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Greg Davis
10-15-2009, 06:07 AM
My situation is that for the over a year now I've had a brutal time getting enough sleep. It has nothing to do with having a crazy schedule and not being able to put aside enough hours (I was doing my Masters for the last 2 years with a flexible schedule). It is that I always, without fail, wake up after about 4-5 hours feeling not able to fall back asleep. My alarm is typically set for somewhere around 5:30-6:00am.. and so I usually wake up some time around 3am and just try my best to fall back asleep which usually results in a lot of laying there or short repeated sleep cycles after that. I have absolutely no problem falling asleep, and I feel tired at the appropriate bedtime (i.e. ~9-10pm).

A little over a year ago I went in to get some blood work to see if I could figure out what was going on. Everything checked out okay except my hemoglobin and free testosterone levels were at the low end of the spectrum. The doctor wasn't too concerned. We chalked up the low iron to having donated blood a bunch of times over the last few years (put a stop to that) and I wasn't too offended by the low free testosterone because I had heard that total was a better indicator.

Well I finally went back in to my new doctor (he is a great guy that I found through my girlfriend) and was like okay this sleep thing is ridiculous can we try to figure this out. We ran some blood work and yesterday he called me to say everything looks great except that my hemoglobin is really low (now apparently even below the normal range). My serum testosterone is within the normal range. I was only given my recent results verbally so I'll have to get a copy next time I'm in there to know all the details. Basically he seems stumped. He ordered me a blood ferritin test (I guess to double check on the iron), and also a stool sample to see if I might have some sort of parasite that could be the culprit. I have a feeling after those results come in we are not going to have much to go on.

I originally chalked up the sleep issue to going through a bit of a stressful time doing my Masters thesis, but was always a bit uncomfortable with making that assumption because I don't feel particularly stressed out by it and the sleep symptoms never seem to correlate with the most stressful times. As far as training goes I don't feel I've overdone anything and one step I've taken to test that is I recently took a whole month off from any lifting or jiu-jitsu; and my sleep seemed to actually get worse.

I don't think I have any signs of insulin resistance (I had my fasting insulin sensitivity tested last year and it was 6 pmol/L (I think that converts to 1.02 mcIU/mL). No signs of abdominal fat (I'm very lean and no different in that area). And in this recent blood work my fasting cortisol was at a very good level according to my doctor. I also feel like my diet is pretty solid (I've posted food logs here before).

I'm posting because here I find a good bunch of people who train/eat in a similar fashion and any chance I could get good advice on how to work with my doctor to figure this out might make a big difference!

Steven Low
10-15-2009, 02:24 PM
What supplements have you tried?

Do you take ZMA (http://en.wikipedia.org/wiki/ZMA_(supplement))? Do you take Vitamin D (http://www.eatmoveimprove.com/2009/10/a-closer-look-at-vitamin-d/)? How about a multi-vitamin?

I found once I started taking ZMA (along with most people) sleep was better. When I started taking ZMA +Vit D (since I was deficient in D too) I got MUCH better sleep.

What's your diet look like?

Greg Davis
10-15-2009, 05:21 PM
What supplements have you tried?

Over the last year I've tried:
theanine serene (http://www.vitacost.com/Source-Naturals-Theanine-Serene)
melatonin (http://www.vitacost.com/Jarrow-Formulas-Melatonin-Sustain)
5-htp (http://www.nowfoods.com/Products/M002915.htm)
enzymatic therapy's sleep formula (http://www.enzymatictherapy.com/Products/Energy/Dr-Teitelbaums-Energy-Products/03233-Fatigued-to-Fantastic-Revitalizing-Sleep-For.aspx)

None have made a lick of a difference in keeping me asleep.

Do you take ZMA (http://en.wikipedia.org/wiki/ZMA_(supplement))? Do you take Vitamin D (http://www.eatmoveimprove.com/2009/10/a-closer-look-at-vitamin-d/)? How about a multi-vitamin?

I found once I started taking ZMA (along with most people) sleep was better. When I started taking ZMA +Vit D (since I was deficient in D too) I got MUCH better sleep.

Yes I have tried ZMA before bed (never noticed any difference) but for the most part I take magnesium + zinc in the morning. No I don't take a multi-vitamin. But I do also take fish oil / CLO, a b complex (http://www.vitacost.com/Jarrow-Formulas-B-Right), and vitamin d, as needed. And for the last few months I've tried taking digestive enzymes (http://www.nowfoods.com/Products/ProductsbyCategory/Category/M011541.htm?cat=Digestive%20Support) with meals.

