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An example of a Step wise approach
A) Self Care Basics (ongoing) – Before diving deeply into more specific and intensive treatments it is best to give some attention to basics like: stress managment and work on emotional health, sleep, movement and exercise (as able, paced), good water, good air, healthy environment and products, management plan for symptom flares and set backs.
B) More Specific Treatments (1-7 with help from doctor with a good understanding of EI e.g. NEM/Integrative or funcitonal or biomedical)
- Primer / Pyrrole
- Methylation/folate acid Cycle
- Sulfation / Glutathione impairment
- Gut health (and metabolic or pharmacological food intolerance or allergies)
- Immune – infections
- Mycotoxicity and Detoxification methods to reduce biotoxicity – high toxic body burden.
- Other as recommended by doctor.
This approach is in my opinion the best way to break the Toxicity, Inflammation and Stress and Sensitisation (TISS) loop and address LINGER ISSUES. That is, the most common maintainers of ill health, exhaustion, and environmental hypersensitivities.
Impaired liver detoxification (measured by FLDP not standard liver test), fatty liver or other liver issues (standard liver test).
Many things can impair liver detoxification
- genes - some people are natural slower detoxifiers (around 1 in 4), people who develop biotoxic/neurotoxic illness usually fall into this category. Disorders like Pyrroles* (excess HPL impairs Cytochrome P450), illnesses like Fatty Liver and Hepatitis can further impair liver functioning.
- diet: high sugar and carbs, junk food, alcohol, drugs (including pharmaceutical) fats - unhealthy and wrong Omega 3/6 ratio*. For some people with very impaired sulfation - eating healthy foods (fruits and vegetables) and medicine high in salicylates*, can further impair this pathway. Poor sulfation is linked to food intolerance - pseudo allergy and multiple chemical sensitivity ! (many people with salicylates sensitivity also have a problem with amines and glutamates)
- low glutathione
- poor sleep
- High exposures to chemicals and other toxicants (TILT) and a high toxic body burden.
Fortunately these things can often be addressed with a series of dietary and lifestyle and environmental changes, and nutritional therapies. Such as
- increasing glutathione, choline, and B Vitamins (in diet and with supplements like Essential Forte and Immunopro Whey Protein),
- making healthy lifestyle changes, reducing exposure to everyday toxicants, improving sleep.
- Other as directed by health professional. Such as Detoxify and bind slowly and safely (binders include Pectosal C, toxaprevent, Zeolites, Charcoal - coconut bullet proof /other), Detox method in Sauna Therapy (FIR, NIR), coffee enema, and use of toxin mobiliser (EDT Chelation, Chlorella) however never early in treatment (detox and other systems need to be strengthened first).
(Note when every you do a detoxification therapy or use supplements that will increase toxin mobilisation it is important to take a toxin binder, but away from food, supplements and medicine (say 1 to 2 hrs) so the binder does not interfere with these good things.
Weakened immune system, chronic low grade infections, immune injury/priming causing immune hyperresponsive to threats (e.g. MCAS, HIT), high CRP or C4A.
- Address by reducing exposures to common threats to the immune system e.g. mold and other fungi, parasites and germs, and for people with MCS/MCAS - injury to Toll like receptors also chemicals and histamines (and for some also salicylates)
- Strengthening the immune system with healthy diet and supplements* e.g. zinc (an absolute must for pyrrole), , colostrum or other advised by health professional
- Addressing underlying chronic infections (at a time that is appropriate e.g. increased reserves and also tolerances to medicines and substances)
- Test for and address Vitamin D Deficiency.
- Address fatty acids omega 6/omega 3 ratio . Note Low omega 6 as commonly found in people with EI that have Pyrrole, (see Omega 3 Paradox), salicylate sensitivity and MDD linked to impaired D6D AA-eiconasoids and Low PGE1. Omega-6 is necessary for our immune system function as it is a key contributor of pro-inflammatory hormones. If D6D is impaired ALA cannot be effectively converted into Omega 6, but omega 6 can be created from GLA as it bypasses D6D.
*supplement choices should consider Allergies and Pseudo Allergies (histamine, salicylates) as required.
The nervous system is generally very wired but tired. That is exhausted, but wound up. This can impact the nervous systems ability to filter sensory and environmental input, leading to sensory overload, central sensitisation and related central sensitivity syndromes (Fibromyalgia and related). To calm the nervous system you need to do BASIC self care/self management that is appropriate to your situation and calm fears and health anxiety. Many benefit from self hypnosis and neural/amygdala retraining programs, or support for mental health workers, particularly if there has been a history of psychological trauma.
If the brain has been injured or traumatised, calming the nervous system can be somewhat more difficult. A common sign of brain trauma is severe and ongoing Sensory overload, as discussed at braininjury explanation https://www.braininjury-explanation.com and also Central Pain. Central Pain needs to be managed with reduced sensory stimulation and reduced activity and exercise, as opposed to Nerve pain (from injury) that can be helped with increased activity and exercise.
Sometimes when the brain is very sensitised and wound up - causing symptoms like seizures, severe anxiety and fear (for non obvious reason) and severe brain fog (neurocognitive difficulties) calming supplements like GABA or medications (anti convulsant) or diets like fasting diets or high fat, low carb (e.g. Ketogenic) are used. Note whilst these diets can be helpful to lots of people, anyone with a fat metabolism disorder needs to very cautious about using these diets - in some situations they can be fatal!
Gut inflammation - address IBD, B6 deficiency, Heavy Metal toxicity, food intolerance (phenols - salicylate, amines, glutamate which impacts up to 7% of people with IBD). Gut inflammation may be helped also with Sunshine D, Resistant Starch, some fibre supplements (psyllium is thought to be most helpful). Some medicines including Naltrexone, can be helpful for reducing gut inflammation.
Gut infections - e.g. candida or SIBO
IBS - Fodmaps (most common), less common pseudo allergy - salicylate, amine, Glutamate
Leaky Gut - The provide a simple explanation of Leaky Gut is provided by the The NHS.A leaky gut can lead to heightened toxicity, inflammation, sensitisation and stress response overactivation. To address this specific diet may be recommended such as Gluten Free/Casein Free, SCD or variations e.g. Paleo, Functional Medicine Elimination Diet. However, if a person has very severe psuedo allergy (histamine/salicylate) these diets may actually worsen this problem, if these are not addressed first. Note while a histamine/salicylate diet (or RPAH Allergy Unit Salicylate, Amine and Glutamate Diet) can be combined with a gluten free and casein free diet, they do not combine well with other leaky gut diets! .
low thyroid, low cortisol (hypocortisolism) is linked to very severe fatigue and environmental hypersensitivity. Low melatonin is associated with poor sleep and so is low MSH - which is also linked to high inflammation (CIRS - C4A) and symptoms associated with CSS Pain syndromes. Your doctor will need to help address these issues, and you will need to get plenty of REST, PACE yourself and REDUCE your total stressor load as much as possible in order to facilitate recovery.
Other endocrine (hormone) issues may also need addressing. Limiting exposure to endocrine disrupting chemicals like BPA is recommended.
Exhaustion and low reserves leads to slowed recovery from stressors. It is important to conserve energy and build reserves for healing (and improved treatment tolerance) with REST REDUCE PACE. REST more (pre emptive rest breaks and improve sleep) , REDUCE everyday stressors (e.g Simplify ADLs, get support, practice anxiety and stress management techniques and 4A approach - avoid, alter, accept and adapt) and PACE, PACE, PACE.