Hi everybody. It’s Dr. Eric Balcavage. We’re back for another edition of Thyroid Thursday. Today I want to talk about the thyroid – SIBO connection. I’ve had a number of listeners and viewers of the Thyroid Thursday videos ask me, “What is the connection,” or if I could summarize the connection of hypothyroidism and SIBO.
So here we go.
SIBO stands for Small Intestinal Bacterial Overgrowth. Now it could also be other organisms as well, but this is the common term. When you have SIBO, you can have symptoms like gas, bloating, abdominal pressure, constipation or diarrhea. You can have fatigue, aches and pains. You can have weight loss, or weight gain.
Essentially, you just don’t feel well.
A classic sign that you’re probably struggling with SIBO versus just overgrowth in your colon is if you have that gas, bloating, or any kind of GI discomfort symptoms within 20 minutes and up to an hour-and-a-half after eating. If GI symptoms occur after two hours and you have pretty regular bowel motility, the overgrowth may be down into the lower part of the GI tract in the colon.
If symptoms occur within 20, 30 minutes or up to an hour-and-a-half, if you’re getting symptomatology that soon after a meal, there’s probably overgrowth in that small bowel.
Is there a connection between hypothyroidism and SIBO? There definitely is.
Remember, when we’re talking about hypothyroidism in my world, we talk about cellular hypothyroidism. We don’t wait for the gland to become dysfunctional and diseased. We don’t necessarily wait for Hashimoto’s to occur and the autoimmune attack to occur.
If you have hypothyroid symptoms, you very well may have cellular hypothyroidism, which is a deactivation of your thyroid hormone at the cellular level. This happens for a lot of people and yet they still have normal TSH and T4 and T3. Blood values are normal, but they have the symptoms.
I look at reverse T3. I look at T3 free and T3 to reverse T3 ratios. I also look at a bunch of stress and inflammatory markers to identify the state of cellular hypothyroidism.
Here are four ways that cellular hypothyroidism can cause or lead to SIBO.
- Reduced Stomach Acid Production:Thyroid hormone’s critical to stomach acid production. Why is stomach acid such an important piece, and why would low stomach acid contribute to SIBO? Well, stomach acid is released when you put food into the stomach. It’s the stomach acid that helps break down the food and it also is what helps kill the organisms coming into the body from your food. (Yes, there are organisms on your food when you eat it.)
The amount of stomach acid is really important to start the process of digestion. The more stomach acid you have and the better that acid works, the more it breaks food down and preps what they call the “chyme” (the stomach contents) to enter into the small intestine.
The chyme needs to get down to a pH of one or two to properly stimulate the appropriate release of bile and pancreatic enzymes. Stomach acid is really important and you need cellular levels of thyroid hormone to make stomach acid.
2. Reduced Bile Production: The second way cellular hypothyroidism can be tied to SIBO is by reducing bile production and secretion. What is bile? Bile is this acid that’s produced in the liver and then it goes to the gallbladder to be concentrated. Then when you eat a meal, and especially fattier based meals, it’s important to have the excretion of functional bile.
What role does bile play in intestinal health and SIBO?
Bile not only helps absorb fats and fat-soluble vitamins, but it’s also a natural innate antimicrobial. At the upper end of the GI tract, bile acts directly as an antimicrobial. In the lower portion of the small intestine, it acts indirectly as an antimicrobial.
Bile health and function is really important to prevent bacterial overgrowth in the small bowel. Many people that I see who have SIBO and have treated for it over and over again with antimicrobials, missed one important point. They didn’t have these things that I’m discussing checked and supported. We have to evaluate and address whether a person has appropriate stomach acid production, bile physiology, and pancreatic function.
If evaluation and support of these three things, then we haven’t supported they didn’t the innate antimicrobial capacity. It’s the innate immune system that’s going to keep the bacterial overgrowth away once the supplemental antimicrobial or antibiotic goes away.
3. Decreased Pancreatic Enzymes: The third reason hypothyroidism, especially cellular hypothyroidism, can cause SIBO is decreased production of pancreatic enzymes. Your pancreas releases insulin to help you regulate blood sugar, but your pancreas also releases a number of enzymes that have a role in proper digestion and antimicrobial capacity, especially in that small bowel. If you have decreased production or secretion of pancreatic enzymes, you have a greater likelihood of developing overgrowth in that small bowel because you lose the innate antimicrobial capacity of the small intestine.
4. Reduced GI Motility: The fourth way that cellular hypothyroidism can cause SIBO is by reducing the motility of your GI tract. There’s plenty of research showing that thyroid hormone plays a role in motility of the GI Tract; esophageal, gastric, intestinal and large bowel motility. When you have cellular hypothyroidism impacting the small bowel or anywhere in the GI tract, you’re going to have decreased movement and motility. The reduced motility allows the bacteria to overgrow because the food doesn’t move along in an efficacious manner, and bacteria has a longer timeframe to act on that food and overgrow.
These are four ways that cellular hypothyroidism can lead to SIBO. Let’s talk about what you can do.
