SIBO/IMO vs. Dysbiosis: Choosing the Best Test for your Symptoms

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'll be covering the difference between dysbiosis and SIBO and its related disorders, IMO, or intestinal methanogen overgrowth, and hydrogen sulfide SIBO. There's some controversy about this subject, so I thought I'd give my two cents. But before I dive in, if you haven't yet followed or subscribed to the show, be sure to do so. And if you want to get transcripts of the podcast, pop over to my website, HighDesertHealthCoaching.com, and sign up for my newsletter. And be sure to open up the first one you get, or you'll get put on the non-responder list and won't get subsequent newsletters. You'll also get my free ebooklet, Finding Your Root Cause Through Stool and Organic Acids Testing, when you sign up. And if you haven't yet done my quiz on which stool test would help you get to your root cause, you can find a link in the show notes and take that. Now on to the show. So I've covered SIBO and IBS several times on the podcast, but in this In this episode, I want to distinguish between SIBO and dysbiosis. The two are very different and usually involve somewhat different symptoms, causes, tests, and treatments, although I know there are some people who would argue that all SIBO should be considered dysbiosis, that SIBO isn't really a thing in and of itself, but I'm convinced it is. If you're interested in my other episodes on SIBO, see episode 36 on IBS treatment, episode 83 on recurrent SIBO, and episode 114 on hydrogen sulfide SIBO. But let's start with the basics. SIBO, for those listeners who may or may not know, stands for small intestine bacterial overgrowth, and it occurs when there's an abnormal increase in the bacteria in the small intestine, which occurs most of the time because of an episode of food poisoning, but can have lots of other root causes, which I'll get more into later. But things as diverse as Ehlers-Danlos syndrome, a traumatic brain injury, long-term PPI use, GLP-1 drugs, or hypothyroidism. But for the SIBO that stems from food poisoning, you may have the initial signs of food poisoning like vomiting, cramping, diarrhea, maybe fever, which you'll usually get over in a day or two, but then maybe a few days to one to several weeks afterwards, things don't quite get back to normal. You will end up with loose stool, what we like to call "multi-wipers" in my house, or maybe even recurrent diarrhea, which may include urgent trips to the bathroom or histamine reactions like allergic symptoms when you eat certain foods. This is particularly the case with hydrogen sulfide species, which produce histamines, But most SIBO is caused by an overgrowth of hydrogen-producing bacteria in the small intestine, which Dr. Mark Pimentel from Cedars-Sinai, the main SIBO researcher, has pinpointed as strains of Klebsiella pneumoniae and E. coli primarily. They'll end up fermenting the food you eat, in particular foods high in prebiotic fibers known as FODMAPs, and creating lots of gas, which is why the absolute most common and determinative symptom of SIBO for me, without which I look to other causes, is bloating. For some people, it tends to increase throughout the day, with dinner being the worst meal, usually because it's the largest. But some people say that they end up bloated even from drinking water. But unless you've severely restricted your diet, with SIBO, the bloating is ever-present at almost all meals. Other common symptoms of SIBO include getting full fast, having a smaller appetite, alternating constipation and loose stool, which can happen if you have EMO, intestinal methanogen overgrowth, and SIBO, excessive burping, abdominal discomfort or cramps, food sensitivities, deficiencies in B12 and iron, urine or signs of that on blood tests, and fat malabsorption. If left unaddressed, SIBO can potentially lead to more serious conditions like autoimmune disorders, mental health issues, skin issues, or systemic diseases like fibromyalgia or chronic fatigue syndrome. They used to delineate SIBO into SIBO-D for diarrhea, SIBO-M for mixed type, meaning diarrhea and constipation, and SIBO-C for constipation. But now they've renamed SIBO-C-EMO or IMO, intestinal methanogen overgrowth, because methanogens can be overgrown in the small or large intestine and cause similar symptoms, and because methanogens aren't bacteria, they're archaea. And they've also just renamed hydrogen sulfide SIBO, or H2S SIBO, intestinal sulfide overproduction, or ISO, I-S-O, because it can also be present in the large intestine as well. And