Help for health issues

X160 · Oct 7, 2014

rHello Forum members,
My mother suffers from chronic hypothyroidism and recently I have modified her diet in RP style and introduced a few supplements. Her lab results are as follows:

1. Total T3: 1.18 ng/ml (normal range: 0.60 to 2.00 ng/ml)
2. Total T4: 5.6 mcg/dl (normal range: 4.50 to 12.50 mcg/dl)
3. TSH: 2.69 uIU/ml (mormal range: 0.30 to 5.00 uIU/ml)
4. Serum Calcium: 8.8 mg/dl (normal range: 8.4 to 10.4 mg/dl)
5. 25 Hydroxy Cholacalciderol - Vitamin D3: 69 ng/ml (sufficiency range: 40-100 ng/ml)
6. Parathyroid: 25 pg/ml (normal range: 11.12-79.5 pg/ml)

Current Supplements and dietary regimen:
20 mcg Synthetic T3 in divided doses, 50 mcg Synthetic T4 after dinner (daily). Great lakes Gelatin, Magnesium Glycinate, Calcium citrate maleate, Vitamin D3, Milk of Magnesia (for constipation), daily carrot salad, watermelons, papaya, weekly serving of lamb liver.

Current health issues:
Chronic constipation for which even milk of magnesia is not able to help, body pains limbs, shoulders and fingers, difficulty in climbing stairs, bouts of depression.

I am looking for help to interpret these results and get some suggestions to alleviate her pain. Thank you!

Mittir · Oct 7, 2014

Test results does not look too bad. But, RP has never seen a comfortably
healthy person with TSH above 2 and i had the same experience.
TSH should be at least below 1. You need to make sure her total cholesterol
level is at least 160, preferably 200 and body is able to store glycogen before
starting thyroid hormone. Thyroid hormone can make you feel worse if
there is not enough sugar/glycogen to burn. Total cholesterol is a good
reflection of thyroid function.

PTH seems to be ok and i have seen in studies that is close to average.
RP mentioned PTH should be at the lower end of normal. I felt my best
when my PTH was around 12. Now it mostly hovers around 22. I have not
tested my PTH after increasing calcium intake.

Ideally T3 should be above normal range and T4 is usually at the middle or
lower end of normal in healthy people. RP has mentioned sometime people
feel noticeable improvement just from 1 mcg of T3. You can experiment
with using much smaller dose of T3 with higher frequency. 1-2 mcg .

You can give a detail description of her diet. Did constipation got worse
after starting new diet or certain foods? I think gelatine and watermelon
both can cause digestive problem in susceptible people. I do not feel good
eating papaya either unless it is completely ripened, which rarely happens.
Avoiding soluble fiber and starch are helpful in alleviating gas problem.
Hydrolyzed gelatine usually does not cause much problem.

I would recommend a good quality commercial apple juice with some added
baking soda as fruit substitute. High fructose in apple improves burning of sugar and
repletes liver glycogen. I think it is a good idea to slowly introduce new foods
one by one to see how body reacts to it.

Easy to digest food can make huge difference in health. Certain food can block
T4 absorption and taking before bed with a fixed type of food is more reliable.
If she drinks a cup of milk with T4 every night, that will give a stable
absorption, even when calcium is blocking upto 25 percent of T4 absorption.
Idea is to keep the same routine around T4 intake.

I think you can add 50-100 mg of niacinamide 2 times a day with fruit juice
or meal to inhibit PUFA release. I found this immensely helpful.
You can also add mixed tocopherol vitamin E to decrease PUFA damage
and it is also anti-estrogenic. I used to take 400 IU daily and now 1000-2000 IU
with good results. Requirement of vitamin E depends on PUFA storage.
Progesterone is quite helpful for females.

Low dose cyprohepatine can improve gut problems and induce quality sleep.
Fixing gut should be the main focus.

aguilaroja · Oct 8, 2014

Imad said:
Current health issues:
Chronic constipation for which even milk of magnesia is not able to help, body pains limbs, shoulders and fingers, difficulty in climbing stairs, bouts of depression....

First, it is great that your mother has an astute and attentive child, and that improvements are underway.

What is the difficulty climbing stairs? Is it being short of breath, back pain, limb pain, or other things?

