my recent subhuman bloodwork for recurring nausea/anxiety
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@the-MOUSE said in my recent subhuman bloodwork for recurring nausea/anxiety:
idk why it wasnt tested again this time, but my ferritin was very low at 34 around a yr back, although other iron markers were fine like tibc
Ferritin at 34 ng/ml isn't low. When you say transferrin saturation was normal, was it between 30 and 40%? If so, your ferritin level is fine.
I'm not sure if I can interpret your serum calcium not knowing if it is ionized calcium or total calcium, and even then not knowing your PTH values and vit D status makes the determination difficult.
About your metabolic acidosis diagnosis, that isn't a main cause as much as it is the result of various factors.
You mention your intake of electrolytes being lacking, but I doubt if you can drink plenty of electrolytes to make your body stores of it. It's better to get your mineral that replenish your body with electrolytes on a regular basis, as these minerals are constantly being used and excreted. When you sweat and urinate and defecate, these minerals are excreted. You get a lot of calcium from milk, cheese, and well-cooked green leaf vegetables (as well as vitamin K and magnesium from Leaves). Potassium from meat and from fruits and vegetables (but little calcium and magnesium). And salt from adding salt liberally to taste. Are you eating enough of these in your nutrition lifestyle? If you're not, you end up having to rely on supplements and there is the matter of whether they are absorbed well in the body. On this aspect, eating whole foods offers this advantage. I'm not even sure I could run into deficiencies if I eat a diversity of foods with enough quantity that fills me up enough as that is what people have been doing at earlier periods in places where there is a variety of food sources to choose from.
And if I ate without having to resorts to fads like carnivore or ketogenic diets and just ate like I never attended universities and took coaching lessons such as the Mediterranean diet or Atkins diet, of which there is dizzying array of in the US, and get good air and sunlight, and not even have to walk 10,000 steps a day or workout, but just attend to manual chores (just being active), I would naturally be living a Peaty lifestyle already without knowing who Ray Peat is. Ray Peat is like a prophet telling us to go back to where we started, as the world teems with false prophets of every stripe.
I simply test my health daily with simple methods that work very well. I would add my own markers to Ray Peat's body temperature with simple tests such as breath rate, which is a proxy for serum pH (instead of an arterial blood gas- expensive and painful), and a urine and saliva pH test using test strips I buy from Amazon (Hydrion pH 5.5-8). With these I know my acid-balance status, which when optimal, and used together with a very reliable blood glucose test I do at home, I get a very good indication of my oxidative metabolic health and overall health. These give me red flags way ahead of time, and I can nip at the bud something bad from developing into worse conditions. I have other tools as well but I don't want to overwhelm you. Those can come later at a more advanced level.
One reason being able to just know how to achieve acid-base balance is it is very reassuring to know that it reflects a general state of balance that keeps me confident that I won't develop stones in the kidneys and that my organs won't develop soft calcification. As with a body in this kind of balance, the electrolytes are doing their job to keep my organs young and healthy. An example is that with the body in this state, potassium in our cells and tissues can very well regulate the entry of calcium into our cells and tissues to where calcium is used to enable our muscles and to contract and relax optimally (eg our heart beats better, we don't experience cramps) without risking too much calcium gets in our tissues and stay there. The balance is naturally expressed as intracellular potassium to being in a 30:1 ratio with extracellular potassium, and extracellular calcium at a 15000:1 ratio with intracellular ratio.
This relationship becomes disturbed when our body becomes very acidic and this is when our blood potassium becomes very high in potassium, which is our body's attempt to move potassium from its cells to its extracellular fluids, as reflected in plasma. Then the doctor will see that and tell us we have "too much potassium." And now we know that is nonsensical because we know better now. But in fairness to the doctor, he will just be exasperated explaining this to the average person.
Anyway, moving on to more diagnosis:
With your high blood glucose (at => 100 mg/dL or 5.555 mmol/L:, and anion gap being high and CO2 or bicarbonate being low, you may have a thiamine deficiency, and with that your metabolism may be stuck at glycolysis which produces plenty of lactic acid, and this could explain why you have metabolic acidosis.
I am not sure is there is such as thing as not being hypothyroid but having low metabolism, but if there is such a thing, then you are a good example because your ECG QTc value of 396 msec puts you at either slightly hypothyroid or euthyroid, and not hypothyroid. So, if I were to hazard a guess, making you sufficient in B1, if that is the only limitting factor in your getting to mitochondrial sugar metabolism and improving your acidic condition.
