Adrenal Fatigue part 5: Worse Than I Thought

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Edit: The results of this test are completely unreliable. For starters, the company was dishonest at the onset of the test. The test claims it analyzes the four saliva tubes throughout the day, but when it came to it, they only analyzed the morning test and threw the others out. Well, you can't very well have an accurate reading of hormone levels if they're not actually tested! I call false advertising and shenanigans on this company. Although I did still have all the symptoms of adrenal fatigue.
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The results came in...late stage adrenal fatigue. The state where, after years and years of compounded stress on a weak adrenal system, my adrenals are just giving up. My dhea levels were extremely low. My cortisol levels and sex hormones, while within normal range, were also very low. In the early stage of afs, the adrenals produce high amounts of cortisol. But eventually they just can't anymore.

The top line is where I should be. The bottom line is where I am. Many people have a reverse graph, where they start really low and then get higher throughout the day. At least mine is going the right direction?

On the upside, it seems like a confirmation that this was the cause of my HG. It's also disappointing because it's worse than I thought. This will be harder and longer to recover from. Every corner I've turned just to find a big, fat sign blaring WAIT! Seems to be a theme. But I don't want to wait! I want to be better now! I want to be healed now! I want to be pregnant now! (Ha. How reflective of our culture, no?) 

I'm taking an adrenal support right now. Not really sure what I do from here. I'm awaiting the micronutrient panel as well. Also not sure how to combine those results with these results. I'm just feeling a whole lot of unknown right now. Everything I've read says "lifestyle changes" and "dietary changes" - and I'm thinking What more could I possibly do?! It's not as though I can just stop mothering.

I'm nervous thinking about delving into healing those area because I know there will be a bazillion opinions out there ranging from insensitive to seemingly impossible. BUT I need to safeguard myself against self pity and helplessness, because that. won't. help. 

In sticking with the theme of this blog, I did find one suggestion about finding ways to increase JOY everyday. That increasing joy naturaly raises dhea levels anyway. So let's bring on some joy in morning!!! (Which is one of the toughest times of day for me, oh man.)

Adrenal Fatigue part 4

The previous post on mitochondrial dysfunction ended with with the question "what about the adrenals?" She mentions liver function over and over, but the adrenals aren't mentioned once! This post will explore if there is a relationship between adrenal fatigue and mitochondrial dysfunction.

First off, let's just talk about the adrenals. The adrenal glands sit atop the kidneys and aren't actually one organ. They are two organs sandwiched together - the adrenal medulla (non-essential for life) and the adrenal cortex (essential for life).  Most of my research has focused on the adrenal cortex. The cortex is in charge of cortisol which assists the body in metabolism (among other essential functions, but the metabolizing of fats, carbs, and proteins is more vital to our purpose, especially as it relates to mitochondria). 

This article discusses adrenal fatigue and its symptoms (note: I've had many of these symptoms for years). It mentions adrenal cortex injections being beneficial, which is what Dr. Kemp gave his HG mamas as a sublingual serum with 100% recovery success. 

I found this very interesting article that discusses the adrenals' role in liver and gallbladder function. In it I learned that high cortisol levels can cause non-alcoholic fatty liver. Also, the body recycles 95% of bile acids from the bowels, and it is cortisol that controls this function. If coritsol levels aren't at their optimum, however, that negatively impacts the gallbladder - one symptom of which is fatigue. So...what came first? I've explored all of these things already in regards to HG. Did HG cause a liver or gallbladder problem? Or was Adrenal Fatigue the underlying condition that caused HG in the first place and, after prolonged insufficiency due to the demands of pregnancy, resulted in gallbladder damage and non-alcoholic fatty liver? These questions are posed, of course, in relation to HG. Clearly liver, adrenal, and gallbladder issues occur independent of pregnancy. 

Of course I haven't even looked at adrenal fatigue AND mitochondria yet...so let's do that now. In short, mitochondrial dysfunction is really, really difficult to determine. It also shares many characteristic symptoms with adrenal fatigue (among other diseases). One good marker is - wait for it! - low glutathione levels. Which is interesting, since glutathione aids in the oxidation stage of the methylation process. (So what role does mitochondria play in methylation?) Many of the nutrients needed in particular for mitochondrial function are: coQ10, carnitine, vit c, glutathione, b complex, trace minerals, marine phytoplanktons (sea food?), vitamin D, magnesium...most of those sound familiar? ALL THE OVERLAP! This article discusses how to treat mitochondrial dysfunction AND adrenal fatigue, if you happen to have them concurrently. It's tricky because treating one could exacerbate the other. Personally, I do not think mitochondrial dysfunction is my problem (mostly because the symptoms do not resonate with me - such as muscle weakness and exhaustion during exercise), but I have also noticed that I do not react well to B vitamins, even in their activated forms and I'm more tired than I've ever been in my life. Which does make me wonder, have I made something worse by trying to target something else? All of this stuff is so off the beaten track (and not even in the "quack" sense), it's frustrating. This article is extremely interesting, though, so please do give it a read. In the end, it seems there is some connection between adrenal fatigue and mitochondrial dysfunction, but it doesn't seem entirely clear what. My own theory, as I understand things so far (someone please inform my ignorance!), is that if the adrenals are in charge of metabolizing fats, proteins, carbs, and nutrients for the entire body and the mitochondria are in charge of breaking down nutrients, glucose, and fatty acids at the cellular level, then the impaired adrenal function comes first. Although, I just wrote that out and two "buts" popped into my head. So. In MY case, I think adrenal function comes first. 

Through reading various articles, I've noticed a strong overlap between adrenal fatigue, mitochondrial dysfunction, and methylation and the nutrients required to support the functions of all of them.  I suppose, realistically, they are all tied together in one way or another as well as being essential for...well...life.

Currently I am awaiting the results of an adrenal test. It was a saliva test that will measure cortisol, dhea, estradiol, testosterone, and progesterone levels over the course of the day. Interesting fact is that I had to take it on the 21st day of my cycle. I love how specific that is. The test is the Endocrine Essential 1, item number 7070. It's also only $99 out of pocket, which is a very good price. 

Additionally, I will be having an intracellular micronutrient panel done. I'm completely geeking out about this one. It will measure everything I've already been researching, which will give me an exact knowledge of what micronutrients my body is lacking: copper, zinc, magnesium, vitamin Bs, glutathione, carnitine, among many other vitamins, nutrients, acids, metabolites, and antioxidants. And if you've been reading this much, you will understand the significance of those specific nutrients listed and are geeking out with me.

