Sample Reports

Sample Reports Completed for Previous Clients

There is a lot of great info on this page, but remember, medicine is always changing and advancing and new info may be available now. Still, sharing this may help many of you and it gives you an idea of part of what a Smart RN could do for you or your loved ones. Personal info has been deleted.

This is a 50 year-old woman with unexplained weight gain, chronic diarrhea, bloating, cramps, fatigue and more.  She provided complete medical history, 5 years of lab tests for analysis, a list of her meds and supplements for evaluation, and a chart of her weight over time.

The recommendation from her Smart RN for follow-up tests on parathyroid based on 5 years of elevated calcium which had gone unnoticed by her doctor, showed that she had a tumor on the parathyroid. It was successfully removed.

Specific Recommendations for XXXXX:

Part 1 of 3


Your cholesterol ratios (the ratios are the most import numbers) and triglycerides are excellent and there is little evidence that cholesterol itself causes heart or vascular disease.  How did that idea get started?
“Cholesterol’s job is to repair this damage by creating patches, or plaques—it is more the Band-Aid for arterial damage than the cause. Researchers are increasingly finding chronic inflammation, not healthy dietary fats, damages the walls of the arteries and raises the risk of heart disease.”

Assuming that cholesterol is the CAUSE of heart disease is problematic.

55-75% of heart attacks and strokes occur in people with normal cholesterol.

Researchers have discovered that inflammation weakens the fatty plaque clogging the arteries and causes it to break apart — triggering a heart attack or stroke. Perhaps the focus should be on inflammation.

To focus on lowering cholesterol, when our brains, cells, vitamin D, bile acids, and hormones are made out of it, or to assume the new guidelines lowering “normal” to below 200 (from 250 as normal) are accurate, ignores the body of newer evidence that low cholesterol contributes to dementia, depression, diabetes and mitochondrial disease.

Your VLDL is very low and that is the other risk factor:  “Cholesterol particles that are large, light and fluffy are what we need, rather than the small, dense and hard particles, which are the type that actually causes heart disease and plaque build-up. We know what causes the damaging small cholesterol particles. And it isn’t fat in the diet. It is sugar. Sugar in any form or refined carbohydrates (white food) drives the good cholesterol down, cause triglycerides to go up, creates small damaging cholesterol particles, and causes metabolic syndrome or pre-diabetes. That is the true cause of most heart attacks, NOT LDL cholesterol.” (Mark Hyman MD)

Better, or Additional, Markers:

C-reactive proteins *recommended test to accompany every cholesterol/ lipid panel:  hs (high sensitivity) CRP

For other, systemic, inflammation markers use CRP (not the hs–they test for different markers, hs is strictly vascular)

C-reactive protein (CRP) is a substance produced by the liver that increases in the presence of inflammation in the body. An elevated CRP level is identified with blood tests and is considered a non-specific “marker” for disease. Data from a large number of studies suggest that over time chronic, imperceptible, low-level internal inflammation can lead to many serious, age-related diseases including heart disease, some forms of cancer and neurodegenerative conditions such as Alzheimer’s and Parkinson’s disease.

Homocysteine levels measure inflammation. This is not a typical blood test, but if your cholesterol is of great concern, this is an additional test that can be very valuable, especially if a significant portion of your diet is derived from animal protein (which I believe it may be).

In 1992, researchers at Harvard University School of Public Health showed that men with homocysteine levels only 12% higher than average had 3.4 times greater risk of heart attack than those with normal levels. Also that year, the European Journal of Clinical Investigation showed that 40% of stroke victims have elevated homocysteine levels compared to only 6% of controls. The links for women appears even higher.

Homocysteine is an amino acid and breakdown product of protein metabolism that, when present in high concentrations, has been linked to an increased risk of heart attacks and strokes. Elevated homocysteine levels are thought to contribute to plaque formation by damaging arterial walls. High levels may also act on blood platelets and increase the risks of clot formation; however, whether high levels of homocysteine actually cause cardiovascular disease has yet to be agreed upon (this chicken and egg conundrum exists in many areas–cholesterol measurement being one). In addition, some evidence suggests that people with elevated homocysteine levels have twice the normal risk of developing Alzheimer’s disease.

ESR:  There are other tests for inflammation–like an erythrocyte sedimentation rate–ESR, which shows if your red blood cells are clumping from the sticky residue of inflammation.  This is not as sensitive as others to change and can reveal longer term conditions, as opposed to transient infections, which can skew an HRP

Cortisol:  Your weight gain may be related to excess cortisol, often called the stress hormone. Cortisol is released in cycles and CAN NOT be tested accurately with a “total cortisol” test. It is highest in the morning then dips in the afternoon.  I recommend the saliva test–which is done 4 times over the course of a day. The minimum acceptable would be the twice a day blood test, ONLY if you can find a lab that is open at 700am, when cortisol typically peaks.  The 4 measurements are more accurate in my opinion, and you just take the 4 tubes home with you.


  Recommended thyroid tests:  TSH, free T3, free T4, TPO, and anti-thyroglobulin antibodies.

  Check for celiac disease with a celiac panel. (you must eat some gluten leading up to the test or it will not be accurate)

  Consider heavy metal toxicity. (I prefer the urine test for this)

Parathyroid hormone:

I recommend you be tested for this.  Your calcium levels are consistently high and your Vit D levels struggle even with large supplementation, sunshine, plenty of cholesterol (the building blocks), and high dietary sources. These are typical of parathyroid issues. Please get tested as this is suspicious.


If the chronic diarrhea is due to a malabsorption syndrome, then your B-12 is likely low. In functional medicine we put a high value of poop and pooping. I doubt this has just zero significance, but a functional or integrative MD would be required to do the sleuthing. I don’t see any obvious deficiencies, but since we are being thorough we should look at everything.

Drinking can cause this, women have half the physical tolerance for alcohol as men, so don’t ignore this possible toxin.

Wellness Prescription:

  1. Whole Foods — Eat a whole foods, high-fiber, primarily plant-based diet, which is inherently anti-inflammatory. That means choosing unprocessed, unrefined, whole, fresh, real foods. Avoid processed foods, sugar and trans fats. I suggest only animal protein form pastured, organic sources, that have been raised without hormones, antibiotics, eaten vegetarian foods, etc. The difference is that they have been fed GMO corn and the like, and other feed with pesticides or other chemicals–at least if it’s veggie food you know they are not eating dead animals. Red meat should be grassfed/ grass finished.
  2. Healthy Fats — Fats are good. Eat healthy monounsaturated fats in olive oil, nuts and avocados, and add more omega-3 fats from small fish like sardines, herring, sable, and wild salmon or fresh, refrigerated (only) flax seed oil. Saturated fats like coconut oil and organic butter, cheeses, fermented goat milk and the like are also healthy. They leave you feeling full longer as well.
  3. Regular Exercise — Mounting evidence tells us that regular exercise reduces inflammation. It also improves immune function, strengthens your cardiovascular systems, corrects and prevents insulin resistance, and is key for improving your mood and erasing the effects of stress. It correlates with improved health in virtually ALL of the scientific literature. I have included a page of exercises you may be able to do from bed or are modified for your back injury.

As we age we need to constantly increase the amount we exercise in order to stay at the weight we were.  Both aerobic and weight bearing exercise is important. Jarring, jumping, running improve bone health and decrease osteopenia/ osteoporosis risks. Yoga is great, but you may want to mix it up with brisk walks or other work outs you enjoy (see yoga below).  30 minutes a day of something is an important target to hit for maintenance over 50, more for weight loss.

  1. Relax — Learn how to engage your vagus nerve by actively relaxing. This powerful nerve relaxes your whole body and lowers inflammation when you practice yoga or meditation, walk by the ocean, breathe deeply, or even take a hot bath. Stress takes a toll on your bodies and causes weight gain.
  2. Avoid Allergens — If you have food allergies, find out what you’re allergic to and get stop eating those foods–gluten and dairy are two common culprits. Often the fopods we crave ar ethe ones we are sensitive to, so try and be aware. There are blood tests to determine food sensitivies although they are not offered by Quest.
  3. Heal Your Gut — Take probiotics and eat fermented foods to help your digestion and improve the balance of healthy bacteria in your gut, which reduces inflammation.
  4. Supplements — You are already taking a lot of supplements, and I checked them all for interactions and side effects and made some notes that might be helpful regarding how many you want to stay on (see the supplement pages for details on too many antioxidants).

