27. Why Blood Tests & Functional Medicine Tests Aren’t the Full Story: Gut, Histamines, Genes, Hormones & More!

In this episode of The Histamine Well Podcast, host Joanne Kennedy and guest Mariella Gebhardt unpack the nuances of medical testing in functional medicine—and why lab results alone don’t always tell the full story.

From histamine intolerance and methylation issues to gut health, Candida, mold exposure, and hormone imbalances, Joanne and Mariela explore the limitations and benefits of testing while emphasizing the importance of case history, symptoms, and environmental factors in shaping treatment.

They break down popular tests—including organic acids tests (OAT), microbiome testing, genetic testing, thyroid panels, iron tests, and hormone testing—highlighting when they’re useful, what they may miss, and how to interpret them in real-world practice.

Whether you’re curious about functional medicine, women’s hormones, SIBO, oxalates, DAO enzyme activity, or vitamin B12 deficiency, this episode offers clarity on when testing helps—and when it can be misleading.

What You’ll Learn in This Episode:

• Why clinical context matters more than test results alone
• How to approach Candida, mold, and mycotoxin testing
• The role of the DAO enzyme in histamine breakdown
• Pitfalls of genetic and gene testing for methylation
• How to interpret iron tests, thyroid panels, and hormone markers
• Insights on organic acids, oxalates, and gut health testing

If you’ve ever wondered whether your test results reflect the whole picture—or how to navigate functional medicine testing with confidence—this conversation will help you understand the bigger picture.

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🧪 Curious about your methylation status? Try our at-home Methylation Test! In just 15 minutes, discover if you're over-methylating or under-methylating and receive targeted supplement recommendations to help rebalance. Use code HISTAMINEWELL10 for 10% off.

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Transcript

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Hi, it's Joanne. Functional medicine testing is powerful, but it's not gospel. The truth is false negatives can happen. A gene mutation on paper doesn't always mean there's a problem, and hormone panels can look completely normal when a patient feels anything but normal. If you're relying on what shows up in black and white, you'll miss the real story. That's why today's episode is such an important one for practitioners. This conversation is going to sharpen the way you interpret testing in clinic, so you can move beyond numbers and connect the dots with what's really happening in front of you. If you're a student, you'll get to hear why learning to read tests in isolation is never enough and how to integrate case history, environmental exposures, and clinical signs and symptoms into your decision making. And if you're someone navigating chronic health issues yourself, this will help you understand why your results may come back normal. Even if you don't feel normal and why, that doesn't mean your symptoms aren't real. So whether you are practicing learning, or living through these health challenges, this episode will give you a new lens on functional medicine testing and how to use it wisely. Welcome to the Histamine Well Podcast. Designed for practitioners and patients alike. This is your trusted source for insights on histamine intolerance, methylation, gut health, women's hormones, and much more. I'm Joanne Kennedy. Your host, naturopath, author, and educator passionate about breaking down complex science into clear, accessible knowledge. Whether you are a health professional or navigating your personal wellness journey, the Histamine Well Podcast bridges the gap between cutting edge research and practical understanding to empower you with the tools to thrive. Before we get started, I just wanna say thank you so much to all of you who've been tuning in. I've loved hearing from so many of my loyal listeners, and even from my patients about how much this podcast is helping you understand your health and giving you extra knowledge about your condition. It honestly means so much to know these episodes are making a difference. If you can just take a minute to leave a quick review. It helps the show so much. It gives us extra traction so more people can find this information, learn and start healing too. Hi everyone and welcome back to the show. Today I'm joined once again by Mariela Gebhardt, a naturopath based in Austria. And we are diving into a really important topic for practitioners and students. And that is why we don't simply rely on test results to guide treatment. In functional medicine, it's never just about what shows up on paper. We discuss why supplementing based solely on lab results. Especially genetic tests can be misleading and sometimes even harmful. We also explore how test results need to be interpreted alongside case history, environmental exposures, and clinical signs and symptoms. Especially because we can sometimes see false negative results in these tests that don't reflect what's really going on. Mariela and I also unpack why supplementing based purely on a gene mutation is outdated thinking and why that approach can miss the bigger picture. We talk about hormone testing too. And why a standard 28 day hormone test might look normal