Opinion about a 50-year-old client dealing with brain lesions. She did a lumbar puncture and it was not demyelination. So she has high blood pressure, constipation for many years, feet and legs are swollen from time to time, gaining weight in the past few years. When she came to see me she was doing a few months of colon hydrotherapy trying to help her constipation. We’re working on diet and lifestyle, and she has a very limited budget for testing. So would you start by testing her gut?

Dr. Amy Nett:  Yeah, I probably would. I mean the constipation, yes, and I mean, our general approach is almost always to start with gut just because we tend to think of that as the foundation. So not entirely sure what’s meant by the brain lesions and if there are certain neurologic symptoms. But if there are neurologic symptoms, I would jump a little bit sooner into something like you want to look at functional methylation, heavy metal toxicity, depending on the clinical history maybe even think about tickborne illness. But I would start with the gut, start with cortisols and start with a comprehensive blood panel. So start with all the basics and see what you find. Especially given the constipation, it sounds like there’s some improvement that can be made there. But yeah, it sounds like a tricky case and you might have to think about those other rabbit holes and maybe send her to someone else to look at some of those if that’s not in your comfort zone. But functional methylation too, so when you do the comprehensive blood panel, because you said limited budget for testing. So when you do the comprehensive blood panel, definitely look for anemia, look for a large MCV that suggests a functional B12 or folate deficiency, and look at her MMA. So that’s a tricky one. Keep us posted.