After an extensive review of your symptom survey and comments, Eoghan, I can now help you find solutions to some of your health concerns that are very specific to your individual needs. Your concerns about energy, mood changes, sleep, weight gain, digestion, and headaches in particular appear to be a top priority, and will be addressed accordingly throughout this report. In some instances, diagnostic testing or treatment recommendations beyond the scope of this service will be suggested, in which case you will need to seek additional medical care.
It's important to keep in mind as you read through this report that our goal is not just to try and palliate your symptoms, but to help you reach an optimal state of health on all levels. One of the biggest examples of this would be recommending that you make time for activities that support your mental and emotional health. This could be anything from yoga or tai chi, to just listening to music or reading a book for pleasure. Ultimately, this cannot be overlooked, as it is crucial for maintaining a positive mood, and making you less susceptible to the depression and anxiety you've been suffering from for so long.
"I get headaches that I can generally relieve by pressing the area at the back of my skull where the muscles attach" - This is a strong indication that the headaches you've been experiencing are related to trigger points, or hypersensitive spots in skeletal muscle that can cause referral pain, into the head in your case. Trigger points can be caused by a number of different factors, including poor posture, direct trauma, prolonged stress, and overuse of a specific muscle group. Fortunately, these trigger points can often be treated successfully with the right combination of therapies. Some treatment suggestions that are recommended in your case include the following: The mineral magnesium, at a dosage of 500 mg per day, for it's muscle-relaxant effects-regular epsom salt baths are also recommended for this purpose; The nutrient CoQ10, at a dosage of 200 mg per day, to improve oxygen delivery to the muscles, helping to break the cycle of muscle spasm; Acupuncture, which I've often found to be effective clinically for this purpose; Finding a practitioner who has experience with Muscle Energy Technique (MET), ischemic compression, Facilitated Positional Release (FPR), and other advanced soft tissue techniques is also recommended, as these therapies will "reeducate" your muscles, so as to prevent the development of trigger points in the future.
According to the height (5'10.0", 178cm) and weight (163lb, 74kg) figures that you entered, your Body Mass Index (BMI) is 23.4. This indicates that you are ideal weight.
Without question, diet is one of the most critical factors when it comes to achieving and maintaining an optimal state of health. Although dietary changes that are specific to your individual needs are going to be made throughout this report, the quality of foods you choose also needs to be emphasized. Whenever possible, try to choose produce that is organic, or at least locally grown, as these foods are less likely to contain chemicals that will have a negative impact on your health. If you are unable to adopt a vegetarian diet, try to choose meats that are organic and low in saturated fats, which will lower your heart disease risk and limit your exposure to foreign chemicals, among other benefits. Striving to make these dietary habits part of your daily routine can ultimately be rewarding not only health wise, but as a result of the environmental impact it can have as well.
"I have a big apple belly, and always have too much weight around my waist" - This is often a sign of insulin resistance, or Metabolic Syndrome, which can cause "apple-shaped" obesity (waist size >40" in men) and increased cardiovascular disease risk. Insulin resistance may also be partially responsible for your mood changes and low libido, as it can cause several other hormone changes in the body that may contribute to these symptoms (for a more detailed description of this condition, visit www.mayoclinic.com/health/metabolic%20syndrome/DS00522). Reversing insulin resistance should be a top priority, as it is central to many of the symptoms you've been experiencing. Some treatments I would recommend for this purpose include the following: The herbs gymnema and bitter melon, which are especially helpful for alleviating carbohydrate cravings; The mineral chromium, at a dosage of 500 mcg per day; A fiber supplement, such as psyllium, which helps to control the absorption of sugars and the release of insulin; A whey protein supplement, preferably taken in the morning, which helps to raise your metabolic set point and diminish carbohydrate cravings: A dysglycemia diet, which is really the most crucial step for getting this problem under control-more detail about this diet can be found at the www.functionalmedicine.org web site.
Although the soft drinks you are consuming are mostly diet, it is still recommended that you discontinue this habit, instead drinking 8-10 8 oz glasses of purified water daily. Even though artificial sweeteners contain little to no calories, there is still speculation that they may mimic sugar in the body, which would further perpetuate your insulin resistance. In fact, it has been speculated that aspartame and other artificial sweeteners may even cause weight gain, in addition to a host of other health problems. Therefore, avoiding or limiting the intake of ALL artificial sweeteners is essential in your case.
It goes without saying that exercise is an instrumental component in the treatment of Metabolic Syndrome. As much as the dietary and supplemental interventions can help, they will be nearly twice as effective with the addition of aerobic exercise. Therefore, make it a top priority to incorporate exercise into your daily routine.
You mentioned digestive bloating and gas as being your most concerning digestive symptoms. There are several underlying conditions that could potentially cause these symptoms, which may require more specific diagnostic to rule out. Some issues that need to be taken into consideration include the following: Gluten intolerance (also known as Celiac disease in it's most extreme form), which can be evaluated by having your anti-gliadin, anti-ttg, and anti-endomysial antibody levels tested; Lactose intolerance; H.pylori, a bacteria that affects the stomach, causing gas and bloating, and even leading to the development of peptic ulcers; Parasites or related bowel infections, which often go undetected due to the non-specific nature of the symptoms they may cause.
