Hey @naslam1603 ,

It’s a good question with a little nuance to it:

Both MK-4 and MK-7 are vitamin K2, but MK-7 has a clear edge. It stays in your blood for days, so even small daily doses keep levels steady. Studies show MK-7 not only strengthens bones but also helps protect the heart by keeping arteries flexible and reducing calcium build-up. That doesnt mean MK-4 won’t give you the cardiovascular protection, but it’s less researched.

Research dossages in studies on mk-4 are however much higher (45 mg compared to 90-180 mcg for mk-7). I dont think there are many supplements providing this amount of mk-4. That’s why i usually advise people mk-7. MK-7 can also convert to MK-4 in certain tissues of the body, however, the other way around will not happen.

Does that answer help you?

Hey @Kkol ,

Thanks for raising this. It’s a smart question, because omega-3s are one of those topics where the headlines often confuse more than they help.

I’ve taken a look at the BMJ Medicine study, and maybe this answer can help you to give the right weight to this study

First: how much weight should we give to this study?

This BMJ Medicine paper was an observational study. That means researchers watched a large group of people (~415,000 in the UK Biobank) over many years and looked at patterns: who took fish oil, who didn’t, and what happened to them.

Observational studies are powerful for large numbers and long follow-up, but they cannot proove cause and effect. They only show correlation. Classic example: if you study where people die, you’ll find that many die in hospitals. But the conclusion “hospitals cause death” would obviously be wrong.

That matters here, because the study has several built-in weaknesses:

• Self-reported supplement use. We don’t know dose, formulation, or quality. One person may have taken a single low-dose capsule occasionally, another several grams daily, but the study lumps them together. We don’t know dose, formulation, or quality.
• Hidden Variables: Supplement users differ from non-users in many ways (diet, income, lifestyle, medications). Even with adjustments, you can’t eliminate all bias.
• Outcome measurement limits: Atrial fibrillation (AF) and stroke were identified through hospital records. If someone had mild, brief, or symptom-free (silent) AF, or a small stroke that never reached the hospital, it wasn’t recorded. This means the study will miss cases. Also, people who see doctors more often get diagnosed more, which can inflate differences between groups that aren’t really due to the supplement itself.
• Contradictions with other research. Other analyses of the same UK Biobank and different cohorts sometimes found protective or neutral effects of fish oil. Differences in statistical models and definitions may explain why, but it shows results aren’t consistent.

This study is meant to see a signal, but it is not meant to be proof of anything.

What the study actually found

• People without heart disease who took fish oil were more likely to develop AF and had a slightly higher stroke risk.
• The relative risk sounds big in headlines, but in real numbers it’s ~1–2 extra AF cases per 1,000 people per year.
• People with existing heart disease sometimes did better: lower risk of progressing from AF to serious events, or from heart failure to death.

So the message is nuanced: it’s not “fish oil is bad.” It’s “fish oil may shift risks depending on who you are and how much you take.”

Dosage & supplement quality (things the study didn’t measure)

• The Biobank study had no dose data. Some participants may have taken one capsule a week, others four a day. We just don’t know.
• Other research shows the AF risk grows mainly at higher doses (>1 g/day EPA+DHA): the kind you’d get with prescription fish oil or multiple capsules.
• Quality matters. Cheap fish oils may contain oxidised fats or contaminants, which add stress instead of helping. The best are molecularly distilled oils (purified, concentrated, tested for heavy metals).

But the more important question is, in light of this study, how could the advice change?

A practical plan for fish oil use

If you like a food-based approach, start with food. Two portions
of oily fish per week (salmon, sardines, herring, mackerel). This gives
steady omega-3s plus selenium, vitamin D, and other nutrients.

