Abnormal Lactulose Hydrogen Breath Test

[nuwavemomma]

I thought for sure there'd be a thread somewhere discussing something to do with this topic.... but no.

So I just got these results back after dealing with symptoms for a year now. This test was a last ditch effort, after the GI Dr. got his endoscopy and all that... :/

Anyway, they are wanting to wipe out the slate with abx and then start me on a massive probiotic routine. I tend to feel abx is not the way to go, but then again, I don't know what specific bacteria is implicated here.

I guess this is a shot in the dark, but does ANYONE know anything about this at all?

TIA!

[JaneS]

It means you have bacterial growth in your small intestine sometimes referred to as SIBO. A functional medicine doctor, instead of mainstream, would have you do a CDSA, Comprehensive Digestive and Stool Analysis and probably food allergy testing. I think Genova lab's CDSA also comes with natural remedies that are targeted for the particular bacteria that is found. But then again, natural remedies like Oregano oil can just be natural antibiotics too and not necessarily fix the condition by themselves.

What symptoms?

Have you investigated food allergies/intolerances?

How do you do with digesting lactose?

I think that diet changes, digestive enzymes, possibly betaine hydrochloric acid tablets, some gut healing supplements such as zinc, glutamine, magnesium and cod liver oil... and yes, very good probiotics, can do quite a lot for this condition rather than antibiotics.

I also think that high protease enzymes taken in between meals can be helpful for this condition as well. Karen DeFelice's book "Enzymes: Go With Your Gut" and her site www.enzymestuff.com might be helpful.

Even C. difficile, one of the worst bad bacteria out there doesn't have a good track record of being 'cured' with antibiotics. At least they are recommending probiotics, which ones do they rec?

[nuwavemomma]

Hi, I appreciate you taking the time to respond.

I've had symptoms for a year now. Initially, I had 6+ episodes of intense cramping burning generalized abdominal pain, enough to send me to the hospital for pain meds. Couldn't see any rhyme or reason to when the attacks were happening except that fiber was an extreme exacerbator. The pain of the attacks lessened in severity and then I spent months with painful attacks at home, unable to parent. Heat helped. Settled into a pattern of getting attacks around bedtime that kept me up all night and then fine by morning. In between attacks, really offensive smelling gas, consistently only at night.

Have been dairy-free over a year, since before this started because DD is sensitive to dairy. Onset was a period of very high emotional stress and also right at the point when I started drinking water kefir regularly, which I have since stopped.

I have never had food allergy testing, though I have several animal/plant allergies. Both my kids have food sensitivities that didn't show up on traditional testing. We're on Medicaid and it seems like RAST testing is the only kind covered. I'd love to do an ALCAT for our entire family, but there's just not cash for that.

I'm not sure how they rule out a functional or structural problem with this, but it would seem stupid to take antibiotics of any form not knowing if this is just going to keep happening, right?

They haven't told me which probiotics they want me to take yet. I have an appointment this upcoming week.

I will definitely be looking over that link, thank you. I've been trying to absorb the "Healing the Gut Tribe" thread, it's slow going though!

Thanks Jane!

[JaneS]

Yes it sounds bacterial. It certainly could be c. difficile.

The only probiotics I know of with clinical studies showing effectiveness at reducing c. difficile is Pharmax Intensive and VSL3. The latter can be had by prescription so I think it might be worth it to ask your dr. for that one as it may be covered by Medicaid. Also the beneficial yeast, Saccharomyces boulardii maybe helpful. Did the water kefir help you? Kefir has beneficial yeasts, but personally water kefir did squat for me, not sure if it just wasn't enough of a dose or what.

I'd be asking the dr. exactly what bacteria you have and how effective the antibiotic has been shown to be against it. Ditto the probiotic they rec. The antibiotics "of last resort" are Vancomycin and Cipro. They really REALLY mess up your gut. If you do take antibiotics, I highly rec saccharomyces boullardii taken with your antibx, as it is a beneficial yeast it is not killed by the antibx. Then do very strong probiotics after you finish taking the antibx.

