Dr. Amy Nett: Absolutely. We’ll get into this a little bit more during the treatment module. In terms of whether or not you refer someone with inflammatory bowel disease to a gastroenterologist depends on a lot of different factors, including how severe their flare is. Are they having a lot of GI bleeding? How elevated are those markers? If I have patients who are having a lot of GI bleeding associated with their IBD, if their markers are incredibly out of range—“markers” meaning lysozyme, calprotectin, and lactoferrin—I do sometimes refer them to work with a gastroenterologist while we’re working on additional immune support and whatever underlying pathologies we can find because they may actually benefit from some more aggressive treatment during that time.
That said, some of your patients may be resistant to that, so I think listen to your patients on this one, have the conversation with them, because sometimes patients will ask, “Well, what’s the benefit?” And the benefit might be more aggressive medication, and if that’s appropriate, then I think that can be a good reason. Some patients will be adamant that that’s just not the right approach for them, but I think there’s definitely a role for colonoscopy and working with a conventional GI doc while you work on the underlying issues because flares can be pretty significant, and you can definitely benefit from help from a conventional GI doctor.
That said, if it’s a more mild case of inflammatory bowel disease, the lysozyme, calprotectin, and lactoferrin are only mildly elevated to the point where you’re making the diagnosis, and if the patient is not very interested in more conventional treatment, then I think the utility of that consult is going to be a little bit more limited. Some patients like a more definitive diagnosis, meaning they want to know, “Well, I have inflammatory bowel disease. Is it Crohn’s or is it ulcerative colitis?” I’ll tell you that a lot of my patients who have IBD, they’ve had multiple colonoscopies over the past 10 or 20 years, however long they’ve had this diagnosis, and the diagnosis of Crohn’s and ulcerative colitis seems to go back and forth for a lot of patients, meaning that at one point they’ll be told they have Crohn’s, and then on a repeat colonoscopy they’re told, “Well, it’s actually ulcerative colitis.” In terms of how definitively we’re really able to diagnose these things right now, I’m not sure. It’s not clear to me, based on what I’m seeing in terms of my patients’ experiences in the conventional GI world.
There’s definitely a role for gastroenterologists here, but I think if you work towards treating the underlying immune imbalance, whether that’s gut dysbiosis, metal toxicity—all of these things that we’re talking about in this course—you may be able to get them to a point where their symptoms and their disease are managed without going down that conventional route. Again, when we get into the treatment sections, you’ll learn more about these different approaches, and again, as we just go through the course and you learn about different approaches to balance the immune system, I think you’ll have different strategies to work with IBD patients.