Diagnosis and Tests
Chronic and ill-defined illnesses such as chronic fatigue (CFS) are opportunities for developers of tests and treatments to market an array of unproven products and services. Some tests are well-motivated but don't work, most are expensive and distracting, a few are downright fraudulent. Whenever chronic illness develops, physicians have a duty to perform a careful history and examination, arrive at a tentative diagnosis and order appropriate tests to detect disease.
There are no definitive tests for CFS or fibromyalgia. The best advice I have to offer; don't spend a lot of money and effort on tests. I have often reviewed thick charts with hundreds of lab results costing thousands of dollars and have come to the conclusion that mostly this effort was wasteful and can be misleading. False positives are common. Abnormal lab results may not explain the problems at hand. Normal results may not rule out diseases in the early stages of development. Many tests are simply inappropriate and some are invalid; some are even bad and bizarre tests.
The Alpha Nutrition Program is suggested as both a diagnostic and a treatment procedure. This standardized method of diet revision can be conducted at home and spare the patient the inconvenience and cost of hospitalization or frequent office visits. In the era of cost-containment and increased patient responsibility for self-care, a well-constructed diet revision program empowers the patient to resolve health problems with a minimum of medical interventions.
The ultimate value of test
Doctors and mechanics have a something in common. A good mechanic will take a history of the problem and arrive at tentative diagnosis - he might say " only three problems act like that". Problem 1 costs $200 to fix and Problem 2 costs $1500 so that you not only need a good mechanic, but also an honest one. I was impressed when my aging car recently lost power after clicking menacingly for a few days and I went to a local garage for help. They attached their diagnostic machine and within minutes, a lengthy printout emerged showing a compression problem in the left front cylinder. I was lucky to get the $200, 2-hour fix. I thought - this is the efficiency of diagnosis and treatment that patients expect from their physicians and seldom get. If a test leads to a solution directly, then it is a valuable test.
With a few exceptions, medical diagnosis is more difficult and uncertain. When you present with chronic fatigue, the diagnosis may be very difficult indeed. Well-defined entities with structural changes in tissues are the easiest diagnose. Most medical technology addresses these needs. The specification of coronary artery disease, for example, can be precise and is a tribute to the combined effort of physicians, technicians, engineers and equipment manufacturers to fully reveal a disease-causing process. The precision of these well-defined areas of medical concern may mislead the unwary into thinking that all areas of medicine are equally well-defined or can be well-defined with just a little more effort.
However, most other disease processes remain obscure and are genuinely difficult to characterize and understand. The diagnosis of depression, for example, is a subjective syndrome that requires a historical understanding more than positive lab tests. The irritable bowel syndrome is a diagnosis of exclusion. The patient may suffer a great deal but tests are negative, repeatedly.
The concept of delayed patterns of immune response ("food allergy") to food materials provides both a theoretic and practical basis for interpreting symptoms of patients with non-specific syndromes. The presence of food allergy (as a pathophysiological mechanism) is concealed in a variety of diagnoses such as migraine headaches, asthma, eczema, irritable bowel syndrome, chronic fatigue, depression, panic disorder, and arthritis. Patients with these problems tend to have two or more manifestations concurrently in a matrix of non-specific symptoms. The grand theory of hypersensitivity disease attempts to explain these illness complexes as expressions of reactive immune networks, responding to food and airborne antigens.
Without a well-equipped research laboratory, it will not be possible to actually measure the pathophysiological events. The patient's symptom reports and a general understanding of pathophysiology will usually suffice to construct an adequate theory (diagnosis) and prescribe effective intervention. Often a burst of symptoms, emerging over hours or days, can be explained by antigenic material from food entering the circulation from the digestive tract. triggering a variety of alarm and defense procedures. Food allergy is diagnosed by physicians who understand the multisystem, polysymptomatic patterns of illness involved. These patterns are revealed by a careful clinical history, and the diagnosis made on clinical grounds.
Proceed With Diet Revision
The desire for simple, definitive tests for food allergy is easy to understand, but difficult to fulfill. The idea of a simple office "test" for food allergy should seem unlikely if you have read and considered other texts at this web site. Food interacts complexly and sequentially with our body with many different consequences. It is unlikely that food allergy occurs in a consistent manner; there are too many variables. No single test will ever reveal the complex nature of this reactivity.
We are suggesting that proper diet revision should always be carried out when food-related illness is suspected. For thousands of patients we have reviewed over the past 15 years, food allergy or food sensitivity tests have for the most part been an expensive distraction - and worse - misleading, confusing, and counter-productive.
