Dr. Amy Nett: OK, so there are two different questions here. Would I say it’s safe to treat yeast overgrowth based on a stool test done seven months ago? It’s not ideal. You could ask them, if symptoms have changed, what have they done in the interim. If they’ve done any sort of treatment in response to those test results, you may more pause. If they say, “Absolutely nothing has changed. My symptoms are exactly the same,” it’s probably safe enough to do some sort of antifungal treatment to see if you can get some improvement, and then what I might do there is just something that’s more targeted towards yeast, so maybe use Yeastonil or just A-FNG or another formula that more specifically is targeted against yeast. Of course, it’s going to be preferable to have a more recent stool test, and I would say if they did do any treatment after that stool test—let’s say, they took a medication or an antifungal formula—then I would suggest pretty strongly that they repeat the test, but again, if nothing has changed, symptoms aren’t changed, then you’re probably OK.
What advice to give patients to prevent SIBO recurrence, that’s a great question. There’s still so much we’re learning, and I think stress management is one of the pieces to prevent SIBO recurrence, but sometimes life just throws things our way that makes that difficult. You know, it’s probably not always possible to prevent SIBO recurrence, but another thing to think about is frequency of eating. The migrating motor complex is that sweeping wave or that peristalsis that moves through the small intestine in between meals, so you could certainly think about recommending that patients don’t graze throughout the day. Maybe if they want to decrease meal frequency to something like two to three meals per day, that might be an option. They can do intermittent fasting sometimes.
The other thing to think about is let’s say they start noticing symptoms and they’re concerned that it’s an early SIBO recurrence. That might be a place for a low-FODMAP diet. Remember that we don’t like a low-FODMAP diet during treatment because during treatment you want the microbes to be metabolically active so that they’re more vulnerable to the antimicrobials, but if you suspect an early SIBO recurrence, that would be a place to use a low-FODMAP diet, and then you sort of starve out the bacteria and don’t give them the chance to grow. It sort of depends where they’re at. If it’s just normal SIBO recurrence but no evidence that they’re going in that direction, just stress management, watching meal frequency, not grazing all the time, and if they suspect they’re starting to go down the path towards SIBO already and notice symptoms, try low FODMAP. But if there’s any question, repeat a SIBO breath test. It’s better to catch it earlier when it’s going to be a little bit easier to treat.