Amy Nett: Next question is from, I think, it’s Aileen. Aileen says, “A 39-year-old male with a history of anxiety, IBS-D, mild acne, MTHFR defect.” I’m guessing that means MTHFR either heterozygous or homozygous. MTHFR status, say, I look at … I don’t necessarily know that MTHFR implies any downstream dysfunction. I mean, I’m certainly going to take a look at homocysteine. I’m going to think about detox, but I always take genetics with, I don’t know, a grain of salt because you have to think about the epigenetics. I have plenty of
MTHFR- homozygous SNPs, patients with these homozygous SNPs. If they’re managing sleep, diet and lifestyle, homocysteine still between 5 and 7, not necessarily seeing anything downstream. But anyway, that was just a side discussion on that. “He was tested for SIBO and was positive. Two to three weeks into treatment, and his new symptoms include poor digestion of fats and proteins, reflux, bloating, and increased diarrhea.” It seems like a worsening of his IBS-D, along with maybe some new reflux and maybe more bloating. She goes on to explain, “The test was positive, with methane elevated to 11 at 120 minutes.” To me that’s kind of borderline. The positive is really at 10 parts per million, so borderline methane. And then she says, “Methane 5 to 7 starting at 75 minutes from a baseline of 4.” Again, that would be within the normal range. And then, “Hydrogen elevating from 5 to 30 parts per million at 75 to 90 minutes, then to a peak of 86 at 120 minutes.” But remember, for hydrogen we’re really looking mostly within that first 90 minutes. So, 5 to 30, you have a change of 25, and you’re looking there for a change, really, of 20 parts per million. Again, this is a very mild SIBO, but he could certainly have more dysbiosis on the stool testing. I don’t know if you ran stool testing, but since the SIBO looks pretty mild, I would wonder if there’s … you mentioned the reflux. Is Helicobacter pylori an issue? I don’t know if you did the stool testing for a little more information. She goes on to say, “He’s been on a long-term ketogenic diet, has histamine intolerance. He has also found since the treatment began, he is able to tolerate histamine foods without issue.” Okay, so his histamine tolerance improved. “Skin is improved. Anxiety is stable, even with increased symptoms, which usually triggers his anxiety. He’s taking GI-Synergy, Lauricidin, InterFase Plus. He is taking D-lactate-free probiotics and just started MegaSporeBiotic in addition to his usual probiotics. Not sure if he should continue the treatment.”
Yes. I think he probably should continue the treatment because you mentioned that quite a few things have actually improved. Again, one of the questions I have is if you didn’t do stool testing, if there’s possibly Helicobacter pylori or some other dysbiosis that’s contributing. Just because the numbers I’m seeing on the SIBO breath test that you reported here, it’s kind of like a mild, mild SIBO. But if we want to stick with the idea that his symptoms, etc., are due to SIBO, what you could do here is you could add some digestive enzymes, in my mind, because of the reflux. I probably would choose digestive enzymes that do not include hydrochloric acid. There’s a whole array of digestive enzymes out there without hydrochloric acid. That would be my preference because of his reflux.
I would also add mastic gum wafers or some chewable mastic gum wafers you can get those off of Emerson Ecologics. Those should help with the reflux. I would probably also consider a low-FODMAP or the microbial reset diet, where you’re removing FODMAPs and fermentation-potential foods to see if that lessens the bloating. Again, that’s going largely with the idea of this being SIBO, but if he’s able to get a little bit more restrictive with diet, then I would try that.
When somebody is having a lot of bloating, I tend to favor cooked foods over raw, and I know in summer, in particular, people are starting to eat more salads and because it’s warm out, they’re going towards cooler foods, but sometimes if people are struggling with digestion I find that cooked foods, warm meals over cold, making sure they’re not drinking cold beverages, everything should be room temperature or warmer. Sometimes that can really help.
The other thing is, I would ask when is he having the reflux? Is that at night? Because if it’s just at night that he’s having it, you want to make sure that he’s eating at least three hours before laying down and going to sleep. I think look into when he’s getting the reflux and see if there are some lifestyle changes, are his meals too big, does he need to eat smaller meals, so maybe look into the heartburn a little bit, but I think I would continue the treatment. I think if he feels that, look, this is too much and I’m not willing to continue, I would try to reinforce that there is some improvement, the skin has improved, the anxiety has improved, so you could dial back to supplements if he feels like it’s too much, maybe take out the Lauricidin, decrease that InterFase. See if you can find a way to make the protocol more manageable, but it sounds like he’s making progress, and so those are some of the things I would consider: the digestive enzyme, mastic gum wafers, think about diet, both what he’s eating and the timing of when he’s eating.