Life is full of surprises. I had almost completed my article for this month’s newsletter when Doug’s office emailed me and said the topic this month would be diabetes. “No problem,” I said to myself. “I can use this case study next month and I will get my article in on time for once.” So I started on a second article and was two-thirds done when Mr. August came into the office. “This is the case I have to write about it.” So, I put aside Case study #2 for another month and started Case study #3. Let’s get started before I change my mind again.
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 his 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 Concern: Mr. August is a 27 year old white male who presented to the clinic for chiropractic treatment of neck and upper back pain. I work in a multidisciplinary clinic with two chiropractors and one of my jobs is to evaluate patients prior to chiropractic treatment. Mr. August woke up two days prior to evaluation with severe pain in his neck. He thought that it would resolve on its own but instead it had gotten worse. The pain is worsened with movement of his neck. He described the pain as sharp and “it is as if my neck is catching” with movement. He also reported a tingling sensation in his right hand. The pain in his neck is constant and it is interfering with his sleep. He denies any trauma or known precipitating event in the days preceding the onset of pain.
Past medical history: Mr. August has a history of asthma and diabetes mellitus type 2.
Past surgical history: Mr. August underwent bilateral inguinal hernia repairs as an infant.
Medications: Mr. August uses Novo Log (rapid acting) and Lantos (long acting) insulin as well as Janumet (a combination of metformin and sitagliptin. All of these medications are for his diabetes
.
Vitamins/Supplements: None
Allergies: None
Social history: Mr. August is married and works as an electrician. He has one child. Mr. August dips tobacco and uses about one can per day. He occasionally drinks alcohol and states that he exercises moderately.
Review of systems: During his evaluation, Mr. August reminded me that I had been his physician in 2003. I had been his primary care physician when he was hospitalized with a methicillin-resistant Staphylococcus aureaus (MRSA) infection. I also treated his girlfriend (future wife) who was hospitalized the same day with the same MRSA infection. (At this point, I have to admit that this routine biomechanical evaluation for neck pain became much more interesting). Mr. August reported that he had recurrent episodes of bronchitis and pneumonia as a child for which he received multiple courses of antibiotics. He denied any problems with shortness of breath and he had not had any problems with asthma in many years. Mr. August does not have any history of high blood pressure or elevated cholesterol although his primary care physician would like him to be on a “statin” medication because of his diabetes. He has been told that he has a fatty liver. Mr. August reports that he was diagnosed with type 2 diabetes mellitus approximately one year after his hospitalization with the methicillin-resistant staph aureaus infection. Mr. August states that he has had chronic problems with skin rashes. He developed thrush after being treated with erythromycin in the past. He states that he had lost a lot of weight but that he had gained some of it back since beginning insulin therapy. He does not have any root canals. The remainder of his review of systems is unremarkable.
Physical exam: Blood pressure: 120/81 Pulse: 88
Height: 6’3” Weight: 288 lbs.
Mr. August was noted to have trace suborbital edema below both of his eyes.
His tongue was noted to be scalloped.
Examination of his hands revealed vertical ridges on his fingernails.
Mr. August was noted to have tightness and spasm of the muscles in his back and neck.
The remainder of his physical exam was unremarkable.
Discussion: I love it when I have the opportunity to see patients whom I have treated in the past during my “traditional years.” However, I am frequently saddened by the deterioration in their health. Sometimes, I get a “second chance” to try to repair the “damage” that has occurred as a result of “standard of care practices.” It reaffirms my resolution to continue to “treat the cause.” Mr. August’s case illustrates the growing epidemic of diabetes in this country. Young people are developing diabetes in the form that was once found only in older adults. Most young people have received multiple courses of antibiotics as Mr. August did. He did not “develop” diabetes until a year after his aggressive treatment for MRSA. There is also something that I haven’t mentioned. His girlfriend, now Mrs. August, also developed type 2 diabetes mellitus. Doesn’t that just set the bells ringing? I could hardly wait to go to my storage facility and pull out his old medical record.
Hospital synopsis: In 2003, Mr. August was admitted to the hospital with a 3-4 week history of recurrent abscesses. His initial abscess was in his right axilla (armpit) which was treated at an urgent care clinic with the antibiotic Ceftin (a cephalosporin). He had some improvement in the initial lesion but developed a second lesion which was very painful and swollen. He was seen again by a second physician and was given another antibiotic, Biaxin, to take in addition to the Ceftin. Despite the multiple antibiotics, Mr. August began to have recurrent fever and chills. On the day of his admission to the hospital, his girlfriend, Mrs. August, was also admitted with several abscesses requiring surgery. On admission, Mr. August weighed 350 lbs.
While hospitalized, Mrs. August underwent surgery to drain her abscesses. Cultures of the material from the abscesses came back positive for methicillin-resistant staph aureas. An infectious disease consult was obtained for Mr. August. As expected, cultures of Mr. August’s abscesses were also positive for MRSA and he was started on intravenous vancomycin and a decolonization protocol for MRSA. After five days of intravenous antibiotics, Mr. August was sent home on three antibiotics: Rifampin, Bactrim DS and Levaquin.
