Dr. Amy Nett: With Gilbert’s syndrome, I think you can probably toss that out the window just because that’s fairly benign
I don’t know what happens after 20 years of PPI use, to be honest. I think I have had patients on PPIs on the order of 10 years, and I have seen them wean off. We wean them off, and then we actually start them on HCl. I don’t know of any reason the body would actually make stop making HCl because I don’t know if proton pump inhibitors actually cause any sort of irreversible changes. As far as I know, they don’t. I think, at least in theory, she should be able to go back to making HCl. I don’t know how old she is, but remember, as we age, we do have a decreased ability to make HCl even at baseline, so she’s most likely going to be a — 68, so no, she’s probably not going to be in a whole lot of HCl on her own. She’s probably going to have to have this huge paradigm shift where we want her to understand that HCl might actually help her, and she’s having stomach discomfort. It’s going to be difficult to wean her. I mean, there’s just going to be a tough transition getting her off the PPI and getting onto her to HCl or digestive enzymes. What would be amazing is if she realizes her stomach discomfort can be resolved by increasing the stomach acid and probably helping the skin eruptions, etc. I don’t know, depending on endoscopy how many samples they did, if that was an adequate test if they did one. I don’t remember of the gold standard like three or four samples.
If you’re going to do the Doctor’s Data stool test, why not just do a BioHealth Helicobacter pylori test as well? It may be one consideration. I do like SIBO. I like the Doctor’s Data CSAP3, absolutely Cyrex Array 3 if she’s eating wheat or gluten. Depending on finances, you could start with Array 4, and then you could also give her the option of holding off on it. If Cyrex Array 3 comes back positive, then run Cyrex Array 4. Because the question is, if she’s eating very little, how many of the foods on Cyrex Array 4 is she even eating? Is it worth looking at those? So maybe yes, maybe no, just something to consider. I might consider the Genova organics comprehensive test. Nausea, allergies, skin eruptions — I’m thinking about detoxification here. You’re going to get a couple of markers for detox on the comprehensive. You want to think about heavy metals. Has she had mercury amalgams? Could that be contributing? So, allergies and skin issues, I’m thinking about having mental toxicity. That might be more than you need to go for her initially, I think, what you’ve written down.
The only thing you didn’t write down, but I’m assuming you’re going to do it, is just the comprehensive blood panel. Just make sure you’re not missing an iron deficiency anemia, B12 deficiency, or something like that. But I think absolutely on the right track. Just make sure you do a comprehensive blood panel and maybe consider the organics comprehensive. It’ll just be one more perspective. In terms of the ANA positive, that’s pretty nonspecific. It may or may not be telling you that she’s tending sort of towards an autoimmune profile, but again, what are we going to do for autoimmune disease? Well, our first step is going to be getting the gut and the diet in alignment, so I don’t know how much I would necessarily go after autoimmune stuff at this point, but you could always run the Cyrex Array 5, the multiple autoimmune reactivity panel, if you wanted to keep walking down that pathway.
I do BioHealth. It’s either 417 or 418. One of those is C. difficile, and one of those is H. pylori. I think 417 is H. pylori, but yes, I trust BioHealth the most for H. pylori. I feel like when we were running Doctor’s Data for H. pylori, it was coming up as a false negative too often because we did split samples where we would have where we would have patients run that test through both BioHealth and Doctor’s Data, so I’ll run the H. pylori through BioHealth specifically, and that’s just like a one-day stool collection, so it doesn’t require two or three days.