[Daniel]

Hey ! Lactose/dairy is off the checklist

Perhaps in the meantime, since this is off the checklist, you can provide me with an idea of your current diet. What are you having for breakfast, lunch and dinner? What types of fats and carb sources do you choose? What are the top 8 foods you consume the most? And what are the moments where you feel you struggle?

[Daniel]

Hey ,

I will provide you with some tips the best way I can! We do have an entire course available right here which focuses on mineral balance. I could provide you with more targeted advice if I have a little more information.
• You say you want to reach mineral balance. Did you do a test to examine your minerals? Or do you experience any symptoms related to an imbalance in certain minerals? And if so, what are these symptoms? In the mineral balance course, you can find signs & symptoms of too much or not enough of certain minerals like iodine, copper, iron, zinc, magnesium, potassium and calcium.
• Can you tell me more about the current state of your skin? For example, is your skin dry? Would you like to prevent wrinkles? Or are there other skin conditions you are experiencing like acne for example?
• Do you experience symptoms of toxicity? Or did you do a test in which the result was you had a certain toxin burden? If you have a test available, would you like to share those results? 
• How would you describe your current diet? What foods do you consume with breakfast, lunch and dinner? And if you drink alcohol, how many glasses per week?
• How do you sleep? Do you wake up with energy? Or do you need a cup of coffee to get going?

Skin tips.
It is estimated that the epidermis turns over every 40 to 56 days. As you get older skin regeneration slows down. A lot of factors can influence your skin positively like regular exercise, a nutrient-rich diet, staying hydrated and reducing stress. Other factors that influence skin greatly are environmental factors like UV radiation, pollution and dry weather.

Having a protein-rich diet is important for skin health. Proteins are essential for tissue repair and cell growth. In this video Bernadette explains her VPF principle, which you can use to guide you on what to eat. Digesting proteins starts in the stomach and requires your stomach to produce enough stomach acid. We do have a handout right here where we describe how to do the baking soda test which could give you an indication about if you experience low stomach acid. You could also watch this video to see if you experience other signs and symptoms of low stomach acid.

Inflammation can also lead to skin ageing or a reduction in skin health. Reducing stress and inflammatory foods (like consuming a lot of low-quality omega-6 fats, foods that make you feel bloated, and cause constipation, diarhea, pain or gas) should be avoided.

A diet rich in antioxidants is important as well. Free radicals that aren’t neutralized by these antioxidants will cause damage to the skin and can cause premature ageing. Blueberries, strawberries, ginger, turmeric, beets, spinach and extra virgin olive oil are all great sources of antioxidants.

You already mentioned collagen, which is a necessary protein needed to produce healthy skin. It is this process that is influenced negatively by inflammation. If your inflammation in the body is low, then adding specific nutrients is the next impactful step. Here are some I suggest to my clients:
• Omega 3 or more specifically DHA + EPA around 1000 mg per day
• DGLA which is a specific type of omega 6 is also helpful for a healthy skin. The precursor GLA that the body will convert to DGLA is found in for example primrose oil and borage oil.
• Vitamin C is necessary for the production of collagen in the body. Having a vitamin C supplement can help.
• Zinc is a mineral we would like to have for a healthy skin. Not enough zinc will influence skin, but also other parts of your health since it is an important nutrient for your immune system as well. But too much zinc will deplete you of copper since zinc and copper compete for absorption. I personally would aim between 10-15mg of zinc per day if no other health issues play a role.
• B vitamins play an important role in skin health.
• Hair/Skin/Nails Ultra from Pure Encapsulations (just click here) combines zinc, copper, vitamin C, collagen and some other nutrients that are important for skin health. 

There are other things influencing skin health as well. Imbalances in hormones like estrogen can impact skin health. A slow thyroid could cause the skin to be dry as well. If you like to see if you have signs and symptoms of a slow thyroid click here. For estrogen dominance symptoms we have a handout right here.

Detoxification
I would love to give you more targeted advice on how to detoxify. But perhaps you could answer my questions first. Detoxification length depends on how much toxins are stored in the body and with more toxins stored detoxification is often not done all at once. It also depends on what type of toxins you like to remove.  Heavy metals will need a different approach as for example toxins produced by the colonisation of mould in the gut.

Detoxification is also done when your body is up for it. If you are experiencing a lot of other symptoms, it is recommended to get better first. Freeing up stored toxins can do a lot of damage and if the body is for example dealing with an infection you might do more harm than good. 