Maybe just like me just last week discovering I am thiamine insufficient, supplementing with thiiamine, or more thiamine if what you're currently taking is too (which was the case with me) would be a good and simple way to start you on your way to better health.
@mostlylurking I would appreciate if you have adding to add.
Add: I don't trust the QTc on its own. If I can view the ECG graph as well, I may get a more confident reading of the ECG results as to whether or not hypothyroid.
Temporal thinking is the faculty that’s
engaged by an enriched environment, but it’s
wrong to call it “thinking,” because it’s simply
the way organisms exist... - Ray Peat Nov 2017 Newsletter -
@yerrag said in my recent subhuman bloodwork for recurring nausea/anxiety:
Just first off, WOW you know a lot! I'll add a few notes here and there.
@the-MOUSE said in my recent subhuman bloodwork for recurring nausea/anxiety:
idk why it wasnt tested again this time, but my ferritin was very low at 34 around a yr back, although other iron markers were fine like tibc
Ferritin at 34 ng/ml isn't low. When you say transferrin saturation was normal, was it between 30 and 40%? If so, your ferritin level is fine.
I'm not sure if I can interpret your serum calcium not knowing if it is ionized calcium or total calcium, and even then not knowing your PTH values and vit D status makes the determination difficult.
About your metabolic acidosis diagnosis, that isn't a main cause as much as it is the result of various factors.
Thiamine deficiency/functional blockage will result in metabolic acidosis. Supplementing with enough thiamine will correct the problem. I just posted on this other thread about types of thiamine and their doses.
If thiamine is deficient (or blocked), the mitochondria in the cells cannot convert glucose into energy (ATP). The process gets derailed and this results in lactic acid being the final product instead of carbon dioxide.
https://www.functionalps.com/blog/2012/11/06/comparison-carbon-dioxide-v-lactic-acid/
When my thiamine function was blocked after taking Bactrim antibiotic, I hurt all over because I had lactic acidosis. I tried taking around 300-350mg of thiamine hcl with water, never juice, and within 45 minutes, all my inflammatory pain went away, my brain fog cleared, and my temperature increased a full degree to normal (98.6). This is how I knew that my ill health was tied in with a thiamine problem.
You mention your intake of electrolytes being lacking, but I doubt if you can drink plenty of electrolytes to make your body stores of it. It's better to get your mineral that replenish your body with electrolytes on a regular basis, as these minerals are constantly being used and excreted. When you sweat and urinate and defecate, these minerals are excreted. You get a lot of calcium from milk, cheese, and well-cooked green leaf vegetables (as well as vitamin K and magnesium from Leaves). Potassium from meat and from fruits and vegetables (but little calcium and magnesium). And salt from adding salt liberally to taste. Are you eating enough of these in your nutrition lifestyle? If you're not, you end up having to rely on supplements and there is the matter of whether they are absorbed well in the body. On this aspect, eating whole foods offers this advantage. I'm not even sure I could run into deficiencies if I eat a diversity of foods with enough quantity that fills me up enough as that is what people have been doing at earlier periods in places where there is a variety of food sources to choose from.
I developed an electrolyte problem after my body started working better via high dose thiamine hcl. I realized I wasn't eating hardly any salt so I changed what I was eating to include some salty foods and I recovered pretty quickly.
And if I ate without having to resorts to fads like carnivore or ketogenic diets and just ate like I never attended universities and took coaching lessons such as the Mediterranean diet or Atkins diet, of which there is dizzying array of in the US, and get good air and sunlight, and not even have to walk 10,000 steps a day or workout, but just attend to manual chores (just being active), I would naturally be living a Peaty lifestyle already without knowing who Ray Peat is. Ray Peat is like a prophet telling us to go back to where we started, as the world teems with false prophets of every stripe.
I simply test my health daily with simple methods that work very well. I would add my own markers to Ray Peat's body temperature with simple tests such as breath rate, which is a proxy for serum pH (instead of an arterial blood gas- expensive and painful), and a urine and saliva pH test using test strips I buy from Amazon (Hydrion pH 5.5-8). With these I know my acid-balance status, which when optimal, and used together with a very reliable blood glucose test I do at home, I get a very good indication of my oxidative metabolic health and overall health. These give me red flags way ahead of time, and I can nip at the bud something bad from developing into worse conditions. I have other tools as well but I don't want to overwhelm you. Those can come later at a more advanced level.
