[Daniel]

Hey ,

Did the doctor also explain how the Glucophage would raise her dropping blood sugars? Usually, Glucophage is used to help people manage high blood sugars. Also blocking glucose absorption in someone experiencing low blood sugar is not done routinely. Could the doctor explain his train of thoughts well to your sister-in-law?

Usually, the body makes its own blood sugar when blood sugars drop. The liver will dump glucose in the blood to push blood sugars back to normal. Also, the main function of the stress hormone cortisol is to push up blood sugars when they drop.

Were there liver tests done that you know of? Did she check her stress hormones? (This can be done by for example doing a DUTCH test – at https://dutchtest.com/.

For the production of stress hormones, we need quite a few nutrients as well. If she is a healthy eater she could experience absorption issues. Gut-related complaints can hint in that direction (think of gas/bloating/constipation/diarrhea/cramps etc)

For healthy (nor) epinephrine production we need for example
• Enough vitamin C
• Cupper (which can be depleted by high dosages of zinc supplementation)

Cortisol is made in mitochondria in the adrenals. Healthy mitochondria need nutrients like:
• CoQ10
• Vitamin C
• B Complex
• Manganese
• Cupper
• Zinc
• Iron (can be tested at the doctor)

Mitochondria can be influenced be negatively influenced by toxins (mycotoxins, heavy metals, pesticides, etc), parasites, heavy metals, alcohol, lack of anti-oxidants.

Do you know if the doctor also examined the pancreas of your sister in low? There could be abnormalities that cause excessive insulin production which could also lead to a lowering of blood sugars.

[Daniel]

 I’m sorry if I was unclear (english is not my mother language!). No, the B vitamins I would like you to take! We need them for healthy nerve function (Especially folate, B12 and B6 which were low or suboptimal on your OAT & Vitamins & Minerals blood test)!

[Daniel]

Hey ,

A natural recipe that works really well is the flaxseed cough remedy. Many users find some relief with that! You can find the recipe here. 

Let us know if this helps!

[Daniel]

Hey ,

I do believe that abnormal stomach function can increase the risks of getting gastritis.

I also believe that poor conversion of T4 to T3 and the low B6 & folate (and suboptimal B12) are the ‘easier’ problems to address that could influence digestion.

The B vitamins are necessary for healthy nerve function (which in my opinion could right now play a role in worsening the dynamic) which is necessary for healthy GI function in general.

The low fT3 will also slow down motility in all parts of the GI tract.

Getting those 2 things in place is necessary for healthy digestion anyway!

Because the healing of the stomach lining can take some time, doesn’t mean you can’t progress in my opinion as well.

A low FODMAP food pattern is for example still a powerful tool that can help with SIBO.

Making liquids from slippery elm and marshmallow root like Bernadette suggested can help with the healing of the stomach lining.

Once you ended your period with healing you could try weaning off PPIs again slowly. In previous attempts of weaning off your medication, could you share with us how you did that?

Medications
We know that antiacids can slow down gastric emptying as well. Do you feel some medicines work better for you than others?

I personally would be really interested in the opinion of your gastroenterologist as well.
• Does he for example feel that an entrogastric reflux is at play here as well? 
• And how does he interpret the results of the Histology report? (Does he for example feel like testing again? And if so in what time frame?)

[Daniel]

Hey ,

I will help you with the translation, although the interpretation of your physician is leading. Let’s focus on the histology report and their findings in the stomach & oesophagus.

Under the ‘Microscopic’ section Alinea ‘B’ the histology report says:
• mild foveolar hyperplasia – this means that the tissue found in the biopsy in the stomach became bigger because of an increase in the number of cells.
• oedema – which means that the tissue is swollen
• vascular ectasia – which means the arteries are swollen and more vulnerable
• mild fibromuscularization of the lamina propria – which means the tissues of the arteries in the connective tissue (which is the lamina propria) have changed mildly in such a way that blood flow can be restricted.

There was no H. Pylori seen in the biopsy although the IHC (Immunohistochemistry report that will come) could give more definitive information.

Reasons why the stomach tissue is ‘irritated’ are unclear. The use of NSAID could explain such an irritation, and a reflux of bile from the duodenum into the stomach (entrogastric reflux) could explain this as well. Alcohol use could cause irritations. Other medications as well.

Have you had an operation when you were younger called pyloroplasty? This is usually done when you are a baby.

Did you have a cholecystectomy?

For now, I would advise you not to use betaine HCl as a supplement. Focus on the healing of the stomach tissue.

And let us know what the opinion of your gastroenterologist is!

[Daniel]

Hey ,

You can try this. I usually recommend my clients 2x 1000mg D-mannose per day to counter an existing infection. If my clients are dealing with frequent infections I usually recommend them to take 1000 mg of D-mannose per day as a way of prevention.