As Mittir noted, TSH in the range reported with hypothyroid symptoms suggests that thyroid function remains low. Even some of the more authoritarian groups concede the point:

http://thyroid.about.com/cs/testsforthy ... bs2003.htm
"A serum TSH result between 0.5 and 2.0 mIU/L is generally considered the therapeutic target for a standard L-T4 replacement dose for primary hypothyroidism."

It is always best to interpret lab values together with symptoms. It is best INHMO if the T3 can be divided into at least 4 times per day frequency. In some, augmenting thyroid function is a primary relief function for constipation.

Sometimes topical vitamin E is a good reliever for the small joints, such as the hands, as the oil is absorbed deep enough to get directly to irritated regions.

X160 · Oct 9, 2014

Mittir said:
Test results does not look too bad. But, RP has never seen a comfortably
healthy person with TSH above 2 and i had the same experience.
TSH should be at least below 1.

Thanks a lot for your reply, Mittir.
I am not sure what to do to get her TSH below 1. She is taking about 50mcg synthetic T4 at bedtime. Should I increase it to 100mcg?

Mittir said:
You need to make sure her total cholesterol
level is at least 160, preferably 200 and body is able to store glycogen before
starting thyroid hormone. Thyroid hormone can make you feel worse if
there is not enough sugar/glycogen to burn. Total cholesterol is a good
reflection of thyroid function.

I will get her cholestrol numbers and post it here soon. The last time she got her total cholestrol checked (about 3 months back), it was 220.

Mittir said:
PTH seems to be ok and i have seen in studies that is close to average.
RP mentioned PTH should be at the lower end of normal. I felt my best
when my PTH was around 12. Now it mostly hovers around 22. I have not
tested my PTH after increasing calcium intake.

Should I try increasing her calcium intake to lower PTH further? She had consulted an orthopedic for joint pains in the past, he got it X-rayed and told her that she has weak bones (and bone loss).

Mittir said:
Ideally T3 should be above normal range and T4 is usually at the middle or
lower end of normal in healthy people. RP has mentioned sometime people
feel noticeable improvement just from 1 mcg of T3. You can experiment
with using much smaller dose of T3 with higher frequency. 1-2 mcg.

She is taking 20mcg synthetic T3 in 4 divided doses spread throughout the day.I will have her spread it to 6 times a day.

Mittir said:
You can give a detail description of her diet. Did constipation got worse
after starting new diet or certain foods? I think gelatine and watermelon
both can cause digestive problem in susceptible people. I do not feel good
eating papaya either unless it is completely ripened, which rarely happens.
Avoiding soluble fiber and starch are helpful in alleviating gas problem.
Hydrolyzed gelatine usually does not cause much problem.

Constipation is pretty much the same for the past 7 years. The problem is whenever she takes something to help her with it, she develops tolerance and it stops working. She has tried Ayurvedic, Unani and they stopped working after sometime. About 6 months back, I asked her to take milk of magnesia which was helping initially and now it is not.
She takes Great lakes hydrolyzed gelatine.
She takes a cup of Oats for breakfast, White rice and indian curry for lunch and dinner. She take lentils occasionally but only after soaking it overnight and cooking it well. In a day she takes about 1 litre of commercial low-fat milk and about 2 cups of commercial apple/orange juice. All this apart from daily carrot salad, teaspoon of coconut oil after every meal and weekly serving of panfried lamb liver.

Mittir said:
I would recommend a good quality commercial apple juice with some added
baking soda as fruit substitute. High fructose in apple improves burning of sugar and
repletes liver glycogen. I think it is a good idea to slowly introduce new foods
one by one to see how body reacts to it.

She is taking apple juice already and it makes her feel good

Mittir said:
I think you can add 50-100 mg of niacinamide 2 times a day with fruit juice
or meal to inhibit PUFA release. I found this immensely helpful.
You can also add mixed tocopherol vitamin E to decrease PUFA damage
and it is also anti-estrogenic. I used to take 400 IU daily and now 1000-2000 IU
with good results. Requirement of vitamin E depends on PUFA storage.
Progesterone is quite helpful for females.

She does have stores of PUFAs because she used to cook in Sunflower oil until I asked her to stop. She has been using refined Olive oil/Palmolein oil ever since though I understand it has about 10% PUFAs. She is of the opinion that not all traditional south indian curries can be cooked in ghee

I will certainly add niacinamide. For Vitamin E, I was under the assumption that what she gets from weekly serving of liver would be enough. But as you said, to counter the PUFAs she might need additional Vit.E and I will add it. Will look at getting Progest-E too. She has a decent amount of fat around her hips.

