I haven't been given all the pieces of the puzzle, my oxalate and homocysteine levels for example
The best test for oxalates is the OAT from GPL (great plains laboratory). They measure 3 oxalate markers - oxalic acid, glyceric acid, glycolic acid. Other OATs just measure oxalic.
You have lots of tests and issues to consider so you might want to prioritise. One possibility is to ask your doctor to just order a urine oxalate test. If it is high, then you could well have issues and should have the GPL OAT to get better insight.
If it is low, probably not worth doing any more now. If somewhere in between you are not much further ahead unfortunately.
It would be important to know your plasma homocysteine. This could be done as part of a plasma amino acids test.
Can you recommend a good serum OAT test[/QUOTE
Just look for a plasma amino acids test. I'm not really familiar with all the options you would have in the USA. Big companies like Genova would undoubtedly offer one but I'm sure there would be others. Your doctor may have some favoured testing labs.
I have very low bacteria count and diversity in my gut as well as inflammation so that needs to be dealt with
Tackling the gut is a long term project but very important. We've already discussed some measures to improve digestion (your pancreatic enzyme production does seem adequate so probably no need for enzymes at this stage).
Providing a wide variety of prebiotics to feed the gut microbiota is also important in improving diversity. Your diet seems good but I've found that diet is not enough to turn around the diversity problem. Providing a mixture of concentrated prebiotic fibres in moderate amounts has made a big difference to me. Probiotics may be helpful, fermented foods certainly.
As far as my high Phe, the only "remedy" I could find was going on a low protein diet and supplementing with BH4 (Phe +BH4=tyrosine ).
Both of those options are problematic. A low protein diet should be a last ditch thing - wait till you know more about what is happening in blood.
Direct BH4 supplementation can cause more problems than it solves - and is expensive. Indirect measures may be better - eg a better functioning methylation/folate cycle. So again wait before trying this option.
I think the first step is going on a B vitamin protocol. Do you think the Douglas Labs B Complex that Freddd recommends will provide the necessary B 2,3, and 6s to unclog my Krebs cycle? Will supplementing with higher amounts cause any paradoxical effects?
Impossible to say - reactions to B vitamins are very individual. You could start with the mixture and if no problems, start adding active B12s and methylfolate and see what happens. If there are problems you may need to take the complex apart to work out the culprit.
Even if no problems in the end some of the sublingual active Bs may be better alternatives. Still keep things as simple as possible in the beginning and assess the effect of the B12s and folate. Once you have a baseline to compare, then you can maybe experiment with the sublingual Bs. Personally I have found them to be much more effective.
You might want to consider B12 oils
These topical products are excellent but I think too potent a place to start and difficult to take a partial dose (though not impossible). Work out you sensitivities and tolerance first with sublinguals. When you have built up dose, then you can consider changing to the topical forms. Estimate that only around 1/10 of the sublingual dose is absorbed, about 80% topical, when working out rough equivalent doses of the two products.
I linked you to a post of mine which discusses some of the issues with active B12's and gives further links.
Absorption occurs in the small intestine. B12 is a special case as it needs intrinsic factor from the stomach as well.
It can be very difficult to know where to start and it is easy to get overwhelmed with information and possibilities but the active B12s and folate (and their attendant base nutrients) can make a big difference to how people feel - though can be problematic also - so worth putting high up the list. The gut should be high up the list also.
The oxidative stress issue will in part be addressed by improved methylation (leading to improved glutathione production) and by improved microbiota. Some additional antioxidant support would also be worth placing fairly high on the list.
Just proceed slowly changing what you think you can best cope with first. Start low with everything and increase slowly.
I hope your new doctor will be able to help.
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