Supplement if needed, but match to your situation:

• General health, no heart disease: keep dose modest. This avoids the high-dose AF risk seen in trials.
• High triglycerides or diagnosed heart disease: this is where fish oil (sometimes in prescription form) can help, but it should be guided by your doctor.
• History of AF or palpitations: Be cautious with higher doses, and involve your cardiologist before starting.
• Choose quality. Molecularly distilled, third-party tested. Store away from heat and light. If it smells fishy, it’s oxidising: stop using it.

Take-home truth: Observational studies raise questions, and not verdicts. This one adds to the discussion, but it doesn’t overturn decades of evidence on omega-3s. The real risks – and benefits – depend on who you are, what dose you take, and the quality of what you use.

Or to put it in a metaphor: An observational study is like watching ships at sea. You may count how many sink, but you cannot blame the ocean without knowing their cargo, their captain, or the storms they faced.

Numbers alone are never the cause

Hi @naslam1603 ,

Thank you for sharing your labs!

Here is what stands out to me in your lab results:

– Your ferritin (storage iron) is a little lower in the last lab, meaning it’s slowly dropping after the infusion

– Your iron in circulation (serum iron and transferrin saturation) is low, so your body doesn’t have enough usable iron to build healthy red blood cells.

– Your hemoglobin is also low, which confirms that new red blood cells aren’t being made as we’d expect.

– And your kidney function has dipped from the 80s to around 66, which is important because kidneys help signal the bone marrow to make red blood cells.

What this could point at:

1. Tiny daily blood losses: Even microscopic blood in the urine can add up over time and be enough to drain iron. This alone could explain your situation, so the cystoscopy your doctor suggested is a sensible next step.

2. Connection with the kidneys: If the kidneys aren’t working at full strength, they may not send out enough of the hormone (EPO) that tells your body to make red blood cells. That means iron can be there, but the “green light” to use it is missing.

3. Inflammation that leads to an “iron block”: Sometimes the body keeps iron locked in storage and won’t release it into the blood. Mild inflammation, chronic conditions, or even infections can play a role here. Your white blood cell count and your T-cell subsets (CD3, CD4, CD8) and the CD4/CD8 ratio are in healthy balance, with only a small dip in CD4. Even with that, the overall pattern makes chronic Lyme less likely… and i should stress this LESS likely… because it should always be interpreted alongside symptoms.

So yes, ongoing microscopic hematuria could explain why the iron isn’t “holding,” especially if it ties back to kidney changes. The dip in kidney function suggests there may be more than one factor at play. The reassuring part is that your immune markers look steady.

When hematuria is persistent, it’s usually traced back to things like:

• kidney-related causes (stones, infections, inflammation and structural changes),

• urinary tract causes (bladder inflammation, prostate issues in men and other stuff

I think getting to the bottom of the hematuria might help you understand the picture better based on what you could share in this post

Hey @Bahareh !

I hope you liked Europe. You were in Germany, right? By the way, I think it’s great that you’re paying such close attention to the changes in your cycle. That kind of awareness can make a big difference during peri-menopause, because it helps spot shifts early and understand what your body is trying to tell you.

At 48, it’s very common to see cycles shorten a little (even if they’ve been steady for years). A shorter cycle usually just means the luteal phase was shorter. This can happen for a few reasons:

• Ovulation “quality”: Even with progesterone support, the luteal phase depends on how strong ovulation was that month. If the follicle doesn’t produce much progesterone on its own, the cycle may still end earlier. Supplementation smooths symptoms, but it can’t completely “force” a full 14-day luteal phase if the ovary didn’t release strongly.

• Stress and lifestyle: Travel, disrupted routines, changes in diet can all affect the brain-ovary communication (the HPO axis), just like stress. It’s likely that cortisol and circadian shifts can change ovulation timing, which shortens the whole cycle.

• Peri-menopause itself: cycles naturally become more variable, and shorter luteal phases are often one of the first signs.

Most of the time, this isn’t concerning. What matters is the pattern: if cycles are consistently under 21 days, if bleeding becomes heavier, or if there’s unusual spotting, that’s the moment to look deeper.

