Sleuthing With Regards To Respiratory Alkalosis And Low C02

[Caitlin]

Hi All,

I wanted to reach out and see if anyone could help me with some physiological “sleuthing.”

I am a 41-year-old female and I have been living in a state of hypoxia and respiratory alkalosis for about ten years. My muscles are permanently weak and as a result of chronic hyperventilation, and not enough oxygen is reaching my cells (per the Bohr Effect). I’m weak and out of breath all the time.

I don’t know how or why this started, but when it began when I was on an extremely low-carb Paleo diet for about 2 weeks. I don't know if that is causation or correlation or just coincidence. And in the years prior to this occurring, I was on birth control and Aldactone (a drug that can lower potassium) for about ten years for Polycystic Ovarian Syndrome. My hypoxia and chronic hyperventilation started in 2011, and I have been living with it ever since. I have seen countless doctors about it, but no one can figure it out. Myself included.

I don’t have a thyroid anymore (it was taken out in 2011), although my symptoms started before shortly before it was taken out.

In addition to the hypoxia, I have really bad acid reflux and a vagal neuropathy. Despite the fact that I have eaten a healthful, low inflammation diet for years (gluten free, mostly paleo-ish) the otolarynologist told me it was some of the worst reflux she has even seen. Also, my hair falls out when I brush it, and I can also see that food isn’t properly digested in my stool. I burp constantly. My legs itch a lot and there's no rash. I have been told that reflux can be counterintuitive and the result of not having enough acid in the stomach. That said, I have tried supplementing with HCL on several occasions and that hasn’t worked either. So I don’t know what to think.

I have tried adding more salt to my diet, thinking that this issue is tied to my thyroid and an electrolyte imbalance, but to no avail. I increased my salt intake to 2 tsp a day and felt much worse. I’ve also tried Buteyko breathing. I practiced Buteyko religiously for several months, thinking that that would finally heal me, but as hard as I tried I couldn’t alter the hyperventilation and bring up my CP.

The one thing that has helped me is an African plant medicine called iboga, from which ibogaine comes. I tried this plant out of desperation and frustration, and it was miraculous. That said, the healing effects lasted only about 1-2 weeks and then the hyperventilation and respiratory alkalosis returned. During every Iboga ceremony I experienced intense burping where trapped air exited my body by what seemed like the liter. The belches were dragon-like and painful. But once the 4-5 hours of constant burping were over, I could breathe again, and oxygen flooded to the rest of my body. My strength returned too. I felt new again. After each iboga ceremony I would feel great, but my respiratory problems would return within two weeks. Each time I did iboga the same thing would happen.

Because iboga/ibogaine is a schedule 1 drug, it has not been heavily studied. I have been told that iboga is a calcium channel blocker, and that it inhibits hERG channels, whatever that means. I have had my electrolytes tested throughout the years, and haven’t found any anomalies. Maybe there is one that hasn't been tested. According to the ENT, I don't have a hiatal hernia either.

I have been on Gabapentin and Amitryptiline for several months per the otolaryngologist’s instructions (because of the vagal neuropathy). I was also put on an H2 blocker, Zantac. After a few weeks I got better. My hyperventilation improved and my CO2 levels rose a little bit. I was so excited! But then things went downhill again as soon as they improved.

People seem extremely intelligent in this forum and perhaps something I have written above sparks a thought or an idea or something that I can explore. Can you think of any tests that I can have done that could provide some insight? Or any obscure syndrome that could be causing this? If you have any insight – any at all – I would love to hear it. I am so sick of being sick and want to feel better. I am surviving, but I am not living. Both doctors I have seen have not heard of the Bohr effect, and don't know how to move forward with my situation. Perhaps someone here could offer a tip or the smallest bit of insight that could help me.

Thanks!

Caitlin

 

[charlie]

B vitamins raise CO2.

 

[Caitlin]

B vitamins raise CO2.

