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IBD/IBS/GERD

IBD/IBS/GERD

To clarify, you wait to use HCl until the patient is completely weaned off PPIs or just until they have lowered their dose significantly?

Dr. Amy Nett: Yeah, I generally wait until they’ve lowered their dose. Again, it can be a little bit tricky...

Steps one to three of GERD treatment summary—are they meant to be done sequentially, or do they overlap? Specifically, would you want to wait until someone is entirely off PPIs prior to introducing HCl, so complete step one prior to moving on to the next step?

Dr. Amy Nett: For people who can’t see, how we approach treating GERD, the first step is going to be...

s HCl with pepsin safe with gastritis, a hiatal hernia, or Barrett’s esophagus? How would you recommend handling long-term use of PPIs in these conditions?

Dr. Amy Nett: Remember you’re increasing stomach acid when you’re using HCl, so I would not use it with gastritis...

Male patient with gut symptoms from loose bowels to cramping. Doctor’s Data test showed no parasites but did have no-growth Bifida and elevated lactoferrin and calprotectin. Had an appointment with specialist who ran biopsy, and while it showed no IBD, it did show lymphocytic colitis. Patient also had elevated cholesterol from triglycerides and cholesterol/HDL ratio 4.1, high ferritin, low vitamin D. Patient has gone overseas for a month. I have advised to follow a Paleo reset diet with cholesterol modifications and recommended more comprehensive bloods and DUTCH test. Patient’s reluctant to spend more money on testing. Feeling unsure whether to do gut protocol with him seeing as there are no parasites. Can I go into prebiotic straightaway to Bifidobacterium up?

Chris Kresser: There’s definitely inflammation going on and in the gut with a calprotectin that high and lactoferrin that high....

A 44-year-old female treated some time ago for dysbiosis unsuccessfully; less experience and knowledge then. She presented to me with severe depression which began after a horrific treatment for intractable acne in her teens, had loads of antibiotics but also Accutane which seemed to be the trigger for her mental health decline. I. Her CSA showed no growth of Lactobacilli, 4+ E. coli, 2+ Bifidobacterium, 4+ alpha hemolytic strep, 2+ coag negative staph it looks like, 4+ pseudomonas. No growth for yeast. No parasites. On the PCR she had—and I’m uncertain how to interpret the significance given the material discussed—she had high Barnesialla, Odoribacter, Pseudoflavonifractor, and E. coli. Lowest butyrate SIgA of 289 and evidence of fat malabsorption. Sensitivities for botanicals showed best for plant tannins and uva ursi, slightly less for oregano. Already gluten-free. Tried all sorts of diets including anti-Candida diet. Organic acids showed every single marker grossly elevated for dysbiosis. Started her micronutrients including B vitamins, probiotics enzymes, and botanical protocol, which is a hybrid of yours, but not using the same products as access to them in the U.K. was tricky. We’d like to repeat her CSA with the Doctor’ Data as the year has elapsed since she has massive bloating with the same issues. Never tested her for SIBO. I also plan to do that if she is game along with the Cyrex panels, then I’ll be following your protocols to the letter. Any insights into the aftermath of Accutane? What are risks of using a course in metronidazole followed by botanical protocol Paleo diet, pre and probiotics, and gut healing nutrients? Do you have any insights on pseudomonas in particular? I’m familiar with its love of biofilm but wonder if there are any other considerations.

Chris Kresser: I’m sure many of you know about the sometimes devastating side effects of Accutane has been associated with...

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