[Daniel]

Hey ,

I can’t for sure know why her doctors recommended a plant-based diet. They could have their own thought process which I can’t speak to. In my opinion, meat can fit. The most important factor is to keep the diet free from additives, toxins, gluten & dairy, and food sensitivities and full of nutrients. If this person is on a vegan diet for example this diet should still meet those requirements.

I do believe going dairy free would be important.

The labs you have attached are helpful. Here are some things about her unique case that stand out:

Important Nutrients
She is low on folate and her labs show clues for a low vitamin B6 as well. I don’t know if she is or has been using oral contraceptives, but the need for B vitamins goes up with the use of oral contraceptives, especially vitamin B6. I would also recommend getting her serum vitamin B12 above 600.

After supplementing for a while with B6, I would retest her liver enzymes as well. They are low, which is common with a B6 deficiency. This could mask a struggling liver.

Her globulins are on the lower side as well. Globulins are a group of molecules which can have different roles in the body. For example, Globulins can bind to hormones. Examples are Sex Hormone Binding Globulin (or SHBG), Thyroxine Binding globulin (TBG) and Cortisol Binding Globulin (CBG).

Globulins also contain Immunoglobulins, which are antibodies produced by the immune system. She might either be using them a lot or struggling to make them. Getting enough serum vitamin D, vitamin B12, folate, zinc and vitamin A is important to produce white blood cells. Make sure these nutrients are in her diet.

Her vitamin D levels aren’t really low, but with auto-immune diseases, we see often that a little higher levels can temporarily bring relief to flares. Here is a handout about vitamin D supplementation if you’re interested.

Keep in mind that for the final conversion of vitamin D, magnesium is required. Serum magnesium is reflective of the amount of magnesium that has been in her diet for the last couple of days. This is why we usually recommend RBC Magnesium as a test since it is reflective of the amount of magnesium that has been in her diet for the last couple of months. We like to see magnesium levels in the upper third of the reference range. If she was consuming her regular diet before the measurement, she might need more magnesium.

Gut Healing
I know I mentioned this in my previous reply, but I can’t stress this enough. She would probably benefit from getting more insight into gut health. There is a good chance a leaky gut is at play. This can be caused by stress, elevations in zonulin (which occur when we eat products that contain gluten) or some form of dysbiosis. If she had ever removed her gallbladder, this is something important to know as well

Joint Pain?
There are definitely some auto immune issues going on. Does she also complain about joint pain? In this case, proteolytic enzymes like Intenzyme Forte from Biotic Research can help to bring some relief. Let me know if you want to know how to use the enzymes if she needs them. There is a protocol she could use. This handout might be helpful as well.

[Daniel]

,

There are electrolytes in tea, although the amount is low. I wouldn’t rely on it as a source for electrolytes. Unfortunately, because it would be an easy add indeed!

[Daniel]

Hey ,

Electrolytes
If you suspect that electrolytes are the problem I would recommend you measure potassium and sodium.

CBC and MCV
A CBC would be helpful to determine if anemia might be at play. In a CBC markers like the red blood cell count, MCV, MCH, MCHC, hemoglobin and hematocrit (The fraction of the blood composed of red blood cells) are included.

Low Vitamin B12 can cause the size of the red blood cells to increase, while low iron can cause the size of the red blood cells to decrease. The MCV (The average size of the red blood cells) could be looking normal when the body deals with a decrease in vitamin B12 and iron at the same time. Therefore I recommend my clients measure B12, iron and ferritin as well.

Thyroid Lab Values
Your doctor might want to rule out imbalances in thyroid hormones. TSH, T4 and T3 are often measured for this reason. If you want to examine your thyroid health, you might want to watch this video well. It explains what in functional medicine is considered a full thyroid panel. If you are experiencing symptoms related to hypothyroidism, a full thyroid panel might be worth doing. Hypothyroidism can also cause you to feel dizzy when you’re standing up. This video explains what other symptoms may present in the case of a slow thyroid.

Stress
Usually, cortisol is measured as a single blood test. However, cortisol follows a diurnal pattern. It is supposed to be high in the morning after waking up and decrease during the day. A single measurement, which is the standard in regular medical care, won’t tell you how cortisol behaves during the day. The DUTCH test would be a better test to asses cortisol levels since it follows cortisol production during the day.

When electrolyte imbalances are at play and you’re doubting that drinking too much water was the cause of the mineral imbalance or if you are recognizing other symptoms of adrenal disbalance, this test could reveal if an adrenal imbalance is at play.

