OpenHealth Q&A

Complex Nutrient Deficiency and Diagnostic Challenges

A 32-year-old Caucasian female, standing 163 cm tall and weighing 45 kg, does not smoke or consume alcohol. I am reaching out for assistance regarding my health struggles. Currently, my primary concern revolves around severe nutrient absorption issues, which may also involve nutrient utilization. My body expels vitamins and minerals exceedingly quickly. To mitigate this, I must consume high dosages of supplements; otherwise, I experience the severe effects of nutrient deficiencies within days, with potassium being critically low within hours. If I fail to take it, I suffer from symptoms like intestinal paralysis, pain, nausea, heart palpitations, extreme weakness, muscle cramps, and lower back discomfort, despite using Spironolactone. Even while supplementing, I endure significant physical and mental exhaustion, and my cognitive function remains subpar. So far, I have received the following diagnoses: hypothyroidism, S-shaped scoliosis, focal gastritis, gastroduodenal reflux, biliary dyskinesia, and a possibly non-classic form of congenital adrenal hyperplasia (with subsequent genetic tests showing no mutations). I also contend with major depressive disorder with dissociative symptoms due to external stressors, complex PTSD, and possibly ADHD. Tests for celiac disease, lactose intolerance, Hashimoto's disease, and H. pylori returned negative results. My pancreatic elastase and calprotectin levels are reported to be normal. Regarding my medications: I am currently taking 100 mg of Spironolactone (which I initiated two years ago), 50 mcg of Levothyroxine (started six years ago), and sporadic doses of Dexamphetamine (begun five months ago). In addition, I use supplements including zinc, potassium, B vitamins, magnesium, iron, vitamin C, and others when financially feasible. In terms of family medical history: my mother has struggled with chronic low stomach acid, dyspepsia, constipation, and has a former diagnosis of PCOS. My maternal grandmother also had low stomach acid issues, regularly utilized digestive enzymes, underwent a hysterectomy with ovary removal, and later passed away from kidney cancer. My younger sister, who exhibited IBS-like symptoms during childhood (which improved with age), has never been formally diagnosed but continues to have symptoms that might align with MCAS after allergies were ruled out. I am aware that my health challenges are multifaceted, yet there remain unanswered questions. Symptoms indicating nutritional deficiencies have persisted since childhood, progressively worsening over the years. Only a few years ago did I learn that many of my ailments were linked to these deficiencies, prompting me to start supplementing vitamins and minerals. It required significant time and experimentation to pinpoint what I lacked and identify effective dosages. I battled Small Intestinal Bacterial Overgrowth (SIBO) for several years, which seemed to resolve with antibiotics and supplementation, alleviating issues like bloating and persistent abdominal sounds. However, nutrients continue to evade absorption. I might not be addressing every single deficiency, but something is inherently amiss. Is it prudent for me to consider the following tests? 1. A glucose tolerance test? Historically, my fasting glucose levels have been normal, but a urine test in 2020 indicated 5 mmol/L of ketones without being on a ketogenic diet at the time—this was prior to beginning my supplementation regime. I typically don't feel worse after consuming simple carbohydrates. My mother shares some similar but milder symptoms, recently identified deficiencies in zinc, iron, and vitamin B12. She has long experienced frequent urination, heightened appetite, stomach pain when meals are postponed, swollen limbs and face, and challenges with weight loss, despite her efforts. We both also cope with ingrown toenails, whereas she reports feeling ill after consuming sugary foods. Her test results from March this year indicated: - Fasting glucose: 5.2 mmol/L (considered in range: 4.0 - 5.5) - HOMA: 1.7 (normal is <2.5) - Insulin: 7.5 (normal range 1.9 - 23) - HbA1c: 5.5% (normal range 4.5 - 5.6). 2. An antiparietal cell antibodies test to exclude the possibility of pernicious anemia? Even after resolving my SIBO symptoms, I am still facing multiple deficiencies. What could be contributing to my persistently low stomach acid? This condition seems prevalent in my family, as both my mother and grandmother experienced chronic low stomach acid without treatment. Could chronic stress potentially play a role? Furthermore, is it possible that Ehlers-Danlos Syndrome is a contributing factor, or could infections be affecting me? I have not noted flare-ups; my condition is generally stable. In 2019, I had tests done for antibodies against EBV and Toxoplasma, could those infections still be affecting my health? The results revealed: Toxoplasma IgM - 0.07, Toxoplasma IgG - 7.5, IgM EBV - 1, and IgG EBV - 13.9.

Answers (1)

7/17/2025, 10:21:04 PM

OpenHealth AI

It sounds like you're facing a complex and challenging array of health issues, which understandably is frustrating and concerning. Your nutrient absorption problems and the wide range of symptoms you've described suggest that multiple factors may be at play, including possible underlying conditions that have yet to be fully explored.

Key Points:

1. Nutrient Absorption Issues: Persistent deficiencies can stem from their inability to absorb nutrients effectively, low stomach acid, or a potential autoimmune issue.
2. Family History: The recurrent theme of low stomach acid and related symptoms in your family may indicate a genetic or hereditary component that warrants deeper investigation.
3. Suggested Tests: You’re considering valuable tests that could further clarify your condition.

Next Steps:

1. Testing for Low Stomach Acid and Pernicious Anemia:

   • Antiparietal Cell Antibodies: This test can help determine if you have an autoimmune condition affecting stomach acid production (possible pernicious anemia). Given your family history of low stomach acid, this is a valid consideration.
   • Glucose Tolerance Test: While your previous glucose tests were normal, this test can help rule out insulin resistance or other glucose-related issues, especially given your symptoms and family history.

2. Addressing Low Stomach Acid:

   • Chronic low stomach acid can hinder nutrient absorption, and stress may exacerbate this condition. Evaluate your stress management strategies—practices such as mindfulness, regular physical activity, or therapy may help reduce stress-related symptoms.
   • Consider discussing the potential use of digestive enzymes or hydrochloric acid supplements with a healthcare provider, as they may facilitate better digestion and nutrient absorption.

3. Exploring Ehlers-Danlos Syndrome (EDS):

   • Given your symptoms and family history, EDS or related connective tissue disorders are worth exploring. Consider documenting any signs such as joint hypermobility, skin elasticity, or chronic pain that may correlate with EDS symptoms and discussing these with your healthcare provider.

4. Monitoring and Managing Symptoms:

   • Keep a symptom diary to track your dietary intake, supplements, and any symptoms that occur. This information can be very helpful to your healthcare provider in understanding patterns and triggers in your health.
   • Continue with your current supplementation, but ensure that financial considerations do not compromise basic health needs. Explore community health resources or programs that may assist with obtaining necessary supplements affordably.

5. Consider Other Infectious Agents:

   • While prior infection tests showed no active disease, if you suspect lingering effects from EBV or other infections, discuss with your provider the importance of retesting or further investigation into potential chronic viral conditions.

Amid these challenges, remember to focus on one step at a time and advocate for yourself as you pursue further testing and treatment adjustments. Your persistence in seeking answers is crucial, and it’s important to find a supportive healthcare team that can guide you through this process. Please reach out if you have more concerns or need further clarification on specific points.