Usually by the time someone comes to us at WholeHealth Chicago with this complaint, they\u2019ve already taken the obvious route. Ralph, a healthy looking guy in his 30s and recently married despite his halitosis, had already seen:<\/p>\n\n\n\n
–His primary care physician, who wasn\u2019t sure he noticed anything odd about Ralph\u2019s breath at all, but suggested regular brushing, flossing, and tongue scraping.<\/p>\n\n\n\n
–His dentist, who did a careful deep cleaning<\/a> and then when Ralph showed no improvement referred him to an ear-nose-throat (ENT) specialist.<\/p>\n\n\n\n –The ENT guy did a nasal endoscopy<\/a> and told him his sinuses were fine, but suggested a gastroenterologist.<\/p>\n\n\n\n –The GI specialist performed a gastroscopy<\/a>, thought there might be a little acid reflux, and prescribed a proton pump inhibitor (like Nexium), which did nothing.<\/p>\n\n\n\n Ralph\u2019s morning oral hygiene ritual, as you might have guessed, was quite involved. He\u2019d awaken anxiously hoping his new wife wasn\u2019t yet awake so he could do a thorough mouth cleaning and return to bed with fresh breath.<\/p>\n\n\n\n \u201cMy breath smells like poop!\u201d Ralph told me when he came in. This was no new problem for him. He\u2019d been alerted to his halitosis by his mother, his grammar school and high school friends, his frat brothers (who gave him just the nickname you\u2019d expect from frat brothers), and some of his longer-term match.com meet ups.<\/p>\n\n\n\n He went through life armed to the teeth (literally) with breath-betterment products.<\/p>\n\n\n\n Ralph had seen information about small intestine bacterial overgrowth (SIBO) online. Had he read the Health Tip I wrote several years ago<\/a> I\u2019m guessing he would have recognized himself immediately. I was really surprised how similar Ralph\u2019s case was to that one. However, as you\u2019ll see, Ralph\u2019s case was also unusual. Parallel story, different ending.<\/p>\n\n\n\n You, of course, as a devoted student of Dr. Google, are aware that your large intestine is filled with five pounds of bacteria containing about 1000 identified species, many of which produce methane, which is why farts smell like farts.<\/p>\n\n\n\n For some people, bacteria meander to the small intestine and set up house. The main symptom of SIBO is bloating, with some affected people reporting they can literally see their stomach expand after eating.<\/p>\n\n\n\n In addition, movement through your intestines isn\u2019t just mouth-to-anus. In one of many sickening moments of medical school, in physiology class I learned of an experiment performed in the 1930s in which a purple dye was administered by enema to healthy volunteers (likely medical students) and traces of the dye were found in their mouths the next morning.<\/p>\n\n\n\n \u201cNow you understand morning breath,\u201d chortled the professor as 200 students groaned aloud.<\/p>\n\n\n\n I had to share that with you.<\/p>\n\n\n\n Anyway, back to Ralph. I ordered a take-home breath test by Genova Labs. You start by drinking a small amount of lactulose, which encourages bacteria to produce gas. Then, every 30 minutes for two hours, you blow into a balloon-like device, snap on a glass vacuum tube to collect the air, and FedEx what look like four empty tubes to the lab for analysis.<\/p>\n\n\n\n Most patients with SIBO have excessive amounts of methane, hydrogen, or both. The test results showed Ralph\u2019s was predominantly methane and the conventional treatment–ten days of an insanely overpriced antibiotic called Xifaxan–usually works nicely (generally insurance pays for it, but at $60 a tablet, they\u2019re not enthusiastic).<\/p>\n\n\n\n Remember, Ralph’s main symptom is his breath. He really didn’t have any symptoms of SIBO, just a positive breath test that was picking up the methane in his mouth.<\/p>\n\n\n\n Ralph reacted oddly to Xifaxan. He reported his poop-smelling breath disappeared for two weeks after completing the meds, but then it quickly returned. I recommended that we next try three weeks of products favored by naturopathic physicians: CandiBactin A\/R and CandiBa<\/a>c<\/a>tin B\/R<\/a>, both by Metagenics. The outcome was the same. Ralph experienced about a month of relief before reverting to his stinky breath.<\/p>\n\n\n\n A second line of conventional treatment is a pair of antibiotics, Neomycin and metronidazole (Flagyl). Because Neomycin can affect hearing, you can only use it only for a few days. Metronidazole is widely used for a variety of infectious conditions, including traveler\u2019s diarrhea, intestinal parasites, and bacterial vaginosis. It\u2019s even applied to the skin for rosacea.<\/p>\n\n\n\n But then a lightbulb went on in Ralph\u2019s brain. He remembered that some years earlier when he was prescribed metronidazole for traveler\u2019s diarrhea, his breath had been fine. He had even renewed that prescription just to get a few more weeks of relief.<\/p>\n\n\n\n Could he just stay on metronidazole forever? Reading aloud to Ralph the drug\u2019s long-term side effects discouraged us both. But then I came across this interesting article from the Iran Journal of Pediatrics<\/em><\/a> in which doctors faced the same fart-breath challenges in kids. They had a compounding pharmacy make metronidazole into a mouthwash, which the kid would swish around every morning and spit out. Success rate? An astonishing 97%.<\/p>\n\n\n\n Obviously, I ordered a bottle of the stuff for Ralph from the compounding pharmacy we use. The pharmacist had heard of it and said it was easy to make and not very expensive.<\/p>\n\n\n\nCould it be SIBO?<\/strong><\/h3>\n\n\n\n
Ralph takes a breath test<\/strong><\/h3>\n\n\n\n
A lightbulb moment<\/strong><\/h3>\n\n\n\n