SIBO

Is there any contraindication to a person with SIBO or pathogenic bacteria or yeast overgrowth taking prebiotics other than PHGG? I’m confused because in the past you mentioned that a person with SIBO should be cautious at this time. Should it just be used in the rebuild phase?

Chris Kresser: The addition of PHGG is only for people who have SIBO and are doing a concurrent antimicrobial protocol....

I’m under the impression that SIBO can cause bad breath as far as a gut infection, but can a parasite such as Blastocystis cause halitosis?

Chris Kresser: Yes. Anything that disrupts the gut microbiome can cause halitosis because you’re getting production of certain gases, which...

A 28-year-old female, long-term severe bloating after eating but no pain or other digestive symptoms. Has tried many approaches for her symptoms, including low FODMAP, removing problem foods from IgG panel, probiotics, removing gluten and dairy, osteopathy. There is more, but the point is she has tried a lot, and none of it has made a difference. I suggested a SIBO breath test and posted the results in the Facebook group recently. Small early rise in hydrogen but below 20 parts per million. In this situation, would you suggest a one-month therapeutic trial of the SIBO protocol, or would money be better spent on a stool test? Funds are tight, so I’m hoping to offer the most cost-effective option.

Chris Kresser: Yes, I mean, this is a great clinical question here. So, if you think it through, if there...

I’m still really confused about why lactulose is preferred over glucose for SIBO testing. It seems like glucose would give more accurate results. Some literature claims glucose is better and more accurate. I’m also unclear why Genova is so unpreferred with you and Amy. Is it only the two-hour test that you disapprove of or is it the lab? I know they are possibly willing to bring back the three-hour lactulose test, but it seems like you don’t approve of the lab. Is that correct? Since this testing is so murky and controversial, it would be good to get it right, of course.

Chris Kresser: Lactulose, I don’t know that you could say it is preferred. I think a lot of clinicians prefer...

Maybe I’m jumping ahead of myself here, as this will probably be covered in more detail in the blood chemistry portion, but how do you determine who’s a hyper-responder—familial hypercholesterolemia or ApoE4 genotype—to dietary cholesterol and saturated fat?

Chris Kresser: Basically, as I said earlier, if you address all of the other underlying issues and the patient still...

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 the pathogen protocols, do you find it’s essential to use the two different probiotics, Prescript-Assist and MegaSporeBiotic, or do you think using just one would be sufficient? Or what about pairing one of those with a Lactobacillus or bifidobacteria probiotic tailored to what stool testing shows is particularly low?

Chris Kresser: There’s a second question, but I’ll answer that one first. These protocols are just made up, and I...

Do you find that you have better success with eliminating SIBO by using a biofilm disruptor? I’ve heard some practitioners say they didn’t notice any difference with using or not using a biofilm disruptor with SIBO.

Chris Kresser: To be honest, I’m not sure we’ve done rigorous testing on that, but I certainly found early on,...

There’s a CSA tincture included for the pediatric SIBO protocol. Can you explain further what this does and why it’s only for kids and up to what age, please? Is there an alternative if it proves too difficult to source?

Chris Kresser: As I mentioned earlier [question #5], CSA stands for cryptolepis-sida-alchornea, which are three herbal antibiotics. It’s definitely not...

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