even when your patient is feeling anything but normal. And finally, we cover the types of tests that hint at methylation issues and why prescribing from those alone isn't best practice, especially now that we can assess methylation in real time through more advanced methods. Hi Mariela. Thank you so much for your time again today. Thank you Joanne for the invitation. It's great. It's so great to have you. So Mariela, let's just start with something that's really, really common when it comes to clinical practice and what we see often and what we can test for and sometimes see some false negatives is actually candida. So do you wanna talk to our listeners about what you see happening clinically with candida and testing? Yeah, like usually a lot of people come with a microbiome test and that's where the test candida and they tell me I don't have candida issues. And when you go through the case history, you recognize quite common symptoms. It might be that they have the classical carbohydrate cravings, sweet tooth, recurrent rush. And it's actually not the most accurate marker for candida in the stool. If I test for candida, I prefer the urine test. So we look at the metabolites of candida. That's provided in the organic acid test or we have a separate test for the candida metabolites in Europe as well. Yeah, that's interesting because so many people will look at a microbiome test, a large bowel stool test for candida, and if it's not there, then they think they're completely clear of candida. But more often than not, if they have symptoms, we need to look further. And organic acids is so much more sensitive for candida, isn't it? It is. It is. And it's one of the fantastic tools we do have, you know. Even though it might not tell us where it is, but we can see there is a higher candida production in the body. Yeah, interesting. Also, listeners, anyone that's had known mold exposure, you often will see yeast in that picture as well for a few reasons. There is a yeast produced in the gut, often due to mold exposure that produces a sugar called arabinose. And that's one of the markers that we can see in organic acids. And interestingly that sugar feeds mold. It's like a food source for mold mycotoxins, which is really interesting. And the other thing we often see is that when people have high gliotoxin, which is a mold marker, that can also cause issues with fungus. Fungal overgrowth. So you can have a mold mycotoxin test that's indicating that there's a potential fungal overgrowth. Fungus, yeast, candida we're all the same sort of bucket is what we are talking about. So yeah, it's just that stool test. It's just never that reliable. You know the other thing with candida, it's so linked to vaginal thrush. And this is another fascinating thing. We so often see patients that have had vaginal swab tests done for candida overgrowth and it comes back negative. But they have chronic, chronic issues like itchy vagina, sore redness. And so often, when we do a vaginal microbiome test, what we can do now, we can often see that they might not have candida, but they could have bacterial vaginosis or they can actually have a disrupted pH in the vagina. So a disrupted pH means often it's a more alkaline environment than acidic, and this is due to low lactobacillus strain. So lactobacillus helps make a more acidic environment in the vagina. And it's so often people have massive issues which what seems like thrush candida, but it's actually a pH disruption. We see in our patient group all the time. So it's not just a one size fits all let's do a microbiome test to assess systemic candida. Exactly. You know where else you can find it is the MarCons test. I just had a patient come back today where they're negative for MarCons, but they had a lot of candida in their nose. How interesting. Yeah. Causing a lot of symptoms. It's just a common overgrowth. Whenever there's a disruption, you can so often get candida. And with SIBO guys, you can't test for small intestinal fungal overgrowth. But if you have an acidic environment in the small bowel, which was happens with sibo, I bet your bottom dollar there is yeast as well. We so often see it, don't we? Yeah. Yeah. Is there anything else about the candida testing you can tell us? I think it's the symptoms that guide us towards the candida rather than the candida test. Most often we don't have access to those tests. And an organic acid test most people, because it has a high cost can't do it. So we have to find other ways around it as well. Yeah, interesting. How would you approach someone that could do any testing and with a potential candida overgrowth. What would you just give them initially to sort of test in your own mind if you thought you were right? Yeah. I would get them to eat lots of foods that we know that can cause reactions. Whether it's get them to eat bananas or like, you know, sweets or even wheats or any of those type of foods and see how they react. Yeah. See how they react, exactly. Yeah. Yeah, I think so. And then be very subtle with, The symptoms because they can range from gastrointestinal until brain fog. So it can be anything from bloatedness feeling heavy, feeling like emotionally, you know, it makes them feel like this itchiness inside? And the minds, they get like this heaviness. They can't think clearly. I would look more outside the box than just digestive or vaginal. Yeah. If they