DAO and Probiotics

A reader requested me to do a review of the literature on probiotics and DAO as a result of my post, The Dilemma of D-Lactate Free Probiotics. As background on why DAO is important for some people, see:

The purpose of this post is to focus on DAO (and not treating histamine issues).

Returning to DAO and probiotics, the news is not good:

  • “Rats that received oral C. butyricum or butyrate had reduced intestinal injury and plasma levels of DAO, LPS, and inflammatory cytokines.” [2020]
  • Streptococcus thermophilesdecreased endotoxin (ET), D-lactate (D-LA) and diamine oxidase (DAO) content in serum. [2020]
  • ” the serum DAO activity and D-lactate concentration significantly increased by fluoride were also reduced (P < 0.05) by…Lactobacillus johnsonii [2020]
  • ” DAO, endotoxin and D-lactate levels were significantly reduced following chronic ethanol consumption.” [2019] — Have lots of alcohol to reduce D-lactate!
  • “the Lactobacillus plantarum group exhibited reduced serum levels of diamine oxidase (DAO) compared with the p-control group” [2019]
  • ” Bacillus amyloliquefaciens …  significantly decreased activity of DAO compared with aureomycin group. [2018]
  • “Bifidobacterium or Lactobacillus … reduced plasma DAO and D-lactate. [2014]

The latest incursions into the probiotic market of claims have posited the amelioration of oxidative stress via potent antioxidant attributes or limiting the administration of probiotics to those species that do not produce D-Lactic acid (i.e., claims that D-Lactic acid acidosis is linked to chronic health conditions)..there is no place in science and medicine that supports unsubstantiated claimsExtravagant industry based notions continue to fuel the imprimatur of distrust and skepticism that is leveled by scientists and clinicians at an industry that is already rife with scientific and medical distrust and questionable views on probiotics. 

Probiotics, D-Lactic acidosis, oxidative stress and strain specificity [2017]

Histamine Intolerance: The Current State of the Art [2020] is a very informative read

  • “DAO (EC 1.4.3.22), also called histaminase or amiloride-binding protein, is a copper-dependent amino oxidase encoded by the AOC1 gene located on chromosome 7 (7q34-36) [14,15,16]. ” – so raising copper levels above average may be helpful (but not in excess).
    • Note that this refers to KEGG Enzyme, a recent addition to the Microbiome Prescriptions – alas, none of the bacterias or fungi associated with this is reported in current uploads.
  • There is an alternative,  histamine-N-methyltransferase (HNMT). “Thus, depending on its location, the histamine present in the body is deaminated or methylated by the action of the enzymes DAO and HNMT, respectively “
    • ” Histamine N-methyltransferase (HNMT) is a histamine-metabolising enzyme expressed in the brain…Clinical studies have suggested that single nucleotide polymorphisms of the human HNMT gene are associated with several brain disorders such as Parkinson’s disease and attention deficit hyperactivity disorder. ” [2019]
  • ” DAO deficiency has also been linked to certain functional gastrointestinal disorders, such as carbohydrate malabsorption and nonceliac gluten sensitivity (NCGS) [63,73,77,78,79]. “
  •  It has been estimated that approximately 20% of the European population regularly take DAO-inhibiting drugs, which significantly increases the number of people susceptible to the adverse effects of dietary histamine [28]

This article gives a nice, high level summary

Fruits, Fresh Meat, and Legumes are the safest

It is important to note that not only probiotics can reduce DAO levels, but many common supplements can too:

Vitamin B1 and Vitamin C should be avoided with histamine issues

Bottom Line

Avoid probiotics unless there is a very compelling reason to use them (i.e. solid studies), Vitamin B1 and Vitamin C. Radical ways to improve DAO levels: lots of fluoride and alcohol (not recommended).

IMHO, the promoter of the probiotics products claiming help for histamine is under a moral obligation to demonstrate with a study that they work. For these products, a study with 15 control and 15 with brain fog/high d-lactate by lab, is a very very low cost study. Take DAO and D-Lactate readings at start for all, give them the probiotics for 30-90 days, remeasure… then publish. BEAUTIFUL MARKETING MATERIAL. The absence of such publications strongly suggests that this is now pure marketing hype (based on a logical idea and being “sold” on logic and not on evidence based studies). For D-Lactate study likely was done with no (or negative) results – which is exactly what was reported in the study below [that did get published, likely because it was a registered trial].

