[Daniel]

Hey ,

You could adjust the amounts a bit. What works for you is something you need to find out experimentally.

In my opinion, VPF should work, but the size of the meals does matter. If you are eating a big meal, even 3 hours before sleeping, this could still impact the quality of your sleep. It could help to have the biggest meal with suhoor (although I have no experience with Ramadan, but I believe it means breakfast right?) while making the evening meals not too big.

Fasting also impacts cortisol levels. If you aren’t eating for a while, your blood sugars are stabilized by elevations in stress hormones during the day. To help break down adrenaline and noradrenaline magnesium plays an important role and could improve sleep quality.

L-theanine (an amino acid in tea) could help you calm down if getting to sleep seems to be the problem. Ashwagandha is a supplement I often recommend if people are sleeping superficially.

I personally have no experience with Ramadan, but perhaps  has some additional tips here.

[Daniel]

Hey ,

Designs for Health has DGL Synergie, which is a chewable. Perhaps you could try that one?

[Daniel]

Hey ,

Did we miss your question? If so, we are sorry! Let’s dive right into your question!

The microbiome is very much alive and always changing and adapting to its environment. It is influenced for example by bile since bile influences the pH in the gut. The microbiome is influenced by the immune system, stress, motility and what you eat. Especially foods can change the microbiome quickly, which is a good thing since the microbiome tries to adapt to what you feed it.

Even small amounts of opportunistic bacteria have their place in the microbiome. They help for example prime the immune system and when everything works well, the immune system helps keeps the balance so these species don’t overgrow.

Having enough nutrients in the diet to support the immune system (like vitamin D, vitamin A, zinc, folate and vitamin B12) is therefore important to help balance the immune system.

Having an optimal bile flow helps the environment of the gut to keep the balance in the microbiome as well. Here nutrients like taurine, glycine and vitamin B6 play an essential role since they are necessary to produce bile salts. Drinking enough water (such basic advice, but the majority of people struggle with this!) is essential for this as well.

Bile is produced in the liver and stored in the gallbladder and the health of these organs plays an important role as well.

Depending on what kind of blood values you measured we could help you to see if your liver doesn’t struggle and your immune system is functioning optimally. If you feel like sharing them, please do!

H. Pylori
Although H. pylori have a bad reputation, it is also a bacteria an endemic species that live in small amounts in our GI tract (particularly in the stomach). Finding small amounts on a test can therefore occur. H. Pylori can grow once the stomach is lesser acid. To get an indication about if you have low stomach acid you could for example do the baking soda test or a hydrochloric dosing challenge test (just click the link – and if it doesn’t work, I have uploaded the handout below).

Things that reduce stomach acid often can be stress or simply bad eating hygiene. These lifestyle factors are equally important to address. If you like to reduce H. Pylori overgrowth, supplements like mastic gum, zinc carnosine, Matula tea and DGL Licorice can help. A supplement that contains a nice blend of some of these ingredients is a product from Designs for Health called gastromend.

The B Better library has a video on this topic right here.

Klebsiella spp & citrobacter fundii
High levels of Klebsiella are indeed associated with inflammatory disease states. Klebsiella is also known to produce histamine, which is a balanced gut that is simply broken down by the DAO enzyme produced by the lining of the gut. When the lining of the gut is damaged (leaky gut), the DAO enzyme production might go down and some gut healing needs to take place as well. If you experience symptoms that are related to elevations in histamine, I would recommend temporarily avoiding high-histamine foods (This handout can help you!). Supplementing with the DAO enzyme can help you as well until the gut has healed. Things that help the gut heal are for example
• Aloe Vera
• Bone Broth
• Zinc carnosine 
• L-Glutamine
• Cabbage juice

There are more options of course. But reducing the number of klebsiella spp and citrobacter fundii should be the first priority.

Supplements with antimicrobials can help reduce the amount. A broad spectrum supplement that I personally advise often is Candibactin AR + BR. Another antimicrobial I often recommend is Biocidin. 

