Chris Kresser: Yeah, I’ve heard that or read that, what she said about bone broth, which is really interesting. Again, I think it’s a case-by-case basis. I think some patients do just fine with broth. We’ve seen successful treatments of SIBO when patients were still consuming bone broth, so I’m quite sure that it’s not a deal breaker for everybody. But at the same time, we’ve seen quite a few patients, actually, who were really dismayed. They got really excited about bone broth as a healing intervention and made their own first batch of bone broth and consumed it and felt horrible. When someone reacts to bone broth like that, one possibility is glutamate sensitivity. Another possibility could be this, if they have GI issues and they’re not able able to consume really collagen-rich foods. You may also see that for people who do well eating leaner cuts of meat, like lean ground beef or chicken breasts, but they don’t tolerate things like oxtail and shanks or chuck or something that has a lot more collagen in it, and that is not uncommon, as well.
I know that Dr. Siebecker recommends against prebiotics. We typically do, with the exception of partially hydrolyzed guar gum during the antimicrobial treatment, as you know, but other prebiotics we would tend to have patients shy away from during the protocol, in terms of supplemental prebiotics. After protocol, I think prebiotics are very important. I know that she may feel differently about that if she’s concerned about SIBO recurrence, but my recommendation comes out of the research showing that long-term low-FODMAP diets can reduce bacterial diversity and levels of beneficial bacteria in the colon, and there are so many studies showing how profoundly connected our health is with the diversity and quantity of beneficial bacteria in our colon, so I’m really wary of making recommendations that would lead to a decrease in the diversity and complexity of our beneficial gut bacteria over time.
Admittedly, this is a very tricky situation with patients who have recurrent SIBO, and there’s, unfortunately, not always an easy answer to every question. One of my mentors talks about the difference between a problem and a predicament. A problem is something that has a solution, and a predicament is something to which there’s no obvious solution. It’s a question that is looking for an answer but doesn’t necessarily have one. I think this issue of people who have recurrent SIBO falls into that predicament category very well. Ideally we want to make sure that they’re getting enough fermentable fiber to support their colon health, which could protect them against cancer and other things that I think we would all agree are much more serious than SIBO, which, as far as we know, has never killed anybody. But at the same time, we don’t want them to suffer, and SIBO can be very problematic and really adversely affect quality of life in its own right. My concern is just that we don’t focus so much on solving one problem that we cause several others, which could become even bigger and more serious and even life-threatening problems down the line. That’s what I’ve based my recommendations on.