Advanced Continual Illness Saved by a Genetic Hormone Profile 

WINNIE SIU, ND 

As clinicians, we frequently come throughout advanced and difficult instances. A lot of our sufferers have been recognized with advanced persistent circumstances corresponding to mast cell activation syndrome (MCAS), persistent fatigue syndrome (CFS), a number of chemical sensitivity (MCS), and fibromyalgia (FM). The Statistics Canada 2005 Canadian Group Well being Survey discovered that 1.2 million Canadians, or 5% of these aged 12 or older, reported having been recognized with at the least CFS, MCS, or FM.¹ These sufferers normally have been sick for a number of years and have seen and proceed to see a number of well being care professionals, together with medical medical doctors, specialists, and integrative and various drugs practitioners. When sufferers are referred for environmental drugs assessments, their signs usually point out that many physique methods are concerned, leading to immunotoxicity, immune dysregulation, hormone imbalance, and neurotoxicity.^2,3 These instances are difficult as affected person signs are quite a few and range extensively. 

From medical expertise, each daily low-level and vital single-dose exposures contribute to a affected person’s whole physique burden: the full load of poisons and toxicants in our our bodies that trigger multi-system signs. The whole physique burden have to be thought-about when assessing the underlying reason for a affected person’s signs. Toxins and toxicants assessed ought to embody each endogenous organic compounds and exogenous chemical compounds, together with drugs and exogenous hormones. 

Hormone remedy is more and more used to assist sufferers with endocrine well being points. Although many sufferers profit from hormone remedy, not all do, and medical doctors have the accountability to establish those that could also be harmed by it. Understanding a affected person’s underlying useful genomic make-up could assist individualize hormone prescription or utilization and forestall it from including to the full physique burden. 

The case report offered beneath reveals how signs of MCAS and MCS may result from improper prescribing of hormones, particularly in an estrogen-dominant feminine with poor hormone clearance and a posh and in depth medical historical past. This report highlights that prescribing progesterone to deal with estrogen dominance isn’t all the time appropriate, particularly in sufferers with extra difficult well being circumstances. The complementary use of useful genomics and urinary hormone metabolite testing can present insights into analyzing suitability. 

Case Presentation 

A 21-year-old girl offered to our clinic with extreme allergic reactions; anaphylaxis to scented merchandise, histamine meals, and solvents; temperature dysregulation; and scorching flashes. She had been recognized with MCAS, MCS, FM, and CFS. She was managed by a number of medical medical doctors, together with an allergist, immunologist, psychiatrist, neurologist, and a household physician. Although she was taking pharmaceutical and pure antihistamine drugs, they had been proving ineffective at decreasing her allergic signs or tolerance. 

She had an intensive medical historical past and had not felt nicely since she was 14 years of age. At that time limit, she began to expertise nervousness, melancholy, and sinus points. She additionally reported vital GI Candida albicans overgrowth (for which she had acquired remedy from her ND for a few years). In her teenage years, she progressively obtained worse. From the ages of 17 to 19, she had panic assaults and recurrently went to the hospital for extreme ache and fainting episodes. She additionally acquired allergy pictures throughout this era of her life. Then, from the ages of 19 to 21, her therapies (dietary adjustments and dietary supplements) targeted on addressing Candida; although lab assessments afterward confirmed decision of Candida, she nonetheless didn’t really feel nicely. She examined optimistic for small intestinal bacterial overgrowth and was handled with rifaximin; this too resulted in no change in signs. 

Considerably, her MCAS signs would all the time flare 2-3 days earlier than her menstrual cycle. A urinary hormone metabolite lab check revealed low progesterone and testosterone, and excessive estrone, estradiol, and the estrogen metabolites 4-hydroxyestrone (4-OHE) and 16-hydroxyestrone (16-OHE). Throughout the next 12 months, she reported that each one her signs obtained worse, and her extreme allergic and anaphylaxis reactions began. Moreover, her persistent fatigue turned so excessive that she needed to be in a wheelchair for any exercise that required appreciable exertion. 

Earlier than this affected person began progesterone alternative within the type of a topical cream, she had skilled amenorrhea for six months. She additionally had a really robust household historical past of polycystic ovary syndrome (PCOS). She herself didn’t have PCOS, although this was suspected sooner or later. 

We accomplished an environmental evaluation and historical past within the workplace and established that there have been no main vital environmental exposures to pesticides, heavy metals, smoke, polychlorinated biphenyls, mould, solvents, or risky natural compounds. As well as, we ran a useful genomics hormone panel to see if this affected person’s genetic profile may clarify her signs – not simply reactions to scented merchandise, histamine meals, and solvents. We suspected that the progesterone cream was aggravating the affected person’s MCS, MCAS, immune reactivity and anaphylactic reactions. 