Mittir said:
Low dose cyprohepatine can improve gut problems and induce quality sleep.
Fixing gut should be the main focus.

I will have to educate myself on cyprohepatine

I will try adding that too if it will help.
I agree that her gut is a mess. She often reports being bloated and full.
She has sleep issues too for which she is taking low dose Melatonin and Clonazepam.

X160 · Oct 9, 2014

aguilaroja said:
First, it is great that your mother has an astute and attentive child, and that improvements are underway.

Thank you, Aguilaroja

aguilaroja said:
What is the difficulty climbing stairs? Is it being short of breath, back pain, limb pain, or other things?

It's the pain in her back and joints.

aguilaroja said:
It is always best to interpret lab values together with symptoms. It is best INHMO if the T3 can be divided into at least 4 times per day frequency. In some, augmenting thyroid function is a primary relief function for constipation.

Sometimes topical vitamin E is a good reliever for the small joints, such as the hands, as the oil is absorbed deep enough to get directly to irritated regions.

She is taking 20mcg synthetic T3 is 4 divided doses already. I can get A.C Grace's liquid Vit.E and have her apply topically to her joints. I will have to look for cheaper options for Vit.E though

Thank you for your reply, Aguilaroja. Appreciate it

X160 · Oct 9, 2014

Just for the context, she is 55 years old. Me and my bro were born through a Cesarean section and she also had to get her uterus removed due to complications after my younger brother's birth.

pboy · Oct 9, 2014

simple lack of calories, to the point of not near abundance, can cause constipation. Especially when you add in the high amount of sticky fiber in oats, lentils, and carrot peels. I haven't tried it cause it disgusts me, but I assume gelatin as a powder is highly sticky also

X160 · Oct 9, 2014

pboy said:
simple lack of calories, to the point of not near abundance, can cause constipation. Especially when you add in the high amount of sticky fiber in oats, lentils, and carrot peels. I haven't tried it cause it disgusts me, but I assume gelatin as a powder is highly sticky also

Thank you for the reply, Pboy.
Makes sense. I will ask her to avoid oats and lentils altogether.
She is taking peeled carrots with a tablespoon of coconut oil. I don't know if shredding it, will make any difference.

pboy · Oct 9, 2014

at least until it clears up, then she can maybe try adding those back in...but any kind of seed that still has the bran layer like oats and lentils are really astringent on the intestines, and not ideal if you aren't already having good rythmn and metabolism

good idea peeling the carrots, shredding probably wont change the outcome

Mittir · Oct 9, 2014

RP has mentioned state of uterus is a good reflection of ageing for the rest of the body.
Estrogen to progesterone ratio is a major cause of aging of uterus. RP's PhD thesis is on ageing
of uterus. Vitamin E is a big factor here. You can check older threads on progesterone use.

Due to excess estrogen female liver is not good at converting T4 to T3. If T4 is not
converted properly it can make one more hypothyroid. Based on below
normal T4 number, you can slightly increase T4 intake, it takes 2-3 weeks for
T4 to reach saturation. but strengthening the liver with 80 grams of quality
proteins, B vitamins, sugar supply, raw carrot salad or other safe fibers are necessary.

All kind of X-rays are very harmful and estrogenic. It would be a good idea to avoid
X-rays in future. Vitamin K is the most important factor in reversing bone loss.
RP mentioned Thorne Research's vitamin K and our forum member haidut has a product
with all the oil soluble vitamins A,D, K, E. There is a thread on the details of the supplement.
RP recommends 1200-2000 mg of calcium daily.

Fructose is beneficial in bone health, blood sugar management, liver glycogen and
whole lot of other health issue. For me, fructose has been life changing.
You can experiment with increasing fructose intake and lowering starch. I think it would be
a good idea to cut out starch completely for a week and use Apple juice with baking soda
as the main source of carb to see how body reacts. Acid and pectin in OJ can
be problematic for people with gut issues.

Fixing gut is a lot of work, there are so many problematic substance in
regular foods and supplements, it takes time to figure out which food or supplement
is causing problem. Avoid supplements with problematic ingredients, even
supplement without declared excipient can cause allergenic reaction.

