When doing an antimicrobial protocol for SIBO, a 60-day treatment, if a patient doesn’t show any improvement in symptoms of bloating or skin changes after 30 days, should they continue or perhaps stop and try another form of treatment? Patient had moderate levels of hydrogen produced and moderate levels of yeast overgrowth with an insufficiency dysbiosis.

Dr. Amy Nett:  So no symptom change after 30 days. I don’t know that I would necessarily change course at that point. If you’re saying moderate yeast overgrowth and moderate hydrogen overproduction, you would certainly hope to be seeing some symptom improvement at the 30-day point, I would agree. As long as there’s no worsening of symptoms, I probably actually would continue for the full 60-day treatment course as recommended. If patients are actually getting a little bit worse or they’re really not tolerating it, there is a point in there where I would say, “OK, let’s kind of abort.”

Let me read this one more time. It’s a recommended 60-day protocol, but I think the patient has only been doing it for 30 days. That’s my understanding. Sorry, just getting clarification here, but I think that’s my understanding. So they’re halfway through the protocol. Yes. Just getting clarification, so we’re good.

Again, the patient is halfway through an antimicrobial protocol for moderate SIBO with hydrogen overproduction and moderate yeast overgrowth. Then no improvements at 30 days. So my question is, is there worsening? If there is no worsening, stick with it for the full 60 days. Do make sure that patient is on, like, PHGG or BiotaGen, some sort of prebiotics, because you mentioned in there the insufficiency dysbiosis. You do want to make sure you’re really supporting the levels of healthy bacteria, but I would continue through. Just let patients know that these things do take time and we don’t always see improvements within 30 days. I agree, it would be nice.

You could also at that time, though, start thinking about where else you want to look. Have you already done testing for HPA axis? Have you done testing for metals? Should you start looking somewhere else? If I don’t see symptom improvement halfway through the antimicrobial protocol, I would continue but start looking at what else I need to think about to improve these symptoms. Skin changes and bloating. Have you done food sensitivity testing? Maybe they’re still eating something that’s triggering them. Maybe there’s a metal toxicity, something like that. Nutrient deficiency. That would be something a little bit less expected for bloating, but just something to think about.

So, no, I would say stick with it, see where you get. I think it’s worth a full 60 days.