• Posted by Dr. Andrew on November 10, 2023 at 5:36 pm

    Histamine/PANDAS complex case; depressed microbiome and fatigue; ear tubes/tongue tie; and PEMT/Choline pathway with severe nausea in pregnancy.


    Zoom Cloud Recording: https://us06web.zoom.us/rec/share/5q7VYXY8v8KVdne71f1BWCzwTUHWHAPhiqCng7PYPhyUfe1p6v44PegyV2NGgpta.fTUgBY5diD43OH9S

    Dr. Dan V. Question

    Patient of ours started care earlier this year and has struggled to see any results thus far. She is extremely fatigued, moderate to extreme anxiety, widespread pain, and feels winded when performing basic tasks when walking up and down steps, or walking from her car into her place of work. Based off of her initial OAT scores (No SIBO or SIFO present) we started her on:

    NutriDyn UltraBiotic Daily Extra Strength

    B6
    L-carnitine 1000mg 2x/day
    CoQ10
    B2
    B3

    B12
    Vitamin C
    Vitamin D

    After 2 months of taking these supplements she was still seeing no benefit, so we started her on the depressed gut microbiome protocol:

    Neuro Balance – 4 capsules with breakfast and 4 capsules with lunch
    Spectrum BR – 3 capsules 2x/day
    Nutricidin – 1 capsule 2x/day
    UltraBiotic Defense – 1 capsule 2x/day
    UltraBiotic Daily Extra Strength – 1 capsule 2x/day
    Dynamic GI Restore – 1 scoop 2x/day as a snack or meal replacement
    Fruits and Greens – 1 scoop per shake of GI Restore
    L-Glutamine – 10 grams (2 scoops) 3x/day mixed into shake or water/juice
    Cellular Energy – 2 capsules 3x/day in place of the L-carnitine and CoQ10
    Vitamin C – 1000mg or more per day
    HCl and Pan 5x – keep taking
    B-Complex – 2 with breakfast and 2 with lunch

    Upon the patient’s request she also took a heavy metal hair test and the MTHFR DNA test:

    +/+ mutation for the MTHFR/A1298C

    +/+ for both COMT genes

    +/- for MAO

    No presence of heavy metal toxification.

    Just last week we got the results back from her follow up blood labs and her new OAT scores.

    Her new oat scores show more activity in the gut microbiome, but she is now positive for SIFO and SIBO all the while still dealing with her original symptoms.

    Part of the issue I believe she has not followed the eating protocol due to her working in the operating room where no food or drinks is allowed at any time. She also has not filled out a food diary because she has a traumatic family history of eating disorders in her family.

    1) Reduce dose of probiotics to once per day, 5x per week

    2) Continue taking the Nutricidin 1 BID for another 2-3 weeks then stop

    3) DUTCH testing next step;

    4) Looking at iron – make sure test the IRON, TIBC, Ferritin, and a CBC w/ diff;

    5) 80% RULE – conserve 20% of your battery, they have to pick one thing to NOT DO every day and simply wait till tomorrow; make sure she saves some battery for tomorrow…and that she does this consistently.

    80% RULE OF STRESS

    You must always save 20-30% of your energy every day in order rebuild your adrenal savings account. In the beginning its hard because we judge ourselves on how much we can accomplish or how productive we are. So in the beginning you have to accept that you will not accomplish everything you want each day, but know that as the weeks go on your energy will increase steadily and so will your accomplishments/productivity. In the morning make your mind up about what you wish to accomplish, and then subtract 20-30% from that total, and what you are left with is your goal for the day.


    Melissa S. Question:

    Good evening,

    I need help interpreting this OAT test if possible – a little background on this patient –

