everywomanover29

Food, Mood and Women's Health – Be your healthiest, look and feel great!

Main navigation

Migraines, Anxiety and Antiphospholipid Syndrome: on the Chronic Headache & Migraine Summit

By 38 Comments

The autoimmune condition called Antiphospholipid Syndrome (APS) is one of many possible contributing factors for both migraines and anxiety. I came across this condition when researching the links between migraine and anxiety in preparation for my interview with Erin Knight, one of the hosts of The Chronic Headache & Migraine Summit, starting July 10. This is one of the reasons I love presenting because I get to learn so much too!

Antiphospholipid syndrome occurs when your immune system attacks some of the normal proteins in your blood. It can cause blood clots in your arteries or veins. And it can cause pregnancy complications, such as miscarriage and stillbirth. (Source: Mayo Clinic)

I share some highlights from a 2015 paper: Antiphospholipid antibodies as biomarkers in psychiatry)

  • Antiphospholipid syndrome (APS) has been implicated in a range of neuropsychiatric presentations
  • The link between depression, stroke, and cardiovascular disease could be explained in at least some patients by the presence of aPL antibodies
  • Approximately one in five (20%) strokes in individuals under the age of 45 years are associated with APS
  • Migraine is one of the most commonly observed symptoms in patients with APS
  • aPL antibodies are often found to show low or moderately positive levels which makes this syndrome a diagnostic dilemma in psychiatry. The St. Thomas ‘alternative criteria’ for APS may be a useful clinical tool for psychiatrists. These criteria include cognitive impairment, affective disorders [like depression and anxiety], headaches [or migraines], and livedo reticularis, with improvement after aspirin treatment

In case you are not familiar with livedo reticularis, it is a mottled purplish discoloration of the skin. Having this skin condition does not mean you have APS because livedo reticularis can be a normal condition that is simply more obvious when you are exposed to the cold. It can also be an indicator of impaired circulation.

Phospholipids are a class of lipids that are a major component of all cell membranes and also facilitate neurotransmitters communication so this condition affects serotonin, dopamine, glutamate and GABA levels.

Working with my client’s doctor, I would recommend an autoimmune dietary approach and trials of the respective amino acids to support low serotonin, low GABA and low dopamine.

My interview also addresses the prevalence of anxiety with migraine sufferers.

We also cover how effective gluten removal can be for certain individuals. We always start with gluten removal for my clients with anxiety and migraines and find it to be a common underlying factor (whether it’s celiac disease or gluten sensitivity). Since gluten is always an important factor for autoimmunity it should always be explored if APS has been diagnosed or is suspected.  

We also cover low serotonin as one possible cause of migraines and the how to do a trail of tryptophan (instead of SSRIs). Erin shares her frightening SSRI experience too.  Using tryptophan also addresses the low serotonin that often occurs with APS and is one possible contributing cause of the anxiety, depression, insomnia and migraines.

The Chronic Headache & Migraine Summit will be online from July 10-17, 2017

Hosts of The Chronic Headache & Migraine Summit, Erin Knight, Corey Schuler and Marta Taylor, are familiar with headache pain and migraines; they’ve all experienced severe headache problems. They found functional medicine solutions, which they now share in their health practices each day. Discover in one week what they’ve spent years learning!

You can register for the summit here

Low-dose suramin in autism disables cell danger response: leads to speech, calm, focus and play

By 6 Comments

I’m fascinated and excited by this new research on cell danger response (CDR): Low-dose suramin in autism spectrum disorder: a small, phase I/II, randomized clinical trial abstract and the ramifications for autism as well as anxiety and other chronic health conditions. This recent study was double-blind, placebo-controlled and involved 10 boys, ages 5 to 14 years, all diagnosed with autism. Five of the 10 boys received a single, intravenous infusion of suramin and the other five boys received a placebo.

As reported in this Science Daily summary: Century-old drug as potential new approach to autism, the results seen in two of the autistic children after a single low dose of the 100 year old medication was profound:

The six-year-old and the 14-year-old who received suramin said the first sentences of their lives about one week after the single suramin infusion.

The most changed behaviors in all of the five boys who received the suramin were: 

social communication and play, speech and language, calm and focus, repetitive behaviors and coping skills.

One of the parents of a 14 year-old who had not spoken a complete sentence in 12 years said this:

We saw improvements in our son after suramin that we have never seen before.