I had my vitamin D tested in the summer and it was spot on.

What's your diet look like?

Diet I think is pretty good. I did have a training log thread (http://www.cathletics.com/forum/showthread.php?t=3824&highlight=food+log) going for a bit. I think towards the end there I tried some PWO carbs to blackbox that to see if I was overtraining but didn't seem to make much of a difference. I've stayed away from anything resembling high volume/intensity over the last few months for fear that might have been my problem.

So just last week I've gotten back in to some BJJ training, working up to 3-4 days/week but I only go to the 1 hour 7am class that is really light. Like were talking a very light warmup, mostly technique and then 1-2 five minute rolls which I take it pretty easy in.

I now eat 3 meals a day. Typical day looks like:

BKFST ~9am
couple pieces of fruit + 3-4 eggs OR some kefir with whey and some fruit

LUNCH ~11-2pm
large salad with chicken breast or seafood /w dressing

DINNER ~6-7pm
nice big serving of meat /w a cooked vegetable, usually a nice amount of fat

maybe a snack of nuts and/or a piece of fruit somewhere in the afternoon

Really pretty clean eating. I live with my girlfriend who is down with paleo foods too .. most of our dinner meats are from our grass-fed meat share, and we've been eating lots of quality veggies from our CSA.

Greg Davis
10-15-2009, 05:40 PM
I spoke with my doctor again today and mentioned to him that H pylori infection has been indicated in a few studies on low hemoglobin (http://www.ncbi.nlm.nih.gov/pubmed/9679031) and sleep apnea (http://www.accessmylibrary.com/coms2/summary_0286-3471670_ITM). So I went in and had a blood test for H pylori today so that result should be in next week. He said in his experience it is mostly linked to stomach ulcers (http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/) but it is worth a shot. Which is interesting because this week for three days in a row been having some stomach pains. I've never had these at all before but they are pretty constant right now, seemingly independent of what and whether I've eaten.

Something that I have also noticed over the same period that I've experienced the sleep problems is that my body weight has been on the low end for what I would consider my normal range. It's been a struggle to stay at 165 lbs and I've dipped below 160 a bunch of times. This is something that I've reported to my doctor before and have had many friends and family make note of. Always assumed it was just a side effect of moving to eating a lot more cleanly. To put that in context I use to weigh ~175 lbs and when I started lifting in college I moved all the way up as high as 190 lbs (but that was eating quite a bit of carbs). So I don't know how relevant that is but might be another sign of some sort of digestion issue.

Steven Low
10-15-2009, 06:04 PM
H pylori seems like a good bet. Might have some other intestinal absorption issues as well possibly.

Garrett Smith
10-15-2009, 07:47 PM
You might ask him for an occult blood stool test, to see if there is any bleeding going on inside the digestive tract. If this were a small but chronic issue, it could slowly eat away at your hemoglobin levels.

Liver or liver powder (leviticus11.com) is good for building the blood back up.

Get some source of vitamin C when you eat red meat, which you might try eating more of.

Vitamin D levels should be at least 50, preferably around 70 IMO. Don't take your doctor's word for where he thinks it "should be".

You might try the www.hibernationdiet.com and see if that helps the sleep issue.

Let us know the test results.

Greg Davis
10-16-2009, 04:05 AM
You might ask him for an occult blood stool test, to see if there is any bleeding going on inside the digestive tract. If this were a small but chronic issue, it could slowly eat away at your hemoglobin levels.

Ok I wonder if the stool sample test I just did would cover this or if this is a special test. I can ask next week when the results come in.

Liver or liver powder (leviticus11.com) is good for building the blood back up.

Yeah I've looked there before seeing you recommend it but they don't ship to Canada :(

Get some source of vitamin C when you eat red meat, which you might try eating more of.

I picked up Enzymatic Therapy R.B.C (http://www.abacohealth.com/index.php/prodid/ENZ021) and plan on taking one with dinner. It has some vitamin C, iron, B12, and "liquid liver fractions".

Vitamin D levels should be at least 50, preferably around 70 IMO. Don't take your doctor's word for where he thinks it "should be".

