Gut Health
I’ve just done my first Cyrex test for gluten for a 58-year-old female who complains of depression, anxiety, frequent migraine headaches, intermittent epigastric pain with nausea, diagnosis of cysts on the liver, spleen, and left kidney. There is also the Cyrex where just two equivocal findings of gluteomorphin and prodynorphin. No other testing, starting with gluten and then looking toward doing the gut testing. Can you help me evaluate this result?
Dr. Amy Nett: So, remember, in functional medicine, we consider equivocal results as positive. Given that you have the two...
From the HPA DUTCH section, part five, under ‘Why is cortisol elevated in obesity?’ I’m not clear on the hypothesis that obesity causes impaired cortisol-to-cortisone metabolism. This would not explain why cortisone metabolites show up in the urine. Wouldn’t there be less cortisone metabolites if the original cortisone conversion process is impaired?
Chris Kresser: I debated on how much detail to go into with this. The HPA axis is incredibly complex, and...
My patient repeated his Doctor’s Data stool after the antimicrobial protocol. The initial test showed that he had 4+ Klebsiella, 3+ ?-hemolytic streptococcus, 4+ gamma-hemolytic streptococcus, and also many for yeast. The test result after the antimicrobial protocol shows that he no longer has Klebsiella or fungal overgrowth but still has the same for hemolytic strep. All of the beneficial bacteria are now 4+. The question is whether to treat the hemolytic strep.
Chris Kresser: No, I wouldn’t in that situation. If he has really good beneficial bacteria, the commensal bacteria are not...
Regarding cortisol-to-DHEA ratios on the DUTCH test, approximately what ratio is considered normal, and what is considered indicating catabolic, i.e., high cortisol compared to DHEA?
Chris Kresser: There’s not really a lot of literature that establishes a specific ratio, especially when it comes to using...
Many of my clients have gut issues and HPA axis dysfunction, so what should I treat first, or is it okay to treat both together with the botanical protocol plus an HPA axis supplement?
Chris Kresser: Yes, this kind of goes back to Dean’s question as well. You have to evaluate on a case-by-case...
I have a patient with strictures in the colon, so she has intestinal blockages. Her M.D. wants her to have a balloon endoscopy. Prior endoscopy showed mildly positive for celiac. Isn’t that like being mildly pregnant? Has to take MiraLax once a day, but still a normal stool only happens once every four to seven days, which a lot of doctors won’t even call constipation. She eats mostly clean for gluten because she has anaphylaxis-type reactions if she eats too much. She can do yogurt and probiotics but can’t do sauerkraut because anything with too much fiber really slows her down. She does well on a low-residue, small-portion diet. How to do Doctor’s Data three sample if she’s only going once a week? Any other suggestions besides getting her to totally avoid gluten, etc.?
Chris Kresser: I mean that, of course, would be my suggestion and giving her as much literature as you can...
For a Hashimoto’s client who was tested at Genova with no growth of Lactobacillus, no growth of E. coli, 4+ Bifido, 4+ ?-hemolytic streptococcus, 1+ Citrobacter freundii, 4+ streptococcus, 4+ gamma-hemolytic streptococcus, 3+ Klebsiella pneumoniae, 4+ Yersinia enterocolitica, and Yersinia in the bacterial section. So, she’s got a lot going on there in the dysbiosis section. She’s had reflux for the last three years, using medication to manage her symptoms. Do you suggest a protocol for Yersinia or just addressing the dysbiosis?
Chris Kresser: So here, because there is so much dysbiotic and commensal bacteria present, I would do 30 days of...
Do you consider essential tremor a neuroinflammatory process? Would you do all the GI testing for that? Do you have any specific recommendations?
Chris Kresser: Absolutely. Yes. A neuroinflammatory process, I would be focusing a lot on the gut. We have all this...
I have a question about my first DUTCH test with a 48-year-old menstruating female with complaints of fatigue and inflammation. She is thin but not overly, eats very healthy. No excessive exercise. SIBO negative. DUTCH was confusing. Low 24-hour cortisol, way low metabolized cortisol, low estrogen and testosterone, normal progesterone, DHEA low normal, 5-α reductase activity high. On the handout regarding patterns, low free cortisol with low total included things such as fibromyalgia, chronic pain, metabolic syndrome, etc. The only thing she does have was a serum borderline hemoglobin A1c of 5.6 and low insulin, so I ran a GTT, glucose tolerance test, and glucose was 91, 74, 67, 75. Insulin was 29, 18, 22, 11. So, I don’t know where to go about the blood sugar issue, or is there one? According to her endocrinologist, no, and/or the other hormone issues.
Chris Kresser: Some of the conditions I listed in the handout are the ones that have been explicitly identified in...
