Fighting Fatigue

Hello and welcome to Nutrition Facts. I’m your host, Dr. Michael Greger. Today, we’re going to explore smart nutrition choices based, naturally, on facts. Whenever there’s a new drug or surgical procedure, you can be assured that you and your doctor will probably hear about it because there’s a corporate budget driving its promotion; but, what about advances in the field of nutrition?  That’s what this podcast is all about. 

You know the feeling.  Your energy is sinking.  You have to will your eyes to stay open.  And this energy ebb keeps returning day after day. Is it your diet, lifestyle – genetics?  Is there anything you can do about it? On today’s show we look at the problem of fatigue. 

Fatigue may be a symptom of a variety of illnesses including celiac disease, multiple sclerosis, PMS, depression, fibromyalgia, diabetes, hypertension and dehydration.   

What about Candida? “Candida-hypersensitivity” symptoms supposedly include tiredness. You don’t know, though, unless you put it to the test.  What happens when people are placed on a high-sugar diet?

Despite its “extensive…use in the brewing and baking industry,” only about 5%—1 in 20—healthy people have anti-yeast antibodies in their bloodstream, whereas in people with Crohn’s disease, that number is more like 60 or 70%. Most people with Crohn’s have antibodies that react to regular baker’s, brewer’s, or nutritional yeast—which are all just different forms of a yeast known as Saccharomyces cerevisiae.

But that baker’s/brewer’s/nutritional yeast had never been directly implicated in Crohn’s. Maybe the antibodies are a direct reaction to it—or, maybe a reaction to another yeast altogether, and the antibodies are just mistakenly cross-reacting with regular yeast. And, indeed, five years later, it was discovered that antibodies against Candida, a totally different kind of yeast, the yeast that causes thrush and vaginal yeast infections, can cross-react with Saccharomyces. So, maybe baker’s/brewer’s/nutritional yeast was just an innocent bystander all along?

For nearly 30 years, we’ve known that antibodies to Saccharomyces are linked to Crohn’s disease. But, instead of bread, beer, and nooch leading to Crohn’s disease, maybe Candida is causing the Crohn’s disease and the antibodies. Or, hey, maybe Candida is the innocent bystander, and exposure to food and beverage yeast is the real culprit. You don’t know until you put it to the test.

Take Crohn’s patients, remove yeast from their diet, and see if they get better. If they do, then indeed, it was the culprit. But if they don’t, then maybe Candida is the real cause.

Before I get to the study, let me just first bust some Candida myths. Candida is a normal constituent of our gut flora. Get some Candida in your bloodstream though, and it can cause a life-threatening infection. But it’s normal to have some Candida hanging around in your mouth or colon. It’s location, location, location. Just like having stool bacteria in our colon is normal, but stool bacteria in our blood or a wound would be bad.

Because of the ability of Candida to cause problems in the wrong location, or in people who are immunocompromised, a Candida syndrome theory arose, linking the presence of Candida to all sorts of health problems, which led to “mycophobia”—fungalphobia—this “false interpretation” that the finding of Candida in your mouth or stool is evidence of some kind of infection, rather than just being totally normal. And, if you think the authors are being a little overdramatic with their phobia talk, just Google Candida, and you’ll see.

Not only is it normal to have Candida in your gut; you apparently couldn’t get rid of it even if you wanted to. Give people powerful antifungal drugs, and you can drop levels down, but they pop right back up again as soon as you stop them. And, this whole concept of sugar feeds yeast; so, go on a low-sugar diet doesn’t make much sense—since, unless you’re lactose-intolerant or something, sugars should get absorbed high up in the small intestine, and never make it down into the colon. And indeed, there appears to be “no correlation” between Candida counts and sugar consumption. You can put people on a high-sugar diet by adding an additional 14 spoonfuls of sugar to people’s diets, and still not see an effect. Of course, there’s lots of reasons to cut sugar from your diet based on science, but Candida does not appear to be one of them.

There does not appear to be good evidence that a so-called “Candida-syndrome” exists at all. But, oh, those are fighting words. “Few illnesses have sparked as much hostility between the medical community and…[the believing] lay public.” The medical community has dismissed purported sufferers as emotionally disturbed, or just plain crazy. Of course, you can’t just come out and call them crazy. “Psychiatric diagnoses need to be presented gently.” For example: “Some patients prefer to” believe their mental illness is caused by the Candida, in which case, doctors may just pat them on the head, so they’ll take their pills. Patients who self-diagnose with Candida apparently “only infrequently relinquish their illness,” some to the extent that they attempt to use their yeast “as a drunk-driving defense.” I wasn’t drinking, your honor; my yeast was just self-brewing beer in my guts.

The whole concept of Candida syndrome is officially derided by the American Academy of Allergy and Immunology as “speculative and unproven,” offering “no…proof…no…proof…no proof…no proof.” The “[presumption] that the ubiquitous [Candida] has [some] toxic effect on [our] system [is] without a trace of…scientific proof.” You want no proof, someone wrote in response, how about the millions of unnecessary tonsillectomy surgeries doctors did? Don’t get me started on the radical mastectomies. At least putting people on low-sugar diets isn’t disfiguring people. Though some anti-Candida therapies can be “potentially dangerous.” Antifungal drugs might breed resistance, and can have side effects. Nystatin’s not so bad, but ketoconazole can damage your liver. And indeed, there are reports of people being treated for what may be a fake diagnosis ending up in quite dire straits because of it. So, it’s important to know if the syndrome actually exists. So, researchers decided to put it to the test.

