Fructose Malabsorption

Dan,

Yes, I definitely remember our conversations earlier this year. In fact, it was some of your comments that got me to look more into thiamine, and I’ve read a lot of goodies since then!

But I’m definitely sorry to hear that things are not better for you!

Here are some thoughts. Stasis dermatitis is common in diabetics (well, relatively common), and the tingling sensation you describe in your legs is a documented feature of the poor venous flow. However, I’m not sure how or why fat would be related to this, outside of the possibility that the dietary fat is increasing the absorbed endotoxins from the GI tract (which it does, but usually isn’t a problem), and that this is exacerbating your inflammatory reaction in your legs.

Do you ever eat egg yolks? Or liver? Phospholipids (which make up a considerable portion of the fat in organ meats and yolks) are absorbed a bit different than dietary triglycerides (most dietary fats). Besides the fact the deficiencies in choline can be a big problem (choline is associated with phospholipids in liver and yolks), it might be diagnostic to see if you had lessened or worsened reactions from eating egg yolks instead of other fat for a meal or two. But to be honest, I really don’t have any knowledge on venous problems.

In terms of the lipid and A1C issues, I have some thoughts. First, for the A1C issues. A1C is just a marker of the amount of glycation on heme. So, the number will go up with high glucose levels, but it will also go up with many forms of anemia. It is important to note that in iron deficiency anemia (or in copper deficiency anemia, or potentially even molybdenum deficiency), the heme in blood cells is degraded more slowly (because our body doesn’t have enough iron to replace it), and this allows the heme to collect glycation sugars to a greater extent. Thus, without knowing fasting glucose and/or insulin, or having a 2-hour OGTT (oral glucose tolerance test), it would be difficult to interpret the A1C. I know most doctors are more than willing to claim a high A1C as indicative of diabetes without further testing, but that’s not accurate. And I’m not saying to go get more tests done, I’m just saying more would be needed for proper interpretation (and perhaps you already have these done).

http://www.ncbi.nlm.nih.gov/pubmed/15345893

For lipids, fructose certainly can increase triglycerides, because fasting triglycerides are a marker of how much fat the liver is synthesizing de novo. The more dietary fructose and the less dietary fat, the more de novo fat synthesized. This is not a problem in and of itself, but it certainly does increase choline requirements and it may indicate overall fat deficiency (your liver is making more fat because the body needs it). This is obliviously not easy to solve if fat worsens your symptoms. But the good news is that fructose can provide the substrates for your liver to make fat (whereas glucose doesn’t as much), so if you must consume lower fat, then having higher sugar is better than higher starch, in my opinion. Now, copper is interesting here, since copper deficiency causes an increase in the amount of fat synthesized in the liver, both triglycerides and cholesterol. I don’t know if the amount of extra lipid material is excessive in copper deficiency, or if copper deficiency somehow increase the peripheral need for fat which is why the liver is making it. But either way, increased LDL-c and/or triglycerides, especially when an anemia is present and/or neurological problems exist, may be very indicative of a long-standing copper deficiency.

Thanks for the collagen and fructose links. Fructose does increase, at least in a test tube, glycation to a greater extent than glucose. But alpha lipoic acid has been studied to increase glutathione and decrease oxidative stress, and copper deficiency causes increased oxidative stress. So, again, I think a good chunk of this is just the same ole? fructose causes copper deficiency, which interestingly may be much worse in men than women. Notice how the one study you showed me shows how men are more affected by fructose in terms of collagen crosslinking. Well, check out the last 2 links here that shows males worse off with copper deficiency than females (rats, that is).