If milk is not digested properly it can cause more problem than it solves.
You can easily figure out the source by not drinking milk for few days.
Low fat milk usually have added vitamin, these vitamin solvent can be allergenic.
Constipation is one of the common symptoms of low thyroid function.
Carrot salad should shredded, if not shredded it should be chewed well
but not to the point of blended carrot. You can also use cooked bamboo shoots.
You can buy those cans ( these are usually boiled) and boil that in water
for 5 minutes to remove the bad taste.

It is not easy to change food habit, but when someone feels better by changing
food they have good incentive to stick to it. I think a good idea would be a
week long experiment with easy to digest food and avoiding all the problematic
foods like starch, spices, lentil, oats etc. Eating protein during the day time is recommended.
and fat and carb mostly after sunset. Protein requires strong digestive power and
after sunset digestion slows down. You can try red light therapy and 1-2 min bag breathing
2-3 times a day to get quick result. You can simply use 200-500 watts of regular
clear incandescent bulb or chicken brooder lamp for light therapy.

RP does not recommend melatonin and i do not know anything about other med.
Cyproheptadine is a old anti-histamine which is used for wide variety of health issues.
Just 1-2 mg daily can bring big change. I have been taking 1-2 mg daily for more than
a month and it is amazing. There will be slight drowsiness for first few days.
It can cause digestion problem in some. Any time you add new food or supplement
always pay attention to it's reaction.

Liver is rich source of vitamin A, not E. Some people react badly to poor quality
vitamin E. You may have try several brand before you can settle for one.
Lot of people here use lotioncrafter, someone got good result from using
non-soy bean oil derived vitamin E ( it was swanson and solaray super bio).

superhuman · Oct 9, 2014

Mittir did you notice increase in appetite after starting the cypro?

Mittir · Oct 9, 2014

superhuman said:
Mittir did you notice increase in appetite after starting the cypro?

I did not notice any increase in appetite, but i did not have appetite problem before.
I always ate a lot without counting calories. I remember reading studies that used much
higher doses to stimulate appetite in underweight people. I take half to 1 mg two times a day.

BingDing · Oct 9, 2014

Imad

It sounds like your mom is receptive to RP's ideas and is already doing a lot of things right, which is great! Don't panic, thinking things through before you try something is fine. The road back to health is long and interesting.

TSH can vary widely over a 24 hour period, even from 1.0 to 5.0, I'm not sure if RP has acknowledged that but the thyroid numbers are generally OK. There are probably better changes to make than thyroid supps.

Cascara sagrada has emodin, and is very good for constipation. RP has written an article saying that Cascara has many other health benefits, too.

"Stickiness" is not a criterion of anything meaningful, as far as I know; RP has never mentioned it. I would ignore any advice about that. Oats, white rice, and lentils are the least problematic of the starches, gas from the digestion of starch in the large intestine is normal and not an issue with RPs ideas. It is only when bacteria move into the small intestine that problems arise. If your mom likes those foods I would not discourage her, she has to eat something.

The need to replete the micronutrients underlies everything, no matter what you eat, and it is not particularly easy. Calcium, magnesium, sodium, and potassium are like a mineral gargoyle, hovering on the edge of the castle. Try to get all of them into the diet, magnesium is widely deficient; topical magnesium oil can be good.

The B vitamins are cofactors in innumerable metabolic pathways essential to good health, without them the enzymes that catalyze the pathways don't work right. Haidut's B complex Energin has good reviews, but you still need B5 and B12.

Vitamin D deficiency is also widespread, and it is s*** simple to fix. A search here will help you find an answer. (Ignore Suikerbuik for the time being, he has a hard on for Vit D that no one else has agreed with).

Best to you and your mom.

Mittir · Oct 10, 2014

Lentil is a legume. Here is a quote on legume from Ray Peat

Ray Peat said:
The estrogenic properties of legumes were studied when sheep farmers found that their sheep miscarried when they ate clover. (I think it's interesting how this terribly toxic effect has been neglected in recent decades.) All legumes have this property, and all parts of the plant seem to contain some of the active chemicals. In beans, several substances have been found to contribute to the effect. The estrogenic effects of the seed oils and the isoflavones have been studied the most, but the well-known antithyroid actions (again, involving the oils, the isoflavones, and other molecules found in legumes) have an indirect estrogen-promoting action, since hypothyroidism leads to hyperestrogenism. (Estrogens are known to be thyroid suppressors, so the problem tends to be self-accelerating.)
The various specific actions of the many estrogenic substances in beans and other legumes haven't been throughly studied, but there is evidence that they are also--like estrogen itself--both mutagenic and carcinogenic.
http://raypeat.com/articles/articles/na ... gens.shtml

Here is a quote on sensitive digestion and starch.

