Diagnosis and Tests
Chronic and ill-defined illnesses such as chronic fatigue (CFS) and fibromyalgia 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, aching, stiffness, 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 illness 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."
Laboratory Investigation
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:
| System |
Tests |
Checks for |
| Blood Disorders/Immune |
Hg. WBC, Differential,
B12, Immunoglobulins |
Anemias, Infections,
leukemia |
| Liver Function |
AST, ALP, Hepatitis
Antigens |
Hepatitis, cancer |
| Kidney Function |
BUN, creatinine,
urinalysis |
Nephritis, Diabetes,
Hypertension |
| Joint, Muscle Pains |
RF, ANA, Uric Acid |
Inflammatory arthritis,
gout |
| Metabolic |
TSH, T4, FBS, 2 hr PPBS,
Cortisol |
Thyroid, Diabetes.
Adrenal |
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.
| Test |
Does what it says 1-10 |
Value rating 1-10 |
| Hemoglobin |
10 |
10 |
| White Blood Cell Count |
10 |
10 |
| T4 (Thyroxine) or TSH |
10 |
10 |
| Allergy skin test |
8 |
3
|
| Skin Provocation tests |
4 |
0 |
| Sublingual tests |
2 |
0 |
| IgE RAST or ELISA |
9 |
3 |
| IgG RAST or ELISA |
9 |
4 |
| Immune Complex Assays |
9 |
5 |
| Immunoglobulins |
10 |
6 |
| Complement assays |
9 |
6 |
| Cytotoxic tests |
3 |
0 |
| Vega Meter |
0 |
0 |
| Live Blood Cell Analysis |
1 |
0 |
| Muscle Testing |
0 |
0 |