One reason being able to just know how to achieve acid-base balance is it is very reassuring to know that it reflects a general state of balance that keeps me confident that I won't develop stones in the kidneys and that my organs won't develop soft calcification. As with a body in this kind of balance, the electrolytes are doing their job to keep my organs young and healthy. An example is that with the body in this state, potassium in our cells and tissues can very well regulate the entry of calcium into our cells and tissues to where calcium is used to enable our muscles and to contract and relax optimally (eg our heart beats better, we don't experience cramps) without risking too much calcium gets in our tissues and stay there. The balance is naturally expressed as intracellular potassium to being in a 30:1 ratio with extracellular potassium, and extracellular calcium at a 15000:1 ratio with intracellular ratio.
When oxidative metabolism is working well, carbon dioxide is the end product (instead of lactic acid). As carbon dioxide leaves the cells, it pulls calcium out of the cells with it. So if you are deficient in thiamine and so are making lactic acid instead of carbon dioxide, there will also be a problem with calcium staying inside the cells.
Ray Peat's article, Calcium and Disease: Hypertension, organ calcification, & shock, vs. respiratory energy has some interesting information.
"Magnesium and potassium are mainly intracellular ions, sodium and calcium are mainly extracellular ions. When cells are excited, stressed, or de-energized, they lose magnesium and potassium, and take up sodium and calcium. The mitochondria can bind a certain amount of calcium during stress, but accumulating calcium can reach a point at which it inactivates the mitochondria, forcing cells to increase their inefficient glycolytic energy production, producing an excess of lactic acid. Abnormal calcification begins in the mitochondria."
-end paste-
Thiamine deficiency de-energizes the cells.The relationship between lactate and thiamine levels in patients with diabetic ketoacidosis
"Thiamine deficiency is a well-documented phenomenon among diabetic outpatients [3–5]. In experimental models, insulin deficiency leads to poor enteral thiamine absorption and decreases thiamine reuptake in the renal proximal tubule [6,7]. Severe thiamine deficiency can trigger acute lactic acidosis [8]. Thiamine functions as a cofactor in mitochondrial oxidative decarboxylation, converting pyruvate to acetyl-CoA and α-ketoglutarate to succinyl-CoA for use in the citric acid (Krebs) cycle [9]. In the absence of thiamine, pyruvate cannot enter the Krebs cycle and, instead, is converted to lactic acid. Lactic acidosis is an increasingly well-recognized phenomenon in DKA, with recent studies suggesting that the overall prevalence may be as high as 68% [10]."This relationship becomes disturbed when our body becomes very acidic and this is when our blood potassium becomes very high in potassium, which is our body's attempt to move potassium from its cells to its extracellular fluids, as reflected in plasma. Then the doctor will see that and tell us we have "too much potassium." And now we know that is nonsensical because we know better now. But in fairness to the doctor, he will just be exasperated explaining this to the average person.
Anyway, moving on to more diagnosis:
With your high blood glucose (at => 100 mg/dL or 5.555 mmol/L:, and anion gap being high and CO2 or bicarbonate being low, you may have a thiamine deficiency, and with that your metabolism may be stuck at glycolysis which produces plenty of lactic acid, and this could explain why you have metabolic acidosis.
I agree; thiamine deficiency increases blood glucose. And thiamine deficiency would explain the lactic acidosis.
I am not sure is there is such as thing as not being hypothyroid but having low metabolism, but if there is such a thing, then you are a good example because your ECG QTc value of 396 msec puts you at either slightly hypothyroid or euthyroid, and not hypothyroid. So, if I were to hazard a guess, making you sufficient in B1, if that is the only limitting factor in your getting to mitochondrial sugar metabolism and improving your acidic condition.
The thyroid (like all the other organs/parts of the body) needs thiamine to do its job. Dr. Chandler Marrs has said (somewhere) that the thyroid is like the Canary in the Coal Mine in that thyroid problems seem to happen pretty quickly in a thiamine deficiency. I think that supplementing with thiamine could well resolve a minor thyroid problem. A thiamine deficiency/functional blockage all by itself would cause poor metabolism.
