Dr. Amy Nett: Great questions! If you see many yeast, I would say that this is at least a moderate yeast overgrowth. Remember, the scale that they’re looking on there is none, rare, few, moderate, many. None and rare are considered within the normal range, but few, moderate, and many are considered overgrowth, so she’s at the higher end here. So I would say this is a case of insufficiency dysbiosis with yeast overgrowth, and certainly having insufficiency dysbiosis is going to allow more easily for yeast overgrowth.
y to follow up. If secretory IgA is still elevated after you’ve brought the microbiome into better balance, then think about whether to follow up. For treatment, absolutely you want the A-FNG in here. You want to be focusing on an antifungal protocol. There are two options here. One, this could be a case for a prescription like nystatin. That’s one option if you’re able to prescribe, and the reason I’m suggesting that is because she has insufficiency dysbiosis. I’m a little bit reluctant here to use GI-Synergy in her because I don’t necessarily want to lower the levels of bacteria any further. That said, we think that the herbal protocol has relatively little effect on the beneficial bacteria, but there’s probably still some. My first line on her, I would talk with the patient. If she wants to do a prescription, I would be open to that, but what I would probably do is instead of GI-Synergy, Apex makes a product called Yeastonil. You could do Yeastonil instead of GI-Synergy. That’s a little bit more targeted just towards yeast, because here there’s really not bacteria that we want to kill, there’s no evidence of parasites, so you could do Yeastonil, Lauricidin, InterFase Plus, and A-FNG. Definitely do probiotics, so you’ll still do your MegaSporeBiotic and Prescript-Assist.
In terms of prebiotics, you want the PHGG in there, but I think I would do more of a focus on prebiotics on her because I think for her, half of the problem might be yeast overgrowth; the other half is the low levels of beneficial bacteria. I would do either PHGG, and depending on what her tolerance is, the other product I like and I’ve recently started using might not work well for her because of the loose stools, but it’s FiberMend from Thorne. It has prune powder in it, and I think it also has some psyllium husk, so it might not be good for the loose stools. Then maybe go with PHGG and add BiotaGen, which is a combination of fructooligosaccharide, larch arabinogalactan, inulin, and/or some additional resistant starch. Start at low doses, but maybe add green banana flour, plantain flour, or potato starch. Really emphasize with her getting in prebiotics to increase the levels of beneficial bacteria. Hopefully that answers the treatment aspect of it.
Then, would I assume that the high sIgA is a result of the yeast overgrowth, or would it point me in another direction? Yeah, I don’t know what’s causing the high secretory IgA. It’s certainly possible that it’s due to the dysbiosis that we’re seeing, and when I say “dysbiosis,” I’m including both the insufficiency dysbiosis and also the yeast overgrowth. Absolutely, but the way to know is to treat the yeast overgrowth and then repeat the test, including a secretory IgA. For financial considerations, I would either do a CSAPx1—because then you’ll get an idea of the yeast overgrowth, and you’ll get all of the markers for gut mucosal inflammation—or you can just order a Doctor’s Data parasitology test and the secretory IgA as an individual add-on marker. I’m pretty sure that’s an option, but that would probably be the most cost-effective waher or not she’s eating a food that’s triggering her or if there is a parasite overgrowth or something else that we’re missing.