Dr. Amy Nett: I would say I might not wait to address the HPA axis until resolving gut dysbiosis, so I’m not entirely sure what you mean, but when I meet with a patient for that 75-minute initial consult, I talk about both gut and HPA axis, and I think the two are pretty intimately related. What you might do for HPA axis might be something as simple as Headspace. I think it was because of the Facebook group. A lot of people mentioned Headspace, and I’d been recommending that to patients for over a year now, but I actually just tried it, and it is really easy and straightforward. It’s a really gentle approach to meditation. It’s 10 minutes a day. It’s guided. It really takes sort of the mystery and the intimidation out of meditation. So I would say jump into HPA axis on the first visit. I actually would not delay it because it can be done in conjunction with the gut dysbiosis. So that’s an aside. That wasn’t your question but just my two cents.
Okay, so great question. So, I’m going to kind of break this up a little bit. It sounds like you’re saying because the Blastocystis is present in all three samples you want to treat that, and I would agree. We don’t always know whether Blastocystis is pathogenic in people because we think it might actually be commensal, right? There are probably six different species of Blastocystis. Some of them are commensal. Some of them might be pathogenic. We don’t have the technology to necessarily differentiate, and then beyond that, is it normal growth, or is there overgrowth? So I agree with what I assume your assessment is here in that Blastocystis, with all three samples showing many on at least one of those samples, whether the Blastocystis is commensal or pathogenic, I think it’s overgrowth. I would agree you want to do an herbal antimicrobial protocol. Then because of the 2+ for dysbiotic yeast, I would add the A-FNG. Yeastonil, so you asked whether or not you should add Yeastonil. Yeastonil, the ingredients in Yeastonil are already included in GI-Synergy. So I would use the core antimicrobial protocol, which is going to be the GI-Synergy, Lauricidin, InterFase Plus, probiotics, maybe MegaSporeBiotic, Prescript-Assist, and add A-FNG because of the Geotrichum, the 2+, the dysbiotic yeast, but again, you already have Yeastonil in the GI-Synergy. The GI-Synergy is also going to have activity against Blastocystis, so that’s the protocol I would go with. I would probably do—Blastocystis can be really difficult to treat, so I would actually do 60 days on that treatment protocol. You can use the A-FNG for the 2+. I would probably—I would also wonder on the Doctor’s Data test where they say microscopic yeast. Does it say none, rare, few, moderate, or many? If it’s moderate or many, I would probably do 60 days on the A-FNG. If it’s rare or few, then I would probably do something more like 45 days, but I would say 45 to 60 days basically for the A-FNG and 60 days total for that core antimicrobial protocol.
Then you asked kind of what to do about the high overall short-chain fatty acids. It’s weird that the short-chain fatty acids are high. We see this sometimes, and we don’t exactly know why. I think we just take it to mean that, you know, there is a dysbiosis. We already know that. I don’t think there is anything that I would specifically do for a high short-chain fatty acid production or high butyrate. With low Lactobacillus and Enterococcus, just make sure she gets prebiotics on board. So, what does her diet look like? She is running a business, two small kids. I don’t know if she has time to prep vegetables, but I would definitely discuss that. Increased variety of prebiotics through food sources. Consider adding partially hydrolyzed guar gum, PHGG, or BiotaGen. If she runs constipated, maybe FiberMend, but think about adding a prebiotic supplement, and then remember that it is a two-step treatment protocol when we talk about healing the gut. Step one, antimicrobials kill things off. Step two, rebuild the healthy gut, so it’s really step two where you’re going to focus on addressing those low levels of bacteria. So remember, a two-step process, but even during the antimicrobial phase, you can bring in some prebiotic supplements to increase those levels of beneficial bacteria. The low secretory IgA, HPA axis. I am guessing that would be related to cortisol, so again, address the HPA axis, and I bet that secretory IgA is going to improve.