So let’s talk about fungus and diabetes. Let’s start with a description of the signs and symptoms of diabetes mellitus type II:
- There is a decreased ability of the cells to absorb sugar from the blood which causes an increase in the blood sugar to higher than normal levels.
- There is also a higher level than normal of insulin in the blood.
- Despite the elevated insulin level the cells are unable to make use of the sugar that is available. Insulin is essential for cells to absorb sugar from the blood. This is where the term “insulin resistance” has become synonymous with type II diabetes.
- The cells are starving in a “sea of plenty.”
- The increased sugar in the blood acts as osmotic diuretic, drawing fluid into the bloodstream. This osmotic diuresis causes increased blood flow to the kidneys which causes increased urination and thirst.
- Uncontrolled diabetes can initially lead to a decrease in weight.
- As insulin levels go higher, the patient tends to gain weight.
- The consequences of type II diabetes are harsh and include an increased risk of heart and vascular disease, kidney failure, blindness and damage to the nervous system.1
Now let’s review some of the “fungal basics.” Fungi produce mycotoxins which are toxic chemicals that are capable of causing disease and death. Diseases caused by exposure to mycotoxins are called mycotoxicoses. The symptoms of a mycotoxicosis depend on the type of mycotoxin; the amount and duration of the exposure; the age, health, and sex of the exposed individual, dietary status. The severity of mycotoxin poisoning can be compounded by factors such as vitamin deficiency, alcohol abuse, poor diet and infection. 2
Mycotoxins are used by fungi to manipulate their environment to ensure survival, as well as a food source. Most mycotoxins can kill or harm other fungi or bacteria. Mycotoxins can also suppress the immune system of the individual and thereby promote survival of the fungus. Medicine has used this to its advantage; many chemotherapy agents and antibiotics are mycotoxins. Some well-known examples of “medical mycotoxins” are the antibiotics penicillin and cephalosporin and the chemotherapy agents cyclosporin A, bleomycin, actinomycin D and L-asparginase.
Now let’s talk about specific fungi and how the mycotoxins produced can play a role in causing diabetes mellitus type II. Some of the mycotoxins can increase the amount of food available (sugar) for the fungus. Fungi, such as Rhizopus arrhizus, are able to produce prednisone and fungi of the species Aspergillus are able to convert a natural hormone, progesterone, into desoxycorticosterone (corticosteroid). Corticosteroids raise the amount of sugar in the bloodstream. Fungi feed on that sugar.
Fungi of the species Penicillium and Aspergillus produce the mycotoxins patulin and ochratoxin. Patulin is able to inhibit a cell’s ability to use oxygen. Our cells cannot survive when this happens but fungi thrive in this acidic environment. In diabetics, this acidic state can result in abdominal pain, muscle cramps, nausea and thirst. Ochratoxin is able to cause cell death (apoptosis) in normal cells. Through apoptosis, the body’s supply of a toxin neutralizing chemical called GSH is depleted. The level of GSH in the body has an affect on how sensitive a cell is to insulin. The lower the levels of GSH, the less sensitive the cell is to insulin.1 Ochratoxin A is a nephrotoxin (toxic to the kidneys).2
Aflatoxin produced by the species Aspergillus is toxic to the liver and is able to suppress the immune system of the individual. Aflatoxin B1 is able to inhibit the breakdown of glucose and glycogen (the form in which glucose is stored in the liver). This prevents the cells from using the sugar and results in an increase in sugar in the bloodstream and liver.
The species Claviceps produces the fungal metabolites known as the ergot alkaloids. Interestingly, the ergot alkaloids have been associated with human disease since antiquity. There is mention of a “noxious pustule in the ear of grain” believed to be an early reference to ergot in an Assyrian tablet dated to 600 BC. Ergot alkaloids affect the blood supply to the extremities and can also affect the central nervous system. The kidney is the primary target organ. 2
Tying it all together, it should be clear that the signs and symptoms of diabetes could easily be caused by fungal infection. I did not address the fungal link with diabetes type I in this article but it is even more compelling.
Based on his history and presentation, Mr. August has chronic fungal disease, dysfunctional thyroid metabolism and a suppressed immune system. This was the first time any doctor had ever addressed his fungal infection. He was unaware that there could be a connection between fungal disease and chronic medical disease. He had only come in to have his spine adjusted! He was very receptive to learning more. Since this was all new to him, I sent him home with some information to read. He has a follow-up appointment scheduled and we will discuss treatment.
I hope that I have piqued your interest in learning more about the fungal link to diabetes mellitus type I and II. Doug Kaufmann has written a book entitled Infectious Diabetes which I strongly recommend, and from which I have paraphrased and copied liberally. Thank you Doug.
Blessings,
Lynn Jennings, M.D.
- Kaufmann, D. Infectious Diabetes, 2003.
- J. W. Bennett and M. Klich; Mycotoxins. Clin Microbiol Rev. 2003
July; 16(3): 497–516.