get Highly sensitive people. I do have certain clients when they eat, a lot of sugary foods, they get fresh the next day. Or the same night. And that's the most common symptom that I find with women actually. Yeah. Yeah. Same. So listeners, you can either double down on like sugar and yeast and see, or you can remove it and see if you improve. Exactly. Yeah. That's the other way round. That's the cold Turkey version. And then you will see how they react. That's the other way round. Yeah, and look, there's just some really strong potent antifungal herbs in like Pau D Arco being one that's really readily available and easy to take. So, you know, you could play around with that. If testing's not available but, you know, this episode is all about how testing is not the be all and end all. But if you do have access, it is often worth testing. And if you do suspect you've got candida and you've done a stool test and it's not there. I would be definitely looking into organic acids as a priority. Absolutely. So, you know, it leads us onto the mold testing. This is a really big issue. Mold produces mycotoxins. And we can test these mycotoxins. But many of the labs in the us, they test for different mycotoxins. So you can do a test and it doesn't actually pick up the mycotoxin that you are exposed to. Which is a really, really big problem. And I know in Australia, the labs that we use, they don't pick up all the mold mycotoxins. They only pick up some of them. So when it comes to mold, it's mold exposure if there's mold. If you can see mold in your house, if there's water damage, damp. If you feel better outside of your home. These are all classic really red flags that there is a mold problem. And the other thing with mold testing, if you've done a mycotoxins test and you haven't provoked, which is like stimulate your detoxification pathways with something like glutathione or n-acetylcysteine, it can come back completely negative. Like you don't have any mycotoxins showing, and that means that you are not detoxifying it at all. I see it all the time, they're like, no, no. I've been told I don't have a mold problem. I've done this mycotoxins test. And it's like, wow. Like you have all the signs and symptoms and you don't even have like low levels, you have nothing. Nothing's coming out. So that's just a really big red flag. And look, people are very reactive to sulfur supplements if they have mold often. They really can't take the glutathione or the n acetylcysteine to get it really moving. It's a useful test, but we don't completely rely on it. Exactly. I also sometimes use the questionnaire from Dr. Krista Jill, where? Mm-hmm. You know, because those tests are usually quite pricey and certain people need other ways and options. And there I get them to do the questionnaire and those questions are extremely detailed and they can really identify the signs and symptoms. And then there is like possible mold exposure. It seems like a definite mold exposure should be taken any further inventions. And I find that useful as well as a screening, a pre-screening. And yeah, I often use that here, and your people love test results? They do. Then they would usually go on and test it. What type of testing you doing for mold in Europe? Yeah. I also do the mycotoxin in urine and you just really put it on a point. They test for different mycotoxins. I used to always use mosaic lab in the States and they have a different panel. Still those are the options I have here and I can only use what I have. Yeah. People do like to see the evidence, especially with mold.'cause people don't believe it. That's actually the biggest frustration when you talk about mold. People think you make it up. People think you make it up that you're crazy. They do think that. People believe in bacteria and they breathe from viruses and worms. It's a microbe essentially. Like it's a living organism so it really can cause havoc in our body. The mold myco testing, just fundamentally try and provoke with n acetylcysteine or glutathione if you can. And if you really think that there's a mold issue and you've done a mycotoxins test and it's flatlined, like there's nothing that's detected. That's a big sign that you're not detoxifying it at all. So Mariella, let's have a chat about the DAO enzyme. Diamine oxidized enzyme, which breaks down histamine.'cause I know that they're right into testing that in Germany. So you must see a lot of that in clinic. I do. Yeah. When they come from doctors to see me usually already come with a test of DAO in blood and sometimes they come with DAO results in the stool. And also in the blood, they usually test the histamine capacity to break down histamine. And often those results don't really say much. But they still Percent of histamine issues. Yeah, yeah, yeah, they do. There is no such golden standard. It's part of the picture, but we need to look at the symptoms as well. Let's use an example. When we have a woman. Her histamine issues flare up more due to her menstrual cycle. We won't see that in the DAO and in the histamine in the blood, or in the DAO in the stool. Yeah., We need to look at different issues. Yeah. We might look into methylation, we might look into estrogen metabolism and things like that. Yeah. That's a classic example. So Dao really breaks down histamine outside of the cell, and it really takes on the brunt of histamine in the gut. And