NutritionFacts Grab Bag 29

Back by popular demand, it’s our NutritionFacts Grab Bag, where we look at the science on a whole variety of topics, starting with a story about how to preserve your sense of smell.

Based on a study of nearly 2,000 people, our sense of smell declines as we age, similar to our loss in vision and hearing. About a quarter of Americans over the age of 50 suffer from olfactory dysfunction—a difficulty identifying odors—which climbs to more than half of individuals between the ages of 65 to 80 years of age, and about 80 percent in those over the age of 80. And, that was before COVID-19, which affected the smell of nearly 50 percent of sufferers. Typically it was temporary, but as many as 15 percent of non-hospitalized COVID survivors were still experiencing problems with the ability to smell three or months later––and there are cases of it lasting for years.

As anyone with even a simple head cold can tell you, when you lose your sense of smell, you lose much of your sense of taste as well. Between 75 to 90 percent of what we think of as taste may actually be smell. This was all too vividly illustrated by the case of Algerian War soldiers whose tongues had been cut out remarkably reporting little loss of food and drink flavor sensation.

But hey, if loss of smell leads to loss of taste, think of all the weight loss! That was apparently the thought behind the development of a “novel nasal device,” gag-inducing silicone tubes you stick in your nostrils to cordon off your smell receptors. Researchers recorded a drop in preferences for sugary foods and beverages along with weight loss, but only among the younger adults––presumably because the sense of smell of the older adults was already impaired. Making everything taste bland may help you skip a few doughnuts, but the flip side is that people with smelling difficulties tend to add more salt.

Older individuals were found to require two to three times more salt than those who were younger to achieve the same salty taste. It’s no wonder that the lifetime risk of developing high blood pressure may exceed 90 percent.

What can we do to preserve our sense of smell? Ambient air pollution is associated with olfactory dysfunction––thought to explain why nasal biopsies from residents of Mexico City, living and dead, showed more lesions and inflammatory changes than those living in low-pollution cities. We may not have a choice where we live, but there is definitely a direct source of air pollution tied to loss of smell we can all choose to avoid: cigarette smoke.

Smell loss can have serious consequences, for instance, missing a gas leak, smoke, or spoiled food. (If you have lost your sense of smell and use natural gas, please consider buying a gas detector). But, in terms of direct disability, most people who are affected don’t even to seem to be aware their smell is impaired, even when asked directly. Nearly eight out of 10 elderly individuals with smell loss thought they had normal smell sensitivity.

Hearing loss, however, is considered a major cause of global disability, ranking among the top chronic conditions affecting older adults. For far too long, though, as a National Academy of Medicine report put it, hearing loss has been “relegated to the sidelines of health care.”.

In our next story, we look at how duct tape beat out freezing and ten other treatments for the removal of warts.

When I was reviewing the science behind common over-the-counter remedies used in dermatology, such as tea tree oil for acne or nail fungus, I was surprised to see on the same page a section on duct tape. Duct tape?! The only time I remember seeing duct tape used in a medical study was on the “[i]dentification of the gases responsible for the odor of human [farts],” which involved a collection system comprised of “gas tight pantaloons…sealed to the skin” with duct tape. (That’s the study where they assessed the wind-breaking ability of a cushion called the “Toot Trapper.”)

But what the dermatology journal was talking about is warts. “Duct tape brings out our inventive, slightly kooky side.” “Given this versatility, it wasn’t so surprising a few years ago when a group of doctors…reported that duct tape could get rid of warts.” As I noted in my last wart video, all sorts of strange things are purported to cure warts, because most go away on their own. A thousand kids were followed for two years, and two-thirds of the warts disappeared without doing a thing. So maybe we should just leave them alone—”although there are cases [that] may warrant treatment.” Otherwise, we can just let our own body take care of them.

Warts are caused by wart viruses, and so, spontaneous wart disappearance is assumed to be an immune response, where our body finally wakes up and takes notice. This assumption is based on studies where foreign proteins were injected into the wart itself—like a measles-mumps-rubella vaccine straight into the wart, which compared to placebo, appeared to accelerate the immune clearance process. The problem, of course, is that injections hurt, and 30 percent of the kids that got their warts injected with the vaccine suffered a flu-like syndrome. Yikes! Okay, scratch that. What else do we got?

Within a few months, any placebo treatment will work in about a quarter of the cases. So, if you put duct tape on 100 warts, and 23 go away, that wouldn’t mean much. The traditional medical therapies—acid treatments and freezing treatments—bump the cure rate up to about 50 percent. So, if you were really serious about testing the efficacy of duct tape, you would pit it head to head against one of those. And, that’s exactly what happened: “The efficacy of duct tape vs cryotherapy in the treatment of…(the common wart).” Cryotherapy is the current treatment of choice for many pediatricians.

“Objective: To determine if application of duct tape is as effective as cryotherapy in the treatment of common warts.” Patients were randomized to receive either liquid nitrogen applied to each wart, or “duct tape occlusion.” When I heard about treating warts with duct tape, I had this image where they were like trying to rip them off or something. But no; they are just applying a little circle of duct tape every week or so.