http://europepmc.org/abstract/MED/1418040

http://www.ncbi.nlm.nih.gov/pubmed/12049840

http://www.ncbi.nlm.nih.gov/pubmed/1325594

http://www.ncbi.nlm.nih.gov/pubmed/12805251

What concerns me the most about your symptoms are the neurological ones. Eye sight, for instance, is temperamental and not easily restored if something goes wrong. Sure, diabetes could cause problems relating to eye sight, but so can deficiencies in choline, copper, B12, protein, zinc, A, D, B2, the essential fatty acids (ARA and DHA; both in liver and pastured egg yolks; ARA in conventional yolks, and DHA in fish). There may be a variety of other things that could cause vision problems too, and electrolyte imbalances can create temporary issues. But if you’ve been avoiding fat for some time, than it could be that you are deficient in vitamins A, D, K2, E; ARA, DHA; and choline/phospholipids. Eating at least few yolks per day, plus the extra vitamin A and D would be something good to do right now, I would think, even as you works everything else out. Perhaps experimenting with copper and/or some other things little by little may help you tease out what is going on. That ‘balanced’ zinc/copper supp you mentioned, what is the ratio on that? I think most are too far in favor of zinc. But something like 10-15mg zinc and 3-5mg copper should be ok as a supplement, I would think. I know ratios of 10:1 to 15:1 Zn:Cu are recommended, but I think lower ratios are ideal (perhaps 5:1), especially when phytic acid foods (grains, legumes, seeds, nuts) are not consumed, since phytates inhibit zinc absorption while doing little or nothing to copper.

Also, I would ignore any bashing you read or hear on copper on the internet. It’s misplaced. Copper levels in the blood increase in times of acute or chronic illness, much like zinc and iron decrease. These are all called ?acute phase reactants?, because their levels change in acute (or chronic) inflammatory conditions. C-Reactive Protein is another acute phase reactant, and since it elevates in many instances of illness, it is used as a marker for disease severity. Serum copper could be used the same way, as a marker of illness severity, but that does not mean one with elevated serum copper is ?overloaded? with copper any more than someone with elevated C-reactive protein is overloaded with the letter ?C? because of eating too much alphabet soup. Severe copper deficiency will lower blood neutrophils (neutropenia) and could cause anemias of all types (with low, mid, or high MCV and MCH). There are many ?clues? of copper deficiency in a blood test, but serum copper itself, is not usually one of them. I think supplementing 3-6mg copper per day (in divided doses) and judging your health response is likely the best way to determine copper status, but you can stop at any time if you don’t think it is going well. Copper could theoretically increases the requirement of molybdenum, so supplementing some molybdenum with copper may not be a bad idea (I would suggest something like a 10:1 ratio Cu:Mo; or 3mg Cu with 250 mcg Mo). But go by feel.

In terms of diabetes and glucose control, deficiencies in potassium, thiamine, and magnesium would all causes an inability to process glucose through glycolysis; and diseases with wasting of potassium and magnesium (such as hyperaldosteronism) always causes a worsening of glucose control, while hypoaldosteronism can actually causes life-threatening insulin sensitivity and low glucose. But if you’re eating lots of fruits I don’t think potassium or magnesium would be a problem. It’s the refined sugars and starches that could be problematic from a potassium/magnesium standpoint (and a copper point of view), since they are void of these nutrients, but require them for proper processing. So, again, this is where fruits and tubers should be fine as staples, while refined sugars better in moderation or not at all. In cases where, let ‘s say cane sugar for example, are tolerated better than fruit, I would recommend supplementing alkaline salts of potassium and magnesium (citrate, for example) along with the sugars, and consider supplementing thiamine somewhere in there, too. But this is just me saying don’t induce a further deficiency in something while you are playing around with finding what is already wrong.

All-in-all, it sounds to me like your body is beaten down quite a lot and that you have a long road to recovery ahead of you, even if all goes well from here on out. I wish I could wave a magic wand and cure you. I suspect you have many long-standing deficiencies, and that fixing one may produce some negative effects along with the positive, since fixing one rate-limiting reaction may causes another to be rate limiting to the point of a new set of symptoms. So, if something feels good at first, but then begins to produce undesirable effects, I wouldn’t take it as that thing being bad but that something else is now needed with it. For instance, many supposedly feel weird taking iodine, but then notice that extra chloride, selenium, B2 and B3 seem to make everything swell. And anecdotally, magnesium, potassium, and niacinamide help those with sudden increases in methyl donors.

Those are my thoughts. Let me know your own thoughts, and keep in touch either way.

Cheers, CP

Hey Dan,

Please forgive my tendency to make typographical errors.

Honestly, your extreme reactions to fat concern me greatly, and I’m not sure how to interpret this.

As I mentioned at some point a while back to you, betaine HCl could definitely hinder fat digestion. Alkaline secretion in the intestine are needed for buffering the acid coming down from the stomach, and fat can only be properly broken apart via lipase enzymes in an alkaline environment. What this means is that if you had been and/or still are consuming many betaine HCl capsules your fat digestion could have become quite poor. Combining this with a low fat intake for some time now, and you could very well have experienced de-myelination from fat deficiency. Upon adding the fat back could give terrible sensations, which is standard for re-myelination.