You might be interested in reading more about a mother's journey with c. diff and her son in the book "Bacteria for Breakfast" written by a pharmacist. She used VSL3 when multiple antibx courses couldn't cure it, it kept coming back. Naturally b/c if you wipe out a lawn and then do not reseed it with healthy grass, the weeds just grow back.

The thing with the immune system is that the gut flora is the gateway... you might have developed some intolerances that will not necessarily be IgE allergies as you seem to already be aware of. A slow and carefully done elimination diet might help you uncover your intolerances on your own. And digestive enzymes taken with meals, go slow, they can irritate an inflamed gut.

Gluten and casein are usually the first the body reacts to b/c the proteins cannot be fully broken down by an inflamed intestinal lining, the enzymes are not being produced, so I would first trial no dairy, no wheat and then go from there. The thing with food intolerances are that once you rebuild your gut lining, you most likely can start eating these foods again b/c your body can digest them, and your gut lining is not longer leaky.

Glutamine supplements and/or 24 hr. bone broths are very helpful for rebuilding gut lining.

The SCD diet might be helpful to you as well, eliminating hard to digest grains and sugars:
www.breakingtheviciouscycle.info

Feel free to ask more ?s and be sure to update after your appt, I'll be thinking of you.

[momofmine]

Oh Jane, I've been wanting to read that book, Bacteria for Breakfast!

[californiajenn]

I'll second mostly what Jane said.

I did not have an official diagnosis but 2 doctors agreed with me when I told them I thought I had a SIBO, in addition to other abnormalities.

I'm healing my gut by going on the GAPS diet; adding massive probiotics (bottled and just recently food due to sensitivities); cutting out most fruit and all sugar except honey, especially apples and pears (foods high in fructose are difficult for a damaged small intestine to process); getting on the proper supplements, including mag, trace minerals, Core Level Health Reserve, L-Glutamine/Permeability Factors, Digestive enzymes, etc.; restarting yoga to stimulate the nervous system to promote healing; and doing 1 round of Humaworm (I'll be doing another round in the next few months.) I'm sure there is other stuff I've done but that's the gist of it. I AM healing and it's very exciting.

Personally, standard western medicine was useless to me. If you decide to use antibiotics, please take probiotics (bottled and food) to replace the good ones. It's actually standard procedure in other countries. Also, be aware the bacteria is due to a damaged intestine and chances are, something else will crop up if you don't heal yourself.

Gluten intolerance is linked to a damaged small intestine so I'd get it out of your diet asap. http://coolinginflammation.blogspot....-and-galt.html

[BellaClaudia]

perfect replies.. not much to add aside maybe from
the fact that you might want to watch out for casein in more
then just stated above..

casein is a favoritive additive of MANY things like hotdogs, sausages
and other coldcuts.. by tons in it..

but there is more things that it is hiding..

there is an article here with link below showing source to all article

Milk has more casein than any other product. Most dairy products also contain high levels of casein, including eggs, butter, cheese, yogurt, ice cream, cottage cheese, infant formulas, whipped toppings, protein bars, salad dressings, coffee creamers, processed meats, bakery glazes and breath mints.

Casein should not be confused with whey, another protein found in milk and dairy products. When cheese is made, an enzyme called rennet is used. Casein is heavier than whey and often sinks to the bottom during the process. The whey is often removed completely. "

Read more: Foods Containing Gluten & Casein | eHow.com http://www.ehow.com/about_5369644_fo...#ixzz0vF3HuDN6

[nuwavemomma]

Wow, thanks for all your thoughts!

Originally Posted by JaneS

Yes it sounds bacterial. It certainly could be c. difficile.

The only probiotics I know of with clinical studies showing effectiveness at reducing c. difficile is Pharmax Intensive and VSL3. The latter can be had by prescription so I think it might be worth it to ask your dr. for that one as it may be covered by Medicaid. Also the beneficial yeast, Saccharomyces boulardii maybe helpful. Did the water kefir help you? Kefir has beneficial yeasts, but personally water kefir did squat for me, not sure if it just wasn't enough of a dose or what.

