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Medical student's apparent celiac disease responded to giardiasis treatment

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Re: Medical student's apparent celiac disease responded to giardiasis treatment

#121
post #14

I've been looking for relief from abdominal pain, bloating, poorly formed movements, and breathing problems for well over a year now. It started right after a round of antibiotics, which strikes me as a very clear cause-and-effect situation involving some sort of microbial imbalance. I don't think restrictive diets are a great idea, because I want to stay healthy otherwise and ultimately restore that balance, but cur…

You need to prove your knowledge to doctors contextually, and even then it's much easier if they are not actively giving you a consultation. Doctors don't respond well to randomly dropping theories on them. If you respond to something by dropping an inappropriate paper for the illness or ask about rare issues when common ones would fit they'll stop listening. Most of the people a doctor gets either almost can't read…

This is about the most charitable thing I've ever read on this site about physicians.

As a physician with a degree in nutrition, I find most HN threads about medicine, nutrition, or the health system very frustrating, and in spite of it being the only area in which I'm formally qualified to opine, it's also where I've earned most of my downvotes (which prior to 500 internet points kind of mattered). I eventually learned to just bite my tongue here.

Curiously, I think my "hacker spirit" is what drove me to medicine. In undergrad, I was spending 5+ hours per day reading medical literature (mostly nutrition, endocrinology, exercise science) and had decided that doctors were mostly idiots, and eventually decided to change majors from ME to pre-med.

In medical school, I was a real handful to many of the lecturers, which I kind of regret now. Ends up it is really easy to publicly humiliate someone when they mis-state or misunderstand a minor detail that you've studied in depth, even if they have far greater expertise in the field.

In medical school, residency, and practice (EM), I've learned a lot about why things are the way they are. In my field, many patients are entirely obsessed about some problem and completely lose track of reality when discussing it. It becomes part of their identity. They don't know how to read or evaluate medical literature, and they lack the background knowledge to the extent that even beginning a discussion is onerous.

It's like your uncle who is far to one side or the other of the political spectrum and is well read but only in support of his biases -- yes, you might learn something this time, but do you really want to get into long discussion to find out? He already "knows" all the answers to many unstudied questions, and knows why the studies are wrong for the others. There are so many of these patient encounters that it is entirely infeasible to engage with even a small proportion of them and still get your job done, so you learn to nod, smile, and move on to determining whether or not a life-threatening emergency exists or not. You definitely don't have time -- at least in my field -- to really listen and consider all of these. Unfortunately it's not always easy to differentiate symptoms that are possibly psychological, exaggerated, self-limiting, or impractical / impossible to diagnose in my clinical context, from those that present opportunities for me to make a difference even if not a true emergency.

I still think that many doctors are idiots that lack critical thinking skills and self-reflection, and unfortunately almost nobody outside of academics reads primarily literature that isn't forced on them (MOC). I've tried to show many friends and colleagues how to set up RSS feeds for pubmed queries for their topics of interest -- zero people have seemed impressed. In contrast, I think much of HN leans heavily on representativeness heuristic and doesn't consider likelihood ratios when evaluating their test results.

Anyway, thanks for the considerate comment.

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#122
post #13

Oh wow, I have the first half of this situation. I went through a period where my digestion was so bad that it was affecting my ability to function from day to day. I didn't get anything useful from my gastro; I even had a negative celiac antibody test. Eventually I started rigorously tracking everything I ate against my symptoms, and after a few months I was able to draw a strong correlation with gluten intake. From…

I can't speak for the US but a friend in the UK was recently diagnosed with giardiasis, not chronic though. As far as I can tell it was simply a routine check because of the symptoms. He didn't give me the impression that it was a difficult diagnosis to obtain. The medics reckoned that it came from a bag of contaminated salad leaves.

Surely you just go to your GP, explain your concerns and symptoms and get tested. Here is the UK NHS page on the subject: https://www.nhs.uk/conditions/giardiasis/

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#123

Earlier quoted context omitted.

Sounds like you've identified that histamine is an issue for you. Vitamin C will clear serum histamine, citric acid is bad since it's a fermented byproduct of black mold (likely triggers histamine release from impurities). In my IBS journey I had a period where I had very strong histamine intolerance, and vitamin C (in the form of QBC vitamin, quercetin + bromelain + vitamin C) really helped stabilize me. Histamine i…

thank you and God bless! I found out about this histamine when drinking wine and after got cramps. But did not find cure for it. B12 which was one aid, normally makes my stomach bad imeadiately. Will try QBC

Happy to help!

