Dr. Amy Nett: Well, that’s a great question, and I would ask back, what are the remaining symptoms? If she has done the dietary changes and says, “I feel great. I have good energy. I’m sleeping well and my mood is good. I don’t have any autoimmune conditions, and as far as I can tell, my IBS symptoms have improved,” then I don’t know that you treat. Otherwise, this is potentially a source of underlying inflammation. If she’s reluctant to do the treatment and says, “Well, I think I feel pretty good. We’ve made these dietary changes,” and I have a patient like this almost exactly. We did stool testing. There was some dysbiosis and yeast overgrowth, and he said, “Well, I’m going to make these dietary changes, and I don’t know that I want to take the supplements, so can I do 60 days on the Paleo reset diet and then repeat the stool test and see if making the dietary, prebiotic, and probiotic changes alone is enough to correct that dysbiosis?” So I said, sure, no problem. So we repeated the stool test, and his stool test improved. He still had 3+ Pseudomonas aeruginosa. Symptoms improved. He said, “Well, I’m still not sure I want to do treatment.” So that’s fine. What we’re doing is just monitoring his symptoms. I also monitor things on him like CRP and lysozyme, so I’m looking at overall markers of inflammation. He has some other health issues going on, so we’re sort of monitoring those, and the deal with him right now is, OK, you can keep doing the dietary approach because, of course, it’s always up to your patients, what they want to do. It’s their body. But if his symptoms worsen, then we’re going to do the treatment.
I think in her, depending on where she stands on being open to doing this, I would either repeat the test, see if it has improved, or if she has other ongoing symptoms, just say, “Well, even though the IBS and the GI-specific issues have improved, this dysbiosis could be a cause of inflammation and other symptoms, and it might be worthwhile just to do even a 30-day antimicrobial protocol.” Hopefully that answers that question. It depends a little bit on the big picture, what her additional symptoms are.