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Omg...i Might Be On To Something


Rachel--24

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mftnchn Explorer

I am so happy to be home for a week!!!

Had a strange experience this last week, last Mon eve and especially Tuesday had fever like symptoms (no thermometer to check), fatigue, abdominal cramping. Was fine Wed, Thur, Fri. Thur/Fri had the massage, and Fri did the detox bath. Sat I was fine when I woke up but late morning on the way to the bus station for my return home, I started to feel faint, fatigue, flu-like. When I got home, discovered I was running a low grade temp (99.5). Sunday later in the day I was feeling better except for major runny nose.

So I am back to trying to figure out what is going on here? Glutened by barley tea a week ago Friday, herx from my switch to Zithromax brand, detox from whatever was in the ascorbic acid that stopped intestinal motility, other lyme symptoms, cold/flu, liver toxicity, mercury moving, the list just goes on!

Does anyone get a low grade fever from a glutening?

Sherry


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Green12 Enthusiast
Does anyone get a low grade fever from a glutening?

I do, I get a low grade fever whenever I eat ANYTHING that I am allergic/intolerant to, not just gluten.

Ridgewalker Contributor
Does anyone get a low grade fever from a glutening?

Sherry

My son, Lucas does. In fact, shortly before we put him on a gluten-free diet, it had gotten to the point where he was having a low fever every single morning. It would gradually go back down throughout the day. Now when he gets glutened, he almost always runs a low grade fever!

CarlaB Enthusiast

Donna, WELCOME BACK!

Kassandra, sorry about the cold ...

Sherry, when I started bart treatment, I would get random low-grade fevers. I didn't get fevers when I'd get glutened.

Julie, glad you're feeling good enough to come back. :)

Andrea, hang in there.

Rachel, sorry you don't have pink anymore .... what about a pink hat?

Judy, you "sound" like you're feeling well. :)

NoGluGirl Contributor

Dear Donna,

Boy did I miss typing that! :) None of us could wait until you got back! We missed you, and things did not feel the same with you gone! I am glad you had fun on your cruise. This time you knew how to pace yourself, which I am sure helped a lot.

I cannot wait to see the pics you took! Sunset pics are always nice. Downloading them can take forever. Patience is not something I have a lot of. My camera is a Toshiba, but gets filled up quickly. I could never take over five or six pics at once. :(

Your supplements may have caused the nausea. Taking them with enough food is often the trouble. I take my bone meal supplement with food. All it has is calcium and B12. I have not taken it for a couple of days, and am starting to feel the effects.

I ate canned fruit without any added sugar, but it gave me lower abdominal pain. The Candida probably got irritated by it.

Stupid yeast! Maybe the fruit is what bothered you, too. I do better on fresh fruit, as long as it is not over a few days old.

Those 3 pounds will probably fly off now that you are back. Most people gain weight on vacation. Going to Rome could make you fat quickly. It is easy to gain 20 pounds in three weeks while there, due to all of the wonderful food. I wish I could go, but the Italians do not believe in air-conditioning. I would never survive that!

Cookies are what I love as well, but lately it is all the Reese's Halloween candy that has me rachonneling. :ph34r: I have done better the past couple of days. My grandfather sent some dark chocolate candy bars, and I ate one of those instead. They have less sugar, and a lot of antioxidants. It is richer, and does not make me crave so much sugar.

I am glad to hear your place was not harmed by the quake! Your mother's place probably is more vulnerable. Being in a trailer is very dangerous. With all of the severe weather around here, you would think that no one would live in one of those.

Thank goodness your mother is alright!

That is so funny about your friend's cousin's ex-wife being in the cabin next door! :lol: You probably did not expect to run into her. Your friend probably did not see that coming, either. Once again, life shows proof of it being a small world. We have had some instances like that, too.

Dear Patti,

Lively Lemon sounds good! I do not know if anyone even sells the Enjoy Life brand here. I need to check with Adele's on the East side of town. I normally bake my own. I have made Keylime Zingers for everyone, and they are really zippy and my brother and mother really liked them. Since I had my own recipes before, I just had to make a few alterations after going gluten-free.

Dear Judy,

Just catch up when you can! Keeping up with this thread can be hard. Pace yourself! We will be here. I am doing the best I can, too. HUGS to you as well!

