Patient who has intermittent epigastric pain lasting for four to 18 hours over the last five months. Gaviscon doesn’t help and has been tested, apparently has no H. pylori. No information on how this was established. Definitely need to check on that because a lot of times they do just an endoscopy or a serum test, which are both not very accurate. Slowly getting better but then starts again. Can’t identify trigger. Avoiding lemon, citrus, alcohol, spicy foods but still comes back. Has seen GP and was referred to a gastroenterologist, due to have endoscopy. What other treatments and diagnostic approaches you could investigate? I’m not licensed in the U.K., so I cannot myself order any test or herb, like to advise nevertheless. She is otherwise healthy and physically slim, 40-something years old, vegetarian, eats gluten.

Chris Kresser:  That last sentence I think is probably part of the issue. I was going to say that I would highly recommend a Paleo reset diet. That often solves these problems, and you don’t even have to get into testing. It’s always important to remember to come back to the basics, especially with cases that seem very complex. We can tend to get wrapped up in the details trying to figure out what’s causing each symptom and approaching it from a functional perspective, and that’s all great. But in a lot of cases these types of cases, if the patient hasn’t taken the most basic step, that’s always a starting place, and it remarkably often it addresses all of the problems or at least 60, 70, or 80 percent of the problems, and it becomes much more clear what you need to use functional medicine to address. In this case, if she’s a vegetarian and she’s committed to that, it really depends why they’re vegetarian. If they’re vegetarian because they think it’s healthier choice, then you can have a discussion about whether that’s a good idea. There’s a conversation that becomes possible. If they’re vegetarian for moral reasons, that’s a little bit different. There’s still a possibility for conversation, but it might be more challenging. I personally don’t try to convince anyone to not be a vegetarian or a vegan. I just give them information, and I explain to them how their dietary choices may be contributing to their symptoms, then I leave it up to them. If they want to remain a vegetarian, they can still do a modified Paleo reset, and I’ve given guidelines in the beginning of this course for how to do that if patients are vegetarians. I think that would absolutely be the starting place. I wouldn’t even do much else beyond that until that’s been done.