Treating Blasto, H. pylori, and Intracellular Infections- Episode 47

Confused about the treatment of gut and intracellular infections? This week we answer a listener question about treating Blasto, and H. pylori and when intracellular infections should be looked for.

If you need help in testing or treating a gut infection, click here.

Dr. R’s Fast Facts

  • Gut infections like Blasto and H. Pylori can co-occur with SIBO and/or with Lyme and Lyme co-infections
  • The gut should always be treated first and follow up testing should be performed to ensure gut infections/imbalances are cleared
  • Certain probiotics can be as effective as antibiotics for treating gut infections
  • Probiotics can enhance the effectiveness of antibiotic treatments, this likely applies for antimicrobial herbs too
  • Gut infections can cause the same symptoms as Lyme and Lyme co-infections
  • Imbalances in the ratio of vitamin D to 1:25 vitamin D (aka calcitriol) may indicate intracellular infection, inflammation or autoimmunity
  • If you are still ill after you have treated the gut and retested, the testing for intra-cellular infections might be a good idea – but should always be done with a doc who is well trained in this


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Fast facts…..0:42
Susan’s information…..2:51
Listener question…..6:56
Intracellular co-infections…..8:50
Testing for vitamin D and calcitriol…..12:51
Intracellular infection panel…..15:38
Blastocystis homini, H. pylori and SIBO…..18:21
Heavy metals…..26:56
Vitamin D and parathyroid…..33:02


(3:11) Evolve Nutrition

(3:28) Evolved Recovery

(12:05) Lyme Disease Causing Chronic SIBO with Dr. Rahbar

Vitamin D metabolites as clinical markers in autoimmune and chronic disease.

(20:46) Systematic review with meta-analysis: Saccharomyces boulardii supplementation and eradication of Helicobacter pylori infection.

(23:29) Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection.


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Treating Blasto, H.Pylori and Intracellular Infections

Welcome to Dr. Ruscio Radio, discussing the cutting edge in health, nutrition, and functional medicine. To make sure you’re up to date on this and other important topics, visit and sign up to receive weekly updates. That’s

The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor.

Now, let’s head to the show!


Fast Facts

Dr. Michael Ruscio: Hey, everyone. This is Dr. Ruscio with your fast facts. Today was a listener question about gut, gut infections, gut co-infections, meaning more than one gut infection occurring at once, and if gut infections can co-occur with other non-gut infections, like Lyme and Lyme co-infections. So here are your fast facts.

Gut infections like Blasto and H. pylori can co-occur with each other, with other infections, with SIBO, and/or with Lyme or Lyme co-infections.

The gut should always be treated first, and follow-up testing should be performed to ensure gut infections and imbalances are cleared before moving on to any other testing.

Certain probiotics can be as effective as antibiotics for treating gut infections.

Probiotics can enhance the effectiveness of antibiotic treatments, and this likely applies for antimicrobial herbs, too.

Gut infections can cause the same symptoms as Lyme and Lyme co-infections—another reason why it’s good to treat and test for gut infections first.

Imbalances in the ratio of vitamin D to 1,25 vitamin D—also known as calcitriol—may indicate intracellular infection, inflammation, or autoimmunity.

If you are still ill after you have treated the gut and retested, then testing for intracellular infections, like Lyme and Lyme co-infections, might be a good idea—but should always be done with a doc who is well trained in this.

All right, guys. That’s it. Let’s head to the show. Thanks.

DR: Hey, everyone. Welcome to Dr. Ruscio Radio. Happy New Year! Per the usual, I am here with the lovely Susan McCauley of Evolve Nutrition. Hey, Susan!

Susan McCauley: Hey, Dr. Ruscio! Happy New Year to you, too. I feel like I might be a little out of practice because I took the month of December off because you had so many great interviews.

DR: Yeah, it’s crazy how time flies, but, yeah, we had a lot of interviews in December, which worked out really well because it’s less prep for us to do and December is already crazy enough as is, so that worked out pretty good!

