A live question from Eileen, “When the patient, a 29-year-old female, can’t pay for all testing and having IBS symptoms, has been tested negative for celiac, she has skin problems with some folliculitis, prone to yeast infections and bacterial vaginitis, and has hypothyroid alternating with hyperthyroid that started with pregnancy, what testing to start with? SIBO, stool testing, or any other suggestions?”
Amy Nett: You mentioned that she has been tested for celiac and was negative. I would say if she’s having IBS symptoms, I don’t know if you’ve run Cyrex Array 3, but I think she probably still has to be gluten-free. If you’re saying finances are an issue, I think the first place to go here is really an elimination diet. She should be grain-free, dairy-free, egg-free. Do that for, ideally, 60 days, and how do those dietary changes alone influence, and then do a careful reintroduction if she improves. If she has IBS, is she tending towards IBS-D or IBS-C? That would be the other question.
But you could think about probiotic support because, again, you’re mentioning a lot going on here with potential microbial imbalances—folliculitis, yeast infections, BV, so there think about elimination diet, probiotics. And then thyroid concerns, I would definitely do—blood testing would probably be the first place to go, and then maybe you could get some insurance coverage, but I think you need to be testing not only for the TPO thyroglobulin antibodies, but also for the TSI. Make sure it’s not a combination of the antibodies that you see in Graves’ and Hashimoto’s, since there can be a co-occurrence there. Depending on how much she’s swinging there, I would say you need to check for those autoantibodies.
That’s where I would start, and that’s a pretty inexpensive way to go—elimination diet, probiotics, and then comprehensive blood testing. I think we haven’t gone over our comprehensive blood panel, but it would include a full thyroid panel, you would add on the TSI antibodies that should include a vitamin D level, B12, folate, making sure she has that basic nutrient sufficiency, and I would start there. I don’t even know that I would start with stool testing until you’ve made those dietary changes.