Around the Web; Morgellons Edition

Here’s what caught my eye this week:

[1] Interesting posts this week: Stephan Guyenet’s discussion with Chris Kresser is sure to be fascinating, because the material left on the cutting room floor is great. I especially liked Stephan’s observations about insulin’s contributions to weight loss, via promoting satiety and leptin sensitivity.

Chris Masterjohn refutes an old canard: The cannibals of New Guinea preferred fishermen, not missionaries. Of course – fishermen are more nutritious, they have more iodine.

Apropos this week’s post (Can Endurance Exercise Promote Cancer?, May 11, 2011), Keith Norris of Theory to Practice discusses the relation between fitness and health:


Personally, I’ve never gotten to the right of the part of the curve labeled “Health” and “Performance,” and spent too much time in the area off the chart called “Unhealth” and “Non-performance.”

Via Obesity Panacea’s Travis Saunders, exercise induces weight loss in controlled laboratory conditions but not in real life. Scientists discover that Vancouver bedbugs are carrying antibiotic-resistant staph (MRSA). Chronic acetaminophen (Tylenol) use doubles the risk of blood cancers. Aspirin is better.

Via Dr Cobb at Z-Health, a study showing that walking barefoot decreases stress on the knees and hips of people with osteoarthritis. Charles Poliquin defends his high-dose fish oil recommendation with a study showing that 7 people were able to take 60 g/day fish oil for 12 weeks without “serious adverse events.”

Finally, Richard Nikoley has some mouth-watering food photos.

[2] Post-Mother’s Day music:

[3] Morgellons, a medical mystery: Via The Guardian, a mysterious complaint:

Morgellons was named in 2001 by an American called Mary Leitao, whose son complained of sores around his mouth and the sensation of “bugs”. Examining him with a toy microscope, Leitao found him to be covered in unexplained red, blue, black and white fibres. Since then, workers at her Morgellons Research Foundation say they have been contacted by more than 12,000 affected families….

Optical image of what sufferers are adamant are morgellons fibres in skin samples – are they made up of alien ­matter, or are ­everyday materials the more likely explanation? Photograph: Vitaly Citovsky/Suny at Stony Brook

Back in London, I find a 2008 paper on morgellons in the journal Dermatologic Therapy that describes patients picking “at their skin continuously in order to ‘extract’ an organism”; “obsessive cleaning rituals, showering often” and individuals going “to many physicians, such as infectious disease specialists and dermatologists” – all behaviours “consistent with DOP”. (For treatment, the authors recommend prescribing a benign antiparasitic ointment to build trust, and supplementing it with an antipsychotic.)

These dermatologists don’t know much, but they know an antipsychotic drug is the treatment.

Fortunately there is an excellent doctor looking into the matter:

I contact Dr Anne Louise Oaklander, associate professor at Harvard Medical School and perhaps the only neurologist in the world to specialise in itch. I email her describing morgellons, pointing out it’s probably some form of DOP. But when we speak, she knows all about morgellons already. “In my experience, morgellons patients are doing the best they can to make sense of symptoms that are real. They’re suffering from a chronic itch disorder that’s undiagnosed. They have been maltreated by the medical establishment. And you are welcome to quote me on that,” she adds….

“That they have insects on them is a very reasonable conclusion because, to them, it feels no different from how it would if there were insects on them. To your brain, it’s exactly the same. So you need to look at what’s going on with their nerves. Unfortunately, what can happen is a dermatologist fails to find an explanation and jumps to a psychiatric one.”

[4] Let’s ride:

Via Yves Smith

This picture reminds me of a story. I once was on a long airplane flight seated next to two girls who demanded piggy-back rides around the cabin. They asked me to guess their ages. After I had guessed every age from 3 to 13, I gave up. Can you guess how old they were?

Select for the answer: They were 5½ and 7½!

[5] Does it cure being a lawyer?: A “therapy dog” is available for checkout at the Yale Law School library. But he can’t be removed from the library, because he’s a rufference work. (Via Tom Smith.)

[6] They’re born and they’re off to college, just like that: Via John Durant, a robin raises her chicks:

Robins: 4 Eggs, 4 Weeks from Fred Margulies on Vimeo.

[7] The raccoon who will live forever in our memories: Stabby has been immortalized:

It’s only the beginning, I believe. That raccoon has great things ahead of him!

[8] Those were the days: The medicines weren’t that great, but the advertising posters were cool. Via The Scientist, a slideshow of mostly 19th century medicinal posters:

[9] The old mannequin head drop prank: This one always works.

via Amy Alkon.

[10] Shou-Ching’s photo-art:

© 2011 Shou-Ching Jaminet.

