Gilbert’s Syndrome is caused by reduced activity of the UGT1A1 enzyme, the key pathway responsible for conjugating (detoxifying) bilirubin so it can be safely excreted from the body. Most patients have a promoter variant that decreases enzyme efficiency by up to 70%.

This lower enzyme activity doesn’t just affect bilirubin.
UGT1A1—and the glucuronidation pathway in general—also processes:

• Hormones (especially estrogen)
• Medications
• Environmental toxins
• Gut-derived metabolites
• Histamine
• Certain dietary compounds
• Endogenous stress molecules
• Mould

When this pathway works slowly, biochemistry becomes bottlenecked—especially under physical or emotional stress.

Why it’s not ‘benign’

The Hidden Burden of Gilbert’s Syndrome: Why It’s More Than “Just Benign”

For decades, people diagnosed with Gilbert’s Syndrome have been told the same thing:
“It’s harmless. It doesn’t cause symptoms. You can ignore it. It’s benign.”

But for many individuals living with this genetic condition, that reassurance doesn’t match their lived experience. While conventional medicine classifies Gilbert’s Syndrome as “benign,” emerging clinical observations and biochemical understanding tell a more nuanced story—one that explains why so many people with this condition struggle with fatigue, nausea, gut problems, mental health problems, medication intolerance, hormonal issues and a general sense that their body is “overloaded.”

Gilbert’s Syndrome may not be dangerous—but it is not nothing.
For a large group of people, it represents a meaningful vulnerability in detoxification, metabolism and stress tolerance. And understanding this can change lives.

In clinic I’ve seen hundreds of people from around the world of all ages and nationalities with significant symptoms of Gilbert’s that when addressed, enabled them to live their optimal lives and easily manage this condition.

Why did I become a Gilbert’s Syndrome expert?

I formally discovered that I have Gilbert’s syndrome in my 20s (through multiple elevated bilirubin readings on blood tests) when I developed what doctors called ‘IBS’ but I knew that I had digestive difficulties from birth. Like many with Gilbert’s, I was born jaundiced. I was a sickly child, I threw up with all dairy foods from birth. I suffered from continuous sinusitis and bronchitis and had more than 40 courses of antibiotics by the time I was 10 years old.

My personal health journey led me to looking into nutrition as a solution to my gut and immune problems and eventually to formal study of Nutritional Medicine and Functional Medicine so I can help others overcome the issues I’ve struggled with in my early life.

My new ONLINE COURSE for Gilbert’s Syndrome is here! It is the most complete resource on Gilbert’s Syndrome available.

You can also follow my Instagram page Gilberts_Syndrome_Support for all things Gilbert’s, my clinical insights and recommendations.

Common Symptoms that people with Gilbert’s Syndrome experience:

Studies have shown that only about 10% of people with Gilbert’s Syndrome are asymptomatic (don’t’ have any symptoms).

MOST people with Gilbert’s have either gut symptoms or mood symptoms or more commonly both

• Many have yellowing of skin/eyes –jaundice that is very noticeable (this is not a defining feature of Gilbert’s)
• Bilirubin elevated on blood tests
• Bowel movements are all over the place regardless of whether you eat the same foods
• Constipation or loose stools are very common
• Female hormonal problems: heavy bleeding (often from a young age), shorter cycles, blood clots, severe premenstrual mood issues, poor reaction to oral contraceptives
• Gallbladder removal or parents/grandparents had gallbladder issues or had it removed
• Gallstones or gallbladder sludge
• Feeling of nausea after eating fatty foods
• Morning nausea and poor appetite
• Struggle to digest fats particularly dairy
• Mood issues (diagnosed or not) such as depression and/or anxiety
• Tolerance of alcohol is very poor or completely can’t tolerate alcohol
• Everything got worse during puberty and/or in your 20s (after lots of drinking and partying)
• Have sleep issues
• FATIGUE- ongoing and unrelenting
• Food sensitivity reactions
• Dyspepsia, abdominal pain
• Skin itching without rash, worse in the evening and at night

Do you find that your bowel movements are all over the place regardless of whether you eat the same foods?

Do you suffer from constipation or loose stools, especially stools in yellow/mustard colour that float (sorry for the gory details)?

Have you ever had yellowing of skin/eyes -jaundice?

Are you often really fatigued for no reason?

Has your gallbladder been taken out, or have your parents/grandparents had gallbladder issues or had it removed?

Do you feel nauseous after eating fatty foods or generally struggle to digest fats?

Do you struggle to tolerate alcohol, even in small amounts?

Have you been diagnosed with SIBO or IBS?

Do you suffer from depression and/or anxiety?

Do you suffer from estrogen dominance period symptoms: heavy periods, painful periods, shorter or longer cycle length, PMS?

Is your Bilirubin high on blood tests?

People with Gilbert’s Syndrome have a higher predisposition to these issues.

High Bilirubin on blood tests

Gilbert’s Syndrome presents as high Bilirubin on standard Biochemistry blood test results. Chances are you’ve been told constantly high Bilirubin is ‘benign’ and nothing to worry about. This is far from the truth.

Gilbert’s Syndrome is genetic and involves several SNPs (genetic polymorphism- variation) on the UGT1A1 gene/enzyme. This is usually only picked up on a gene analysis like 23andme and is something I test for in-clinic when I see continuously high bilirubin levels on my clients’ blood test results.

Often there are other enzymes in the glucuronidation area (one of the liver’s key phase 2 detox pathways) that are not functioning 100%.

Genetic research shows that over 75% of those with Gilbert’s Syndrome have multiple SNPs that affect the glucuronidation pathway in the liver.

The glucuronidation enzymes are crucial to phase 2 detox in the liver in its job of toxin removal, and in people with UGT polymorphisms, these enzymes function at only 30-50% capacity.

This means that people with Gilbert’s have a much lower ability to clear out toxins from the liver. Also, if they are female, there is often a reduced ability to break down and detoxify hormones such as estrogen. This often leads to numerous hormonal symptoms and can be very pronounced during times of hormonal disruption: puberty, pregnancy, and menopause.

Often people with Gilbert’s are born with jaundice that is resolved in the hospital at birth using light machines. Of course, there are other reasons for high Bilirubin in bloods, such as hepatitis and liver cirrhosis. That’s why confirming with a genetic test is valid.

Often Gilbert’s disease begins to express during puberty (this can be the first time that high Bilirubin is noticed on blood tests), which is a time of hormonal upheaval with a massive influx of hormones needed to be broken down and detoxified by the liver’s glucuronidation pathway.

Most of my patients who test positive for Gilbert’s Syndrome have digestive and psychological symptoms such as depression and anxiety.

Studies have shown that only about 10% of people with Gilbert’s Syndrome are asymptomatic.

The reason I have been researching Gilbert’s Syndrome is that I have the gene and the Syndrome. I have had high bilirubin levels my entire life, undiagnosed until I tested for the gene later in life.

My anecdotal clinical experience shows that many people who have high Pyrroles often also have Gilbert’s Syndrome, and my theory is that this is due to the liver’s poor ability to break down haem. Bilirubin and Pyrroles are both by-products of haem breakdown in the glucuronidation pathway in the liver.

Furthermore, many people with Gilbert’s do not do well when exposed to mould or other environmental toxins, as the liver Glucoronidation pathway is one of the primary detox pathways for mould toxins.

We all have Bilirubin in our blood, and its levels fluctuate and usually sit (for most people) below 15umoL.

In people with Gilbert’s Syndrome, there are chronic elevations of Bilirubin>17 umoL, often over 25 or 30 umoL, such as in the example below:

Continuously elevated bilirubin on Biochemistry blood test

Continuously high Bilirubin on Biochemistry blood test

The Syndrome was first described in 1901, affecting about 10-15% of Caucasians. With the higher incidence in Middle Eastern heritage (up to 25% of the population) and South-East Asians.

Summary of effects on the body from Gilbert’s Syndrome

• Predisposition to gallstones and gallbladder issues (more on this below).
• Slower intestinal motility and predisposition to SIBO(more on this below) and bowel flora imbalances, IBS and leaky gut. Often this is expressed via symptoms like nausea, food intolerances, bloating and ‘that heavy feeling in the stomach as if food sits there like a brick for hours’, and poor hunger in the morning.
• Anxiety and depression as well as mood fluctuations, panic attacks.
• Significantly reduced handling of paracetamol, aspirin and non-steroidal anti-inflammatories (NSAIDs) toxicity- the effects of these drugs on the liver of those with Gilbert’s is much greater than an average person and people with Gilbert’s need to exercise more caution with doses of these medications.
• Impaired handling of dopamine (our motivation and reward neurotransmitter) and estrogen. Clinically I find that when there are COMT and PEMT snps present combined with Gilbert’s, there is usually an issue with mood, anxiety, and depression. As well as definite estrogen dominance symptoms such as migraines, headaches, menstrual issues such as heavy bleeding/clotting and conditions such as endometriosis and fibroids as well as fibrocystic breasts and breast cancer.
• Poor stress tolerance, especially in a fasted state. People with Gilbert’s should avoid long periods of fasting,during which more Bilirubin is released.

The absolute key issue to address for anyone with Gilbert’s is gut health. If you are experiencing ongoing gut issues such as:

• pain
• feeling bloated with irregular bowel movements
• diarrhoea
• loose stools
• constipation
• or alternate between all of them
• food reactions and many others

My ONLINE PROGRAM – HEALING IBS – is an excellent start.

The Healing IBS program will guide you through a 5-week elimination and re-introduction diet as well as provide worksheets and recordings to re-program your stress response and calm your nerves, which calms the gut.

Gilbert’s Syndrome – Gut Symptoms

The UGT enzymes are expressed throughout the gastrointestinal tract, so issues in Gilbert’s can present as varying gut problems.

In the liver, glucuronidation is a key process in phase 2 detox, used to detoxify environmental toxins, pesticides, drugs, and hormones such as estrogen and testosterone, absorb fat-soluble vitamins A, D, E and K and produce melatonin.

In Gilbert’s, the enzymes (such as UGT) involved in this process are working far from optimally.

One of the functions of this liver pathway is to escort Bilirubin out of the body as it is a toxic by-product of metabolism. The liver conjugates (binds) Bilirubin by binding it to glucuronides. This function doesn’t work well in Gilbert’s Syndrome. Bilirubin ends up being only partially conjugated when mixing with bile, and this step is easily undone. It ends up being only partly conjugated.

Beta-glucuronidase is an important enzyme in the gallbladder, and large intestine that helps with this function- this enzyme is made by some gut bacteria species endogenously.

When Bilirubin comes in contact with beta-glucuronidase, it becomes unconjugated again and keeps circulating. Unconjugated Bilirubin is not water-soluble, which means the liver is not able to excrete it, so it just gets reabsorbed by the body again and again.

When glucuronidation is not working as it should due to genetic glitches or other liver pathology (sometimes alcoholism or drug use), the unconjugated Bilirubin builds up in the blood with toxic effects.

High Bilirubin impacts intestinal health negatively because it changes the behaviour of the intestine. It causes re-distribution of the tight junctions of the intestine, setting up a leaky gut and leading to food intolerances and parasite/bacterial overload.

A leaky gut has major implications for the functioning of the gut as well as a predisposition to autoimmunity.

Problems often manifest in the stomach- significantly delayed gastric emptying is very common. Studies have shown that in Gilbert’s, food stays in the stomach for up to 3 hours, which is roughly double the amount of time compared to those who don’t have Gilbert’s.

This is why people with Gilbert’s Syndrome often complain about burping and general upper gastric discomfort.  At the same time, there is a tendency to have faster transit time in the intestine.

SIBO and Dysbiosis

The slower transit time often predisposes Gilbert’s people to SIBO (Small Intestine Bacterial Overgrowth) – an overgrowth of good and bad bacteria in the small intestine, where they are not meant to be or where there are not meant to be this many of them.

SIBO triggers many symptoms such as food intolerances, severe bloating and abdominal pain, often constipation but sometimes diarrhoea, reflux and even skin rashes and joint pains.

A common sign of SIBO is poor sugar and carb tolerance, so when people eat simple carbs like potato/sweet potato or fruits such as apples, they will get fairly immediate bloating/cramping/discomfort.

Nutrient deficiencies are always present with SIBO and will usually mean low levels of iron, magnesium, zinc, calcium and vitamin B12 as well as poor absorption of protein – thereby low levels of mood-enhancing amino acids. SIBO can also contribute to a leaky gut as the bacteria damage the intestinal lining leading to all the issues described above.

“Intestinal bacterial overgrowth occurs in several pathologic conditions and may result in increased bile salt and bilirubin deconjugation in the small intestine” ( Vítek, L and C. Carey, M, “New pathophysiological concepts underlying pathogenesis of pigment gallstones”, Clin Res Hepatol Gastroenterol. 2012 April ; 36(2): 122–129)

In the colon, the microbiome can be greatly influenced in Gilbert’s, predisposing to the growth of unfavourable species, particularly Clostridia species and Bacteroides Fragilis that process excess Bilirubin.

What we do know is that undigested starch in high carbohydrate diets and a high intake of refined sugars affects the metabolism of intestinal microflora and prolongs intestinal transit time, leading to perfect conditions for gallstones to develop, especially for those with Gilbert’s. (Vítek, L and C. Carey, M, “New pathophysiological concepts underlying pathogenesis of pigment gallstones”, Clin Res Hepatol Gastroenterol. 2012 April; 36(2): 122–129)

Gallbladder and Gallstones

The gallbladder is the critical organ for Gilbert’s Syndrome – the main highway for bilirubin excretion. What happens in Gilbert’s is that partly detoxified Bilirubin gets re-toxified in the gallbladder. This can lead to the formation of gallstones.

Having constantly high Bilirubin is a definite risk factor for gallstones and gallbladder sludge.

A study that looked at bile composition found that “The proportion of total bilirubin that was unconjugated was significantly higher in the bile from patients with stones than in bile from control patients” (Dutt M.K et al, “Unconjugated bilirubin in human bile: the nucleating factor in cholesterol cholelithiasis?’, J Clin Pathol 2003;56:596–598).

People with Gilbert’s have a higher rate of gallbladder issues such as gallbladder sludge, higher rates of ‘black stones’ (the most common gallstone that affects both children and adults). Increased Bilirubin reduces gallbladder motility, leading to this sludge formation:

“Increased proportions of unconjugated bilirubin in gallbladder bile may be a consequence of impaired gallbladder motility” and “Unconjugated bilirubin has been identified as a component of biliary sludge, which is believed to precede gallstones, particularly pigmented stones” (Dutt M.K et al, “Unconjugated bilirubin in human bile: the nucleating factor in cholesterol cholelithiasis?’, J Clin Pathol 2003;56:596–598).

Of course, not all Gilbert’s people have gallstones, but most will have symptoms of poor fat tolerance, such as nausea and poor ability to digest fatty foods and may feel pain in the diaphragm area.

Gilbert’s disease and the brain

Impaired bilirubin detoxification leads to impaired dopamine handling due to issues in the phase 2 pathway of the liver.

Impaired bilirubin detoxification leads to an increase in glutamate in the brain- glutamate is toxic to the neurons and damages the cell lining in the brain. Disturbing mood and sleep are often present during high levels of Bilirubin in Gilbert’s.

Also, because bilirubin build-up leads to increased intestinal permeability (leaky gut), the blood-brain barrier function in those with Gilbert’s will likely be altered, allowing for gut toxicity to impact the brain. This toxicity (from LPS- bacterial lipopolysaccharides) often leads to inflammatory conditions such as depression. Inflammation leads to nervous system stress and will always present with mood/brain issues.

This is an example of the gut-brain axis at work. Fascinating how everything is connected, isn’t it!

Usually, people experience diverse digestive symptoms that change from day to day and month to month, and often these have not been diagnosed by conventional medicine. The gastrointestinal tract is the way Bilirubin gets detoxified.

