For patients with SIBO and fungal dysbiosis who are not complaining of symptoms such as gut pain or bloating, is there any need for them to follow the low-FODMAP diet, at least initially, while starting a treatment protocol, or is a standard Paleo template good enough?

The standard Paleo template is good enough in those cases, and in fact, we don’t necessarily recommend a low-FODMAP diet now with everyone. It kind of depends on their symptoms. If it’s helpful for symptom relief, then yes, we’ll do that for sure. But if someone doesn’t really notice any difference from doing that diet, then it’s probably unnecessarily restrictive and I don’t see a lot of value in doing it.

Okay next question from Jessica. I think that was a similar question. In terms of the question that you sent in Jessica, to some extent we have to meet patients where they are of course and if someone has SIBO and they’re not willing to do a Paleo reset diet, will we still treat? It depends on the situation. I mean, if they’re just eating complete junk like Standard American Diet, I’ll explain very clearly that the results of that treatment are likely to be limited and almost certainly need to treat again even if the treatment is successful. I’ll explain to them the recurrence rates of SIBO and the risks of overtreatment and try to help them see the light, so to speak, in terms of cleaning up their diet or just focusing on diet first before we treat SIBO. In most cases, at least for my patients, they’re not on a full-on Standard American Diet. Even if they’re not on Paleo reset or they’re doing a Paleo template type of diet or a pretty clean diet, in those cases, yes, we will go ahead and treat because they often still get some significant benefit.