Ray Peat said:
For people with really sensitive intestines or bad bacteria, starch should be zero.

Source: http://peatarian.com/peatexchanges
You can find lots of RP comments on starch there.

BingDing · Oct 10, 2014

Mittir,

I know Ray's opinion about legumes, and I'm not ignoring it. That quote says what it says, legumes are estrogenic.

Nonetheless, he has said lentils are the least problematic of them. I'll try to find a reference.

And there is a difference between people with "really sensitive intestines or bad bacteria" and people without.

I see a continuum between the desperately sick and the vigorously healthy, context is important. What is significantly estrogenic to one person might be trivial to someone smart enough to supplement Vit E, for example. Imad will have to decide for him/her self what is best.

But an occasional meal of lentils, if other nutrients are well taken care of, shouldn't be a problem, IMO. And the benefits of a socially graceful meal should not be disregarded.

X160 · Oct 10, 2014

BingDing said:
Imad

It sounds like your mom is receptive to RP's ideas and is already doing a lot of things right, which is great! Don't panic, thinking things through before you try something is fine. The road back to health is long and interesting.

TSH can vary widely over a 24 hour period, even from 1.0 to 5.0, I'm not sure if RP has acknowledged that but the thyroid numbers are generally OK. There are probably better changes to make than thyroid supps.

Cascara sagrada has emodin, and is very good for constipation. RP has written an article saying that Cascara has many other health benefits, too.

"Stickiness" is not a criterion of anything meaningful, as far as I know; RP has never mentioned it. I would ignore any advice about that. Oats, white rice, and lentils are the least problematic of the starches, gas from the digestion of starch in the large intestine is normal and not an issue with RPs ideas. It is only when bacteria move into the small intestine that problems arise. If your mom likes those foods I would not discourage her, she has to eat something.

The need to replete the micronutrients underlies everything, no matter what you eat, and it is not particularly easy. Calcium, magnesium, sodium, and potassium are like a mineral gargoyle, hovering on the edge of the castle. Try to get all of them into the diet, magnesium is widely deficient; topical magnesium oil can be good.

The B vitamins are cofactors in innumerable metabolic pathways essential to good health, without them the enzymes that catalyze the pathways don't work right. Haidut's B complex Energin has good reviews, but you still need B5 and B12.

Vitamin D deficiency is also widespread, and it is s*** simple to fix. A search here will help you find an answer. (Ignore Suikerbuik for the time being, he has a hard on for Vit D that no one else has agreed with).

Best to you and your mom.

Thanks a lot, BingDing :)
I remember few years back when she was severely depressed and on SSRIs, her TSH was 150. It's been a long and interesting journey since then

I will definitely give her Vit.E and B's. Her Vit.D3 looks ok from the lab results. She is already taking 400mg of Magnesium Glycinate daily.

X160 · Oct 10, 2014

Mittir said:
RP has mentioned state of uterus is a good reflection of ageing for the rest of the body.
Estrogen to progesterone ratio is a major cause of aging of uterus. RP's PhD thesis is on ageing
of uterus. Vitamin E is a big factor here. You can check older threads on progesterone use.

Due to excess estrogen female liver is not good at converting T4 to T3. If T4 is not
converted properly it can make one more hypothyroid. Based on below
normal T4 number, you can slightly increase T4 intake, it takes 2-3 weeks for
T4 to reach saturation. but strengthening the liver with 80 grams of quality
proteins, B vitamins, sugar supply, raw carrot salad or other safe fibers are necessary.

All kind of X-rays are very harmful and estrogenic. It would be a good idea to avoid
X-rays in future. Vitamin K is the most important factor in reversing bone loss.
RP mentioned Thorne Research's vitamin K and our forum member haidut has a product
with all the oil soluble vitamins A,D, K, E. There is a thread on the details of the supplement.
RP recommends 1200-2000 mg of calcium daily.