[11] Video of the week: Polar photographer Paul Nicklens shares some remarkable photographs. Don’t miss the part where the friendly leopard seal tries to feed him penguins:

Leave a comment ?

32 Comments.

  1. Hi Paul,

    Great round up as always.

    What are your thoughts on what Stephan has said about biasing your diet toward carbohydrate? Does this alter the PHD ratios in your mind in any way.

    Me, I tried to go higher carb (60%) for a few weeks but the blood sugar rollercoaster was crazy. I definitely run ‘cleaner’ on fat. Do you think that Stephan is ignoring the massive amounts of anecdotal evidence that many people do spectacularly well on high fat?

  2. Hi Sarah,

    Well, I disagree with Stephan’s preference for carbs. My reasoning is in the book. Basically, babies utilize about 50% of calories as carbs, but human breast milk is only 40% carbs; similarly most animals consume fewer carbs than they need, forcing some gluconeogenesis or occasional ketosis. I think if evolution selects for slightly low-carb diets, we should have a presumption in their favor. For adult humans a similarly slightly low-carb diet would be 400-500 carb calories a day, and I think the clinical and other evidence suggests that most people do really well on that, if it’s composed of safe sources.

    I think the low-carb community, eg Taubes, Eades, Wolf, de Vany, has done good work in highlighting the benefits of low-carb dieting. However, most of the health benefit — probably well over 90% — comes from giving up toxic foods (wheat, sugar) rather than from giving up carbs per se; and they have tended to overshoot toward being too low-carb, which has risks of its own. So I think it’s good to see a very smart scientist like Stephan making the case for carbs.

    I think eventually people will end up in the middle where we are, but the science still has to be played out.

    Also, I think carb ratios need to be tweaked for different diseases. Diabetes and neurological ailments are often aided by a ketogenic diet. Bacterial and viral infections also. Fungal and protozoal infections, and hepatitis C, are often aided by high-carb diets. So there’s not a single macronutrient ratio that’s optimal for everyone. There may be benefits to intermittency also.

  3. Paul,

    I will be very curious to hear your take on Stephan’s new theories as he rolls them out. What do you think of his (very mild) endorsement for high carbs over high fat?

    Good to see you reading a little on Z-Health (no doubt from Zach’s recommendations.) I have learned a great deal from Dr. Cobb, and in case you are interested, my blog has lots of discussion on movement health from a brain centered perspective, which is what Cobb essentially teaches. toddhargrove.wordpress.com.

  4. Hi Todd,

    Yes, I’ve started looking at your blog too, great stuff. I’ve enjoyed several of your audio lessons but would like them even more if I could see some pictures or video.

    I’m very interested in mobility but have never spent much time looking into these things. One of your audio lessons got me interested in looking into the Feldenkrais method.

    Would you like to do a guest post sometime? I might be able to look up research on how movement and relaxation improve immune function, and so we could tie our work together.

    Best, Paul

  5. “Unfortunately, what can happen is a dermatologist fails to find an explanation and jumps to a psychiatric one.” That reminds me so much of ME/CFS. I know it is a human reaction, but it’s wrong and the medical profession needs to do more to fight this.

  6. I’ve had several patients with delusions of parasitosis that respond very well to antipsychotic therapy – partcullarly the old school ones that are better dopamine blockers than the new ones- and major perturbations of the dopamine system can cause itching (as in cocaine use) – it’s all very intriguing.

  7. Stephan strikes me as being very Weston Price-friendly, a la Chris Masterjohn. If you start from a position of health, that diet is probably healthful, or at least least not particularly harmful.

    However, too many of us — some with decades of wrecking our health or weight on a Western diet — aren’t starting from that position.

    I think Paul had a great comment months ago about the paleo and WAPF communities and the benefit of meeting in the middle.

    I too am interested to see Stephan’s series. I suspect there’s a may be a little bit of the blind men and the elephant metaphor at work, and obesity is going to look to him the way it does because of his perspective. As I said on this blog just recently, I’m somewhat surprised at how little he looks at industrial food and its role in appetite dysregulation. I.e., is it possible that the obese are not so much resistant to leptin as it is that their other appetite pathways are stronger?

  8. Hi Emily,

    Maybe it is the right treatment! But I would trust it more if it was the neurologist recommending it.

  9. Hi Beth,

    I definitely think industrial foods (actually toxin-rich “foods” some of them natural but unsafe, others industrially created) are the cause of obesity. I think Stephan is right about some of the mechanisms, but metabolic damage takes many forms and affects multiple tissues. That’s why CarbSane’s speculations also interest me. I’m still looking for the smoking gun showing how food toxins affect brain, liver, and adipose tissue. Unfortunately very few researchers are following up the food toxin angle.