[Daniel]

 I think these are already a lot of choices. There are more schools, but I don’t have experience with them.

The Functional Medicine University (FMU – click here) is one for example, although I heard the way they teach is pretty dry. At the Integrative Health Practicioner (IHP – click here) functional medicine is offered as well, but they have other holistic approaches as well, just like CNM.

In the end, the most important thing about the school you choose is the question ‘Do you like the teaching experience?’. If you don’t like the teaching style, it gets less likely to commit to the school.

[Daniel]

Hey ,

The first thing I recommend you do is to take a look at this handout about how to eliminate dairy. There could be some hidden dairy sources you are not aware of.

Lactose intolerance and milk allergy are not the same, but there is some overlap in symptoms. Avoiding lactose alone might not do the trick if you are also experiencing a milk allergy, so it is important to cut out dairy 100% if you would like to find out if dairy is the problem.

Immediately after eating your food ends in the stomach. When digestion doesn’t go well in the stomach, this can lead to bloating. The second thing you could do is follow  excellent tip on how to test if you experience low stomach acid.

In this handout you will find the backing soda test which only requires you to have baking soda and time. The backing soda test isn’t a diagnosis, but it can give you a strong indication if your stomach produces acid. I would perform the test a few times since stomach acid production also depends on factors like stress and hurried eating.

Focus on these 2 things first, let us know how the test went and if you experience any difference in bloating.

I hope this helps you on where to start!

[Daniel]

Hey ,

That looks really good! I’m actually surprised about how well concentrated this fish oil is, so I checked it out and it this product has an IFOS certification (which means it is tested by a third independent party)

[Daniel]

Hey ,

I remembered when I wanted to sign up for an education in functional medicine, I was really excited! Back then there wasn’t so much to choose from me. Functional medicine was (and still isn’t) something well-known in my country.

I agree with Bernadette that having a basic understanding of nutrition will help a lot. Since my first education where all Dutch education, I can’t help you there, but with the options Bernadette mentioned I have heard some positive critics. (If you like to know more: the IIN offer a sample class here. The NTA offers something similar here)

Because functional medicine isn’t well known in my country, I didn’t care about the type of certification as well. I just wanted to offer my clients the best possible advice for their health-related questions. I ended up studying at The School of Applied Functional Medicine as well, but I remembered looking at IFM (The Institute for Functional Medicine) as well. 

If you can use certificates to increase job opportunities in your country, I would definitely let this take into account in your decision.

I would recommend trying out one of their free classes and seeing if you like how they teach you.
• Here is a free class about constipation offered by the school of applied functional medicine
• Here you can find free classes of IFM.

Just like Bernadette said, also talk to their students, preferably in different years as well. They will give you an idea about the pros and the cons and the workload…

… and let us know what you would like to choose!

[Daniel]

Hey ,

What we think paracetamol (or acetaminophen) does is that it blocks the action of an enzyme called COX-2 that produces prostaglandins. Research shows that DHA and EPA also help reduce the amount of COX-2. The fatty acid members of the Omega 3 family also help to resolve the inflammation.

Usually, with pain, I recommend a combination of Omega 3’s and Curcumin in pretty high dosages. I would often aim at 2x 1500 mg of DHA+EPA per day. With Curcumin I would advise you to use a phytosomal formulation (I find Thorne’s curcumin supplement pretty effective). I would start with 2x 500mg per day and go up to 2x 1000 mg per day.

Reducing Omega 6 intake would be effective as well. This is so that the enzymes needed to use omega 3s are not consumed to process omega 6s.

Another thing you can try is to keep yourself warm and see how that influences your pain. Take a hot shower or bath for example.

[Daniel]

Hey ,

I’m so sorry for the overwhelm! There are just so many reasons why people can experience bloating!

Perhaps we can help you narrow it down. It would be helpful if you could answer some questions first.
• Do you continuously feel bloated?
• Does the bloating get worse after dinner? And if so, does the bloating start after 15 minutes? An hour? 2-3 hours? It doesn’t need to be exact.
• Put your hands on the place where you feel the bloating.  Tell me where did you put your hand?
• Does one of your parents is lactose intolerant or allergic to gluten?
• Do you need to go to the toilet for a number 2 at least 1 time a day?
• Besides feeling bloated, do you have other gut-related issues? Are you gassy? Do you experience diarrhea? 
• Do you experience acid reflux? Or do you have ulcers that you know of?
• Are experiencing anemic symptoms? (Are you feeling cold, or fatigued, do you have tingling sensations in the arms or legs, do you look pale? Are you short of breath?)
• Do you have other pains or symptoms?

