3rd functional doctor visit: Results and a treatment plan for GI issues

To start off- I’m not a doctor, nor do I pretend to be one on TV. I’m sharing my results and what treatments were recommended to me by my doctor in the hopes it’s useful for others to hear about someone else’s experience.  None of this information is intended to diagnose or treat anyone.

 Also, my brain fog is pretty intense at times. I try to make sure what I write is correct, but I may get things wrong from time to time.

On August 28^th, 2018 I had my 3^rd appointment with the functional medicine doctor. We reviewed the data for the SIBO breath test, the stool panel, and the urine analysis.

My 1st appointment was a 2 hour long session to cover my health history and order tests.

My 2nd appointment was to go over bloodwork results, hormone results, betaine HCL trial results, and talk about a treatment plan given the findings from those tests.

At the end of the 2^nd appointment, the doctor noticed that the SIBO lab had come in early so she looked at it quickly. She told me I had methane dominant SIBO, but didn’t go into much detail.

I spent much of my time between the 2^nd and 3^rd appointment looking up as much information as I could about SIBO and related issues. Based on what I had read, I went to the 3^rd appointment prepared for a complex treatment plan.

What is SIBO, you may ask? I'll summarize it a little here, but this article gives a pretty good overview.

SIBO stands for small intestinal bacterial overgrowth. While there is bacteria present all along your digestive system, your small intestine is not supposed to have much compared to the large intestine and colon. As far as I understand, the bacteria that overgrows in your small intestine is not necessarily bad bacteria, it's just that it's growing in the wrong place. SIBO can cause lots of digestive issues and icky GI symptoms. Before the test, I did not think I had SIBO because I really only ever experience one normal SIBO symptom- constipation. However, I also found that SIBO can cause fatigue and brain fog, both of which I have experienced for about 2.5 years.

We started out reviewing the SIBO test results, which was pretty quick since I already knew I had methane dominant SIBO.

My treatment course for SIBO looks a little different than others I had seen online, but I’ll talk more about it at the end of this post. The reason for this is because my SIBO treatment takes into account other issues that came up in the tests. Just like every person is different, each SIBO treatment for an individual may vary depending on what other issues they have. 

The doctor then walked me through the results of the GI effects stool profile. I did look up the interpretation guide for this test a few weeks prior to the 3^rd appointment, but I didn’t spend as much time looking at it, because there are lots of potential results.

The results indicated I have a parasite, I don’t digest fats well, I have a yeast overgrowth, and the bacteria in my gut are not well balanced.

The parasite results are pretty easy to understand- they’re either found in your stool or they’re not. It turns out I have blastocystis hominis.

When I asked my doctor how one obtains blastocystis, she said it was fecal to oral transmission typically from contaminated food or water. Gross! I learned from the CDC website  just now that people who have blastocystis may or may not have any symptoms. Given everything else we found, I don’t know what, if any role, it might play in my health issues. My treatment for this parasite is an antibiotic called metronidazole.

The stool samples had quite a bit of fat in them, meaning I don’t break down fats well. The test splits fats into triglycerides, long-chain fatty acids, cholesterol, and phospholipids. My values for phospholipids and long-chain fatty acids were over the reference range, the triglyceride value was on the high end, and cholesterol was normal. The total fat count was over the reference range. I was prescribed a digestive enzyme that should help with the fat break down until my gut health improves.

The yeast result was not a surprise to me in general, but the way it showed up in the lab was surprising. I have had issues with yeast in the past, and I know if I eat lots of sugar I will end up with a yeast infection. In the stool results, yeast showed up on the low end of the range, but apparently, if it shows up at all it indicates the number would have been higher before it reached the lab. The yeast will be treated with a round of Nystatin.

The gut bacteria imbalance results were the ones I found most interesting.

 I had previously thought that lots of good bacteria in your gut are good. However, having too much good bacteria in your gut can be bad, because they can out compete the other good bacteria. For example, I have some lactobacillus, but it’s on the low end. I have lots of other bacteria that are quite high and aren’t allowing some of the other types of good bacteria to thrive.

In conjunction with the bacterial levels being imbalanced, my results indicate I have low short chain fatty acids (SCFA). SCFA’s are produced by good gut bacteria as part of their fermentation processes and help the gut to be healthy. Until we can get the gut levels rebalanced, I’ll be taking a supplement called probutyrate to help with the low levels.

After all of the GI effects results, we went over a small portion of the urine analysis results. I had completely forgotten I had given urine samples, so I was surprised when we went over those too! I think I forgot about them because they were the easiest sample to give.

We really only looked at the bacterial dysbiosis markers. Since this was towards the end of my appointment, my memory on what the doctor said about them is fuzzy. I think she was just pointing out that the gut dysbiosis markers were wonky in the urine analysis, which confirmed the results of the stool samples. I was told the urine results would be gone over in more detail at the 4^th appointment.

Let's loop back to SIBO for a moment so I can tell you how my doctor arrived at my treatment plan. There are both manmade and plant-based antibiotics that can be used to treat SIBO. The manmade antibiotics have had more studies done, and the results are pretty well established. While the plant-based antibiotics aren’t studied as well, those prescribing them have seen that they can work just as well as the manmade antibiotics.

In my research, most others treating methane dominant SIBO use a combination of Rifaximin and Neomycin that are taken at the same time.

Because of the blastocystis, I need to take a course of Metronidazole to kill it off. Apparently, Neomycin and Metronidazole can both be used in SIBO treatment. Since I already needed one manmade antibiotic, it made sense to go ahead with the Rifaximin assuming my insurance covered some of it. Rifaximin is quite expensive and tends to only be covered in certain instances, so we’re waiting to see what amount insurance might cover.

Apparently, we can replace the Rifaximin with herbals if necessary, but I got the feeling from my doctor that it’s more typical to pair like antibiotics together.

The doctor had mentioned that she had seen a different patient earlier in the day that had SIBO and other concurrent issues that needed herbals, so in that case, it made more sense to go the herbal antibiotic route for that patient. Again, depending on what other conditions a person has, the treatment can be quite different.

I had read in several others blogs that people took either Allicin or a type of guar gum to help activate the SIBO bacteria so they could be more easily killed off during the treatment phase. When I asked about this, the doctor said to focus more on food sources that cause symptoms for me rather than on another supplement. I found her to be very conscientious about level of functionality during treatment and number of pills taken at a given time.

Speaking of functionality, most other treatments I had read about combined the Rifaximin and Neomycin at the same time. With my treatment plan, I’ll be taking a course of the Nystatin to kill off the yeast, a course of Rifaximin for the SIBO, then a course of Metronidazole (Neomycin alternative) that will help with the SIBO and the parasite. The courses are taken one after the other instead of at the same time to help with functionality during the treatment.

After all of that, I’ll have a four-week course of Berberine and an olive leaf complex. This was at the very end of my appointment, and I honestly don’t remember the exact reason for this. 

The whole treatment period will take about 10 weeks.

During the active treatment, I will also be taking some supportive supplements:

•      A digestive aid
•        A SCFA supplement
•        A probiotic
•        An immune globulin concentrate to help with passive immunity

I will also be taking supplements to support other issues that were discussed in my 2nd appointment, which I’ll talk about in a different post.

While hearing about the treatment itself wasn’t overwhelming during the appointment, sitting down and trying to figure out how to get through it is becoming increasingly overwhelming, especially with decreased mental capacity. I’ll talk about prepping for the treatment phase in a different blog post.