Chris Kresser: I think we addressed some of this in my earlier response [to question #8], but for a therapeutic trial, it would depend on symptoms, and it would also depend on other test findings. If the zeros on the breath test were the only gut things that you identified, I’d probably do 30 days, but if there were issues on the stool test and the organic acids test, I would extend that out to 60 days.
As far as retesting, you would expect, to some degree, that you’d see a normal single peak, but the other side of that coin is that you’ve just given them antimicrobials for 30 days, which can impact bacteria in the large intestine, as well. They don’t have as big of an impact as antibiotics would, but they could have some impact, so it’s possible that production of all gases would be somewhat suppressed just after an antimicrobial protocol. That can also explain why sometimes if you treat someone successfully you see on the retest that their breath gases are normal, but then two months later they start to have symptoms again, and you retest and they’re positive again. That’s probably because the treatment suppressed the organisms that were overgrown but didn’t completely eradicate them, and then over time they grow up. You just need to use clinical judgment, as I said earlier, because there’s no black-and-white way to answer that question.
I do think it is a good idea to add liver support in most cases, something like Liver-GI Detox from Pure Encapsulations can be a good option.