what can happen is you might be making adequate DAO enzyme because you have a relatively healthy gut lining, and the microvilli, where a little DAO enzyme resides is healthy. You're producing enough dao, but your gut is so overloaded with histamine from gluten, digestive enzyme insufficiency, from sibo, from oxalates that it's just overloaded with histamine. So you might be producing enough, but it just can't deal with the amount of histamine that you actually have. So that's a classic example. It's not really a test that I would refer people to. I know in Germany, they just do it as a routine. Interestingly, this is anecdotal, but every time I've seen low dao, it's always been from mold. Have you ever noticed that Mariella? Interesting. I've not looked at that, but you really now gave me some inspiration to observe that more. Yeah, it's not common. So the only patients that I've seen with that have had low DAO enzyme have had mold illness. So it does make sense also of all the interruption it mold causes in your gut. If your histamine in your blood is normal or a bit low, it does sort of mean that you are breaking it down with methylation enough. That your methylation is breaking it down. But it doesn't mean that your methylation is on point or balanced. It's just sort of breaking down the histamine. But you can still have so much histamine coming from your gut and from estrogen that it's actually a false negative. Your whole blood histamine doesn't actually really tell us what's going on with your entire histamine bucket. Histamine is symptoms. It's really a symptom picture. And the testing we do around histamine, it's all about root causes. So you can go to episode two all about root causes because it will just tell you all the root causes and you're much better off spending your money on working that out. Like doing organic acid test is mold mycotoxin testing, SIBO testing rather than just fixating on like whole blood histamine and Dao. It's just not that clinically useful, is it? Yeah, I think you've just explained it really well with the bucket. I love that analogy. The histamine buckets. There is so many, it's the histamine, many factors that come into the histamine bucket and then it overflows. You know, stress and high cortisol is another thing that really increases histamine? We need to really focus on this and not just people get very fixated in like testing dao and it's like, okay, test it. You're probably gonna see it's in range, but you've still got a histamine problem. Exactly. Yeah. Yeah. And the symptoms lead the way. So something that's really important to talk about is gene testing. I've got a lot to say about this. It's become quite big business, this genetic testing nutrigenomics whereby you send your saliva swab off. They test your DNA and it comes back with all of these SNP's on all of these different genes. And it's sold as being the cure all to your health ails. And it's just not,. Simply not. Potentially beneficial for in some ways. But what we need to understand is that the genes that are being tested are the genes that provide code for enzymes. And it's the enzymes that are functioning in your body in real time and enzymes are disrupted by many, many things. Environmental things. One thing in particular is just being more acidic than alkaline. So if you look at your blood panel and you've got low bicarbonate or a high anion gap, that can indicate a lot of acidity and being acidic slows down the enzyme function. This is just really simple stuff. Then we have genes like the M-T-H-F-R gene, which is a really popular gene. Like the most famous gene. And people do these tests and they're told to take methylfolate just because they've got an M-T-H-F-R gene mutation. Now, I've had a patient recently. Gorgeous girl, who has some really quite severe health issues. And she's actually an over methylator, even though she's got M-T-H-F-R. Mainly'cause she's full of estrogen and it pushes women into over methylating. And she was told to take methylfolate just'cause an of M-T-H-F-R gene mutation, and it's made her extremely distressed. She can't stop crying. She's in a really, really bad way. So giving methylfolate out like candy is not the way to go. That's a good example. Another example is the co-factor for dao. So if you've got a mutation on dao, people go, oh, that's why I've got a histamine problem. It's like, it's really not. Just you got a mutation on dao, it doesn't mean that's the cause and people are told to take co-factors to help that enzyme work. Copper being a co-factor for dao. Now what drives up copper is inflammation, which is a histamine issue. So histamine is driven from in, it comes from inflammation. Estrogen can also drive up copper. And then what happens is if you take copper, it's reduces the absorption of your zinc. And zinc is really, really important for so many functions in your body. Like everything really. So it's important for neurotransmitter synthesis. It's important for your skin, your immune system. It's important for gut healing. Many, many things. That's just an example of why just supplementing for a gene mutation is just not good practice. You know the other thing, people have massive SNP's on their glutathione genes and their sulfur genes. What causes havoc with sulfur is mold, mycotoxins, particularly gliotoxin, hydrogen sulfide, SIBO, and oxalates. These are all big