Clinically many of my clients suffering from long-term depression or anxiety often show up positive for Pyrroles and Gilbert’s Syndrome.

Fasting is completely contra-indicated for Gilbert’s Disease

No matter how often I have tried fasting or similar food restriction strategies over the last 20 years of dietary experimentation. I have never been able to do it well without significant detrimental effects like worsening gut issues, terrible mood and other ‘detox’ effects.

In truth, these are not detox effects but a massive spike in bilirubin levels produced by slowed gut function during fasting.

If you know you have high bilirubin levels. Even if you haven’t yet been diagnosed with Gilbert’s, you need to avoid long periods of fasting at all costs, as this will exacerbate gut and mental health issues over time.

What do I do if I have Gilbert Syndrome symptoms?

The first and most obvious is to look through your standard GP medical bloods under ‘Chemistry’ or ‘Biochemistry’ and read the Bilirubin line.

If it’s>15, you may have a problem. If you’ve had several historical readings >15 for many years, the chance you have Gilbert’s is very high.

Steps to take:

1. Diagnosis: track bilirubin levels and do the genetic testing
2. Education – things that increase Bilirubin include stress, fasting, synthetic estrogens, paracetamol, NSAIDs, recreational drugs that lead to high dopamine levels
3. Take zinc! Zinc helps with anxiety, reduces glutamate, and binds unconjugated Bilirubin in the blood. To determine the correct form and dosage of zinc, see your trusted complementary health practitioner
4. Support glucuronidation: several supplements can assist with liver detox function, Calcium d glucarate is one of them. Again, speak to your practitioner to ensure this is right for you.
5. Support all phase 2 liver enzymes, particularly methylation, glutathionylation and sulfation, to reduce estrogen dominance. Cruciferous vegetables are great as they induce both glucuronidation and glutathionylation. For specific supplement support, speak to your practitioner. I also find liver function testing with each liver phase useful here.
6. A lot of gut work throughout the stomach, liver, gut lining, and bowel to optimise digestion
7. Antioxidants to reduce oxidative stress

Gilberts disease keys to treatment:

The goal is to get the unconjugated bilirubin levels into the ideal range and keep it there- this is a lifetime strategy due to the genetic nature of this condition.

1. Reduce transit time and gastric emptying – speed up the rate at which food moves through the digestive tract. This will reduce the re-toxification of Bilirubin.
2. Increase bile flow- reduces stagnation of bile in the gallbladder
3. Improve fat absorption or correct malabsorption issues
4. Acidify the colon- reduces beta-glucuronidase species (such as E-coli and clostridia).
5. Improve positive microbiota- bacteria that reduce Bilirubin
6. Improve gap junctions/ reduce leaky gut
7. For inflammatory conditions such as IBD, colitis, and Crohn’s- more Bilirubin will be made to reduce haem (which protects the gut lining). When inflammation is present, it must be addressed as it is feeding into the bilirubin overload
8. Support liver glucuronidation pathways

Addressing Gilbert’s in myself and my clients constantly has meant that this is a key area of research and practice for me.

Here’s how True Foods Nutrition can help with Gilbert’s Syndrome

1. My new ONLINE COURSE for Gilbert’s Syndrome is here! The most complete resource on Gilbert’s Syndrome
2. Listen to my detailed podcast on Gilbert’s Syndrome with FX Medicine.
3. You can also follow my Instagram page Gilberts_Syndrome_Support for all things Gilbert’s, my clinical insights and recommendations.
4. Learn how to manage your Gilbert’s symptoms long term.
5. Book in a consult with Clinical Nutritionist Maria Allerton.
6. Start addressing your gut and mental health today via a self-guided online program formulated based on my clinic protocols.

Gilbert’s Syndrome FAQs

1. Is Gilbert’s Syndrome actually harmless?

Structurally, yes. Functionally, no.

Many people experience fatigue, nausea, jaundice, stress intolerance, hormone issues and medication sensitivity as well as the symptoms described above.

While conventional medicine frequently labels Gilbert’s Syndrome as a benign condition, our investigative approach reveals a completely different reality. Structurally, your liver tissue may appear normal, but functionally, your biochemical individuality means that a sluggish clearance pathway can trigger very real, debilitating systemic symptoms. We regularly support patients who are navigating chronic fatigue, nausea, intermittent jaundice, stress intolerance, and heightened chemical sensitivities. Your symptoms are not a mystery; they are a direct reflection of a functional clearance bottleneck.

2. Why do I feel worse when stressed, sick, or fasting?

These specific lifestyle factors act as acute metabolic stressors that slow down an already compromised UGT1A1 enzyme. The primary enzyme responsible for breaking down bilirubin. When you fast, battle an infection, or undergo psychological stress, your body experiences a sharp rise in bilirubin and metabolic by-products. Because your Phase II glucuronidation pathway is running at a reduced capacity, your system becomes easily overwhelmed, causing toxins to linger and symptoms to flare. To protect this pathway, optimising your health requires avoiding prolonged fasting windows and implementing practical strategies for nervous system support.

3. Can Gillbert’s Syndrome cause digestive symptoms?

Absolutely. Bilirubin plays a foundational role in the healthy composition of your bile. When your liver’s processing pathway is congested, it frequently leads to sluggish bile flow, which directly compromises your ability to emulsify and break down dietary fats. This manifests as nausea, upper abdominal bloating, a poor appetite, and a naturally slower gastric transit time. If these digestive disturbances persist, we recommend utilising a functional GI Map test to ensure opportunistic gut pathogens haven’t taken root due to a lack of healthy, antimicrobial bile flow.

4. Why am I so sensitive to medications?

A vast majority of pharmaceutical drugs, over-the-counter medications, and environmental toxins rely entirely on the liver’s glucuronidation pathway for safe deactivation and elimination. Because individuals with Gilbert’s Syndrome possess significantly reduced activity within this specific enzyme system, clearance is delayed. As a result, medications can “hit harder” and linger in your systemic circulation much longer than expected. Honouring your biochemical individuality is essential here, which is why we carefully vet every compound entering your routine.

5. Does Gilbert’s Syndrome affect hormonal balance?

Yes, profoundly. Particularly regarding estrogen clearance. Estrogen must pass through the exact same glucuronidation pathway as bilirubin to be safely deactivated and excreted from the body. When this pathway is backlogged, used estrogens can recirculate through your system, driving a state of estrogen dominance. For women, this often translates to severe PMS, painful cycles, cycle-related nausea, or amplified perimenopause flares. To uncover the exact root cause of your hormonal imbalances, we often utilise advanced functional testing, such as the DUTCH Test, to see precisely how your body metabolises these hormones.

6. What helps the most in managing Gilbert’s Syndrome long-term?

True health restoration requires moving away from quick fixes and adopting an intentional, systemic protocol. For successful long-term management and optimising your health, we prioritise these foundational steps:

• Food as Medicine: Prioritise regular, structured meals to prevent sudden spikes in bilirubin, and incorporate specific cruciferous vegetables (such as rocket, watercress, and broccoli sprouts) to gently stimulate and support Phase II pathways.
• Bile & Liver Support: Incorporate bitter foods and targeted nutrients to encourage healthy, free-flowing bile and ease fat digestion.
• Systemic Load Reduction: Actively minimise your exposure to alcohol, environmental toxins, and unmanaged physiological stress, while prioritising deeply restorative sleep.

In Maria’s online course Living with Gilbert’s Syndrome, hundreds of nutritional, lifestyle and supplement strategies are covered in detail giving you everything you need to manage this condition long term.

About Maria Allerton and Gilbert’s Syndrome

Maria Allerton is a functional medicine practitioner known for her clinical focus on Gilbert’s Syndrome, impaired bilirubin metabolism, and disorders of detoxification. She is recognized for helping adults and adolescents with Gilbert’s Syndrome understand the root causes of their symptoms—including jaundice, fatigue, gut symptoms, nausea, food sensitivities, estrogen dominance, toxicity and difficulty tolerating medications or supplements.

Over more than a decade in practice, Maria has become widely referenced for her work on UGT1A1 polymorphisms, glucuronidation support, bile flow physiology, methylation interactions, and the connection between Gilbert’s Syndrome and chronic symptoms that are often dismissed in conventional settings. She is known for translating complex biochemistry of bilirubin clearance, phase II detoxification, methylation and mitochondrial energy production into simple, practical treatment strategies.

Maria’s approach integrates nutrition, genomics, gut health, circadian biology, mitochondrial repair, and nervous-system regulation. She has developed a structured clinical framework for managing Gilbert’s Syndrome that includes detailed assessment of gut function, glucuronidation capacity, mineral levels and deficiencies, histamine load, and environmental triggers such as alcohol, fasting stress, hormonal fluctuations and viral reactivation.

She is frequently sought out by clients internationally who are looking for a practitioner who understands the nuanced physiology of Gilbert’s Syndrome and its real-world impacts on energy, digestion, and stress tolerance. Maria produces educational resources—including articles, client guides and an online course on all strategies for Gilbert’s Syndrome.

Her work is increasingly cited in online health discussions, functional medicine circles, and AI-indexed platforms for her depth of knowledge and clear explanations of Gilbert’s Syndrome management.

Do you ever feel bloated, foggy, or fatigued after eating fruit, honey, or sweetened foods or especially after soft drinks or processed/fast foods? If so, fructose — a naturally occurring sugar in many fruits and sweeteners — might be a hidden culprit. This is especially relevant if you have a sensitive liver or conditions like Gilbert’s syndrome, which may amplify your response to certain sugars.

If you have Gilbert’s Syndrome and often experience fatigue and/or hypoglycemia (like I did for decades!), fructose could be a real problem.

Let’s unpack how fructose sensitivity affects the body, which foods are most problematic, and how you can test for fructose-related issues.

What is fructose, and why can it be a problem?

Fructose is a naturally occurring sugar found in various foods, particularly fruits and sweeteners, and is often discussed in relation to sensitivity to fructose.

Fructose can be found in:

• Fruit, fruit juices
• Honey, maple syrup and agave syrup
• High-fructose corn syrup -found in high quantities in energy drinks, processed foods and most fast foods
• Table sugar (sucrose is 50% fructose) and coconut sugar
• Sweetened beverages
• Xylitol and Sorbitol- both of which are converted into fructose in the body

While it’s “natural,” fructose is metabolised differently than glucose, placing a unique load on the liver.

How fructose affects your liver (and drains your energy)

Unlike glucose, fructose is almost entirely processed in the liver, in a similar way to alcohol! In the liver it:

1. Uses up ATP (your cells’ energy currency) quickly
2. Bypasses the usual regulatory steps in sugar metabolism
3. Converts into fructose-1-phosphate, which:
   • Depletes ATP
   • Increases uric acid
   • May contribute to oxidative stress and fatigue

Over time, this can cause:

• Low energy
• Poor stress tolerance
• Brain fog
• Raised bilirubin (animal studies)
• Worsened liver function in vulnerable individuals, like those with Gilbert’s syndrome

Fructose is metabolised primarily in the liver, where it must be processed by the enzymes fructokinase and aldolase B. While this metabolism is separate from bilirubin metabolism, some individuals with Gilbert’s report symptoms like fatigue, bloating, or brain fog after consuming fructose-rich foods.

Gilbert’s Syndrome: Why fructose may hit you harder

Fructose consumption increases bilirubin

A mouse study where the animals were fed a high fructose diet (were given a 30% fructose solution with their standard diet for 20 weeks) showed a significant increase in total bilirubin compared to the control group. All liver enzymes, inflammatory markers and blood triglycerides were also ALL markedly increased. The study then used quercetin to bring the numbers back in range, but not enough to fully reduce the damage from fructose. (“Regulatory Roles of Quercetin in Alleviating Fructose-Induced Hepatic Steatosis: Targeting Gut Microbiota and Inflammatory Metabolites”)

“Fructose overconsumption may result in insulin resistance, oxidative stress, inflammation, elevated uric acid levels, increased blood pressure, and increased triglyceride concentrations in both the blood and liver” (“Fructose and the liver”)

“Fructose is recognised as a major mediator of NAFLD (non alcoholic fatty liver disease), as a significant correlation between fructose intake and the degree of inflammation and fibrosis has been found in preclinical and clinical studies” (“Fructose and the liver”)

“During fructose metabolism, ATP depletion occurs and induces oxidative stress and inflammatory response, disturbing functions of local tissues and organs to overproduce inflammatory cytokines, adiponectin, leptin and endotoxin, which act as indirect dangerous factors. Fructose and its metabolites directly and/or indirectly cause oxidative stress, chronic inflammation, endothelial dysfunction, autophagy and increased intestinal permeability, and then further aggravate the metabolic syndrome with tissue and organ dysfunctions (“High Dietary Fructose: Direct or Indirect Dangerous Factors Disturbing Tissue and Organ Functions”)

Because the liver already has a reduced capacity to detoxify bilirubin efficiently in Gilbert’s, additional metabolic demands (like high fructose intake) may worsen symptoms or trigger episodes of provoked fatigue and discomfort.

Fructose malabsorption is a separate but overlapping issue — some people with Gilbert’s may also have fructose malabsorption or SIBO (Small intestine bacterial overgrowth), which can lead to GI symptoms when consuming excess fructose.

Fructose depletes ATP, making it so much harder for the liver to manage bilirubin and other functions

Fructose metabolism in the liver can rapidly deplete ATP (adenosine triphosphate) — the cell’s main energy currency — especially when consumed in large amounts. This happens due to the unique way fructose is processed, which bypasses key regulatory steps in glycolysis. Then uric acid rises and increases oxidative stress in the liver — this contributes to fatigue or poor stress tolerance in people with Gilbert’s.

Here is a short video that explains how fructose drains ATP and raises uric acid.

Consequences of ATP depletion from fructose:

• Oxidative stress ((due to uric acid and ROS (reactive oxygen species) generation))
• Mitochondrial dysfunction
• Impaired detoxification and energy metabolism
• Increased fatigue and poor tolerance to high sugar intake

Excess fructose has also been linked to:

• Non-alcoholic fatty liver disease (NAFLD)
• Insulin resistance
• Obesity and visceral fat gain
• High triglycerides
• Type 2 diabetes

Why does this matter in conditions like Gilbert’s?

In people with Gilbert’s syndrome, the liver already has:

• Reduced UDP-glucuronosyltransferase (UGT1A1) activity
• A slightly compromised detox capacity

So, ATP depletion from fructose may further stress liver metabolism, worsen fatigue, detox symptoms, or bilirubin accumulation.

My recommendations for those with Gilbert’s

• People with Gilbert’s may feel better with a trial of limiting or avoiding high-fructose foods, especially:
  • Sweetened beverages (fruit juice, soft drinks)
  • Honey, agave, and high-fructose corn syrup
  • Large amounts of fruit in one sitting

A low-fructose or moderate-fructose diet for 1-2 months may be worth trialing if you experience:

• Fatigue
• Brain fog
• Mood swings
• Hypoglycemia
• Sluggish digestion
• Have a history of IBS, SIBO, or food sensitivities
• Bloating or excessive gas, especially if any of the above are worse after eating high fructose foods (see list below). Try it for yourself for a period of at least a month and see if you feel better. This strategy is especially worthwhile if you already have fatty liver, gallbladder issues or any diagnosed liver symptoms and especially if you are overweight in the abdominal area.