Super simple study. Give some people some “stool-tubes” to take samples, ask them a bunch of questions about the symptoms they have—headaches, stomachaches, tiredness—all the typical Candida syndrome symptoms. And, they found no relationship to whether or not they had Candida growing in their gut. So, no “[h]ints of…Candida-syndrome could…be found.”

Here’s a crazy story about chronic fatigue.  It appears that fatigue can be the result of a neurotoxin that contaminates fish like red snapper and grouper.  Here’s the story.

Ciguatera is one of the most common forms of food poisoning, which occurs after the consumption of fish contaminated with neurotoxins, produced by certain algae that build up the food chain. Just a few bites can be sufficient to induce the condition. Disturbingly, affected fish looks, smells, and tastes normal, and ciguatoxins are resistant to all forms of cooking, so there is no straightforward method to predict whether your tropical culinary dream will be followed by a ciguatera nightmare.

Literally, it can cause nightmares; about 1 in 6 may experience signs of hallucinatory poisoning: lack of coordination, hallucinations, depression, nightmares. Most suffer some kind of neurological symptoms, tingling, numbness and a burning cold sensation. For example, ciguatera sufferers have reported that a refreshing dive in the ocean actually caused burning pain, or that drinking cool beer felt like too hot coffee.

So, sometimes a reversal of temperature sensation occurs, like cold objects feel hot, vice versa. The toxin itself may also be apparently sexually transmitted either direction after fish consumption, or as one of my favorite public health bloggers put it, when hot sex turns cold and painful, blame it on dinner.

And the symptoms can persist for months or even years. Ongoing research has shown that people with chronic fatigue syndrome may actually be suffering the long-term effects of this fish food poisoning, or a condition called polymyositis, which causes diffuse muscle aches, pains, and inflammation. Some individuals intoxicated by fish consumption 25 years previously can experience a recurrence of the main neurological disturbances during periods of overwork, fatigue, stress. You can still find the toxins stuck in their body decades later.

Recent outbreaks in New York City have drawn attention to the problem. A man eats grouper at a Manhattan restaurant, and goes swimming two miles a day to all of the sudden having difficulty walking that lasts for months. But these aren’t just rare anecdotes. Ciguatera fish poisoning affects an estimated 15,000 Americans every year, causing hundreds of hospitalizations and even a few deaths. And, again, the toxins are colorless, odorless, tasteless, not destroyed by cooking. Therefore, CDC scientists suggest education efforts aimed at the prevention of seafood intoxication by avoidance of high-risk fish altogether. The AMA put out a similar advisory, suggesting that the only way to prevent it is to avoid eating fish like red snapper or grouper, but the problem is that a third of fish sold in the US is mislabeled, so you don’t know what you’re getting. Some suggest feeding a large fish flesh meal to a cat, treating them kind of like a court tester, and if they’re okay six hours later, you can dig in, but this is considered inhumane. But if it’s inhumane to feed it to your cat, how is it not inhumane to feed it to other members of the family?

Here’s an interesting study on the anti-inflammatory effect of curcumin.  The yellow pigment in the spice turmeric was put to the test to see if it could reduce postoperative pain and fatigue after surgery.  Here’s what they found out.

Medicine is messy. One of reasons researchers experiment on animals is that they can create uniform, standardized injuries to test potential remedies. It’s not like you can just cut open 50 people and see if something works better than a sugar pill. But, wait a second, we cut people open all the time. It’s called surgery. The efficacy of turmeric curcumin in pain and postoperative fatigue after laparoscopic cholecystectomy—people getting their gallbladder removed: a double-blind, randomized, placebo-controlled study. Fifty people were cut into, given curcumin, or an identical looking placebo, along with rescue analgesics—actual pain killers to take if the pain becomes unbearable. Even though it’s just laparoscopic surgery, people don’t realize what a toll it can take—you can be out of commission for a month.

In India, turmeric, in curry powder, has traditionally been used as a remedy for traumatic pain and fatigue; so, let’s put it to the test.

In the weeks following surgery, a dramatic drop in pain and fatigue scores in the turmeric pigment group, the curcumin group. Those are my kind of p-values. It’s hard to come up with objective measures of pain and fatigue, but drug-wise, the curcumin group was still in so much pain, they were forced to take seven of the rescue painkillers. In the same time period, though, the control group had to take 39. Of course, better to not get gallstones in the first place, but their conclusion was like no other I’ve ever read in a drug trial. “Turmeric is a natural food ingredient, palatable, and harmless.” Okay, so far so good. “It proves to be beneficial as it may be an ecofriendly alternative to synthesized anti-inflammatory drugs which have a definite carbon footprint due to industrial production.” Since when do surgeons care about the greenhouse gas emissions from drug companies? I just had to look up this reference. And, there it is, the journey of the carbon-literate and climate-conscious endosurgeon. I don’t know what’s stranger, seeing the word holistic in a surgical journal or the name of this guy’s practice: Dr. Agarwal’s Surgery & Yoga.

To see any graphs, charts, graphics, images, or studies mentioned here, please go to the Nutrition Facts podcast landing page.  There, you’ll find all the detailed information you need plus links to all the sources we cite for each of these topics.

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Thanks for listening to Nutrition Facts. I’m Dr. Michael Greger.

This is just an approximation of the audio content, contributed by Allyson Burnett.