Going back to the endo! What tests to ask for?

[BillytK03]

I have asked a few questions on here before (Hard as Nails has been so kind to give me some advice) but I still have found no answers or solutions to my fatigue and depression. So I am going back to endo for more testing......

I have been dealing with fatigue, mild depression and constant stress for about 3 years now. I have had my Blood work tested 3 times in the past TSH> 1st- 2.18, 2nd- 2.28, 3rd- 2.36 Testosterone 1st- 285, 2nd- 365, 3rd- 350 (ref=255-285) LH 1st- 2.3 2nd- 1.9 3rd- 2.5 (ref=1.5-9.3) HDL cholesterol 1st- 71, 2nd- 67, 3rd- 68 (ref=40-59)

A little on my history..... I am 6'1" 188lbs, 6.1% body fat........ always eat very clean, high protien, low carbs, very low fat intake..... also very hight intensity workout regimine (3 on/ 1 off).... I have used ephedra/caffiene for the past 4 years only 1x a day and only on workout days...... I have however stopped using all stimulants as of 3 weeks ago, no more ephedra, caffiene, etc.....

Now for the past 6 months I have extreme fatigue, more depressed feelings and still no answers for my problems..... I have all the symtpons of hypo-thyroid... fatigue, depression, rapid thinning hair all over my head (sides, top, back, sideburns just like female pattern baldness but no recession and no balding).....

I started taking Armour thyroid on my own (not prescribed by doctor) and I feel a little bit better but not that much better. Could I have induced a thyroid problem or even T4/T3 conversion problem resulting from the strict diet coupled with the extreme stress and intense work out regimine I have endured the past 4 years? I have all the classic signs of hypo, maybe even an EFA deficiency.....

What tests should I ask for at the endo? Free T3, Free T4, EFA analysis, Zinc/ Copper analysis...... any more ideas? anyone?

 

[hardasnails1973]

i hope your endo is open minded. Watch self medicating with armour thyroid because if you adrenals are weak it could make your hypothyroid symptoms worse. I learned the hard way. Cortisol is a tricky thing when you think it is high it can suprise you and be low. Might want to try to add 1/2 tsp unrefined sea salts in the morning in 8 oz of water and see how you feel. Then again in mid afternoon maybe 1/4 tsp. You have a very complete supplement regiment. Did you back down on that magnesium? 2400 mgs a day is alot it could affect other minerals so again balance in the key. Too much magnesum could POSSIBLY offset your potassium levels over a prolong peroid of time.

If you already do not have may be add
200 mgs same before breakfast and mid afternoon
500 mgs TMG 1/2 hour before each breakfast lunch dinner
300 mgs rhoidola rocea 1-2 times a day (this really calms you down)
200 mgs theanine morning and may be late night
5,000 mgs methylcobalin sublingual once a day
300 mgs pantheine breakfast and dinner - help with adrenals

GEt as much sun as you can it will help with serotonin metabolism, liver detoxifcaiton, melatonin synthesis


practice stress reduction and lifestly changes - you dumped the girl friend and so did I. Now you could just be experieincing the after effects of the prolong stress and its just going to take time to rebalance system. You may want to ask endo for gluclose tolerance test to check for hidden hypoglycemia and insulin dyregulation. These can play havoc with your adrenals

If you have blue cross and blue shield personal choice.
i had amino acid, organic acid test all covered by insurance by great plains a chiro or nutirtionist, or dr can order them for you we used diagnostic codes as chronic fatique, but you need to stop all supplements 3-4 days a head to get a true reading.
Great smokies can run cortisol salvia and also the EFA analyisis which can also be covered by insurance, With anything make sure you call and verify that your insurance covers these other wise if you got the money prices are really reduced if you pay by cash, but why pay when you do not have too.

Before getting mineral analysis by blood STOPP ALL SUPPLEMENTS for 3 days other wise it will give you a false reading....

i found this to be a very informative thread
http://forum.mesomorphosis.com/mens-health-forum/adrenal-thread-134240195.html

 

[BillytK03]

HAN,

I do have BsBc (ppo) as my insurance! The physician I see i very open minded and I assume she will order any test I ask her to! If I order the EFA analysis, Glucose, amino acid test, etc... etc.... will she know where to send them or do I need to do the leg work prior? will labs like Grest Smokie take BcBs? The doc sent my tests to Lab Corp last time.... thanks

 

[Trouble]

My guess is you have intestinal issues related to your stress and probably sleep habits.

Preliminary guess (since you gave us sparinly little facts): gastric reflux disease, chronic metabolic shortages of many coenzymes and cofactors, quite a few of them necessary for fatty acid and amino acid metabolism (biosynthesis). In other words, malnutrition and possible dysbiosis started. There are breath tests that the Great Smokey Lab do as well to check for this. Have them check for H.pylori.

