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New Treatment for SIBO and IBS-C—with Dr. Kenneth Brown


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As you know, I treat a lot of patients with gastrointestinal issues. Two of the most challenging conditions to treat are methane-predominant SIBO and constipation-predominant IBS. Join me as I talk with Dr. Kenneth Brown, a practicing physician and clinical researcher who has been specializing in treating these conditions for the past 15 years. We discuss the drawbacks of existing treatments and a new product that Dr. Brown has developed, called Atrantil.

Revolution Health Radio podcast, Chris Kresser

In this episode we cover:

  • 04:26 The problems with current treatments
  • 08:03 The underlying issues with IBS-C
  • 11:12 The connection between SIBO and rosacea
  • 12:25 The drawbacks to Xifaxan/rifaximin
  • 15:48 How Atrantil works
  • 21:08 Studies published on Atrantil
  • 25:36 Clinical pearls for treating with Atrantil

Chris Kresser: Hey, everybody, it’s Chris Kresser. Welcome to another episode of Revolution Health Radio. This week, I’m going to be talking with Dr. Kenneth Brown. He received his medical degree from the University of Nebraska Medical School and completed his fellowship in gastroenterology in San Antonio, Texas. He’s a board-certified gastroenterologist and has been in practice for the past 15 years with the clinical focus on inflammatory bowel disease and irritable bowel syndrome, or IBS. For the past 10 years, he’s been doing clinical research for various pharmacologic companies. It was during these years that he saw the unmet need for something natural that could help his IBS patients. He had been working on a development of Atrantil for the past six years and officially launched Atrantil one year ago. He developed this product with the intent of helping those suffering from the symptoms of IBS, which we now know are caused by bacterial overgrowth.

So, I reached out to Dr. Brown because we started to use Atrantil in our practice, at California Center for Functional Medicine, and had some good results with it, and there definitely is a lack of SIBO natural treatments that are effective and safe to use over the long term in general, but particularly for methane-predominant SIBO and also for constipation-predominant IBS. And when I learned about Atrantil and Dr. Brown’s work here and the research he has done on it so far, I wanted have him on the show to talk about it further. So without further ado, let’s dive in.

Chris Kresser: Dr. Brown, thanks so much for joining us. It’s a pleasure to have you here.

Dr. Kenneth Brown: Oh, Chris, thank you so much for having me on your show.

Chris Kresser: So I thought we could just start up with a little bit about your background and what led you into research on SIBO and IBS, particularly constipation-predominant IBS.

Dr. Brown: Yeah, so I’m actually a practicing gastroenterologist in the Dallas, Texas, area, and I’ve been doing clinical research for the last 10 years as well. This all kind of started when we were doing research for Salix at the time, on Xifaxan, and I think you’ve had, Dr. Pimentel was a guest on your show, and that’s when he and I came in contact and we were trying to help fill their study, and that’s when he noted that SIBO would be a really big problem, and it’s a very exciting time to be involved with it. He demonstrated with rat models at that time the difficulty it would be to get rid of bloating and constipation in all those people that actually have nothing, and the way that they were going really was not going to work with just the Xifaxan. So it was literally 10 years ago where I was like, “Wow!” So if we could figure out the methane aspect of this, we would really be onto something really cool and that’s initially where all the ideas kind of started.

The Problems with Current Treatments

Chris Kresser: Great. So, I’m going to step back just for my listeners who aren’t as familiar with all the terms we’re throwing around here, but many of you have been listening to the show for a while and know about SIBO, small intestinal bacterial overgrowth. You know that the small intestine normally shouldn’t have much bacteria, but occasionally it will become overgrown with bacteria, and that bacteria can produce hydrogen or some of the species of organisms which can produce methane. So, when you have SIBO, you can have a SIBO that’s hydrogen predominant, meaning you have mostly bacteria that are producing hydrogen, or you can have SIBO that is methane predominant, where you have mostly organisms that are producing methane gas, or you can have both, and they tend to present with different symptoms and they require different treatments. And so, part of the challenge here has been that the most effective treatment has been rifaximin [brand name Xifaxan], which is a drug that’s used to treat primarily hydrogen-predominant SIBO, and I think, if I remember off the top of my head, the efficacy of rifaximin for treating methane-predominant SIBO is only about 40 to 45 percent used, when it’s used alone. Does that match with your recollection, Dr. Brown?

Dr. Brown: Well, I think it’s a little bit less than that, actually. In their target studies that they just got published, they are 41 percent for the diarrhea predominant, which is how they got their FDA approval, and so we know that it’s a little bit less or significantly less when used alone for methane.

Chris Kresser: Wow. Yeah, that’s not very effective at all.

Dr. Brown: Yeah, so that’s actually why I’m treating all these people and they’re so frustrated.  As a gastroenterologist, I’m frustrated. As a patient, they’re frustrated, and that’s why we really started doing some of the research on this.

A promising treatment for SIBO and IBS-C

Chris Kresser: So, let’s talk a little bit about some of the other treatments for IBS-C and why they are lacking and why they haven’t been effective, because people are typically—a conventional gastroenterologist isn’t even necessarily prescribing rifaximin, they’re using other medications as a first line for this, right?

Dr. Brown: Correct. So, I see a lot of people that tend to fail other things, and one of the biggest issues is that almost everything out there is some form of laxative. Everybody’s focusing on colon, and you’re way ahead of the curve that already realizing that there’s a lot going on in the small bowel but needs to be addressed. But a lot of times, people say, “Oh, you’re bloated and constipated. Here, take this …” And so there’s lubiprostone, which is Amitiza. We’ve got Linzess out there. There’s a new one called Plecanatide, which is coming out. These all can help people go to the restroom, but they still feel very bloated and distended and have an “uncomfortableness,” so they get very frustrated with that.

Chris Kresser: And they’re not really addressing the underlying cause of the problem, which is perhaps the biggest issue.

Dr. Brown:  Correct. That’s the biggest thing. It’s that it’s just putting a Band-Aid on it and that’s why they get so frustrated and really start looking for alternative treatments.

Chris Kresser: I think there are even drugs for IBS-C in the past that had to be pulled because of severe side effect. I’m thinking, was Zelnorm one of those or—

Dr. Brown: Zelnorm was, and it was a good drug. We liked it. When it worked, it worked really well. And in fact, not to get off topic, that was when Pimentel first looked at Xifaxan. He was treating people with Xifaxan during the day and Zelnorm at night. That was his regimen because it worked as a phase III contractant. So yes, drugs have been pulled off because of that. When Zelnorm was there, it worked only 10 percent better than placebo, but when it did, it worked well.

Chris Kresser: Hmm-mm.

Dr. Brown: And that’s also one of the drawbacks that these products that are out there are really only slightly better than placebo and some of them can cause a ton of money.

