Three Months Later

Wow! Hard to believe it's been three whole months since my last post. Plenty going on, as usual.

In December I started seeing a chiropractor who was also a functional medicine doctor, and despite the fact I started seeing him primarily for active release therapy/technique, he spent the majority of my seven sessions (the initial consultation plus six sessions) bullying me and ranting about how I refuse to go gluten free and dairy free. Mind you--there was no rapport--how does he expect me to build up any trust in him as a health care provider if all he's going to do is rant about what I'm not doing--and of course, conveniently overlook all the things I did manage to alter. My suspicion is, that his primary focus seems to be a clientele who are high performance athlete. Let's just say, I'm NOT his target clientele. After six sessions of being bullied directly (as well as being subjected to his political rants), I decided this was not a good fit for me personally.

In December I also managed to see a new rheumatologist for yet another rheumatological screening--and he was quite thorough and was testing all kinds of things, even things my previous endocrinologist (the one who retired in December 2017) would test. 

I was really impressed with how thorough he was and how easy it was for us to build up a rapport. Only problem is when I saw him in January, I was informed the hospital is trying to get him to retire (he's only in his early 70s, and not ready yet). Looks like the hospital is trying to get an infusion of young blood, and aren't all that concerned with the patients this doctor treats. I have one more appointment with him (in April) and I hope to get some kind of conclusive diagnosis--my suspicion is Ehlers Danlos Syndrome--as I have a collection of seemingly unrelated issues, yet when I connect the dots, it brings me back to EDS.  I hope when I see him, he'll suggest I get genetic testing--and whether I get that done or not will hinge directly on how much the % insurance will cover, as Maharajah's plan changed this year and it is utter garbage--I'm pretty much hemorrhaging money this year with our high deductible.

Undaunted, I found another chiropractor for the active release therapy, and I have been getting treatments weekly. This will be the sixth week, and between this and a kenalog injection I had (right into my psoas bursa), I am walking better, able to dismount from a chair better, and climb stairs better--at least the lifting of the leg, but not the "push off" movement. I am allowing myself a total of 12 visits to get everything "dealt with." Doc Handy (as I'll call him herein) is great.

Doc Handy thinks I should set up a blog regarding my affinity for diet supplements--but I don't know where to start. I am not certified in anything, whether nutraceutical or nutrition related, I only know I am my own best case study and I know what works for me and my collection of issues.

My acupuncturist thinks I should set up a YouTube channel with affiliate links for the same topic--supplements.

And my rheumatologist thinks I could do this even without any type of professional certifications.

This is clearly something I want to do for a living, as it helps me, and a bunch of my friends have sought my advice, I dispensed my advice, and it has made impacts in their lives--now that's something truly lovely--fulfillment in helping others!

If anyone reading this has any suggestions regarding potential paths for me to take (online certification courses regarding supplementation, or a nutritionist certification course or something I have yet to articulate which will help me in this endeavor--please leave a comment. 

Short of this, I'm considering finding an ND (naturopathic doctor) locally (if they exist nearby), schedule a consult to see if they would be up to the task to be my internist, and or whether they can help me on my path to helping others. 

In the meantime, things at the Salt Mine continue to change and erode, and never, of course, in a good way. Last Monday, I applied for a job at a civil rights organization and I am hoping when I get hired (see? I'm trying to remain positive with the WHEN, not IF), that this will be a bridge job, something to pay my bills (and make a tangible impact in the lives of others, too, hopefully), and will bridge the time between now and whenever I am able to finally make the transition into what I believe is patient advocacy regarding consulting with them more thoroughly about their current medications, health issues, and trouble shooting any possible vitamin/mineral deficiencies.

Last Monday, I not only sent in my application and resume, but I also had an automated phone screening--so I'm hoping and waiting for the next step--the face-to-face interview. I need to dust off my prepared scripts I generated in previous years--and start reading up a bit more on this new organization, to ask specific questions during the interview.

