Dr. Amy Nett: In reading about L-glutamine and glycine-rich foods, I think they sound very promising, and for some people, they do seem to work really well. They’re very safe supplements, so I think that’s always a reasonable approach to start with those.
That said, clinically we tend to see fairly inconsistent results in terms of using L-glutamine and glycine for healing, so I don’t generally start with those alone, and I do generally start with probiotics, whether that’s part of an overall antimicrobial protocol or we’re just doing more of a focus on prebiotics and probiotics. I don’t generally find a need to do dedicated glutamine and glycine-rich foods prior to getting started to more of the sort of meat of the treatment. Glutamine I’ll most often use in patients who have very severe gut mucosal inflammation, so the population I probably would consider it for would be patients with inflammatory bowel disease. If someone does have Crohn’s or ulcerative colitis and they’re coming back with really high lysozyme, calprotectin, and lactoferrin, that would probably be a case for working with glutamine and glycine initially. Otherwise, try to figure out what’s causing the leaky gut and start there. Most often I’m actually going to start with an antimicrobial protocol.
In terms of “low and slow,” that’s always a good approach for starting any supplement. Response to probiotics also really depends on the probiotic being used. Soil-based organisms, which we commonly use in Prescript-Assist, and transient commensals like we use with MegaSporeBiotic, and beneficial yeast like Saccharomyces boulardii are normally a little bit better tolerated than some of the Lactobacillus-containing probiotics. We’re going to be covering all of this in more detail in the gut unit, but I would say depending on the type of probiotics you’re trying to use, that may also affect how quickly patients are able to adjust with them. If I’m ever concerned, I tell people to open up the capsules and start with a half a capsule or even less.