The Underlying Issues of IBS-C

Chris Kresser: Right, right. Okay. So, we have a situation where the currently available treatments have been inadequate because they’re not addressing the cause or when they’re attempting to address the cause with rifaximin, they’re just not very effective at doing that when the cause is methane and the symptom is constipation rather than hydrogen and diarrhea, as is the case with IBS-D. So, let’s step back a little bit more and talk about the underlying causes of IBS-C. So if someone has IBS, they have constipation, the conventional paradigm, they’re labeled with this diagnosis, which basically just describes their symptoms, but there’s rarely any investigation into what’s actually happening under the hood, so to speak.

So you mentioned SIBO, but what about disruptive gut microbiome in general? Have you found that that’s an issue for these patients?

Dr. Brown: I think there’s so much overlap with this and what happens is, is that if somebody comes in and they go see a doctor and they end up maybe seeing even a specialist, like a gastroenterologist like myself, they get an endoscopy, colonoscopy, blood work. It’s normal and unfortunately, a lot of people get sort of patted on the head and said, “Oh well, you have IBS,” and the problem is, is that’s kind of a trashcan diagnosis. Really, anybody that has abdominal pain, if they got a change in bowel habits, then you qualify as having IBS. And once you get labeled, I think a lot of times doctors stop thinking about what else could be going on, and that’s where some of the functional approaches come in. What I tell my patients is that I do see a lot of people that actually improve when we do treat them with Atrantil, and what I tell them is, is that it’s possible that either you had an infection, took antibiotics, even went through a stressful situation and something shocks your small intestine. When that happens, bacteria can start to grow in that area. Then, every time you eat, specifically, starchy foods, then the bacteria will break down the food before you can and then that results in all the bloating and discomfort.

Now, the interesting thing is, I’m starting to see this very close link to where you’re going right here, which is the disruption of the microbiome. We now know that even a lot of research is showing that we’re having an overall inflammatory process that happens in the body. You can call it “leaky gut” if you want, you can call it “intestinal permeability.” Whatever you want to label it, we do know that people feel miserable beyond their intestines and that’s where—once you address that, and I said, “Look, it’s not in your head. We don’t just pat you on the head and say this. I really think that this could be going on and this could be leading to these symptoms, not only in your intestines but throughout your whole body.

Chris Kresser: Yeah. And that’s why there’s such high comorbidity with IBS and depression, anxiety, all kinds of other health conditions. It’s not because it’s just in their head, it’s that low-grade inflammation that’s happening in the gut that’s affecting it as you would expect it to every part of the body.

The Connection between SIBO and Rosacea

Dr. Brown: Exactly. I mean, we’re seeing people—and you’ve probably had the same results in the practice of functional medicine, people that have skin issues, once you treat them, certainly if you treat them from their intestines, their skin gets better. People that have restless leg, pelvic floor syndrome, all these other what we’re calling “trashcan diagnoses,” I’m seeing a lot of my patient gets better after we treat them.

Chris Kresser: Yeah. It’s really fascinating. I don’t know if you saw this, a recent follow-up from an original study that was done showing 100 percent correlation between acne rosacea and SIBO patients, and then they follow them for several years and found that 100 percent of people who successfully eliminated SIBO had a significant improvement in their rosacea. So, it wasn’t just an association, they actually were able to prove causality there, which is pretty amazing.

Dr. Brown: Yeah. I’ve had patients who have been to multiple dermatologists, and I had one patient that was so sweet. She drove in from Austin, which is four hours away just to let me know that she’d suffered from rosacea for about eight years, and after treating her SIBO with Atrantil, that went away and she drove in to tell me so that I could let other dermatologists know. I thought that was fascinating.

The Drawbacks to Xifaxan/Rifaximin

Chris Kresser: Yeah. So let’s talk a little bit more about rifaximin, which is the drug of choice for SIBO typically at this point, and one of the issues that we’ve already covered is that it’s not very effective for methane-predominant SIBO. But there are some issues too, like costs and insurance coverage and recurrence. Can you talk about those a little bit?

Dr. Brown: Sure. So, let’s look at the target studies. We just got Xifaxan approved by the FDA to treat IBS-D. In those studies, really, it was 41 percent effectiveness versus overall versus 31 percent. So we get a 10 percent than placebo. In defense of that in my practice, when I use it on the right person, my results are a little bit better in the IBS-D population. There is still almost 60 percent recurrence rate with these people, so they’re going to come back in and then you did mention that it is very expensive. If you don’t have insurance, it’s essentially cost prohibitive. If you do have insurance, it still can be extremely expensive with copays and such. So the problem is that … okay, let’s back up and talk a little bit, you had mentioned at the very, very beginning you’re telling your listeners about methane production. The issue and the problem that makes it hard to treat SIBO in the first thing is the location of it. It happens to be in the small bowel, but it happens to be intraluminal or inside the intestines, so a lot of the medications we’ve used in the past, metronidazole, sulfa drugs, things like that, those get absorbed so you have this system effect and little effect in the intestines. So Xifaxan, at least, is poorly absorbed, so it does seem to work in the right area, so the first problem is that. Now, the problem that Xifaxan runs into, is that the type of organism that’s actually producing the methane is called an archaebacteria. These are known as methanogens, and they’re actually really cool in the sense that they’re very old organisms. They’re in their own kingdom. They sort of constitute a domain in a kingdom of microorganisms where they don’t even have any cell nucleus or other membrane-bound things like other bacteria.

Chris Kresser: Right. They’re not bacteria, they’re not yeast (just to fill people in here) and they’re in their own place here taxonomically.

Dr. Brown: Yeah, so it’s interesting in that our modern-day antibiotics work in a way that does not affect archaebacteria. So let’s look at Xifaxan, for instance. Xifaxan actually works by binding to the bacterial RNA polymerase so that it doesn’t let the bacteria produce protein. So I think there was a paper that came out not too long ago where they talked about increased efficacy using guar gum plus Xifaxan.

Chris Kresser: Yeah, yes.

Dr. Brown: And that’s kind of interesting in the sense that the bacteria, the more active they were, the more they were absorbing both the guar gum and the Xifaxan because the Xifaxan had to be gobbled up.

Chris Kresser: Right. Dr. Pimentel put it, “You gotta feed ’em to kill ’em.”

Dr. Brown: Yeah. So that’s one of the things about archaebacteria is that it’s not going to do that. And so the exciting thing and one of the reasons why we developed this is that we don’t need the archaebacteria to be eating a whole lot because the way that the quebracho works and the conker tree is that it actually disrupts the methane production of it and it weakens the wall of the archaebacteria.

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How Atrantil Works

Chris Kresser: Cool. I mean, this is a good segue, let’s talk about Atrantil, and I’m glad that you pronounced it because now I know I was pronouncing it completely incorrectly in the intro.

Dr. Brown: Don’t worry. Even my patients that love it mispronounce it, I keep telling them, it’s like, “Ah, my belly feels better.”