… and I’m glad you’re enjoying the content here!

[Daniel]

Hey ,

You’re asking a good question! There can be different reasons for getting lightheaded when standing up. The term for this is ‘orthostatic hypotension’.

Salt and other soluble molecules attract water. When the body loses a lot of electrolytes, loses the ability to hold water. This can happen when you’re drinking a lot of water. There can be other reasons too that you might want to consider when drinking electrolytes doesn’t solve the problem. I will give you some tips on how to replenish your electrolytes below.

Here are some other reasons that could cause you to get lightheaded when you’re getting up:

Chronic stress
The body regulates potassium and sodium through a hormone called ‘aldosterone’. Aldosterone, just like the stress hormone cortisol, is made in the adrenals. In fact, the two hormones are regulated by the same hormone produced in the brain called ACTH. In stressful periods initially, the brain produces more ACTH leading to elevations in cortisol, however…

when stress continues, the brain reduces ACTH. The body knows that prolonged elevated stress hormones take a toll on the body. For example, elevations in stress hormones can cause suppression of the immune system. Since ACTH is also needed to produce Aldosterone, chronic stress can cause loss of electrolytes as well, which causes blood pressure to drop.

You might associate elevations of cortisol and stress hormones with emotional stress. This is true, but besides emotional stress, there can be physical forms of stress. Examples are pain, infections and sleep deprivation. Bernadette explains it well in this video.

With stress, other symptoms could also appear, like exhaustion, depression and getting sick more easily. When you’re in your reproductive years, it could also influence your cycle. Chronic stress can also cause lower production of progesterone. For a complete list of symptoms, I would recommend you watch this video.

In this case, drinking electrolytes can help, but it won’t fix the root cause.

Hypoglycemia
Low blood sugars can also cause low blood pressure. Blood sugars can be low because of beginning insulin resistance or simply not eating enough. This post I wrote a few weeks ago explains in more detail how this works.

Anemia
To maintain healthy blood pressure, we need blood volume. When we are unable to produce enough red blood cells or when we lose a lot of blood (for example after blood donation, blood loss during heavy cycles or blood loss from wounds after an accident), blood volume will lower and can cause low blood pressure. Did your doctor check your red blood cells? If so, sharing your labs could provide us with more insight and it will help us to give you more personalized advice.

Nutrients we need to produce a healthy amount of red blood cells are vitamin D, vitamin A, zinc, folate and vitamin B12. Vitamin D, folate and vitamin B12 can be checked by your doctor. Iron is also needed to give volume to red blood cells.

Iron deficiency can also cause low blood pressure. Iron is needed to produce hemoglobin which is a molecule that gives size to red blood cells. Without hemoglobin you could therefore lose blood volume which could cause orthostatic hypotension as well.

Medications
When you’re using medications like beta blockers, ACE inhibitors, diuretics… If you’re using other medications, I would also read this post about low blood pressure which provides causes and tips about low blood pressure in general.

How to raise electrolytes
There are different ways to raise electrolytes. Sole is a salt solution which is easy to make.

1. Add 1 tsp of Himalayan salt or (Celtic) sea salt to clear water into a glass water bottle which is about 750ml.

2. Keep the jar on the counter and put a piece of wax or parchment paper between the metal lid and the jar. Salt corrodes metal so it will rust with time.

3. Drink during the day to replenish your electrolytes.

If your like to use supplements, this is also an option. In this video, you can find several good options.

[Daniel]

Hey ,

It also depends on what brands she prefers and what type of supplements. If you could share what specific brands/products she prefers, I might be able to help better. If she is just searching for some general advice. I think  did some really good recommendations. I use some of these websites as well.

Welldium sells brands like Designs for Health, Pure Encapsulations, Seeking Health, Thorne and more. Although I’m from Europe and there are some great products, I stick a lot to these brands myself.

iHerb is often a good online shop in Europe. It has a wide range of supplements and is easily accessible to a lot of people. Although brands can change from country to country often you can find brands like now foods, Jarrow, Life Extension, and Garden of Life, but it sells also some products of Thorne.

A lot of these brands are sold internationally. If she prefers popular European brands, this can be difficult. Even when I’m travelling to Germany or Belgium (right next to The Netherlands – where I live) the brands will differ a lot. Since I am based in The Netherlands and Portugal is on the other side of Europe, it is hard for me to estimate what is accessible there unfortunately.

