Low energy, low mood? Phosphorous might be key (hypophosphotemia may be triggered by thiamine - refeeding syndrome)

[ZeroGravitas]

Interesting thread for me, @Mary. Thank's for posting.

I decided to start cautiously supplementing the same Swanson's monosodium phosphate powder as yourself (with my morning multi-mineral, supplement concoction and porridge). Starting on 200mg daily (of the recommended 1g of monosodium phosphate that provides 250mg of phosphorus - 20% the RDA).

I looked into phosphorus deficiency (and searched up this thread) following NHS tests investigating my osteoporosis (T-scores: spine -3.1, hip -2.6). I'm 37, male, with slightly *above* normal serum Vit-D and testosterone, plus good calcium. The rheumatologist ordered PTH, to look for hyper-parathyroid hormone levels that might cause phospaturia, which returned normal, too. But the 24h urine sample showed well *below* normal range phosphorus excretion (rather than excess). Normal calcium excretion.


No reference ranges on results, and GP had no clue. So technically I have to wait for a (hopefully) upcoming repeat appointment to interpret this for sure, but the ranges I searched up for this type of collection were:
15 – 50 mmol/24hr for phosphate (and 2.5 – 7.5 mmol/24 hours for calcium).

So I've been figuring that this *must* mean my intake is inadequate. (Right?) And has been deficient for at least the last 6 years that I've plummeted in bone mass. (I figure I've probably lost well over 1kg of skeleton! )

Context: 7 years back (around my 30th birthday - whoop), I suddenly got IBS, which was key to quickly figuring out my dietary intolerances. Since then I've been excluding diary, egg, yeast, (wheat why not) and high histamine foods. This change gave me, by far, the biggest improvement I've ever had in my energy and function, plus prevented most of my (post breakfast) energy crashes. Letting me jump into more research and testing, etc. But sadly the improvements dropped down over ~6 months or so...

I figured this might well be due to something I was excluding. Adding iodine, a couple years later, helped a bit. But initially I assumed it was the reduction in (easily digestible) protein - protein powder gave me a boost for a day or two, but then made me worst. Seemed like a histamine issue (all protein sources are potentially very problematic with this). Similar response with home long-fermented live yogurt (and plain milk) - an almost simultaneous boost and intolerance type crash, over the next day or two. Of course, I'm now wondering if milk's highly available phosphorus content might have been part of the positive effect...

I'd taken a lot of care over dietary changes, consulting my GP, two NHS dietitians and a private nutritionist. But I don't think anyone highlighted phosphorus as a potential issue (only calcium). Indeed, my daily diet over the time since (of meat, veg and a few safer grains) looks to have plenty of phosporus, on paper - 140% or so (as calculated on ChronOmeter):


I only added a calcium citrate supplement (13% RDA) in the last few months, after the leatest, worrying DEXA bone scan. Figuring it must be that, having been fairly blazé about the NHS advice of meeting the RDA. (I initially had more leafy greens, by mild hypothyroid symptoms later meant having to cut goitrogens.) Some of my other supplements are not included in there, but should have the relevant ones.

But a bit of researched has revealed that I probably won't have been able to absorb/use about half of that:

[1] Most of the phosphorus in plant seeds (beans, peas, cereals, and nuts) is in the form of phytates, which humans don't have the (phytases) enzymes to release [ref1]. So we may get only half of the stated amounts from those foods [ref2].

Of course, phytates are also considered an anti-nutrient, that chelate Calcium, Iron, and Zinc, preventing absorption [ref3]. But unfortunately I don't have many other viable food options to ditch the breakfast oats.

[2] Calcium supplements also substantially reduce the amount of phosphorus/phosphate that can be absorbed from a meal. From 80% down to ~30%, when taken with a full RDA of calcium [ref]:


I'd been taking a 1/3 of RDA calcium tablet at the end of my main meal, so perhaps halving (?) the effective phosphorus content from the meat, etc (my only substantial non-phytate source). So overall I might have been on ~70% RDA effectively. But who knows exactly what's been going on.

Now, I did get a *reduction* in my slight back discomfort after adding a little more (easily absorbed) calcium. But then I also tripled my K2 supp, tried to sleep even more carefully and added the odd flexation stretch. So I'm unsure if that has any meaning.



Anyway, I'd worked up to about ~700mg of monosodium phosphate (~14% phosphorus RDA), over 2 weeks, without experiencing any energy boost (sadly), or other notable effects.

However, since a week ago I've backed off that (to ~400mg) due to a few negative symptoms that now look like a cold (with a little bit of a temperate tonight). It's notable because I don't think I've had any (infectious) illness in the last 7 years to a decade or more; I'm in the "sick but never sick" category with relatively few symptoms, thankfully. I had a *very* gradual onset, since teenage years, preceded by ADHD, (dyslexia) and delayed sleep phase. I'm mostly just cognitively and socially crippled (non-24-hour sleep), with just enough energy to grocery shop and cook for myself.

I had a day or two of depression, then slightly reduced thinking speed and a bit of a headache, then stuffiness, then a slight sniffle, now full blown drippy nose, and tonight a temperature spike up to 38.3 Celsius (I normally run on the colder side of normal).

Slightly unnerving, with global COVID-19 news (there's no way it's that, where I am in the UK). But wondering if I should take this as a positive development...? I initially thought it might be a detoxification reaction... Which I've not seemed to have in the past, despite GI protocols and trying Freddd's methylation protocol (to an extent).

Maybe there's some kind of (dormant) viral activation, though...? I've no infectious event history. Tiny possible indicator - 4 or 5 tiny little pimples popped up in completely different places, possibly at some sites of past little (HPV) warts... Almost certainly reading too much into that. But maybe immune system is powering up with the (relatively tiny) amount of available phosphate...?