I'd be asking the dr. exactly what bacteria you have and how effective the antibiotic has been shown to be against it. Ditto the probiotic they rec. The antibiotics "of last resort" are Vancomycin and Cipro. They really REALLY mess up your gut. If you do take antibiotics, I highly rec saccharomyces boullardii taken with your antibx, as it is a beneficial yeast it is not killed by the antibx. Then do very strong probiotics after you finish taking the antibx.

You might be interested in reading more about a mother's journey with c. diff and her son in the book "Bacteria for Breakfast" written by a pharmacist. She used VSL3 when multiple antibx courses couldn't cure it, it kept coming back. Naturally b/c if you wipe out a lawn and then do not reseed it with healthy grass, the weeds just grow back.

The thing with the immune system is that the gut flora is the gateway... you might have developed some intolerances that will not necessarily be IgE allergies as you seem to already be aware of. A slow and carefully done elimination diet might help you uncover your intolerances on your own. And digestive enzymes taken with meals, go slow, they can irritate an inflamed gut.

Gluten and casein are usually the first the body reacts to b/c the proteins cannot be fully broken down by an inflamed intestinal lining, the enzymes are not being produced, so I would first trial no dairy, no wheat and then go from there. The thing with food intolerances are that once you rebuild your gut lining, you most likely can start eating these foods again b/c your body can digest them, and your gut lining is not longer leaky.

Glutamine supplements and/or 24 hr. bone broths are very helpful for rebuilding gut lining.

The SCD diet might be helpful to you as well, eliminating hard to digest grains and sugars:
www.breakingtheviciouscycle.info

Feel free to ask more ?s and be sure to update after your appt, I'll be thinking of you.

Thanks so much Jane.

So the GI said she very much doubts that it's c. Diff, and that she's seen a whole bunch of it lately. She also said she can't (doesn't?) test for what bacteria it is. She said it's native to my colon. I don't know how she can say that for sure. ??? At any rate, that book still looked full of good info, so I have a copy coming, thank you!

I'm not currently symptomatic. She seemed to indicate they view SIBO like GBS - they won't test me for it again, they'll just assume that's at play for me, and she said that it tends to recur. :/ Because I'm not in pain right now, she said I could do nothing, just do probiotics, or do antibiotics and probiotics. I don't want to carpet bomb with antibiotics at this point - she said they recommend Xifaxan if I ever want to go that route. For probiotics, they hand out coupons for Align at this clinic and call it a day. :/ I've had no luck giving them away even.


Oh, and water kefir definitely changed my BMs, like right away, drinking 2C/day. But I couldn't say if it was beneficial honestly, because it was fairly soon after I started making it that I had my first flare up, which then continued over the last year. I think it's not related, but in the back of my mind, there's always been a tiny doubt about whether or not I did this to myself using a bad culture. My dad *definitely* thinks that. I bought the starter from Fruit of the Vine Naturally, and it always seemed and tasted fine. I think it's just my "Sanitize Everything!" upbringing, still haunting me.

I've tried enzymes a few times and they left me doubled over with a heat pack for 30 minutes each time. I have no clue about how to start slowly with them. I assume I need to avoid them until I'm healed up a bit more. A quick question: if a person doesn't tolerate enzymes, does that generally mean the gut is inflamed? I'm actually thinking of someone else here who's had bad luck with enzymes. Just curious.

I have not done tons of bone broths yet, and in warm weather, oh it just doesn't sound appealing at ALL. lol I guess I'd rather supplement until it's not so hot in my kitchen. But I can certainly go GF and I'll look at SCD. You know, it's overwhelming. Just going DF has been a real challenge, so... all in I guess.



I will have to come up with a shopping list of my own apparently, so any further recommendations about where to start would be much appreciated!

Posted by californiajenn I'll second mostly what Jane said.

I did not have an official diagnosis but 2 doctors agreed with me when I told them I thought I had a SIBO, in addition to other abnormalities.

