After running an organic acids test, there are no bacterial or fungal markers out of range. How would you suggest moving forward with a 12-year-old who is having extreme difficulty with salicylates and phenol-containing foods? Other symptoms are dry hands, cracking lips. She’s been gluten free and dairy free for one month. No significant changes.

Dr. Amy Nett: Hopefully by now you would know that we would go with a SIBO breath test and stool testing. Again, organic acids testing can certainly be helpful, but it’s not going to be definitive, so I would definitely consider a SIBO breath test. I would do stool testing. Trouble with salicylates and phenol-containing foods. Yeah, I would think about gut issues first, so first and foremost, gut testing. If you do methylation testing, you could certainly think about that as well. For the OAT test, I would also look at markers of detoxification. Does she need any detox support? Let’s see … gluten free, dairy free for only one month. It might need to be a little bit longer. I would recommend that patients are gluten free and dairy free for at least three months in terms of seeing changes in symptoms. Also you’re saying “pretty much dairy free.” You might want to recommend that she’s strictly dairy free. I know that can be really difficult with 12-year-olds and teenagers. Sometimes it can be very hard to get them to embrace a gluten-free, dairy-free diet, but I would start there. Hopefully some of that will give you a little more information in terms of where to go with her.