I would lose the multi and add:

  • I suggest a good probiotic every day. Many probiotics are crap, I take Advanced naturals, Ultimate FloraMax 50 billion with 10 probiotic strains. It is a delayed release products as I was having a hard time taking a one hour before eating twice a day dose.
  • magnesium supplementation. Magnesium deficiency is common, causes a LOT of problems as we age and with your high calcium levels it is especially important for you to balance these minerals.
  • High serum calcium could mean it is leaching from your bones or failing to uptake into your bones–both are not healthy situations. If you have not yet had one, I recommend a baseline DXA scan for osteoporosis. I have seen 4 years of high calcium results and that is worth following up on.
  • I recommend magnesium-L-threonate or There are several brands. It is very bioavailable (an issue with all minerals, many forms are not well assimilated) and it crosses the blood brain bareer and improves cognitive function and memory.  Approx 140mg per day.


Other Suggestions:

Hot Flashes:

There are two primary causes, in my mind:

That your estrogen level has fairly recently reached the menopause level (although it was going up not down, I’m not sure our body’s know the difference).  Try:  Lachesis Muta.  Homeopathic med. You can get it at Santa Monica homeopathic (or any place that has homeopathic meds). 4 pellets 3 or 4 times a day for 4-6 weeks.

The other cause of hot flashes is that you are taking too much thyroid–mimicking hyperthyroidism.  Since your MD upped your thyroid recently, and I can’t see any cause for it on your lab tests, this could be the cause. If so, it could represent a serious approaching problem.

The only thyroid test that goes back to 2011 is your TSH, the one usually used by MDs to check thyroid function.  Yours has been: 0.69, 1.69, 0,69, 1.39.

The newer guidelines of the American College of Endocrinology consider anybody with a TSH level over 3.0 as hypothyroid.  You have not been anywhere near 3.0 in the records I have, plus you are not responding to the additional dose at all, in terms of weight loss.  The other thing to consider, since you are using replacement that has both T3 and T4 is that your results, once you started taking it, do not reflect what your thyroid is doing.  Don’t get me wrong, you may need supplementation, but it is hard to tell right now. I also think that any time you adjust the dosage or add additional thyroid, it is important to check it before 6 months–your hot flashes could be a warning sign (or not, don’t panic).

I would recommend labs:

  TSH, free T3, free T4, TPO, and anti-thyroglobulin antibodies. (get off the supplementation for a few days first? Check with MD)

  Check for celiac disease with a celiac panel. (this might also explain your chronic diarrhea and you extreme reaction to carbs)

  Consider heavy metal toxicity testing.

Half your daily alcohol dose.

It is basically sugar and toxins, it taxes your liver and adds considerable health risks to your life. It could easily be adding to your weight gain, especially with the lack of exercise. Women are safely recommended one five ounce glass of wine per day, men can have two.  Go to two if you prefer (don’t we all) but stop there.  One is better. None is best while you see if it is contributing to weight gain. If you quit for a week and start losing, you have part of your answer.

Liver Ultrasound

There is a very common condition (seriously under diagnosed) called fatty liver that does not always show up in the liver enzyme tests typically done, it is easy to spot on an ultrasound–if you have never had it done it might be an idea–that contributes to abdominal weight gain, for sure.


Change up your exercise routine–try a recumbent bike (may be better for your back), walk sideways or backwards, take the stairs, do stuff with your arms when you walk (reach, flex, tighten then relax muscles, whatever, just keep them active), dance around when you have a few minutes.

A good page for exercises with/ after back pain/ injury:


Cut back on coffee/ caffeine

I saw how much coffee you drink, and although I’m a big believer in the health benefits of coffee, I did some research:

Experts warned that drinking five or more cups a day increased the amount of fat stored in the abdomen.

It was revealed that even a “moderate intake” of coffee in the average day could also lead to problems such as increased risk of heart disease and diabetes.

Repeated studies in the past have shown that coffee can have benefits for regular drinkers, including lowing the chances of a stroke and certain forms of cancer.

In the latest research, Australian academics had been attempting to analyse how health-boosting compounds contained in the drink could improve cardiovascular function.

One of the compounds, chlorogenic acid – known as CGA – has been linked to health benefits such as a reduced risk of diabetes, lower blood pressure and even combating fat.

But the study – published in the Journal of Agricultural and Food Chemistry – actually found that too much coffee, including decaffeinated, could be bad for people’s health.

Assistant Prof Vance Matthews, of the Western Australian Institute for Medical Research, said: “This study proved the opposite in dosages equivalent to five or six cups of coffee per day.”

The researchers found that the equivalent dose of CGA fed to laboratory mice affected the utilization of fat in the liver and caused abnormal retention of fat within cells.

The obese mice also had a tendency for a higher degree of glucose intolerance and increased insulin resistance.

Prof Matthews said coffee was safe in moderation but cautioned against drinking too much.

“It seems that the health effects are dose-dependent,” he said.

“A moderate intake of coffee, up to three to four cups a day still seems to decrease the risk of developing diseases such as cardiovascular disease and Type 2 diabetes.

“Everybody knows about the effects of caffeine, but when we’re considering our lifestyle choices it’s important to remember that compounds such as CGA can have an effect on our health if they aren’t consumed in moderation.”

The study, carried out in conjunction with Western Australia’s School of Medicine and Pharmacology, found that people who look slim can have dangerous amounts of fat around their abdominal organs, which causes diabetes, cardiovascular disease and other health problems.

Prof Matthews said: “There’s a lot of people who look quite lean but they have accumulation of fat in certain cells around the organs and in the liver.

“This could be worsened by drinking too much coffee.”

Daily Diarrhea

Organic diarrhea vs irritable bowel syndrome

  • The irritable bowel syndrome is characterized by recurrent abdominal pain or discomfort that occurs at least 3 days per month for at least 3 months, with two or more of the following:
    • improvement with defecation,
    • an onset associated with a change in the frequency of bowel movements, or
    • an onset associated with a change in the form (appearance) of stool.
    • ABSENCE of alarm characteristics such as weight loss, nocturnal symptoms, a family history of colorectal cancer, rectal bleeding, or anemia; these would warrant further evaluation.
  • When measured, daily stool output is low, typically less than 400 g per 24 hours.
  • Consistency varies from loose to soft and rarely is water
  • Diarrhea does not wake patients from sleep.
  • Long Hx, extending back to adolescence
  • Labs are usually nl (hg, esr, albumin)
  • The irritable bowel syndrome should be a diagnosis of exclusion (leaving organic diarrhea by default)

Other symptoms to note:

Tenesmus is a painful spasm of the anal sphincter with a sensation of the urgent need to defecate, with involuntary straining, but with little bowel movement if any.

Does the stool float?

Integrative medicine is obsessed with stool because it tells us a lot about your overall health.  A condition called, dysbiosis, is a major, underdiagnosed cause of health problems in the developed world.

Here are some things to note:

  • Undigested food
    This may indicate insufficient HCL (stomach acid) and/or pepsin production. An insufficiently acidic bolus of chyme moving into the intestines from the stomach may not trigger sufficient cholecystokinin release and a decrease in pancreatic enzyme production causing pancreatic insufficiency. Also consider that your patient is not chewing their food appropriately.
  • Mucous on stool
    Mucous on the stool is usually due to gastrointestinal irritation (colitis, food sensitivity, pancreatitis). Translucent gelatinous mucus clinging to the surface of formed stool occurs in: spastic constipation; mucous colitis; emotionally disturbed patients; excessive straining at stool.
  • Loose stool
    Loose but not watery stool is associated with mild intestinal irritation and malabsorption.
  • Floating stool
    Consider malabsorption (esp. fats), reduced tract time due to anxiety or irritation, and a high fiber diet. The stool may also be described as slippery or greasy looking.
  • Ribbon-like shape 
    A ribbon-like stool suggests a possibility of spastic bowel, rectal narrowing or stricture (pencil shaped), decreased elasticity, or partial obstruction (uterus malposition, prostatitis, polyp, tumor).
  • Brown
    A brown colored stool is probably due to Sterobilin (urobilin), a bile pigment derivative resulting from the action of reducing bacteria in bilirubin. It is a normal finding.
  • Dark brown
    A consistently dark brown stool is associated with an excessively alkaline colon that may indicate dysbiosis. A dark brown stool can be a normal finding indicating good bile flow and elimination of fat-soluble toxins.
  • Yellow
    Usually seen with severe diarrhea, may be due to lack of intestinal flora and will also occur from antibiotic use. Consider excessive bile secretions due to over stimulation or irritation to the small intestine.
  • Black
    This is usually a result of bleeding into upper GI tract (ulcer, Crohn’s, Colitis, cancer); also the use of drugs, iron, bismuth, charcoal or a heavy meat diet.
  • Tan or clay colored 
    This is associated with a blockage of the common bile duct (lack of bile pigments) as well as pancreatic insufficiency, which produces a pale, greasy acholic stool. Consider gall bladder insufficiency or hepatobiliary obstruction.
  • Offensive odor 
    Indole and Skatole, intestinal toxins formed from intestinal putrefaction and fermentation by bacteria, are primarily responsible for odor. If the stool usually has an offensive odor then consider that it may be due to malabsorption, food decay, or dysbiosis. If the stool is occasionally offensive then consider intermittent malabsorption with food decay and dysbiosis.