Thanks, Charlie. I have tried taking B Vitamins -- and B 12 specifically -- multiple times and nothing changed, unfortunately. I was hoping that pernicious Anemia or a B12 deficiency was the answer, but sadly supplementing didn't change anything

 

[aguilaroja]

If the thyroid was removed (reportedly here in 2011), chances are that one of the physicians has prescribed some supplementary replacement thyroid. Dogmatic thyroid replacement is L4/levothyroxine/Synthroid only. It is rare, in "anecdotal" experience, that T4-only-replacement has thyroid-less people feeling well.
If there has been no replacement thyroid to boost function, many symptoms of decline would be expected.

The role of thyroid in supporting metabolism is a long time theme of Dr. Peat:
Thyroid: Therapies, Confusion, and Fraud

If there has not been added T3/liothyronine/cytomel since that time, please look into supplementing both T4 &T3. There are many posts on the forum in the Peat resources about how to do this, which include monitoring resting temp, pulse, symptoms and reflexes to track improvements. Bioidentical thyroid supplements vary in quality, even if "generically" equivalent. The true measure of effectiveness is relief by symptoms and signs. Avoid accepting blood test results, nor their usual interpretations, as the full assessment of thyroid effectiveness.

This is an accessible starting point, with prospect of bringing rapid improvement.

 

[lampofred]

Have you ever gotten a test for lactic acid? Without enough active thyroid hormone (T3), your glucose won't go all the way to CO2 and lactate will build up, leading to low blood sugar, panic attacks, hyperventilation, etc. Methylene blue and vitamin B1 reduce lactic acid production, I think niacinamide helps to clear existing lactate from the brain but I would be careful about supplementing that if you don't have T3 because it can make you severely hypoglycemic, and since the situation sounds extreme dichloroacetate (which poisons glycolysis, forcing you to produce CO2, but is unhealthy in the long-run) might also be worth a try.

 

[Caitlin]

Hi Aquilaroja and Lampofred,

Thanks so much for your feedback. Oddly, the hyperventilation and muscle weakness started just before I had my thyroid out in 2011. I should have mentioned this in my original post, but in the past 8 or so years I have tried supplementing with Cytomel in addition to the T4. At one time I tried just using time-released Cytomel morning and night. I am taking Levothyroxine now, but for years I took Tirosint (a gel-based T4) with Cytomel and that didn't make a difference. That's why I am back on the generic. So I guess in total, the only three things I have taken so far are Synthroid, Tirosint and Cytomel. I have done so many different thyroid tests (even Reverse T3 and all that jazz) but maybe I'm still not looking at the right thing. That's interesting about the lactic acid. I have never tested it before. I wouldn't be surprised if it were high. My legs are stiff and creaky and contracted ALL the time. It feels like I am going through low-grade rigor mortis.

Do you any of you know how lactic acid relates to acid production or burping? I know the burping is my body trying to tell me something. I just can't figure out what.

Thank you again.

 

[tara]

Hi Caitlin, welcome. Sorry you are struggling.

I second reading Peat on thyroid. There are more articles on his site too.

Despite the fact that I have eaten a healthful, low inflammation diet for years (gluten free, mostly paleo-ish)

Do you want to spell out what this means? Healthful diet means so many different things to different people - even paleo means quite a wide range of diets apparently. What have you been eating? Have you had a go at running a few typical days through cronometer to get a rough idea of the basic nutrients in it?

 

[CrystalClear]

Hi Caitlin, welcome to the forum. Sorry to read of your struggles.
I have issues similar to you regarding respiration. I'm a bit older and have experienced strong chronic stress of various types all my life. Part of that was dieting - on and off for years. I became very hypothyroid due to liver dysfunction.
I also have tried over time to improve my breathing like you, with buteyko and trying as many things in the Peat nutritional toolbox as possible.

I haven't noticed much improvement since it doesn't take much effort before I am hyperventilating. I make sure I keep breathing through my nose. But there might be subtle improvement.
Have you tried a bit of bicarb of soda to calm your breathing? It helps to oppose the lactic acid that occurs with faulty respiration. Haidut also says Methylene Blue can work like oxygen when O2 it is lacking.

