What’s your protocol CCFM for ordering tests for new patients? My impression from the ADAPT Academy Framework is it’s pretty standard to orders complete blood panel, SIBO, Cyrex Array 3, or is there another standard battery of lab tests that CCFM orders?

Dr. Amy Nett: I would say it’s pretty​ ​variable.​ Sometimes we’re actually starting with just that comprehensive blood panel, and our comprehensive blood panel we’ll be covering towards the end of this course, but the comprehensive blood panel includes a complete metabolic profile, kidney function, liver function, full thyroid, full iron panel with ferritin. We check vitamin D levels, B12, folate, homocysteine, cholesterol profiles, zinc and copper levels, so pretty comprehensive blood panel. We’re experimenting with patients who don’t want to invest sometimes thousands of dollars in tests considering the option of just starting with the comprehensive blood panel. What we’ve done previously is the case review blood panel, which I just described, SIBO breath test, two different stool tests through Doctors Data and BioHealth, so two different stool tests, but one from each of those companies. BioHealth stool test normally 401H. Helicobacter pylori though only for patients over generally 30 years old is what we were using for the cut off and then the urine organic acids test, your Genova, so the organics comprehensive and then Precision Labs Dutch Plus looking at sex hormones and cortisol levels. Then depending on mercury or heavy metal exposure, we would sometimes order any heavy metal screen. That was actually our starting place, which is a pretty significant amount of testing, and it can be a lot of tests for patients to get through, especially if they have brain fog or difficulty with concentration, executive function. Again, that probably is costing about $3000-$4000. Then Cyrex Array 3, that one we actually only do for patients who were still eating wheat and gluten, and I would say the minority of patients coming to CCFM are actually eating wheat and gluten. For the most part, I would say, relatively few of my patients are getting the Cyrex Array 3, so that’s kind of our “standard.” Again, comprehensive blood panel, SIBO breath test, two different stool tests, urine organic acids, Dutch profile, Cyrex panel if they’re eating wheat and gluten, and then heavy metals testing if there’s significant exposure. Pretty big array. It gets pretty expensive, and again, this is something we’re experimenting and so we can kind that keep you posted on that.