Probiotics Revisited From Gut-Expert Ray Medina

DaveFoster

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I'm 19 years old, and I've dealt with autism, anxiety, and depression my whole life. I've cut out PUFA's the past year, and I plan to continue doing so (under 4 grams/day until I die.) My diet consists of milk, sugar, coffee, OJ, potatoes, coconut oil, chocolate, salt/baking soda, occasional shellfish (shrimp, mussels, clams), along with daily oysters and liver. Supplements include a baby aspirin, liberal caffeine (coffee), methylene blue (250 mcg/day), K2 (5 mg/day), vitamin E (400 IU/day), occasional B-vitamins via haidut's Energin (30 drops), occasional Lapodin, and Pansterone (DHEA and pregnenolone 2-5 mg/day each).

I've recently been dealing with mild fibromyalgia symptoms, along with the IBS symptoms I've suffered from my whole life. I used smaller doses of tetracycline (50 mg) with positive effects. My doctor placed me on a 10-day course of amoxicillin and clavunic acid; this resulted in diarrhea and an initial increase in feelings of well-being. By day 7, I started to experience some severe regression of symptoms. Post-antibiotics, along with some potato starch, I now have full-blown fibromyalgia, chronic fatigue syndrome, arthritic pains in my joints, excessive body hair, acne breakouts, swollen throat, migraines and absolute apathy about it all. It happened directly after the 10-day antibiotic course. Labs reveal elevated AST and ALT enzymes (slightly) and high reverse-T3. My thyroid supplementation focuses on a high ratio of T3:T4 (3:1 - 2:1). My pulse is between 60-70: a new development after the amoxicillin.

I e-mailed Ray Peat before the amoxicillin; he recommended thyroid and an antibiotic. Thyroid helped, amoxicillin did not. I recently contacted Ray Medina, writer of gutcritters.com. He extensively researches the impact of the microbiome on human health, and since Peat recommended the carrot salad and flowers of sulfur (which I did both, and which still did not work), I'm going to the probiotic route.

Here's what Ray Medina replied to me in an e-mail:

Hi Dave,
Like so many of us, you likely inherited a disordered gut flora from your mother. In this age of antibiotic overuse and caesarean births, it’s sadly the norm.
I don’t have specific FOS prebiotic recommendation. There are several on the market you can try. I would just do an Amazon search and see what comes up. As for probiotics, I currently recommend this one: Dr. Ohhira Probiotics | On Sale | Probiotics Supplements | Probiotic Soap | Probiotics Oils | Buy Probiotics From Dr. Ohhira Probiotics
Keep in mind that I wouldn’t start off with the prebiotic until after your gas and bloating symptoms have subsided. Any fiber, soluble or insoluble, can be very hard to take when battling IBS. That is why prebiotics are on the FODMAP list of prohibited foods. Once things normalize, begin introducing a small amount of prebiotic fiber to your diet. I take mine in my morning coffee just once a day.
I can only assume that you are already on a gluten-free diet. If not, please consider it. I wrote about the connection between gluten consumption and fibromyalgia here: Fibromyalgia And Non-Celiac Gluten Sensitivity | Gut Critters
Best regards and good luck,
Ray
Gut Critters
My reply:

Dear Ray,
Thank you so much for your insight. I've ordered the probiotic that you recommended, and also this as a prebiotic, as it's the top-rated: Dr. Tobias Ultimate Prebiotic - The Perfect Complement & Boost For Every Probiotics Supplement
I'm going to barter with my doctor to get a 14-day course of Xifaxan, and then start both of the aforementioned for 30 days, along with eating plenty of potato resistant starch.
A couple questions; should one take the probiotic or prebiotic during the antibiotic treatment along with afterward?
Also, do you personally take probiotics or just prebiotics daily indefinitely?
Best regards,
Dave
His reply:

Hi Dave,
Yes, I would take the probiotic during antibiotic treatment. (Not the prebiotic. But if you don’t suffer from any gas or bloating issues than you can take the prebiotic as well.) Just take your probiotic away from your antibiotic. Say the antibiotic is to be taken every 8 hours, take the probiotic at the four hour mark between doses.
I take probiotics and prebiotics every single day and will do so until I expire.
Best regards,
Ray
Dr. Ohira's probiotic contains carrageenan, which is not ideal. Anecdotally, I hear "the more strains, the better," from countless reviews of probiotics. People who have tried more strains have better results than those who try a few strains. So, a 15+ strain probiotic seems ideal. Unfortunately, these probiotics have excipients.