Gut Dysbiosis:

Western (allopathic) medicine has been slow to recognize the role of gut health in immunity and general health, but functional, integrative, even veterinary medicine has long recognized it. The results can be: impaired immune response, systemic inflammation, diarrhea, food sensitivities,

There is a lot more to healing gut dysbiosis (malabsorption, yeast overgrowth, “leaky gut” allowing gut bacteria into the bloodstream, etc) than this, but this is a great start and is appropriate for everyone:

  • Probiotics (Lactobacilli and Bifidobacter species) Capsules, powders, enteric coated
  • Probiotic foods
  • Yogurt-dairy, soy, coconut milk (avoid high added sugar products-flavored activia)
  • Kefir
  • Cultured vegetables-sauerkraut, etc


Part 2 of 3

Daily supplements/meds

Bergamet Pro = vitamin c as ascorbic acid 50 mg, chromium polynicotinate 200 mcg, alpha lipoic acid as thioctic acid 25 mg, bergamot orange (citrus bergamia) “juice” 700 mg (38% poly phenolic extract)    Inert:  Calcium carbonate, cellulose, silicondioxide, cellulosegam, magnesium stearate (vegetable source) polyethylene glycol, carnauba wax

  • cholesterol lowering
  • antioxidant
  • can interfere with other meds


 Nature-throid 65 mg (1 grain)

  • some medications and supplements may affect how Nature-Throid functions. It is important to take Nature-Throid at least 4 hours before any supplements or other medication.
  • A higher medication dose will not result in quicker weight loss. Raising your dose could lead to increasing health problems such as muscle weakness and heart issues. Please see my note under hot flashes

Liothyronine sodium 5 mcg  (details from Natural

  • Thyroid extracts are derived from animal thyroid tissue. Thyroid extract is a type of glandular nutritional supplementation that refers to dried and ground-up raw animal tissues or extracts of these tissues.
  • Thyroid hormones have a wide range of actions. They increase rates of growth and metabolism and thereby increase respiratory rate, body temperature, heart rate, reproductive behavior, and energy expenditure.
  • Although thyroid extract has been traditionally used to replace patients’ normal thyroid activity, results from open-label studies do not support the use of thyroid extract for hypothyroidism
  • Take pulse and inform the health care provider if signs of tachycardia or dysrhythmias occur.

  Instruct patient to call the health care provider immediately if any adverse symptoms such as chest pain, palpitations, headaches, irritability, increased nervousness, diaphoresis, tachycardia, dysrhythmias, or heat intolerance occur. (sounds like a panic attack?)

  Possibly unsafe: When used in postmenopausal women, as replacement thyroid hormone and suppressive thyroid hormone has been associated with bone loss. When used in patients with endocrine disorders. When used in patients taking anticoagulants or antiplatelets, as thyroid extract may increase the risk of bleeding. When used in patients with low levels of pituitary hormone.

  Likely unsafe: When used in patients with known or potential allergies/hypersensitivities to desiccated thyroid or thyroid extract. When used for the treatment of obesity. When used in patients with uncontrolled hypertension or uncontrolled angina, as thyroid extract may cause tachycardia, palpitations, angina, and arrhythmias.

  Note: Monitoring of thyroid hormones may be more difficult in individuals using natural thyroid sources, due to the presence of both T3 and T4.


You are taking 2 types of desiccated thyroid and estradiol cream (and testosterone, see below)

  • Estrogens may increase serum thyrotropin concentration, which could increase dosage requirements in patients with hypothyroidism receiving thyroxine for replacement therapy. Estrogens are known to increase serum thyroid-binding globulin concentration in a dose-dependent manner. Consequently, there may be a reduction in unbound, or free, thyroxine available for hormone activity, which, in turn, leads to an increase in serum thyrotropin concentration. Normally, thyroxine secretion can increase to compensate for this effect, but patients with hypothyroidism lack the mechanism to adapt. Limited evidence suggests that transdermal estrogen therapy may not affect thyroid-binding globulin concentrations; however, more data are required to confirm that.MANAGEMENT: In patients treated with thyroxine, serum thyrotropin should be measured approximately 12 weeks after estrogen therapy is initiated, changed or discontinued, and the thyroxine dosage adjusted accordingly. Patients should be advised to contact their physician if clinical manifestations of hypothyroidism occur, such as fatigue, cold intolerance, constipation, unexplained weight gain, depression, joint or muscle pain, thinning hair or hair loss, dry skin, hoarseness




  • MONITOR: Androgens may induce reversible clinical hyperthyroidism in patients receiving thyroid hormone replacement therapy (see hot flashes). The proposed mechanism is androgen-induced decrease in T4 binding globulin resulting in decreased serum T4, increased T3 uptake resin and free T4, and decreased TSH levels.MANAGEMENT: Clinical and laboratory monitoring of thyroid function may be necessary, as may a 25% to 50% reduction in thyroid hormone dosage.


NOTE:  Using multivitamin with minerals together with thyroid desiccated may decrease the effects of thyroid desiccated. You should separate the administration of thyroid desiccated and multivitamin with minerals by at least 4 hours.


** There are over 200 “moderate” drug-drug interactions and some food-drug interactions–most just diminished the effect of the thyroid supplement so be aware to take the thyroid separate from other drugs or fiber-rich foods.

Estradiol cream 12 mg
Testosterone 20 mg
Progesterone 200 mg

Milk thistle 200 mg (silymarin from milk thistle seed powdered extract containing silybin, isosilybin, silydianin, silychristin and turmeric rhizome powdered 27.5 mg)

Vitamin C (as ascorbic acid) 1000 mg incl. dried rose hips 100 mg

Glucosamine sulfate from shellfish 600 mg plus MSM 600 mg plus chondroitin 400 mg

Cranberry concentrate 8400 mg plus 40 mg vitamin c and 6 IU vitamin e

DIM 200 mg plus vitamin e 100 IU plus lecithin 200 mg plus black pepper fruit extract 6 mg

  • DIM is oil soluble and is best taken with food or flax oil
  • moderates estrogen
  • antioxident

Ubinquinol 100 mg

  Coenzyme Q-10 is an antioxidant. There is some concern that antioxidants might decrease the effectiveness of some medications used for cancers.

  Medications for high blood pressure (Antihypertensive drugs) interacts with COENZYME Q-10

Coenzyme Q-10 seems to decrease blood pressure. Taking coenzyme Q-10 along with medications for high blood pressure might cause your blood pressure to go too low.

  Warfarin (Coumadin) interacts with COENZYME Q-10


WARNING: (Natural Standard)
Use cautiously in people taking heart rate-regulating agents, thyroid medications, or warfarin. Use cautiously in patients with biliary obstruction or liver failure; headache or migraines; mitochondrial, platelet, skin, stomach, or intestinal disorders; and thyroid or liver dysfunction.


** The most bioactive form of this crucial enzyme (CoQ 10) is the fat-soluble type–it is twice as bioactive as the dry form.

Turmeric 1.44 g

  • antioxidant, anti-inflammatoryVitamin d 5k to 10k IU plus vitamin k 550 mcg to 1100 mcgz
  • The name “vitamin K” refers to a group of chemically similar fat-soluble compounds called naphthoquinones. Vitamin K1 (phytonadione) is the natural form of vitamin K, which is found in plants and provides the primary source of vitamin K to humans through dietary consumption. Dietary vitamin K is found mainly in green leafy vegetables (such as spinach, swiss chard, and parsley), vegetables in the Brassica genus (such as cabbage, kale, broccoli, and cauliflower), and fruits (such as avocado, kiwi, and grapes).
  • required for normal blood clotting. K2 required for calcium uptake into bone

Vit D:  (Natural Standard)  A new study suggests that having too much vitamin D may be just as harmful to health as having too little.

