April 10, 2019 at 7:47 am #2994Monica Lascar BensimonParticipant
Please advise-44 year old man with viral symp 4 years, fatigue, 25 years of alcohol excess, 10 yrs Gilbert syndrome, 8 years diagnosed with celiac disease and Grave’s disease. Not on any medication except regular paracetamol and codeine. Remarkably all blood test via GP normal, TSH=2. Main symptoms are nasal congestion and bloating, intermittent diarrhoea and fatigue, unrefreshed with sleep and exercise intolerance. Not labelled CFS yet and still works full time as investment banker, spends 10hrs daily on screens. The trigger was a traumatic split from long term partner 4 years ago followed by an admission with septicaemia following a dental extraction and 4 weeks of intravenous antibiotics.
All in all, a beautiful functional medicine approach is the best way forward and he is v committed to changing. He has stopped all alcohol for 6 weeks. Eats a gluten free diet (did not find improvement with it). Difficult to know where to start but decided to start with the gut and he will have a GI Comprehensive stool, more thyroid tests and salivary cortisol. An elimination diet to exclude dairy. Please advise on supplements as I feel he needs both detox and mitochondrial support. So far, he is on B vitamins, Mg glycinate, elite electrolyte support and liver support (milk thistle and NAC-something he bought on the internet).
Thank you for your advice
Monica Lascar Bensimon
April 10, 2019 at 7:49 am #2999Carrie Decker, NDModerator
Thank you for contributing this case here. I’m glad this man has found the motivation to make the changes he has, and that you are able to support him in this. Hopefully his general practitioner has done a full thyroid panel including free T3 and free T4, as this is important in assessing fatigue, particularly with thyroid autoimmunity as thyroid function can be up and down.
Difficulty sleeping and a dysregulated hypothalamic-pituitary-adrenal (HPA) is not uncommon for individuals in recovery from alcohol abuse. A text that my colleagues in the US have often referenced (and I have on my office shelf) is the book titled “Seven Weeks to Sobriety: The Proven Program to Fight Alcoholism Through Nutrition,” by Joan Mathews Larson, Ph.D. – http://tinyurl.com/nv9xztx. This text discusses many aspects of therapies including breaking addiction, supporting biochemistry, adrenals, digestion and absorption, and neurotransmitter balance and is a great reference for supporting individuals in recovery.
There are many common threads with the issues that individuals in recovery from alcoholism will face– sleeping difficulties, digestive dysfunction and flora imbalance, cravings, emotional imbalance, and other aspects of withdrawal which vary depending on how recently the substance was discontinued. Alcoholics are often immunocompromised and are susceptible to infection, which may have contributed to the septicaemia you mentioned. Nutritional deficiencies are also common with alcohol abuse. Alcohol abuse is one of the most common causes of nutritional folate deficiency in the US, leading to a megaloblastic anaemia.
Savage D, Lindenbaum J. Anemia in alcoholics. Medicine (Baltimore). 1986 Sep;65(5):322-38. http://tinyurl.com/mr956bu
Supplementation with B complex vitamins should generally be a core part of alcohol dependency and recovery programs, as they are in his case. B complex vitamins are depleted by chronic alcohol consumption. If possible, including a complete greens formula with probiotics will help to meet the nutritional needs as well as support gut and liver recovery.
Cravo ML, et al. Hyperhomocysteinemia in chronic alcoholism: correlation with folate, vitamin B-12, and vitamin B-6 status. Am J ClinNutr. 1996 Feb;63(2):220-4. http://tinyurl.com/pd7tnsh
Although alcohol acts as a sedative to promote sleep, the physiology related to sleep patterns are altered with alcohol consumption leading to diminished sleep quality. Laboratory evaluation of cortisol will likely show an elevation associated with the history of heavy alcohol consumption.
Roehrs T, Roth T. Sleep, sleepiness, sleep disorders and alcohol use and abuse. Sleep Med Rev. 2001 Aug;5(4):287-297. http://tinyurl.com/owwjb5r
Thayer JF, et al. Alcohol use, urinary cortisol, and heart rate variability in apparently healthy men: Evidence for impaired inhibitory control of the HPA axis in heavy drinkers. Int J Psychophysiol. 2006 Mar;59(3):244-50. http://tinyurl.com/ow3hjvg
Working with this man to address things that contribute to his stress is important, as alterations in the hypothalamic-pituitary-adrenal (HPA) axis response can be associated with alcohol relapse. Phosphatidylserine has evidence for blunting the stress activation of the HPA axis, and may be supportive both short and longer term. Supporting stress reduction long term may include encouraging individual counseling and participation in groups supportive to alcohol abstinence such as Alcoholics Anonymous.