My new glasses are wonderful! Being able to see has made life easier. Straining to see can really be exhausting when you are this near-sighted. The eye doctor said his prescription is close to mine. He was also ecstatic that I do not sleep in my contacts. So many people do, and they should not.

Your avatar is great! Cape May looks beautiful! Your girl's night sounds like fun! My mother and I used to have those. After I got sick, we had to stop.

Your kitchen sounds like ours! No matter how hard I try to clean things, my parents make a mess of it. I often get the silverware divided (the knives with each other in one cup, then the small forks in another, etc.) because it makes things easier. You put the silverware in the slots, and then you run the machine. All you have to do once it is done is grab one bunch from each slot, and put them away.

My parents always put them in with the wrong ones. :angry: I mean, seriously! How hard is it to put a big spoon with the big spoons, and a small fork with the other small forks? What is it with these people? I could actually keep things neat if they were not here.

Dear Carla,

Maybe I should get a pink hat, too. I have one. It is a newsboy. Maybe I should get a ballcap as well. There are so many great possibilities with pink!

Dear Sarah,

I do know others on here have said their children have fevers when glutened. It seems more common with children. Adults do get fevers sometimes, though. I know people have discussed it. Fevers are not a typical reaction for me, though.

Dear Rachel,

Do not worry! I am sure you can find ways to sneak pink into your life! Julie's underwear suggestion is a good one. Also, how about ponytail holders or barrettes? I love those flip-clips, and if they have sparkles, even better!

Dear Kassandra,

That is terrible about you having a fever! :( I hope it is nothing to nasty. Colds do not usually cause fevers, but they can. I have had them before. Maybe I had the flu instead, I am not sure.

I normally start getting a sore throat, then it just gets worse over a day or two before everything gets really bad. Since your mother has been sick, you might have caught it from her. Dad is sick, and he is not feeling good. His head was throbbing, and his body ached yesterday. He is feeling a little better right now, but is very tired and not up to par yet. I hope I do not catch it, and Mom has not felt good today either.

I am thinking about getting some of that Airborne stuff. I heard it is pretty good. I need all of the help I can get! Why take chances? Dad cannot figure out how he could have caught anything. I told him, you do not have to be around someone who is sick. A person could be a vector and carry the virus or germ, but not become ill from it. When you come into contact with them, they can transfer it to you.

My own cookies are the only kind I really can afford. I love cookies too much to eat just one or two. Four is the normal number. Like you said, they are best from the oven! They are delicious! It is like being in heaven!

We will keep sending positive energy your way for the IVs! The thing is, if your body cannot metabolize the iron, what good will it do? I cannot figure this out. If your system cannot transport it due to the low ferritin, I am not sure more iron will help. I wonder what your doctor is thinking about this situation? There is something that does not make sense to me here.

Dear Julie,

I had a feeling that stupid angioedema was why you had disappeared. :( I hope it goes and stays away! I know how miserable that must be. We all have our issues. None of them are any fun. At least we can help each other get through the suffering when it is there!

I am a big fan of Tollhouse cookies. I make my own. I can get one of those Lay's Stax tubes and rinse it out after I eat the chips. Then, I put my dough in it in the fridge so it is ready to go when I am! Freshly baked cookies are the best!

I need more pink! Pink undies are a good thing to have. I have two pink bras. Maybe a couple more would be a good idea! A pashmina would be pretty, too!

Dear Sherry,

Let me know how your rice milk yogurt turns out! I have never had that kind. No one sells it around here that I know of. How do you make it? Someone suggested goat yogurt for the probiotics in it, but she said it tasted gross.

The fever you had sounds very odd. It could be from being glutened. I do not get that as a symptom, I always get violently ill at both ends. Thank God for promethazine! My brother cannot take it, though.

He hallucinates. I looked it up, and it turns out that can be a side-effect for some people. He said he cannot take that stuff, because he will start seeing pink elephants! Promethazine has been my saving grace upon being glutened. Fevers do not occur with everyone, but they are not totally unheard of.

It probably is nice to be back in the states for a bit! Is it difficult to readjust? Of course, you have to go back in a week. Travel can be fun, but there is no place like home! Maybe one day, I will get to travel a little.

Dear Laura,

Thank you for the MDL information again! I made a shortcut. Now I can get to the page much faster! In case someone cannot afford IgeniX due to insurance, this would be a good alternative. I am keeping this in mind if I ever get insurance.