Yeah I actually paid to have a D test on my own. I was at 65 a few months ago so I feel like I have a good handle on how much to take. Sometimes it's easier to just pony up the $$ and pick my spots to use my (Canadian public health care) doctor. Unfortunately I'm in a bit of debt from grad school and the job I've lined up, although great, does not give me any extended health coverage. So I can't be as proactive as I'd like to be!

You might try the www.hibernationdiet.com and see if that helps the sleep issue.

I took a look.. I dunno it sounds like their main recommendation is to try some honey before bed. Couldn't hurt to try and see if that helps short term.

Let us know the test results.

Will do.

My doctor seems genuinely really engaged in wanting to figure it out so thats a good thing. He was like with iron levels that low you may have been operating at 50% and there is the potential to feel a lot better.

Makes me think about a lot of symptoms that I didn't think much of. For example, I feel quite dizzy when I do front and back rolls in jiu-jitsu, and have always thought it was poor form. I kept telling my instructors and they didn't quite get it.. I worked on my form, made sure I was tucking my head properly, and all that etc. but maybe it is due to the low iron.

Garrett Smith
10-16-2009, 05:10 AM
Hibernation Diet, from what I've been able to glean from internet feedback, mainly consists of taking 1-2 tablespoons of (preferably raw IMO) honey before bed. I shake cinnamon on mine. Myself and a training buddy definitely noticed improved sleep on it, we actually both started gaining weight (good weight) pretty quickly when doing that, and all I was add to my intake was a single small whey+hemp protein shake.

Greg Davis
10-23-2009, 12:29 PM
Some more test results came in this week . . it has all been told to me by phone so I don't have numbers.

- ferritin test confirmed iron deficiency (assuming it was high)
- free testosterone was "low"
- h. pylori blood test came back negative

I had read a bunch of h. pylori literature that had me convinced this was causing my low iron and was surprised to hear it came back negative. We just have one last test still waiting which is a stool test (not sure what that looks for).

My doctor admits he is stumped. For now he prescribed 300mg ferrous gluconate 3 times a day. He said we'll need to get together next week to discuss how to "cast a wider net". Doesn't leave my feeling very hopeful that we'll get anywhere !

Robert Johnson
10-24-2009, 05:16 AM
To me your diet looks like it lacks a thousand or two calories from starch.*

*or with nothing to replace it if you have something against starch.

Greg Davis
10-24-2009, 05:49 AM
To me your diet looks like it lacks a thousand or two calories from starch.*

*or with nothing to replace it if you have something against starch.

If I had to guess I am eating ~30-50 g CHO at breakfast and lunch (each) from fruit and veggies.. lunches always include a salad that includes some sort of starch like beets, carrots, tubers, etc.. I'm probably in the 150g CHO range daily average .. and around 3000k cals

Greg Davis
12-24-2009, 11:36 AM
Update:

No luck on doctor's end for what might be causing the sleep issues. Why iron is low is a puzzle too.

Still taking some iron supplements and will have that retested in the new year. Sleep issue still largely the same, except I've made some progress of late.

Although I'm still pretty puzzled, here is my best guess as to what is going on (pretty off topic but it could only help to share).

I think my sleep cycle has become somehow so screwed up that I have what you could label "advanced sleep phase syndrome (http://en.wikipedia.org/wiki/Advanced_sleep_phase_syndrome)". Basically my body is trying to sleep from early in the evening until about 3-4am. I've noticed before but never really connected it to my sleep cycle- that right after dinner (low carb) I feel really tired.

Weird that something like that would not reset itself given my schedule but anyhow many of the things I've been trying that have been recommended to me may have been counterproductive. For example, I keep being told to avoid light at night, get light first thing in the morning, try herbal aid x before bed, etc. but these are meant to help people who can't get to sleep or constantly wake up. I sleep like a rock when I do get to bed.. but just wake up ready to go super early. So some of the stuff I have tried to use to help may have just been further supporting an early sleep cycle..

So for the past little while I've been trying to stay stimulated a bit more at night, forcing myself to stay up later, as opposed to having an attitude anywhere near "ok i just need more sleep so lets go to bed as early as possible". So far so good as my wake up time seems to be pushing back slowly but still too early to tell.

As for the iron issue.. and digestion in general: well I don't know but I can guess that the constant sleep issue has just effed up my digestion to the point where iron has become low, and I'm not digesting meals well. So I started taking dig enzymes with most meals and making proper digestion a really high priority.