I'm healing my gut by going on the GAPS diet; adding massive probiotics (bottled and just recently food due to sensitivities); cutting out most fruit and all sugar except honey, especially apples and pears (foods high in fructose are difficult for a damaged small intestine to process); getting on the proper supplements, including mag, trace minerals, Core Level Health Reserve, L-Glutamine/Permeability Factors, Digestive enzymes, etc.; restarting yoga to stimulate the nervous system to promote healing; and doing 1 round of Humaworm (I'll be doing another round in the next few months.) I'm sure there is other stuff I've done but that's the gist of it. I AM healing and it's very exciting.

Personally, standard western medicine was useless to me. If you decide to use antibiotics, please take probiotics (bottled and food) to replace the good ones. It's actually standard procedure in other countries. Also, be aware the bacteria is due to a damaged intestine and chances are, something else will crop up if you don't heal yourself.

Gluten intolerance is linked to a damaged small intestine so I'd get it out of your diet asap. http://coolinginflammation.blogspot....-and-galt.html

You know what's frustrating here is that I had a endoscopy done and they told me they saw no damage in my villi. But how on earth can that be true? I mean, I don't know how far in they went. So it's possible then that they just missed it right? What informed your choice to try GAPS as opposed to SCD?



BellaClaudia, we've been DF for over a year but I'm sure there's always more I can learn! Thanks!

[JaneS]

Originally Posted by nuwavemomma

So the GI said she very much doubts that it's c. Diff, and that she's seen a whole bunch of it lately. She also said she can't (doesn't?) test for what bacteria it is. She said it's native to my colon. I don't know how she can say that for sure. ???

Native? don't know what the heck that is supposed to mean. Overgrowth of something that is supposed to be there? How is an antibiotic treatment recommended w/o knowing what you are trying to kill off?

Originally Posted by nuwavemomma

I'm not currently symptomatic. She seemed to indicate they view SIBO like GBS - they won't test me for it again, they'll just assume that's at play for me, and she said that it tends to recur. :/ Because I'm not in pain right now, she said I could do nothing, just do probiotics, or do antibiotics and probiotics. I don't want to carpet bomb with antibiotics at this point - she said they recommend Xifaxan if I ever want to go that route. For probiotics, they hand out coupons for Align at this clinic and call it a day. :/ I've had no luck giving them away even.

Well that is good re: symptoms. Then gut healing measures will probably have a good chance of helping.

Re: Xifaxan
36% improvement but needing more at the 2-3 month mark. Seems ridiculous to me to say this is "beneficial".
http://www.cbsnews.com/stories/2006/...n2096522.shtml

Apparently Align is the new marketed probiotic then.
Align is for the colon, not the small intestine. It was my understanding that SIBO stands for "small intestine bacterial overgrowth". Also clinical results don't wow me...

The improvement in global symptom assessment exceeded placebo by more than 20% (p < 0.02).
http://www.ncbi.nlm.nih.gov/pubmed/16863564

Originally Posted by nuwavemomma

Oh, and water kefir definitely changed my BMs, like right away, drinking 2C/day. But I couldn't say if it was beneficial honestly, because it was fairly soon after I started making it that I had my first flare up, which then continued over the last year. I think it's not related, but in the back of my mind, there's always been a tiny doubt about whether or not I did this to myself using a bad culture. My dad *definitely* thinks that. I bought the starter from Fruit of the Vine Naturally, and it always seemed and tasted fine. I think it's just my "Sanitize Everything!" upbringing, still haunting me.

I would think that a bad culture would smell or look bad since they are symbiotic organisms which make up kefir but you can't argue with experience, I would stay away from it. Did the problems start while you were drinking regularly or when you stopped?

Originally Posted by nuwavemomma

I've tried enzymes a few times and they left me doubled over with a heat pack for 30 minutes each time. I have no clue about how to start slowly with them. I assume I need to avoid them until I'm healed up a bit more. A quick question: if a person doesn't tolerate enzymes, does that generally mean the gut is inflamed? I'm actually thinking of someone else here who's had bad luck with enzymes. Just curious.