Chris Kresser: Right. Okay. Great. So yeah, tell us a little more about how this fills the gap. You already mentioned two of the ingredients, but let’s start it with what’s in this and then what it does that other treatments are not doing right now.

Dr. Brown: So, what we developed is very specifically for this, and so the key to Atrantil is that the molecules work together and they stay intraluminal, meaning, they don’t really get absorbed or they’re very poorly absorbed. So the first ingredient is M. balsamea, which is actually peppermint leaf, so a very, very small amount of it. But we wanted to use the actual leaf instead of the oil because it has polyphenols in it, and the polyphenols are those molecules that are good for you that we find in the Mediterranean diet and such. That calms the area down and then it allows the other two ingredients to do their job. The second ingredient is something you probably never heard of and it’s called quebracho colorado, and what that is, is that it’s a very large flavonoid, which also is a polyphenol, and that comes through the intestine, and what it does is it actually soaks up the hydrogen and absorbs gas, and what’s that going to do is that’s going to starve the archaebacteria. And then it happens to be from the bark of a very old tree that actually has natural defense against fungus and archaeal species, which is why we chose that particular molecule, and so what it does is, as it comes with contact with archaeal species, it weakens the wall. Then the third ingredient, the conker tree, which is known as a saponin, does two things. It actually kills—it’s bactericidal, meaning it kills bacteria—but it very specifically can shut off the enzymatic production of methane from the archaeal species. So to sum it up, we got one ingredient that calms the area, the second one starves the achaebacteria, and the third one shuts off the methane production.

Chris Kresser: Makes sense given the pathology of SIBO and IBS, and you’ve done, I think, two papers on this. There it is, Atrantil. If only we have video, people could see that. You published a couple of research on this, with the second one very recently published—which I read, thanks for sending that. One thing, before we dive into the specifics of that, it stuck out in the second paper was that some researchers have suggested that people with IBS have a quality of life that is lower than people with type 2 diabetes and even end-stage kidney failure. I found that actually easy to believe having a lot of experience with IBS patients myself. It didn’t surprise me and yet it’s pretty remarkable when it’s phrased that way.

Dr. Brown: I try and reassure my patients. A lot of them come in and they feel embarrassed of the fact that they were told they have a functional disease yet they’re still miserable. And when we compare it to these other disease processes that sound very bad—CHF, congestive heart failure, arthritis, things like that, you can modify your life to adapt to that disease. The problem is, your intestines, once they’re in control, you can’t will it to not have diarrhea or to not bloat, to not pain. So it tends to own you, and that lack of control really wears on you and it’s almost like having chronic pain, and so I really empathize with my patients that have this as I know it’s very real and it’s linked to depression, it’s linked to all of those things.

Chris Kresser: I think it’s the number two cause of missing work too, behind the common cold, so this is definitely a serious problem that really wreaks havoc on people’s lives, and I’ve seen that. I’ve seen patients with just a “simple IBS diagnosis” that have pain 9/10 and have taken several trips to the hospital because they thought they were having appendicitis, when it just turned out to be gas pain or something related to IBS. So it’s definitely … it can be a serious problem.

Dr. Brown: Oh, for sure, not just for the patient but on the overall cost to our healthcare dollars. They’ve estimated that over 30 billion dollars a year are actually attributed to irritable bowel syndrome. This includes the patient going to the emergency room, getting CAT scan after CAT scan, which we know isn’t good getting, other tests done, doctor shopping, having some frustration. You know, we’re seeing this a lot. I think that we have shown that now you can have this post-infectious IBS, which essentially is SIBO. We have a lot of our veterans coming back, 20 percent of those veterans who get sick in a foreign land come back and then they sort of get shuffled around, and we’re now showing that it’s probably bacterial overgrowth and they get very frustrated and that’s a huge cost on the overall healthcare system, and so there’s a lot more than just calling this as a functional disease. This affects people’s lives, it affects people’s work, and everything—their relationships, all of it.

Studies Published on Atrantil

Chris Kresser: So tell us a little bit more about these papers. I think the first one was a clinical trial and the second one was a retrospective analysis.

Dr. Brown: Yes. So we have this brief … little bit of background on how we actually came up with these three ingredients. It’s always something that my patients want to know and it has kind of an interesting story. When we were looking at this, when we were doing research, I was writing on a dry erase board that ultimately methane was the answer and my research manager, Brandy Scott, she actually is a very bright woman. She was an attorney and then got her masters in political science, I said, “Look, Brandy, if we can figure out how to do to this, we could help a lot of these people with severe bloating.” She had been a policy writer for a senator in Iowa, and she went, “Holy cow, wait a minute. Back when I was doing some policy writing, they were trying to mandate how to decrease methane production in cattle.” She’s like, “I got a bunch papers on this on how to do it through food products” and that’s how it all started. So, that’s how we figured out that putting these ingredients would be the best combination on how to decrease methane. So that led to our first trial, which was a randomized trial. We’re just trying to have proof of concept on that, and we did a randomized trial, and that was published in the Journal of Gastroenterology and Hepatology in September 2015, and it was pretty remarkable. We ended up having bloating scores improving almost to 91 percent, constipation improved up to 77 percent, and we didn’t have a whole lot of side effects. So, we knew that we were really onto something really big, and that’s when I decided to put it to the test. As a clinical gastroenterologist, that’s pretty cool that it worked in a randomized trial, but we all know that randomized trials have their pros and cons. I just want to be able to treat these people who are frustrated coming in, so we did a retrospective study—right sort of people, 26 people that had failed everything else available. I mean, the worst of the worst, they had to have failed Amitiza, Linzess, GlycoLax, probiotics, and I’m a big Xifaxan writer, they had to have failed Xifaxan plus neomycin. So we took people that really were at their wits’ end, and shockingly, I gave you that paper there—or not shockingly I should say, that as we expected—they did equally as well. We had almost an 88 percent quality of life improvement. Bloating improved threefold. We had a threefold improvement … I’m sorry, bloating improved fivefold, pain improved threefold, constipation improved three-fold. So, super-exciting in the sense that we felt like, “Wow! Now we finally have something that we can actually help some of these people!”

Chris Kresser: Yeah, that is really exciting, and we’ve been using it in our practice and I’ve seen some good results so far. It’s pretty early in the game for us, so we don’t have as much experience yet, but we have definitely seen some improvement and I like the idea, as a functional medicine guy and someone who’s originally trained as an herbalist, before anything else, I’m definitely interested in botanical medicine, and I’ve seen the trial. There was one trial that compared the botanical protocol for SIBO with rifaximin, where the botanical protocol came out as performed as well or better than rifaximin with fewer side effects. And so, we have these amazing plant medicines available to us; we often forget about them.

