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,...
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...