  10. Yes, I’m quite fond of Peter@Hyperlipid’s hepatic injury theory! But wouldn’t it be interesting if it modern, diet-related obesity might start in the brain — perhaps some of it being pre-natal or developmental in origin — and that overwhelming prevalance/marketing of toxin-rich “foods” leads to overeating that overwhelms liver -> metabolic syndrome -> obesity/diabetes.

    As an aside, I wonder how many LC folks who plateau/struggle are eating industrial LC foods. Hmmm.

  11. Paul – I would say DOP rarely present to psychiatrists (I’ve seen more in the ER than I have in my outpatient practice). In the ER the “DOPs” often throw a positive meth or cocaine toxic screen. However, that is certainly not always the case. A “real” DOP has a certain presentation that is very typical – a deep concern coupled with delusion and itching, NOT hallucination. Tactile hallucinations are almost always neurological or drug-induced (or withdrawal-induced) The literature on DOP is primarily written by dermatologists.

  12. Hi Paul:

    I always enjoy (and get to discover) you round-up posts! Thanks so much.

    Relative to foods as toxins: don’t you think that all foods have some element of toxicity? Maybe the questions should be which foods in what amounts (doses) and prepared in which ways produce hormetic effects and under what circumstances do those foods serve as toxins?

    The confounders with foods, nutrition and eating are so tremendous that at best, we will only get rough approximations. The RCT model is one that I don’t think will ever be able to serve as the gold standard.

    What might “work” better overall is to use anthropologic investigative methods. To that end, it would be interesting to use an online crowd sourcing method, such as Cure Together or Patients Like Me for people to self-report detailed food intakes, preparation, and eating patterns layered with health parameters such as lab values, exercise, diagnosed diseases, and quality of life indicators.

    Since one size fits none in nutrition and health, I would expect that patterns correlating with health would emerge, and that even specific foods might be identified as key foundational foods.

    People who do well on any particular diet would probably be more motivated to participate, so bias would probably we in evidence. However, the converse might also be true, and people who are not doing well might also wish to describe their experiences.

  13. Beth – I think it is very easy to overdo the omega 6 on a high fat diet – which would presumably mess with the obesity regulation system. Seems to happen more in women and those with long-term damaged metabolism – but I would say there is such a difference in appearance between the “paleo” high fat appearance and the standard “low carb” after weight loss appearance – the latter folks can look deflated, with circles under the eyes, and somewhat inflamed (not always). George Stella comes to mind of an example of this – though of course one must take under advisement the proof of these anecdotes: http://www.stellastyle.com/

    Personally, I *look* better when I’m going out of my way to add fat. However, I do have to deliberately fast quite a bit not to gain weight when I cook my meals with butter and add coconut milk to things.

  14. Indeed, Paul. If raccoons get such praise just for eating garbage and burglarizing houses imagine what the bards will sing when we accomplish something.

    Scary stuff about the Tylenol. I don’t suppose ibuprofen is a big deal? My arthritic dad (who is improving by implementing some Perfect Health Diet principles) uses quite a bit of it.

  15. Ah, right, indeed there doesn’t appear to be a risk for ibuprofen. Still, it seems like you can get just as good relief from a ginger/curcumin approach so maybe I’ll suggest that.

  16. Hi Beth, Emily,

    I think it’s easy to plateau even on a non-toxic diet if it’s not well nourishing. I think a lot of Paleo people have low-level nutrient deficiencies.

    Perhaps the puffiness Emily noticed is due to potassium deficiency, which can cause edema.

    Emily, thanks for the education about DOP, itching, and dopamine.

    Hi aek,

    I don’t think all foods are toxic … but in modern life, that’s probably a fair approximation. Still, some are worse than others.

    I agree about the limitations of RCTs.

    I think the approach you have in mind would generate the best results (sort of a China Study on steroids, with the ability to drill down and do person-by-person correlations with all sorts of biomarkers and good statistics). But it will do even better once we get more dispersion in diets. Right now almost everyone worldwide eats 50% carbs.

    Hi Stabby,

    I think once the garbage is lower in omega-6 and wheat, we’ll see the real raccoons emerge.

    Ginger/curcumin probably is best. Both help modulate gut flora in a positive way, and help GI tract health. Ibuprofen can cause GI tract issues.

  17. Has it been mentioned already? but what is DOP? Disappearing Object Phenomenon? So is Morgellons real or imagined? Real in the mind of the affected?