Getting back to consuming sugar and all the good things Peat recommends puts us on the path to healthier respiration and a more functional life. I have lost quality of life with hypothyroidism - I got very stuck, no motivation and dragging fatigue. I am becoming more functional now after three years.

I've been benefiting from the Live podcast Danny Roddy and Haidut (Georgi) have been doing every second Friday. Perhaps you might find it good too.

Wish I could help more.

 

[opiath]

How long does it take for your forearm to get red after you scratch it with one of your nails?
Is it more than 30-40 seconds?

 

[Caitlin]

How long does it take for your forearm to get red after you scratch it with one of your nails?
Is it more than 30-40 seconds?

Hi there. It gets red within 4-5 seconds.

 

[Caitlin]

Hi Caitlin, welcome. Sorry you are struggling.

I second reading Peat on thyroid. There are more articles on his site too.


Do you want to spell out what this means? Healthful diet means so many different things to different people - even paleo means quite a wide range of diets apparently. What have you been eating? Have you had a go at running a few typical days through cronometer to get a rough idea of the basic nutrients in it?

Hi there,

In terms of the diet, I guess it means that I have tried almost every diet there is and have stuck to low-inflammation foods. Extremely low sugar (processed sugar), no processed foods, no alcohol, no dairy, no gluten, no caffeine. I have done the grain-free thing for a while, and I have even been vegan. Eaten good fats, etc. And I agree, obviously a healthful diet is different for everyone. I feel worse when I drink caffeine, eat significant sugar, eat beans, etc., but I don't necessarily feel "Good" when I don't eat them. Just low to average. I haven't heard of a cronometer before, but I have kept all sorts of journals.

I first tried eating gluten-free and paleo back in 2011. I was having really SIBO symptoms and I was convinced I had some sort of parasite or candida. I decided to combine the Paleo diet with the GAPS diet and more or less try to "starve" out the parasite, or whatever was there. Years later I did finally confirm that I had a parasite at one point (e. histolytica), but symptoms come and go. Sometimes my digestion is great. Other times I have gas and constipation. Anyway, I do know that my weakness issues started within a week or two after going on a hardcore Paleo diet in 2011. The diet helped with so much inflammation in my body -- back pain I had had for years disappeared for the first time. But a couple months later I realized that not eating enough carbs could have caused the weakness. I tried adding them back in, and in the years following, tried many incarnations of diets and carbs. And I still have the weakness. I just wonder if there was something that was about to "tip" back then and I irreparably pushed myself over the metabolic edge by doing that hardcore diet back then.

Thanks for your insight!

 

[Caitlin]

Hi Caitlin, welcome to the forum. Sorry to read of your struggles.
I have issues similar to you regarding respiration. I'm a bit older and have experienced strong chronic stress of various types all my life. Part of that was dieting - on and off for years. I became very hypothyroid due to liver dysfunction.
I also have tried over time to improve my breathing like you, with buteyko and trying as many things in the Peat nutritional toolbox as possible.

I haven't noticed much improvement since it doesn't take much effort before I am hyperventilating. I make sure I keep breathing through my nose. But there might be subtle improvement.
Have you tried a bit of bicarb of soda to calm your breathing? It helps to oppose the lactic acid that occurs with faulty respiration. Haidut also says Methylene Blue can work like oxygen when O2 it is lacking.

Getting back to consuming sugar and all the good things Peat recommends puts us on the path to healthier respiration and a more functional life. I have lost quality of life with hypothyroidism - I got very stuck, no motivation and dragging fatigue. I am becoming more functional now after three years.

I've been benefiting from the Live podcast Danny Roddy and Haidut (Georgi) have been doing every second Friday. Perhaps you might find it good too.

Wish I could help more.

Thanks, Crystal. I appreciate all of this. I know there's something more going on with the thyroid, it's just so tough to say what. I'm fatigued a good majority of the time, my hair is falling out. Yet I get my numbers in the normal range and I still have the hypoxia and hyperventilation. I was convinced all of this could be related to mouth breathing. I started nose breathing more, and sleeping with paper tape on my mouth to encourage it (as per the suggestion of two different dentists). I even had a frenectomy to fix a tongue tie that I thought could have contributed to the mouth breathing and therefore the hyperventilation. Getting the tongue tie fixed has helped other things, but it hasn't changed anything with regards to my hyperventilation. Now I am much more conscious of the nose breathing. When I walk it is hard to breathe only through my nose, but I try to walk slowly enough to make sure I do it.

