• Marsha

    February 29, 2024 at 2:01 am

    Could you describe the POTS mechanism? Origin in autoimmunity?

    23 y/o female with lifelong gut issues from infancy. Very pale in appearance, POTS, can only tolerate 2-3 hours of activity before requiring a rest break. Performing the OAT now.

  • Dr. Andrew

    March 1, 2024 at 3:56 pm

    CC – I believe a mix of a vaginal infection, h pylori and stress.

    ONSET – the pandemic stress triggered gut changes, and vaginal dysbiosis/infections;

    TESTING – H.Pylori discovered via endoscopy

    Rx TREATMENT – antibiotics for H.pylori and antibiotics for vaginal bacterial infections 2019-2021 time frame

    Nausea, hard to digest food, Small food quantities
    Bloating, body discomfort Clean diet
    Lower back pain Apply heat, stretch,
    Constipation Elimination of greasy, heavy meals,
    Brain fog, headcahes Rest, clean diet, sleep
    Genital skin changes, burning Prescribed all types of creams, no success
    Muscle/bone discomfort Clean diet,
    Anxiety Omega 3 fish oil, magnesium bisglycinate
    Fatigue, tiredness Clean diet, rest,


    DIET – not any seed or toxic oils, cooking and eating with Ghee, Gluten Free for the past few months;

    Breakfast – small quantity

    Lunch – often skips lunch, not hungry after breakfast

    Dinner –

    FOOD REACTIONS – Red meats (hard to digest)
    Anything greasy/heavier (hard to digest)
    Grabulated sugars/processed sweets (bloating, discomfort)

    CHRONIC BLOATING / NAUSEA – can be triggered randomly, she basically eats the same foods – organic and clean oils, etc. – that don’t bother her on Monday but could irritate her again on Wednesday; food pattern inconsistent suggesting functional issues with her GI Tract; Stomach will actually INCREASE in size, abdominal swelling is worse in the evening; bloating and abdominal symptoms increase greatly when she cheat on her diet;

    FAT DIGESTION – rich food, even clean rich food, is very hard to digest suggesting

    MOLD EXPOSURE – living in a very moldy house as a teenager, visual mold on the walls and could smell the mold, etc.

    STOOL – has white specs every day, has 1-2 bowel movements per day, usually well-formed

    ANTIBIOTIC EXPOSURE – one round of antibiotic therapy every 2-3 years with a total life exposure of 8-10 rounds in her entire life; last couple of years AB therapy has been more frequent due to

    SLEEP: Lights out 11pm, takes 1-2 hours to fall asleep; wakes up around 9:00am for total sleep of 8 hours or so;

    NAPPING – does not nap, even when very tired after days of poor sleep;


    MENSTRUAL / PMS – very high depression, high anxiety and panic attacks, experiences anxiety, lasts a couple of weeks if not longer;

    Bacterial VAGINOSIS – experienced concurrent infection during the GI problems that started during the Pandemic; treated with antibiotics but still an issue, resistent to topical treatments, etc.


    DIZZINESS – orthostatic hypotension, been an issue for a long time since she

    CRAVINGS – varies throughout the week; lots of cravings for sugars/flours/starches and worse in the evenings


    Quercetin 500mg 1 capsules 1 morning Good
    Betaine HCL 324 mg + 5mg pepsin 1 tablet 1 before main meal Good
    Digestive enzymes 540mg 1 cpasule 1 before main meal Good
    Vitamin D 1000IU 1 softgel 1 morning Good


    GI MAP #1 –

    GI MAP #2 – Low bacteroides, low fermicutes, low Enterococcus and low Enterobactor; Staphylococcus aureus 6.92e2 High; Streptococcus spp. 3.68e3 High ↑; Citrobacter spp. 8.99e4; Klebsiella pneumoniae 2.32e3;

    Enterobacter spp. 5.43e5 < 5.00e7
    Escherichia spp. 1.04e7 < 3.80e9
    Fusobacterium spp. 1.67e6 < 1.00e8
    Prevotella spp. 1.55e7 < 1.00e8


    None Found


    PHENOTYPE: Chronic reactive hypoglycemia, adrenal deficiency; irregular cycle suggestive of progesterone steal and estrogen dominance; likely SIBO and possible occult yeast/mold overgrowth including skin dermatological infection in perianal and vaginal area.

    TODAY’S PLAN: OAT, MYCOTOXIN, Blackseed Oil topical groin area; HCl, Enzymes, D3, Glutamine

    FUTURE PLAN: Review biome, progress with protocol and suggest DUTCH

    Dr. Andrew Rostenberg