Maybe just like me just last week discovering I am thiamine insufficient, supplementing with thiiamine, or more thiamine if what you're currently taking is too (which was the case with me) would be a good and simple way to start you on your way to better health.
Could you rephrase the above paragraph? I'm having a hard time understanding. What is being taken in possibly too high a dose? Or did you mean to say the thiamine dose was too small?
I am hypothyroid. Adding thiamine to my own program improved my thyroid function so I was able to lower my dose of thyroid medication.
So I think that a thiamine deficiency alone would derail oxidative metabolism because it acts as a co-factor for several enzymes in the process. Thiamine deficiency would also derail thyroid function, so this is another way that thiamine deficiency would hamper oxidative metabolism. Supplementing thiamine improved my thyroid function.
@mostlylurking I would appreciate if you have adding to add.
Add: I don't trust the QTc on its own. If I can view the ECG graph as well, I may get a more confident reading of the ECG results as to whether or not hypothyroid.
Thiamine and Heart Function
also
The Hypoxic Heart, Thiamine, and Calcium Regulation -
@mostlylurking said in my recent subhuman bloodwork for recurring nausea/anxiety:
Could you rephrase the above paragraph? I'm having a hard time understanding. What is being taken in possibly too high a dose? Or did you mean to say the thiamine dose was too small?
My brain and typing coordination had a miss (I wonder if there is a pathology to this. Happens to me too often). Sorry. I'll rephrase:
Last week I discovered I was thiamine insufficient, even with my thiamine daily dosage being high (at
250mg) relative to rda. Just like me, you may just need more thiamine. In my case, I had to increase my dosage to 1500mg. You could be either thiamine deficient (below rda) or thiamine insufficient ( above rda but still lacking in thiamine intake).@mostlylurking Thanks for adding your thoughts and references. I could use them also.
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I'm trying to make sense of why your triglycerides are below reference range. It's either a liver problem or you're not making enough insulin. Since your liver looks ok (based on your AST and ALT enzyme test results), Insulin signals your liver to convert blood sugar to triglycerides, and a lack of insulin secretion from the pancreas could keep the liver from getting the signal to convert blood sugar to triglycerides.
But I am not sure as your blood sugar is not so high. It is only milldly high, and so it's possible you are metabolizing sugar well enough or that you're not eating enough carbs such that your intake of sugar/carbs is such that your sugar metabolism is not really put to the test. Are you on low carb, or keto, or carnivore diet or doing intermittent fasting? As using these methods are a poor substitute to deal with having a faulty sugar metabolism.
Temporal thinking is the faculty that’s
engaged by an enriched environment, but it’s
wrong to call it “thinking,” because it’s simply
the way organisms exist... - Ray Peat Nov 2017 Newsletter -
@yerrag said in my recent subhuman bloodwork for recurring nausea/anxiety:
@mostlylurking said in my recent subhuman bloodwork for recurring nausea/anxiety:
Could you rephrase the above paragraph? I'm having a hard time understanding. What is being taken in possibly too high a dose? Or did you mean to say the thiamine dose was too small?
My brain and typing coordination had a miss (I wonder if there is a pathology to this. Happens to me too often). Sorry. I'll rephrase:
Last week I discovered I was thiamine insufficient, even with my thiamine daily dosage being high (at
250mg) relative to rda. Just like me, you may just need more thiamine. In my case, I had to increase my dosage to 1500mg. You could be either thiamine deficient (below rda) or thiamine insufficient ( above rda but still lacking in thiamine intake).@mostlylurking Thanks for adding your thoughts and references. I could use them also.
You're welcome. I'm glad to try to help out. FWIW, I think your writing/typing has improved recently. Maybe it's the additional thiamine....
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I dealt with nausea for long periods of time. It made me want to punch holes in walls.
After trying everything, thyroid was the thing that took it away and there was good reason for that, so you could consider thyroid.
