Wondering if you could touch on pediatric obesity? Question regarding 9-year-old female, 62 inches, 160 pounds. Looking to offer direction for mother and child as they indicated exhausted all options. This 9-y. Mother states that she’s had all the lab tests, and nothing has come back positive except mainly swollen lymph nodes on an abdominal CT.he’s not had Cyrex Array 3. She is hungry all the time, headaches, usually stomachaches, joint pains especially on her knees. She’s trying to change the way the family eats to see if that helps with less gluten and sugar and has minimal compliance. This is kind of sad. Is this simply a matter of sugar and exposome issue, or is there something else the lab work that should be addressed?

Yes. It’s kind of sad if she’s trying to decrease gluten and sugar but not really able to. I need to be completely honest. I don’t know how you address obesity if you’re not decreasing sugar intake, right? I mean, this is going to cause sort of a haywire within the endocrine system, right? I mean, I would be very curious. What does this 9-year-old have in terms of fasting insulin levels, glucose, fasting glucose, hemoglobin A1c, fructosamine levels, maybe even looking at leptin? If she’s eating the standard American diet, the question is how do you work on diet changes, and the other question is exercise and movement, right? I think sure running the Cyrex Array 3 might be helpful because maybe that would be sort of a convincing factor like, look, this antibody production is showing we have to prioritize changing the way this child is eating, so kind of sad. I think, sure, you can certainly do the SIBO breath test and stool testing. Those can absolutely be contributing factors if you have dysbiosis, but if you’re not going to be getting gluten and sugar out, it’s going to be hard to treat the dysbiosis, I think, in a sustained way. I think the question is how can you make stepwise changes, and I don’t know Amy if you’re a nutritionist or a functional medicine physician, or which approach you’re coming from, but if you can do the gut testing, I think that’s absolutely reasonable. I think the bigger question is how do you work on actually getting out the gluten and actually getting out the sugar because it sounds like that’s going to be the bigger question. What changes can you make? Can you start by just increasing vegetables and sort of making— you know, I’ve worked with a nutritionist, and she sort of makes a game of how many different vegetables did you eat? How many different colors were there? You get like stars for all of the different colors, something like that making sure that she’s eating the rainbow. I think diet here sounds like the biggest piece. Cyrex Array 3 and gut testing would certainly be reasonable, but again, I would be very curious what this girl has in terms of her basic blood work.