Sandra Ishkanes is a Functional Medicine specialist. She takes a whole-body approach to healthcare, combining nutrition, lifestyle and cutting-edge medical testing.
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The client stories and case studies presented here reflect the diversity of symptoms and conditions that I see in my practice. In many instances there are interactions between environmental causes of illness such as toxins, allergens, infections and poor diet, and multiple clinical imbalances in digestion, inflammation, hormones, detoxification and stress.
SB was 43 when he presented with a history of hypertension. His doctor indicated that if his blood pressure was not controlled then he would need to have it managed pharmaceutically. SB was keen to avoid medications, as he was already taking drugs for gout, as well as benzodiazepines and painkillers for a back injury. SB was concerned the he was overweight and that his liver enzymes were elevated. He was having trouble sleeping at night due to Restless Legs Syndrome (RLS) and was experiencing joint pains associated with gout. Despite going on long fast walks during the week and following an intermittent fasting diet (restricting his calorie intake to 600Kcal for 2-3 days a week) he was unable to lose weight. His diet was generally good, although it was high in alcohol and simple carbohydrates. SB was working long hours and was experiencing high levels of work-related stress.
In this case, hypertension and weight gain, the chief presenting complaints, don’t require direct intervention. Rather, an investigation of root causes led to the identification of oxidative stress and poor detoxification as the likely causes of subtle nutrient deficiencies that contribute to high blood pressure and weight gain.
Gout and RLS are associated with high oxidative stress and chronic inflammation, which can lead to increased weight and hypertension. Gout develops when high concentrations of uric acid deposit as crystals in the joints. Under normal physiological conditions, the liver produces uric acid which acts as an antioxidant and provides over 50% of the antioxidant capacity of blood plasma. However when antioxidant capacity is low, uric acid rises, representing an attempted protective response in the body. At high concentrations uric acid can function as a pro-oxidant, correlating and predicting the development of obesity, hypertension and cardiovascular disease.
RLS is associated with the oxidation of dopamine in the brain which leads to impaired neurotransmission for generating movement. RLS increases the risk for cardiovascular disease and hypertension.
Antioxidant depletion may be caused by a number of factors including: a high alcohol intake, heavy metals such mercury in fillings, toxic elements in vaccinations, infections, pharmaceutical drugs, a low intake of vitamins, minerals and phytonutrients, and stress.
The protocol focused on increasing the antioxidant status of the body, however for antioxidant supplementation to be effective, an optimum level of digestion and assimilation is required. Given suspected hypochlorhydria, bile and intestinal permeability issues, these were dealt with first, in Phase I of the protocol. Increasing antioxidants will increase detoxification and production of oxidants in the liver, hence elimination and excretion pathways must also be addressed. In particular, gastrointestinal permeability can lead to an increased level of toxins entering enterohepatic recirculation, causing more stress to the liver. Additionally, dietary changes are recommended to support the protocol.
The protocol aimed to:
SB made excellent progress in 2 weeks. He adhered closely to his new nutritional plan, in which he was well supported by his wife who took all the recommendations on board when planning meals.
SB’s weight reduced by 2kg and his blood pressure lowered from 163/113 to 133/93. He was not having any sugar cravings or feeling hungry. His RLS and gout symptoms decreased significantly so he slept much better. His shoulder and back pain reduced from 8/10 to 5/10 and so he reduced his intake of painkillers and benzodiazepines. His mind was clearer and his mood was much improved.
SB now progressed to Phase II of the protocol, addressing anti-oxidant status and support for detoxification and nutritional deficiencies.
Four weeks after starting the protocol SB lost 4kg in weight and his blood pressure further reduced to 120/87. His blood work showed normal uric acid production, normal liver enzymes, normal cholesterol and ferritin levels. SB’s doctor was happy for him to stop all his medications and reported that his stroke risk had reduced from 19 to 9.6.
SB reported that his evergy levels were high, and despite being very busy at work and home, he was coping very well. He was having several days in a row without any pain at all, and when there was shoulder or back pain, it was very much reduced. RLS and gout symptoms had completed resolved.
Identifying and treating the underlying cause of imbalances, which in this case were oxidative stress and poor detoxification, resulted in improvements in blood pressure and weight.
DL was 36 years old when she presented with stomach pain, indigestion and bloating after meals. Her GP had diagnosed a Helicobacter pylori stomach infection and prescribed the first round of antibiotics. She was reluctant to take antibiotics and was seeking a holistic approach. She reported consistently high stress levels. She was a student, was working and had 3 children under 6 years old. As she said “I was such a happy go lucky person – and then I had 3 children”. Her energy levels were low, particularly in the afternoon, although she had 8 hours of uninterrupted sleep every night. Other symptoms included headaches, mood disturbances, sore muscles, brittle and flaking nails, bleeding gums and cold sores.