I am anxious to get the results back from these tests. I should know about the adrenals by the end of the week. The micronutrient panel won't be for another 5 weeks (2 weeks until my appt, 3 weeks for the results)! I am having some good lessons in patience. Which is good. It's not my strongest area. 

**Unrelated, but I feel a need to mention it. Mitochondrial disease can be inherited. A few years ago the first ever court-awarded vaccine-autism case happened. It was found that the child, Hannah Poling, had an undiagnosed mitochondrial disease that, exacerbated by the vaccinations, resulted in her autism. When I think about my mother and her many physical problems, my own health issues, and some of the frustrations I've had with my daughter, I find myself frequently wondering if she's been spared a starker future because we chose a different vaccine path for her. Genetic predisposition is real. Which is not at all meant to incite a vaccine debate, it's just to say there are deeper problems some of us carry, things they don't test for in those newborn exams. Medicine isn't one-size fits all. And I bring this up because it was the first time I ever heard about mitochondrial disease before starting this HG research.

Ferritin

It was recently suggested to get my ferritin levels to 70, so naturally I had to explore this. Ferritin is the body's store of iron, which is different from hemoglobin. In short, one can be iron-deficient (lacking iron stores, ferritin) but not be anemic (lacking hemoglobin). I was diagnosed as anemic in college and then again during my first pregnancy. In fact, I nearly risked-out of my first Homebirth because my iron levels were too low (I'll have to look up specific numbers and if it looked at ferritin too). Thankfully, with Floradix and an iron-folate-A supplement, the iron levels were increased and my child still had perfect iron levels after 15 months of exclusive breastfeeding (she didn't give a crap about food - it was for the birds).

This article on iron deficiency anemia was interesting to me because many of the symptoms coincide with adrenal fatigue, as do a number of the supplements (ex: b12). Symptoms of fatigue, depression, dizziness. When I was diagnosed with adrenal fatigue, I was also simultaneously diagnosed with anemia. The two are definitely connected, but it's unclear to me which comes first, if there is, indeed, one which does come first. Perhaps it varies. 

The best sources of iron are meat and shellfish, and some foods that inhibit iron absorption are diary, coffee, tea, and chocolate. This is interesting, personally, because I have very few cravings when pregnant, but one has consistently been seafood. My second pregnancy specifically had me craving crab. I have also learned that my body type needs red meat. I can feel the low iron when I don't consistently eat red meat (but I do have aversions to meat when pregnant...go figure). I've also decided to consciously increase my seafood intake to 2-3 times a week, if/when possible.

In my first post on adrenal fatigue there was an article that discussed having functional adrenal levels that, when taxed by pregnancy, resulted in low adrenal function. It seems to be a similar situation with the ferritin. Perhaps one has functional Ferritin levels, but, with the increased demand caused by pregnancy, the levels become low and readily depleted. 

So next up is an iron test specifically to measure my ferritin levels. 

Mitochondrial Dysfunction and HG (or Adrenal Fatigue part 3)

Mitochondria...the word conjures up an image of a picture I had to draw of a magnified mitochondria. It was either middle school or high school. I recall being very proud of the finished product...I wonder if it's stashed away anywhere...hmmm...

Google def: 

1. an organelle found in large numbers in most cells, in which the biochemical processes of respiration and energy production occur. It has a double membrane, the inner layer being folded inward to form layers (cristae).

Rachel over at HyperG Pregnancy sent me a link about mitochondrial dysfunction and HG. Fascinating, complex stuff. Dr. Chandler, the author of the article, began comparing HG to other diseases caused by mitochondrial dysfunctions that involved vomiting. She found that in the other "disease processes...severe, ‘unexplained’ nausea and vomiting are present and, more importantly, share mitochondrial components in the form of deficient fatty acid oxidation." She goes on to say that "a critical component of mitochondrial energy production is impaired within the liver (and likely elsewhere) that hinders the liver’s capacity to metabolize fatty acids and detoxify metabolic waste products effectively." So, basically fatty acids can't get processed and the body needs to eliminate them - ergo, vomit. That's her theory anyway.

It seems like there is a lot of minute overlaps in the article and what I've already researched, which I'll note below:

- Mitochondria are responsible for breaking down nutrients and giving energy to cells. One of the key roles they have is breaking down fatty acids. Carnitine - an amino acid micronutrient - is necessary for metabolizing fatty acids (as well as glucose). Carnitine is derived through diet (meat - particularly beef, dairy...), but a leaky gut or poor bacterial balance can prevent proper absorption of this essential nutrient. I found that last part to be particularly interesting, considering the previous post on gut health and HG. (Perhaps unrelated, but I'm also convinced, more than ever, that a vegetarian lifestyle is not a pro-fertility lifestyle.)
- The article mentions "that supplementation with L-carnitine also appears to offset liver damage and improve liver function " in an animal-study (specific to acetominophen damage to the liver). Which, I found interesting because that's what Milk Thistle does, too; it helps the liver repair itself. 

- In the HyperG podcast on methylation, genetics, and HG, Dr. Tim specifically mentions that the heart and the liver are particularly mitochondrially dense. Now I want to re listen to that podcast! I think he also mentioned something about carnitine supporting the oxidation stage of the methylation process. But don't quote me on that yet. 

While reading through the article, though, I couldn't help but think "what about the adrenals?" She mentions liver function over and over, but the adrenals - secretions of which are necessary for full liver function - aren't mentioned once! So, of course, adrenal fatigue and mitochondria need to looked up. I will address that topic in another post. 

Adrenal Fatigue part 2

I have been thinking back on first being diagnosed with adrenal fatigue. I'm seeing some overlap from then and now. I remember having to take a magnesium supplement and a (horrible tasting!) B complex. The Dr. told me that the body needs magnesium to stay asleep, and if I'm not getting enough magnesium, then my body will just wake up when it runs out. Seeing the overlap? Magnesium....B vitamins....

What's the next step? is what I keep thinking. I did the at-home adrenal test of my eye contraction/dilation. I did this in college too. Instead of remaining contracted for 1-2 minutes, my eyes would dilate again after barely 5 seconds. no bueno. I now understand why my eyes hurt so much when driving at night....oh, and also anytime outside.

So I think the next step is a saliva test that measures my cortisol levels over the course of a day. I've already got an appointment scheduled with my dr...but i have to wait and that's stressful! I also have an appt with my dentist tomorrow for help with my chronic clenching due to alignment issues.