Dr. Brown: Exactly, and I think that was the one out of Pittsburgh there. Yeah, I saw that. The only problem with that one was there was no real regimen for which antibiotics combination to use, I mean, herbal antibiotic combination to use. But I love seeing that an academic center is at least trying it and that’s awesome because a lot of times—and I’m just now really kind of getting involved with my functional medicine society down here, I gave a lecture—I really believe that there is some sort of Venn diagram where we can put this all together. Think of IBS and SIBO in one circle, think of leaky gut in the other, and then think of diet in the third, right there in the middle is the sweet spot. And I had so much fun being in a room full of functional medicine doctors where I gave a 45-minute lecture and we ended up with a two-hour Q&A where half of it was me asking them questions and their experience and what they have success with. I really think that we’re heading in the right direction as far as gut health, bringing a lot of gastroenterologists and MDs, speaking with naturopaths, speaking with dieticians because everybody just wants people to get better. That’s the bottom line.

Clinical Pearls for Treating with Atrantil

Chris Kresser: Yeah, absolutely. So, a lot of, about 25 percent of my audience actually, are healthcare practitioners of some sort. So for their benefit and for the patients, I’m curious just to know some clinical pearls that you’ve discovered over the last year or longer. I’m not sure how long you were using it before it came available, but what would you tell patients or clinicians who are treating patients some things to be aware of in terms of Atrantil. Like, did the people typically get better right away, or is there a Herxheimer type reaction in a lot of patients where they get a little bit worse initially and have what some colloquially refer to as a “die-off” reaction? What should patients and clinicians expect in terms of using this treatment?

Dr. Brown: Absolutely great question. I really kind of put these … I put each patient into two different categories. There are the ones that have mild disease or intermittent disease and they’re going to respond a little bit different, and then those are the ones that come to see me. And you probably get this a lot also, patients come to see you that you may be a second opinion person.

Chris Kresser: Yeah.

Dr. Brown: So by the time they come to see me, I’m really dealing with difficult people. So I’m going to start with that group first. What I have found is that depending on the bacterial load, really, we need to hit them hard and strong, just like we did in the original studies with Xifaxan, and that’s how I explain it to them. I said, I want you to do a course of this. I want you to take two capsules three times a day until you start feeling better, and clinically, I can say that now that we’ve been out for a full year, we’ve treated more than 40,000 people with this countrywide. We’re very open about having people contact us, give their experience. So we’ve sold 40,000 units in a little bit more than a year. We know that those people that have very, very tough-to-treat disease are really going to take 10 to 20 days to really start feeling better. So, 80 percent of those people are really going to start noticing that. Of those, I would say, and I warn all my patients about it, so I tell them that if they start feeling bad or start experiencing a die-off, that’s not necessarily a bad thing. I don’t want you stop. I want you to stick through it. I add a little bit of baby aspirin, which tends to help and they can get through it, and so they get very excited when they start to have that because they kind of feel like something’s happening. In my own practice, I never really saw that very much whenever I would treat people with Xifaxan if they have constipation, so that kind of explains why we’re not having that kind of success with that. So, of these people that do that, what I do is I have them take that course, they get through it and then we’re learning something that most of my patients, they taught me this, they just feel better if they sort of take it as a daily supplement. And the reason is, is that these are just polyphenol molecules. They are the molecules that our body really wants and they almost work like prebiotics then. Then, they go into your colon where the colon breaks them down and makes you feel better. So most of my patients do a course and then they just stay on it, and then as needed, go back up. So that’s really tough to treat.

Now, the extreme to treat, it always makes it a tough day when I show up to clinic and somebody’s already holding my product and I’m like, “Oh no, that’s all I had.” Then, we sit down and talk and then we really start going through some different things. And that’s where I have a … I have a great nutritionist that I work with here and she helps me look at it, okay, maybe there’s some food products and things like that, so we do leak testing and things. And as we’re going through it, very surprisingly, I have had some of these patients come back to me and say, “Hey doc, you know what, I increased it to three three times a day and now I’m better.” So we know that there’s the dosing thing. This is a moving target. We’re new, we’re breaking ground, and so just because it doesn’t work, maybe we need to add something else, and I’m talking about the bell curve here way to the right, people that just are struggling with everything. I have treated people with both Xifaxan and Atrantil, I’ve tried putting people on erythromycin at night, and you know, I can maybe get another 10 percent out of it. And so as the type of doctor I am, I tend to just focus on those ones that don’t do well and I almost forget about this whole left of the bell curve that does absolutely awesome on an as-needed basis. So from a clinical standpoint, I actually have severe gluten intolerance, and when I take Atrantil with any type of bread products or gluten products, I have zero issues.

Chris Kresser: Interesting.

Dr. Brown: It’s really interesting, and so that is an angle why I have all these patients taking it as needed. The mechanism of action, I don’t know. I don’t know if we’re binding zonulin. I don’t know if it’s the hydrogen sink that works that way, but I actually have celiac patients that swear that they can, and I’m not telling anybody that has celiac to go out and try this, but they’re the ones that actually say, “Yeah, there’s something else going on here,” and so that’s where we kind of where we start thinking of what else is going on, what’s the future of this. But for the clinicians in the audience, it’s two separate groups, main groups: the ones that need to take it periodically and then sort of take it as an overall digestive health; the ones that need a good round of treatment, 10 to 20 days, sometimes a little bit longer, and then that little subset that I’m going to … well, basically, people like you and myself are trying to figure out, right? Those people that keep getting second opinions and that’s what I really like, when I get feedback from people and they say, “Hey, I took it with barberry and I had a better response.” “Oh, that’s awesome.” We’re trying to figure those stuff out.

Chris Kresser: Yeah. Makes sense. Are there any typical symptoms in terms of a die-off reaction that, is there anything that’s typical, like, worsening of constipation or even diarrhea or gas or bloating, or does it just kind of run the gamut?

Dr. Brown: I think it runs the gamut, but they will typically have whatever symptoms I tell them the die-off will cause.

Chris Kresser: That’s the nocebo effect.

Dr. Brown: Yeah.

Chris Kresser: Very well documented, real deal.

Dr. Brown: Yeah. I just want to go as, “If you do have this, it’s a die-off, you may notice some headaches, fever-like, and maybe increased bloating and constipation,” and then for sure it happens. So it’s kind of all over.

Chris Kresser: Yeah.

Dr. Brown: And very interesting, when we first launched one of my patients who was actually on a SIBO form and she said, “Hey, I took this and I got better,” so we jumped right into the most difficult group, great feedback from them. We have 100 percent money back guarantee, I just want to know why. How did you feel? What happened? Because we learn, it’s a learning process. And that particular group that was already on the forum had already failed everything. They kind of whittled themselves down to being really tough people. Those people gave us great feedback on the die-off reaction and what worked and what didn’t. And some of them tried Saccharomyces and that seemed to help a little bit, and some of them took the aspirin, so I love when my patients in the internet community give us feedback. We’re just trying to help people, is the bottom line.

