Medical Fads and Fantasies
Section titled “Medical Fads and Fantasies”Hypoglycemia: Simple, Not Complex
Section titled “Hypoglycemia: Simple, Not Complex”In the 1980s, hypoglycemia was blamed for all kinds of unexplained symptoms. Weakness, fatigue, sweating, tremors, and dizziness — you name it — hypoglycemia was supposedly the cause. People would read about this and come in asking for a glucose tolerance test. Just to survive the test was a challenge. The patient had to fast overnight, come to the office and drink a sugary drink, then fast another five hours while we drew their blood periodically to see if their sugar fell too low. If they didn't already have weakness, dizziness, sweating and tremors, they had them now!
Moreover, after that harrowing blood test, they learned that authorities could not agree on what blood sugar level was too low. As it turned out, a few people would feel fine with a blood sugar of 50, while some would be fatigued, headachy, and grouchy with a blood sugar level of 80. To complicate things even more, a flurry of unrealistic, impossible-to-follow, anti-hypoglycemia diets emerged.
Today, I still have people wondering about hypoglycemia. I tell them to drop by the office when they're having symptoms, and we'll do a quick finger-stick blood sugar and see what it is. Some people have low levels, some don't. If they have symptoms related to mealtimes and types of foods, it's best to just pay attention to what triggers the symptoms and work with that. Avoid too much sugar and bread. Put a protein bar in your pocket. Move into a restaurant. Keep life simple.
Fads and Fantasies Come and Go
Section titled “Fads and Fantasies Come and Go”Hypoglycemia is one of many "fad" diseases I've seen throughout my career. Fads emerge because medicine is imperfect. It is troubling for the patient to suffer the unknown and hard for the physician to admit ignorance. Both start looking for an answer. Fad diseases are one result. The fantasy is that "curing" that "disease" will eliminate all those uncomfortable vague symptoms.
Both mainstream and alternative medicine are subject to fads — hence the vogue among mainstream docs for tonsillectomies in the 1940's, hysterectomies in the 1960's, and overuse of antibiotics ever since they became available. During my years as a physician, I've seen groundswells of opinion among alternative practitioners that all otherwise unexplainable symptoms were caused by hypoglycemia, Candida infections, hypothyroidism, food allergy, nanobacteria, chronic Lyme disease, and more recently Gulf War Syndrome. In this month's newsletter, I examine fad diseases that have come and gone or may still be around.
Candida infections
Section titled “Candida infections”Chronic candidiasis succeeded the hypoglycemia fad. Not to be confused with the common vaginal yeast infection, the yeast Candida albicans supposedly infected the intestine and then invaded the body to cause tiredness, headaches, dizziness, body aches, and a host of other symptoms. The cure was to take an anti-fungal agent and avoid sugar, which fed the yeast. The books and practitioners even proscribed fruit because it contains sugars.
The truth is that many people normally have one or more species of yeast in the bowel along with the thousand or so different kinds of bacteria. They feel fine. Unless a person is severely ill, all the billions of bacteria and yeast in the intestine stay there. If they start roaming around the body, the result isn't fatigue — it's the ICU, or death.
That said, there are a very few people who seem to be sensitive to certain yeasts in the GI tract and report that they feel better when it is eradicated. For those people, avoiding fruits and other healthy foods is not necessary to recovery.
Hypothyroidism
Section titled “Hypothyroidism”While hypothyroidism, or low thyroid function, is a common malady and has always been with us, the idea that medical doctors cannot accurately diagnose it is just a fantasy. Proponents of this idea suggest that blood tests for thyroid function often mislead, leaving you to suffer fatigue, aches, headaches, heartburn, dizziness, weight gain and depression with no diagnosis or help. Instead they advise people to take their temperature before getting out of bed in the morning, and if it is low, that means their thyroid is underactive.
As it turns out, the "normal body temperature" of 98.6 degrees Fahrenheit dates from a few observations in the nineteenth century, never really examined again until the 1990's, when investigators in Baltimore took another look. They found that normal body temperature ranges from 96.1 °F to 100.8 °F in healthy young adults, most readings falling between 96.85 °F and 99.6 °F. They found average temperatures of 97.5 °F in the morning, 98.4 °F in the afternoon, and slightly higher readings in African Americans.
We will revisit the thyroid gland in a future newsletter. For now, if you see a book telling you that all your problems result from an underactive thyroid gland, don't waste time reading the book. Ask your doctor for a brief examination and a blood test, and that will tell the tale. If you don't want to wait for us to cover hypothyroidism in this newsletter, ask our receptionist to let you see our half-hour video about thyroid disease.
Nanobacteria
Section titled “Nanobacteria”A less successful fad was the idea that a new life-form, much smaller than bacteria, was causing otherwise unexplainable illness. These organisms were christened nanobacteria and said to be causally linked to kidney stones, rheumatoid arthritis, ovarian cancer, and Alzheimer's disease. Pictures of these little motes under a microscope were published. Mainstream microbiologists said they were just tiny specks of dust or dirt. Proponents of the nanobacteria theory deployed the usual paranoia about medical conspiracies to suppress information. And naturally you could buy costly treatments on the Internet.