And I'll be honest....I'm exhausted. Maybe it's the heat or the blogging or the researching or just the reality of life and mothering etc...I am dead tired every afternoon. I'm getting more sleep than I have in a really, really long time (thanks magnesium and B vitamins!), yet wake up exhausted still. Why do I STILL have this problem so many years out? Even with a much better diet? It answers so many other issues I've dealt with - especially the myriad after my 2nd birth (inability to heal from a mild tear, low testosterone, PPD for 2 years, falling asleep while driving and eventually totaling our car - and God had so much mercy on me because I was milliseconds away from a head-on with a pick-up, funky milk supply - not low, but off....among other things). I don't know why, but I didn't want to believe I had something. I still don't want to have something. But it's also something that's fixable. Which is silly to try and fight against. Especially if it's my answer.

Copper and Zinc

There seems to be a strong connection with copper/zinc imbalances, low zinc, and low magnesium and HG. You can read about it here, here, and here (the latter has a commenter testimony about copper deficiency causing her HG). HyperGPregnancy suggests having an RBC Magnesium draw done which tests all three levels. I don't know about you...but I have copper pipes. There's not much more to add to this, other than it's another possible factor for some women with HG. Of which, I am more certain than ever, that there is not just one cause, but many possible causes.

Adrenal Fatigue and HG

I'm not sure why, but adrenals have been on my mind. Maybe it's because I tried the very low carb diet and was exhausted beyond anything I've ever experienced, only to learn that the vlc is not good for those with adrenal fatigue. I've always questioned my being diagnosed with adrenal fatigue back in college, but maybe it was accurate. I was under chronic stress, to the point where I became anemic and would black out for a second upon standing up. I had to go to bed at 9 pm in order to function. I would cry at the drop of a hat. I was depressed. Among other things. The more extreme symptoms were gone before my first pregnancy, but lately I've been wondering if maybe there are some lingering adrenal problems. In fact, while en route to an herbal class recently I was taking a mental note to research the relationship between adrenal fatigue and HG, and what herb did we then learn about? Borage - one that calms the endocrine system. It was Providence!

I'm pretty floored at what I'm reading right now in the Journal of Orthomolecular Medicine.  In 1933 a Dr. Kemp argued that HG is a result of subclinical, temporary adrenal cortex insufficiency. He reasoned that:

"Prior to pregnancy some women have suffcient adrenocortical function just able to meet their physiological demands. However, when these same women become pregnant they experience a temporary adrenocortical insuffciency until their adrenal cortex hypertrophies suffciently (usually at the end of the third month) to produce adequate amounts of hormone to meet the demands of their remaining pregnancies. " (pg. 70)

Dr. Kemp successfully treated cases of HG with a physiological (as opposed to pharmacological) dose of adrenal coritcol extract (bovine sourced) taken subcutaneously.  There have been modern studies based off of Kemp's theories that were less successful (Dr. Kemp's clients made an immediate and complete recovery from HG). However,

 "None of these modern reports used physiological doses of cortisol as a treatment approach. Kemp’s work showed that physiological doses of adrenal cortical extract possess therapeutic value in keeping NVP (nausea and vomiting in pregnancy) from progressing to HG. For patients that progress to HG, highdose steroid therapy appears to be indicated based on the best and most current available evidence. It appears more likely that physiological doses of cortisol when given during the first trimester of pregnancy might serve to prevent the onset of HG, and thus eliminate the need to resort to hospital admission and high-dose steroid therapy. Given the possibility that early pregnancy does represent a state of “relative adrenal insuffciency,” the use of physiological doses of cortisol to prevent HG should be more formally studied. " (pg. 72)

Dr. Kemp's original study is here. Bless his soul - he argues for his sick mamas, during a time when HG women were told it was purely psychological. He notes in his research that because of the lack of adequate adrenal function, "the liver bears the brunt of the pathological changes from this grave disturbance in body chemistry while degenerative changes also take place in the kidneys." I have read that liver and kidney diseases can result from HG. He goes on to postulate that "the liver only exercises its manifold and excessive functions in the presence of an adequate supply of a catalyst or autocoid (possibly several) which is a secretion of the adrenal cortex." - HOLY LIVER!!!! So, I could do everything to help my liver, but if my adrenals aren't functioning fully, neither will my liver. This is sobering.

There have been multiple instances where I've been encouraged to take a cortisol test. Maybe I ought to, finally, look into this.

I'm having a moment right now. A "THIS IS IT" moment. I truly, truly think this is the root of my problem. I am part of the 1% of women that suffer from HG. I am further part of the 10% of that 1% that suffer for the entire pregnancy. I'm not saying this is the "across the board" root for all HG mamas, because I think there are many underlying causes, but for me....my intuition is screaming and crying within me... this is it!

H. Pylori and Other Bacteria

Bacteria is awesome. I'm fascinated by the growing field of microbiology. While food has been discussed, what processes that food - the gut - hasn't. And inside that gut are millions and billions of bacteria. But sometimes things get out of whack. We quit breastfeeding our babies, take antibiotics, eat unhealthy foodstuffs, remove traditionally-fermented foods and drinks from our diets, clean obsessively, eat too much sugar, wash with antibacterial soaps, don't eat food from the dirt....all these things which can lead to imbalances in our guts - bacterial overgrowths like h. pylori and yeast like candida. There are many studies out there showing that a high percentage of women with HG also test positive for H. pylori (large list of studies), indicating a connection between gut health and HG.

I stumbled upon this product from Pink Stork Solutions - Cocolaurin. According to the site it is lauric acid derived from coconut oil. Lauric Acid is an essential compound found in breastmilk that "helps maintain a normal, healthy balance of intestinal flora and yeast." It's also effective against viruses, fungi, and parasites, according to this site. This article has more interesting info on monolaurin and how it works in general.

I've had gut issues my whole life. So this product has been added in with a probiotic every day.

Clay

It's fun stumbling upon things unexpectedly that fall right in line with what I'm researching. I'm reading a fascinating book called Honey, Mud, Maggots, and Other Medicinal Marvels: The Science Behind Folk Remedies and Old Wives' Tales by Robert and Michèle Root-Bernstein. I came across this quote, which of course piqued my interest: 

 "Clays are still being used as medicines today. The Toba-Batak of Sunatra claim that eating clay stops the vomiting associated with morning sickness in pregnant women. Many Nigerian tribes prescribe local clays for morning sickness..." (pg 66)

Naturally, I had to follow this rabbit trail. I have taken clay before to resolve some stomach issues in college (not sure if it helped or not, but I did have zero body odor when regularly ingesting it, both in the pits and bowels), so I was not repulsed at the thought of taking clay for nausea and inclined to find out more. 

