A follow-up for a 55-year-old female with type 2 gastroparesis, entire colon removed seven years ago. In April, she had many polyps removed from her small intestine, very rare surgery performed at Duke. She has extreme fat malabsorption, six bowel movements a day, but is thankfully down from 10, so making headway. GI doc requested I develop a botanical protocol for her to prevent future polyps from forming. She’s currently three weeks into care and on GAPS Level 3, Prescript-Assist, phosphatidylcholine, ox bile with enzymes, and supplements for polyp prevention and HPA axis, namely curcumin, essential oils, and aromatic medicine. Doctor’s Data results just came in. I would love your feedback. 4+ for B. fragilis, 1+ Bifido, 1+ E. coli, 1+ Lactobacillus, no growth Enterococcus, 3+ alpha- and gamma-hemolytic strep, 4+ Klebsiella, no yeast, high sIgA, SCFA production nonexistent with only propionate within range and on the lower end, fecal pH low.

Chris Kresser: This is where we just don’t know. What is this test supposed to look like in someone that doesn’t have a colon? We don’t really have much data on that, as far as I know, and it could be that these levels of Bifidobacteria, which is exclusively found in the colon, from what I understand, and E. coli, which is another colonic bacteria. Lactobacillus, some is found in the small intestine. Enterococcus is mostly colonic bacteria. And then you have 3+ for alpha- and gamma-hemolytic and 4+ for Klebsiella. The Klebsiella is probably the biggest concern there, and possibly with a botanical antimicrobial protocol, that would come down, and possibly that would reduce the sIgA. It’s not surprising that the short-chain fatty acid production is low, given that she doesn’t have a colon, which is where that is produced by the bacteria. So I would start with a two-week antimicrobial protocol, and you may want to supplement with short-chain fatty acids, like butyrate, as you mentioned. I don’t know how much you’re going to be able to deal with the deficiency of beneficial bacteria because there’s no colon for it to reside in.

These are kind of the outlier situations that are more difficult to handle because we don’t really have good data on how to approach them, basically.