SIBO-M, or mixed, would now just get you 2 diagnoses amongst the 3: EMO, SIBO, or ISO, depending on what the symptom was and the actual bacteria causing it. So EMO is a different beast because it's characterized by an overgrowth of specifically methane-producing organisms called methanogens in the intestines, which are from the kingdom Archaea, which are single-celled organisms that differ from bacteria enough to warrant their own kingdom. The singular of Archaea is archaeon, and archaea are known for their ability to survive in extreme environments like hot springs, hydrothermal vents, and our digestive tracts. Unlike bacteria, archaea aren't susceptible to most types of antibiotics, which is why people who've taken lots of antibiotics may end up with an overgrowth of methanogens. Methanobrevibacter smithii is the best-known methanogen and primarily responsible for EMO. EMO always presents with constipation and lots of painful bloating and distension as well, although not everyone with bloating has EMO or SIBO for that matter. Some people are just so constipated and backed up that they're bloating because gas is simply getting stuck in their systems, and once cleared out, the bloating clears. In theory, you might smell methane gas, which is a more metallic-smelling gas, in EMO, but in my experience, people will sometimes have smelly gas with it and sometimes not. And often it depends on what they're eating. Emo is definitely more common in people on a more plant-based or vegan diet because methanogens like carbs, and for that reason also hard to get rid of for people who want to stick with that diet. Then the final type, hydrogen sulfide SIBO, now called ESO, can be present in the small intestine, usually due to an overgrowth of Dysulfovibrio, Fusobacterium, or Proteus mirabilis, the latter in particular in the small intestine but also in the large intestine. I've heard Bilophila wadsworthii as another hydrogen sulfide producer, which it is, but don't see it mentioned in Dr. Pimentel's most recent work as a likely culprit in ESO. Dr. Pimentel's group has experimented with giving Dysulfovibrio and Fusobacterium species to rats and has successfully provoked diarrhea in them, which is the most common presentation of ESO, but not the only one. I have seen cases of ESO that present as constipation, which can happen when the overgrowth is in the colon. Not the small intestine, and also when it co-occurs with emo. This often presents as someone who's constipated most of the time but occasionally has a bout of bad diarrhea, but it's usually diarrhea in the case of ESO that has a sulfury rotten egg smell at least some of the time. Along with diarrhea, ESO sufferers will often mention a painful gurgling gut known as increased visceral sensitivity, horse bloating, excessive burping, urinary urgency, a burning bladder or an interstitial cystitis, systemic inflammation, rampant food intolerances, and often histamine reactions after eating. You might also see weight loss, postprandial hypotension, meaning low blood pressure after meals, an elevated heart rate, exercise intolerance, brain fog, or insomnia. And I did a whole episode on hydrogen sulfide SIBO or ESO. It was episode 114, so do check that one out if you want to dig more in on that topic. Then there's also the possibility of an autoimmune component to SIBO or ESO, but much less common in EMO, although I have seen it. I did a whole episode on recurrent SIBO that details how that happens, but suffice it To say, if your SIBO or ESO goes away after antibiotics for SIBO, like Rifaximin or herbal antimicrobials, but then comes back after 2 to 4 weeks, then you likely have the autoimmune kind. If your EMO comes back or never goes away after treatment, you likely just need a stronger or longer course of treatment. As I mentioned before, there are numerous potential root causes of SIBO, EMO, and ESO. Beyond food poisoning, some of these causes stem from impaired digestion, such as low stomach acid or hypochlorhydria, which is crucial for breaking down proteins into amino acids. There may also be a deficiency in pancreas pancreatic or brush border enzymes, which can result from conditions like celiac disease. Enzymes play a key role in breaking down all types of foods, so when food isn't properly digested, it can fuel bacterial overgrowth. Other root causes include low secretory IgA, a key component of the gut's immune defense, often depleted by chronic stress, or poor bile flow, which is essential for fat digestion and also for killing pathogens. So if you've had your gallbladder removed, which stores