Commensal flora, 3+ alpha-hemolytic strep, no yeast. The only marker that was out of range was fat-stained many red blood cells. I’m thinking she has insufficiency of dysbiosis, I’m planning on putting her on MAT protocol. My concern is about the red blood cells. Yeah, this lady started having dizzy spells a couple months ago and her blood pressure varies from about 100/75 to 80/60 with a pulse in the low 60s and she gets very weak. Her pH is 6.2, negative occult blood, not complained of hemorrhoids. I think my question is, would intestinal bleeding cause the dizziness? And with this view red blood cells, results point to that. She’s seen a cardiologist, but no one is looking at the gut but me.

Dr. Amy Nett:  Great question. I think that red blood cells and occult blood tend to be over-called on the Doctor’s Data stool test. What you need to check is a complete blood count and an iron panel with ferritin. I would definitely follow up on this and you could also, you know what? I don’t know if LabCorp does a fecal RBC. I would check to see if they do. I’ve only run fecal, whenever I see an occult blood on Doctor’s Data, I always run it through Doctor’s Data and 98 percent of the time it comes back normal on LabCorp. So I think the RBCs may be kind of a false positive here. The other thing is that the false, or the few red blood cells could indicate that there’s something like a parasitic infection or something that was missed on the Doctor’s Data test. So if money is available you could consider running a BioHealth 401H because I would want to look for Helicobacter pylori, which Doctor’s Data doesn’t do a good job of testing, and just have a BioHealth assessment for parasites. So if it’s an option, I would run BioHealth 401H. If not, see if LabCorp can run a fecal red blood cell. But the most important thing is for you to run a complete blood count because I want to see the hemoglobin, hematocrit, MCV, and I would run an iron panel with ferritin. Because you’re looking to see if she has low iron because that’s what’s going to suggest GI bleeding.

So just few red blood cells, that’s not enough to make a diagnosis of GI bleeding leading to iron deficiency anemia. But I think you’re absolutely on the right track and need to continue working that up. So I think do that additional workup, but otherwise I think it makes sense. Let me see what her symptoms are. I think it’s okay that you want to do 30 days on an antimicrobial protocol and then after 30 days just switch to really prebiotics and probiotics. Because she doesn’t have a lot of gut symptoms. With the neuropathy it’s also going to be nice to look at the CBC and maybe order a homocysteine because I worry more about B12 deficiency or folate. But some B vitamin deficiency, sleep disturbance and dizziness and low blood pressure, think about cortisol. So those could all point to cortisol as could the mood issues.

So I don’t know how much gut is playing, yeah I don’t know how much gut is playing a role here and it’s not overwhelming based on what you’re seeing. But I do like you working up the additional red blood cells.