Amy Nett: The first question is a follow-up to one that she asked previously, and the original question from early in February was what’s my take on sudden onset of Chilblains first in the toes of one foot one day, then the toes of the other the next after spending an hour in the cold in an 8-year-old with mild psoriasis. I asked for a little more background information in terms of the context, and then she follows up and says, “The background information, the 8-year-old (9 years old next week) with psoriasis is my daughter. She has been fed an organic whole food, gluten-free diet since weaning and Paleo for six years.
She says, so this is the mom, “I have Raynaud’s in my fingers and occasional pernio in one of my toes. My 5-year-old has mild eczema and glaucoma, which could be autoimmune in her left eye, so I experimented with egg, dairy, and nightshade elimination to begin. There is no change in the 9-year-old’s psoriasis, so we did a 90-day AIP trial. The older daughter’s psoriasis improved a teeny bit, and I am wondering what test would be most beneficial and easy/practical bearing her age in mind to get to her root cause. I would love to do a stool test, but she is pretty disgusted by the idea of collecting the sample. It’s so much easier to figure this out for clients, but when my children are concerned, I cannot see the woods for the trees. I would really appreciate your thoughts.”
This is a great question because I think pediatrics can be a little bit more difficult because, as you said, getting kids to do a stool test is not necessarily easy. In this case, with a 9-year-old, I would think about doing the urine organic acids test. You could either do the organic comprehensive profile from Genova. Great Plains also has a comprehensive organic acids test, or you could do just the microbial organic acids, again, either through Genova or through Great Plains. Those are both perfectly good options, but doing the microbial organic acids, you’re going to get some markers of either small intestinal bacterial overgrowth or at least dysbiosis that’s involving the first portion of the colon.
I think urine organic acids test is going to be a lot easier for pediatric patients to collect. The prep is not too involved. Effectively, all you’re doing for that is some mild fluid restriction the day before and then collecting the urine sample first thing in the morning, so I would definitely do urine organic acids. Whether you do the microbial urine organic acids or the comprehensive, I think you could go either way. I tend to think that organic acids testing there is a lot of variability. Meaning, if you were to do urine organic acids test, let’s say, seven days in a row, you’d probably see about five variations on a theme. I take those markers as a guide in terms of where I might want to look a little bit further, but I don’t necessarily take each of those markers too seriously and do the nutrient corrections suggested, but if you see a lot markers for B vitamins being insufficient or mitochondrial function being insufficient, then that’s just something to consider. Since you’re going to be limited on the number of tests your 9-year-old is willing to do, probably go for the comprehensive organic profile, so either Genova or Great Plains. I would probably favor Genova little bit for the microbial organic acids, but either way, you’re fine.
A 9-year-old can generally also do the SIBO breath test. The thing with kids on that, you want to make sure they don’t do too big of an inhalation that makes the results invalid, but again, breath testing is pretty benign, and 9-year-olds can definitely follow those instructions, then you’re not dealing with stool collection. Probably run a SIBO breath test. The biggest issue there with a 9-year-old is the diet the day before because it’s so restrictive. It’s basically going to be white rice, maybe some meat, so I would say do the diet with her so that you guys are both kind of doing that really limited diet the day before. Then in the morning, she’ll drink that lactulose solution and collect the breath sample. Here you’re trying to get an idea of what’s going on in the gut, so SIBO breath test and organic acids test. Those should be reasonable for a 9-year-old to do.
The other thing is that you didn’t mention here whether or not you’ve kind of played around with probiotics, but the other thing you could say is, well, if one of the theories of autoimmune concerns is that three-legged stool that Alessio Fasano has proposed where we talk about having the genetic predisposition, environmental triggers which we don’t always know what those environmental triggers are, and then having a leaky gut that allows that sort of inappropriate immune stimulation. You could potentially say— I’m suspicious enough that there is a gut microbial imbalance contributing to leaky gut that I want to do, the herbal antimicrobial protocol and/or just start with a combination of probiotics and prebiotics. It sounds you’re so on top of it in terms of doing this whole food organic diet since they were little, so I’m guessing your kids have not had a lot in the way of antibiotics, which makes gut microbial dysbiosis less likely, so I’m a little bit hesitant to recommend the herbal antimicrobial protocol, but again, if your daughter’s just not going to do some of the testing, I think it’s possibly a consideration to do four weeks of the herbal antimicrobials. But again, I have a little bit of hesitation there. I would start instead with just probiotics and prebiotics and see if that allows for any change in terms of her symptoms.
You mentioned really the psoriasis being her main issues that saying she is otherwise “healthy,” so it’s hard for me to think, ”Well, do we want to do much in the way of chronic infection testing?” But again, just thinking what are some of the other triggers for autoimmune diseases. You might think of chronic infections whether chronic viral infections. You could think about high toxic burdens. You can do environmental toxic profile through Great Plains. You mentioned two kids and yourself, so I don’t know if there’s a husband or someone else in the family, if he’s having symptoms. But if all of you are having symptoms, have you looked at your home for mold or mycotoxin exposure to make sure there is not an environmental exposure if the gut is okay? Again, lowest hanging fruit is going to be gut, but if everyone in the family is affected, think about environmental triggers as well. Within my home, you would think about mold or mycotoxins. For kids, you could definitely think about environmental allergies, and remember that some food and environmental allergens do cross react. I don’t remember those off the top of my head, but birch allergies might cross react with stone fruits or something like that. There are some environmental and food cross reactivities.
Hopefully that gives you some ideas in terms of where to start. Basically, the SIBO breath test and the urine organic acids are where I would to start. Probiotics and prebiotics to support the gut if she won’t do any gut testing. Then just make sure there is nothing at home that could potentially be triggering immune issues, just as you mentioned. The three of you in your home, do you have some evidence of immune dysregulation? There is certainly the genetic predisposition.