So the question I have submitted from Jessica, she asks, “Is there a specific timeline around replacing stomach acid as far as whether it needs to be continued after completing an antimicrobial protocol for SIBO? Do you repeat breath testing and comprehensive stool analysis testing first?”
Amy Nett: So I would say there is no one-size-fits-all for using HCl in terms of treatment. And I don’t even put all of my patients who have SIBO on HCl. So remember that we’re giving you guidelines, and then you really want to tailor the treatment to each individual patient. So, if I have younger patients and maybe they’re struggling with all of the supplements that we give them, I mean, we give them a lot of the supplements in terms of treating SIBO. So you have to really look at how many supplements the patient’s used to taking, how many do you think are feasible for this patient to take. Because you really want to try to set them up for success. And sometimes it’s fair to ask patients, “How realistic is this for you?” Some people just hate taking capsules, and they’ll tell you, “No. Just taking this many capsules sort of upsets my G.I. tract.”
So I would say I don’t even give HCl to every patient that I’m treating for SIBO. And when it comes to continuing digestive enzymes, whether they include HCl or not, that also varies. I would say the most significant factor there is probably age. Because as we age, we naturally have a decrease in our hydrochloric acid production. So in my patients who are, let’s say, 60 years old or older, I generally do continue them on some sort of digestive enzyme. But again, always asking them, “How do you feel? Does this provide any benefit?” So younger patients, I generally just stop any sort of digestive enzyme support as soon as they’re done with treatment. Remember that you definitely want to stop the digestive enzymes before doing comprehensive stool analysis testing. So in the question it says, “Do you repeat breath testing and stool analysis testing first?” Well, first, you would actually want to have them come off of all the G.I. supplements. You don’t necessarily need to have them come off nutrient support if you’re using that, as well if you’re using some magnesium glycinate or cod liver oil for other reasons. But they do need to come off any of those supplements that we’re using for the G.I. treatment, including probiotics, digestive enzymes. Because when I do that comprehensive stool analysis testing, I want to see how they’re digesting food. So I want to know … remember, part of that comprehensive stool analysis from Doctor’s Data is, are you seeing vegetable fibers in the food? Are you seeing some evidence of muscle fibers from meats that they were eating? Are you seeing fat in the stool, too much fat? So there I want to get a sense of how their gastrointestinal tract is digesting food without any sort of supplemental support.
So if the stool analysis comes back and shows a lot of undigested food, first question is, how long are you chewing your food for, right? Because the most common cause of seeing undigested vegetable fibers in particular is just not chewing enough. And the amount of times we should be chewing, I don’t remember if it’s 30 or 60, but it’s a lot, and most of us are not chewing our food. We should really be chewing it down almost to like having a smoothie in our mouth before we swallow. Most of us don’t do that. But it’s a reasonable consideration if you’re talking about putting someone on digestive enzymes including HCl for a long time, do they want to try just chewing their food first.
So, no, there’s no specific timeline. You really need to look at the age of the patient. If they’re older, you’re going to be more likely to keep them on digestive enzymes, including hydrochloric acid. If they’re younger, probably okay without keeping them on it. But make sure you take them off prior to doing the follow-up testing. And then if you want to do a trial, say, “How do you feel when you take digestive enzymes versus not taking them?” And if symptomatically they feel better, then I think it’s probably okay to use digestive enzymes, even for fairly long term. I always like my patients to take supplement holidays, so taking at least two weeks off from pretty much all supplements probably a couple times a year. Maybe at least two to three times a year. Just remind the body that it can function, it can get by without the supplements. That we’re just doing supplements to really optimize things. But I think some people can start to feel really dependent on supplements, which I want to try to avoid that if possible.