Susan’s Information

SM: Yeah, and I guess there was a question about me because I am Dr. R’s sidekick, so I thought I’d take a second just to give you guys a little bit more information about what I do and who I am.

I am a clinician. I’m a certified nutrition consultant. I went to Bauman College. I have a website,, and more recently, I’ve partnered up with Kendall Kendrick of Primal Balance, and we have a website completely devoted to nutrition and health and fitness and wellness for people with drug and alcohol addictions, and that’s All the information’s out there. You can go find out all about me on both of those websites.

DR: Sweet, and that was for Erin, who asked that question. There’s your answer, Erin, and to put it, I guess, succinctly, Susan’s a pretty sharp gal, and that’s why she’s here!

SM: I always have my hands in a lot of different arenas because I don’t like to get bored. I know that’s like a lot of us in this field. We like to keep moving and keep learning and keep growing.

DR: You have to. I mean, if you’re not updating your opinion, your opinion is going to be… I don’t want to say “wrong,” but it’ll be moot or antiquated pretty quickly, especially in the Information Age. That’s actually something that’s very exciting about the new wave of doctors that’s coming out. They seem to be much more open minded, I think, because they’re used to just having access to so much information and they’re used to the concept of “what I learned in school isn’t necessarily going to be the holy grail of information that I can never change or question or update or expand upon.” That’s hopefully one ray of light for the newer generations of conventional docs coming out, is that they’ll be a bit more, hopefully, open minded.

SM: Yeah, and then also I’ve noticed a lot of people, in general, tend to think that they know a lot about health and nutrition because they watch television or they’re on the internet. I had an interesting conversation about the blood type diet the other day. The person was really, really, really strongly in favor of the blood type diet, and I said, “Well, have you read the study on PubMed that kind of debunks the whole thing?” And they said, “What’s PubMed?” And at that point, I knew!

DR: Right.

SM: Make sure that when you’re having conversations with people that they do know what PubMed is or do know what research is and they are well studied and that they’re not just getting it from Dr. Oz.

DR: That would be a good indicator, yeah. If you got your nutrition information from the back of a cereal box, then it may not be the best information.

SM: Yeah, and this time of year, I swear, if I see one more Weight Watchers Oprah commercial, I think I might just have to shoot myself!

DR: Oh, man. Well, fortunately, today the topic we have is a bit more clinical than it is dietary and a bit more practical. It’s a listener question, and before we jump into the listener question, there are a number of listener questions that we haven’t had a chance to get around to yet. As soon as I’m done writing the manuscript for the book, which will hopefully be within a month or two—it should be very, very soon now—I’ll have much more bandwidth to get to some of these other questions. I try not to just answer a question. If it’s something that I’m not actively involved in researching and treating, I really like to get myself and my team to research the issue deeply so we can provide a really robust answer to it and not just give you kind of my opinion. So those questions are in queue. We will be giving responses to them sometime hopefully in the next couple of months.

With that, let’s play the listener question that’s kind of in the realm of the stuff that we’ve been talking about lately, and we’ll use that as a springboard into this episode.

SM: Sounds good. I have it cued up right now. Here we go.


Listener Question

Jeffrey: Hi, Dr. Ruscio. This is Jeffrey. I’m an avid listener of your podcast. I was wondering if it’s possible to have several co-infections in addition to maybe H. pylori or Blastocystis hominis. Is it possible to also have SIBO and intracellular pathogens on top of that? I’m definitely more interested in learning more about intracellular pathogens as well as parasite treatment. I know a lot of the podcast has been centered around SIBO. Personally for myself, I have tested positive for Blastocystis hominis and H. pylori, but I’m trying to figure out if it’s worth it to get vitamin D 1,25 and 25-hydroxy tests to see if I do have any intracellular pathogens. And I know on one of your podcasts you were saying you were working on a panel to detect all these intracellular pathogens. Did you have any updates on that? Thank you very much, and I’m really looking forward to your next podcast.

SM: Well, there you have it.

