@naslam1603 – First, I’m really sorry to hear about the loss of your brother. We’ve noticed that you’ve been quiet in the forum lately… if you’re up to it, we’d love to show our support during our upcoming community meet-up. It’s a casual gathering where we come together as a community; laugh, cry, listen, and offer support where we can.

What you’ve gone through is a huge shock, and going through something so traumatic while dealing with acute pain is a lot for your body to handle all at once. Situations like this can absolutely act as a trigger for inflammatory flares, including gout, especially when sleep, hydration, and regular meals are disrupted.

Looking at the full picture, this doesn’t appear to be just a random gout episode. There are several contributing factors that may be layering together.

We know that you already have a history of gastritis (have you been successful in weaning off the PPI yet?), which can influence digestion, mineral absorption, and gut balance over time. You’ve also had SIBO on and off, histamine sensitivity, and a fairly restricted diet. All of these can increase inflammation and affect how the body handles uric acid.

On top of that, are you still living in the same environment which has mold? Chronic mold exposure can stimulate the immune system, worsen histamine issues, and contribute to ongoing inflammation. That type of background immune activation can make the body more reactive and may indirectly contribute to both the elevated immunoglobulins and susceptibility to flares.

When we put all of these pieces together, your gout flare was likely triggered by a combination of:

• acute emotional stress and grief
• dehydration
• reduced food intake
• underlying gut imbalance
• histamine and inflammatory load
• possible reduced uric acid clearance

Your uric acid level itself is not dramatically elevated, which sometimes suggests the issue is more about clearance than overproduction. Hydration, kidney handling, insulin sensitivity, gut health, and inflammation all play a role here.

I’ve attached two resources to guide you:

• The Gout Symptom Dictionary handout lists possible contributing factors and lifestyle support for gout
• Our latest protocol “Gout Flare Relief” focuses on calming inflammation, supporting uric acid clearance, and includes suggested testing to help identify underlying drivers if flares recur.

The protocol includes steps like increasing hydration, temporarily lowering purine and fructose intake, and nutrients such as vitamin C, quercetin, tart cherry, potassium citrate, omega-3, and curcumin to help support uric acid clearance and reduce inflammation during a flare.

To answer your questions more directly:

• Given your already limited diet, I would not recommend a very restrictive autoimmune or paleo diet right now. Instead the priority should be balanced, anti-inflammatory meals that you tolerate well. The protocol above explains some temporary dietary changes to make to help reduce the flare.
• Your elevated IgG and light chains simply reflect immune activation. Environmental issues like mold can be the reason, in addition to the other factors I mentioned above. Since your doctor didn’t flag anything, this doesn’t require any new intervention at the moment.

For now, I would focus on the steps mentioned in the gout relief protocol. I know I sound like a broken record, but supporting stomach acid (with the help of a practitioner to wean off PPI) and getting away from the moldy environment (if you haven’t done so already), continue to be two major contributing factors that can have many downstream consequences.

Also, give yourself some space to recover from the stress and grief. Acute emotional trauma can have real physiological effects, and your body may need time to settle. Do you feel emotionally supported?

From a practical standpoint, I would focus on:

• prioritizing hydration consistently throughout the day (add lemon juice only if tolerated)
• eating well cooked meals even if portions are small
• following the gout relief flare protocol for short-term relief
• gradually expanding your diet as tolerated rather than further restricting it
• addressing gut support step by step
• reducing mold exposure if that is still ongoing

Note that it can take a few weeks for the inflammation to fully settle so it’s not uncommon for a gout flare to leave some residual sensitivity for a while. The anti-inflammatory support in the protocol should help with that.

Keep us posted on how the ankle is feeling and whether any of the steps above help. And please know that we are here for you, not just from a health perspective, but also as a community.

Hi @sheetalramchandani1 – I was able to open and access the SIBO/IBS program. Can I ask you to please refresh your page and try again. If it’s still not working for you, can you please share a screenshot and what device you’re using so my tech team can investigate further.

Thanks!

@shazreh – thank you for sharing that. A few things come to mind, but I have so many questions because chronic hives can have several different triggers and sometimes more than one thing can be happening at the same time.

First – can you walk us through the timing with Mounjaro…

1. When did you start it?
2. What dose did you begin with?
3. What dose are you currently on?
4. How often are you taking it?

I’m asking because GLP-1 medications can sometimes trigger hypersensitivity reactions like hives or rashes in some people, and the fact that your symptoms appeared and then got worse after you increased the dose recently makes me suspicious.

5. Also, do your symptoms show up after your injection, or is the timing not really related? Sometimes reactions can happen hours or even a day or two later, so understanding that pattern can help determine if the medication is contributing.

