Case study-Mandy LaGreca
This is my cortisol report taken using the Biohealth 205 during my FDN training in the summer of 2017.
I was finishing my first year of teaching with high anxiety and inability to relax. I also had just started thyroid medications to address fatigue and hair loss. I was bloated often, and it was worse around my menstrual cycle. I had 2 young children in a divorced family. Labs suggested dysbiosis, adrenal dysfunction, low estrogen, oxidative stress, malabsorption, low vitamin D, and multiple chronic infections both in my gut and also systemically.
It was taken at a time where I had the following symptoms:
-chronic UTI’s and bladder pain
-reactive hypoglycemic and shaky between meals
– I walked around with a knot in my stomach all the time and started to notice I was more sensitive to noise and startled easily. I was unable to shut my mind off at night.
The test was taken when I was under stress, and this is indicative of adrenal dysfunction because my body should have responded by secreting more cortisol. The total cortisol SUM is 18.3, and this places me in the exhaustive phase of cortisol dysfunction. The afternoon levels were low, which were evidenced by mid-afternoon fatigue. Nighttime has a slight peak, and this can be due to gut or immune dysfunction. My body is not responding appropriately to stress, and this is also evidenced by my frequent infections and neurological issues at that time. Below is a chart that we often use with clients to discuss HPA axis dysfunction in regards to cortisol dysregulation.
A few other markers had given me clues to the dysfunction:
–Urinary lipid peroxides were elevated. Lipid peroxidation is a mechanism of cellular injury and used as an indicator of oxidative stress (Biohealthlabs, n.d). The elevation of lipid peroxides serves as an early warning of the potential long-term effects of oxidative stress, due to exposure to toxins or pathogens, lifestyle imbalances (over-exercising or smoking) or byproducts of metabolism.
–Urinary indican was positive. Urinary indican is an effective screening tool for assessment of protein digestion, dysbiosis, SIBO and malabsorption states. Indican is produced when there is putrefaction of tryptophan from dietary protein by dysbiotic bacteria in the GI tract. Problems with protein digestion are often seen in the context of H. pylori, parasite infection, lack of digestive enzymes of liver dysfunction (Biohealthlabs, n.d.). “Inability to digest protein can lead to bowel putrefaction, adverse effects on glycemic control, and hormone imbalance”.
–Estrogen levels were on the low side. My value was 1.5 where the range was 1-5.0 pg/mL. This may have been due to some liver dysfunction or need to detoxify toxins, as that may cause circulating hormones to be reabsorbed.
-Dysbiosis-Stool test indicated dysbiosis, overgrowth of a few pathogens and candida overgrowth in Organic acid test.
The recommendations that I made for myself (with the help of my FDN mentor):
–Stress management– At the time I had finished a very stress year of full -time teaching and also was known for over exercising. I decided slow down and do more restorative exercise like walking and reducing the need to exercise every day and took more days off. Also, I tried to improve sleep hygiene, which has always been an issue for me, I tend to stay up too late and often do not get more than 6 hours of sleep.
–Improve GI microbiome. I started to take spore-based probiotics and prebiotic containing foods. I also tend to eat the same foods, and I decided to try new foods and to diversify my diet.
–Infections and pathogens– I realize I had many infections that built up over the years. I started to rotate natural anti-fungals and anti-microbials. These include things like grapeseed extract, Ph structured silver, oregano oil, olive leaf extract, berberine, caprylic acid, Monolaurin, and biofilm agents such as horseradish, curcumin, ginger, and over the counter supplements such as Interphase plus. I also consume plenty of raw and cooked garlic (I make an amazing hummus with over 20 cloves of garlic). Garlic has been shown to have bactericidal and bacteriostatic activity on may bacteria such as E coli, Klebsiella pneumoniae, proteus vulgaris, Candida albicans. Garlic has been demonstrated to be a powerful remedy to protect against infections of many bacteria, fungi and viruses. “Of all its reputed benefits, one significant advantage of garlic is its effectiveness against nosocomial strains that frequently display above average resistance to many antibiotics”(Li et al., 2015) .
-Improve antioxidant status- I added fish oil, black seed oil, black cumin seeds, and I make a drink with turmeric and ginger that I take daily. I also take liposomal glutathione, liposomal vitamin C, and NAC (n-acetyl cysteine).
