Dr. Amy Nett: Yes. Some gastroenterologists do in-office breath testing, but remember, we prefer to look at them from the Quintron machine, so how reliable they are that’s another issue. It depends what kind of equipment they have. Remember with that yeast sensitivity we do tend to think about increased intestinal permeability.I feel like she has SIBO because she’s describing your really typical symptoms. The option is, number one, do you just assume based on symptoms she has small intestinal bacterial overgrowth. Do another round of treatment, maybe just going with the herbal antimicrobials, saying like, “Based on symptoms we know something is going on with your gut. We know you have intestinal permeability. Let’s just do 60 days of treatment. Then we’re going to do a SIBO breath test. We’re going to do it by this validated method using the NUNM test, and then we’re also going to do the school test to see what else we’re missing.” That would be one consideration because the fact that she did well on rifaximin does tell us a lot. What’s interesting is the other thing we need to think about is this could this be like a case of SIFO, small intestinal fungal overgrowth, or SIBO due to a microorganism that produces hydrogen sulfide. Remember, if you do a SIBO breath test and it looks completely negative, but the patient is otherwise screaming I have SIBO, then you need to think about these other causes that are going to give you a false negative test result.
Yes she can mix another prescription of rifaximin in the fold. I mean, if she’s doing so well on it, it’s so tricky because part of me thinks like, yes let’s just do a four-week course. I wish we had to do a longer course like that. I wish we had some positive results. The other tricky thing is if she’s going to do rifaximin again, you almost wonder if you should add neomycin and do like rifaximin for two weeks with maybe 10 days of neomycin into the mix, because a combination of rifaximin and neomycin is going to be a lot more effective for a methane-predominant SIBO. We’re a little bit limited just in terms of the testing information that we have. I think just doing two more weeks of rifaximin, we’ve done that. She feels better on it, but I’m concerned it’s not quite getting to it. If you’re saying, well, can I do maybe 60 days of the herbal antimicrobial protocol and see how she does on that and then top her off with another two weeks of rifaximin, maybe depending on how she feels that has to be a discussion with the patient because this isn’t something where you’re saying look here’s the test data, here’s the research. This is where we’re going to go forward. Adam was thinking “rifaximin and the botanical. So doing rifaximin in place of the GI-Synergy kind of. So like, rifaximin, Lauricidin, InterFase Plus, PHGG, probiotics” — You could, but then I would want to do probably a four-week course.
The other thing is, well, she has a leaky gut. Is that specifically because of we suspect the SIBO or is there actually something on the Doctor’s Data stool test? If you’re going to do rifaximin as part of the botanical protocol, then you would want to do a stool test first. I don’t do GI-Synergy along with rifaximin. I think that’s kind of overkill. I tend to use GI-Synergy or rifaximin, and you might do them sequentially. I might do sort of the nonstop transition — GI-Synergy, Lauricidin — that whole core protocol and then transition to a course of rifaximin. But I prefer to have testing data to sort of make that recommendation. A Cinergy for you know Laura see it in that whole core protocol and then transition to a course of rifaximin, but I prefer to have testing data to sort of make that recommendation for a longer course. It might make sense to just get the Doctor’s Data stool test first, but I would feel comfortable with her based on the symptoms saying, “You know, what let’s do 60 days of the herbal antimicrobial protocol.” Then let’s do the stool test, a legit SIBO breath test because it might be that the rifaximin needs to be longer or that it needs to be combined with neomycin. But you have to do something about the gut what the symptoms are telling you. We just need to figure out how to approach it correctly.