Absolutely consider cypro also, given its got good evidence behind it for cyclical vomiting syndrome etc
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@yerrag thank you very much again for this very insightful response
@yerrag said in my recent subhuman bloodwork for recurring nausea/anxiety:
This relationship becomes disturbed when our body becomes very acidic and this is when our blood potassium becomes very high in potassium, which is our body's attempt to move potassium from its cells to its extracellular fluids, as reflected in plasma. Then the doctor will see that and tell us we have "too much potassium." And now we know that is nonsensical because we know better now. But in fairness to the doctor, he will just be exasperated explaining this to the average person.
yup, i had slight hyperkalemia in the past as well with accompanying high anion gap of 19. doctor just said lower cocnut water, bananas etc when i wasnt even consuming muhc potassium in diet. they were oblivious and overlooked acidosis. iron saturation was 27% but i think mayve improved as of recent as was 1 yr ago.
@yerrag said in my recent subhuman bloodwork for recurring nausea/anxiety:
But I am not sure as your blood sugar is not so high. It is only milldly high, and so it's possible you are metabolizing sugar well enough or that you're not eating enough carbs such that your intake of sugar/carbs is such that your sugar metabolism is not really put to the test. Are you on low carb, or keto, or carnivore diet or doing intermittent fasting? As using these methods are a poor substitute to deal with having a faulty sugar metabolism.
i unwittingly intermittent fast, low carb sometimes due to low appetite and nausea. esp of recent this has been exacerbated. mayve affected this recent blood test too, days prreceding this blood test i would have only 1-2 meals a day rlly. even today i could eat very little, which then in a negative feedback loop caused me to vomit out the little i did eat. im recovering rn just thru mix of salt/sugar drinks. today i tried BRAT diet for nausea as was especially nauseous and low appetite eating just banana, 2*20g pea protein, 500-1000g salt drinks throughout day, 2 slices bread, carrot salad with coconut oil i still vomited. but in part i think psychological factors could be playing significantly as well in addition. think i notice these especially spur up when i feel high serotonin, low t, anhedonic. rn trying meditation for that i guess.
also another thing is i usually wake with a white/green coating on back third of the tongue. think it could be due to my diet which rn is like oats with cocoa powder, extra virg olive oil, banana in morning eaten slowly like 1-2hrs. i eat slow due to nausea and in general im just unable to eat quick. i think fibre in morning helps me, i vomit if i have plain orange juice/milk in morning. then sugar/pea protein drinks throughout day, lunch/dinner of rice with fatty gelatinous lamb, extra virg olive oil. on days im nauseuous ill usually just have liquid meals of sugar/protein every few hrs until it settles a bit around later in day and eat rice/lamb.
thiamine ill improve through nutritional yeast flakes i think. yeah i dont think i consumed much of this.
ill heed your suggestions and update how it goes. ill be visiting the doctor in around 4 days, ill try to suggest to him this could be due to acidosis, than him suspecting just anxiety and prescribing ssri.
doing some self research i think ye it seems to be lactic acidosis
https://en.wikipedia.org/wiki/Metabolic_acidosis#Causestreatment they dont suggest much apart from taking bicarb
https://en.wikipedia.org/wiki/Lactic_acidosis#Treatmentlooking at causes could maybe give more insights to treatment methods, fixing underlying causes. like ye it lists thiamine deficiencies as you stated, Impaired delivery of oxygen to cells is interesting too, i mayve unwittingly induced this from butekyo
https://en.wikipedia.org/wiki/Lactic_acidosis#Causes -
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@Hando-Jin
thank you, ive considered cypro but that lowers hgh and i want to take hgh peptides soon for possible late puberty masculiniation. ik its bad in short term, but im seekign to care about longevity etc after this first.also heard cypro long term can have side effects. think itd be better for me to solve underlying issue acidosis causing this nausea rn.
rn i think maybe consider ondanesteron, Promethazine( esp this could help high ige maybe too) instead. @thyroidchor27 thoughts on Promethazine? i promptly got the idea from here of Antihistamines with antiserotonergic activity section. idk much bout this tho, maybe serotonin antagonists can have rebound/effects from long term use
https://en.wikipedia.org/wiki/Serotonin_receptor_antagonist#Antihistamines_with_antiserotonergic_activity
https://raypeatforum.com/community/threads/otc-anti-histamines-with-anti-serotonin-action.8588/#post-976641definitely agree i got to ameliorate my current suboptimal thyroid. i think i can do it through addressing this underlying issue first before exogenous t3 maybe. but even so, yeah it could be quite beneficial to start t3 now
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I think all I can do for you is to try interpreting your blood test results. I have the feeling that I don't have the complete picture and your doctor knows enough of your history and you're right in having to check with your doctor what you learn from me. I hope he would consider what I've shared with you though chances of that happening are slim. Perhaps if you went to a another doctor and the doctor told you the same thing I did, and you told your doctor you have a cousin who is a doctor overseas and that he gave you some suggestions, your doctor would be more receptive as he won't feel insulted you asked for a second opinion, and he would be more open to considering what you share with him.
