SIBO

I’ve heard that PHGG is less well tolerated with methane-predominant SIBO and that it may be best with hydrogen-predominant SIBO. Have you observed this?

Dr. Amy Nett: I have not, actually. I’ve found that partially hydrolyzed guar gum is actually pretty well tolerated by...

I have a patient who I want to do the SIBO test, and she’s really afraid of lactulose because dairy exacerbates her Hashimoto’s skin rash. I want to assure her it’s OK, but I’m not sure if it is.

Dr. Amy Nett: Yeah, if a patient has a significant reaction to dairy that they think is due to the...

Regarding the SIBO breath testing, are there any special considerations for diabetic patients on oral medications or insulin concerning hyperglycemic or hypoglycemic reactions during the collection window? It would seem that 12 hours of fasting and then 100 grams of glucose followed by three hours of no other foods would be very likely to cause adverse reactions.

Dr. Amy Nett: That’s a great question. In this particular case, I generally use lactulose. I don’t use glucose a...

I have a question regarding SIBO lactulose breath test interpretation. The test result has a classic double peak with hydrogen at 14 parts per million at 90 minutes, dips down, and then peaks again at 15 parts per million after 160 minutes. Does this suggest SIBO? I’m not sure if it needs to be over 20 parts per million.

Chris Kresser: Yeah, that wouldn’t be suggestive of SIBO. There has to be an increase of over 20 parts per...

Does Genova’s SIBO test use glucose or lactulose?

Dr. Amy Nett: I believe you can order either glucose or lactulose from Genova. I think when patients self-order they...

I have a patient that tested with Commonwealth Labs and showed very high methane and normal hydrogen. I treated her for a month with CandiBactin-AR, CandiBactin-BR, and neomycin. She is feeling great with virtually no symptoms, very excited to retest, and her repeat test came back with normal methane, but now hydrogen overproduction. Could there be a lab error? Do I still treat her even if she’s symptom free? What are your treatment recommendations?

Dr. Amy Nett: Great question, and next week we’re going to be talking more about SIBO, but quickly I’ll mention...

Two new SIBO tests have come out. Curious about your thoughts. First one isn’t a new test so much as it’s a new combo of pre-existing tests. BioHealth recently announced that they have a combo package where one can do both the glucose and a lactulose SIBO test. Given the fact that they involve two 24-hour prep diets and two three-hour test periods, are there clinical situations in which you would see the utility for such a double test?

Chris Kresser: Not really. I’d have to think about it a little bit. I think lactulose is much more sensitive...

For patients that routinely fast for longer than just overnight or 18 hours, what changes to the botanical SIBO protocols does one make? Is it correct to say that two specific considerations are number one, no digestive enzymes if not taking MBL? Second part of the question. Should the patient, take all other supplements, even though not taking any food, at about five times a day as depicted in the handout or week 10’s antimicrobial protocol PDF sample day slide?

Chris Kresser: Yes to both parts of your question The only downside of fasting to the protocols is that in...

Have you found any main causes for calcitrate candida in your practice? We recently saw a patient with positive candida on Doctor’s Data and markers for yeast and organic acids. Was treated with A-FNG for almost three months. Patient got better on A-FNG, but within a week of being off it, the symptoms returned. Patient’s also very dependent on molybdenum. Once she gets off, she has very sore and stiff muscles. Any thoughts?

Chris Kresser: It’s a good question. I mean, mold exposure comes to mind certainly as one possibility there if the...

When working with someone who has SIBO and HPA-D, I had understood from the SIBO point of view, in order to help the MMC, it’s a good thing to have four to five hours minimum between meals and 12 hours of no eating overnight, but then the HPA-D may need to support more frequent eating. How do you approach this, and what would be your advice as the SIBO is also likely contributing to the HPA-D? So is it just important to focus on getting rid of that first?

Chris Kresser: I don’t know how important either of those strategies is on an absolute level. I think it really...

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