-thyroid
CLINICIAN DATABASE
http://www.thyroidpharmacistconsulting.com/clinician-database.html
FIND A FUNCTIONAL MEDICINE CLINICIAN
https://www.functionalmedicine.org/practitioner_search.aspx?id=117
Hello Dr. Isabella,
What do you recommend to get Secretory IgA up….mine is 465??
I only tested positive for Citrobacter freundii and C. difficile Toxin B…antibodies seem to be stuck around the 200 range for a year now, follow an AIP diet also for the past year.
many thanks….jk.
JK – Thank you for following this page. Please, understand that due to liability issues, I am unable to answer specific medical questions, but I highly recommend that you work with a functional medicine clinician. It’s an entire medical specialty dedicated to finding and treating underlying causes and prevention of serious chronic disease rather than disease symptoms. Here are some links which might help:
FUNCTIONAL MEDICINE APPROACH TO THE THYROID
https://thyroidpharmacist.com/articles/functional-medicine-approach-to-the-thyroid
CLINICIAN DATABASE
https://www.thyroidpharmacistconsulting.com/clinician-database.html
MY RECENT CHALLENGES AND FINDING DR. RIGHT
https://thyroidpharmacist.com/articles/my-challenges-and-finding-dr-right/
Dr. Izabella, thank you for your insightful articles, I have followed you for several years after diagnosed with/Hashi “the monster”, lol. I’ve been following the AIP protocol since & did well until my husband had a near fatal crash. The long chronic stress took it’s toll, especially my gut. Have ALWAYS had issues (constipation) & bloating, but really bad past year. I do ok for a while, then it gets bad, ok again, then bad. That’s stressful. It’s always elusive! It surely has to be SIBO?? Does SIBO have a roller coaster pattern like that? That’s what holds me back from spending money on tests. Your insight would be so appreciated! Thank you so very much!
Sue – you are very welcome! I appreciate you sharing your journey! I am so sorry about your husband, I hope he is doing better. My heart goes out to your both. <3 We know that intestinal permeability (aka leaky gut) is present in every case of autoimmunity and often precedes the development of Hashimoto’s. Symptoms of leaky gut may include bloating, diarrhea, constipation, stomach aches, acid reflux and irritable bowel syndrome. According to the Institute of Functional Medicine, many people develop IBS 5-10 years before an autoimmune diagnosis. I was one of them and didn’t take my gut health as seriously as I should have. Gut problems are often caused by infections like H. pylori, parasites like Blasto, SIBO, an imbalance of bacteria, and enzyme deficiencies or food sensitivities (especially to gluten, dairy, and/or soy). Even stress can be a factor in gut permeability. Here are a couple articles you might find interesting.
6 DIFFERENT ROOT CAUSES
https://thyroidpharmacist.com/articles/6-different-hashimotos-root-causes/
ARE YOUR ADRENALS SABOTAGING YOUR HEALTH?
https://thyroidpharmacist.com/articles/are-your-adrenals-sabotaging-your-health
Hi Dr. Wentz,
I am going through the self-management course and loving all the information! It is so rich and worth every cent!! I recently printed off the Histamine Intolerance Guide. Back in Feb., my dermatologist told me I was FULL of histamine after checking me for a skin fungus. Not sure why she said that, but it got me to thinking after reading your guide – SIBO can cause the histamine intolerance. My question is this – I have diffused hair loss and losing it even more on my front top hair line and over both ears badly. Been going on for many, many years, so I am at the point of having lost about 75% of my hair all over and worse in those areas. If the histamine and/or possible gut infection or overgrowth has caused my Hashimoto’s, which causes hair loss, can treating the histamine and gut issues resolve my hair loss? I have tried everything to fix this. I am dairy, gluten, grain, soy, sugar, gluten cross-reactors, free. After reading your guide, I have discovered that I do not have food allergies as I thought. Your risk assessment in the self-management course said I was at high risk for infections, etc. My doctor put me on iodine and you address my question about that, thank you!!! so my TPOab. tripled and TSH tripled. Functional Doc put me on a T3 supplement and re-checked 7 weeks later. TSH cut in half to below 4 but my TPOab went up from 462 to 472. I know I am all over the board here, so if I check and treat possible infections, will my histamine intolerance stabilize and possibly grow hair and drop antibodies? My other thyroid numbers are not too bad, most in the low healthy functional range or clinical range. I am so incredibly grateful for all your resources, blogs, etc. I finally feel like I am on the right path after going to three doctors with hardly any results. My main issue is hair loss. God bless you!!
