I’m needing help on what to do with first gut testing. No overt gut symptoms, eats Paleo, no gluten. Array 4 with no positives. Eats fermented food. Has sarcoidosis, which is an autoimmune condition, but no overt symptoms. SIBO test negative. BioHealth shows only Citrobacter abundant, everything else fine. Doctor’s Data red column says dysbiotic flora expected. No growth of Bifido. Only a +1 for Lactobacillus, and no growth of beneficial E. coli. Imbalanced commensals shows +1 for Citrobacter and Staph aureus, +2 for gamma-hemolytic Strep and Klebsiella. +3 for hemolytic E. coli.

Chris Kresser:  You’re exactly right with your next line. This is insufficiency dysbiosis, which can be quite severe in terms of how it presents and symptoms that it causes. We often think of dysbiosis as being more of a presence of pathological bacteria, which it could, but it also can be just from a significant deficiency of beneficial bacteria. Remember, we have potentially pathogenic bacteria in our gut at all times, and normally that’s fine because we have beneficial bacteria that keep it in check, but if that beneficial bacteria drops, then that potentially pathogenic bacteria can start to cause problems for us. So, yeah, I would do the standard gut protocol. I would probably limit the antimicrobials to a maximum of a month and maybe even just two weeks, and then focus a lot more on rebuilding the healthy gut in phase two, where you do the probiotics and prebiotics and you really rotate those in and make sure that they’re getting plenty of fermentable fiber. You mentioned that the patient eats fermented food, but you didn’t mention fermentable fiber, so make sure of that.