Doctor Detective with Bryan Walsh


In this week’s case study, the patient is a young student with empty pockets and a nagging yeast infection. Sounds innocuous enough—but it turns out that her “problem” is really a symptom of diabetes, and she needs insulin. The patient can’t afford a hospital visit. Can Doctor Detective reduce her glucose until she sees her allopathic doctor?

Eat less and exercise more. It’s generally a great prescription for improving health and improving body composition. However, it doesn’t always work.

Even with an awesome exercise plan and a rock-solid diet, some people suffer from mysterious symptoms and complaints that seem puzzling, given how much effort they put into their fitness and health.

When we meet clients who have problems that exercise and nutrition — not to mention their own doctors — can’t seem to solve, we know there are only a few experts on the planet to turn to. One of them is Bryan Walsh.

Dr. Walsh has a sharp mind, a fitness background, a degree in naturopathic medicine, and extensive additional training and certifications. His wife is a naturopath too. (We bet his kids are the healthiest on the planet.)

When clients have nowhere else to turn, Dr. Walsh turns from mild-mannered dad and husband into forensic physiologist. He pulls out his microscope, analyzes blood, saliva, urine, lifestyle – whatever he has to, in order to solve the medical mystery.

When Dr. Walsh volunteered to work on a regular case study feature with us, we jumped at the chance. By following along with these fascinating cases, you’ll see exactly how a talented practitioner thinks. You’ll also learn how to improve your own health.

In today’s case, we’ll meet a client who thought she ate healthily, but still suffered nagging yeast infections. Turns out, the problem was more serious — and, sadly, more common — than she expected.

Learn how “Doctor Detective” Walsh unraveled the mystery and radically improved his client’s health with just a few simple changes.

Blood chemistry testing is one of the most inexpensive and illuminating laboratory tests available. That’s why we recommend an annual blood chemistry panel to everyone, regardless of how they feel.

At minimum, your annual blood tests will provide you with some basic biochemical data. And who knows? Someday, that data may help you play detective on yourself.

For example, if you happen to notice that your hemoglobin has been falling successively over a period of years, you might want to get your colon checked; one study links progressive hemoglobin reductions to colon cancer. Wouldn’t you rather catch that in the early stages?

Not only is blood chemistry testing good insurance, but as this month’s case demonstrates, it can also reveal the answers to unsuspected mysteries. It might even save your life.

The client

Nicole, a 31 year old yoga instructor and acupuncture student, contacted our office originally for her chronic vaginal yeast infections. A strict vegan, Nicole exercised regularly, meditated, was mindful of what she ate, and took supplements. In fact, apart from some stresses associated with being a “starving student”, she seemed to be doing everything right.

When asked about her overall health, she claimed to feel pretty good most of the time. Oh, maybe once in a while she got a bit fatigued, she admitted, but mostly, she felt fine. If only she could eliminate those pesky recurring infections…

It was time for Doctor Detective to get to work. Little did I know what I would find.

The client’s signs and symptoms

Signs / Symptoms My thoughts – potential issues
Vegan (not a sign or symptom, but significant) Possibly anemic, possibly deficient in vitamin B12, iron, choline
Vaginal yeast infections Abnormal vaginal pH, possible functional metabolic acidosis, gut dysbiosis, STDs, estrogen/progesterone imbalance
Fatigue Anemia, thyroid, adrenal, sex hormones, blood sugar

Based on Nicole’s chief complaint of vaginal yeast infections, we could have simply treated her with natural anti-microbial herbs both vaginally and systemically. But being detectives at heart, we’re always interested in looking for the underlying causes. So the next step was to run lab tests.

The tests and assessments

We had a few tests in mind for Nicole, including salivary hormones and a stool test to look at possible dysbiosis, but given that she was a student and didn’t have a lot of disposable income, we decided to start with — you guessed it! — a standard blood chemistry panel. We told you blood chemistry was good value for money.

