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Dear Patient,

As you know, in Functional Medicine we look at antecedents, triggers, and mediators (things that maintain dysfunction) of illness. We consider the systems (digestion, nutrition, immune/inflammatory/infectious, detoxification & biotransformation, oxidative stress/mitochondrial function, endocrine function, genetics, epigenetics, and lifestyle and psychosocial factors) which when dysregulated, cause disease. We test suspected systems and determine a personalized treatment plan based on the whole picture (symptoms, signs, history and lab data).

We detected a number of factors which have contributed to your current difficulties. These are:

  • Paroxysmal Leg Movements of Sleep: These can be caused by B12 deficiency, clostridia (in gut), toxins (you have many), or low iron (your iron is normal). I suggest that we treat the B12, the toxins and the gut, and re-test. Medications such as the duloxetine can cause this as well, and unless this has been particularly effective and helpful, it should be discontinued. You should be re-tested in 3-4 months (sleep study) and if the PLM’s are still present they should be treated. Alternatively, we could treat them now with any of a number of dopaminergic medications. Let’s discuss this. We do not know if you have sleep apnea, because you didn’t sleep on your back during the study. Sleep apnea can cause the small vessel changes seen in the MRI.
  • Low oxygen saturation-your Pulse Oximetry showed 95% Oxygen saturation, normal being 98-99%, and your mycotoxin test shows mold toxins likely in your home environment. These mycotoxins can inhibit your oxygen exchange at the level of the lung, leaving you deficient in O2. The ERMI test needs to be done ASAP. Get a Molekule air filter for your bedroom and workspace to clean the air until the mold question and source are identified.
  • Mitochondrial dysfunction: the Nutreval and organic acids test indicate slowed processing through the mitochondrial electron transport chain (produces energy for the cells in your body). Iso-citric acid is accumulating, succinic acid is low, methyl and oxy-glutaric are accumulating
  • The NeuroreaderMRI test indicated 5 primary findings:
    • The thalamus on the left is quite reduced in size (20% of normal)
    • The left fronto-temporal regions are reduced in size
    • There is not much change since 2016 (great)
    • There is evidence of small vessel disease
    • The hippocampus (memory) is average or above average in size-indicating this is not a memory issue, or an Alzheimer’s process, rather a Fronto-temporal process.
    • Neurotoxins (organotoxins, mycotoxins-heavy metals pending)
  •  Immune:
    1. Infections:
      • Nasal (2)
      • Intestine (2 or more, including fungal)
      • Vascular (1)
      • Bartonella (tick or cat-borne);
      • viral (coxsackieviruses [4])
    2. Multiple food sensitivities
    3. Probable mold exposure
  • Gastrointestinal Issues:Bacterial overgrowth of the small intestine is severe (treatable), causing malabsorption, as well as re-absorption of some of the neurotoxic substances (zearalenone) due to the high levels of beta-glucoronidase (which is undoing what your liver is doing to get rid of the toxins); Low butyrate (necessary for the GI-Immune barrier, and also for brain functions)
  • Hormones:Low normal: Cortisol , DHEA, testosterone: Melatonin low. I think most of the hormones will come up with dietary and supplementation
  • Nutritional deficits:
    Clear evidence of B12/folic acid deficiencies-affects the brain ability to make myelin (the fatty coating around nerve cells), as well as hundreds of methylation reactions. You are making antibodies against the cells (parietal cells) which absorb B12. You will need to be on B12 injections for at least one year

    Overall, you have a picture consistent with multiple toxins, hypoxemia, nutritional deficits, head injuries, and infections as the causes of your cognitive problems.  It is reasonable to assume that treatment of these items will stabilize you, cause a much greater sense of well-being; It is possible that with these items corrected, other modalities can be effectively used (e.g., speech therapy, exercise, photo-biomodulation [laser], hyperbaric oxygen) to increase neurogenesis and regain some degree function.

    Robert Hedaya, MD, ABPN, DLFAPA, CFM
    Clinical Professor, Georgetown University Hospital
    Faculty, Institute for Functional Medicine