Hormone Profile Findings 

The outcomes of the affected person’s genetic hormone profile established a number of points contributing to her symptom image. For instance, she exhibited genetic predispositions to suboptimal methylation, glutathionization, and glucuronidation. Nonetheless, most importantly, her profile indicated that she was estrogen dominant and was liable to a sluggish clearance of estrogen metabolites and androgens. Her mixture of a quick cytochrome P450 17A1 (CYP17A1) and reasonably quick CYP19A1 (aromatase) resulted in an general quick conversion of progesterone to estrogen. This resulted in low ranges of progesterone and excessive ranges of estrogen. Prescribing progesterone to assist steadiness the excessive estrogen resulted in shunting of the progesterone, growing each estrogen and estrogen metabolites. 

The estrogen metabolites 4-OHE and 16-OHE are extremely inflammatory; their presence is linked with MCS and different circumstances that exhibit immunotoxic results.⁴ Subsequently, by including much more “gasoline to the fireplace,” the rise of progesterone doubtlessly ended up downstream, leading to vital irritation based mostly in excessive ranges of dangerous estrogen metabolites. This flared her pre-existing MCS/MCAS situation to the purpose that she was experiencing doubtlessly anaphylactic reactions to allergens she had by no means reacted to earlier than. 

Remedy Plan 

• Discontinue progesterone. Function: get rid of the trigger and aggravation of signs. 
• Liposomal glutathione – 400 mg within the morning on an empty abdomen. Function: help section 2 detoxing. 
• Part 2 detoxing nutrient help mix (B nutritional vitamins, vitamin C, magnesium, manganese, selenium, zinc, Silybum marianum, and N-acetylcysteine) – 1 teaspoon within the morning. Function: help section 2 detoxing. 
• Colon hydrotherapy – 2 occasions per week for 3 weeks. Function: convey down whole physique burden. (Be aware: this was restricted by the affected person’s schedule) 

• Scale back as many on a regular basis environmental exposures / whole physique burden stressors as doable. 

Comply with-up 

The affected person adopted the remedy plan for two.5 months. Upon follow-up, she reported a serious enchancment in allergic and anaphylactic signs. She felt nice for the primary time in a very long time, with nearly no reactions to meals when consuming out at eating places; she had been unable to do that over the earlier 12 months. MCS reactivity was additionally considerably lowered however not absolutely resolved. 

Conclusion 

This case research serves as a reminder of how an individual’s genomic hormone profile can result in vital medical outcomes. Environmental toxins and toxicants corresponding to hormone disruptors, neurotoxins, and immunotoxins usually are not the one potential dangers to our sufferers. Medical doctors additionally have to completely assess whether or not exogenous prescription hormones are upsetting reactions in our sufferers. 

As clinicians, we have to make the most of instruments that assist us differentiate affected person instances and never fall into the lure of utilizing non-specific protocols solely. Not all estrogen dominance is appropriate for remedy with progesterone remedy, particularly for sufferers with an intensive medical historical past and complicated persistent circumstances. Improper use of hormone remedy can lead to a symptom profile that presents like MCS and MCAS. 

[REFS] 

1. Lavergne MR, Cole DC, Kerr Ok, Marshall LM. Practical impairment in persistent fatigue syndrome, fibromyalgia, and a number of chemical sensitivity. Can Fam Doctor. 2010;56(2):e57-e65. 

2. Crinnion WJ, Pizzorno JE. Scientific Environmental Drugs. St. Louis, MO: Elsevier Well being Science; 2019. 

3. Nationwide Report on Human Publicity to Environmental Chemical substances. Facilities for Illness Management and Prevention. https://www.cdc.gov/exposurereport/index.html. Revealed April 12, 2022. Accessed July 23, 2022. 

4. Straub RH. The advanced position of estrogens in irritation. Endocr Rev. 2007;28(5):521-574. 

Winnie Siu, ND, graduated from Canadian Faculty of Naturopathic Drugs and is a licensed naturopathic physician. She is the medical director for The DNA Firm, a Canadian-based useful genomics testing firm. Dr Siu cofounded (together with her husband Aviad Elgez, ND) the EnviroMed Clinic in Toronto, Canada, targeted on caring for sufferers with environmental diseases. She takes an energetic stance on educating the general public in regards to the unwell results of poisonous chemical compounds in our meals, water, physique care, cosmetics, and family merchandise. In her spare time, she enjoys leisure studying and going for adventures in nature together with her husband regionally and internationally.