In my research trying to help myself I've come to the conclusion that histamine intolerance is really more of a symptom of a larger issue. It seems to suggest SIBO or any other sort of inflammatory process in the small intestine. Reason being that dysbiosis (of which SIBO is just one sort) has multiple synergizing effects: not only that often the bacteria associated with dysbiosis will produce lots of histamine through fermentation activity (there's a certain klebsiella type I've seen implicated) but also the dysbiosis causes a cascade of issues that degrades the gut lining which increases the amount of dietary histamine that crosses into the body.

Otherwise I've seen histamine intolerance also suggestive of Crohn's, etc. where the gut lining is chronically damaged.

Like you said wine often reveals it for people, also vinegar, aged cheese, meat or seafood. It's funny that now that I know what to look for I notice when eating with people when they get a stuffy nose right after eating that stuff.

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#125
post #102

Earlier quoted context omitted.

Sorry, I didn't want to turn my original post into an essay, but I've already done low FODMAP and various other restricted diets for diagnostic purposes, without any noticeable shift in symptoms. Only bread and sugar seem to be correlated, and not strongly. To me it's a curious symptom rather than the root of the issue.

Have you looked into Mutaflor probiotics? It’s a beneficial E. Coli (seriously) that has research showing it can colonize the gut and clinically improve e.g. IBS symptoms. I’ve personally seen it solve (or significantly mitigate) issues for multiple people.

Thanks! I'll take a look at this.

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#126
post #119

Earlier quoted context omitted.

Here is a thought. If you're having difficulty finding proper testing, just have a doctor prescribe the treatment for giardiasis. After finishing it, you can test whether things are now better for you.

In your experience, are doctors generally willing to do this?

If you're in the US, I'm sure you can convince a doctor to help you. Since the treatment is not life threatening or a narcotic and just a course of antibiotics, you should have no problem.

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#127
post #109
post #104

Earlier quoted context omitted.

... Take it from someone with celiac. You don't always feel it. I didn't for decades. But it caught up with me. Really badly. And when I say badly, it nearly killed me. I got hypocalcima, and fuck me if it wasn't the most painful thing I ever endured. I've broken bones, etc. All that shit is child's play to every muscle in your body locking up and your body feeling like it is getting stabbed with needles all over. Th…

Wow, I'm the same. Celiac with very few symptoms. Hearing this makes me want to keep on track. But I would like regular blood tests to find out if my nutrition absorption is improving. That would at least motivate me to keep eating this restricted diet. Good to hear your story as a warning.

Then push for them.

For me the motivation is maybe not having to worry about breaking a hip if I fall.

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#128

Earlier quoted context omitted.

This is good general advice, but for as long as I've been an independent adult, I've cooked three fresh meals a day. Even with breakfast I usually do fish and rice instead of something quicker and easier. Like the individual in the OP story, I'm more inclined to suspect a specific undetected infection rather than a lack of dietary discipline. I just don't know how to explore this without having my sanity questioned.

Using a dish washer for all of that? I tend to question whether small amounts of dish washer detergent or SLS/etc in toothpaste might change us as environments for our bacteria and replacement bacteria. But that's also a tough area for rigorous scientific study.

This is also a good lead, but I've already chased it. I only use hippie detergent and toothpaste. I do wonder about this while eating out, but hopefully once a week isn't enough to make a difference.

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#129
post #88

Earlier quoted context omitted.

Depends on if their mind is made up. Yeah, I failed the food challenge test because you used the wrong thing! No, you can't use pork in place of ham--the trigger was something that gets added in the process of making it ham.

Kind of. Even when their mind is made up, they're likely to try to answer (since the framing places them on a pedestal). Both you and the doctor will notice anything obviously wrong with the answer. I've met a few young doctors who would dig in their heels (different from explaining why they're right; if they're actually right and teach me why then I think that was an incredibly valuable opportunity), but you ought t…

It's obvious he thought the problem was upstairs. If you're a medical mystery they're going to consider psych and some of them will consider it too much.

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#130

> No matter how much he ate, he kept losing weight. At one point, he logged his caloric intake for a college nutrition class and found that he had been eating seven thousand calories a day, despite looking sickly thin Is this even possible? And- only half joking- if it is indeed possible, why isn't there a queue of people waiting to get the parasite installed in their body?

I think there are people that have intentionally swallowed some tapeworm eggs for a similar reason to this.
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