Hey @R-S,

Quick note: I messaged you after Saturday and was checking if you’d had a chance to see it. I can’t view my private messages right now.

Hey @R-S ,

Although gut complaints with IBS can vary from person to person, flare-ups like this can sometimes last a few days and in some cases a week or even a bit longer. If you’re ever unsure whether it’s “just” IBS or something else, it’s always best to ask the opinion of a doctor you trust, especially someone who can see you in person and assess things directly.

Introducing new foods when you’re already having a flare can be tricky because it’s hard to know what’s causing what. For now, the best course of action is to focus first on calming the cramping before adding anything new.

It’s interesting that the hot water bottle helps. That shows the warmth is relaxing the gut muscles, which is exactly what’s needed right now. If you feel comfortable with Iberogast and have tolerated 10 drops well, it’s generally safe to increase gradually toward the recommended 20 drops with meals or when pain is present.

A few other gentle ways to relax the gut and hopefully ease lower abdominal pain:

• You could try a belly massage. Use your fingertips to make slow, small circles starting at your right lower abdomen, moving up the right side, across under the ribs, and down the left side (clockwise direction). This follows the natural movement of the colon and can help gas and spasm pass.
• Since the hot water bottle helped: warm, soft foods might be your best friend right now.

Regarding the supplements, my earlier suggestion of DGL was mostly to protect the stomach and upper gut lining since you’ve had some gastritis. The enzymes may help more directly with cramping and food breakdown. So if the cramping is your main issue at the moment, it’s perfectly fine to start with the enzymes first and bring DGL in later once things have calmed.

Take it slow, keep meals warm and gentle, and give your body a few days to reset before reintroducing foods again. You’re listening carefully to your body, and that’s exactly what will lead you forward.

Hey @kkol,

One more thing that comes to mind if you live in the UAE: Damp indoor air keeps the nasal lining inflamed, thickens mucus, and feeds dust mites and mold. Even without a positive “mold allergy,” mold fragments and gases can be of influence and drive post-nasal drip and cough.

Start by measuring, not guessing. Put an inexpensive hygrometer in the bedroom and living area and aim for 40–50% most of the day. Anything consistently above ~50% is a problem. Use the AC to dehumidify (Dry/Dehumidify mode if available), keep windows closed on humid days, and set the fan to Auto so coils actually remove moisture. Service the unit: replace filters on schedule, clean evaporator coils, and clear the condensate drain. If you still can’t hold 40–50%, add a bedroom dehumidifier, vent bathrooms and kitchen during use and for 20 minutes after, fix leaks promptly, and avoid drying laundry indoors.

Check the common hiding spots for mold: the AC closet and drip pan, around windows and sills, under sinks, shower grout and curtains, behind furniture on exterior walls, inside wardrobes and shoe cabinets. A musty smell is a clue. If growth is widespread, recurrent, or dark/black on porous materials like drywall, bring in a qualified expert and don’t clean/remove yourself: expert advice matters here.

Lower exposure elsewhere too. Run a room HEPA purifier in the bedroom and keep fabrics and clutter to a minimum. For foodborne molds and aflatoxins, buy nuts, peanuts, pistachios, corn, and spices from reputable brands, use smaller packages, store them sealed in the fridge or freezer, keep the pantry cool and dry, and discard anything that smells musty or tastes bitter.

Mold and humidity are easy to overlook because they’re invisible and skin tests can be negative while the nose is still irritated. A simple two-week log of morning and evening humidity alongside symptoms often makes the link obvious. You’re doing smart detective work. share what you find and we’ll fine-tune.

I wish i had a easier and shorter answer to your question!

Hey @R-S ,

Welcome to the community! 🙂

First things first: trust Bernadette’s sequence.
She’s read the other posts posted by you, I’m still catching up. If Bernadette recommended you to start with bitters first, let’s keep that as the north star. My earlier note was only a caution that, with gastritis, a “low and slow” start is usually a safe bet (micro-dose, with food, pause if there’s burning) if an ulcer were present.

