The Nutritional Supplement

56 year female presents with complaints of fatigue and recurrent ovarian cysts:

• She dates her fatigue to 9 years ago after she moved into a new home with new carpeting, newly painted and recently remodeled.
• One year after moving into this home, she experienced lower left pelvic pain. She had a history of ovarian cysts and pelvic ultrasound confirmed a new cyst. She opted for a laparoscopic oophorectomy and hysterectomy which she had 7.5 years ago.
• After this surgery, she developed urticaria which lasted for several months and malaise. She had a very slow recuperation and still feels that she has not recovered even her pre-surgery energy level.
• She is significantly tired now, energy = 3/10 most days.
• General: Fatigued (energy is 3/10 most days); poor appetite

• Likely menopausal; sp hysterectomy and B/L oophorectomy. Occasional hot flashes. No pregnancies
•  Alternating constipation with diarrhea. Somewhat improved with metamucil daily
• Hives resolved; still experiences extreme reaction to insect bites
• Mitral valve prolapse with benign murmur
• Bronchitis every ear; sinusitis and PND seasonally
• Mild anxiety regarding health

Family History:

• Hypothyroidism (Rx’d with armour thyroid 1 grain)
• Family Hx
• Mother –dementia diagnosed at age 75
• Father –colon cancer age 56; osteoporosis; age 79

Personal History:

• Family –married x 15 yr; 2nd marriage
• Occupation-Works from home as a financial planner
• Toxic Exposure Hx: Grew up working on a golf course (drove the beverage cart); lives in a midwest city; recently purchased a new car
• Diet: 24 hr recall:
• Breakfast –whole grain cereal with almond milk or eggs and whole grain toast
• Lunch –salad with chicken
• Dinner –fish (salmon, halibut, tilapia), grass-fed meat, vegetable
• Snacks –cookies, nuts, fruit
• Activity: aerobics 3 x/week at home; walks daily
• Stress: Worried about her own health

Recent Lab Results:

• Inflammatory markers -hsCRP is normal at 1.1, homocysteine is normal at 10

• Hormonal markers -TSH at 3.8 (N), ft4 0.8 (low N), T3
• 103(N), DHEA-sulfate 51.7 (low N), am cortisol 15.2(N)
• vitamin D 43.7(N)
• Solvent Profile:90th percentile for MEHP phthalate (16.8), DDE chlorinated pesticide detected: 0.89, PCB 138, 153, 180 all detected, 95th percentile for elevated ethylbenzene volatile solvent (0.17)

Assessment Considerations

• A history of recurrent ovarian cysts along with current environmental exposure (new carpet, paint, new car, golf course) history is suggestive of oestrogen dominance. Under chronic oestrogen exposure, oestrogen receptors are likely upregulated. This creates a metabolic (and proliferative) stress on cells and increases risk for chronic proliferative disease.
• The surgery and, particularly the anaesthesia used, likely overwhelmed a liver already potentially deficient in phase 2 detoxification. This, coupled with an upregulated phase 1 from the environmental exposures, will generate significant oxidative detoxification intermediates, leading to oxidative stress.
• Additional laboratory testing that would be helpful to better understand the HPA axis, neurotransmitters, nutritional status, methylation and toxicity would be a urinary organic acids test.

Management Considerations

• Although the patient’s use of Panax ginseng as an adaptogen is on the right track, this particular adaptogen is perhaps too stimulatory. Changing to Panax quinquefolius or Withania somnifera may be more effective for this patient.
• Although within normal limits, the TSH is higher than optimal and the free T4 too low. This indicates the need for additional T4 therapy as well as the need for optimising membrane health so that there is better response to TSH on the part of the thyroid and to T4 on the part of the periphery. Consider essential fatty acids, phosopholipids and tocotrienols.

Insights, Tips and Perspectives

• Oxidative stress, along with decreased antioxidant capacity has several implications – decreased metabolism of toxic compounds leading to environmental sensitivity, increased sensitivity to medications, insufficient hormonal metabolism. Additionally, increased oxidative stress reduces the intracellular redox potential – especially in dendrites,  macrophages and T cells. This functional immune impairment leads to susceptibility to infection – perhaps the cause of the rash in this patient (superinfection with bacteria or yeast).  Finally, oxidative stress disrupts HPA axis, leading to overactive HPA axis and resultant anxiety and depression.
• A protocol would include an exercise plan and stress management strategies. Additional therapeutics to consider are vitamin E (tocotrienols particularly), Schisandra chinensis as an adaptogen and antioxidant, Silybum marianum as a liver antioxidant and phase 2 supportive, glutathione to reduce oxidative stress and low heat saunas to support gentle detoxification.