Further, the acid load of the betaine HCl is worth considering. If you’re not familiar with acid/base balance as it relates to diet, consider reading these:

http://www.ncbi.nlm.nih.gov/pubmed/11842946

http://www.ncbi.nlm.nih.gov/pubmed/11416968

http://www.ncbi.nlm.nih.gov/pubmed/21352078

http://www.ncbi.nlm.nih.gov/pubmed/11842945

http://www.ncbi.nlm.nih.gov/pubmed/9575887

http://www.ncbi.nlm.nih.gov/pubmed/12450898

http://www.ncbi.nlm.nih.gov/pubmed/20042527

Basically, a net production of acid in the body which is not buffered by the kidneys at the response of various stress hormones results in massive wasting of potassium, magnesium, and calcium; lowered blood volume (which can produce the same symptoms as hyponatremia, or low sodium); and all the consequences of depleted electrolytes, including insulin resistance, poor digestion, excess histamine release, and muscle and bone loss.

Well, betaine HCl is 23.5% HCl, which means that one capsule of 648 mg betaine HCl (the NOW Foods one, for instance) has 152mg HCl. This represents about 4.3 moles of H+ ions, which is typically put into ‘equivalents’ of H+, so this would be 4.3 ‘meq’ (milli-equivalents). So, if you had taken let’s say 10 per day, then that would be ~43 meq acid, which would put you into a pretty decent acidosis. On our own, the body produces about 30-70 meq acid from normal metabolism. Ideally, your diet would perfectly balance this, so the diet would be negative 50 meq, or 50meq alkaline. It doesn’t have to be exact, but what this means is that an extra 43 meq from betaine HCl plus the body’s ~50 would result in a bout 100 meq acid needing to be buffered. Hypothyroidism (and other problems) prevents the body from properly acidifying the urine, meaning that the urine will be not acidic, but the blood is retaining acid. This is called Renal Tubular Acidosis, since an acidosis is occurring due to the renal system’s inability to excrete acid.

In any case, this could definitely create a potassium deficiency, which can, on its own, create diabetes. Fortunately, supplementing potassium in an alkaline form (such as potassium bicarbonate dissolved in OJ) can cure this fairly quickly. Something like 1/2 tsp K-bicarb with 1-2 cups OJ with each meal. This assumes you stop and/or have already stopped the betaine HCl.
http://www.amazon.com/Home-Brew-Ohio-Potassium-Bicarbonate/dp/B0064GZPU4

Here are some paper showing/discussing rapid glucose/insulin improvement with potassium:

http://ajcn.nutrition.org/content/22/12/1589.long

http://www.ncbi.nlm.nih.gov/pubmed/19209185

http://www.ncbi.nlm.nih.gov/pubmed/24979149

This may also explain your leg issues. I would add that if you are potassium deplete, you are also likely magnesium deplete. And since potassium supplementation can exacerbate magnesium problems, I would recommend supplementing some Mg-citrate or glycinate with the potassium. Something like 10-20:1 ratio K:Mg, since this is the ratio of the nutrients in most foods high in potassium.

By now, after years of restrictions of various kinds, you are likely deficient in several nutrients that could be causing a myriad of problems.

I urge you to consider ‘re-setting’ your diet to a well-rounded diet, sufficient in all known essential nutrients. Even if restricting fat makes you feel less bad for now, it is causing problems that will manifest sooner-or-later, and may already be causing a great deal of problems. Restricting an essential nutrient is never a good approach, in my opinion. I’ve done it for years myself in well-meaning attempts to help various symptoms, but it has never made anything better long-term and only ever made things worse. Any single deficiency will cause terrible symptoms eventually, and purposeful restriction of anything is likely to cause numerous deficiencies.

So, without knowing for sure which deficiencies are likely to have caused any particular symptom (though in some cases it may be obvious which deficiency is causing which symptom, it certainly isn’t always), I would say to re-focus yourself on a nutrient dense diet, expecting that an acute exacerbation of some things will occur. Then, on top of a well-rounded diet, I would recommend you consider continuing to experiment with various add-ons (‘supplements’), but no more than a couple at a time, and with the provision that you discontinue any that doesn’t seem to help after a couple weeks and that you don’t have a darn good reason for continuing. Symptoms can be caused by relative deficiencies as much as absolute, and increasing anything as the potential to induce a relative deficiency of something else, though some things less likely to do this than others.

