A patient with a strongly positive SIBO breath test, both hydrogen and methane, insufficiency dysbiosis, and D. fragilis on Doctor’s Data. The patient reports a wide variety of symptoms, all of which could be related to her gut pathology—GERD, bloating, gas, diarrhea, skin rash, multiple food sensitivities, and anxiety. She was taking HCl with pepsin on her own to treat what she thought was low stomach acid. She was able to get up to as many as 10 pills three times a day without feeling any burning. She stayed on this protocol for about nine months. She discontinued the HCl about six months ago since she didn’t feel that it helped her symptoms much. Despite her positive results for SIBO and a parasitic infection, all of her other markers on Doctor’s Data are within normal limits. Digestion, absorption, inflammation, short-chain fatty acids, etc., are all normal. Her symptoms and her high tolerance of HCl were suggestive of low stomach acid, but these lab results don’t support that since she has been without digestive support for many months and her numbers are great. Do you often see such normal results on the second half of the Doctor’s Data test when the patient has SIBO, a parasitic infection, and insufficiency dysbiosis? I was surprised, given the extent of this patient’s symptoms. Should I just treat the SIBO and the parasite and rebuild with beneficial species and assume that no other supplementation is needed? As a side note, this patient has a strong family history of colon cancer and is overdue for a colonoscopy. Considering the state of her gut, I’m thinking now might be a good time to get that colonoscopy prior to treatment and rebuilding protocol.

Chris Kresser:    To answer your questions, we do sometimes see patients who have a parasite and SIBO and other gut infections or issues that have fairly normal digestion, absorption, inflammation, and short-chain fatty acid markers. It seems counterintuitive, but there it is. We see that. It’s not super common. We’ll often see at least lysozyme elevated and sIgA either low or high, maybe one of the short-chain fatty acids out of range or something like that, but not always. In that situation, yes, that’s exactly what we would do. I would treat the SIBO and the parasite, confirm that they’re gone with retesting, and then I would do phase two of the protocol, which is rebuilding with probiotics and prebiotics, which I think we’re going to be talking about shortly. As I said, I think, earlier in this section, not all patients need enzymes and HCl. In fact, many of our patients don’t get it and don’t really notice much of a difference one way or the other, even though you would expect them to when you look at their overall presentation.

In terms of when to get a colonoscopy, that’s always very controversial. There have been some new guidelines in Canada, actually, that are pretty strongly recommending against routine colonoscopy as a screening procedure for colon cancer, and then there was a statement or a rebuttal published by some US authors, so it’s a controversial area. To some extent, it depends on the patient and where they feel the most comfortable, but if they have already decided to do a colonoscopy, certainly I think it would make sense to do it first and then do the protocol after that, but it depends what your goal is. If your goal is to actually figure out the effects of this protocol, then it would make sense to do it after you do the protocol. If your goal is to figure out if they have some structural gut issue that’s causing some of their symptoms that hasn’t been detected by the functional testing, then you should do the colonoscopy before the protocol.