DR: All right. A lot of questions in there, and this is actually a good question because I think it will help people who are looking at, “Oh, my gosh, I could have a Lyme co-infection, a viral reactivation. I could have, in this case, H. pylori and Blasto. Might I also have SIBO? Should I test the vitamin D/calcitriol ratios? What do I do?” It’s definitely important to have an idea as to the most efficient way to navigate through this stuff because some things are just noise and other things are really the issues that need to be dealt with.


Intracellular Co-Infections

DR: Regarding co-infections and intracellular infections in addition to having something like SIBO, many of the Lyme co-infections and Lyme are intracellular—Bartonella, Babesia, Ehrlichia, Anaplasmosis, Chlamydia. Epstein-Barr virus appears to be able to migrate intracellularly. Mycoplasma does not appear to be intracellular, and there may be other viruses that aren’t. I don’t know every virus’ niche off the top of my head. So there are many infections that can be present here, and oftentimes the intracellular infections are kind of the infections that you see in the chronic Lyme, Lyme co-infections, and chronic virus realm.

Now, it’s always been my practice to start with the gut and then reevaluate and then consider doing the more Lyme, Lyme co-infection, intracellular type of testing. And to be honest with you, using that flow, it’s very rare that I actually have to move on to intracellular testing like Lyme and Lyme co-infection testing, because after getting the gut straightened out—which is, again, much easier said than done in a lot of cases—but after getting the gut straightened out, the need for further testing and treatment dissipates in the majority of patients.

Now, I may be seeing a biased sample—and it’s likely that I am—of patients that have predominantly gut issues because I talk so much about the gut, speak so much about the gut, write so much about the gut, so it’s not unusual to think that. However, there have been a number of patients that have come in with another condition, a non-gut-based condition, wondering if a gut evaluation and treating anything that’s found could help with the non-gut condition, and in the majority of those cases, as well, we see improvement.

SM: I have to chime in on this because we talked earlier this year that I had a parasite.

DR: Right.

SM: And I had some weird other things going on. Like, I had some hair thinning, but my thyroid was fine. My skin wasn’t right. As soon as I cleared up that parasite, my hair is thick and nice, my skin is clear—all those other things started clearing up because I cleared my gut up.

DR: Absolutely.  Actually I was speaking with a colleague about this the other day, that at least in my opinion—I hope I’m not stepping on any toes here—but in functional medicine, we pay such credence to the importance of the gut, yet I think it is one of the most poorly taught areas, in terms of functional medicine education and seminars, out there. I think that’s one of the main reasons why so many functional medicine practitioners flounder, is because the most important aspect of health is the most poorly taught. That’s something I’m hoping to rectify with the book and the clinical course that at some point I’ll release, but it’s definitely something that I think there’s a large area for improvement.

Now, something that I should say and a resource that may be helpful if those listening are really curious about the connection between SIBO and these co-infections, which are oftentimes in the Lyme and Lyme co-infection family, is the interview from a few months ago with Dr. Rahbar (Episode 33), where we talked about the association between chronic Lyme and SIBO. He also supports my thinking of starting with the gut and then moving on to Lyme. Hopefully, that gives a little bit of context.

Now, to his comment about having Blasto and H. pylori, I think we’ve already answered that the most important thing to do first would not be to do testing for the Lyme and Lyme co-infections.


Testing for Vitamin D and Calcitriol

DR: What about the other part of his question, should he test vitamin D and calcitriol? Well, I would only test the calcitriol if he will have insurance coverage or if he’ll be testing through insurance. In my opinion, right now the vitamin D-to-calcitriol—or calcitriol also known as 1,25 vitamin D—that ratio and the clinical utility of it is still something that I think is to be determined. Infection—intracellular infections, specifically—may cause low vitamin D with high calcitriol, as also might inflammation, and there was recently a paper published showing that this may also be a marker of autoimmunity, which I found very, very interesting. This is something else I’ve been kind of monitoring and keeping an eye on in the clinic.