For starters, I would suggest a well-rounded diet. Here is one suggestion (only a suggestion), which should have all the essential nutrients:

>= 4 egg yolks
~4 yellow to yellow-green bananas (more ripe reduces the prebiotic effect)
>= 4 cups OJ (with 1/4 tsp salt and 1/4-1/2 tsp potassium bicarbonate per cup)
>= 4 ounces of cheese
oatmeal (as desired)
Liver (>=2 ounces daily average)
One serving of green vegetable (spinach, kale, broccoli, whatever)
Plus whatever else you want

This would not be high fat, but it definitely has more fat than you’ve consumed in a long time. If the fat is causing your problems because of increasing endotoxin absorption, then eating good prebiotic foods (not pro-biotics, but pre-biotics) should help this. Greenish bananas, carrots, leeks are the natural foods high in good prebiotics. Oats and cold potatoes are also good. Supplementing inulin or potato starch is something some find helpful, but I would prefer whole foods to refined fiber supplements. On a personal level, eating 1 greenish banana with each meal was the thing some time ago that made a curative difference in my life-long IBS-d, and studies show that this can reduce endotoxin and ammonia, and their negative health complications.

As for the methylation thing you asked about, here are my thoughts. Most things out there on the internet or in books about health, whether from Mayo Clinic or Johns Hopkins or from ‘alternative’ health blogs and whatnot, are statements without any attempt at citing data to back up the comments. For some things that are easily searchable, I would think that is ok. But the issue I have with mainstream Big Med–where medical statements are entirely unsupported by real data, and often times completely disproved by data–is the same issue I have with most blogs. They are essentially opinion pieces. So, what does the data say on histamine and methylation, well methyl transferase enzymes are certainly involved in histamine degradation, as you can see by looking at the enzyme pathway on figure 2 of this paper:

http://ajcn.nutrition.org/content/85/5/1185.full.pdf+html

But it is only one part of an entire pathway. The other cofactors needed for the other enzymes are copper (DAO), B2 (MAO), niacinamide (aldehyde dehydrogenase). Without these, intermediates like aldehydes can build up. Alcohol, for instance, is toxic. However, the degradation of alcohol in the liver is ethanol to aldehyde, then aldehyde to carboxylic acid. The carboxylic acid is easily excreted and is relatively nontoxic. As it is, the aldehyde is far more toxic than ethanol, and so this is what produces most of the effects. Persons with low levels of aldehyde dehydrogenase (AD), whether genetic or due to niacin or thiamine deficiency will have symptoms, most of which look a lot like ‘histamine’ excess problems. Molybdenum is also important for aldehyde metabolism.

So, when someone starts taking methyl donors and has problems, my thought is that something else in the pathway is now the new rate-limiter, and that needs to be fixed, not that someone has ‘methylation excess’. I would think B2, B3, copper, and molybdenum must be supplemented. I would also think potassium potentially, since kick-starting an important pathway may kick-start cell division which requires the intracellular ions, most notably potassium. Anecdotally, potassium has helped some people when they kick start methylation.

http://forums.phoenixrising.me/index.php’threads/why-is-potassium-supplementation-needed-in-methylation-treatmt.18670/

Now genetically, various SNPs can effect methylation and the surrounding enzymes, such as CBS (trans-sulfuration) and so on, which could certainly make one person require a higher amount of one nutrient compared to another person. But, I don’t believe methylation could ever be in excess. Methyl donors only come from three places: methionine itself; betaine (through choline or just as betaine); or glycine transferring its methyl group upon catabolism to folate to produce methylfolate. Folate and B12 are just cofactors, and they have nothing to do with methylation excess.