How my suggestion fits the bigger picture

In functional medicine, we often go:

1. Remove stressors → 2) Replace (enzymes, bile, etc.) → 3) Repair the lining → 4) Rebalance.
   Because you’re on duloxetine (which can be a gut stressor for some) and may not change that right now, I wanted you to know you can still repair the lining in parallel if you like. That’s why I mentioned zinc-carnosine/DGL as options, not must-haves today.

Keep the plan simple
If you tend to react strongly to supplements, start with fewer, not more. You can absolutely begin with bitters only at tiny doses with meals, and watch your stomach’s response. If that goes well, add enzymes later to lighten digestion. Zinc-carnosine and DGL can wait until you feel ready, or skip them if you’re improving without them.

Last but not least: You’re not alone!

No need to feel overwhelmed: we’ll help you pace it and adjust. One change at a time, listen to your body, and we’ll steer with Bernadette’s plan as the anchor.

You’ve got this!

Hey @Kkol ,

First off, you’re doing a great job pushing for answers and getting the right specialists involved. A dry cough plus years of post-nasal drip is exhausting for a kid (and a parent), and your note shows you’re thinking exactly like a great advocate.

Seeing what the immunologist is doing, I’ll first try to explain what he is probably doing. Then I’ll give you a clear, step-by-step plan you can follow alongside your immunologist:

What the doctor is testing:

• Is the nose the driver? (Rhinitis vs sinusitis)
  Daily saline clears mucus and lets the steroid nasal spray reach the lining. If cough and drip ease within 1–2 weeks, nose inflammation is the likely driver (rhinitis). If there’s persistent facial pressure, thick colored mucus, and smell loss, sinusitis stays on the table.

• Is it allergy or not?
  Cetirizine (Zyrtec) blocks histamine. If symptoms improve on it, that supports an allergic component. If not, non-allergic triggers (irritants, cold air, infections, reflux) are more likely. The skin test will map which allergens matter.

• Is there a lower-airway piece (cough-variant asthma)?
  If the cough lingers, your doctor may add a brief inhaled steroid trial or do spirometry/FeNO. Improvement points toward airway hyper-reactivity.

What to do the next 4-8 weeks:

Often, with true post nasal drip, dairy products can worsen symptoms. I often recommend my clients to remove dairy products and see what happens. However, it seems there is some uncertainty about what your son is really suffering from. Therefore, a wider scope of interventions could help you find out what is at play:

• Tighten the bedroom environment (can be a big win).
  Make the bedroom the cleanest air in the house. Vacuum with a HEPA machine if you have one. If you don’t have one, dust with a slightly damp microfiber cloth so dust sticks to the cloth. Mop hard floors with water, and beat rugs outside, then let them sit in the sun for an hour. Use pillow and mattress dust-mite encasings if you have. Wash bedding at 60 °C every week. Keep humidity between 40 and 50 percent with a simple hygrometer. Do not let it climb higher, because mold and dust mites thrive in high humidity. If humidity is higher, mold could sure be a player and I recommend you to take a look at the course we provide here! Reduce clutter and open shelving so less dust accumulates. Keep pets out of the bedroom at all times. Avoid fragrances, candles, incense, and aerosols. If budget allows later, add a room HEPA air purifier for the bedroom; it often helps more than upgrading the vacuum.
• Protect the throat and calm reflux habits.
  Sometimes reflux can cause post-nasal drip. In this case, it is more likely that the next interventions will work: Eat dinner earlier and keep evening portions smaller. Elevate the head of the bed by 10–15 cm. Offer warm fluids. If your child is older than one year, a teaspoon of honey at bedtime can soothe a dry cough.
• Check the lungs if the caugh lingers:
  If the cough remains, ask for spirometry or a FeNO test to screen for cough-variant asthma. If asthma is at play, let us know, and we could advise you further. If you like to see what interventions you could think of, take a look at this handout.

You’re on the right track. Give this plan a clean 4–8-week run, then let the skin test and response guide next steps. You’ve got this!

Hey @R-S,

Love how thoughtfully you’re approaching this! You’ve already removed a few variables (slippery elm), started soothing the lining (aloe, Iberogast), and you’re timing thyroid support to real data. That kind of step-by-step tinkering is exactly what will help you to calm your sensitive guts down.