Dear Everyone,

Well, I am sorry to report that Dart has had another seizure. My mother is so stubborn about the gluten thing. If she really wants to help Dart, she will let me try it. I told her she cannot feed him crackers or his dog biscuits. I need to make him some that are made of rice flour. It still may have to do with a shunt in his liver, but gluten-free is worth a try.

Sincerely,

Jin

confusedks Enthusiast

Jin,

The only reason we are looking for the iron IV's to help is just as a band-aid. We know we need to get to the bottom, but in the meantime...it is dangerous to walk around with levels this low. I officially have no color in my skin. Never mind the fact I am supposed to get my period, but I haven't yet. So, once I get it (if it decides to come) my numbers will get even lower. The iron IV's did last a little while last time...and that's all we're looking for.

Kassandra

NoGluGirl Contributor

Dear Kassandra,

Now I understand why the doctor is doing them. There is bound to be an answer to this.

We will find it! I am doing more research. I wonder if perhaps heavy metal poisoning may be a problem? Could mercury be causing this?

Sincerely,

Jin


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AndreaB Contributor
It probably is nice to be back in the states for a bit! Is it difficult to readjust? Of course, you have to go back in a week. Travel can be fun, but there is no place like home! Maybe one day, I will get to travel a little.

Sherry is still in China. She doesn't come stateside for a couple more months. She's just back home there for a week.

NoGluGirl Contributor

Dear Andrea,

I thought she meant the U.S. when she said home for some reason. I knew she was going to be back stateside from mid-January until March. She probably cannot wait to come and see her family! Spending the holidays away from family is tough for her, I bet. I know some people celebrate Christmas in China, but not too many. Most of the population is Buddhist.

Sincerely,

Jin

confusedks Enthusiast

Update: My mom spoke with the insurance advocate and she said I need to go to the ER for Iron IV's. She said it is getting dangerous for me to be walking around like this with my ferritin so low. So, I just talked to my mom and she is thinking about taking me to the ER. EEEK! I guess I am getting yellow and the advocate (she is a RN) said that I am getting jaundiced and that is dangerous.

In the middle of all of this we are trying to figure out online school options. It is looking like I am going to have to leave my school altogether...no more specialty programs for Kassandra. lol. <_<

Also, I am going to have my blood drawn today for Igenex. Wish me luck...hope I don't pass out...considering I am driving myself. lol.

Kassandra

CarlaB Enthusiast

Kassandra, I would get to the ER today .... that will have to make you feel better than you do now!!! I'd do it before the blood draw if you can, not that it's necessary or that it's a lot of blood, I just think you'd feel better.

You can do the homeschool work, it'll be fine. Check out Saxon for math ... as long as you've already had Geometry, it's a great program. It's not cheap, but it's self-explanatory ... the textbooks tell you how to do the work.

I can give you some other ideas, too, but don't worry about it, you will probably end up having more fun with your school work than you did before .... though the social aspect will be gone :( .... homeschool groups are great, but with your reasons for homeschooling, they might not serve you well.

My kids still talk about how much more they liked history, science, etc. when we homeschooled! My daughter likes to write, so we focused a lot on that when she was in HS.

NoGluGirl Contributor

Dear Kassandra,

Yikes on going jaundiced! :o I agree that the ER might be a good idea. That iron is very important for you right now.

At least this can prevent things from getting worse possibly. We have had a little emergency of our own.

Dad's leg began swelling and turned red where he had scraped it on something the other week. That is what was making him feel bad. :( He had blood poisoning in the past that turned into a flesh-eating bacteria that literally could take over your body within 24 hours! :blink: We did not want that to occur again! I was seven at the time, and Dad had been cut on his leg by a riding mower. The doctor later told my mother that he did not expect Dad to make it through the night.

Schools are a pain about curriculum when a student has health issues. :( I have been there as well. I was your age when they forced me to resign from high school. The American School is an accredited program that earns you a diploma, not a certificate. Although everything is done by the mail, you actually learn more and are better prepared for college than you are by attending regular school.

Good luck on your blood draw today! We are all pulling for you! Maybe some answers will finally come out of the woodwork. I am hoping for the same myself. All I need to do is get my doctor moving, which may require some magickal intervention.