Chris Kresser: Absolutely. So what’s next? Do you have any other research projects going on or things you’re thinking about for the future or just continuing that, kind of, learn more about Atrantil in this approach?

Dr. Brown: Well, I think there are a couple of things. I’ve got my interests, and then of course, we do have still pay the lights to keep manufacturing Atrantil, so we’re actually working with some great doctors at Texas Tech right now and they are putting together a large multicenter study that we’re almost ready to start rolling in and we’re doing that just like it would be for any large pharmacological agent because as we start to bridge this gap between the natural products and pharmacologic products, I want to hold this up to the same standards. So that’s going to be third party. It’ll be done out of Texas Tech, they got some great guys over there. And when we start enrolling, we would love to have you enroll people and everything. Let’s do a large multicenter trial. The reason why it hasn’t been done before—people, whenever I talk, they’re like, “I’d like to see a larger trial.” I’m like, I would like to also except that much of this is just being funded by me and my colleagues—actually, everything is only funded by me and colleagues. You know, everything takes money and that’s why—it’s one of the reasons why we don’t have good studies on probiotics, for instance. Somebody has to foot the bill, and if you want to foot the bill and then risk having your particular probiotic combination not look good, well, you’re out several hundred thousand dollars, you know, so—

Chris Kresser: Yeah. It’s one thing for a pharmaceutical company to shove it in the file drawer, as they say, the file drawer phenomenon. It’s another—

Dr. Brown: Exactly.

Chris Kresser: Because you’re a small company. So, thanks so much for taking the time to be with us, Dr. Brown. I’m really grateful that you took a risk and decided to make this product because I’ve had a similar experience to you where IBS-D and hydrogen-predominant SIBO are a lot easier, more straightforward to treat than methane-predominant SIBO, and so it’s really great to have another tool and arsenal not only for us at the California Center for Functional Medicine but all the clinicians on training in the ADAPT framework program and the future clinicians that I hope to train. So, I appreciate your work in this area.

Dr. Brown: I do want to say one thing, and I appreciate what you’ve done also, the doctor’s tend to try and treat themselves, so I finally went as a patient to a colleague friend who is a functional medicine doctor and he recommended your book.

Chris Kresser: Oh, cool.

Dr. Brown: And this is actually before any of this took place, so I had to laugh, I’m like, okay, so I think that the future of autoimmune disease lies in diet and polyphenols and things like that. And looking over that, I need to order your book, and I’m going to do that and figure out what type of Paleo diet I need to be on.

Chris Kresser: That’s right, cool. Well, thanks again, Dr. Brown. I look forward to more collaboration in the future. Definitely let us know about the new study because we have an enormous number of patients that we have treated and are treating for SIBO, so we would be definitely interested in participating.

Dr. Brown: Absolutely. Thank you so much for your time.

Chris Kresser: All right. Take care.

Dr. Brown: Bye, Chris.

Okay everyone, I hope you enjoyed that interview with Dr. Brown. If you’d like to try Atrantil, you can get it in my online store. As I’ve said, we’ve been using it at the California Center for Functional Medicine and had some really good results with some patients, so I definitely think it’s worth a try, and if it does work well for you, I agree with Dr. Brown that taking a lower maintenance dose over a long period of time or indefinitely, it may not be a bad idea especially because of the really high recurrence rates for SIBO. And studies have shown that it can recur anywhere between 40 and 60 percent and up of patients, depending on their particular presentation, and it’s a real challenge clinically to treat these patients because even when we’re successful in getting rid of SIBO, it’ll often come back. So I think having an option that’s just a simple combination of botanicals that patients can take over a long term rather than multiple courses of very expensive drugs that have potential side effects is a much better option in my opinion.

So again, thanks for listening, I’ll see you next time.

If you’d like to leave a question for me to answer in a future episode, you can do that at chriskresser.com/podcastquestion. You can also leave a suggestion for someone you’d like me to interview there. If you’re in social media, you can follow me at twitter.com/chriskresser or facebook.com/chriskresserlac. I post a lot of articles and research that I do throughout the week there that never make it to the blogger podcast, so it’s a great way to stay abreast of the latest developments. Thanks so much for listening. I’ll talk to you next time.

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Join the conversation

  1. My daughter had sever GI problems at 10. We found that she had lactose intolerance. Up to 20% of caucasians and 80-90% of people of Asian and African descent will become lactose intolerant, at some point in their life. Many of her paternal relatives also became lactose intolerant, but not until their 20’s and 30’s, or even later, and with varying degrees, but all cannot tolerate cow’s milk.

    One double blind crossover study in chronic constipation in children determined that up to 68% of the 65 children, their consipation was resolved by removing cow’s milk from their diet.

    Pub med study: https://www.ncbi.nlm.nih.gov/pubmed/9770556

    We found out our daughter’s lactose intolerance by using an elimination diet with a rechallenge, to find potential food intolerances.

    Unfortunately, Lactose intolerance is grossly under diagnosed, with much unnecessary suffering by kids and adults.

    After going through this with my child, I would encourage anyone with IBS symptoms, including chronic constipation, to try an elimination diet, along with your current treatment with health care professional. Your best best/ probability of success is to start with eliminating dairy.

  2. Hi,
    I am in your ADAPT program and did the SIBO coursework.
    I am wondering what the bottomline protocol is that you’re now recommending for SIBO with methane? Thanks so much.

    • Hey Susan!

      In November the SIBO protocol (week 10) was updated to include Atrantil. Have you had a chance to look over the updated content?

  3. I’d be grateful if someone could please shed some light on the reason why titanium dioxide and magnesium stearate are present in Atrantil? What are their purpose? Are they preservatives, active ingredients or something else? In what percentages do these particular ingredients form part of the overall ingredients list?

    Appreciate the help of a specialist. Thanks in advance!

    • We realize that some people are concerned about the titanium dioxide in Atrantil. There is less than .01% of titanium dioxide in each capsule and there are no definitive studies showing that ingesting very small quantities of this naturally occurring mineral is unsafe. That said, we hear your concerns and we are happy to announce that moving forward Atrantil will be completely titanium dioxide free. Expect the updated Atrantil formula to be available in December.

      • A “Springer Link” on Magnesium Stearate

        “This hydrophobic layer decreases the tensile strength of tablets and prevents water from penetrating into the tablet restraining the disintegration and dissolution of the tablets.

        Although over lubrication of the powder mass during MS blending is a well-known problem, the lubricant distribution in tablets has traditionally been challenging to measure. There is currently no adequate analytical method to investigate this phenomenon”

    • Someone after my own heart. An excellent enquiry.

      Why is it that these products include binders and fillers?

      Magnesium stearate. one of the synthetic compounds is only there because, known as a “flow agent,” it helps speed up the manufacturing process because it prevents ingredients from sticking to the mechanical equipment.

      No, you don’t want this in your body, it is not a good enough reason, just because it helps industry.