Some foods that have antimicrobial properties could help you here as well, like:
• Caprylic acid found in coconut oil or in MCT oil
• Extra Virgin Olive Oil – Especially oil that leaves a peppery or bitter taste on your tongue is good since this means it contains a lot of polyphenols
• Garlic

Adding a probiotic could help you as well. Strains that help are for example: Lactobacillus acidophilus‚ Bifidobacterium bifidum‚ Bifidobacterium longum‚ Lactobacillus rhamnosus‚ Bifidobacterium breve‚ Lactobacillus casei‚

A broad spectrum probiotic I often recommend to my clients is Ther-Biotic complete from Klaire Labs

If yeast isn’t a problem for you, you could also use Saccharomyces boulardii.

I hope you have some answers to your questions. If I missed something, let me know! Posting your labs will help us to provide you with more targeted advice. 

I hope this helps!

[Hydrochloric acid supplement recommended dosage challenge.pdf]

[Daniel]

 Sorry I misread that! I see Bernadette already wrote an excellent response! 

[Daniel]

Hey ,

All dairy containing lactose would trigger someone who is lactose intolerant. To help you avoid dairy we have a handout right here that can help you avoid dairy products.

Kefir based on milk products should be avoided as well, although you can consume water-based kefir. There is even a recipe in the library! Just click here.

[Daniel]

Hey ,

Thank you for sharing your symptoms! A lot of these symptoms point to a hypothyroid state, but this is not a surprise to you of course. 

Often I recommend my clients to explore what type of slow thyroid they are having. A slow thyroid could be caused by:
• Nutrient deficiencies like Iodine, zinc, iron, magnesium, vitamins A & D, selenium but also protein.
• Stress could also interfere with fT3 production. 
• And last but not least, sometimes thyroid hormones become sluggish because of autoimmune issues (like with Hashimoto’s disease).

If you have Hashimoto’s (or other autoimmune diseases) I would recommend avoiding dairy and gluten for a while. Avoiding grains for a while would even be better.

A test can point you in the right direction and help you with making more targeted lifestyle choices. This video explains what you would like to test. 

Stomach acid
You mentioned you are currently not taking any stomach acid medication at all – did you used to? If you took stomach acid medications for whatever reason or if you experienced in the past heartburn, you could also do the baking soda test. It is easy to do at home and it can provide you clues as to if your stomach produces enough stomach acid.

Stomach acid is needed to digest protein, and absorb iron. As I mentioned earlier, these nutrients are needed for a healthy thyroid hormone balance.

You can find out how to perform the baking soda test in this document.

[Daniel]

Hey ,

Yes, you are totally right! Hypothyroidism can cause concentration problems because with hypothyroidism energy production goes slower. Also energy production in the brain.

Every disease that creates a significant amount of inflammation can make you feel tired including celiac disease, but so do allergies, fibromyalgia, diabetes, long Covid… the list can get quite overwhelming

Perhaps we can guide you better by asking you first what other kinds of symptoms you are experiencing.

With hypothyroidism, there are other signals your body might give. Do you for example have one of the following other symptoms?
• Feeling cold
• Fatigue
• Hair loss/thinning of hair
• Unexplained weight gain/problems losing weight
• Slowed heart rate
• Constipation
• Slowed Heartrate
• Muscle weakness
• Depression

Symptoms that come with coeliac are typically the following:
• Diarrhea
• Gas
• Feeling bloated
• Abdominal pain
• Nausea/vomiting
• Weight loss
• Fatigue.

Another reason why you might experience fatigue can be anemia. Signs & Symptoms of anemia are for example
• Feeling cold
• Looking pale
• Being short of breath
• Feeling fatigued even after a good night of sleep
• Cold hands & feets
• Tingling sensation in the arms/legs
• Dizziness/lightheadedness
• Headaches
• Feeling weak.

If you have any other symptoms, let us know. They hold the key to helping you in the best way possible!