bile produced by the liver, it's likely that there is a bile insufficiency. In addition, certain medications such as opiates, antidepressants, proton pump inhibitors, cholesteramine, GLP-1 agonists, antibiotics, narcotics, and antispasmodics can trigger SIBO or IBS-like symptoms or SIBO itself, even once you stop them. Physical conditions like Ehlers-Danlos syndrome, which is associated with extreme flexibility, adhesions from abdominal surgeries, endometriosis, or ileocecal valve dysfunction can contribute to SIBO as well. Environmental factors like mold toxicity or underlying health issues such as diabetes, prediabetes, hypothyroidism, and even traumatic brain injuries may also be at the root of SIBO. But the most common trigger is autoimmune dysfunction caused by a bout of food poisoning, which disrupts the migrating motor complex. Now that we have a basic understanding of SIBO, SIBO, and SIBO, we can differentiate between those disorders and dysbiosis. Dysbiosis refers to an imbalance or disruption in the normal composition of the gut microbiome. And it occurs when harmful bacteria, fungi, parasites, viruses, or other microorganisms outnumber beneficial ones, leading to various digestive and systemic health issues. Unlike SIBO, EMO, and ESO, which are more specific conditions involving bacterial and methanogen overgrowth, which we've now targeted to specific bacteria and methanogens, and that people can often have for years without getting treatment, dysbiosis is a broader term that encompasses any microbial imbalance in the stomach or intestines, some of which may necessitate more urgent treatment. Symptoms of dysbiosis can include bloating, gas, diarrhea, loose stool, constipation, reflux, stomach pain, abdominal pain, and more systemic issues like fatigue, mood changes, skin issues, or weight changes. Dysbiosis often overlaps with conditions like SIBO, EMO, and ESO, but is a more general term for disrupted gut environments. Dysbiosis can be caused by multiple factors, oftentimes distinct from those root causes of SIBO and friends, which I'm going to use to refer to SIBO, EMO, and ESO from here forward. Single organism bacterial infections, for example, can cause dysbiosis in the gut. The presence of harmful pathogens like Clostridium difficile, abbreviated as C. diff, or Campylobacter can lead to an imbalanced GI system, especially when there are predisposing weaknesses in the digestive process, like low secretory IgA, your gut immune defense system, or few beneficial microbes due to a poor diet or the use of antibiotics. C. diff is a bacterium that causes diarrhea and colitis, or inflammation of the colon, and explosive all-day diarrhea. Which causes about 30,000 deaths in the US annually. C. diff germs spread via stool, but can also be found in the environment, living on surfaces or in soil. People with already weak immune systems or people who are taking antibiotics are more likely to become sick after ingesting C. diff spores and are therefore more likely to develop a dysbiosis in the gut. Campylobacter is another bacterial diarrheal illness, but is often spread from animal to human as chickens, cows, and other animals can carry it without becoming sick. Humans can contract Campylobacter by eating raw or undercooked meat or seafood, drinking untreated water or touching certain infected animals. After coming into contact with Campylobacter, there's a risk of becoming sick and developing a dysbiotic gut. And there are a number of other single organism bacterial infections that are not dissimilar to those two, C. diff and Campylobacter, including Enterohemorrhagic E. coli, E. coli O157, Enteroinvasive E. coli/Shigella, Enterotoxigenic E. coli LT/ST, Shigella-like toxin E. coli, Salmonella, Vibrio cholerae, and Yersinia enterocolitica. Other infections like those caused by parasites can also attack a healthy gut, creating dysbiosis. One example is Giardia, a protozoan parasite that lives in the intestines and is often contracted through contaminated water or food. Other protozoan parasitic infections include Cryptosporidium, Entamoeba histolica, and certain subtypes of Blastocystis hominis. Other parasites are worms called helminths. These include parasitic worms like tapeworms, roundworms, and hookworms that can affect the intestines, causing symptoms like diarrhea, abdominal pain, malnutrition, and weight loss. And the worms can be contracted through undercooked meat or contaminated soil. Although you may have heard that some people are using helminths as a therapy to treat an overactive immune system manifesting in