What do you recommend for a 28-year-old female patient with Hashimoto’s on 90 mcg of armor. Did a Doctor’s Data. CSA x3 came back with yeast, Chilomastix mesnili, trophozoite, red blood cells and no-growth Bifidobacterium. She is FUT homozygous, which makes sense for low Bifidobacterium. For those of you don’t know about that SNP, people with FUT are more likely to have disrupted gut microbiomes, low Bifidobacterium, low butyrate producers. All the other good bacteria were 3+ and 4+. Didn’t see the CMT parasite in the stool section week six. Treated it with berberine, wormwood, olive leaf, oregano, Caprylic for two months, then she said she had coughed up a black 1-inch thing. She didn’t save it, but it was duly noted. Retested her Doctor’s Data, and the CMT parasite, RBCs, and yeast were still present. Went back on the same protocol, just different dosing, and she was spitting out blood. She is a ballerina for a company in Denver, which makes her diet very limited due to staying at a certain weight. Has severe histamine rash reaction to beef, chicken, orange, and gluten, mostly on joints but can spread to the whole body. I wanted her to go to modified Paleo but says it’s too hard with beef causing response. I think she has heavy metal load. Doesn’t sweat. Liver enzymes were normal. Loves sushi and instant coffee. Cleaned up her diet, supported her gut, but would like help with supplements in the support of parasites and gut dysbiosis.

Chris Kresser: Parasites can be tricky. What you’ve done so far are certainly worthwhile. If you haven’t tried the core protocol that we taught you in ADAPT, that’s worthwhile, more concentrated. Liquid antiparasitic herbs can be worthwhile, and sometimes you actually need to use medication to fully clear parasites, and that can be true as I mentioned with Blastocystis, Dientamoeba fragilis, and some of these other organisms will typically start with the most benign protocol that could be effective. But then we scale up over time with more potent treatments that become more effective if the initial treatments aren’t effective. The other thing to consider is Chilomastix mesnili accidentally falls into that same category as Blastocystis and D. fragilis, which is considered in some, if not most cases, to be nonpathogenic. When you see this in the stool and someone is having gut symptoms, it’s tempting to assume that this is what’s causing the symptoms, but that’s not necessarily a safe assumption. It may be worthwhile focusing on other mechanisms and seeing if you can make progress before, especially if this patient, if you don’t have access to the antibiotic protocol or someone that can do that, or if the patient doesn’t want to do that, you may want to try focusing on some of these other mechanisms that you mentioned and coming back to the CMT if you don’t make the progress that you think you should be making. In terms of Paleo, lots of people do Paleo without beef. It’s totally doable. There are lots of other choices—fish. I mean I have patients who do Paleo with just fish—patients who are allergic to beef who eat chicken, pork, fish, lamb, venison, and organ meats. Obviously, you can’t make somebody do something if they’re not willing or ready, and it sounds like they may not be given that that’s the excuse. You could do heavy metal testing as well. I’m not seeing anything here on HPA axis. Maybe we haven’t gotten there yet, and then there’s a variety of stuff that you can figure out with blood chemistry too. Given that she has the histamine issue, Hashimoto’s which is immune dysregulation, and the skin rash and some of these other problems, I think is certainly focusing on the gut is good, but I’m not sure that eradicating the parasite is necessarily essential to accomplishing your goals.