Aquestion about ​Kaiser diagnosis​ of polymyalgia rheumatica, high C-reactive protein, and ESR (erythrocyte sedimentation rate), scheduled for gastric balloon. This is a 63-year-old male on and off prednisone for three years, [who] has hypertension, [has] high cholesterol, [is] overweight, [and] has been eating a plant-based diet for the past few months, but his weight [has] stayed constant. First thoughts on gastric balloons: [it] sounds absurd to me. [The] balloon goes in for six months and [the] patient is put on PPIs, Zofran, and [an] antispasmodic. My plan is [to] run ​LabCorp opti integral VA​, the blood test, GI-MAP, [and] Cyrex Array 3. Any additional tests come to mind? [I] may do a Paleo reset.

Yes. I mean, this is like a typical conventional approach to a condition like this based on symptom suppression [and] not actually investigating the root cause. I think depending on how far this patient is willing to go, certainly a Paleo reset is an obvious starting place. You might even consider AIP [autoimmune protocol diet], given the inflammatory load that we’re seeing here. I would definitely want to see [a] SIBO [small intestinal bacterial overgrowth] breath test in addition to the GI-MAP because that can often result in [a] presentation like this, so that would be pretty important. You definitely want to aim for a lower-carb approach, either with the Paleo reset or AIP, because [for] the overweight for one and the hypertension, and then also just the GI stuff, [a] lower-carb approach can often be helpful in that kind of situation. And then, you could also layer in some intermittent fasting like a fasting mimicking diet approach or keto fast type of approach, or just supervise [a] two- to five-day broth fast. Depending on your experience with that and the patient’s willingness, that can help tremendously with both gut reset and metabolic reset. There’s lots that could be done here without the gastric balloon, the antacids, and [the] antispasmodic. Those are all, as you know, designed just to address symptoms and not really to address [the] cause of the problem.