allergies, autoimmunity, and/or migraines. And I've been trying to get someone on the podcast to discuss helminth therapy for ages, but an expert on this keeps eluding me. And then there are, of course, viral illnesses that can manifest in GI symptoms like norovirus, rotavirus, adenovirus, astrovirus, picoburnavirus, cytomegalovirus, and even COVID-19, which has even been found to cause gastric ulcers in a small number of cases. In any case, all these organisms can contribute to dysbiosis, and their presence may make other infections or dysbiosis appear or get worse. And if overgrown bacteria and parasites weren't enough, you can also have fungal overgrowth contributing to dysbiosis, and often present in biofilms with bacteria. SIFO is an umbrella term that refers to small intestine fungal overgrowth, which is caused by Candida, although there are different types of Candida that can overgrow, like different species. Candida naturally lives on your body, in your mouth, on your skin, and in your intestines, but it can become unhealthy when it's overgrown, often caused by the use of antibiotics, which deplete beneficial bacteria, allowing the yeast and harmful bacteria to thrive. And then also, of course, a poor diet of processed foods, sugars, and additives can also contribute to dysbiosis. And you can learn more about additives and preservatives in episode 128, which covers those in detail. So when Candida becomes overgrown in the gut, or even extending into the bloodstream or other organs, it's called systemic candidiasis. Candida is also the cause of oral thrush, which you can see when you have a thick yellow or white coating on your tongue in the morning, and vaginal yeast infections, which cause itching, redness, pain with intercourse or urination, and a cottage cheese-like or off-color discharge from the vagina. I often suspect candidiasis if there have been lots of antibiotics plus one of these other types of bodily Candida, including fungus in the toenails, and in people who tend to run cold or have cold hands and feet, as Candida thrives in a cooler environment. And sometimes dysbiosis isn't caused by any one single pathogen, but just shows up on a stool test as a gut that's depleted of most of the keystone beneficial species, but enriched in one or more of the opportunistic bacteria or genuses of bacteria that aren't problematic unless they overgrow, like certain Bacillus species, Enterococcus faecalis, Enterococcus faecum, Morganella species, Pseudomonas species, Pseudomonas aeruginosa, Staphylococcus species, and Staphylococcus aureus in particular. And then Streptococcus species. Although I have to say, I see very few guts that don't have at least one of those overgrown. And there are also opportunistic bacteria that are associated with autoimmunity that can overgrow, including Citrobacter species, Citrobacter fringii in particular, and Klebsiella species, M. avium subspecies paratuberculosis, which is associated with Crohn's disease, Proteus species, and Proteus mirabilis in particular. However, these dysbiotic bacteria may not present with bloating and are usually overgrown in the colon, or at least that's where the sampling is taking place when you do a stool intestine where I'm seeing them. And Dr. Pimentel's work on SIBO shows that what's going on in the small intestine in SIBO, as measured by an aspirate of the contents of the small intestine, is completely different from what's found in the stool, which better represents the colon's contents. And I think it's worth distinguishing between SIBO and friends and dysbiosis, because although they may present similarly in the body, they are distinct with different causes, testing, and treatments. Breath tests are recommended as the first line of testing for SIBO, ESO, and EMO, because they're the only way to access what's going on in the small intestine. Patients will take a sugar solution and their breath is analyzed at 15 or 20-minute intervals for 2 to 3 hours to measure hydrogen and methane levels. Lactulose and fructose are the best two substrates to use for the sugar solution for testing, at least according to Dr. Jason Haralak's work, but glucose has been used historically and lactulose is only available by prescription in the US. Currently, I think the best choice for breath testing if you suspect hydrogen or methane is the FoodMarble device you can buy and reuse, which I did a deep dive on in the last episode, and the Triosmart test, which is the only test that includes hydrogen sulfide currently. I have had issues with breath tests and clients though, as many times the