[Daniel]

I don’t have personal experience with this product from Pure Therapro called Elite IgG, but these immunoglobulins look good. Perhaps you could give this one a try.

[Daniel]

,

Aloe vera gel is often made from the inner leaf and can help. The root seems beneficial as well (see this research).

You could use regular extra virgin coconut oil. The lauric acid and capric acid in the oil have anti-microbial effects. Some MCT oils (made from coconut) have even higher lauric and capric acid content. I like the MCT oil from Aman Prana for example. Make sure you choose the premium version. You can find the oil here.

Famotidine is an H2 blocker and helps reduce stomach acid. The ‘H’ in H2 stands for histamine. Histamine is involved in stomach acid secretion. This is why medications like famotidine – which block the receptors where histamine in the stomach binds to – can reduce stomach acid production.

H1 blockers are often used as antihistamine medications. The type of receptors H1 blockers work on are however located differently (for example on T cells). To my knowledge famotidine is only an H2 blocker and not an H1 blocker. H2 blockers like Famotidine can make H1 blockers more effective (see this study) but shouldn’t affect the H1 receptors.

I know… a difficult answer!

[Daniel]

Hey ,

For some reason I didn’t see the pictures the first time, but these pictures help!

Dermatitis just means that the skin is inflamed. The cause can indeed be fungal or bacterial. And your right, this can be related to gut problems. Supporting the immune system with nutrients like vitamin D, vitamin A, zinc, folate and vitamin B12 (which you already do) helps.

On top of that, the blue discoloration on your ankles could be an indication of poor blood flow (although a doctor should be the judge of that). Poor circulation means that it is harder for white blood cells to reach your feet. Improving circulation can be done by exercise or moving more. If you have an inactive lifestyle, simply walking could improve blood flow a lot!

There are some natural remedies you could try as well. Coconut oil has some anti-microbial properties. Just apply the oil to your skin.

Aloe vera gel has antimicrobial properties and could help as well.

Some people use tea tree oil since it has anti-microbial properties as well.  In some sensitive persons tea tree oil can however cause irritated skin. Most people however don’t experience skin irritation. Just dilute the oil a bit since it is very strong with a carrier oil (olive oil for example).

I hope this can help!

[Daniel]

Hey ,

Excellent question! I regret to hear she had to see so many doctors. Often part of the health journey becomes eliminating options, which can take unfortunately a while. As a result: the last doctor is always right!

Getting to the true root cause of her unique case will help get her some relief. Psoriasis is an autoimmune disease. T-cells attack the body’s skin cells. This attack causes the body to make new skin cells more often. The extra skin cells pile up on the surface of the skin, and you see psoriasis.

With an autoimmune disease, we often see increased gut permeability (aka leaky gut). Often gut healing plays an incredibly important role.

It is well understood that poor bile function plays a role in many cases of psoriasis as well. Bile helps break down LPS or Lipopolysaccharides – which are ‘body parts’ of bacteria living in the gut that can cause problems in the body when they enter circulation.

Here are some key things to focus on:

Nutrient Deficiencies
The immune system needs nutrients like vitamin B12, folate, zinc, copper, vitamin D and vitamin A. With gut problems absorption of these nutrients can be impaired. Bile, which helps to bring balance to the gut microbiome through the regulation of the pH degree in the gut, is also needed for the absorption of fat-soluble nutrient vitamin A.

Getting her serum levels of vitamin D checked and bringing it up to 70 ng/ml if necessary is what I focus on with my clients.

Dysbiosis
Often some form of disbalance in the gut microbiome plays a role. Clostridia, yeast overgrowth, a parasite, or simply an insufficiency of or imbalance in indigenous gut bacteria can cause some malabsorption of nutrients or damage to the gut lining.  GI maps is a test that can provide you with insight into what type of disbalance is at play.

Bile flow
As I mentioned earlier, bile flow can be impaired in people with psoriasis. In the library of B Better you can find some excellent tips on how to improve bile flow (just click here). A liver enzyme panel can help examine if some biliary congestion might be at play. Testing for lab values like ALT, AST, GGT, alkaline phosphatase and bilirubin can help determine if this might be at play in her case.

Leaky Gut
If the gut lining is damaged (which we see often in auto-immune patients) helping to repair the gut lining becomes part of the healing journey as well. Zinc carnosine,  l-glutamine, Vitamin D, glycine, quercetin, and/or mucilaginous herbs are all nutrients that can help. GI Relief from Thorne and DGL Plus from Pure Encapsulations are blends without L-glutamine (in some people L glutamine can cause some problems like anxiety). GI Revive from Designs for Health is a nice blend with L-glutamine you could try. For additional tips, I recommend you watch this video explaining gut healing strategies.