Dear Carla,

I really liked being homeschooled my last year-and-a-half of high school. I did not have to rely on anyone but myself.

That was way better than dealing with favoritism and everything else I used to have to deal with in public school. I missed being with my friends, but we found a way to communicate. Homeschooling was also great for me because I got to learn and work at my own pace, which the public school would not let me do. :angry: In a lot of ways, regular school held me back.

Sincerely,

Jin

AndreaB Contributor
Also, I am going to have my blood drawn today for Igenex. Wish me luck...hope I don't pass out...considering I am driving myself. lol.

Hope all goes well today and that you don't pass out. Going to the ER for a iron IV sounds like a good plan to be done ASAP!

School from home will work itself out. Don't stress out about that part.

Jin,

I hope your Dad's leg will be ok and that he won't get worse like when you were little.

covsooze Enthusiast
make things worse, too. Testing is hard on your body.

Dear Susie,

Reflux is a problem for me as well. Candida contributes to it, too. Getting glutened and having yeast really bothers it. As long as I am on time with my Prilosec, it is minimal. I cannot drink a whole lot at once, and I do not tolerate lactose either.

Except, I have noticed that fudge and candies, as well as some other milk containing foods do not tend to aggravate my system.

Well, I was on another Celiac site, and it said something about what has puzzled me since last year. My doctor might be interested in what I found. She was unable to answer why I could tolerate milk containing foods that were heated or baked, but not others. According to this site, it said there are numerous proteins Celiacs can be reactive to aside from casein. Some are destroyed with heat! :o I can look the site up and post a link if you like. The site talks about other food sensitivities like MSG, too.

I began drinking lemon water the other day. I have felt a bit better! It is one of five or six things I can do that is inexpensive for detox. Are you thirstier when you drink it? That must be my body telling me I need it. Getting some PH strips might be a good idea. Healthfood stores and pharmacies carry them.

Hi Jin :) Very interesting about the casein. Please could you let me have that link?

Not sure about being thirstier when I drink the lemon, will have to experiment to see! Mind you, I'm thirsty nearly all the time anyway.

Sorry to hear Dart's had another seizure :( How's he doing?

Everything I eat is in massive amounts.

How come I eat all this food and I never freaking gain a pound!! :angry:

Where the heck does it go?? :huh:

That's me exactly! I always say to other people who make out they're jealous I can eat so much - why do I have to eat cookies, cakes and chocolate to not lose weight? (that's in addition to eating large amounts of healthy stuff). That can't be right! And my thyroid is overactive, so I really shouldn't be skinny :o:lol:

Update: My mom spoke with the insurance advocate and she said I need to go to the ER for Iron IV's. She said it is getting dangerous for me to be walking around like this with my ferritin so low. So, I just talked to my mom and she is thinking about taking me to the ER. EEEK! I guess I am getting yellow and the advocate (she is a RN) said that I am getting jaundiced and that is dangerous.

In the middle of all of this we are trying to figure out online school options. It is looking like I am going to have to leave my school altogether...no more specialty programs for Kassandra. lol. <_<

Also, I am going to have my blood drawn today for Igenex. Wish me luck...hope I don't pass out...considering I am driving myself. lol.

Kassandra

Kassandra I'm so sorry to hear you're in such a bad way :( I hope you manage to get your blood drawn done and your IV iron. I'll be praying for you.

Donna, it's great to see you :)

Everyone,

I saw my baby niece for the first time yesterday :D She's so gorgeous :D Also talked to my sister about our maladapted mileus (sp?!), as we're so similar. She loved that phrase :)

I ended up in the ED last week as I had palpitations and funny breathing all night...they couldn't find anything wrong. So now I've got yet another consultant (specialist dr) to see in November :rolleyes: It's all happening in the next couple of weeks :lol:

Susie x

CarlaB Enthusiast

Susie, I had air hunger and heart palpitations from babesia ... fortunately that has gone away with treatment .... it was miserable and no test ever showed anything wrong. :(

How fun about the niece!!!

CarlaB Enthusiast

Kassandra,

I had an idea about your school situation ...

You mentioned that you are on an accelerated program, right? Well, how much of the standard school curriculum have you done?

Here's what I'm thinking, if you set your goals, which seem to be - 1) To get healthy, 2) To get into college - then you can establish a plan of action.

If you want to take a year to put getting healthy first in your life, obviously, as you have discovered, your current program isn't working ... so, how else can you get into college?

