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Autoimmune Disorders

I have a 32-year-old active female with adrenal fatigue, autoimmune disease, and digestive issues. I know Chris recommends to eat adequate protein, 40 to 50 grams, especially in the morning, but my client has great difficulty eating that much protein first thing in the morning. She has just started taking betaine and pepsin to help with digestion. I have suggested a smoothie with collagen hydrolysate, but two tablespoons is only about 12 grams of protein. Do you have any suggestions of how she could incorporate more protein into her diet that would be reasonably easy for her to eat first thing in the morning?

Laura Schoenfeld: This is a perfect example of a question that is ideal for me and Kelsey to be answering....

How do you determine the dosage for LDN?

Chris Kresser: Well, the dosage that has been used in most studies is 4.5 milligrams, but almost every clinician that...

What kind of herbs and supplements do you use for Graves? Do you treat Graves the same as hyperthyroid?

Chris Kresser: Well, to the second question, Graves is an autoimmune disease that causes hyperthyroidism, which is kind of what...

A 39-year-old female patient in the first trimester of pregnancy, presenting with hyperthyroidism, prior history of subclinical hypothyroidism, and hyperemesis gravidarum. Do you have a preference in prescription?”—PTU is one drug that’s used for hyperthyroidism, for Graves, versus methimazole, which is another drug that’s used. Both are extremely hepatotoxic. PTU is more hepatotoxic, and methimazole, as Debbie points out, has risk of potential birth defects in the first trimester.—“The patient showed negative for Graves antibodies, but endocrinologist felt strongly that the patient did have Graves.”

Chris Kresser: Yeah, I have some personal experience with this, actually. Back when my wife and I were trying to...

I have a patient with ALS who sees a specialist, and when she mentioned possible gluten ataxia-type issues, the specialist didn’t think there was much to it. I have mentioned the Cyrex test. Besides Cyrex 3, what other tests should we run? I think there’s a neuro panel with Cyrex but haven’t used it much.

Dr. Amy Nett: Yeah, absolutely. Agreed. I think the Cyrex Array 3 is a great test, especially if the patient...

A patient with MS, depression, and fatigue. Had a Cyrex Array 3 panel, and she had equivocal IgG wheat agglutinin, tTG3 out of range, everything else normal. Should I consider intestinal permeability and/or anything else?

Dr. Amy Nett: I would suggest that she does remove wheat and gluten entirely from her diet. Again, we consider...

I have a patient with multiple sclerosis with increasing spasticity of the lower extremities. She has been gluten free for 12 years, tried the Wahls protocol, struggles with gas and bloating, has not done a SIBO test, and feels from her studying that this is mainly a carbohydrate issue. She does not digest resistant starches. Her history is long. She has done organic acids testing, stool analysis, heavy metals testing, and food sensitivity testing. In 2009, she had parasites, mycoplasma, and yeast. Mercury might have been a little elevated. Lead was elevated. Where do you recommend I start?

Dr. Amy Nett: There’s a lot going on there. We can certainly take out a few points for this, and...

A 41-year-old female, ongoing mood symptoms. Mother of three, history of childhood asthma and allergies, antibiotics. Has been on prednisone for nine months for worsening asthma and respiratory infections. Currently on 7.5 mg with plan for a reduction to 5 mg, but patient’s anxious. Because every time they reduce it, she feels she does poorly in terms of respiratory health. Not been able to exercise as she develops palpitations, feels that she’s out of shape. Sleeping less than seven hours due to prednisone, increases her background anxiety. HIstory of childhood trauma. Been gluten and dairy-free for many years. Has eliminated soy and corn as well. Brain fog, difficulty with focus and concentration, anxiety, mood symptoms, also cramps. How to best support her in the context of the prednisone taper. Like her to do CSA and Cyrex testing as well as host of labs. However many of her labs would be skewed by the prednisone. I’m not up to speed in GI testing. Recommended 30-day reset along with autoimmune diet as well as addition of magnesium, curcumin, l’theanine, and probiotic. I’d like to know her D level and supplement as needed as well as her TFT, TPO status. Any words of wisdom re: prednisone or taper, her workout post-steroid treatment, and how to best support that transition re: HPA axis?

Chris Kresser: Yeah. So in situations like this, you really have to dial in the diet and lifestyle first more...

What are the best immune support supplements that can be taken with blood thinners such as Coumadin, as this is for a 76-year-old male with a history of arrhythmia?

Dr. Amy Nett: It depends on what kind of immune support. Is there an autoimmune condition? Do you have high...

A 39-year-old female diagnosed with Hashimoto’s after first baby—that’s the most common time of diagnosis in women —also tested positive with Blastocystis. Functional doctor prescribed LDN, but she didn’t take it, did a reset with antimicrobials. She has had two miscarriages since second baby. Obstetrician thinks it’s thyroid causing it and advised going on thyroxine low dose. The patient is unsure if they’ll try for another baby but does want to know if it’s the best option or if should she do LDN or the Armour. Open to getting her stool screened again to see if Blastocystis is still there. Currently follows Paleo but include eggs, nightshades, and full-fat raw dairy. Scared to give them up because she loves them. Also wants to know even if she doesn’t have any more kids should she be on something for thyroid considering she can’t get the antibodies completely down through diet supplements and lifestyle.

Chris Kresser: Okay, lots of questions in there. First is if she’s not willing to try —if a patient has...

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