      • Agreed. Pure Encapsulations and Premier Research Labs make a bazillion products without MS and TD, which shows you it can be done. Plus, people who take a lot of supplements every day over a period of years aren’t getting a “tiny” dose of these things, it all adds up.

    • I wanted to let you know that Atrantil has updated their formula – titanium dioxide is no longer used. Also, Chris wrote about magnesium stearate on the blog before:


      He concludes the article with:

      “Overall, I haven’t found scientific evidence to substantiate the claims against magnesium stearate, and the small amounts found in supplements shouldn’t be a problem for the majority of the population.”

  4. I am a nurse practitioner who uses a functional medicine approach. I also have Hydrogen dominant SIBO (methane levels normal) but IBS-C with bloating as my most distressing symptom when it happens. Many of my patients have similar issues. Would this work for IBS-C given lack of methane production in the SIBO test?

  5. Chris,
    My husband has been suffering IBS-D for 10+ years. He did a xifaxan protocol with VSL#3 and Florastor, food intolerance illumination, and no tobacco/alcohol, and removal of hard to digest foods for 3 months – he did this about 5 years ago. In the last 2 years, while I’ve been super busy with school(RN) and work his symptoms have returned with a vengeance – fatigue, fat and fructose malabsorption, diarrhea, anxiety, agoraphobia, insomnia, etc… He started Paxil about a year ago out of frustration and a desperate need to function outside the home. 2 months ago I started him on my own little protocol as getting my husband to go to a functional practitioner has proven very problematic. Berberine, neem, candibactin-ar, and allicilin for 3 weeks, vsl#3, florastor, fish oil, zinc, and glutamin, and healing grain/dairy/soy/lintel/legume free diet, etc… He finished the antimicrobial and is now just on the supplements. Sorry this is so lengthy… Now he is just on the probiotics and supplements. Here’s the problem: I have repeatedly tried to get him to take acacia fiber with the probiotics but he HATES it because when he does take it his stool loosens and increases in frequency. My concern is that we did not eliminate the SIBO… or is it an increase in bifido and lactobacilli numbers that is causing this? He now refuses to take the fiber. We both desperately want success this time around but I don’t want the fiber to cause unwanted distress. He does eat potatoes/yams daily and some low fructose fruits, and some gentle vegetables (green beans, cucumbers, squash, lettuce, spinach, tomatoes, etc…) He does VERY well with one perfect movement daily unless he adds the acacia. So the big question is – How critical is the acacia and what are the chances his unfavorable reaction to it may indicate a failure to eliminate the SIBO?

  6. Hi Chris – fascinating article, and it came at just the right time personally. My question is how the herbs identified in Atrantil interact with herbs used as antibiotics (e.g. allicin, berberine, etc.)? Also, when would be the optimal time to employ Atrantil, given the SIBO healing trajectory?

    The biological mechanisms in this article suggest their role might be biofilm disruption, but I am looking for more specifics on timing.

    Personal context:
    After my insurance rejected rifaximin (hopefully a blessing in disguise, as there was no way I’d pay for a barely-statistically-significant 41% efficacy rate!), I’ve decided to use herbal antimicrobials to eradicate SIBO. I purchased CandiBactin AR and BR and plan on consuming them for ~14 days before moving to a healing stage (L-glutamine, pro-motility agent like Iberogast, probiotics: specifically B infantis and S boulardii to avoid D-lactate probiotics, diet, and meal spacing for MMC promotion).

    Although I have not officially been diagnosed via breath test, I’ve been suffering with IBS-C since March and have since ruled out any infection (H pylori, C diff, etc) and IBD from colonoscopy and biopsies. Also, since this was not a post-infectious type of IBS and I know that I was stressed eating a poor diet at the time of onset, I have strong reason to believe it’s methane-predominant SIBO.

    Upon the onset of IBS-C I started low FODMAP, which was effective at preventing C, but pivoted into IBS-D 3-5x a day. After 2 months of VSL#3 with no improvement, and not wanting to eat like this forever, I performed more research. Learning about SIBO (thanks-for-nothing GIs) and noticing an overlap between grain consumption and D, I have since eliminated rice, oats, bananas, and other starchy carbs from my diet (embracing more of a LCHF/keto approach) and noticed immediate relief. I no longer experience distention after each meal and am down to 1 BM per day in the morning; however, undigested food, floating stools (steatorrhea), and diarrhea consistency suggest malabsorption issues are still at play.

    I’d like to eradicate this once and for all. I planned on executing the plan of care above. After seeing Atrantil on Amazon several times and now hearing more about the science from Dr. Brown, I would love to learn how it intersects with some of the other anti-SIBO agents. Thanks!

    • Brittany,

      Did you have any luck with the Candibactin protocol? My illness and how it happened is almost exactly like yours, and I have tried almost all this things you mentioned (with the exception of Candibactin) with only temporary results, but the problem always comes back. I suspect Sibo-D in my case. Anyway, I would very much like an update on your progress if any, since you are approaching it so much like I have 🙂 I too have put Rifaxin as a last resort, but it looks very much like I will have to just take the SIBO test (hard to even get i twhere I live) and take Rifaxamin if/when the results confirm my suspicion. But following Dr. Pimental’s work, I know there is a very good chance this is as much a motility disorder as it is a colony of bacteria in the wrong place (the motility disorder I guess is another overgrowth in another place) and so Im wary of Rifaxamin alone can achieve, even if it could give 6 months of a cure.



  7. What happened to the theory that damaged MMCs were behind SIBO? You can knock down the bacteria all you want with antimicrobials, but won’t it come back if the source of the problem isn’t addressed? If a person has poor motility, the bacteria will build up again unless motility is addressed.

    I was speaking with a SIBO specialist who believes the MMCs can be led into a state of paralysis (of varying degrees) after a food poisoning episode or after gastroenteritis. It’s a type of autoimmune disease of the nerve cells of the small intestine. The food poisoning antibodies cause this paralysis. They can be cleared out of the body, but it takes a period of 5 to 10 years.

    I also just watched an interview with Ben Lynch where he believes that bile problems (from dysfunctional liver/gall bladder) lead to SIBO. Unless the bile problems are fixed, the bacteria will continue to build up in the small intestine.

    I’ve read so many things about SIBO where the focus is on killing, but motility, the underlying cause, has not been addressed.

    • So interesting Karen. I had gall bladder problems off and on for years before I tested positive for SIBO. I never had it removed even thought the Drs wanted to. Did Ben Lynch say how to go about treating bile problems? Very curious about his theory because the order of my problems are consistent with this.

      • Carla — Here’s the interview with Ben Lynch where he talks about the SIBO/bile connection. He mentioned taking ox bile/bile salts as one treatment, but he said that many things affect the functioning of the liver/gallbladder and other things might need to be addressed (he didn’t say what).