Stress
Stress is also an important player in auto-immune disease. Stress can lower digestive enzyme secretion and stress impacts immune function. Just remember that stress can be emotional, but there are many other stressors like for example surgeries, a major car accident or other physical trauma, other autoimmune activation, pathogenic microbes, toxicity, and chronic viral infection.

Toxin build-ups
Toxin build-up can be caused by toxin exposure or poor detoxification abilities. In people with exposure to mercury for example (which you can find in amalgam teeth fillings) we often see candida overgrowth since candida can scavenge mercury and provide some protection against this heavy metal.

Food sensitivities/Gluten & Dairy
Last on the list, but maybe one of the first things to do are avoiding food sensitivities. Food sensitivities cause the immune system to be busy as well and cause inflammation in the body.

In people with leaky gut or people who experience auto-immune disease, I often recommend avoiding gluten & dairy in total. In the first period, if she has it in her, I would recommend going even grain free. Just temporary.

Can a plant-based diet be part of the cure?
Sure! Why not? Keep in mind that a plant-based diet often provides us with lots of copper which can prevent zinc to be absorbed and cause low zinc in the body.

In these diets, we often remove a lot of ‘junk’ where part of the magic comes from. Clean plant-based diets are full of nutrients and can help as well.

Just keep in mind that some of these root causes might not be addressed by plant-based diets. No amount of vegetables will reduce stress and increase vitamin D. In the case of yeast/mold/parasites in the gut a plant-based diet might not be enough as well.

I hope this provides you with some information on where to start!

[Daniel]

Hey ,

Lab results can provide more insight into what might be at play. If you feel like sharing your husband’s results, we could give more targeted advice.

If there are any other symptoms present, these can help us find clues as to why your husband can’t lose weight as well. For example

Blood sugar dysregulation:
Blood sugar dysregulation can cause weight gain and can make it hard to lose weight. With insulin resistance, other symptoms can present as well, like:
• Frequent urination
• Increased thirst
• Fatigue, especially after eating a meal
• Blurred vision
• Cravings for sugar
• Insomnia
• Memory problems

A more detailed description of symptoms you can find in this video and this one as well.

Hypothyroidism
When we aren’t able to produce enough of the hormone free T3 (fT3) we call this hypothyroidism. This makes it hard to lose weight as well. Other symptoms that could present are:
• Feeling cold
• Hair loss
• Fatigue
• Thinning of eyebrows (especially the outer third of the eyebrow)
• Constipation (not able to get one bowel movement per day)
• Dry skin

A more detailed list of symptoms you can find here.

Stress
When the body experiences a lot of stress, this can interfere with the function of fT3. The body can produce in this case more reverse T3. Reverse T3 looks like free T3, but is slightly different. It fits on the same receptors as free T3, but it doesn’t cause activate it in the same way as free T3 causing metabolism to slow down.

Inflammation caused by stress can also reduce the body’s ability to form T3 from T4 (the metabolic inactive form of thyroid hormone)

Things that can cause a stress response, besides emotional stress are:
• (Chronic) Infections
• Sleep deprivation
• Inflammation
• (Chronic) pain

It’s usually not the first step for a doctor to measure minerals when people experience problems with losing weight. Was there another reason perhaps to measure minerals? What minerals were measured?

Digestive enzymes can play a role in digestion. The pancreas (which produces insulin to regulate blood sugars), when inflamed, can produce fewer pancreatic enzymes. A high-stress state can also negatively influence enzyme production.

What digestive enzymes were measured? And can you help us understand why these enzymes were measured in the first place?

If it was a regular doctor you have spoken to, it might be that your doctor measured liver enzymes. Although the liver is involved in digestion, liver enzymes don’t help digestion but help indicate when the liver struggles. Usually they are also measured for different reasons. You will find on your lab results abbreviations like ALT(or ALAT), AST (or ALAT) and GGT. Alkaline phosphatase is also often measured in a liver panel.

[Daniel]

Hey ,

There could be several reasons why skin can get discoloured. Eczema, allergies, some fungi, viruses and bacteria… all these reasons can cause discolouration of the skin. Skin can lose its colour when melanin production gets prevented. When the circulation is impaired and blood doesn’t go back to the heart, this can cause discolouration as well. 