I found another book called Ancient Bodies, Modern Lives: How Evolution Has Shaped Women's Health by Wenda Trevathan which mentions the valid use of ingesting clay in some 60 societies for pregnancy sickness. 

    "A phenomenon some what related to food aversion is the craving for clays (geophagy) reported by pregnant women in a number of societies. In medical literature, this craving is often reported as pathological, but its existence is so widespread that scholars of evolutionary medicine search for adaptive explanations. Worldwide, clays are used to relieve diarrhea (the original kaopectate, after all, was mostly kaolin, a clay), detoxify compounds, and provide minerals that are insufficient in the diet. In Africa, this practice is also employed by women seeking to relieve nausea of pregnancy and it can serve to bind toxins that would harm the fetus at this stage.

         When geophagy continues beyond the early stages of pregnancy, it probably adds important nutrients to the diet, especially calcium, essential for fetal skeletal development and maintenance of blood pressure in pregnancy. Anthropologists Andrea Wiley and Sol Katz propose that clay as a source of calcium helps to explain the distribution of geophagy in African populations. Their survey of 60 societies confirms that where dairying is practiced and calcium is available in the diets of pregnant women, geophagy is less common than where dairy foods are not available. This work confirms that what may be seen as pathological or abnormal by clinicians may make sense from an evolutionary perspective because in many cases geophagy serves to reduce the negative aspects of morning sickness, detoxify agents early in pregnancy, and provide calcium and other minerals." (Pgs 80-81)

I further found a couple of other mama bloggers mentioning their use of clay for pregnancy sickness. Each site mentions the high mineral content in clay, as well as its alkalinizing affects. Hello! It all just keeps coming full circle! 

Benefits of Healing Clays

10 Reasons Clay Should Be in Every Mama's Cupboard

This is not a popular remedy, but I did read a couple of testimonials here and there. The most specific saying that she took 1 tsp in water before bed and it made a significant difference. This was her third HG pregnancy.

This overview on HG contains a warning by the FDA about not ingesting particular clays (of African origin) due to being high in lead and arsenic. So it would seem that enough women have taken clay as a remedy to alleviate HG that it's on their radar. I also saw warnings about being careful when to ingest the clay - such as not within an hour of eating and not within two hours of taking medication, otherwise the clay itself will absorb the nutrients and/or medicines, depriving the body of it. If this is something you might choose to do, only use a food-grade bentonite clay, talk with your practitioner, and do your own research.

Acupuncture

I heard about acupuncture for Hyperemesis after my first pregnancy. I don't recall if I was seeking out solutions in a birth and pregnancy forum or if I had just mentioned that I had HG and was still having heart burn a year out. Either way, a mama told me "Oh your spleen qi is off and that can cause heartburn and HG." Doubter that I was, I went and Googled "spleen qi" and "traditional Chinese medicine" and I found some compelling information. I decided to give it a try. During the first session the practitioner was putting in the needles and suddenly I felt a sharp sensation in my foot that immediately subsided and then a chill went through my whole body, from head to foot. I said "What was that?!" "Your spleen," she responded. Well, call me a believer. After that session I had no more heart burn. 

Shortly before my second pregnancy I read a clinical study (there are a number available) on acupuncture and pregnancy-related nausea. During my second trimester of my second pregnancy I had two acupuncture sessions. After each one I would come home, vomit immediately, and for a week following I had decreased nausea, no vomiting, and increased energy. I now know that having acupuncture done preemptively, and especially in the first trimester, is even more effective. I plan to start going weekly (? We'll see what the practitioner thinks) prior to conception. 

You will find an excellent podcast on the subject at HyperGPregnancy.

While researching B Vitamins I came across this post that mentions kombucha and how, according to traditional Chinese medicine, it balances the middle qi, which is connected with the spleen. It's comforting to learn that I've been preparing my body in more specific ways than I was aware of. I happen to just really like kombucha, so I began brewing my own 9 months ago. I hope I can tolerate it during pregnancy so I can continue to reap its benefits. 

Magnesium

I first learned about Magnesium and HG just weeks before my second pregnancy. I took weekly epsom salt baths and drank mineral water that had a natural magnesium content. Another suggestion I often read is to make or buy magnesium oil and use topically, I think I did this a few times. But I was already pregnant, so I can't say I noticed much help. Though I do crave the baths when pregnant.

Currently I am taking a Magnesium Concentrace Mineral supplement. It tastes pretty awful. I do think I am sleeping better because of this. Though, I need to go to bed earlier, reduce my screen time, and reduce other stimulating activities at night to encourage easing into a drowsy state. One piece of advice re:HG I read was to not nap during the day so the body is tired enough by bedtime to stay asleep. I will remember this for next time. Hopefully the magnesium will help with this, too, as it also reduces restless leg, which I've had in both pregnancies, disrupting my ability to fall asleep.

Magnesium can be found in bone broths, seaweed, nuts, green leafies, and unrefined sea salt - yay! Don't you just love all the overlap happening? I do. Sigh. Food is medicine, ya'll. Food is medicine.

::EDIT:: I am using spray on magnesium from Pink Stork Solutions

Food Matters

I am a big believer in food as our first medicine. This is especially true when it comes to hyperemesis.

I'm linking you up to two podcasts - one interviewing an OB and the other a Food Scientist.  Both of these interviews wind up overlapping in their suggestions for the ideal diet for a woman dealing with, and more specifically trying to prevent, HG. In short, they recommend a high fat/moderate protein/low carb diet. As a quick picture, this would be similar to eating "Paleo." They are fantastic, interesting interviews. Please give them an ear.

This site has an interesting note about women who are more prone to HG. One study showed that women who regularly ate seafood and allium vegetables (onion, garlic, etc) prior to conception had significantly lower rates of HG. Additionally a Norwegian study of 51,000 HG cases found that they "were more likely to have diets high in carbohydrates and added sugars, particularly soft drinks." The first study truly fascinates me as foods from the sea are a traditional fertility food, with societies often seeking out and feeding special foods to their women of child-bearing age.