Vitamin D is sold as softgels, capsules, tablets and liquids. The recommended daily allowance for vitamin D is 600 IU daily for people age 1-70 and 800 IU for people over age 71 (I think these are too low–I take 2000 per day, since I get more through sunshine and diet)  I am concerned that at 10,000 per day supplemented, plus eggs and sunshine, you are getting a LOT, but your blood levels are not high.  The recommended serum level is about 50 – 60 nanomoles per liter. BUT YOU ARE TAKING 5-10,000 IU AND YOUR VIT D LEVELS ARE NOT EVEN UP TO OPTIMAL.  See LAB TEST SECTION.

Vitamin D is found in many dietary sources, such as fish, eggs, fortified milk and cod liver oil. The sun also contributes significantly to the daily production of vitamin D, and as little as 10 minutes of exposure is thought to be enough to prevent deficiencies.

Berberine HCl 1000 mg plus mega natural BP grape seed extract 300 mg

  Berberine is a bitter-tasting, yellow compound found in plants. It has a long history of medical use in Chinese and Ayurvedic medicine. “tree tumeric”

  There is some evidence to support the use of berberine for eye infections, bacterial diarrhea, and some parasite infections (leishmaniasis). Berberine may also protect against viruses, fungi, protozoans, worms, and chlamydia. More research is needed in these areas, as well as heart disease, skin disorders, and liver disorders.  Other uses remain unproven.

  Berberine is generally thought safe. However, it may interact with many prescription medications.


Grapeseed extract:

  • (Natural Standard) antioxidant, chemopreventive
  • Randomized, controlled trials have documented the effectiveness of grape seed in relieving symptoms of chronic venous insufficiency, injury related extremity edema, diabetic retinopathy, arteriosclerosis and high blood pressure. Grape seed extract has been used by natural practitioners in Europe to treat venous insufficiency, promote wound healing, alleviate inflammatory conditions, and as a “cardioprotective” therapy.


Biotin USP 3000 mg plus chromium 800 mcg plus gymnema leaf extract 400 mg plus alpha lipoic acid 300 mg plus cinnulin 150 mg plus vanadyl sulfate hydrate 50 mg

  • Gymena may impair the absorption of fat soluble vitamins and supplements

Alpha lipoic acid 600 mg

Alpha-lipoic acid acts as a co-enzyme for the production of energy (ATP) within the cell.  Other specific actions of Alpha-lipoic are: anti-oxidant, recycling of other anti-oxidants such as Vitamin C, Vitamin E, Glutathione and CoEnzyme Q10 and is used in the metabolism of proteins, carbohydrates and fats. Alpha-lipoic acid is classified a member of the B Vitamin family much like Biotin and Folic acid are.  Just as it is not recommended to take individual B Vitamins for long periods of time without a break, the same is true for Alpha-lipoic acid.  It is not considered a Vitamin because it can be manufactured in the body in small amounts.  Lipoic acid binds to the mineral Iron and for this reason it is recommended to take Lipoic acid away from ingesting Iron supplements or food groups as a deficiency in this important mineral may result.

>> Multi:
>> Vitamin a 5k IU
>> Vitamin c 120 mg
>> Vitamin d3 800 IU
>> Vitamin e 30 IU
>> Vitamin k 100 mcg
>> Thiamin 25 mg
>> Riboflavin 25 mg
>> Niacinimide 25 mg
>> Pyridoxine HCl 25 mg
>> Folic acid 800 mcg
>> Vitamin b12 25 mcg
>> Biotin 150 mcg
>> Pantothenic acid 25 mg
>> Calcium 200 mg
>> Iron 6 mg
>> Magnesium 100 mg
>> Zinc 10 mg
>> Selenium 200 mg
>> Copper 1 mg
>> Manganese 2 mg
>> Chromium 200 mg
>> Molybdenum 75 mg
>> Choline 20 mg
>> Inositol 20 mg
>> Boron 1 mg
>> Citrus bioflavonoid complex 25 mg

>> “Women’s nourishing blend”
>> “4:1 vegetable juice complex”
>> “Digestive support”



You are taking a LOT of antioxidants–almost everything on your list are antioxidants, and you are taking them together.  The best source of antioxidants is food–eating whole food.

I have made notes above and would suggest that you consider if you need them all…

The mechanism behind the protective action of antioxidants is the same one that makes them potentially dangerous in high amounts. Antioxidants work by giving away an electron to compounds that are missing one. These compounds without enough electrons are called free radicals, and they can rampage through the body, destroying cellular components in their quest to acquire an electron. An adequate supply of antioxidants halts these free radicals in their tracks, but by doing so, they actually end up lacking an electron themselves. The body normally can provide enough of its own antioxidants to quench these newly needy molecules, but excess antioxidants can disrupt this balance.

Few studies have been done with humans investigating the potential effects of excess doses of antioxidants other than beta-carotene and vitamin E, so the effects of most of these substances remains unknown. The best solution to keep from taking in too many of a given antioxidant is to choose whole foods instead of supplements. Because antioxidants work in synergy with other components in the diet, the problem of too many antioxidants could be a result of isolating these compounds, not any fault of the compounds themselves.


Part 3

Possible Causes of Weight Gain (food for thought)


Early symptoms:

  • Hard stools or constipation
  • Increased sensitivity to cold temperature
  • Fatigue or feeling slowed down
  • Heavier and irregular menstrual periods
  • Joint or muscle pain
  • Paleness or dry skin
  • Sadness or depression
  • Thin, brittle hair or fingernails
  • Weakness
  • Weight gain

Late symptoms, if untreated:

  • Decreased taste and smell
  • Hoarseness
  • Puffy face, hands, and feet
  • Slow speech
  • Thickening of the skin
  • Thinning of eyebrows



Weight gain is a common symptom of Cushing’s syndrome, a condition in which you are exposed to too much of the hormone cortisol, which in turn causes weight gain and other abnormalities. Cushing’s syndrome can occur if you take steroids for asthma, arthritis, or lupus. It can also occur when your adrenal glands produce too much of the hormone, or be related to a tumor. The weight gain may be most prominent around the face, neck or upper back, or waist.


Poor sleep/ little sleep

According to the National Sleep Foundation, 63 percent of American adults don’t get the recommended eight hours of sleep a night. And the less you get, the worse your weight-gain odds are.

Sleep deprivation appears to result in decreased leptin, a hormone thought to regulate appetite and metabolism, and increased ghrelin, a hormone that likely stimulates appetite. Thus, the following studies, both from November 2004, make sense:

  • Columbia University researchers found that people who get four or fewer hours of sleep a night are 73 percent more likely to be obese than those who get seven to nine hours. The researchers studied records of over 6,000 people ages 32 to 59. Get a whopping six hours a night? Count yourself 23 percent more likely to be substantially overweight.
  • In a study from the Annals of Internal Medicine, 12 young men who slept only four hours a night for two nights had a 24-percent increase in hunger, compared to when they were allowed two 10-hour nights. Cravings for high-calorie, high-carb foods especially increased.

PCOD  Polycystic Ovaries (you don’t have this)

Stress and Anxiety

Stress and anxiety can lead to elevated cortisol levels. That’s the same hormone associated with Cushing’s syndrome. However, the cortisol levels in established Cushing’s are thought to be much higher than what would be expected in a patient with stress, anxiety, etc. For the chronically stressed, research into the effects of long-term elevations in cortisol and its effects on obesity—and more specifically abdominal obesity—are in progress.

One thing is certain, though: If stress and anxiety make you want to eat more, weight gain is a likely outcome, no matter what your levels of cortisol are. (I know you are not eating more)

The National Women’s Health Information Center also offers the following stress reducing tips (not to replace any needed medications or psychotherapy):

  • Unwind with yoga, meditation, massage therapy, music or a book.
  • Make time for yourself—at least 15 minutes a day for a bubble bath, walk, or calling a friend.
  • Sleep.
  • Exercise.
  • Talk to friends.
  • Keep a journal.
  • Help others.
  • Get a hobby.
  • Set limits (don’t be afraid to say no).
  • Plan your time.

Depression (see above)

Medications (see your list too)

Not eating enough. Oddly enough, starving yourself may have the opposite effect than what you desire, at least at first. When your body is starving it will slow down your metabolism and store energy, causing food to stick around longer. So eat right instead of just eating less.

  Spending too much time at the bar. Beer and mixed drinks can form a sneaky way for calories to creep into your diet. If you’ve been drinking more than usual your liquid diet could be to blame for your weight gain.

