Chris: There’s a little more data here. Let me see what’s relevant. She does have low iron, normal hemoglobin. No H. pylori, chronic atrophic gastritis, gallbladder sludge, low progesterone, and then Blastocystis hominis in the stool.
I don’t think taking probiotics will cause SIBO, but probiotics can definitely exacerbate it in some cases, especially if it’s the type of probiotic that’s released in the small intestine and isn’t protected and delivered in the large intestine. I think that is something to be concerned with, and the best idea or the best option in this case would be to have the patient tested for SIBO if she hasn’t already been tested, so a breath test would be a really good option. Blastocystis hominis is a controversial pathogen that we’ll be talking about in much more detail in the GI section of the course. If you look conservative websites like the Center for Disease Control, you’ll see that it’s still considered to be a fermentable organism and nonpathogenic. However, there are hundreds of studies in the literature that show correlations between Blastocystis hominis and symptoms, all kind of different sometimes, mostly GI symptoms but also others as well. It’s not necessarily just a correlation because some of those studies showed that those symptoms decrease when Blastocystis was eradicated, so that obviously suggested a relationship.
I’ve been looking at these patients for 10 years now, and what I can say is that I think that it varies from person to person. I think there are healthy people who can have Blastocystis in their stool and not have any issues, and there are also people for whom Blastocystis can impose a significant problem. I think what determines where people fall on that spectrum is probably many different factors including their own ecosystem, the host ecosystem. How is their gut health when they acquire Blastocystis? Do they have sufficient level the beneficial bacteria to protect against that? There are some evidence to suggest that subtype of Blastocystis, which there are five different subtypes, I think, that have been identified, and some are more pathogenic than others and then probably genes and gene expression and bunch stuff we don’t not fully. We’ll go into this in a lot more detail, but I think in this case, testing for SIBO would be the first step. Intolerance of probiotics can sometimes even be used as not a diagnostic criteria but as a kind of screening criteria for suspecting that SIBO might be an issue.