In the years before my first pregnancy I was probably more like a vegetarian except that I ate a little meat (hello vitamin B deficiency!). About a year after my first birth I really began to be more in line with the Weston A. Price mindset, adding more fat and meat. Nourishing Traditions has actually been one of my favorite books since my sophomore of year of college (even when I wasn't eating much meat). Gradually I realized I have a wheat and dairy allergy, so I took on more of a Paleo flare. Then, exactly a year ago, I started the GAPS diet with my daughter. I do try to eat eat seafood once a week.  Now, I've never been religious about any of these, I do believe there are times to celebrate, let go, and not worry about food (within reason, of course). But the majority of the time, my food eating habit is very...whole.

I don't say that to toot my own horn, but rather to track my diet along with the advice I am hearing. I still have some adjustments to make in these months before conception (lowering excess carb intake, especially at night, and increasing good fats even more). I read that some women were basically healthy before pregnancy, had HG, and then after pregnancy continue to have health problems. I would say I had the opposite. I would not say I was healthy before pregnancy - I frequently suffered horrid stomach aches, gastrointestinal distress, anemia, low energy, heart burn, constipation, and was under acute chronic stress for three solid years. My body was in rotten shape. Fast forward after my first HG pregnancy, after increasing protein and fats, I have very rarely suffered from stomach aches, anemia has not been an issue, and, well, I could use some better "stress" coping techniques, but it's no longer chronic. Food mattered. 

Ideally, I would get all the nutrients I need from eating whole foods, but if I have an underlying condition that prevents proper absorption, my body might not function optimally. So I'm wondering if a nutritionist might be helpful at this point. We'll see. I'm enjoying learning at any rate.

::EDIT:: I did the very low-carb diet devotedly for two weeks. I'm currently questioning whether going that route is good for me, someone who's already been more or less low-carb for about 2 years. A friend also sent me this interesting article about fertility and carbohydrates. So I'm still trying to figure out the balance that's right for me.

::EDIT:: I read another article talking about monolaurin and candida. It mentions how a low carb diet is actually bad for candida. It's common thought that foregoing carbs will starve the candida, however, candida also thrives off of ketones. So if one is in a state of ketosis (such as what a very-low-carb diet would do) it can actually cause the candida to have an outbreak! I did experience an eruption of itching spots on my elbows during my vlc diet, which I now think was candida-related. I am glad to have learned this! Finding the right balance for my body's needs is my goal. So more carbs and fruits are being added back in, however, with more attention to their being paired with fats and proteins (peaches with creme fraiche anyone?!).

The B Vitamins

One of the consistent remedies for HG is vitamins Bs, specifically b6. In fact, an antiemetic just came back on the market that contains b6. The standard suggestions (which I am doing) is to take 50mg of B6 (P5P) along with vitamin C 3x a day as a preventative, and then 50 mg b6 (P5P - which is the activated version of b6)) along with a half a tablet of Unisom morning and night when pregnant and already nauseous (this was my pregnancy saver both times). My research has led me to believe that it's a little more complicated than just taking your Bs, because, not surprisingly, the quality and kind really do matter. 

Ideally we would be getting our vitamins completely from our foods. Much of my efforts so far have done that - eating raw liver, drinking kombucha, and eating other naturally fermented foods. These all contain b vitamins, especially the raw liver. 

One of my weird pregnancy quirks is that I crave alcohol and carbonation. Those are my only, legit cravings. With my first pregnancy I craved beer - I had never liked beer before. Now, I love a nice cold porter. With my second I craved red wine. I also craved carbonated beverages, whether sparkling water or soda (the latter of which I never drink outside of pregnancy, ugh). I now have a theory, and that theory is B Vitamins. Traditionally fermented beers and other such drinks are quite high in vitamin Bs. I think a biological part of me knew that's what I needed, unfortunately our carbonated beverages are no longer traditionally fermented. So in a sad irony, drinking soda and other carbonated beverages actually depleted me even further of my precious Bs. They are also bladder irritants (diuretic), which furthered my dehyrdration and nutrient depletion cycle. 

So I was happy when I did some looking into my kombucha and its b vitamin content. While it has a low b vitamin content over all, they are extremely bioavailable as the drink as a whole is synergistic. It stands to reason that ingesting small amounts of a nutrient daily is probably more beneficial than taking a mega-dose of a nutrient - most of which will be peed out anyway. Add that to its alkalinizing affect and liver support, and I've been tackling a number of my "prevent HG" areas for nearly a year unknowingly! 

One of the most fascinating things I've come across is a podcast about genetics and HG and the necessity of b vitamins in the body's whole process of methylation. It of course affects the liver. It illuminates the problem with folic acid that pregnant women are told to take (and, in fact, everyone who eats processed foods are forced to take). Please give the podcast a listen to, you won't regret it. I'd explain further, but I don't fully understand it all myself. I am, however, fascinated by it.

Just Another Reason

It can be discouraging running across information that tells me how my HG may have negatively impacted my children. I'm saddened to know that some of the most frustrating parts of my first child's personality could very well be because of how very sick I was. And it may or may not be the case, I won't blame myself or carry unnecessary guilt, I won't let it control me because God is bigger. But it does give me more gumption to fight. One more reason to keep learning and reaching out to the resources provided me, for the sakes of my children...and their children. The changes I make now can make a difference multiple generations out. That's huge. If the sins of one generation impact the next generations, perhaps the blessings do too? I love the Iroquois Nation mindset to think seven generations out. I wonder how different we would all be if we did that. 

Genetics

I'm currently exploring the possibility of a genetic component with HG. Although I hadn't yet come across this topic while researching HG prevention, a friend directed me this way. One of the studies I cited previously actually mentions that there might not be much someone could do since current research seems to indicate it might be genetic.

We used to think genes were set in stone, but new research is beginning to show that is not the case. Our genes can be switched on and off. 

The recommendation is for me to take the 23andMe genetic test and have the results evaluated by a dr. I decided to see if I could find any connection between that test and HG prevention. I didn't come across very much all, but I DID stumble upon this gem. A podcast! A whole podcast series (available on iTunes) dedicated to HG Prevention. So far I've listened to a few and they've been extremely interesting. Especially this one. Holy cow!

All of this really ties in closely with other things I've been learning about (such as folic acid being the cause of tongue ties, MTHFR being the root cause of repeated miscarriages and preeclampsia). In my learning about MTHFR I learned about the necessity of taking methylfolate instead of folic acid, and, further, its need to be taken with B12. Nearly everything on my "timeline" falls in place with what this doctor in the Methylation podcast is talking by about. First focusing on diet and gut health, next liver and gallbladder health, then milk thistle, then vitamin Bs, magnesium, and then methylfolate. 