  Feeling guilty. Many people feel guilty about putting on weight and get depressed, sometimes giving up or emotionally eating instead. Don’t beat yourself up over a few pounds, just try to do better in the future.

  Skipping meals. Skipping meals can slow down your metabolism and cause you to overeat when you do actually sit down to a meal. So space your meals throughout the day to avoid meal related weight gain.

  Eating too fast. You may be starving, but slow down and take time to enjoy your meal. It will give your body a chance to register that it’s full before you eat too much.

  Not intensifying your workout routine. You may be working out, but are you working hard enough? Over time you need to ramp up your workout routine to get the same effect, so make sure you’re not just working out in name alone.

  Menopause. Menopause causes many changes in the body, one possible one being a redistribution of weight in the body, moving from the hips to the midsection. Hormonal changes can also trigger greater appetite, poor sleep and depression.

  Food allergies. Some food allergies, even mild ones, may be causing you to put on weight. As odd as it may sound, when you eat these foods you’re allergic to it can cause an addictive effect, making you crave the food even when you’re full.

  Aging. Most people, as they age, feel their metabolisms beginning to slow down. If you’re not feeling that its as easy to lose weight as it used to be, take this into account and start working at a program that better reflects your new needs.

  Getting a cold. New studies suggest that getting a cold may actually cause you to gain weight. Certain viruses seem to increase the number of cells that develop into fat, causing a marked increase in weight over time.

  Inflammation. Many lifestyle factors including stress, drinking and lack of sleep can contribute to inflammation and certain foods can have an inflammatory effect as well. This can lead to weight gains where you feel there should be none.

  • Water retention. Most women are familiar with the bloating that can happen when their menstrual cycles are on the horizon but there are times when this water weight gain can be more serious can caused by kidney or heart failure so it’s important to get unexplained water retention checked out.
  • Thyroid problems. A common but sometimes undiagnosed cause of weight gain is hypothyroidism. It causes a deficiency in the thyroid hormones leading to fatigue, weight gain and slowed metabolism though much of the weight loss associated with its regulation comes from loss of accumulated body fluids.
  • Cushing’s syndrome. This syndrome is caused by an excess of the hormone cortisol in the body, the same one that’s released when you’re feeling stressed, and causes your body to react in much the same way it would to stress, storing energy and putting on weight.
  • Essential Fatty Acid Deficiency. Essential fatty acids, such as in flaxseed oil, help our bodies to manufacture hormones and maintain a good metabolism. Deficiencies in these can cause cravings for unhealthy foods and metabolic problems and over time, weight gain.
  • Kidney disease. One of the symptoms of kidney disease can be weight gain due to fluid retention. If you’re noticing an especially large amount of bloating without a particular reason, head to your doctor as soon as you can to rule out this serious condition.
  • Heart trouble. A sign of heart trouble may actually be weight gain. This can be caused by your body retaining more fluid than usual. If you can push your fingertip into the skin and it leaves a mark rather than springing back you’re retaining water and should head to the doctor.
  • Blood sugar imbalances. Eating simple carbs can cause rapid fluctuations in blood sugar which in turn can cause more cravings for sugary foods as your body struggles to maintain a balance.
  • Ovarian cysts. Women should look out for polycystic ovary syndrome. It can potentially cause a weight gain of up to 30 pounds over a period of years and over goes unnoticed because it’s so gradual. Caregivers are unsure why exactly it causes weight gain but have noted that it appears to be genetic, so get checked out if you know a family member who’s had it.
  • In women, sometimes rapid, unexplained weight gain can be associated with ovarian tumors. Many of these are benign, but if left unchecked can grow to huge proportions.
  • Liver dysfunction. Problems with the liver can often be associated with weight gain. Your body may start retaining excess fluid and you will notice a little tightness around your waistline even though you have little appetite. If you suspect this is the reason for your weight gain get to the doctor ASAP.
  • Fibromyalgia often causes weight gain as it causes hormonal imbalances, affecting levels of cortisol, thyroid, serotonin and insulin, as well as the production of growth hormones. This means your metabolism can slow down and you can put on weight.
  • Adrenal dysfunction. Dysfunctions in the adrenal glands can lead to imbalances in your body’s hormones, upsetting your metabolism and natural balance. Sometimes, this can lead to a noticeable gain in weight.
  • Sleep apnea. Sleep apnea can prevent you from getting a truly restful nights sleep and because of this lack of sleep leave you feeling unrested, stressed out and irritable. Not getting enough sleep can lead to the slowing of your metabolism and sometimes cravings for less than healthy foods.




40 year-old woman with severe chronic anemia x 10 years, nonresponsive to oral iron

Smart RN ultimately helped her find a hematologist and went with her to insure she was able to secure the iron infusions she needed. After two infusions, her symptoms resolved and hemoglobin returned to normal after more than a decade.



Is when your blood lacks enough healthy red blood cells or hemoglobin. Hemoglobin binds and carries oxygen. If you have too few or abnormal red blood cells, or your hemoglobin is abnormal or low, the cells in your body will not get enough oxygen. Iron is also required for erythropoiesis (RBC creation) and DNA synthesis.

It’s the most common blood disorder on earth.

Iron-deficiency anemia is a form of microcytic hypochromic anemia characterized by depressed ferritin, serum iron and iron saturation and elevated TIBC and transferrin. There can be many causes of iron-deficiency anemia, many of which involve either reduced iron intake or absorption, or increased blood loss, or both.

It’s critical to correctly identify the underlying cause of anemia. For example, it is important to identify if a person is anemic because of a yet undiagnosed H. pylori infection, or the anemia could be caused by heavy periods.

Possible causes: Diet: iron or folate deficiency.  Alcoholism, liver disease, vit B-12deficiency, kidney disease, hyperthyroidism, leukemia, genetic issues, infections, blood loss, toxoplasmosis (from cats)

Folate deficiency

Symptoms:  Anemia, mood swings/ irritability, poor digestion, frequent illnesses like colds, low energy, pale skin, frequent mouth sores

Causes: Alcoholism, poor diet (no veggies or beans), liver disease, zinc deficiency

Supplements: Use folate! Folate is a naturally occurring and essential vitamin, folic acid is a synthetic B vitamin found in supplements and fortified foods. Your body uses folate, not folic acid.

Iron deficiency

Symptoms:  Fatigue, Dizziness, Feeling grumpy or cranky, Headaches, Pale skin, nail beds, and gums, Short of breath, Trouble concentrating.

Causes:  Dietary deficiency (eggs and leafy greens, especially cooked, eat them), Chronic blood loss in the body from ulcers, heavy bleeding during menstruation, uterine fibroids, hemorrhoids, cancer, or regular aspirin use; Inability to absorb iron. Iron-deficiency is common in undiagnosed celiac disease, food intolerances or poor digestive function.

Helpful: do not drink coffee, tea, beer or cola with meals as these inhibits the absorption of iron. Instead, drink citrus juices. Avoid excessive alcohol. Monitor diet closely

You need two things to digest and absorb Iron: Stomach acid (to break it down) and a healthy intestinal tract (to bring it into the body).

Low stomach acid, or hypochlorhydria, can be caused by a myriad of things including infection by a bacteria called H Pylori, or drugs that decrease stomach acid. For example, proton pump inhibitors (Prilosec, Omprezole) decrease the stomach cells’ ability to make stomach acid. Likewise, acid blockers such as Zantac and Pepsid have become increasingly popular and are often taken on a long term basis. Alkaline water can also lower stomach acid

Many things can cause malabsorption at the small intestine level. Celiac Disease, Crohn’s Disease, Ulcerative Colitis, and Leaky Gut Syndrome have all been known to cause nutrient deficiencies.

Eat food that contains Iron–meats, spinach, kale, chard and other green leafy veggies. Keep in mind that meat will have the most bio-available form of Iron as most minerals in plants and grains are chelated (bound) to something else such as phytates, which typically impedes their absorption.

is a pretty good, commercially available Iron supplement.

Iron Infusions

Works for most types of iron deficiency anemia—sometimes it is just the results that count.

