Chris Kresser: This is an interesting case. The truth is no one really knows what this looks like in clinical practice for certain. She doesn’t have a colon. It’s believed that when the colon is removed the lower part of the small intestine starts to fulfill some of the functions of the colon, but all of the data that we have both from a research perspective and from a clinical perspective on what those species of bacteria should be at the very top of the first page of the Doctor’s Data stool test, it comes from people with colons. So, we don’t really know what is normal for someone without a colon. I think you should take the results of the Doctor’s Data stool test with a grain of salt with a patient like this. If you do do the follow-up testing, yes, I agree. Keep the patient on the prebiotics and probiotics to see what effect those have, and please share your results, anonymously of course, with the class because I’d be very curious. We have a few patients who have J pouches, who don’t have colons, and we have some follow-up data on Doctor’s Data stool testing on different interventions, but I would love to kind of add to that with this additional case. If she gets symptom benefit from the prebiotics and probiotics, I imagine that will be enough for her to stay on them. If she is not getting any symptom benefit, I’m not even personally convinced that they would be necessary for ongoing maintenance because I’m not really sure what is physiologically normal in that situation.
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- Regarding our patient, who I am now familiar with, a 55-year-old female with colon removed seven years ago. We expect that without a colon she’ll need long-term prebiotic and probiotic support. We’re getting her started on antimicrobial protocol and will follow that with a rebuild. The question is, in this case, would we do the follow-up Doctor’s Data stool analysis while still on prebiotics and probiotics for maintenance? We want her to believe they work, and if we take her off these supplements during the test, we worry she won’t see much improvement in sufficiency dysbiosis and will assume the supplements are not helping.
Regarding our patient, who I am now familiar with, a 55-year-old female with colon removed seven years ago. We expect that without a colon she’ll need long-term prebiotic and probiotic support. We’re getting her started on antimicrobial protocol and will follow that with a rebuild. The question is, in this case, would we do the follow-up Doctor’s Data stool analysis while still on prebiotics and probiotics for maintenance? We want her to believe they work, and if we take her off these supplements during the test, we worry she won’t see much improvement in sufficiency dysbiosis and will assume the supplements are not helping.
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