Just to throw in the kitchen sink (because I'm like that), my serum amino acid test (from 6 years back) showed, amongst other derangements, a weird hiccup in my phospho-(serine/ethanolamine/) pathyway, that I wondered if it implied that my phosphatidyl-choline symthesis was blocked/slowed. Now wondering if phosphate deficiency might impact here...?:

My essential protein aminos were low accross the board, too (as was commonly seen in the ME/CFS metabolomics studies). Particularly lysine, which I've heard is important for bone formation (but the Rhuematologist knows nothing of that).

Thank you if anyone manages to read this and has any thoughts on any of it.

 

[YippeeKi YOW !!]

So I've been figuring that this *must* mean my intake is inadequate.

Or that your absorption is poor, which, as you've noted, could be due to excess calcium, zinc, or potassium, tho that seems unlikely.

Alternately, you could have overactive parathyroid glands, which leads to high levels of parathyroid hormone, but you say your Dr already tested for that and it was negative.

You may have an underlying issue that affects your ability to store phosphorus, like pre-diabetes, a genetic condition, previous alcohol use (Ahhh!!! Glorious misspent youth!!!), possibly medications that interfere with absorption generally, like frequent use of antacids (but you would have already looked into this, unless I'm really missing my bet).

Phosphorus is one of the minerals that requires some caution. Too much can really throw a spanner in multiple different mechanisms, and since phosphorus is present in a wide range and diversity of foods, additional phosphorus might be too much of an otherwise good thing. It's important to keep daily notes on your reactions, as you clearly have, and back off if that seems necessary.

But unfortunately I don't have many other viable food options to ditch the breakfast oats.

If you soak your breakfast oats overnight, you can reduce the phytate considerably. Pain in the butt, but it may be helpful it oats are your best breakfast option.

Also, Vit D seems to influence the amountof phytate/phytic acid you retain, with a higher presence of Vit D equaling more retained phytate, and lower levels, less phytate.

It really turns into a complex game of chutes and ladders, in terms of the timing of supplements. I need to take Vit D early, otherwise it seems to interrupt my sleep. If you do the same, then you have a whole load of Vit D when you eat your oatmeal, and hence, more retained phytate....

You might consider adding Vit C to your morning meal. There was a study a few years back that showed that adding 50 mg of vitamin C counteracted the phytic acid load of a full meal, so it should be albe to contend with even a large bowl of oatmeal, and 80 mg of ascorbic acid (vitamin C) counteracted 25 mg of phytic acid in another research project..

It's all so frustrating ...

protein powder gave me a boost for a day or two, but then made me worst.

After years of using protein powder to increase protein intake and energy, I finally had to give it up altogether due to a severe GABA/glutamate imbalance which played merry hell with my neurotransmitters and CNS/brain.

Ditto the gelatin I used to increase lysine and proline.

Both of those powdered forms are created by hydrolyzing proteins, either thru prolonged high heat or various types of acids, severing their bonds and creating free-everything, but particularly damaging (at least for me) free glutamic acid, which is sort of like putting your nervous system threw a threshing machine. Or a wood chipper.

You apparently reacted to it a lot faster than I did, not sure if there's a clue in there or not.

It's notable because I don't think I've had any (infectious) illness in the last 7 years to a decade or more; I'm in the "sick but never sick" category with relatively few symptoms, thankfully

It's interesting that multiple members here have commented on the fact that they haven't had a serious infectious illness since developing ME.

If there's any justice, it might also mean that we'll all avoid Covid19. But then, I 've pretty much stopped looking for justice as a pay-off for anything.

(I normally run on the colder side of normal).

So do I. Usually as much as 1.5 degrees below normal. And I'm betting that you already know that's often a sign of hypothyroidism or Hashimotos Thyroiditis.

Particularly lysine, which I've heard is important for bone formation (but the Rhuematologist knows nothing of that).

Lysine and, I think, proline are both important factors in bone formation. Along with a boatload of other factors. Very confusing trying to keep up with it all.

As for your rheumatologist knowing nothing about the connection between lysine (and possibly proline as well) and normal bone formation, color me, like, stunned. No emoji for cynical laugh, insert your own version --here--.

Phosphorus deficiencies are sometimes the result of acid-base deficiencies or sometimes kidney function problems.

By the bye, I love your username. Totally cracked me up , so thanks for that, eh ...

PS ..... as an afterthought, how much, and which type of menaquinone do you supplment with? MK-7 has gotten the most press, but MK-4 has been tested as extremely effective for redirecting calcium et al to bones, teeth, etc ...

 

[junkcrap50]

And has been deficient for at least the last 6 years that I've plummeted in bone mass. (I figure I've probably lost well over 1kg of skeleton!

Have you looked into Vitamin K2? Somewhat common knowledge but thought I'd mention it in case you haven't heard of it's involvment in calcium / osteoporosis.

 

[YippeeKi YOW !!]

@junkcrap50

Have you looked into Vitamin K2?

Yeah, @ZeroGravitas been there, done that .... and I mentioned both MK-7 and MK-4 in my post to him above. MK7 takes all the bows, but MK-4 has a solid record in Japan of reversing bone loss ....

calcium. But then I also tripled my K2 supp,

So, like everything else about this irritating little dumpster fire of an illness, there are no easy, clear answers ....

 

[bread.]

Interesting thread for me, @Mary. Thank's for posting.

I decided to start cautiously supplementing the same Swanson's monosodium phosphate powder as yourself (with my morning multi-mineral, supplement concoction and porridge). Starting on 200mg daily (of the recommended 1g of monosodium phosphate that provides 250mg of phosphorus - 20% the RDA).



