I need a little help with a case. So 48-year-old male, no significant past medical history, diarrhea is the chief complaint. SIBO and stool testing. SIBO’s negative, stool test showed Blasto and insufficiency dysbiosis. Everything else looked great. Treated with a modified protocol, specifically using Parastonil. But the components of GI-Synergy that are specifically for parasites. So treated with that antimicrobial Saccharomyces boulardii and Prescript-Assist for 60 days. But now secretory IgA, beta-glucuronidase, and PP bacteria (Citrobacter) are elevated. Any ideas on why this would happen? Is Citrobacter one of the organisms that promote recirculation? I didn’t pick GI-Synergy initially because I wanted to protect his already fragile microbiome, so now I’m unsure what to do

Dr. Amy Nett: Okay, so I’m wondering did you use Genova for both the tests, or did you do Doctor’s Data initially and then follow up with Genova? Just because if you’re using different companies that could cause that.

Yeah so this one’s tricky and I sometimes do see changes. It’s rare but I have had something where I’ve used a Doctor’s Data stool test and then we do treatment, and then we follow-up and we do occasionally see some worsening of what the microbiology profile looks like. And I don’t know in this case that you got rid of the Blastocystis, so some of what filled in that real estate, so to speak, was actually just Citrobacter and some of these less favorable bacteria. So what was, I mean one question, I think, is what was the symptom change? Was there symptom improvement with 60 days? And remember sometimes too with insufficiency dysbiosis we will still actually use GI-Synergy maybe for a shorter course. Like we’ll often just do 30 days of the herbal antimicrobial protocol.

So if secretory IgA is through the roof, something’s inflaming him. So it could be diet. So what does his diet look like? He didn’t do an elimination diet previously. Has he gotten rid of at least like gluten, dairy, and the most inflammatory dietary pieces? So definitely explore the option of an elimination diet, Cyrex testing if needed. I probably would do, at this point, with the Citrobacter, I probably would do depending on his symptoms, 45 or 60 days of the protocol using GI-Synergy and InterFase Plus and lauricidin. So doing like that core protocol, I think it’s worth repeating that. And then add in, so when I’m worried about low levels of beneficial bacteria, but I want to use GI-Synergy, I will often just use more in the way of prebiotic. So you might just use PHGG and BiotaGen, something like that to make sure that they’re getting enough to feed the beneficial bacteria.

So I would think about 45 to 60 days on just the standard dysbiosis protocol, GI-Synergy,  lauricidin, InterFase Plus, Prescript-Assist, MegaSporeBiotic, PHGG. Also bring in some BiotaGen or green banana flour or whatever your prebiotic of choice is to help support the beneficial bacteria. Okay, yeah, and then check the food, see what he’s eating, see if there’s anything there that might be triggering. And if he’s still having diarrhea, the other thing if he’s not open to an elimination diet, then Intro GAPS probably isn’t an option. But for diarrhea, I really like the Intro GAPS diet.