If you are going to use Uva Ursi as well, it is not for everyone. It is not for kids or for individuals with liver disease. It also works better if the urine is at a lower pH. Avoiding soda, coffee, black tea, cow dairy foods (especially cheese), and too much animal protein, and grains will help lower the pH of the urine.

Vitamin C in the supplement of ascorbic acid will make the urine more acidic as well, so if you are using Uva Ursi it would be helpful to stop this supplement temporarily as well. Of course, vitamin C from foods is not a problem.

Good luck!

[Daniel]

Hey ,

You could try to make the flaxseed cough remedy, see if you can find some relief with that! You can find the recipe here. Let us know if this helps!

You could use this for your son as well, just be aware that if you have a kid younger than 1 year old: avoid honey and replace the honey for example with maple syrup.

[Daniel]

 Do you feel not rested after 7-8 hours of sleep? Do you feel you are a light sleeper? Or do you wake up in the middle of the night and can’t sleep continuously?

I will link here some excellent videos giving you tips on sleep hygiëne and your bedroom. You can find the videos here, here, here & here.

If you have trouble falling asleep because your mind seems to be too active in the evening you could try herbal teas or l-theanine. Of course, avoiding stimulating activities in the evening will help as well.

If you are waking up several times in the middle of the night 5-HTP could help. Try the dosages Bernadette is mentioning.

Magnesium glycinate can help you sleep deeper (if you are constipated, use magnesium citrate instead). Together with Ashwaganda (make sure it says KSM-66 on the label) it can help you sleep even better.

[Daniel]

Hey ,

You could use for example  D-mannose from Pure encapsulations or D-Mannose Plus from Cytoplan (clicking on the descriptions will bring you to the online supplement store fullscript – which gives discounts to B Better members. But you have to have an account first)

It doesn’t matter if it’s a pill or powder. The benefit of Cytoplan is that is has also some cranberry extract which is helpful with UTIs as well! 

Perhaps you have seen Bernadette’s recommendations for UTIs already. If not, click here to find the full protocol!

[Daniel]

Hey ,

I personally never had clients with elevated homocysteine. I have seen research with patients who were giving B12, folate and B6 and they saw impressive improvements in 5 weeks. But the research didn’t gave their starting homocysteine numbers.

Now your homocysteine elevation is ‘moderate’. I expect a measurable difference after using b vitamins after a month or so, but perhaps your cardiologist could give you a better indication than I can.

Correcting folate deficiency will also affect the size of your red blood cells. After 3 months usually all red blood cells have been replaced leaving you with smaller red blood cells. Your slow thyroid could possible delay the process a bit. This is something you should get checked after 3-4 months.

Adding B vitamins will do a lot for detoxification. Three  (from the 6!) major detoxification routes are depending on folate, B6 and B12:
• Methylation: yes it is needed for detoxification as well!
• Glutathion conjugation.
• Trans-sulfuration pathway

So adding in B vitamins shouldn’t be done to fast. If detoxification starts up to aggressively and you have some toxicity issues, you could feel worse. Start with the dose you are taking right now, see how you feel.

Once homocysteine starts to drop, you probably start detoxifying better. Sometimes this means that toxins on toxicity tests start to go up first since they come free now.

Zinc
Men need about 11 mg elemental zinc per day. Sometimes it is recommended to boost zinc, but I wouldn’t do this longer then 1 or 2 months since high zin levels can lead to lower copper levels. I personally have boosted with my male clients the total zinc in supplements to 40 mg of elemental zinc if they could tolerate that. Some people can however experience nausea and vomiting with higher dosages so I do recommend to be cautious and go slow there as well. If you decide to try this, perhaps combine this with a little copper.

[Daniel]

Hey ,

First of all, great lifestyle choices by not drinking caffeine and trying supplements instead of medications!

Unfortunately having the focus on improving sleep can itself be a root cause for not falling asleep.

Here are some things that might help lower anxiety & help you fall asleep (and stay asleep!):

Kombucha
Kombucha can be a source of caffeine. This is because the tea leaves used to make kombucha contain caffeine. How much caffeine is in kombucha can depend on different factors: the amount of time the kombucha was fermenting, but also how much caffeine was added to the blend. Try a few days without and see if this helps.

Other sources of caffeine are indeed tea. If this is something you consume I would try some herbal teas without caffeine. Chamomile, lemon balm, passionflower and magnolia bark are for example herbs that can work calming and help you fall faster asleep as well.

Magnolia bark has honokiol which has been shown to reduce the time it takes to fall asleep by binding to GABA receptors (click here). Like chamomile, passionflower contains certain flavonoids that bind to the same receptors in the brain as benzodiazepines and may help reduce symptoms of anxiety (click here).

