BUGS AMUNGUS

My results from Genova Diagnostics came back. I must say that these stool sample results are hard to comprehend, even as a scientists!

Overview
- Low Gut Biodiversity
- High level of potentially pathogenic bacteria
- Low n-Butyrate
- Low Short-chain Fatty Acids

Fat and Inflammation Markers
- High (>5th quintile) fecal Cholesterol, malabsorption indicator
- Elevated (5th quintile) Long-Chain Fatty Acids, malabsorption indicator
- Elevated (5th quintile) Total Fat, malabsorption indicator
- Elevated (4th quintile) Fecal SIgA, marker of inflammation
- Low Short-chain Fatty Acids, insufficient fermentation of soluble fiber
- Low n-Butyrate Concentration, insufficient fermentation of soluble fiber

Commensal Bacteria
- Elevated (5th quintile) Bacteriodes vulgatus
- Elevated (5th quintile) Odoribacter spp.
- Elevated (5th quintile) Desulfovibrio piger
- Elevated (5th quintile) Escherichia coli
- Very Low (1-2 quintile) concentrations of most other commensal bacteria

Potentially Pathogenic Bacteria Resistance
Citrobacter freundii
Resistant to 3/6 tested prescription medications
- Susceptible to Ciprofloxacin, Tetracycline, and Trimethoprim/Sulfa*

Citrobacter Species (general)
Resistant to 4/6 tested prescription medications
- Susceptible to Ciprofloxacin and Trimethoprim/Sulfa*

Klebsiella pneumoniae
Resistant to 1/6 tested prescription medications
- Only ampicillin resistant

* I am allergic to sulfur antibiotics, and therefore cannot take this to treat any of these infections

References
1) http://www.healthy.net/scr/Article.aspx?Id=423

Root Cause Research

As a health researcher, I cannot avoid trying to understand the mechanism and cause of my condition. I want to summarize and share information as I find it for my own notes, and to potentially help one of my fellow SIBO/IBS/Leaky Gut/Low T3 Syndrome/Malabsorption/Adrenal Fatigue folks!

Clostridium Difficile Toxin B and Vinculin Auto-antibodies
C. diff is one of many bacterial strains linked to instances of food poisoning and gastrointestinal issues, and produces two toxins (A and B). To combat food poisoning, your body makes antibodies against these toxins, and literature shows that the antibody for toxin B (CDT-B) is also sensitive to a protein called Vinculin.

Vinculin is a protein that is essential to proper functioning of the electrical stimulus responsible for pushing food around or small and large intestines. This function is what is called motility, and impaired motility is linked to SIBO.

Ileocecal Valve
This valve is between the start of the large intestine and end of the small intestine, and is responsible for making sure that food moves from the small intestine into the large intestine. Improper function of this valve can lead to large intestine bacteria moving into the small intestine, leading to SIBO.

This valve is located near the appendix, and pain due to this valve tends to be diagnosed as appendicitis.

I find this particularly interesting because I have had lower right abdominal pain for as long as I have had my other symptoms. I had an MRI and ultrasound, but nothing came of it (as with all other loose ends we pursue in seeking a diagnosis for digestive issues).

Nutrients Essential in Thyroid Function
Nutrient deficiencies associated with malabsorption from leaky gut (caused by SIBO) can impact the thyroids ability to produce T4 and the body's ability to change T4 into T3, the active thyroid hormone essential to many body functions.

Some essential nutrients are:
Protein
Magnesium
B-12
Zinc
Iodine
B2
Vitamin C
Selenium
Vitamin D
Vitamin A

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References:
1) http://siboguru.com/
2) http://emedicine.medscape.com/article/179937-overview?pa=S3pqM53BeKVHVHd39yxCcqipNL27xV5pU5cKYaVsYrs9ZAVW4Mjin0syjsQfex%2BemqBvyHAGf1b3PC%2FeNqHG2U3B6KLODm2MpyHuPkYf%2Bs0%3D
3) http://hypothyroidmom.com/10-nutrient-deficiencies-every-thyroid-patient-should-have-checked/

Dx and Rx: Part 2

I got more lab tests back, and they are painting a clear picture!

