Then another question. “Can I quickly confirm that the diagnosis of SIBO is a combo of breath test and stool testing?”
Chris: No. Actually, the current diagnostic criteria for SIBO do not include still testing. They’re solely based on the breath test, or if someone has a duodenal aspirate via endoscopy, that’s another method. That’s really actually the gold standard method for diagnosing SIBO, but it’s rarely used because it’s a pretty invasive test and not really practical in an outpatient functional medicine setting. Right now, if you’re going by the North American Consensus Criteria, it’s solely on the basis for hydrogen having an increase of 20 parts per million or more within the first 90 minutes, and for methane, a value of 10 parts per million or higher at any point during the three hours of the test. That’s it. That’s the definition of SIBO. Even though there are markers that are being explored for SIBO like lactic acid or indican on their organic acids urine test, those are not validated yet, and they can be used to diagnose SIBO. The HCl challenge test, they take HCl or betaine until they feel the burn and back off.
“What’s the prescription afterwards? For how long?”
Chris: Yes, this is a very unscientific test. I think in functional medicine we always want to use evidence and lots of different kinds of evidence as much as we can. There’s also place, I think, for anecdotal experience and experimentation as long as there’s not any harm, and I think the HCl protocol and challenge fall into that where a lot of people have found benefit from taking betaine, and betaine is a really important nutrient and helpful for a lot of different conditions. As long as someone doesn’t have an ulcer or a condition for which HCl is contraindicated, then taking it in this way where you do build up and then if you feel any kind of burning sensation you back down to one or two pills below or capsules below that dose where you felt the burning can help restore healthy gut function and get that person off of a lifetime of PPIs, then I think it’s a win. We never have anyone personally go above five capsules even if they don’t experience burning at five capsules, and then gradually, the intention is to get them to reduce the dosage as they’re able to get to the point where they don’t need it all.