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Help Topics
- How would you explain to a patient why autoantibodies, specifically TPO and thyroglobulin antibodies, are rising after 90 days of a full autoimmune Paleo diet with selenium and lifestyle changes, and now she’s worried about continuing with the intervention?
- Are you seeing any correlation with particular microbes associated with MS? My patient has had EBV, has shown positive on 4+ on Citrobacter on the GI Effects panel we ran. Also discuss running Doctor’s Data to be current. Wanted your take on the viral microbial possible contribution.
- I have a tough case of a 23-year-old obesity outpatient with recurrent pineal cysts, which started after trauma to the sacral area. And even after multiple surgeries and acne, she has very mild gut issues if any. She’s borderline anemic, low normal MCH, MCV, MCHC, hematocrit, and RBC. Her HbA1c was low at 4.3. Should be high with iron-deficiency anemia (although I have seen a lot of variation with HbA1c in anemias and that’s one of the problems with that marker). And low ferritin at 19. Considering Medihoney for the cysts and a Paleo diet with A, D, and K2 supplementation. All other tests normal, B12, hormones. TSH, fasting glucose normal, kidney function good. She can’t afford testing yet, but I was wondering if you could provide direction on this presentation. Looking forward to your thoughts.
- Female patient with anemia. Here are test results according to the ranges for iron you provided, she’s on the lower end. What dose of iron would you recommend? And how long?
- What do you recommend for someone who tests their blood sugar with a glucometer, and something like sweet potatoes in a meal raises their blood sugar pretty high? Should they try sprouted beans or something else that has a high fiber content instead?
- Well-researched approach abridging conventional medicine, functional medicine has really helped increase confidence. How accurate of a marker is insulin? How are you using insulin in clinical practice? When you run the advanced metabolic workup with insulin C-peptide, etc., as markers, do you have guidelines on how to determine beta cell destruction?
- I have a patient with long-standing depression, episodes of suicidal thoughts. Chief complaints are morning fatigue, bacterial vaginosis, skin issues, and depression. She believes depression can change even after 24 years. Gluten and dairy free for years. Recent labs indicated anemia. Not sure if it’s B12, B6, folate, or iron. She’s responsive to eating more animal protein, which is good. She doesn’t seem to eat enough in general. Her mom requested OAT lab as they’ve tried everything else, including working with a functional medicine practitioner. I’d like your input on the OAT results below and any other thoughts.
- Any thoughts about the Feingold diet, which eliminates artificial colors, flavors, preservatives, and foods high in salicylates for ADHD kids? If patient is already on Paleo and not eating grains or dairy, to eliminate salicylates makes the diet very restrictive and hard for a child to follow. Do you think salicylates are a problem for ADHD kids and worth removing to find out?
- Have you seen Cyrex food sensitivity panel antibodies such as gluten or dairy drop after successful treatment of all heavy metals and/or SIBO? Have patients subjectively been able to tolerate more foods after healing their bodies that they previously could not?
- Would it be possible that cross-reactive foods with gliadin could also cause elevated TPO antibodies? Also have you seen TPO antibodies decrease with removal of iodine supplementation?
- Regarding histamine intolerance, is it preferable to supplement quercetin with bromelain or diamine oxidase? And if SIBO is not a causative factor in histamine intolerance, what other factors would one consider?
- Liver detoxifies. Are there cases where it can cause more harm than good?
- Do you have patients stay on the same probiotic or do you switch them up over time?
- Do you have any recommendations for constipation?
- With patients with heart disease who want to lose weight, what macro percentages do you usually recommend? Do you still shoot for about 15 percent carb or go a little higher to allow for less total daily fat intake while still focusing on total daily calories being about 10 to 20 percent deficit?
- If a patient has heart disease and is on Plavix, is there a safe amount of vitamin K to supplement with?
- My stepdad has very high blood pressure and I’m trying to encourage him to increase his intake of potassium in food on a daily basis. Can you recommend the best method for doing that? Which tracker applications would be most suited to potassium checking?