Some tests came back outside of normal range, so they are up front and center for my doctor. Many other tests are outside the optimal range, and these ranges are only found by sleuthing the internet. I urge you to do your own diligence to understand your blood tests, because the ranges given by labs are broad and tend to indicate the level at which research has shown increased morbidity... I don't know about you, but I am focused on living well rather than not dieing!

Indicative Tests (including tests from previous post):

Test	Type	Result
Zinc	Blood	Outside Optimal
Selenium	Blood	Outside Optimal
Iron	Blood	Outside Optimal
Ferritin	Blood	Outside Optimal (high)
Folate	Blood	Outside Normal
Iodine	Blood	Outside Normal
Magnesium	Blood	Outside Optimal
Testosterone	Blood	Outside Normal
T3, Total	Blood	Outside Optimal (low)
T4, free	Blood	Outside Optimal (high)
TSH	Blood	Outside Optimal (low)*
Cortisol (AM)	Blood	Outside Optimal
Cortisol (AM)	Saliva	Outside Normal
Cortisol (Noon)	Saliva	Outside Optimal
Cortisol (PM)	Saliva	Outside Optimal
SIBO	Breath	Outside Normal

*my TSH used to be 3.5 a year ago, then 2.6 a couple months ago. I like to think that an extremely clean diet has helped that a little.

 Key:
Outside Optimal
Outside Normal

What I am seeing here is Low T3 Syndrome as a result of low vital nutrients as a result of SIBO-related malabsorption. Magnesium, B-12, Zinc, Iodine and Selenium are all essential nutrients for optimal thyroid health¹. When SIBO and leaky gut are wreaking havoc on your gastrointestinal tract, the body has a hell of a time absorbing what it needs, which is why all of my nutrient levels are low. I am going to talk to my functional medicine doctor about taking digestive enzymes as a short term solution.

Sources:
1. http://hypothyroidmom.com/5-tips-for-dealing-with-hypothyroidism/

Dx and Rx: Part 1

Right off the bat, my new functional medicine doctor told me that everything I am experiencing is linked to my gut health. 6 years ago I experienced some kind of event that triggered a gut bacterial imbalance, and it has wreaked havoc on my ability to absorb nutrition and regulate hormones.

Initial treatment:
She did not want to wait before starting a round of antibiotics and probiotics.
For sleep-
Melatonin-1 mg
2 weeks-
Xifaxan, 1 pill 3x/day
2 months-
Candibactin AR, 2 pills 2x/day
Candibactin BR, 2 pills 2x/day
2 hour gap between next two
GI Revive, 7 pills 2x/day
Ultra Flora IB, 1 pill 2x/day

This sounds like a lot, but if it helps I am all for it! I would do FMT if it was available for people without C. Diff.

Initial tests:
Stool Sample- Genova Diagnostics
This was pretty weird, and I am still, waiting for the results. I look forward to the results.

Cortisol Saliva Sample- Quest Diagnostics
Quest only shows upper normal limits for this test, so it is hard to assess adrenal fatigue. I looked up lower bounds and discovered that my levels were extremely low. This occurs when your body is bombarded by stress and it becomes unresponsive to it. That's what 6 years of stomache pain will do!

40 blood tests- Quest Diagnostics
We checked for metal poisoning as well as auto-antibodies, metabolic markers and markers of PCOS. I have only gotten 1 of 4 tests back, but I have found this so far:
- TSH: 1.4, down from 3.5 last year and 2.6 3 months ago, progress!
- T3 total: 91, low normal and much lower than the optimal/functional values
- blood cortisol: 7, low normal is 4. Again, much lower than ideal
- DHEAS: 343, in high normal.

