Hi  – I feel so sad for this 15-year old boy. Can you please provide a little history so that we can help guide you a little better. Also very important – did the boy or his parents provide consent to share his labs with us here in the forum? If not, please remove his labs and any identifying information.

Starter questions:
1. When did you start working with this boy? What were his major symptoms/complaints when he came to see you?
2. What is his diet & lifestyle like?
3. Were all of these medications given to him when his stomach pains started? Did he get relief?

A few key markers jumped out:

-suboptimal homocysteine. Does he consume animal proteins by any chance or is he vegan/vegetarian?

-high CRP. There is a lot of inflammation. Was it food poisoning? The doctors prescribed antibiotics… did he get relief?

-TSH is suboptimally high. I’d be interested in seeing his fasting insulin and glucose levels. Is his diet high in sugar/flour products?

-Iron and vitamin D are clinically low. Does he take any supplements? Has he always struggled with low iron?

It would also be great if you can ask his parents to join B Better as well so we can ask them questions about his case directly.

Hey Aashish Bhupathi,

I was writing my reply at the same time as Bernadette, so there might be some overlap.

Stomach aches can have many causes. You probably know (but other readers might not) Mesenteric lymphadenitis itself can cause pain in the abdomen centred to the lower abdomen. Typically a full recovery of mesenteric lymphadenitis can take 4 weeks or more. Mesenteric lymphadenitis is often caused by some type of infection and the most common infection causing this is a stomach flu. 
As I probably don’t need to tell you: mesenteric lymphadenitis usually goes away by itself. Drinking water and rest are important.

In functional medicine, we treat the body as one system. Here are some takeaways from the labs you gave us.

High CRP
Stomach aches can be caused by inflammation in the body. You can help the body address inflammation by giving it the tools it needs to resolve inflammation. Supporting the body with omega 3 (2 to 4 grams per day) can help produce resolvins, protectins and other specialized pro-resolving mediators, which can help to resolve inflammation.

Curcumin can also help with lowering inflammation. Make sure you use a high bioavailable formulation such as Meriva phytosome complex (click here), 1,000-2,000 mg
Low vitamin D
You probably noticed the low vitamin D already so I won’t dive deep into this topic. Bringing up vitamin D is necessary for an optimal functioning immune system. It is estimated that vitamin D regulates between 0.5-5% of the gene expression in the human genome. A lot of those genes are involved in regulating inflammation.

High Alkaline Phosphatase
High alkaline phosphatase is often related to bone or liver issues. Although your client is 15 and might have elevations because he is simply growing which causes more activation of osteoblasts. It is something you might want to recheck in time.

High Total RBC, high Hemoglobin, low MCHC, low MCH and low iron
Although hemoglobin is high, it looks like the red blood cells contain less hemoglobin. The elevations of hemoglobin could be caused by an elevation of the total Red Blood cell Count. It could also be because your client was dehydrated at the moment of the blood draw. Your client has also a decrease in serum iron. Decreases can be caused by 
• low absorption of iron, possibly because of gut issues
• a low intake of iron, 
• but since your client has some form of infection and is inflamed, the body might choose to sequester iron away as well in an attempt to fight infection. 

It would be helpful to know if your client was suffering from anemic symptoms before he became ill. When was his last serum iron measurement?

Excess manganese
Manganese is slightly elevated, which could be due to environmental exposure (manganese exposure can be high because of smoking, contaminated drinking water, contaminated teas, living in a mining area or near a steel production factory). It could also be caused by low iron status.

Homocysteine
Although homocysteine is below the upper range, I usually aim for homocysteine between 6-8 nmol/ml. Elevations above the ideal zone are an indication that the methylation cycle is struggling to a certain degree. Methylation is necessary for many things, like DNA repair, good nerve health, histamine production, and detoxification.

B vitamins play a big role in the methylation cycle. In particular vitamin B6, folate, B12 and B2. I personally aim with my clients for a vitamin B12 above 600. If I don’t know if my client have SNPs (Single Nucleotide Polymorphisms) I will support them usually with the methylated (or bioactive) B vitamins forms. For example:
• I won’t choose cyanocobalamin but methylcobalamin
• I won’t choose folic acid, but methylfolate (also called  L-methylfolate and L-5-methyltetrahydrofolate or 5-MHTF)
• I won’t choose pyridoxine HCL, but pyridoxal-5-phosphate

Thorne’s has a B vitamin complex called Basic B (click here) with all the B vitamins in the bioavailable form in it.