testing returns invalid results for some of the specimens sent in, which seems to happen a good bit on the Triosmart. I think probably because it's, it's very sensitive testing for hydrogen sulfide. And I often get negative results, but the symptoms are so specific to SIBO, and then the client responds to SIBO treatment, so I assume the test was wrong. And you also have to be careful that you're instructed to take the correct amount of substrate. Since I only recently started using the FoodMarble with clients— normally I would just, you know, send them to do the test, and how it was done was not something I was that concerned with— I only recently started doing more research on how much of these sugars to take before the test. As I described in my last podcast, I got the Arrow Diagnostic test and did the FoodMarble at the same time. But the Argo diagnostic test had come in the mail because my doctor's office had sent in an order, and they sent a pack of glucose with instructions to take a certain amount based on my body weight. So I ended up taking 22 grams of glucose, only to learn later that the consensus— and I'll link to this in the show notes— on the amount of glucose to take is 75 grams, not 25 or 22. So no wonder I got a negative result. The consensus for fructose is 25 grams, and lactulose is 10 grams. All are mixed in 1 cup of water. But apparently fructose catches a lot more cases of SIBO. So now I'm instructing my clients to take fructose as their substrate unless they live somewhere where they can access lactulose easily. And I should also mention that testing for the elevations in antibodies to the bacteria that cause SIBO, called Cytolethal Distending Toxin B, or CDTB, and to the protein in your body responsible for the migrating motor complex that resembles that bacteria, vinculin, is not only another way to test for SIBO, but also to test for whether you have autoimmune SIBO or officially called post-infectious IBS. The first test of this kind was developed by Dr. Pimentel's group, and it's called the IBS Smart Test, although there's at least one copycat test out there. I knew I had recurrent SIBO for years, but it was only when I saw that my vinculin antibodies were elevated on this test that I knew officially why my SIBO kept recurring. Apparently, the Pimentel group is studying something to bring down these antibodies and ultimately cure SIBO. I'm not sure what. But I think my next personal experiment will be to try LDN, or low-dose naltrexone, which I suspect is what they're testing, a prescription drug that you can get with an online doctor, which has been successful in lots of other types of autoimmunity for bringing down antibodies. Anyway, despite current recommendations, I sometimes prefer a stool test like the GI-MAP, US Biotech GI Advanced Profile, GI Effects, or Tiny Health Pro if I suspect hydrogen sulfide or methane overgrowths, that is ESO or EMO. And sometimes I think it's best to order both the SIBO breath test or the FoodMarble and the stool test if I suspect multiple pathogens. Stool tests have PCR or metagenomic shotgun sequencing data that will tell me the levels of specific pathogens like Desulfovibrio pyger, Bilophila wadsworthii, Proteus mirabilis, Fusobacterium, and Methanobrevibacter smithii that can point me to the likely cause of someone's distress. And then of course, if you want to test for candidiasis, you need to order an organic acids test test, preferably with the marker arabinitol or D-arabinitol, the most validated marker of candidiasis, as Candida rarely shows up as positive on a stool test. I also like that the stool tests I just mentioned include markers of intestinal health, which gives me an idea of whether someone's digestion is impaired, if they have sufficient pancreatic enzymes, fat in the stool, sufficient secretory IgA, elevated markers of inflammatory bowel disease like calprotectin or lactoferrin, or low levels of short-chain fatty acids like butyrate. Most tests also have at least one marker of gluten sensitivity, which when discovered can really turn things around for some people. So to finish up, I wanted to share a case study of one of my clients who had a few different types of dysbiosis without having SIBO, EMO, or ESO, because there are a few good lessons to learn related to why testing is so important before being treated. So he came to me with diagnosed gastritis, which is inflammation of the stomach, GERD, or reflux manifesting as spitting up after a meal, constipation, a white coating on his tongue, shortness of breath, tightness in his jaw, pain between his