Eating disorder thanks to self-diagnosis
In the course of my research and my self-experiments, I came across an interesting topic that I hadn’t anticipated when preparing for this blog series: eating disorders.
Edburg Edlinger, dietician and nmi portal expert, tells me that she has more and more patients in her practice who have slipped into malnutrition as a result of such self-tests and self-diagnoses and who like to see these tests as social legitimization of their illness. Wow! Tests that are supposed to promote health according to the manufacturer do exactly the opposite?
The dietician explains to me that there are many factors here. On the one hand, an existing eating disorder can be “justified” by such a test, i.e. if the test classifies 30 foods as intolerable, then the person affected has a good excuse to eat less or no longer eat certain products. In my case, according to the IgG test, I can no longer tolerate almost 20 product groups (almonds and other nuts, dairy products of all mammalian species, all cereals including gluten, hazelnuts, quinoa, peas, lentils, soy or yeast). A lot of food would be lost. That would actually be a good “justification” to my social environment to ban certain products from my diet.
Histamine intolerance: self-diagnosis as an “excuse” for eating disorders
However, such tests and self-diagnoses can also lead to deficiency symptoms. In practice, there are mainly problems with the histamine tests . After self-diagnosis by means of a home blood test, those affected would compile their own “compatible” lists via the Internet. Often all that’s left is zucchini, rice, potatoes and cream cheese. According to Edlinger, the resulting malnutrition is not uncommon here.
Are grocery lists a problem?
Two things are going through my mind: We, the nmi portal, compile such lists. Do we make it sufficiently clear that no self-diagnoses or self-tests should be made? Do we make it sufficiently clear that you should seek professional support from a doctor or therapist? I check my own website and am quickly reassured. Yes, we do. But I think we will make it even clearer in the future.
Histamine test by blood analysis
The second thought revolves around the histamine home tests. These test, for example, the DAO activity in the serum. A method that was considered the standard diagnostic procedure a few years ago. Some time ago, we also wrote that this was the currently recognized diagnostic method. But times are changing fast and the level of knowledge is growing. It has now been shown that the DAO value in the blood does not correlate with the DAO value in the intestine, either in terms of activity or quantity. Dr. Kofler, an allergy and histamine intolerance expert, tells me about a study he conducted himself. He was able to show that these tests only indicate a kind of background noise and could not be distinguished from control groups. DAO activity in the intestine can be determined, but only by means of endoscopy and small intestine biopsy. An unnecessarily complicated and, above all, expensive diagnostic path. The same applies to histamine intolerance tests in stool or urine. They are not meaningful. Blood testing as a diagnostic method for histamine intolerance has been refuted and is no longer recommended by most experts. Home tests, as they are still offered, are therefore not recommended, as they do not provide any information about the DAO activity in the intestine.
Florastatus: The power of intestinal flora
We now know that the intestinal flora has an enormous influence on our lives. We know that there is a small intestinal mal-colonization, which can occur mainly as a result of untreated food intolerances. We know, for example, that certain intestinal flora bacteria can promote obesity. We know that the number of bacteria in our body is ten times higher than the number of our own body cells. The influence of these gigantic quantities of intestinal bacteria is enormous. It is also being discussed whether anorexia and other eating disorders are directly linked to the intestinal flora (1).
The general interest in intestinal flora is growing. It is therefore not surprising that tests on our own flora status, so-called “intestinal flora analyses“, are becoming increasingly popular. Based on these results, certain probiotic preparations are often recommended in Facebook groups, nutritional tips are given or even diagnoses such as small intestinal colonization are made. The scene is surprisingly large. But can you read all this out of these tests, or are these tests even useful?
“Yes, at least in part,” says Prof. Dr. Heribert Insam, Head of the Institute of Microbiology at the University of Innsbruck, and immediately explains the nomenclature to me. Intestinal flora is an outdated term and dates back to the time when bacteria were thought to belong to plants. However, as they form an independent kingdom, the intestinal flora is now called the (intestinal) microbiome.
Florastatus partly useful, but without diasgnostic relevance
Such home tests are only a snapshot, but they can provide clues. For a detailed and, above all, evaluable microbiome analysis, several samples would have to be taken, ideally by endoscopy, and the bacteria determined at the species level.