Within an hour after the infusion, he started to make more eye contact with the doctor and nurses in the room. There was a new calmness at times, but also more emotion at other times. He started to show an interest in playing hide-and-seek with his 16-year-old brother. He started practicing making new sounds around the house. He started seeking out his dad more.

We have tried every new treatment out there for over 10 years. Nothing has come close to all the changes in language and social interaction and new interests that we saw after suramin. We saw our son advance almost three years in development in just six weeks.

I can’t even begin to imagine the joy these parents must have felt to see their children respond like this!

Unfortunately the therapeutic benefits of suramin was temporary and the benefits gradually faded after several weeks as the effects of the drug wore off.

Suramin is used for African sleeping sickness and river blindness, which are caused by parasites and does have some very serious side-effects when used at higher doses (in AIDS research in 1987 sixteen patients died while receiving suramin or within three weeks of discontinuation of drug therapy).

In this autism study the children received a single very low dose intravenous infusion which did cause a rash.

The authors do acknowledge that suramin isn’t the solution but rather a way to test the cell danger hypothesis as a “possible unifying theory” that contributes to the cause of autism (and other chronic conditions that don’t resolve).

So what does the cell danger response actually mean? It’s taken me a fair bit of reading to understand it so let me share this explanation from one of the earlier mouse studies done by lead researcher Robert K. Naviaux, MD, PhD:

When cells are exposed to danger in the form of a virus, infection, toxin, or even certain genetic mutations [or traumas], they react defensively, shutting down ordinary activities and erecting barriers against the [real or] perceived threat. One consequence is that communication between cells is reduced which …may interfere with brain development and function, leading to autism [and other chronic conditions]

Even when the danger is no longer there – the infection or toxin or trauma has been removed, the diet has been changed, the nutritional imbalances have been addressed, the inflammation has been reduced etc. – the cells stay in danger mode and are not able to communicate and do what they need to do.

By using suramin the cell danger response/CDR signal is blocked or disabled or switched off so the cells no longer see the perceived danger, allowing cells to restore normal communication and function, and symptoms are reversed.

A simple way to think of it is like this: like a bear, the cells are in hibernation because it’s winter and when summer comes around they stay in hibernation because they still think there is the danger of winter or the lack of food. This is the cell danger response and the cells are stuck. The suramin tells the cells it really is summer, there is plenty of salmon and berries and it’s safe to come out of hibernation.

This approach is called antipurinergic therapy or APT and research shows it has applications for a number of conditions. These are disorders corrected or improved by antipurinergic therapy:

(table from Metabolic features of the cell danger response)

I’m excited about the amazing results in these children and about the promise of what this holds. But I do still have so many questions about this research and look forward to learning more and sharing more with you as I do:

  • Why was suramin used and is there a safe drug that could achieve the same results?
  • Or rather, what natural herb and/or nutrient/s can achieve the same or similar results without the side-effects?
  • What is planned for future CDR research for children with autism and for other conditions? (I do know Dr. Naviaux is planning CFS research later this year)
  • What role does vitamin B6 and serotonin play in all this? (the cell danger response yields vitamin B6 deficiency)
  • Could there be applications for anxiety for you if you have tried ALL the nutritional/biochemical approaches and are still not seeing symptom resolution?
  • Could this mechanism help you if you’ve been harmed by benzodiazepines, SSRIs and/or fluoroquinolones and can’t take any supplements?
  • Could this mechanism help when you have a combination of many stresses like past trauma, genetic defects, heavy metals, mold and Lyme, as well as gut issues and nutritional imbalances?

Feel free to share insights and questions in the comment box below.

I suffer from severe anxiety, have social anxiety and am afraid of everything

By 10 Comments

For the first time I have come across your blogs about amino acids and anxiety. I’ve suffered from severe anxiety since 2011, and have tried the SSRIs and hate them. I refused to take them, as they caused me to gain so much weight and [have] withdrawals. I’ve also read how bad they are for you.

In order to work, I am relying heavily on 0.5mg of Clonazepam up to 3-4 times a day. It makes me so drowsy in the mornings. I try for the most part to make sure to get 7-8 hours of sleep because I can tell how when not having enough rest can trigger my anxiety. But I’m in desperate need of a solution. Not sure if the clonazepam is something I can continue to take long term, as I also know it’s bad for you.

