Male patient with gut symptoms from loose bowels to cramping. Doctor’s Data test showed no parasites but did have no-growth Bifida and elevated lactoferrin and calprotectin. Had an appointment with specialist who ran biopsy, and while it showed no IBD, it did show lymphocytic colitis. Patient also had elevated cholesterol from triglycerides and cholesterol/HDL ratio 4.1, high ferritin, low vitamin D. Patient has gone overseas for a month. I have advised to follow a Paleo reset diet with cholesterol modifications and recommended more comprehensive bloods and DUTCH test. Patient’s reluctant to spend more money on testing. Feeling unsure whether to do gut protocol with him seeing as there are no parasites. Can I go into prebiotic straightaway to Bifidobacterium up?

Chris Kresser: There’s definitely inflammation going on and in the gut with a calprotectin that high and lactoferrin that high. If it’s not IBD, there’s still colitis happening. Colitis is inflammation of the colon, so there’s something going on that’s driving that. You want to look at diet, Paleo reset but even potentially you could look into it like autoimmune, or you can look at GAP’s diet as being helpful in this situation. I would actually consider doing a therapeutic trial of the antimicrobial protocol because there’s almost certainly some dysbiosis going on that’s contributing here. Yes, you could consider prebiotics as well as probiotics to help get the Bifidobacteria up. I didn’t mention butyrate. I’d wonder if butyrate is low given that the Bifidobacteria is low, and he’s got so much inflammation on the gut, so you could try butyrate as well. We have to remember these tests are great, and they’re much better than nothing, but they’re not always perfect, so sometimes we need to do therapeutic trials as part of the evaluation process to see what level that we should be pushing on and what’s going to make the biggest impact.