This disparity or this imbalance between vitamin D and its metabolite, calcitriol, may indicate a few things, but it doesn’t really diagnose anything. We have been tracking this with patients in the clinic, and it’s too early to be able to say, and also I don’t think we’ve set up strict enough monitoring parameters to really tease out a ton of information. It’s more something I’m observing, and once you make enough observation, then you can kind of tug in the parameter or the area for which you want to monitor and kind of ask and answer a question. Because the clinical utility of this is still questionable in my mind, I don’t think it makes sense to test the calcitriol.

SM: He didn’t say if he had low vitamin D to begin with, and that would be… when we did that podcast (Episode 6), we talked about how if you’re supplementing with vitamin D and you have low vitamin D, then you might want to check the 1,25 to see, correct?

DR: Right, correct.

SM: And I don’t think he said anything about having low vitamin D to begin with, so that would be another reason not to go off in that direction.

DR: Right, although I should say it’s not just about the absolute levels, but also about the relative levels.

SM: Mm-hmm.

DR: His vitamin D could be at 40, but his calcitriol could be at 135.

SM: That’s true.

DR: If the imbalance is there, that can still tell you something, but again, it still tells you you could have autoimmunity or infection, and you still have to go back to what’s causing that. That’s why unless you are wanting to geek out with all these markers and have more academic information than clinical information, I would say don’t test it. Or if you’re trying to be financially conservative, I would say don’t test it unless you have insurance coverage.


Intracellular Infection Panel

DR: Now, to his other part of the question about the intracellular infection panel, that’s something that I was looking into, but there are just too many infections to have a standard panel to be run.

The other thing that really complicates this is that for many of these intracellular infections the testing is very ambiguous. With Lyme and Lyme co-infections, the testing is a very, very gray area. I mean, it could be positive, it could be negative. We have partial confirmation, but we don’t have all the reaffirmations to confirm a true black-or-white diagnosis. Because of that, my take on this is you really need to work with a doc who can personalize the testing to what fits your presentation and, more importantly, when you start treatment, a doctor that knows what the response to treatment should look like, which would reaffirm the gray or ambiguous testing that there is to begin with—a very, very important part of this whole, I guess, clinical algorithm, if you will. If the testing is ambiguous, you really lean more heavily on the patient’s response to the treatment to confirm that the testing was actually uncovering an issue and it wasn’t just noise that you were seeing.

Does that make sense, Susan?

SM: Yeah, it does. It really does. With the co-infections of Lyme, the more I read about it, it seems like the less I know!

DR: Right!

SM: There are doctors and clinicians that work specifically with this set of co-infections because there is so much interplay and there’s so much we don’t know right now.

DR: Right. Again, it’s a very ambiguous area, and that is another reason why I think starting with the gut is a really good idea because that’s a bit more straightforward in terms of the testing and the treatment and the follow-up and everything else. Once you have that addressed, then you want to reevaluate, and again, it’s very possible or very probable that after cleaning up a problem in the gut, the symptoms that you thought were coming from a Lyme co-infection have now cleared.

SM: Right.

DR: And you say, “Oh, boy! Now there’s no need for me to go any further.” But if they haven’t cleared, now at least you know it’s probably not the gut that’s contributing to those symptoms.

SM: Right, and a lot of times when people think of Lyme, they think of the fatigue, which is the symptom that comes to mind the most, and when you do clear up the gut, a lot of times that fatigue gets significantly better.

DR: Oh, absolutely.


Blastocystis hominis, H. pylori and SIBO

DR: Now, the other thing that he mentioned that I wanted to speak to was that he has Blasto and that he has H. pylori. This, again, is a nice point to make here, which is if he has those, he really wants to treat those before he’s concerned with any other additional testing.

The only thing I would maybe add to that would be testing for SIBO if he hasn’t been tested or if he has some of the symptoms, and it really depends on what his symptoms are. The more severe his symptoms are, I would say testing for SIBO also would potentially be a good idea, even if they’re not textbook symptoms of SIBO because you can have—in my opinion, again, there’s not much in the way of published data to really support this—you can have maybe what we could term “silent SIBO,” which means you have a gut infection, you don’t have any gut symptoms, but you have all extra-intestinal symptoms. This is not a farfetched concept. We see this with food allergies like celiac and non-celiac gluten sensitivity. We see patients can react with non-gut symptoms to a gut irritant, and we can certainly see patients that have gut infections that have non-gut symptoms. So depending on the overall severity of the symptoms, not limited to gastrointestinal symptoms, the more severe his symptoms are, the more I would say testing for SIBO would be a good idea.

