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Male, age mid-60s with allergies, chemical sensitivities to paint, chlorine, history of anxiety and mood issues, yo-yo weight loss and gain, food addictions, high quinolinate, colonate, 5-HIAA forming a glutamic acid and very low power of glutamate. Patient’s doing liver detox and some methylated B vitamins, but would you advise an HDRI methylation panel and SIBO testing?

Chris Kresser: Yeah, I would advise a full gut panel with allergies and chemical sensitivities and anxiety and mood issues,...

Last week someone asked if we find someone who has Helicobacter pylori, do we test his partner too? You said that you often do, and that you might even hold off treatment until the results come through. This was interesting to me because I’ve always thought we all have a bit of H. pylori, but we need to keep it under control, but if this reinfecting thing is true, what if they have young children? H. pylori can be protective if you get it early enough, right? So, it’s my understanding that you wouldn’t treat symptoms in a young child for H. pylori, but they could reinfect the adults time and time again.

Dr. Amy Nett: Yeah, so this is nuanced, and I don’t know if we even have all the answers because,...

One of my patients did a Doctor’s Data stool analysis. In terms of the beneficial flora, the significant finding was no growth of Bifidobacterium, but otherwise, beneficial bacteria looked pretty good. There wasn’t much in the way of commensal organisms or dysbiotic organisms. In terms of yeast, there were a few different types of yeast identified on the culture, and then under the microscopy, there were reports of few—so three samples: few, rare, and few yeast. This patient is having bloating and gas depending on certain foods and is otherwise healthy. Would I treat her with botanicals and for how long?

Dr. Amy Nett: With a mild yeast overgrowth, I probably—let’s see. A little bit of bloating and gas depending on...

Patient with a Doctor’s Data stool test has expected flora 4+ Bacteroides, 3+ Bifido, 4+ E. coli and no growth Lacto, 1+ Entero. Commensal flora 2+ on one, vegetable fibers, rare, lysozyme is elevated at 695. Secretory IgA is pretty elevated at 512. She complains about intense bloating, gas, abdominal distention, fatigue, insomnia, joint pain, migratory joint pain, tingling in her palms, hands, sole of feet. She can’t afford any other testing. So would I treat her with a botanical protocol?

Dr. Amy Nett: Does she have at least a blood panel? I would get a blood panel because the tingling...

My patient repeated his Doctor’s Data stool test after the antimicrobial protocol. The initial test showed that he had 4+ Klebsiella, 3+ alpha-hemolytic strep, 4+ gamma-hemolytic strep, and also many free yeast. The test results after the antimicrobial protocol showed that he no longer has Klebsiella or fungal overgrowth but the same for hemolytic strep.

Dr. Amy Nett: So he has 4+ gamma-hemolytic and 3+ alpha-hemolytic. Honestly I don’t remember if 4+ gamma and 3+...

So we have a patient who has Helicobacter pylori. Do you treat only the patient or also his or her spouse?

Dr. Amy Nett: Great question. I actually test household members. So anyone living in the house over probably 30...

The client has a very severe insomnia and anxiety for at least 40 years and no gut symptoms. He has a stool test that came back with insufficiency dysbiosis and a few Blastocystis hominis in his three samples. Would you treat Blasto, or is treating the insufficiency dysbiosis enough?

Dr. Amy Nett: Yeah, great question. He has no gut symptoms, but he does have severe insomnia and anxiety. Yes...

I did a Doctor’s Data stool test on a 12-year-old girl, all the markers look good with the exception of having a few microscopic yeast and a stool pH of 5.8. She’s very underweight and gets occasional abdominal pain. My question is, would you treat the yeast and also if the low stool pH is a concern?

Chris Kresser: Low stool pH often occurs, it is often present with yeast and it’s another sign of fungal overgrowth....

Patient of mine with metabolic syndrome and significant hydrogen SIBO and significant gut bacterial overgrowth on Doctor’s Data. All metabolic syndrome markers with the lowering of moderate carb, Paleo, and gut treatment. However, her liver enzymes are not elevated and they were normal before. Could the treatment do this? Her doctor is concerned and wants to know what supplements she’s taking. Had her on NAC for biofilm and the label says that it can alter liver markers without altering liver function.

Chris Kresser: Yes, that is true. I would take her off the NAC and use something else for biofilm and...

Twenty-four-year-old male presenting with depression for seven to eight years but also lethargy and poor digestion after a trip to India four years ago. Doctor’s Data showed susceptible amounts of beneficial bacteria, five species of commensals and 1+ or 2+. 1+ of candida and Saccharomyces boulardii, but Blasto and giardia in all three stool samples. If Saccharomyces boulardii could be used to treat these parasites, is it possible that they could coexist? Patient opted for a course of Flagyl with S. boulardii. Would this be redundant given he already has it, and would you follow with another month or two of herbal antimicrobial parasitic protocol, SIBO results still pending?

Chris Kresser: I would definitely treat the giardia, and probably the Blasto in this case as well, given the symptoms...

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