Customer Story

Professional triathlete Sarah Piampiano struggled with chronic inflammation.


Professional triathlete Sarah Piampiano struggled with GI issues and a host of other symptoms due to chronic inflammation.

For years, Sarah had worked to manage symptoms of Hashimoto’s disease, an autoimmune disease that attacks the thyroid gland. She became cold easily, had poor circulation in her hands and feet, and would get sick often.

She also experienced constipation and would sometimes go up to two weeks without going to the bathroom. She endured bloating and gas; swelling of her legs, face, and feet; irregular periods; disrupted sleep; terrible night sweats; iron deficiency; and lethargy and general fatigue. Sometimes, she felt like she was dragging herself through her days in a fog. For years, she thought these symptoms were normal.

When Sarah began training and racing as a full-time professional triathlete, she learned more about nutrition, body function, health and wellness—and Hashimoto’s. She became acutely aware of how her body felt and reacted to intense training and races.

Her body would swell during travel and after races. Although some swelling is normal, Sarah would sometimes retain upward of twenty pounds of fluid after a race. Her night sweats were unbearable. Some nights, she would have to change four times and put several towels down because she soaked through the sheets. She was very uncomfortable, disheartened, and frustrated.

She thought that this was all a normal part of post-Ironman recovery. Nothing she tried made her symptoms go away, and she continued to suffer. She ate red meat five nights a week and added other iron-rich foods to her diet to try to boost her iron levels. She cooked everything in a cast-iron skillet and removed gluten from her diet. She ate few processed foods and tons of fruits and veggies. But nothing made a difference. Her iron levels were still low, her thyroid continued to deteriorate with what felt like an endless Hashimoto’s flare-up, and she still battled the same symptoms. She felt like she had tried everything—until she finally found Ixcela.


Sarah’s Ixcela test showed that she had a gut bacterial imbalance and the stress marker metabolite xanthine was above optimal levels. This reflected that her body was under stress and she was at risk for further inflammation and further gut microbiome damage.

Her test also reflected that her serotonin was below optimal levels. Because serotonin is the precursor to melatonin, the body’s sleep hormone, this offered insight into her disrupted sleep.


Sarah and her trainer and her Ixcela dietitian first discussed how a gut bacterial imbalance can contribute to and cause Sarah’s symptoms. They explained that the symptoms of IBS and thyroid diseases (like Hashimoto’s) are greatly affected by the health of the gut microbiome. To support Sarah’s gut health and help alleviate her symptoms, they discussed considering an elimination diet.

Because of their strenuous training schedules, professional athletes like Sarah often find that their xanthine, a stress marker, is above optimal levels. Although Sarah’s training contributed to her high xanthine levels, her swelling, inflammation, and fatigue were also signs that it was important for Sarah to reduce the amount of stress on her body.

Connecting Sarah’s disrupted sleep with her serotonin levels helped her to understand her poor sleep quality. Knowing that about 90% of serotonin is produced in the gut gave her even more reasons to make changes to support her gut health.


Sarah, her trainer, and her Ixcela dietitian, reviewed her Ixcela test results and decided that Sarah should first focus on a low FODMAP elimination diet. Sarah’s dedicated Ixcela dietitian helped her identify which foods to include in her diet and which foods (even certain fruits and vegetables) to avoid. This temporary diet change was meant to reduce Sarah’s inflammation and allow her gut to heal.

The Ixcela team also advised Sarah to start taking 4 personalized supplements:

  • Ixcela Biome Support (Probiotic + Prebiotic): Supports the population and diversity of the gut microbiome
  • Ixcela Balance (5-HTP + Vitamin B6): Supports serotonin production
  • Ixcela Defend (Vitamin C + Zinc): Supports the stress marker and purine metabolite xanthine
  • Ixcela Protect (N-Acetyl L-Cysteine + L-Methionine + Selenium): Supports stress marker metabolites like xanthine


Within one week of being on the low FODMAP diet, Sarah began to feel better. Her bloating and gas went away, she was sleeping better, and her energy improved. Over time, she found that she swelled significantly less after races and travel, and she retained only eight pounds of fluid instead of twenty.

When Sarah began the low FODMAP diet, she avoided all high FODMAP foods. After a couple of months, she began adding high FODMAP foods to her diet again and experimenting to see if she tolerated some foods better than others. She found that avocados, sweet potatoes, and blueberries were fine, but garlic, onion, stone fruits, and a few other items just didn’t work well for her.

To her surprise, her digestion became regular. Her energy levels improved dramatically, which boosted her happiness levels. As soon as her other symptoms began to improve, her thyroid stabilized. Since taking the Ixcela test and deciding to go on the low FODMAP diet in February 2018, she hasn’t needed to increase her thyroid medication dosage—it is stable for the first time in several years!

Note: Sarah experienced the Personalized Accountability Program with Dedicated Dietitian Support.

Here's what Sarah said:

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