Amy Nett: Crohn’s disease. I agree absolutely that you need to do gut testing and so SIBO breath testing. Again, either the Doctor’s Data CSAP, and again at CCFM, I think most of us have switched more to DSL GI Maps. Again, this is a fairly recent change, but I’m liking the test right now. I’m getting good information from it, but I’m still seeing a lot of Doctor’s Data stool testing, of course, because I still do some follow-ups with that just to compare apples to apples a little bit more, but definitely doing the gut testing you have to do that in Crohn’s.
To be honest, I would not run the Cyrex Array 3 because in somebody with Crohn’s, to me, gluten is a nonissue. She doesn’t get to eat it, unfortunately. That’s my opinion. Crohn’s is a pretty serious autoimmune disease, and I don’t think I have any inflammatory bowel disease patients that I’ve even run Cyrex Array 3 on because I just don’t think it’s worth the risk. Even though Cyrex Array 3 and technically now it’s 3X is the most comprehensive panel for looking at wheat and gluten sensitivity, it’s still not 100 percent. If Crohn’s disease isn’t managed well, you’re risking partial bowel resection or ileostomy bags. Again, when I used to work as a radiologist, just the complications from Crohn’s are pretty horrendous. To me, this is one that I don’t see the point in running Cyrex Array 3 because gluten just needs to be off the table, and it needs to be a conversation with the patient. This is why I just don’t see this as an option.
Cyrex Array 4, I’m trying to think what you’re going to see on there. You want to do gluten-free grains. To me, dairy also has to be out. Cyrex Array 10 would probably be the one I would consider just to see if there are other foods that are being triggered, and there I wouldn’t have her eating those foods specifically but just seeing if there some something that she’s eating that is triggering her immune system. I would probably put that lower down the list though, and I would first run the comprehensive blood panel, stool test, SIBO breath test and just start there. Again, in my newly diagnosed Crohn’s and ulcerative colitis patients, I generally recommend an AIP diet, an autoimmune Paleo diet. It’s restrictive. It’s going to be potentially difficult to do with a 19-year-old depending on where she’s at, like, if she’s a college eating dorm food, this is going to be challenging. But remember, autoimmune Paleo is grain-free, so there, Cyrex Array 4 not even worth running because autoimmune Paleo – grain-free, egg-free, soy-free, take out nightshades, dairy-free, so that that would be my preference in terms of diet, and I wouldn’t even run food sensitivity testing at this point.
In terms of, so then you mentioned the gut testing, absolutely. Would it be prudent to discuss low-dose naltrexone while looking for underlying pathology? Absolutely. I would think about doing what you can in terms of supporting immune function. Certainly, mitochondrial health, lowering inflammation, so look at phytonutrients are going to be kind of anti-inflammatory. Think about a form of curcumin, whether that’s a curcuma longa, Meriva, Curcusorb, the Tesseract medical one. I would start Probutyrate. It would probably be another one I would think about after you have done the stool testing but colon. Meriva is my most commonly used form of curcumin, so I should just say curcumin. Probiotics after you do gut testing, I often use VSL#3 in Crohn’s. Also, most commonly in ulcerative colitis is something that’s where more the research is, but I also use it in Crohn’s sometimes. Probutyrate would be another one. Think about maybe glutathione or at least N-acetylcysteine can be a really important nutrient for immune balance. Diet, we talked about maybe autoimmune Paleo diet and then low-dose naltrexone. I probably would start that. If it’s a sensitive patient, maybe start at 0.5 mg and build up, but 90 percent of my patients start at 1.5 mg and increase over two to three months to 4.5 mg to see where they feel best and then get a compounded capsule at the dose that feels best to them, whether that is staying with 1.5 mg, 3 mg, 4.5, or anywhere in between. I think low-dose naltrexone in Crohn’s because again you want to be pretty aggressive early on because you don’t want to see any sort of progression, like, stop this as quickly as you can so plan on six to nine months of low-dose naltrexone to see where she is at, and then maybe you can wean off of that a little bit, but I see no reason not to start with low-dose naltrexone.
Also, think about, again, some of the essential fatty acids for immune balance. Is she getting her omega-3? Is it worth using you know a gamma linoleic acid source like borage oil or evening primrose oil, or something like that with at least 500 mg of EPA, so making sure the cell membranes look good, the mitochondrial membranes are healthy and functioning.
Reading the question one more time I think we covered everything in that. So, gut testing number one; diet – if she’s open to it, autoimmune paleo, but at a minimum, gluten-free dairy-free for now and low-dose naltrexone absolutely along with some curcumin, maybe fish oil, maybe sulforaphane or if she is open to eating broccoli sprouts, do it that natural way.