Yes, see Karen DeFelice's website
http://www.enzymestuff.com/discussionadjustments.htm

lots of info at that site and her books are very good too.

Originally Posted by nuwavemomma

I have not done tons of bone broths yet, and in warm weather, oh it just doesn't sound appealing at ALL. lol I guess I'd rather supplement until it's not so hot in my kitchen. But I can certainly go GF and I'll look at SCD. You know, it's overwhelming. Just going DF has been a real challenge, so... all in I guess.

Glutamine supplements (as a pp recommended Permeability Factors) or probiotics with glutamine added might be helpful to you. Glutamine and sulfur (can take epsom salts baths for bioavailable sulfate) are the key nutrients the gut uses to repair itself.

Originally Posted by nuwavemomma

You know what's frustrating here is that I had a endoscopy done and they told me they saw no damage in my villi. But how on earth can that be true? I mean, I don't know how far in they went. So it's possible then that they just missed it right?

Hard to know without knowing their diagnostic criteria. I know that the villi can be damaged but still present. Or gone, which reveals celiac disease. Maybe they don't differentiate and they saw something was there so just pronounced you "fine"?

A CDSA will reveal inflammation and other markers including beneficial and harmful bacteria.
http://www.genovadiagnostics.com/ind...&nav=test&id=4

A mainstream dr. would not be familiar with these types of tests.

[nuwavemomma]

Originally Posted by JaneS

Native? don't know what the heck that is supposed to mean. Overgrowth of something that is supposed to be there? How is an antibiotic treatment recommended w/o knowing what you are trying to kill off?



Well that is good re: symptoms. Then gut healing measures will probably have a good chance of helping.

Re: Xifaxan
36% improvement but needing more at the 2-3 month mark. Seems ridiculous to me to say this is "beneficial".
http://www.cbsnews.com/stories/2006/...n2096522.shtml

Apparently Align is the new marketed probiotic then.
Align is for the colon, not the small intestine. It was my understanding that SIBO stands for "small intestine bacterial overgrowth". Also clinical results don't wow me...





I would think that a bad culture would smell or look bad since they are symbiotic organisms which make up kefir but you can't argue with experience, I would stay away from it. Did the problems start while you were drinking regularly or when you stopped?


Yes, see Karen DeFelice's website
http://www.enzymestuff.com/discussionadjustments.htm

lots of info at that site and her books are very good too.




Glutamine supplements (as a pp recommended Permeability Factors) or probiotics with glutamine added might be helpful to you. Glutamine and sulfur (can take epsom salts baths for bioavailable sulfate) are the key nutrients the gut uses to repair itself.



Hard to know without knowing their diagnostic criteria. I know that the villi can be damaged but still present. Or gone, which reveals celiac disease. Maybe they don't differentiate and they saw something was there so just pronounced you "fine"?

A CDSA will reveal inflammation and other markers including beneficial and harmful bacteria.
http://www.genovadiagnostics.com/ind...&nav=test&id=4

A mainstream dr. would not be familiar with these types of tests.

I asked for a CDSA from the get-go and they "don't do them." ??? I just emailed the lab you linked to asking for a referral to someone local. I was hoping it was a mail-in test, but I'll take what I can get. Thank you!

Re: water kefir, symptoms started within maybe 2 weeks of starting to drink it. I started water kefir because I realized that my daughter was dairy sensitive. It's such a mystery.

Re: villi, they said, "no flattening." Beyond that I don't know.

I'm definitely going to be looking more at Karen DeFelice.

In your opinion, is there reason to wait on probiotics at this point assuming I find dairy-free ones?

Thanks so much Jane, it's really appreciated.

[JaneS]

The CDSA is a mail in test and it's in the "alternative medicine" catagory... you can order yourself at www.directlabs.com

Hmmm, that's weird re: kefir, but I do know that some people have healing crises related to clean out. It should have stopped when you stopped drinking it though.

I wouldn't wait on probiotics. Just start slow.