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Nineteen-year-old male patient with active UC. Raised unvaccinated but on antibiotic six times in life with three rounds when a baby toddler. Recent antibiotics in high school for acne prescription, college baseball player just finished first year of college upon diagnosis of UC. Has got low levels of some beneficial bacteria. 2+ of alpha-hemolytic strep, 1+ for Citrobacter, 2+ for gamma-hemolytic strep, 1+ for Pseudomonas and staph, no pathogens or yeast. Many white blood cells, low lymphs, high monocytes, that’s all consistent with IBD and ulcerative colitis, as is lactoferrin of 219. Calprotectin of 541, wow. Lysozyme of 27,500, wow, wow. sIgA of 251, low short-chain fatty acid production and acidic fecal pH, iron deficient based on the functional medicine iron panel. Not surprising given the extent of the gut inflammation. Anemia based on CBC with normal B12, MMA and homocysteine. So that’s iron-deficient anemia. Excretion of liver burden detected from metabolic panel, low vitamin D. Three weeks into the low-FODMAP diet, low in soluble fiber, gut reset diet with motility improvement of 14 bowel movements per day down to four to five. That’s great. Visible blood in stools and fecal incontinence is resolved. Still experiencing immediate BMs following meals and mitochondrial dysfunction. Tell me again why 4+ Clostridium is in the commensal column. Given the symptoms, it seems like a warning sign to me when correlated with symptoms. Number two, is it okay to perform the Rebuilding Healthy Gut Protocol on GAPS Level 1, or should we layer that in? Three, is vitamin C okay to take for iron repletion when motility is hyper?

Nineteen-year-old male patient with active UC. Raised unvaccinated but on antibiotic six times in life with three rounds when a baby toddler. Recent antibiotics in high school for acne prescription, college baseball player just finished first year of college upon diagnosis of UC. Has got low levels of some beneficial bacteria. 2+ of alpha-hemolytic strep, 1+ for Citrobacter, 2+ for gamma-hemolytic strep, 1+ for Pseudomonas and staph, no pathogens or yeast. Many white blood cells, low lymphs, high monocytes, that’s all consistent with IBD and ulcerative colitis, as is lactoferrin of 219. Calprotectin of 541, wow. Lysozyme of 27,500, wow, wow. sIgA of 251, low short-chain fatty acid production and acidic fecal pH, iron deficient based on the functional medicine iron panel. Not surprising given the extent of the gut inflammation. Anemia based on CBC with normal B12, MMA and homocysteine. So that’s iron-deficient anemia. Excretion of liver burden detected from metabolic panel, low vitamin D. Three weeks into the low-FODMAP diet, low in soluble fiber, gut reset diet with motility improvement of 14 bowel movements per day down to four to five. That’s great. Visible blood in stools and fecal incontinence is resolved. Still experiencing immediate BMs following meals and mitochondrial dysfunction. Tell me again why 4+ Clostridium is in the commensal column. Given the symptoms, it seems like a warning sign to me when correlated with symptoms. Number two, is it okay to perform the Rebuilding Healthy Gut Protocol on GAPS Level 1, or should we layer that in? Three, is vitamin C okay to take for iron repletion when motility is hyper?

Chris Kresser: So you have to do, in this situation there is a follow-up test you do from Doctor’s Data. I think we talked about it in the gut section, where they can differentiate between beneficial species of Clostridia and pathogenic species. So you definitely want to do that in this patient. And if they do have a positive for pathogenic species of Clostridia, then a fecal transplant will be high on the list; although they don’t qualify for that in the US unless they’ve already tried antibiotics and failed them. But he could maybe go somewhere like the Taymount clinic or something like that.

GAPS Level 1 would preclude the use of some of the prebiotics on the Rebuilding a Healthy Gut Protocol. So I wouldn’t combine those.

Yes, if you take a highly absorbable form like liposomal C. I don’t typically see diarrhea with liposomal C.

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