Now, coming to Blasto and H. pylori—and this is actually good timing because I was just writing about some of this in the book—to treat, for example, H. pylori, there can be resistance to treatment for H. pylori. One of the reasons why I think this is, is more conventionally, it seems that it’s more of a monotherapeutic intervention. Antibiotics, acid blockers, yes, but it’s typically antibiotics and an acid blocker, your triple or quadruple therapy, which can be effective; however, when we add things like one study showing pretreatment with an antibiofilm agent, N-acetylcysteine, that has shown to greatly increase the effectiveness of antibiotics for H. pylori.

There was even recently a systemic review with meta-analysis—this means a group of researchers went and examined all the available clinical trials they could find—looking at the administration of a probiotic called Saccharomyces boulardii in the treatment of H. pylori (1), and they found that when Saccharomyces boulardii was added to antibiotic treatment for H. pylori, it greatly enhanced the effectiveness of the antibiotics.

Similar data has been shown for your more classical, traditional Lactobacillus and Bifidobacterium species, and this is likely because when we give these probiotics with the antibiotics, this is a more robust nudge to the microbiota, if you will. Rather than just giving antibiotics, we give probiotics that have anti-inflammatory abilities, can stimulate mucus, can stimulate the immune system, and may even help crowd out some of the overgrowths. A more, I guess, holistic treatment of infections tends to yield much better results because the gut is really an ecosystem, and so we want to try to have a robust support.

If you were to think about if you had a rainforest that was dying and you just went into the rainforest and you planted some flowering plants, that would be analogous to probiotics. Would you expect it to have a huge impact on the rainforest? Probably not. But if you planted some plants, if you brought in some manure as fertilizer, if you watered it, if you could somehow manipulate the cloud cover so that the forest had adequate shade and wasn’t exposed to constant sun, which can also be a problem for deforestation—if you modulated all those environmental factors, then you’d have a much more favorable outcome with the rainforest.

The same thing happens with humans. If you’re not sleeping, if you’re not drinking enough water, if you’re exercising too much, if you’re not eating healthy food, if you’re not using any kind of probiotic—all those things manipulate the environment in a favorable or an unfavorable way, and the environment will either be hospitable to healthy bacterial growth or hospitable to pathogen growth, depending on if it’s a healthy or if it’s an unhealthy environment. That’s part of the reason why I think we’re seeing when we have these more holistic interventions for treating infections, even if they’re herbal, they tend to be more powerful or synergistic to antibiotics.

That’s a good transition point to another study that showed that showed that Saccharomyces boullardi was as effective as metronidazole, also known as Flagyl, for the treatment of Blasto. So a probiotic was shown to be as effective as an antibiotic in the treatment of Blasto.

These are some of the things that I think often can be left out of the treatment protocols that are natural because I think a lot of times in the natural circles we also think a bit mono-therapeutically. It’s better to know what biofilm agent can work synergistically with what probiotic, can be synergistic with what antimicrobial herb. When you use these things together for whatever infections that you have, that’s where you can really see the results be very, very favorable.

In your case, hopefully you’ve gleaned some positive notes here for yourself, but treating the Blasto and H. pylori first would be a great idea. You may want to test for SIBO if you haven’t done so because that’s very common and that may be co-occurring with these, and all three of them can, of course, co-occur. I would start there before doing any other testing. Make sure you follow the digestive testing and treatments through to completion, and if you’ve cleared any gut infections or imbalances and you still have quite a bit of symptoms, then additional testing may make sense.

The one other thing I should add to this regarding part of your question, which was can Blasto and H. pylori and SIBO all occur at the same time, they definitely can. One of the beautiful things about herbal medicines is many of the herbs have antibacterial, antifungal, antiparasitic, and anticandidal characteristics. They can have quite a bit of impact on these different imbalances in the gut.