Since you’re already on progesterone and DHEA and monitoring every 3 months, you’re doing already a lot of stuff that helps. The fact that it happened during a less structured period makes it likely that this was just a temporary blip. Do your regular check-up. Once you have your routine back for a few cycles, and the short cycles still persist, that’s the moment to see if your hormone support or dosing needs a little adjustment.

Still, I’d be curious to hear:

• Did your flow or symptoms feel different with those shorter cycles?

• Any changes in sleep, mood, or energy around them?

• Now that you’re back in your normal rhythm, do you feel things are settling?

Bottom line: what you’re seeing is not necessarily a red flag. What matters most is the overall pattern.

It sounds like you had a really frightening experience. Sudden blood and clots in the urine can be very alarming. I’ve looked through the results you attached, and here’s what they show:

• The urine test confirmed blood and lots of white cells, which points to infection or inf s) was in the urine, also fitting with infection.

• Kidney function (creatinine, eGFR) looked normal, so your kidneys work fine, indicating the infection could be in the bladder.

• Blood work was mostly fine, though hemoglobin was just a touch low, possibly from the bleeding episode. But it’s good to get that measured in a few weeks to rule out starting anemia.

• The urine culture grew only a small amount of bacteria, but the ER doctor noted the first antibiotic (clavulin) wouldn’t work for that bug, so they switched you to a different one.

Why the clots and bleeding?
Even a not-so-severe bladder infection can sometimes cause bleeding if the bladder lining gets irritated. Passing clots usually means the bleeding was coming from the bladder itself. Other possibilities (like stones, but also other stuff) are why a urologist’s follow-up is important.

The reassuring part:

• Kidneys are fine.

• No fever or signs of the infection spreading.

• The bleeding has already started settling down with fluids.

When to go back sooner:
If you get a fever, worsening pain, can’t pee, or the heavy bleeding returns, don’t wait: go back to the ER.

Practical tips:
I would also recommend reading this next article on the forum — it’s about natural remedies for UTIs, which can give you more ideas for prevention once this infection is under control. You can find it here.

Just one last question: were these labs measured fasting?

I hope you will feel better soon!

Daniel

Hey @naslam1603 ,

Let me help you with “the drawing board”! I’ll give you some other tips as well (some are new, some you already know… but perhaps providing you more context might help you make a better plan. The plan is based on the tough trio: low stomach acid, delayed gastric emptying, and mucosal sensitivity.

Alcohol-Free Digestive Bitters:

If you’re sensitive to alcohol or prefer to avoid it, there are still effective alcohol-free bitters that support bile flow and digestive enzyme signalling. In place of alcohol, these formulas typically use glycerin, a sugar alcohol that acts as a gentle solvent (compared to alcohol) to extract beneficial plant compounds.

Glycerin has its upsides: it’s soothing, sweet-tasting, and can help soften stools by drawing water into the colon. But it also comes with a caveat, because it’s a fermentable sugar alcohol, it may aggravate symptoms in people with SIBO or sensitive gut flora.

So as always: start low, go slow, and listen closely to your body’s response.

When it comes to alcohol-free bitters that are also safe for people with histamine intolerance, the list narrows quite a bit. But here’s one that passes my filters and is worth considering:

• Energetix Core Bitter: Contains Dandelion root, yellow dock, gentian, burdock root and is alcohol-free.

If you only have access to alcohol-based bitters, it’s totally okay to let the alcohol evaporate: just place your dose (say 5–10 drops) into a small amount of hot water and let it sit for 5–10 minutes. You’ll lose most of the alcohol but still retain the bitter effect.

Prokinetic Support (for delayed emptying)

Bitters alone might not fully restart motility, especially if inflammation or nervous system dysregulation is in the way. A gentle prokinetic can help move things along:

• MotilPro (by Pure Encapsulations): This combines ginger, 5-HTP, and artichoke extract. It’s often used in functional medicine to support gut motility without being too stimulating.