Since I've really scaled back my activity levels.. I have simplified my diet to be small breakfast (typically a few eggs or leftover meat with one piece of fruit), ~40-50 g PRO on a salad for lunch, and big serving of meat with cooked veggies for dinner. Some nuts for a snack sometimes. Kind of like de vany style eating that first got me on to paleo eating. <100 g CHO.

Other things I'm doing just to eliminate any other factors: staying away from intense workouts, cleanest diet as possible, no carb ups, aiming for a one month coffee hiatus (first week was tough!).. and supplementing with some theanine 3x / day on empty stomach. If it is just an adrenal/cortisol issue I'm hopefully addressing that as well.

My new job is going good and can't complain about life otherwise.

Doctor's appointment in new year.. I guess just get my iron retested and try not to think too much about it.

Garrett Smith
12-24-2009, 01:04 PM
I just had a patient with very screwed up sleep and an iron deficency anemia that was extremely resistant to iron supplementation (from her other doc).

We started working on general liver herb/nutrient supplementation (to help with detoxification), she started sleeping better relatively quickly. Then we tested her for toxic metals, because chronic lead toxicity is definitely something to rule out in unresponsive iron deficiency anemia. Lead binds to the same places as iron, and can keep iron from binding much at all.

She tested high in lead (shocker!). We are starting more direct treatment for the lead now, I expect her to improve quite rapidly.

Greg, you might want to look to an ND up there who will do the urine toxic metals test (preferably using DMPS as the chelating agent) and look for lead toxicity. Don't waste your time with a blood test.

Update:

No luck on doctor's end for what might be causing the sleep issues. Why iron is low is a puzzle too.

Still taking some iron supplements and will have that retested in the new year. Sleep issue still largely the same, except I've made some progress of late.

Although I'm still pretty puzzled, here is my best guess as to what is going on (pretty off topic but it could only help to share).

I think my sleep cycle has become somehow so screwed up that I have what you could label "advanced sleep phase syndrome (http://en.wikipedia.org/wiki/Advanced_sleep_phase_syndrome)". Basically my body is trying to sleep from early in the evening until about 3-4am. I've noticed before but never really connected it to my sleep cycle- that right after dinner (low carb) I feel really tired.

Weird that something like that would not reset itself given my schedule but anyhow many of the things I've been trying that have been recommended to me may have been counterproductive. For example, I keep being told to avoid light at night, get light first thing in the morning, try herbal aid x before bed, etc. but these are meant to help people who can't get to sleep or constantly wake up. I sleep like a rock when I do get to bed.. but just wake up ready to go super early. So some of the stuff I have tried to use to help may have just been further supporting an early sleep cycle..

So for the past little while I've been trying to stay stimulated a bit more at night, forcing myself to stay up later, as opposed to having an attitude anywhere near "ok i just need more sleep so lets go to bed as early as possible". So far so good as my wake up time seems to be pushing back slowly but still too early to tell.

As for the iron issue.. and digestion in general: well I don't know but I can guess that the constant sleep issue has just effed up my digestion to the point where iron has become low, and I'm not digesting meals well. So I started taking dig enzymes with most meals and making proper digestion a really high priority.

Since I've really scaled back my activity levels.. I have simplified my diet to be small breakfast (typically a few eggs or leftover meat with one piece of fruit), ~40-50 g PRO on a salad for lunch, and big serving of meat with cooked veggies for dinner. Some nuts for a snack sometimes. Kind of like de vany style eating that first got me on to paleo eating. <100 g CHO.

Other things I'm doing just to eliminate any other factors: staying away from intense workouts, cleanest diet as possible, no carb ups, aiming for a one month coffee hiatus (first week was tough!).. and supplementing with some theanine 3x / day on empty stomach. If it is just an adrenal/cortisol issue I'm hopefully addressing that as well.

My new job is going good and can't complain about life otherwise.

Doctor's appointment in new year.. I guess just get my iron retested and try not to think too much about it.

Greg Davis
12-25-2009, 07:38 PM
We started working on general liver herb/nutrient supplementation (to help with detoxification), she started sleeping better relatively quickly. Then we tested her for toxic metals, because chronic lead toxicity is definitely something to rule out in unresponsive iron deficiency anemia. Lead binds to the same places as iron, and can keep iron from binding much at all.

