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I’ve just done my first Cyrex test for gluten for a 58-year-old female who complains of depression, anxiety, frequent migraine headaches, intermittent epigastric pain with nausea, diagnosis of cysts on the liver, spleen, and left kidney. There is also the Cyrex where just two equivocal findings of gluteomorphin and prodynorphin. No other testing, starting with gluten and then looking toward doing the gut testing. Can you help me evaluate this result?

Dr. Amy Nett: So, remember, in functional medicine, we consider equivocal results as positive. Given that you have the two...

From the HPA DUTCH section, part five, under ‘Why is cortisol elevated in obesity?’ I’m not clear on the hypothesis that obesity causes impaired cortisol-to-cortisone metabolism. This would not explain why cortisone metabolites show up in the urine. Wouldn’t there be less cortisone metabolites if the original cortisone conversion process is impaired?

Chris Kresser: I debated on how much detail to go into with this. The HPA axis is incredibly complex, and...

My patient repeated his Doctor’s Data stool after the antimicrobial protocol. The initial test showed that he had 4+ Klebsiella, 3+ ?-hemolytic streptococcus, 4+ gamma-hemolytic streptococcus, and also many for yeast. The test result after the antimicrobial protocol shows that he no longer has Klebsiella or fungal overgrowth but still has the same for hemolytic strep. All of the beneficial bacteria are now 4+. The question is whether to treat the hemolytic strep.

Chris Kresser: No, I wouldn’t in that situation. If he has really good beneficial bacteria, the commensal bacteria are not...

Regarding cortisol-to-DHEA ratios on the DUTCH test, approximately what ratio is considered normal, and what is considered indicating catabolic, i.e., high cortisol compared to DHEA?

Chris Kresser: There’s not really a lot of literature that establishes a specific ratio, especially when it comes to using...

For a Hashimoto’s client who was tested at Genova with no growth of Lactobacillus, no growth of E. coli, 4+ Bifido, 4+ ?-hemolytic streptococcus, 1+ Citrobacter freundii, 4+ streptococcus, 4+ gamma-hemolytic streptococcus, 3+ Klebsiella pneumoniae, 4+ Yersinia enterocolitica, and Yersinia in the bacterial section. So, she’s got a lot going on there in the dysbiosis section. She’s had reflux for the last three years, using medication to manage her symptoms. Do you suggest a protocol for Yersinia or just addressing the dysbiosis?

Chris Kresser: So here, because there is so much dysbiotic and commensal bacteria present, I would do 30 days of...

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