- Chris mentions in the exposome unit on HPA axis dysfunction that if a patient is having low blood pressure to consider limiting high-potassium foods. To what extent do you think this is necessary? For example, would a medium banana and half an avocado in one day be too much? If the patient starts taking half to one teaspoon of sea salt in the morning, can they be a little more liberal with the potassium in the foods they’re eating? Lastly should the patient be monitoring blood pressure throughout the day? If so, how often and when?
- Has any connection been established between dysbiosis and hypothalamic-pituitary-adrenal axis dysfunction?
- What do you recommend for someone who has adrenal fatigue and needs some safe starchy carbs but also has blood sugar issues?
- Uncle, 75-year-old has been diagnosed with Parkinson’s early. Besides a very-low-carb diet and doing comprehensive gut testing, association with SIBO, etc., how would I know if I would supplement him with betaine hydrochloric acid empirically? He has no gut symptoms. Excess undigested food in the stool. Does he need HCI supplementation?
- This is the first patient I’ve had with truly high stomach acid, and he has a history of heavy NSAID use for migraines from the age of nine. He is 21 now and can’t even drink water without burping. Nearly everything he eats gives him reflux. Bread is the only thing that helps. He has a bleeding ulcer, resulting in surgery, and was put on PPIs a year-and-a-half ago. He stopped all these medications. He still gets headaches, although less severe. We’re doing a reset diet, and I’ve suggested slippery elm along with licorice tea. H. pylori has been ruled out. His stools are oily. Due to limited finances, we’ll do labs one at a time. Plan to start with Doctor’s Data, the comprehensive stool. Any suggestions regarding a treatment plan or to relieve his symptoms are welcome. He manages stress well by working a low-stress job and cutting out partying. He is active, which seems to help his headaches.
- Recommended water filters
- Can you recommend some biofeedback resources? Which devices do you use, and how would you approach implementing this?”
- Do you find that there are issues with Prescript-Assist, MegaSporeBiotic, or S. boulardii with mold toxicity or yeast sensitivity issues, and are there certain patients where this would not be recommended?
- Are plantain chips OK during the 30-day reset?
- Many patients in the clinic that are alcoholics or have other addictions, in general, they tend to not be as compliant as other patients and have much lower success rates. Do you use a qualifying process to exclude these new patients or do you use specific functional medicine tools to address these addictions?
- Does CCFM do gut testing on everyone?
- In my obstetrical practice, we have a large Hispanic population with a high incidence of gestational diabetes. Seems to me that the ADA diet these patients are given is higher in refined carbohydrates than what we learned about in the ADAPT program. Any thoughts on dietary recommendations to help avoid the diabetes clinic putting them on insulin? Also, do you have any thoughts on using Metabolic Synergy or GlucoSupreme herbal and pregnancy?
- Do you have any supplements you recommend for postpartum? Many doctors recommend continuing prenatal, but how long?
- How often do you see problems related to the MMC, migrating motor complex, in cases of SIBO? Do you think it’s important to supplement after negative testing for it?
- If someone is on Cortef, will the stool test and SIBO breath test be accurate?
- Would you recommend treating a person who has fungus in his nails, low income, and no chances for testing?
- Is gluten in skin care products absorbed through the skin? And if so, does it have the same effects as ingested gluten?
- Do you find that there are issues with Prescript-Assist, MegaSporeBiotic, or S. boulardii with mold toxicity or yeast sensitivity issues, and are there certain patients where this would not be recommended?
- Do you have patients stay on the same probiotic or do you switch them up over time?
- Running thyroid panels plus or minus reverse T3 and often finding tests within normal limits. Can you comment on how common it is of subclinical hypothyroidism, how the symptoms may differ from overt hypothyroidism, and common differentials for subclinical presentations?
- Can you figure out these thyroid test results in a patient who’s taking three-quarters of a grain of WP Thyroid and 45 micrograms of T3. TSH is zero, not surprising given how much thyroid medication she’s on, free T4 is low, also not surprising given that she’s taking free T3 and WP Thyroid, which contains T3 in it. So T3 suppresses negative feedback system and the body’s only way of- What can we do to reduce the levels of thyroid hormone?
