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A Case Study in Autoimmune Disease – Part 2 – Testing

Doctor explaining prescription to senior patient, healthcare concept
February 1, 2021

(Before reading this post, be sure to check out A Case Study in Autoimmune Disease – Part 1 – Evaluation, where Dr. Ian gives an overview of Molly’s case and what she presented with initially.)

Molly’s blood work findings:

Homocysteine 12.5 TSH 1.2 (normal!) Vitamin D 31 Ferritin 15 WBC 4.4 Eosinophils 5 EBV positive for reactivation Candida Abs IgA +


Having an elevated homocysteine level above a 7.0 increased the chance that Molly was suffering from an inability to methylate, which is one of the most important detoxification reactions the body undergoes. It also may indicate a B vitamin deficiency that must be corrected because methylation requires specific forms of B vitamins.

Molly was struggling with hormonal symptoms including low libido, severe cramping during menstruation and mood fluctuations. In addition to these challenges, her Epstein-Barr virus that most likely triggered her thyroid condition had become reactivated and was most likely wreaking havoc on her hormonal system. Throw in the inability to detoxify and you can begin to understand why she was having such a hard time.

Her ferritin (stored iron) was borderline low and certainly was part of her chronic fatigue. Most likely this was from the state of her gut, not from a lack of iron in her diet as she ate red meat. Keep in mind her TSH was spot on perfect and she still suffered from classic thyroid symptoms like fatigue, brain fog, constipation, cold intolerance and anxiety. Even though her TSH was normal, her vitamin D was not optimal. Vitamin D hormone regulates the immune system and is one of the primary protectors against viral infections.

It was obvious that Molly had been fighting infections for quite some time (candida + Epstein-Barr at the minimum) because her white blood cell (WBC) count was borderline low at 4.4. On top of this, her eosinophils were elevated which indicated either an environmental or food trigger (it can take up to 72 hours for symptoms to surface from food sensitivities).

Lastly, Molly’s Candida antibody was high. This indicated a severe immune reaction more than likely from overgrown fungus. Candida is found in every one of us but when Candida is overgrown from overconsumption of refined, processed sugars, it creates inflammatory havoc with the endocrine and immune system. Molly had symptoms of hypoglycemia and fatigue after meals, but after we lowered the candida in her body, her blood sugar swings were a thing of the past.

We also ordered specialty lab tests including:
1. Urinary hormone test
2. DNA based stool test
3. Wheat sensitivity test

1. The “DUTCH” test -Dried, Urinary Test Comprehensive Hormones:

Molly’s hormone levels were not in a great place. Her progesterone was fine, so she was ovulating, but her estrogen was in the tank. Estrogen is a critical component of a normal cycle and her levels were basically menopausal, yet she was only 35 years old. Molly’s DHEA-s level was also low. DHEA-s is a precursor hormone critical to estrogen production.

When someone experiences high levels of inflammation like leaky gut, infections, or food sensitivities, their hormonal balance is disrupted. This illustrates perfectly how the body is interconnected. If Molly had gone to a primary care or endocrinologist, they more than likely would never have connected her gut problems to a hormonal imbalance. Molly’s cortisol level was normal. In her condition, I would have expected an abnormal cortisol level, but except for her waking cortisol, her pattern was relatively fine. What is important was that her cortisone was low. Physiologically, this is important because it is an indication of chronic inflammation. So, her adrenal function was becoming taxed by inflammation and this was causing adrenal symptoms of fatigue, low motivation and chronic hip and knee problems.

2. The GI Map test:

This test is an amazing way to see what is replicating in the gut (good guys and bad guys), inflammation markers and digestive enzyme activity. Molly was in trouble because she was dealing with an overgrowth of virus and her firmicutes level was high, indicating bacterial overgrowth in her small intestine, A.K.A, SIBO (small intestine bacteria overgrowth). These infections were driving inflammation, hormonal disruption and the poor overall health her thyroid and body was in.

We immediately customized her supplementation to address both infections and to give her gut the support it needed to “weed & feed.” Molly began anti-microbials, gut healing compounds and prebiotics that were gentle yet effective in healing her gut. We also tailored her diet so she had everything she needed to keep her momentum once the supplements stopped. This was the most important aspect of her case and spending the three months of strict adherence to the diet changed her life!

3. Wheat Sensitivity Test

What you see above is Molly’s positive antibodies to wheat and markers indicating leaky gut. She also had active antibodies to LPS (lipopolysaccharides), which are basically bacterial poo. So, she had leaky gut (intestinal permeability), was highly reactive to wheat (and one exposure could be causing months of inflammation) and was mounting an immune reaction against gram negative bacteria (indicating small intestinal bacterial overgrowth). That was all from just one test!

This confirmed her gut was in big trouble and we needed to start her on a 5R program: Remove, Repair, Replace, Re-inoculate and Rebalance. Molly required a customized 3 month plan using dietary interventions (think a step above Paleo) and customized supplementation (led by our fabulous staff nutritionist). The amazing part is, within 30 days she was already feeling so much better!

The news about Molly’s condition only gets better, as you’ll read about in part 3 when we detail the in-office therapies she took advantage of.

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