You know I just recently received back the BED book that my gf's sister borrowed from us and I gave it another read. Sounds like the section in there on liver cleansing might be highly relevant here.. I'm very interested in what it has to say about liver and sleep. There is a lot in the book that makes me skeptical all around but maybe there is something to go on here..


Greg, you might want to look to an ND up there who will do the urine toxic metals test (preferably using DMPS as the chelating agent) and look for lead toxicity. Don't waste your time with a blood test.

Hmm.. thanks for the recommendation. I will go to my MD in the new year, get another iron test. See how things are going and then potentially look up an ND.

Greg Davis
01-05-2010, 12:05 PM
Caught a cold over the holidays so havenít been training much and skipped a few meals. Otherwise managed to have only a few glasses of wine and ate well over the holidays.

Sleep still disturbed although Iíve had a few solid nights in last couple weeks.

Saw my doctor and managed to get my hands on the actual tests Iíve had done (from October).

Abnormal:
Creatinine: 113 (higher than normal 60-110)
Hemoglobin: 124 (lower than normal 135-170)
Hematocrit: 0.36 (lower than normal .38-.49)
RBC: 3.93 (lower than normal 4.2-5.7)
MCH: 32 (right at high end of 27-32)
Transferrin: 1.7 (lower than normal 2.1-3.6)
Free testosterone: 21.2 (lower than normal 31-94)

Relevant:
Ferritin: 121 (within 31-300 normal range; I was actually led to believe previously that I was also abnormal in ferritin, but I donít think this is real low so it seems that my haemoglobin is more of a problem than my stored iron)
Cortisol fasting (AM): 419 (normal 170 Ė 540)
Total testosterone: 17.9 (normal 8-38)
Stool test came back ok
Iím told my liver, thyroid, look ok

Doctor ran one more set of blood tests to see if some of my levels have moved.. added a few that I canít remember. Results back next week.

Garrett Smith
01-05-2010, 02:10 PM
Observations in your blood test:
You have an anemia. Doesn't look too iron-related to me.
Your MCH is high. This can indicate B12 deficiency.
WHAT CAN CAUSE THE MEAN CORPUSCULAR HEMOGLOBIN TO BE TOO HIGH? (http://www.medfriendly.com/meancorpuscularhemoglobin.html#high)

Generally, if the MCH level is over 34, this is considered to be too high. The main reason that the MCH level would be too high is because of macrocytic anemia. Macrocytic anemia is a blood disorder in which not enough red blood cells are produced, but the ones that are present are large (thus fitting more hemoglobin). Macrocytic anemia is often caused by having too little vitamin B12 or folic acid (a type of vitamin) in the body.
Read this: Non-transferrin-bound serum iron (NTBI) in megaloblastic anemia:
effect of vitamin B12 treatment (http://online.haematologica.org/thj/2004/6200332a.pdf)
If you can understand it (it's not very layperson-friendly, but you're a smart guy), you may be able to see the relevance to your situation.

Funny thing, B12 plays a crucial role in melatonin production (can you say insomnia if one is deficient?):

B12 and sleep (http://www.lef.org/magazine/mag99/aug99-report3.html)

Those who can't get to sleep at night may need vitamin B12. Studies show that B12 causes an earlier release of melatonin at night which resets the sleep-wake cycle. (Melatonin has been called "the sleep hormone" because of its effects on sleep). B12 acts directly on the pineal gland to provoke a faster release of melatonin. At the tail end, B12 causes melatonin to drop off faster. B12 helps you get to sleep earlier, and may help you wake up earlier if you leave a curtain open to the morning sun. B12 sensitizes you to morning light, which helps you wake up. Very serious sleep-wake disorders have been successfully treated with vitamin B12 in the methylcobalamin form, although it may not work for everyone. Unfortunately, the vitamin doesn't help people who want to cut down on their sleep time altogether.
A couple of symptoms, a couple of funny lab tests.

Your lesson here (besides finding some good B12 to take, I suggest methylcobalamin injections at the start to improve your situation most rapidly, look to an ND for these) is to ALWAYS get copies of your lab reports.

Greg Davis
01-05-2010, 05:47 PM
This can indicate B12 deficiency.

Hmm even if my B12 level is showing as normal on the standard blood work?

(I don't have the test result in front of me but it did test for B12 and came out not deficient- I will check the actual number tomorrow)

Is this a case of (a) the standard test used is a poor indicator of actual B12 levels; (b) the normal accepted "not deficient levels" are set too low; or (c) some people just need much higher levels of B12?