It may or may not be accurate, but I kind of got the feeling that whether or not I do the genetic test the reality is I'll have to take these same steps anyway...

Feelings (or Bearing Crosses)

Today I'm feeling down about a 3rd pregnancy. I've been cutting out excess carbs (and increasing fats), so that's part of it (I'll be posting about Diet and HG soon). I'm feeling nauseous as my body adjusts. It feels exactly how my pregnancy nausea feels. That "always on the verge of puking" feeling with little energy. Unable to care for the kids - though we're at Gramma and Grampa's, so it's a moot point...Mama's not as fun as they are anyway. (Which is how it should be, no?)

It's a keen reminder of WHY I'm making some hard changes: because I DON'T want to feel this way for the greater part of 9 months. It also brings up fears. The fear of HG in pregnancy isn't just that I'll have it again, it's that it will be worse. It's also the fear of missing nearly an entire year of children's lives. It's also the fear of being alone again. It's the fear of never experiencing the joy of a new child again because of HG's control over the whole experience. It's the fear of raging depression and darkness that was so consuming it took years to heal from. 

But then I'm reminded how much better my second pregnancy was, with comparatively minimal changes to what I'm doing now. I'm reminded that I have family and friends so close by that it won't feel lonely. I'm reminded that I am part of a faithful church community that will anoint with me oils and prayers. And it reminds me how very small I am. It's overwhelming. It reminds me that if Christ bore His cross for me, then I can bear this cross for my children. 

Alkalinity and Hydration

One of the things that helped me dramatically in my second pregnancy was drinking alkaline water. Initially I started off drinking Gerolsteiner Natural Sparkling Water, which has a natural pH of 5.7. I didn't choose this water for any particular reason other than that it was in a glass bottle, sparkling, and contained magnesium. Fresh squeezed lemons were added to the water. Lemons, although containing citric acid, have an alkalinizing affect on the body. They are also a great liver cleanser. Lemon essential oil was also essential (ha!) for quelling the urge to retch. I'm not sure the specifics of how drinking alkaline liquids helps with HG, but it did.  Apparently, it can also help with chemo-related nausea, though I couldn't find anything substantial to back up these claims.

While I was pregnant I learned about Kangan water systems. These are water filtration systems that can make highly alkaline water filled with all the essential nutrients our modern water supplies lack, and ionized in some particular way that it is readily absorbed by the cells, thereby deeply hydrating the body at its most basic level. Japan has been using these in their hospitals for 40 years. 

I truly believe hydration is among the biggest factors in preventing the HG cycle. Because once you are dehydrated, it is really, really hard to catch up. 

“Early pregnancy morning sickness is a signal of dehydration of the mother and fetus. It is caused by the water and the regulatory action of histamine. Pregnancy creates a very high demand for water. As the fetus grows into a full-term baby, over 1 trillion cell divisions take place. Each new cell must be filled with water. Pregnant women need and should drink water and eliminate all sources of dehydration, especially the consumption of caffeine and alcohol.”
            - Water: For Health For Healing For Life by Dr. F. Batmanghelidj, a researcher pioneering in dehydration

(I found the above quote to be very interesting because Unisom, the drug that helped abate my vomiting, is an antihistamine.)

Thankfully local people in my town who had machines shared their water with me and then a friend loaned me her machine for a large percentage of the pregnancy. I went from being dehydrated while drinking 90-140oz of reverse osmosis water a day (which happens to be extremely acidic water due to its lack of nutrients of any kind - it's basically dead water), to drinking just one gallon a day and feeling more hydrated than I had in a long time. 

The other thing about the water was that I digested it so much faster, it didn't slosh around in my stomach like regular water did. My daily routine was to drink 32 oz before I got out of bed. I always kept this down, even if I could keep nothing else down the rest of the day. 

Another interesting result of the highly alkaline water was that I had zero heartburn until I had to return the machine at 35 weeks. With my first pregnancy the heartburn was horrendous. I went through multiple bottles of Tums a week - tropical smoothie for the win! (Fun story, Tums might not be all that safe during pregnancy, especially for mamas just popping them every time heartburn rears its ugly head; it is a class C drug, which means it crosses the placenta. Whomp whomp. Might explain the calcified placenta in my first pregnancy.) But with my second pregnancy I had zero heart burn until two days after returning the machine and resuming regular water. And my baby had a good amount of hair. Take THAT old wive's tales!

Taking in all this info that I'm learning and relearning, I'm reminded of dandelion tea. While it is a diuretic, it is high in essential minerals, so that while it creates more urine, it does not deplete the blood of these minerals, such as potassium. Instead it replenishes, while simultaneously aiding the liver in it's heavy load.

Unfortunately I will not have access to an ionizing machine, but my grocery store carries gallons of alkaline water and cases of Gerolsteiner water, so I feel set. And lemons. They have lemons.  I WILL make lemonade from my lemons!

According to traditional Chinese medicine, Kombucha also has an alkalinizing affect on the body. 

H.G. Well

Leave it to my husband to crack an HG joke. "You should have named your blog H.G. Well." So I decided to run with it. Quotes from H.G. Wells to encourage the journey of HG Prevention and thriving:

"Adapt or perish, now as ever, is nature's inexorable imperative."

"If you fell down yesterday, stand up today."

"The forceps of our minds are clumsy forceps, and crush the truth a little in taking hold of it." (Well...it's kind of birthy at any rate...)

"Sometimes you have to step outside of the person you've been and remember the person you were meant to be. The person you want to be. The person you are."

"We all have our time machines, don't we. Those that take us back are memories....And those that carry us forward, are dreams."

"Losing your way on a journey is unfortunate. But losing your reason for the journey is a fate more cruel."

"We should strive to welcome change and challenges, because they are what help us grow. Without them we grow weak like Eloi in comfort and security. We need to constantly be challenging ourselves in order to strengthen our character and increase our intelligence." ~ The Time Machine

"What on earth would a man do with himself, if something did not stand in his way?"

"Looking at these stars suddenly dwarfed my own troubles and all the gravities of terrestrial life." ~ The Time Machine

"There's truths you have to grow into." ~ Love and Mr. Lewisham

"We must not allow the clock and the calendar to blind us to the fact that each moment of life is a miracle and a mystery."