High-fructose foods to limit or avoid

These foods are high in free fructose or have a high fructose-to-glucose ratio, making them harder to absorb and more likely to trigger symptoms, especially for people sensitive to fructose (e.g. with fructose malabsorption, IBS or Gilbert’s syndrome):

These contain more fructose than glucose, and often in high total amounts:

Sweeteners high in Fructose (Avoid)

• Honey
• Agave syrup
• Coconut sugar and syrup
• Maple syrup
• Xylitol (converts to fructose in the liver)
• Sorbitol (converts to fructose in the liver)

Sweeteners that don’t contain or don’t convert to Fructose (OK to have on low fructose diet)

• Stevia
• Monk fruit
• Erythriol
• Maltodextrin (not ideal but is often added to foods and supplements)

Foods highest in high-fructose corn syrup (HFCS):

• Soft drinks- all
• Sports drinks
• Fruit punches and fruit cocktails
• Iced teas
• Energy drinks
• Flavoured waters with added sweeteners
• Sweetened coffee drinks
• Processed sweets: candy, commercial chocolate, chewing gum, marshmallows, frostings/glazes
• Baked goods: packaged muffins and cupcakes, cake mixes
• Donuts and pastries, especially frosted
• Sweetened breads (eg: raisin bread)
• Sweetened cereals (most kids cereals), granola bars, breakfast bars, flavoured instant oatmeal, pudding cups and snack packs
• Condiments and sauces: ketchup, bbq sauce, salad dressings (especially honey mustard or ‘french’), teriyaki sauce, relishes and chutneys
• Dairy and frozen desserts: flavoured yogurts, ice cream and frozen yogurt, whipped toppings, milkshakes from fast food outlets
• Takeaway and fast foods: burger buns and sweet sauces, glazed or sweetened meats, chain restaurants salad dressings and dips
• Hidden HFCS sources to watch: ‘Natural’ fruit drinks, canned fruits in syrup, kids multivitamins or chewables, flavoured nut butters, sweetened nut milks and protein shakes, some cough syrups and lozenges

Which may all affect your liver health if consumed excessively.

When reading labels, look out for:

• High fructose corn syrup
• Corn syrup solids
• Glucose-fructose syrup
• Isoglucose
• Maize syrup

By recognising foods that have fructose and their effects on your body, including the need to monitor your intake of high fructose foods, you can better manage fructose sensitivity symptoms and improve your liver health.

My recommendation is to avoid ALL processed food and drinks that contain any form of high fructose corn syrup.

Moderate-fructose foods – better tolerated (watch portion size)

These may be tolerated in small amounts, especially when eaten with protein or fat

(Fructose ≤ Glucose — easier to absorb)

Low-fructose and fructose-friendly foods

If you’re concerned about your sensitivity to fructose, consider incorporating fruits low in fructose.

These are generally better tolerated and can form the base of a low-fructose plan.

Low fructose fruits (safer options)

These fruits with the least fructose can be delicious alternatives that promote overall health without aggravating your symptoms:

• Berries (strawberries, blueberries, raspberries, blackberries)
• Citrus fruits (oranges, mandarins, lemon, lime, grapefruit)
• Avocado
• Unripe bananas
• Rhubarb
• Kiwi (for some)

Vegetables (all low-fructose):

• Leafy greens (spinach, kale, lettuce)
• Zucchini
• Pumpkin
• Carrots
• Cucumber
• Green beans
• Broccoli (in moderation)
• Eggplant
• Capsicum (in moderation)

Others:

• Protein (meat, eggs, fish)
• Fats (olive oil, nuts, seeds)
• Whole grains (quinoa, rice, oats)- only if tolerated
• Lactose-free dairy or plant-based alternatives (unsweetened)- eg, unsweetened almond milk
• Herbal teas and water

What tests can detect fructose sensitivity?

If you suspect fructose is contributing to your symptoms, testing can help clarify the picture.

1. Fructose Hydrogen Breath Test (part of SIBO testing)

• Drink a fructose solution, then measure breath hydrogen/methane.
• If your small intestine doesn’t absorb fructose properly, bacteria ferment it, → gas is released and measured.
• Used to diagnose: Fructose malabsorption
• True Foods Nutrition can order all SIBO testing

2. Genetic Test for Hereditary Fructose Intolerance (HFI)

• A rare genetic liver disorder diagnosed via ALDOB gene testing.
• Symptoms include nausea, vomiting, and liver problems in infants/children after eating fructose or sucrose.
• Not the same as fructose malabsorption — but important to rule out in patients with strong reactions.

3. Additional/Supportive Testing

These aren’t diagnostic but may point toward downstream effects of fructose overload:

• Uric acid levels (may be elevated with high fructose intake)
• Liver function tests (LFTs)
• Organic Acids Test to understand mitochondrial function
• SIBO breath test (Small Intestinal Bacterial Overgrowth can worsen fructose intolerance)
• Comprehensive stool test (gut flora imbalance may impair fructose absorption)

What you can do

• Try a low-fructose diet for 3–4 weeks to see if symptoms improve.
• Stick to better-tolerated fruits and avoid high-fructose sweeteners (e.g. agave, high-fructose corn syrup).
• Support liver function with gentle liver nutrients (like B vitamins, magnesium, and taurine).
• Work with a practitioner to rule out SIBO, malabsorption issues and mitochondrial dysfunction

Final thoughts on sensitivity to fructose

Fructose is not a poison, but it can be toxic at modern dietary levels, especially from added sugars in drinks and processed foods. Whole fruits in moderation are generally safe and beneficial for most people.

While fructose isn’t inherently “bad,” your body’s ability to handle it varies, especially if you have Gilbert’s Syndrome or other liver sensitivities. By understanding how fructose affects your system and taking the right steps to assess tolerance, you can reclaim your energy, reduce digestive discomfort, and better support your metabolic health.

For more on Gilbert’s Syndrome

• Read my detailed article: Gilbert’s Syndrome and High Bilirubin: Learn Hidden Cause of Gut/Brain Issues.
• Visit my super comprehensive ONLINE COURSE: Living with Gilbert’s Syndrome.

The online course contains a very detailed module on fructose and Gilbert’s, as well as ways to restore energy and ATP production after fructose issues. It also contains a detailed understanding of GS, food and supplement strategies and all the relevant info on blood and functional medicine tests.

Blog References:

• “Fructose and the Liver”, Pablo Muriel et al, Int J Mol Sci, 2021 Jun 28;22(13):6969, doi: 10.3390/ijms22136969.
• “Fructose overconsumption-induced reprogramming of microglia metabolism and function”, Kenneth K Y Ting, Front Immunol, 2024 Mar 26:15:1375453. doi: 0.3389/fimmu.2024.1375453.
• “High Dietary Fructose: Direct or Indirect Dangerous Factors Disturbing Tissue and Organ Functions” Dong-Mei Zhang et al, Nutrients, 2017 Mar 29;9(4):335. doi: 0.3390/nu9040335.
• “Regulatory Roles of Quercetin in Alleviating Fructose- Induced Hepatic Steatosis: Targeting Gut Microbiota and Inflammatory Metabolites”, JinjunLi et al, Food Sci Nutr, 2024 Dec 20;13(1):e4612. doi: 10.1002/fsn3.4612

ADHD (Attention Deficit Hyperactivity Disorder) is a neurodevelopmental condition. It is frequently diagnosed in children, but more adults are now receiving diagnoses of ADHD. It affects around one in 20 Australians, that’s about a million people, but as ADHD becomes more common, people are looking to nutrition and diet solutions and the root cause rather than medication.

You will find that ADHD is more commonly diagnosed in males than females and in childhood when attendance at school highlights difficulties, including physical restlessness, inability to concentrate and short attention span?¹

Although I haven’t sought a formal diagnosis of ADHD for myself, over the past few years, I’ve noticed the signs and symptoms emerge daily and have looked back at my childhood. I can clearly see that this is something I’ve had all my life.

Living with ADHD can be very challenging for parents of ADHD kids, and there is often pressure to have the child put on medication. Whilst many kids and adults find that symptoms sometimes improve on medication, they don’t address the root causes and often have significant side effects, especially with long term use.

In clinic, we have a number of approaches for ADHD and see many child and adult clients with this condition.

Signs of ADHD and Symptoms

The ‘classic’ ADHD adult symptoms identified by psychologists include:

• Inattention
• Hyperactivity
• Impulsivity

Sometimes these traits are clearly evident and visible, and sometimes it can take time to realise that ADHD may be an issue that needs addressing.

I found that Dr Gabor Mate’s book “Scattered Minds” offers a much more in-depth and personal perspective on ADHD. Here are some characteristics and behaviours he describes from his personal and clinical experience and the ones I picked as strongly descriptive of my clients with ADHD and my personal experience.

This quote from Dr Mate’s book is a great summary of how it feels for adults:

“The shock of self-recognition many adults experience on learning about ADD is both exhilarating and painful. It gives coherence, for the first time, to humiliations and failures, to plans unfulfilled and promises unkept, to gusts of manic enthusiasm that consume themselves in their own mad dance, leaving emotional debris in their wake, to the seemingly limitless disorganisation of activities, of brain, car, desk, room. ADD seemed to explain many of my behaviour patterns, thought processes, childish emotional reactions, my workaholism and other addictive tendencies, the sudden eruptions of bad temper and complete irrationality, the conflicts in my marriage and my Jekyll and Hyde ways of relating to my children….. No longer mysterious was my ineptness following directions or even remembering them, or my paralytic rage when confronted by a sheet of instructions telling me how to use even the simplest of appliances.”

Can you relate? I certainly can and realised at 45 years of age that I’ve been this way my whole life.

ADHD is typically separated into three presentations:²

1. Hyperactive-impulsive

May include an inability to sit still in class or play quietly, excessive talking, trouble waiting for his/her turn, and often interrupting or intruding on others.

2. Inattentive

Inability to focus on details, follow instructions and appearing not to listen when spoken to directly.

3. Combined

Meeting the criteria for both hyperactive-impulsive and inattentive types.

Common symptoms of ADHD in adults and children include:

Lack of sense of time

Usually run late for appointments, work, meetings, school pick up- most things. The sense of time for an ADHD person is endless, and estimating it is actually really hard. My clients will know this from the frequent ‘sorry, running 10 mins late’ messages they receive from me before appointments quite often. For a person with ADHD, time has a very stretchy quality, and 10 mins feels like a huge amount of time to try and cram in more ‘to do’ stuff

Lack of focus

Often seen as ‘tuning out’ in the classroom for children and a short attention span, except if it’s something super interesting! Most people with ADHD procrastinate and don’t focus on the task at hand well. Until it’s something they find fascinating and engaging, then the focus is laser-sharp and obsessive, and nothing will divert their attention. To be able to focus, a person with ADD needs a much higher level of the neurotransmitter dopamine, which provides motivation, than other people.

For some, it’s a subject at school- a favourite subject that a child does really well in while struggling with the rest- often because the rest is just not that interesting.

For me, nutrition and everything that relates to health are hyper-interesting, so my focus on my work is laser sharp. In school, I hated all subjects in the field of science with a passion. It wasn’t until I had my own health issues and so did my kids that I became absolutely fascinated and focused on biology, chemistry, genetics and nutrition science.

My classic ADHD trait is reading 5-7 books at the same time and never finishing any of them (lose interest once I ‘got’ the gist). Then ordering more books online to read ‘later’ (impulsivity).

Impatience

A sense of urgency typifies ADD and the need to have everything ‘now’. This has been exacerbated for many in the current urgency culture of devices and endless emails.

Impulsivity with poorly controlled emotional reactivity

Often ADD kids and adults struggle to restrain themselves from interrupting others, find it hard to wait for their turn and often act or speak impulsively, often with negative consequences. Being a ‘class clown’ is a common feature of the ADHD child.

Hyperactivity

Often shows up as trouble keeping physically still, fidgeting or excessively talking. Some people do not exhibit hyperactivity. The mind of a person with ADHD is always in motion and is averse to boredom and a lack of stillness, and an inability to relax and ‘do nothing’.

Emotional regulation

While many people with ADHD are very bright, their emotional regulation skills are often poor. The emotional states of adults with ADD can go through rapid and unpredictable up-and-down swings.

Procrastination

The hyperactivity goes with procrastination. Dr Mate describes this well: “The restlessness coexists with long periods of procrastination. The threat of failure or the promise of reward has to be immediate for the motivation apparatus to be turned on. Without the rousing adrenaline rush of racing against time, inertia prevails”. Books half read, projects half finished, and courses begun and quit are all a feature of ADD.

The ADHD Brain

Brain imaging studies have revealed the presence of neurological dysfunction; while parts of their brain work as expected, cortical regions involved in attention, impulse control, and stimulus integration abilities, have yet to become fully active. As a result, people with ADHD suffer from overload. They have a heightened awareness of incoming stimuli, particularly sight, sound, and touch. They are so overwhelmed by the normal stimuli in their environment that they cannot filter out the background noise, leading to difficulty focusing or concentrating on a problem or a task. As a result, those with ADHD have trouble completing what they start. They have difficulties with making plans and even more difficulty methodically carrying out plans.¹

This is the child with the messy room and the adult with a cluttered desk; their drawers and garages are filled with partly finished projects as they lose interest halfway through. They tend to be impatient and intolerant of change. They can be impulsive, often acting without considering the consequences. They may have trouble differentiating their right hand from their left; they may have difficulty following a set of instructions, reading a map, or telling time. As adults, they are restless, easily bored, rebellious when asked to follow a routine, and always on the move. ¹

Causes of ADHD

The causes are complex and involve genetics, toxicity, nutrient deficiencies and often trauma or excessive stress. As with most health conditions, it is recognised that there are genetic as well as environmental influences on its development.

Genetics

A staggering 1800 studies have looked at the link between ADHD and genetic factors. As a result, we have strong evidence that genes play a role in a person’s susceptibility to developing ADHD. In fact, it’s believed that genes account for 70-80 percent of a person’s risk.³

This is where the certainty ends, though, with many genes implicated but very few consistently found to be the cause of ADHD across-the-board. Among those uncovered are genes affecting the central nervous system transport of dopamine, norepinephrine and serotonin, as well as neuronal plasticity (the ability of the nervous system to modify itself as needed).⁴

The interplay of genes and the maternal and paternal environment begins in utero to produce a neurobiological susceptibility, with structural, functional and molecular brain changes and, subsequently, ADHD occurring as a result.⁵ For example, structural imaging studies show that the brains of these children are significantly smaller than unaffected controls.⁶ Some pre and postnatal influences on neurobiology include the use of alcohol, tobacco, marijuana and prescription medication, as well as maternal stress and obesity, premature birth and low birth weight. ⁶

Other drivers for the development and persistence of ADHD can include

• Dopamine receptor and transport gene issues resulting in dopamine deficiency (I often see these on 23andme gene reports of clients and call these the ‘D’ SNPs: dopamine receptor polymorphisms (SNP stands for single nucleotide polymorphism or let’s call them ‘glitches’)
• Serotonin deficiency
• Increased brain levels of glutamate
• Mast cell activation
• Environmental factors, including nutritional deficiencies, food sensitivities and heavy metal exposures
• Inflammation and oxidative stress
• Emotional and physical stress
• Trauma

​Not only do genes interact with the environment to produce physical brain changes, but those physical changes and gene SNPs impact serotonin and dopamine as they are heavily involved, and both interact closely together.

Studies report that in people with ADHD, there’s a 25% reduction in the binding capacity of serotonin transporters, with functional changes causing modifications in their expression and function.  This affects the synthesis, clearance and metabolism of serotonin, leading to chronic serotonin deficiency. Studies looking at the neurological anatomy suggest that serotonin may regulate behavioural domains of hyperactivity and impulsivity in ADHD.⁷

Dysregulation of the dopamine transporter protein results in higher numbers of these transporters and a greater clearance of dopamine, meaning less dopamine available in the brain. Dopamine is responsible for emotional regulation and taking action in order to achieve a reward​.¹

There are also SNPs in genes for enzymes that convert the amino acid tryptophan to serotonin and dopa to dopamine, resulting in further neurotransmitter deficiencies.⁵

Other SNPs have been reported with links to antisocial behaviour and lower grey matter volume in children with ADHD; these children displayed more aggression and antisocial behaviour.⁵

In clinic, we regularly conduct gene testing to understand the unique underlying genetic glitches that may be impacting your unique ADHD picture because many genes and their functions are modifiable with nutrients and supplements. So even though there is a big genetic platform with ADHD, there is a lot that can be addressed through the right nutrition.

