[Daniel]

Hey ,

I uploaded my answer by accident, but it is corrected and finished.  Are you taking any B vitamins or multivitamins? What about other supplements (like iron containing supplements perhaps)?

[Daniel]

Hey ,

Your vitamin D appears to be borderline low. I usually recommend my clients have their serum levels around 50 ng/ml. Also folic acid (or vitamin B9) I usually recommend being in the upper half of the reference range.

Your fT3 is in the lower half of the reference range while your fT4 seems to be fine. This could indicate a sluggish conversion from fT4 to fT3.

This handout will help you guide in what nutrients are important for healthy thyroid hormone balance.

The values concerning female hormone health are a bit dependent on when in your cycle you took your blood. Do you remember? One thing that does stand out to me is the elevation in prolactin. This can happen with pregnancy, and breastfeeding, but also with stress and a low fT3.

Do you recognize symptoms of a slow thyroid? For example, are you feeling cold easily? Are you feeling fatigued? Do you struggle with weight loss or do you have unexplained weight gain? Do you experience hair loss? Are you constipated?

[Daniel]

Hey @Sara,

With SIBO often a low fodmap diet is recommended. Below I attached a handout from the BBetter library so you won’t need to search it!

I would, however, recommend stopping sourdough and all gluten-containing grains. Breakdown products of gluten will elevate zonulin and zonulin will cause the gut to be more leaky by opening the tight junctions (basically doors between cells) in the gut lining.

SIBO
To prevent SIBO from reoccurring you should also spend some time in finding what causes it. Here are some factors that can lead to SIBO:
• Low Stomach acid. Stomach acid is our first line of defence against foreign invaders. When stomach acid is low (for example to chronic stress, a slow thyroid or simply bad eating hygiene) the wrong microbes can populate the microbiome.
• Snacking. The migrating motor complex (MMC) is a pattern of electrical activity observed in the gastrointestinal tract causing intestinal peristalsis. Eating stops the MMC. If you find yourself snacking all day, you might want to change this habit, since it can cause bacteria from the large intestine to migrate to the small intestine causing SIBO.
• Antibiotics kill bacteria. In order to prevent yeast and fungi from growing I often recommend my clients take a good broad-spectrum probiotic supplement. Ther-biotic from Klair Lab has a wide range of probiotics and I often recommend this one myself. It can take a really long time after a course of antibiotics to repopulate the gut microbiome. I would advise you to at least take probiotics for half a year.
• Make sure you aren’t constipated. This video offers great solutions if you are in need of them.
• Are you using Berberine as an anti-microbial? Berberine is a great option. With SIBO I often use a mix of antimicrobials containing wild oregano, thyme, cat’s claw, pau d’arco, peppermint, garlic, cinnamon and olive oil extract. Great multi-herbal supplements that are anti-microbial are Metagenics CandiBactin-AR + CandiBactin-BR.
• The immune system plays a critical role in ‘allowing’ which microbes can live in the gut. I often recommend my clients check their vitamin D levels. I personally aim for around 50 ng/ml. Zinc and vitamin A are also important nutrients for the immune system.
• Digestive enzyme support in your case could help you as well. Bile for example is antimicrobial to a degree and creates a good environment for an optimal microbiome.

Pain in the upper stomach
There are a few reasons why you could experience pain in the upper stomach.
• Indigestion.
• Abdominal muscle strains from exercising for example can also cause abdominal pain.
• Hiatal Hernia, which happens when the stomach pushes through the diaphragm.
• Gallstones are formed by cholesterol crystals and can cause pain in this region. Make sure you aren’t hydrated. D-lemonene in this case can help resolve the cholesterol crystals.
• Peptic ulcers can also cause pain in this region
• Inflammation in the liver can also cause some pain in this area

The type of pain is hard to assess for me. If you feel worried, you should talk to your doctor since he will be able to judge the situation better and faster.

If you did talk to your doctor, you can share his findings. We could provide you with much more targeted advice!

I hope you feel well soon!

[Daniel]

Hey ,

You might be describing a migraine. People who have tension headaches often complain of a band of pain across their forehead or pressure on either side of the head. The pain is tiring, but less severe than a migraine. Migraines, on the other hand, usually hurts worse on one side of the head often combined with pulsing or throbbing pain. Visual changes can occur, but it isn’t always the case. Sensitivity to light and sounds do often occur, but in a minority of people, these symptoms stay away.

