I’m sorry, did I break your concentration?
As so often happens at Science Based Medicine, the inspiration for today’s post comes from a reader of the blog, seeking evidence-based advice and references after receiving conflicting (and perhaps even contradictory) information from other sources. On one hand, it saddens me when people get bad advice from health care professionals or elsewhere, whether it’s from their “regular” doctor, an “alternative” practitioner, or from Dr. Google; on the other hand, the fact that well-meaning patients are seeking out science-based recommendations through Science Based Medicine is encouraging and emphasizes the important role this blog serves.
The email that was referred my way was written by a man who is considering having a tooth extracted in the hopes that it will alleviate some general health issues he is having. He writes:
May I request that you write an article refuting the claims made in the book “Toxic Tooth — How a Root Canal Could Be Making You Sick”?
The purpose of my request is that I am considering getting a root canal pulled out.
After an initial back and forth where I told him that I’d look into it and to meanwhile not do anything hasty, he related his general symptoms (all correspondence reprinted with permission):
My personal information is I am a ** year old male, and I have a lot of fatigue. MDs are not able to tell me why. I have a TSH of 12. MDs are not able to tell me the root cause. I have Monocytes of 13, normal range is 4-13, this means I have an infection. This makes me wonder if maybe that root canal is the cause of that infection.
To translate (very superficially and simplistically): His TSH (Thyroid Stimulating Hormone) level is elevated. TSH is a hormone released from the pituitary gland and helps regulate the thyroid hormones which are involved in the body’s cellular metabolism. Normal values are in the 0.3–3.0 µIU/mL in an adult, and an elevated TSH usually means that the patient has an underactive thyroid (hypothyroidism). On rare occasions, it can indicate the presence of a thyroid tumor or other uncommon issues. His monocyte level is a bit elevated as well, which could mean the presence of a chronic infection or perhaps an auto-immune disease, but that lab value alone is not enough to make that call. But I’m just a dentist; what do I know? (more…)
The adrenal gland, sitting on top of the kidney, presumably taking a nap because it’s tired.
One of the realities of being a pharmacist is that we’re easily accessible. There’s no appointment necessary for consultation and advice at the pharmacy counter. Questions range from “Does this look infected?” (Yes) to “What should I do about this chest pain?” to more routine questions about conditions that can easily be self-treated. Part of the pharmacist’s role is triage — advising on conditions that can be self-managed, and making medical referrals when warranted. Among the most common questions I receive are related to stress and fatigue. Energy levels are are down, and patients want advice, and solutions. Some want a “quick fix,” believing that the right combination of B-vitamins are all that stand between them and unlimited energy. Others may ask if prescription drugs or caffeine tablets could help. Evaluating vague symptoms is a challenge. Many of us have busy lifestyles, and don’t get the sleep and exercise we need. We may compromise our diets in the interest of time and convenience. With some simple questions I might make a few basic lifestyle recommendations, talk about the evidence supporting supplements, and suggest physician follow-up if symptoms persist. Fatigue and stress may be part of life, but they’re also symptoms of serious medical conditions. But they can be hard to treat because they’re non-specific and may not be easily distinguishable from the fatigue of, well, life.
This same vague collection of symptoms is called something entirely different in the alternative health world. It’s branded “adrenal fatigue,” an invented condition that’s widely embraced as real among alternative health providers. There’s no evidence that adrenal fatigue actually exists. The public education arm of the Endocrine Society, representing 14,000 endocrinologists, recently issued the following advisory:
“Adrenal fatigue” is not a real medical condition. There are no scientific facts to support the theory that long-term mental, emotional, or physical stress drains the adrenal glands and causes many common symptoms.
Unequivocal words. But facts about adrenal fatigue neatly illustrate why a science-based approach is a consumer’s best protection against being diagnosed with a fake disease. (more…)