Live Case Study Call – September 8 2022 (Severe Nausea)

Key Pearls:

Case Presentation: 21 years old, struggling with severe morning nausea for 3-4 years; has done many functional tests; calprotectin (inflammatory marker for the gut) showed some elevation, possibly parasite); ultrasound showed gas in the abdomen; given antibiotic which led to lower calprotectin levels; SIBO breath tests, showed some intolerance to lactose; Gut Zoomer (functional gut test: issues with gallbladder; high MMp9 (inflammation marker); test thought maybe nausea a result of silent reflux; given D-limonene, first time he did not wake up with nausea but only lasted 3 days

Health Goals: 

• • Get rid of nausea: worse when he smokes (quit smoking in July)
  • Increase appetite: no appetite with nausea
  • Gain weight: 62k wants to be 72k
  • Symptoms:
    • Severe post-nasal drip
    • Acne
    • Gut: constipation, diarrhea, gas, belching 
    • No appetite, severe nausea
    • Mood: anger, poor memory (had fall on head 6yo and 16yo), anxiety, depression (triggered by circumstances)
    • Sleep: disrupted; bed at 12am, up at 9am, up 1-2x per night to urinate
    • Lactose and fructose intolerance
  • Hobbies:
    • Music
    • Gym
  • Diet:
    • High protein; high calorie
    • Used to eat 1-2 meals/day but wants to eat more
    • Craves salt
  • Other:
    • Zirconia implant
• Elevated Thyroid Antibodies:

• Needs to consider 100% removal of dairy and gluten due to molecular mimicry with thyroid tissue
• Consuming water should be between meals rather than with meals to avoid potentially diluting digestive enzymes
• Constipation, poor digestive function can contribute to nausea 
• LAB RESULTS:

• WBC: suboptimal; should be above 5 (something is taxing the immune system); make senses considering we notice the autoimmune dynamic (thyroid)
• Pancreatic Elastase: low, marker that shows how much digestive enzymes are being released
• Low bile acids: can contribute nausea
• Microbial overgrowth: imbalances in GI tract; can lead to inlammation, intestinal permeability, autoimmune dynamic
• Monocytes (found on CBC): should be < 7%; second line of defense (remove debris); usually see elevation after infection; has been above 7% – could be related to liver dysfunction (want to look at liver markers!)
• ALT (June 2020): clinically high; was given liver support, ALT marker dropped on later blood test
  • B6 used to make serotonin, then convert to melatonin
  • B6 contributes to motility (low levels = constipation)
  • B6 needed to make taurine, taurine needed to make bile salts (bile is antimicrobial; without enough of it can increase risk for microbial imbalances)
  • B6 needed for GABA production (which is necessary for good sleep)
  • B6 needed to breakdown histamine; has some symptoms of histamine overload
  • ALT dependent on B6; present in liver
  • Low ALT (in single digits): may be a need for more B6; may not be reflecting true ALT value; need more liver markers to get a true full picture
• Cortisol Awakening Response:
  • Low morning cortisol 
  • High sodium, lower potassium
  • Recommended to do a DUTCH test to look at CAR; cortisol
  • Relation between 16yo head collision and adrenal glands. TBI can impact the communication between the brain and the adrenal glands
  • Low adrenal function can lead to nausea
• RECOMMENDATIONS:

• Priority: improve gut function; need to have open elimination pathways to properly excrete waste and toxins
  • D-Limonene, Bile support, enzymes, HCL betaine with pepsin
• Constipation rapid relief: magnesium citrate (to bowel tolerance)
• Liver support: start with a B complex for 1 month, then switch to a B Complex higher in B6. Then re-test liver panel that includes Total and direct bilirubin.
• Castor oil packs over the liver/gallbladder area (under right rib cage) 4-5 days per week for 30-45 minutes.
• Focus on autoimmune thryoid & immune support (remove food sensitivities, optimize vitamins D, A, zinc if needed (test levels), histamine-friendly probiotic (ex. Seeking Health ProBiota HistaminX), immunoglobulin support (ex. IgG2000)
• Once digestion is supported, consider a parasite cleanse (15 days on, 10 days off, 15 days on) + Para 1 + Biotoxin Binder
• Limit snacking and focus on 3 main meals per day; focus on VPF+C (starchy carbs due to training schedule)
• Support morning cortisol: Sleep hygiene (sleep before midnight), morning cold showers, inversions, seeing the sun within 20 mins of waking. Consider Dutch Adrenal to check sex hormones, cortisol & B6, B12, glutathione organic acid markers.
• Try DAO enzyme to see if histamine intolerance is at play (or test histamine breakdown)
• Investigate brain-adrenal communication (test ACTH)