"I hope, or I could not live." ~ The Island of Dr. Moreau

Milk Thistle

I'm sorry. I really, really thought I was done with all the liver talk. However....

One of the things I am doing right now is taking milk thistle. This is one of the first things I came across as a means of HG prevention. I had actually heard about milk thistle shortly before I learned #2 was in my belly and took it for a short time. I'm reading that ideally one should take it for 2-6 months before conceiving and then up the dosage once conceived.

Milk thistle is one of the most studied and widely used herbal medicines, even today. It contains a compound called silymarin, which is the active ingredient.  Milk thistle is an antioxidant, which protects the body against free radicals.  Our livers, like our skin and blood, are able to totally regenerate themselves when they have been injured - no other organs can do this. Milk Thistle aids this process by stimulating the growth of liver cells. 

Since we've already talked about the liver, we know how important it is in the role of HG (and, um, everyday life...seriously, it performs more that 500 different functions in our bodies!), it's rather obvious how this herb is helpful. The suggestions I have seen in HG forums is to take 280mg of Milk Thistle extract with a minimum content of 70% silymarin. However, I further read that if milk thistle is taken with dandelion, artichoke, licorice, among other herbs, it's action is enhanced, and one can take a lower dosage. I am taking 175mg with 80% silymarin that also contains dandelion, artichoke, and turmeric. I was taking 2 capsules initially, but it was too much. 1 capsule seems to be working well. *edit: 1 capsule seems too much, so I'm going to try half a capsule.*

Milk Thistle is also used as a galactogogue. Yay!

Now, I also read some information that indicates the verdict might still be out on some milk thistle claims. And this is why you must do your own research. 

EDIT:: 8/25/15 I have ceased taking milk thistle for the time being. I took it consistently for about a month, but I think it was a key player in my fatigue. An accupuncturist also suggested I not take it because it was depleting my liver, and my liver really needed replenishing. She said milk thistle really should not be taken for more than a month at a time and even then not every day. This was good to hear because she validated something I'd been feeling anyway (I had already stopped it by then). Especially since common HG advice is to take it for 2-6 months prior to pregnancy. Maybe it's just that my liver was already at a good place and didn't need the milk thistle anymore. Ironically, my milk supply also increased a few days after ceasing it.  So it was definitely over-taxing me - and I was only taking about 1/4th the recommended dosage for HG prevention.

Oils

In another post I mentioned using lemon essential oil to quell the urge to vomit. I would dab my finger with oil on the back of my tongue and the urge would go away almost instantly. Realistically, this might not be the best method as the safety of ingesting essential oils is questionable to begin with. However, it worked and I didn't do it all too often, so I don't regret doing it (but I also can't advise it, and I do advise that less is more when it comes to EOs). However, I set out to research lemon essential oil and nausea and came across an interesting clinical study that demonstrated its effectiveness. Their method was through inhalation. Another study compares peppermint and ginger essentials oils. Ultimately the results of that study show some improvement with the oils, but negligible. I think the testing would also be questionable because you really couldn't have a true blind study - it's obvious if you're smelling peppermint or ginger or saline solution. So who knows.

I also came across a number of sites explaining that lemon essential oil is far more effective than ginger at eliminating nausea....but they were about countering the side affects of a certain psychedelic herb, so who knows. (Thank you, Internet.) It's an interesting read at any rate as it goes into the specific compounds that counter the nausea. I doubt it's applicable, but it's still interesting. 

It at least appears I have another option available to me via aromatherapy.

Each Sunday, at the end of our Eucharistic service, there is an anointing with oil for the sick and the suffering. It is an anointing for healing, but it's not just that. It's also a reminder to suffer well. To carry the cross of sickness and suffering, partaking in Christ's work, and bearing along with Him. I did not participate in this much with my last pregnancy (probably couldn't stand the smell, whoops!) but this past Sunday I decided to start accepting this gift now. While I'm preparing my body for the suffering of pregnancy, I need to prepare my heart and soul, too. Although I still can't stand the smell. Oh well!

More Liver

YOLO! You only liver once. This week I'm adding liver into my regimen. Liver is high in bio-available necessary nutrients such as Vit Bs - esp B12, iron, folate, and Vit A which are particularly essential for healthy pregnancy and beyond. Liver has traditionally been heralded by all cultures for its many benefits. There is, apparently, an as of yet undiscovered factor in liver that fights off fatigue.

 I spent three hours making liver "pills". Super easy. I obtained about 1 and a half lbs of bison liver and a pound of chicken livers from a local market (pastured/grassfed etc). However, only a few chicken livers were used because they were much softer and generally more difficult to cut up. I'll figure out something else to do with them...meatloaf? One thing I did do different from the "recipe" was soak the livers in lemon juice prior to using. This is recommended in the Nourishing Traditions cookbook before using livers, and I opted to apply that here. 

I will take a few of these daily. 

(so much liver...I was totally over it by the end)

I've resumed cod liver oil/fermented cod liver oil (FCLO for short) as well, which I take periodically anyway. 

Here's to liver! 

Thyroid

Of course one can't talk about hormones and not mention the thyroid. It was recently brought to my attention that the thyroid can be a major factor in hyperemesis. Just a quick search brings up research all the way from 1985 about a condition known as Transient Hyperthyroidism. It is caused by pregnancy and can result in HG. It can happen in women who don't otherwise have thyroid issues (hence "transient"). So in my efforts to thrive through HG, I am trying to cover all possible bases.

Early last winter I was feeling off and had my thyroid tested. My thyroid was fine, but my idodine receptors were blocked which ultimately affected thyroid function. I did a cleanse and some adrenal support and was able to clear that within the month. 

So what have I been doing to support my thyroid specifically as it relates to HG? Well, not much. I don't really know too much about the thyroid. As a precaution I have had my thyroid levels tested so that I have prepregnancy base levels to compare to when I actually am pregnant. All levels are currently good. Although, according to the research, transient hyperthyroidism is actually quite rare and the condition causing HG abates around 18 weeks. Since mine lasts the entire pregnancy, I do not  believe this is my problem. However, I'm covering bases. And my thyroid still needs love. 

So I'm giving my thyroid love by adding seaweed to my diet. Seaweed is rich in trace minerals (10-20 times that of land-based plants, including iodine and B vitamins), balances the thyroid, soothes and nourishes the digestive system (hi, liver!!), and is particularly beneficial for women's needs in general. 

