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Feedback request: Gastrointestinal function, Triad (Organic, fatty and amino acids)

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by iacyi, Mar 19, 2012.

  1. iacyi



    These tests are quite out of date now, probably coming up 9 months. I was putting all my faith in my doctor, but I just can't afford it any more. Sorry the PDFs are a bit big, all the scanning and PDFing has fried my brain! I've had to upload the main Triad test here:

    My general history is always having coeliac problems, then given antidepressants aged 8-16. Symptoms of fatigue, brain fog and isolation set in gradually and I was assured it was all in my head; I can't pinpoint when things started getting bad. I'm 22 and male.

    At the time of taking the test I was on quite a high meat diet with as much fat as I could get from frying and eating fatty cuts. Tried to get as much carbs as I could from squashes and some root vegetables etc, but couldn't tolerate much potato or grains without getting bloating and acne. I eat very excessive portions, but without starch, dairy and sugar I don't think my calories are all that high.

    After these results I started taking different amino acids, a high potency multivit+mineral, SAMe, 5htp, NAC and a bit of antifungals with probiotics. The amino acids didn't seem to help, but the SAMe and 5htp made me depressed and a bit moody.

    I haven't attached my thyroid results, but TSH was borderline suppressed and rT3 was borderline high.

    The only supplement I was taking at the time was progesterone to try and support my cortisol. It would help but then crash later in the day.

    I appreciate any input. I'm trying to get my head around things, but I always seem to end up going in circles...


    Attached Files:

  2. richvank

    richvank Senior Member

    Hi, iacyi.

    I have studied your test results and will offer some comments below.

    You mentioned that you have always had "coeliac problems." I'm wondering if you have had a diagnosis of celiac disease, by biopsy of the duodenum. Based on what you've reported and the test results you've posted, I'm going to assume that you do have celiac disease. As you probably know, it is very important to avoid all foods that contain gluten, which is found in wheat, barley and rye. It is difficult to do this, because so many processed foods contain gluten, but nowadays there are more foods sold as "gluten-free," which is a big help. Many people who have celiac disease also become lactose intolerant, if they were indeed not so before, so avoiding dairy foods is important also, and I see that dairy showed up as a problem on your IgG Bloodspot panel. In most cases of celiac disease, if these foods are avoided carefully, the gut wall can regenerate itself.

    Looking first at your G.I. Function Profile, I note that your bacterial counts in general are low. I suspect that this may result from a low surface area of your small intestine, due to the destruction of the villi, which occurs in celiac disease. You also mentioned that you eat "very excessive portions," and the large volume of residue that must result may dilute the bacteria, also contributing to the low bacterial counts. It does not appear that you have elevated counts of any deleterious or pathogenic bacteria, which is good. This is consistent with your low dysbiosis markers on the organic acids panel.

    Your G.I. Function Profile did not find a significant amount of yeast. However, your organic acids profile did show high D-arabinitol, and your report of bloating from eating potato or grains, which contain starches that break down to produce glucose, a food for yeasts, suggests gas production, which may be caused by yeast.

    The G.I. profile reports a parasite present, but with taxonomy unavailable. I see this frequently on this profile, and I don't know if it has significance. Metametrix does not seem to think it is important unless there are symptoms and inflammatory markers consistent with a parasite infection. I suggest that the celiac disease is a more important issue to deal with in your case. If problems remain after correcting the damage to the gut from that, you could consider following up with a parasitology test.

    There are some abnormalities in the distribution of the short-chain fatty acids in your stools. These probably result from abnormalities in your bacterial populations. You do appear to have enough butyrate, though, and that is the food for the colonocytes (cells lining the large intestine), so that's good.

    You don't appear to have intestinal inflammation, which is good. Your secretory IgA is somewhat low, which is probably due to low cortisol, which you suggested that you have, and which would be consistent with the low DHEA sulfate on your other tests, given that your sulfate was high, thus suggesting that DHEA itself is low.

    I was surprised to see that your Anti-gliadin sIgA was normal, given that you reported having celiac disease, though I understand that this does not always show up positive when there is gluten sensitivity.

    Assuming that you do have celiac disease, we should expect that there will be malabsorption of nutrients from the food. This can be seen on your organic acids panel. Considering first the carbohydrates, note that pyruvate on this panel is below the detection limit, and lactate is also quite low. Although other things can cause this, it is consistent with malabsorption of carbohydrates and with your report that you avoid sugars and starches, which would also lower the absorption of glucose. Considering next the fats, note that your plasma fatty acids levels in general are low, that the first four Krebs cycle metabolites are low-normal or below the detection limit, and that your omega oxidation indicators (except for adipate) are low-normal. These markers indicate that there is malabsorption of fats, also.