“Open-label pilot for treatment targeting gut dysbiosis in myalgic encephalomyelitis/chronic fatigue syndrome: neuropsychological symptoms and sex comparisons’ 2018 – very similar product to below. “A small, negative correlation was observed between change in D:L lactate concentration ratios and change in Streptococcus count for the total sample (r s  = − .243, p = .142). ” This is NOT STATISTICALLY SIGNIFICANT ( p < 0.01 is what we want to see). 

Probiota Histiminix

This product claims ” contains probiotic species that have been carefully selected to exclude those that are known to increase histamine in the gut.” They omit to state that it probably decrease DAO. It contains:

  • Bifidobacterium infantis
  • Bifidobacterium bifidum
  • Bifidobacterium longum
  • Lactobacillus salivarius
  • Lactobacillus plantarum (study cited above states this species reduced DAO)
  • Bifidobacterium lactis
  • Bifidobacterium breve

Post Script for those with Histamine issues

This page may be useful, it includes how to check for DNA mutations that can result in low DAO or HNMT.

Addendum

Using KEGG for DAO and HNMT, we do find that DAO and HNMT are produced (i.e. have the genes to produce) by the following which are not technically probiotics (not bacteria), but are called such by some people.

  • Fungi
    • DAO
      • Ascomycetes
      • Basidiomycetes
      • Microsporidians
    • HNMT
      • Ascomycetes
      • Basidiomycetes
      • Microsporidians

Ascomycetes in both cases contains Saccharomycetes, and these specific strains (both available as a “probiotic” ):

There have been no studies of these on human histamine impact. There are reported allergic reaction (rare).

Feedback

A reader forward this image

Image may contain: text that says "Microorganisms capable of degrading histamine (DAO producers) Leuconostoc mesenteroides Leuconostoc sp. Escherichia faecium sp.group Sarcina lutea Lactobacillus curvatus Lactobacillus sakei Lactobacillus sp. Weisella hellenica Capable of degrading food sources of histamine and may reduce total histamine load Possible future role of probiotics? Dapkevicius.M Nout MJR, RomboutsF Houben JH, Wymenga W. ogenic amine format ion and degradat.ion by potential ish silage starter ganisms ntemationalj ouma Food Microbiology 2000 7:107 euschner Heidel Hammes N. Histamine and tyramine degradat Microbiology 1998 39:1-10 by ood er International of Food"

I looked at the sources of this information — food processing. Such studies are very very difficult to work from — because of murky causality. Is the observed change due to antibiotics produced by them inhibiting the bacteria producing histamines. We are also dealing with a very high oxygen environment (compare to the body). What we need to answer the questions are human studies…. where they are tested, is the effect an increase or decrease of DAO. So far (see above), lowering of DAO.

The Dilemma of D-Lactate Free Probiotics

A reader asked me to do a review of Spectrumceuticals Pro4-50 D-Lactate Free Probiotics which contains

  •  L. rhamnosus,
  • B. lactis,
  • B. breve and 
  • B. longum

Custom Probiotics offers a similar one labeled with the strains.

  • L. Rhamnosus, Strain LR-32
  • L. Salivarius, Strain LS-33
  • B. Lactis, Strain BL-04
  • B. Bifidum, Strain Bb-06
  • B. Infantis, Strain Bi-26
  • B. Longum, Strain BL-05

The latest incursions into the probiotic market of claims have posited the amelioration of oxidative stress via potent antioxidant attributes or limiting the administration of probiotics to those species that do not produce D-Lactic acid (i.e., claims that D-Lactic acid acidosis is linked to chronic health conditions)..there is no place in science and medicine that supports unsubstantiated claims. Extravagant industry based notions continue to fuel the imprimatur of distrust and skepticism that is leveled by scientists and clinicians at an industry that is already rife with scientific and medical distrust and questionable views on probiotics. 