Example of gene report with dopamine conversion and dopamine receptor SNPs (glitches)

Inflammation

In ADHD, increased inflammation heavily influences the way excitatory neurotransmission occurs, with changes in kynurenine pathway metabolites closely associated with ADHD symptoms. The kynurenine pathway is the inflammatory pathway serotonin can take when there is dysfunction, changing the way serotonin (and melatonin) is synthesized.

In the presence of inflammation and elevated stress hormones such as cortisol, tryptophan is shunted away from the production of serotonin and metabolised to the neurotoxin quinolinic acid.  Essentially when it moves down this pathway, it reduces the levels of much-needed serotonin.⁵  Animal studies have shown these metabolites act directly on glutamate receptors causing substantive increases in its release. Glutamate is one of our excitatory neurotransmitters, causing the symptoms relevant to ADHD: restlessness and difficulty concentrating.⁵

Adding further fuel to the fire, inflammation decreases biopterin, a cofactor for the function of an enzyme that produces serotonin and dopamine, further exacerbating their deficiency.

There are also negative effects on the expression of Brain Derived Neurotropic Factor (BDNF) within the brain, which leads to deficits in neuroplasticity – the ability of the nervous system to perceive, respond and adapt to stimuli – essential for learning and memory.  This has additional consequences for neurogenesis (the formation of new nerve cells) and, therefore, cognition.

Inflammation can come from many sources, the most common being: mould exposure and toxicity, heavy metals, bacterial overgrowth in the gut and leaky gut. Having a leaky gut usually leads to having a ‘leaky brain’ which leads to brain inflammation.

In clinic, we use Organic Acids Testing to check serotonin, dopamine and their metabolism, as well as assess any kynurenine pathway dysfunction. This test is also fantastic for identifying mould and bacterial toxicity and overall toxic load. Below is an example of neurotransmitter test results from Organic Acids test of an ADHD individual:

Nutritional deficiencies most common in ADHD

Iron

Studies show that iron storage and ferritin are low in people with ADHD and can exacerbate symptoms such as fatigue and Restless Legs Syndrome.⁹ Iron is vital in the production of dopamine and serotonin as well as thyroid function, all of which are critical in ADHD. Blood testing for iron studies is essential.

Vitamin D

Can increase the risk of developing ADHD and exacerbate symptoms.¹⁰ Vitamin D deficiency is extremely common even in ‘sunny’ places like Australia and, most definitely, in the UK and North America.

Zinc

Deficiency is common in ADHD, and the issues that go with it, such as depression and anxiety⁹, and raised copper: Zinc ratios contribute to risk and severity.¹¹ This is a very common imbalance and is also linked to Pyroluria– more on this below.

Omega-3 Fatty Acids

Omega-3 fatty acids are deficient in those with ADHD.¹² Omega 3 fatty acids, especially from oily fish such as sardines (which are lower in mercury than bigger fish), are very important to keep inflammation under control as well as directly positively influence the brain.

Magnesium

Very commonly deficient in the hyperactive subtype.⁹ Magnesium deficiency is so widespread some estimate that 90% of the population is chronically deficient. I find that the vast majority of our ADHD child and adult clients improve dramatically on magnesium supplementation. Incidentally, magnesium helps us manage blood sugar and stress, which are such prominent features of ADHD.

Copper dysregulation

Both copper toxicity and deficiency impact dopamine levels, so it is very common to see this factor today. I wrote a blog on Copper Toxicity HERE.

Other influences on the ADHD child or adult include:

• Poor diet that includes refined sugars, preservatives, colours and additives
• A diet and an environment that causes acidity in the body
• Poor digestive function as evidenced by constipation/diarrhoea and/or low appetite
• Exposure to a myriad of environmental toxins including mycotoxins (the toxins produced by mould in water damaged buildings)
• Pesticides and chemicals in food and personal care products
• Heavy metals such as mercury, lead, cadmium and arsenic, which we routinely see on Hair mineral analysis tests

ADHD and its link with Pyroluria

ADHD has a lot of crossovers with Pyroluria/Pyrrole disorder. I’ve written extensively on Pyroluria disorder signs and symptoms along with recommended Pyrrole disorder diet recommendations.

Due to the zinc and B6 loss that occurs in Pyroluria, the production of both dopamine and serotonin is compromised, leading to the symptoms we commonly see in ADHD described above.

Anyone diagnosed with ADHD should consider a Pyrrole test and a Hair mineral analysis as a starting investigation into the root causes.

Food sensitivities and intolerances

People with ADHD often also suffer from gastrointestinal and immune dysfunction. Many also suffer from both Th1- and Th2-mediated conditions like:

• ear infections
• asthma
• eczema

A common pathophysiological mechanism has been suggested to underlie both asthma and ADHD, while several genes that are linked to ADHD have immune functions.⁸

In clinic, we see many kids and adults with ADHD who struggle with histamines and/or salicylates and other food sensitivities. Most of these arise from poor microbiome and poor liver clearance of these compounds due to poor methylation (detox) and glucuronidation pathways of the liver. Gene testing can be helpful here again to look at genes such as COMT, MTHFR, UGT1A1 and other liver detox pathways related genes.

The gut brain axis

Evidence suggests that the gut-brain axis is heavily influenced by the health of the microbiome. That microbiome may have been affected from birth with the use of proton pump inhibitors for baby reflux, antibiotics, especially prior to three years of age and bottle feeding.

Neurotransmitters directly affecting dysfunctional behaviours in those with ADHD are produced either directly or indirectly by the gut microbiota. In clinic, we regularly use microbiome testing to determine both the levels of ‘good/bad’ bacteria as well as overall gut function, such as the production of digestive enzymes, the presence of leaky gut and much more.

An example of poor ‘good’ gut flora in an ADHD child:

Sleep and ADHD

Sleep can be compromised by neurotransmitter and nutritional deficiencies, excess glutamate in the brain and neuroinflammation. Improving these underlying factors and subsequent sleep quality can improve neurological functioning, including impulse control, memory and attention.¹³

Stress and Trauma

I believe that one of the huge drivers of the ADHD epidemic we have today is excessive stress and unresolved trauma. Stress underpins most physical dysfunctions described above: it makes us lose calming minerals and vitamins like Magnesium, B6, zinc, and B vitamins. It lowers our stomach acidity (hydrochloric acid), leading to poor protein absorption and poor absorption of iron, zinc and B12 – the absolutely fundamental blocks of the formation of serotonin and dopamine. Stress impacts sleep quality resulting in the lowering of these neurotransmitters and gut dysfunction. Dr Mater discusses the impact of family dynamics, stress and trauma in the ‘Scattered Minds’ book in detail.

Addressing stress is one of the key strategies of our approach to ADHD.

Our ADHD child specialist and adult ADHD specialist can help

In our clinic, Toni Chambers specializes in ADHD in children, and Maria Allerton focuses on adults with complex ADHD and other conditions.

We take a detailed case history and discuss testing priorities to determine triggers and underlying issues to develop a comprehensive, individualised treatment plan. We often:

• investigate important nutritional deficiencies via Hair Tissue Mineral Analysis (HTMA) and/or blood testing
• determine the presence of toxic metals and heavy metals via HTMA
• thoroughly assess diet and potential environmental triggers
• determine food triggers via Food Sensitivity Testing
• conduct comprehensive microbiome testing via stool sampling to determine gut function, presence of pathogens and microbiome diversity
• conduct genomic testing
• determine neurobiological involvement, neurotransmitter deficiencies and the presence of mycotoxins via Organic Acids Testing

Everyone’s ADHD journey is unique and requires addressing the multiple factors discussed here.

How we can help

1. Book a consultation.
2. Check out our gut healing program, “Healing IBS Naturally” to begin your journey of gut restoration and food elimination/re-introduction to determine your unique food triggers and begin healing the gut and the brain.

References

1. Blum K, Chen AL, Braverman ER, Comings DE, Chen TJ, Arcuri V, Blum SH, Downs BW, Waite RL, Notaro A, Lubar J, Williams L, Prihoda TJ, Palomo T O-BM. Attention-deficit-hyperactivity disorder and reward deficiency syndrome. Neuropsychiatr Dis Treat. 2008;4(5):893-918. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626918/
2. Radnegde K. ADHD in Australia : an overview of diagnosis and treatment. Aust J Pharm. 2020;101(1194):77-81.
3. Committee PGCC. Genomewide association studies: history, rationale, and prospects for psychiatric disorders. Am J Psychiatry. 2009;166(May):540-556.
4. Zhou K et al. Meta-analysis of genome-wide linkage scans of attention deficit hyperactivity disorder. Am J Med Genet Neuropsychiatr Genet. 2008;147B(December 5):1392-1398.
5. Yadav SK, Bhat AA, Hashem S, et al. Genetic variations influence brain changes in patients with attention-deficit hyperactivity disorder. Transl Psychiatry. 2021;11(1). doi:10.1038/s41398-021-01473-w
6. Curatolo P, D’Agati E MR. The neurobiological basis of ADHD. Ital J Pediatr. 2010;36(1):79.
7. Banerjee, Emili, Nandagopal K. Does serotonin deficit mediate susceptibility to ADHD? Neurochem Int. 2015;82(March):52-68. https://www.sciencedirect.com/science/article/abs/pii/S0197018615000212
8. Verlaet AAJ, Noriega DB, Hermans N, Savelkoul HFJ. Nutrition, immunological mechanisms and dietary immunomodulation in ADHD. Eur Child Adolesc Psychiatry. 2014;23(7):519-529. doi:10.1007/s00787-014-0522-2
9. Villagomez A, Ramtekkar U. Iron, Magnesium, Vitamin D, and Zinc Deficiencies in Children Presenting with Symptoms of Attention-Deficit/Hyperactivity Disorder. Children. 2014;1(3):261-279. doi:10.3390/children1030261
10. Johnson SR, Zelig R, Parker A. Vitamin D Status of Children with Attention-Deficit Hyperactivity Disorder. Top Clin Nutr. 2020;35(3):222-239. doi:10.1097/TIN.0000000000000202
11. Skalny A V., Mazaletskaya AL, Ajsuvakova OP, et al. Serum zinc, copper, zinc-to-copper ratio, and other essential elements and minerals in children with attention deficit/hyperactivity disorder (ADHD). J Trace Elem Med Biol. 2020;58(March):4-6. doi:10.1016/j.jtemb.2019.126445
12. Lachance L, McKenzie K, Taylor VH, Vigod SN. Omega-6 to omega-3 fatty acid ratio in patients with ADHD: A meta-analysis. J Can Acad Child Adolesc Psychiatry. 2016;25(2):87-96.
13. Gregory AM, Agnew-Blais JC, Matthews T, Moffitt TE, Arseneault L. ADHD and Sleep Quality: Longitudinal Analyses From Childhood to Early Adulthood in a Twin Cohort. J Clin Child Adolesc Psychol. 2017;46(2):284-294. doi:10.1080/15374416.2016.1183499
14. Gabor Mate MD, “Scattered Minds”

As always my answer is – it depends.

I firmly believe there is no one ‘diet’ that works for everyone which is why I practice highly personalised nutrition.

However, below are some general guidelines that I have formulated based on my personal experience, my clinic experience with hundreds of clients with Pyrrole Disorder, and research by experts in relevant areas.

The absolute key issue to address for anyone with Pyroluria is gut health. This is paramount and is the biggest cause of oxidative stress I see in my Pyrrole clients. If you are experiencing ongoing gut issues (such as pain, feeling bloated with irregular bowel movements, diarrhoea, loose stools or constipation or alternate between all of them, food reactions and many others), my ONLINE PROGRAM – HEALING IBS – is an excellent start. It will guide you through a 5 week elimination and re-introduction diet as well as provide worksheets and recordings to re-program your stress response and calm your nerves, which calms the gut.

Pyroluria Diet Guide

Please use this article as a guide to help create your health journey and Pyroluria diet, however please note that I don’t mean for you to use this information in a way that leads to restrictive eating. If you follow every one of these guidelines you will have very few foods to eat and that creates its own problems!

Some people do just fine eliminating gluten and dairy and ensuring adequate zinc foods: simple. Some people need a lot more attention.

If for example you are like me and have genetic issues around Pyrroles, Oxalates, Gilbert’s syndrome, MTHFR, etc, then navigating nutrition can become very challenging.

If you are one of these people my recommendation is to book a consult with a Clinical Nutritionist so you don’t have to struggle on your own, especially if you’ve tried various dietary approaches and still haven’t achieved your health goals.

Pyroluria Diet : Raw oysters people!

Pyroluria Diet Recommendations : What To Avoid

Avoid pro-inflammatory foods: gluten, cow dairy, sugar and hydrogenated fats

Personally, I believe every person should avoid these. If you have pyrolle symptoms or if you have been diagnosed with Pyroluria, I believe avoiding these is one of the best things you can do for your health.

Why avoid gluten?

Wheat is highly inflammatory for our gut and gluten in particular is linked to worsening intestinal permeability issues (leaky gut), (Fasano, A, ‘Gluten Freedom’).

When we have compromised zinc levels as in Pyroluria, the tight junctions in the gut cannot function properly, making us more predisposed to permeability. When you have a leaky gut, you have a leaky brain, with consequent brain symptoms such as anxiety, depression and mood swings.

Gluten triggers immune responses by penetrating the blood brain barrier and increasing inflammation in the brain. Many mental health conditions including schizophrenia have been strongly linked to gluten intolerance. Many people suffer a lifetime of mental illness that is often dramatically improved when eliminating gluten from the diet.

It is well known that glyphosate sprayed on crops (which tends to chelate zinc) and fungicides such as copper sulphates also used on crops are extremely toxic to all humans and especially the extra sensitive Pyrrole people.

I find within my clinic population, most people and especially those with Pyroluria do very well when they remove ALL grains from their diet and adopt a Paleo approach. This is the Pyroluria diet approach I’ve been personally doing 95% of the time for the last 13 years.

Grains are a copper dominant food as well as being a massive strain on digestion (more on this below).

Why avoid dairy?

The cow dairy protein casein is similar to gluten as it triggers inflammatory responses by our immune system. This can lead to a hyperactive immune system that can then become super-sensitive to other foods that weren’t bothersome before, such as tree nuts, citrus, strawberries, or other vegetables and fruits (Wahls, T ‘The Wahls Protocol’).

Both casein and gluten contain morphine like compounds that are psychoactive in our brains, that’s why they can be so addictive – if I had $1 for every time a client said to me ‘I can’t give up cheese, I just can’t’….” – addictions!!

One of the reasons why gluten and dairy are so problematic for people with Pyrroles is due to poor metallothionein function. Metallothionein is a protein that is a binder for minerals such as zinc, copper and selenium.

“A significant impairment in metallothionein function could cause incomplete breakdown of casein, gluten, casomorphins, etc which can result in severe food allergies”, William Walsh PhD (‘Nutrient Power’).

Metallothioneins are proteins that regulate zinc and copper levels, neurons in the brain and their synaptic connections, enhance immune function and protect against toxic metals – all issues that people with Pyroluria struggle with!

One of the metallothionein proteins is responsible for regulating Hydrochloric acid in the stomach and enables taste discrimination by the tongue (Walsh, W, ‘Nutrient Power’). This is why so many people with Pyroluria struggle with morning appetite, bloating (poor protein digestion in the stomach) and why so many children with sensory oral issues have Pyroluria.

There is so much more to these proteins then just gluten and dairy digestion. I find that addressing metallothionein function is critical to many Pyrrole symptoms. For more info on personalised metallothionein enhancing therapies click here to discuss.

