A 79-year-old client has been on a proton pump inhibitor intermittently for 30 years. Doctor’s Data stool test revealed 3+ and 4+ beneficial bacteria, commensals 1+ and 4+ on a few, GI-MAP showed low secretory IgA, so maybe some chronic stress, chronic infection, high ​E. coli​ species and other dysbiotic bacteria. SIBO was borderline. I’m not experienced with the GI-MAP, but I’ve heard good things about it, so I’m inclined to go with the GI-MAP over the Doctor’s Data. Is it worth putting him on a SIBO protocol since it’s a good catchall?

Did the GI-MAP show ​Helicobacter pylori?​ Well, I guess you’re saying it just showed other dysbiotic bacteria. You’re saying the GI-MAP showed overgrowth of some of those kind of less favorable microorganisms. If that’s the case, I would think given the reflux, it probably is, and that’s why I was wondering, though, if there is ​Helicobacter pylori.​ Just because when I think about proton pump inhibitors and reflux, I’m always going to be a little bit more suspicious of Helicobacter pylori​ and of course you’re going to tweak the protocol a little bit if ​H. pylori​ is present.

Chi says, “No. I was expecting ​H. pylori​, but it wasn’t there.”

Yes. I think based on symptoms and based on just saying that there’s dysbiosis on the GI-MAP test, yes, I probably would go with treatment, and I have started using the GI-MAP test more and more. With any of the stool tests, you just have to look at symptoms as well, and I think in this case just knowing that someone’s been on a proton pump inhibitor over, like, 30 years, I’m thinking there’s got to be dysbiosis. I’m almost surprised that the SIBO is only borderline. I think it probably would do … I think by “SIBO protocol” you just mean GI-Synergy, Lauricidin, InterFase Plus, probiotics. It looks like the Doctor’s Data stool test showed good levels of beneficial bacteria and more or less the GI-MAP, it sounds like didn’t show any insufficiency dysbiosis, so it doesn’t sound like prebiotics are too necessary, just in case SIBO is more of an issue than we’re realizing, so going with probiotics. And then because of the proton pump inhibitor, I might include something like ​GastroMend​ just so you’re getting those nutrients like the DGLs, zinc carnosine … What else is in there? It’s like slippery elm, or something like that.

But just kind of healing the stomach lining and sort of the upper mucosa. I would probably do that core antimicrobial protocol with GastroMend-HP, maybe give some mastic gum wafers, again. You can get those just on Emerson, but I found that giving patients some mastic gum wafers to chew on when they’re getting reflux can sometimes help get them off of the PPIs if the patient is still on those, and I’ll sometimes use even, there’s these ​Dr. Formulated Organic Digest Chewable Enzymes​, and they’re pretty mild. But again, I think giving patients those, just have one after a meal. It’s a gentle digestive enzyme that I think can be nice and can sometimes give patients a sense that they’re getting some lessening of that heartburn and the results.

There’s also some products I’ve been experimenting with more recently, like some peppermint oil products. I think there’s one from ​Protocol for Life​, I think. I can see the label, it’s like a red label, and then another one I found on Emerson that’s like a peppermint oil, fennel oil, and maybe ginger oil that can be kind of soothing for the GI. It sounds like, again, if you’re going partly based on symptoms, which I think of course we have to, think about getting some supplements in there to help just kind of heal and calm the upper GI tract. Natura also has a nice one. It it’s called ​Digest Mend​. It sort of overlaps with the GastroMend, so you could see which of those products you like more, but yes, I think that’s what I would I would do based on that.