Labs that are critical in the workup of anemia:

CBC w/

  • Red blood cell (RBC) indices
    • MCV– It is a measurement of the volume occupied by a single RBC and is an indicator of individual cell size. Increased values indicate macrocytic anemia (eg, vitamin B-12 or folate deficiency, liver disease, alcoholism), while decreased values indicate microcytic anemia (ie, iron deficiency, thalassemia, anemia of chronic blood loss).
    • MCHC– It represents the average concentration of Hgb in the red blood cells. Increased values point to spherocytosis (eg, congenital hemolytic anemia), and decreased values indicate iron deficiency, thalassemia, or macrocytic anemia.
    • MCH confirms the accuracy of MCV value. Increased values occur in macrocytic anemia, newborns, and infants. Decreased values indicate microcytic anemia
  • Reticulocyte count and Index
    • A reticulocyte is an immature RBC formed in the bone marrow. Increased values indicate accelerated erythropoiesis and can be present following treatment of anemia, after splenectomy, 3-4 days following hemorrhage, in sickle cell disease hemolytic anemia, during pregnancy, or in infants. Decreased values indicate decreased RBC production by the bone marrow and can be a result of aplastic anemia, chronic infection, or radiation therapy. A persistent reticulocyte deficiency is a poor prognostic sign.
  • Examination of peripheral blood smear

Additional laboratory tests:

  • Serum iron concentration
  • Total iron-binding capacity (TIBC)
  • Serum vitamin B-12
  • Serum folate and red cell (erythrocyte) folate
  • Serum bilirubin
  • Liver function tests (LFTs) including bilirubin
    • Liver Ultrasound — rule out fatty liver diagnosis
  • Thyroid panel
  • Hgb electrolytes
  • Heavy metal studies (urine and blood)
  • Comprehensive stool (yeast or other infection causing malabsorption?)

Toxoplasmosis Tests
IgG, IgM and acridity tests

Imaging studies

CT of the chest abdomen and pelvis for masses, histoplasmosis/coccidioidomycosis.

Iron markers and disorders

Common causes of iron-deficiency anemia:

  • Reduced iron intake:
    • Evaluate diet for iron intake, vegetarian/veganism
    • Heme iron vs non-heme iron
  • Reduced iron absorption:
    • pylori
    • Hypochlorhydria
    • Celiac disease
    • Parasites (hookworms, roundworms, pinworms)
  • Increased blood loss:
    • Gastric ulcer
    • Internal bleeding
    • Heavy menses
    • Occult blood in stool

Vegetarians and vegans are often deficient in iron, despite making a concerted effort to eat iron-rich vegetable sources like spinach. Vegetable sources of iron contain non-heme iron, which must be converted into heme iron to be utilized in the body. In contrast, animal sources of iron are much higher in heme iron. One of the best sources is red meat. Plant foods do not contain B12. Consequently, strict vegans and vegetarians who do not eat any fish or shellfish are at increased risk of B12 deficiency, as well as iron deficiency.

Easy bruising

Causes:  Liver disease/ heavy drinking, anemia, supplements like ginko, vit. e, ginger

Reduce your tendency to bruise by taking a daily combination of at least 400 mg of vitamin C and 400 mg of flavonoids, such as hesperidin and rutin. Try Pycnogenol and/ or bilberry extract.


63 year-old woman with recent diagnosis of fibromyalgia.

This client did not request an evaluation and comparison of available treatments, but treatment options are included in the diagnostic work-up.


Sample Diagnosis Report — Detailed

Client #4520  63 y.o. female

Diagnosis Detail


Definition:  (CDC)

Fibromyalgia is a disorder of unknown etiology characterized by widespread pain, abnormal pain processing, sleep disturbance, fatigue and often psychological distress. People with fibromyalgia may also have other symptoms; such as,

  • Morning stiffness
  • Tingling or numbness in hands and feet
  • Headaches, including migraines
  • Irritable bowel syndrome
  • Sleep disturbances
  • Cognitive problems with thinking and memory (sometimes called “fibro fog”)
  • Painful menstrual periods and other pain syndromes

American College of Rheumatology states that:  Fibromyalgia often co-occurs (up to 25-65%) with other rheumatic conditions such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and ankylosing spondylitis (AS).

Rheumatic conditions are all linked to Systemic INFLAMMATION

Causes and Concerns:

  • New research shows that about half of fibromyalgia patients have damage to nerve fibers in their skin and other evidence of a disease called small-fiber polyneuropathy (SFPN), this can often be confirmed with a skin biopsy.  (Aug. 6, 2013, HealthDay News)
  • Obesity is a common comorbidity (occurs with) of fibromyalgia that may compromise clinical outcomes. The adverse impact of obesity is evidenced by hyperalgesia (extreme sensitivity), disability, impaired quality of life and sleep problems. Recent evidence suggests weight loss improves fibromyalgia symptoms, perhaps resulting from patients adopting healthier lifestyles and taking more positive attitudes toward symptom management, and overall quality of life.  (Relationship Between Fibromyalgia and Obesity in Pain, Function, Mood, and Sleep. The Journal of Pain, 2010; 11 (12): 1329 DOI: 10.1016/j.jpain.2010.03.006)
  • Toxins associated with FM:  Phthlates and Parabens, TEST urine.  In addition to obesity, elevated levels of phthlate have been associated with chronic fatigue syndrome, fibromyalgia, ADD, syndrome X, diabetes, arteriosclerosis, allergies, and much more.
    • “Phthalate plasticizers are the most abundant man-made pollutants that have recently received wide-spread attention…  Insults occur to various organs, including the reproductive system, pulmonary, central nervous system, immune system and liver. Toxic reactions are also reported involving inflammation, mitochondria and carcinogenicity.”  (Kovacic, P. , How dangerous are phthalate plasticizers? Integrated approach to toxicity based on metabolism, electron transfer, reactive oxygen species and cell signaling.  Medical Hypotheses – April 2010)



Alternative treatments with published supporting research:  (click here and note: table 2 states protocols used)


Ann Myers, MD, Functional Medicine MD offers this list of causes/ treatments for FM symptoms:

  • 1. Gluten intolerance
    Gluten has been liked to more than 55 diseases and is often called the “big masquerader.” The reason for this is that the majority of gluten intolerance symptoms are not digestive in nature, but are instead neurological, such as pain, cognitive impairment, sleep disturbances, behavioral issues, fatigue and depression.
  • 2. Candida overgrowth
    Candida is a fungus, or yeast, and a very small amount of it lives in your intestines. When overproduced, Candida breaks down the wall of the intestines and penetrates the bloodstream, releasing toxic byproducts into your body and causing a host of unpleasant symptoms such as brain fog, fatigue, digestive issues and pain. Virtually every one of my patients with fibromyalgia has had Candida overgrowth.
  • 3. Thyroid
    It’s vital that your doctor check all six blood markers to accurately measure your thyroid gland’s function. It’s also imperative that your doctor use the optimal levels rather than the standard reference range when assessing and diagnosing thyroid disorders. Getting my patient’s thyroid levels into an optimal range typically alleviates their fatigue, brain fog, sleep disturbances and depression.
  • 4. Vitamin deficiencies
    Magnesium, vitamin D and B12 deficiency are the most common vitamin deficiencies I see in those who have been diagnosed with fibromyalgia. I’ve had several patients completely reverse their fibromyalgia symptoms with magnesium alone. The best way to measure magnesium is a red blood cell (RBC) magnesium level, which can be tested through any conventional lab.
  • 5. Small Intestine Bacterial Overgrowth (SIBO) and Leaky gut
    There are more bacteria in us and on us then there are of our own cells. When these bacteria get out of balance through use of antibiotics or a sugar-rich diet, we can lose our ability to digest and absorb nutrients, particularly B12. Gluten can cause SIBO and leaky gut and SIBO and leaky gut can lead gluten and other food intolerances. It’s a catch-22 and a vicious cycle. You must “fix the gut” first in anyone with fibromyalgia.  **WITH THE GERD, B-12 DEFICIENCY AND FM, YOU ARE EXHIBITING CLASSIC SIGNS OF THIS, IT NEEDS TO BE ADDRESSED–PL
  • 6. Mycotoxins
    Mycotoxins are very toxic substances produced by molds. Conventional environmental mold testing only tests for levels of mold spores and does not test for mycotoxins. I use a urine mycotoxin test in my clinic to determine if someone has been exposed to toxic molds.
  • 7. Mercury toxicity
    I recommend that all my patients find a biological dentist and have their mercury amalgam fillings removed. Mercury is toxic to our bodies and can be one piece of the puzzle for those with fibromyalgia. I then recommend heavy metal testing using a pre- and post-DMPS urine challenge test.
  • 8. Adrenal fatigue
    Adrenal fatigue is a result of the chronic stress. Chronic pain is a stress to the adrenal glands, though it’s typically not the initial adrenal stressor. The initial stressor is usually something such as food intolerances, Candida, mercury toxicity, vitamin deficiencies or mycotoxins. My goal is to support the adrenals with adaptogenic herbs while we search for the root cause of the stress and correct it.
  • 9. MTHFR mutations
  • This is a genetic test you can get though any conventional lab. The more mutations you have to the MTHFR gene the less able you are to methylate and detoxify toxins, such as mercury and lead. The more mutations you have at this gene the higher your requirements for methyl-B6, methyl-B12 and folinic acid in order to keep your detoxification pathways working properly.
  • 10. Glutathione deficiency
  • Glutathione is the most critical part of our body’s detoxification system. Glutathione gets recycled in our body — unless our toxic burden gets too high, or we lack GSTM1 and GSTP1, the enzymes needed to recycle and produce glutathione. Taking glutathione or the precursors (NAC, alpha lipoic acid, milk thistle) often help dramatically with fatigue.As you can see from the above list, many of these causes are interrelated, and often there’s no single root cause of fibromyalgia.