Ask your doc to have a meta-analysis of pathway function done using The Anylst. HAN knows how to order it, he had it done.

Then, you have a series of lifestyle changes you have to make. Your idea of a clean diet and what constitutes a healthy diet for gut and liver health may not be the same thing. You will need to alter daily habits and routine to reduce stress and improve general condition. Your doctor may have some ideas.

Have your homocysteine measured. Also have the doc check for over signs of undermethylation and histamine and glutamine hypersensitivity.

Oh, you need selenium. 200 mcg, methionate form. Once per day, with meals when you take vit E. May need to take molydenum 100 mcg, chelate form, once per day with meals, not with selenium. Do NOT take selenium with vitamin C. Take vit C at another time of the day.

DO NOT take selenium if you have NUT allergies!!

 

[hardasnails1973]

Yes great smokies take BCBS might even look at liver detoxification panel this should were alot of my problem was and where exactyl I was blocked. You may want to add super digestice enzyme by now with each meal as a safe guard to make sure you are properly digesting your food. If you food is not digested right protein putrifies, carbs ferment and fats go rancid and will clogg up your liver pathways which will not show on any blood test resul. This will create unwanted phyiscal stress triggering excessive cortisol to deal over time your cortisol will drop, but it is the doctor you are working with to determine the proper diagnosis because whats in the serum is not reflective at cell level. That thread i listed here explains how serum cortisol levels are skewed and men should be in the upper 20's to lower 30 range for first am cortisol. i have a flat out coritsol deficeinct which is now reflecting as severe hypoglycemia, but it was hidden untill the glucose tolerance test. I am using stress reducing and adaptens to help regulate it, but cortisol may need to be used for the severity of my case. Let your dr do the testing and then she can determine proper treatment. Per troubles suggestion if you are taking glutemine you may want to seize for a while. IF you have amino acid test come back and your glutemine/glutamate is low then that will answer that question. I was taking zinc for longest time but with my thyroid being screwed up and low adrenals, high stress levels it was not absorbing it. The core cause is stress and you have to do what you can do to reduce it. IF that means stop working out for a week or too do it. From past conversations you tend to be highly addicited to the gym and this is common with people that are undermethylated with serotonon and adrenaline imbalances. Also remember not only can you over train a muscle group, but also your nervous system. As with muscle recovery it needs nutrients and rest to recovery the same applies with your nervous system. I had to avoid bodybuilding for a while so I got involved with Lodge and now i goto meetings every tuesday nights and saturday volunteer to do community service. Your muscle had memory it will return. By keeping your body fat so low for so long you are adding extra stress from the dieting and lifestyle to keep it there. Take a step back and just take a look at things and reassess your life. Some times we get so wraped up in things that forget the finer things in life that over look.

 

[BillytK03]

Ok in a nutshell I need to have the following done:

meta-analysis of pathway function done using The Anylst

amino acid test

glucose tolerance test

homocysteine measured

H.pylori

check for over signs of undermethylation and histamine and glutamine hypersensitivity

cortisol

zinc/copper

anything else? and how do I/Dr. order from Great Smokey Lab? Is this a lab that is allowable for the DR. to order from in relation to my BCBS insurance?

Trouble- is there any other facts/symptons that I should list that would help to give a clearer picture of my situation.

Oh yeah, I had my ferritin level checked and it was 104 (ref= 22-322)

Also, I dont have any problem gaining weight! I just have major energy issues (fatigue, I can get a solid 8 hrs of sleep and still feel tired like a need another nap), depression, rapid hair loss/ thinning but no balding or recession ( i read that this a sign of hypo)

 

[hardasnails1973]

When they check your thyroid check for antibodies as well. According to your testosterone it is way out of range. Is this correct? because excessive testosterone could cause your hair to then as well as elevated DHT levels.
You could have elevated testosterone but if only a small percentage of that is free where is the other going. I wish i knew of all this 2 years ago so you can get it all done at once so your practicioiner can get a better all the data at once and come up with proper treatment protocol. These tests will help dr to examine HPA axis/liver/ gut issues and the overall picture instead of bits and pieces.

Organic acids test from metametrix or great plains labs this check to see which one is covered by insurance they are both reputable labs.

The organic acid test/amino acids/EFA analysis were the icing on my cake and just brought out all the hidden imbalances of other tests. Stress from not being able to utlize fats clogged up my liver and also causes adrenals and thyroid to work twice as hard untill they both gave out

 

[hardasnails1973]

TRouble how true is this about serotonin and thyroid connection?