disruptions to sulfation. It's not just a gene. Then people are told you need to take glutathione'cause you've got SNP's on your glutathione SNP's, and then you're full of sulfur. What is glutathione? It's sulfur and then you feel terrible. There's so many examples of that. Another COMT enzyme, another quite popular enzyme because it breaks down catecholamines dopamine and adrenaline. It also breaks down estrogen. You can have no mutation on COMT whereby it's meant to be fast acting and like really detoxifying your estrogen well, but you're bucket of estrogen because you've got endometriosis, you've got fibroids. You have low progesterones, you've got unopposed estrogen. You are chronically constipated. You've got gut issues and you've got high histamine. So essentially, if you've got so much estrogen, that enzyme might just get completely overloaded with the substrate. So this is why testing genes is really not that clinically helpful. And it's not individualized enough. No, it's not individualized. It's not looking at the environment the person lives in. It doesn't look at lifestyle factors. It doesn't look at the person as such. It just looks at the genes. Yeah. Yeah. And we can't treat genes as such. So listeners, if you've done a gene report and a practitioner is just prescribing of that, it's not that helpful. You need to be looking to work with a practitioner that's more into functional medicine testing and who understands how to read these tests.'cause some of them are complicated, like the Dutch hormones and organic acids, because that's where you're gonna get the improvement on your health. Not just a gene report. And people will say, oh, but look at all these SNP's on my glutathione genes, and this is why I can't detoxify mold. It's like, no, you've got a problem with mold because you have been living in mold for a long time. You are also chronically stressed and you've taken a lot of antibiotics and you've had vaccinations, and you've had viral load and you've had Lyme disease. The list goes on and on and on. When you see these gene reports, everyone has SNP's everywhere. They're really, really common. And when it comes to the genetic SNPs for methylation, to help support the production of Sam e like MTHFR, MTR, BHMT, CBS, these genes that support the recycling of these pathways to create Sam e. It has really been thought that if you've got Gene SNPs on a lot of those enzymes, on a lot of those genes that you've been under methylator, but not necessarily. Not necessarily. And even if you've got high homocysteine, not necessarily because what we now know is that estrogen cortisol can push someone into being a complete over methylator, not an undermethylator. I will talk about this now. It's actually a test I'm using a lot in clinic. It's called Mood Sense. It is an at home saliva swab test for methylation. And it tests your methylation in real time so you can understand if you're over or under methylating. Nothing to do with a gene test because you can't tell from a gene test. You even can't tell from a high homocysteine level. So this test will show you exactly where you're at. And for listeners, I have secured a 10% discount off the test strips with discount code HISTAMINEWELL10 and you can find that test on my website. That's all I wanted to say about genes. You can obviously see I'm quite passionate about not over prescribing from a gene test because I've never seen it that useful. Yeah. When I did your course that's when I learned about all the gene testing and about the MTHFR and I think it's extremely important that we practitioners switch in our head when we see these MTHFR. We straightaway think of, oh my God, this person needs methylated folates and methylated forms of B vitamins. No, it shouldn't be the first thing that we think of. You know, there's so many other thoughts that we need to place first. And it was eye-opening exactly when I did your course. Yeah. Thanks Mariela. It's just'cause I've dealt with it for so long and I can really see that one of the big things that methylation does is it really impacts histamine. Often when people start taking a lot of methyl, you'll see that it pushes the breakdown of histamine too much and it's not treating the cause. This is why often when people take methyl, they can have an increase in neurotransmitters, which can cause like anxiety and depression. But they often can get a headache or a rash or a histamine response, right? And that's because they've got too much histamine in their body and hasn't been identified. Yeah. So guys, when you push methylation and you are over methylating and you increase your methyl again, what that's doing is it's increasing your dopamine and your noradrenaline and your adrenaline in your brain. Agitation, irritation, anxiety, insomnia. It can push it too much. One of the first signs and symptoms that occur when methylation shifts is mood. It's the first thing to show. Other things, you know, energy production, bile synthesis, cell membranes and things like this. They take longer. The mood is very instant for a lot of people. So anyone, if you've taken methyl and you feel agitated, wired, anxious, insomnia, you potentially, you are an over methylator not an under methylator, and I highly encourage you to do that at home methylation test. The mood sense test. Before we go any further, I want to speak directly to the practitioners and