July 12, 2013 at 6:23 am #8703Archived PostsModerator
Advice sought re which tests to recommend to female, 40yrs, with chronic fatigue & digestive health issues complicated by antibiotics 7 yrs ago
5’10’’, 11st 2llbs – BMI 22 – 23
Works for an environmental charity, involved in education and teaching. Chronic health issues main source of stress for her.
Recurrent upper respiratory tract infections with fatigue, lasting 2 – 3 weeks, low mood & energy, with swollen sub maxillary glands, runny nose, sore throat . Ok for 2-3 weeks then relapses. Also chronic tendency to very loose stools OD.
General blood tests by GP few yrs ago, including thyroid NAD, Stool test few months after virus 7 yrs ago, ? for microbiology which was also NAD
7 years ago had a virus (URTI), felt wiped out by it, difficulty raising arms, legs, had 2 lots of antibiotics, after which she developed IBS, ++ diarrhoea, loose stools and general feeling of unease, with a tendency to headaches, & joint pains.
She gave up alcohol after this as felt she was intolerant to it, then treated for Candida overgrowth (she didn’t have any diagnostic tests). She felt a lot better for avoiding sugar and alcohol, wheat, & following a basic therapeutic ‘anti inflammatory’ way of eating. She also started to drink plenty of water and to take a quality multi vit/mineral, B complex, probiotic and flaxseed oil.
Her health improved significantly after this, however the IBS, recurrent acute URTI’s & fatigue has continued, on and off, but worse again in last year.
After some time, she started to eat sugar and bread and a little alcohol again but not so much, knowing that they do not suit her. She has been a Vegetarian since 15 yrs. She likes and eats plenty of varied raw and cooked vegetables but her diet is very lacking in protein, her main source being eggs (not daily), Feta, and other cheeses, small amounts beans and lentils. She tends to only eat gluten when she is out of her normal day to day routine, so not strictly avoiding. She’s mostly dairy free, drinks rice milk and has one espresso coffee with a little milk daily after breakfast.
Apart from the recurrent acute URTI with fatigue, her digestive symptoms are: sensation of fullness after any meals, but no actual stomach distention unless she eats gluten containing foods.
She feels the need to ‘clear’ her throat straight after eating always, which lasts a long time
She gets ‘abdominal cramps’ often at night when she goes to bed around 10pm, and is trying to sleep. The tendency to very loose stools daily in the mornings has continued
Other significant issues: she was on contraceptive pill of about 10 years, but now has copper coil since 2 – 3 years.
She notices her mood is affected by eating sugar (i.e. low mood)
Tendency to dry brittle hair.
Family Health wise, her mother has treatment for hyperthyroid, Father atrial fibrulation, takes anticoagulants.
On E. Lipski’s ‘digestive health questionnaire’ she scores high on hypoactivity small intestine, liver, colon and dysbiosis / intestinal permeability, and moderate score for hypoacidity.
Though her memory is hazy, it looks to me like she had a post viral fatigue further complicated by the ill effects of antibiotics resulting in dysbiosis compromising an already compromised immune system.
I am considering the ‘comprehensive stool test’ to be able to target the right supplements for her.
Currently on probiotic one BD, S Boulaardi OD & B complex, ground flax seed with yoghurt and lecithin once a day instead of the flax seed oil.
For now I’ve advised gluten free, protein powder to boost intake, probiotic foods, general anti inflammatory way of eating.
I’d appreciate suggestions for priority tests for this client who is willing to do this, and also any other thoughts recommendations re diet and supplements prior to tests
May 12, 2019 at 6:25 am #8707Antony HaynesModerator
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
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 (http://tinyurl.com/34ag2r7), 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) – http://tinyurl.com/3yq73yg – at a dose of 1 with lunch & dinner, for example.
A CDSA test with CP (comprehensive parasitology) may well be of value, yes, since there may be unwelcome guests that require attention. Genova’s – http://tinyurl.com/6wqajvo, 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.
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.
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:
• 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.
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