You might not know me yet. My name is Daniel. I’m a functional medicine practitioner as well, and I help Bernadette out on the forum. I know I’m stepping into a discussion that is bigger than this post alone. As I’m writing, I realise I might not have the entire picture complete yet, since quite a few posts have been written about stuff already. That being said, here is what I think about digestive enzymes in your mix, given you suspect IBS/SIBO, mild gastrotis and possible histamine issues, while you’re still on duloxetine:

• Yes, you can trial enzymes now: choose a gentle, broad-spectrum blend without betaine HCl.
• Start low, take them with food, and adjust the dosage by symptoms.
• Pause if you feel burning/pressure (especially with protein-heavy meals) or if upper-abdominal pain worsens.
• Keep Iberogast short-term and dose-limited; pair lining-support (aloe, ± DGL or zinc-carnosine) to help gastritis heal even while on duloxetine.

Why enzymes may help you:

• Since you suspect IBS/SIBO: partial carb/fat/protein mal-digestion can feed gas and bloat upstream; enzymes reduce the “substrate” that reaches bacteria.
• Histamine-sensitivity: enzymes don’t lower histamine directly, but better digestion lowers “trigger load” (less fermentation, fewer mast-cell nudges).
• Gastritis: be careful when using. Always “sandwich” your enzymes with food(eat half your meal first -> then take your enzymes -> eat the rest of your meal) and don’t add acid. Enzymes can, however, ease the workload without irritating the lining.

What to choose (and what to avoid):

• Search for a supplement with a broad blend. A blend with amylase, proteases, lipase, plus brush-border helpers like lactase and alpha-galactosidase, for example, would be my first pick
• No betaine HCl and no large doses of spicy bitters inside the capsule.
• No prebiotics (inulin/FOS) in the formula.

Products that fit these recommendations are, for example, Enzymedica Digest Gold® with ATPro and Pure Encapsulations Digestive Enzymes Ultra. If histamine is a clear trigger (flushing, headaches after aged foods), you can optionally add a DAO capsule before histamine richer meals. It doesn’t fix root causes; it just buys tolerance during the healing phase. But preventing histamine rich foods would always be better.

How to use enzymes safely:

1. Like I mentioned earlier, “sandwich” the enzymes in foods. Eat half your meal first, take the enzymes and then eat the next half of your meal
2. Start low and slow: consider starting with half a capsule of if you are really sensitive, start with 1/4 capsule. Keep the dosage the same for a few days to see how your body reacts
3. If a meal still feels heavy/bloated, increase the dosage
4. Stop or adjust if you feel a burning sensation under the sternum, gnawing pain, nausea, or diarrhea shows up.
5. Space with your meds: keep 2–3 hours away from your thyroid med once you start that, and at least 1 hour away from supplements like iron. Pancreatic enzymes can decrease the absorption of iron supplements. There is no special spacing needed from duloxetine.

Specific precautions for your case:

• Mild gastritis: Keep enzymes strictly with food and I can’t stress this enough: no HCl containing products!
• Allergies: avoid fruit-derived proteases if you react to pineapple/papaya. Bromelain is often derived from these fruits and it would be best to avoid it in this case.

Other considerations in your current plan:
Digestive bitters (from Mercola for example) are helpful for motility, but bitters can sometimes flare histamine since they sometimes contain citrus fruits. They also stimulate gastric acid production and can therefore worsen gastritis symptoms. Try micro-doses (1–2 drops) and don’t use them yet if you are testing the enzymes, so you can understand what supplement does what.

Can you heal gastritis while you’re on duloxetine?

I can’t really advise you on what you should do with your medication since I don’t have all the details. However, even with Duloxetine, you can initiate the gut healing process. Duloxetine can irritate the gut in some people, but lining repair still happens if you lower irritants and support the mucosa. What helps most:

• Give the gut lining support: The general recommendation to support healing of the gut lining is 75 mg zinc-carnosine daily (if you are already using zinc, this dosage should be adjusted accordingly), Aloe inner gel as you’re doing and DGL (deglycyrrhizinated licorice) could help. Avoid whole-licorice if you have high blood pressure.
• Food hygiene: warm, simple meals; avoid alcohol, NSAIDs, smoking; limit coffee on an empty stomach; smaller, more frequent meals during flares.
• Rule out H. Pylori if you haven’t done that already.
• Prioritise stuff that reduces stress: breath work, light walks after meals; these matter for gastric blood flow and motility

Here is a simple step by step plan:

Week 1: Keep aloe + Iberogast. Pair it with zinc-carnosine/DGL. Add a gentle enzyme at ¼–½ cap with lunch/dinner only. Track: fullness, belching, bloat, stool form.