shoulder blades, cramping in his hands and shooting pain down the arm that came after eating, headaches, dark urine, a funny body smell, dizziness, low blood pressure overall but episodes of high blood pressure, tinnitus, insomnia, and internal hemorrhoids and diverticula which were found during a colonoscopy, which are small pouches that form in the colon's muscular wall that can get infected causing diverticulitis, plus undesired weight loss. He didn't describe bloating as an important symptom, so I chose the route of a stool test, and we did the US Biotech GI Advance Profile, which is one of my new favorites because it includes zonulin, a marker of leaky gut, and the short-chain fatty acids, and H. pylori and its virulence factors, which tells you whether the H. pylori could cause an ulcer or stomach cancer. And its price is in between that of the GI-MAP and the GI-FX, but it has more markers than both of those tests. So what showed up on his test was whipworm, which is a parasite, high Streptococcus species, high Fusobacterium species, which I really don't like people to have much of because certain members of that species, in particular Fusobacterium nucleatum, is associated with cardiovascular disease, rheumatoid arthritis, respiratory tract infections, Alzheimer's disease, colorectal cancer, pancreatic cancer, and inflammatory bowel disease. And most of his commensal bacteria levels were low, but he had high Clostridium species but not C. diff. Which can constipate. In terms of digestive health markers, he had low butyrate despite being constipated, high calprotectin, a marker of inflammatory bowel disease, although that wasn't diagnosed in his recent colonoscopy, so I assumed that that was not actually in this case showing inflammatory bowel disease, high zonulin, meaning a leaky gut, low pancreatic elastase, meaning not enough enzymes being produced by his pancreas to digest his food, and high beta-glucuronidase, which can put you at risk for colorectal cancer and for women, breast cancer. And I want to pause a moment and say, if you have high beta-glucuronidase on a stool test and have a history of breast cancer or colon cancer, this is a marker that says that your gut is dysbiotic and has too many of the wrong bacteria that are producing this molecule that will untag estrogens and toxins from your bile and send them back into circulation. These toxic forms of estrogen are what causes some breast cancers. So thank your lucky stars that you took the stool test and you know what's going on, but take it very seriously if you want to prevent a recurrence of breast cancer. I have a client who was in this very situation, and I recommended interventions including a vegetarian low-fat diet to help turn it around and educated her on the supplements to prevent recurrence and to bring down that beta-glucuronidase and change her gut microbiome. But I then didn't see any of them purchased on Fullscript. Maybe she found them elsewhere, I don't know, but she didn't respond to any of my follow-up emails. Who knows where she was in the disease process at the time I saw her, but she contacted me about 10 months later diagnosed with stage 4 metastatic uterine cancer. So please everyone, if you get a high level of beta-glucuronidase on a stool test, take it seriously. See someone who understands the marker, follow their instructions, and retest after doing interventions. I had a little bit elevated beta-glucuronidase on my last stool test, and I markedly decreased my meat and saturated fat intake and went on 4 different supplements to counteract it. Sorry, fat interlude, but sometimes gut stuff can be a signal for much more important things, so I don't want you to blow off gut-related recommendations. Anyway, back to my original client. We also did a NutrEval test because of the all-over body complaints, weight loss, and to check on Candida because the white coating on his tongue. I won't go into all the details of everything we found, but he did have high arabinitol on the NutrEval, which means he had systemic Candida. So one of the first things I taught this client about was SBI powder because that's safe to start with even before you know what's going on. So he opted to get on that right off the bat, which helped him feel much better even before he got back his test results. It works by adhering to gut pathogens of various types and ushering them out in the stool. Then my usual go-tos for constipation are magnesium citrate and vitamin C, so he opted to take those to get his bowels flowing better. And he ended up getting antiparasitic medication