So, methionine, betaine/choline, and glycine are all nutrients that must be looked at. Methionine, it is very clear, has close to zero toxicity within a reasonable range of what could be gotten from food AS LONG AS enough glycine, B6 and B2, molybdenum, and alkaline are present, since glycine and B6 are needed to clear Met out of the methyl cycle through trans-sulfuration. B2 just activates B6. Molybdenum is needed to handle sulfite creation in the catabolism of sulfurous aminos, and since some of met and cys can be catabolized to sulfuric acid, extra bicarb will be needed to buffer this. Betaine and choline have such low toxicity, they are both considered very safe in high doses; my only concern on them would be their effect on the flora. And glycine appears all good and potentially a must-have supplement. So, I don’t buy-in to a true ‘methylation excess’, outside of precipitating a relative deficiency in something else that was already deficient but not noticed. I suppose the term ‘over-methylation’ could be used to describe symptoms upon increasing methylation pathways, which then implies deficiencies in something else. But I’m afraid many out there use ‘over-methylation’ to actually refer to methylation excess. Maybe I have missed something, but as of now I really don’t think that is possible outside of relative deficiencies.

There is more that could be said in terms of methylation, but that it my jist.

http://www.westonaprice.org/health-topics/meat-organs-bones-and-skin/

http://www.fasebj.org/cgi/content/meeting_abstract/25/1_MeetingAbstracts/528.2

http://valtsus.blogspot.com/2013/12/glycine.html

http://blog.cholesterol-and-health.com/2010/11/does-choline-deficiency-contribute-to.html

http://blog.cholesterol-and-health.com/2010/12/meeting-choline-requirement-eggs-organs.html

http://www.westonaprice.org/uncategorized/does-dietary-choline-contribute-to-heart-disease/

Dan, I may have left some things unanswered. I did not mean to do that, but I wanted to make special mention of fat metabolism and glucose control since that is what may be your biggest issue symptomatically.

I urge you to consider potassium bicarb supplementation, discontinuing betaine HCl (using anhydrous Trimethylglycine would be fine and potentially even good since it can partly makeup for deficient choline, but just not with the HCl), and adding egg yolks, liver, and some prebiotics to your diet. I am sorry your leg symptoms are so bad, but continuing to restrict choline and essential fatty acids (arachidonic and DHA, both of which are found in egg yolks and liver) is not going to end well.

Humbly, CP

Hey Dan.

For the K-bicarb, I would suggest starting at 1/2 tsp dissolved in 1-2 cups juice (something acidic), which will become a carbonated juice, to be drunk with each meal. OJ, apple juice, or whatever will work. Let the bubbles dissipate mostly, which should take a couple minutes after stirring the K-bicarb in. Theoretically, taking enough to bring your total ‘net endogenous acid production’ (NEAP) to zero would be ideal. This would depend on what you eat. But 1/2 tsp K-bicarb 3x daily with meals is a good guideline for most people, I think. You can always adjust from here.

I would also say that persons with adrenal insufficiency problems, which may be a big part of CFS, have a hard time expelling potassium and tend toward high potassium in the blood, even if tissue levels are low. Increasing blood potassium normally results in increased aldosterone secretion from the adrenals, which then increases potassium excretion, increases potassium uptake into tissues, and decreases sodium excretion. Thus, if one has healthy adrenals, increasing dietary potassium may actually lower sodium needs to a point. However, if one’s adrenals are not up to par and/or if ‘aldosterone resistance’ is present, then the increased blood potassium will lead to a natiuresis (a wasting of sodium into the urine), which will lower blood volume, drop blood pressure, and make you feel terrible. Independent of aldosterone, alkaline (from the bicarb) helps increase potassium uptake into cells, so K-bicarb is much less likely to cause this problem than K-chloride would. However, it should be guarded against when first supplementing with the K-bicarb. So, I recommend eating and/or drinking plenty of salt throughout the day to ensure the potassium isn’t lowering blood sodium. You can do this any way you want, including adding salt to your juice mix, or drinking salted water or whatever. But 20-40 grams of salt daily is not unreasonable for Addison’s or hypoaldosteronism patients.

As I said before, magnesium may also be needed. So, in sum, I recommend 1/2 tsp K-bicarb dissolved in at least 1 cup juice with each meal, along with ample salt and some magnesium. Ultimately experimentation is needed to sort out the ideal ratios and so on. Using sodium bicarbonate (baking soda) is a way of adding extra alkaline without the potassium, and perhaps one day you decide to do a combo of potassium and sodium bicarbonates, and other experiments. But for starters, I would recommend keeping it at potassium bicarb and sodium chloride since that is how the minerals come in foods and nature most often.