The two highest quality probiotics I can find are the following:

11 Strain Probiotic Powder
(They also have a bifidobacterium-only product, which has been favorably mentioned on this forum.)

GutPro™ Custom Probiotic - Organic 3, Inc.
These only have 11 and 8 strains respectively.

Please open the discussion, and for the love of God please share any advice.
 
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meatbag

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Jan 15, 2016
Messages
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I'm 19 years old, and I've dealt with autism, anxiety, and depression my whole life. I've cut out PUFA's the past year, and I plan to continue doing so (under 4 grams/day until I die.) My diet consists of milk, sugar, coffee, OJ, potatoes, coconut oil, chocolate, salt/baking soda, occasional shellfish (shrimp, mussels, clams), along with daily oysters and liver. Supplements include a baby aspirin, liberal caffeine (coffee), methylene blue (250 mcg/day), K2 (5 mg/day), vitamin E (400 IU/day), occasional B-vitamins via haidut's Energin (30 drops), occasional Lapodin, and Pansterone (DHEA and pregnenolone 2-5 mg/day each).

I've recently been dealing with mild fibromyalgia symptoms, along with the IBS symptoms I've suffered from my whole life. I used smaller doses of tetracycline (50 mg) with positive effects. My doctor placed me on a 10-day course of amoxicillin and clavunic acid; this resulted in diarrhea and an initial increase in feelings of well-being. By day 7, I started to experience some severe regression of symptoms. Post-antibiotics, along with some potato starch, I now have full-blown fibromyalgia, chronic fatigue syndrome, arthritic pains in my joints, excessive body hair, acne breakouts, swollen throat, migraines and absolute apathy about it all. It happened directly after the 10-day antibiotic course. Labs reveal elevated AST and ALT enzymes (slightly) and high reverse-T3. My thyroid supplementation focuses on a high ratio of T3:T4 (3:1 - 2:1). My pulse is between 60-70: a new development after the amoxicillin.

I e-mailed Ray Peat before the amoxicillin; he recommended thyroid and an antibiotic. Thyroid helped, amoxicillin did not. I recently contacted Ray Medina, writer of gutcritters.com. He extensively researches the impact of the microbiome on human health, and since Peat recommended the carrot salad and flowers of sulfur (which I did both, and which still did not work), I'm going to the probiotic route.

Here's what Ray Medina replied to me in an e-mail:

Hi Dave,
Like so many of us, you likely inherited a disordered gut flora from your mother. In this age of antibiotic overuse and caesarean births, it’s sadly the norm.
I don’t have specific FOS prebiotic recommendation. There are several on the market you can try. I would just do an Amazon search and see what comes up. As for probiotics, I currently recommend this one: Dr. Ohhira Probiotics | On Sale | Probiotics Supplements | Probiotic Soap | Probiotics Oils | Buy Probiotics From Dr. Ohhira Probiotics
Keep in mind that I wouldn’t start off with the prebiotic until after your gas and bloating symptoms have subsided. Any fiber, soluble or insoluble, can be very hard to take when battling IBS. That is why prebiotics are on the FODMAP list of prohibited foods. Once things normalize, begin introducing a small amount of prebiotic fiber to your diet. I take mine in my morning coffee just once a day.
I can only assume that you are already on a gluten-free diet. If not, please consider it. I wrote about the connection between gluten consumption and fibromyalgia here: Fibromyalgia And Non-Celiac Gluten Sensitivity | Gut Critters
Best regards and good luck,
Ray
Gut Critters
My reply:

Dear Ray,
Thank you so much for your insight. I've ordered the probiotic that you recommended, and also this as a prebiotic, as it's the top-rated: https://www.amazon.com/dp/B01FICESXE/?tag=rapefo-20
I'm going to barter with my doctor to get a 14-day course of Xifaxan, and then start both of the aforementioned for 30 days, along with eating plenty of potato resistant starch.
A couple questions; should one take the probiotic or prebiotic during the antibiotic treatment along with afterward?
Also, do you personally take probiotics or just prebiotics daily indefinitely?
Best regards,
Dave
His reply:

Hi Dave,
Yes, I would take the probiotic during antibiotic treatment. (Not the prebiotic. But if you don’t suffer from any gas or bloating issues than you can take the prebiotic as well.) Just take your probiotic away from your antibiotic. Say the antibiotic is to be taken every 8 hours, take the probiotic at the four hour mark between doses.
I take probiotics and prebiotics every single day and will do so until I expire.
Best regards,
Ray
Dr. Ohira's probiotic contains carrageenan, which is not ideal. Anecdotally, I hear "the more strains, the better," from countless reviews of probiotics. People who have tried more strains have better results than those who try a few strains. So, a 15+ strain probiotic seems ideal. Unfortunately, these probiotics have excipients.