–Balance hormones– I added adaptogen such as Maca root powder, Ashwaganda, and cordyceps, rotating them. I also started to take things to optimize liver detoxification such as dandelion root, alpha lipoic acid, fresh herbs like parsley, cilantro and basil on my food, and I take activated charcoal during my once per week “cleanse” days. I also started a new product called “The Ultimate detox program” by Prime my body that consists of agents for the liver and charcoal.
–Balance immunity and inflammation– I started adding adaptogens such as Reishi mushroom powder and AHCC. I also started taking a CBD oil to help modulate my immune system. CBD also has the ability to mediate the suppression of pain and inflammatory processes (Russo, 2008). CBD also supports lowering inflammation. For the most part, exogenous and endogenous cannabinoids interfere with proinflammatory cytokine and nitric oxide production by LPS or LPS stimulated monocytes, macrophages, microglia and macrophage cell lines in culture” (McCoy, 2016). Cannabinoids suppress inflammatory and neuropathic pain by targeting a3 glycine receptors (Xiong et al., 2012). I felt this would help me with pain. I also started taking LDN (Low dose naltrexone) to help with some of the autoimmune issues I was developing with my thyroid and with some of the bladder pain. Within a specific dosage window, opioid antagonists such as naltrexone can exert a “paradoxical” analgesic effect” (Younger, Parkitny, & McLain, 2014).
I also ran a food sensitivity test and identified numerous food sensitivities and a few allergies and I eliminated them from my diet in the attempts to lower inflammation. I also take vitamin D with K2 since my vitamin D was very low.
-Optimize energy / ATP production and mitochondrial function– I started taking Coq10 in the form of ubiquinol and PQQ. The main function of Coq10 is energy production. The reduced form of CoQ10, ubiquinol, is considered an important lipophilic antioxidant to protect free radical induced damages to DNA, lipid, and proteins. This is important that in that aging adults have increased production of free radicals, suboptimal antioxidant defenses toward free radicals, and a decreased capability to replenish utilized CoQ10. Ubiquinol is the more bioavailable form of Coq10. A study in 2014 indicates that the “enhanced bio accessibility and bioavailability of ubiquinol compared to ubiquinone results from reduced coenzyme being more efficiently incorporated into mixed micelles during digestion and its greater uptake and basolateral secretion in a glutathione-dependent mechanism” (Failla, Chitchumroonchokchai, & Aoki, 2014). PQQ can influence energy related metabolism and neurological function (Harris et al., 2013). PQQ supplementation is neuroprotective when administered as a dietary supplement (Chowanadisai et al., 2010). “Because mitochondria function as the principal energy source of the cell, compromised function of this key organelle is linked to numerous diseases and metabolic disorders”(Chowanadisai et al., 2010).
-Rebuild mucosal lining and optimize digestion– I started taking a mucosal healing powder called GI-optimum that contains multiple agents that are soothing and healing to the gut. I also take collagen supplement and collagen drops called Biosil. I cannot do bone broth because I have a sensitivity to chicken and beef. CBD oil can also be supportive for gut function. Alhamoruni, Larvin, and O’Sullivan (2012) looked specifically at the role cannabinoids had on intestinal permeability. They concluded that “locally produced endocannabinoids, acting via CB1 receptors play a role in mediating changes in permeability with inflammation, and that Phyto cannabinoids have therapeutic potential for reversing the disordered intestinal permeability associated with inflammation”. I also drink a potent aloe vera I buy from Stockton Aloe, which is raw and unpasteurized and it has made a big difference in my gut function.
Ultimately my efforts listed above substantially improved my symptoms. I have attached my adrenal stress index to show you the improvements I have made over the last few years. The first one was taken almost 2 years ago, the second a year ago and the third I took today. However, I realize I did not address the brain as directly as was probably necessary. The following clues now tell me that I demonstrated some brain -based issues:
- Motility– I often needed coffee to have a bowel movement and sometimes felt I had a tendency toward constipation, and this may explain why earlier in my illness I had symptoms that resembled SIBO. I also was noticing my TSH was creeping higher, it reached a value of 3.85 and antibodies were detected on my thyroid test. My rT3/T3 ratio was less than 20%, which aligned well with my motility issues.