The test results

Blood chemistry panel

These are Nicole’s lab findings:

Marker Result Lab Reference Range Thoughts
WBC 10.6 x10^3/uL 4.0-10.5 Elevated – possible acute infection
Hemoglobin 15.1 g/dL 11.5-15.0 Elevated – usually dehydration and/or elevated testosterone
Hematocrit 45.3% 34.0-44.0 Elevated – usually dehydration and/or elevated testosterone
MCV 100 fL 80-98 Elevated – possible B12 and/or folic acid deficiency
MCH 33.3 27.0-34.0 Borderline high – possible B12 and/or folic acid deficiency
Eosinophils 8% 0-7 Elevated – allergies and/or parasites
TSH 1.78 uIU/mL 0.450-4.500 Normal
T4 (thyroxine) 5.4 ug/dL 4.5-12 Borderline low – with low-normal TSH, likely a pituitary issue, need to investigate further
T3 uptake 41% 24-39 Elevated – low thyroid binding globulin, possibly due to elevated testosterone and/or poor liver function
CO2 22 mmol/L 20-32 Borderline low – possible functional metabolic acidosis, often due to blood sugar issues
Potassium 5.6 mmol/L 3.5-5.2 Elevated – possible kidney issues, insulin deficiency, excess RBC destruction, adrenal dysfunction, poor blood draw
Cholesterol 161 mg/dL 100-199 Normal*
Triglycerides 107 mg/dL 0-149 Normal*
Vitamin D 25 ng/mL 32-100 Low – cause unknown

Based on these tests, we can see that Nicole has possible vitamin B12/folic acid deficiency, elevated testosterone, low thyroid hormone, elevated potassium and possible blood sugar issues. But none of those compare to the following marker, which explains many of her other markers:

Marker Result Lab Reference Range Thoughts
Fasting glucose 350 mg/dL 65-99 Elevated – diabetes, possibly non-fasting

A fasting glucose above 100 mg/dL typically indicates blood sugar dysregulation, so a fasting glucose of 350 mg/dL obviously indicates that something very significant is going on.

Still, glucose can be a relatively transient marker, so as canny detectives, the first thing we did was ask Nicole if she went into that first blood draw in a fasted state. She confirmed that she had, indeed, been fasting. Hmmm. Things weren’t looking good for our patient.

To double check the result, we wanted to test again. Fortunately, Nicole had access to a glucometer, so we had her take her fasting blood sugar the next morning. This second measurement was 375 mg/dL.

All signs were pointing to diabetes.

But was it Type I or Type II? The answer is important, because the treatments will differ. In particular, Type 1 diabetics need exogenous insulin.

Type II diabetics are typically overweight and have a poor diet and lifestyle. That didn’t seem to describe Nicole. Meanwhile, Type I diabetes, which used to be called juvenile diabetes, is most often discovered during childhood—but Nicole had never shown symptoms of diabetes as a kid.

Time to put on our detective hats again. We ran some more tests to help determine what was going on.

Marker Result Lab Reference Range Thoughts
Hemoglobin 16.8×10^3/uL 4.0-10.5 Very elevated – Long-term blood sugar dysregulation, probably kidney, nerve and retinal damage taking place
C-Peptide 0.9 ng/ml 1.1-4.4 Pancreatic peptide that correlates with insulin production. Low C-peptide may indicate low insulin levels.
Anti-GAD Antibodies 8.3 0.0-1.5 Indicates an immune attack on glutamic acid decarboxylase, an enzyme present in the pancreas. Positive antibodies to this enzyme indicate an autoimmune reaction.

With low levels of insulin being produced, positive anti-GAD antibodies, and an elevated Hemoglobin A1C, we pretty much determined that Nicole had type 1 diabetes (or more likely type 1.5, called Latent Autoimmune Diabetes in Adults) requiring the use of exogenous insulin.

And all this time, Nicole thought her only problem was a little too much yeast!

The plot thickens

But the story doesn’t end there.

Since regular protein consumption can help to regulate blood sugars, we wondered if Nicole was getting enough protein. So, as an experiment, we asked her to include a bit more protein in her diet, which she agreed to do. And, given that she had a glucometer at her disposal, we asked her to take her blood sugar after meals. We were curious about what we would learn.

One hour after two eggs and a handful of nuts, Nicole’s glucose was 575. Anyone who knows anything about protein’s effects on the body knows that two eggs and some nuts shouldn’t raise glucose that high.

A blood glucose level above 500 is often considered to be a medical emergency. But Nicole , being a starving student, didn’t have medical insurance. What’s more, though we encouraged her to go to the hospital, she refused.

Faced with a patient who is resisting treatment and a very serious medical situation, what’s a good detective to do?

The prescription: Get the glucose down

Nicole did consent to book an appointment with her doctor. But her appointment was two weeks in the future. In the meantime, we needed to figure out a way to get the excess glucose out of her blood.

How could we address her glucose metabolism non-medically? Here is what we suggested.

Step 1 – Exercise

Yoga is great, but on its own, it wasn’t enough for Nicole. She needed to add resistance training to her exercise regime.