Lifestyle questions
Perhaps you could tell us also about how you are sleeping. Do you feel rested when you wake up? From when to when do you sleep? Are you waking up in the middle of the night? When and how often?

Other things that can influence concentration are medicines. Are there any you are taking? Don’t forget to think about antacids, any form of painkillers or oral contraceptives.

Other factors that can help us in our search for your concentration problems can be diet related. What do you eat normally for breakfast, lunch and dinner? And do you experience cravings for sweetness (and how often do you give in to these cravings?)

I know these are a lot of questions, but they could help us narrow down the options.

[Daniel]

Hey ,

Sure I do! But this platform has already so many insights to give. I would advise you to make a general post. A lot of people share here their lab results and Bernadette and I share our experience with other clients here. We will help you with tips and guide you to the right information on the platform when it is available.

I know some people like to stay anonymous when sharing information. Here is a video that explains how to stay anonymous if this is something you are concerned about.

The great thing about this platform is that it can help you to understand the basics of your sleep problem. For example, we have even a video here that explains how to interpret insulin on your lab results. Depending on who interpreted your values it might be helpful to look again at your lab values. Through the functional medicine lens, insulin is differently interpreted than through the conventional lens. In general, we derive different conclusions than traditional medicine from all kinds of lab values.

Perhaps you can tell us a little more about when your sleep problems started and if you experience emotional stress in your life. What did you try already to get some relief? What worked and what didn’t? Sometimes sleep problems can occur with other medication use. Are you currently on any medications? And what does your intuition tell you about your sleep problem?

Other symptoms you experience can also be a great guide. You should also think about stuff you probably wouldn’t complain about to a doctor. For example, are you stiff in the morning? Do you experience muscle cramps? Do you feel low on energy? Do you experience heartburn? Are you experiencing hot flashes? All details matter!

[Daniel]

Hey ,

Thank you for sharing all this detailed information! It will take some time to analyze this all, but here are already some important key points:

Vitamin D
To raise vitamin D from your levels, you will need a dose that is higher. The Biotics ADEK-Mulsion is a great supplement, but it won’t bring your vitamin D levels up when they are down since there is only 10 mcg of vitamin D in it. This handout is all about vitamin D and how to raise it. I recommend you check this out! I usually recommend my clients to use dosages of 50 mcg (or 2000 IU) daily for 2-3 months, then retest and adjust the dosage if this is necessary.

A low vitamin D level can contribute to low calcium levels and needs to be addressed.

Vitamin D is very important to the immune system. It regulates about 5% of your genes which is a lot. And a lot of those genes are involved with the immune system and regulating inflammation!

It does however require magnesium to be activated.

Magnesium
When you still experience constipation, my preference goes for magnesium citrate or a mix that contains a good amount of magnesium citrate. Because magnesium is not particularly tasteful, most liquid forms contain some form of sweetness (fructose/xylitol or natural flavours). If liquid magnesium is something you like to try because it is easier for your stomach you could make it yourself by mixing some magnesium powder in water or some kind of liquid with more flavour.

Zinc
Personally, I would leave out the zinc supplements for a few days and see if some symptoms you are experiencing get less. Let us know the results! I didn’t take a look at your medicines yet, but perhaps some zinc is hidden in there. If these supplements are all supplements you take, it makes me wonder if there aren’t other zinc sources in your environment (I mentioned this earlier, but other examples of zinc compounds are zinc oxide and zinc sulfide.

Zinc oxide is used to make various products including make-up  and prescription drugs. Checking the ingredients of your drugs could be a good idea. Zinc sulfide can be found in x-ray equipment and different kinds of paints. I don’t know if you work with paint, but I am just mentioning it.

Free T3
As long as you are low in iron, a low T3 is not a weird outcome since iron is needed for T3 production. Once iron levels are restored, I would recheck free T3.

Iron, oxygen and why an iron deficiency can have a lot of impacts.
As I mentioned earlier, 70% of your iron is used to build hemoglobin for red blood cells.

