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What do you recommend for a 28-year-old female patient with Hashimoto’s on 90 mcg of armor. Did a Doctor’s Data. CSA x3 came back with yeast, Chilomastix mesnili, trophozoite, red blood cells and no-growth Bifidobacterium. She is FUT homozygous, which makes sense for low Bifidobacterium. For those of you don’t know about that SNP, people with FUT are more likely to have disrupted gut microbiomes, low Bifidobacterium, low butyrate producers. All the other good bacteria were 3+ and 4+. Didn’t see the CMT parasite in the stool section week six. Treated it with berberine, wormwood, olive leaf, oregano, Caprylic for two months, then she said she had coughed up a black 1-inch thing. She didn’t save it, but it was duly noted. Retested her Doctor’s Data, and the CMT parasite, RBCs, and yeast were still present. Went back on the same protocol, just different dosing, and she was spitting out blood. She is a ballerina for a company in Denver, which makes her diet very limited due to staying at a certain weight. Has severe histamine rash reaction to beef, chicken, orange, and gluten, mostly on joints but can spread to the whole body. I wanted her to go to modified Paleo but says it’s too hard with beef causing response. I think she has heavy metal load. Doesn’t sweat. Liver enzymes were normal. Loves sushi and instant coffee. Cleaned up her diet, supported her gut, but would like help with supplements in the support of parasites and gut dysbiosis.

Chris Kresser: Parasites can be tricky. What you’ve done so far are certainly worthwhile. If you haven’t tried the core...

A 44-year-old female treated some time ago for dysbiosis unsuccessfully; less experience and knowledge then. She presented to me with severe depression which began after a horrific treatment for intractable acne in her teens, had loads of antibiotics but also Accutane which seemed to be the trigger for her mental health decline. I. Her CSA showed no growth of Lactobacilli, 4+ E. coli, 2+ Bifidobacterium, 4+ alpha hemolytic strep, 2+ coag negative staph it looks like, 4+ pseudomonas. No growth for yeast. No parasites. On the PCR she had—and I’m uncertain how to interpret the significance given the material discussed—she had high Barnesialla, Odoribacter, Pseudoflavonifractor, and E. coli. Lowest butyrate SIgA of 289 and evidence of fat malabsorption. Sensitivities for botanicals showed best for plant tannins and uva ursi, slightly less for oregano. Already gluten-free. Tried all sorts of diets including anti-Candida diet. Organic acids showed every single marker grossly elevated for dysbiosis. Started her micronutrients including B vitamins, probiotics enzymes, and botanical protocol, which is a hybrid of yours, but not using the same products as access to them in the U.K. was tricky. We’d like to repeat her CSA with the Doctor’ Data as the year has elapsed since she has massive bloating with the same issues. Never tested her for SIBO. I also plan to do that if she is game along with the Cyrex panels, then I’ll be following your protocols to the letter. Any insights into the aftermath of Accutane? What are risks of using a course in metronidazole followed by botanical protocol Paleo diet, pre and probiotics, and gut healing nutrients? Do you have any insights on pseudomonas in particular? I’m familiar with its love of biofilm but wonder if there are any other considerations.

Chris Kresser: I’m sure many of you know about the sometimes devastating side effects of Accutane has been associated with...

What are your thoughts on pea protein? On week 9, you discussed that it’s an acceptable form. Is it the legume factor, FODMAPs? I’ve given some patients Ben Lynch’s pea protein, and they ended up having diarrhea. I recently switched over to Paleo Protein Designs for Health.

Chris Kresser: Which protein you choose depends on a number of different factors, your goals, the patient tolerance, expense, etc....

Slippery elm versus guar gum for GI healing, IBD, SIBO. Thoughts?

Chris Kresser: They have different functions. Guar gum soluble fiber that is bifidogenic and is microbiotic accessible, meaning it should...

What partially hydrolyzed guar gum do you use, and where is it sourced?

Chris Kresser: We often will recommend the Healthy Origins. It uses Sunfiber, which is like a brand that patented trademark...

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