- Last week’s content you mentioned some cases you had suspected biotoxin illness and mentioned the biotoxin illness survey, visual contrast sensitivity test, and biomarkers for service testing. I know you said you weren’t going to go into this in detail in ADAPT but unfortunately, I seem to be attracting these types of cases already. I need to know how to screen or point them in the right direction. And there are no functional med doctors anywhere near me that would know the first thing about this. Can you briefly describe this and or let us have access to that biotoxin survey?
- We’re just starting to get comfortable interpreting DUTCH. Noticed something that was confusing. They provide age-specific ranges for select markers like testosterone, androgen, metabolites, and total DHEA. But the dial indicators of the patient do not reflect the age-specific ranges for the patient. As an example, 62-year-old male patient, total DHEA was 3,761, age-specific range is 1,000 to 2,500, but the arrow is in the middle range of the dial. Which range should you use?
Uncategorized
- Is it better to do [a] cortisol or Dutch test after a good night’s sleep?
- Seed’s Daily Synbiotic says [to take] two capsules a day; our antimicrobial protocol recommends three daily. I’m curious [about the] reasons behind this.
- Should we attempt to support serotonin production in patients with high cortisol?
- How do you go about introducing the supplement protocol? Do you introduce one at a time and monitor side effects, or start them all at once?
- I’m treating HPAD. Under what circumstances, if any, do you attempt to treat it without any supplements, instead relying entirely on lifestyle behavior and diet and how common people get back to baseline that way?
- What would you recommend for Herx reaction for those who have constipation SIBO who cannot tolerate modified citrus pectin because it aggravates SIBO?
- Bioavailability of foods: is it the nature of the food or the health of [the] gut or both?
- Should we treat hydrogen sulfide SIBO any differently or should we treat the patient by their main complaints, diarrhea or constipation?
- How do you judge when even prolonged periods of inflammation are supporting [the] body’s healing process? Are we ever in danger of interfering with the natural healing process by administering botanical anti-inflammatories like curcumin and boswellia?
- Will telemedicine restrictions lighten in the face of the pandemic? Can a licensed practitioner treat anyone from anywhere?
- Do you know if oral steroids are a risk factor for SIBO?
- For someone [doing] intermittent fasting, how do you recommend doing the botanical protocol? Does the time of day matter? Is it more important that some amount of food be taken with products that are at lunch and dinner?
- For those with limited funds for testing, do you find that [the] Dutch test or cortisol gives a good start [to] figuring out what’s ailing those that are not feeling well because they’re not their usual self and their basic labs are normal?
- How careful do we need to be with S. boulardii and those who are immunocompromised? Technically, diabetes makes people compromised, so is there something we need to watch out for? Any evidence of systemic infection with probiotics?
- What’s the likelihood that [a] patient’s HPAD markers are highly variable over time? I’m concerned about the risk of recommending an incorrect protocol on this basis.
- Can you speak on the new stool test from Microbiome Labs? How it compares, etc?
- Looks like NeuroScience discontinued making Kavinace in 2019. Kavinace OS, [which] they now make, has no GABA, but has magnesium, zinc, selenium, melatonin 5 mg, and a blend of L-theanine and resveratrol.
- Do you have any thoughts on Andy Cutler’s chelation protocol where he recommends using increasing doses of ALA to chelate mercury on a specific time schedule?
- Can we potentially exacerbate HPAD if those are taken in inappropriate times and doses? How can we be confident that we are dosing those appropriately?
- For reducing cortisol and decreasing stress, can a single botanical such as magnolia be effective or even a single combination like Kavinace or HPA Balance rather than several botanicals together?
- How does one wear blue [light] blockers if they wear prescription glasses? [I’m] asking for a friend.
- From my understanding, natural desiccated thyroid (NDT) has 150 mcg of iodine. For those patients on such replacement, do you still advocate additional iodine or ___ [2:20] food sources?