I looked into phosphorus deficiency (and searched up this thread) following NHS tests investigating my osteoporosis (T-scores: spine -3.1, hip -2.6). I'm 37, male, with slightly *above* normal serum Vit-D and testosterone, plus good calcium. The rheumatologist ordered PTH, to look for hyper-parathyroid hormone levels that might cause phospaturia, which returned normal, too. But the 24h urine sample showed well *below* normal range phosphorus excretion (rather than excess). Normal calcium excretion.

View attachment 36357
No reference ranges on results, and GP had no clue. So technically I have to wait for a (hopefully) upcoming repeat appointment to interpret this for sure, but the ranges I searched up for this type of collection were:
15 – 50 mmol/24hr for phosphate (and 2.5 – 7.5 mmol/24 hours for calcium).

So I've been figuring that this *must* mean my intake is inadequate. (Right?) And has been deficient for at least the last 6 years that I've plummeted in bone mass. (I figure I've probably lost well over 1kg of skeleton! )

Context: 7 years back (around my 30th birthday - whoop), I suddenly got IBS, which was key to quickly figuring out my dietary intolerances. Since then I've been excluding diary, egg, yeast, (wheat why not) and high histamine foods. This change gave me, by far, the biggest improvement I've ever had in my energy and function, plus prevented most of my (post breakfast) energy crashes. Letting me jump into more research and testing, etc. But sadly the improvements dropped down over ~6 months or so...

I figured this might well be due to something I was excluding. Adding iodine, a couple years later, helped a bit. But initially I assumed it was the reduction in (easily digestible) protein - protein powder gave me a boost for a day or two, but then made me worst. Seemed like a histamine issue (all protein sources are potentially very problematic with this). Similar response with home long-fermented live yogurt (and plain milk) - an almost simultaneous boost and intolerance type crash, over the next day or two. Of course, I'm now wondering if milk's highly available phosphorus content might have been part of the positive effect...

I'd taken a lot of care over dietary changes, consulting my GP, two NHS dietitians and a private nutritionist. But I don't think anyone highlighted phosphorus as a potential issue (only calcium). Indeed, my daily diet over the time since (of meat, veg and a few safer grains) looks to have plenty of phosporus, on paper - 140% or so (as calculated on ChronOmeter):
View attachment 36358

I only added a calcium citrate supplement (13% RDA) in the last few months, after the leatest, worrying DEXA bone scan. Figuring it must be that, having been fairly blazé about the NHS advice of meeting the RDA. (I initially had more leafy greens, by mild hypothyroid symptoms later meant having to cut goitrogens.) Some of my other supplements are not included in there, but should have the relevant ones.

But a bit of researched has revealed that I probably won't have been able to absorb/use about half of that:

[1] Most of the phosphorus in plant seeds (beans, peas, cereals, and nuts) is in the form of phytates, which humans don't have the (phytases) enzymes to release [ref1]. So we may get only half of the stated amounts from those foods [ref2].

Of course, phytates are also considered an anti-nutrient, that chelate Calcium, Iron, and Zinc, preventing absorption [ref3]. But unfortunately I don't have many other viable food options to ditch the breakfast oats.

[2] Calcium supplements also substantially reduce the amount of phosphorus/phosphate that can be absorbed from a meal. From 80% down to ~30%, when taken with a full RDA of calcium [ref]:
View attachment 36359

I'd been taking a 1/3 of RDA calcium tablet at the end of my main meal, so perhaps halving (?) the effective phosphorus content from the meat, etc (my only substantial non-phytate source). So overall I might have been on ~70% RDA effectively. But who knows exactly what's been going on.

Now, I did get a *reduction* in my slight back discomfort after adding a little more (easily absorbed) calcium. But then I also tripled my K2 supp, tried to sleep even more carefully and added the odd flexation stretch. So I'm unsure if that has any meaning.



Anyway, I'd worked up to about ~700mg of monosodium phosphate (~14% phosphorus RDA), over 2 weeks, without experiencing any energy boost (sadly), or other notable effects.

However, since a week ago I've backed off that (to ~400mg) due to a few negative symptoms that now look like a cold (with a little bit of a temperate tonight). It's notable because I don't think I've had any (infectious) illness in the last 7 years to a decade or more; I'm in the "sick but never sick" category with relatively few symptoms, thankfully. I had a *very* gradual onset, since teenage years, preceded by ADHD, (dyslexia) and delayed sleep phase. I'm mostly just cognitively and socially crippled (non-24-hour sleep), with just enough energy to grocery shop and cook for myself.

I had a day or two of depression, then slightly reduced thinking speed and a hit of a headache, then stuffiness, then a slight sniffle, now full blown drippy nose, and tonight a temporary temperature spike up to 38.3 Celsius (I normally run on the colder side of normal).

Slightly unnerving, with global COVID-19 news (there's no way it's that, where I am in UK). But wondering if I should take this as a positive development...? I initially thought it might be a detoxification reaction... Which I've not seemed to have in the past, despite GI protocols and trying Freddd's methylation protocol (to an extent).

Maybe there's some kind of (dormant) viral activation, though...? I've no infectious event history. Tiny possible indicator - 4 or 5 tiny little pimples popped up in completely different places, possibly at some sites of past little (HPV) warts... Almost certainly reading too much into that. But maybe immune system is powering up with the (relatively tiny) amount of available phosphate...?



Just to throw in the kitchen sink (because I'm like that), my serum amino acid test (from 6 years back) showed, amongst other derangements, a weird hiccup in my phospho-(serine/ethanolamine/) pathyway, that I wondered if it implied that my phosphatidyl-choline symthesis was blocked/slowed. Now wondering if phosphate deficiency might impact here...?:
View attachment 36360
My essential protein aminos were low accross the board, too (as was commonly seen in the ME/CFS metabolomics studies). Particularly lysine, which I've heard is important for bone formation (but the Rhuematologist knows nothing of that).