Many of your symptoms–dry, sensitive eyes; poor peripheral circulation; potential diabetes–sound like they could be Sjogren’s like issues and ‘mixed connective tissue disorder’. From some of the things I’ve read, the symptoms of Sjogren’s–which is said to be an autoimmune issue of secretory and excretory glands–are manifestations of acidosis, which is induced due to kidney damage. I would think fixing the acidosis with bicarbonate supplements could solve the eye, skin, and circulation problems. It will be interesting to see if you notice any benefit. Of course we both will be hoping for good improvement in your symptoms.

For digestion, you mentioned ox bile. Sure, try whatever. Some studies indicate taurine can glycine can both help increase bile acids, which can assist with fat digestion. But I would not assume that this will make you ‘handle’ fat better. In fact it may make you feel worse after eating fat, depending on why it is you feel worse after eating fat. If it is the absorption of endotoxin from the intestinal lumen, then any emulsifier (phospholipids from egg yolks, ox bile, or your own bile) will likely increase endotoxin influx and make your symptoms worse. But there are other possible causes of your problems, so giving ox bile a try is not a bad idea. And remember, fat needs alkaline to help digest (lipase enzymes from pancreatic excretions require an alkaline environment), so metabolic acidosis and/or too much betaine HCl with meals may severely hinder fat digestion, independent of emulsifying agents. Keep that in mind.

For your eyes and sleep, perhaps you would find a blue-light filter on your computer helpful? I know I have benefited from a blue light filter on my computer. I use F.Lux, but there are also others. I put the ‘color temperature’ usually to 2700 on bright sunny days when I have the windows open, and 1900 otherwise. Melatonin synthesis is also inhibited with blue and green light peaks, so yellowish-orangeish-redish lights before bed are likely best. A healthy person may not be bothered, but I have found it helps. It’s free and something to consider.

https://justgetflux.com/

As for people in the Seattle area: I grew up in the Seattle area, myself. Though I don’t have any recommendations for doctors or persons to get in touch with, I would say to anyone and everyone that many (though not all) churches offer a number of supportive programs to those with disabilities and financial troubles. Catholic churches vary considerably in their help based on the assigned priest and the parishioners; Mormon churches, especially wealthy ones in upper-middle-class venues may be the best bet for getting support. Some may take offense to me saying this, but our society does not have great out-reach programs for those who, through no fault of their own, fall through the cracks, especially those with serious physical disability. The goal should always be to get back on one’s feet, and I think you can get there. But even if all goes well, it won’t happen overnight. And just surviving in the meantime, as you well know, can be near impossible. Many Mormon and Catholic churches often have support programs for persons who are not even attending or registered parishioners. Many other groups force attendance in order to get any help, which, while I understand, is less helpful for most.

Hopefully you will notice benefit soon from alkaline potassium, and perhaps soon you’ll be able to tolerate egg yolks in your diet. I am less concerned with absolute levels of fat in your diet than I am with choline-rich fats (yolks, liver) and the EFAs ARA and DHA (again, yolks and liver). While it’s not cheap, desiccated liver is a convenient option for people on the run or who can’t stand liver taste but want the health benefits of liver. It’s very low total fat but high in the phospholipids, so it may (or may not) be something you could tolerate better.

http://www.perfectsupplements.com/Perfect-Desiccated-Liver-p/desiccatedliver120.htm

I wish you well. Stay strong. Keep in touch. I’ll be here if you have any questions for me, but I’m afraid I don’t have the answers. But perhaps you can pick up a thing here or there from me and from others and from your own experimentation and ultimately find some good answers. But I enjoy our dialogue so don’t be a stranger.

Peace, CP

Hello Dutchie,

I am sorry to hear about your issues. And I’d be happy to answer any questions you have, or to try to help explain things to you the best way I can so that you can hopefully solve all your problems. However, as a matter of principle, I won’t be giving out personal or contact information on the forums, since these forums are open source to all and forever. I would like to keep my personal privacy, and the only way I know how to do that is to use a pen name and to not give out personal information. I hope you can respect my position on this.

But I am patient and more than happy to communicate with you whenever you are able to write. An added benefit of doing it this way is that any golden nugget we discover together on the forums will be readable by future readers for whom the information may be a saving grace. Though I know this may make things more difficult for you in some ways, I would like to think we can make this work, if you’re up for it.

I’ll think about these things you listed and respond back soon with my thoughts.

Sincerely, CP