Reasons can vary and are hard to pinpoint since there are many. But here are a few:
 
• If you still are sick, viral infections can cause headaches and on some occasions a migraine. With COVID infections a migraine is more common than with the flu.
• You mentioned in earlier posts your stress levels are high as well and also stress can cause headaches or trigger migraines.
• Food sensitivities can cause migraines as well. The most common food sensitivities that are related to getting migraines are oranges, coffee, tea, wheat and eggs. 
• Foods contain tyramine like cheese, cured meats, alcohol and vinegar. 
• Foods containing tannins can provoke a migraine as well, like coffee, tea, chocolate and wine.
• Histamine intolerance can cause migraines as well
• Certain heavy metals like lead and cadmium
• Fluctuations in atmospheric pressure
• An elevation in homocysteine is also associated with migraines. Homocysteine is something you could test if you experience migraines regularly.
• Dehydration can also play a role in triggering migraines

Things you could try
I often recommend my clients to try one (or a combination) of the following things for relief:

• 300-400 mg of magnesium 2x per day with food. Malate & glycinate are well absorbed. Citrate might be a better choice if you also experience constipation, but if it is the only magnesium form you have at home, you certainly can try it.
• CoQ10 has been shown effective with migraine prophylaxis (click here if you like to see some research)
• An elevation in homocysteine is can be influenced by genetics or a deficiency in B12, folate, B9 and riboflavin.
• Water!

Stress reduction: journaling, meditation, massages… they all can help reduce the incidence of migraines should they occur more often.

If toxicity is at play, a different kind of approach should be taken.

But since stress and viral infections are at play, I would focus my attention on those two primary causes first!

I hope you feel better soon!

[Daniel]

,

I have attached the handout “go-to immune boosting protocol when sick” below. Let me know if you could open it now!


[Daniel]

Hey ,

I know a lot of people recommend it – especially in the blogosphere. There are studies that confirm that regular use of saunas can increase white blood cells in healthy adults (according to this study for example)

I believe having saunas can be really beneficial, but you should consider it like the effect of a workout. It is a stressor to which the body adapts positively.

The direct benefit of a sauna is that it can release heat shock proteins. Heat shock proteins can directly stimulate innate immune responses, such as the maturation and activation of dendritic cells and the activation of natural killer cells

But it is also a stressor. We see studies mentioning that a sauna can increase cortisol and catecholamines like adrenaline and noradrenaline (Just like workouts!). And although taking regularly a sauna can increase white blood cells, having a sauna while being sick isn’t being investigated well.

So what does this all mean?
Based on what I have read I would recommend letting you guide by how you feel. If you’re too sick (especially when you have a fever), I would recommend staying in bed. There is a risk of fainting. If you feel like a sauna, I wouldn’t use too high temperatures or stay in too long.

The rule of thumb would be to feel warm, but not so warm that my body needs to fight off the urge to go outside. This is the moment that your body wants to go into a fight-or-flight state. A reason for me to stay out would be if I’m dehydrated because of a fever for example – or having diarrhea.

One last thing: I would also make sure I’m the only one in the sauna since I wouldn’t like to contaminate others.

I hope this makes sense!

[Daniel]

Hey ,

Did you send them an email? Perhaps they could provide you with a solution!

[Daniel]

Hey ,

I have to disagree with you there. In the time you did your anti-inflammatory diet, symptoms became less! Which to me means, you were able to reduce inflammation.

One of the core beliefs in the world of functional medicine is that everyone is unique. Two persons with the same disease might have different root causes and might need 2 different approaches.

Reducing inflammation might be the perfect example to explain this to you. Of course, there are recommendations that help the majority of people: getting vitamin D up and taking omega 3’s are two such examples. Reducing fast digestible carbs, sugars and processed foods are examples that often reduce inflammation as well.

When it comes to reactions to specific foods the area becomes much more ‘grey’. With rheumatoid arthritis removing nightshades might help. It just doesn’t help everyone. The same goes for avoiding lectins. They are in a way nothing more than educated guesses.

Maybe you are thinking: but why is it there so much variation from person to person?

We often see in autoimmune diseases that the gut for some reason suffered some damage or is more ‘leaky’ and lets in undigested foods. The immune system sees undigested foods as possible invaders and starts to clean up the mess. The reaction of the immune system causes inflammation. And although there are rules of thumb (like nightshades with rheumatoid arthritis), many reactions to food are also really personal. I for example had a food sensitivity to fish, which is considered anti-inflammatory.

