I have an 8-year-old with gut issues. Family eats fairly clean, but gluten gets in regularly. Started out with Arrays 3 and 4, was positive to wheat IgG, rye, barley, spelt. Equivocal to gamma-gliadin-15 IgA and chocolate milk. You said if the wheat IgG was the only thing that really popped out, to consider intestinal permeability, so using the protocol for it, what should the dose for zinc be in a kid? Where would one find sodium-potassium butyrate, again half the dose? I’ve started him on BiotaGen. Should that be enough to feed the good commensals? Is there is a probiotic that has E. coli Nissle, L. plantarum, and S. boulardii in one place? I also wonder, because of what did show up, that he potentially has celiac, but the patient’s parents aren’t gung ho for an endoscopy right now.

Chris Kresser:  OK, so wheat IgG does indicate wheat intolerance, but it doesn’t indicate gluten intolerance, and it also suggests that if you fix the gut, that this kid may be able to tolerate both wheat and gluten in the future. That was the only thing that came up. However, the equivocal antibodies to gamma-gliadin, in a functional capacity, we would consider equivocal to be positive, so I wouldn’t go so far as to say that this kid doesn’t have gluten intolerance. He very well might with the equivocal antibodies to gamma-gliadin. You could also do the intestinal permeability testing. I’m not sure if you’ve done that yet, and I don’t see any information on stool testing or breath testing. The very first thing I would do when you’re seeing these food intolerances is look at the stool, urine, and breath testing that we’ve talked about and treat those issues, and I would do that before treating intestinal permeability because as we discussed during the gut unit, intestinal permeability is almost always a consequence of some other issue, like fungal overgrowth or a parasite or SIBO or something like that. So if you haven’t done that already, I would back up and do that first.

Sodium-potassium butyrate is made by BodyBio, a supplement manufacturer, and you can get it from Emerson and a few other places, I think.

The dose for a child for zinc is based on weight, and you should be able to just look that up at the Linus Pauling Institute or the NIH or just Google. I don’t know, off the top of my head, but it’s probably going to be somewhere between 5 and 10 milligrams.

There, unfortunately, is no probiotic that has E. coli Nissle, L. plantarum, and S. boulardii in one place. The only way to get E. coli Nissle is Mutaflor, ordering Mutaflor from Germany and having it shipped over. So there is one option for that, and it’s not in any combination products that I’m aware of.

Lactobacillus plantarum is in some combination products. It’s in Ideal Bowel Support alone. I’m trying to think. Mark Sisson’s Primal Flora might have Lactobacillus plantarum and Saccharomyces boulardii [yes, it has both]. That’s a good product. I like it. It works pretty well.

Based on what you’ve told me from the Array 3, it’s not looking like celiac. Typically—but not always—you would see elevated deamidated gliadin antibodies and alpha-gliadin and then transglutaminase 2. That’s certainly not always the case, and you can’t rule out celiac when those things are absent, but based on what you’ve said so far, it’s certainly not a big red flag for celiac.