What test would you recommend for pancreatic insufficiency? [The] patient is taking digestive enzymes and HCl with Pepsin with meals, but should there be additional pancreatic support? Would low elastase on [a] GI-MAP also be a consequence of SIBO, given the patient’s positive SIBO test result?

Yeah, basically, whether you are using GI-MAP or [the] Doctor’s Data comprehensive stool analysis, elastase is a marker for pancreatic insufficiency, and, as I think we discussed in the content, if it’s low but it’s still above 100, maybe 110, 120, it’s much more likely to be a functional cause, and that functional cause could be SIBO, or it could be parasites, it could be fungal overgrowth, it could be celiac, it could be food intolerances, it could be anything that is impairing the function of the whole GI system. If it’s lower than 100, it can often be related [to] a structural problem in the pancreas like pancreatitis, so you’d want to follow up on that. If it’s not your domain, you want to refer out to a gastroenterologist. The way that you can tell is when you retest. So let’s say that the elastase is 150, and they’ve got SIBO and parasites and some other stuff going on in the gut; after you address that with your protocols, you want to retest and see where that pancreatic insufficiency marker or where the elastase is. In most cases, what we see is it goes back up into the normal range. If it doesn’t, and especially if it’s lower, even after those things have been addressed, then you would probably, again, want to refer out in that situation.