There are 2 reasons why I’m explaining this. Often the most inflammatory choices aren’t about choosing between bell peppers and broccoli, but about choosing to sleep 8 hours, reduce emotional stress/trauma and reduce the number of processed foods.

If guess what I try to tell you is that you probably did more right then you thought! If you like to learn and read more about anti-inflammatory foods I could recommend you the book Digestive Wellness: Strengthen the Immune System and Prevent Disease Through Healthy Digestion. It’s written by Elizabeth Lipski. 
The second reason why I explained the relationship between the gut and how the immune system can be triggered by undigested foods is that even when you follow the best anti-inflammatory diet in the world, when the gut lining is leaky (which we see a lot in auto-immune diseased) you need to reduce the leakiness. You might not have focussed on this step the last time, but here are some steps to reduce a leaky gut:
• Remove gluten-containing grains. Breakdown products of gluten will open the doors (also called tight junctions) between the cells of the gut lining.
• Remove dairy.
• Vitamin D is necessary to close the tight junctions. A low serum vitamin D needs to be addressed in my opinion
• Focus on gut-healing foods – watch this movie about gut-healing therapies.

Of course, I could recommend more, but have you watched the Gut Health Masterclass already? It might be something that could help you in your healing journey!

 

[Daniel]

Hey ,

It can be a little tougher to get enough protein in your diet, but it is still possible. Legumes like beans for example are rich in protein. They are a source of lectins though and some research shows that lectins aren’t helpful with rheumatoid arthritis. I’m mentioning this, because ankylosing spondylitis is also a rheumatic disease.

Cooking does however destroy almost all lectins, so make sure you cook your beans well. Other sources of lectins are for example other legumes like soybeans, peas and peanuts. If you like to consume a low lectin diet, you should also cook them well.

Nuts can be a great source of protein as well. But some other nuts like walnuts, almonds, and sunflower seeds contain some lectin as well. The next nuts are low in lectin and fit in a low lectin diet if you choose to follow this route: pecans, pistachios, pine nuts, flax seeds, hemp seeds, sesame seeds, and Brazil nuts.

Plant based protein powders can also be a solution. In this case I would recommend hemp based protein powders.

I hope this helps!

[Daniel]

Hey ,

The handout Bernadette mentioned is wonderful and full of tips!

I would also like to add that being sick, although it definitely isn’t fun, might also have an upside.

When you are sick, your immune system is very active. You could also see it as a way to ‘clean’ your body from possible other pathogens that aren’t causing a problem but still are a burden for the body.

Just provide the healing possibilities for your body! Make sure you rest and give in to it if that’s possible so your immune system can do its job effectively.

I have a rule of thumb: once you can vacuum clean your house, you could consider yourself better! If it is an option, don’t go back to work too soon since your body is still busy removing waste products afterwards.

Get well soon!

[Daniel]

Hey ,

Nightshades are a group of plants that can protect themselves from insects and bugs by producing certain chemicals. These chemicals are nature’s variation of insecticides.

Solanine for example is such a compound that you can find in nightshades like potatoes, tomatoes, eggplant, goji berries and peppers (Bell peppers, chilli peppers, cayenne, etc)

While nightshades are completely healthy for most people, they are a common (but not always) food sensitivity in those with joint pain, IBD, Rheumatoid Arthritis, and other inflammatory autoimmune diseases.

Ankylosing spondylitis is a form of arthritis that causes chronic spine inflammation. Avoiding nightshades can be something you could consider.

That being said, the supplements I recommended earlier can also be used with Ankylosing spondylitis. Following an anti-inflammatory lifestyle is definitely something that could help. I know your husband followed an anti-inflammatory diet which helped. Other things that can help the healing process are having a focus on good quality sleep and avoiding stress.

If you are unsure if your husband sleeps well, just ask him the question if he feels he has enough energy for the day when he wakes up.

If you like some more detailed tips around those topics, let me know!

[Daniel]

Hey ,

Personally, I have no experience with this test, so I can’t speak to that. It looks to me like a special kind of food sensitivity test.

The test does this by looking at changes in the volumes of white blood cells. The idea is that once white blood cells have released their mediators, they shrink in size. In this way, they test how your white blood cells react to different foods.

Compared to the KBMO food sensitivity test (which you can find here), they use a different approach. I only know that KBMO has been used much more in the functional medicine world and has built trust with its results.

You could try the MRT test if you would like. The advantage is that histamine is also mediated by white blood cells. I only can’t speak about my experience with this test.

