Dr. Amy Nett: Again, I would approach this the same way I would any other case. You need to think about – so she has an insufficiency dysbiosis, and we’ll talk about this when we get more into the treatment protocols. But with an insufficiency dysbiosis, we still might run a 30-day herbal antimicrobial protocol. I would want to look and see if she has a SIBO breath test, so do we need to extend that herbal antimicrobial protocol a little bit longer? So meaning, if she has SIBO, I would push that out, but I mean, low short-chain fatty acids and an insufficiency dysbiosis is still potentially going to cause symptoms and still potentially cause problems. If she really doesn’t have any other GI symptoms, and she tolerates probiotics and probiotics well, then at a minimum I would want to do a course of probiotics/probiotics for two or three months to increase the beneficial bacteria, increase short-chain fatty acid production because those are going to modulate inflammation and her immune response.
If she has some GI symptoms or she doesn’t tolerate prebiotics very well, then you want to think about doing the minimum 30-day herbal antimicrobial protocol. If you get the SIBO breath test results, then you want to think about doing maybe even a longer herbal antimicrobial protocol. And again, we’ll go into more of these details when we get into more of the meat of the course, but make sure the gut is there because I would treat an insufficiency dysbiosis.
I would also treat the hypothyroidism. You’re mentioning the abnormal glucose, so you want to get the blood sugar under better control, because again, are we worried about inflammation there? Is there a hyperinsulinemia picture? What does her CRP look like, ferritin look like, some of these other markers of inflammation?
If I’m treating a skin condition, again, I’m going to think about treating from the inside out first. If that doesn’t work, then you think about an outside in and so that might be increasing. Sometimes I will use essential fatty acids, or I might do a combination of omega-3, gamma linoleic acid, have patients eating more flaxseed. I will sometimes use a topical cream with ceramides, but again, I’m always going to start from the inside out approach. You want to get the gut on board. You want to make sure that you are lowering inflammation wherever you can. Start with the gut, also get the blood sugar under control.