Kresser Institute

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SIBO

Can you explain again the issue of hydrogen sulfide related to false results on SIBO testing. Unclear about when you would make this guess. The issue is foggy, so any clarity is appreciated.

Dr. Amy Nett: So hydrogen sulfide, what we’re seeing there is that you can have SIBO associated with hydrogen sulfide...

Can you supplement with betaine before a SIBO breath test?

Dr. Amy Nett: I wouldn’t do it the morning of, but patients are not going to be eating the morning...

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...

My question is regarding a repeat lactulose hydrogen breath test. The first test from five months ago was suggestive of SIBO with a peak in hydrogen of 34 before 120 minutes. Methane was 5 to 7 throughout the test. When the patient repeated the test, she had zeros for both gases for the whole three hours with the exception of a 1 for hydrogen at only one point throughout the test. Am I correct to suspect hydrogen sulfide in this case, despite the first test result being quite different from the second one?

Dr. Amy Nett: I think it’s a little bit difficult to answer because I’m not sure what the symptoms were...

On the SIBO diet, patients feel immediate bloating, but now I understand that that the treatment is more effective if they eat fermentable foods. When you start patients on SIBO antimicrobial protocol, when do you expect symptoms of bloating to decrease or disappear? If they’re very uncomfortable, do you tell them to remove the fermentable foods?

Dr. Amy Nett: I think by “SIBO diet” you just mean a standard Paleo diet where you’re not limiting FODMAPs....

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