While these are some of the more common medical conditions that could potentially cause your digestive symptoms, Eoghan, it's more likely that the underlying cause of your digestive symptoms is more of a functional nature. This could be anything from poor hydrochloric acid production in the stomach, to an imbalance of beneficial bacteria within the intestinal tract. Some "alternative" laboratories (such as Genova Diagnostics and Doctors Data www.doctorsdata.com) offer tests that can measure some of these functional changes, identifying the exact cause of your symptoms in many cases. However, until more specific testing can be done, the following treatments are recommended for enhancing your digestive function, and hopefully alleviating the gas and bloating you've been experiencing: Eliminating some of the more common food allergens, such as gluten, dairy, soy, eggs, peanuts, corn, citrus, and nightshade vegetables for 10 days, followed by a systematic reintroduction of these foods; A probiotic supplement, such as acidophilus and/or bifidobacter, to replace beneficial bacteria within the intestinal tract, making you less susceptible to the overgrowth of pathogenic microorganisms that may be contributing to your symptoms; 2 tsp of apple cider vinegar, taken before meals, which stimulates the digestive cascade, allowing you to breakdown and assimilate foods more effectively; Activated charcoal capsules can be taken as needed when your gas and bloating are more pronounced; The actual approach you take to eating, such as being in a relaxed setting and taking time to eat and digest your food, can also go a long way in the treatment of your symptoms.
A complete blood count (CBC) is being recommended to rule out anemia or any underlying infectious or cancer related causes of your fatigue. Your doctor will be familiar with this test, and should be able to order it for you upon request.
You mentioned having "very little hair" at the outer third of your eyebrows, compared to the inner two thirds. This sign, along with your weight gain, fatigue, cold intolerance, and depressed mood, are all indicative of hypothyroidism. Therefore, I would recommend that you have your TSH, free T3, free T4, and thyroid antibody levels tested, as this will give you a more comprehensive assessment of thyroid function than only looking at TSH, which is what most doctors will typically do. In the meantime, the following treatments should help to enhance your thyroid function: Kelp, which is a form of seaweed used specifically for this purpose; The mineral selenium, at a dosage of 200 mcg per day, to facilitate the conversion of T4 to T3, the more active thyroid hormone in the body; The amino acid L-tyrosine, in combination with folic acid, which act as precursors in the production of thyroid hormone.
You could benefit from adrenal hormone support, which is especially beneficial for helping you adapt to stress, and making you less susceptible to the physical and mental symptoms that result from excess stress, including depression and insomnia. Addressing this problem should ultimately help to enhance your energy level as well. For this, I would recommend the following: The herbs ashwagandha and licorice root, preferably taken in the morning and early afternoon; The herb rhodiola, especially useful for treating fatigue and an "overactive" stress response; A vitamin B-complex supplement, particularly vitamin B5, or pantothenic acid; The nutrient L-theanine, which is also found naturally in green tea; The nutrient 5-HTP, at a dosage of 200 mg per day (preferably before bed, as it will help to induce sleep); Supplementation with the hormone DHEA may be indicated, but only if your levels test on the low end of normal.
The nutrients niacinamide and L-glycine are often used successfully for treating acute anxiety and insomnia, and should be used on an as needed basis, as opposed to the treatments mentioned in the last paragraph, which are meant to be used more long-term.
As your depressed mood is typically more pronounced in the wintertime, I would suggest some treatments that are usually prescribed specifically for this purpose: Vitamin D, at a dosage of 800 IU/day (only during the winter months); The amino acid L-tryptophan, at a dosage of 2,000 mg per day (which should help to improve your sleep as well); Melatonin, at a dosage of 5 mg per day; The herb St. John's Wort, at a dosage of 1,500 mg per day. For a summary of some of the research demonstrating the efficacy of these treatments, visit www.emersonecologics.com/Newswire.asp?id=266
An overwhelming amount of research that has come out in the past few years demonstrates the effectiveness of omega 3 essential fatty acids, particularly EPA and DHA, in the treatment of depression and other mood disorders (J Clin Psychiatry. 2006 Dec;67(12):1954-67.) These essential fats are usually best obtained through the use of a fish oil supplement, preferably made by a brand that screens for heavy metals, PCBs, and other environmental toxins. In addition to mood support, these omega 3s help to protect you from cardiovascular disease as well, which is another reason to be supplementing with them on a daily basis.
Although it wasn't one of your chief complaints, you still expressed some concern about allergic rhinitis, and wanting to work towards getting off of your allergy medications. To help you reach this goal, the following treatments are recommended: The nutrients quercetin and hesperidin, for their natural anti-histamine and anti-inflammatory properties; Daily use of a Neti pot, which is a device used to irrigate the nasal passageways, preventing offending allergens from coming into contact; The nutrient N-acetyl-cysteine, especially effective in the treatment of post-nasal drip; A mixed bioflavonoid supplement, which usually contains such nutrients as rutin and rose hips.
While I tried to highlight all of your concerns, Eoghan, you may still have further questions, or may have acquired lab results or other evidence that is pertinent to your case. Please don't hesitate to contact me if this is true, especially if you think it will make a difference in my interpretation.
In the meantime, I hope you are satisfied with my findings, and sincerely hope that your health will improve as a result of this report.
Wishing you the best of health,
Dr. Matthew Fisel |