Dr. Amy Nett: Okay, so skin issues, gut issues and question if there’s some sort of like developmental delay, or maybe like attention and concentration. Okay, so now we have all the results. Okay, so I would consider the Blastocystis could be a problem in this kid because even though there’s some controversy over whether or not parasites are actually a problem, when I see them on all three samples and when I see one coming up as moderate, that makes me think even if that’s not an inherently bad strain of Blastocystis, that there might be some degree of overgrowth. So given the issue he’s having, I think it’s probably worth treating the Blastocystis and then the next. Yeah, so is it a congenital IgA thing? Is it just like chronic stress and maybe internal sources of stress?
So, I’m not at all familiar with this, but it looks like it’s a stool analysis, comprehensive stool analysis, maybe.
Okay, so we have a problem with parasites again. So both digestion and parasites. Great Plains Lab showed high levels of arabinose, which I think is maybe a little bit sensitive, and I don’t always treat for yeast overgrowth based just on that, especially given the stool test markers that you loaded. And then the other marker that was high was the quinolinic-to-5-HIAA ratio. And that goes along with some degree of inflammation. So he’s got some degree of inflammation and parasites. SIBO breath test, oh, man, this kid has a lot going on.
Okay, so methane at baseline was 43 parts per million and then 58 parts per million at 100, hydrogen, which is one to two. So this is pretty severe SIBO as well. So we have parasites, SIBO, poor digestion, Cyrex test results are not back yet. And the reported findings, I’d call this insufficiency dysbiosis. Let me go back up. Okay, I probably wouldn’t call it insufficiency dysbiosis because you said beneficial bacteria are all 4+ except Lactobacillus. If just one of them is low, I don’t call that insufficiency dysbiosis. I would have to see probably three or four of them at like, no growth, 1+, maybe 2+. Remember, we don’t know exactly what everyone’s bacteria should look like. So in the future I personally would not call that insufficiency dysbiosis, but I would just call it dysbiosis with parasite overgrowth. So that would be fair. If I were to do this in a review findings or reported findings, my first box would say I would probably say Blastocystis and D. fragilis, and then the test markers or which test it was identified on, and then in comments I would say something like, I sometimes depending on the degree to which my patients have read on this and might say something like, “There is some controversy over whether or not Blastocystis is truly pathogenic, but given the overgrowth on the Australian CBSA test through NutriPATH and the Doctor’s Data CSAP, it appears that there is overgrowth, and in combination with the symptoms, I would recommend treatment for this.”
So parasite overgrowth, basically, and then Steve also for his report of findings wrote “methane-dominant SIBO.” Absolutely agree. And then he wrote “underlying parasite infections.” I don’t know that I would throw an “underlying” there. I would just say “parasites,” and like I said, these are probably a problem given the degree to which they showed up on those tests. So yeah, I would say number one, parasites; number two, I might even say something like moderate to severe methane-dominant SIBO. And then I might add on there two others for the report of findings. I might add in impaired digestion because the digestive markers on the NutriPATH stool test showed food remnants, putrefactive short-chain fatty acids. So I might add in impaired digestion, which you could argue could be due to the SIBO, but I would nonetheless put it there. And then as a fourth one I might mention markers of inflammation, and I would note the quinolinic-to-5-HIAA ratio.
It depends on the eight-year-old and it depends on the parents. Because I think that this is absolutely appropriate because Blastocystis and D. fragilis are pretty difficult to treat, and you may even have to go on, both of these are pretty significant. Like a methane-predominant SIBO with those levels you mentioned going up to 58 of the 100 minutes. This kiddo might be going on to rifaximin and potentially also a prescription for the Blasto and D. fragilis. Maybe something like Alinia. So it depends on the eight-year-old and how present that eight-year-old can be in the conversation. But really with the parent I know these are a lot of supplements. I think the one you could probably get rid of would be Saccharomyces boulardii, but definitely keep the Prescript-Assist and Lactobacillus planetarium in there. PHGG I would keep in there because it may increase the efficacy of Biociden, CSA tincture, and Lauricidin. I think you absolutely need all three of those. I agree with you, I would think about adding a digestive enzyme as well because I think it had a slightly different action than the Iberogast.
So depending on the kid’s symptoms, you’re saying he does have problems with stooling. So I would want to keep the Iberogast in there if you could. But I would still add in, and it might be something like half a capsule of the digestive enzymes, like a pretty low dose, especially with the bigger meals. So maybe when he’s eating away from home, doesn’t need to do the digestive enzyme. I would be reluctant to ditch the Iberogast because you want to get him going to the bathroom more regularly, preferably without having to be prompted. So given the symptoms you described, I think you do want to be a little bit more aggressive, especially because like underperforming in school, you don’t want them to get too far behind. So I would do that for probably 45 days actually, because of parasites and the severity of SIBO, and then repeat those tests. I don’t know that you need, need to do both stool tests. If they can afford them and are willing to do them, I think that would be best. Otherwise, you can pick one of the stool tests since Blastocystis showed up on both. Though D. fragilis only showed up on the NutriPATH.
So I like the protocol you have. If you feel like it’s too much, maybe take out the, I don’t know, S. boulardii maybe. And maybe add in a little bit of digestive enzymes. I agree. And yeah try that for 45 days, repeat the tests and let us know. Oh, sorry, and then you said, “What length of treatment would you recommend?” So 45 days and then, “How soon after would you retest?” Two weeks. “With retesting, would you do a breath test and CBSA at that same time?” Absolutely, I would because you need to address both of those things and you’re going to have to decide. I’m very hopeful because kids are very resilient. So I’m very hopeful that with this protocol, you’re going to treat both the SIBO and the parasite. That said, these are both pretty tricky to treat.
So what I would want to see is what are you left with in terms of the SIBO and what are you left with in terms of the parasites? Because if SIBO is still looking a little bit worse, let’s say SIBO comes back and methane is 36 peak. I might do rifaximin. But, and that’s sort of like, let’s say you have SIBO comes back at 36 parts per million and Blasto comes back maybe still present, but maybe it’s only few on two of the samples not detected on one. Then I would do rifaximin, then see where symptoms are. If he’s still having symptoms, consider going after the Blasto and/or D. fragilis with something like Alinia. That said, let’s say tests come back opposite where you have minimal SIBO, maybe the methane comes back at 14 parts per million as a peak, and Blasto is still detected on all three samples. Then I would probably do Alinia first where symptoms, then consider rifaximin. So I hope I didn’t just completely confuse you, but that was to explain yes, do both of the breath testing and the stool testing and follow up two weeks after completing a 45-day treatment protocol. See what you’re left with and go from there and keep us posted.