host posted on June 29, 2009 18:08
Dear Readers,
July is the month we celebrate our independence. I would ask everyone to stop for a few minutes and reflect upon the sacrifices that have been made by our military personnel and their families, both past and present. Through their efforts, we live in the greatest country in the world. We need to remember this, in spite of all the “bad press,” bankruptcies and bail-outs. Ask yourself, why do so many people continue to come to our country, legally and illegally, risking their lives and leaving their homes? We are blessed.
I’ll step off my soapbox to present this month’s case study. The patient I will be presenting this month is also one of our unsung heroes. She is a teacher. With that said, let’s get started.
Here is the disclaimer. This case study is for educational purposes only. I am using it to show you how a typical patient presents and the things I consider when I make a diagnosis. The patient’s name has been changed to protect her identity. I practice integrative/alternative medicine and my recommendations for treatment are often considered outside traditional practice. It is not my intent to criticize or denounce traditional medicine. I am merely providing an alternative opinion. Most importantly, the information provided here should not be used as a substitute for an examination and/or treatment by a licensed health care provider.
Presenting illness: Mrs. July is a 59 year old white female who presented to the clinic for an alternative medicine consult. Mrs. July works as a teacher and is on her feet all day. In 2006, she read the book The Fungus Link by Doug Kaufmann and she decided to eliminate sugar, grains and bread from her diet. After doing this, she noticed that her hands and knees “felt better.”
Mrs. July states that her problems really began in 2008. In January 2008, she was suffering from joint pain, so she restarted the initial phase diet. She saw her family physician who did some laboratory blood tests on her. Her sedimentation rate was high (which is indicative of inflammation), so she was referred to a specialist, a rheumatologist, for further evaluation. The rheumatologist obtained more lab work and diagnosed Mrs. July with systemic lupus erythematosus and rheumatoid arthritis. Despite her discomfort, Mrs. July continued to work. She remained on the LifePhase diet and began taking beta-glucans. Mrs. July stated that the beta glucans really helped her. She states that, during the summer, she did well.
When school started back up in the fall of 2008, Mrs. July had a “flare-up.” In October 2008, she was diagnosed with osteoporosis and she was started on a bisphosphonate (Fosamax). Mrs. July stated that this medication caused her arms to ache and so it was discontinued. Her rheumatologist then prescribed Plaquenil (immunomodulator) for treatment of her rheumatoid arthritis and lupus. Mrs. July began the Plaquenil in December along with a short course of steroids. Mrs. July reported that the Plaquenil made her legs ache and because of this it was discontinued.
In January 2009, Mrs. July was diagnosed with oral thrush (oral candida). She received Nystatin for this and she stated that this seemed to” clear up the infection.”
In February 2009, Mrs. July was given Enbrel (immunomodulator). She received 3 injections of his medication (one injection per week) but after the third injection she developed a high fever. The Enbrel injections were discontinued but Mrs. July continued to have high fevers 103-105F. She has also developed a diffuse sensory polyneuropathy which she has been told is the result of the medication. Mrs. July began losing weight and continues to have intermittent high fevers. Despite work-up by her rheumatologist, no cause for the fever has been determined. Mrs. July is taking ibuprofen every twelve hours to keep her temperature down.
Mrs. July states that she has recently developed a rash on her face and chest. Her most recent laboratory blood work shows that she has anemia. She underwent a lymph node biopsy a few weeks ago but the results are not available.
Past medical history: Mrs. July has a history of thyroid disease, specifically Hashimoto’s thyroiditis, in addition to the above disorders listed in the presenting illness.
Medications: Mrs. July is on levothyroxine (thyroid replacement) and daily prednisone (steroid).
Vitamins/Supplements: Mrs. July is taking a multivitamin, fish oil, probiotics, olive leaf extract, grape seed extract, glucosamine chondroitin, calcium and vitamin D.
Allergies: Plaquenil, methotrexate, Fosamax and Enbrel.
Past surgical history: Mrs. July has recently undergone a lymph node biopsy, colonoscopy and endoscopy. The colonoscopy and endoscopy were performed because of her anemia to look for a possible source of blood loss. She was noted to have some irritation of the esophagus. This is thought to be a result of prolonged use of ibuprofen.
Social history: Mrs. July is married and works as a school teacher. She is currently on summer break. She has two children. She does not smoke or drink alcohol. She exercises “when she is able,” swimming and using an elliptical trainer.
Diet: She does not use diet drinks or artificial sweeteners. She has tried to follow the antifungal diet but states that she is losing too much weight. She had dropped to a low of 92 lbs and has used ice cream and pasta to gain some weight.
Review of Systems: Mrs. July states that she has had problems with tachycardia (heart racing). Yesterday she had an episode of nausea and vomiting. Her last menstrual period was “long ago.” She does not have any root canals although she does have some amalgams. Mrs. July has an appointment to see a dentist to have her amalgams removed. She has not traveled out of the country. The school where she is employed does not have any obvious mold, although there was a leak in the air conditioning. Her home was built about 30 years ago. Mrs. July states that she had been fairly healthy most of her life until the past few years.
Physical exam:
Blood pressure: 127/68, Pulse: 104, Height: 5’2”, Weight: 105 lbs
Temp: 97.6 F
Her tongue was noted to have mild scalloping.