Peggy – thank you so much for reaching out and sharing your journey with me. <3 I understand how upsetting this can be. Hair loss is a distressing symptom experienced by women with Hashimoto’s. For women, our hair represents our femininity, and losing our hair is a constant reminder that something is off and that we are not well. Since you are in the Hashimoto's self management program, please email my team at info@thyroidpharmacist.com and they will be happy to help you.
Thank you so much! I will do that! And, thank you again for all the wonderful research you are sharing with us. So very grateful!!
Peggy – you are very welcome! Please keep me posted on your progress! <3
Hi dr.i have hashimoto disease too and i have too much gas 10 minute after eating food.
I get sick almost every two month.I have a itch in my throat.and i should consume drug to heal.
Do you know what the reasone is?
Gm – thank you for reaching out. We know that intestinal permeability (aka leaky gut) is present in every case of autoimmunity and often precedes the development of Hashimoto’s. Symptoms of leaky gut may include bloating, diarrhea, constipation, stomach aches, acid reflux and irritable bowel syndrome. According to the Institute of Functional Medicine, many people develop IBS 5-10 years before an autoimmune diagnosis. I was one of them and didn’t take my gut health as seriously as I should have. Gut problems are often caused by infections like H. pylori, parasites like Blasto, SIBO, an imbalance of bacteria, and enzyme deficiencies or food sensitivities (especially to gluten, dairy, and/or soy). Even stress can be a factor in gut permeability. Here is an article you might find interesting.
6 DIFFERENT ROOT CAUSES
https://thyroidpharmacist.com/articles/6-different-hashimotos-root-causes/
Thanks so much for all your clear instructions. I have suffered with Hashimoto’s for many years and actually had to almost diagnose myself. Also got my med changed to Nature Thyroid (despite dire warnings from MD) from levothyroxine.
Am finally seeing nutritional/functional doctor (talk about expense) but digestive issues are 100% improved after only 2 weeks on elimination diet. So I do have SIBO that was so bad I dreaded any social interactions, even family.
Hopefully someone will start to work on the insurance and government industries whose main objective is to keep people sick or at least mandate functional medicine to be covered.
Would be interested to know if you have ever looked into homeopathy for Hashimoto’s.
Thanks again for all you do!
Sabra – you are very welcome! I am happy to hear you have found a practitioner. Thanks for your question about homeopathy! I’ll add this to my list of future article possibilities. I would love to hear more about your experiences here on this page. <3
I’d like to know why the foods listed to avoid are not good for you. For instance asparagus, quinoa, pears, cherries, apricots, pistachios etc. all of which I love
Phyllis – thank you for reaching out. <3 FODMAPs are foods that are poorly digested or ferment in the gut and include wheat and diary and some fruit and vegetables. SIBO is a Small Intestine Bacterial Overgrowth, where an overgrowth of bacteria prevents proper absorption of nutrients. The low FODMAP diet is considered an effective therapy for SIBO. Removing foods high in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), this diet essentially cuts off the food supply to the bacteria that may be causing issues in the intestines. I understand how hard this can be so I created The Root Cause Recipes to give you a shortcut to healing. When I first changed my diet it took SO LONG, and I also had bought hundreds of dollars worth of cookbooks and then had to sort through each one to create a plan for myself. And I still got it wrong at first! I want you to learn from my mistakes, and I want to make it easy for you! Many of my readers have asked for recipes and meal plans, and so I created them.
Hope you check it out:
Root Cause Recipe Bundle
https://thyroidpharmacist.com/get-root-cause-recipes/
Hi Dr. Wentz,
I did a sibo test. I do have severe intestinal bacterial overgrowth and my methane value is very high. I want to choose a herbal treatment to treat sibo according to your advice. But I am a bit questionable about Candibactin-BR. I found out from Amazon’s comments that it really works. But berberine can activates Th1 cells, it may exacerbate Hashimoto’s thyroiditis. Is Candibactin-BR Ok for Hashimoto? Does it have other alternatives?
Thank you very much.
Ashley – thank you so much for reaching out. <3 I do recommend the Candibactin-BR as an herbal treatment for SIBO in this article as well as oregano, and garlic which are all herbal antimicrobials that can help eliminate bacterial overgrowth. Please understand, I am not able to advise on whether these supplements would be appropriate for you and your specific health needs without a comprehensive health assessment. I recommend that you discuss this with your personal doctor.
I had methane SIBO and was prescribed berberine (working up to 2 capsules with each meal). It worked (SIBO free for about 1.5 yrs) but I got very sick while taking it – severe!!! diarrhea and NO energy. A very big caution about berberine – it’s other major use is for diabetics, to lower blood sugar. As someone who tends to have low blood sugar (hypoglycaemic) 6 berberine/day was way too much.
