Protocols

[Denise DeRosier]

Really found the first module to be very informative. Are you going to be discussing or providing some basic protocols on how to address these imbalances and gut infections?

I have a client with almost all of the markers you discussed tonight – slightly elevated arabinose, elevated oxalic, low 5-HIAA, high Quinolinic/5-HIAA, high 3-Hydroxybutric + Acetoacetic, high B5, low Vit C, and low aconitic

[DrWoeller]

Denise,
We are definitely going to be discussing and providing protocols on the gut related infections and imbalances, along with oxalates too. This course really focuses on the fungal, bacterial, and oxalate related sections of the OAT, along with other tests. I brought into the discussion briefly some of the other areas because these are commonly influenced by yeast, bacteria and oxalate imbalances. The mitochondria and neurochemical imbalances, i.e. quinolinic acid go off into another area that is beyond common GI problems. However, we can discuss these sections via the question and answer session, and the forum. What you will find in clinical practice is these other areas are commonly effected by the 3 primary factors – yeast, clostridia, oxalates. Perhaps what I can do is go through a sample OAT again and discuss these other areas and provide recommendations for supplementation. The supplement recommendations are actually fairly straightforward and are normally done in conjunction with addressing the yeast, clostridia and oxalate issues.

I will plan on doing this today through the Q&A.

Sincerely,
Dr. Woeller

[Deborah Nelson]

I find the comments at the end of the OAT test helpful but they only seem to address an area that is completely out of range and not when the marker is nearly out of range. The difference in being directly on one side or other of the black range line is a fine line indeed. More specifics to aid us in bringing those nearly out of range markers back in line woold also be helpful. Thanks.

[DrWoeller]

Deborah,
You are right. Some of these markers can be a fine line between doing something or nothing. I have found that the decision is often based on the clinical context of the patient. I have never seen an OAT, initially, or after a period of time of treatment where everything lines up perfectly. There are variations of normal and the certain values can fluctuate somewhat depending on diet, exposure, supplements, etc.

What specific markers are you needing assistance with?

Sincerely,
Dr. Woeller

[Clarice Moussalli]

I would also appreciate a review of therapy for exactly the same OAT presentation as Denise DeRosiers client of sept 2 – thank you ,
Clarice Moussalli, MD

[DrWoeller]

Clarice,
Do you have an OAT you can upload here? I will review it for you. Is this what you are needing?

Sincerely,
Dr. Woeller

[Clarice Moussalli]

Thanks Dr. Woeller,

Elevated OAT results are as follows:
#7 arabinose of 47;
#12 and #13 4-hydroxybenzoic and 4- hydroxyhippuric both high 2.0 and 39 respectively ;
#16 HPHPA 289;
#21 oxalate 161;
#22 lactic 84;
#30 3-methylglutaric 1.4;#31 3-hydroxyglutaric 5.4;
#39 Quinolinic/5-HIAA ratio 2.8;
#42 3-hydroxybutyric 13; #43 acetoacetic 72; #46 methylsuccinic 3.1;
#50 methylmalonic 3.3; # 53 glutaric 0.78;
#59 2-hydroxybutyric 6.3;
#65 2-hydroxyisocaproic 4.6; #69 phenylacetic 0.53
Low on OAT : #54 ascorbic 8.5

Appreciate your thoughts,
Clarice

[DrWoeller]

Clarice,
How old is this individual and what is going on with them clinically? Are they on any medication?

1 – Arabinose is mildly elevated
2 – HPHPA (this is the most significant marker that is high). The other two bacterial markers indicate some type of digestive bacteria imbalance.
3 – Oxalates being high too could come from yeast, but probably diet too.
4 – the Kreb and Mito markers are likely present because of the high clostridia and oxalate. They are not extremely high, but certainly point to some compromised cellular metabolic activity.
5 – The Quinolinic/5-HIAA ratio is common. Does indicate some sluggish activity in the serotonin pathyway.
6 – Fatty acid markers point back to what the Mito markers indicate and most commonly affected by bacteria and yeast.
7 – Glutaric acid is commonly mildly high with the presence of candida. The Methylmalonic is not something you see a lot of. It does suggest vitamin B12 deficiency.
8 – #59 at this level is probably from digestive bacteria. Acetaminophen, aspartame and artificial sweeteners/coloring can cause it to be high too.
9 – Amino Acid Metabolites – these too are most likely linked to digestive bacteria imbalance, i.e. clostridia (HPHPA)
10 – low ascorbic – very common. Doesn’t indicate a vitamin C deficiency.

If you can give me some background I can correlate some of this clinically for you.

Sincerely,
Dr. Woeller

[Clarice Moussalli]

Thank you for reading the OAT. Pt is a 61 year old generally healthy slender female who has had some increasing fatigue and brain fog in the last few months.. On no meds other than HRT with bioidentical hormones ; prometrium and estradiol patch as well as some progesterone/ testosterone cream. Had always had digestive issues, prone to constipation/ bloating. All symptoms exacerbated post a bout of viral gastroenteritis and then a 5 week course of clindamycin for dental issues. Never prone to yeast with antibiotics. Thyroid profile Ok. No recent DHEA/ cortisol levels. No anemia. CMP wnl.Some DJD in hands, but doesn’t take anything for this. Worsening symptoms with any probiotic. Managing stressors of being a caregiver. Generally a good diet, mostly vegetarian; but recently trying to follow the low FODMAP, SCD, low oxalate.
Plan is to support digestion and elimination with Swedish bitters or betaine, Mag citrate for 1-2 weeks,iberogast; then add nystatin and biocidin .Continue diet and retest MOAT.
Should I introduce some 5-HTP at this time, or wait until we have a neg reading on arabinose and HPHPA?

[DrWoeller]

Clarice,
Adding should be fine right now if you feel like she could benefit from it.

Biocidin – I would recommend doing a cyclical approach like I have discussed in the clostridia module:

-one dose three times daily for 2 weeks, then
-every 3rd day thereafter do another dosing day at one dose three times for that particular day. Follow this cycle for an additional 4 weeks, and repeat the MOAT during the last week.

Sincerely,
Dr. Woeller

[Clarice Moussalli]

Appreciate your input, Dr. Woeller. Clarice

[Author]

Posts