    The other possible fuel source for the cells is protein, which is normally broken down into amino acids. Note that your amino acids panel shows high levels for the amino acids in general (except for methionine). A likely cause of this is low B-complex vitamins, especially B6 (based on elevated xanthurenate and kynurenate), but probably some of the other B vitamins are low, also. B2 is needed to convert B6 to its active form, P5P. Biotin appears to be somewhat low, and that is necessary to feed some fuels to the Krebs cycle. The methylation markers are probably not being challenged because of the low B-complex status, so you may have a partial methylation cycle block as well. This suggests that protein is being broken down and amino acids are being absorbed, at least at some rate, but the amino acids are not being burned for fuel at a very high rate. It could be that your protein digestion and amino acids absorption are also low, but that this is being masked by the low B-complex status.

    The lack of fuels being fed to the Krebs cycle would account for your fatigue, and probably the brain fog as well.

    Your neurotransmitter metabolites are low. This could also be due to low B6 (or also B2), because the active form of B6 is needed to make the neurotransmitters. Adding SAMe in this situation will likely lower the levels of the neurotransmitters even more, which could account for your depression and moodiness from supplementing it.

    The high albumin on your Protein Metabolism panel is probably due to hypovolemia (low water content of your blood), which would be consistent with your somewhat elevated 24-hr urine volume. You may have mild diabetes insipidus (not to be confused with the more common diabetes mellitus, which involves blood sugar and insulin).

    From what you reported, you have been trying to correct some of these issues with supplements. I would suggest emphasizing the B-complex vitamins and also being very careful to avoid all gluten and dairy products. Hopefully the villi will regrow on the wall of your small intestine, improving the absorption of nutrients.

    I hope for the best for you.

  3. Enid

    Enid Senior Member

    Thanks rich - a great help here too (though little testing but understanding what's going on and trying to address).
  4. rlc

    rlc Senior Member

    Hi iacyi, thanks for taking the time to put up all your test results it makes it a lot easier to get a picture of what is going on, largely have the same opinion as richvank from reading your tests, Have you actually been diagnosed with Celiac? If so you have to make sure that there are no sources of gluten in your diet whatsoever, this can be hard to do as it can be found in unexpected sources e.g. a lot of literature says oats are safe, but they are often processed in the same plant as wheat and it gets cross contaminated, even if youre eating gluten free bread, if you share a toaster with someone eating normal bread this can cause cross contamination, so it can be hard, but it is very important to make sure that you are completely gluten free for the villi to heal properly.

    I noticed you said you had a bad reaction to potatoes, potatoes are a member of the Nightshade family and a lot of people have bad reactions to them, the nightshade family includes the likes of tomatoes and capsicum as well, it is possible that you should be avoiding the nightshade family. Although it doesnt come up on your IgG food antibodies and it says your ok with tomatoes, these kinds of tests tend to only show results if you have recently consumed the foods that youre having a reaction to. If you didnt have potatoes around the time of the test you are likely to get a negative result.

    You have reacted strongly to milk, so it would be advisable to avoid all milk products according to this test.

    You say youre taking testosterone to support your cortisol; do you have a result that says you have low cortisol? Because youre urinary cortisol levels are normal and so is your testosterone.

    I would be interested to see what your TSH and RT3 say; there is a lot of research that says that the TSH reference range is wrong, so it would be interesting to see what the results are and what reference ranges are being used, it may point to a treatable thyroid problem.

    Your albumin is slightly high, but it might just be from slight dehydration? Diabetes insipidus has symptoms of excessive thirst and urination, I dont know if you have these?

    There is one thing in your tests that seems to be being missed from what you have said, you are Vitamin D deficient!!!

    Your test says 23.6ng/ml reference range 30-60, which means you are vitamin D deficient, vitamin D deficiency can cause chronic fatigue, depression, brain fog, muscle and joint pains etc, it is needed to absorb phosphorus and without phosphorus your ATP doesnt work properly, ATP are like little batteries that are found in all the cells in your body. Vitamin D deficiency is common in people with Celiac.

    Although your level doesnt look very low compared to the reference range used, new research has found that this reference range is wrong and levels should be above 50ng/ml, which makes you very deficient according to the new research, for information on this see vitamin D council web site there is a good article here that explains modern research into vitamin D and I have written out a lot of information on things related to vit D in post # 56 here

    Im not a doctor but my opinion from what you have said and what your tests say is that if you have been diagnosed as having Celiac, then double check that there is absolutely no sources of gluten in your diet. If you havent been tested properly for it get tested and make sure. You may need to take extra vitamins and minerals for a while once the celiac problem is healed, to lift levels to where they should be as Celiac can cause malabsorbtion.