The two highest quality probiotics I can find are the following:

11 Strain Probiotic Powder
(They also have a bifidobacterium-only product, which has been favorably mentioned on this forum.)

GutPro™ Custom Probiotic - Organic 3, Inc.
These only have 11 and 8 strains respectively.

Please open the discussion, and for the love of God please share any advice.

Have you heard of Elixa

http://freetheanimal.com/2013/12/resistant-primer-newbies.html
 
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Jayfish

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256
I wouldn't take any a advice from Richard Nikoley, he has done nothing but regress and switch sides since he started his blog. Everything he does is an amazing epiphany in health that ends up petering out and he's onto the next band wagen, pretending like he's always been there.

Personally I think RS is the most detrimental thing you could possibly do and dont be suprised if you get some crazy endotoxin related symptoms which I know you have already experienced.

Personally I think you don't eat enough real food and have been relying heavily on supplements which look good on paper but never really help in the long run. Real food is the key along with a robust digestive system.

Personally I'd recommend a starch "free" diet, maybe white bread or white rice once in awhile but otherwise focus on seafood, eggs, meat, dairy and sugar. I think your pufa avoidence is a bit misguided, pufa from animal products in small amounts is fine, maybe helpful.
 
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DaveFoster

DaveFoster

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Thanks you, Blossom. Well that's depressing.
Have you heard of Elixa
You should really check out Richard Nikoley's stuff at Free the Animal -
A Gut Microbiome, Soil-Based Probiotic, and Resistant Starch Primer For Newbies

I got into all that stuff when it first came out and the results weren't great. Can't say I recommend it but the stuff Richard's posted is interesting. I'm sharing because that is the highest quality probiotic available.

Frankly I have the best digestion of my life after taking Mirtazapine and drinking less OJ. I only drink ripe oranges that I squeeze myself. Been drinking more watermelon juice lately since it's more affordable
Mirtazapine? Why do you think that is? Thanks for the Eliza by the way; I'll consider that after I finish another course of antibiotics.

I wouldn't take any a advice from Richard Nikoley, he has done nothing but regress and switch sides since he started his blog. Everything he does is an amazing epiphany in health that ends up petering out and he's onto the next band wagen, pretending like he's always been there.

Personally I think RS is the most detrimental thing you could possibly do and dont be suprised if you get some crazy endotoxin related symptoms which I know you have already experienced.

Personally I think you don't eat enough real food and have been relying heavily on supplements which look good on paper but never really help in the long run. Real food is the key along with a robust digestive system.

Personally I'd recommend a starch "free" diet, maybe white bread or white rice once in awhile but otherwise focus on seafood, eggs, meat, dairy and sugar. I think your pufa avoidence is a bit misguided, pufa from animal products in small amounts is fine, maybe helpful.
I don't do well on meat; it makes me tired. Potatoes are a good staple for me, but I do think it's causing a worsening of my symptoms, so maybe I should limit them.

That probiotic doesn't even have L Reuteri in it, I would just get some kefir.
Do you have any good experiences with kefir, Rob?
 

Bodhi

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"I'm 19 years old, and I've dealt with autism, anxiety, and depression my whole life. I've cut out PUFA's the past year, and I plan to continue doing so (under 4 grams/day until I die.) My diet consists of milk, sugar, coffee, OJ, potatoes, coconut oil, chocolate, salt/baking soda, occasional shellfish (shrimp, mussels, clams), along with daily oysters and liver. Supplements include a baby aspirin, liberal caffeine (coffee), methylene blue (250 mcg/day), K2 (5 mg/day), vitamin E (400 IU/day), occasional B-vitamins via haidut's Energin (30 drops), occasional Lapodin, and Pansterone (DHEA and pregnenolone 2-5 mg/day each).