    he was diagnosed with autism at 3 years old – he was at or ahead of all of his milestones until his 2 year check up and then he regressed and we moved from Georgia to Texas – he was verbal up until 2 years old and he has lost most of his verbal communication – he has been treated by a lot of different naturopathic and holistic practitioners – we started to see a naturopath when he was 4 years old – she treated him for chronic Lyme, mold – she treated him with herbs and supplements – she never did any blood work but she used the biometric feedback to identify triggers for him – we moved to Savannah when he was 7 years old and we started seeing Dr. Ramos as his pediatrician – I had brought up PANDAS with him and he did a rapid and culture of strep – he also drew titers of strep and identified him as a strep carrier and treated him with an antibiotic – he also identified him as having candida colonization and he treated him for 8 weeks of Vancomycin and Nystatin and weekly IV glutathione infusions – he hasn’t been on antibiotics since then and we took him to another holistic practitioner and she did a lot of blood work on him and she started treating him with supplements and herbs – he hasn’t had any other functional medicined tests since then – August 23 of this year he had a candida flare that I knew was related to candida because he had all the symptoms he had when he had it at 7 years old – his appetite started to decrease and he told me through his letter board that his throat, ears, and stomach were hurting him – we went to Orlando the following week and one of the nights that we were there he started to flip out screaming, kicking, and hitting which is not like him at all because he has never been aggressive – another day during the trip he had another horrible episode that I had never seen him do before, hitting, screaming, and kicking – this lasted an hour – on the way back home he had 3 more episodes of raging – at that point PANDAS popped back into my head as a possible diagnosis – I went to the his pediatrician in Savannah and they started him on Cefdinir prophylactically for 10 courses of 10 days of antibiotics – when the yeast gets really bad his incontinence comes back with urine and stool – I think he stools every day but I’m not sure because he is 14 years old – he’s currently taking adrenal calm, pro cortisol, neuralli, fish oil, biocidin, and methylated B12 – he is compound heterozygous for MTHFR

    Update on patient’s condition 3 weeks after initial visit –

    Ezra smells heavily of yeast and ammonia almost every day, to the point where it turns my stomach and I have a hard time being around him…which is a problem when I’m his primary caregiver. What can I do? He spends the entire day compulsively wiping saliva all over every surface and I cannot get him to stop! The incontinence is completely out of control. He’s not wetting himself, like he did in the past; now he’s pulling his pants down and soaking the floor and the furniture with urine. I’ve had to take all the rugs out of his bedroom and the landing upstairs, and I am mopping those rooms at least 2-3 times every day. Now he’s starting doing it in the bedrooms downstairs and in the backyard. He says (on the AAC) that he’s not doing it on purpose, that he doesn’t want to do it, that he can’t control it and that he does not know how to make it stop. I’m careful about what he eats (when I can get him to eat). The probiotics and antifungals and histamine blockers that I’ve depended on in the past are failing me, this time, and I am at my wit’s end. I need help. I don’t know how much more of this I can stand. And I am terrified to take him on a cruise ship in this condition. Do you have anything else I can add to my arsenal?

    I’ve attached the results of his OAT test and lab work I just got back – any help with his plan of care would be greatly appreciated!

    Thank you!!

    1) Look at Cromolyn Sodium as a candidate medication for lowering histamine. Has two forms…has a NASAL spray that is OTC called NasalCrom…and an oral stronger version that is call GastroCrom

    2) High electrolyte, high sodium intake plus vitamin C to control Mast Cells.

    3) Aldehyde Traffic Jam (page 129 of Your Genius Body book) – histamine and fungal metabolites polluting the aldehyde detoxification system, this will influence the Catecholamines, Histamine, Yeast and Alcohol. So we need to be more aggressive at removing. Nutricidin, Spectrum BR, GSE Pro, plus any dosing of pharmaceutical antifungal. I would also add GI DEFEND (1 TID) and a charcoal binder (GI DETOX).



    Marsha M. Question


    1) Tongue tie and the need for intervention with a myologist

    2) MTHFR increases likelihood and frequency of tongue tie – it is a midline defect

    3) Consider running a Bioterrain blood panel (homocysteine specifically) on Mom and Dad

    4) Look at hiatal hernia, you can adjust babies, toddlers and really everyone for the hiatal hernia as long as you adjust force appropriately

    5) Eustachian tube in children is rarely pointing downhill, so it collects fluid easily, blocking middle ear drainage…add to that reflux, poor occlusion and tongue function, plus some food allergies from Mom’s side of the equation…this will just irritate tissue enough to create some mild swelling


    1) Giving Choline > 1000mg per day to pregnant mothers increases IQ and visual acuity in offspring. This relates also PEMT genetics, a very common SNP and one that when present, lowers the production of choline. PEMT is upregulated by estrogen, this helps make sure pregnant mothers can produce CHOLINE in higher doses during pregnancy.

    2) Across the board in pregnancy…nausea/vomiting/hyperemesis gravidarum…it all points to GB dysfunction. Every day forward through pregnancy, there are more hormones to process thus the stress placed on the GB keeps increasing.

    3) Treatment should be placed on the GB and GB meridian.

    4) BONE BROTH!!!!! – drink the protein in a liquid form.


    • This discussion was modified 6 months, 2 weeks ago by  Dr. Andrew.
    • This discussion was modified 6 months, 2 weeks ago by  Dr. Andrew.
    Dr. Andrew replied 6 months, 2 weeks ago 1 Member · 0 Replies
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