Week 2: If tolerated, use with all main meals. Consider tiny-dose bitters or hold them if you are uncertain about histamine.

Week 3: If meals feel lighter but histamine-type reactions persist, consider a DAO trial before high-histamine foods while continuing lining support.

You’re doing a great job listening to your body and making smart, small moves. Keep that pace!

I hope this answer helps you as well

Daniel

Hey @naslam1603 ,

That’s great! Any reason why vitamin K2 on to your radar?

Hi @R-S

You’re welcome! Thank you for sharing your thyroid and selenium results: I know you shared earlier somewhere, but it’s very helpful!

Since your digestion is improving, it’s best to finish the “gut-healing” phase before adding anything for the thyroid. Think of it as giving your system a solid foundation before layering in the next step. It’s also worth remembering that duloxetine can influence gut function and microbiome balance. You can absolutely make progress and heal while using it, but it may mean you won’t reach textbook “perfection” in gut health (and that’s perfectly fine!). The goal is “good enough” stability rather than flawless labs or zero symptoms. Once digestion feels reliably calm, that’s the moment to introduce selenium.

Here’s a simple way to sequence things from here:

Step 1 – Continue bitters and enzymes
They’re clearly working.

Step 2 – Add either DGL or zinc-carnosine (not both at once)
Both protect and soothe the lining but by different routes:

• DGL coats and shields the surface mucosa. Start with this one if you still notice gut discomfort

• Zinc-carnosine supports tissue repair a little deeper in the lining.

You can start with DGL first (15–20 min before meals) because it’s gentle and gives quick feedback. If you still feel mild tenderness after a week or two, add zinc-carnosine. They can eventually be used together if tolerated, but introduce them at least a week apart so you can read the signals of your body.

Timing guide

• Bitters: 1–2 min before meals.

• DGL: 15–20 min before meals.

• Zinc-carnosine: with or right after meals.

• Enzymes: sandwich method

• Selenium (later): with food, at least 2 hours away from duloxetine.
  Use a small gap between DGL and bittes so the DGL can coat before the bitters trigger stomach acid flow.

When to bring selenium in
Once your stomach feels consistently calm and you’re tolerating a wider range of foods, you can start selenium

And finally, because duloxetine can affect sleep quality, paying attention to sleep hygiene becomes extra important. Good sleep supports thyroid conversion (Free T3) and overall energy. If you notice changes in your sleep, a short sleep journal can help you spot patterns and small improvements.

Let us know if we can help you in any other way!

Daniel

Hey @R-S ,

Congratulations! It’s great to hear how much progress you’ve made. The fact that both the bitters and enzymes are going well and that bloating and fullness have improved shows your digestion is responding nicely.

Let’s go through your questions step by step.

1. What to add next: DGL or selenium
Since Bernadette mentioned starting with selenium, it’s best to stay close to her plan. Selenium and DGL work in different areas:

• Selenium mainly supports thyroid and antioxidant balance.

• DGL mainly supports the stomach and gut lining.

Because your digestion is now improving and you’re still on duloxetine (which can mildly stress the stomach), both could help, but in sequence, not together.

If you feel your digestion and energy are stabilizing, it makes sense to start with selenium first for 6–8 weeks. If any stomach tenderness or irritation returns later, add DGL at that point. No tapering is needed between them, just introduce one new product every 10–14 days so you can clearly see what’s helping.