No hemoglobin = no oxygen transport

No oxygen transport means your altering your cell’s metabolism. The powerhouses of your cell (the mitochondria) are using a lot of oxygen to produce energy. Actually, they are a huge reason why we need to breathe.

With anemia, not all cells are getting oxygen optimally. This in theory causes mitochondrial dysfunction because they need oxygen. It are the mitochondria that play a huge role in programmed cell death.

I know we talked a lot about iron. I just wanted to stress how important iron is for healing. Optimizing red blood cell function is a benefit to all cells in your body.

Calcium
Calcium is found in lots of foods. Green vegetables, seeds, lentils, beans, almonds, amaranth, GMO-free organic soybeans… Lots of options. I usually recommend my clients that are low on vitamin D to choose calcium-rich foods while optimizing for vitamin D first. Retest calcium with vitamin D 2-3 months later.

The new labs
These labs look great! Proteins are negative in the urine. Do you know if it was measured with a urine dip stick or a quantitive determination of  micro-albumin? Micro-albumin is a very small protein and is more indicative for small damage on the kidney.

I think these are the most important basics to focus on. I will respond in more detail later.

[Daniel]

Hey ,

Welcome to B Better! My name is Daniel and I help Bernadette on the platform. I hope you like what you see! If you ever have questions about health or where to find content, let us know! There is quite a bit already.

There can be different reasons why you wake up in the night. You mentioned you had your insulin measured. I was curious about your lab values. Perhaps we could help you shed a different light on them through the functional medicine lens.

[Daniel]

Hey ,

Unfortunately, I couldn’t personally help you recommend a professional who can help you in Dubai, but I know Bernadette once recommended the Vivamus Clinic. They offer counselling and EMDR I believe. I wish I could have helped you by recommending a psychiatrist with a more holistic vision in Dubai.

But there are things you could already recommend to this person.

Trauma hijacks the brain. We have in our brain a system called the ‘fear network’. The fear network involves three elements of the brain: the amygdala, the hippocampus and the prefrontal cortex.

That sounds really difficult, but basically, these systems work together to monitor the environment, to remember what the threats are, to regulate emotions and then to make decisions for us in the face of those threats.

When Trauma happens, it hijacks that fear network via the enormous amount of neurotransmitters your brain and body produce during the traumatic event. This can in the end result in a person who is continuously on high alert, who is continuously on edge and who is continuously activating his/her sympathetic nervous system.

It is my experience that a broad approach works best. More recommendations you can find in this video, but here are the ones I like:
• EMDR can help to heal from the symptoms and emotional distress that are the result of disturbing life experiences.
• But EMDR is often just part of the healing process. Finding meaning in experiences that happened to them is often part of this process as well. A good therapist can help with that, but it requires some work from the person itself.
• DBT or Dialectical Behaviour Therapy is especially effective for people who have difficulty managing and regulating their emotions. DBT has proven to be effective in treating and managing a wide range of mental health conditions, including Borderline personality disorder (BPD), self-harm, suicidal behaviour and Post-traumatic stress disorder (PTSD). If the person you like to help has problems with this, you could consider this type of therapy.

Working on fundamental stuff to help the body can help enormously as well: 
• Improving sleep (I know some of these medications can make this very difficult), 
• making sure someone has enough vitamin D, and adding in DHA, EPA and protein in their diet since these are needed to produce serotonin, 
• Checking inflammatory markers and working on reducing inflammation by focusing on an anti-inflammatory diet.
• Food sensitivities/allergies can increase inflammation.
• Checking RBC magnesium.
• Checking for a slow thyroid (Click here if you would like to look for other signs & symptoms of a slow thyroid. Click here if you like to know how to test for thyroid hormones), since a slow thyroid can cause depression and might make things worse.
• In the adrenal balance course there are a lot of tips about how to balance stress hormones.
• Having enough B vitamins in the diet is important. Especially B6 is needed to create neurotransmitters. But B6 is also needed to create adrenalin/nor-adrenalin so go really low & slow since it could also increase anxiety.

