After the clean month, use one decision router: the end results improved in paired fashion (ferritin 61.60, TSAT 33.4%, WBC 7.7, platelets 444 borderline/high by lab range, FOB negative, stool RBC absent), which supports alcohol/smoking abstinence as a high-value stabilizer and cools the April occult-blood branch. Old RPPH papers now add mild right common-femoral plaque/PAD from 2024, so BP, echo/CAC/CCTA, lipid-target review, and smoking/alcohol abstinence remain the highest outcome-yield cardiovascular moves; recurrent stool blood/iron drift and persistent CBC abnormalities trigger GI/hematology branches; bloating/SUDD-SIBO is handled separately from bleeding; low-yield novelty testing stays parked.
thirty-day-experiment · post-experiment-router · stool-blood · iron · thrombocytosis · bloating · lp(a) · bp · imaging · treatment-priority
This is the single current router for post-experiment decisions. The older exam-plan, treatment-priority, and knowledge-roadmap material has been consolidated here so the reader does not have to cross-check multiple planning pages.
Do not decide from one symptom day or order a broad “Round 2” panel. The completed clean-month result is encouraging — ferritin/TSAT recovered, WBC normalized, platelets improved to 444, and repeat stool FOB/RBC cleared — but the next branch still depends on objective persistence/recurrence:
| Result after clean month | Meaning | Next move |
|---|---|---|
| Recurrent severe chest/epigastric/arm/autonomic symptoms | Possible cardiac/ACS-type recurrence | Same-day ECG + high-sensitivity troponin route; see recurrence owner. |
| Visible red/maroon stool, melena, clots, faintness, tachycardia, rapid weakness, or rapid Hb fall | Active bleeding concern | Urgent GI-bleed assessment. |
| FOB/direct exam negative, Hb/MCV/RDW stable, ferritin stable/rising, TSAT >=20-ish, WBC/platelets improve | GI bleeding branch cools | No default endoscopy. Continue monitoring; focus on BP/cardiac imaging and symptom management. |
| Ferritin/TSAT and WBC improve after abstinence, but stool blood is missing/not repeated | Exposure-cleanup signal improved, bleeding branch unanswered | Superseded for this round: stool follow-up was completed negative on 2026-05-28. |
| Stool blood/RBC persists but Hb/ferritin/TSAT stable | Occult blood unresolved but not clearly depleting | GI-source discussion if repeat positivity persists. High-quality 2024 colonoscopy prevents reflex repeat colonoscopy, but does not erase persistent blood. |
| Ferritin falls toward <45-50, TSAT stays <20, MCV/RDW drifts, or Hb drops | Possible ongoing loss/iron restriction | GI-source planning becomes stronger; endoscopy threshold lowers. Iron is a bridge, not a diagnostic substitute. |
| Platelets remain >=450 or WBC remains high | Reactive explanation still possible but unclosed | CBC differential + peripheral smear if available; JAK2/CALR/MPL or hematology only if persistent unexplained or clinician wants early uncertainty reduction. |
| Bloating persists but stool/iron/Hb are clean | Symptom branch, not bleeding proof | Meal-spacing/diet/SIBO-SUDD clinician logic; no routine CT/endoscopy solely for bloating absent alarm features. |
| 7-day BP average elevated or morning BP high | Major modifiable CVD risk variable becomes actionable | Clinician discussion, ABPM if uncertain, BP treatment if confirmed. |
| Known mild right common-femoral plaque/PAD from 2024 | Cardiovascular disease burden is not zero, but coronary/valve staging is still missing | Cardiology/prevention discussion; keep BP/echo/CAC/CCTA high priority; antiplatelet only with GI-risk review. |
| CAC >0, CCTA coronary plaque, or echo valve disease | Risk tier changes from peripheral-only/subclinical evidence to heart/valve-burden-documented disease | Lower ApoB/LDL targets, ezetimibe/PCSK9 discussion, antiplatelet only with GI-risk review. |
| IgA remains high but true SPEP-style protein electrophoresis shows no obvious narrow spike | IgA branch cools from “missing pattern test” to trend/formal-interpretation watch | Repeat quantitative immunoglobulins later or escalate only if clinician/lab reads SPEP as suspicious, IgA rises, or red flags appear. |