Let us know and we will try to help you in smaller steps!

[Daniel]

Hey ,

Excellent questions! I will answer them the best way possible one by one.

Vitamin D
Excellent supplement choice! When I have clients dealing with low vitamin D levels, I usually make sure that they supplement with magnesium as well. We need magnesium to transform vitamin D3 into the bioactive form of vitamin D. This happens in 2 steps: one is done in the liver and the second step is done in the kidneys. Remember this for later.

Usually, once magnesium is repleted or at least in sufficient quantities added into the diet, I recommend somewhere between the 2000-8000 IU. But I would really recommend you to read this handout about vitamin D. It will provide you with a protocol description on how to raise your vitamin D levels.

One final tip on this topic: the amount of D3 units to raise serum vitamin D levels is personal. Some need more than others. Once you are on a maintenance dosage for 2-3 months retest your serum vitamin D levels. Personally, I aim with my clients to have serum levels around 50 mg/dl.

TSH
Elevations in TSH can indicate that your thyroid function has slowed down. Since vitamin D is needed to produce healthy amounts of T3, a lack of vitamin D can influence TSH levels.

Other nutrients that should be in your diet are Iodine, Iron, Zinc, Vitamin A, Selenium and enough protein (in particular the amino acid Tyrosine is needed to produce thyroid hormones). Examining your intake of these nutrients can be helpful as well.
 
There could be other reasons why your TSH is influenced, but since this isn’t considered a full thyroid panel in functional medicine, we can’t dive deeper into what other things might have caused these elevations. It might be a logical next step to investigate this further. Especially when you experience symptoms like:
• feeling cold all the time
• experiencing unexplained weight gain/hard to lose weight
• Hair loss
• feeling fatigued.. moving slowly or feeling that your thoughts are slow.
• depression
• constipation

You can find information about how to test your thyroid in this video.

Cholesterol
I already touched on this a bit. There could be more reasons why LDL is elevated. LDL is a taxi and it drives cholesterol around. But its primary function is to transport fats and therefore fats do influence LDL. A diet high in fast carbs and sugars can also elevate cholesterol. If you believe diet isn’t a factor, cholesterol secretions might also be worth something to examine.

Cholesterol is transported out of the body through the bile produced by your liver. Cholesterol crystals could form and cause a bile duct obstruction leading to elevations in cholesterol in the body.

These crystals are called gallstones and when there sometimes can cause sudden pain in the upper right portion of your abdomen, sudden and rapidly intensifying pain in the centre of your abdomen, just below your breastbone or back pain between your shoulder blades.

If you experiencing these pains the supplement D-limonene can help solve these cholesterol crystals.

Iron
We can say a lot about lab values, but lab values never answer the most important question: how do you feel?

Hemoglobin for example is at the lower end of the reference range. Some people can feel already start presenting anemic symptoms like: 
• Feeling cold
• Feeling fatigued, even when you have slept well
• Looking pail
• Shortness of breath
• Dizziness or lightheadedness
• Pins & needles in hands & feet (although often not in the beginning)

A lack of vitamin B12, folate and B6 however can also lead to another type of anemia. When both types of anemia are present at the same time, they can hide each other to a certain degree making some lab values look really great, while your body takes the hit.

MCV is for example such a marker. MCV is a value that describes the size of the average red blood cell in your body. A lack of iron can make the size of red blood cells smaller, while the lack of B12, folate or B6 can make the average size bigger. If both types of anemia are present at the same time, the MCV might average out to a normal value.

Asking yourself “how do I feel?”, is therefore leading to what you should do.

As to your question: what part confuses you in particular? Perhaps I could give you a more targeted answer there.

Are there any additional things I need to keep an eye on given these lab results?
Most of the markers look really great! Your liver enzymes (ALT, AST) are on the lower end of normal though. This can indicate the need for more B6 in your diet. The alkaline phosphatase marker is also at the lower end of the reference range. This often happens with a zinc deficiency since zinc is a cofactor needed to produce this enzyme.

The white blood cells should also be interpreted in light of your current health circumstances. Vitamin D is needed for an optimal functioning immune system. A lack of vitamin D can lower the number of white blood cells in your body making you more receptive to flues. There is some evidence in your white blood cell differentiation that your immune system is dealing with something. Were you sick recently?

