* bloating
* gas
* diarrhea

History of Atopy manifestations: The patient has

* asthma / reactive to mold, cats, and smoke 
* eczema 
* dyspareunia with biopsies showing chronic allergic type inflammation. Her CRP is also high at 3.6 despite a good diet and exercise. I sent off an IgE Rast which was sensitive to barley, peanuts, and wheat and the metametric IgG food allergy which showed mod-strong reations in 19 foods. She's started an elimination diet but what do you make of the rotation diet that comes with the metmetrix labs?

The skin conditions make me wonder about fat-soluable vitmin levels, vita D especially, and EFA levels. Of course, each of these independently impact GI health.

Physical Data:
· Female
· Asthma
· Eczema on hands
· Dyshydrotic eczema on feet
·Bloating and gas
·Dyspareunia
· “Biopsies from both a dermatologist and gyn showed lesions with chronic allergic type inflammation” Were these vaginal biopsies?
· CRP is also high at 3.6
· Allergies: IgE Rast which was sensitive to barley, peanuts, and wheat and the metametric IgG food allergy which showed mod-strong reations in 19 foods
· Klebsiella pneumoniae
· Bacillus species
·Fatty acid testing was done and all levels were within normal – I am very surprised at this and I would begin to wonder if the lab is providing accurate results

Unknown: http://www.fxmedresearch.org/IFMMatrixCasepresentations.txt
· Age
· Height / weight
· Klebsiella pneumoniae - quantity
· Bacillus species – quantity
· Probiotic status
· sIgA
· MCV
· Other labs, especially TSH and Free T4
· Lactoferrin or lysozyme (other GI marker for inflammation)
· Lactulose/mannitol assay
· Diet
· Constipation, bowel frequency?
· Brain fog, dyscognition?


It would be easy to hypothesize that most of her symptoms could be due to intestinal overgrowth of Klebsiella pneumoniae in combination with Bacillus species. Both are known to cause gastrointestinal injury, and Klebsiella is gram negative, which means that it promotes increased intestinal permeability, impaired C-p450, activation of NF-KappaB, and non-specific immune activation (since LPS acts as a superantigen). Once these latter 4 steps are in place, then Pandora’s box is officially open for business and the patient can be expected to have multiple symptoms suggestive of allergy and immune dysfunction (eg, elevated CRP), which is what we have here.

From a Matrix perspective, I would start with her gastrointestinal tract, since you already have objective evidence of abnormalities here. See http://www.fxmedresearch.org/gastrointestinal.htm for suggestions and concepts.

My approach would be to review the culture and sensitivity results that you hopefully received with the stool test results and to do whatever is necessary to eradicate the Klebsiella and Bacillus – both of these need to be eliminated. If I had to shoot from the hip I would use, berberine sulfate up to 400 mg BID with emulsified oregano (ADP) 150 mg QID. I might add Artemesia annua depending on how sick she appears clinically and if she has no plans to become pregnant anytime soon. I’m surprised the stool test did not show yeast. Probiotics orally and vaginally would help to fend off the invaders while we wait for her immune system to begin working properly again. Her diet needs to be low in carbs and sugar and high in vegetables/fiber. Low fat is preferred. NO SUGAR, bread, pasta, candy, cookies, pastry, cake, coke, soda, or potatoes. In other words, she needs to be a clean-living (pesco)vegetarian for a while to get the best results.

I would, as you have done, keep her on the GLA and fish oil. Broad-spectrum high-potency multivitamin with 400-600 mg magnesium. ~90 grams of protein per day (bodyweight unknown). Some extra vitamin A (20,000 – 50,000 IU) and glutamine (6-9 grams TID) would help support mucosal defenses, as would bovine colostrum, but if you suggest a good whey protein supplement then she will get dual benefits from the Ig’s already present. She can use honey as a sweetener, since it helps to fight infections, heal the mucosa, and downregulates inflammation. CoQ10 levels are low in female asthmatics, so I’d rx 100 mg BID to promote normalization of her immune system for now until the infection is gone.

I would do the above (assuming no other data) for the next month, at which point I would reevaluate, and probably get a repeat CRP. Gas and bloating are easy to monitor and should be gone within 10 days - a good indicator of microflora improvement.

Just because she is not having a lot of GI symptoms does not mean that the problem is not in the gut or that the Klebsiella and Bacillus are not worth treating. Some of the sickest GI-infected patients I’ve seen have absolutely no GI symptoms but their systemic symptoms reverse with clear-cutting and reflorestation. As I mentioned before, both Bacillus and Klebsiella can cause intestinal irritation/inflammation. Why let this continue, especially in a patient with asthma, eczema, and mildly elevated CRP?


Bacillus cereus is becoming one of the more important causes of food poisoning in the industrialised world. It produces one emetic toxin and three different enterotoxins.FEMS Microbiol Lett. 1997 Dec 15;157(2):223-8.

Many strains of Bacillus cereus cause food poisoning and other infections. Two principal types of food poisoning caused by B. cereus, emetic and diarrheal, have been described. The emetic type is effected by a small cyclic heat-stable peptide, which cause vomiting a few hours after ingestion. Diarrheal types are attributed to enterotoxins, a group of heat-labile proteins causing abdominal pain and diarrhea after incubation for 8 to 16 h and vegetative growth of the bacteria in the intestine (8, 22). / http://aem.asm.org/cgi/reprint/67/1/185.pdf

Rice, which you say is a staple of her diet, is the classic source of Bacillus cereus. Broad-spectrum probiotics are good.
I would recommend getting rid of K. pneumoniae as well. It is one particularly nasty and persistent pathogen I have seen do a lot of "damage". You should be aware that K. pneumoniae is quite adept at "munching" on many of the prebiotics used, such as inulin, FOS, pectin and so forth. So you really ought to eradicate the "_" before starting any prebiotic supplementation. I have seen cases of K. pneumoniae being completely impervious to any sort of antimicrobial treatment (both natural and pharmaceutical) as long as prebiotics were administered.
If you want to check for yeast, you might consider testing for urinary metabolites of Candida. This can be done with either the Organix or Dysbiosis Markers profiles from MetraMetrix Laboratories. I also believe Meridian Valley Laboratories do the same.
If you are a bit reluctant to use any sort of antimicrobials, you might try doing a sort of intestinal "flush". This is done by having the patient take increasing amounts of Epsom Salt dissolved in water until the point of diarrhea is reached. You then have to keep to that dosage for 2-3 days to basically "flush" out any unwelcome visitors of the GI tract (both small intestine and colon). Afterwards, it is crucial to reforestate the gut with massive amounts of probiotics and nutrients for the GI epithelium. A "gentle" diet consisting of steamed vegetables and fish along with non-glutenous grains soaked overnight and some extra virgin oils (preferably flax, sesame and olive along with non-hydrogenated coconut oil…the lauric acid in the latter is extremely effective at killing unwanted critters in the gut).
You might also want to look into issues "further up". In other words, any hypochloridia, pancreatic exocrine insufficiency and/or decreased bile synthesis/release. Problems in any of these areas will help create conditions in the small intestine and colon that are favourable to microbial overgrowth.

Recalcitrant Dysbiosis Treatments: Try an "intestinal flush" 

* High-dose magnesium can be used. 
* First-morning vitamin C flushes for as long as 2 months. For people who are willing.
----Ascorbate has some antimicrobial effects in high doses, and helps to reacidify the gut. 
* Follow the flush with antimicrobials and probiotics.