Chris Kresser: Okay, so this is an interesting question. There was a question on the Facebook group from Laura that I answered earlier today related to a patient who was on the SIBO botanical protocol and then was either hospitalized or diagnosed with pancreatitis. I can’t remember exactly what, but it can be really tempting to draw, make a causal relationship between those two events: botanical protocol and pancreatitis onset or diagnosis, we don’t know about onset. But when you look at the scientific literature, you see that there is a strong correlation between chronic pancreatitis and SIBO. So did the patient already have chronic pancreatitis and SIBO and Laura discovered the SIBO in testing and then started treating? And then the pancreatitis at that time became clinically apparent, which is probably the most likely scenario. And it makes sense that pancreatitis patients would have SIBO because they don’t produce enough of the pancreatic enzymes that break down foods in the small intestine and so they can remain undigested and provide food for the bacteria.
So in many cases that’s what’s often will be happening. Is it outside of the realm of possibility that a patient could do a botanical protocol and have a reaction like that? No, it’s not. There’s always a chance that something like that could happen. But it’s very low in my experience. As for the antifungal protocol, it’s certainly possible that antifungal protocol could cause abdominal pain and the question is, is it the antifungal protocol itself, meaning the agents? Is she having adverse affects to the agents in the protocol? Or is the protocol working and killing the yeast and causing a Herxheimer reaction? It’s sometimes difficult to discern between those two things when you’re doing it. Typically if the pain persists and doesn’t change at all over a two-month period, then it would more likely be a reaction to the protocol itself rather than a die-off reaction. Because with a die-off reaction, you’d expect to see maybe a shift. It’s as organisms are killed and toxins are released, then maybe the patient would get some relief and actually experience some improvement, which might then be followed by another wave of die-offs. So it tends to sort of go up and down like that if it’s die-off, whereas if it’s just constant pain or discomfort, then it’s more likely to be a reaction to the protocol itself.