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In this episode, Dr Nirala Jacobi is in conversation with Dr Michael Ruscio about the gut-thyroid SIBO connection.

Dr Ruscio is a functional medicine practitioner, chiropractor, clinical researcher, and host of the Dr Ruscio Radio Podcast.  Dr Ruscio and Dr Jacobi both recently presented and connected at the Integrative SIBO Conference 2017 in Chicago.

Topics discussed in this episode include:

How Dr Ruscio became interested in SIBO.

What is the gut-thyroid-SIBO connection?

Discussion of 4 main areas:

1. The way the gut affects thyroid autoimmunity
2. The way the gut affects thyroid hormone absorption.
3. The way the gut can cause hypothyroid-like symptoms, even when thyroid hormone levels are normal.
4. Those on thyroid medication and/or have hypothyroidism, are at increased risk of SIBO.

Being hypothyroid, or being on Levothyroxine as presenting an increased risk for SIBO, and why this may be.

The SIBO-H.Pylori relationship and the increased risk of SIBO after conventional H.Pylori treatment.

The relationship between H.Pylori and thyroid autoimmunity.

Does Dr Ruscio treat H.Pylori even if the patient is asymptomatic?

Pylori as an indicator of overall gut health.

Pylori pathogenesis v.s. commensalism with the host.

Recalibrating the gut microbiota in light of H.Pylori, with natural treatments such as:

  • Probiotics
  • Herbal antimicrobials
  • N-acetylcysteine

Testing for hypothyroidism

    • What is true hypothyroid?
    • What is subclinical hypothyroidism?
    • TSH high
    • T4 normal according to the reference ranges.
    • When to treat hypothyroidism, and when not to.

The relationship of gut inflammation to thyroid autoimmunity.

    • Switching focus from treating the lab values, to treating the person and the underlying causes of disease.

What testing does Dr Ruscio use diagnose thyroid issues?

Thyroid antibodies and the response to diet and lifestyle adjustment.

    • TPO antibodies between 100-300 and Dr Ruscio’s interpretation of this and patient care suggestions.
    • TPO antibodies over 500 and the correlation to thyroid autoimmunity.

Intestinal permeability and the link to autoimmunity.

What are the other links between Hashimoto’s and SIBO?

Implicated elements include:

    • Impaired bile production.
    • Impaired phase 3 detoxification.

What are Dr Ruscio’s preferred treatments for Hashimoto’s Thyroiditis?

      • Vitamin D
      • Combined selenium, CoQ10
      • Magnesium

Best therapeutic duration for selenium supplementation discussed.

How exogenous thyroid hormone facilitates thyroid repair.

Dr Ruscio’s thyroid medications and whether to use a T3, T4 combination, or a liquid thyroid medication, and which medication to consider in light of chronic digestive conditions.

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About the Author


Dr Nirala Jacobi BHSc ND (USA)

Dr. Nirala Jacobi, BHSc, ND (USA) graduated from Bastyr University in 1998 with a doctorate in naturopathic medicine. She practiced as a primary care physician in Montana for 7 years before arriving in Australia and is still a licensed physician in the USA.

Dr Jacobi is considered one of Australia’s leading experts in the natural treatment of small intestine bacterial overgrowth (SIBO), a common cause of IBS. She is a national and international speaker on this topic and her annual SIBO Webinars and SIBO Master Classes are popular and well-attended.

She frequently lectures on her Bi-Phasic SIBO diet and herbal approaches for the treatment of SIBO.  Dr Jacobi is the medical director of SIBOTest, an online testing service and educational portal for practitioners.  She also has a busy practice in northern New South Wales and offers mentorship sessions for practitioners


"Since specialising in SIBO our practice has grown enormously, people are seeking us out for the treatment. Specialising in SIBO as a business owner has…what do I say…made us busy!"


"Because there are the clearly defined treatment protocols to follow, the treatment outcomes are excellent."


Natalie Cruttenden
Natalie Cruttenden Resonance Complementary Therapies

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