I am using the power of positive thinking and the law of attraction with the words I choose. The job would be close to a 6% pay cut, but the commute is shorter--and by shorter, I mean shorter by 200 paces--it literally is at a halfway point between where I park my car and my current office building. I literally can see the building from where I park my car. I've been doing a lot of visualization and planning. I've taken the time to empty my desk out of anything extraneous or non-essential, purging out old stuff--so it's like a spring cleaning of sorts, and I'm setting up a big 3-ring binder of stuff for whomever will become my replacement--something which was not done prior to me landing this job nearly 18 years ago. 

So, I think while I have a wee bit of a lag today, I'm going to do a quick search for NDs, and I'm also going to set up my reference page, in anticipation of a face-to-face interview.  

Mondays are my least favorite day of the week--and I'm trying to change that.

I hope you're having a good day.

The Digestive Enzyme Debacle

I did some reading up on digestive enzymes (amylase, lipase, and protease, in particular), and justified taking them for two reasons:

1. As you age, your enzyme production declines; and
2. As I had a gastric bypass, no doubt, that decreased my digestive enzyme production (along with my HCL production.

Well. LESSON LEARNED!

Amylase supplementation does NOT play nice with my reactive hypoglycemia. And fortunately I had the foresight to zap a blood glucose reading about 3 days into this experiment. 

9/18 I started the supplement.
9/21 I started feeling like shit. I took a glucose reading and have continued to take readings (and being very very alarmed by it).
9/24 Was the last supplement I took.

How high is too high?

Well, my normal fasting glucose level is around 92-96.

This morning it was 141. Two hours after my first meal it only dropped down to 121. For me, this IS "alarming."

Right now I'm worried about whether it caused a cascade effect, triggering something in my pancreas. Only time will tell if my levels will revert back to my norm. 

In the meantime, I zapped an email to my endo (Yes, the one who is retiring), and I'm hoping he'll give me a QUICK reply back to reassure me.

I've also zapped emails to a friend who is an RN, a friend who is a PA, and another friend who is an MD, all hoping one of them will reply and put my mind at ease. 

My chiropractor and I always have conversations about supplements we're both taking, in a way, we're both comparing notes. And I mentioned to him about the glucose readings and asked him if HE personally thought the enzymes could be the culprit, or if I should just focus on lipase, since I lack a gall bladder. And he didn't see how it could impact my glucose--but then again, I KNOW MY ERROR, in asking a chiropractor about endocrine issues.  Lesson learned.

And now I wait, and hope I didn't damage what I've managed to either achieve or maintain after my bypass.  

Notes Re: Methylation, Homocysteine, Betaine, etc

Homocysteine & Methylation "Take Aways" 
Note: Methylation = Complex combination of actions whereby Homocysteine + “Certain B Vitamins” (i.e., b6, b9 (folate), b12) + Betaine, SAM-e, Adenosine etc etc = (recycled into) Methiones 

(Image from Wikipedia)

1. Homocysteine can be recycled into methionine or converted into cysteine with the aid of certain B-vitamins;
2. Normal homocysteine levels should be less than 13, with the ideal range being between 6-8, with hyperhomocysteinemia Dx at over 15;
3. Homocysteine levels are typically higher in men than women, and levels elevate with age;
4. MCV greater than 95 can indicate a methylation problem;
5. Blood or urine methylmalonic acid test for b12 deficiency (may be ordered as a follow up to a standard b12 test);
6. Daily diet should include one cup a day of dark green leafy vegetables, and daily protein intake should be between 80-120 gm;
7. Reducing AGE (advanced glycation end products) by diet and or supplementation can potentially lower homocysteine levels (and protect the kidneys);
8. Supplementation: All B vitamins, but IN PARTICULAR emphasis on b6 (up to 250 mg) & b12 (500 mcg), plus more than 400 mcg (RDA) folate (unless person has cancer), choline (precursor to betaine*);
9. NOTE: If one were considering supplementing with betaine to lower homocysteine levels, the IDEAL formulation appears to be BETAINE ANHYDROUS *NOT* betaine hydrochloride;
10. Digestive diseases, caffeine, some meds (i.e. acid blockers, methotrexate, or HCTZ), and no doubt, malabsorptive bariatric surgeries can impact levels of B vitamins in blood;  