| Bucket | Concrete action | Owner |
|---|---|---|
| Core repeat dataset | Completed 2026-05-27/28 for blood/stool. Next repeat is trigger-based: CBC/platelets/fibrinogen if persistence matters; stool/iron only if symptoms, visible blood, or iron drift recur. | 30-Day Experiment / Lab Dashboard |
| Logs | Summarize Tracker meals/symptoms/circumference/exercise, stool photos, Apple Health, and exposure slips | 30-Day Experiment |
| BP | 7-day validated upper-arm home BP protocol; average days 2-7 | Blood Pressure Profile |
| Cardiac baseline | Echo for valve/LV; CAC as low-friction coronary plaque anchor; CCTA if symptoms/CAC/specialist threshold or known peripheral plaque makes direct anatomy useful | LDNCP/Cardiac Imaging owner |
| IgA clarification | True protein electrophoresis now completed; preserve graph/quantitation and trend IgA unless formal read or future markers trigger IFE/FLC | Elevated IgA Workup |
| Clinician review | Bring one-page timeline, repeat labs/stool results, 2024 colonoscopy report, and selected stool photos if useful | Whole-profile / GI owners |
| Priority | Move | Trigger / boundary |
|---|---|---|
| 0 | Red-flag response | Cardiac-type recurrence or active bleeding overrides routine planning. |
| 1 | Durable smoking abstinence | Always highest modifiable ASCVD/thrombotic lever with very high Lp(a). |
| 2 | Alcohol abstinence / strict low-use rule | Keep while stool-blood, BP, sleep, gut, and experiment-quality questions are live. |
| 3 | BP diagnosis and control | Elevated home/ABPM or repeated morning BP. |
| 4 | Lipid/plaque-prevention escalation | Mild peripheral plaque already exists; CAC/CCTA plaque, valve disease, or clinician-selected lower target would further intensify the case. Current ApoB is good but burden changes intensity. |
| 5 | Stool-blood/iron source plan | Persistent FOB/RBC, iron drift, Hb/MCV/RDW worsening, visible blood, or clinician concern. |
| 6 | Iron repletion bridge | Falling ferritin/TSAT or symptoms, while source question is not ignored. |
| 7 | CBC/platelet-WBC pathway | Persistent platelets >=450, high WBC, abnormal differential/smear, or reactive causes fade. |
| 8 | Bloating/SUDD/SIBO symptom strategy | Symptom burden persists after bleeding/iron branch is separately handled. |
| 9 | Skin/dental/infection source cleanup | Active eczema/psoriasis, oral inflammation, infection clues, or persistent inflammatory markers. |
| 10 | Fear/anxiety support | Monitoring causes rumination, avoidance, reassurance loops, or quality-of-life loss. |
| Avoid | Reason |
|---|---|
| Routine endoscopy for bloating alone | Bloating/SIBO does not explain positive FOB/stool RBC and does not itself mandate invasive workup. |
| Routine abdominal CT or full-body CT | Low value without acute pain, fever, obstruction, mass, weight loss, abnormal exam/labs, or clinician-directed structural concern. |
| Broad tumor markers | Poor screening strategy; CEA is clinician-directed only, not a reflex FOB add-on. |
| Broad autoimmune/microbiome/SCFA/TMAO panels | Too many false trails unless a defined branch creates a target. |
| Aspirin/NSAID prevention logic | No self-directed aspirin or NSAIDs while stool-blood/GI bleeding risk is live. |
| Immunofixation/FLC by default | Second-line only if SPEP or clinical red flags make monoclonal gammopathy plausible. |
| 48-72h fasts during the clean month | Adds lean-mass, sleep, lipid/ApoB, inflammatory/platelet, bowel-output, and refeeding confounding; optional 24h fast is symptom/motility-only and low priority. |
Research anchors retained here include AGA/BSG iron-deficiency guidance, AGA bloating guidance, AHA/ACC chest-pain guidance, EAS Lp(a) consensus, thrombocytosis reviews, ACG celiac/H. pylori guidance, BP/LDL/smoking/alcohol outcome evidence, MASLD FIB-4/VCTE thresholds, CAP monoclonal-gammopathy lab guidance, KDIGO CKD baseline logic, AUA/SUO PSA repeat-test principle, and prolonged-fasting safety/noise evidence. The migration manifest tracks provenance/checksums.