Thyroid function and serotonin activity are highly linked. Both need to be addressed to optimize function.

T3 (the active thyroid hormone created from T4 in the liver by the 2D6 enzyme) desensitizes presynaptic serotonin autoreceptors - thus leading to an increase in serotonin production. Giving T3 induces serotonin production. Similarly, in hypothyroidism, serotonin production is reduced. T3 augments the effects of serotonin-increasing medications (such as the SSRIs) by the additive effect both have on desensitizing presynaptic serotonin autoreceptors.

Serotonin stimulates hypothalamic TRH production, leading to an increase in TSH production from the pituitary. Adequate serotonin production is necessary to maintain thyroid hormone levels. Increasing serotonin levels with an SSRI may thus help improve thyroid hormone production.

A caveat: Theoretically, an excess serotonin may lead to the opposite reaction. For example, excess serotonin leads to reduction in dopamine production, which then leads to increased norepinephrine production, leading to an increased stress response and cortisol production.

High levels of cortisol (which can also be caused by high stress levels, low testosterone, etc.) can directly lead to suppression of pituitary TSH secretion, and impair conversion of T4 to T3, and can impair serotonin function (by reducing serotonin receptor density, increasing serotonin uptake via increase in serotonin transporter production, and by increasing tryptophane oxygenase production in the liver - thus reducing tryptophan, the precursor to serotonin).

It may be thus important to have an idea of serotonin levels (unless one has a good clinical feel as to a patient's clinical response to assess serotonin levels - as a psychiatrist may have) by measuring urine serotonin levels. This, somewhat, correlates with brain serotonin levels, though I am still assessing this for clinical utility."

 

[Trouble]

Lets start with a simple point. If you haven't read Fufus recent post on his progress with sleep hygiene improvements, you might want to review it.

What time do you do to bed and what time do you rise at in the morning, Billy?

 

[BillytK03]

Trouble,

my sleep is all out of whack! I do an extreme amount of traveling with my job! So basically (I mean this literally) I wake up and start my day in different time zones constantly/daily......... Sometimes I may get 6 hrs sleep, sometimes 4 hrs sleep, its very hectic! Last night for example, I went to bed at 11pm est and it took me about 3 1/2 hrs to fall asleep (no kidding)

HAN,

my testostrone levels are low normal according to my tests as well as my Leutinizing Hormone (that is very low normal as well)... I have absolutely no problem with sex drive and performing considering that these 2 tests are low which is peculiar.....

I guess its not Great Smokey Lab anymore they changed the name to Geneva Diagnositcs!!

So those tests I listed above are what I need to have performed? and the doc should know how to order from Geneva Diagnositcs or do I need to make arrangements or phonecalls to them?

I want to stop feeling like this >

 

[hardasnails1973]

Practicing better sleep hygeiene will be a big help because sleep deprevatation is known to lower testosterone and elevates cortisol over time it will lover the cortisol as well plus other hormones. Any dr can order these test. You might as trouble said research fufus thread to see what he did to help her self here. This should be an excellent start. First thing i experienced with my problems was sleep problems and be hyper at hell at night time and stare at ceiling for hours. For 2 months i come home from the gym and then from 10 pm to 1 am I would study on line for a test i had to take at work, which I still failed miserable. My job as customer service rep dealt with talking to agravated people on the phone, navigating a computer and problem solving all at once. I had an non stop life style compunded by added stresses of dieting and others unwanted stresses. Eventually my body said enough and shut down, but being stubborn as I was I pressed even though I cut back working out and extreme eating. It still was not enough. I also have been hypoglycemic my whole life ever since child hood. i'd sleep through classes and still pass with A's. i must have learned by osmosis. In college I went back to 3 meals a day from 6 and I would sleep 16 hours of the day. I remember eating at the cafateria walking back and waking up in my bed not remembering how I got there. After post work out i have a 90 grams dextrose 50 protein and one time literally blanked out at the wheel and ended up in a ditch.

http://www.ironmagazineforums.com/showthread.php?t=68431

 

[Trouble]

OK, so now we have your core problem identified.

Your intestinal absorption issues that are resulting in screwed up energy metabolism are secondary to this sleep deficit and diurnal cortisol shifts.

So we need to help you figure out how to manage this problem with constant travel through different time zones.

Hold off on the testing; its not necessary unless you fail to respond to recommendations.

First, lets see if we can find useful advice from others who have tackled this situation. I see the basic accomodation:

<-------------------------total available workday hours ----------->

5am.......................................................................................9pm

What is your homebase time zone, Billy?

 

[BillytK03]

I constantly travel daily (5 days travel/ 2 days off approx 50-60 hr work weeks of travel). Today I was supposed to fly to the West Coast for an overnight but I took time off because I only managed 3 hours sleep and felt like crap.