Her diet was reasonably healthy, although it was low in fruit and vegetables, with moderate water intake. Eating meat gave her indigestion so she avoided it.
Initial Lab Results
We agreed on a health optimisation plan that included a natural anti-bacterial agent, as well as targeted supplements for her sluggish digestion, vitamin and mineral depletion, high stress levels and lack of energy:
Multivitamin and multimineral transdermal spray
Rhodiola rosea, an adaptogenic herb that modulates the stress response
Increased range of fruits and vegetables: red – raspberries, apples, beets, tomatoes; yellow: oranges, nectarines, carrots, butternut squash; blue: blueberries, plums, cabbage, olives; green: avocado, kiwi, broccoli, asparagus, green leaves
The first priority was eradicating the parasite, and mastic gum has shown to minimise H. pylori infections. The infection may have lead to malabsorption of nutrients from the gut, hence a transdermal multivitamin and multi mineral spray was employed to bypass impaired digestion and assimilation in the digestive system. High stress levels were modulated with Rhodiola rosea, a botanical adaptogen which has shown to modulate cortisol levels. Finally the diet was improved with the addition of a variety of fruits and vegetables.
DL responded very favourably to the protocol. Her digestive symptoms completely resolved and her energy levels had improved significantly. She felt much more able to concentrate on her studies and had much more patience with her children. She felt much more resilient to the stresses of life.
Resistance to stress is one of the hallmarks of good health, and DL had been experiencing chronic stress for over 6 years. Psychological stress affects the central nervous system, through the combined action of the hypothalamus, pituitary and adrenal glands (the HPA axis), and the endocrine and immune systems. The impact of these factors may have inhibited her immune function and increase her susceptibility to infection by H. pylori. The stress response produces cortisol, which acts as an anti-inflammatory, inhibiting the production of prostaglandins. The protective mucus layer in stomach is dependent on prostaglandin synthesis, so high levels of cortisol can weaken this barrier, allowing the proliferation of H. pylori. Over time, chronic stress leads to cortisol dysregulation which impacts energy levels and the body compensates by increasing adrenaline production, leading to fatigue, anxiousness and irritability (the feeling of being tired but wired).
H. pylori impairs stomach acid production which prevents the absorption of nutrients, particularly vitamin B12 and iron, as well as impacting digestion. The release of bile and pancreatic enzymes used to digest food is dependent on the acidic pH produced by the stomach, so inadequate acid reaching the gut can reduce the digestion of food, leading to low nutrient availability, and indigestion. A lack of nutrients can result in a multitude of symptoms, like those experienced by DL: sore muscles, brittle and flaking nails, bleeding gums and cold sores.
The protocol for DL was very straightforward: eradicate the parasitic infection with mastic gum, increase nutrient availability with a transdermal multivitamin and multi mineral spray that bypassed the impaired digestive system, modulate cortisol levels with an adaptogenic herb (Rhodiola rosea) and increase overall nutrition with a wide variety of fruits and vegetables. DL was also advised on stress reduction techniques to be employed going forward. Response to the protocol was swift: within 4 weeks DL reported resolution of digestive symptoms, increased energy, reduced perceived stress and anxiety, and a significant improvement in secondary symptoms such as muscle aches and bleeding gums.
Chronic GIT complaints are common and H. pylori may be a factor in their aetiology. While antibiotics may be helpful in eradicating the infection, the mediators and triggers of dysfunction also have to be taken into account. In this case high stress levels and low nutrient availability played a part in symptom progression, and addressing these factors lead to successful symptom resolution.
SR was a 47 year old journalist living in Scotland and working from home. She reported fungal infections for the last 14 years after the birth of her first child, prior to which she reported the use of antibiotics for childhood ear infections, and asthma when she moved to London at 22. She used antibiotics again for a sinus infection 2 years ago, and had polyps removed. She reported constant diarrhoea for the last year. She occasionally used Salbutamol for asthma when she got coughs or colds.
SR felt sluggish after eating sugar and 3-4 months ago moved from eating chocolate and sweets to fruits, seeds and nuts, on which she was snacking throughout the day. She ate fish and chicken 2-3 times a week but but did not eat red meat as she doesn’t like the texture. Alcohol, and specifically white wine brought on sneezing fits.
SR was concerned as she had ‘seen everybody there was stop see’ about the fungal infection on her toes and had not had any satisfactory treatment. Now the infection had spread to her fingers and she was worried about it spreading further.