- Reactive hypoglycemia and insulin glucose interaction impairment, which was evidenced on the Spectracell micronutrient test and symptoms of reactive hypoglycemia. I even “passed out” a few times when I skipped meals, and this was exacerbated when I was pregnant.
- Low iron levels -both my iron and ferritin are low! My serum iron is 52 (optimal 85-130 ug/dL) and my ferritin is 41 (range 50-100ng/mL).
- B6 deficiency-Spectracell micronutrient test indicated I have B6 deficiency. According to Dr. David Coursin, a variety of CNS disorders may result from abnormal metabolism of vitamin B6 (Coursin, 1964). In fact, serotonin is synthesized from tryptophan, but this synthesis requires vitamin B6 as an important co-factor (Mikawa, Mizobuchi, Egi, & Morita, 2013). In fact, both low B6 and iron were indicated in patients who suffered frequent panic attacks and hyperventilation attacks (Mikawa et al., 2013). According to Fraser (2017), when vitamin B6 and iron levels are too depleted, the blood has a hard time producing enough hemoglobin, a vital component of red blood cells. Red blood cells are responsible for transporting oxygen through the blood, so low levels can contribute to fatigue and shortness of breath. Vitamin B6 is also important to produce GABA and dopamine, essential for carbohydrate metabolism, and required by heme for its production. Interestingly, lack of this vitamin can be associated with chronic inflammation, depression, skin issues, high blood pressure and anemia (Fraser, 2017). And a deficiency can be associated with panic and anxiety attacks.
- HPA axis dysfunction– evidenced by my symptoms and cortisol report.
The following are things I would have done differently after taking this module:
- Licorice root-I could have benefitted from licorice root supplementation to inhibit breakdown of the cortisol and help with tissue repair and my immune system. Interestingly, licorice root has other benefits. Licorice root can promote Treg cells, which can play a critical role to control immune responses and to prevent autoimmunity and inflammatory diseases (Guo, He, Xu, Geng, & Zhao, 2015). A flavonoid in licorice called dehydroglyasperin C can stop the pro-inflammatory activity in the brain and help prevent neuron cell death (Kim et al., 2013). It can also prevent oxidative damage in the brain due to its antioxidant effects (Zeng et al., 2013).
- Address the blood sugar imbalances more directly. This means not skipping meals, making sure I include fiber and fat to balance the blood sugar. In addition, taking a supplement to optimize blood sugar utilization, such as chromium GTF. Chromium GTF is interesting as it can act as an insulin mimicker and insulin potentiator: it can decrease glucose in the blood and it can also activate insulin effect. Essentially a small dose of insulin becomes more effective when administered with a dose of GTF (Mirsky, 2012). “When GTF is added with insulin-an augmented glucose transport is detected” (Mirsky, 2012).
- Improve blood circulation to optimize nutrient delivery to the brain-Ginko biloba and L-arginine. My hands, feet and nose are always cold, and that could be due to low blood circulation. This is also a clue for HPA axis dysfunction and the brain- based symptoms as well. Although the results of studies are mixed, ginko biloba may improve cerebral insufficiency, which is often associated with low concentration, confusion, decreased physical performance, fatigue, mood disturbances and headaches (Kleijnen & Knipschild, 1992). Interestingly, a study published in Neural Regeneration Researched found that the flavonoid and terpenoids in Ginko biloba can improve memory and cognition impairments. However, they also found that this was marked by a significant growth of neural stem cells in certain brain regions (Gray, 2013).
- Optimize improve iron deficiency without feeding the pathogens with iron. Supplement with lactoferrin may be helpful. Lactoferrin appears to have various biological roles in the human body, and one of them is the ability for it to enhance iron absorption (Lonnerdal & Bryant, 2006). Studies comparing iron absorption from lactoferrin vs. ferrous sulfate indicate that the mean value for iron absorption from lactoferrin did not differ significantly from that for ferrous sulfate. This showed that lactoferrin-bound iron is well utilized (Lonnerdal & Bryant, 2006). In adults, the low pH after a meal and secretion of pancreatic enzymes is able to release the iron from the lactoferrin from the stomach, partially digested by pepsin, and then the iron can become associated with the various dietary components known to affect iron absorption. Iron bound to lactoferrin is in ferric form and thus is not prone to cause oxidative damage. After a few months of lactoferrin, I will check my iron levels. If it is not effective, I will look into other sources such as Ferrabsorb, which contains both ferritin and iron-biglycinate.