I've recently been dealing with mild fibromyalgia symptoms, along with the IBS symptoms I've suffered from my whole life. I used smaller doses of tetracycline (50 mg) with positive effects. My doctor placed me on a 10-day course of amoxicillin and clavunic acid; this resulted in diarrhea and an initial increase in feelings of well-being. By day 7, I started to experience some severe regression of symptoms"

Clearly i was the amox and or clavuncic, if you research this subject and Peatarians anecdotes you will find that most do pretty good on Doxy and not so good on others...

Read my post : Bowel Cleansing, Gut Flora And Confusion

I have decided to cleanse my bowels with the arise and shine protocol combined with galbladder flushes from Andreaz Moritz

Whole Body Detox and Cleanse Systems | Arise & Shine

I ordered the Biosporin forte from Ukraine the one Ray Peat recommends and i ordered these ones to build up flora:

Jarrow Formulas, Saccharomyces Boulardii + MOS, 90 Veggie Caps
Hyperbiotics, PRO-15. The Perfect Probiotic, 5 Billion CFU', 60 Tablets
Garden of Life, Primal Defense, Ultra, Ultimate Probiotic Formula, 90 UltraZorbe Veggie Caps
Flora Grow 90
A means for normalization of the intestinal microflora Biosporin Forte capsules 10pcs

Now the reason is why i take so many different brands is that i tried to find one product with all the strains that i read positives about but could not find this..

Offcourse some contain same strains but that is no problem, after the cleanse i will take one pill from another brand to re colonize and i wil not take ALL the pro-biotics, just see how i go after i took it for 2 weeks....

If i still have problems after this protocol i wil go for carrot, charcoal and Sulfur, if that does not work i will try doxy as a last resort...
I am not Autistic but suffer from high sensitivity and it seems a bit within autistic spectrum and i believe it's endotoxin /serotonin, thyroid related.

Good luck!
 
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DaveFoster

DaveFoster

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"I'm 19 years old, and I've dealt with autism, anxiety, and depression my whole life. I've cut out PUFA's the past year, and I plan to continue doing so (under 4 grams/day until I die.) My diet consists of milk, sugar, coffee, OJ, potatoes, coconut oil, chocolate, salt/baking soda, occasional shellfish (shrimp, mussels, clams), along with daily oysters and liver. Supplements include a baby aspirin, liberal caffeine (coffee), methylene blue (250 mcg/day), K2 (5 mg/day), vitamin E (400 IU/day), occasional B-vitamins via haidut's Energin (30 drops), occasional Lapodin, and Pansterone (DHEA and pregnenolone 2-5 mg/day each).

I've recently been dealing with mild fibromyalgia symptoms, along with the IBS symptoms I've suffered from my whole life. I used smaller doses of tetracycline (50 mg) with positive effects. My doctor placed me on a 10-day course of amoxicillin and clavunic acid; this resulted in diarrhea and an initial increase in feelings of well-being. By day 7, I started to experience some severe regression of symptoms"

Clearly i was the amox and or clavuncic, if you research this subject and Peatarians anecdotes you will find that most do pretty good on Doxy and not so good on others...

Read my post : Bowel Cleansing, Gut Flora And Confusion

I have decided to cleanse my bowels with the arise and shine protocol combined with galbladder flushes from Andreaz Moritz

Whole Body Detox and Cleanse Systems | Arise & Shine

I ordered the Biosporin forte from Ukraine the one Ray Peat recommends and i ordered these ones to build up flora:

Jarrow Formulas, Saccharomyces Boulardii + MOS, 90 Veggie Caps
Hyperbiotics, PRO-15. The Perfect Probiotic, 5 Billion CFU', 60 Tablets
Garden of Life, Primal Defense, Ultra, Ultimate Probiotic Formula, 90 UltraZorbe Veggie Caps
Flora Grow 90
A means for normalization of the intestinal microflora Biosporin Forte capsules 10pcs

Now the reason is why i take so many different brands is that i tried to find one product with all the strains that i read positives about but could not find this..

Offcourse some contain same strains but that is no problem, after the cleanse i will take one pill from another brand to re colonize and i wil not take ALL the pro-biotics, just see how i go after i took it for 2 weeks....