Dr. J. Gerrard, a prominent Canadian allergist summarized the problems of evaluating food allergy:
"... foods can cause not only classical IgE-mediated allergy but also the irritable bowel syndrome, migraine, arthritis, and disturbances of behavior. The identification or confirmation of IgE-mediated allergy is simple, for it correlates well with skin prick tests and RAST results. The identification of other adverse reactions to foods is more difficult and is sometimes hampered by preconceived ideas both on the part of the patient and the physician. To throw light on this problem we have admitted patients, thought for one reason or another to be reacting adversely to foods, to a hostel unit where they have first been fasted for four days on spring or filtered water, and have then been given single foods one by one so that adverse reactions to them might be recorded by both the patient and the physician. The patients studied had for the most part a combination of symptoms which included nasal stuffiness, headaches, irritable bowel syndrome, arthralgias, eczema, and neurological problems such as depression and lassitude. 33 patients have been investigated so far. In 6, symptoms persisted unchanged, the presenting symptoms being headache in 3, neuralgia in 2, and asthma in 1; symptoms cleared completely in 12 and diminished to 50-90% of previous levels in 15. When foods were reintroduced the reactions were unexpected, both by the patient and by the attending physician, for neither knew beforehand that foods, let alone which food, were precipitating symptoms. Had the patient been aware that foods were playing a part in causing his symptoms he would have avoided them. Foods seem to play a part in severe chronic disorders which have no recognized aetiology. To establish the role of foods in precipitating these disorders we need hospital units where patients can be fasted and then tested individual with foods, with biochemical and immunological studies if required. Investigations such as these are inexpensive and, when foods are implicated, the treatment, food avoidance, is cheap. When food avoidance prevents headaches, the irritable bowel syndrome, arthralgias, and depression, it is more effective and less costly than traditional treatment, and the observation also throws light on the aetiology of the disorder."
A trial of diet revision is safe, practical and effective when the clinical pattern suggests the diagnosis of food allergy or when the patient believes that food is responsible for causing symptoms. Knicker's advice is worth repeating: "To diagnose adverse reactions to foodstuffs the clinician chiefly need to be satisfied that the ingestion of a food predictably and repeatedly causes disease. It is not necessary to know the precise triggering mechanism or which mediators of inflammation are activated. Such information is difficult to obtain, often requiring considerable laboratory investigation beyond the scope of clinical practice."
Gerrard suggested: " The identification or confirmation of IgE-mediated allergy is simple, for it correlates well with skin prick tests and radio-allergosorbent test results. The identification of other adverse reactions to foods is more difficult and is sometimes hampered by preconceived ideas both on the part of the patient and the physician... Foods seem to play a part in severe chronic disorders which have no recognized aetiology. To establish the role of foods in precipitating these disorders we need hospital units where patients can be fasted and then tested individual with foods, with biochemical and immunological studies if required. Investigations such as these are inexpensive and, when foods are implicated, the treatment, food avoidance, is cheap. When food avoidance prevents headaches, the irritable bowel syndrome, arthralgias, and depression, it is more effective and less costly than traditional treatment, and the observation also throws light on the aetiology of the disorder."
When confronted with chronic fatigue, physicians will check for anemia and low thyroid first. The measurement of hemoglobin and a stained blood smear are probably the most valuable tests- if the hemoglobin is low and the blood smear show small red blood cells then the diagnosis is iron deficiency anemia and the fix is iron supplements. Similarly, a low hemoglobin and large red blood cells means Vitamin B12 or folic acid deficiency - taking supplements fixes the problem, although you may have to inject the B12. Physicians and patients alike prefer this kind of problem because there is an easy, obvious connection between tests and treatments There are a number of basic tests, familiar to all physicians that screen for the most important major diseases that could present as chronic fatigue. While the following list is not exhaustive it is adequate for most purposes.
Recommended laboratory examination:
Many other tests have been suggested, some are normal lab tests, others are frankly fraudulent. Here is a short list of tests with two ratings on a 1 to 10 scale. The first rating is an estimate of the validity of the test - does the test actually do what people claim? - how reliably does it measure what it is supposed to measure? The second rating shows the value of the test either in assessing the mechanism of symptom production or in directing treatment.
Aching & Fatigue is a book about non specific illnesses with aching and fatigue as prominent symptoms. Diagnoses such as Chronic Fatigue Syndrome, Fibromyalgia, Depression have become popular. Some patients say " I feel sick all over". These are overlapping symptom complexes and are often part of a larger illness complex. Dr. Gislason explains why diet revision as the first and most essential form of therapy. Long term management of food intake and exercise are required to sustain improvements. Drug prescriptions are best avoided.
Aching and Fatigue is intended to be used with the Alpha Nutrition