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 are issues on the Doctor’s Data stool test, then you’re going to need to do a therapeutic protocol, probably pretty similar to the SIBO protocol because, as you know, the protocol for dysbiosis, parasites, H. pylori, and some of the things you’d find on the stool test are really similar to the SIBO protocol plus or minus certain specific supplements. If funds are really tight, it would make sense to me, logically, to do a trial of the antimicrobial protocol given that that is what you would end up doing with any positive results on the Doctor’s Data stool test, and then see how that goes. Possibly then retest the SIBO breath test and Doctor’s Data stool test after the therapeutic trial, presuming the patient can afford it and if there are still symptoms. It’s ideal to retest even if there aren’t symptoms just to confirm that you did what you set out to do, but that’s not always practical, especially in a situation where resources are tight like you suggest.