MERCURY’S Relationship to Chronic Fatigue and Fibromyalgia (as well as Neurosarcoidosis??):

1: Mercury is known to denervate nerve fibers, similar to the pathology of multiple sclerosis. In other words it makes it so the nerves do not work.

2: Mercury can leak into the blood-brain barrier and reduce nerve conduction velocity and visual evoked responses, diagnostic tests used for multiple sclerosis.

3: Mercury can inhibit the action (binding) of happy hormones, like serotonin, at the synapse (nerve to nerve connection) leading to depression.

4: Mercury can cause hearing loss.

5: Mercury can decrease norepinephrine and dopamine activity at synapses, damaging our molecules of emotion. This can make a person lack zip, enthusiasm, joy, and creativity and make him anxious, insomniac, and terribly tense.

6: Mercury can create peripheral neuropathy, auto-immunity and interferes with synapse transmission, decreasing infection control so the unsuspecting victim gets recurrent sinusitis, prostate or gum infections, as examples.

7: Hidden mercury toxicity can be at the root of a resistant Candida infection. Sometimes you just cannot clear Candida symptoms until you get rid of the mercury.

8: Mercury is also a major undiagnosed cause of chronic fatigue and fibromyalgia.

9: Whenever we see someone resistant to all treatments, there is a high probability mercury toxicity is at the root of it.

10: Mercury toxicity can create any baffling neurologic disease as well, burning & migrating pain and impair cure for any disease of other body systems.

**  It is imperative that you be tested for mercury

Restless leg syndrome

  • High Rate of Restless Legs Syndrome Found in Adults With Fibromyalgia (impairs much needed sleep)
  • Oct. 15, 2010 — A study in the Oct. 15 issue of the Journal of Clinical Sleep Medicine found that adults with fibromyalgia had a much higher prevalence and risk of restless legs syndrome than healthy controls. The study suggests that treating RLS may improve sleep and quality of life in people with fibromyalgia.
  • Results show that the prevalence of restless legs syndrome was about 11 times higher in the fibromyalgia group than the control.

This is a serious issue with autoimmune patients since they require 8-9 hours of good sleep per night.  First thing is to check all medications and supplements to be certain they are not causing or contributing to the problem.  I checked yours.  Then practice good sleep hygiene:

  1. Maintain a regular bed and wake time schedule every day, including weekends.
  2. Establish a regular, relaxing bedtime routine such as soaking in a hot bath or hot tub and then reading a book or listening to soothing music.
  3. Create a sleep-conducive environment that is dark, quiet, comfortable, and cool.
  4. Sleep on a comfortable mattress and pillows.
  5. Use your bedroom only for sleep and sex.
  6. Finish eating at least two to three hours before your regular bedtime.
  7. Exercise regularly, but complete your workout at least a few hours before bedtime.
  8. Avoid caffeine (e.g., coffee, tea, soft or energy drinks) close to bedtime, as it can keep you awake.
  9. Avoid nicotine (e.g., cigarettes, tobacco products) too close to bedtime.
  10. Avoid alcohol close to bedtime.

The hot bath often works especially well, as does massage.  There are also meds if needed.  Melatonin is good first choice for sleep.  I recommend an evaluation by a functional or integrative doctor if you continue to have this issue.


Peripheral neuropathy


  • Diabetes
  • Chemotherapy
  • Use of Statin drugs (damage to mylin sheath, made from cholesterol)
  • Physical blockage, usually from spine out of alignment
  • Nutrient deficiency:  acetyl-L-carnitine, lipoic acid, vitamin E, B1, B6
  • Fibromyalgia & Neurosarcoisosis

***  Small fiber polyneuropathy:  Treatments remain the same as with all neuropathic pain except:  “In the only published study specifically examining treatment of small fiber neuropathy, both gabapentin and tramadol were found to be effective.”  (Curr Pain Headache Rep. 2011 June; 15(3): 193–200)



Sarcoidosis is a disease of unknown cause that leads to inflammation.   It can affect various organs in the body. (NIH)

AUTOIMMUNE:  Normally, your immune system defends your body against foreign or harmful substances. For example, it sends special cells to protect organs that are in danger.  These cells release chemicals that recruit other cells to isolate and destroy the harmful substance.

Inflammation occurs during this process. Once the harmful substance is destroyed, the cells and the inflammation go away. In people who have sarcoidosis, the inflammation doesn’t go away.

Instead, some of the immune system cells cluster to form lumps called granulomas in various organs in your body



Following from:‎

Neurosarcoidosis is characterized by inflammation and abnormal cell deposits in any part of the nervous system – the brain, spinal cord, or peripheral nerves.  It most commonly occurs in the cranial and facial nerves, the hypothalamus (a specific area of the brain), and the pituitary gland.  It is estimated to develop in 5 to 15 percent of those individuals who have sarcoidosis.  Weakness of the facial muscles on one side of the face (Bell’s palsy) is a common symptom of neurosarcoidosis.  The optic and auditory nerves can also become involved, causing vision and hearing impairments.  It can cause headache, seizures, memory loss, hallucinations, irritability, agitation, and changes in mood and behavior.

Causes and Concerns:

Excessive inflammation: (this next section is from holistic source:

One of the underlying causes of sarcoidosis is excessive inflammation in the body. There are many inflammatory agents in our food supply that must be strictly avoided if you have sarcoidosis. You may be over-consuming carbohydrates, especially in the form of high fructose corn syrup (HFCS). You may also be eating too much fried foods, polyunsaturated vegetable oils, and food additives like nitrates, MSG and artificial sweeteners. These substances are highly toxic and cause inflammation.

Symptoms of low levels of vitamin D
There’s substantial evidence that sarcoidosis is one of the symptoms of low levels of vitamin D and vitamin D metabolism. Low levels of vitamin D can contribute to this disease, however many patients with sarcoidosis have hyperactive immune systems, which can cause excessive vitamin D.  Excess vitamin D will increase calcium levels in the cells, which will activate the nerve cells and cause excess inflammation, leading to more damage. Calcium deposits in tissues like lung and kidney are the hallmark of sarcoidosis. These calcium-laden lesions are named granulomas. Therefore, vitamin D supplementation should be very carefully monitored. Special blood tests looking at various forms of vitamin D should be utilized to determine your needs. . Sarcoidosis specialist MD Wellness can help determine what your body requires.

Food Allergies
If you have sarcoidosis, food allergies may be contributing to your problems. You may also have a high incidence of bowel flora imbalances with excessive levels of pathogenic bacteria and low levels of beneficial bacteria. Often times, sarcoidosis patients also have leaky gut syndrome. These imbalances can over activate your immune system and add to inflammation.

Envirnonmental Allergies
If you have sarcoidosis you want to be careful to minimize your exposure to environmental allergies like mold and mold toxins. These harmful, common poisons can over stimulate your immune system and contribute to “autoimmune” disease.


There is no agreed upon standard of treatment for neurosarcoidosis.  Doctors generally recommend corticosteroid therapy as first-line therapy for individuals with the condition (this therapy has considerable undesirable health ramifications and I would caution you to speak with your MD, or seek a second opinion regarding this–PL).  Additional treatment with immunomodulatory drugs such as hydroxychloroquine, pentoxyfilline, thalidomide, and infliximab, and immunosuppressive drugs such as methotrexate, azathioprine, cyclosporin, and cyclophosphamide, have benefited some individuals.  While the use of corticosteroids and other immunosuppressive drugs is effective, these medications also have undesirable side effects. Side effects and experience with certain drugs may play a role in medication choices. (‎)

Nutritional:  (very important in systemic inflammation!)