Garrett Smith
01-05-2010, 06:50 PM
All 3 to some extent, mostly A:
http://www.naturalnews.com/027027_vitamin_B12_vitamin_B_doctors.html

Greg Davis
01-06-2010, 05:45 AM
Vitamin B12: 417 (>150 considered not deficient)

From preliminary research it does seem to fit that this is on the low end of normal (sub-500) and so I am going to follow up on this

Greg Davis
01-06-2010, 05:12 PM
Interesting day today.

Called my MD to hear his thoughts on possible B12 deficiency. He didn't think much of it. Said that if I had macrocytic anemia I would have an elevated MCV (which I don't) and that my high MCH isn't alarming. Ok, but I insisted we consider B12 and he agreed to schedule me a B12 shot this friday.
Also, apparently my next blood test partially came back and my total testosterone has plummeted even further, to a level of 6.4 (from 17.9 back in October). Yikes. MD brought up possible need for testosterone therapy. Crap that scared me, I don't think that is a good idea, at least only as a last resort.

So, a bit freaked out, I made it over to an ND that I had recommended to me a ways back (wish I was near Dr. G but had to take a bit of a leap of faith on this guy). Have been holding off on that not wanting to spend the $$. Anyway, I ate threw a bit of money but hopefully enlisted the help of someone who might be able to help.

We talked about my issues and ran through some stuff including:
- LBC analysis
- gave a urine and saliva sample for bio terrain analysis (results next week)
- glucometer (I was at 4.9 I think.. slightly low, this was before having lunch)
- got a B12 injection

Looked at my blood cells under a microscope.. saw some really wacky things that I'm told by the ND is quite abnormal.. showing major signs of b-12 deficiency, digestion issues, gut and/or liver inflammation, and possible allergies

treatment thus far:
- B12 shot today (will get another B12 injection from MD on friday, another from ND on monday)
- B12 supplement (methyl) given to take daily
- recommended to take 15-30 billion probiotics daily

We talked about possible contributing factors being liver congestion and adrenal fatigure that we might want to look at depending on how things go

Follow up appointment on monday:
- getting another b12 shot
- taking a look at a food log
- zinc tally test
- look at results from "bio terrain anaylsis"

I don't know exactly what to think about the ND stuff.. the live blood analysis (http://en.wikipedia.org/wiki/Live_blood_analysis) looked intriguing but whether or not it is bogus I just don't know. Will need to assess the guy's process moving forward.. don't want to waste money but he was highly recommended..

Garrett Smith
01-06-2010, 09:14 PM
Give it a fair shot. Your MD obviously doesn't have a good answer for you at this point.

You should notice the B12 shot pretty quickly.

Greg Davis
01-08-2010, 09:45 AM
Definitely going to give the ND a shot..

Just received my 2nd B12 shot about half an hour ago. While I can't say I felt a huge change in energy from the 1st one, I have noticed an interesting effect from both of them. Call me crazy but I notice a sense of euphoria, more specifically an opening up of my peripheral vision and an appeciation for colors/patterns around me. Sounds weird and I havent had a chance to google around about others experiences to see if that is something others have reported, but I distinctly noticed it both times.

Sleep seemed the same after 1st one, we'll see how this weekend goes.

Garrett Smith
01-08-2010, 11:27 AM
B12 is going to help you a lot then. Keep it up.

Greg Davis
01-13-2010, 09:27 AM
Latest:

Nothing new from my MD. We met last Friday to get a B12 shot and talk further, but nothing really came of it. He brought up looking at some sort of androgen topical application but I was resistant and at least had him try to get me in to see an endocrinologist before doing that.

Have had one more ND consultation:
- we ran through a ďbio terrain analysisĒ, which showed a bunch of stuff I wonít get in to here.. nothing super alarming but I think did show I need to drink more water, might need to more o-3s to fight some inflammation, some other kind of neat stuff..
- did a basic urine adrenal function test (not an expensive one) that showed Iím pretty tapped out.. I think the scale was 17-35 for normal, and I came out a 7
- we talked about a few more things, looked at a diet log, and he seemed to agree with my self-diagnosis of having a bad case of leaky gut and adrenal fatigue.. the question is what is/has caused it
- using some of his recommendations Iím focusing on good digestion above all else, trying to think more about my breathing, and supplementing with fish oil / dig enzymes at meals, glutamine + probiotics in morning/before bed, and a tribulus supp 2x day to help with the t-levels..