Fructose is beneficial in bone health, blood sugar management, liver glycogen and
whole lot of other health issue. For me, fructose has been life changing.
You can experiment with increasing fructose intake and lowering starch. I think it would be
a good idea to cut out starch completely for a week and use Apple juice with baking soda
as the main source of carb to see how body reacts. Acid and pectin in OJ can
be problematic for people with gut issues.

Fixing gut is a lot of work, there are so many problematic substance in
regular foods and supplements, it takes time to figure out which food or supplement
is causing problem. Avoid supplements with problematic ingredients, even
supplement without declared excipient can cause allergenic reaction.

If milk is not digested properly it can cause more problem than it solves.
You can easily figure out the source by not drinking milk for few days.
Low fat milk usually have added vitamin, these vitamin solvent can be allergenic.
Constipation is one of the common symptoms of low thyroid function.
Carrot salad should shredded, if not shredded it should be chewed well
but not to the point of blended carrot. You can also use cooked bamboo shoots.
You can buy those cans ( these are usually boiled) and boil that in water
for 5 minutes to remove the bad taste.

It is not easy to change food habit, but when someone feels better by changing
food they have good incentive to stick to it. I think a good idea would be a
week long experiment with easy to digest food and avoiding all the problematic
foods like starch, spices, lentil, oats etc. Eating protein during the day time is recommended.
and fat and carb mostly after sunset. Protein requires strong digestive power and
after sunset digestion slows down. You can try red light therapy and 1-2 min bag breathing
2-3 times a day to get quick result. You can simply use 200-500 watts of regular
clear incandescent bulb or chicken brooder lamp for light therapy.

RP does not recommend melatonin and i do not know anything about other med.
Cyproheptadine is a old anti-histamine which is used for wide variety of health issues.
Just 1-2 mg daily can bring big change. I have been taking 1-2 mg daily for more than
a month and it is amazing. There will be slight drowsiness for first few days.
It can cause digestion problem in some. Any time you add new food or supplement
always pay attention to it's reaction.

Liver is rich source of vitamin A, not E. Some people react badly to poor quality
vitamin E. You may have try several brand before you can settle for one.
Lot of people here use lotioncrafter, someone got good result from using
non-soy bean oil derived vitamin E ( it was swanson and solaray super bio).

Thanks a lot for the detailed reply, Mittir.
I will try modifying her diet one step at a time and also introduce the Vitamins and Cyproheptadine and see how she feels. Will also try Cascara as BingDing suggested.
I have myself been taking Levocetrizine for my allergy issues and sinusitis. Will try switching to Cyproheptadine as it supposed to function as an anti-histamine as well.

aguilaroja · Oct 10, 2014

Imad said:
...I have myself been taking Levocetrizine for my allergy issues and sinusitis. Will try switching to Cyproheptadine as it supposed to function as an anti-histamine as well.

Please keep in mind that Cyproheptadine tends to cause drowsiness or be sedating. It would be best to start by using it at night, and when you could sleep late the next day if needed. That would give experience with its duration of action and how daytime alertness goes.

Levocetrizine, and the 2nd or 3rd generation anti-histamines are known for generally being less sedating. The pharmacology dogma is that sedating action of anti-histamines relates to their ease of crossing into the brain. As has been noted, Cyproheptadine has helpful properties beyond its "anti-histamine" actions.

X160 · Oct 11, 2014

aguilaroja said:
Imad said:

...I have myself been taking Levocetrizine for my allergy issues and sinusitis. Will try switching to Cyproheptadine as it supposed to function as an anti-histamine as well.

Click to expand...

Please keep in mind that Cyproheptadine tends to cause drowsiness or be sedating. It would be best to start by using it at night, and when you could sleep late the next day if needed. That would give experience with its duration of action and how daytime alertness goes.

Levocetrizine, and the 2nd or 3rd generation anti-histamines are known for generally being less sedating. The pharmacology dogma is that sedating action of anti-histamines relates to their ease of crossing into the brain. As has been noted, Cyproheptadine has helpful properties beyond its "anti-histamine" actions.

Thank you, Aguilaroja. I will keep that in mind and see how it goes :)

X160 · Oct 22, 2014

Mittir, BingDing, Aguilaroja and others,
I got my mom to start with 2mg of cyproheptadine and stop the melatonin tablets. She reported lack of sleep and lot of stress the next morning.

I took 2mg of cyproheptadine too and stopped cetrizine. It definitely helped with the histamine mediated skin itching and I got normal sleep. I am planning to do this from now on.

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