Thank you if anyone manages to read this and has any thoughts on any of it.

I have the exact (!) same issues, intermittently my calcium in blood was high though, but the the low phosphate in urine is the same, I also had a kidney stone 3 months ago, I am very severe me/cfs,... do you feel better with the phosphate supplement?

 

[Mary]

@ZeroGravitas - You are certainly thorough in your investigation! I don't really know what to tell you about phosphorous. For me it was simple, a very clear case of hypophosphatemia triggered by thiamine, due to refeeding syndrome. The hypophosphatemia symptoms came on quickly, and resolved almost as quickly when I added in phosphorous. I don't know what to tell you about your urinary excretion tests.

I have just been reading about silica/silicon and bone health, and this may be something you could look into.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658806/

Dietary silicon intake and BMD

As mentioned above, the main and most important source of exposure to silicon is from the diet and recently two cross-sectional epidemiological studies from our group have reported that dietary silicon intake is associated with higher bone mineral density (BMD).

Specifically, I've been reading about diatomaceous earth. I've been concerned because my nails break very easily and my hair has been thinning (sob!). Though my Dexa scan is pretty good, my bones apparently are not doing too badly. It's not my thyroid, I take a thyroid supplement. And I seem to be on top of my calcium and magnesium intake, as well as K2.

btw, do you take magnesium? It's very important for bone health and energy. I don't think you mentioned magnesium. I've found the best form to be magnesium glycinate. I take a high dose - 700 - 800 mg., at night, and it helps with sleep too. And I've also stopped my calcium supplement and my bones are doing fine without additional calcium.

There are silica supplements which are made from horsetail (herb) but I've been reading about dangers associated with horsetail, so am avoiding it. It may adversely affect the kidneys and liver.

There are lots of testimonials though not a lot of research on diatomaceous earth and bone health, hair, nails, etc. It has to be FOOD GRADE DE - that's very important. DE is also sold for swimming pools, but that is not food grade and not to be ingested by humans.

So this is my latest experiment, I've just started it (DE), and think I will see results, if any, within a few months, hoping for stronger nails and thicker hair.

If you have absorption problems, you may be low in stomach acid, which is very common in persons with ME/CFS. A simple test which may help determine this is to dissolve 1/2 teaspoon baking soda in 8 ounces of water and drink on an empty stomach. The empty stomach part is important because the baking soda will neutralize stomach acid. Anyways, if you don't burp within a few minutes after drinking this, it can indicate low stomach acid. I've been taking betaine HCL with pepsin for years with meals and it's made a huge difference in my digestion.

Your low aminos can indicates absorption problems. But also it seems to be common in persons with ME/CFS. Some studies show we do use our aminos for fuel, especially women, but men too I think. Have you ever tried branched chain amino acids? They've helped many of us with energy and they've helped me recover much quicker from PEM crashes. I take 4,000 - 5000 mg. a day. @ljimbo423 takes I think twice that amount, but when I tried, it caused insomnia for me.

 

[ljimbo423]

They've helped many of us with energy and they've helped me recover much quicker from PEM crashes. I take 4,000 - 5000 mg. a day. @ljimbo423 takes I think twice that amount, but when I tried, it caused insomnia for me.

I added in a third dose of BCCA's a couple of weeks ago. I now take another 600 mg at 6:30 pm to help keep my energy up until bedtime and it don't give me insomnia. It really helps me to focus better and stay more alert.

So now I take 8 gms first thing in the morning, 5 gms at 1:30 and 600 mg at 6:30 pm, which works great. I can't image how much worse I would feel if I didn't take these and I'm not going to find out!

 

[Mary]

@ljimbo423 - wow - I'm really glad that high dose works for you! I know how you feel, I remember 3-day crashes and long slow recoveries, and never want to go back to that!

@ZeroGravitas - one more thing that might help you is glutamine. It also boosted my energy some. After awhile it did start causing insomnia - it can help produce both GABA and gluatamate - so I had to stop it. But I recently started taking it again (500 mg.) and am doing okay and it seems to be good for me, it's also good for gut health.

 

[YippeeKi YOW !!]

@ZeroGravitas
As an aside, I'd be cautious with adding in glutamine, at least in more than small initial amounts, til you know how your neuro/CNS/brain is handling it.

Glutamine is a double-edged sword, sometimes converting obediently to whichever neurotransmitter your system needs at the time, but with other disregulations, of which ME patients have a multitude, it can suddenly turn on you, converting only to glutamate, and that's the threshing machine/wood chipper effect that I mentioned in my post to you above.

When your GABA/glutamate balance is out of whack, you'll experience a Toad's Wild Ride of deeply unpleasant neuro effects that will leave you beggin for mercy.

Just trial it carefully. As a friend, it's terrific. As an enemy, it's deadly .....

 

[ZeroGravitas]

Thanks for all the great replies! Sorry that I seem to be partially diverting the thread onto my bone density...

could be due to excess calcium, zinc, or potassium

My calcium intake is ~80% RDA, potassium ~60% (despite all the veg...), but zinc is actually kinda high at ~400% RDA (from what I worked out yesterday). What's the mechanism for excess zinc potentially preventing phosphorus absorption?

overactive parathyroid glands

I should have included the serum test result for that, yeah. PTH low normal at 1.8 pmol/L (range 1.6-6.9). And serum phosphate itself is low-mid normal, at 0.96 mmol/L (range 0.8-1.5).


So my body's doing OK at keeping the blood phosphate levels up (it's a pretty important metabolite after all). I'm presuming it's been breaking down bone to do it, though. And these graphics give a clearer picture of the rapidity of my bone loss:

Note: my rheumatologist stressed that there's a big margin of error on these measurements. They were also done on 2 different machines, which apparently isn't ideal, either.

