More Gut Drama - 034
Happy New Year! I wish everyone a healthy and happy 2024.
Weight loss
A little over a month ago, I began losing weight rapidly. I lost ten pounds in about two months without trying. As the weight loss progressed, I developed a lack of appetite and intermittent nausea but no abdominal pain.
The weight loss started as my old fatigue, bloating, and constipation symptoms resolved. I wasn't worried the weight loss was due to cancer as prostate cancer is not a highly metabolic cancer, especially when castrate-sensitive and the PSA is in the low one hundred level. These new symptoms were due to something else.
Lab results
I had labs done, and my PSA is now 135, representing a slowed doubling time of 17.7 months compared to the May to August doubling time of 3.6 months. My PSA in August was 117, and in May was 63. Treating the suspected small intestinal bacterial overgrowth and fungal toxin exposure seems to have helped my body from the cancer perspective.
A complete blood cell count, glucose, kidney function, and liver function tests were normal, as was a testosterone level of 870. Keep in mind that my practitioners would like to have me on androgen deprivation therapy to keep my testosterone at a castrate level of less than 50.
One other test that Dr. Kessler suggested we get was an immunoglobulin panel. IgG, IgM, and IgE were normal, but my IgA level was low at 78. Selective IgA deficiency is the most common inherited immune deficiency disorder. The International Consensus requires blood levels of IgA below 7 mg/dl for this diagnosis, so my level represents a partial IgA deficiency.
Partial IgA deficiency can be due to drugs, none of which I've been on, and can be due to viral infections such as Hepatitis C and Epstein-Barr virus (EBV). I suspect EBV is the cause of mine due to the August labs suggesting reactivation.
We found a published study showing that “1 g of valacyclovir taken daily is a safe and successful regimen to attenuate herpes viral reactivation (particularly EBV reactivation,)” so I’ve been taking generic Valtrex. Hopefully, my low IgA level is on the way up due to this.
Seeing a gastroenterologist
My weight loss continued, so I saw a gastroenterologist. She ordered an upper and lower endoscopy. The colonoscopy was normal, and the upper endoscopy showed diffuse chronic gastritis - inflammation of the stomach lining. There was no evidence of Helicobacter pylori, a bacteria sometimes found in the stomach associated with chronic gastritis, peptic ulcer disease, and rarely stomach cancer.
She also biopsied the first part of my small intestine, which showed some flattening of the villi or lining. Celiac disease can cause flattening of the villi. Celiac disease is due to a severe reaction to eating gluten, where the immune system attacks the small intestine lining. The downstream effects of celiac can be weight loss, malnutrition, and anemia, among many other things.
But, the pathologist reported that the flattening was likely an artifact. Artifacts are caused by how biopsies are taken and how specimens are prepared. Regardless, she asked me to have blood work done to help rule out celiac disease, and these labs are pending.
I avoid gluten since I've had food allergy labs in the past that suggested gluten sensitivity, but I do remember eating food containing gluten over the holidays. Regardless, if it is celiac, the remedy is strictly avoiding gluten.
She also told me the pathologist said my small bowel biopsy showed excessive lymphocytes in the lining. Celiac disease, food allergies, and small intestinal bacterial overgrowth can all cause flattening of the villi and lymphocytosis.
Putting weight back on
What allowed me to put some weight back on was stopping a digestive supplement containing betaine, which can mimic gastric acid, and starting omeprazole, an acid blocker. This change also relieved my lack of appetite and intermittent nausea.
I've since switched from omeprazole to famotidine, generic Pepcid, and am doing much better. I plan on staying on the acid blocker for a few more weeks until my stomach heals and then coming off of it. Stomach acid is essential for adequately digesting protein, B12, and minerals.
As I've said, getting my gut back in optimal condition is paramount since the gut-associated lymphoid tissue (GALT) adjacent to my intestines makes up the bulk of my immune system. Excessive inflammation, as reflected by the lymphocytosis in my intestinal lining, will only trigger more chaos in my immune system.
Chaos in the immune system is not conducive to getting cancer under control.
Next newsletter topic
I saw my radiation oncologist, who recommended I undergo another PET scan. The interesting but disturbing discussion we had and the hunt for an affordable PET scan with my new health insurance will be the topic of the following newsletter.
Until then, stay healthy.
Much love,
Keith