Junghanns K, et al. Impaired serum cortisol stress response is a predictor of early relapse. Alcohol Alcohol. 2003 Mar-Apr;38(2):189-93. http://tinyurl.com/prulllt
Sinha R, et al. Effects of adrenal sensitivity, stress- and cue-induced craving, and anxiety on subsequent alcohol relapse and treatment outcomes. Arch Gen Psychiatry. 2011 Sep;68(9):942-52. http://tinyurl.com/npqk5xb
Monteleone P, et al. Blunting by chronic phosphatidylserine administration of the stress-induced activation of the hypothalamo-pituitary-adrenal axis in healthy men. Eur J ClinPharmacol. 1992;42(4):385-8. http://tinyurl.com/oqw2kxa
A garum armoricum Ling-fish-based food concentrate has been shown to balance adrenal function under stress as well as supporting mood and sleep. This food concentrate (http://tinyurl.com/pntrrf4) contains polypeptides that act as precursors to neurotransmitters such GABA, encephalins and endorphins. They can exert a regulatory effect on the nervous system, potentially enabling the organism to adapt to stressful conditions. It also contains the essential omega-3 fatty acids, DHA and EPA. These are precursors of the prostaglandins and prostacyclins, cellular chemical mediators which help regulate the main biological functions of the body, including the noradrenergic functions of the central nervous system.
As the liver is likely still in a state of repair and recovery, further support for the liver with supplements such as antioxidants (glutathione, alpha lipoic acid, vitamin E, selenium), and phosphatidylcholine may be of benefit. Phosphatidylcholine also supports cellular and mitochondrial health and repair. Probiotics may be beneficial as the gastrointestinal tract is negatively affected by high doses of alcohol consumption. Probiotics also support a healthy response to stress and the reduction of anxiety and depression which may contribute to drinking patterns.
Lieber CS. Alcoholic liver disease: new insights in pathogenesis lead to new treatments. J Hepatol. 2000;32(1 Suppl):113-28. http://tinyurl.com/mlxsw4b
Dinan TG, Cryan JF. Regulation of the stress response by the gut microbiota: implications for psychoneuroendocrinology. Psychoneuroendocrinology. 2012 Sep;37(9):1369-78. http://tinyurl.com/pl387g2
Individuals with coeliac disease often experience gastrointestinal symptoms even in the absence of gluten consumption. As the primary issue with coeliac disease is autoimmune destruction of the intestinal mucosa lining where digestive enzymes are activated and food is absorbed, this is not surprising. Support for digestion in the form of enzymes as well as for gut mucosa repair might be helpful in alleviating his gastrointestinal symptoms.
Rothenbacher D, et al. Prevalence and determinants of exocrine pancreatic insufficiency among older adults: results of a population-based study. Scand J Gastroenterol. 2005 Jun;40(6):697-704. http://tinyurl.com/lzga6cs
Epithelial Growth Factor (EGF) is a polypeptide that stimulates growth and repair of epithelial tissue. EGF is a normal constituent of saliva production during the act of eating, is also secreted into the gut lumen and found in colostrum and milk. Salivary EGF also upregulates small intestinal absorption of electrolytes and nutrients. Michael Ash has written more about the use of epithelial growth factor in the resource “Epithelial Growth Factor For Reduced Gut Permeability / Pathogen Attachment And Nutrient Uptake” which can be found here – http://tinyurl.com/qf2qbr6.
Topical castor oil to the abdomen and right upper quadrant of the liver are very supportive for liver and gastrointestinal function as well as detoxification support. Dr. Todd Born recently wrote about the many benefits of castor oil which can be read here – http://tinyurl.com/kqsrfga. I generally instruct clients to utilize a simplified castor oil pack by simply massaging castor oil into the region, applying a cotton cloth to protect other garments from the oil, and utilising the body heat to draw the oil internally. A warm water pack may also be applied for a period of 15 – 20 minutes.
The topic of Gilbert’s syndrome has been addressed quite extensively in multiple discussions on the Clinical Education Group. Please do see some of the discussions pertaining to this topic at http://tinyurl.com/nromlyx&http://tinyurl.com/pxm9st5&http://tinyurl.com/keusflm&http://tinyurl.com/oetfw6u.
The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Pro-Greens (ARG): 1 scoop up to three times daily in 8oz liquid. http://tinyurl.com/27uruzy Greens powder high in antioxidants including probiotics.
Bio-3B-G (BRC): 1-2 tabs with each meal http://tinyurl.com/ose948a Active B vitamin formula designed to support the nervous system.
Gastrointestinal support to consider:
Intenzyme Forte™ (BRC): 1 with breakfast & 1-2 with lunch & dinner. http://tinyurl.com/ndqfvak Digestive support.
Perm A Vite® (ARG): Gradually increase to 1 Tbsp daily mixed in liquid 1h away from meals. Contains L-glutamine and epithelial growth factor. http://tinyurl.com/37dv2cl Support for gastrointestinal healing.
Antioxidant support to consider:
NAC Enhanced Antioxidant Formula (ARG): 1-2 tablets twice daily. http://tinyurl.com/p2o6k85 Antioxidant support.
Se-Zyme Forte (BRC): 1 tablet twice daily. http://tinyurl.com/k8f4vrh Antioxidant support.
For the support of HPA axis balance:
Stabilium® 200 (ARG): 4 capsules with the first meal, possibly decreasing to 2 or 3 capsules every other day, as desired. http://tinyurl.com/3x35v63 Supports healthy response to stress and healthy sleep.
PhosSerine Complex (ARG): 1 capsule one to three times daily with meals. http://tinyurl.com/kxf3wdr
NT Factor ATP Lipids (ARG): ½ teaspoon two times daily. http://tinyurl.com/n7b7sap Support for cellular and mitochondrial health and repair. (Phospholipid combination including phosphatidylcholine).
Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.
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