Reply To: 40 yo F with chronic fatigue & digestive health issues

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Antony Haynes

Hello Anita,

Many thanks for providing the information about this 40 year old woman and it does seem that the trigger infection for her chronic fatigue syndrome symptoms was the URTI virus of 7 years ago. The antibiotics she was given at that time for the URTI also had a marked negative impact, unfortunately.

I agree with the summation you make: post viral fatigue was complicated by antibiotics resulting in dysbiosis compromising an already compromised immune system. Also, well done on your recommendations for her to be GF and to add a protein powder to her otherwise vegetarian diet aiming at low inflammation.

Having a sensation of fullness after eating is strongly suggestive of low HCl acid levels, which as a vegetarian she is perhaps more likely to have as there is less food consumed as a vegetarian that requires HCl acid. A low level of HCl acid could also be involved in a lowered immune function which could be related to her repeated URTIs, loose stools and fatigue. It also could be linked with the need to clear her throat, and to the abdominal cramps at 10 pm.

I note that on the Lipski Questionnaire that there is a moderate score for low acid levels too, and it fits in with hypo-function.

If there is a low level of HCl then this can affect the gut lining and the balance of bacteria, and lead to dysbiosis. However, there may well be benefit on supporting these aspects of her health whilst addressing the low HCl levels.

Tests to Consider

Food intolerance?
It is possible that there are other foods to which she has a negative reaction which is contributing to feeling full, having the lump in her throat and having loose stools? If this was the case, then it is interesting that no other symptoms such as bloating or discomfort are occurring. Other than a careful dietary analysis, I am not certain that pursuing testing for food intolerances is a wise clinical choice.

H. Pylori ?
Low stomach acid can be contributed to by the presence of H. pylori which is one of, if not the single most common bacterial infection in the land. Therefore, it may be wise to rule this out. If it is present then it becomes a priority to deal with. The patient’s GP could rule this out, or the patient could undertake the stool antigen test. Breath tests and stool tests are effective and useful for repeat testing to verify its absence after treatment. Blood tests are not helpful for repeat testing because the antibodies take some time to diminish.

Stomach Acid levels?
Rule out low stomach acid with the Gastro-Test (, and it is always encouraged that you do the test once yourself before conducting it with the patient. Most often with this test, we have appreciated that having the patient conduct it whilst in the clinic room is the most effective and helpful method. Much time can be spent otherwise on talking with the patient about the test and how it was done and so on. If the results confirm low levels, which is strongly suspected, then it may not always be ideal to immediately introduce an HCl supplement. Apple Cider Vinegar can be useful for an initial phase. To strengthen digestion, organic apple cider vinegar: half a tspn in a small amount of water, swish and swallow before meals. There then may be value in introducing an HCl supplement such as HCl Plus (BRC) or HydroZyme (BRC) – – at a dose of 1 with lunch & dinner, for example.

Stool test
A CDSA test with CP (comprehensive parasitology) may well be of value, yes, since there may be unwelcome guests that require attention. Genova’s –, and Regenerus Labs offer Dr’s Data CSA + CP which is another very accurate and useful stool test. However, there may be some logic in putting off this test in the first instance whilst the HCl acid & H. Pylori are assessed, along with a careful review of other potential trigger foods. After some time of addressing the imbalances (i.e. of low HCl acid) there may be value in then proceeding with a stool test.

Salivary SIgA
You have already recommended S. Boulardii (ARG) which is a very sound choice since mucosal immunity of her respiratory system is supported by SIgA as well as that of her gut. SB can also help reduce loose stools, although not all causes are directly influence by this probiotic yeast. SB will not affect the loose stools, typically, if the cause is maldigestion which may or may not involve low HCl acid levels.

Intestinal Permeability
Whilst this test may come back ‘positive’ there is not much weight behind pressing for this in my professional opinion, since you would still then be looking for the causes which are related to the other issues being discussed here.


In my mind, there are priority tests to consider:

• Gastro-Test

• H. pylori

• Clinical review of potential offending foods

And secondary tests of

• Stool analysis with CP

It is appreciated that even when the digestive issues have been successfully resolved, this woman’s immune function needs support (and you are already engaged in that process at least to some degree) and the CFS imbalance also may warrant specific support. However, the correction of her GI issues is the most important aspect of health on which to focus in the first instance and I hope this helps.