I'll also mention that I've never smoked, not drunk any alcohol since dietary exclusions (7 years), never used/abused steroids or had any eating disorder. I did also have to stop playing badminton (and squash) for a couple hours a week, around 6 years back, too. (It's odd, but I used to be able to work up to intense sports, then be mildly crashing most of the rest of the time. The diet changes kinda flattened my energy envelope out and made me more obviously ME/CFS-ish in other ways.)

But again, rheumatologist not that excited about exercise changes - he's keen that in (young) men there's usually a pronounced problem, resolving it resulting in restoration of bone mass.

phosphorus is present in a wide range and diversity of foods, additional phosphorus might be too much

In a standard diet, with diary (and egg) and maybe soft drinks (that have it as an acidity regulator), yeah. But then my diet's even more restricted than standard paleo, in many ways.

What problems might excess/imbalanced phosphorus (hyperphosphatemia) cause? It seems that it's common in those with (and may cause) poor kidney function, but mainly causes issues via lowered calcium levels [ref1].

If you soak your breakfast oats overnight

Good suggestion, I'd read that too, but I don't think I can leave any protein source wet like that for an extended period, due to the histamine it would develop (as well as me being kinda lazy). As per my nutritionalist's advice, I tried soaking almonds to go with cooked apple breakfast. But stopped with the apple eventually too, as that amount of fruit sugars seemed a little unhelpful for me.

higher presence of Vit D equalling more retained phytate

Oh, I'd not heard of that, heh. (Or phytate as an anti-oxidant.)

I think this is saying that (my) high vitamin-D serum levels are optimal for phosphorus absorbs ion (as well as calcium)...?:

A slight drop in blood calcium levels [...] is sensed by the parathyroid glands, resulting in their increased secretion of PTH, which rapidly decreases urinary excretion of calcium but increases urinary excretion of phosphorus and stimulates bone resorption. [...] PTH also stimulates conversion of vitamin D to its active form [...] in the kidneys. [...] Increased circulating 1,25-dihydroxyvitamin D in turn stimulates increased intestinal absorption of both calcium and phosphorus.
-ref2

There was a study a few years back that showed that adding 50 mg of vitamin C counteracted the phytic acid load of a full meal

Again, interesting. That's quite a small amount of vit-C. From chronOmeter it looks like I almost get that much my usual serving of sweet red peppers, although with breakfast specifically, blueberries have less than I thought. or well.

I had (initially during that period) been taking (I think) a gram, or so, of ascorbic acid in my water, with breakfast and dinner. I follow Dr Myhill, and she's keen on large amounts of it. As are others. But taken in a long drink like that it seemed to wreck my teeth. (Despite no processed sugar, etc.) Of course phosphate is important for tooth enamel too, so low levels might help explain that.

The vit-c seemed to slightly drop my next day energy too. I was unsure if the corn based ascorbic acid was a problem because of histamine sensitivity - others with this had problems with it. But tapioca source vit-c seemed similar. I've actually loaded up a bit on this over the last couple days, to support my improptu bout of man-flu, heh.

Ditto the gelatin I used to increase lysine and proline.[...] hydrolyzing proteins, [...] free glutamic acid [...] You apparently reacted to it a lot faster than I did, not sure if there's a clue in there or not.

So, I tried a whole lot of supplements (and foods) in that ~year of partial 'recovery'. Frustratingly, I reacted negatively to a lot of the things that should have best helped me...

The following gave me next day fatigue reactions a lot like a food intolerance reaction (but generally without the IBS component): Bone broth (or long stewed meat), gelatin (I still stick to vegi capsule shells), hydrolysed collagen, glutamine, cysteine, NAC, lysine, glycine(!). Don't think I ever figured out these mysteries... (Mthyl-B9 also wore me down progressively.)

Basically all the things that might help repair my (presumably) leaky gut (causing the intolerances, etc). Or help make glutathione.

Of course the cologen ingredients are probably also important for formation of the (cologen) bone matrix, right? (And vit-C helps with that, too, I think.) That's where my deficient amino acids may have stopped the constructive part of regular bone turnover. I'd love to get that AA serum test again (to see if it god even worst), but I'd have to find a new (willing) nutritionist, order the test through a third partys and get the blood draw with another party (previously a trip to London Biolab, and that's all a bit much...

1.5 degrees below normal. And I'm betting that you already know that's often a sign of hypothyroidism or Hashimotos Thyroiditis.

Sure. Although I was only 1 degree C below (at 36C) and might be a little higher now... (I got an optical ear thermometer recently, but have only used it while slightly feverish, so far.)

I actually did a cheaky piggy-back on an NHS blood draw, recently, for a private extended thyroid panel. As with the NHS test it showed T3 and T4 normal range (for as much as that means). But reverse T3 high. Although that probably only means that my thyroid is (quite sensibly) throttling back a little to conserve my limited energy. So no big deal, but I felt it fit with my experience of mild hypothyroid symptoms (dry eyes, carpul tunnel on both wrists, etc) upon reducing supplemental iodine intake at all.

how much, and which type of menaquinone do you supplment with?

I've been on supplemental K2 the whole time. Mostly at around the RDA. I was on this handy combined A + D3 + K2 (MK7) supp until it discontinued about 3 years back. Then this one with MK4 (which was only 38% RDA). Now this one of just MK7, for the last 6 months, which says it's 267% the NRV (at 200ug).

I love your username.

Thanks. It's a slightly oblique reference to the sci-fi of Iain M Banks, as well as being kind of self deprecating.

Ok, that's all the energy and time I've had for today. Thanks again. More replies to other tomorrow, if I may.

 

[bread.]