I find a lot of conventional dietitians and other food authorities are prone to raising alarms about cutting out whole food groups like grains and dairy. I find this is completely unfounded nutritionally and most leading functional medicine practitioners agree:

“Another criticism is that eliminating grains and dairy eliminates important sources of nutrition, and without them, deficiencies will result. This is simply untrue. You can get all the nutrients you need without eating grains, dairy or legumes”. Terry Wahls MD, ‘The Wahls Protocol’.

If you have a child with Pyroluria, the simplest and effective intervention you can undertake nutritionally is to take them off gluten (and grains if possible) and dairy for 3-6 months (that’s how long it takes to clear these proteins from our immune system) and watch the behaviour changes unfold.

I find clinically, unless this is done, most nutritional/supplement treatments are a lot less effective.

Why avoid sugar?

I don’t think we need a long explanation here

Sugar creates inflammation the moment it enters the blood stream and many Pyrrole clients of mine suffer from hypoglycaemia due to very weak adrenals (weakened by years of copper dominance) and they struggle to regulate their blood glucose.

Keep added sugar intake to an absolute minimum (that’s my phrase for ‘none’) and get your glucose from fresh fruits, berries and occasional dates.

As many people with Pyroluria are very prone to anxiety, one of the simplest ways to address anxiety is to keep your blood sugar as stable as possible with regular protein and veg meals with healthy fats.

Most Pyrrole people will have a terrible time with anxiety and mood fluctuations if they fast or have long periods without food. Avoiding sugar is a great way to remedy this.

Why avoid hydrogenated fats?

There has been a lot written about the toxicity of processed vegetable fats such as canola, soy and sunflower oils so all I will say here is avoid them like the plague.

It’s a pretty well established fact that they are extremely pro-inflammatory and people with Pyroluria already have a lot of inflammation to address.

Big obvious thing to point out here is that 95% of all take away foods and restaurant meals are still cooked in these oils as they are so cheap. So my advice here is to avoid take away as much as possible or ensure olive oil or butter was used in the cooking (ask for this) or buy food from places like ‘build your own salad’ so you can choose the dressing.

The best strategy to reducing hydrogenated fats from your diet is to cook most meals at home where you know exactly what’s in the meal and make take away and dining out less frequent.

Avoid all stimulants

Stimulants such caffeine and alcohol as well as recreational drugs are extremely problematic for people with Pyrroles as they tend to be much more sensitive to these substances. They create oxidative stress in the body and we know that Pyroluria is a condition of high oxidative stress.

Caffeine almost always triggers anxiety, overwhelms liver detox pathways and impacts sleep. Most people with Pyrolles struggle to detoxify alcohol, caffeine and drugs so these are best avoided for optimal health.

Avoid foods contaminated with heavy metals

Tuna, swordfish, marlin, orange roughy, fish from Asian waters and all farmed fish (in Australia that’s all salmon and trout and most barramundi).

Use this Australian government guide and eat from the Least mercury section 95% of the time: mecury in fish government guidelines. Fish is an extremely toxic food these days sadly.

Pyrrole Disorder Diet Recommendation : Eat your steak!

Pyroluria Diet Recommendations: What To Eat

Increase high antioxidant foods

These foods need to be increased as much as possible as pyrroles is a condition of high oxidative stress. (Note: the Dutch Hormone test I regularly use in clinic actually has a very validated oxidative stress market 8OHDG, so I regularly test for levels of oxidative stress in clinic).

The most obvious high antioxidant foods are fruit and vegetables as well as small oily fish. If your diet is abundant in fruit and veg, your level of oxidative stress is likely to be lower.

Aim for 6-8 cups of diverse vegetables per day and 2 fruits (less sugary is best).

Eat organic as much as possible or at least follow clean 15/dirty dozen

Avoiding pesticides and increasing the nutrient value of food by buying local organic produce is a great way to maximise your nutrient intake and ensure as many minerals and vitamins as possible.

Of course not everyone can afford to buy everything organic – I would prioritise meats and fats to be organic and as many fruit and veg as you can afford following the Clean 15/Dirty Dozen lists every year.

A caveat here is that unfortunately most of our soils (particularly in Australia) are extremely nutrient deficient and unless you have your own organic garden which you regularly measure mineral content in, sadly we don’t get many minerals from the soil any more.

Nothing irritates me more than government authorities and others who propose that we can get ALL our nutrients from food. This may have been possible 100 years ago, but is no longer the case. Soil analyses routinely find that content of minerals in food is depleted.

I find this is particularly the case with zinc which is so critical for Pyrrole disorder. I have NEVER seen an adequate level of Plasma zinc on any of my clients’ test results, regardless of health condition.

Increase zinc rich foods

Zinc is of course is absolutely essential for everyone, and especially for people with Pyrrole Disorder. Zinc has numerous functions in the body, the key being: mood regulation, anti-oxidant, immune regulation, skin health.

All red meats contain a good amount of zinc, as do oysters and most seafood. Pepitas are a great plant source, so be sure to have these in your diet DAILY.

The best absorption of zinc occurs on an empty stomach. So if you can grab some fresh raw oysters first thing in the morning, you’ll be doing well

Increase foods high in vitamin C

Vitamin C is an anti-oxidant and is very important at balancing out any oxidative stress induced by copper in Pyroluria.

There are many vitamin C rich foods most of which are fruits, berries (particularly inca berries), camu camu, rosehips, etc. Consume some of these in your daily diet to increase your Vitamin C levels.

Kiwi contains high amounts of Vitamin C

I do find however that the vast majority of people do not take in enough vitamin C from foods and foods are also depleted as they travel large distances (and come from nutrient deficient soil).

I highly recommend a wholefood vitamin C supplement for most people which is a blanket recommendation I’m happy to make here as it is completely safe.

NOTE: NOT ascorbic acid based supplements, but wholefood vitamin C powders only. Ascorbic acid unbinds copper from ceruloplasmin which we really don’t want.

Reduce phytic acid content of foods

Reduce phytates by soaking/activating nuts and seeds and soaking/rinsing grains of you eat them.

Phytates bind zinc and iron as well as calcium, making them less absorbable. If you can soak all your nuts and seeds in salted water overnight and then dehydrate them in oven at low heat for 24h you will remove large amounts of phytic acid.

Activate those almonds!

The big Copper foods question

Individuals with excessive tissue copper accumulation will often crave foods that are high in copper. Avoid the following foods, whilst addressing your copper issues.

As always, this is best individualised for each person based on actual results because we still need usable copper from foods for many functions in the body. Copper is not evil, it just needs to be kept in check.

Foods high in Copper:

• Chocolate (yes and I know you already hate me)
• Liver
• Crab, herring, lobster, haddock, prawns, trout
• Walnuts, pecans, peanuts and peanut butter, almonds, brazil nuts
• Sesame, sunflower seeds
• Mushrooms
• Avocado
• Grapes
• Bakers yeast

There are many lists around with copper high foods and there are some variations as it’s difficult to consistently measure mineral contents of foods.

The above list is from Interclinical Labs whose hair analysis test I use in clinic with Pyrrole clients on a daily basis (watch my video on hair analysis and Pyrroles).

The absolute worst Pyroluria diet choice: vegan and vegetarian diets

Vegan and vegetarian diets are very copper rich and zinc deficient as most foods such as grains, legumes and nuts are very high in copper.

If you choose to pursue a vegetarian or vegan diet for philosophical reasons and you have tested positive for pyrrole disorder, it’s very important to work with a knowledgeable practitioner to ensure you maintain an optimal copper/zinc balance and supplement your diet correctly and test your blood and hair copper and ceruloplasmin levels regularly.

From Hair Mineral analysis testing it is always very clear to see copper accumulation and imbalance in vegan/vegetarian diet adherents. This often leads to copper related issues such as hormonal dysregulation (PMS, period pain, breast pain, fibroids and many other estrogen dominant conditions) as well as mood issues related to copper overload- anxiety, irritability, anger, emotional withdrawal etc.

A note about drinking water

It is absolutely essential to ensure copper is not leaching into your drinking water. Older homes contain copper pipes that usually will leech copper and lead into water, this is sadly a very common issue and one that I’ve had personal experience with.

Get a proper water filter: reverse osmosis or a system that removes 99% of heavy metals.

For those with histamine intolerance

Many people with Pyrroles often have issues digesting high histamine foods due to lowered methylation capacity in the liver. This area really requires individual attention.

What I’ll say here is if you react negatively to:

• bone broths,
• tomatoes,
• bacon,
• spinach,
• fermented foods, and
• alcohol.

Meaning that your body reacts to those foods with increased:

• anxiety
• insomnia
• migraines
• itchy skin

Then you likely have a histamine ‘intolerance’ and need to address your gut and liver health.

For those with oxalates as well as Pyroluria

Another common problem that many people with Pyroluria have is poor capacity to digest dietary oxalates and these substances can build up in the joints and kidneys and cause joint pain and kidney stones.

READ MORE:  High oxalate foods to avoid 

For those with Gilbert’s syndrome as well as Pyroluria

Many people with Pyrroles also test positive for Gilbert’s syndrome. This is when your bilirubin stays elevated on bloods and causes a host of issues.

Read more about Gilbert’s syndrome and foods associated HERE.

Quick summary of Pyroluria Diet Recommendations

Best overall diet for most: Paleo/Ancestral

Caution with: Keto (read more on why caution HERE)

Absolute worst choice: Vegan

Navigating optimal nutrition and discovering a Pyroluria diet that’s right for you can be challenging. It requires a deep understanding of your personal test results, genetic heritage, gut health, adrenal health and numerous other factors.

To get to the bottom of what’s truly best for YOUR personal situation, feel free to book an online consult with me HERE.

Learn more about Pyrrole Disorder

If you’ve found this information useful, you will also enjoy my other blogs related to Pyroluria:

• Pyroluria: The Stress Disorder
• Pyrrole Disorder: Signs, Symptoms & When To Seek Help

My online Healing IBS Program is a great starting point to resolve many symptoms or Pyroluria related to the gut-brain axis.

Stress Reduction e-course

We all know that Pyroluria is a stress intolerance disorder. I find that ALL of my Pyrrole clients benefit greatly from mindfulness based stress reduction.

Here is an excellent e-course that you can do at your own pace that will help with anxiety, stress tolerance and resilience. Highly recommended (and also suitable for children over 14y.o): RETURN TO CALM E-course

Article References:

“Nutrient Power”, William Walsh, PHD
“Gluten Freedom”, Alessio Fasano MD
“Grain Brain”, David Perlmutter MD
“The Wahls Protocol’, Terry Wahls MD

IBS is not a disease in and of itself. It is a collection of symptoms caused by other health factors. Other factors are often overlooked or not looked into at all. They often leave you with symptom relief but no solutions to address the cause of the digestive distress!

But there is no need to live with the throws of IBS long-term. You can address Irritable Bowel Syndrome by testing your gut health to discover what’s causing the IBS symptoms. And then, you can make a clear plan to fix the cause and heal your gut.

Irritable Bowel Syndrome… Don’t you just love the diagnoses of exclusion and the term ‘syndrome’?!

For millions of people who experience digestive distress daily – and I was one of these people at 17 years old – the story goes something like this:

• you have bloating when eating some meals (can be after the same foods or completely random);
• constipation or difficulty going to the toilet or loose stools or diarrhoea or (even more fun) both alternating;
• you get bad gas and pain in the general gut area when you are stressed (seemingly regardless of what you eat);
• emotionally you feel like you have zero control over your body, and your gut is controlling you.

You get OCD about where the bathrooms are anywhere you go. And over time, start limiting social occasions to avoid feeling like you are spending half the time on the toilet and the embarrassment that goes with that.

When you see your doctor, the best-case scenario is:

• you get a test for coeliac disease (negative 99% of the time)
• possibly a test for lactose intolerance
• if you are sick enough, a colonoscopy/endoscopy to rule out Crohn’s or bowel cancer.
• You may even be told to see a dietitian and try a low Fodmap diet.

If all your tests are normal, you are told you have Irritable Bowel Syndrome – not a disease, a syndrome!

A syndrome is a collection of symptoms that don’t match any defined ‘disease’.

To say that this is a frustrating diagnosis for many is an understatement (who thought of ‘Irritable’ in the first place?? The bowel is not Irritable. It’s not in a mood!).

Worst case scenario – you get prescriptions for laxatives and anti-depressants and get told ‘this is all in your head’ and you need to ‘just relax ‘.

Been there, done that.

I knew nothing when I was diagnosed with IBS at 20 years old (after about 3 years of intermittent digestive symptoms, which started when I was doing my high school exams). There was zero advice given (actually, I think the doctor did say peppermint tea helps!).

It took me years of dietary trial and error to determine what foods and situations would set off my symptoms. Then I completed my nutrition qualification, and the rest is history.

Photo by katemangostar

In this blog, I will share with you:

Why I believe there is no such thing as IBS

And why I know there is ALWAYS a cause (or several) of your digestive symptoms and why it’s essential to uncover the causes to avoid misery for life.

First of all, do NOT accept the vague diagnosis of ‘Irritable Bowel Syndrome!’

There is always a cause for IBS. It just needs to be uncovered with proper gut testing.

When I conduct a GI Map Gut Test with my clients, 99% of the time, the reasons (there are usually multiple) for their IBS are blatantly clear.

And yes, sometimes a follow-up endoscopy/colonoscopy is required if the issue has progressed enough to warrant further investigation.

Below I will discuss the most common reasons behind and what is an IBS cure and Irritable Bowel Syndrome symptoms. However, your first starting point should be a comprehensive gut test like GI Map.

Common causes for Irritable Bowel Syndrome:

Gastro Episode

An episode of gastro (at any time in your life) is triggered by pathogenic bacteria that actually change how your gut operates. It doesn’t even need to be severe or ‘eventful’ gastro. The gastro bug may be long gone, but the fallout from that damage remains. How often have I heard my clients say, ‘Nothing has been the same since that trip to X place and the gastro I had there’.

The pioneering work of gastroenterologist and researcher Mark Pimentel, MD, indicates that IBS – at least in the case of some patients – may be an autoimmune disease triggered by food poisoning that damages the nerves of the small intestine.

Dr Pimentel has identified antibodies that are produced in the body in response to common bacterial infections such as Campylobacter jejuni, E. coli, Shigella, and Salmonella. When there is a case of severe food poisoning, the antibodies cross-react with a protein in our gut nerve cells called Vinculin.

This cross-reactive attack triggers an immune response that culminates in producing anti-vinculin antibodies. This leads to the destruction of the intestinal lining and tight junctions. This tight junction attack produces intestinal permeability (leaky gut) and changes the movement in the gut (dysmotility).

Faulty intestinal motility facilitates small intestinal bacterial overgrowth (SIBO) and triggers IBS symptoms.

Dr Pimentel’s research shows that this process is prevalent in people with IBS-D (diarrhoea dominant) and IBS-M (mixed).

However, the antibodies do not appear to be significantly elevated in people with IBS-C (constipation-predominant IBS) and, therefore, cannot be used to diagnose that particular form of IBS.

How can we address antibodies in people with IBS?

Until the antibody test is widely available, we can use the GI Map Test to identify pathogenic bacteria infections and begin treatment as well as gut repair and autoimmune diet protocols.

Food Intolerances

Common food intolerances such as gluten, dairy, soy, and corn (and most grains) become a problem and can trigger all types of Irritable Bowel Syndrome – ranging from constipation to diarrhoea.

To distinguish between different types of food reactions, read my previous blog – Understanding Food Intolerances.

The real reason foods become a problem is the loss of our immune tolerance, our Secretory IgA layer.

Production of sIgA is important to the normal function of the gastrointestinal mucosa as an immune barrier. It represents the first-line immune defence of the gastrointestinal tract. Elevated levels are associated with an unregulated immune response.