Interesting articles:
Betaine supplementation decreases plasma homocysteine in healthy adult participants: a meta-analysis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3610948/

Maximizing Methylation: The Key to Healthy Aging, by Mark Hyman MD http://drhyman.com/blog/2011/02/08/maximizing-methylation-the-key-to-healthy-aging-2/

Below the Radar: Advanced Glycation End Products that Detour “around the side” Is HbA1c not an accurate enough predictor of long term progression and glycaemic control in diabetes? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320176/

Lowering homocysteine levels with folic acid and B-vitamins do not reduce early atherosclerosis, but could interfere with cognitive decline and Alzheimer's disease https://www.ncbi.nlm.nih.gov/pubmed/23224755

BEETS & GREEN LEAFY VEGGIES & METHYLATION 
CONFLICT #1: Green, leafy veggies, lowers homocysteine yet elevates oxylates 
CONFLICT #2: Green, leafy veggies lowers homocysteine (which would lower risks for DVT, clots, stroke) yet they contain Vitamin K which would increase risks for DVT, clots, stroke. 

BEETS: Despite the fact that beets are high in betaine, which helps lower homocysteine levels in blood, they are ALSO high in oxylates, which elevates purines in the blood, which then elevates uric acid and contributes to gout inflammation. 

GREEN LEAFY VEGGIES: People who have blood clotting disorders (Leiden varieties, in particular), like myself should be wary of ingesting too much in the way of green leafy veggies, as they are also high in Vitamin K (“klottenfactor”) and can have a potential negative impact (i.e. clots, stroke, dvt, etc), and it’s this reason (as well as having had a gastric bypass) that I use a variety of supplements to make sure my needs are met. ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬

Notes on Benfotiamine (fat soluable, B1): 

Below the Radar: Advanced Glycation End Products that Detour “around the side” Is HbA1c not an accurate enough predictor of long term progression and glycaemic control in diabetes? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320176/ 

Effect of Benfotiamine on Advanced Glycation Endproducts and Markers of Endothelial Dysfunction and Inflammation in Diabetic Nephropathy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3391239/

Supplement Comparison: Omega-3 vs Krill et al

Omega 3 vs Krill Oil vs Cod Liver Oil

On the Surface, both, Omega-3 and Krill oils, supply Omega-3 fatty acids, HOWEVER, the source fish are different, and more importantly, the potency of EPA and DHA differs MARKEDLY.  There are claims online that Krill oil “typically contains more EPA,” However, I did not find this to be true (see chart).

Krill oil contains fatty acids similar to fish oil, and these fats are thought to be beneficial in helping decrease swelling, lower cholesterol, and make blood platelets less sticky, and less likely to form clots.

Omega-3 and cod liver oil are two different oils even though they both come from fish and have a similar fatty acid profile. Fish oil is extracted from the flesh of tuna, herring, cod and other deep-sea oily fish species. Cod liver oil is a good source of omega-3 fatty acids such as EPA and DHA but doesn't have much (if any) in the way of omega-3 fatty acids.

I’m not going to devote any more time to cod liver oil—as that wasn’t part of the original discussion (which I had with my chiropractor), but thought I didn’t want to exclude it from the entire discussion.

I found that the Mega Red Advanced 4-and-1 which contains both, fish oil and krill oil to be lacking, despite its high regard in its reviews (as well as great marketing); however, that might be related more to the antioxidant astaxanthin which is in the krill oil rather than than the EPA/DHA that their source fish, pollock, provides.

My theory/hunch is: whatever benefit people MIGHT get from a krill oil supplement isn’t due to the EPA/DHA, but actually from the astaxanthin.

