SIBO
I have patient who has been on PPIs for over 20 years. She has stomach discomfort, eats very little, complains of occasional nausea, allergies, and skin eruptions. Endoscopy in 2012 showed no ulcers and no Helicobacter pylori. Recently tested positive for ANA, and doctors have mentioned Gilbert’s syndrome to her as well. What tests do you think of to do initially? I was thinking of SIBO, Doctor’s Data, Cyrex 3 and 4. Also, after 20 years of PPI, can we expect her to wean off the PPIs and go back to making HCl?”
Dr. Amy Nett: With Gilbert’s syndrome, I think you can probably toss that out the window just because that’s fairly...
I have a client diagnosed with polychondritis of the ear. She came in months ago. I suggested food elimination and she disappeared. She is back now after beginning some food elimination. I suggested the Paleo reset and avoiding nightshades and eggs. What testing would you think of right away? She’s also very sympathetic nervous system type and was interested in what HPA testing you might suggest if you use one.
Yes, absolutely. Polychondritis of the ear, so uncommon chronic disorder of the cartilage that’s characterized by recurrent episodes of inflammation...
A 42-year-old female, normal weight, good general health. Five years ago, she had double vision in one of her eyes. About two weeks ago, she lost vision in the other eye. Both times she went to her ophthalmologist and was treated. The neuro-ophthalmologist recommended she see a multiple sclerosis specialist. She presented with a history of mild chronic constipation since childhood and chronic low hemoglobin levels. Other than that, she claimed to be a very healthy person, remarkable given the fact that as a child she lived in Belarus close to Chernobyl at the time of the disaster. I ordered general a general blood panel and SIBO test to begin my intervention. Gave her the 30-day Paleo reset and puzzled about what route to take regarding the radiation exposure and the possible effects on her health.
Dr. Amy Nett: Yes. Radiation exposure is a really difficult one because I don’t know how much can be done...
A 40-year-old with a history of breast cancer, status post radiation and chemotherapy, come six months after chemo and radiation with a primary complaint of abdominal distention described as feeling like she’s pregnant. She has been to a gastroenterologist. Was prescribed rifaximin, did two rounds and felt great while on it, but then the problem came back. Do you know how long those rounds of treatment run? The gastroenterologist did an in-office breath test, said she was negative — never heard of an in-office test. Two weeks maximum for the two rounds. Maybe she did four weeks, and she felt great on it. Cyrex lab shows casomorphin, gluten, and yeast sensitivities. Cyrex 2 shows occludin/zonulin IgGa and LPS. I also suggested the Doctor’s Data stool test. Should I consider another SIBO test? What do you think about her feeling good on the rifaximin? She has another prescription of rifaximin ready. Can they mix it into the fold?
Dr. Amy Nett: Yes. Some gastroenterologists do in-office breath testing, but remember, we prefer to look at them from the...
I’m a fan of that old-fashioned practice of a large glass of warm water with a fresh squeezed juice of a whole lemon upon first rising. In considering the initial acidity of lemon water and SIBO protocol, do you think this practice would interfere with the mechanism of action of InterFase Plus and/or Prescript-Assist?
Kelsey Kinney: Okay, good question. So I’ll start with what I think the easier one of these is, which is...
I received an update from BioHealth that they’re changing the way they’re reporting SIBO. Are you aware of these changes? I know you use NUNM, but can you comment?
Amy Nett: Adam quoted basically the North American Journal of Gastroenterology’s hydrogen- and methane-based breath testing in gastrointestinal disorders, and...
Do you think the high rate of SIBO recurrence could be due to the fact that because the lactulose breath test runs the risk of false positives and therefore overtreatment, the clinician starts looking for the real underlying root cause, i.e., focuses on SIBO, might miss something else, for example?
Chris Kresser: Okay. The first question from Steph, this is number one, “Do you think the high rate of SIBO...
When you see SIBO tested and in a case the patient didn’t follow the prep diet, baseline hydrogen elevated and then drops down before going back up, is the result still valid? Do you need to take anything special in their account while interpreting?
Chris Kresser: Sometimes high baseline hydrogen or methane values can be a sign of SIBO. They’re not always a sign...
What are your thoughts in using organic acids for differentiating between SIFO, SIBO, or other types of dysbiosis?
Chris: Organics from Genova uses D-arabinitol, and there’s actually some research behind that marker. If you search go to PubMed...
A 57-year-old male symptoms consistent with SIBO and nonceliac gluten sensitivity that has recurring upper respiratory infections. Recently had pneumonia. He was on the antibiotics for 10 days, ending 10 days ago, and chest symptoms mostly gone except for residual cough. I’m waiting for his SIBO breath test result and recent CBC but wanting to help them and nagging cough. What would you recommend? Raw honey or any other strategies to help ameliorate his cough symptoms in the interim?
Dr. Amy Nett: I really like Natura brand. They have a formula called, I think, it’s lung and bronchial tonic....