If i still have problems after this protocol i wil go for carrot, charcoal and Sulfur, if that does not work i will try doxy as a last resort...
I am not Autistic but suffer from high sensitivity and it seems a bit within autistic spectrum and i believe it's endotoxin /serotonin, thyroid related.

Good luck!
Best of luck, Bodhi. Keep us updated. The Elixa probiotic looks very promising. I'm planning a rifaximin + (maybe) neomycin with a co-administered probiotic and prebiotic (see above post) followed by Elixa (the 12-day course) after my antibiotic ends. If this doesn't fix the problem, then it's very likely not due to an imbalance of gut flora; maybe it's parasitical, fungal, or otherwise.

I agree with JayFish, try to eat properly. But here's another probiotic that I've taken in the past: vsl3
I'm just eating according to craving and plenty of nutrients (all of them). I've heard mixed reivews of VSL3 (mostly positive but not lifechanging). What was your experience?
 

Suikerbuik

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Dave, be careful with raw potato starch. The stuff even persorbs in healthy guts let alone in damaged guts and will absolutely inflame/clog your capillaries.

Goodluck, these issues are really difficult.
 

Amazoniac

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Hi Dave,
What would happen if you fasted? I know that there's a stress response that can mask diagnosis, but in intestinal problems things seem more accentuated, the initial crash and the relief are greater.
What foods do you crave?
I would focus on motility of the intestines, keeping things dynamic; having odorless gas (initially) until minimal gas, probably encouraging safer microbes and hopefully they inhibit the detrimental ones to some degree, just eating nourishing foods that give you that effect is enough; and aim for minimal or absence of soiling when you poop, a good thing to track.
You live in a sunny place?
 

narouz

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dave-
This is not Peatian,
but here's something you might consider trying:

Get some Nystatin--it's an antifungal/anti-yeast which is not systemic, will stay in the gut.
Do diagnosis by treatment.
If you take round of Nystatin, and you feel better, then that will give you some strong clues
as to where to go next.

S. boulardii is a yeast you can take which kills the candida yeast.
So you could try that in the same vein,
although I don't think it as strong as Nystatin.
(Don't take the boulardii at the same time you take the Nystatin.)

How does your tongue look? Not just now, but typically, usually, over time...?
Do you have any discomfort, bloating, pain on the right abdominal side?
 

Jakester

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dave-
This is not Peatian,
but here's something you might consider trying:

Get some Nystatin--it's an antifungal/anti-yeast which is not systemic, will stay in the gut.
Do diagnosis by treatment.
If you take round of Nystatin, and you feel better, then that will give you some strong clues
as to where to go next.

S. boulardii is a yeast you can take which kills the candida yeast.
So you could try that in the same vein,
although I don't think it as strong as Nystatin.
(Don't take the boulardii at the same time you take the Nystatin.)

How does your tongue look? Not just now, but typically, usually, over time...?
Do you have any discomfort, bloating, pain on the right abdominal side?
Nystatin has done wonders for my gut. It was prescribed to me by a very alternative-minded MD. I was taking it four times a day for a while; I now do maintenance of once a day. I take it in conjunction with a product called Interfase, from Klaire, which purportedly breaks down biofilm. (There's also Interfase Plus which I had big trouble with.)
 
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DaveFoster

DaveFoster

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Dave, be careful with raw potato starch. The stuff even persorbs in healthy guts let alone in damaged guts and will absolutely inflame/clog your capillaries.

Goodluck, these issues are really difficult.
Thanks for the support.
For resistant starch, I was going to cook the potato and let it cool, but I'm not terribly interested in RS at the moment; more so a strong anti-biotic followed by a probiotic and prebiotic.

Hi Dave,
What would happen if you fasted? I know that there's a stress response that can mask diagnosis, but in intestinal problems things seem more accentuated, the initial crash and the relief are greater.
What foods do you crave?
I would focus on motility of the intestines, keeping things dynamic; having odorless gas (initially) until minimal gas, probably encouraging safer microbes and hopefully they inhibit the detrimental ones to some degree, just eating nourishing foods that give you that effect is enough; and aim for minimal or absence of soiling when you poop, a good thing to track.
You live in a sunny place?
When I fast, my mood improves dramatically.

My bowel movements are diarrhea, but there's some minimal constipation with some bleeding. The main thing is the chronic fatigue, fibromyalgia, and lack of motivation/concentration that goes along with these. The depression of getting a condition like this at a young age compounds the negative mood effects of an inflamed gut. My sleep schedule is moving toward insomnia and 13-hour blocks of sleep, where I can't move.

