45 yo F with tiredness and poor digestion

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    • #3122
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      45 year old female presenting with tiredness and poor digestion (bloating and loose bowel movements) for more than 5 years. Originally saw this client in December 2014. She also presented with possible peri-menopause symptoms due to cycle irregularity and elevated FSH. She works full time as a live in nanny to 2 x small children.

      Of interest in her presentation was the trigger of an unknown viral illness in 2004 resulting in swelling of wrists/ankles/joints. Blood tests ruled out ross river fever and barmah forest viruses. Tiredness has ensued since this illness.

      Private testing included:

      Adrenal stress index (completed April 2015) – sample 1 showed elevated cortisol(26.4) with sample 2, 3 and 4 showing reduced cortisol (1.3, 1.3 and 1.1). All DHEA readings indicate very low normal ranges.

      Complete thyroid profile (completed April 2015) – low T4 (11.4) and low FT4: FT3 conversion (2.2). All other readings normal.

      GI Effects stool test (completed August 2015) – Dientamoebafragillis (rare), very low diversity with elevated faecal fat and products of protein breakdown, elevated n-Butyrate

      On return of first completed tests, we embarked on a regime to support health of the adrenals; including herbs and nutrients to support conversion of T4 to T3 (inc. Se, Zn, glandular, B vits, Mg, vit C, Dig Enzyme & herbal mix inc. licorice, rehmannia, withania and sib. Ginseng). Dietary support included balancing blood sugar, increasing relaxation time.

      Digestion and defecation improved (more solid bowel movements), however tiredness remained and in August 2015, client embarked on stool tests. Based on results (see above), we changed direction and have followed a 5 ‘R’ protocol including supplement regime (biocareeradicin forte, symprove probiotic, biocare slippery elm plus, nutri glutagenics, betaine hydrochloride).

      Client has followed supplemental regime and dietary modifications for 4 months with very little improvement.

    • #3124
      Carrie Decker, ND

      Hello Gillian,

      Thank you for posing this question. I am glad you are supporting this woman in her attempts to address her symptoms of bowel irregularity and fatigue.

      I’m not sure what combinations you have used of these many herbs, vitamins, minerals, and glandulars so I cannot offer specific support concerning dosing. In general, the supplements you have listed are also things I have used in individuals with symptoms and testing indicative of adrenal fatigue. Additionally, I often include vitamin A as it also supports adrenal function and thyroid use of iodine. Vitamin A deficiency may further worsen the effects of iodine deficiency due to the effects of vitamin A on the pituitary-thyroid axis.

      Zimmermann MB. Interactions of vitamin A and iodine deficiencies: effects on the pituitary-thyroid axis. Int J Vitam Nutr Res. 2007 May;77(3):236-40. http://tinyurl.com/zoh5hdn

      If loose stool continues to be an issue consider backing down on vitamin C and Mg or try alternate forms (topical magnesium, chelated vitamin C or magnesium, liposomal C) as these supplements may have a side effect of loose stool. In addition to the GI Effects test which assesses gastrointestinal function and large intestine flora balance, you may want to consider testing of the small intestine bacterial overgrowth (SIBO) if you suspect ongoing dysbiosis and the follow-up testing with the GI Effects has shown the dysbiosis to be improved. SIBO can be assessed for with a breath test through Regenerus Labs (codes which cover SIBO are CMI26 and CMI27), and they can be contacted at http://www.regeneruslabs.com or by email on info@regeneruslabs.com or tel +44 (0)333 9000 979. Biolab in London also offer a breath test for SIBO and can be contacted at http://www.biolab.co.uk or tel 020 7636 5959 / 5905.

      The BioCareEradicidin Forte is one product of many which address dysbiosis. In clients with chronic gastrointestinal issues such as SIBO I often alternate products for several months making sure a fairly high therapeutic dosage is used for at least 30 days. By rotating gastrointestinal antimicrobial herbs, I definitely have seen that everyone has different herbs or herbal combinations which are the most effective for them. Some other ideas of combinations which may be supportive for the resolution of small intestine or large intestine dysbiosis can be found here – http://tinyurl.com/j6bzybj&http://tinyurl.com/hdujy5x

      Saccharomyces boulardii is one probiotic strain which has been well studied for the reduction of diarrhoea that you also may want to recommend that your client try for her gastrointestinal symptoms. It supports the gut in producing secretory IgA and restoring the mucosal layer which other probiotic populate. I often use it as a part of reinoculation phase in combination with other probiotics, or on a longer term basis for individuals who tend to have loose stool or yeast overgrowth. Supporting the immune system to return to balance in the gut is important and other supplements such as colostrum and immunoglobulin are often key for longer term recovery after the treatment of large or small intestine dysbiosis.

      McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol. 2010 May 14;16(18):2202-22. http://tinyurl.com/3oxv2e4

      Mantis NJ, Rol N, Corthésy B. Secretory IgA’s complex roles in immunity and mucosal homeostasis in the gut. Mucosal Immunol. 2011 Nov;4(6):603-11. http://tinyurl.com/kw5ds5r

      Chamomile and fennel are herbs that I often recommend to clients who tend to run at higher stress levels, and have digestive symptoms of nervous dyspepsia and/or poor digestion. Finding a quality chamomile and brewing a very strong tea or making a tincture for use before and/or after meals will support her normal stomach acid secretion as it is a bitter herb. Both of these herbs are alsonervines and anti-spasmodic.

      A garumarmoricum 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. I have at times found that when individuals struggle with adrenal recovery due to prolonged stress and anxiety that working with this supplement can be more balancing than other herbal or glandular combinations.

      I have used a variety of B complex combinations in my practice, and have found that some forms are better than others on an individual basis as well.The use of low dose B vitamins, but in their active form, has been found clinically to be a very effective means of supporting the nervous system. Thiamin’s active form is cocarboxylase, riboflavin’s active form is robiflavin-5-phosphate, and pyridoxine’s active form is pyridoxal-5-phosphate, and these three active forms are available in supplement form. One benefit of their use is that one can use a small dose compared to a strong B vitamin formula which is more traditionally understood to support the nervous system vs anxiety and stress. One B vitamin formula that contains these active B vitamins is detailed in the suggested considerations below.

      Do consider if other things are important to look into further with the issues of prolonged fatigue despite appropriate support. Items which should be considered are the possibility of autoimmune disease, other hormonal abnormalities, or the possibility of a latent infection especially given her historic issue. Testing for chronic viral infections via Infectolabs (available through Regenerus Labs) is an option if you did wish to consider suchtesting. Please also view Nutri-Link’s supporting material concerning supplementation protocols for virus infections found here – http://tinyurl.com/bgvyl6h.

      Given the joint swelling with the initial illness in 2004 it also is important to rule out Lyme disease as a contributor to her symptoms. Suggested testing for Lyme disease and related coinfections is by InfectoLabs via Regenerus Labs in London – http://tinyurl.com/lzs2hqa. Although testing may indicate that disease is present, it may not be sufficient to rule out the possibility of Lyme disease or related co-infections. I have seen several clients with similar symptoms of fatigue respond well to interventions to address the possibility of latent viral issue or Lyme disease, and such may be case with your client as well.

      Some previous discussions on the topic of Lyme which you may find useful can be found here:

      • Testing for Lyme disease – http://tinyurl.com/j3vb2nc

      • Treatment strategies including immune support, proteolytic enzymes, and hydrolyzed collagen – http://tinyurl.com/hvqflnw

      • Dietary issues and suspected Lyme – http://tinyurl.com/hska97a

      • Lipid replacement therapy and Lyme – http://tinyurl.com/hfu7oau

      Topical castor oil to the abdomen supports the body in healing overall as well as improves many aspects of digestion, lymphatic drainage and detoxification. I generally instruct clients to use 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 using the body heat to draw the oil internally. If constipation is an issue, gentle massage in a circular pattern working up the ascending colon, across the transverse, and down the descending is also recommended. A warm water pack may also be applied for a period of 15 – 20 minutes. This should be done at least 3 – 4 times per week.

      I also often use homeopathy or recommend counselling or meditation in my practice. Such things often help someone to make an energetic shift in their internal being, and support improved compliance with therapies (both diet and supplementation). You may wish to recommend one of these things, the selection to be determined by which you anticipate she will find the greatest benefit or be compliant with.


      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.

      As a part of repair and reinoculate consider including:

      • S. Boulardii (ARG) – 1 with breakfast and dinner. http://tinyurl.com/35392bw

      • Immuno-gG (BRC): Gradually increase to 2 with breakfast & 2 at bedtime. http://tinyurl.com/p598nqq Immunoglobulin G from bovine colostrum. Provides support for healthy immune function.

      Support for function under stress:

      • Bio-3B-G (BRC): 3 tabs twice daily with meal. http://tinyurl.com/ose948a Active B vitamin formula designed to support the nervous system.


      • Stabilium® 200 (ARG): 4 capsules once daily on an empty stomach for 4 weeks, decreasing to 2 -3 capsules after this. http://tinyurl.com/pm5ou44 Supports response under stress.


      • Casein Concentrate (BRC)(formerly De-Stress): 1 caps twice daily. http://tinyurl.com/ax5t7vp

      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.

      In health,
      Dr. Decker

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