I suffer from social anxiety (on a level 1-10, I would be 20!) and also some agoraphobia symptoms [an abnormal fear of being in crowds, public places, or open areas, sometimes accompanied by anxiety attacks.]. I am not able to go to stores alone, and I am afraid of everything.

I suffer at work the most, because I’m constantly busy and stressed and dealing with customers all day. Please help

The above question was recently posted on my blog and I’m sharing my response to her in case you are new to using the amino acids for neurotransmitter imbalances and may be able to relate to any of the above. This is my response to her:

Welcome to the community! I use the amino acids with clients and do a trial to find out if they are needed and how much to use. This blog post Anxiety and the amino acids: an overview has links to the amino acid questionnaire, the precautions and how to do a trial. When someone has fear and phobias I immediately think we need to be looking at low serotonin and a trial of tryptophan. It’s not uncommon to also see low GABA and blood sugar imbalances being an issue too.

Once you address low GABA, low serotonin and low blood sugar I would expect the work stresses to feel less overwhelming. In an ideal world it would be wonderful to be able to remove this stress so I encourage you to consider this too.

For social anxiety I start with the pyroluria questionnaire. The great aspect of this is the nutrients for pyroluria – zinc, vitamin B6 and evening primrose oil – help the social anxiety and help to make the neurotransmitters. They also happen to help with PMS and other hormonal imbalances too.

Keep in mind it’s a comprehensive nutritional approach that I use with clients so we are also looking at diet, blood sugar control, the gut, adrenals and thyroid health, quitting sugar and caffeine and so much more. My book The Antianxiety Food Solution (on Amazon here) covers everything in detail, including the amino acids and pyroluria.

I’m sure you’re aware that Clonazepam (or Klonopin) is a benzodiazepine and should be prescribed a maximum of 2 weeks and even then they can be problematic. It may likely be contributing to your anxiety. Here is one blog post to get you started with some information about benzodiazepines: World Benzodiazepine Awareness Day – say NO to Benzodiazepines for anxiety! It covers tolerance issues and resources for tapering. I encourage you to search the blog to find plenty of additional information about the benzodiazepines.

Be very careful with the morning drowsiness as there is an increased risk of being involved in a road accident as driver when on a benzodiazepine prescription.

I speak on selected online summits that I know will be of value to my community so do keep reading the newsletter. The summits are a great way to start learning about my work and other nutritional and functional medicine approaches for anxiety and other chronic health conditions so be sure to sign up and tune in. There is also a wealth of information on this blog.

New testing approach for Lyme disease: ultrasound and PCR urine testing

By 2 Comments

Dr. Dietrich Klinghardt’s interview with Dr Jay Davidson, host The Chronic Lyme Disease Summit 2 is one of the most interesting and encouraging Lyme disease interviews I’ve heard for a long time! He covers the Latest on Lyme Testing and Treatments. The reason it’s so encouraging is that chronic Lyme disease is notoriously difficult to test for.

Dr. Klinghardt starts by sharing why Lyme disease goes undiagnosed in many instances:

Lyme is highly compartmentalized. That means it sets up sanctuaries in different body compartments, and chronic Lyme is not living in the blood. Lyme may be in the blood in acute Lyme but not in chronic Lyme.

In chronic Lyme it may be in the right hippocampus but not in the entire brain, maybe in the brain stem but not the liver. It may be in your disk of L4-L5 but not in other disks and so on and so forth.

It lives in biofilm. We know that. It lives in the cell, but it doesn’t stray.

He goes on to share that the common immune system-based Lyme disease tests that use blood testing are misleading because with chronic Lyme

the blood or the white blood cells are not in contact with the actual microbes and you do not get the immune activation…So many cases go undiagnosed.

Dr. Klinghardt shares a wonderful technique that he and one of the world’s most renowned ultrasound radiologists, Dr. Marco Ruggiero, have developed for both testing and to improve treatment:

We know that when you put ultrasound …on a group of cells, it squeezes and relaxes the cells at a very high speed and squeezes out things from the cell that shouldn’t be in there. And so, we had the theory if you apply ultrasound to an area where we suspect Lyme spirochetes or Bartonella or Babesia or Ehrlichia, then those microbes are forced into the connective tissue. And some of them will stray from there into the blood, and some of them will be excreted through the kidneys into the urine.