I have tried adding bi carb to my water. I did it a good amount this winter, especially when I was doing Buteyko. I seemed to get a little bit of a boost from it, but nothing major. I tried it again the other day, thinking that I should revisit it. I put about 1/2 tsp in water. The rest of the morning I was ridiculously fatigued. I have no idea if my fatigued stemmed from it or it was just coincidence. How much do you take a day?

Thanks for the recommendation about Danny Roddy. Oddly enough I used to listen to him and Chris Kresser's podcast back in the day when I was first trying to sleuth all of this. He was the first person from whom I ever heard of Ray Peat. Then my Buteyko coach mentioned Peat so I started looking into him more. I will look into DR's podcasts. Thanks!

 

[tara]

Hi Caitlin,
Without a thyroid, getting that right is probably at the top of the list. T4 and T3 - some people seem to need to supplement both T4 and T3, either synthetics or natural, and getting the levels right is personal and can take time. Bear in mind that T4 has a long half-life - it can take 3 weeks for a steady dose to reach a stable blood level. So it can be dosed once (or twice) a day, and changes need to be made slowly - like monthly. Whereas T3 has a short half-life, I think a healthy thyroid naturally only produces about 3-4 mcg per hour, and it's better dosed small a few times a day, so you don't get big ups and downs, and it can be adjusted quickly.

Cells also need reliable fuel and materials to work with. Thyroid hormones without fuel can be stressful.
It's tough when there are lots of things that are hard to digest. Seems like there are a lot of things you are not eating - but I'm still wondering what you are eating. Living on fat?
cronometer.com - you can put in foods and it estimates how much fats, carbs, protein, micronutrients in them, and totals up for a day, etc. So you can get a rough idea of whether you are low on particular minerals or vitamins or calories or something. (Don't put any store by its generally low-calorie advice - the site's about calorie restriction, which can have a negative effect when you want to raise metabolism.)

 

[lampofred]

Hi Aquilaroja and Lampofred,

Thanks so much for your feedback. Oddly, the hyperventilation and muscle weakness started just before I had my thyroid out in 2011. I should have mentioned this in my original post, but in the past 8 or so years I have tried supplementing with Cytomel in addition to the T4. At one time I tried just using time-released Cytomel morning and night. I am taking Levothyroxine now, but for years I took Tirosint (a gel-based T4) with Cytomel and that didn't make a difference. That's why I am back on the generic. So I guess in total, the only three things I have taken so far are Synthroid, Tirosint and Cytomel. I have done so many different thyroid tests (even Reverse T3 and all that jazz) but maybe I'm still not looking at the right thing. That's interesting about the lactic acid. I have never tested it before. I wouldn't be surprised if it were high. My legs are stiff and creaky and contracted ALL the time. It feels like I am going through low-grade rigor mortis.

Do you any of you know how lactic acid relates to acid production or burping? I know the burping is my body trying to tell me something. I just can't figure out what.

Thank you again.

Just a thought but RP has said in some cases the body doesn't respond to thyroid until the t3:t4 ratio is 3:1 or even 2:1, and the buildup of t4 without t3 can actually inhibit oxidative metabolism (increasing lactic acid and lowering CO2) even more than not taking thyroid at all. Have you ever tried T3 only?

And lactic acid is pretty closely related to acidity in the body because I think it's the primary substance that increases extracellular acidity. I don't know how it relates to burping directly, but I notice that I have more gas in general on days that I have more symptoms of lactic acid excess.

Gas also makes me think of endotoxin, which can definitely impair metabolism on a grand scale.

 

[opiath]

Hi there. It gets red within 4-5 seconds.

