Practitioner Question of the Month – October 2017

GREG WILLIAMS asks

“Dr Ruscio – where do you stand on the use of Biofilm disruptors as [art of an anti-bacterial, anti parasitic or anti-fungal protocol? Do you believe they are worthwhile? And if so, are there certain times that you decide to use them and certain times you wouldnt (and if so what helps you decide that?). Thanks”

Great question, Greg. We performed a study at my office wherein we showed the addition of anti-biofilm agents to standard herbal anti-microbial therapy significantly increased the clearance of H2 SIBO, but not CH4 SIBO.  Methanogens (archaea) have also been shown to produce biofilms, but interestingly our study did not show impact. Parasites (protozoa, amoebas, helminths…), to my knowledge, do not form biofilms, but there may be some exceptions to that rule. Fungi do form biofilms.

What do I do? I use biofilm disruptors for patients who have only responded partially to treatment for bacteria (including SIBO) or fungus previously. I only do this in some cases, not in all. If someone has responded very well to treatment, but just not completely, they may only require one more round of treatment. Or, they may only require time to realize the rest of the improvement they are seeking. You could argue that all partially responsive patients should get anti-biofilms agents during their next round of treatment, but I remain unconvinced that this is essential. I am open to this, just not sure I get this feeling clinically.

In terms of how I decide, it’s more of an instinctual call. That being said, if

• Someone’s labs show dysbiosis or SIBO and
• We treat them and their symptoms and labs both respond well, but not completely, and they then start to regress after stopping anti-microbial treatment, then
• This is a good candidate.

However,

• If the labs and symptoms don’t match or track together, or
• If their response to treatment is sub-optimal or even reactive, then
• I consider other treatment options entirely.

Hope this helps!

Adding severity and frequency of symptoms to your intake paperwork might seem obvious, but not everyone in the field does this. It’s also important that in your paperwork you remind patients that syndromes and conditions they read about on the internet are not symptoms. For example, SIBO and adrenal fatigue are not symptoms. We need to know the specifics. Both SIBO and adrenal fatigue have many different symptoms, so how well do you understand a patient’s condition based upon these two conditions? Do they have gas? Bloating? Constipation? Diarrhea? Both? Are they tired? Or not sleeping at night? Both? Cravings?

Coming back to severity and frequency, consider this. If someone reports:

• Weight gain
• Fatigue
• Abdominal pain
• Constipation

But we then add frequency and severity:

• Weight gain, 2, constant
• Fatigue, 2, occasional
• Abdominal pain, 2, intermittent
• Constipation, 10, constant

You see two very different profiles, right? With the additional information in the second set of data, it rouses suspicion of either slow transit or dyssynergic constipation, and not so much IBS/SIBO driven constipation.

I check in on each symptom individually at each follow-up visit. We also have patients fill out an updated short form for their symptoms every 6 months. This can help you hone in on the most important aspect of your patient’s presentation.

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