Food
Too much food, directly before you go to sleep is indeed not a good idea for sleep quality. But sometimes taking dinner too far away from your sleep can make you wake up early as well. Perhaps experimenting with a little snack 3 hours before bed can help you stay asleep longer.

Melatonin
Stress hormones can often interfere with melatonin production. Besides sleep, are there other sources of stress at play? Stress hormones can also rise by pain, inflammation, medications (like prednisone or other corticosteroids) or aggressive workouts.

Melatonin is made from tryptophan which under the influence of an enzyme (tryptophan hydroxylase) turns eventually into 5-HTP, then serotonin and melatonin. The production of tryptophan hydroxylase is influenced by estrogen (so female hormones can interfere with sleep as well). Serotonin production in the brain is influenced by vitamin D and also needs vitamin B6. Making sure you have enough of these nutrients in your diet is helpful as well.

Melatonin can help you fall asleep, but the body produces about 0.5-0.8 mg in puberty to fall asleep. When we are adults, the body produces even less melatonin: 0.3 mg. Although most supplements contain much more melatonin, we usually don’t need that much.

Do lower melatonin dosages not work? Perhaps you could try a combination of melatonin (a lower dose) and 5-HTP. 5-HTP is the precursor of melatonin and can help you stay asleep longer.

L-Theanine
L-theanine can help increase the calming neurotransmitter GABA in the brain and lower anxiety – for example, induced by the desire to fall asleep. It is in tea, but there can also be caffeine in tea. A supplement can be a convenient option. Usually, L-theanine works quite quickly.

Adaptogens
Night-time intake of calming adaptogenic herbs can often be helpful (e.g. holy basil, ashwagandha, magnolia). Personally, I have had great success with ashwagandha KSM-66. For stronger supplement blends, I have used stress complex from Klaire labs (click here to find this product in fullscript – the supplement store we have in B Better)

[Daniel]

Hey ,

Let’s start with the most important marker that should be brought back into balance: homocysteïne.

Homocysteïne is an important amino acid. It is part of something we call the methylation cycle. The goal of the methylation cycle is to transport methyl groups from one molecule to another to change and rebuild them.

Homocysteine is formed from an amino acid called Methionine. What happens is that Methionine donates its methyl group to something else and now it transforms as a consequence into homocysteine.

Several ‘fates’ for homocysteine are possible. For the biggest part, it usually gets a methyl group donated from methyl-folate, the bioactive form of folate, and then it changes back into Methionine. The enzyme needed for this conversion is also dependent on vitamin B2

From this report in March, we can see that folate is low. Vitamin B12 we would like to see higher as well compared to what we see on your lab report. Also vitamin B12 plays a role in the methylation cycle as well. If there isn’t B12 or folate present, Homocysteine can not transform back into Methionine.

If you have been addressing B9 & B12 issues I would recheck:
• Homocysteine
• B12 & folate
• Vitamin B2 (it makes your urine yellow, so if this is the case, you at least have absorbed it in the gut)

We would like to know if B12 & B9 are doing their work inside cells. Lab tests that provide us with that information would be helpful. Check:
• MMA – Methylmalonic Acid (Is elevated if B12 isn’t absorbed at the cellular level)
• FIGlu – or Formiminoglutamic Acid (Is elevated if B9 isn’t absorbed at the cellular level)

Red Blood Cell
Since your iron markers are looking good, I would suspect your hemoglobin levels to be much better – have you been tested for Thalassemia (an inherited blood disorder caused when the body doesn’t make enough hemoglobin)?

Thyroid
The test shows low T4, T3, fT4 & fT3.  A deficiency in zinc, copper, and vitamins A, B2, B3, B6 and C will cause a decrease in the production of T4 by the follicles of the thyroid gland. Conversion of (f)T4 to (f)T3 needs in addition selenium and iron. Magnesium plays also a role in thyroid metabolism.

I would test:
• RBC Zink
• RBC Magnesium
• RBC selenium

Vitamin B6
Your OAT earlier uploaded here was done in the same month right? It did show low levels of B6 which can also contribute to anemia. I would probably like to retest that as well if you tried to correct for that. Inclusive Xanthurenate & Kynurenate if that is an option. Those markers elevate with high serum B6 but inadequate cellular B6.

Vitamin B6 is also needed to make a lot of neurotransmitters, like dopamine, (nor)-epinephrine, GABA, serotonin & melatonin. Dopamine & serotonin play a major role in the gut as well and are necessary for the breakdown of histamine since they work together with the DAO enzyme.

Remember I told you that homocysteine had different fates? Homocysteine is also a precursor and necessary to make  Glutathione, Taurine and it is necessary for the sulfate pathway. Taurine is needed for bile production and guess what they all need as a cofactor: vitamin B6.

Without B9, B12 and B6 homocysteine can’t transform and now it could pile up as a result.

