Dr. Amy Nett: No. So if all beneficial bacteria are 4+ except Bifidobacterium, no I don’t think that’s enough to consider it insufficiency dysbiosis. So 4+ for alpha and mucoid E. coli and 2+ for gamma-hemolytic strep and Pseudomonas. No I don’t think that’s enough for me to call it dysbiosis. That’s within normal range for me. And then you also mentioned that her diarrhea is improving, there are no markers of inflammation like lysozyme or calprotectin. So what I would probably do, okay so you’ve switched her diet and I’m trying to decide honestly if I would run one more test for C. difficile. If her diarrhea does not improve, I would run one more test for Clostridium difficile. Maybe run it through BioHealth. Yeah, run it through BioHealth and you can run an individual marker for C. diff, but I think it’s worth ruling out if diarrhea persists just because of the context you put this in.
Otherwise, I would try the rebuilding the healthy gut protocol which is going to be the focus of prebiotics and probiotics. And I would see what her symptoms look like at that point because I think that’s going to be the most likely in terms of what’s potentially contributed. And I know we’re seeing all 4+ here, but something disrupted her gut microbiome after that antibiotic and of course we’re not measuring the full spectrum of GI microbes here. So I would try the rebuilding the gut protocol. If she gets worse on that, then reconsider. Maybe do an antimicrobial protocol but anxiety, hopelessness, I would also take a look at her blood panel. In an 85-year-old woman who was eating nothing but vegetables, this could be a nutrient deficiency issue so I would think about really a big focus on a nutrient-dense diet.