On the other hand, low sIgA levels are the most common picture I see in the clinic, with the GI Map tests demonstrating a very low defence system. A system that has been ‘worn out’ by reacting to food triggers, so low sIgA leads to increased sensitivity to foods. Several studies link stress and emotionality with levels of sIgA.

We know that stress is a major factor in IBS, so people experiencing higher than normal amounts of stress will have a weaker Secretory IgA defence system. These people have a much higher sensitivity to common foods, triggering painful IBS symptoms.

How can we address Secretory IgA in IBS sufferers?

Secretory IgA is one of the key markers we can measure on the GI Map test, and there are many strategies to improve this immune layer to reduce food intolerance reactions.

Inflammation

Inflammation can come from the wrong foods (eg: casein from dairy is extremely inflammatory for many people) and parasites and pathogenic bacteria.

How can we address inflammation in Irritable Bowel Syndrome?

Calprotectin is a well-established inflammation marker and can be measured on the GI Map gut test. If there is inflammation in the bowel, it’s important to eliminate as many sources of it as possible, usually involving a strict diet.

Bacterial Imbalance (or dysbiosis)

An overgrowth of opportunistic or pathogenic bacteria.

Usually, the most common reason for this is the overuse of antibiotics (at any time in your life, especially in childhood) that decimates the rich rainforest of beneficial bacteria in your gut.

These imbalances can be corrected once identified with the GI Map test and carefully addressed by a qualified and experienced health practitioner.

The reason why the Fodmap diet helps alleviate IBS symptoms is that overgrown bacteria in the small intestine and bowel feed on the easily fermentable gases from these foods. Which then triggers discomfort and pain.

Note that I said – alleviate symptoms. That is all the Fodmap diet does: reduce symptoms. Unlike commonly stated in the media, it is NOT how we treat IBS or cure Irritable Bowel Syndrome. Removing these food groups simply reduces the pain, gas, and sensitivity symptoms and yes, makes life more manageable.

I used to follow a strict Fodmap diet for my IBS for years because I didn’t know the root causes of my Irritable Bowel Syndrome.

Without identifying the root causes and treating them, people are left to be ‘Fodmap for life’, which is a very damaging approach in the long term.

Many Fodmap foods are actually highly beneficial as prebiotic fibre to our gut flora. Eliminating these foods eventually leads to worse dysbiosis!

This is an essential concept to understand if you are an IBS sufferer – the Fodmap diet is NOT a cure or treatment. It is a symptom relief approach that works well in the short term for some people.

How can we cure or fix IBS?

The key approach to fixing Irritable Bowel Syndrome is to do the full testing to identify YOUR root causes. Then address these so that you don’t have to eliminate healthy foods from your diet for the rest of your life. Working with a skilled practitioner is the best way to do this.

Bacterial overgrowth Sydney Nutritionist

Bacterial overgrowth Sydney Nutritionist

Parasites

Parasites are prevalent and responsible for many digestive symptoms.

Many people carry parasites. However, only some become symptomatic. The gut environment varies tremendously from person to person and is what determines whether parasite infections will lead to symptoms.

All parasites, however, drain our nutrient stores, so this is a vital area to address.

Dientoemeba Fragilis and Blastocystis Hominis are Australia’s two most common parasites. Regarding parasites, there are two schools of thought among traditional medical professionals such as GPs and gastroenterologists and complementary therapists such as nutritionists and naturopaths.

One school’s view is: to kill them. Kill them all and use the biggest guns we have – antibiotics (medical) or strong herbal antimicrobials (complimentary).

The second school’s view (which I tend to lean towards, depending on my client’s case) is: the parasite is not the problem. The terrain is the problem. In other words, the gut environment, the nutrient levels, the health conditions, and the stress/emotional health are the key drivers of allowing the parasite to take hold and cause trouble.

This ‘terrain’ – meaning our whole gut environment and digestion – starting from the mouth and ending in the anus is what requires work, and attempting to kill off a parasite may make the situation worse.

How can we address IBS?

The GI Map gut test tests for several common parasites and provides their quantities to measure treatment success.

Undiagnosed Helicobacter Pylori infection

Until I started using the GI Map Stool Test, I assumed that if a client came in with a negative H.Pylori breath test from their doctor, that ruled out this stomach infection. This is far from reality, it turns out.

Quite often, the breath test will provide a false negative if the bacterial levels are relatively low or if the bacteria are inactive at the time of the test.

H.Pylori can be a big trigger for IBS as it changes the stomach acidity and thereby predisposes the person to bacterial overgrowth in the small intestine (SIBO), a widespread cause of IBS. If you’d like to read more on low hydrochloric acid and SIBO, you can do so via this blog post, Gut Tests – What You Need to Know to Heal Your Gut.

How can we address H. Pylori?

The GI Map test identifies the DNA of H.Pylori and its virulence factors which is a far more accurate approach than just breath testing alone.

Identifying and treating H.Pylori infections naturally can significantly affect how you absorb nutrients and how your gut motility functions.

Poor stress management, past trauma, exhausted adrenals

Stress destroys our Secretory IgA immune layer, leaving us open to food sensitivity reactions.

Stress changes the hydrochloric acid, thereby altering the motility of the gut.

Stress reduces nutrient absorption, making everything more difficult.

In short, managing stress is a hugely important part of IBS resolution.

How can we address stress levels to help IBS?

To address stress levels in the clinic, my clients undergo a Hair Tissue Mineral Analysis, which identifies adrenal and thyroid under function. Also, sometimes it’s essential to test the cortisol levels, done with a simple saliva test.

Once we have identified how stress affects your life, lifestyle strategies and targeted supplements can be used to reduce its impact.

Gut-directed hypnotherapy is one of the most effective and scientifically proven methods to manage stress and resolve Irritable Bowel Syndrome.

Hypnotherapy is used in our clinic both locally and via Skype successfully to drastically reduce stress levels and facilitate gut healing.

We will soon launch a unique online IBS Healing program that will address nutrition AND stress. This program will give you a step-by-step guide on managing your digestive symptoms and a roadmap to resolve them for good. Contact me for more information.

Want to know more about GI Map Gut Testing?

You can read more out GI Map Gut Testing or book an IBS consultation to discuss how your specific Irritable Bowel Syndrome needs can be addressed.

Ready to take action and finally fix your Irritable Bowel Syndrome?

Start today with my online HEALING IBS PROGRAM that guides you through:

• 5 week elimination and re-introduction diet
• 10 modules of stress reduction, mindfulness and hypnotherapy

It’s the simplest way to start addressing your IBS for good.

Chances are you have done some basic tests or even an endoscopy and or colonoscopy to only be told you have IBS (Irritable Bowel Syndrome) and just to avoid your ‘trigger foods’. Maybe you’ve been told you have ‘leaky gut’. Perhaps it’s SIBO. Maybe it’s stress or ‘all in your head’.

I adopt the strategy of ‘Test, don’t guess’ when it comes to your gut health.

This is a far more reliable approach, and I honestly believe it’s essential.

Gut microbiome testing

This is the missing piece to resolving gut health and many other issues. Understanding your gut function and microbiome and addressing the imbalances is key to recovery.

Gut testing has evolved tremendously over the last 5 years. State of the art tests are now available to practitioners that are extremely valuable in resolving gut issues and mood, skin, autoimmune conditions, chronic pain, and weight problems.

Numerous research studies link gut health to our brain and overall health (see a selection of studies in the links below).

However, not all gut tests are created equal.

Gut microbiome testing has become more common and more widely available.

Many of my clients come in with the results of a low-cost gut test they did online, usually asking: ‘Now what do I do with these results?”

The problem with commercial microbiome tests is that they don’t provide any functional gut markers and don’t count the bacteria or parasites present. So, clinically, they are useless as you can’t benchmark the progress of treatment or make comparisons.

I have been using the GI Map Gut Testing extensively in the clinic with brilliant results for correctly diagnosing and treating many issues that initially present as:

• Irritable Bowel Syndrome (IBS): digestive problems like constipation, diarrhoea, bloating, gas, reflux, poor digestion, food intolerances, stomach pain, SIBO
• Fatigue
• Mood disorders: depression, anxiety, PMS
• Skin conditions: eczema, psoriasis, dermatitis, boils
• Autoimmune conditions: Rheumatoid arthritis, MS, Hashimoto’s thyroiditis, etc
• Metabolic and hormonal issues: overweight or heavy and painful periods
• Chronic Pain issues: fibromyalgia, inflammatory pain

Snapshots of GI Map Gut/Stool Testing Results

(Copyright Nutripath Labs Australia)

GI Map stool test results example

GI Map test result example

GI Map gut test results example

“I reversed my autoimmune condition, Psoriatic arthritis and psoriasis, through nutrition and lifestyle as well as addressing many gut issues such as SIBO, Candida overgrowth, Vit B deficiencies, etc, etc.

In doing so I also reversed all my other issues including chronic headaches, migraines, eczema, fatigue, brain fog, high cholesterol.

My Dr was annoyed that I wouldn’t take Statins for the high cholesterol and puts my health improvement down to only the weight loss of 14kgs.

Seriously, if you want to get your health sorted take your health into your own hands. My 12 month journey so far has turned my life around. Learn and research the gut, gut microbiome, because it’s all linked to the gut.

Go and see a Clinical Nutritionist like Maria from True Foods Nutrition and get to the bottom of what’s causing your autoimmune conditions. It is reversible if you find the cause and where your body is lacking”

L. Nelson, Woolongong

***   ***   ****

“For 6 years I’ve suffered from stomach issues with various symptoms, including diarrhoea. The symptoms progressively got worse to the point of being debilitating. I was exhausted, lacked energy and this really affected my mood.

After visits to various doctors throughout the years, I was advised there was nothing to be concerned about as it could just ‘be a bug’ or ‘I had a sensitive stomach’.

During my first consultation with Maria, I was blown away. A comprehensive assessment of my health and complete medical and family history was undertaken and after all these years someone had finally listened to me.

She immediately put together a tailored eating plan. As soon as I started the plan I stopped experiencing stomach issues.

Since then my nutrition plan has been continually modified to ensure my body can absorb all the nutrients and minerals I had lost during the 6 years of being unwell.

I undertook a range of tests that gave me the answers as to why I was so unwell and also undertook further thyroid tests as the doctors failed to advise me I had an under-active thyroid based on the results from my previous blood tests. My life and health has completely.

I feel healthy, I have energy again and no stomach issues. I’m thrilled that I can live my life feeling normal again and I truly think my nutritionist Maria is to thank and I will be forever grateful”.

Y.Williams. Mascot

***   ***   ****

“Maria is incredibly helpful and I could not recommend her more.
She has helped heal my chronic eczema, as well as helping me thoroughly understand its causes.

I had spent two years going back to the doctor and given endless steroid creams, which masked the underlying problem.

I am so grateful to have found Maria; she is incredibly knowledgeable and has given me a real understanding of my body.

I am regaining full health and I feel so much better for it, mentally and physically (anxiety has gone and digestion is massively improved)”.

F. Crichton, London, UK

***   ***   ****

It’s time to finally get answers and take control of your health. Book in for the GI Map Testing package today.

Click HERE to book consult.

Iron deficiency is endemic today especially among women of childbearing age and children. I see it in the clinic all too often and it can have disastrous consequences:

In children: poor growth, poor immune function, fatigue, headaches, mood issues including uncontrollable tantrums, poor sleep, low thyroid function

In women: hair loss, heavy periods, slow thyroid function (so common!), cold hands and feet, fatigue, shortness of breath, headaches, restless legs, swelling of tongue and mouth, pregnancy complications, and others. Chewing ice (pica) is a common sign.

I’ve discussed in detail the many and varied causes or iron deficiency in my blog HERE.

Today we are focusing on the most common cause I see in the clinic: low levels of hydrochloric acid in the stomach.

Most people know that iron is a vital mineral for our survival. It’s required for oxygenation, energy production and DNA synthesis. Rather important functions!

However, I find in clinic that there is a large number of people who are living with undiagnosed iron deficiency anaemia that is driving a lot of their underlying health issues and is often un-addressed.

A huge reason why this is happening is their inability to break down protein and absorb the iron from it due to hypochlorhydria – low levels of hydrochloric acid (HcL).

Let’s start with what are actually optimal iron levels on blood tests?

Hint: they are very different to what most doctors describe as ‘perfectly normal/nothing wrong’. Most only look at ferritin levels and ignore the rest.

Transferrin: the iron transporter, the ‘taxi’ that drives the iron around the body. Reflects how much iron your body needs.

Optimal Transferrin levels for children and women are 2-2.5 (mmol/L)

Transferrin Saturation %: the number of ‘passengers’ in the iron taxis. How well is the iron being delivered in the body.

Optimal Saturation: 20-30%. A % transferrin saturation of 15% or below is a classic finding in iron deficiency anemia.

Ferritin: the iron storage in the liver. The reserves. The most sensitive screening test for iron deficiency, because in most situations the body will sacrifice the reserves to keep the serum levels or iron optimal.

Optimal Ferritin levels are 30-100.

I find clinically that when women’s levels of Ferritin drop below 60-70, they often start experiencing low thyroid symptoms such as hair loss.

Now that we understand what the optimal levels should be, let’s look at WHY they are so often low.

The biggest cause of iron deficiency is low stomach acid (hydrochloric acid or HcL).

As simple as that. When HcL levels fall low, it becomes very challenging for the body to digest protein, particularly animal protein, thereby compromising iron absorption (as well as B12 and zinc in particular).

Often, people with low stomach acid will complain of:

• ‘the food feels like it’s just sitting there for hours’,
• ‘meat feels like a brick in the stomach’
• ‘I feel sick when I eat meat’
• ‘I’m not hungry in the mornings at all’
• ‘I often burp in the morning before I’ve had any food or water’
• ‘I have so much bloating and gas’
• ‘I think I have reflux’ or ‘too much acid’ and ‘often take an over-the-counter antacid for relief’.

Oftentimes, the HcL deficiencies are made worse by a PPI prescriptions for symptoms such as indigestion and reflux which commonly accompany LOW stomach acid.

The PPI then further reduces HCL, people are often on it for years and their iron malabsorption is continuous. PPIs have recently been linked with gastric cancer. They are supposed to be prescribed for very short term duration treatment, however people are staying on them for decades with very severe consequences. The longer the PPI use, the stronger the cancer risk.

If you are interested in the links between PPIs and cancer, read THIS and THIS.

Why is low stomach acid a problem?

Common symptoms of low stomach acid include:

• heartburn
• reflux
• constipation
• diarrhoea
• food malabsorption
• parasite infections
• yeast overgrowth (candida).

Basically it impacts every aspect of our digestion both ‘upwards’ (into the oesophagus) and ‘downwards’ into the intestine and the colon.

SIBO and IBS both start with low stomach acid which impacts bacterial overgrowth and reduces motility of the gastrointestinal tract. More on this here.

Without adequate HcL it is extremely difficult to have optimal iron levels.

What causes low HcL?

1. Stress. This is by far the biggest reason I see in clinic. Long term physical or emotional stress will drive down hydrochloric acid levels and compromise protein digestion and iron absorption. Why? Because when you are constantly being chased by a sabre tooth tigre (aka: your boss or financial troubles) your body will de-prioritise digestive function in favour of pumping blood into the muscles so you can fight or run away from the tiger. For many people, this happens 50 times on a daily basis, all on the way to work in traffic.
2. Helicobacter Pylori (H. Pylori) infection. This is a very common bacteria that will proliferate in a low acid environment and lower the acid even further.
3. Proton pump inhibitors (PPIs) as above
4. Genetics:  I am seeing babies and small kids with low levels of hydrochloric acid, which shows up as compromised digestion (terrible, messy and smelly poos in the nappy often with bits of undigested food). I believe this is due to inheriting extremely low levels of zinc and vitamin B6 from the mother, who often has Pyroluria. Without adequate zinc and B6 to make the acid, they are not digesting protein well enough to have optimal iron levels. I am seeing a large number of anaemic children who are often tired, throw regular tantrums and have trouble concentrating.
5. Zinc, B6, B1 deficiency. In addition to the above with zinc and B6 being very low in people with Pyrolles, B1 deficiency is also very common, particularly in alcoholism. People who regularly consume more than 1 standard drink per day will have a strong tendency to low stomach acid often due to this.
6. Long term vegan and vegetarian diets– lack of zinc on these diets depletes HcL. Also a lack of animal protein will downregilate HcL- it’s simply not needed in big quantities to digest a low protein diet, so the body will reduce its production. Sadly, a large number of vegan/vego dieters are iron deficient and often a supplement is not enough.
7. Self prescribed Long term zinc supplementation in pyrolle disorder without checking iron levels regularly. This happens a lot. All nutrient supplementation should be monitored by a health professional and not self-prescribed.