Plan rationale: SR was aware that a high carbohydrate diet can promote fungal growth, and she thought that by switching from obviously high sugar foods such as biscuits and cakes to healthier foods such as fruits and oat bars, she would reduce her sugar intake. In fact these ‘healthy’ foods still contain high amounts of sugar if eaten in high quantities. A high sugar diet can destabilise regulation of blood sugar, and this can lead to energy highs and lows in the daytime, particularly in the afternoon. We agreed on a diet that focused on increasing proteins, beneficial fats and vegetables, reducing carbohydrates. SR was encouraged to eat 3 meals a day and avoid snacking. SR was using Salbutamol for asthma, and this may have depleted calcium, magnesium, phosphate and potassium. SR was advised on a number of supportive supplements. As the infections had been going on for a number of years, SR was advised to perform a comprehensive stool analysis which can identify multiple microbial infections and digestive and immune functionality in the GIT.
SR responded well to the protocol. Her energy levels improved and she felt more able to work in the afternoons. Her fungal infections, digestive symptoms and diarrhoea showed some improvement, and she lost some weight.
SR’s test results had come back from the lab and her bacteriology culture indicated dysbiosis – no growth of Enterococcus, low level of E. coli and high levels of Streptococcus. Streptococcus overgrowth in the gut can be problematic as it acts as a reservoir for reinfection leading to sinusitis, and produces D-lactic acid which can lead to fatigue. Excess lactic acid can also disrupt the normal pH of the gastrointestinal tract, making it overly acidic, as seen by the pH result. This may damage the mucosal barrier of the intestine, leading to increased gut permeability and the leaking of bacterial by-products and partially digested food proteins into the blood which may cause allergies.
Yeast microscopy identified the presence of small amounts of yeast. Streptococcus can potentiate Candida, amplifying the severity of infection.
Fat stain was positive indicating fat maldigestion, as reported by SR. This may may due to low bile production and/or deconjugation and reduction of bile acids by Streptococcus bacteria. Deconjugated bile acids are injurious to the gut epithelium and may cause diarrhea.
Lactoferrin and calprotectin were within range, indicating a lack of appropriate immune response, as both have anti-pathogenic activity. Immune markers were high as would be expected indicating inflammation, however Candida has the ability to inactivate immune system antibodies and so lowers the body’s immune response.
Analysis of the test results indicated that the presence of Streptococcus was likely to be enhsncing the effects of Candida, hence both pathogens needed to be addressed at the same time. Eradication of pathogens may cause a die off reaction and unpleasant side effects if the the gut is permeable, hence a protective amino acid was recommended to support the gut epithelium. SR’s immune response was low hence supplementation with colostrum was advised. Colostrum is rich in immunoglobulins which provide passive immunity against pathogens. Additional supplements were recommended to help eradicate the infections
SR responded very well to the protocol. The fungal infections on her fingers and toes had significantly receded, and they were healing well. SR was enjoying higher energy levels and hence a much enhanced quality of life. The diarrhoea had stopped completely and she was having normal bowel movements, meaning that she could happily leave the house, as well increase her exercise activities. She had lost weight, was sleeping better, and had not used her inhaler or had any wheezing episodes in the whole month. She had excellent compliance to her upgraded diet, and had involved her family in healthier eating, so they were all repeating the benefits. She was particularly happy that she did not have to worry about the fungal infections anymore.
SR presented with a long standing fungal infection which began following the birth of her first child. During pregnancy the mother’s immune system switches to Th2 arm of the immune system and should switch back to Th1 post birth. If however she has remained Th2 dominant then there is likely to be a pro-Candida bias, and further, Candida enhances Th2. Antibiotic use can cause an imbalance in the bacterial flora of the GIT which can further enhance Th2 bias. Antibiotic use may have lead to strep overgrowth and the subsequent diarhhea. Often the detrimental effects of Candida are an allergic reaction to the yeast as well as from a reaction to its toxins. The Th1 cellular response is crucial to controlling Candida and supplementing with colostrum can be beneficial to shift the cellular response.
The comprehensive stool test was very useful in this case, showing that focusing solely on Candida eradication would not have had the desired impact, as the presence of Streptococcus was playing a part in the entrenchment of the infection. Dealing with both pathogens lead to a higher likelihood of eradicating the fungal infection.
Acid production by the stomach and bile synthesis in the liver play a large role in eradicating pathogens in the GIT. Optimising liver and digestive function not only protects the body from infections, but also allows more efficient extraction and assimilation of nutrients, which are required for all of the body’s cellular functions.
Candida infection is common, particularly in women, where it can flourish in the presence of high oestrogen. This case demonstrates that in some instances there may be additional pathogenic infections as well as imbalances in digestive, immune and liver function, hence focusing solely on Candida may not the whole answer. I recommend testing for all digestive complaints, as the results can provide so much information for a targeted protocol to finally overcome long-term symptoms.
The protocols outlined here were tailored specifically to each client. They should not be taken as advice or replace any direction from medical professionals. Each client has given permission for their anonymised case to be reported here for educational purposes, including their medical history, laboratory data, and testimonials.