        There’s a handy index below the video that tells you what they’re discussing at which minute-mark. For SIBO, go to 26:00, but you might find the other info on liver/gallbladder (before the SIBO discussion) to be useful, too (including choline and liver/gallbladder).

        Hope this helps.

        • Thank you so much! I will definitely listen to it. I am very familiar with Ben Lynch and have listened to other interviews with him!

    • Hey Karen! Interesting.

      I don’t have bloating or discomfort, been using megasporebiotic (probiotic) which helps with regularity, but definitely have some liver issues, and detox problems. Have you ever had any positive results with Colonics hydrotherapy? I believe that may help my liver, with recirculated toxins. would love to hear your thoughts.


      • I’ve never had colonics, but sounds like it would be worth experimenting with. I know of people who have had drastic improvements in their health with colonics.

        The motility I was talking about has to do specifically with the cells that line the small intestine. They lose their motility which leads to SIBO. They fail to sweep out the debris, etc., in the small intestine itself (not the large intestine). You might already know that, but sometimes people confuse motility of the large intestine with motility of the small intestine (the MMC, migrating motor complex).

        So, colonics work on the large intestine (colon), but I’m sure they end up affecting everything above it, too, such as the stomach and small intestine (just thinking out loud here :-), since everything is connected, all just one big tube.

        • Amazing Karen,

          I agree, with that. One of my functional dr. friends just told me that you have to be careful when doing colonics, not to remove the good bacteria. But chances are if you have SIBO, your large intestine is not in great shape either! So I think it is on a patient per patient basis if it will help.

          Also, thanks for providing the Ben Lynch link, I really feel like mine is connected to the liver, when I meditate and feel into the root cause. As you may notice he mentions doing colonics when taking the ox bile to help with die off.

          It is a bit intimidating to take ox bile haha, have you ever done it? seems really intense 😛

          Thanks again for all your insight.

          • I either forgot about the colonics when starting ox bile or didn’t notice that he said it. Thanks for the reminder. I just started ox bile, and it’s been okay, no weird reactions, so I probably needed it. If it was too much (dosage) I would probably have a reaction. You’re supposed to build up slowly in dosage, which makes sense. So, now I just have to see how the ox bile improves things over time. I think it’s definitely worth trying. Good luck!

            • Hey Karen,

              Thanks for the support,

              What supplement are you using, what is the dosage? I have a few here that are incorporated in digestive enzymes: http://catalog.designsforhealth.com/Digestzymes-180

              But would be interested to know what you are starting out with. as of now I am taking 25 mg incorporated in a Detox protocol.

              Have you ever done a liver cleanse? by Hulda Clark, or used castor oil pack to help too?

              Look forward to hearing back and keeping the discussion going

              Best to you

              • I’m using Allergy Research Group Ox Bile 125 mg, taking 1 to 2 caps before each meal.

                I’ve done the Hulda Clark liver cleanses and always feel better afterwards. I haven’t recently, though, it’s quite a process!

                I do like castor oil packs, but I don’t use a “pack.” I just put the castor oil over the liver/abdominal area and use a TDP (far infrared) heat lamp over it. I don’t like dealing with the packs.

                I also read that you can apply the castor oil before bed and wear an old t-shirt, and just let it absorb overnight. The pack itself is Edward Cayce’s idea. I think it’s a great idea, but I found that I use castor oil far more frequently *without* the messy flannel pack/heating pad combo.

                • Hey Karen, I hope you had a great weekend!

                  Thanks for the info on that supplement, it seems to have gotten good reviews.

                  I have done a liver cleanse myself, and haven’t found much difference, though it was early in my treatment. A few sources and people have mentioned doing a kidney cleanse before the liver one.

                  I have really cleaned up my diet over the last year and a half, and not sure if I have “fatty liver” but possibly the bile does not flow as easily. Do you think that is possible? Do you have fatty liver? do you have trouble with digesting fats?

                  Would love to stay in touch to hear how your progress goes with the ox bile, 🙂

                • “I have done a liver cleanse myself, and haven’t found much difference, though it was early in my treatment. A few sources and people have mentioned doing a kidney cleanse before the liver one.”

                  I’ve never done a kidney cleanse before, so don’t know how they work or how they feel. Sometimes you need to do multiple liver cleanses before things really start to move out of your system.

                  “I have really cleaned up my diet over the last year and a half, and not sure if I have ‘fatty liver’ but possibly the bile does not flow as easily. Do you think that is possible? Do you have fatty liver? do you have trouble with digesting fats?”

                  I’ve been told by doctors that you can definitely have bile flow issues without anything showing up on the lab tests. Your liver labs will be normal, your kidney labs will be normal, etc., but you can still have sluggish bile flow.

                  I don’t have trouble digesting fats when they’re in food, but if I take a big dose of fish oil by itself or if I eat 2 tablespoons of coconut oil, I feel like it just sits in my stomach, so, yes, I have trouble digesting large doses of fats/oils by themselves, which was a clue to my doc that I needed ox bile supplementation.

                  Good luck with your treatments!

                • That is so helpful Karen,

                  Sorry for so many messages, I have yet to meet anyone who has similar symptoms. So I really appreciate and find it worthwhile connecting with you.

                  How many Liver cleanses do you do a year? and how often?
                  I will try and do more with the castor oil in the mean time.

                  Have you ever done any genetic testing? ever done the 23 and Me/ Nutrigenomic testing?

                  If so I got a mutation on my PEMTrs7946 gene which has connections to liver and gut health.

                  All the best to you

                • “How many Liver cleanses do you do a year? and how often?”

                  I haven’t done one for a year because I became focused on treating SIBO, following several different demanding protocols, but the last time I did them, I did a series, a month apart from each other, for around 6 months in a row. That’s when you can notice big changes, when you do more than one.

                  “Have you ever done any genetic testing? ever done the 23 and Me/ Nutrigenomic testing?”

                  Yes, but I haven’t yet met a doctor who really knows how to interpret the results. Also, the docs I’ve seen all have different opinions on how these SNPs actually affect people. I think it’s kind of uncharted territory and the money I spent on 23andme and the subsequent reports (through Strategene, etc.), haven’t yielded much *practical* info for me in terms of making a real difference in my health. But I know some people have greatly benefited from this kind of information, so, my experience is just my own.

                  “If so I got a mutation on my PEMTrs7946 gene which has connections to liver and gut health.”

                  It could definitely be significant, but I’m not sure how. It would be great if you could connect with a doctor who has a lot of experience with SNP testing. Unfortunately, I don’t know of anyone at the moment.

  8. What a shame that these comments end up devolving into arguments and breast beating. I will say that I was made to feel hopeful again at least for achieving some symptom relief, after hearing this, admittedly promotional podcast.

    I appreciate that Chris and other healthcare professionals at least seem to be trying to help those of us suffering from these digestive issues. The human body is complex…and not the least of what influences us is our outlook and attitude.

    Placebo–believing that something will help– can be the most efficacious healer. I’m hopeful. Thanks for bringing us this information, Chris.

