Gut Health
Recently ran a Doctor’s Data CSAP on a client. Everything was normal except no growth or Lactobacillus. All other beneficial flora were 4+. Symptoms include constipation, sometimes only one bowel movement a week, but she can also swing over to the diarrhea extreme as well. She has years of these symptoms but also gained between 30 and 40 pounds in the past year or two with no identifiable cause. Also has a history of seriously long fasting periods of up to 30 days where she has only juices. I would think that these extended fasts would have really starved her good gut bacteria, but her results would indicate otherwise given only the low Lactobacillus. Any thoughts on this? I want to run a SIBO test on her ASAP, but she’s saving up for that. In the meantime, I suggested she try adding in HCl, Iberogast, Prescript-Assist. I’m curious as to what probiotic or prebiotic you would suggest specifically for increasing her Lactobacillus. I suggested Lactobacillus plantarum to help with her symptoms and also fermented foods, but would you have any other specific suggestions?
Chris Kresser: Okay. Great. Let’s go back. The Doctor’s Data stool test with the proteomics can be helpful in quantifying...
Do you still recommend people getting their stomach acid tested? Is it very accurate? Page 27 of my heartburn/GERD e-book. I like the idea that people get to see a solid result to get them on board with treatment.
Chris Kresser: That testing, I’m not sure. I think you’re in the U.K., Justine. I’m not sure how available...
Regarding our patient, who I am now familiar with, a 55-year-old female with colon removed seven years ago. We expect that without a colon she’ll need long-term prebiotic and probiotic support. We’re getting her started on antimicrobial protocol and will follow that with a rebuild. The question is, in this case, would we do the follow-up Doctor’s Data stool analysis while still on prebiotics and probiotics for maintenance? We want her to believe they work, and if we take her off these supplements during the test, we worry she won’t see much improvement in sufficiency dysbiosis and will assume the supplements are not helping.
Chris Kresser: This is an interesting case. The truth is no one really knows what this looks like in clinical...
Where would you start with a child with aphthous ulcers stomatitis? Would you look at it as a possible first sign of autoimmune disorder? Would you recommend an autoimmune protocol (AIP) diet even before testing?
Chris Kresser: Yes, I would look at it definitely as a sign of autoimmunity. I would start looking for things...
I’m pretty concerned about probiotics and fecal transplant treatment in Crohn’s disease because of the fact that those patients have antibodies to several species of gut bacteria. Couldn’t the above treatments cause potentially an exacerbation?
Chris Kresser: That’s a very astute question, and the answer is absolutely yes. I just read a study, I’ll try...
I have an 8-year-old with gut issues. Family eats fairly clean, but gluten gets in regularly. Started out with Arrays 3 and 4, was positive to wheat IgG, rye, barley, spelt. Equivocal to gamma-gliadin-15 IgA and chocolate milk. You said if the wheat IgG was the only thing that really popped out, to consider intestinal permeability, so using the protocol for it, what should the dose for zinc be in a kid? Where would one find sodium-potassium butyrate, again half the dose? I’ve started him on BiotaGen. Should that be enough to feed the good commensals? Is there is a probiotic that has E. coli Nissle, L. plantarum, and S. boulardii in one place? I also wonder, because of what did show up, that he potentially has celiac, but the patient’s parents aren’t gung ho for an endoscopy right now.
Chris Kresser: OK, so wheat IgG does indicate wheat intolerance, but it doesn’t indicate gluten intolerance, and it also suggests...
As far as extrapolating the health of the microbiome of your patients, are you using anything else besides a stool analysis?
Chris Kresser: No, that’s pretty much the tool of choice. As I mentioned, though, using things like American Gut and...
SIBO patient took Prescript-Assist prior to starting herbal antimicrobial protocol and developed a serious rash. Stopped Prescript-Assist, and a few weeks later started two-month SIBO protocol with MegaSporeBiotic, starting very slowly with it. Rash was still pretty bad weeks into treatment. Stopped MegaSporeBiotic, and weeks later rash persists, actually worse. Patient feels great otherwise. GI symptoms have significantly improved, and patient has no other adverse reactions. Suggestions? Stay the course for one more month? Doctor’s Data showed no growth bifido and few yeast.
Chris Kresser: Yeah, that’s interesting. It seems like there was some reaction to both of the soil-based and transient commensals,...
I know you’re not hot on the Genova SIBO test, but it’s the only one I can order until I create the elusive connection with an MD or a DO that will order them for me. Running the test, among others, on a 12-year-old boy with ODD and some autism spectrum symptoms as well as fecal incontinence, but not diarrhea. I know some practitioners have been using the Genova test and instructing their patients to wait 30 minutes between samples instead of sample instead of 20, but because this is a child with presumably faster transit time, do you think 20 minutes would be OK? In general, how do you feel about tweaking the instructions to wait 30 minutes between samples if Genova is the only SIBO test we can order?
Chris Kresser: I wouldn’t do that because all of the research on SIBO lactulose breath testing uses either 20 or...
With all the talk of acid reflux in week 12, I wanted to get clarification on bicarbonate of soda. I have a colleague who recently told me he suffers quite seriously from time to time from acid reflux. In the last episode of it, he started taking bicarbonate of soda, one teaspoon in water with half a lemon squeeze three times a day. He says it really helps him, I imagine only with the symptoms, but some people take bicarbonate of soda anyway because they think it’s good on several levels. It got me thinking about bicarbonate of soda. There’s so much chat about it online, bathing in it for detox, bathe in huge amounts, and equal good-quality sea salt. Can you be damaging yourself or making your inner chemistry imbalanced taking it internally so often or is it pretty harmless? In terms of reflux, is it just neutralizing the acid in the esophageal tract and that’s good or bad? Is it suppressing acid in the stomach? Will it lead to low stomach acid too?
Chris Kresser: The answer is, as you suspect, that yes, it is not really that different in principle than taking...