- Breath Test Confirmation: If you think you have SIBO, you can easily confirm SIBO with what’s called a “Breath Test”. Aerodiagnostics is the lab we use. It’s a great lab. If you call the lab, a test is sent usually within 24 hours. There is only a 48-hour turnaround from the time you do the test until we can have a confirmation of whether there’s overgrowth in that small intestine.
2. Diet Modification: Once you confirm that you have SIBO, you really want to follow what’s called a low FODMAPs diet or a Bi-phasic diet. If you google those keywords you will be able to find examples of both. The diet is important to reduce the foods that allow the organisms to flourish.
3. Anti-Microbial Support: Third thing you need to do is you’re going to have to get some type of antimicrobial support. Typically, what I find is I must rotate antimicrobial support and we do this over time. It can take three months or more to truly eradicate SIBO.
4. Biofilm Disruption: The fourth thing is to use what we call biofilm disruptors. Organisms tend to live underneath a biofilm, which is like a protective fence, and the longer you’ve had GI issues and bacterial overgrowth, the bigger the fence. Biofilm disruptors are things that break the fence down, allowing the antimicrobials we give somebody and the innate immune system, to get in there and start working on killing or breaking down that overgrowth.
5. Stomach Acid Support: You’re going to need to support stomach acid. You will probably want to work with a functional medicine practitioner. Something like Betaine HCL can help support stomach acid production and start that antimicrobial process at the top end of the GI Tract.
6. Gall Bladder Support: You may need to look at gallbladder or bile support. Some people like to use ox bile. I like to use combination formulas, things that have a combination of ingredients (like taurine) in them. You will want to get that bile support on a regular basis, every meal. You want to support bile until the body seems to be producing it appropriately on its own because until the body’s making sufficient bile, you don’t have its natural antimicrobial effect to prevent bacterial overgrowth.
7. Pancreatic Enzyme Support: You may need to support with pancreatic enzymes. If you’re pancreatic enzyme function is low, you want to get these pancreatic enzymes in with food. They not only help digest the foods and absorb the nutrients, but also for their antimicrobial capacity.
A good test to consider is called the “GI MAP” test. It’s a test that checks for the DNA of organisms. It’s not necessarily a small bowel test, but we can get a good indication of bacterial overgrowth in the large bowel. We can also get marketers of bile physiology and pancreatic enzyme production when we do a test like the GI MAP test. A good test to confirm SIBO is the Breath Test.
8. GI Lining Support: You’re probably going to want to have some form of GI lining support product. Many of these are glutamine-based support powders (if your body can tolerate glutamate). There are a number of these products that can help that GI tract heal and repair. Since the immune system is often compromised as well supporting the immune system is important as well. GI support products that contain colostrum can be very beneficial to help support the secretory IGA system. be really helpful to help rebuild the GI tract.
9. GI Motility Support: If you have constipation or slowed motility, you’re probably going to need to get some type of motility agent. If you can’t move your bowels, it’s hard to knock down the organisms. If you have constipation, you can use things like magnesium citrate. Different people do better on different forms of magnesium, but magnesium citrate is a form that can help with bowel motility. You can do things potentially like a vitamin C flush to find out how deficient you are in vitamin C and increasing your vitamin C can help with motility. Things like 5-HTP or a product called Serotone can support motility. It’s got a combination of 5HTP and some other ingredients that help with serotonin production. Serotonin is really important for bowel motility.
So there’s about nine things that you can do to help improve, if you have SIBO. I don’t typically go directly at trying to get somebody’s thyroid hormone levels up if they have cellular hypothyroidism or glandular hypothyroidism if they have SIBO. Typically, what we want to do is try and support the acids and the enzymes first, and get the dietary changes made.
Then we want to get rid of the organisms. As we do that, we reduce the stress. As we reduce the stress then we’ve reduced the cellular hypothyroidism. We don’t have to try and force the thyroid physiology. If the body’s already deactivating your thyroid hormone and you give the body more thyroid hormone, it’s just going to have to work harder to deactivate all that thyroid hormone that you’re giving yourself through a prescription.
Address the SIBO first. Use antimicrobials, bowel motility support, make sure you have acids and enzymes supported, and then over time as you get healthier you can do a retest to make sure you’ve knocked organism overgrowth down. Than you can start reintroducing foods back, start weaning off of the antimicrobials, and start weaning off the acids and enzymes. If you do these things in the right order, not only will you address your SIBO appropriately, but you’ll probably see your hypothyroid symptoms clear because as you reduce the SIBO, you reduce the stress that’s actually causing cellular hypothyroidism.
Here is the last piece.
Stress triggers cellular hypothyroidism. Stress can also trigger dysbiosis (an imbalance of bacterial flora). Cellular hypothyroidism leads to decreased acids, enzymes and decreased motility. The decreased acids, enzymes, and motility can lead to SIBO. Dysbiosis, especially in the colon, can cause organisms to move up into the small bowel and we can get SIBO.
But the SIBO and SIFO also create stress, more inflammation, more symptomatology. That stress triggers more cellular hypothyroidism. Then once we have lots and lots of cellular hypothyroidism going on, we typically see the next phase and that is autoimmune attack, and we see things like Hashimoto’s, and then full-on glandular hypothyroidism occur. It’s a vicious cycle.
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