Did you ever consider finding help from an osteopath? A big factor why you might still be experiencing acid reflux might also be caused by the position in which your stomach is. Perhaps an osteopath can be of help here.

[Daniel]

Hey ,

Three years of stress is a long time to be stressed… I hope there is some pressure relief possible for you in the near future!

Stress can influence health for sure. The way stress influences your health is unique to you and your circumstances though. Both the frequency you need to go to the toilet and hair loss can be caused by stress, but still in different ways. Here are some things to consider:

Stress can influence nutrient absorption
Nutrient deficiencies like iron and zinc can cause hair loss. These minerals need to be sufficient in your diet of course, but for absorption, these minerals also need strong stomach acid. Testing iron can be done by your doctor as well. An iron deficiency can also cause anemia. Other symptoms of anemia are looking pale, feeling fatigued, shortness of breath, mouth ulcers, an inflamed tongue, brittle nails or even the desire to eat ice or other non-food things.

The HCl dosing challenge can give you a clue as to if you are deficient in stomach acid. Just remember that this challenge isn’t a diagnostic tool.

Other nutrients that play a role
Proteins, Selenium, B vitamins, vitamin A and vitamin D play a role as well. How much vitamin D are you supplementing with? And do you know your current serum levels? All these nutrients are also needed for a healthy thyroid hormone balance. In fact, a slow thyroid can also cause hair loss, which brings me to the next topic.

Stress and thyroid function
If you are sensitive to cold, feeling fatigued, depressed, constipated or have unexplained weight gains, these are all extra symptoms that could point to having a slow thyroid.

Stress raises reverse T3 and blocks the action of the metabolic active T3. If you aren’t sure how this all works, I recommend you watch this explanation.

Attached below I have added a handout that will dive into details of what nutrients you should be focussing on.

If you recognize more symptoms I would recommend you watch the full Thyroid Balance course, but as a bare minimum, this video will explain to you how to test your thyroid.

Hairloss & hormones
Elevations in androgens can also cause hair loss. If you experience hormonal imbalances in sex hormones, this might be worth exploring.

Stress, hair loss & auto-immune issues
In some auto-immune diseases the immune system attacks the hair follicle. Just asking: do you have any that you know of?

Stress & Urination
Ongoing stress can lead to frequent urination. Making sure you get enough electrolytes (for example by making sole) could help you. But basically your body, in a parasympathetic dominant state, will lose water. The long-term solution will be addressing stress.

Another possible reason why you might lose water is the fasting process which you are going through. If the body gets depleted from glycogen (the cells storage form of glucose) your cells will lose water.

This is actually normal and might not be something you should worry about too much.

If you experience these symptoms also when you’re not fasting, this might be more related to a parasympathetic state. If your stress is emotional in nature or caused by for example work-related seeking out somebody who can give you another perspective on your personal situation can be really valuable. Here you can find recommendations that might be helpful to you!

If you like to test your stress hormones I would really recommend the Dutch test.

Last but definitely not least: we have a full course that talks about stress hormones called Adrenal Balance. If you haven’t seen this course, I would really recommend you watch it!

Let me know what resonates with you!
[Thyroid Nutrition.pdf]
[Hydrochloric acid supplement recommended dosage challenge.pdf]

[Daniel]

Hey ,

I think your husband is lucky to have you! There are some interesting patterns on them. Some things might be low-hanging fruits. Others might need a deeper dive. Unfortunately, labs without symptoms are a little hard to interpret. Perhaps you could give us some insights into his top 5 symptoms, diet, sleep and stress levels.

For now, I will do the best I can with these lab results. Let’s start with the low-hanging fruits first:

His vitamin D is really low. This can lead to several symptoms like fatigue (and yet not sleeping well), less resilience to fight of infections, weakness in the muscles, feeling depressed,  and a low vitamin D that can even result in back and joint pain. Since you know his serum vitamin D levels, I recommend you look at one of my favourite documents on the platform: The vitamin D handout. It will provide you with a protocol for the dosages.

His B12 levels are also clinically low. Symptoms that a low B12 can cause are fatigue as well. A vitamin B12 deficiency like this probably will cause in time anemia. It doesn’t show up in his labs yet, but if a deficiency like this isn’t addressed it is my experience that it is just a matter of time.