Probiotics, D-Lactic acidosis, oxidative stress and strain specificity [2017]

We should note a few things from the literature:

  • ” Gut permeability markers (D-lactate and diamine oxidase (DAO))  …. the serum DAO activity and D-lactate concentration significantly increased by fluoride” [2020]
    • Translation: No fluoride toothpaste or fluoridated water (beware of bottled water – it’s often sourced from civil fluoridated water systems)
  • “The indicators of intestinal mucosal barrier function, such as Dlactate, endotoxin, and diamine oxidase, were significantly improved and the systemic inflammation (interleukin 10) was attenuated after probiotic [live Clostridium butyricum plus Bifidobacterium infantis] therapy. “
  • “D-lactic acidosis is characterized by brain fogginess (BF) and elevated D-lactate and occurs in short bowel syndrome….  SIBO was more prevalent in BF than non-BF group.  After discontinuation of probiotics and a course of antibiotics, BF resolved and gastrointestinal symptoms improved significantly (p = 0.005) in 23/30 (77%).”  [2018]
  • “Compared with control, d-lactate content, diamine oxidase activity, and adrenocorticotropic hormone level in serum decreased significantly [with Bacillus licheniformis]” [2013]
  • “a stand-alone synbiotic treatment was started, specifically Bifidobacterium breve Yakult and Lactobacillus casei Shirota as probiotics, and galacto-oligosaccharide as a prebiotic. Serum D-lactate levels declined, and the patient has been recurrence-free for 3 years without dietary restriction.’ [2013]
  • ” she was treated with sodium bicarbonate and oral antibiotics. The probiotics the patient had taken were likely the cause of D-lactic acidosis and should therefore be avoided in patients with short bowel syndrome.” [2009]

The reader requesting this review cited “Open-label pilot for treatment targeting gut dysbiosis in myalgic encephalomyelitis/chronic fatigue syndrome: neuropsychological symptoms and sex comparisons’ 2018. Which used the above mixture. “A small, negative correlation was observed between change in D:L lactate concentration ratios and change in Streptococcus count for the total sample (r s  = − .243, p = .142). ” This is NOT STATISTICALLY SIGNIFICANT ( p < 0.01 is what we want to see). In fact, a chart in it illustrated the problem of using averages with the microbiome.

A small percentage had a dramatic effect with treatment — this cause the average to go down, but the change was not statistically significant (i.e. may be randomness)


Bottom Line

The apparent reason for the promotion of D-Lactate Free probiotics is to reduce D-Lactate levels. There is no gold standard (or even silver standard) evidence that the above probiotics will do that. The dominant successful way of treating D-Lactic Acidosis is with antibiotics and avoidance of probiotics.

The best documented, all probiotic treatment is:

  • Clostridium butyricum plus Bifidobacterium infantis
Promoter’s Moral Obligation

IMHO, the promoter of these products is under a moral obligation to demonstrate with a study that they work. For these products, a study with 15 control and 15 with brain fog/high d-lactate by lab, is a very very low cost study. Take DAO and D-Lactate readings at start for all, give them the probiotics for 30-90 days, remeasure… then publish. BEAUTIFUL MARKETING MATERIAL. The absence of such publications strongly suggests that this is now pure marketing hype (based on a logical idea and being “sold” on logic and not on evidence based studies). A study likely was done with no (or negative) results – which is exactly what was reported in the above study [that did get published, likely because it was a registered trial].

The Dilemma

The literature indicate that reducing D-Lactate also reduces DAO. Insufficient DAO is associated with Mast-Cell Activation and Histamine issues. There is a need for a balance here. A tightrope that may need to be carefully walked.

MAST CELL ACTIVATION SYNDROME (MCAS) and the Microbiome

A reader from Romania requested that I do a post on MCAS. It’s of special interest to me because some close friends appear to have this issue. I know from prior posts that there is limited professional knowledge that is effective, and most of it is symptom relief and not addressing the underlying cause.

I recently added a major component to my microbiome analysis site – enzymes from Kyoto Encyclopedia of Genes and Genomes. Witg this, we have had a significant number of microbiome samples shared to the site reporting Comorbid: Histamine or Mast Cell issues. One of the challenges is that there may be some fuzz since this is self reported.

In this post you will see that enzyme imbalances from a microbiome sample can lead to a root cause of some symptoms. In some cases, lead to actions that may moderate the symptom.

The process that I going to use, is simple:

  • Look at each species reported in each of 224 people microbiome (over 10,000 different bacteria species)
  • Look up the genes in each one of these species.
  • Look up which ones of 1600+ Enzymes each gene produced. Most bacteria produces many many enzymes – they have a lot of genes.
  • Look at statistically significant oddities in the enzymes of those reporting a certain symptom

When this data is pushed thru some artificial intelligence, one enzymes leaps out for MCAS, lipopolysaccharide 3-alpha-galactosyltransferase.