    Your Tests indicate to avoid all milk products, so I would do that, unless you have a medical reason not to.

    If your reacting badly to potatoes stop eating them and the whole nightshade family, no matter what tests say, if a food is making you sick it is best to stop eating it for a while and see what happens. You can always reintroduce it later and see what happens then.

    Ask your doctor to get your vitamin D levels up, if you have Celiac and are eating gluten containing foods it will affect your ability to absorb vitamin D, so you have to be gluten free,

    If you dont have low cortisol, and unless you have been specifically told by a doctor to take Testosterone for some reason I wouldnt advise taking it, its a hormone and taking too much will throw everything out of balance.

    And let us know what your thyroid results are they might be being misread by relying on out of date reference ranges.

    Hopefully that will lead to an improvement in your condition, you have had quite comprehensive testing, but there might be something else going on that hasnt been tested for yet.

    Hope this helps

    All the best
  5. nanonug

    nanonug Senior Member

    Virginia, USA
    Does your multivitamin include the active forms of the B-complex vitamins? Things like methylcobalamin and methylfolate?

    Your low values on the neurotransmitter metabolites suggest that you might have problems producing enough BH4.

    Also, your heavy consumption of meat products will necessary lead to high levels of ammonia. This ammonia will have to be properly disposed of which requires a great deal of BH4.
  6. iacyi


    Wow, thank you for the detailed responses!

    My thyroid results are as follows:
    TSH 0.872 mIU/L (0.4-4.0)
    Total T4 116 (58-154)
    Free T4 15.4 (10-22)
    Free T3 5.15 (2.8-6.5)
    FT4:FT3 Ration 3.0 (2.0-4.5)
    Reverse T3 0.48 (0.14-0.54)
    Thyroglobulin <20
    Peroxidase <10

    I was diagnosed as coeliac with a biopsy at 14. I've got to say I am very strict when it comes to avoiding gluten: When I was eating breads etc. I had my own toaster, and still use my own chopping board and essentially my own side of the kitchen. The only person who uses the kitchen other than me eats mostly gluten free now too. I do react badly to coconut and soy lecithin, both give me sharp pains and blood if I eat too much of them, though I avoid them completely for the most part (Someone gave me some coconut macaroons at Christmas and it slipped my mind..!). Maybe there are some other foods as well stopping my gut from healing.

    My multivitamin had: Folate (as Metafolin** L-5-methyltetrahydrofolate) 800 mcg and Vitamin B12 (50% as methylcobalamin and 50% as 5-adenosylcobalamin) 200 mcg. I must admit though I have been taking a cheap B complex the last couple of months while I try to regain some direction. I definitely need to find a good one I can get without a doctor so I can give it a bit more time.

    Although it was progesterone I was taking for the cortsol (I have stopped it now), I was actually given some testosterone gel after testing much lower a couple of years ago. I felt much better for about a week and a half and then it wore off. As you say taking hormones just sends everything out of balance and so I discontinued it.

    Thanks again. I will have a look around and think about things a bit more, just wanted to post this up for now
  7. rlc

    rlc Senior Member

    Hi iacyi, your thyroid results look ok, if you have Celiac and you have avoided all gluten then that shouldnt be the cause of your current problems, but do a double check that there isnt something somewhere with gluten in it, you are vit D deficient which can be treated, and may help.

    However you said I do react badly to coconut and soy lecithin, both give me sharp pains and blood if I eat too much of them,

    Where is the pains and where is the blood? Sounds like it could be a sign of a serious gastric problem. It might be worth getting a gastroenterologist to look into it. The fact that it is causing bleeding concerns me and I think it should be investigated to find out why!
    All the best
  8. iacyi


    I can't remember exactly, but I can specifically remember pain in the lower right corner of my abdomen. Sorry, I keep missing out details I did go to the doctor about this a couple of years back and got referred for a colonoscopy. They found lymphocytic colitis, but said it wasn't causing my problems and discharged me to a coeliac specialist instead. He then tested me for gluten exposure and it came back normal.

    Dealing with doctors really wears me down... for now I try my best to avoid exposure. I am kind of hoping to build myself up with other treatments so I can better jump through any other hoops doctors might throw at me
  9. roxie60

    roxie60 Senior Member

    Central Illinois, USA
    Just found out today I also have lymphocytic colitus, dont know much about it, see Dr 5/30 but they said if my symps have reduced may want to wait on taking the med, "it's expensive" , I think it was called Anticort. Did they tell you how to resolve/cure your lymphocytic colitus? I know what you mean about the Drs, I knw there are/have to be some good ones but they sure were me out, physically, emotionally and financially.

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