Resistance training helps increase the exercise-induced GLUT-4 glucose disposal mechanism in our skeletal muscles and adipose tissue. Nicole didn’t own weights or hold a gym membership, so we told her to do as many lunges, pushups, and body weight squats as she could do, up to 10 separate times during the day. Nothing fancy, but it might help.

Step 2 – Diet

Although Nicole had good intentions and tried to eat well, a little probing revealed that in actual fact, her vegan diet wasn’t the healthiest. Rather than eating predominantly whole foods, she ate quite a lot of refined carbohydrates. And she didn’t eat enough protein.

So we decreased refined carbs, increased her vegetable and fiber intake, and convinced her to start eating small amounts of protein a couple of times a day. We hoped that these changes would help balance blood sugar and supply her with micronutrients and essential fatty acids that she probably lacked.

Step 3 – Supplements

We gave Nicole a number of blood sugar-regulating compounds, including:

  • gymnema sylvestre (400mg daily);
  • alpha lipoic acid, or ALA (1,800mg daily);
  • chromium (1,000mg daily);
  • banana leaf (100mg daily); and
  • cinnamon extract (500mg daily).

The outcome

Three days after beginning exercise, improving her diet, and taking the supplements, we asked Nicole again to take a fasting glucose. Her reading? 175. Obviously, still elevated—but a far cry from her original readings of 350-375, and definitely a step in the right direction.

We also asked Nicole to repeat her experimental eggs-and-nuts meal, and then to take another reading. Whereas originally her glucose was 575 after that meal, this time it had dropped to 235. Again, not out of the woods, but improvement.

Two weeks later, Nicole’s physician prescribed exogenous insulin. And Doctor Detective sighed a huge sigh of relief!


Just before writing this case study, follow-up labs came back for Nicole. In just three months, her hemoglobin A1C has dropped from 16.3% to 8.0%, and her GAD antibodies have dropped to 1.6.

Oh. And those yeast infections? All gone.


So what can we take away from Nicole’s story?

  • Just “being vegan” isn’t necessarily “healthy”. See below on how to be a healthier plant-based eater.
  • Diabetes is more prevalent than ever, including Type 1 and Type 1.5, both autoimmune conditions that attack the pancreas. Type 1.5 is sometimes considered “atypical Type 2” diabetes, but looking at markers such as C-peptide and Anti-GAD antibodies can help differentiate between the two.
  • While we hope that most Precision Nutrition readers will not have underlying diabetes, or develop Type 2 diabetes, everyone should get a comprehensive blood chemistry at least once a year and have it interpreted by someone who truly understands blood chemistry results.
  • Good nutrition and resistance exercise are powerful blood sugar regulators. Along with carefully chosen supplements, natural medicine can be part of a comprehensive diabetes treatment plan.
  • Autoimmune conditions are rampant today, even in seemingly healthy adults following a “healthy” diet and exercise program. If you have nagging symptoms, get them checked out immediately.

But isn’t vegan always healthy?

Eating more plants in your diet — as vegans do — can definitely improve your health. But, just like diets that include animal products, not all vegan diets are created equal.

Some vegan eaters make the mistake of thinking that as long as they avoid meat, they can eat pretty much whatever else they like. Not so.

Without regular, lean protein, blood sugar levels will fluctuate. This leads to greater hunger—and the risk of landing face down in the vegan cupcake tin. High consumption of refined, sugary carbs in turn contributes to even greater blood sugar dysregulation—not to mention less muscle and more fat.

So what’s a good vegan to do? Follow the PN Habits for plant-based eaters, of course!

  1. Eat mostly whole, unprocessed foods. That means stay away from most breads, cookies, cakes, juices, and the tofurkey. Soy products in moderation can be a part of a healthy vegan diet, but prefer them in their least processed form, e.g. soy beans vs. soy milk. Just because it’s labeled “vegan” on the box… wait, why are you buying a food in a box anyway?
  2. Eat lean protein at every meal. An example of lean protein would be ½ to 1 cup legumes such as lentils. You may also need to use a vegan protein powder. Yes, this is a processed food, but it is a processed food with a difference. Look for a powder without added sweeteners.
  3. Eat healthy fats, including olive oil, avocado, seeds, and nuts—but in moderation. 10 nuts is a serving.
  4. Eat more fiber. You’ll find fiber in most vegetables and whole grains, so in theory, as long as your diet is mostly whole foods, you should get enough.

Looking for more tips on how to be a healthy vegetarian or vegan? See our Plant-Based Eating section in the Precision Nutrition System.

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