Actually the number is closer to 1200 — many of those with this symptom have zero of the bacteria producing this enzyme.

Four other enzymes are also suspect (and low) but without as strong statistical significance at present, as the one above.

We can also walk this bacteria-to-enzyme path backwards, from the enzymes that are low, we look up the genes that produces it, then from the genes identify the bacteria; as a final step, we see if any commercially available probiotics produces this enzyme. The thinking is simple: if you are short of an enzymes, then increasing enzymes may calm down the processes causing MCAS. We come up with two of them:

This looks like AI magic, machine learning of other evils of technology. Not quite, we can look for studies dealing with allergies and/or MCAS and see if either of these have been studied. First, we discovered that is not a single study on using the above to treat MCAS. For allergies, histamine reactions, we find significant literature

There are additional studies of these two lactobacillus species with other probiotics being effective with allergies (unfortunately with multiple probiotics being involved, things are unclear as to which part is helping). Note that most lactobacillus species do NOT produce this enzyme.

This is a Novel Approach

The body’s circulating metabolites/chemicals imbalances causing symptoms is well accepted. At present, there is testings of a few of the chemicals that can identify to a medical person that there is an imbalance. They do not provide a clear answer on what the source is. With the use of the microbiome down to the species (and strain) levels, we can estimate levels of over 1600 enzymes. If we have a sufficient reference population, we can identify major shifts. We also jump to an understanding of the root cause — which has eluded us before — our microbiome is not producing enough of certain chemicals due to the current composition of the bacteria population.

In the case of MCAS, it is too little of one specific enzyme. This enzyme happens to be produced by two probiotic species. We have also confirmed that these same two species are known to help allergies (but the exact method of helping is often speculated on).

People often want a simple explanation of how it is connected. Unfortunately when dealing with KEGG, we enter the world of a ton of biological wiring as shown by the chart below. This does not means that we can’t use this information; it just means that for most people, the how may be above their formal education and bandwidth.

From: https://www.kegg.jp/kegg-bin/show_pathway?ec01100+2.4.1.44

Let us return to this LOW enzyme for a moment and see what is in the literature about it or what is influenced by it: lipopolysaccharide 3-alpha-galactosyltransferase.

In other words. this enzyme seems connected to mast cells and its activation. Artificial Intelligence magic applied to a large data store of facts, gave us this enlightenment as to cause and suggestions on how to improve MCAS. We lack any case studies — but given the low risk, it is likely worth trying after consulting with your medical professional.

This same pattern can be applied to dozens of individual symptoms (see this page), or across a microbiome sample as a whole.

CAUTION: What is claimed to be in a probiotic may not be

This is a long standing problem with commercial probiotics — there is no effective regulation that what is advertised is actually in the bottle. In this case, we want specific species — ideally just those species.

My family’s usual source is Custom Probiotics – because their products have no filler, single species usually, and single strains. Unfortunately, they only sell one of these species: Lactobacillus Acidophilus with a recommended adult dosage of 160 BCFU/day. A list of commercial probiotics with claimed species is here, unfortunately L.H. is almost always in mixtures except for one UK source, Metabolics, species LMG 26307 (they also sell Lactobacillus Acidophilus, species LMG 8151) so an ideal single source for a MCAS person in the EU who wish to trial these suggestions.

If you an “off the shelf” probiotic mixture, your odds are better of actually getting the right species when the probiotic does not just say “lactobacillus helveticus” but gives a strain, i.e. one of these: ATCC:15009,  CCUG:30139,  CIP:103146,  DSM:20075IFO:15019JCM:1120,  BCCM/LMG:13555 BCCM/LMG:6413 NBRC:15019NRRL:B-4526 CGMCC:1.1877. It is available from manufacturers, i.e. creative enzymes.

  • “A new study by scientists at the University of California has found that contents of many bifidobacteria probiotic products differ from the ingredients listed….16 products.. only one matched the ingredient list .. Some products also contained non-label species” [Source 2015
  • “Current trademark law and the lack of stringent regulation of probiotic manufacturing mean that the trademark owner can commercialize any formulation under the same brand, even if significantly different from the original.” The Unregulated Probiotic Market
  • My earlier post: Deceptive Probiotic Labels

Genome Sequence of Lactobacillus helveticus, an Organism Distinguished by Selective Gene Loss and Insertion Sequence Element Expansion tells how unique this species is.