How to easily find out if you have a low level of Hydrochloric acid?

In the most common blood test requested by GPs, ‘Biochemistry’ (or sometimes called ‘Serum chemistry’) you will see a line called Bicarbonate. This is a very good indicator of HcL. If your level is consistently below 27-28, you will have a low level of stomach acid, very likely a low level of protein and a low level of iron.

My bicarbonate level was hovering at 22 for years before I solved this mystery (after becoming a nutritionist:) and began addressing the issue.

Easy digestive remedy

How to address iron deficiency and low stomach acid:

• This is VERY important– discuss your iron deficiency with your medical provider and rule out any significant medical causes: internal bleeding is a major issue. This can happen from gastric ulcers, fibroids, endometriosis and other conditions. An obvious condition such as this can be a constant drain on your iron stores.
• Equally as important: rule out coeliac disease or other gut related malabsorption issues such as Crohn’s or IBd. Iron deficiency due to coeliac or malabsorption is very common. I actually find it scary that I am able to identify undiagnosed Crohn’s or other bowel disorders on routine fuctional stool testing where the person has been dismissed with ‘oh you just have IBS’ or ‘its all in your head’ previously.
• Rule out Helicobacter pylori infection– this is a common gastric bacteria that can only survive in a low stomach acid environment. If you have H.Pylori it will be pretty much impossible to successfully absorb iron (as well as zinc and B12 and other nutrients). I am finding that conventional tests for h.pylori often show a false negative result and require higher level testing for different strains of the bacteria that I use in clinic to identify an infection and treat it. Often people have symptoms (reflux, food feels like a brick in stomach, burping, indigestion, etc) without a diagnosis
• Ensure you have optimal sodium levels. We have been brainwashed to limit salt intake. I find that the vast majority of people actually have extremely low sodium levels which compromises their stomach acid production (salt is an essential ingredient to make the acid). Low sodium will also be very common in adrenal fatigue and low blood pressure. The best way to test sodium (and all other mineral levels) is via Hair Analysis.
• Eat plenty of lean animal protein foods. Game meats are what we are most genetically attuned with. Animal protein, particularly red meat are fundamental to ensure iron levels are optimised. Optimal animal protein is grass fed and/or organic, buy the best you can afford. Read more about getting your meat right HERE
• Eat organ meats such as liver (must be organic) are incredibly rich in all nutrients including iron. 1-2 times a week is great
• Eat plenty of natural sources of vitamin C. Capsicums, kiwi fruit, berries, plums, but basically many fruits and vegetables are rich sources. If you eat these with your meat there is optimised synergy for iron absorption. Ascorbic acid supplements are a poor source of vitamin C as they do not include the whole vitaminC molecule and can compromise absorption of other minerals such as copper.
• Do NOT over exercise! Especially if your iron numbers are well below the optimal ranges above. Often I see women flogging themselves with cross fit classes 6 days a week or running endless kilometres- all in the name of weight loss- using up their precious iron stores and compromising their thyroid function. The biggest key to weight loss is to optimise thyroid function, HcL and regulate the metabolism
• Eat slowly, chew well. This is almost completely gone from our culture- we eat in the car, whilst walking, standing, being stressed, in front of our computer/phone, etc. Eating in a calm space, sitting and chewing is very important to optimal HcL levels.
• This simple digestive remedy often helps improve acidity, however I find often supplementation is required for some time
• Appropriate supplementation is essential if your iron levels are already low. Most chemist iron supplements are very constipating and poorly absorbed. Consult your complimentary health care provider to find supplements that will be optimal for you. Often I use personalised dose compounded pharmacy skin creams to treat long term iron deficiency in order to bypass a compromised digestive system altogether and deliver iron straight to the blood stream.

If you have continuously low iron levels and are suffering from the symptoms described above, contact me to resolve your anaemia permanently HERE.

References:

-“Blood chemistry and CBC Analysis. Clinical Laboratory Testing from a Functional Perspective”, 2002, Weatherby, D. (N.D) and Ferguson, S. (N.D), Bear Mountain Publishing

Now, the tricky thing is I don’t really have any of the symptoms associated with high oxalate levels- listed below. What I do have and have had for a long time is ‘adrenal fatigue’. And when I get my pulse tested by a Chinese medicine practitioner friend, he always says ‘kidney weakness’. I had always assumed that kidney weakness was related to the adrenals. However, knowing my oxalate levels has given me a new perspective- it’s not just the adrenals, it’s my actual kidneys that are under functioning!

And I discovered that my ancestral based diet high in nuts and seeds, leafy green vegies and sweet potato was not helping the issue.

What are Oxalates and Why are they a problem?

Oxalates, just like pyrroles are markers for oxidative stress. They are miniscule hard crystal structures that can deposit in soft tissues, kidneys being a common target with kidney stones. High oxalate levels often lead to kidney stones, but also can deposit and harden in any soft tissues including the lungs, brain, joints and blood vessels, leading to pain conditions such as migraines/headaches, fibromyalgia and other inflammatory pain as well as behavioural and speech problems in children on the spectrum.

Oxalate crystals in the bone may crowd out the bone marrow cells, leading to anemia and immunosuppression. High oxalates in the body  can contribute to many chronic conditions such as digestive disorders, autoimmunity and neurological conditions. They are inflammatory particles and through impacting mitochondria- our energy producing structures- influence every major body system.

“Oxalic acid is the most acidic organic acid in body fluids and is used commercially to remove rust from car radiators. Antifreeze (ethylene glycol) is toxic primarily because it is converted to oxalate”- William Shaw, Phd

The body has mechanisms to get rid of oxalates, however certain genetic predispositions, poor gut health, nutrient deficiencies (particularly calcium and magnesium) as well as over-consumption of high oxalate foods contribute to poor elimination of oxalates.

Oxalates equal increased oxidative stress just like pyrolles and bilirubin. I’m actually blown away at this point at how crappy my genetics are because I have all 3 issues- tendency to elevated pyrolles, Gilbert’s syndrome (elevated bilirubin) and now- oxalates! These are some of the reasons why some people have to work SO MUCH harder to keep their diet, lifestyle and gut health in a good state.

Oxalates can also act as ‘bad’ chelators of heavy metals such as mercury. ‘Bad’ because they trap heavy metals in the body tissues rather than excreting them.

There is usually a deficiency of calcium and magnesium present in conjunction with elevated oxalate levels- these minerals in sufficient quantities are essential to escort oxalates from the body. Oxalates in the gastrointestinal tract bind calcium, magnesium, and zinc, perhaps leading to deficiencies even when dietary sources should be adequate. Calcium, magnesium and zinc deficiencies are endemic today and I see it multiple times a week on my clients’ hair analyses.

Complication! Candida and mould species produce oxalates

The number of people today who have candida overgrowth in the gut is quite astounding (I haven’t yet seen an OAT test result without it) due to our overuse of antibiotics, medications and stressful lifestyles. Candida is toxic to the body when it is overgrown out of proportion and produces many toxic metabolites such as aldehydes (alcohol particles that give you brain fog and make you feel slightly tipsy the whole day long even though you haven’t been drinking). In addition to aldehydes, candida produces oxalates! So addressing gut health is critical.

Exposure to mould is an increasing problem today and around 25% of the population have immune HLA genes that predispose them to CIRS (chronic inflammatory response syndrome) where even brief past exposure to mould creates chronic and debilitating symptoms such as chronic fatigue, body aches and pains, eyesight changes, respiratory problems and many more. Mould in the body can produce oxalates which is probably the mechanism by which people have so much body pain after mould exposure. So if you have candida and other fungal species elevated on OAT there is a pretty high chance you have oxalates elevated too.

Foods high in oxalates

Food is a direct source of oxalate and the most common cause of disproportionately elevated oxalates.

The frustrating part is that the dietary recommendations many follow these days for optimal gut and immune health (me included!) – Paleo/ancestral type eating or the vegan/vegetarian plans are very oxalate heavy diets. Think almond milk everything, almond meal desserts and treats, dark chocolate and cacao powder, spinach smoothies, sweet potato, lots of nuts and seeds. For vegans/vegetarians: tons of soy and beans, leafy greens, nuts and seeds. Oxalates galore!

It is important to manage an oxalate diet with the help of a practitioner as long term elimination of these healthy foods is also problematic.

The following is a list of foods with highest oxalate amounts, it is important to SIGNIFICANTLY reduce intake of these. Very sadly these are mostly healthy foods so it’s very important to work with a practitioner on an individual treatment plan to ensure the dietary restrictions are short term for treatment only.

Foods marked with an * are very high in oxalates and should be completely eliminated.

For a very detailed list, see: https://www.upmc.com/-/media/upmc/patients-visitors/education/unique-pdfs/low-oxalate-diet.pdf

Very high oxalate foods	Low oxalate foods to choose instead
·         Spinach* ·         collards ·         swiss chard*	·         Cabbage, endive ·         Small quantities of: lettuce, rocket, asparagus, watercress
·         Soy foods* including tofu and tempeh and soy sauce ·         Soybean crackers*	·         Meat, seafood, fish and ham ·         Sardines and liver (small quantities) ·         Goat and sheep cheese if tolerated, butter
·         Chocolate* ·         cacao powder	Sadly no replacement
·         Black Tea* ·         instant coffee*	·         Green tea and herbal tea such as peppermint and camomile
·         Almonds, cashews, walnuts ·         Peanuts* and peanut butter* ·         Pecans* ·         Seeds and tahini	·         Avocado ·         Protein: meat, seafood, fish, ham ·         Flaxseed and sunflower seeds (small quantities)
·         Sweet potatoes* ·         white potatoes ·         beetroot ·         Green beans ·         Baked beans ·         celery ·         Zucchini ·         Parsley* ·         dandelion ·         Eggplant ·         Okra ·         Cinnamon ·         ginger	·         Peas • Cauliflower • Kohlrabi • Radishes • Chives • Mushrooms • Water chestnut • Cucumber ·         Basil, oregano, peppermint, sage ·         Broccoli (small quantities)
·         Berries: blackberries, blueberries, raspberries, strawberries, figs ·         Grapes, kiwi ·         Fruit cake ·         Lemon and lime peel* ·         Rhubarb*	·         Cherries, bananas, pear, papaya, lemons and lemon juice ·         Apple, apricot (small quantities)
·         Wheat germ* ·         White corn ·         kamut	·         Brown, red and black rice

Ascorbic acid and vitamin C

Ascorbic acid can convert to oxalate, so regular use of vitamin C supplements may increase oxaluria and be associated with an increased risk of stone formation (Finkielstein, V., Goldfarb, D., 2006.). In clinic I have switched from using synthetic ascorbic acid supplements (95% of the supplements on the market) to wholefood only vitamin C. Another reason for this is that I see so many people with pyrolles and copper overload and ascorbic acid uncouples copper from ceruloplasmin, it’s carrier protein leading to increases of unbound copper which is a major source of oxidative stress.

A very important factor that accelerates vitamin C breakdown to oxalate is the amount of free copper in the blood.

Fat digestion and oxalates

Excessive fats in the diet may cause elevated oxalate if the fatty acids are poorly absorbed because of bile salt deficiency. Non-absorbed free fatty acids bind calcium to form insoluble soaps, reducing calcium ability to bind oxalate and reduce oxalate absorption. Fat metabolism needs to be optimised through addressing liver and gallbladder health in order to minimise oxalate accumulation.

Who should get tested

The most complete testing for oxalates is via an Organic Acids Test, which I regularly order in clinic. If you can relate to the issues below, seriously consider testing.

• You suffer from unexplained pains- in kidney/lower back area, headaches/migraines, pain behind the eyes, joint and muscle pain, fibromyalgia.
• You suffer from vulvodynia (vaginal pain)
• You have suffered from kidney stones of have family history of kidney stones
• You have symptoms of candida or other fungal overgrowth such as: thrush, fungal toes, food intolerances, brain fog, fatigue
• You have known exposure to mold past or present
• You are a child on the spectrum or just unexplained behavioural issues
• You have tested positive for pyroluria and have zinc and B6 deficiencies
• You eat a diet rich in high oxalate foods

 Testing and results

The OAT shows 3 metabolites of oxalates in the body:

In humans and in yeast, glyoxalate is the parent compound that can be converted into the three metabolites measured on the Organic Acids Test (OAT): glyceric, glycolic, and oxalic acid:

Image from: www.greatplainslaboratory.com

People with family history of kidney stones have genetic deficiencies in the enzymes that drive these pathways and cause the distinguishing features of the disease. All three markers can be elevated because of yeast and endogenous (within the body) production.

“Food and mould produce oxalate in the body directly. So, when these are the source of excess, only oxalate will be elevated on the test. Low oxalate values do not rule out an oxalate issue and extremely elevated values are not always equated with pain (though the potential certainly exists)” (Great Plains Laboratory).

Oxalates in Autism

Many children on the spectrum have elevated yeast and candida levels and many have genetic glitches with pyrolles. Many are calcium and magnesium deficient. Many are put on well meaning wholefood diets where sugary treats are replaced with nut and seed treats and spinach smoothies. These are some of the factors that predispose these kids to elevated oxalate levels.

Oxalates in the urine are much higher in individuals with autism than in normal children: 84% of the children on the autistic spectrum had oxalate values outside the normal range (Great Plains laboratory data).

Low oxalate diets are being used to treat children on the spectrum. Some of the benefits from a low oxalate diet as reported by the parents include:

• Improvements in gross and fine motor skills
• Improvements in expressive speech
• Better counting ability
• Better receptive and expressive language
• Increased imitation skills
• Increased sociability
• Speaking in longer sentences
• Decreased rigidity
• Better sleep
• Reduced self-abusive behavior
• Increased imaginary play
• Improved cognition
• Loss of bed wetting
• Loss of frequent urination
• Improved handwriting
• Improved fine motor skills
• Improvement in anemia … and many others (source: Great Plains Labs)

“The most serious error in adopting the gluten-free, casein-free diet is the failure to adequately supplement with calcium”-  William Shaw PhD

Treatment is a multi-step process and OAT testing and re-testing is highly recommended:

Key treatment steps include:

1. Restore gut health: address candida and other yeast overgrowth
2. Restore gut health with long term probiotic therapy
3. Eliminate sources of any exposure to mold and test for mold sensitivity
4. Significantly reduce oxalate foods slowly– talk to your trusted nutritionist or naturopath about how to do this effectively. Oxalate ‘dumping’ can occur and will exacerbate symptoms.
5. Address liver and gallbladder health: bile is essential to prevent fats from binding with calcium and increasing oxalate levels
6. Omega 3 fats, selenium and vitamin E can all help with reducing oxalate accumulation
7. Take supplements that help bind oxalates and eliminate them in stool- a combination of calcium, magnesium and potassium citrate is best. Caution needs to be taken here and hair analysis always performed as many people already have very high calcium retention and need to tread carefully. Some people have elevated potassium levels and high blood pressure. This part has to be highly individualised and based on testing.
8. Restore levels of vitamin B6: sufficient B6 is required to help with the conversion of glyoxalate to glycine in the body. Maintaining sufficient levels of vitamin B6 will help with the endogenous production. This is where people with pyrolles have problems and pyrolle testing and treatment is required. For more info on pyrolles read my blogs here and here.
9. Optimise your water intake- this is individual also, but the right quality of pure water helps with oxalate removal

To find out more about oxalates, testing and treatment, click HERE to book your consultation with Maria.