With that principle, we found an incredible increase in our findings that most of the people that were suspected of having chronic Lyme disease didn’t just have Borrelia burgdorferi, but they had also Borrelia miyamotoi. They had Babesia duncani, Babesia microti. They had Bartonella henselae.

So what we do, we have set up a certain sequence of using ultrasound on the brain, on the thymus, on the spleen, on the vagus nerve, and on the brain stem. We drive out the microbes, and then we collect the urine and find the microbes. This is by far the best test we use – the PCR testing – looking for whole strands of DNA of the bugs in the urine.

That testing has been the most rewarding test in my whole lifetime. We are publishing a paper that comes out later this month in the American Journal of Immunology where we lay out the details of this technique. That’s what we do at the Sophia Health Institute.

The whole treatment takes less than 10 minutes, and then it’s the first urine that naturally occurs after that that’s collected. And then we send it to the lab for PCR testing, and insurance pays if you do it with Lab Corp. There’s other labs that offer this test now. And it can cost up to $500 to test for 14 of the coinfections.

Here is the title of that paper: The Ruggiero-Klinghardt (RK) Protocol for the Diagnosis and Treatment of Chronic Conditions with Particular Focus on Lyme Disease and the lab DNA Connexions is mentioned in this paper. 

He goes on to explain how they also use the therapeutic ultrasound as an instrument to optimize drug uptake and utilization in specific areas of the body order to eliminate the bacteria.

Later on in the interview Dr. Klinghardt makes this bold and rather concerning statement:

Most of my patients with severe, persistent Lyme disease have never had a tick bite. They had a spider bite or a flea bite or a bite from a stinging fly. So these are insect-borne diseases but not tick-borne diseases.

Dr. Klinghardt has been at the forefront of Lyme disease treatment for years and now bringing even further wisdom to this very challenging condition. I really look forward to learning more about all this from this amazing practitioner.

The Chronic Lyme Disease Summit 2 runs June 19-26, 2017 and Dr. Klinghardt’s interview airs on day 2 of the summit.

Be sure to also listen to:

  • Leslie Douglas: DNA Connexions PCR Assay (the testing Dr. Klinghardt uses) and
  • Jonathan Streit: Testing for Functional Neurological Issues

This summit will help you understand symptoms (common and rare), diagnosis and testing, practical at-home health tips, healing protocol explanations and more!

And it will hopefully give you some insights to any ongoing health issues you may have that may actually be due to Lyme disease (even if you have not yet been diagnosed). It’s something I consider with all my clients that are not seeing symptom resolution.

Register here for The Chronic Lyme Disease Summit 2

Last year I was interviewed on Lyme anxiety and how to use GABA and other amino acids to ease the anxiety while you are working on addressing the Lyme disease. I’m not speaking this year but that interview and some of my other Lyme anxiety resources are available to summit purchasers. I actually mention Dr Klinghardt in that interview because he finds that his Lyme patients don’t get well until they have addressed pyroluria.

If you live in Sydney, Australia, you can hear Dr. Kinghardt present live this weekend during his 1 day event: Core Protocols for Chronic Illness. If you’re not a practitioner be sure to let your healthcare provider know about this event.

Feel free to post questions or feedback below.

Anxiety in autism, ADHD and sensory processing disorders

By 8 Comments

I had the pleasure of being interviewed by Tara Hunkin on the upcoming Autism, ADHD and Sensory Processing Disorder Summit and share my expertise on anxiety since we so often see anxiety in this population. My topic is: Anxiety’s Role in ASD, ADHD and SPD and how nutrient therapy can help.

I start out sharing some of the research on the incidence and connections.

This 2009 paper Sensory Overresponsivity and Anxiety in Children With ADHD in the American Journal of Occupational Therapy, reports that:

Approximately 25% of children with attention deficit hyperactivity disorder (ADHD) have a comorbid anxiety disorder.

The purpose of this particular study was to determine whether sensory overresponsivity (SOR) or sensory processing disorders are related to increased anxiety in children with ADHD. There were twenty-four children between the age of 6 to 10 with ADHD and 24 children without ADHD.

The study concluded that:

Children in the ADHD + SOR [sensory over responsivity] group were significantly more anxious than both the ADHD-only and non-ADHD (control) groups.

Occupational therapists treating children with ADHD and SOR should be aware that these children may also have anxiety and discuss options with families for prevention or treatment.