I also want to clarify the type of rash you’re experiencing…

6. Are the spots raised and itchy and do they move around and disappear within a day? True hives usually come and go within 24 hours and can appear in different places on the body. If the rash stays in the same place for longer, that can point us in a slightly different direction.

You also mentioned dizziness before the hives started, which is interesting. I’m asking about that because sometimes dizziness can happen when histamine or mast cells are activated in the body, not just in the skin. So it helps to know if you had any other symptoms around the same time.

7. Did you also get things like flushing, heart racing, swelling of the lips or eyelids, nausea, or feeling faint?

8. The dizziness only happens when you’ve been on Mounjaro, right? Have you experienced dizziness at other times of your life?

Since you were diagnosed with Hashimoto’s, would you be able to upload your latest set of thyroid labs with antibodies please? Chronic hives are actually pretty common in people with autoimmune thyroid conditions because when the immune system is dysregulated it can activate mast cells and lead to ongoing urticaria.

I’m also curious to know why the gastro suspected H Pylori…

9. Do you have gut symptoms like bloating, gas, reflux, constipation, diarrhea, or food sensitivities? The gut and immune system work closely together so it’s possible that any underlying gut dysfunctions can keep hives going even when the original trigger is gone.

So from a functional root cause perspective here, a few things could be happening at the same time. Hashimoto’s itself can predispose a person to chronic urticaria because of immune activation. At the same time, insulin resistance and metabolic stress can create inflammation that makes mast cells more reactive (and high cortisol worsens insulin resistance). On top of that, Mounjaro could potentially be acting as a trigger, especially if symptoms worsened after increasing the dose.

So before guiding you any further, it would really help if you could answer the questions in bold above, one by one, and upload a copy of your latest lab results to help narrow down whether it’s pointing to an autoimmune-related issue, a reaction from the medication, mast cell activation or perhaps a combo of all of these.

Awaiting your reply…

Hi @resh1016 – I personally haven’t heard of this brand nor do I have much experience with this newer technology, so I can’t make any strong recommendations for or against it.

From my understanding, polar or bipolar ionization machines work by releasing charged ions into the air that attach to airborne contaminants, but the research is still fairly mixed and it is not nearly as well studied as traditional HEPA filtration. Ultra Hepa technology is still my preference for mold and mycotoxins.

And yes, the concern with ionization devices is how they might produce small amounts of ozone or react with VOCs in the air and create other byproducts like formaldehyde. That’s why HEPA and carbon filters are still gold standard.

If you’re considering this product, just make sure it has independent testing and ideally a UL 2998 certification showing that it does not emit ozone.

@Vidu – thanks for sharing your reports. It’s actually common to get a sore throat, chest discomfort, or difficulty with dry foods 1 to 2 weeks after an endoscopy, especially if biopsies were taken. So the pain you’re experiencing is most likely a result of the lining getting irritated and inflamed post-op, especially that your report states there were no strictures and the esophagus was otherwise normal. The lining can get irritated and temporarily more sensitive, and if you already have reflux or gastritis, it can feel more intense.

If however your swallowing gets worse, like food keeps getting stuck and you can’t swallow liquids, definitely seek medical attention.

From a functional perspective, here are some possible drivers that could be at play:

Inflammation

• Chronic mild gastritis causing irritation

• Stress and sympathetic dominance

• Bile reflux, which was noted in your 2023 report

• Food triggers

• NSAID use

• Prior H. pylori history

Bile reflux is important because it burns differently than acid and does not respond well to PPIs.

Low acid and motility issues

• Long term PPI use

• Poor protein digestion

• Delayed gastric emptying

• Increased intra abdominal pressure

• More reflux symptoms over time

Pressure dynamics

• Diaphragm tension

• Breath holding

• Constipation

• Heavy lifting

• Abdominal weight gain

• Chronic stress

To help you rule things out, can you please answer the following questions:

1. Do you feel bloated after meals?
2. Do you burp frequently?
3. Does food feel like it sits in your stomach?
4. Are you constipated or straining?
5. Are symptoms worse with stress?
6. Are they worse when lying flat?
7. Do you notice a bitter taste versus a sour acidic taste?
8. Are you on daily PPIs or only using them occasionally?
9. Any history of anemia or B12 deficiency?

And in the meantime, focus on calming the inflammation and reducing upward pressure by:

-Eating smaller meals and chewing thoroughly (eating hygiene is powerful!)

-Don’t lie down for 3 hours after eating. Go for a gentle walk after meals instead.

