Interview by Sarah Clark, LAc
Recently I had an opportunity to sit down with Dr. Whitney Hayes, who specializes in treating gastrointestinal disorders. She talked about the causes and the mechanism of small intestine bacterial overgrowth, healing the gut through antimicrobials and dietary changes, and the reality of how gut dysbiosis affects our mood. Here is our conversation.
Sarah: What led you to become a healer?
Whitney: I come from a long line on my mom’s side of medical professionals of some sort. I remember in high school thinking I never wanted to be a doctor, because everyone in my family is a medical professional–pharmacist, doctor, nurse, the whole gamut. So I wanted to be different. But I’ve always had an affinity for the sciences, for the human body. So when I started college it just came easily to me, and I started pre-med Biology and wound up studying Botany with a Chemistry minor.
In ‘99 I moved out to Portland and was at a crossroads professionally, and the relationship I was in had ended. So I decided to do a year of Peace Corps. I went to Morocco. I thought I would do some good and also figure out what I wanted to do with my life. That’s what everyone in their twenties does–venture out and try and figure out their purpose in life. But a ways into my year, I felt even further from knowing what I wanted to do with my life than I was when I got there. And then I had a friend come visit me who was from Portland. At the time she was studying at OCOM. We were talking, and she just casually said, “You should become a naturopath.” I said “What is a naturopath?” I’d never heard of that. But I looked into it while I was there in Morocco. Any time I’d go into the city to an internet cafe, I’d look it up. And I thought, wow, the philosophy behind naturopathic medicine is the philosophy I want to embody in my life.
After my Peace Corps tour, I came back to Portland and applied to NCNM. Things just sort of starting falling into place. I trusted my intuition, which has always done me well, and let fate guide me.
Sarah: How did you end up deciding to study acupuncture as well?
Whitney: I didn’t intend to study acupuncture when I started school. But then I got into Heiner Fruehauf’s Intro to Chinese medicine class that all the NDs had to take, and I was just floored. I was so inspired that I just couldn’t not do it.
Sarah: How did you find your way to treating gastrointestinal disorders?
Whitney: Well, a couple of ways. One of my first patients had terrible IBS, one of the worst cases I’ve ever seen. Everything I did for her aggravated her. Nothing made her better. Believe you me, I tried everything. I thought, “What is going on with this woman? Why is everything making her worse?” Then Dr. Siebecker had a one day SIBO seminar in 2011. I went to it and came back and tested my patient. Sure enough she was positive for SIBO, so I started treating her and she started getting better. Also, when I came to Kwan Yin, Ilana Gurevich was transitioning to moving to New York, and she said, “I think you’d be a really good fit for my patient population.” So that was great. She treats a lot of gastrointestinal stuff, so it just kind of fit.
Sarah: So, with that first patient, how did the SIBO diagnosis change the way you treated her?
Whitney: Well, before that, I never would have thought about antimicrobials or antibiotics. That wasn’t even in my realm of thinking.
Sarah: Can you define SIBO?
Whitney: It stands for small intestine bacterial overgrowth. Basically there’s a mechanism where the motility of the small bowel becomes dysfunctional and then normal flora are allowed to overpopulate. The large bowel should have lots of bacteria, and the small bowel should be relatively sterile or very, very small amounts. When you have lots and lots of bacteria in the wrong place, it causes a lot of symptoms. People can have malabsorption. They can be underweight. They can have lots of digestive symptoms but they can also have skin issues, like acne, psoriasis, eczema. Those tend to go very commonly with SIBO. Often something goes off in the gut that causes an autoimmune condition to be triggered. So, autoimmune conditions can go along with it.
Sarah: What kinds of autoimmune conditions?
Whitney: Any really. But I’ve definitely seen Hashimoto’s Thyroiditis, Rheumatoid Arthritis, and Lupus in correlation with SIBO. I’ve seen people’s autoimmune symptoms get better when we treat their SIBO. It can mean that they take less meds if they’re on a lot of pharmaceuticals for those conditions. They can lessen or even get rid of some of them.
Sarah: Can you explain the mechanism of how overpopulation of bacteria in the small bowel leads to other problems in the body?
Whitney: Well the leading theory is that food poisoning or traveler’s diarrhea triggers an initial cascade of effects. Whatever impacted the person initially isn’t what causes the problem now. It’s that the initial bacterial infection produced toxins that attached to the nerves in the small bowel which would prevent the small bowel from cleansing the way that it should. Normal small bowel function will cleanse every 90 minutes through the migrating motor complex that sweeps and cleans the bowel. In a normal bowel, if there’s bacteria there, it sweeps it down. In a dysfunctional bowel, the bacteria stay and are allowed to overpopulate because the sweeping isn’t happening properly. Whatever infected the patient initially paralyzed that mechanism. For some people this paralysis can cause partial or permanent nerve damage, which then decreases motility.
It comes down to a motility issue in many cases, but not all. I’ve had some patients who are positive for SIBO who have no recollection of traveler’s diarrhea or food poisoning–who didn’t have that initial insult. So, in cases that don’t stem from that, recovery could be a bit more favorable. These cases could be related to multiple rounds of antibiotics that set the flora off. It’s probably a combination of things. Stress is correlated with the gut shutting down. Low stomach acid can trigger the shut down. I’ve seen Accutane usage associated with it. I had one patient who correlates statin drugs as the initial insult. So, medications can definitely be a cause.
Sarah: If someone comes in with Hashimoto’s Thyroiditis, do you immediately test for SIBO?