You can homeschool following the rules in your state, that's ONE way.

The other way would be to prepare on your own for the SAT and GED. I know at first glance, you think, "Gosh, no, GED?!!" BUT, it would legally get you finished with high school and then you could take some correspondence classes from a Community College to get the classes you were hoping to have in high school. Then, by second semester of next year, you will have been in treatment for a year and can go to the Community College for that semester.

With the high SAT score and the time in Community College, not to mention one heck of an impressive essay about your journey back to health and having to take your education into your own hands, you are sure to get into the college of your choice.

So, why you are primarily focused on getting healthy, you can finish Algebra II if you haven't already, take an SAT prep course online, and a GED prep course. You can fill in other HS requirements like American History, Government, Grammar, Writing, on your own, not as a class.

Just trying to think outside the box ....

dlp252 Apprentice
My mom has been sick so I took my temp for fun ( I LOVE those ear thermometers...lol) and I have a 100.4 degree fever!!! What the heck!?? I am going to be on the couch for the rest of the night apparently. UGH!

Hope you feel better today!

Donna, WELCOME BACK!

Thanks! :)

This time you knew how to pace yourself, which I am sure helped a lot.

Yes, I think this is key for me. I can still go on vacation but I have to learn how to pace myself better. It was so nice to NOT get sick this time afterwards.

Update: My mom spoke with the insurance advocate and she said I need to go to the ER for Iron IV's. She said it is getting dangerous for me to be walking around like this with my ferritin so low. So, I just talked to my mom and she is thinking about taking me to the ER. EEEK! I guess I am getting yellow and the advocate (she is a RN) said that I am getting jaundiced and that is dangerous.

...

Also, I am going to have my blood drawn today for Igenex. Wish me luck...hope I don't pass out...considering I am driving myself. lol.

The ER sounds like the best thing right now eventhough it isn't pleasant! Good luck with the blood draw...they took 7 vials for me, but some of that was for other testing...not sure how much they'll need for just the western blots.

We have had a little emergency of our own.

Yikes, hope he's okay!

Donna, it's great to see you :)

...

I ended up in the ED last week as I had palpitations and funny breathing all night...they couldn't find anything wrong. So now I've got yet another consultant (specialist dr) to see in November :rolleyes: It's all happening in the next couple of weeks :lol:

Thanks! Scarey about the palpitations...I was having that for a while a couple of years ago too. Very scarey to be awaken from sleep with it.

dlp252 Apprentice

Now for the "old" business, part 1:

Rachel: Glad the

dlp252 Apprentice

Old business part 2:

Is it just me, or does it feel strange without Donna? She is on the cruise, and we are here. I hope she gets to check in at least. The pictures will be nice. I cannot wait to see them!

Aw shucks, lol! By now you have your glasses

dlp252 Apprentice

Old business part 3 :lol: :

I've been feeling so toxic the past few days. I don't know if it's the Tindamax (cyst buster) stirring up the dormant Lyme or if it's the Samento I started a couple days ago (three drops per day) ... so I finally tried an epsom salt bath after a sauna. It's amazing how much it helps! I feel less toxic and it relieved a lot of the aches.

Yep I agree

CarlaB Enthusiast

Well, I have a date with an orange jug tomorrow ... testing to be sure we got all the metals. :)

Fortunately, with the kitchen torn out, the refrigerator is in the hallway right next to the bathroom! LOL :lol: :lol!:

I just took my last Tindamax for the month this morning .... stopped taking Mino for the week (because I'm going to Naples, FL Thursday!) .... today and tomorrow off all supplements ... tomorrow off all meds .... SO, it's a good couple days for rest and detox!!!!

I still don't have my laser from Nurse A .... but that's entirely my fault .... we have been running everything through our credit card for miles on Adam's car lease ..... with the kitchen, I was at the limit :lol::o She said she'd run it through again this week as she was out of town last week. I'm looking forward to getting that. :)

confusedks Enthusiast

Thank you everyone for the well wishes. I don't know why...but I don't feel like I need to go to the ER. Maybe it's denial...again! :mellow:

I had the blood draw, and I did okay. I am just starting to feel cruddy though, I am nauseous. It is really close, so that was good...I didn't have to sit in LA traffic!