- I’ve seen possible adverse effects on immunomodulators like elderberry for those taking immunosuppressants because of an autoimmune disease. How seriously should we take this precaution?
- In the situation where you design to target Prevotella for treatment, do you currently have additional botanicals to attempt to increase [the] efficacy of treating it?
- Is it possible that Doctor’s Data misses any species on this test, given the large number of species that result in GI-MAP results are not in Doctor’s Data results?
- Are we going to learn about metal toxicity testing? Chris has referred to it but has not specified what he uses. I have used limited serum testing before chelation therapy, a test for mercury, lead, and calcium. Is this reliable?
- Under what circumstances do you consider the presence of Prevotella to merit treatment, particularly if the patient has one or more autoimmune diseases?
- What is the best probiotic that does not have prebiotic in it that you would recommend for patients?
- Roughly what frequency of fish, tuna, or salmon consumption would cause you to order a metal toxicity lab?
- Is there value in distinguishing probiotics for men versus women?
- In Diagnostic Solutions results, which concentration of H. pylori do you consider to be high requiring treatment?
- From the perspective of Functional Medicine, do you attempt to interpret the body’s various external messages of imbalances such as fraying nails, thinning hairs, swollen tongue, [and] excess mucosa surrounding stool?
- Can the botanical intestinal peristalsis stimulants be effective in improving peristalsis even among diabetics? Is the effect equivalent for both [types 1 and 2] diabetes?
- BioHealth Lab closing
- What do you know about EverlyWell? I had two patients tell me they got tested, [and I’m] not sure [of the] quality.
- In general, could you please mention if there are any additional Cyrex tests that you find particularly useful other than the 3, 4, and 10?
- If sensitive patient[s] starting the botanical protocol do react in a strongly negative way to GI-Synergy, do you ever need to use an alternative? If so, what do you recommend?
- I have a patient who has taken an unbelievable amount of antibiotics over five to seven years in the Army, [such as] Doxy [and] anthrax drugs. [The patient] reports no gut symptoms, [and] only reports rosacea. [I’m] curious what you think could be going on, as she has no gut symptoms, [or] maybe she doesn’t feel them, yet they are there. I’m going to order Doctor’s Data, yet [I’m] curious [about] your experience.
- Do we cover genetic testing analysis, i.e., how to interpret? When is it indicated? [I was] wondering, as I saw this as an example in [the] Week 15 module and case review. I find genetics and epigenetics confusing, to say the least.
- Do you find that the Cyrex 5 to 8 (the autoimmune reactivity screens) are useful for patients who have already been diagnosed with autoimmune disease? Under what circumstances would you run these tests?
- I have a couple of patients who are in a lot of discomfort and pain, and I find that they have been doing research and taking things they find on their own. Have you had this happen, and how do you prevent [it]?
- In treating IBD or IBS patients with dysbiosis and parasites using the botanical protocol, are they often intolerant of the Seed probiotic? If so, how do you adjust for that?
- In treating SIBO with the botanical protocol, do you take any special precautions among highly sensitive patients, such as those with fibromyalgia, atrial fib[rillation], excessive blood clotting, IBD, [or] IBS? In such patients, do you consider introducing one botanical at a time? If so, what is your recommended order?
- Do you often find that low serum ferritin can be resolved after treating H. pylori infections?
- Are there specific antimicrobials for different pathogenic bacteria, i.e., Klebsiella? After stool test results show pathogenic, what antimicrobials are used? Maybe Chris has told us, yet [I’m] not sure where to find [the information].
- What’s your view on colon hydrotherapy? Would it be beneficial during an AM protocol?
- I have a one-off question. I have a patient on blood thinners, and he wanted to know if diet, nutrition, and lifestyle changes are enough to ever be able to come off the blood thinners. He has the Leiden V genetic clotting factor.
- The next question, the last one for the presubmitted questions, is about MegaSporeBiotic, so the question is “Is it an endospore former and is it a synbiotic?