This means your cells have high mineralocorticoid action and retain sodium because:

A.You have metabolic acidosis and your body is retaining the sodium using aldosterone in order to ventilate faster and get rid of CO2

or

B. Long term Aldactone intake upregulated your aldosterone receptors which lead to your body loosing balance and now something is missing to reset the receptors and you are stuck in sodium-retaining potassium-wasting state.

 

[Caitlin]

Just a thought but RP has said in some cases the body doesn't respond to thyroid until the t3:t4 ratio is 3:1 or even 2:1, and the buildup of t4 without t3 can actually inhibit oxidative metabolism (increasing lactic acid and lowering CO2) even more than not taking thyroid at all. Have you ever tried T3 only?

And lactic acid is pretty closely related to acidity in the body because I think it's the primary substance that increases extracellular acidity. I don't know how it relates to burping directly, but I notice that I have more gas in general on days that I have more symptoms of lactic acid excess.

Gas also makes me think of endotoxin, which can definitely impair metabolism on a grand scale.

Thank you! Good to know. Back in the day, immediately after getting my thyroid out, I did take T3 only. Just Cytomel. But I wasn't doing well and was really really tired. So then they had me on a combination of Tirosint (gel cap t4) and Cytomel. And then I was on just Synthroid and Cytomel. When I was in Peru two years ago I was robbed and my Cytomel was stolen along with everything else valuable) T3 isn't really sold in Peru, so I switched to generic T4 and didn't really notice a difference. I mean, I still didn't feel well, but it's not like I felt significantly better with the Cytomel. My Buteyko practitioner mentions a T3 thyroid supplement that people get from Mexico. Is that different from Cytomel? And if so, how is it different? Apparently you chew on it throughout the day? Thank you so much!

 

[Caitlin]

This means your cells have high mineralocorticoid action and retain sodium because:

A.You have metabolic acidosis and your body is retaining the sodium using aldosterone in order to ventilate faster and get rid of CO2

or

B. Long term Aldactone intake upregulated your aldosterone receptors which lead to your body loosing balance and now something is missing to reset the receptors and you are stuck in sodium-retaining potassium-wasting state.

Hmmm... very interesting. I have looked into all of those things but never really understood them correctly. For years I wondered if maybe I put myself in ketoacidosis or something (I don't fully understand it so I don't want to pretend I do). How does respiratory alkalosis (what I believe I have with the low C02) relate to metabolic acidosis or the other types of acidosises? I did have my potassium tested throughout the years and it was normal. I remember at one point feeling convinced that that was it. But my levels were normal. And then on top of that, supplementing with Potassium didn't really change anything. Thank you for this insight. I really appreciate it.

 

[Caitlin]

Hi Caitlin,
Without a thyroid, getting that right is probably at the top of the list. T4 and T3 - some people seem to need to supplement both T4 and T3, either synthetics or natural, and getting the levels right is personal and can take time. Bear in mind that T4 has a long half-life - it can take 3 weeks for a steady dose to reach a stable blood level. So it can be dosed once (or twice) a day, and changes need to be made slowly - like monthly. Whereas T3 has a short half-life, I think a healthy thyroid naturally only produces about 3-4 mcg per hour, and it's better dosed small a few times a day, so you don't get big ups and downs, and it can be adjusted quickly.

Cells also need reliable fuel and materials to work with. Thyroid hormones without fuel can be stressful.
It's tough when there are lots of things that are hard to digest. Seems like there are a lot of things you are not eating - but I'm still wondering what you are eating. Living on fat?
cronometer.com - you can put in foods and it estimates how much fats, carbs, protein, micronutrients in them, and totals up for a day, etc. So you can get a rough idea of whether you are low on particular minerals or vitamins or calories or something. (Don't put any store by its generally low-calorie advice - the site's about calorie restriction, which can have a negative effect when you want to raise metabolism.)

got it, good to know. I mentioned this to Lampofred, but I heard about the thyroid you get from a pharmacy in Mexico and want to explore that. Just trying to learn more about how it is different from Cytomel. My Buteyko practitioner mentioned something about chewing it throughout the day?