Alison – thank you so much for sharing your journey! <3 I'm so sorry! I hope you are feeling better. I appreciate you sharing your cautions. It is always a good idea to discuss the addition of supplements with your practitioner whose care you are under.
Hi Alison I am suffering from sibo can you please tell Me the brand of berberine you took ? 🙏
Hi Isiah, thank you for following. Here are a couple articles that includes some info on Berberine as well as my recommendations.
Hashimoto’s Blood Sugar and Diabetes
https://thyroidpharmacist.com/articles/hashimotos-blood-sugar-and-diabetes/
SIBO
https://thyroidpharmacist.com/articles/sibo-prevent-remission-hashimotos/
Hi Dr. Wentz thank you for those informative articles but i still do not see a specific brand of berberine that can be helpful for sibo, like alison mentioned.
Isaiah – you are very welcome. The supplement that I recommend in the SIBO article the Candibactin-BR is a formulation containing berberine. I hope this helps. As always I recommmend discussing any supplements with your practitioner whose familiar with your health history. <3
Hi Izbaella,
I have your book The Hashimoto’s Protocol and I’m following the fundamental protocols in it, currently in the gut support one 🙂
I bought Saccharomyces Boulardii, Probiotic but it is measured in 10 Billion CFU not mg. How many capsules i should take in this case?
Lora – thank you for reaching out. You should start with the directions on the bottle and adjust your dosage from there. If you have more specific questions on how and when to take particular supplements under normal circumstances, please do reach out to my team at info@thyroidpharacist.com, they will be more than glad to help. <3
Thanks. What a nice article on an underestimated subject that many of us really should have known about many years ago. Wonder how old the diagnosis is?
Oregano oil should be taken together with Boulardii I presume. The oregano capsules should be on which dosage size preferably?
Which clinics measure H. Pylori?
Soren – you are very welcome! <3 Here is an article I wrote with more information about H.Pylori. I hope you find it helpful:
HASHIMOTO’S AND GRAVES’ REMISSION AFTER HELICOBACTER PYLORI ERADICATION
https://thyroidpharmacist.com/articles/hashimotos-and-graves-remission-after-helicobacter-pylori-eradication/
What do you treat first, SIBO or hypothyroid with thyroid medication and then treat SIBO.
Lindsey – thank you for reaching out. <3 If you have subclinical hypothyroidism, it’s a gray area for treatment. For me, this is the way I think about it: if you don’t have any symptoms and you are trying to reverse Hashimoto’s the natural way, you can give yourself three months or so to get into remission. But, if you continue to worsen, and if it doesn’t get better, then I would start considering medications. Medications can help reduce many patients’ symptoms. They may also help reduce thyroid antibodies. In people who have really high antibodies or who have a lot of symptoms and antibodies, it may be a good idea to get on medications right away. There are quite a few options for thyroid medications. In my experience, what works for one person may not work for another. If your doctor will not prescribe the medication you are looking for, you may consider asking your local pharmacist for doctors in your area who prescribe the medication you are looking to try. I’m a big fan of using everything we can to get ourselves better, and medications are not always life-long. Some people are able to get off of them if they figure out their triggers and root causes.
How do you treat EBV and HPV when you have SIBO, I can’t take Berberine or Oil of oregano. Is the lomatium protocol ok to use if you have SIBO? What is the best mulit for folks with sibo as I know a lot of the constituents in Vitamins can trigger sibo.
Lisa, thank you for reaching out. ❤️ Please understand, I am not able to advise on what would be appropriate for you and your specific health needs without a comprehensive health assessment. I recommend that you discuss this with your personal doctor.
Hi Dr. Wentz. I’m having trouble with SIBO currently, and I ordered the 4 products you mentioned(oil of oregano, Candibactin BR,allicillin, and s.bouillardi).
Two questions:
1) Is it okay to take the 4 products you referred above while water fasting for a few weeks?(I can’t do the elemental diet due to the sugar/carbs as I’m on keto diet to prevent blood sugar spikes)
2)Should I also take Betaine HCL with the 4 products referred if I do have to eat food with them?