-Avoid heavy lifting or tight clothing

-If constipated, this is a priority to be addressed. Let us know!

-Consider gut and throat soothing support like:

• Slippery elm tea or lozenges
• DGL before meals
• Zinc carnosine
• Small amounts of aloe vera (inner fillet)

Also consider daily diaphragmatic breathing to lower intra abdominal pressure. If you’re stressed, deep breathing can help regulate the nervous system as well. Consider doing slow nasal box breathing (ex. inhale for 4, hold for 4, exhale for 4 to 6), humming, gargling… all of these help with vagal tone as well.

@Vidu – I can personally relate to this, and I agree, cyclical pain without a lump is most often hormone related. That said, because this episode has lasted longer than usual, imaging is still the responsible next step. If you’re concerned about getting a mammogram, you can request an ultrasound and physical examination by a gynecologist instead. Breast pain alone is rarely cancer, especially without a lump, but some imaging and professional assessment can give you clarity and peace of mind. I wouldn’t ignore that part.

Personally, I’ve had months where my breast tenderness lasted almost all month long as well. In fact, breast tenderness and headaches were the first signs of perimenopause for me. I never used to get any headaches or breast pain, and then suddenly they started appearing randomly until I realized they were cyclical. And there were times where they were so tender that I couldn’t hug my kids or husband. Even the sheets at night would hurt! So you’re not imagining the pain…

Since you still have your ovaries, you’re still cycling even without periods. At 42, perimenopause commonly causes estrogen fluctuations and lower progesterone. That pattern often shows up as:

• Breast tenderness (can be one sided)
• Pain with touch, tight clothes, or hugs
• Symptoms that come and go every couple of months

From a functional perspective, the usual drivers are:

• Relative estrogen dominance
• Slower estrogen clearance through the liver
• Constipation
• Stress suppressing ovulation
• Lymph stagnation

Simple things you can start now:

• Make sure you’re having daily bowel movements
• Increase cruciferous veggies to help with estrogen detox
• Reduce caffeine for a few weeks and see if that helps
• Support sleep and stress regulation
• Gentle movement or rebounding to support lymph

Also, I have personally seen a lot of benefits from doing the “Specific 7” lymphatic drainage technique every day as part of my morning routine. You can watch the tutorial video here by Dr. Caitlin. She has other videos that break down each point one by one if you need more guidance. But since implementing the Specific 7, the tenderness has reduced considerably! I realized that the soreness in my breasts was actually lymph nodes close to the breast tissue. So it’s worth giving this technique a try!

I would also suggest tracking your hormones with an at-home device called Mira. This has been a game-changer for me too because I can now associate my symptoms to my hormones every single day! It’s much cheaper than a DUTCH hormone test, and it allows you to test throughout the month instead of just 1 snapshot in a month.

It allows you to track FSH, LH, Estrogen and Progesterone metabolites in urine. The wands are similar to a pregnancy or ovulation test. You simply collect urine each morning, dip the wand in it for 20 secs and stick it into the Mira analyzer device to get a reading. It then uploads the results to your app and starts tracking. You can also input symptoms so that you can keep track and see patterns. It’s honestly been a game changer for me to see that some months I’m not ovulating, and how that translates into symptoms as a result of low progesterone (no ovulation = no progesterone = relative estrogen dominance!). I wish it also tested testosterone, but it doesn’t at this point in time.

I reached out and got B Better members a discount. You can check it out here.

Hope this helps. Let me know if you have any questions.

Hi @Inga-55 – take a look at Defender Shield products. They have a range of different shielding products for phones, laptops, ipads, etc. I personally have and use their laptop pad, and got my kids the same too for their laptops and iPads.

Hi @resh1016 – I had to look that up. And no, it seems it’s the not same as UL 2998.

CARB (California Air Resources Board) certification allows low levels of ozone (<0.05ppm), whereas UL 2998 is stricter and doesn’t allow any measurable ozone.

@Vidu – the takeaway from your reports is that nothing suspicious or malignant was found, which is reassuring.

What they did see are benign fibroadenomas or small cysts, and in your case they’re very small – only a few millimeters. That’s why they’re not too concerned and recommend monitoring with a repeat ultrasound in 6 months.

When nothing alarming is found, this is always good news, and that’s where functional medicine shines. Fibroadenomas are usually due to hormone fluctuations, especially estrogen dominance, and during perimenopause, the fluctuations are unpredictable. This can stimulate breast tissue and lead to tenderness, cysts, or fibroadenomas.

