I’m at Mayo right now with my sick sister and it’s -10F 
it just doesn’t get this cold where I’m from (Seattle)
I hope your sister is ok.
Lucky for me I grew up in Eagan MN which is a little north of Mayo. I remember trick or treating in a snow storm in a full snow suit including face mask; I told them I was a robber!
Best Halloween ever because there weren’t any other kids out and the houses gave us tons and tons of candy!!
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I Grow up in Apple Valley @Nate_Pearson. Halloween storm of 91!!! I remember it well!! We tricker treated and snowmobiled the same day!
@Nate_Pearson I have no personal experience with this guy but look for “Gojiman” on Youtube. He is currently pursuing a PH.D in the UK in a related area. He strikes me as an earnest fellow. He offers personal consultations.
@Nate_Pearson @IsaacBB Glutamine is one of the few things that I see being mentioned that is reasonably supported by science.
Hi @Nate_Pearson ,
Sorry I’m a bit late to the party. I’m a GP and Emergency Medicine doctor (I’m no expert on IgG deficiency, nor on anything else for that matter as I am a generalist).
I must also confess I haven’t read the entire thread, so I do apologise if some of this has been discussed (although I have attempted a ctrl+F to find any relevant topics).
Your initial post is extremely detailed and useful.
I have a couple of suggestions that may (or may not) help.
(1) The low IgG is likely to be the main underlying factor (but its anyone’s guess what is causing that) - So I would seriously considered continuing down that route for treatment. However, lots of people probably have this (often undiagnosed) and don’t have symptoms - so I suspect there are some other factors exacerbating it. Whether or not controlling these other factors will stop the clinical symptoms is probably a case of trial and error. Stick in there. You must feel like you have tried everything and no one has an answer - which is often the point at which people turn to alternative medicine (which - keep an open mind - may or may not work, but I would always recommend trying to find an evidence based solution).
(2) Do you get any symptoms of acid reflux (GERD in the USA, GORD in the British English speaking world)?
There is frequently reflux (it is often asymptomatic - except for the recurrent infections) playing a contributory factor to many sinus and ENT related issues, particularly sinusitis and sleep apnoea.
If you are spending 8+ hours a day with an unusual acid environment in the back of your nose/throat that that is going to cause some inflammation and pre-dispose you to sinusitis. I would be pretty surprised if no one has discussed this with you by this stage already so I apologise if this is old news
If I saw a patient with your history in my clinic, I would recommend some lifestyle factors to reduce any potential GORD, and a trial of a proton pump inhibitor - PPI (e.g. pantoprazole 40mg daily or omeprazole 20mg daily) for 1-3 months. Lifestyle factors to reduce GORD include:
- Don’t lie down (i.e. go to bed) within 2 hours of eating
- Smaller portion sizes (e.g. consider 5 smaller meals per day instead of typical 3 meals per day)
- Certain foods are also associated with increased risk - such as alcohol, caffeine, fatty foods, spicy foods (most delicious things really).
- I would seriously consider NO alcohol or caffeine, strictly not eating (or drinking anything other than water) in the last couple of hours before bed, and a PPI - at least as a trial for a couple of months. I suffered terrible GORD myself for several years and have almost cured it with the above advice - and it soon comes back if I stop. Not lying down for 2 hours after eating requires extensive planning and preparation.
- I would also mention the possibility of GORD to the next doctor / ENT person you see. It may even be worthwhile thinking about having a gastroscopy.
