I have a female patient with severe bloating since her teens. Starts the day with a flat abdomen, describes herself as looking pregnant by the evening. She has normal bowel movements and the bloating isn’t painful. Suggested a SIBO breath test but the results were equivocal. Decided to try a one-month therapeutic trial of the SIBO protocol, and she’s tried many other options in the past with no success. No change. So where would you go next for a case like this?

Dr. Amy Nett:  Stool testing if you haven’t already. This could also be an issue where she doesn’t have enough beneficial bacteria. There could potentially be some dysbiosis involving the colon, so next step would be stool testing. The other thing to think about, food sensitivity. So patients are fluctuating. If you see a patient fluctuating with weight throughout the day and it might not just be bloating but actual changes on the scale, think about whether or not they’re eating the foods that are triggering them.

So if she’s still eating gluten, think about a Cyrex panel; if she has a Paleo diet, think about Cyrex Array Four or Ten and doing some sort of an elimination diet. So those are the next two places I would go.