students listening. If you're intrigued by histamine and methylation and eager to expand your knowledge in this fascinating area. We offer the Histamine and Methylation online group coaching course. The only program of its kind. It covers everything you need to know about histamine and methylation, providing both the theory and guidance you need to treat these issues effectively in clinical practice. We cover sibo, hormonal imbalances, oxalates, M-T-H-F-R, the four pathways of methylation, including the folate pathway, methionine pathway, tetra hydrobiopterin pathway, and the all important transsulfuration pathway and much more. The program is delivered by detailed online webinars and handouts for you to keep. And for 8-weeks you'll meet with me for live coaching calls in a private community space with other practitioners from all over the world dealing with histamine and methylation issues in their patients every day. Together we learn so much. To learn more and apply, visit joannekennedynaturopathy.com So I'll get off my soapbox about that and we'll shift gears. And we're gonna talk about another test that is really important and really common which is iron. And so Mariela can actually tell us a lot about iron testing and what it means and what we need to think about it with our patients. Yeah. Always thinking in relation to histamine because we do of course see a lot of low iron levels in women particularly. And then we have the SIBO and a lot of histamine issues. And usually it's very tempting to give them iron supplementation. But we have to be really careful especially in this initial phase when we go into the elimination of SIBO eradication. Because when we load the gut with iron, we then have too much free iron available and it can contribute to the creation of the biofilm. And it's counterproductive. So we want to break that biofilm so we can get all those bacteria out. It's something we need to be careful about when we have an iron deficient woman. And a SIBO treatment, for example. So if it's really necessary to supplement, then it's best every second day and four hours away from any anti-microbials or bioform disruptors. And if there isn't an iron deficient anemia, it's just low iron, low ferritin, let's say. It would be the foods that we would prefer in that phase. So that's a relationship we really need to consider when we talk about iron. Yeah. So people, when it comes to testing, you will see low ferritin and you know, especially listeners. Like a lot of practitioners are aware of this. But like, if you just go and supplement with all this iron, it's potentially causing your SIBO to be worse.'Cause Sibos a major cause of iron deficiency. This episode's about testing, it's like, yes, low iron, but it's like, do I need to take iron? Well, potentially no. Potentially You need to get your gut fixed first. It is a bit of a clinical dilemma because patients can be very, very, very fatigued, very tired, can have heavy menstrual bleeding. And it becomes quite tricky. I will really hone in on my women about how they feel really exhausted. And if they do have SIBO I will get them on a little bit of iron or get them to take hydrochloric acid and eat a lot more red meat to get more iron that way. Exactly. Yeah. That's the first line we always look at if there's enough hydrochloric acid production. Yeah, all the all liver capsule supplements some liver with some iron in it. But I'd like, it's not necessarily oh, low, low iron test. You go in with iron. That's just not necessarily the case. Another really important test I wanna talk about is organic acids test and how you can get a false negative for oxalates. And this is really important because if you've done an organic acid test and you don't have high oxalic acid, it really doesn't mean that you are clear of oxalates and you do not wanna go undiagnosed with an oxalate problem. Yes. That's common in practice. Basically when they have not eaten any oxalate rich foods and have done the organic acid tests. It won't show up that there is an oxalate issue. And then when you actually go into treatment and they create these beautiful recipes, with almond breads and they make carrot juice, whatever, and then they really start to feel awful and it happens fast. When they have oxalate issues, they feel awful. And then when you recognize there is an oxalate issue and then you remove them slowly and you see an improvement very fast. It's a false negative within the test. Yeah. It's really true. So sometimes people will often identify that they've got an oxalate problem and then just stop eating the oxalates. Then they'll come and see me or another practitioner, and we do organic acids for many reasons. Look at mold and aribinose and glutathione and things. And the mitochondrial damage that oxalates can cause. And their oxalic acid comes back normal in range, but they're not eating any. That can happen a lot. So I'd be really careful for that. And I've also had, look, I know that Melanie had a massive oxalate problem and she was eating oxalates and for some reason it didn't come back high in her test. Maybe her urine was not dilute enough. Not really sure. But removing oxalates from your diet and seeing an improvement or a worsening of your symptoms, which can happen with dumping is a classic sign that there's an oxalate problem. And risk factors for oxalates guys is poor microbiome if