from his doctor to treat the whipworm, which is usually easier as prescription worm treatments in my experience are just one or two pills for a few days. Then I educated him on how multivitamin and vitamin D and K would help in bringing up his own immune system to fight infections. With vitamin D, I always recommend testing 6 months later, then adjusting to hit optimal levels. And I always recommend taking D with K, preferably MK-4, as it's the form our body makes, in order to direct the calcium the D will help you absorb to your bones and not to your arteries. An optimal level of vitamin D is 50 or 60 to 80 ng/mL. So after testing, you can adjust your dose. Most people settle on a dose of 3,000 to 5,000 IU a day to maintain that optimal level, but usually start around 5,000 IU a day just to bring it back up. Then I taught him about digestive enzymes to help when pancreatic elastase is low, and most importantly suggested a high-fiber vegetarian diet and calcium D-glucarate for high beta-glucuronidase. I also educated him on how Iberogast can help with reflux after meals and Sliprium can help with healing the lining of the digestive tract, and my favorite all-around probiotic, Seed Symbiotic, which can help bring up commensal bacteria levels and better shape the microbiome to reduce beta-glucuronidase. But keep in mind, most probiotic species are transient and don't settle in the gut, pass through, making your microbiome healthier as they go. Given his low butyrate levels but constipation, I also taught him about how a one pill of a low-dose butyrate or Tributrin supplement every 1 to 3 days can help heal the lining of the colon. This is a situation where I don't recommend my own Tributrin supplement, Tributrin Max, but rather another Tributrin supplement in the 300 to 500 mg range, and usually starting every 3 days and up to once a day because it does have a constipating effect. And then perhaps the most important part, along with a high-fiber diet, is a gut shake that I shamelessly stole and adapted from Mark Hyman's recipe to bring up commensal bacteria. In this client's case, his shake included doctor-formulated fiber, pomegranate powder, cranberry powder, matcha powder— these are all good polyphenols that help promote healthy bacteria— L-glutamine, collagen peptides, continuing on the SBI powder to keep the pathogens at bay, and added NutraFlora FOS, a prebiotic that helps bring up beneficial bacteria in order to bring down beta-glucuronidase and freshly ground flaxseed, which may have related to specific bacteria we wanted to bring up. And then add frozen fruits and water and your favorite milk, and voilà. He told me he loved the smoothie. I also taught him about how adding creatine and branched-chain amino acids could help with building muscle, which was based on his test results, which didn't indicate his general amino acid deficiencies. Now, one particularly interesting thing about his case was that after he was feeling way better from all this and most of his symptoms were gone or improved, he took a trip to Costa Rica and Panama and got food poisoning from some seafood. Now, I did suggest he take some SBI powder and sprinkle it on all his meals to try to avoid traveler's diarrhea, which he did. But sometimes the pathogens are stronger than the amount of IgG you can throw on it. So he and his companion did have one day of diarrhea, but it did not continue. So when he came back, he was retested, incidentally after a round of antibiotics for an unrelated thing, and I'll get back to why these antibiotics were ill-timed in a minute. So on the retest, his butyrate was high now, pancreatic elastase was almost to optimal levels, his zonulin was normal now, so no more leaky gut, his beta-glucuronidase was normal, but he had a new marker that was high, steatocrit, which is indicative of fat in the stool, which was likely coming from the Enterohemorrhagic E. coli, which was highly elevated on his test, which must have been the source of the food poisoning. Now back to why the antibiotics were ill-timed but fortunately didn't have a bad effect in his case. When you have enterohemorrhagic E. coli, taking antibiotics can destroy that bacteria, causing a release of even more toxins, which can cause something called hemolytic uremic syndrome, which is from the toxins damaging and inflaming the small blood vessels throughout the body, which can cause clots to form in the blood vessels, which can damage the kidneys and other organs, and in the worst cases can lead to kidney failure and be life-threatening. Bloody diarrhea, abdominal pain and