With regards to supplements, evening primrose oil tends to help more with hormonally driven breast tenderness because it supports prostaglandin balance and can calm the breast tissue response. But it does take a few weeks to notice improvements. Vitamin E can be added later if still needed. But keep in mind that they won’t “get rid of” fibroadenomas. What they might do is help reduce the breast pain.

There could also be lymphatic congestion in the breast tissue, so doing the Specific 7 lymphatic drainage exercises daily may also help.

Now in terms of how the gut could be connected… well it’s connected in a big way. The gut plays a role in estrogen metabolism through what is called the estrobolome, which is a group of gut bacteria involved in processing estrogen to clear it out through stool. When there are healthy levels of gut bacteria, estrogen clears out well. If there’s gut dysbiosis, or if there’s constipation, estrogen can recirculate in the body and contribute to estrogen dominance, which worsens breast pain, fibrocystic changes, PMS-type symptoms, and even heavier periods in women who still menstruate.

So in addition to the supplements and Specific 7, it’s important to make sure digestion is working well, you’re having daily bowel movements, eating enough fiber and cruciferous vegetables, and reducing caffeine intake.

Here’s a guide to understanding Estrogen Dominance if you’d like to learn more.

@Vidu – thanks for sharing the additional details. It really helps clarify things.

The fact that you’re not really waking up at night with reflux is a good sign. Night reflux usually happens when there’s really severe acid reflux or there’s significant structural issues. But since most of your symptoms present during the day, it’s likely a result of pressure, motility, and gut sensitivity which I described in my previous replies.

What’s interesting is your bloating pattern AFTER bowel movements which to me points to possible gas fermentation or motility issues in the small intestine. When the gut starts moving, trapped gas can move too and therefore create that pressure feeling. That can possibly explain the bloating, burping, and sometimes the smelly gas you mentioned as well.

So in terms of solutions, it’s important to be supporting the main digestive players “GPS” (Gallbladder/bile, Pancreas/enzymes, Stomach/acid) to improve motility and digestion. Digestive bitters for example, is a support tool that can stimulate digestive secretions by signaling the brain that digestion is about to happen.

If you haven’t yet watched the Gut Health Masterclass, then I encourage you to at least watch the sections “How Digestion Works” and “How Digestion Dysfunctions” starting here with “Meet the Players” to better understand the symptoms you’re experiencing and why they’re happening.

I also suggest you go through the SIBO/IBS Relief program given the likely fermentation in the small intestine. There are questionnaires that you can fill out to help determine which digestive players need the most support in the “What Tests Should I Run?” lesson. But it’s a program, so you’ll need to watch the videos in order.

The fact that you an tolerate certain foods while on vacation but not at home is quite telling. It usually has to do with the fact that we’re relaxed and eating in a parasympathetic state when we’re on vacation, and that’s why Eating Hygiene is so powerful and important. A reminder to be practicing this if you’re not already doing so. So this strengthens my suspicion of how stress and the nervous system are likely influencing your digestion instead of it being related to a specific food intolerance alone.

So as I previously mentioned in my other replies, the likely contributors of occasional bile reflux and mild gastritis are related to:

• Stress and nervous system sensitivity – this should be priority #1. Eating hygiene as well. Let us know if you need more resources and support with this.

• Diaphragm tension and shallow breathing – this goes together with priority #1. Diaphragmatic breathing and breathwork in general will be very helpful for you.

• Gas fermentation in the gut – please go through the SIBO/IBS program and those sections I shared in the Gut Health Masterclass. It will clarify and explain so much for you.

So to summarize the important points of action:

• Reduce stress. Practice eating hygiene.
• Start with gentle diaphragmatic breathing daily, but without forcing deep breaths. Slow relaxed breathing is enough.
• Keep magnesium citrate consistent to support regular bowel movements.
• Take short walks after meals to help with motility
• Support overall digestion with digestive bitters
• Continue with slippery elm powder if it feels soothing to your throat and gut
• Keep meal times consistent. Avoid snacking and late night dinners.

Hopefully the throat pain will gradually improve over the next week or two. If not, it’s reasonable to check back with the gastro. Hope you feel better!

Let us know if you have any other questions as you begin to implement some of the teachings above.

@Vidu – just a note about the slippery elm capsules. If it’s for gut irritation, then capsule form is fine. But if your goal is to soothe the sore/irritated throat, then consider removing then content from the capsule and drinking it in water. The idea is to help coat the throat with something mucilaginous like slippery elm. That’s why the recommendation was in tea or lozenge form.

@Vidu – thanks for sharing the additional details. It’s helpful when trying to connect the pieces and figure out root causes.

From what you’re describing, it sounds like a long-standing pressure and motility issue layered with stress physiology.