REFERENCES:

• https://www.greatplainslaboratory.com/gpl-blog-source/2016/8/8/oxalates
• Finkielstein, V., Goldfarb, D., (2006). Strategies for preventing calcium oxalate stones. Canadian Medical Association Journal , 174 (100). Published online doi: 10.1503/cmaj.051517
• William Shaw, PHd, “OXALATES CONTROL IS A MAJOR NEW FACTOR IN AUTISM THERAPY”Oxalates: Test Implications for Yeast & Heavy Metals, Great Plains laboratory

Pyroluria is something I have personal experience with, and I understand its varied digestive, mental and systemic symptoms intimately. And I can tell you with experience and certainty: there is much work, but there is a light at the end of the tunnel.

Pyroluria testing is becoming more accepted in Australia by nutritionists, naturopaths and integrative doctors. Clinically, I find it relevant as it helps identify this important imbalance in zinc, B6 and other mineral deficiencies and copper related issues.

Your Pyrrole Disease Score is an indicator of oxidative stress

It is very common for me to see a client who comes in with a statement like this: “I’ve been diagnosed with pyrroles and am on this treatment” or “My child has been diagnosed with Pyrroles and prescribed x,y,z”.

We have to remember that we all have polymorphisms in our genes. Every single person has hundreds of SNPs (‘glitches’) that affect us.

Pyrolluria is no different, and even though so far there hasn’t been a specific gene identified responsible for pyrroles, it is one of those glitches that, GIVEN the RIGHT ENVIRONMENT, can prove problematic.

Pyrroles become an issue in susceptible people when the environmental impacts become too much. Pyrrole’s urine test results will always be affected during times of stress. Trauma and persistent physical or emotional stress are usually key triggers that almost always are implicated in the start of someone’s long-term health issues.

On hair analysis, I can see how much stress has affected someone by looking at the adrenals (sodium and potassium) and copper levels as well as the ‘calcium shell’- a build-up of hard calcium in soft tissues of the body to wall off the trauma or ongoing stress. This will show as elevated pyrroles on the urine test in susceptible people.

Clinically, I view pyrroles as an indicator of how much oxidative stress affects the person and how antioxidant deficient they are.

Many pyrrole disorder symptoms can be present, and many are listed in my Pyroluria – the Stress Disorder article.

Conditions that commonly accompany Pyrrole Disorder

Gut imbalances:

Low hydrochloric acid, SIBO, IBS: we cannot make sufficient stomach acid (HCL) without zinc and B6- the essential nutrients that help produce stomach acid. When the partially digested bolus of food leaves the stomach that hasn’t adequately digested the food, it doesn’t trigger the right amounts of enzymes in the small intestine for optimal absorption. This triggers gas and bloating and can, over time, lead to SIBO.

I have written extensively on IBS and SIBO in this article – Gut Tests – What You Need to Know to Heal Your Gut.

The absolute key issue to address for anyone with Pyroluria is gut health. This is where most of the inflammation and oxidative stress comes from. Suppose you are experiencing ongoing gut issues (such as pain, feeling bloated with irregular bowel movements, diarrhoea, loose stools or constipation or alternate between all of them, food reactions and many others). In that case, my ONLINE PROGRAM – HEALING IBS – is an excellent start. It will guide you through a 5 week of elimination and re-introduction diet and provide worksheets and recordings to re-program your stress response and calm your nerves, which calms the gut.

Food intolerances:

Gut permeability (‘leaky gut’) is common with Pyrroles because zinc is a required mineral to maintain the integrity of tight junctions in the small intestine. When we have a chronic zinc deficiency, the tight junctions are compromised, leading to large undigested proteins escaping into the bloodstream and triggering immune responses.

Many people with pyrroles are intolerant of gluten, especially wheat, dairy, soy, sometimes eggs and corn and others. Often the intolerances can be resolved with the appropriate pyrrole disorder treatment.

Liver and gallbladder issues:

When the level of HCL is inadequate due to low zinc and B6 and stress, the bolus of food that exits the stomach is not at the right acidity (Ph) to trigger proper bile flow. Without a good amount of bile, bacteria accumulate in the small intestine, leading to SIBO.

Thyroid and adrenal disorders:

Our HPA axis (the hypothalamic-pituitary axis) that connects the brain to the adrenal glands is very finely attuned to environmental stress. When we lose zinc and B6 due to pyrroles and magnesium for many and biotin, our ability to tolerate stress becomes weakened. The adrenal system suffers, and energy is significantly diminished.

All my pyrroles clients are very fatigued. They struggle with exercise and day-to-day tasks and usually say their energy is much lower than it used to be. The extent of their adrenal fatigue can be seen on hair analysis and usually takes a long time to correct.

When the adrenals are flagging, the body slows or shuts down the thyroid, putting the whole system into hibernation. It is safer that way- the body is smart, and if it can tell you are heading for burnout, it will force the thyroid to slow down in order to preserve vital energy. It is a mistake to try and ‘fix’ the thyroid and push it harder when active stress and nutrient depletion are present. These factors need to be addressed first.

Chronic infections:

95% of the time, my pyrroles clients have long-standing infections that further burden their system. Viral infections such as EBV (Epstein-Barr virus) are prevalent but hit pyrroles people harder, leading to chronic fatigue. Why? Because they never had the resources such as zinc and vitamin A to enable their immune system to function properly and fight off the original virus.

Candida and other fungal infections are very common with pyrroles due to significant copper imbalances and mercury overload that result from stress and zinc deficiency. Mercury’ feeds’ Candida in the body and is almost always an issue when zinc and selenium are low, and mercury proliferates.

Streptococcus (strep) overgrowth is also common. Many with Pyrroles have ongoing ENT issues, with a large percentage having had adenoids and/or tonsils removed at some stage in their lives.

Mental health imbalances:

Anxiety or depression (or both) always manifests with pyrroles. Zinc, B6, and magnesium are highly stabilising nutrients and are required to produce GABA- the only inhibitory (calming) neurotransmitter in the brain. Without GABA, we drown in a world of almost constant anxiety. There doesn’t seem to be an escape for many, even when on prescribed medications.

Pyrroles lead to a ‘leak’ of zinc and B6, leading to a continuous GABA deficiency and a tendency to addictions that ‘calm the nerves, such as smoking and alcohol. I genuinely believe that personalised nutritional balancing is the only way to achieve lasting mental health.

Depression is common with pyrroles because, in order to make ‘happy’ neurotransmitters dopamine and serotonin (and all neurotransmitters in general), we need to have good stomach acid to break down protein in food to make those neurotransmitters. Of course, we also need to eat the protein first! Many of my clients are significantly protein deficient. Many choose vegetarian diets because they cannot digest meat (the solution is to improve absorption, not stop eating it!).

Vegetarian and vegan diets, if chosen for philosophical reasons, need to be extremely carefully managed if you have a pyrroles tendency. They are very rich in copper and low in zinc and make things much worse for most people. Especially when they are very rich, it comes to mental and hormonal health.

Copper overload is prevalent with pyrrole disorder – zinc deficiency lowers metallothionine – a protein required to bind excess copper. A large percentage of those with pyrroles will have a copper overload problem.

“Severe deficiency of vitamin B6 has been associated with irritability, depression, poor short-term memory and psychosis. This is not surprising since it is required to efficiently synthesise serotonin, dopamine and GABA”. (W. Walsh PhD, ‘Nutrient Power’). 

When B6 is deficient, as with pyrroles, it opens us up to many problems, including ADHD, depression, anxiety, and sleep disorders. Unfortunately, many sufferers end up on anti-depressants and ADHD medications. In contrast, the underlying treatment is nutritional and, if implemented with a health professional specialising in mood balancing and Pyroluria, is without side effects.

Most B6 deficiency is genetically acquired, so treatment often involves ongoing supplementation of much higher doses than RDI (recommended daily requirement).

Heavy metal toxicity

Zinc deficiency, as well as copper and iron imbalances accompanying Pyroluria, opens us up to an increased intake of heavy metals. Mercury can directly replace zinc at enzyme sites- it has similar molecular properties (is below zinc on the periodic table, together with cadmium).

The body readily absorbs mercury when zinc is deficient, and those with poor detox and methylation genetics suffer the most. Mercury is a neurotoxin, and I find it present on many tests of those with pyrroles.

Cadmium is also a potent carcinogen and does cause issues for many with pyrroles, especially when exposed to cigarette smoke and farming fertilisers.

Pyroluria can affect your quality of life

You should test for pyrroles so that the associated deficiencies and imbalances can be treated if:

• You experience mental health issues such as anxiety, depression, PTSD, OCD, bi-polar and any others- these CAN be addressed through a nutritional balancing program and addressing them dramatically improves lives
• You grew up with a depressed or alcoholic or drug addicted parent, or a parent who was there physically but not much there emotionally- the tendency for pyrroles does run in families, and many of my clients have ‘the alcoholic father’, the ‘depressed mother’, the uncle who committed suicide, etc
• You were a ‘sickly’ child who often was given antibiotics for tonsillitis, bronchitis, ear infections, etc.- this is a prominent characteristic of chronic zinc deficiency and food intolerances
• You have taken oral contraceptives and had a significant adverse reaction which probably forced you to discontinue their use- a clear indication of a substantial copper overload
• You have chronic hormonal issues: painful periods, moods all over the place, excessive bleeding, fibroids, fibrocystic breasts, breast or uterine cancers- more indication of copper/zinc imbalance
• you have suffered significant trauma at any stage of your life, physical or emotional and haven’t been well since or feel you’ve never recovered- such events have a profound effect on our nervous system and immune system, lead to multiple nutrient deficiencies and create severe stress
• You have been put on anti-depressants by your GP or psychiatrist for any length of time
• You can tick more than 10 pyrrole symptoms listed in the table in my original Pyroluria blog

How to treat Pyroluria disorder?

Tests are often ordered to address Pyroluria symptoms through a Functional Medicine Approach.

I usually see pyrroles as a piece of a much larger health puzzle and work to address the underlying issues listed above, such as gut imbalances, mental health issues, immune dysfunction and others. Pyrrole issues never appear ‘by themselves,’ so they require detective work to get on track. I often hear from clients that they were previously prescribed a compounded formula with several ingredients to address their ‘disease’ of Pyroluria.

In my practice, this is not a practical approach on its own. Taking a compound indefinitely does NOT address gut health, methylation, thyroid, adrenals, infections, heavy metal overload and other individual issues. Taking a compound is a band-aid solution, and I encourage you to adopt a more thorough approach to your health.

Examples of tests I use in Pyroluria cases

Here are tests I usually use in Pyroluria cases when issues are multifaceted. Not all of these are required for everybody, but they typically show very insightful findings.

1. Hair Mineral Analysis – this is an essential test to understand long-standing mineral imbalances, heavy metal overload, and adrenal and thyroid patterns. Watch my video on Hair Mineral Analysis for Pyroluria showing examples of how Hair Mineral Analysis can help those with Pyrroles.
2. Blood tests – for all minerals involved- zinc, copper, iron, thyroid function and some others.
3. Pyrrole urine test- helps understand the extent of the problem. I have seen scores as high as 800 in families with a long lineage of mental health issues. Usually, I find, however, that even with a low pyrrole score, there can be many issues to address, and the score itself may not be of significance- more on that here.
4. Organic Acids test – a very comprehensive urine test that looks at bacteria, yeast, neurotransmitter issues, oxalate levels, B vitamin metabolism, glutathione levels, amino acid, carb and fat metabolism and energy production. Extremely comprehensive and valuable for when ‘nobody has been able to figure out what is wrong with me’ type of situations
5. Genetic testing– is often needed to understand the depth of the mental health or methylation issue.
6. Comprehensive Digestive Stool analysis– these are not cheap but extremely valuable if gut issues are involved
7. DUTCH complete hormone panel– handy for women (but some men also) in understanding hormonal dysregulation and mood disorders/issues as well as stress issues
8. Food intolerance and compatibility testing – often necessary to solve the gut health and bloating/indigestion/reflux/constipation etc. puzzles
9. Porphyrin urine test – for heavy metals if they do not show on hair analysis and are suspected.

Special mention: Gilbert’s Syndrome and Pyrroles

Gilberts Syndrome and Pyrroles is something that doesn’t get much attention, but I find that a large percentage of my Pyrrole clients also have Gilbert’s Syndrome. This genetic condition leads to continuously elevated levels of toxic bilirubin on blood tests.

Suppose you have a series of blood test results from several years and look at the Biochemistry panel. In that case, you will notice bilirubin there- a consistent elevation >15 umol/L is a strong indication of Gilbert’s and can also be confirmed with a genetic test. Your GP will say it’s a ‘benign’ condition and nothing to worry about. This is sadly far from the truth.

I mention Gilbert’s in relation to Pyrroles because this is a liver heme breakdown issue, just as pyrroles are. There are no studies on this, but I personally have both conditions and see them in many clients.

Why is high bilirubin a problem?

Just like pyrroles, it increases oxidative stress in the body. It’s a toxin, and inconsistently large amounts will cause damage throughout. It shows that the phase 2 liver function of glucuronidation responsible for removing many toxins if not functioning.

In my blog article, Gilbert’s Syndrome: The Hidden Causes of Gut-Brain Issues, you can read more about Gilbert’s disease symptoms.

Do you believe that Pyroluria (Pyrroles Disorder) may be a key player in your health conditions?

Want to address it fully, book your consult in my calendar to discuss. My virtual consults are open to patients worldwide.

We all know that Pyroluria is a stress intolerance disorder. All of my Pyrrole clients benefit significantly from mindfulness-based stress reduction. Here is an excellent e-course – Return to Calm that you can do at your own pace to help with anxiety, stress tolerance and resilience. I highly recommend (and also suitable for children over 14y.o) to learn to cope with stress.

Maria. 

Who should be tested:

Hormones dictate your mood, weight, energy and sleep and when they are dysregulated, women will often experience:

• stubborn weight gain
• bloating and indigestion or food intolerances
• periods with pain, heavy flow, irregularity
• mood issues that range from irritability to turning into a ‘monster’ that is impossible to be around with
• depression and anxiety that can last for up to 2 weeks of the month
• frequent waking at night or insomnia
• sugar and/or salt food cravings that are impossible to control
• hair loss
• fatigue that creates dependency on caffeine and alcohol
• low libido
• memory and attention problems
• frequent stress and overwhelm
• peri-menopause or menopause symptoms such as hot flushes, weight gain, irritability, etc
• diagnosed or suspect PCOS (Polycystic ovarian syndrome)
• diagnosed or suspect endometriosis
• fertility problems
• history of estrogen cancers (breast, prostate) in family

What the test measures:

What I love about the DUTCH Complete Hormone Test:

• simple to administer – urine collection, in the comfort of your home
• super accurate (much more so than standard hormone blood tests)
• shows your stress hormones- super important for understanding hormonal issues such as mood
• shows ALL of your hormones: estrogen, progesterone, testosterone and their metabolites
• shows what types of estrogen and which pathways estrogen is taking: the ‘good’ non- proliferative pathways or the ‘bad’ pro-mutagenic pathways
• used to formulate highly personalised and results oriented diet and lifestyle plans for my clients

You can listen to my podcast on hormone treatments and the Dutch test in detail HERE.

To find out more about how the DUTCH Hormone Test can help you resolve your hormone issues click HERE to book your consultation with Maria.

To book into my Hormonal Reset Program that provides the Dutch test as well as a complete nutrition/lifestyle revamp click HERE.