  18. Oh delusions of parasitosis, right?

  19. Hi Ellen,

    Yes, delusions of parasitosis. Morgellons – I don’t know if it’s real or not – probably real but neurological and the skin lesions are due to scratching, but some sufferers say they have lesions on their backs where they can’t reach.

    There’s no reason you can’t have a real infection and a mental state or neurological condition that makes it much worse. There are many undiagnosed chronic infections.

  20. Paul,

    Wow, you’ve read the blog and done some lessons, glad you like it!

    I would love to do a guest post, it would be an honor. I will think of some potential topics and send you an e-mail in a day or two.

  21. Paper came out yesterday that is pertinent – histology of those afflicted with delusional infestations – http://archderm.ama-assn.org/cgi/content/abstract/archdermatol.2011.114v1

    • Thanks, Emily. Great paper, right on point.

      The only caveat I have is that most infections are missed in tissue biopsies … they don’t do thorough checks, usually they do culture. Many pathogens don’t culture. Also, it’s quite likely as the neurologist says that the problem is in the nerves, causing itch, and there could be a nerve infection.

      But it seems certain that the fibers are environmental, not parasite-produced.

  22. I have symptoms of Morgellons without the fibers. It all started with with about six lesions that I got on my underarm and back that itched and gave me symptoms of tingling going down my arm. Later symptoms included the feeling of a bug crawling on me and biting stinging sensations. I have been to the dermatologist that took a biopsy of one of the very small lesions and found evidence that I was being biten.Nothing I have tried has gotten rid of these symptoms which come and go except when I take a supplement called OSR which seems to keep symtoms low. The OSR helps the body make more glutamine. My son also has symptoms and gets lesions on his back where he can’t reach so I hardly think this is delusional. I believe it is something that attacks the nervous system as the biting sensations can sometimes cause an intense pain momentarily.

    I find any doctor that says it is delusional is insulting.

  23. Hi Terry,

    Yes, I agree, diagnoses of delusion when people have clear skin lesions and you have no evidence of brain trauma/damage/infection that might produce delusions is going against the evidence. The simplest explanation is that there is some occult infection producing the lesions and/or nerve issues.

    Undiagnosable chronic parasitic infections are extremely common, much more common than delusions, so there should be no presumption against the possibility that an infection has occurred.

    This is not to say that people cannot become delusional, but when physical evidence for brain trouble is lacking but for skin and nerve trouble is present, it’s a presumptuous diagnosis.

    I think the Morgellons folks have hurt their case by arguing the fibers are parasite-produced. People think that if the fiber argument is a mistake, the whole experience may be a delusion, which does not follow.

  24. I know nothing about the fibers, but I do know about the symptoms and they can be very disconcerting. They seem to wax and wane though so there are periods of normality. I quit talking to doctors about it because of the DOP thing. I just got the impression that they think that is the only answer and were not helpful. I try to be as healthy as I can and am not bothered constantly by the symptoms so I can cope. From my experience glutamine if very helpful at keeping symptoms at bay but not curative.
    By the way I have been following the perfect health diet for 3 months and have not been able to lose weight. I do have a thyroid problem but am on medication and I have been able to lower it, so I am hopeful. Thanks for beign so attentive to all the posts and comments. i guess I may have to implement the lowering my fat intake. Something I am not very interested in doing.

  25. I have tried intermittent fasting intermittently :). I haven’t tried it on a regular basis with the coconut oil. I do however use coconut oil in my cooking along with coconut milk on occasion. I probably need to come up with something more consistent. I have been mystified by my body because on a couple of occasions I have lost weight without trying or changing anything. I can also gain with no change in diet or exercise. Also hard exercise seems to make me gain weight so I have stopped doing a boot camp style workout. Thanks for reminding me about the fasting.

  26. I dont have lesions or fibers but i feel sometimes that something is crawl on me or biting me. I have ears ringing. I have eye floaters whej i look somewhere. Ut i dont see them on eye . My. Vision sometimes gets blurry but shortly. My mood changed. I got anxious and isolated.my hair is thin and no quality sonetimes moves on its own.i have little memory loss. So…

    • Hi just a person,

      I would look into any possible infections. Floaters, tinnitus, hypothyroidism (thinning hair), impaired mood, anxiety, and memory loss are all common symptoms of chronic infections. Neurological impairment can cause itching/crawling/pain feelings. You might test a relatively benign antibiotic, like doxycycline, to see if it relieves symptoms.

  27. Tnx for answering my question….
    Can you tell me if have many eye capilars that ppeared n one day and are still here with some light yellow stuff too how can i tel. Difference between that and. Maybe some fibers that people have in eyes in. that case.

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