There are many reasons, but perhaps you could tell us more about what discolouring looks like since there are many types of discolouration.

[Daniel]

Hey ,

When symptoms in winter appear (provided you live in an area where you might see less sunlight) I’m always curious about your serum vitamin D levels. As you may know, vitamin D is a nutrient/hormone needed to produce white blood cells.

The reason why corticosteroids like Betamethasone Valerate are prescribed is because corticosteroids reduce inflammation. Corticosteroids resemble the stress hormone cortisol. This is why a higher intake of corticosteroids can also reduce the body’s need to produce cortisol.

Am I understanding correctly that you have experienced acid reflux after using Betamethasone Valerate? This could be related since stress hormones impact the function of your digestive tract. Acid reflux is also seen when people experience a lot of stress for example.

You might want to check your vitamin D levels. I usually would like my clients to have serum vitamin D levels around 70 ng/ml.

Other nutrients that are needed to produce white blood cells are zinc, vitamin B12, folate and vitamin A.

Often debris trapped in pores can cause different kinds of skin issues. Topical retinoid creams (they contain vitamin A) might be helpful since they can help unclog and loosen pores. Warm baths can help as well. Make sure that your legs aren’t covered by tight clothing.

Hydration is important as well for the skin. This sounds simple and basic, but for skin care it is important.

Other nutrients that might be helpful with skin rashes are magnesium and B vitamins (B9, B12 and B6 are key for methylation, but also keep in mind that B2, B5 and biotin are important for skin health.)

Did your doctor take a look at your liver enzymes?  If you see ALAT (or ALT), ASAT (or ALT), bilirubin and alkaline phosphatase have been measured, you might want to share those results with us. If the hepatic-biliary system struggles, this can influence skin health as well. In this case, supporting liver and bile function can be helpful as well.

A lot of the recommendations for acne could be helpful for you as well. Therefore this handout might be helpful.

[Daniel]

Hey ,

Am I correct to assume sleep is the most important thing for you?

If it is, the Oura ring can provide you with the insight when your sleep is improving. It also is pretty accurate in recognizing deep sleep vs being awake.

It can also help you with what habbits (for example what behaviours in your evening) will influence the quality of your sleep. You will need to log these behaviours of course.

It’s just not really accurate in recognizing rem sleep/light sleep. This problem exists with most sleep trackers. I think the Oura ring is pretty good, but only in recognizing REM sleep it isn’t the best.

[Daniel]

Hey ,

Good question. Since it is a general question, I can only provide you with some guidelines.

To me, it depends on how the person feels. If this person has symptoms I might give a different answer versus if a person wants to learn how to optimize health.

If someone wants to reduce inflammation, removing food intolerances can help. Foods we often eat can become a problem when digestion is impaired and cause inflammation. Gut-related symptoms like constipation, diarrhea, bloating, gas, and cramps become clues to asses if I would like to do a food intolerance test. Auto-immune disease, joint pain, skin problems like acne, psoriasis, rashes and eczema as well.

When removing foods brings relief, addressing the root cause becomes important as well. Immune support and gut healing are often part of the health journey.

Something to keep in mind when doing a food intolerance test: the body can also react to lectins, mycotoxins, chemical additives, histamine and other triggers in food which will not always show up on a food intolerance test. This is why the gold standard is still an elimination diet.

If the goal is improving general health, variety, in general, would be better. If you would like to examine the impact of the current food pattern on how the immune system reacts a food intolerance test will provide you with insight. 

Just remember that other foods could still be a problem. Foods that this person hasn’t eaten for the last few months, won’t show up on a food intolerance test. 

If you like to know more about how this person would react to other foods, you could ask this person (if this is optional) to eat different foods for a few days before taking the food intolerance test. This might bring up other intolerance that otherwise won’t show up on the test.

I hope this helps!

[Daniel]

Hey ,

It also depends on what you like to learn from the Oura ring. For example, the Oura ring measures HRV which I think is an important measure that can help you learn if you experience stress. The HRV measurement is accurate when you are not moving too much, but becomes unreliable when you’re moving a lot.

For tracking sleep it can estimate well if you are in deep sleep. It is less accurate (compared to an EEG measurement) in estimating if you are in REM and light sleep. If sleep is something you like to track, it is pretty good, but not the best.

One important detail: when you choose an Oura ring, make sure the size is right. If your ring is too big, the readings become inaccurate.