you know you've taken a lot of antibiotics or if you've had mold exposure. Another test I wanna talk about is just vitamin B12 and the enormous lab ranges. When we test serum B12, it's something like 150 up to 600 or something like that. If your vitamin serum B12 is a 150, 200, 250, it is low. it's not adequate. Then we've got active B12, which is intracellular B12. And if that is any lower than 150, like 148, I think is the cutoff. Then absolutely you are low in B12, but the lab range will say, oh, it's fine if active b12 is over 30. This is so important. Like it is not high enough. A classic B12 deficiency symptoms is neuropathy, pins and needles, tingling, numbness, just poor vision, fatigue and poor memory, brain fog, lack of concentration. Would you say mariela? Any other classic B12 symptoms? Yeah, like nervous system. If there are a lot of nervous system symptoms coming up and if you look at the diet and then you see that they just don't have enough B12 foods. Or they might be vegans or they're so stressed. The hydrochloric acid is just not sufficient to get it out of the foods. Things like that, I think. That's really important. Yeah. So just taking a sublingual hydroxycobalamin. Getting your serum B12 up to like 600 at least. Active B12 definitely over 148. I just wanted to flag that. So we can't end a conversation without Hormones. The bane of my existence. No, I'm not. I'm joking. I've got on top of my hormone problem. My menopause problem. I feel great on my hormones now. But took a bit of time. So ladies, beside yourself, you are anxious, depressed, you got breast tenderness, you got fluid, bloating retention. You have flooding periods, you have hot flushes, you have night sweats, you got PMDD. All your histamine issues are worse at different times of your cycle and you feel terrible. You go to the doctor and they test your hormones and they're completely in range. Especially if you've got like a regular cycle. And so you're like, what on earth is wrong with me? And the doctor will say, oh, you're fine. Or We can put you on the pill, or we can give you an antidepressant. Okay? So this happens all the time but the problem is your detoxification pathways, particularly methylation pathway, sulfation pathway, glucuronidation pathway. You can have massive gut issues causing a big deconjugation of your estrogen. You can have constipation. You're not pooping out your estrogen. You can have a lot of inflammation. This dries up a lot of histamine, all causing like estrogen dominance. Estrogen dominance is gonna cause you to feel tired. Breast tenderness, like bloated, fat, emotional. And then at the same time, you can have progesterone deficiency because you don't have the nutrients required to make progesterone including zinc, B6, iron, iodine, and vitamin D. This is all very sort of simple cases whereby we see this all the time. It's detoxification, it's gut issues, it's inflammation. It's nutrient deficiencies where you're just not making enough progesterone. And then when it's getting a bit more serious presentation, particularly around the mood. It is often a methylation issue. It is often women over methylating due to the estrogen, which is causing any increase in their neurotransmitters, particularly dopamine and adrenaline and noradrenaline. And it will cause the PMDD symptoms. Ladies, you just don't stop just with the doctor saying it's all fine, because it's not fine. This is the thing with hormones. I'm really late perimenopause now. I'm not menstruating. I'm taking hormones now. Estrogen, testosterone, I'll talk about this in a minute. This is ridiculous, this one. And progesterone. But I went to the doctor about six months ago when I was sort of feeling really tired and I did my hormones on day two. I hadn't had a regular cycle for months, like years. Really. My issue on day two was fine, normal, but I started spotting on like day 9, 10, 11. I'm like, that's not normal for me. I don't have endometriosis or fibroids or anything. I'm like, that's low estrogen. And luckily the doctor, just the gp, she was great. She knew I was 49 and we just got on the estrogen, but it didn't show at that time. Four months later when I started getting hot flushes, I'm like, oh, I know what this is. And I went back and lo and behold it was low, right? So it's not necessarily gonna be picked up on this particular day. Its symptoms are really important. The other thing. So I went to the gp, got the bloods. This is just easy for me up the road. Got all the bloods done for menopause, and they did total testosterone, sex hormone binding globulin, and free androgen index. I was just in a bit of a state, right? So I was exhausted. Hot flushes like anxious, felt terrible. I just wanted to get the estrogen in and it was good. And I'm really sensitive to progesterone. So it took me a while to sort of get that balance. Anyway, my energy wasn't picking up and my motivation, I'm like, I looked in my blood, I'm like high sex hormone binding globulin. That mean that binds up your testosterone. It binds up your free testosterone. They didn't test free testosterone. They didn't test it. Now guys, I was just in a bit of a state, right? So I had to get like estrogen progesterone sorted first. And so I'm like, this is low, I'm sure. And so I did the calculation and really low in free testosterone, which is what you need to an active testosterone. So I