- Optimize vagal function– with gargling and deep breathing. This can improve motility, gut function, and optimize the gut-brain axis and the symptoms associated with it
6. Feed the brain-Another area I have become really interested in is exogenous ketones. Emerging evidence supports several clinical uses of ketogenic diets such as in neurodegenerative conditions. I do not do well on a ketogenic diet, as I find it very restrictive particularly for my high activity levels a as fitness instructor. Endogenous ketone production requires low insulin, high glucagon and cortisol which can be stressful on my already stressed adrenals. “Exogenous ketones drinks are growing in popularity as a method to elevate blood ketone concentrations and mimic a ketogenic diet without the need for dietary changes” (Stubbs et al, 2017). An alternative way to increase blood D-β-hydroxybutyrate (D-βHB) concentrations is to consume ketone drinks (Stubbs et al, 2017). Interesting, exogenous ketones appear to lower blood glucose through limiting hepatic gluconeogenesis and increasing peripheral glucose uptake, despite normal carbohydrate intake (Stubbs et al, 2017). “Thus, the ability of exogenous ketones to lower blood glucose without elevating blood FFA concentrations could deliver the desired effect of the diet, whilst also decreasing a potential risk” (Stubbs et al, 2017). Even more, the lowered blood glucose and lipids occurred without altering endogenous insulin secretion. I am going to try a product made by perfect Keto that is in the salt form, to see if it can enhance my brain function.
Alhamoruni, A., Wright, K., Larvin, M., & O’Sullivan, S. (2012). Cannabinoids mediate opposing effects on inflammation-induced intestinal permeability. British Journal of Pharmacology, 165(8), 2598–2610. http://doi.org/10.1111/j.1476-5381.2011.01589.x (Links to an external site.)
Chowanadisai, W., Bauerly, K. A., Tchaparian, E., Wong, A., Cortopassi, G. A., & Rucker, R. B. (2010). Pyrroloquinoline quinone stimulates mitochondrial biogenesis through cAMP response element-binding protein phosphorylation and increased PGC-1alpha expression. J Biol Chem, 285(1), 142-152. doi:10.1074/jbc.M109.030130
Failla, M. L., Chitchumroonchokchai, C., & Aoki, F. (2014). Increased bioavailability of ubiquinol compared to that of ubiquinone is due to more efficient micellarization during digestion and greater GSH-dependent uptake and basolateral secretion by Caco-2 cells. J Agric Food Chem, 62(29), 7174-7182. doi:10.1021/jf5017829
Gray, N. (2013). Ginko biloba may boost brain functions by increasing stem cell growth: Rat study. Retrieved (2018, October 30) from https://www.nutraingredients.com/Article/2013/07/26/Ginkgo-biloba-may-boost-brain-functions-by-increasing-stem-cell-growth#
Harris, C. B., Chowanadisai, W., Mishchuk, D. O., Satre, M. A., Slupsky, C. M., & Rucker, R. B. (2013). Dietary pyrroloquinoline quinone (PQQ) alters indicators of inflammation and mitochondrial-related metabolism in human subjects. J Nutr Biochem, 24(12), 2076-2084. doi:10.1016/j.jnutbio.2013.07.008
Kim, J., Kim, J., Shim, J., Lee, S., Kim, J., Lim, S. S., . . . Lee, H. J. (2013). Licorice-derived dehydroglyasperin C increases MKP-1 expression and suppresses inflammation-mediated neurodegeneration. Neurochem Int, 63(8), 732-740. doi:10.1016/j.neuint.2013.09.013
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Lonnerdal, B., & Bryant, A. (2006). Absorption of iron from recombinant human lactoferrin in young US women. Am J Clin Nutr, 83(2), 305-309. doi:10.1093/ajcn/83.2.305
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Zeng, L. H., Zhang, H. D., Xu, C. J., Bian, Y. J., Xu, X. J., Xie, Q. M., & Zhang, R. H. (2013). Neuroprotective effects of flavonoids extracted from licorice on kainate-induced seizure in mice through their antioxidant properties. J Zhejiang Univ Sci B, 14(11), 1004-1012. doi:10.1631/jzus.B1300138