A last tip:
What often can happen to trauma survivors after a while is that they might get offered a lot of solutions from their friends and family. Trauma survivors often get told by their surroundings that ‘all is going to be ok’ or they ‘need to cheer up’. This type of advice can come from a good heart. But for a traumatized person this could also feel emotionally invalidating since it is sometimes felt as ‘he/she doesn’t want me to talk about this anymore’ or ‘talking about this topic makes him/her uncomfortable’. This can often lead to a feeling of loneliness in the victims.

If there is an opportunity to educate family and friends, explain to them that the best healing environment for a traumatized person is one with empathy, compassion and one without judgement. That road to finding meaning in their experience can take a while. Making sure the environment facilitates healing can help these persons enormously.

I hope this advice can help you

[Daniel]

Hey ,

A lot of the results confirm already what we know. For example, we see elevations in eosinophils and basophils which is indirect evidence for elevations in histamine. Basophils also protect against bacterial, fungal, viral and parasites and could be elevated by these pathogens.

Kidney function
The eGFR, a marker used to evaluate kidney function, is a little low on your lab results. This can indicate you were dehydrated at the moment of blood draw. But there is a pattern of elevated markers (uric acid, fructosamine, Anion gap) that might indicate your kidneys are struggling.

Asking your doctor to measure proteins in the urine can help you to exclude that your kidney health is impaired.

There might be other reasons why these markers could be elevated. Fructosamine for example can be a reflection of the amount of sugar your body has seen in the last 2 weeks. It would be helpful to know if you struggled with foods.

An anion gap can also be elevated because of dehydration – or it could indicate the pH of your blood is a little more on the acid side. For the right interpretation, it is important to trace back your steps around the time of blood draw. Do you know if you were dehydrated back there? 

Assessing blood values is complex without knowing the circumstances. I would like to give you more targeted advice, but having more details about sleep, current diet, current supplements, medications and changes in symptoms would be of much value here

I hope this makes sense!

[Daniel]

Hey ,

Thank you for posting your lab results! Right now I will highlight just a few points, but I will respond in more detail.

Zinc
The serum zinc markers in your lab results were slightly elevated above normal and the RBC Zinc is high normal. Usually, this doesn’t happen with consuming foods alone. Although there can be other reasons why serum zinc gets elevated, a common reason for elevations are supplements. High doses of zinc can cause symptoms like pain in the stomach, nausea, vomiting and diarrhea. If you aren’t on any supplements, inhalation of vapours  (e.g. during welding, plating, etc.) can lead to toxicity as well.

Vitamin D
Are you on any vitamin D supplements? Your vitamin D levels are low on your test results. If you are supplementing with vitamin D, it looks like it doesn’t get absorbed.

Serum Folate vs RBC Folate
It looks like your red blood cells are built with enough folate. Your total amount of red blood cells increased a little bit as well, which is good news since your test result from last year showed that the number of red blood cells was borderline low.

The serum folate looks still low, this can be because the body quickly consumes the folate. Another reason could be your folate intake is still not enough. Usually, I would recommend my clients to go a little higher in folate in this case.

Homocysteine
Lab results show also a lowering in homocysteine. Although we aren’t in the ideal zone, I think a little congratulations are in its place! Again we need B vitamins to lower homocysteine. Folate and B6 both play a role. B6 also plays a role in bile production. Having them both enough in the diet is important.

Low free T3
The test does show a low T3. For sure that a lowered iron plays a role still. Kidney and liver health can also play a role here since these organs are key players in T4 to T3 conversion.

Elevations in Bilirubin
I believe you already talked with Bernadette about poor bile flow or bile production. Bilirubin is a waste product from dead red blood cells. It gets mostly removed through bile and is the reason why your stool turns dark. Elevations in bilirubin can also cause the urine to be unusually dark yellow. Since Bernadette gave you already some tips here, I won’t. It is however something you would like to recheck in a while.