• Standalone ginger extract: Even 500–1000 mg of powdered ginger with meals can gently nudge stomach emptying and reduce that “rock in your stomach” feeling.

Gut Lining and Heartburn Support

Given your heartburn and sensitivity after protein, supporting the gut lining is just as important as stimulating digestion. Here are some options that are well tolerated:

• Zinc Carnosine: Helps repair the stomach lining and reduce inflammation. Doses around 75 mg, taken between meals, are often effective.

• GI Revive (by Designs for Health): As I’m writing this, I remember you once mentioned you couldn’t tolerate one of the ingredients. But since I’m unsure, I’ll mention it anyway and leave the choice to you. GI Revive is a strong blend of DGL, slippery elm, marshmallow, and aloe. It’s one of the best full-spectrum gut-lining formulas out there.

• MegaMucosa (by Microbiome Labs): Supports immune regulation in the gut and repairs the mucosal barrier. Includes dairy-free IgG and amino acids.

• DGL (Deglycyrrhizinated Licorice): You can chew this before meals to reduce acid-related discomfort and protect the stomach lining. Again… I remember you tried something like this, but I’m not sure anymore if you stopped this because if side effects.

• Marshmallow root or slippery elm tea: These are old-school but still incredibly effective if you prefer a gentle and food-grade approach.

Putting It All Together

Bitters might give you a gentle nudge and help you with digestion. Just start low (3 to 5 drops is enough to begin) and track how your body responds. You could try combining:

• A glycerin-based bitter 10 minutes before meals

• A small ginger capsule or MotilPro during or right after meals

• A mucosal repair agent like Zinc Carnosine or GI Revive between meals

Also, don’t underestimate the impact of post-meal movement (even a 10-minute slow walk) and meal spacing (3–4 hours between meals) to support the migrating motor complex.

Wishing you relief and a clear next step,
Daniel

Hey @naslam1603 ,

You’re absolutely right to be thinking about probiotics here. Long-term antibiotics like doxycycline can alter the gut microbiome. If you are looking for a supplement, I would probably go for a broad-spectrum probiotic like Klaire Labs Ther-Biotic Complete. Start with a low dose (for example, half a capsule, perhaps even every other day).

Although this formula is gentle, in some cases lactobacillus and bifidobacteria can cause some bloating. Most of the time this disapears over a few days as the body adjusts.

I hope this will help your mum Naveed!

Thanks for sharing her story; it’s clear she’s been through a lot. Based on everything she’s tried and her history, I’d look at this situation from a broader functional lens. Here are some key thoughts and practical tips she could consider. Let’s start with breaking down what might be going on:

Hormonal Shifts as a Root Trigger

Estrogen supports skin hydration, immune regulation, and barrier repair. When it drops (like during menopause), underlying immune issues often come to the surface. That could explain why symptoms began around 2019 and worsened post-menopause.

<strong data-start=”748″ data-end=”793″ style=”font-family: inherit; font-size: inherit;”>Food Intolerances Suggest Gut Involvement

The wide range of intolerances, gluten, lactose, legumes, and yeast points toward possible gut permeability (“leaky gut”), low microbial diversity, and maybe even mild mast cell activation. It’s not uncommon for histamine intolerance and autoimmune tendencies to appear together.

<strong data-start=”1079″ data-end=”1133″ style=”font-family: inherit; font-size: inherit;”>Immune system support

If even a small dose of betamethasone keeps the symptoms down, but symptoms return immediately after stopping, her immune system might be stuck in an inflammatory loop that hasn’t been resolved upstream (gut, hormones, mast cells, etc.)

What she can do to repair her gut:

Her symptoms and food sensitivities suggest that the gut lining may be compromised. Supporting this foundation can often reduce skin flares and immune overactivation.

Gut support stack:

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