Debating Dr. Gott

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A few years ago, when I still had a subscription to a print paper (Ventura County Star), a question to Dr. Gott’s medical advice column caught my eye. It made my heart ache to read it, as I had a very similar experience to the gentleman who wrote to Dr. Gott for help. I was very dissatisfied with Dr. Gott’s answer and mailed my own explanation of the man’s symptoms to Dr. Gott, but I don’t think it was ever considered. Here is the article from April 4, 2009:

DEAR DR. GOTT:

I am a 47-year-old male smoker. I have a lot of stomach problems that started after a stomach virus in January 2007. I used to weigh 214 pounds but now weight 138 pounds and am 6’ 4” tall.

I have had 3 complete blood counts, thyroid and B12 tests, a CT scan of my chest, stomach and pelvis, a colonoscopy, and an endoscopy. I was told I have irritable bowel syndrome (IBS) since my tests have all come back normal. A nutritionist has told me that my body mass is extremely low.

My symptoms vary and can include headaches, increased urination, fatigue, lower stomach cramps, plugged ears, tender stomach, nausea, bloating, gas, loss of appetite, abdominal pain, skipped heart beats, different bowel patterns every day, and high anxiety.

I used to be a very upbeat positive person but now I have very nervous and have many strange thoughts and behaviors. I have an extreme fear of vomiting which sometimes causes me to miss entire meals. I drink coffee every day even if I don’t eat. I have skipped lots of meals because of pain and fear, and even if I feel hungry and can hear my stomach growling, I will ignore.

I am now a very self-centered, depressed person and care only to read about what could be wrong with me.

My doctor told me I could be ill because of my anxiety and has offered medications to try but I refuse them because of the possible side effects.

Could this really be IBS or are my doctors missing something?

DEAR READER:
I believe your problems can all be traced back to one thing: your irrational fears and anxiety. By not eating, you have lost far too much weight, are likely undernourished and your caffeine intake and smoking habit are not helping.

Caffeine is essentially a diuretic which could explain your increased urination. It can also cause or worsen nervousness, anxiety and palpitations. Your bowel patterns are different every day because of your inconsistent food intake. Stomach pain, bloating, tenderness, nausea and gas can be linked back to your inadequate and infrequent eating habits. After a period of not eating anything substantial, your stomach will become unable to properly digest and absorb nutrients.

I believe your best course of action is to seek out a physician, nutritionist and therapist who can all work together to help you understand your fears, develop an appropriate eating plan and monitor you. In my opinion, if there were an underlying physical illness, it would have been found. IBS is unlikely but once you are back on a normal diet, the IBS diagnosis can be confirmed or denied.

You have essentially developed a serious eating disorder. Eating disorders are not about gaining or losing weight, they are about control, fear and other emotional and psychological factors.

You need help. Consider admitting yourself to a facility that specializes in eating disorders where you will have access to physicians, nutritionists and therapists to help you work through this difficult time.

To give you related information, I am sending you a copy of my Health Report “Eating Disorders”. Other readers who would like a copy should send a self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

In my opinion, and I’m going to focus on the symptoms related to low serum levels of tryptophan, it does seem like this man has been traumatized by his symptoms and may need therapy to recover, but many of his symptoms mirrored my own. Shortly before showing signs of a stomach virus, I too had anxiety, which continued for many months after I had recovered from the norovirus infection. I had headaches, stomach pain, nausea, gas, palpitations and many other symptoms. I had an upper GI endoscopy to diagnose my constant stomach pain with the result being negative. What I believed happened to me, and possibly this person, is that my blood tryptophan levels were already low due to inflammation caused by a food allergy or sensitivity. I don’t know what could cause this man’s inflammation. Perhaps he has a food or gluten allergy or a food sensitivity. Maybe he had/has a chronic viral or bacterial infection or even cancer that would cause IDO to be expressed at an elevated level and cause serum tryptophan levels to be chronically low. Then along comes a norovirus and sends the body into a tail spin, with an increased production of serotonin to trigger diarrhea and vomiting to physically rid the body of the virus, which in turn deplete tryptophan levels in the blood. IDO expression elevates even more to help slow the replication of the stomach virus, catabolizing tryptophan  and creating byproducts that are neurotoxic. Inflammation continues because the source of the undiagnosed food allergy/infection/cancer has not been treated and doesn’t allow the body to recover sufficient levels of tryptophan, so the anxiety as well as the eating disorder continues.

In this case, Dr. Gott links the mans poor eating habits to stomach pain, bloating, tenderness, nausea and gas, but I would argue these are the signs of a food allergy or sensitivity. I know in my case, the anxiety, depression and other symptoms discussed did cease when I removed gluten and dairy from my diet.

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