got an appointment with the integrative doctor who's amazing and straight away. She could just tell from those bloods that I was super, super low in testosterone. So I got my testosterone up. And it's helps with brain function and motivation. And is great. But that's another thing. So it's like if you just look at those tests, what the GP thinks is adequate, you will most likely find that they're missing something. Also, this is really important. Thyroid. So TSH. My TSH is good. It's like 0.8. Okay. So you would suspect that my T4, T3 would be great. But I did a test. TSH, T4, T3 and reverse T3. TSH, thyroid stimulating hormone tells the thyroid to produce thyroid hormone. It's made from iodine and tyrosine. Then it gets converted into T3 with zinc and selenium. And T3 is the active hormone that you need. Now reverse T3 is there as a buffer.'Cause you don't want this big T3 party, otherwise you go into hyperthyroidism. So reverse T3 buffers T3, right? If your T3 is four, your reverse T3 shouldn't be any higher than 400. So it's a one to 10. Or if your T3 is 3.5, your reverse T3 shouldn't be much higher than 350. My T4 was fine. It was like 17 but my T3 was low. It was like 3.5. Zinc and selenium deficiency. And then my reverse T3 was really high. It was like 450. That is stress. Yeah. Amongst other things, but it's like it's high. So if you don't do a full thyroid panel, you have no idea what's going on with your thyroid. And unfortunately. The doctors will let it go. Your thyroid go into a thyroid storm before they even catch it. So if you suspect a thyroid problem, you really need to test TSH, T4, T3, thyroid antibodies and reverse T3 to get a clear picture.'Cause it's not like my thyroid was even tending to be hypo, like even 3 or 3.5. It was actually 0.8. It looked really healthy. But lo and behold, that is So interesting and so common, I believe because we see it in clinic. And yeah. How lucky that you can interpret it. well, yeah, but it's just, it's so true. You know, as a naturopath, it's really hard to treat yourself. It's funny because you just. I don't know. You think you can cheat on some things? You can't. And I needed to see the integrative doctor to get testosterone.'Cause she's the only one that prescribe it. And she's like, let's just do a full thyroid panel. It was really, really interesting to see that I actually had really high reverse T3. So funny'cause I also need to tell you this, to get prescribed testosterone in Australia, this is a joke. You have to fill in a form to say that you are delusionally upset beside yourself about having a low libido. It's beyond, right? So nothing to do with motivation, brain function, muscle mass, being able to work function. Nothing about being a high functioning woman, a career woman. It's all about your libido. Seriously. I said to my doctor, my libido is fine. I'm so tired and I'm not functioning like my brain is pretty good at going from A to Z and like all the in between, I could go to A to B and that's it. And I said to my doctor, like is this a joke? Like I need testosterone to function. And she's like, I totally get it, Joe. But I did need to fill in a form saying, yes, I have a low libido and I'm so beside myself about it and I'm really upset and like it's ruining my life. I literally had to do that. What body claims that? Well, it would be.. I don't know. The Australian Medical Board or something. I'm not sure. Yeah, because there's this study done on testosterone and women with hypo libido where there's some efficacy, but that's it. And it's orally like oral. Well, it's a tra it's a transdermal, it's a cream. Yeah. It's a cream. Yeah. But ladies, just push back. Yeah, sure. Your libido might be low, but you're tired in hot flushed and everything. That's fine. But it's like your cognition and your memory and your work and your mojo. You get up and go. Your motivation, your strength at the gym, all these things are super important. And then they need testosterone. So you need to do total testosterone, free androgen index, sex hormone binding globulin. And then they'll test free testosterone, and then you can actually see your real levels. Hormones, you just need to push. You need to get a good doctor who's just gonna do all the hormone tests for you because things can just go missed so you couldn't tell, like, I couldn't really tell I had low testosterone because I was exhausted from having low estrogen. I was exhausted from having not sleeping well with low progesterone. So it's important to do all these tests and give you a much better clinical picture. So, Mariella, thank you so much for your time today. Thank you, Joanne. It was such a pleasure. Very interesting topics. You're welcome. Yeah, no interesting topics. Testing is helpful, but we need to be able to read the test, the nuances and just relying on signs and symptoms is such an important part of what we do. Thanks again, Mariela. I'll speak to you soon. So thank you for joining me. I hope you found this episode beneficial. Be sure to subscribe to the histamine well so you don't miss an episode. Leave a review and you can also share this episode with someone who could benefit. If you have any questions you'd like answered or have a topic you'd like me to discuss, please go to my website, joanne kennedy naturopathy.com, where you can provide us with that information. Until next time, take care and be well.