Dr. Amy Nett: Yeah, so bloating is often SIBO but it could also be fungal parasites, that sort of thing. So a little bit tricky. So not getting better on a low-FODMAP diet, so maybe it’s not SIBO. A little bit tricky. I think it absolutely makes sense to start an antimicrobial protocol and if you go with just the G.I. Synergy, you know lurasidone and all of those, I think that makes sense because you have a broad enough spectrum and the thing would be is if she can afford it, maybe after doing 45 to 60 days do a stool test too. A SIBO breath test and a stool test. Yeah, I like trying to keep the diet as diverse as possible. I’m worried about the supplements because she’s sensitive. And I think that’s smart and you do just have to add things one at a time and I think I talked to my patient yesterday who’s about eight months and still adding in G.I. Synergy. So sometimes it takes awhile. Time frame as far as turning the corner, yeah, and wow is correct. So the time frame as far as turning a corner in gut health, it depends so much on the patient. I’ve had patients within two weeks who think, “Oh, my gosh, this is so much better,” and they’ll continue to see improvements. I’ve had other patients where it’s not as clear and it’s maybe three, four weeks and they think oh that was a little improvement and then plateau and a little improvement.
So it also depends how slowly she’s layering in these supplements. So I often, patients who are sensitive, I often just tell them okay we just need to be really patient and know that this can take a while, and know that if you get a little bit worse then that might actually mean we’re on the right track. So sort of be encouraging there. I’m not sure why she got more bloated after having a full bowel movement. Again it could be that the supplements are going to kind of worsen some of the symptoms before she gets better. And make sure, so it’s good you said you’re trying to keep her diet as diverse as possible. Once she is on some of the antimicrobials, since she’s on a lower-FODMAP diet just because of what she can tolerate, think about what fibers and prebiotics you can bring in because again having prebiotics whether it’s FODMAPs, resistant starch, supplemental forms of prebiotics, those are potentially going to make the microbes more metabolically active and make a treatment a little bit more efficacious. For my patients who can’t really tolerate those without severe bloating and discomfort, I tell them once you get on to the G.I. Synergy then that’s when I want you to bring in the prebiotic. So unfortunately there’s not a standard time frame but hopefully within at least two to three weeks she’ll start seeing some improvement. But keep us posted.