Dr. Amy Nett: OK, so on the CSAPx3, I don’t think all of the beneficial bacteria need to be at 4. That would be amazing, but I never see that. If there’s a combination of 3s and 4s, I think that would be good enough. So we’ll assume that this is a dysbiosis of insufficiency, but if one of these is no growth and the other ones are 3+, then I wouldn’t be terribly worried.
Then the question around this is what to do to boost beneficial bacteria, and you’re saying specifically E. coli, Enterococcus, and Clostridium. You said, “Is there a specific probiotic to target them?” I think you mean prebiotic because, again, probiotics are the healthy bacteria that we use in supplemental forms and that are in fermented foods, but probiotics don’t actually increase the numbers of beneficial bacteria in our GI tract. They don’t really set up residence, so to speak. They pass through our GI tract. They might be in there anywhere from a few days up to 28 days or so, and they probably perform beneficial functions, but they don’t actually stick around long term. To increase levels of beneficial bacteria, you want to think about prebiotics. You probably just confused these because I do that all the time when I’m saying prebiotics and probiotics and I catch myself saying the incorrect one or not the one that I mean for that situation.
Prebiotics are going to be the fermentable carbohydrates that actually increase levels of beneficial bacteria. I would say variety is the best approach. The more variety you can get, the better. I don’t know of any specific prebiotics that will increase levels of E. coli, Enterococcus, or Clostridium. In general, I would recommend just going with variety if the patients are able to. I think we’ve talked about this before. You may not always need to use a supplement. Some of my patients just want to increase their diet and I’ll tell them, “Maybe put a piece of paper up on the fridge and keep track of how many different vegetables you eat in one month. Try to push yourself to try a new vegetable once a week, something like that, just to increase the sources of prebiotics. But otherwise, PHGG we’ve said. That one has been shown to increase Lactobacillus and Bifidobacterium, but it might have some beneficial effect on the other ones. Unfortunately, no specific prebiotics that I know of, but just go with variety as much as you can with the prebiotics on those.