Practitioner Question of the Month – January 2018

Joe Mather asks

1. Is candida dysbiosis or overgrowth something you routinely find to cause problems?
2. do you find elevated candida abs to accurately reflect a yeast dysbiosis – ie consistent with doctors data stool workup?

Good question Joe.

1. Yes. I would estimate I see a relative prevalence of GI dysbiosis as follows: SIBO > H. pylori > Candida or other yeast > B. hominis > true ‘parasites’ like worms or amoebas.

2. No. Unfortunately, what happens more often is two different tests that assess the same thing show different results. For example, LabCorp candida abs will be high, but the accompanying stool culture will be negative. We don’t really know what this means, but I speculate that a negative stool test + positive antibodies, in a symptomatic patient, may indicate SIFO.

Testing is not perfect, hence part of the reason I advise against a high degree of reliance upon testing. It is one tool, but it must be combined with assessing patient history and presentation and response to treatment.

Hope this helps!

Using fewer supplements – a key to success and compliance

I am constantly reminded of how important it is not to ‘drink your own Kool-Aid’ in clinical practice, and to constantly be re-evaluating if therapies are needed in attempt to minimize treatment. I have been working with a patient for several months now who was a good reminder of this. This patient has been ill for many years and is very committed to getting better. He is the type of patient who would perform thousands of dollars of testing and take 15+ supplements at a time if he were instructed. It is for this type of patient I think we do the most service when preventing them from falling into excess.

We had performed some GI antimicrobial therapy, and he responded well. He wanted to stay on antimicrobials, but I guided him through a gradual wean off and he is now feeling just as well off the antimicrobial treatment as he was on it. He then had some symptoms that were non-GI in nature; fatigue and exercise intolerance mainly. We elected to perform an empiric course of antivirals, which improved his symptoms. He again wanted to stay on this therapy, but after guiding him through an experiment of ‘come off, wait, go back on, and then reevaluate,’ he realized he was feeling just as good off the antiviral therapy as he was on (sometimes it helps to humor a patient to help them realize the grass isn’t greener).

Essentially, he came into my office willing and expecting to be on lots of stuff, because that is what he was accustomed to. However, today he is doing better than he was with his prior doctor, and only taking a fraction of the stuff. Doing this is good for him, but also helps me as the clinician become more adept at knowing what response to therapy should look like. It also helps me continue to define the line of appropriate treatment versus overtreatment. Additionally, by doing this you can weed out any dogma or bias you may have, because the proof, or disproof, will be right in front of you with the patient outcomes.

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I’d like to hear your thoughts or questions regarding any of the above information. Please leave comments or questions below – it might become our next Practitioner Question of the Month.