cramping, fever, vomiting, loss of color in the skin, easy bruising or bleeding, swelling in the hands, feet, ankles and high blood pressure are some of the signs of hemolytic uremic syndrome. Do get help immediately if you're having those symptoms. Now, fortunately, in his case, he was taking the SBI powder the whole time, so he was protected from these toxins as the SBI powder binds to them. And it's a great thing for continuing to fight off the E. coli even after that. So he just chose to stay the course on SBI powder. So if you're planning a trip to a developing country that doesn't have great water or food sanitation, I can't recommend SBI powder enough as a preventative measure and as a possible treatment if you do get sick. And then not just taking antibiotics without knowing what you're treating because of the possible danger of hemolytic uremic syndrome. If you have a diarrheal illness, getting liquids and electrolytes and letting your body fight it is the best plan if you don't have something on hand to deal with it and can't get tested. But if it doesn't subside after several days, getting tested before treating it is recommended. Other things to note on the retesting were that his Staph species were back to normal and his Fusobacterium species were now at normal levels. They had been at 30 × 10⁴ and now they were only at 1.33 × 10⁴. Forth. An interesting thing to note, even though he still had the Enterohemorrhagic E. coli elevated at the time of testing, he had returned to being constipated, which is interesting for a diarrheal illness, right? But it was likely because the levels had already come down a lot from the original infection, and his Clostridium species were high, which can be constipating. So it wasn't a perfect resolution quite yet, but I like this case as a demonstration of the fact that, one, diarrhea can come from all sorts of different sources that aren't SIBO, and you need to know what you're treating. To treat it safely unless you're going to choose something, you know, super safe and harmless like SBI powder. Number 2, constipation can be present for many reasons, from a magnesium deficiency to high levels of constipating bacteria that aren't methane producers to typical emo, which he had none of it in his gut, by the way. And 3, you never know when you're going to find a parasite, although honestly I would say that I've only seen parasites show up on about 5% of all the gut tests I've done. Now, some people will argue that they're lodged in the digestive tract or under biofilms or otherwise hiding, and we all have them, and maybe that's the case. I'm not sure, but in terms of testing results, that's what I found. So if you do try everything to deal with digestive symptoms and aren't having any luck, aren't seeing any SIBO or other dysbiosis, there's no mold in your background or other potential problems, and even if you don't see this parasite on stool test, you may want to try taking some antiparasitics. And for this, I'm a fan of the Cellcore Biosciences Para-1 and Para-2 products. So that's all for today. If you're suffering with any of the symptoms I mentioned in this podcast, I see individual clients to help them resolve their digestive issues, and you're welcome to set up a free 30 a 15-minute breakthrough session to see if you'd like to work with me. There's a link to that in the show notes, as well as links to articles and products I've mentioned in this podcast. I also have my own two products, Tributrin Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up stool, and SBI Powder, which is an all-around gut pathogen binder, which is super safe and won't harm beneficial bacteria. It's usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs. Links to those two are in the show notes, or go to perfectstool.com. Com. If you'd like to support the podcast, you can buy supplements at a discount from my Fullscript dispensary, order tests at a discount from my Rupa Health Lab store, or use my affiliate links to iHerb, which is available worldwide, or Amazon. And not just for supplements, so please bookmark my Amazon link and use it whenever you buy on Amazon, especially as we head into the Christmas season, or become a regular supporter on Patreon. If you'd like to connect with me online, you can follow my High Desert Health Facebook page, join my Gut Healing Facebook group, or join my newsletter list at highdeserthealthcoaching.com, as well as follow me on Instagram, X, TikTok, or Pinterest. Links for those are in the show notes. Thanks for joining me today, and here's wishing you all the perfect stool.