2. How long to stay on each supplement and what to watch for
It’s a bit hard to talk about time periods. I would always assess where possible if symptoms improve. But I’ll give you a general guide:

• Digestive Bitters: Try 6-8 weeks and then reassess
  Signs it’s time to pause/reassess: If you feel increased warmth, burning, or reflux.
• Digestive enzymes: try 8–12 weeks, then test a few meals without them. If you can eat a mixed meal without heaviness or bloating, you may not need them daily.
• Zinc-carnosine: Try 6-8 weeks. If your stomach feels settled and meals no longer irritate you, you can stop without tapering.
• DGL: Try 6–8 weeks or as needed. Usually not needed long-term once the lining has healed and meals feel comfortable.
• Selenium: Here, I need your help a bit. Do you have a slow Thyroid? If so, try selenium 8-12 weeks and see if your thyroid markers improve

Spacing and timing with duloxetine

• Bitters: take just before meals (1–2 minutes).

• Enzymes: sandwich method. I think you know what I mean!

• Zinc-carnosine and DGL: best taken about 15–30 minutes before meals.

• Selenium: with food (to avoid nausea).

Keep all supplements at least two hours apart from duloxetine to avoid interference with absorption. Morning or lunchtime is often best for the supplements, with duloxetine at a consistent time of day that suits your schedule.

4. Next phase
If things continue to go well, the next phase is about maintenance and reconditioning. Assess by how symptoms improve, but if the time is right, you could gradually reduce support while expanding your food range and seeing how the gut performs on its own.

For now: Continue making one small change at a time. I think you’re doing excellent!

Daniel

Hi Raahema,

That’s a really good question. Testing would be the only way. H. pylori can irritate or even thin the stomach lining, so it’s important to wait until healing has taken place before reintroducing Betaine HCl.

Here are a few tips to know if you are ready to test:

• The burping, bloating, or burning sensations have fully settled.

• You can eat without that heavy, slow-digesting feeling in your upper abdomen.

• There’s no tenderness or nausea after meals.

Even after H. pylori is gone, the stomach lining may still need time to heal. That’s why working with a healthcare practitioner is wise before restarting Betaine HCl: it can aggravate any remaining irritation if introduced too soon.

Yes, what you describe is actually very common. After a longer period of limited foods, the gut can become hypersensitive and, like you described, almost like it “forgets” what a normal variety feels like. The digestive nerves and immune cells in the lining can react to reintroduced foods simply because the system has been quiet for a while. It doesn’t mean you’ve caused harm or that the food itself is suddenly bad; it’s more about retraining tolerance slowly.

You’re absolutely right to take the hint and focus on settling things again first. It’s important to wait until the discomfort has completely passed before testing that food again. Once your gut feels calm and predictable for a few days, you can reintroduce the same food in a very small amount and build up gradually. Each small exposure helps the system relearn that food is safe.

Increasing Iberogast a little is a good step as long as it continues to feel comfortable. Keep meals warm, simple, and well-chewed, and give your gut time to rebuild its confidence.

Hey @Raahema ,

You’re right about Betaine HCl, but I’d hold off for now. When there’s still an active H. pylori infection, the stomach lining is often irritated or inflamed. Adding acid at this stage would feel like pouring lemon on a wound, too harsh before the tissue has a chance to heal. Once symptoms calm down and the infection load is reduced, that’s when reintroducing gentle acid support can help digestion recover.

About the supplements you mentioned:

Garlic and curcumin have shown in some small studies to help reduce H. pylori activity, but on their own they won’t eradicate the bacteria. Think of them as helpers, not the main treatment.

NAC (N-acetyl cysteine) has mixed results. Some research suggests it can help break down biofilms and improve treatment, others find no significant benefit. It could help, but on its own it won’t eradicate H. pylori either.

Feel free to add these foods and supplements, they can be supportive tools.

When the trigger is an environmental allergen (dust-mite, pollen, cat, mold), the functional-medicine goal is twofold: calm the whole system now, and retrain tolerance long-term if we can. Here’s how I’d explain it to a client.

First, natural relief that actually helps: make the bedroom the cleanest air in the house. Think HEPA air filter, dust-mite covers on pillow and mattress, bedding washed hot once a week, damp-dusting, pets out of the bedroom, good ventilation, dehumidifier if the room feels damp(see my earlier reply). Do a simple nasal routine: isotonic saline rinse morning and night. These two steps alone often drop symptoms fast because you’re lowering the “histamine bucket” where you sleep.

