New 34-year-old female client with history of H. pylori, GERD, bloating, constipation, rashes, white coating on tongue. Previously done Gut Thrive program to help reset her gut and has had food sensitivity testing. Strictly avoids yeast foods and eats only organic whole foods. Started an elemental diet two weeks ago for suspected SIBO and is doing well except for continued rashes and white tongue. Is this a die-off situation, and what should be the next step beyond the elemental diet? Considering SIBO test and then possible antimicrobial protocol if indicated.

Chris Kresser: A lot of people get a really thick white coat on the tongue with an elemental diet. It could just be local fungal overgrowth in the mouth because the elemental diet is just full of super simple monosaccharides, glucose, or dextrose and tapioca dextrin or something like that. That’s a sugar basically, so if all the patient is eating is that all throughout the day, then it makes sense to me that you could get an oral thrush situation. That happen to me when I did the elemental diet. It has happened to almost every patient that I’ve seen. I wonder if the skin rashes are related to that. It’s not clear whether they’re worse or discontinued, but if you have re-test for SIBO and the SIBO is now clear, you might consider a core antimicrobial protocol as a way of dealing with any fungal overgrowth that might have occurred during the elemental diet or that was pre-existing that the elemental diet exacerbated.