- I found monolaurin on Emerson’s site. Can I use that for SIBO protocol instead of the Lauricidin brand? I’d like to be cost-conscious, and this will limit ship[ping] costs from multiple sources, and if so, can you please provide the dosing, as it comes in capsules of 300 mg?
- In your experience, would you agree that ferritin over 90 is required for optimal thyroid health, as it drives T3 into receptors, and, if so, how [do you] get it there? Supplementation [with] iron with C?
- I just listened to a lecture by Allison Siebecker. She always orders the three-hour breath test because if she sees a flatline the first two hours without the typical rise of hydrogen in the third hour, then she suspects hydrogen sulfide SIBO. Thoughts?
- Why don’t you have your intake questionnaire forms before the initial consult? To me, it would seem like this would make more sense in order to have a better sense of what labs to get after the first appointment.
- What is the optimal vitamin D range for those with IBD or another autoimmune condition, and what about those who do not have an autoimmune condition?” Then, there’s also a subquestion here, “Do you use a form that contains K2?
- In reference to Evergreen Authority, any suggestions on how to be [a] common authority? What is the definition of one?
- You cautioned to avoid long-term use of MagO7, [which is] oxygenated magnesium. What do you consider long-term?
- In treating GERD, what conditions merit supplementing with GI Revive or GastroMend to support mucosal healing?
- What role do you think nutraceutical protein powders and products are playing in Functional Medicine practice?
- You mentioned that if patients experience detox symptoms on the botanical dysbiosis protocol, you may provide activated charcoal. What are the detox symptoms that would merit the use of activated charcoal?
- Can you talk more about the neural connection and SIBO? How would this be related to lack of stimulation of the vagus nerve? If so, how can we address it?
- I hear from a lot of people that their food guru also cites studies to back up their stands on veganism. I tell people there are many ways that studies are interpreted and this does seem to cause some distress. How do we handle those concerns?
- For a patient with IBD/IBS, how long do you use low-carb-specific diets? You mentioned glutathione being important in IBD, but we will need carbs to produce the electron donors NADPH to make glutathione. How do you reconcile this?
- Do you refer out to work with Dynamic Neural Retraining System (DNRS), or is it applied within your practice? How often have you applied this?
- I’m having trouble sourcing out all the recommended supplements in Canada. Any recommendations? Could you put together a list of the top suppliers you use?
- If [the] patient has H. pylori and is asymptomatic, doesn’t have access to the virulence test, and may or may not have the risk factors, if not serious risk factors, then leave it, if serious risk factors, then treat [it] as a judgment call?
- In your experience, what’s the efficacy of the H. pylori botanical protocol for eradicating H. pylori?
- What test would you recommend for pancreatic insufficiency? [The] patient is taking digestive enzymes and HCl with Pepsin with meals, but should there be additional pancreatic support? Would low elastase on [a] GI-MAP also be a consequence of SIBO, given the patient’s positive SIBO test result?
- Subsequent to recording, the lecture”—I assume she means the content of the course—“what’s your experience with efficacy in treating methane-predominant SIBO or IBS-C with Atrantil plus botanicals?
- Will you consider doing a webinar to review [the] diagnostic test GI-MAP, since our practice is now using it?
- How do you know when to repeat SIBO and try pharmaceuticals, or shift to [a] leaky gut test and treatment?
- For patients who don’t have stool lab results or cannot do them, how do you suggest we approach [getting] them back to basics with diet?
- Do you prefer soil-based probiotics, or [are] both soil-based and regular similarly beneficial? Should we take and recommend both?
- [There’s a] teenage female with a history of necrotizing enterocolitis at birth with subsequent removal of two-thirds of her colon. What are the implications for [the] gut microbiome with [a] missing colon and large amounts of antibiotics as [a] newborn for the above condition?
- I’m working through Keith’s Evergreen audience program and brainstorming niche, as I’ll be working in a small town. I’m not sure that working with this specific group of patients, for example, gut would be feasible. [Are there] any other ways to develop a niche?