A B12 deficiency can be caused by several reasons. It might not be in his diet (is he on a plant-based diet?). It can be caused by hypochlorhydria (low stomach acid) as well. If your husband is willing to explore these options, I recommend he at the very least watch these 3 movies:
• Signs of hypochlorhydria
• Causes of Hypochlorhydria
• Stomach Acid Support

His cholesterol is elevated. This might be caused by insulin resistance or the imbalance in the thyroid hormones that show up in his lab report.

Let’s break this down:

Insulin resistance
His HbA1c is elevated. This is caused by sugar molecules sticking to hemoglobin and is often caused by dysregulated blood sugar levels. Perhaps he can recognize himself in the next set of symptoms: strong cravings for sweets or caffeine, fatigue (again!), tingling sensations in the body, ravenous hunger, weight gain, difficulty concentrating, feeling jittery or shaky between his meals and even a blurred vision can be a symptom.

If he is on a carb-rich diet, temporarily lowering the carbs will help him address this. The blood sugar regulation course might be interesting for him. If he is only interested in what he should alter in his diet, he can watch this video:
• Dietary Guidelines & Sample Daily Meal Plan

If he likes a deeper dive, these videos are also important for him. Especially with more advanced stages of insulin resistance, we can see thyroid hormones be unbalanced as well and therefore it would be good for him to understand the differences between the phases since the recommendations are also slightly different.

I grouped the videos together for you right here:
• The Phases of Dysfunction: Phase 1 & 2 Signs & Symptoms
• Insulin Resistance & Phase 3 to 5 Signs & Symptoms
• Supplement & Lifestyle Considerations: Phase 2
• Supplement & Lifestyle Considerations: Phase 3 to 5

Thyroid Disbalance
On his labs his TSH is suboptimally elevated. His free T4 is also elevated, but his metabolic most active thyroid hormone is in range. Since there are a few scenarios possible, I would like to know a bit more about his symptoms first.

While his metabolic health and vitamin D might contribute to fatigue and his TSH is suboptimally high (like the brain is feeling it needs more energy) he seems to produce thyroid hormones in the upper half of the reference range.

If he despite the high thyroid hormones feels fatigued, he might on a cellular level not accept the hormones.

Here are some reasons why a slow thyroid might be considered: 
• A slow thyroid can contribute to elevations in cholesterol.
• A slow thyroid can contribute to a decrease in SHBG (Sex Hormone Binding Globulin)
• Alkaline phosphatase is suboptimally low which could be caused by a zinc deficiency. A zinc deficiency can cause a slow thyroid and influence the immune system as well.
• Vitamin D is really low, which can also contribute to slow thyroid symptoms.

With his set of labs, he could also feel normal: the fatigue caused by the vitamin D deficiency and the insulin resistance might be compensated by the elevations in thyroid hormones.

With these labs, symptoms of a fast thyroid are also an option. An overactive thyroid gland can cause heart palpitations, sensitivity to heat, and nervousness, anxiety and irritability.

If you like to dive deeper into what is at play, I really recommend a full thyroid panel (just click here for the video).

I hope you have some starting points to help your husband here. Good luck!

[Daniel]

Hey ,

What you can do in the meanwhile might depend on the root cause. Do you know your current blood pressure? If it is on the low side without changing the dose of your medication, you could discuss lowering the medication with your GP.

Magnesium is not in your supplement stack might help you to lower blood pressure as well. A magnesium deficiency can also contribute to higher blood pressure levels.

Making sure you have enough nutrients to support thyroid function can be something you could focus on as well. The library has a great document for that right here.

Assessing stress levels can also be a game changer. Think big on this topic! Work pressure, and emotional stress from relationships, friends or families are only part of that. Think also about other stuff like loneliness (yes, also if you are in a relationship!), spiritual fulfilment, resentment, sadness, setting the bar high for yourself (or others), shame, blame… all these things are examples you could consider.

If insulin resistance is at play, lowering blood sugar can help. Smoothies can be a great source of nutrients, however, they can be a source of fast digestible sugars. Feeling fatigued after drinking a smoothy can be a sign that your body doesn’t deal well with the amount of sugar in them.

The tingling sensation in your fingers can be caused by slow thyroid, insulin resistance and anemia. The low hemoglobin is an anemia usually caused by an iron deficiency. But a B12, folate and B6 deficiency can also cause another type of anemia.

If you consume enough iron, you might want to try the hydrochloric acid dosage challenge. I have attached the protocol below. Stomach acid is needed for iron absorption, but it heavily influences the amount of B12 absorption as well.[Hydrochloric acid supplement recommended dosage challenge (1).pdf]