Might get one more B12 show at end of week. Otherwise going to see how things go for a few weeks. Iíve had a few good sleeps in the last couple days which gives me some hope on that end!

Still feel stumped on the hemoglobin thing though, and unsatisfied with any attempts at researching (or answers from MD/ND) about why it would be low, if I just have a really messed up gut / adrenals.

Garrett Smith
01-13-2010, 10:34 AM
Methylcobalamin injections will help many times more than cyanocobalamin ones.

I'd bet your ND is using methyl and your MD is using cyano. They don't work the same.

Greg Davis
01-13-2010, 01:43 PM
Well it certainly seems like pernicous anemia would be a good bet for my low hemoglobin.

Garrett (or anyone else), do you know of a good way to explain to my doctor how my serum b12 test result might not be an accurate representation of my true b12 situation?

I know that testing homocysteine and MMA will give a good indication and would like to get them looked at, but this will be a hard sell unless I can rationalize how the his standard serum test could not be a great indicator.

I've done a lot of reading and looking around but I can't seem to find a good answer for what is wrong with the "normal" test.

Garrett Smith
01-13-2010, 08:17 PM
You could offer to pay cash to cover the difference.

Or try using this:
Pract Neurol. 2009 Feb;9(1):37-41.
Functional vitamin B12 deficiency. (http://www.ncbi.nlm.nih.gov/pubmed/19151237)

Turner MR, Talbot K.

Department of Neurology, John Radcliffe Hospital, University of Oxford, Oxford, UK.

We describe a case of functional vitamin B12 deficiency where the repeated measurement of a serum B12 level within the normal range led to delay in the diagnosis of subacute combined degeneration of the spinal cord, and possibly permanent neurological damage as a result. Failure of intracellular transport of B12 by transcobalamin-2 can lead to functional B12 deficiency but with apparently normal serum levels, and is suggested by raised levels of either serum methylmalonic acid or homocysteine, associated with low levels of transcobalamin-2. Such patients may respond to repeated high-dose injections of B12.

PMID: 19151237

Greg Davis
01-14-2010, 06:42 AM
Thanks. Using "functional b12 deficiency" to look around is very useful.

I'm going to try to nail that down to make sure that is what is going on.

Also as far as root causes I'm going to try to get my ND/MD to take a look at my heavy metals situation.. that might be relevant here. In particular I'm seeing that "mercury can block the methylation cycle and thus induce a functional B12-deficiency":
http://www.ever.ch/medizinwissen/b12hg.php

(not the most reputable reference there but it gives a good explanation)

Garrett Smith
01-14-2010, 10:40 AM
Mercury and lead are the most common toxicity culprits out there, IMO.

Greg Davis
01-15-2010, 08:54 AM
Had a quick chat with MD. He is not keen on pursuing an MMA or homocysteine test.. I was in a hurry but didnít want to push on this just yet. He makes some good points about my anemia not looking to be of the pernicious type, with my normal MCV. Sending blood work to an endocrinologist but this could take a while to get a follow-up appt. Angle here seems to be that the anemia could be driven by the low t-levels.

One thing I havenít asked/addressed is if my elevated creatinine or low WBC has any relevance.

One more b12 shot today at ND, next step with him is a provocative urinary challenge to check on the mercury/lead.

Greg Davis
03-08-2010, 12:04 PM
Don't have any conclusive news on what I was/am experiencing, but thought I would give a quick update without getting in to to much detail.

On the MD side of things I managed to get a referral to an endocrinologist (one that is quite accomplished) so I am working through a bit of a process of elimination with them to see what could be going on hormonally to cause low RBC.

As for the ND, he gave me some good feedback but I had to pull the plug on that a bit prematurely as the cost/benefit there turned pretty quickly to be net stress producing based on the money it costs.. wish I could afford to fully follow through but not at the moment.

And on my own side of things I continue to be wary of anything that could lead to overtraining, made some helpful diet tweaks, and have a made a little progress on the sleep. Right in the thick of all this I made a pitch for a pretty amazing job opportunity that I stumbled upon- some unavoidable stress there- but managed to land it and so it doesn't hurt to have a boost in the career situation.