Elevations in HDL
Elevations in HDL are another clue to sluggish bile production. The liver breaks down HDL and removes it through the bile. Optimizing bile production and flow will probably lower HDL.

There is more to say about these labs, but perhaps you could share first with us which supplements you currently are using. This will help us guide you better!

[Daniel]

Hey ,

I usually recommend my clients to value urine tests above serum tests, new values above old values and I would look at them through the lens of how I felt around the measurements. Another factor to consider is that different labs use different equipment which makes different errors (I am saying this as an ex-physics and astronomy student). Labs can even use slightly different reference ranges.

That being said I don’t think these differences in results tell a totally different story.

Even if the levels on your serum are in the upper part of the reference range, I would not add it to the list ‘yet another thing that goes wrong in my body’. 

From earlier lab reports we saw some elevations in mercury. Mercury can bind to serum B12 leaving it unavailable for the cell. Through this lens, these results are actually good. Be aware that B vitamins also are needed for detoxification and can help free up stored mercury. This in theory could also lead to fluctuations in MMA.

The focus is on reducing inflammation, supporting liver and gut function, get iron & folate up. Getting your body strong enough for active detoxification. Bernadette posted some really good tips for general detoxification in a post called ‘Mineral Balance’. You could take a look there and implement things you aren’t doing yet. 

But I would wait to help the body actively detoxify to a later stage.

[Daniel]

Hey ,

There are a lot of reasons why hair can turn grey. Unfortunately, there is a genetic component here as well. An indication of if you are getting grey premature is by looking at how old your parents became grey.

Although there is a genetic component to it, lifestyle factors can influence becoming grey as well. Melanocytes in the hair produce melanin which gives hair its color. These melanocytes are cells and just like every cell in the body they produce waste products and free radicals. One of those products is hydrogen peroxide – the same stuff that is used to bleach hair.

Normally hydrogen peroxide gets neutralised by an enzyme that protects cells from free radical damage that is called catalase. When we get older our melanocytes’ ability to produce catalase goes down and the hydrogen peroxide bleaches our hair from the inside out turning it grey.

When the body experiences more oxidative stress and inflammation the enzyme catalase gets busier and hydrogen peroxide can do more damage.

The nutrients Bernadette mentioned are important. Here are some other things you can do.
• Vitamin D – most people are deficient. If you don’t know if you are deficient, I would recommend testing your levels and bringing serum vitamin D levels into the ideal range. Here is a handout that can guide you if you like to know more about vitamin D. Vitamin D regulates a lot of the genes that are necessary to reduce inflammation. It is also involved in calcium metabolism and also calcium plays a role in hair health.
• Adding in Omega 3s helps to reduce inflammation as well. I usually recommend my clients a maintenance dose of 1000 mg EPA + DHA. If you are experiencing symptoms that are related to inflammation, I usually recommend higher dosages (usually between 2000 and 4000 mg)
• If you have autoimmune issues, this can be a source of inflammation as well. Autoimmune diseases can lead to becoming grey early for this reason.
• A lot of B vitamins are involved in hair health. Folate and B12 keep red blood cells healthy which transport oxygen to hair follicles. Vitamin B5 and B6 play an important role in healthy hair as well. Basic B is a B vitamin supplement from Thorne with all the B vitamins in the bioavailable form – just click here.
• Another supplement I could recommend is this one from Pure Encapsulations called Hair/Skin/Nails Ultra. It has a combination of nutrients that is mentioned by Bernadette. Just be aware that I wouldn’t combine it with Basic B from Thorne. It is the one or the other – not both. Hair/Skin/Nails Ultra has also 30mg of zinc in it. If you are using other supplements containing zinc, I wouldn’t recommend this product either since you might risk getting too much zinc in your diet.
• Remove foods that are inflammatory as well as possible. If you are lactose intolerant, have food sensitivities or are allergic to foods, I would avoid them. If you have symptoms like gas, bloating, constipation or diarhea after certain foods, avoid these.

I hope these tips will help you!