I do live in a sunny place; sometimes I go outside, but I use two red lights that shine on me throughout the day, and they help me immensely. As long as I'm under these lights, I usually do not have pain.

Cravings: chocolate, sometimes potatoes with coconut oil and salt, and often coffee. I crave coffee with milk and sugar quite a bit. I sometimes crave OJ. I don't usually crave protein.
dave-
This is not Peatian,
but here's something you might consider trying:

Get some Nystatin--it's an antifungal/anti-yeast which is not systemic, will stay in the gut.
Do diagnosis by treatment.
If you take round of Nystatin, and you feel better, then that will give you some strong clues
as to where to go next.

S. boulardii is a yeast you can take which kills the candida yeast.
So you could try that in the same vein,
although I don't think it as strong as Nystatin.
(Don't take the boulardii at the same time you take the Nystatin.)

How does your tongue look? Not just now, but typically, usually, over time...?
Do you have any discomfort, bloating, pain on the right abdominal side?
I will look into nystatin. I've heard very good things about S. Boulardii, so I might purchase a separate product with this in it.

Yeast, fungus, and viral infections are something I've considered. I don't think I have a huge problem with heavy metals, but I don't know. Elevated monocytes point to a virus. For my tongue, I used to have white thrush all the time, but now it's just the color of the food I eat. (Maybe it was the milk before). It's easy to scrape off with my tongue scraper, and I believe it's an improvement from previously.

Priorities on point lol :praying:
:wink Thanks, Peat would be proud.
 
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DaveFoster

DaveFoster

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I should add that I didn't have a good experience with the raw potato starch (resistant starch) and also with Probiotics; kefire, saurkraut, Elixa. Literally I became a gas factory, got multiple skin fungal infections, the absolute worst brain fog I've ever experienced, etc. Actually that experience of mine is why I might more readily accept Peat's view of the gut biome than others.

I do not endorse Elixa and think it mostly a waste of money. I think it would be more helpful to improve the "redox state" and take a good antibiotic like Mino of Peni VK.In relation to the better mood while fasting it could be the euphoric effects of cortisol- coming from someone who did IF for 3 years with great effects on body comp. but terrible results in every other aspect of health.

I've had amazing results with Doxy and Minocycline. Cleared up skin, no more orange coating on tongue (fusobacterium), and better memory (almost). Digestion is good on both of them too in my experience. Also had a really good experience with Penicillin VK.

I had a bad time with Amoxicillin when I was younger. I really don't know what the issue is with it but I would take PeniVK over it any day.

I think Mirtazapine is helpful for diarrhea because of its anti-serotonin properties. I asked Ray about the drug and he said its anti-serotonin effects are helpful. I also found Pregnenolone (health natura brand) helpful for diarrhea as well. I haven't experienced bad digestion since I started the Mirt. and less gas/sluggishness after using the antibiotics-including when eating a lot of potatoes.

Anyway I just wanted to share my experience from experimenting with different things- Ray's approach and Probiotic/Prebiotic route.
I appreciate the time you put into that. This complicates the matter. Maybe the antibiotic was the problem. This is difficult to deal with. I'm getting some good results from kefir, (although it's very hard to separate variables). I'll have to put some thought into this.
 

Amazoniac

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Not Uganda
Were you raised under pressure to become a overachiever? I'm not a soul reader but there are little things in the way you write that made me think that, I can be wrong though.
Anyway, living under pressure makes you lose the desire for protein because you cannot digest it well when you're under stress. Paul Eck wrote a bit about that, he even went further to speculate that vegetarians start losing their interest for animal protein gradually as a defensive measure: first ruminant meat, then poultry, then fishes.
Protein needs under stress are increased, but in prolonged stress you cannot keep up and match the needs, so you know the snow ball story..
If there's something that almost every article that I read so far regarding nutrition and immunity agree on is that protein is one of the most important anti-infective nutrients.
If something mentioned relates to you, you can google kwashiorkor + symptom.

Some other things that I would consider:
Magnesium malate or bicarbonate.
Selenium, vit C are two things that are worth experimenting more or less.
Lowering K2?
More sun exposure.
A1/A2 milk.
I would also evaluate if I'm not getting things in excess.
 
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