YouTube on the process used

Update on postural orthostatic tachycardia syndrome (POTS)

I have done prior posts on POTS (POTS Revisited) and been requested to check the latest research. Checking PUBMED statistics, we see there have been many papers in the last few years

From https://pubmed.ncbi.nlm.nih.gov/?term=+Postural+orthostatic+tachycardia+syndrome+&sort=pubdate&sort_order=asc

Trying Citizen Science

We have 55 samples annotated with POTS and we recently added enzymes to the system. Time to go on a statistical fishing expedition… and we found some fish, all of them small one (i.e. too low production)

EnzymeNamePOTS AverageNo POTS AverageTest StatisticObs
crotonobetainyl-CoA reductase1741500-5.3151128
L-carnitine CoA-transferase1771381-5.0420431
D-apionate oxidoisomerase5731541-4.5786129
nitrite reductase (NO-forming)531117941-4.4625451
5-aminopentanamidase590016862-4.3163151
phosphatidyl-myo-inositol alpha-mannosyltransferase552317379-4.1609450
cysteinylglycine-S-conjugate dipeptidase561117868-4.1582348
polyphosphate—glucose phosphotransferase562117638-4.0976448
8-oxo-dGDP phosphatase572517788-4.0517347
8-oxo-(d)GTP phosphatase593017351-3.9343248
lactocepin14118104-3.9051450
formyl-CoA transferase599817156-3.8491146
oxalyl-CoA decarboxylase623418799-3.8026339
galactofuranosylgalactofuranosylrhamnosyl-N-acetylglucosaminyl-diphospho-decaprenol beta-1,5/1,6-galactofuranosyltransferase571414910-3.6073450
lipid II isoglutaminyl synthase (glutamine-hydrolysing)829222101-3.593754
galactan exo-1,6-beta-galactobiohydrolase (non-reducing end)687619457-3.5312935
N-acetylhexosamine 1-kinase687619434-3.5263735
dehydrogluconokinase671018931-3.5200736
Pup amidohydrolase571815393-3.5116647
prokaryotic ubiquitin-like protein ligase571815393-3.5116647
all-trans-retinol dehydrogenase (NAD+)648417326-3.4796641
gamma-glutamyl hercynylcysteine S-oxide hydrolase687619217-3.4786735
glucosyl-3-phosphoglycerate phosphatase780418811-3.47450
isopenicillin-N epimerase636717710-3.4454638
2-acetylphloroglucinol acetyltransferase629515991-3.4397145
phosphatidylinositol dimannoside acyltransferase889920502-3.3803350
dolichyl-phosphate-mannose—protein mannosyltransferase815617812-3.3424654
sorbose reductase614415938-3.2934941
tRNA (adenine57-N1/adenine58-N1)-methyltransferase809318743-3.2685348
tRNA (adenine58-N1)-methyltransferase809318743-3.2685348

This is actually a happy path because for too low, we can identify probiotics that produces these missing enzymes. Three bifidobacterium are at the top of the list. Custom Probiotics daily recommended dosage for these are 350-400 BCFU /day.

bacillus pumilus8
bacillus simplex2
bacillus velezensis8
bifidobacterium adolescentis26
bifidobacterium animalis subsp. lactis bb-1226
bifidobacterium longum26
clostridium beijerinckii5
clostridium butyricum5
enterococcus durans1
enterococcus faecalis1
lactobacillus acidophilus4
lactobacillus helveticus4
lactobacillus kefiri2
lactobacillus paracasei2
lactobacillus plantarum1
lactobacillus rhamnosus (strain atcc 53103 / gg)2
lactobacillus salivarius2
lactococcus lactis3
leuconostoc lactis2
streptococcus thermophilus3

Bottom Line

We have deduced which probiotics should help POTS (if taken in sufficient dosage) by using citizen science on the annotated-with-symptoms uploads, the KEGG Enzyme data and statistics. We may not know the why’s of these enzymes missing causing POTS, but we have some ideas of where to start looking for explanations. Until then, we at least know what to try.

There have been NO STUDIES using Bifidobacterium probiotics with POTS published.

Again consult with your medical professional first.

Another Microbiome Analysis of a ME/CFS person

This person has an interesting set of symptoms for ME/CFS. 40 yo male. I am following the same pattern as the two previous analysis. Every ME/CFS person share some factors and are different in other factors. There is nothing that works for all ME/CFS people.

