There was an organic acids test, you said there was one in particular in which organic acids was used every time, including the first test. I’m still trying to understand when you would bring that in and why it was decided in this particular case from the get-go. Every time this patient retested, there wasn’t much improvement, so I wondered why that test was used three times. There weren’t any clear symptoms that would call for his test that I could tell. The case ended up going for mercury testing, but that was after a lot of organic acids tests.

Dr. Amy Nett: Part of our initial workup, Chris and I are still mostly doing this for initial consults, maybe a little bit less, but our routine set of tests when patients were coming was pretty much a SIBO breath test, one or two stool tests, most often stool testing from both Doctor’s Data and BioHealth, and we were running a urine organic acids test. We tend to run the urine organics comprehensive because we get some markers for dysbiosis. We also use it because you get some markers of methylation, peripheral neurotransmitter metabolism, markers for cellular energy production, mitochondrial function, so we pretty routinely run the urine organic acids test just to get the big picture overview.

If you see markers for dysbiosis, those can be somewhat reliable, especially if you’re seeing a few markers in that category. If you see three or four markers in the category for dysbiosis, then that’s pretty suggestive that you do have dysbiosis. Of course, we can’t tell if that’s in the distal small intestine or the proximal colon, but nonetheless I think there is some valuable information from the organic acids test. Again, we most often use it just in our initial battery of tests, and again, remember most of our patients are coming and they’ve already done probably a fair amount of testing before.

So it’s pretty routine for us and then if we see an abnormality there, and again, I’m not looking at this case specifically, so I’m not sure exactly, but normally if we see abnormalities, I’m just talking about it more generally, but if we see abnormalities that suggest there’s dysbiosis, we’re looking at several markers in that dysbiotic category that are out of range and that’s what we’re treating, we’re going to be following those markers just like if you had a SIBO breath test. So again, maybe the patient doesn’t have symptoms of gut issues, but maybe that person’s there for brain fog or weight issues or something due to inflammation, we’re going to be using those markers of dysbiosis to tell us what’s going on with the gut. We’re going to be treating based on those and we’re therefore going to be using that test as a follow-up. So that’s why we would be using an organic acids tests and tracking it because we’re looking for improvement in that test to indicate improvement in the gut microbial balance.