- Do you ever send a patient results from a test without a consult, i.e., if that result or additionally measured diagnostic comes after a case review, how do you handle an assessment fee?
- When do you really consider treating H. pylori? Truly, many people will be H. pylori positive, [so] who [would] you treat?
- Can you please explain why you do not include apolactoferrin in your first-line, first 30 days H. pylori botanical treatment protocol?
- On the last call, Chris mentioned that he doesn’t find the Cyrex 12 test helpful, and I’m curious why.
- The patient complains of onion or garlic ‘allergy.’ She explains she has a threshold of how much she can eat before she gets brain fog and mucus production as well as GI discomfort. Can this solely be attributed to SIBO, or should I look elsewhere?
- Explain dietary acid load. Is this the acid-alkaline conversation or a different topic?
- I’m used to learning using a space repetition application, basically computer-augmented flashcards. I found lots of repetition video transcripts. Would you recommend only learning the handout info by heart or I miss out on things?
- What’s your take on polyreactivity and the idea that chronic inflammatory syndrome can create false-positive food reactivity?
- Are Lyme patients’ chronic illness that comes and goes under the category of immunocompromised patients that we should be careful with [for] the use of Saccharomyces boulardii?
- I’m practicing in a small rural town where Functional medicine is a relatively unheard-of term. I don’t think it would be reasonable to do all the tests suggested in this course secondary to cost concerns. What are the most necessary labs?
- Have you found that successful restoration of damaged microvilli is common?
- On the SIBO breath test, what does it mean if the hydromethane [is] low but combined as high?
- [A] patient had Functional Medicine type testing a few years ago, [and] now complains of multiple health issues and that food restrictions are made of more sensitive foods. What is a good time to retest [for] food sensitivities and stool testing? She is a 69-year-old, [who was] told she had no yeast, no parasites, some other food sensitivities, but now [has] immune dysfunction. [She] can’t fight off colds or flus, and is upset that she’s been unable to keep weight off despite avoiding sensitive foods. Also, [she] doesn’t believe she needs more testing, [and] had all that done not too long [ago]. [She’s] frustrated that she isn’t better.
- In what percentage of your herbally treated H. pylori patients does reinfection occur subsequent [to] successful eradication?
- n what proportion of patients with SIBO are you able to resolve their SIBO by treating their other underlying issues rather than directly treating their SIBO?
- Under what circumstances do we run Dr. Pimentel’s ibs-smart test?
- After initiating an intermittent fast that combines daily meals within eight hours, what’s the mechanism behind the two-phase effect in which some overworked exhausted people initially feel great on the fast but subsequently [feel] much worse?
- Could you clarify how a single short-term incident of food poisoning would lead to long-term release of the anti-vinculin and anti-CdtB antibodies?
- What are your thoughts on ProLon therapy, i.e., fasting with minimal calories for five days?
- Can H. pylori, given this tendency to develop antibiotic resistance, also readily develop resistance to non-pharmaceutical treatments?
- an treatment protocols for dysbiosis, like Saccharomyces boulardii in treating Blastocystis hominis, exacerbate on our immune response in some autoimmune patients? In those situations, do you continue the protocol nevertheless?
- Would you treat H. pylori regardless of age and treat patients with pancreatic insufficiency?
- When the Clostridia species are overabundant in [a] stool test, do you then conduct [a] microbial organic acids test to determine whether the overgrowth of species [is] pathogenic?
- Can you give your opinion on red light therapy?
- Are some dysbiotic organisms less responsive to herbal treatment, like Blastocystis hominis, [which] typically require resorting to pharmaceuticals?
- In stool test results, can abundance of any of the following gram-negative genres potentially trigger autoimmune response: Prevotella, Fusobacterium, Proteus, and Citrobacter? If so, what testing would you then request to check for autoimmune antibodies? [Does] the presence or abundance of these organisms change your treatment method?
- I just got on board on Doctor’s Data. I’m curious what your thoughts are on the iodine tests pre-/post-loading after reading your thyroid eBook. Also, do you like the cardiometabolic risk test on people and [the] metals test, as well?
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