Dietary Recommendations

  • Prostaglandin Diet


    • All fried foods (deep fried and pan fried) Trans fats- Margarine
    • Hydrogenated and partially hydrogenated vegetable oils
    • Commercially processed vegetable oils
    • Polyunsaturated vegetable oils- mayonnaise, salad dressings, nuts and nut butters, cooking oils, and all other vegetable oils (except olive oil and coconut oil)
    • Excess arachidonic acid – shrimp, lobster, crab, and other shellfish and mollusks
    • Excess alcohol
    • Food additives
    • Any refined sugar or high fructose corn syrup
  • Avoid toxins in the diet
  • Eat a balanced diet


I found this center near you:


Lyme Disease  (your previous diagnosis of Lyme disease, and the similarities to both Neurosarcoinosis and Fibromyalgia cause me to include info here)


Fast Facts

  • Lyme is fastest growing vector-borne disease
  • 85% do not recall tick bite
  • Less than 70% of people develop a rash
  • Treatment should begin without testing if rash is present
  • Lab tests may be negative in the first 4-6 weeks

Early symptoms

  • Flu-like illness (fever, chills, sweats, muscles aches, fatigue, nausea and joint pain)
  • Rash (10% have EM rash)
  • Bell’s palsy

TESTS:  Western Blot  Antigen detection tests look for a unique Lyme protein in fluid (e.g. blood, urine, joint fluid). Sometimes people whose indirect tests are negative are positive on this test.

Later Symptoms

  • Headache
  • Stiff neck
  • Light or sound sensitivity
  • Cognitive impairment
  • Sleep disturbance
  • Depression, anxiety, or mood swings
  • Arthritis
  • Fatigue
  • Abdominal pain, nausea, diarrhea
  • Chest pain, palpitations
  • Shortness of breath
  • Tingling, burning or shooting pains
  • Fibromyalgia
  • Vision & hearing impairments


The IDSA thinks Lyme symptoms after treatment represent a possibly autoimmune, “post-Lyme syndrome” that is not responsive to antibiotics. ILADS physicians believe that on-going symptoms probably reflect active infection, which should be treated until the symptoms have resolved. These physicians are using the types of treatment approaches employed for persistent infections like tuberculosis, including combination treatment with more than one antibiotic and longer treatment durations.

Functional and integrative MDs are using many other forms of therapy for chronic Lyme and a visit to one is recommended.


Vitamin D deficiency

  • Sarcoidosis is one of the symptoms of low levels of vitamin D and vitamin D metabolism. Low levels of vitamin D can contribute to this disease, however many patients with sarcoidosis have hyperactive immune systems, which can cause excessive vitamin D.  Excess vitamin D will increase calcium levels in the cells, which will activate the nerve cells and cause excess inflammation, leading to more damage. Calcium deposits in tissues like lung and kidney are the hallmark of sarcoidosis. These calcium-laden lesions are named granulomas. Therefore, vitamin D supplementation should be very carefully monitored.  (
  • Sarcoidosis is one of the few diseases where you need to be cautious in supplementing with vitamin D and cautious in getting good amounts of sun exposure. The reason is that in sarcoidosis, 4–11% of the patients develop high serum calcium (hypercalcemia). In any hypercalcemic condition, caution is needed in supplementing with vitamin D. While supplementation doesn’t need to be avoided, it should be closely monitored by a health care professional, to make sure that it doesn’t further increase serum calcium levels.  (



Osteopenia refers to bone mineral density that is lower than normal peak, but not low enough to be classified as osteoporosis.


  • Aging, being thin, white, Asian, family history, lack of exercise, smoking, cola drinks, excessive alcohol consumption, medication side-effect, esp: chemotherapy, steroids, radiation – WebMD  (I checked your meds and this is not a significant risk with your current list – PL),
  • Zinc deficiency:  One important clue that you may have a zinc deficiency is an alkaline phosphatase blood test below 70. (

**Your last two alkaline phosphatase:  61 iu/ 60iu

  • Check:  RBC intracellular nutrient and toxic heavy metal profile (cadmium?)
  • A zinc deficiency can come from cadmium, plasticizers, unbalanced high calcium doses, and more.
  • Check parathyroid levels as this is the gland responsible for calcium and phosphorous regulation


B12 vitamin deficiency


  • strange sensations, numbness, or tingling in the hands, legs, or feet
  • difficulty walking (staggering, balance problems)
  • anemia
  • a swollen, inflamed tongue
  • yellowed skin (jaundice)
  • difficulty thinking and reasoning (cognitive difficulties), or memory loss
  • paranoia or hallucinations
  • weakness
  • fatigue

Recent (2013) articles in New England Journal of Medicine and Harvard Health @ state this is fairly common—especially with Vegans/ vegetarians, people with gastric bypass surgery and people over 50.

Supplementation is better absorbed sublingually (under the tongue) or by injection.  You are already getting good B-12 supplementation.


Primary hypercoagulable state

Hypercoagulable state: A condition in which there is an abnormally increased tendency toward blood clotting (coagulation).

Primary means inherited or born with.

There are numerous hypercoagulable states. Each has different causes and each increases a person’s chances of developing blood clots such as those associated with thrombophlebitis (clot in the veins).

Causes of primary hypercoagulable states include elevated blood homocysteine levels, and inherited protein deficiencies (antithrombin III, factor V Leiden, protein S, protein C, and others).

I haven’t seen anything in the records I have to far to substantiate this, awaiting older records to make more detailed evaluation– PL


GERD [Gastroesophageal reflux disease]

Stomach acid escapes into the esophagus, damaging tissue there, through a valve (sphincter) that should never open except to let chewed food down into the stomach. In GERD, the sphincter malfunctions.

Traditional thinking is that GERD is caused by excess acid, so antacids of all types are used with abandon, but that may no longer be a viable theory–and is probably contributing to the problem.  We need stomach acid to digest food and even if you wanted to, one could not neutralize all the stomach acid so it would be harmless.  Correcting the pH has become the more logical approach.  Now, specialists are prescribing what is essentially stomach acid to improve the pH and digestion.

How it works:  Stomach acid digests carbohydrates, so when it is low carbohydrates sit in the stomach or move through without being broken down and decay, causing gas and pressure. Carbohydrate malabsorption leads to bacterial overgrowth, resulting in more intra-abdominal pressure (IAP) which drives reflux (the pressure forces the sphincter to open and allow acid into the delicate tissue of the esophagus). Low stomach acid can contribute to both bacterial overgrowth (independently of carbohydrate intake) and carbohydrate malabsorption, the process looks like this:


Let’s look at each step in turn.

Low stomach acid causes bacterial overgrowth

One of the chief roles of stomach acid is to inhibit bacterial overgrowth. At a pH of 3 or less (the normal pH of the stomach), most bacteria can’t survive for more than 15 minutes. But when stomach acid is insufficient and the pH of the stomach rises above 5, bacteria begin to thrive. Research mice, which were bred to be incapable of producing stomach acid, suffered from bacterial overgrowth – as well as inflammation, damage and precancerous polyps in its intestines.

It is also well documented that acid-suppressing drugs promote bacterial overgrowth. Long-term use of Prilosec, one of the most potent acid suppressing drugs, reduces the secretion of hydrochloric acid (HCL) in the stomach to near zero. In one trial, 30 people with GERD were treated with a high dose of Prilosec (40g/day) for at least 3 months. 11 of the 30 Prilosec-treated people developed significant bacterial overgrowth, compared with only one of the ten people in the control group.

While obesity, overeating, lying down after eating, bending over after eating, and wearing tight belts or clothing, play a role, for the problem to become chronic (which is what GERD is) then it is believed other factors are at work.

In is book, Heartburn Cured, Dr Robillard notes that when stomach acid is sufficient and carbohydrates are consumed in moderation, they are properly broken down into glucose and rapidly absorbed in the small intestine before they can be fermented by microbes. However, if stomach acid is insufficient and/or carbohydrates are consumed in excess, some of the carbs will escape absorption and become available for intestinal microbes to ferment into gas.  Evidence that bacterial overgrowth causes GERD is that tests have shown that antibiotics–erythromycin–can kill the bacterial overgrowth and stop the IAP and GERD.

Try eating fewer simple carbs.  Sugar, bread, pasta, rice, starchy veggies (like white potatoes), etc. all contribute.  Stick with protein sources and veggies, primarily.  And don’t overeat, or eat before bed. If that doesn’t do it, then talk with your doctor about restoring your stomach acid. (