My mom is taking off work tomorrow so we can sit at home and get a plan in place. I am going to start calling some of the online schools to see what their programs are about.

Carla,

I am going to call you soon! I want to talk to you about some of my thoughts...if you don't mind. :)

Donna,

They only needed 2 vials. Thank goodness!

Jin,

I hope your dad is okay. I don't want to go to the ER because last time I went, we had to wait for hours and it was nasty! I was having an asthma attack and couldn't breathe and by the time they got me in, I had taken so many puffs of my inhaler, I was discharged.

Susie,

Thank you! I am so jealous you got to see a little baby! I love babies! I have bad air hunger too! It is really terrible. I think part of it is my anemia though too.

Kassandra

CarlaB Enthusiast
Thank you everyone for the well wishes. I don't know why...but I don't feel like I need to go to the ER. Maybe it's denial...again! :mellow:

Get thee some iron!!!! You are in denial. I know it would be easier to lie around the house than go to the ER, but the ER is the way your insurance will cover it ....

Carla,

I am going to call you soon! I want to talk to you about some of my thoughts...if you don't mind. :)

I look forward to it. :)

CarlaB Enthusiast

Kassandra, if you can, let me know when you think you'll call ... just a ballpark ... I'm going to take a sauna now, so I'll be away from the phone for a while.

Rachel--24 Collaborator

Quick drive by..

Donna...YAY...glad you're back! Could you tell you were missed?? :D

Patti...hope you're loving your new home. :)

Susie...an overactive thyroid will definately keep you thin. Was that a typo or are you really hyperthyroid??

I used to blame my inability to gain on my overactive thyroid...but now my thyroid is gone...and I'm STILL thin. :rolleyes:

Stupid mercury. :angry:

Kassandra, glad the blooddraw went well today. Good luck with figuring out a plan for the schooling. Its nice that your mom is helping you out with all of this. :)

About the Snickerdoodles...Donna dont feel bad...be happy you're holding out for the pumpkin pie. :)

I have no idea what it is about the Enjoy Life stuff but my body just reacts heinously. :blink:

Its been a LONG time since I've gotten the urge to try something again...but I did...I ate 4 snickerdoodles. :ph34r:

So I reacted immediately...got the typical swelling, blurred vision, brainfoginess BUT it didnt stop there. My stomach started hurting (stabbing pains). I also got alot of inflammation...so much that it was hurting to swallow and then my chest was hurting really bad ...air hunger and all that. I felt like my heart was hurting. :huh:

None of this has happened in such a LONG time that I'd forgotten how bad I used to feel on a daily basis...just from FOOD!

It didnt stop there though...I woke up in the middle of the night freezing cuz my clothes and bedding were soaked. I had to change clothes. Sheeesh...I havent had any nightsweats in the longest time. In the morning my shoulders and neck were totally stiff. :(

All of this over 4 cookies!! Imagine if I'd racheled them!! :blink:

Soooo not worth it. <_<

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      The positive DQ2 result is important since it suggests a genetic predisposition to celiac, but the bloodwork not showing clear signs is confusing. The inflammation in her stomach could still be related, and it’s worth pushing for more tests, like a biopsy or a deeper look at other possible causes. It’s a tough spot, but you’re on the right track trying to get clarity.
    • dublin555
      I totally agree, it’s so much more than just the physical struggle that occurs, there is the emotional struggle that goes along with it. It’s almost like you’re always navigating people who are uncomfortable with your needs and that pressure really wears you down. The fact is, the one that really did care will understand. This has nothing to do with you being a burden, it’s about protecting your health, first and foremost. If they don’t like being honest, that’s their problem.
    • knitty kitty
      @ABP2025, Here's some studies and articles that will help you learn more about thiamin and all... I will write more later. It's possible that your antibiotic for giardiasis has caused thiamine deficiency.   https://hormonesmatter.com/metronidazole-toxicity-thiamine-deficiency-wernickes-encephalopathy/ And... https://hormonesmatter.com/thiamine-deficiency-testing-understanding-labs/ And... Thiamine and benfotiamine: Focus on their therapeutic potential https://pmc.ncbi.nlm.nih.gov/articles/PMC10682628/ and... Safety of High-Dose Vitamin D Supplementation: Secondary Analysis of a Randomized Controlled Trial https://pubmed.ncbi.nlm.nih.gov/31746327/      
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