Kidney function.
I would also retest your kidney function. Make sure you are hydrated though (i know this is hard), otherwise the markers might get unreliable! Kidneys convert part of the T4 to T3 as well. We need to know how healthy your kidneys are!
• eGFR
• Creatinine

Vitamin D
Did you recheck your vitamin D? Otherwise I would also retest 25 OH Vitamin D3

White Blood Cell Differentiation (WBC Diff)
Your last WBC was low normal possibly the body was struggling to produce white blood cells. White Blood Cells production needs nutrients like Vitamine D, zinc and B vitamins as well. If you have been correcting for these nutrients and the WBC count is still low normal, this together with the low normal Red Blood Cell count (don’t let the blue-colored representation misguide you!) can be an indication of heavy metals. So I would also retest
• WBC + differentiation
• RBC count

Honestly, I don’t know if this answered your question. I still need to replay the group call, so I might miss a bit of context to this question. I also based my answer only on looking at the test and what would be a logical next step based on the information coming from this test.

[Daniel]

 that is not a problem!

[Daniel]

Hey ,

Welcome to B Better! I hope we can assist you with your health problems. My name is Daniel and I help Bernadette on the platform.

Feel free to ask anything!

[Daniel]

Hey ,

I would still be interested to see fT3 as well. Iron is necessary to convert T4 into T3. Other nutrients are necessary as well like selenium, zinc, vitamins A & D, iodine, and magnesium.

Talking about Magnesium, I would test in the Red Blood Cells(RBC).  This isn’t done standard in conventional medicine, unfortunately, but maybe you can. RBC Magnesium reflects your magnesium intake from the last 3 months, while blood magnesium will be reflective of the last few meals you have eaten. RBC zinc I would test as well.

What is the DUTCH test?
The DUTCH test is used in the US and although it isn’t used standard, more conventional doctors are using it these days. Still, it isn’t a standard test and it is more used in the functional medicine world.

With the DUTCH test, you can see how much of the 3 estrogens you are making and how they are broken down. It also takes a look at stress hormones and metabolism. There are even clues to get from the test if your thyroid is working optimally.

Thyroid
You have shared your top 5 symptoms, but I was wondering if you still have symptoms that are related to a low thyroid like:
• Feeling cold
• Feeling slow
• Feeling fatigued
• Hair loss or Thinning of the outer parts of the eyebrows
• Constipation
• Depression
• Etc

If these are still at play, especially hair loss & constipation, I would run a full thyroid panel. Not only TSH, fT4, but also fT3, thyroid antibodies (these can be done usually in the conventional medicine setting, although where I live doctors are a bit hesitant to measure fT3 & thyroid antibodies) and reverse T3 or rT3 for short (which most doctors never heard of).

Reverse T3 can block the action of fT3, the metabolic most active thyroid hormone, and can elevate when there is a lot of stress at play. It also can elevate with infections, which your lab result from June shows signs of as well.

You mention you are using an iron supplement. Sometimes this can lead to constipation as well. If this is the case you could switch to a liquid iron supplement (click here to find one after you have made a profile on fullscript, which is a store for supplements the B Better platform uses)

If you were constipated to begin with using magnesium citrate in the right dosage can help as well.

Iron & Absorption
Iron is a bit of a stubborn element. It doesn’t get absorbed easily. It needs vitamin C in the stomach to activate the enzymes that cleave out the iron in your food. Inflammation in the gut can DEFINITELY reduce iron absorption by increasing a hormone called hepcidin.

Chronic gut inflammation should be addressed. I would recommend seeing if digestive enzymes cause some relief if you are experiencing bloating/gas/constipation/diarrhea.

SIBO and/or a microbiome disbalance called dysbiosis can cause inflammation in the gut. Enhanced intestinal permeability or a Leaky gut can be a reason for inflammation as well. With SIBO foods containing FODMAPs (Fermentable Oligosaccharides Monosaccharides Disaccharides And Polyols) can cause cramps, bloating, constipation/diarrhea and gas. An inexpensive (but maybe a bit overwhelming way, at least in the beginning) is to eat a low FODMAP diet, and see if you are experiencing relief. There are also tests for that available as well, although having a normal transit time makes this test much easier to interpertate.

Sometimes operations done on the gut can lead to malabsorption issues as well, did you have any?

Also, you mentioned you were in India, I assume you live(d) there? Travelling from 1 place to another, eating different foods with different species of bacteria, do you feel that problems became worse after travelling?

PCOS
High levels of insulin can cause high testosterone in women. I do believe fasting Insulin levels are a much better way to assess insulin resistance than HbA1c. Bernadette recommended an fasting insulin test, I would recommend this as well. Again, this test is available. It can be done in conventional medical settings, but it isn’t the protocol most of the time. At least not where I live.

Hopefully, some of this will be helpful for your appointment tomorrow!