Her heart and lung examination was normal.
Mrs. July was noted to have some mild, generalized tenderness in her abdomen but there were no noted masses and no enlargement of her liver or spleen.
She was noted to have mild beta-carotenemia (yellowish color) of her feet. Her hands revealed nails with vertical ridges.
Mrs. July was noted to have multiple, small, scattered, discrete, reddened, non-raised, non-tender lesions on her chest. These lesions blanch with pressure. She also has a reddened patch on the skin above her upper lip.
The remainder of her physical exam is unremarkable.
Discussion: Mrs. July has been diagnosed with Hashimoto’s thyroiditis, systemic lupus erythematosus and rheumatoid arthritis. What do these three disorders have in common? They are considered to be autoimmune disorders. Let’s talk a little about autoimmune disorders.
Autoimmune diseases are thought to arise from an overactive immune response of the body against substances and tissues normally present in the body. In other words, the body attacks its own cells. In some cases, this may be restricted to certain organs such as the thyroid, in the case of thyroiditis. In other cases, such as rheumatoid arthritis and systemic lupus, the disease process may be more generalized, affecting tissues in multiple areas. Other examples of diseases that are thought to be autoimmune in origin are multiple sclerosis, psoriasis, scleroderma, Sjogren’s syndrome, celiac disease, ulcerative colitis and Crohns disease. There are more than 80 recognized autoimmune disorders.1
The underlying cause of autoimmune diseases is not fully known. Some researchers think autoimmune diseases occur after infection with an organism that looks like certain proteins in the body. The proteins are later mistaken for the organism and wrongly targeted for attack by the body's immune system.2 The question is, why would someone’s immune system “go haywire” and start attacking normal tissue? I believe it is more likely that the body’s immune system is reacting to something foreign, specifically fungi or mycotoxins.
Dr. Constantini (former head of the World Health Organization) believes that the concept of “autoimmune” diseases contains a fatal flaw. No successful species can develop a system of defense which attacks itself. Antibodies that are measured in the blood stream, and which imply an autoimmune condition, are actually antibodies against "ubiquitin," a substance that is present in many species including that of fungi.3 Dr. Constantini also believes that these diseases can be treated with antifungals and diet. Unfortunately, this is not a very widely accepted idea.
Traditional medical treatment of autoimmune disorders is based on suppression of the immune system through the use of prescription medications such as Plaquenil and Enbrel and steroids. (Follow the money). Unfortunately, when you suppress the immune system, you increase the risk of developing an opportunistic infection. In addition, use of these medications comes with the potential risk of developing irreversible retinopathy (blindness), neuromuscular dysfunction and blood disorders (aplastic anemia). Worse, these medications don’t cure the problem and ultimately make the problem worse.
Mrs. July has been diagnosed with three separate autoimmune diseases. One could argue that she has a “tendency to develop” autoimmune problems. I agree. She does have a tendency to develop these problems because she has chronic fungal disease. When you have a chronic fungal infection, you can virtually be assured that you have fungal overgrowth in the gastrointestinal tract (leaky gut). Leaky gut (dysbiosis) allows the passage of proteins, viruses, bacteria and fungus into the bloodstream that would ordinarily be prevented from entering. The immune system then goes after these foreign invaders, setting up an inflammatory reaction.
Going back to the original question, what do these three “diseases” have in common? Chronic inflammation is the common denominator. Based on her history, and the findings on her physical exam, it is clear that Mrs. July has chronic fungal disease. I started Mrs. July on ketoconazole (systemic antifungal), nystatin and daily probiotics.
On her examination, Mrs. July was also noted to have clinical signs of hypothyroidism (no lab test required to make this diagnosis). I started her on an iodine replacement, Iodoral. Over 90% of adults in the United States are iodine deficient.4 Mrs. July was also started on Armour thyroid and her levothyroxine was discontinued. Poor thyroid function equals poor immune function. In order to optimize Mrs. July’s immune system, it will be necessary to optimize her thyroid metabolism as well.
In addition to the above, I recommended that Mrs. July start on Vitamin D3. Vitamin D3 is essential to good immune function. Vitamin D3 deficiency is also common in adults. This should come as no surprise since we have been brainwashed into believing that the “sun is bad” and ‘sunscreen is good.” The importance of vitamin D3 is slowly becoming apparent to mainstream medicine, which can be a good thing.
Following an antifungal diet will always be important for Mrs. July. I have encouraged her to include powerful antifungal foods in her diet such as cilantro, purple cabbage, garlic and acai.
The prevalence of autoimmune diseases is increasing at an alarming rate. Prevention is going to be the key. For those of you who are interested in learning more about the fungal link to chronic medical disease, I recommend: The Fungus Link Volumes 1-3 by Doug Kaufmann.
Blessings,
Lynn Jennings, M.D.
1 www.nih.gov/medlineplus
2 www.nih.gov/medlineplus
3 Di Fabio, A. Systemic Lupus Erythematosus and Progressive Systemic Sclerosis, The Arthritis Trust of America®.
4 Brownstein, D. Iodine-Why You Need It, Why You Can’t Live Without It, 2nd edition. 2006