I would add that anyone working with these children should be aware of the connections: doctors, nutritionists, psychologists and anyone else on the health team.

We also discuss this 2012 paper, also from the American Journal of Occupational Therapy – Sensory Overresponsivity and Anxiety in Typically Developing Children and Children With Autism and Attention Deficit Hyperactivity Disorder: Cause or Coexistence?

Reviews of the coexistence of ASD [autism spectrum disorder] and anxiety disorders have concluded that among children and youth with ASD, anxiety disorders are highly prevalent, clinically significant, and varied as to specific type of anxiety disorder

Approximately 25% of children with attention deficit hyperactivity disorder (ADHD) also have anxiety disorder, a rate that is elevated when ADHD is seen in conjunction with conduct or oppositional defiant disorders

The paper mentions these 3 factors as models worthy of further study in order to understand the relationship between anxiety, sensory overresponsivity, autism and ADHD:

(1) anxiety caused by, or a symptom of, SOR (primary anxiety model);
(2) SOR caused by, or a symptom of, anxiety (primary SOR model); and
(3) the presence of both anxiety and SOR, linked by way of another factor

Based on what I know about anxiety I feel it could be a combination of all of the above.

My interview also covers the following around how to address the anxiety in these children and their moms (who also often have anxiety):

  • Low serotonin anxiety, symptoms, using tryptophan and 5-HTP and precautions with using them with an SSRI
  • A young girl with RAD (reactive attachment disorder) with rage/anger, anxiety, insomnia, and sugar cravings and the successful use of chewable tryptophan, addressing low iron and a gluten-free diet
  • A young boy with OCD and the successful use of both tryptophan and inositol
  • Low GABA anxiety, the use of GABA and not phenibut, and cautions about using too much
  • A young girl with ADHD and irritability and the successful use of GABA
  • Pyroluria incidence and symptoms and how it ties back to neurotransmitter imbalances

Sensory processing disorders, ADHD and autism are not my expertise and I don’t work much with children so I’m really pleased to be bringing you this information via the other amazing speakers AND listening and learning myself!

Here are some speakers and topics I’m particularly interested in

  • Brandon Brock, RN, DC: Understanding PANS and PANDAS role in ASD, ADHD and SPD.
  • Elizabeth Mumper, MD: Mitochondrial Dysfunction: What it is and how to address the underlying causes.
  • Richard Frye, MD, Ph.D.: Cerebral Folate Deficiency: and how it impairs neurological health.
  • Nancy O’Hara, MD: What you need to know about cell danger response in ASD & other neurodevelopmental disorders.
  • John Tjenos, NTP: The importance of the vagus nerve and how to build vagal tone with essential oils.

We have so much to learn from practitioners and researchers working in this area. And children affected by these conditions do recover!

The Autism, ADHD and Sensory Processing Disorder Summit, hosted by Tara Hunkin, NTP, runs from June 19-28, 2017.

It will be 10 days of eye opening information into the root causes of your child’s neurological dysfunction. Imagine learning about what may have caused their symptoms and how to address them with nutrition and biomedical approaches and leverage the power of positive neuroplasticity to improve function, health and their lives.

Do also keep in mind that these topics may have relevance for you even if you don’t have a child with a sensory processing disorder, ADHD and/or autism. These children are the canaries in the coal mine and many of my clients with anxiety can benefit from the biomedical support that many of these speakers are addressing. Simply replace sensory processing disorder, ADHD and/or autism with anxiety and listen and learn.

You can register for The Autism, ADHD and Sensory Processing Disorder Summit here

Feel free to ask questions or provide feedback and your experiences in the comment section below.

Anxiety is a common symptom of IBS/SIBO: breath and antibody testing at MINDD 2017

By 7 Comments

I attended Dr. Nirala Jacobi’s presentation on at MINDD 2017 practitioner training and here are some highlights from her presentation on SIBO (small intestine bacterial overgrowth) which is the leading cause of IBS and a major cause of leaky gut syndrome. It is the presence of an overgrowth of beneficial bacteria in the small intestine i.e. good bacteria in the wrong place.

She shares that:

Bacterial overgrowth has also been implicated in a host of other conditions such as developmental delay, fibromyalgia, interstitial cystitis, malabsorption syndromes and many more [such as anxiety and depression and even insomnia]. SIBO requires a methodical approach to testing and treatment in order to successfully re-establish a healthy digestive tract.

