Twenty-four-year-old male presenting with depression for seven to eight years but also lethargy and poor digestion after a trip to India four years ago. Doctor’s Data showed susceptible amounts of beneficial bacteria, five species of commensals and 1+ or 2+. 1+ of candida and Saccharomyces boulardii, but Blasto and giardia in all three stool samples. If Saccharomyces boulardii could be used to treat these parasites, is it possible that they could coexist? Patient opted for a course of Flagyl with S. boulardii. Would this be redundant given he already has it, and would you follow with another month or two of herbal antimicrobial parasitic protocol, SIBO results still pending?

Chris Kresser:  I would definitely treat the giardia, and probably the Blasto in this case as well, given the symptoms and history. Saccharomyces boulardii can be effective, as you know from the unit, but to be, in my clinical experience, I haven’t seen great results only using Saccharomyces boulardii in a situation like this. So Flagyl alone isn’t that effective either. Hopefully, Flagyl with Saccharomyces boulardii will be effective. Then we talked all about different protocols for the giardia and Blasto back in the gut section. So you’ve just got to see where he’s at after. I would do a retest after the Flagyl and Saccharomyces boulardii treatment, and then make the determination on what to do based on that, those retest results.

So, if he has only fungal overgrowth after the antibiotic, then you could continue with some antifungals. But you would, if the only species that’s identified is Saccharomyces boulardii and there’s nothing else, that would be tricky. You wouldn’t know that there was actual fungal overgrowth. It could just be the saccharomyces boulardii that is being picked up on the test. And then of course it would also depend on what the SIBO results brought back because that could be contributing as well.