Given the symptoms you’ve mentioned (long history of bloating, constipation that’s on/off, breath holding and shallow breathing, chest and shoulder tightness, B12 deficiency, occasional severe abdominal pressure, smelly gas and stress clearly triggering reflux), the following dynamics are likely at play:

1. Impaired motility

2. Pressure dynamics in the abdomen

3. Nervous system dysregulation

4. Possible small intestinal overgrowth or fermentation

5. Intermittent bile irritation

The severe bloating episodes where you felt you couldn’t breathe are very telling. That is pressure. When the abdomen distends, it pushes upward against the diaphragm. If the diaphragm is already tight, the pressure goes upward toward the esophagus. That alone can cause reflux, throat pressure, and burping.

You being in the habit of holding your breath is also huge. Chronic shallow breathing keeps the diaphragm locked. A locked diaphragm weakens the lower esophageal sphincter and worsens reflux. It could also explain your chest and shoulder tightness.

The B12 level of 116 is low which likely indicates that acid production has likely been suboptimal for a long time. And yes, the PPI just worsens that. Low stomach acid impairs protein digestion, slows gastric emptying, and increases fermentation downstream. That can explain the smelly gas and pressure.

Now about your question on deep belly breathing pulling on your throat and chest. That pulling sensation is most likely tight fascia and a restricted diaphragm. It is safe to continue, but go gently. Do not force big inhales. Start with slow, small, relaxed breaths. Think soft expansion, not pushing. Please look up Human Garage and start their free fascia release program.

About slippery elm capsules, yes, it’s usually a safe supplement to start with. But always go low and slow, such as 2 caps twice daily for a few days to a week, and see how the body responds before increasing.

Whenever someone has smelly gas, there’s likely fermentation happening in the gut. That doesn’t mean probiotics are bad, but the combination of inconsistent use plus underlying motility issues can potentially cause flare ups. Right now I would not focus on adding more supplements. You are overwhelmed already.

Here is what I would prioritize next:

1. Stabilize the nervous system daily. Five to ten minutes morning and evening of slow nasal breathing. This is simple, but very powerful. Consider a device like the Truvaga or Pulsetto to help achieve parasympathetic state if needed.

2. Support regular daily bowel movements. Keep magnesium citrate steady and consistent rather than alternating forms. Regularity reduces upward pressure.

3. Chew meals thoroughly and stop when you’re 3/4 way full. Avoid large evening meals.

4. Go for gentle walks after meals. If it’s too cold outside, find a step or stairs to walk up and down on.

5. Consider doing the Fascial Maneuvers by Human Garage.

Can you please answer the following questions:

1. Are you waking at night with reflux?
2. Do symptoms improve when bowels are regular?
3. Do certain foods clearly worsen bloating?
4. How is your sleep overall?

@Vidu – one more suggestion… if you like listening to podcasts, I highly recommend Dr. Carrie Jones’ podcast called “Hello Hormones”. She focuses on perimenopause and it can really help you feel less alone and more in control of the changes that are happening.

As for books to read on the subject, consider reading:

• Dr. Felice Gersh’s book “Menopause: 50 Things You Need to Know”
• Dr. Lisa Mosconi’s book “The Menopause Brain”

It’s important to know and understand what to expect as our body enters this new phase of life which can begin as early as 35 in some women, and can last for a decade before menopause.

Knowing what to expect is empowering and can remove a lot of fear and lack of control. And of course, we’re always here when you need us too. 🙂

@Vidu – yes, both vitamin E and evening primrose oil may help, especially if the pain is hormonal and cyclical.

Vitamin E has actually been studied for breast tenderness, and many women notice improvement when they take around 200 to 400 IU daily for a couple of months. It works more on the inflammatory side since it’s an antioxidant and helps stabilize breast tissue. It is not an overnight fix, but it can take the edge off over 6 to 8 weeks. When choosing a form, look for a mixed tocotrienols (d-alpha, d-beta, d-delta, d-gamma) version and avoid the synthetic dL-alpha tocopherol. It should be taken with food.

Evening primrose oil is probably the one I’d reach for first when the pain clearly feels hormonal. It contains GLA, which helps regulate prostaglandins. Some women with cyclical breast pain have sensitivity in that pathway, and this can calm the tissue response. A typical dose is around 1,000 to 1,300 mg once or twice daily, again giving it a good 6 to 8 weeks before deciding if it is working.

@Jyl with regards to lab tests, in addition to the ones already mentioned, it’s helpful to get a basic CBC (complete blood count) with differentials to look at immune status and signs of histamine overload, along with a CMP (complete metabolic profile).

You can find the full list of these markers in this handout on p.5.