Kind of a long answer there, but to put it simply, start with the gut, a thorough gut evaluation, see all those results through until they’re cleared, and then reevaluate. If you’re not doing better, then you may want to move on to some additional testing.

SM: Yeah, and I want to reiterate with the H. pylori that it is really important to treat that because it’s associated with so many other things—ulcers, stomach cancer, all those other things—and it is really important to treat that and to retest to make sure that it’s gone.

DR: Absolutely. The retesting is really key. One of the things that I will sometimes see—and I warn against—is a patient will have a certain test result, they will treat for it, they will not retest, and then they get all excited about something like methylation or heavy metals, and they run off down one of those rabbit holes and burn through a bunch of money, and all the while, it was a gut problem that was really there. I’m not saying that things like methylation or testing of metals are not important, but I have to be honest that every passing day I feel like they are of lesser and lesser importance because I just see my patients getting so much better with treating problems in their gut.


Heavy Metals

DR: Again, I’m aware of the fact that I may be seeing an increasingly specialized patient population that predominantly has gastrointestinal problems, but also, looking at some of the heavy metal research that I’ve done, and we’ve talked about this briefly, looking at the comprehensive review that I’ve done and I haven’t published yet, I think for most people that heavy metals do not really pose an imminent health threat, only for a small number of patients that are very sensitive. If we look at that in the context of this greater clinical model, what would that mean? Well, because the metals may not be a problem even if someone has a mild elevation of metals, we should probably start with the things that we have better data on—like a gut problem—and then reevaluate. If all their symptoms are gone after the gut, we don’t need to go into heavy metals.

I hope I’m not getting too tangential there, but start with the gut. As Susan said, make sure you see any results through to clearance, and then reevaluate. And also remember, if you clear an infection and you improve 30 percent, give your body some time because you may improve from 30 percent to 80 percent over the next three to four months after you’ve cleared that infection. It’s important for me maybe to also mention that after you clear an infection, just because you look at a negative lab result does not mean your symptoms should be 100 percent cleared. It can take time for your gut to heal, for your immune system to calm down, and for everything to rebalance itself after you’ve cleared a gut infection. What you want to look for is, are you trending in a positive direction or a negative direction or making no movement at all? As long as you are trending in a positive direction, then give yourself time before moving on to other testing and treatment because the missing ingredient to going from, let’s say, maybe 30 percent improvement to that 60, 70, 80, or 90 may just be time.

SM: And then make sure that all of the other factors—the sleep, the food, the stress management—don’t just do it until your infection is cleared and then say, “Ooo! I can eat whatever I want now!” because I guarantee you’re not going to feel good. Keep up with all that other stuff, and you’re going to get to that 100 percent eventually.

DR: Yeah, and if you don’t, then that’s when it would be a good time to move on to some other testing. That’s a really good point, Susan, to say with the lifestyle factors and also to give it time. That’s one of the things that sometimes I really have to explain to my patients. Sometimes patients expect that everything should be back to normal as soon as an infection is cleared. And that is some patients, but there are also patients—and I was one of these patients—that after the infection is cleared, that’s when the healing starts. Some people, by the time they get to the infection being cleared, they’re already all healed. For other people, the healing only begins once the infection has been cleared, and it takes weeks and weeks and weeks and weeks for this improvement to slowly accrue until you can really notice a substantial change. That’s what happened to me. It was three or four months after my infection was cleared, and I said, “Wow. I never could have done this a few months ago.” And then it was probably a couple of years until all my food tolerances and my reactivity kind of got back to normal.

These things can take time. Just be patient, and again, look for the direction that you’re trending, and remember to stay true to at least a decent adherence to lifestyle and diet principles so that you can accentuate the healing that is occurring underneath the surface.

SM: I bet you, for most everybody listening that is not feeling good, sick—wherever they are on the spectrum—they didn’t get there overnight, and they shouldn’t expect to get better overnight either. I mean, it took me a long time to get to where I was when I was pretty sick, and so it took me a good couple of years to start feeling better.

DR: Yeah, absolutely.