• Marine Bioactives: Pharmacological Properties and Potential Applications against Inflammatory Diseases:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3366677/ 
•  A worthy mention regarding astaxanthin and cancer: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515619/

To cover all bases, I’m ALSO going to contrast/compare that Omega XL supplement that Larry King promotes on TV into my analysis. 

Despite the fact it has “Omega” in the name, my theory/hunch is:  whatever benefit people might derive from that (VERY EXPENSIVE) supplement actually comes from the Green Lipped Mussel extract, which is high in boron.

SPOILER ALERT: At $1.11 per pill (PER PILL!), rather than buying the Omega XL, perhaps it would be more economical to consider buying a good quality omega-3 fatty acid supplement, and then buy a separate and less expensive boron supplement.

•  Nothing Boring About Boron:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712861/

I *thought* I did a thorough contrast/compare, though I think I should have added how many pills make up the dose, as each manufacturer has different # of pills to make up the totals listed below.

Brand	# Pills	$ Per Pill	EPA (mg)	DHA (mg)	Total # Fish Oil (mg)	Source Fish	Notes:	Purified/Distilled
PacificCoast NutriLabs 2000mg Fish Oil	60	$0.17	800	600	2000	Herring, Mackerel, Salmon, Sardines		YES
Nordic Naturals - Ultimate Omega	90	$0.33	650	450	1280	Anchovies, sardines	"Other" Omegas: 180 mg	YES
Mega Red Advanced 4-in-1	80	$0.36	314                               (combined)		339	Krill, pollock	Total Fish Oil + Krill = 500 mg (Krill contains astaxanthin)	YES
Omega XL	60	$1.11	12	7		?	Green Lipped Mussel Extract (high in Boron)	?
Carlson Super Omega-3	120	$0.12	300	200	600	Macerel, sardines	"Norwegian Fish Oil 1,000 mg"	?
Carlson Lightly Lemon Cod Liver Oil	300	$0.07	85	100	1000	Cod liver	"Norwegian Cod Liver Oil, 1000 mg"     "Other" Omega-3: 45 mg	?

I, myself, have been on 3 mg of boron for a month or two now, and I originally started it out of concerns for bone density, as I'm getting older, plus I had gastric bypass six years ago. However, I might have a chat with my nephrologist (who treats me for hypertension), as the boron might impact my kidney function. I also started my husband on it due to his periodontal issues which have morphed into perio & endodontal issues. 

Astaxanthin tibit: From what I can find online, astaxanthin is derived from krill or shrimp or salmon.  And this site (while I don't know if it's credentialed) has some interesting information on the merits of consuming shrimp.  Cliffnotes: 4 oz of shrimp contains about 1-4 mg of astaxanthin--the true amount of astaxanthin in shrimp pretty much vascillates depending on if it's wild caught vs farmed, as the whatever farmed shrimp is fed impacts the astaxanthin levels, whereas wild caught shrimp feeds off of kelp and other sea vegetation.  Just a hunch here, but when buying shrimp or salmon, you want it to look as pinkish-orange as possible (I suppose this is why some farmed shrimp or salmon looks dull in comparison to wild caught).  

Just sharing my notes and take-away a-ha! information I've culled thus far, and by no means am I suggesting someone use my information INSTEAD of talking with their doctor FIRST before starting these supplements. I've made up my own mind with what information I have on hand, and making judgment calls for MY OWN health; however, I do think that someone interested in adding astaxanthin (or boron, for that matter), SHOULD run it by their doctor first, to see if it's a good fit for them.

A preliminary caution on astaxanthin (in supplement form) can be found on this site.  Again, that, too, is just a website, and not a replacement for talking to a doctor, but I think reading and thinking and wanting to be an advocate for your own medical care is KEY to optimal health. At best, the doctor might agree it should be included in your daily regimen, and at worst, the doctor would say to avoid it entirely (and hopefully provide a couple of reasons, too).