"Seaweed is an ally in women's mysteries. Seaweed flows and shifts like the energy of a woman. Saline solutions of ocean and uterus rock in rhythm. Pulses of tide, menstruation, heartbeat, and fertility join seaweeds and wombs. Nourishing breastmilk merges with waves of green fronds...optimum nourishment and the salts of life...breasts, seaweeds. Seaweed eaten daily is a powerful ally to the a wise woman, for prevention and healing of herself and others." (Susan Weed Women's Mysteries)

I love the analogy of the flow of life in my body and the ocean, especially in pregnancy and thinking about labor. 

So nearly daily there is some intake of nori, kelp, kombu, arame, or dulse seaweeds (all readily available at your health food store or the Asian section of a grocery store or Asian market). I make sushi, add seaweeds to soups, arame makes an excellent noodle replacement and is very mild in taste, sprinkle kelp flakes on everything, or even make a tea/broth from kombu. 

It's just one more thing. One more thing to do for my future baby. One more thing to help me mother and be a part of my family while pregnant. 

Liver (and probably t.m.i.)

I guess I'll talk about the Liver first, since that's what is currently on my mind. The Mothering.com source in the Quick Links is where I got the commendation to do a liver cleanse. From what I've read, among the liver's 500+ functions is to filter out pregnancy hormones. However, if the liver is congested or not functioning properly, it can't filter them out and they continue to recycle and accumulate in the body causing HG. This is just a theory. But there seems to be (mostly) theories when it comes to the source of HG.

I came across this liver flush from my niece, which we did together. Warning: this is where it might get tmi. Also a little "quacky" (though I don't like that term). I'll be honest, western allopathic medicine only offers me three different kinds of medications and IV drips when it comes to HG, so I'm willing to take the "quack" route, in addition to any necessary meds. If you're not into being nontraditional, then this probably won't interest you...or most of what I end up doing for that matter. I'm too stubborn and naturally minded to believe that x, y, and z meds are the only things that can help me, and postmortum at that. Because HG is basically a daily dying, not just spiritually. 

I suppose my liver cleansing really started a year ago when I went on the GAPS diet rather intensely. Thanks to this I cured my carb addiction and got myself in a better eating habit (though I'm not perfect by any means...whatever perfect means when it comes to food...ask the vegan, the frutitarian, or the WAPF-ian). Then in an herbal class in April/May we spent two weeks focusing on our livers which included body work, herbs, clean eating and juices, and intention. Then, in June, I commenced this more intense flush. 

And the flush is intense. I believe it was extremely effective, albeit left me feeling like crap initially. I felt as sick as I do while I'm pregnant, which was both a poignant reminder and a motivation. I also learned that I could have halved the recipes for my body size (which probably would have kept me from being so nauseous). The second time I did the flush I was diligent to use coffee colonics before and after the flush, skin brushing and epsom salt baths to assist the detox, activated charcoal to carry released toxins out, Vit C to keep things moving, and acupuncture to balance everything out. I recovered much better the 2nd time taking those measures. I feel no need to continue with the flushes.
   

Something I learned while doing these flushes is that liver disease and gallbladder disorders can actually cause HG. And, in a sad twist of irony (?), HG can also cause gallbladder disorders. So if you didn't before, now you do! Yay! Well, this liver flush also flushes out the gallbladder and bile ducts. Hooray! I feel stronger and more aware. I can do this. 

Herbs that also assist the liver that I will be or already am taking: Blessed Thistle (280 mg a day prepregnancy, increased once pregnant), dandelion (gentle and excellent for pregnancy and breastfeeding as it is high in essential nutrients like potassium and a galactogogue), and burdock root (supports and strengthens the liver). I like to drink a tea of dandelion, burdock, and licorice roots. I'm trying to drink a cup a day. I also have a cup of home-brew kombucha daily, which is a cleansing tonic rich in B vitamins all by itself.

Which reminds me, I haven't had my 'buch today. Here's to my liver!

Introduction to Hyperemesis Gravidarum

Welcome to Joy in the Morning, a blog dedicated to a journey of thriving with hyperemesis gravidarum (HG). If you don't know, HG is a condition that affects 1% of pregnant women. It is severe (hyper) nausea and vomiting (emesis) in pregnancy (gravidarum), that usually lasts until about 18 weeks, and in an even smaller number, the entire pregnancy. I happen to be a part of that smaller number. From about 5 weeks on I am dreadfully sick. I cannot look at anything green without hurling. I have aversions to nearly all smells, textures, tastes (or lack thereof), even sounds. This is no quaint morning sickness, in which a saltine cracker and some ginger ale will quell the nausea. This is all day, all night, constant, for 9 months. Some days the prayer is that one cup of water will stay down. And, unfortunately, I learned recently that when it comes to HG, my experience was practically rosy. Other women suffer throwing up blood, esophageal tearing or rupturing, severe electrolyte imbalances, handicapped babies due to growth restrictions and lack of nutrients, gallbladder disease, uterine infections, even fetal and/or maternal death (among other things that I can't remember).

So why "Joy in the Morning"? What is that, some sort of twisted irony? Maybe. I'm thinking of it as an intention. My first two pregnancies I suffered through HG. With my first, I felt like it would mean I was a strong person if I resisted meds. Thankfully I found Unisom at 6 months and was able to cope the rest of the pregnancy. With my 2nd pregnancy, I had learned a few things. I managed my HG much better and threw up less frequently, though the nausea, aversions, and depression were constant. I survived my first two pregnancies. I am now gearing up for number 3. This time there is no "Oops, we're pregnant." There can't be. There is months of prepping and researching and learning. My goal is not really to prevent HG, because everything I've read seems to indicate there's no sure-fire thing I really can do since they don't really know what causes it. Though I've read a number of articles and testimonies that seem to indicate there are things I can do now to counter the HG, I can't rely on this, because there's always the very real chance that it won't work. Rather, my goal is to THRIVE with it.  I intend to have joy in my next pregnancy.

When I first set out to research everything I could, I think my goal was ultimately to not be sick and not have to take meds, but I realized that might be unrealistic. I don't want to set my self up for failure. So I have changed my perspective. Thriving with HG will require persistence, consistency, and hard work. It will require a lot of supplements, probably a few medications, outside help, and diligence. And I want to share everything I learn and do with anyone who needs this, too. This is my journey. I do not know where it will lead, and so Joy in the Morning will be my mantra. I'm going to choose joy in the morning, in spite of what comes of my efforts.