I hope this answers your questions.

Let me know if you have any more!

[Daniel]

, I see Bernadette gave you a nice detailed response! I would like to give you a simple but important tip before you talk to your doctor: write your questions down.

I have noticed with my anemic clients that memory and focus often is a little more challenging from time to time. 

Definitely ask your doctors opinion about causes for the elevations of bilirubin.

[Daniel]

Hey ,

I understand your feeling of being in a limbo. I can only help you with making educated choices. I think understanding why your doctor gave you this option is key here.

Right now your lab results show evidence of a clinically mildly lowered hemoglobin. Ferritin is low (which is a storage form of iron) and your serum blood levels of iron are low. What this means is that:
• Once serum iron is low, it will become hard to build hemoglobin for red blood cells. This will create smaller red blood cells since they contain lesser hemoglobin.
• Once you start supplementing with iron, you will probably feel better in a few weeks. It will take about 3 months to replace all red blood cells with normal healthy hemoglobin rich new cells.

With a blood infusion, you can feel better much more quickly. But it isn’t going to fix your blood loss or other possible reasons why you became anemic.

Right now I am just taking a quick piek at your labs. I’ll respond in more detail later.

I would however ask your doctor to evaluate your B vitamins as well. I am talking about vitamin B12, B6 and folate. Deficiencies in those vitamins can contribute to another type of anemia which isn’t ruled out by these labs. 

[Daniel]

Hey ,

I’m curious! Let us know!

[Daniel]

Hey ,

I can imagine that you feel a bit worried.

Blood transfusions can be recommended when haemoglobin is very low. But having a low iron/ferritin status is usually insufficient for a doctor to reach such a conclusion. I believe there should have been measured more lab values. Would you like to share them with us? 

With anemia it can take a while before your body has produced enough red blood cells and hemoglobin. Are you experiencing heavy blood loss because of your copper coil? If you do, supplements might not do the trick until you have addressed the blood loss.

If you would like a more detailed response, it would be helpful to know what kind of symptoms you are dealing with. For example:
• Are you feeling fatigued?
• Do you have problems with focus? Dizziness?
• Are you fainting?
• Are experiencing palpitations?
• Are you short of breath?
• Are you feeling cold? And if so, is it in the hands and feet? Or is your whole body feeling cold?
• Are you losing hair?
• How is your gut? Do you feel bloated? Constipated? Diarrhoea? Gas?
• Are you experiencing heartburn/GERD?

[Daniel]

, just one last tip, although it probably isn’t necessary since you probably have experience enough.

Your sister might be highly motivated. All these tips can also be overwhelming. Let her pick something that is within her reach to work on. 
• Removing the bad stuff can already make her feel less fatigued.
• Reducing insulin resistance can improve her energy levels as well.
• Adding in the nutrients could be done with a simple multivitamin and a vitamin D supplement.
• You can start the gut healing, but staying off gluten is a higher priority because of the inflammation.
• Addressing autoimmune issues takes a longer time and takes more consistency.

You don’t need to start with everything at once. I hope this helps you a bit with how to prioritise everything.

Good luck!

 

[Daniel]

Hey ,

With perimenopause, estrogen can go up and down quite a bit. I would focus on reducing the ‘bad estrogen’, but probably not with DIM since it lowers estrogen out of circulation which is fine when estrogen is high… but once estrogen drops it could cause complaints.

DIM also helps the first part of estrogen detoxification (also called phase 1 detoxification).  I would mainly focus on phase 2 detoxification and reducing the ‘bad estrogen’. We do by the way have a handout for that right here that give you some suggestions to support phase 2 detoxification as well.

I usually would recommend NAC and/or sulforaphane. They both reduce the risk of DNA damage. Sulforaphane also helps with phase 2 detoxification but doesn’t lower estrogen like DIM can do. 

As to the second part of your question, I would probably only consider bioidentical estrogen therapy if I like what I see happening downstream. And only with someone who has the right background to prescribe bioidentical estrogen. If I see elevations in 4OH metabolite with low estrogen, I wouldn’t consider adding estrogen until I addressed that.

With SNPs on COMT I would support a mindful way of living (since COMT is needed to break down adrenaline and noradrenaline) and I would also support the complete methylation cycle by making sure there is enough B2, B6, methyl-folate and methyl B12 present in the diet either through foods or supplements. Magnesium is also important to support COMT and the supplement SAMe can help COMT as well. 

I hope this answers your question!