SIBO

Can you explain again the issue of hydrogen sulfide related to false results on SIBO testing. Unclear about when you would make this guess. The issue is foggy, so any clarity is appreciated.

Dr. Amy Nett: So hydrogen sulfide, what we’re seeing there is that you can have SIBO associated with hydrogen sulfide...

Can you supplement with betaine before a SIBO breath test?

Dr. Amy Nett: I wouldn’t do it the morning of, but patients are not going to be eating the morning...

When doing an antimicrobial protocol for SIBO, a 60-day treatment, if a patient doesn’t show any improvement in symptoms of bloating or skin changes after 30 days, should they continue or perhaps stop and try another form of treatment? Patient had moderate levels of hydrogen produced and moderate levels of yeast overgrowth with an insufficiency dysbiosis.

Dr. Amy Nett: So no symptom change after 30 days. I don’t know that I would necessarily change course at...

My question is regarding a repeat lactulose hydrogen breath test. The first test from five months ago was suggestive of SIBO with a peak in hydrogen of 34 before 120 minutes. Methane was 5 to 7 throughout the test. When the patient repeated the test, she had zeros for both gases for the whole three hours with the exception of a 1 for hydrogen at only one point throughout the test. Am I correct to suspect hydrogen sulfide in this case, despite the first test result being quite different from the second one?

Dr. Amy Nett: I think it’s a little bit difficult to answer because I’m not sure what the symptoms were...

On the SIBO diet, patients feel immediate bloating, but now I understand that that the treatment is more effective if they eat fermentable foods. When you start patients on SIBO antimicrobial protocol, when do you expect symptoms of bloating to decrease or disappear? If they’re very uncomfortable, do you tell them to remove the fermentable foods?

Dr. Amy Nett: I think by “SIBO diet” you just mean a standard Paleo diet where you’re not limiting FODMAPs....

Is there a study on IBD and EnteraGam.

Dr. Amy Nett: Yeah, and I think I saw a question about using EnteraGam for IBD. EnteraGam is similar to...

If a patient has a flat-line result on a SIBO breath test and you treat as positive for hydrogen sulfide bacteria, is there a way to retest to make sure that the treatment is successful? Even though the breath test is not measuring for hydrogen sulfide, could you expect that the repeated breath test would show a normal result or least a changed result that would no longer be flat? How do you know when you’re done treating?

Chris Kresser: Those are all the operative questions here, and that’s why the hydrogen sulfide thing is problematic. As you...

What do you think of Allison Siebecker’s diet treatment detailed in her book for SIBO? It was interesting to learn from her that bone broth can exacerbate some patients’ SIBO symptoms due to collagen and the inability to break it down, which then becomes food for bacteria in the small intestine. She also recommends against prebiotics, fermented foods, and mucilaginous herbs like licorice, slippery elm, comfrey, and marshmallow, as these tend to be too large to be broken down and will also feed the bugs.

Chris Kresser: Yeah, I’ve heard that or read that, what she said about bone broth, which is really interesting. Again,...

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...

In Week Seven, you used a case example of a woman with insomnia who tested negative for SIBO. I understand SIBO can often show up in people with no GI symptoms, but I’m wondering whether you would routinely go to SIBO and stool testing right away with someone with this kind of presentation. I’m guessing you ordered other tests and we’ll talk about that thought process when we get to putting it all together, but since many of us are already ordering tests, it would be really helpful to get some insight into your thought process when first choosing which tests to order, especially because money is almost always a big consideration. Do you ever a SIBO test without ordering a stool test? If so, when and why?

Chris Kresser: Most patients who get a case review with me get the full suite of gut testing plus the...

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