Come to think of it, all my problems did start to manifest itself about a year after I started my job (the stress, the travel, along with maintaining my intense workouts coupled with basicly undereating to stay lean and cut! (ate plenty of protien but probably not enough total calories). I have been doing this job for almost 5 years now. Ive always had stressful jobs One major thing I want to point out is that from mid June 02 until the end of last year, I worked out very intensely, at least 4 days on 1 off, used ephedra/caffiene only on work out days, ate literally only chicken breast, tuna, white rice, wheat bread, protien shakes..... I did not supplement with EFA's (big mistake).... Only in the past 6 months I have started taking fish oil, epo, multi-vit, b complex, vit c and e, off and on with magnesium, zinc.......

My symptons are all along the lines of being hypo (the fatigue, depression, hair thinning (no balding, no recession.... just all over the head rapid uniform thinning and no balding history in my family as of right now I still have full coverage "thank god!") I read in a few places that you can induce your body into a hypo state due to malnutrition, stress..... I guess basically suppressing T3 and making RT3, does this make sense? One thing I found really strange, when I used to take ephedra... I would feel an intense rush of energy and be able to work out for hours.... about 5 months ago I noticed ephedra did not work for me anymore, Id take it and get a little buzz but no more energy rush, I thought that was weird... I was thinking that I was suffering from along the lines of Adrenal fatigue or hypo....

Moderators Edit: Facts offered by the petitioner have been edited at the descretion of the moderator to remove personal liability; these facts are relevant, but can be described in general terms to avoid potential censure and disciplinary action (not ours).

Beg pardon for this unusual intrusion, Billy.

 

[Trouble]

OK, you travel for a living, and you spend 10-12 hours out of 24 "at work".

I presume you move through at least 2-3 hours of time shifts (time zone changes).

What is the earliest time you have to report to work and the latest time you get off at night?

Bless your heart, I didn't need the details, but now I understand the stress as well. You have to use an iron hand for re-regulating sleep and diet, plus exercises and cardio. You will have to be resourceful for carrying good quality food with you. You'll need behavioral modification to forestall stress effects, as well.

You admit to a really limited diet, little cardio and limited lifting, and you work a stressful job with limited time off during the day and variable hours.

For whatever reason, you have had recent lifestyle changes that prohibit you from getting enough physical activity (noted, from your job description). You also have overt vitamin deficiencies, the cause of your thyroid/adrenal function problems, they are derived from dietary status and lack of necessary vitamins and cofactors.

 

[BillytK03]

I didnt know I was gonna be censored!!! LMAO

Actually, you got my situation half right, I have very limited sleep, travel alot, but even If I am pressed for time and lack of sleep... I always go to the gym for about 20 min cardio/ 40-50 min lifting sessions..... I never missed a workout despite how little sleep I had and how much time constraint I had..... this job is draining me, but I enjoy what I do and I have a 8yr old son to support who lives on the west coast....... so as you can see I have a full plate....... my work days can start as early as 4:30 am est then fly to the west coast at 9pm western time/ which is 6pm eastern time then have to wake at 5am western time/ which is 2am eastern time and fly a 10-12 hr day barring no delays and get home about 5pm eastern time and then start the next day the same way but maybe at a later time, etc..... I have a varying flight schedule.......

so do you agree with everything I have listed and explained that I may be suffering from hypo or adrenal probs? and if so... what now would be the best tests to identify the underlying causes contributing to my problems, I am really intrigued with the theory that my body is stuck in RT3 mode,,,,,
thanks to you and HAN so much for the help

 

[Trouble]

Nosir, I didn't say I subscribed to your RT3 notion. We have no idea how much of your adrenal (test values look normal to me) or thyroid function is compromised by diet, sleep deprivation and prolonged stress. You have very long days; its going to be tricky to work out a schedule that will provide you with a solid dependable sleep schedule. We can discuss options privately if you wish.

You do indeed have vitamin deficiencies. If you are not currently using a multimineral/multivitamin, add one. Find and use Coeznyme Q10 supplements. Take a minumum of 100 mg per day, in 1 or 2 doses, with olive oil. This will provide you with some immediate relief.

You have nutritional insufficiency beyond micronutrients and mineral supply; they must be addressed, if you are to improve your current energy supply status. You also have other issues that I see that could be adding to your physiological difficulties.

HANs laundry list is a bandaide for stress reaction; it will not get you well.

 

[BillytK03]

Trouble,

What supps should I be taking along with the Q10?

also I am gonna still follow through with the endo so what tests do you feel that I should indeed get to obtain a baseline of where I am at?

thanx billy