In the parasite lecture, Chris mentions that a botanical anti-parasite approach ‘doesn’t have a significant adverse impact on gut flora.’ How do we know this? Can you elaborate? Furthermore, since they are rather broad-based, what makes them a better choice than drug treatment? Are they better tolerated?

Dr. Amy Nett: Generally I would say botanicals do have some effect on the GI microbiome, so I don’t think they can necessarily tell, as you say, the good guys from the bad guys, but based on our stool testing pre- and post-treatment, there seem to be relatively minor changes in the beneficial bacteria. We do stool testing, then we do treatment, and we almost always ask for our patients to do post-treatment stool testing. When we compare the beneficial bacteria before and after treatment, it seems that there tends to be relatively little change. I think that’s probably one of the reasons we’re saying that it’s less likely to cause significant impact, especially when you’re comparing it to an antibiotic.

I think there is an argument, though, to be made sometimes for using an antiprotozoal agent if we are treating a parasite in particular. I do have patients where sometimes they have really low levels of beneficial bacteria, and I’m cautious in using the herbal antimicrobials, because as you said, they are botanicals, and if patients are sort of indifferent between prescriptions and herbals, I will sometimes use a prescription medication at that time because it is a little bit more targeted towards the parasites. That said, I think you can still make the argument that pre- and post-treatment stool testing overall doesn’t consistently show a significant impact on the beneficial bacteria.

Then Chris also mentioned—I think he has mentioned this previously—that a potential advantage to herbs is that the antimicrobial effect is due to multiple different mechanisms rather than when you have, like, an antibiotic or some of the antiprotozoal medications. They’re generally designed to kill a microorganism through one specific mechanism, so when you rely on one approach that a drug company has said, “We’re going to make this a target. We’re going to design are antibiotic to kill the microbes this specific way,” you have an increased risk of developing antibiotic resistance because then the microbes evolve to evade that specific mechanism. That’s one of the reasons we have this antibiotic resistance. That’s a huge benefit of herbals and, I think, one of the reasons we feel comfortable using them for longer durations because we don’t worry about the development of resistance as consistently. Great questions.