SM: That’s just the way it is.

DR: There’s an old saying, actually from chiropractic philosophy, that there is no process that does not require time.

SM: So true!

DR: That rule always stuck with me. I thought that was a really insightful principle, and it’s true. It’s definitely true.

SM: That’s where the patience comes in, and I think that we all as practitioners, sometimes it’s really, really hard when we’re working with people to try to instill that patience because people want to jump, like you said, “Oh, maybe it’s methylation, maybe it’s heavy metals. Let’s do a panel that has 89 different things in it so we can find out what the answer is,” when you might be on the right track right where you are.

DR: Precisely. Hopefully, as the science advances, we’ll have more efficient things like methylation testing and treatment that will hopefully make these things more efficient for people. It’s just something that I want to reiterate. I think it’s a major hurdle that the entire movement of functional medicine needs to improve, which is not making the treatment this crazy, cost-prohibitive venture. We need to keep moving in an economical direction because unless we do, we’re really going to limit the growth of the movement. And there’s no reason that we shouldn’t be able to. I totally understand holistic treatment, but holistic treatment doesn’t mean you have to treat eight things at once. We should always be looking for the handful of causative factors and focusing on testing those, identifying those, and treating those in an efficient manner.

SM: Right, and it always starts in the gut, always starts in the gut.

DR: Yeah, I would say it’s definitely one of the first evaluations you want to have. It’s the first evaluation that you should have after you’ve tended to dietary and lifestyle principles. It’s not a guarantee, but… boy, for the majority of patients, that’s going to be the one issue that if you can get right, you’ll see most of your symptoms go away.

SM: Is there anything we left out from our listener question that you want to address before we sign off for the day?


Vitamin D and Parathyroid

DR: There’s only one other thing that I maybe should mention. This is a bit more academic, but the calcitriol, the derivative metabolite of vitamin D, can be thrown off if there are perturbations in parathyroid hormone or calcium. I just want to let people know that when I screen these things in my patients, I screen for all of these markers so that if there was some confounder for the calcitriol, I would be seeing it, and I haven’t seen any problems with some of those confounding markers like calcium or parathyroid hormone with any of my patients, so it seems that whatever’s going on with the conversion of vitamin D to 1,25 vitamin D, it’s happening because of inflammation, infection, or potentially autoimmunity or maybe something else that we don’t understand. I haven’t seen too many parathyroid problems that are driving that, and of course, parathyroid problems are rare. That would be the only note there.

The other thing I just would like to say is that the podcast has been growing at a stunning rate. I just want to thank everyone again for their listenership, if that’s even a word! Or for those that read the transcripts, thank you for reading. And for the people that comment, thank you for commenting. It’s nice to see these discussions starting to grow. This has been great because the growth that we’re experiencing is quite remarkable.

If you are a new listener to the podcast and it’s helping you, please head over to iTunes and leave us a review because that drives us higher and higher and higher in the search on iTunes for people are looking for health results and help with their health. I’d like to reach as many people as we can, and your simple review carries so much weight that it’s really helpful, so thank you, guys, so much again for your support.

SM: And if you disagree with something we say or you agree with it or you want to start a discussion, there’s a blog post for each podcast. You can leave comments, and we moderate those, so let us know what you think!

DR: Yes. It’s a great place to have discussions. I think people know that both you and I, Susan, we’re not dogmatic. We’re certainly not hard-driving on a certain opinion, so if people have questions or they want to refute something, please go ahead. The only thing I would ask—do it politely! If it’s not done politely, your comment will be sent to the trash can very quickly. But if it is polite, then I am all about having a healthy academic discourse.

SM: Yeah, the only thing I’m probably dogmatic on is that we just all need to eat real food! That’s the only thing, if that’s even considered dogma.

DR: Yeah, I think it’s pretty easy to back that one up. Cool. Well, thanks, guys. Thank you for the listener question. Hopefully that helped, and we will see you guys next time.

SM: We’ll get to the rest of them soon, we promise.

DR: Definitely. All right, thanks again, guys.

SM: Take care. Bye-bye.

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