  • Symptoms
    • Depression
    • Irritability
    • Brain fog
    • Post exercise malaise
    • Tinnitus
    • Post nasal drip
    • Stuffy nose
    • Cold extremities & insensitivity to cold
    • Fragmented sleep
    • Low libido
    • Low appetite
    • Frequent bowel movements
  • I’ve had different tests and bloodwork done over the years and these were the common outliers:
    • Low DHEA-s
    • Very high B12
    • High Vitamin D despite not supplementing
    • Low Estradiol (E2)
    • Mild blood coagulation
    • High(ish) eosinophils% (~5%)

Looking at Naive Predicted Symptoms From Bacteria table, we have:

There are more hits than the last person (who reported that fatigue has improved) – and gender prediction is wrong.

Enzyme Analysis

The awesome results in a past post on an autism child, where the enzymes were identified as coming from bacteria species constantly reported as high with Autism, is causing me to look at enzymes shifts as a good strategy to identify the key bacteria to look at.

So the next step is to look for probiotics that can also produce these enzymes.

Any of the probiotics with a 5 is good and sufficient. A higher BCFU is desired.


The easiest combination to obtain retail from the above are clostridium butyricum (Miyarisan ) which produces all 5 enzymes! or any of bifidobacterium adolescentis, bifidobacterium animalis subsp. lactis bb-12, and bifidobacterium longum. The latter ones (without additives) are available at Custom Probiotics (with a recommended daily dosage of 320-400 BCFU/daily) at the lowest cost per BCFU that I have seen.

KEGG Module Analysis

This is another way to evaluate the functions of the bacteria in a microbiome sample. There are less items then with Enzymes and, to be honest, I have not examined the results much after adding the code and data to compute them. There was nothing there.

End Product Outliers

Nothing was found outside of the ranges, and looking at Core Supplements there was one item of concern, high d-lactate production. High D-lactate is associated with neurological issues. (See these posts: Killing Lactobacillus to improve Brain Fog, Approaches to D-Lactic Acidosis). We also see that the microbiome suggests high B-12 (at 76%ile) which the labs report.

Unlike my last post on an autism child, there were no high enzymes to indicate the troublesome bacteria.

We turn to the Advance Suggestion engine and apply some filters.

Pass 1 for suggestions

First from Citizen Science we look at filtering for neurological decision making and drive a blank until we widen the search as shown below

The prior ME/CFS person require a 9% level to get any suggestions

Looking at the suggestions, we only find one item in common with the prior ME/CFS person: inulin (prebiotic).

Vitamin B12 is called out explicitly as a to-avoid.

Top probiotics suggestions all contain  saccharomyces boulardii. Flavonoids are a short list

This is close to my usual breakfast for many months: Barley porridge with walnuts!

Pass 2 for suggestions

We change the filtering to CFS/ME and drop back to the most extreme 3% – where we get results

There was no items over 0.5 for to take, we just have a critical list of items to decrease,

We have a conflict on triphala. One subset of bacteria says to use it, a different subset says not to use it. Given that it’s the highest value in both cases we need to do an experiment. I would advocate doing triphala for 4-6 weeks to see if it improves neurological issues, then stop it and re-evaluate.

We have a long list of probiotics, all with appropriately the same value

Rerunning with only probiotics, we find just one lactobacillus plantarum (probiotics)

Bottom Line

Remember this is strictly on the basis of the microbiome and our current state of knowledge in interpreting and being able to act on it. It is important not to view microbiome analysis as a magic silver bullet. A summary of suggestions to discuss with your medical professional.

In summary, clinical studies have tested some substances on various conditions which have been reported on PubMed. Microbiome analysis is based on microbiome shifts reported on PubMed by consuming some substances (ignoring medical conditions usually). If you construct a full list of both sets of substances, you will likely have only 10-20% of the substances in common. What has been studied in one context, has not been studied in the other context. Microbiome analysis is complimentary, not a replacement.

As always, to be reviewed with your medical professional before starting. There are algorithm/artificial intelligence generated suggestion based on data that has been entered (usually from gold standard sources).

Postscript on High Vitamin D

See these posts:

Feed back from person

” Indeed very insightful! Strangely enough, walnuts, tea and inulin both made me feel better despite not knowing why and your analysis make a lot of sense.”