And some of the typical symptoms SIBO patients experience:

I was not familiar with all these prior surgical procedures being a possible cause but this makes sense. I’ve added gastric bypass, appendix removal, endometrial surgeries, C-section and gallbladder removal (cholecystectomy) to my SIBO questionnaire.

Other possible causes include certain medications, stress and anxiety (which affects how much HCl or stomach acid you produce and gut motility) and overconsumption of simple carbohydrates.

Going back to the #1 possible cause i.e. post-infectious due to a stomach bug, the gastroenteritis and autoimmunity connection was presented. Bacteria which cause food poisoning produce a toxin called CdtB which is similar to human vinculin which is important for nerve function.

Due to the similarity between CdtB and vinculin, the body produces anti-vinculin and anti- CdtB antibodies which lead to an auto-immune attack on the enteric nervous system. This causes damage to the MMC/migrating motor complex and contributes to SIBO.

A press release from Cedars-Sinai and Dr. Pimental: Definitive Tests for Irritable Bowel Syndrome Developed at Cedars-Sinai announce the multicenter study validating the accuracy of the new blood tests:

Dr. Pimentel and fellow researchers studied nearly 3,000 people, comparing IBS patients to those diagnosed with inflammatory bowel disease, celiac disease and those with no GI disease. The blood tests identified the two antibodies associated with IBS – anti-Cdtb and anti-vinculin – with greater than 90 percent certainty.

The tests are marketed under the name IBSchek™ and are produced by Commonwealth Laboratories Inc., in Salem, Massachusetts.

This paper reports this autoimmunity connection: Autoimmunity Links Vinculin to the Pathophysiology of Chronic Functional Bowel Changes Following Campylobacter jejuni Infection in a Rat Model and this paper discusses the two tests: Development and Validation of a Biomarker for Diarrhea-Predominant Irritable Bowel Syndrome in Human Subjects

These blood tests are available in the USA but are not yet available in Australia where Dr. Nirala Jacobi now lives and practices.

Dr. Nirala Jacobi, BHSc, ND (USA) graduated from Bastyr University in 1998 with a doctorate in naturopathic medicine. She practiced as a primary care physician in Montana for 7 years before arriving in Australia. Nirala is considered one of Australia’s leading experts in the natural treatment of small intestine bacterial overgrowth (SIBO), a common cause of IBS. In 2014, she designed the SIBO Bi-Phasic Diet to aid practitioners in simplifying their treatment approach with their SIBO patients. She is the Chief Medical Officer and Director of SIBOtest.com, an online breath testing service and educational portal for practitioners. She frequently lectures to national and international professional audiences on the topic of SIBO and founded the first Australian SIBO Summit in 2016 Nirala has had a busy private practice in Brisbane since 2008 and recently moved her clinic to Wilsons Creek in the beautiful northern rivers region of NSW, Australia.

For SIBO breath testing services in all countries check out the testing page on Dr. Siebecker’s SIBOinfo site

Keep in mind that most SIBO studies are on IBS. According to Dr. Siebecker

Drs. Pimentel and Lin originated the theory that SIBO is the underlying cause of IBS.  As with all theories, there is debate and controversy about this idea, with many who agree and many who do not.  One thing is certainly clear, the symptoms of SIBO overlap with those of IBS and a large percentage of IBS sufferers test positive for SIBO.  One study by Dr Pimentel and team, showed SIBO in up to 84% of IBS patients, though the percentage has been lower in other studies, with an average of 60%.

Here is the most recent study showing the mental health effects of IBS (which we could presumably extrapolate to SIBO and confirm with the testing discussed above) – Neuroendocrine Dysregulation in Irritable Bowel Syndrome Patients: A Pilot Study

Irritable bowel syndrome (IBS) is a multifactorial disorder, involving dysregulation of brain-gut axis

Prevalent psychological symptoms in IBS were maladjustment (60%), trait (40%) and state (17%) anxiety, obsessive compulsive-disorders (23%), and depressive symptoms (23%).

If you are not getting anxiety symptom resolution with dietary changes, the use of targeted individual amino acid, adrenal support, addressing dysbiosis and other biochemical approaches it’s time to work with a practitioner to rule out or address SIBO as a causal factor.