Dave – thank you for reaching out. ❤️ Please understand, I am not able to advise on whether these supplements would be appropriate for you and your specific health needs without a comprehensive health assessment. I recommend that you discuss this with your personal doctor. When it comes to fasting, it can be beneficial in many cases, however, some caution is required for people with Hashimoto’s due to our blood sugar issues. Blood sugar imbalances are a big contributor to Hashimoto’s. Balancing blood sugar levels should be one of the priorities for anyone who is hoping to overcome autoimmune thyroiditis and adrenal fatigue. Balancing my blood sugar made a big difference for me, helping with my anxiety levels and reducing my thyroid antibodies. Here is an article you might find interesting:
BLOOD SUGAR IMBALANCES AND HASHIMOTO’S
https://thyroidpharmacist.com/articles/blood-sugar-imbalances-and-hashimotos
So you are saying all the people whom are taking Levolthyroxin have SIBO.. So is it better to pay extra money for Synthroid? Also you recommend Oil of Oregano S. bouldardii as you recommended to rid of SIBO? What if Synthroid isn’t on my insurance? Very expensive..
Lisa – thank you for reaching out. ❤️ SIBO can be a root cause, consequence, or exacerbating factor of Hashimoto’s. I have seen many people clear their SIBO oil of oregano and S. boulardii, and often recommend this line of treatment to my clients, however everyone is different, that is why I added other options in this article and as always I recommend discussing further with your practitioner. When it comes to medications, there are quite a few options for thyroid medications. In my experience, what works for one person may not work for another. Have you read these articles?
MEDICATIONS FOR HASHIMOTO’S AND HYPOTHYROIDISM
https://thyroidpharmacist.com/articles/medications-for-hashimotos-and-hypothyroidism/
TOP 11 THINGS YOU NEED TO KNOW ABOUT THYROID MEDICATIONS
https://thyroidpharmacist.com/articles/top-11-things-you-need-to-know-about-thyroid-medications/
Hi, I’m wondering if SIBO were a persons only root cause, how long after successfully treating the SIBO would you expect TPO to go down? (from something like 800 kIU/L). Is my understanding correct that it can take a few months, sort of a delayed response, for TPO to go down?
Les – thank you for following! ❤️ IgG subclass antibodies have a half-life of 21 days and stick around on immune cells for about two to three months. They need constant “reminders” in the form of an antigen so that their production continues. If the antigen is removed, the antibodies will go away as well. The time period required for them to completely forget about the antigen and disappear is nine to twelve months. The following things need to be in place for the antibodies to forget about the thyroid:
1) The thyroid stops expressing TPO.
2) The thyroid cells are not damaged and able to regenerate.
3) There are no substances that look like TPO (glandulars, gluten, infections, other triggers).
4) The immune system is balanced.
5) The autoimmune cells are confused by a decoy.
Some of these requirements are quick and easy, and others will take some time …
The thyroid will stop expressing TPO for two reasons. One of them is thyroid destruction, which we do not want; the other is thyroid suppression. Thyroid suppression is induced by limiting iodine and taking a thyroid supplement to bring TSH to 1 mIU/L or so. This can take up to three months. In the case of autoimmune conditions, traditional and alternative medicine practitioners may focus on rebalancing the immune system (i.e. steroids and immune-modulating drugs used in traditional medicine, or else herbs, supplements, or acupuncture used in alternative medicine). While this approach may be helpful for taming the immune system in the short term or overcoming autoimmune flares, it is often a temporary solution and the immune system may become imbalanced again once the medications,acupuncture, and herbs and supplements are stopped if the underlying issue that lead to the immune system imbalance is not addressed. Thus we can say that immune modulation treats only the symptoms, and not the root cause.
As we can’t change genes, our approach to addressing the root cause of Hashimoto’s is threefold:
1) Reducing triggers
2) Eliminating intestinal permeability
3) Providing the body with nutrients to regenerate
Identifying and eliminating triggers and toxins will likely take a few weeks to a few months. Providing the thyroid with the nutrition needed to help rebuild and detoxify will likely take three to six months.
Rebalancing the immune system by addressing the root cause of autoimmunity (intestinal permeability, gut dysbiosis, infections) may take one to three years, but in the meantime, we can modulate the immune system and throw our thyroid antibodies a decoy. Hope this helps! Here is an article you might find interesting:
https://thyroidpharmacist.com/articles/hashimotos-and-tpo-antibodies/
It seems strange that Allicillin (garlic extract) is used to treat SIBO, but is not allowed on a SIBO – Low Fodmap diet. Can you do all 3 of the following treatments together:
Candibactin-BR
Oil of oregano
For methane-producing bacteria, add Allicillin (garlic extract)
Thank you!
MGR – thank you for following. The reason it is allowed as a treatment for SIBO is because Allicin does not contain the high FODMAP part of the garlic. As for the treatments shared in the article I do typically recommend them together, but of course please work with your practitioner to help determine if they are an option for you.
Can you still have sibo if you had a gastric bypass?