Thanks for all the great replies! Sorry that I seem to be partially diverting the thread onto my bone density...

My calcium intake is ~80% RDA, potassium ~60% (despite all the veg...), but zinc is actually kinda high at ~400% RDA (from what I worked out yesterday). What's the mechanism for excess zinc potentially preventing phosphorus absorption?


I should have included the serum test result for that, yeah. PTH low normal at 1.8 pmol/L (range 1.6-6.9). And serum phosphate itself is low-mid normal, at 0.96 mmol/L (range 0.8-1.5).
View attachment 36365

So my body's doing OK at keeping the blood phosphate levels up (it's a pretty important metabolite after all). I'm presuming it's been breaking down bone to do it, though. And these graphics give a clearer picture of the rapidity of my bone loss:

View attachment 36366
Note: my rheumatologist stressed that there's a big margin of error on these measurements. They were also done on 2 different machines, which apparently isn't ideal, either.

I'll also mention that I've never smoked, not drunk any alcohol since dietary exclusions (7 years), never used/abused steroids or had any eating disorder. I did also have to stop playing badminton (and squash) for a couple hours a week, around 6 years back, too. (It's odd, but I used to be able to work up to intense sports, then be mildly crashing most of the rest of the time. The diet changes kinda flattened my energy envelope out and made me more obviously ME/CFS-ish in other ways.)

But again, rheumatologist not that excited about exercise changes - he's keen that in (young) men there's usually a pronounced problem, resolving it resulting in restoration of bone mass.


In a standard diet, with diary (and egg) and maybe soft drinks (that have it as an acidity regulator), yeah. But then my diet's even more restricted than standard paleo, in many ways.

What problems might excess/imbalanced phosphorus (hyperphosphatemia) cause? It seems that it's common in those with (and may cause) poor kidney function, but mainly causes issues via lowered calcium levels [ref1].


Good suggestion, I'd read that too, but I don't think I can leave any protein source wet like that for an extended period, due to the histamine it would develop (as well as me being kinda lazy). As per my nutritionalist's advice, I tried soaking almonds to go with cooked apple breakfast. But stopped with the apple eventually too, as that amount of fruit sugars seemed a little unhelpful for me.

Oh, I'd not heard of that, heh. (Or phytate as an anti-oxidant.)

I think this is saying that (my) high vitamin-D serum levels are optimal for phosphorus absorbs ion (as well as calcium)...?:


Again, interesting. That's quite a small amount of vit-C. From chronOmeter it looks like I almost get that much my usual serving of sweet red peppers, although with breakfast specifically, blueberries have less than I thought. or well.

I had (initially during that period) been taking (I think) a gram, or so, of ascorbic acid in my water, with breakfast and dinner. I follow Dr Myhill, and she's keen on large amounts of it. As are others. But taken in a long drink like that it seemed to wreck my teeth. (Despite no processed sugar, etc.) Of course phosphate is important for tooth enamel too, so low levels might help explain that.

The vit-c seemed to slightly drop my next day energy too. I was unsure if the corn based ascorbic acid was a problem because of histamine sensitivity - others with this had problems with it. But tapioca source vit-c seemed similar. I've actually loaded up a bit on this over the last couple days, to support my improptu bout of man-flu, heh.


So, I tried a whole lot of supplements (and foods) in that ~year of partial 'recovery'. Frustratingly, I reacted negatively to a lot of the things that should have best helped me...

The following gave me next day fatigue reactions a lot like a food intolerance reaction (but generally without the IBS component): Bone broth (or long stewed meat), gelatin (I still stick to vegi capsule shells), hydrolysed collagen, glutamine, cysteine, NAC, lysine, glycine(!). Don't think I ever figured out these mysteries... (Mthyl-B9 also wore me down progressively.)

Basically all the things that might help repair my (presumably) leaky gut (causing the intolerances, etc). Or help make glutathione.

Of course the cologen ingredients are probably also important for formation of the (cologen) bone matrix, right? (And vit-C helps with that, too, I think.) That's where my deficient amino acids may have stopped the constructive part of regular bone turnover. I'd love to get that AA serum test again (to see if it god even worst), but I'd have to find a new (willing) nutritionist, order the test through a third partys and get the blood draw with another party (previously a trip to London Biolab, and that's all a bit much...


Sure. Although I was only 1 degree C below (at 36C) and might be a little higher now... (I got an optical ear thermometer recently, but have only used it while slightly feverish, so far.)

I actually did a cheaky piggy-back on an NHS blood draw, recently, for a private extended thyroid panel. As with the NHS test it showed T3 and T4 normal range (for as much as that means). But reverse T3 high. Although that probably only means that my thyroid is (quite sensibly) throttling back a little to conserve my limited energy. So no big deal, but I felt it fit with my experience of mild hypothyroid symptoms (dry eyes, carpul tunnel on both wrists, etc) upon reducing supplemental iodine intake at all.
View attachment 36373

I've been on supplemental K2 the whole time. Mostly at around the RDA. I was on this handy combined A + D3 + K2 (MK7) supp until it discontinued about 3 years back. Then this one with MK4 (which was only 38% RDA). Now this one of just MK7, for the last 6 months, which says it's 267% the NRV (at 200ug).



Thanks. It's a slightly oblique reference to the sci-fi of Iain M Banks, as well as being kind of self deprecating.

Ok, that's all the energy and time I've had for today. Thanks again. More replies to other tomorrow, if I may.

Re low phosphorus in urine, what is your total urinary output in liters per day?

 

[ZeroGravitas]

I also had a kidney stone 3 months ago

Ouch! Did you find out what type, what it was made of? It's usually some form of calcium, right?

I'm a little concerned of causing a stone from supplementing too much calcium. Although my current excretion levels seem fine and I drink plenty of water.

what is your total urinary output in liters per day?

