I have a patient with ALS who sees a specialist, and when she mentioned possible gluten ataxia-type issues, the specialist didn’t think there was much to it. I have mentioned the Cyrex test. Besides Cyrex 3, what other tests should we run? I think there’s a neuro panel with Cyrex but haven’t used it much.

Dr. Amy Nett: Yeah, absolutely. Agreed. I think the Cyrex Array 3 is a great test, especially if the patient is still eating wheat and gluten, because you can look for those tissue transglutaminase antibodies that, as you mentioned, are associated with decreased neurologic function. In particular, they can cross-react with the cerebellar tissue and potentially lead to gluten ataxia. That’s certainly one thing to think about, but also go back to the basics. The place I would start would be SIBO breath test and stool testing because you need to decrease inflammation in the gut. Depending on how much testing the patient is open to, you could certainly run additional antibody panels through Cyrex, but you’re asking what to do with the results if those were positive. If those are positive, you have to go back to the basics and say, well, is there increased intestinal permeability? What could be contributing to inflammation in this patient? What could be contributing to immune imbalance? More often in this setting, I would actually, again, start with a SIBO breath test, start with stool testing, see if there’s anything I can correct there to help bring down inflammation. Depending on the results there, let’s say we found something, let’s say we do GI treatment, if we see improvement, wonderful. If we’re still seeing residual symptoms, then think about where else we can look. Maybe that would be the time to look at the additional Cyrex panels, looking for other antibodies, particularly to cerebellar tissue. If you see elevations in antibodies, again, you need to come back to how you can bring the immune system into better balance. What could be triggering the immune system? Could it be a heavy metal toxicity? Are there other things you can do to balance the immune system? Would there be a role for low-dose naltrexone? There are a lot of different things to think about, but again, it’s always coming back to how you can bring the body into balance, and we’re generally looking for places to lower inflammation and bring the immune system into better balance.