All this took a while to sort out. The microscopic motes turned out not to be living forms, but "self-aggregating microscopic mineral structures," which sounds to me like a polite term for dirt or dust. As far as we know, these structures don't cause any illness. For more information, see Nanobacteria Are Mineralo Fetuin Complexes, published in the online journal PLoS Pathogens.
Food allergy
Section titled “Food allergy”There are many books on food allergies. Whatever undiagnosable symptom you may have, you can find it blamed on food allergy in one of these books.
I'm sorry, but food allergy is not usually the slam-dunk diagnosis such books proclaim it to be. First, odd symptoms can be due to a wide variety of illnesses, some we can readily detect and many we cannot. Second, what the $500 blood test says you are allergic to may not be what actually causes your symptoms. Skin tests too can be inaccurate.
When we are concerned that food allergy may play a role in illness, I suggest a food elimination diet, which is more work but usually more accurate and less expensive. Even though people undertake such a diet only when we are really suspicious, only half the time does it give us the ultimate answer.
In summary, many people do not tolerate certain foods. They discover that by themselves at home at no cost and with no physician involvement. Hidden food allergies are not as common as the health food store books would have you think.
Chronic Lyme disease
Section titled “Chronic Lyme disease”There is an entire Internet industry based on chronic Lyme disease. A microbial infection spread to humans by tick bites, Lyme disease causes fever, aches, a rash, depression and — if not treated early — can affect the nerves, joints, and heart. Lyme disease usually responds to a two- or three-week course of antibiotics.
Lyme disease is real, but not nearly as widespread as the faddists claim. A naturopath told one of our patients "your doctor misinterpreted the Western Blot test for Lyme disease, because you had two bands positive, and his belief that you require five bands is false." The truth is each band on the test indicates the presence of a certain protein. We all contain many, many kinds of protein, both from ourselves and from outside sources. The presence of two proteins tells us very little. Here's an analogy. Imagine a huge alien trying to identify Earthling vehicles by grinding them up and analyzing the pieces. Sure, finding a certain kind of fuel pump and a certain kind of fan belt might lead the alien to conclude that he's found a Chevrolet sedan, because the Chevy contains those particular parts. But a Buick also contains that same kind of fuel pump and fan belt. Complete identification of the Chevy would require finding a certain type of windshield wiper, wheel, and that special Chevy gearshift lever, because that rules out the Buick and every other car. This is similar to the five different proteins the mainstream doc is looking for. You can't call it Lyme based on just two proteins when there are other reasons besides Lyme disease that those two proteins can turn up.
There are labs on the Internet claiming to do a more accurate job of diagnosing chronic Lyme disease. As noted before in Medicine for People!, you can lie with a laboratory just as you can with a stock prospectus. Caveat emptor!
In addition to more liberal diagnosis, chronic Lyme disease proponents promote several-month-long courses of antibiotics for treatment. They have testimonials, even. The trouble is, compare "chronic Lyme disease" sufferers getting real antibiotics with those getting placebo and there's just no difference.
Research aside, patients who have tried these marathon antibiotic regimens have not reported to me that they've been successful.
Beyond Fads and Fantasies
Section titled “Beyond Fads and Fantasies”Yes, there are people who truly suffer from hypoglycemia, Candida sensitivity, hypothyroidism, food allergy, and Lyme disease, (though not, as best I can tell, chronic Lyme disease). But if you run across a book or website that claims that one of these is the secret, undiagnosed cause of a major proportion of fatigue, dizziness, aching, sleeplessness, etc., take a deep breath and go outside for some fresh air.
I can talk with some authority of the fads mention above. People have asked me to consider these ideas in hopes they would explain their problems. I take these inquiries seriously because once in a while, they bear fruit. I look into them. But in most cases, patients suffer from much more individual illnesses, illnesses not easily found in the books or the medical literature, and they require a much more individual approach than these one-size-fits-all fads.
What to do about Undiagnosed Vague Symptoms
Section titled “What to do about Undiagnosed Vague Symptoms”Sometimes we docs need to take a lesson from Franklin Roosevelt, when he said "the only thing we have to fear is fear itself." Fear drives us to unrealistic ideas and expectations. Often it is better to just wait (see our July 2008 newsletter), better to accept that we can lose a battle and still win the war, better to realize that when we don't waste time on fantasies, we can more quickly determine the truth.
For those who suffer symptoms we doctors cannot explain, I can still offer hope. The path to excellent health lies not through fad diagnosis and cures, but through you and your health care provider staying alert to whatever explanation time and investigation can bring. Careful observation, staying in touch with your body, and monitoring your health habits can all potentially help. It can't hurt to do the simplest things: get adequate exercise, avoid foods that you know aren't good for you and choose the ones that are, don't smoke, spend time with people you love, and get enough rest.
If you can accept the bad news that there is no miracle cure, the good news is that no miracle will stand between you and positive health habits and intelligent medical decisions. You may very likely feel better and your wallet will definitely stay in better shape.