With the recent test it was exactly one full bottle at 2.5 litres. Which makes sense, as I refill my 1.5l carafe in the fridge with filtered tap water twice a day (and always have a pint glass on the go).

do you feel better with the phosphate supplement?

Haven't noticed any improvements yet. Gonna see if I feel any different after this new found cold.

I don't know how much of the supplemental phosphorus my body will use for each purpose; assuming I was deficient for 7 years, my bones are presumably going to be crying out for any phosphorus they can get. From my quick calculations my skeleton's about ~200g of phosphorus short of normal density bones. Although I've always been pretty light weight and done little heavy lifting, etc (I'm currently 58Kg and ~10% body fat). So four times that mass of monosodium phosphate (if it all went to skeleton) ~800g. I'm taking 0.4/day right now. So rebuilding will take a long time, even taking 1g/day and even if phosphorus is the only limiting factor.

Reference for that - apparently 85% of the body's phosphorus is store in the skeleton (compared to 99% of calcium):

Adult body phosphorus makes up about 1.0%–1.4% of fat-free mass or ∼ 12 g (0.4 mol) per kg. Eighty-five percent of this total is in the mineral of bones and teeth

 

[ZeroGravitas]

silica/silicon and bone health

Oh, thanks, I'll take a look. (I could swear my multi-mineral supp had trace silicon... But it doesn't.)

I've bough some strontium, as a Myhill recommendation for osteoporosis. My rheumatologist says that it is certainly "bone avid" and they used to use a strontium medicine but it went out of favour some time back...

btw, do you take magnesium?

Yes, sorry for not mentioning:
• My main calcium supp has 133mg magnesium (to 333mg calcium), in various forms.
• Also a 1g magnesium malate tablet at night (that I found helped with sleeping and leg muscle discomfort) - 115mg magnesium. (I recommend magnesium glycinate to others, too, but the glycine screws me up, somehow...)

Actually, that also has 100mg calcium, that I failed to add to my chronOmeter sheet. So I am currently at 100% RDA calcium, heh.

Just potassium intake is below, at 60%. Perhaps I'll think about trying that again at some point; I'd taken a couple types when trying methylation protocol, too. Didn't seem to do anything much in itself. Was also nervous of taking it in tablets, etc, given the warning of damage it can do to the GI tract, if in pockets of hit concentration. And I couldn't stand the taste of potassium chloride in Dr Myhill's MMM (although that wouldn't be a huge deal at ~200mg/day).

you may be low in stomach acid

Yeah. It's something I've wanted to test directly, e.g. with a Heidelberg test, but couldn't find anyone who could. I think I'll give the baking soda test a go some time, although I feel like it would be a pretty ambiguous result, any which way. (I like hard numbers, heh.)

I was taking betaine HCL + pepsin for a couple years and tried a couple different digestive enzyme mixes. I *think* I might have had a little energy boost the first time I took the digestive enzymes, in the same vein as the initial protein powder boost (both faded fast). Hence thinking I'd excluded more easily digestible protein sources, that I was struggling with meat. A GI (stool) test showed a high amount of left over fat, 6 years back, so something was probably lacking, if not a one-off fluke.

I kept taking one tablet of this Now Super Enzymes (all in one digestive aid) with my main meal every day for the whole 7 years. But have now stopped with it, not feeling any difference either way. No direct digestive symptoms either way. My nutritionist wasn't keen to start enzymes, and I'm not sure if any of the ingredients could cause damage to the GI tract, in long term use...

Have you ever tried branched chain amino acids?

I did for a while, during that good year, they maybe gave me a little energy. I was mostly having them with my breakfast juice-mini-fasts. I think I could potentially start them again OK...

They share a transporter with tyrosine and lysine, I think it is. And I don't want to imbalance those, as they were my lowest in serum in test. I take the tiniest sprinkle of tyrosine in my first drink and have occasionally needed to rub a tiny amount of lysine on my gums to ward off mouth ulcers (canker sores). Which gives an indication, perhaps, of just how low my lysine levels have been. (And how that's definitely something to try to keep looking into, in terms of bone health.)

one more thing that might help you is glutamine

Yeah, I wish. As I say, it didn't agree with me, next-day energy wise. I think GABA supplements at night either did nothing (to be expected, as can't really reach brain from gut), or were similarly unhelpful, too...

 

[YippeeKi YOW !!]

Hi @bread .....

Here's an unsolicited posting hint, apologies if you're already are familiar with it:

When you hit 'Reply' at the bottom of a post that youre responding to, it posts the ENTIRE thing in your answer, which can clog up a thread pretty quick.

If you highlight a specific sentence or paragraph that you want to respond to, a little pop-up will appear with 2 choices: 'Quote' or 'Reply'. If you click on 'Reply', the portion that you highlighted will appear in your reply box, and you can proceed as usual, replying to it just below it.

Hope this helps, and is reasonably clear .....

 

[YippeeKi YOW !!]

@ZeroGravitas
If you want to increase silica, try powdered bamboo extract.

I'm using BulkSupplements bamboo, and so far, so good .... no negative reactions, and I think there's been a lessening of joint/bone pain, tho it's early times .... the bamboo is a little less daunting than diatomaceous earth, which can scare some people off ....

 

[Mary]

Was also nervous of taking it in tablets, etc, given the warning of damage it can do to the GI tract, if in pockets of hit concentration.

I believe this is mainly related to prescription Klor-con which is time-release - so I think is in a higher dose than regular potassium tablets (which are 99 mg. - I can't figure out the equivalency of something like Klor-Con which is in meq) and also would stay in the stomach longer. I've been taking potassium gluconate tablets for 10 years, generally 2 tablets (200 mg.) with each meal and 200 mg. middle of the night with no problems. If you think you might be low in potassium, a simple thing to try is drinking several glasses of low sodium V8 or vegetable juice, which is high in potassium. And very often people who are low in potassium will start to feel better in a couple of hours after trying this.