(3) Otherwise, a couple of other factors may help with the acute infections. These are really just tinkering at the edges. There is some underlying issue that needs to be sorted, but these things might help reduce the frequency or severity of your infections in the meantime:
Zinc. Some evidence (not great evidence, but not terrible either). Recommended dose of 75-100mg daily when you are sick (not when you are well - that’s too much to take on a daily basis). Works best if you take it as soon as you feel the very first symptoms starting. Recommended in 3-4 divided doses (i.e. 25mg 4x per day). Studies suggest can reduce the duration of an upper respiratory tract infection by about 30%. This may or may not reduce your chances of you getting the sinusitis whenever you get an infection. Its unlikely to do you any harm. Lozenges supposedly better than pills, but hard to find. (I have never seen them in that dose in Australia, where I work). No other multi vitamin or any other sort of vitamin (including Vitamins c) has been proven to make any difference. (In fact, some studies suggest that people who take regular multivitamins have a shorter lifespan than those who don’t…)
Some evidence for zinc:
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Zinc for the treatment of the common cold: a systematic review and meta-analysis of randomized controlled trials - PMC
Yes, this evidence if for “the common cold” but I suspect that is the underlying issue - you catch some sort of viral illness (i.e. the common cold), and it sets off a sinusitis (which may be due to a secondary bacterial infection, or may just be an inflammatory issue - in either case, the antibiotics will be helping - as a side note - antibiotics have good anti-inflammatory properties and in many cases like yours it may be these effects that are helping, rather than their anti-bacterial effects)
And, as mentioned elsewhere in this thread - hand hygiene. This is the biggest factor in reducing your chances of contracting infections from your family members. I would recommend washing your hands thoroughly anytime before you put them near your face or eat anything. I would teach the rest of your family how to wash their hands properly. And when a family member is sick, was your hands immediately after touching ANYTHING that they have touched.
Finally, regarding the whole discussion of antibiotics and gut flora. Yes, the antibiotics are affecting your gut flora. Yes, this is probably having adverse effects on your health. But, my understanding is that no one really knows exactly what health implications this alteration is gut flora has, and that the main health implications are probably long term in relation to chronic disease risk. It is a pretty exciting, but still very much emerging field of medicine. My advice would be to take the antibiotics when you need them because this is of proven short term benefit, and the risks are obscure and currently unquantifiable - therefore - benefits outweigh risks. I would be somewhat skeptical of tests for microbiome flora quality - I don’t believe there is a lot of evidence behind this.
In the next 5-10 years I suspect we will learn a lot more about gut health and its relation to other far-flung issues.
I hope you find a fix soon!
P.S.
High bilirubin and jaundice need investigation but most likely cause would be Gilbert’s Syndrome (harmless, and probably unrelated to main issue)
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it seams as if your gut microbiome is pretty F’d considering all the rounds of Abx you have been prescribed. I see that you already take probiotics, which is good; however, some research has shown that the reported benefits are overblown when simply taken in pill form. eating probiotic-rich foods would potentially be much more beneficial. store-bought kombucha is rich in sugar and low in bacterial diversity. kimchi, kefir, and sauerkraut would be better options (no dairy in kefir). fermenting at home is relatively easy and results in exponentially greater bacterial diversity. (occasionally those who have endured Abx tx will have an overgrowth of “bad” bacteria. these individuals will often react negatively to probiotics, worsening their Sxs. it’s hard to say whether or not this is the case for you w/o actually testing for it. however, seeing that you are able to tolerate a lot of carb-rich foods w/o any reported GI distress, it’s highly unlikely.)
seeing that you are lactose intolerant, you are most likely allergic/sensitive to a number of other foods as well. it may benefit you to try an elimination diet (AIP, GAPS, elemental) for a period of time, w/ a gradual reintroduction process.
the fact that you tend to become ill w/ bacterial infections is interesting. bacteria utilize carbs to proliferate, unlike viruses. you could trial a diet that is higher in protein and fat and target your carb intake around your workouts to mitigate the rise in blood glucose/insulin response.
fruit bats, guinea pigs, and humans are the only mammals that do not intrinsically produce vitamin C. it appears that all other mammals not only synthesize but significantly increase Vit C production during times of illness. intensivists are even starting to prescribe Vit C to patient’s w/ sepsis, as studies have shown some beneficial outcomes. you could try mega dosing w/ 1.5 -3g q6h, as more than this at can result in GI distress. plenty of water too, as this vitamin can potentially cause kidney stones.
thank you for the awesome training platform and very informative podcast.
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Hey Nate, it looks like you have tried a boat load of everything and that must be exhausting. Most of your research and things tried seem to be looking for a mechanical or medical “fix”. From listening to your podcast it sounds like you need to take a different attitude to your training and racing - (completely different) and this will conflict with everything that Trainer Road is and also go against the kind of athlete that you sound like you are and that is going to be tough. It sounds like with your training it is all and then nothing and then full on again. Everything is planned and measured and examined and reviewed and all your training is prescribed and that produces a load of stress. I would suggest that you do not keep any kind of training diary - just do exercise - just ride your bike when you feel like it - do not take any metrics and do not make any notes about your ride or your FTP or your time spent at this that and the other wattage. This will give you a far healthier relationship with exercise and may result in less stress and anx with sessions missed FTP lowered etc.,. This is not easy to do as I can hear your enthusiasm for training and racing but being ill that much just isn’t right.