Food can push that same bucket up or down. Try a short low-histamine check for 10–14 days: fresh-cooked proteins, same-day carbs, lots of simple veg and olive oil, pause alcohol and the big histamine hitters like aged/fermented foods and long-kept leftovers. It’s not forever, just a reset while you see what changes.

Where do quercetin and stinging nettle fit? They’re like good fire extinguishers: they soothe mast cells and histamine signaling and can make you feel better, but they don’t retrain the immune system’s memory of “cat = danger.” So you’re right: they don’t fix the root by themselves. They’re tools for symptom control while you work the plan. If used, I tell clients to start one at a time, low and slow, follow the label, and check meds first. Quercetin has benefits above antihistamines: they dont make you feel foggy and tired, but quercetin can interact with some antibiotics and blood thinners; paired with bromelain quercetin gets absorbed better, but avoid bromelain if there’s a pineapple allergy or you’re on strong anticoagulants. If someone flares with fermented foods or restaurant meals, a DAO enzyme before those meals can be helpful as a temporary crutch; note that many DAO products are porcine-derived.

Gut and immune “terrain” still matter even for an environmental allergy, because a leaky, irritated gut or poor sleep/stress rhythm keeps mast cells jumpy. I often layer in gentle gut supports (enzymes if meals sit heavy; zinc-carnosine or DGL if there’s reflux/upper GI irritation; glutamine if someone tolerates it), plus an omega-3, vitamin D to the person’s sweet spot, and a histamine-friendly probiotic profile (seeking health has good ines). Go slowly if there’s SIBO history. All terrain work should be personalized and started one change at a time.

Now, immunotherapy. My stance: if testing clearly shows a single or few meaningful environmental triggers and symptoms actually match real-life exposure, allergen immunotherapy (shots or sublingual) is one of the few disease-modifying options we have. It teaches tolerance; it’s not just a band-aid. It is a commitment over years and only works when the target is right, and it doesn’t replace the terrain work above. Safety is generally good with proper oversight. So, I like to lower total load for a few weeks, run targeted IgE testing if that hasn’t been done, and if “dust-mite” or “grass” lights up and the story fits, add immunotherapy for long-term retraining while you keep the environment and habits clean.

If I turn this into a simple starter plan for a client with an unknown environmental allergy, it looks like this: two weeks of bedroom reset + nasal care + low-histamine food reset, track symptoms daily from 1–10; keep anything that clearly helps. Add one calm-the-bucket tool at a time if needed (vitamin C, quercetin, nettle, DAO for “risky” meals), checking interactions first. In weeks 3–6, support gut lining if digestive flags exist and tidy sleep, stress, and movement. Then do targeted allergy testing guided by the story. If a major trigger is confirmed and life is still limited by symptoms, have a real conversation about shots vs drops, and decide based on convenience, safety, and preference.

Bottom line: yes to immune terrain and histamine-load reduction now, yes to immunotherapy when a clear allergen is identified and symptoms matter, and no, quercetin/nettle don’t “retrain” the immune system, they buy you comfort while you build tolerance and precision

’m missing key background (what’s already been tried, how severe his symptoms are, and how they affect his days), so I can’t judge treatment choices for him. I can only try to explain from the meds what your doctor might be thinking. A good response to cetirizine is a clue that histamine is involved, but in conventional medicine it is not proof of allergy. Allergy is diagnosed by history plus testing. For skin testing, antihistamines usually need to be stopped for 5–7 days beforehand

Hey @naslam1603 ,

Depending on the vitamin D dosages you are looking for, you could look into the next brands:
– Metagenics (just click here)
– Sunday’s Naturals (just click here)

I think the last one would be the best choice. It has the MK-7 in the right form (the trans-isomer), and you can choose different strengths. Metagenics uses the brand MenaQ7 to deliver their MK-7 and MenaQ7 uses the trans-isomer as well, but Metagenics didn’t put it on their bottle. Metagenics is a brand with a good reputation, however I couldn’t find a public report about screening for heavy metals and other polutants. I could find such a report for Sunday’s Naturals… However I’m not sure if you could order this in the UK.

Both use MCT oil as a carier oil to transport these vitamins into the body.