Also, people with ME/CFS can have normal blood levels of potassium but have low intracellular potassium, which was the case with me: https://forums.phoenixrising.me/thr...ded-in-methylation-treatmt.18670/#post-291422

I understand you have trouble with glycine in magnesium glycinate. When I first took glycine all by itself for sleep, it hit me like a truck and caused a severe detox reaction. It's a long story but I kept taking it albeit in much smaller doses, and gradually was able to take more. It's used in Phase II liver detoxification, so I'm just wondering if your bad reaction to glycine had something to do with detoxing. I now take 4000 mg glycine at night (in divided doses) for sleep, as well as magnesium glycinate and do fine with it, no detox reaction.

About your calcium/magnesium ratio - I've read that the traditional ratio of 2-1, calcium magnesium, is not necessarily the best, and some now recommend a 1:1 ratio, or even more magnesium than calcium. I go by symptoms.

 

[YippeeKi YOW !!]

@ZeroGravitas , @Mary
The warnings about potassium settling in a clump on your stomach lining applies to any kind of potassium. If you use powered potassium and whisk it briskly into water and drink it quickly, you'll avoid a pill dissolving slowly on the outer edges of your stomach and burning a hole in it ....

I use BulkSupplements potassium gluconate because that's the mildest, most easily absorbed form of potassium, at least for me, and I take it in the 250-400 mg range in one dose, when I'm feeling the need. Otherwise, I take a smaller dose, about 150 mgs, every AM in my morning kick-start drink.

 

[xena]

My need for phosphate seems to increase with methylation, I assume because it encourages cell division. I noticed this once three years ago and again now that I'm taking folate and methyl donors more regularly. I get very tired, lack of appetite. Also using the Swanson product.

Also tried inositol since it is a plant source of phosphate but not sure if this works. In any case it causes me anxiety so not a fan

 

[Mary]

My need for phosphate seems to increase with methylation, I assume because it encourages cell division. I noticed this once three years ago and again now that I'm taking folate and methyl donors more regularly. I get very tired, lack of appetite. Also using the Swanson product.

Also tried inositol since it is a plant source of phosphate but not sure if this works. In any case it causes me anxiety so not a fan

The methylation might also be increasing your need for potassium. It's extremely common for methylation to cause potassium deficiency as it causes cells to divide more rapidly and thus use more potassium. One way which may help discover whether you need more potassium is to drink several glasses of -low-sodium V8 or vegetable juice (the low-sodium kind has more potassium than regular) and see if you feel any better after a couple of hours.

Low potassium made me extremely tired after I started taking methylfolate, which initially boosted my energy. Over a couple of days I titrated up to 1000 mg. a day of potassium in divided doses, and that awful fatigue went away. I later found that the best form of potassium for me was potassium gluconate.

People with ME/CFS may have low intracellular potassium despite normal blood work (see https://forums.phoenixrising.me/thr...ded-in-methylation-treatmt.18670/#post-291422)

 

[ZeroGravitas]

Has anyone noticed weight loss in conjunction with phosphate supplementation [Nature 2015]?:

Phosphorus status is inversely correlated with body weight; [...] Phosphorus supplementation for 12 weeks significantly decreases body weight, BMI, waist circumference and subjective appetite scores.

I'm trying to figure out why I've lost 1-1.5kg over the last couple months or so (when I was already a modest 58-59kg @ 5'8"). Same diet, still eating as much as possible.

I figure the loss period coincides roughly with the time I've been taking monosodium phosphate. But I also added a couple grams of vit-C (for the first time in a long while) and there's been the mild stress of impending coronavirus... Then lockdowns where I switched from 25 minute grocery shops, every 3 days, to 90 minute family shops, once a week.

So, I'm wondering which is more relevant a factor. I don't generally get very distinct PEM. Although, a couple of days after my previous week's super-shop (plus wipe-down ritual, back home) my limb muscles were definitely aching a noticeable amount (more than normal). Assuming muscle breakdown, I went back on (pea) protein powder (~6g with breakfast) and that seems to have stayed things better after the most recent shop. It's not fully crashed me yet (maybe slight energy improvement, even), but will see.


Bumped into this old mouse study paper [NCBI 1983] while just have a Google:

The effects of phosphate depletion (PD) [...] Adenine nucleotides, ATP, ADP, AMP, and creatine phosphate levels did not change. Mitochondrial respiration and oxidative phosphorylation were impaired by PD. Total cellular mitochondrial and myofibrillar creatine phosphokinase activities were significantly reduced

I don't think we talked about the possible molecular basis of this low energy in detail, yet...? I'm trying to brush up on these pathways, molecules and enzymes again, as a follow-up to the Prusty HHV-6 transactivation paper thread...

I actually did a [...] private extended thyroid panel. [...]

Oops! Those were someone else's results I was looking at, not my own! They're similar, but my TSH is actually mid-normal (not that it's that relevant in this thread anyway...):

So do I. Usually as much as 1.5 degrees below normal.

Actually, I monitored my temperature with a good optical in-ear thermometer and I've been running at close to 37C during my day (dropping to 36.6C when I'm sleepy). About a degree warmer than years ago when testing with a contact digital thermometer, under the tongue.

I've still been unable to ramp up my m. phosphate back up past 350mg, without getting sore throat and then mild fever. I'd be a little curious to see where there flu symptoms go, but for the coronavirus context making them too stressful. The cold it seemed to give me also passed onto each of my parents, in turn, which was very odd... (But I was going to start a new thread to as about about all this.)