I would also suggest that you have a read about a chap called Wim Hoff - he suggests breathing and cold showers as a boost to your immune system.
Good luck Nate -
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Thanks for this!
No acid reflux here, but I have done 30 days of Prilosec to try to rule that out.
I also do Zinc nasal swabs and/or spray at the first signs of a cold. I keep them in my backpack so I carry them everywhere I go.
I agree with you on the antibiotics and gut flora too.
I think all roads lead down to this. I’m not looking forward to an elimination diet.
I got a gut biome test, I’ll probably post about it today!
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Nate, low DHEA levels are causing reduction of white bloods and therefore impairing the immune system. Check your DHEA level - a quick and low cost test.
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Hello Nate, am new to the show but have already learned tons. I’m an old roadie (45 y/o), have kids, am lean, raced from 14 till 40 something years old. And because I have kids and suffer horrifically from allergies (have cats and live in New England, where Spring time can be lethal to allergic people). I was getting sick over and over, missing workouts, sucking it up at work, etc. This is what I learned:
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reishi mushroom powder, which i mix with MACA root, will make you indestructible health-wise. I have escaped myriad bugs at home, and in 2018 i got sick ONCE, as opposed to almost every month.
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tongkat ali, also a plant, like a “malaysian ginseng”, is also marvelous for overall health.
I have found that a little goes a long way with those combinations, plus they’re not expensive at all and last a long time. All are available at Amazon or your local Trader Joes. I know you’re close to 2m tall (I’m 6’/182cm), so the dosage have to be tested to ascertain best results. Mind you: those supplements do not have side effects, they’re 100% effective and taste ok. You can blend them in your smoothie, protein shake, whatever. I kix them with almond milk before going to bed and it also helps w recovery. But my main concern was to get, and stay healthy. Those supplements fit the bill and I’m better for it. Give them a try, you have nothing to lose. I can promise you you won’t regret it.
also, get some sleep, more sleep if you can. Cut off bad sugar (outside of “exercise food” like gels, etc).
good luck - you’ll be glad you tried those supplements.
G
Reading through Nutrient Timing, and chapter 9 covers glutamine supplementation. Here’s what the text said about it, specifically as it relates to a deficiency due to intense training…
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Who is the author?
John Ivy
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Who run Bartertown?
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I am a dental hygienist that is trained in myofunctional therapy. My question to you is did you have any teeth extracted for ortho? I would consider the ALF appliance or the Vivos DNA appliance if you have a narrow palate or those missing teeth. Have an airway centric dentist assess your airway and the position of your hyoid bone. Also, see an Orofacial myologist, cranial sacral therapist and get a myofacial release for the hyoid bone. Consider reading the book the Dental Diet and the book 6 Foot Tiger in a 3 Foot Cage. Sleep apnea can be found in individuals with small dental arches and individuals that are tongue tied. Palates can be expanded and tongues can be released. I have so much more info for you regarding sleep. This is just the start…
+1 for this! Nate, do you know if you have a tongue tie? Through seeing a really amazing Physical Therapist, I recently learned that I have a stage 4 tongue tie that no doctor/dentist had ever diagnosed. (I’m 34 years old)
Long story short, I’m now seeing a fantastic myofunctional therapist based in Oakland, CA and am scheduled to get surgery to address this which will hopefully improve my breathing. Some of the success stories these doctors have shared is pretty amazing - from memory, there was one about a very fit pilates instructor who has been on a CPAP for 15 years. Through the tongue tie surgery and a few weeks of post-op exercises, she was able to get completely off of the machine.
If this is relevant at all for you @Nate_Pearson, I’m happy to send you more info on the doctors in case you’d like to reach out.
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Thanks, I’m I’m going to the Mayo Clinic tomorrow. I’ll see what they can do, and if I can’t get help I’ll reach out.
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This is super “crunchy” - but ever try Oregano oil?
People claim it helps w/ gut issues and has antibacterial properties.
Good luck Nate.
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Great tasting too! 
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