re: eating, for the past few months I have been on a low acid diet, so it's been a little bit different from different diets I have explored in years past. In the morning I will have a smoothie with avocado, english cucumber, watermelon or cantaloupe, banana, spinach, and almond milk and protein powder. For lunch and dinner I will have chicken or salmon or a turkey burger with things like ginger and cilantro and parsley and basil. I sauté veggies like zucchini, spinach, mushrooms, and leeks in olive oil. I steam veggies a lot and make broccoli and cauliflower. I make sweet potatoes and rice and occasionally will have cassava and yucca. I eat nuts from time to time, but not a huge amount. No dairy, really, just almond milk or pumpkin seed milk in my smoothies from time to time. Ginger and chamomile tea in the morning. No coffee. I do have gluten free bread occasionally, but not a lot. I haven't used a ton of oils because of this whole acid reflux thing. I haven't had red meat in a while as a result either, and not a ton of fats either (with the exception of the avocado and olive oil). Occasionally I will make fresh hummus but chickpeas tend to give me bad gas, so I don't have them a lot. No citrus, vinegar, garlic, onion, mint, and chocolate either because they apparently activate pepsin that has come up in to the throat of they loosen the LES.

I have tried so many different diets and I haven't found one that spoke to me. Gluten and dairy definitely don't work. Foods high in sugar don't either. I do have carbs throughout the day and sugar from the fruit in the morning. And I eat a lot of watermelon because it's one of the few fruits I can eat on this "low-acid" diet.

Anyway, I do believe diet plays a big role in my health and well-being, but at this point I have tried so many different incarnations of things and haven't felt a significant difference in my hypoxia that I feel there's got to be something larger going on physiologically.

Thanks again for all of your insight!

 

[Caitlin]

Also, I should add that there are so many things malfunctioning in my body (thyroid, autoimmunity, gut health, vagal neuropathy, acid reflux, and the low C02/hypoxia) that I don't know what is a primary symptom and what is a residual effect from other things in the body malfunctioning.

I know there's
1) Low c02 - hyperventilation (I've done various capnometer tests and obviously the low CP also confirms it)
2) vagal neuropathy
3) acid reflux - my throat and larynx were super inflamed "scorched" by acid the otolaryngologist said.
4) constant burping. This burping is a symptom of something not happening correctly in my body and it's trying to adapt. It's constant. That said, when I did the iboga, the healing (albeit temporary healing) came after a long session of insane burping. So burping seems like it can be a positive and a negative thing:)

Thank you all.

 

[SOMO]

Also, I should add that there are so many things malfunctioning in my body (thyroid, autoimmunity, gut health, vagal neuropathy, acid reflux, and the low C02/hypoxia) that I don't know what is a primary symptom and what is a residual effect from other things in the body malfunctioning.

I know there's
1) Low c02 - hyperventilation (I've done various capnometer tests and obviously the low CP also confirms it)
2) vagal neuropathy
3) acid reflux - my throat and larynx were super inflamed "scorched" by acid the otolaryngologist said.
4) constant burping. This burping is a symptom of something not happening correctly in my body and it's trying to adapt. It's constant. That said, when I did the iboga, the healing (albeit temporary healing) came after a long session of insane burping. So burping seems like it can be a positive and a negative thing:)

Thank you all.

I read that acid reflux is caused by undigested food traveling from the stomach into the small intestine and then the SI "sensing" that it is undigested, it forces it back up into the stomach and esophagus, in other words a DEFICIENCY of stomach acid, not an excess.

Basically the food is going stomach -> small intestine -> stomach

I'm skeptical anyone has too much stomach acid. The stomach is supposed to be extremely acidic and if not adequately
Too much stomach acid ensure the food is properly digested, and you claim the food leaves you undigested.

I would look into:
-Betaine
-Digestive enzymes (with pepsin, proteases, + ox-bile)
-Bromelain
-Extra salt in combination with the above ^. Salt increases stomach acid.



And excessive burping (which I had in the past) is pretty much a sign you have SIBO.
I would try Rifaximin + another antibiotic to reduce SIBO. After Rifaximin excessive dragon burps stopped.


As far as increasing CO2, try plain baking soda + magnesium carbonate on an empty stomach first thing in the morning.