But I'm still lacking a lot of information on your history and your use of substances in the past such as psychiatric drugs that altogether make your condition what it is now. Filling that gap is hard. For example, I don't know what led to you becoming nauseous. I also wonder how SSRIs got into picture and whether you have been a long time user of SSRIs.
I would make no attempt to second guess your doctor. It is bad enough if your treatment is hampered by having so to speak too many cooks that spoil the broth. If you stsy with your doctor, you must have confidence in him enough to keep on being treated by him. If you think he has not diagnosed you satisfactory, then you have to consider whether to see another. Although that is easier said than done as most patients cannot discern whether their doctor is a good one or not. My sister, for example, likes a doctor because he is very bubbly and friendly and I wonder if competence ever came into the picture. Then again, it is hard to differentiate a Big Mac from one Mickey D branch to another.
What I'm in effect saying is that it would be difficult for me to help you if I have an incomplete understanding of your context. If your intent is to simply be to have your blood work interpreted, I hope I have been able to do that satisfactorily.
Temporal thinking is the faculty that’s
engaged by an enriched environment, but it’s
wrong to call it “thinking,” because it’s simply
the way organisms exist... - Ray Peat Nov 2017 Newsletter -
@yerrag completely understandable yeah its very different over internet text than in person with medical records etc. nontheless youve provided very good inisghts im grateful for and will bring up. i think it could very well be tied with this too, ive had lindsays nails for a substantial period now https://bioenergetic.forum/topic/266/do-you-have-lunula-on-nails/3?_=1708866810091
thats a good suggestion, to say family doctor from overseas told me this. ive never been on ssri, he just prescribed zoloft as he thinks its due from anxiety, without consideration of other underlying issues like acidosis indicated by anion gap etc. only real significant past medication id say was antibiotics and probiotics.
ill try ameliorate this with him and post further results if needed, maybe i could request more specific tests that can provide further insights.
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@yerrag hey, just updating on my situation. its gotten quite better as of recent. i think it was acidosis due to respiratory acidosis( i used to do butekyo and that gave me the habit of short inhalations with small volumes of air, like maybe 30% of a full inhale), excess gut bacteria causing d lactic acid production indicated as i get white coating on tongue in the morning. for this ive been taking bicarb, inhaling more full volume of air slowly, around 5 secs inhale, carrot salad slowly kill off to avoid herxheimer reaction. planning to take mct, antibiotics like doxycicline soon however and then repopulate with kefir, probiotic after i look more into which bacteria is beneficial like boullardi, lactobacillus. i think small intestine should be sterile and then large gut have some bacteria but not too much, think losing bacteria could cause lactose intolerance, digestion problems maybe. i then take promethazine, ondansetron every now and then but not too often to create tolerance, maybe cannabis oil soon. also found avoiding empty stomach in morning, atleast eating a bit helpful. when i was younger tho i could do intense exercise in morning while intermittent fasting not eating much later without issue, if id do that now id get nauseous
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Mike Fave gives you his take on the gut:
https://www.youtube.com/watch?v=Bkph9FRpcAk&t=718s
Mike was a regular at RPF. He had been having gut issues, and struggled with it. He learned a lot in overcoming his gut issues. I never had real gut issues. It's always been good and became even better for me, learning from Ray Peat. So I cannot advise people on their gut issues just as people born with a silver spoon can't teach us how to make money. But Mike understands Ray Peat very well, and builds on it further. If you could get some coaching from him, it may do you a lot of good.
Temporal thinking is the faculty that’s
engaged by an enriched environment, but it’s
wrong to call it “thinking,” because it’s simply
the way organisms exist... - Ray Peat Nov 2017 Newsletter -
@yerrag very good video and channel, definitely gonna look more into this guy, thank you.
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@the-MOUSE
https://bioenergetic.forum/topic/1630/soil-health-and-its-relations-to-plant-animal-and-consequently-human-health/10Have a look at the second post for ideas about gut health too. Not exactly the same type of approach but can still work.