  9. Does Atratil work for those who test high hydrogen but have C instead of D? That’s how I test.

  10. Great information here! Thanks so much for sharing.

    This comment has absolutely nothing to do with the content, but I’d invite Dr. Brown to consider his use of the word “actually” in the sentence below. I can see only one meaning. Imagine that he’s talking about a man and see if the word “actually” makes sense. I know it’s only a word, but this subtle language points to a much deeper problem in our world that we all need to be aware of. Unconscious biases often show up in language.

    “When we were looking at this, when we were doing research, I was writing on a dry erase board that ultimately methane was the answer and my research manager, Brandy Scott, she actually is a very bright woman. She was an attorney and then got her masters in political science,…”

  11. I have had misdiagnosis for years and finally got tgw root diag of SIBO, 52 yr old female. Methane gases immense, extreme weight loss this year. Your product is out of stock. When will it be available??

    • Is selling like hot potatoes but you can also get it at Amazon. I have the same but mild, still I have lost a great deal of weight myself. I decided to try first Manuka Honey 15+ if not I will buy this.

  12. Looking at the supplement, my biggest and only concern is the titanium dioxide. Isn’t titanium a known heavy metal with no use in the body, and also toxic? I’m highly suspect of this ingredient especially since it’s only purpose is for artificial color.

    • Titanium Dioxide has nothing to do with health.
      It is a manufacturing agent with scant regard for the illness.
      The most important application areas are paints and varnishes as well as paper and plastics, which account for about 80% of the world’s titanium dioxide consumption.
      Why you would absorb an oxide of titanium is worth asking?

    • Hey Ryan!

      I wanted to let you know that Atrantil is no longer using titanium dioxide in their formula. This January we will stock the updated formula!

  13. Very interesting and logical approach.
    Research is mostly focused on lower gut microbiota while the upper tract is almost totally overlooked. This is a pity because it’s really crucial and I argue that the lower issues may be in some cases a downstream effect.
    Refined stuff like acellular carbs are going to wreak havoc on the small intestine and it plays a major role for me on the overall ecosystem.
    I saw that when you don’t address these issues, turning toward an healthy diet is not always enough, and this generates a negative feedback leading to believe that diet is not important.

  14. Well – A-N-D-R-E-W – again:

    Its not your GRAMMAR I don’t understand – I do speak several foreign languages, in addition to English – its YOUR responses in this “comment section” thrown out (as apparent quotes!) without mentioning the person, to whom you are addressing them to!

    Only quotation marks around your responses, sets you up for misinterpretation of your intended message…it did it for me!

    • Well I-N-D-I-E

      It was under Eugenia’s comment, as a reply, which is the norm.

      Maybe look before you leap?

  15. Hi. I was wondering how Atrantil would compare to using lauricidin (monolaurin) for treating methane-predominant SIBO?

  16. I was recently diagnosed with methane predominant SIBO and followed a strict fodmap/scd diet for a month while taking high dose herbal antimicrobials (garlic, goldenseal, peppermint oil, berberine). I quickly gained 5 pounds and started having major carb cravings (worse than I’ve had in years!) while my constipation got worse than ever! I panicked and stopped everything, going back to my predominantly paleo diet and continued to gain another 5 pounds (I was not overweight to start). I have spent thousands on tests, doc visits and supplements and feel very frustrated and discouraged, ready to give up. I will try this Atrantil and hope to see some positive change. Thank you Chris Kresser for your amazing podcast/website and all the work you do!

    • That is what happened to me, where I gained 80 lbs in 6 months from doing juice fasting and hiking 50 miles per week. I still eat all organic, non gmo, no gluten, no dairy, no soy, no caffeine, no alcohol, no fun AND the weight will not come off no matter what I do. Exercise and Diet DO NOT help severe conditions. I am so frustrated with all of the ignorant doctors who think that exercise and diet will fix everything OR they think they know how to heal certain conditions even though they haven’t ever been truly sick. I know I am not alone in this, How many other people really want to punch their doctors face in????????? lol

      • jejejeje. Sorry, I feel like that as well but I do not feel like punching them in the face. All I want them to accept is that they might be wrong so what other options I have. But let me be honest, regular Doctors or functional medicine is all the same in my book. Doctors tell you is this and that is it, and functional medicine tells you it could be anything so lets start the Ginny pig program on a trial and error period that could last 10-20 years. Hey, I’ll be underground by then. ;-( At this pace I prefer to treat myself and save $$$ not paying the hourly services which in the last 4 months was near $4000. This does not include all the extra money I paid for grain free foods which are 300% more expensive. ;-(

    • Hi.

      Have you tried Atrantil? Your situation is very similar to mine and im curious if Atrantil has helped you?

  17. I think my SIBO issues are related to my very low stomach acid. With every meal I take 9 Betaine Hydrochloride/Pepsin capsules (and I can take up to 20 before I have any acidity issues). Even if I were to take this new supplement, the underlying issue of low stomach acid would be a problem. Does anyone else struggle with this? Does anyone have any suggestions on how to improve stomach acidity to help avoid SIBO recurrence?

  18. Regarding taking the supplement ATATRIL which was mentioned in this podcast… During the treatment phase what should the diet be like? Does it need to be grain free sugar-free like other SIBO treatments? I have read that that causes the bacteria to go into hibernation so you can’t treat it.

  19. Ok, regarding SIBO: everything that Paleo (and vegans, for that matter) suggest, it’s all band-aid. In fact, SIBO is one thing with the least success among all the good things Paleo has brought on to people.

    Probiotics? They’ve known to be transient, and need to constantly eat them to see minor changes.

    Other diet changes: sure, they help, but they don’t reverse illness, they only make them mostly asymptomatic.

    And I definitely won’t start taking medicine again, being it Atladir, or Rifaximin.

    I have come to a conclusion, after thinking why tribal people have no SIBO problems. Their diet is not as glorified as Paleo people think that it is (they mostly eat the same and the same, and many times they go to bed starving — ask some ex-jungle Amazonians about starvation, and they’ll tell you).

    My conclusion is that what makes the whole difference between tribal people and western people is outdoors living. Being out in the sun almost all day. I bet you, this will fix any SIBO problem you have because newer research has shown that gut bugs NEED UV and D3 directly on them.

    Citing having a “job”, and not having the time to be out in the sun all day, is an excuse. Either you live a Western life and you pay your health price, or you go become a semi-naked farmer in some organic/hippie settlement and you regain your health. Choice is yours.

    Suggesting chemical solutions for a lifestyle problem on this blog, I find it offensive.

    • “Suggesting chemical solutions for a lifestyle problem on this blog, I find it offensive.”

      In principle, I agree, conversely they are “doctors” so you won’t have your expectations met here; but here we are, it is his blog and he’s promoting a new concoction.

      Maybe he thinks this one might be better than the others?