Although there had been a few anecdotal reports of using tape, “no prospective, randomized controlled trial had yet [been] performed,” until this study, which found that the duct tape was “not only equal to but [exceeded] the efficacy of cryotherapy,” which worked in 60 percent of the cases. But 85 percent of the duct tape patients were cured—significantly more effective than cryotherapy for treatment of the common wart. More effective, and fewer side effects. “The only adverse effect observed in the duct tape group during our study was a [small] minimal amount of local irritation and [redness]”—whereas cryotherapy hurts.

Oh, you want to hear the saddest thing? “1 young child actually vomited in fear of pain before each [cryotherapy session.]” They were like torturing the poor kid.

Cryotherapy can cause pain and bloody blisters that can get infected and mess up your nail bed.

So, duct tape: more effective, fewer side effects, and more convenient. Compare applying a little duct tape at home to making multiple clinic visits, dragging the poor kid back every two weeks. I mean it’s like a win-win-win.

Duct tape can now be “offered as a nonthreatening, painless, and inexpensive technique for the treatment of warts in children.” I mean, how much does a little piece of duct tape cost? So, it’s like a win-win-win-win. Ah, but the money you save is the money the doctor loses. There’s no way the medical profession is going to just let this go unchallenged. Further studies were performed and failed to show an effect, and so we end up in the medical literature with conclusions like this: “Is duct tape effective for treating warts?” “Bottom line? No.”

Huh. Is duct tape really not effective after all, or was there some kind of critical design flaw in the follow-up studies?

And so, “even if the effectiveness of duct tape…is shown to be merely equivalent to that of cryotherapy,” it would be better; and it was shown to be even more effective, in fact maybe most effective. Compared to 10 other wart treatments, duct tape beat out them all in terms of effectiveness, and also in terms of cost—cheaper than all but the DN option (which stands for “do nothing.”) Compared to the most cost-effective prescription treatments available, OTC duct tape, meaning over-the-counter duct tape, is 10 times cheaper. “It is an unusual and welcome event in health care when a common ailment is proven equally amenable to an inexpensive, tolerable, and safe alternative therapy.”

Finally today, I ask and answer if there really is such as thing as adrenal fatigue.

Many seeking treatment for common nonspecific symptoms are led to believe they are suffering from some sort of hormonal deficiency. “Adrenal fatigue” is the prototypical example. Chiropractor-coined in 1998, the invented diagnosis has since been embraced by naturopaths, functional medicine, and anti‐aging doctors. But does adrenal fatigue even exist? The alleged condition is said to result from chronic stress leading to an “overuse” of the adrenal glands and their eventual functional failure. Symptoms supposedly include fatigue, body aches, sleep issues, and digestive problems (at least according to the websites not so coincidentally selling a suite of supplements to remedy it). It will come as no surprise that the originator of the term sells supplements on his website to treat it for $200 a month. But it may not be an actual medical condition.

The symptoms people have are real, but they just may be caused by something else––for example, sleep apnea, chronic fatigue syndrome, or fibromyalgia. Saliva tests for adrenal hormone levels are not reliable, with studies showing so-called “adrenal fatigue” patients having higher levels than controls, similar levels, or lower levels, “an almost systematic finding of conflicting results.”

There is an actual disease of adrenal insufficiency known as Addison’s disease, which is diagnosed with an ACTH stimulation test. You inject people with adrenocorticotropic hormone, the signal your brain uses to get your adrenal glands to pump out the stress hormone cortisol, and if your adrenals don’t respond, that shows your adrenal glands must be in trouble. But inject those presumed to be suffering from chronic stress and fatigue with ACTH, and sometimes you even get a greater rise in cortisol, disproving the notion that stress causes the adrenals to “burn out.”

But wait, you were diagnosed with “AF,” given corticosteroids, and now you feel great; so, it must have been real. That’s the thing about corticosteroids, though. One of the side effects is a euphoric sense of well-being. The problem is that even low doses can increase the risk of osteoporosis, psychiatric and metabolic disorders, muscle damage, glaucoma, sleep disturbances, and cardiovascular diseases.

But wait, you took some quote-unquote “adrenal support” supplements, checked the labels, confirmed they don’t have any hormones, and still felt better. They lie. Researchers checked the 12 most popular adrenal-support supplements, and every single one contained hidden hormones, none of which were declared on the product labels. All contained thyroid hormone, and most a steroid hormone as well (pregnenolone, budesonide, androstenedione, progesterone, cortisone, or cortisol).

Adrenal fatigue reminds me of what used to be called “electromagnetic hypersensitivity,” now referred to in the medical literature as “idiopathic environmental intolerance attributed to electromagnetic fields”—unspecific symptoms supposedly triggered by things like cell phones. There have been at least 46 studies involving more than 1,000 people that claimed to be affected, yet when put to the test in blinded trials, the studies near universally failed to show that anyone could even detect the fields.

Why don’t journalists covering these stories mention the data? Because there are snake-oil salesmen profiting off the perceived condition, selling all manner of so-called  “protective” gadgets, that viciously attack anyone for even daring to mention the science, accusing them of denying the reality of people’s symptoms. But it’s arguably the opposite. They are the ones hindering sufferers from getting to the bottom of what is actually causing their symptoms. Similarly, hawking unproven tests and treatments for adrenal fatigue could delay the diagnosis of a real, treatable condition.