Whitney: Not immediately. I’m definitely going to do a thorough GI history with them–fish around–see if they’ve had episodes of traveler’s diarrhea. So, it depends. It’s certainly going to be in my mind.
Sarah: Talk to me about the gut brain connection and how you see that playing out with your patients.
Whitney: In clinical practice any gastroenterologist will tell you that anyone who comes in with IBS has some sort of mood issue. People have a harder time stabilizing their moods when there’s an IBS type picture. Antidepressants are a common treatment for IBS, and they make the IBS better in a sense, because they are helping to re-establish the hormones that their brains aren’t getting. 70% of neurotransmitters–like serotonin and dopamine–are made in the gut. They get upregulated into the brain and then regulate your mood. If someone has a lot of inflammation going on in their gut and they’re not able to make those neurotransmitters, then helping to clear up that inflammation can greatly improve their mood. But it takes time to heal that tissue and get it to build back up and start making those neurotransmitters again.
Sarah: Is that a place where you bring your acupuncture in?
Whitney: Yes. I do some TCM. I do some Five Element. The Five Element can really help with mood issues while their gut is getting healed. Acupuncture can help SIBO as well.
Sarah: If someone tests positive for SIBO, do you find that there are often associated pelvic issues, such as with the bladder and reproductive organs?
Whitney: There’s no research on this yet, but a lot of times if you’ve got inflammation in the small intestine, which is a lengthy bit of digestive tract right next to the ovaries and the uterus and the bladder–it’s all right there in the abdominal cavity–that inflammation can transfer to those other organs. We often see endometriosis, PCOS, and Interstitial Cystitis associated with SIBO–especially methane SIBO.
Sarah: So how does someone begin to treat that kind of imbalance? Where do you start with people?
Whitney: We always go to diet at some point with people–and that varies according to the individual lifestyle of the patient. But diet alone just doesn’t fully treat the problem. It can help people’s symptoms, but in the long term they need to probably do some sort of antimicrobials–whether they’re Western herbs or antibiotics. There’s also a fasting diet that people can do for it. I usually just lay out all of their options to initiate treatment and say this is what we can do to try and get those gas levels down. They’ll choose one and we’ll start with that.
Sarah: Do people mostly comply with the diet?
Whitney: I think it depends on how motivated they are to feel better. The worse the symptoms the more motivated they are. The lesser the symptoms the less likely they’re going to be to make those radical diet changes.
Sarah: Initially they have to give up grain, right?
Whitney: Yes, most people do.
Sarah: So there’s this new fad called the Paleo diet that involves giving up grain and many are quite critical of it. Can you distinguish that from the SIBO diet?
Whitney: We know that bacteria like to feed off of certain types of carbs. Their preferential foods are carbohydrates and sugars. So the more of those you consume in your diet, the more that overgrowth of bacteria is going to flourish. So diet is a very integral part of treating SIBO, because you want to stop feeding that overgrowth of bacteria and shift that flora over time. Proteins and fats don’t feed bacteria. Carbs and sugars are their preferential foods. We have to really individualize the diet for each patient. I want my patients to be successful with the treatment plan. So I talk with them about various obstacles that might come up. Maybe they’re a single mom. It’s going to be a lot more challenging for them than it would be for someone who lives alone.
Sarah: How do you support someone who works sixty hours a week and eats on the fly? How do you help them make this dietary change?
Whitney: Those cases can be hard. I really try and talk with them about all the obstacles that might be there. In talking through those obstacles I can get a sense of how important it is to have them be very strict. One of the leading researchers in the SIBO field, Dr. Pimentel, will prescribe a preventative diet once gas levels are normal and motility is normal. Naturopaths kind of shudder at this diet. It’s low fiber and there are processed carbs and sugars within it. The theory is that these foods are processed so quickly that bacteria don’t have time to feed off of them. I’m not necessarily a proponent of this diet. It’s called the Cedar Sinai diet. It includes things like white rice and white bread. I have seen people for whom this works. But as naturopaths we have to look at the nutritional value of it. People can get blood sugar dysregulation issues. I’m cautious with it.
There is a whole range of diets out there. There’s SCD, there’s GAPS, there’s an SCD FODMAPS combination, there’s just FODMAPS, there’s Cedar Sinai. Part of where a provider that’s treating SIBO needs to go is to figure out what type of diet this person sitting in front of you is going to succeed with.
Sarah: How do you work with people who have eating disorders or an eating disorder history?
Whitney: I ask people, “Do you have an eating disorder? Is this going to trigger it?” And if it is, we’re not going to go there. We’re going to try and figure out something else. Because I don’t want to dredge up the past and trigger them. Or maybe I send them to someone who can help them process through things until they feel ready. Readiness is really important. Are they ready to make these changes? And if they’re not, we have to respect that.
Sarah: Food can be so emotional.
Whitney: Yes, it can dredge up a lot.
Sarah: On a lighter note, what do you do for fun?
Whitney: That’s an interesting question for someone who has little children at home. Fun is very different than what it used to be. I love riding my bike and hiking, which I don’t do nearly as much as I used to. I love cooking, and I still do that. And gardening. We bought a house a year and a half ago, and we’re delving into building our garden. It’s going to be a multi-year process getting that where we want it to be.
Sarah: And you have two little girls?
Whitney: Yes, 3 and 6. They’re loads of work but also really fun. Most of the time, if I’m not at work, I’m hanging out with them doing something fun. They keep me busy.