SIBO

With the Doctor’s Data stool test they give a list of the botanical and prescription agents for the isolated organisms in the dysbiotic or yeast categories. Do you use the information to modify the antimicrobial protocols? For example, G.I. Synergy has many botanicals on the DDI list, but if the organism is only susceptible to silver, then should we add or replace that to the protocol?

Dr. Amy Nett: I rarely even look at the sensitivities. I have found G.I. Synergy to be effective almost all...

I have a female patient with severe bloating since her teens. Starts the day with a flat abdomen, describes herself as looking pregnant by the evening. She has normal bowel movements and the bloating isn’t painful. Suggested a SIBO breath test but the results were equivocal. Decided to try a one-month therapeutic trial of the SIBO protocol, and she’s tried many other options in the past with no success. No change. So where would you go next for a case like this?

Dr. Amy Nett: Stool testing if you haven’t already. This could also be an issue where she doesn’t have...

This question is related to pancreatitis and SIBO correlation. Which do we assume comes first? Is it safe to treat the SIBO given the pancreatitis history?

Chris Kresser: Yeah, it’s a good question. We don’t know for sure which comes first. But as I mentioned before,...

So we have a 28-year-old female with significant bloating, stools that alternate between being well formed or hard and then loose. She opted to do a SIBO breath test, but the lab lost the sample. Because she hasn’t gotten better on a low-FODMAP diet, she’s not tolerating fruit or much carbs, we opted to go ahead and use the antimicrobial protocol with Iberogast, which she started this week. She had a full bowel movement today and felt more bloated after. Any tips for troubleshooting? Trying to keep her diet as diverse as possible, worried about the supplements because she seems sensitive. So we’re starting slow. What’s the time frame we see as far as turning a corner in gut health with protocols?

Dr. Amy Nett: Yeah, so bloating is often SIBO but it could also be fungal parasites, that sort of thing....

Are there any iron supplements safe to take with SIBO? Given the bacteria sequester iron for their needs. I ask because I frequently have female patients, often with low thyroid, who have low iron and ferritin. And in many of these cases, iron supplements don’t bring up their levels. Ferrochel Designs for Health. This makes me suspect SIBO, among other causes. If they do have SIBO, how do you raise iron without making SIBO worse, especially if they won’t eat liver?

Chris Kresser: So, yeah, very interesting question. Iron is used by beneficial bacteria as well, and I don’t know that...

Female patient, been on the antifungal protocol for a couple months after high levels of yeast detected on Doctor’s Data panel. During this time she developed severe abdominal pain. I advised her to stop the protocol and see her doctor, who gave her omeprazole PPI blood test for gallbladder issues. Of course it’s hard to know whether the protocol caused these problems, but patient is convinced it did. Have you had similar experiences and if so are they suggestive of particular pathologies?

Chris Kresser: Okay, so this is an interesting question. There was a question on the Facebook group from Laura that...

If he tested positive for SIBO, would you not do the pediatric herbs?

Chris Kresser: I would do the pediatric herbs. And so to some extent you could say why not just do...

About methane-predominant SIBO. I attended the June SIBO conference, and all of the practitioners who use botanicals all use high-dose allicin for methane, apparently based on research. I keep hearing that methane will not respond to other potentials if allicidin is not included, usually in high doses of 450 mg capsules up to six per day. I’m very interested in why this whole group of practitioners has a consensus that this must be used for methane, yet we don’t use it. What do you think about this?

Dr. Amy Nett: That is interesting. Let’s see. I don’t know. I tried to watch some of that conference, but...

I’m having many issues with a patient not tolerating the SIBO protocol, even when he starts slowly, adding the different elements one layer at a time. By the time he gets to the full program, he has really severe symptoms, particularly constipation. Would you know which of the different elements are most likely to cause the constipation? I noticed MegaSporeBiotic does. I’m wondering if Lauricidin, NAC, or other biofilm disruptors are likely to be constipating as well. Any hints in terms of helping with the side effects?

Dr. Amy Nett: Oh, this is a great question, and I get it from my patients all the time. They...

Treating a patient with significant dysbiosis and hydrogen-predominant SIBO. She has metabolic syndrome, high blood pressure, and excess weight. She decided she wanted to do an autoimmune Paleo diet along with it, not at my suggestion, but in support of her brother, who I’m also treating, who has Parkinson’s and is following that dietary approach. So this person went in for routine labs with her HMO doctor, and all the metabolic syndrome markers were better. However, liver enzymes were quite elevated, which has never been the case for her before. Last labs in November 2015, liver enzymes were fine. HMO doctor is really concerned about the supplements, and I haven’t encountered this before, so I wasn’t sure what to think myself. Do you think the treatment could elevate liver enzymes, and if so, is this something to be concerned about? What I did was have her stop treatment in order to retest. It’s been six weeks. I thought she needed more time for treatment, but I’m concerned about her enzymes. I also added liposomal glutathione and milk thistle. Opinions.

Dr. Amy Nett: Great question. I am not sure why the liver enzymes went up. I’m guessing that you mean...

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