Thyroid Ultrasound- TBD
My doctor felt a nodule during my physical exam, and I have yet to follow up on this test

Lactulose Breath Test- Brigham and Women's Hospital- 
My kind technician let me take a copy of my results. My hydrogen levels had a HUGE peak at 60 min indicating SIBO.

My next visit is in 2 weeks, and I can't wait to discuss these results and come up with a plan.

*If you need Xifaxan, don't let your insurance bully you into taking an alternative, less effective, antibiotic. Use their copay card: https://www.xifaxan.com/Copay-Card?gclid=CPbxsIv0xNACFYWVfgodMHoD0g

GAPS-friendly Cranberry Sauce

I was determined to spend one holiday free from feeling ill. My recent hydrogen breath test results pointed me in the direction of being SIBO friendly, so I have adopted this GAPS food list as my Bible until I see my doctor in a few weeks.

I used to LOVE jarred cranberry sauce, but since that is off the table I set out to make a version that I could eat. I adapted a recipe my mom uses, and I am going to share it with you now!

GAPS-friendly Cranberry Sauce

Ingredients:
12 oz cranberries, fresh
1 cup cranberries, dried
1/3 cup honey
1 orange
1/2 cup water
1 tsp cinnamon
1 tsp nutmeg

Directions:
- bring honey and water to a low boil
- add fresh and dried cranberries, boil until they start to pop
- turn pan off, and add juice and rind, and zest of orange, and spices

GAPS-friendly Stuffing

My family does not eat bread stuffing. We have a vegetable stuffing recipe that has been in our family for generations. I am in so much luck, because the premise of the stuffing is to roast a rhino's-load of vegetables for hours!

The recipe was adopted slightly to remove saltine crackers, potatoes and onions since onions make my stomach flip upside down. Here is the recipe!

GAPS-friendly Vegetable Stuffing

Ingredients:
1.5 lb celery
4 turnips
1 lb butternut squash
1 lb carrots
1 tbsp onion powder
1 tbsp garlic powder
1 tbsp paprika
1 tbsp cayenne
1/2 cup olive or Coconut Oil
2 cups turkey bone broth or juice from your turkey

Need:
Food processor
Roasting pan with high edges for oven or large pan for stovetop

Directions:
- peel all vegetables and chop into manageable sizes for food processor
- process all the vegetables in food processor, transferring it into your ungreased pan
- add and mix in your seasoning
- set oven to 350 or stove on medium
- cook vegetables, mixing occasionally
- when water from vegetables has finished cooking out add olive oil
- when all of the vegetables are brown and taste roasted add your turkey juice, cook for 30 more minutes

Note:
This takes a long time to cook, and taste pretty gross and veggie-like for a while. It requires patience to let it cook until the roasted flavor takes over. I personally don't think you can cook this too long, the more roasted the better!

Renewed Journey: New Answers

I first started feeling sick about 6 years ago, and used this blog 3 years ago when I initially tried to find some answer and solve my health problems.

The symptoms I have are:
- stomache upset that I call "rabid racoon in the bowel" syndrome
- fatigue, I yawn when lifting
- insomnia
- raspy voice
- weight gain

I have gone through traditional medicine avenues to understand the root of these problems a couple times without success. Despite arguably high TSH (3.5), my doctors told me I was fine and gave me a muscle relaxant, which did nothing.

Now, in 2016, I began getting very serious about addressing my health. I started playing semi-pro tackle football and lifting like a madman. I realized that I will never meet my athetlic potential without finding answers, and any attempt to improve my body composition will be useless without the help of medicine. I did the ketogenic diet, which helped a bit with some weight loss but did not address the extreme fatigue and sleep problems.

A colleague told me to look into functional medicine, and it was the best piece of advice I have ever been given! I will delve into my diagnosis and treatment in the next post, but I want to first say that my new doctor is the first person ever to listen to my story and tell me that she can help. It has been a mental and physical game-changer.