Our intestines are long and have many sections with different functions. Depending on the section, we have a different microbiome. Depending on the section, different types of bacteria – and we are talking about thousands of different species – are present. While Streptococcus and Lactobacillus species tend to dominate at the beginning of the digestive system, Clostridia or Bifidobacteria, for example, dominate in the large intestine. What ends up in the stool that we excrete is a mixture of all sections, including what is added in the last section, the rectum.
In addition, these home tests only determine the genera of bacteria, not the species. And above all, the species or subspecies of the bacteria can make the difference between dangerous and completely harmless. I looked at my results and indeed only genera were ever determined. It says “Lactobacillus species“. “Species” means that the species has not been precisely defined. There are 40 species that occur in the human small intestine alone, and many more Lactobacillus species are known (2).
Dr. Straub, a gastroenterologist at Innsbruck University Hospital, explains to me again that this test result only tells me which bacterial strains I have in my rectum, i.e. the last section of my intestine. It is not possible to tell from such a test what the exact colonization in the individual sections looks like or whether there are any diseases. Like the microbiologist before him, he confirmed to me that a meaningful microbiome analysis could only be carried out by taking endoscopic samples from different sections of the intestine and analyzing the exact species.
So if you do a home test like this, you should definitely discuss the result with your doctor, says Prof. Insam, as the interpretation is very difficult and the medically relevant information will probably be very limited. The gastroenterologist Dr. Straub also confirms this. He explains it to me using the example of “Escherichia coli“. The bacterium is listed in my findings as 1×10^6 colony-forming units per gram of stool. Two things need to be considered: Firstly, it is not known at what quantities certain bacteria must be considered pathogenic. The determination by means of microbiome analysis is therefore nice, but cannot be interpreted. Secondly, as Prof. Insam has already explained to me, there are sometimes dangerous and sometimes harmless species or subspecies of the various bacteria. There are pathogenic and completely harmless subspecies of E. coli in particular. Since this was not broken down, the test would actually have no diagnostic relevance.
Diagnosis in Facebook groups
I’ve been following these Florastatus tests, or rather their analyses in Facebook groups, for some time now. Since most of them can’t do anything with the findings and are more confused than enlightened by them, they post their results (including their name and date of birth) in Facebook groups. Other users diagnose, give nutrition tips, suggest medications and explain which intestinal bacteria need to be taken and in what quantities.
I do the same and post my results in several groups. It doesn’t even take 30 minutes and the first comments are already trickling in. I should eat more fiber, take alkaline powder and two different probiotics. But most of the comments are about the other users who would also like to have the “beautiful intestinal flora” that I have. One even recognizes a “Leaky Gut” based on my flora status and says I should take a special remedy for “Leaky Gut Syndrome”. Another user suggests that I could have hemopyrrollactamuria. This tongue twister is a genetic metabolic disease postulated by naturopathy. It is a so-called “pseudo-disease”, i.e. there is no proof of its existence.
None of these statements would actually be substantiated by these findings, none of the Facebook users advising me seem to have any medical training and not a single user points out to me that it would be better to go to the doctor. I also post my gluten stool test and not a single user would think that these tests can make false statements. I am congratulated on not having coeliac disease. Only in a special celiac group do people immediately point this out to me.
Conclusion of the flora status analysis
Such stool analyses of the microbiome, offered by manufacturers as “intestinal flora analysis” or “flora status”, are therefore nothing more than expensive gimmicks with no medical significance. It cannot be used to detect diseases, nor can it provide a serious assessment of pathogenic germs or intestinal colonization per se. Missing bacterial species can be detected to a limited extent, but only to a limited extent, as the colonization of the individual sections cannot be read out. As probiotics are not harmful according to current knowledge, but in some cases have a subjectively positive effect on the microbiome, taking them is at least not harmful and at best beneficial. However, this is also possible without a Florastatus test. Do we even need such tests? “At least you can use them to set your students brainteasers,” says Prof. Insam with a grin.
1 Tennoune N, Chan P, Breton J, Legrand R, Chabane YN, Akkermann K, et al. Bacterial ClpB heat-shock protein, an antigen-mimetic of the anorexigenic peptide α-MSH, at the origin of eating disorders. Transl Psychiatry [Internet]. 2014;4(August):e458. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25290265
2 Hof H, Dörries R. Medical Microbiology [Internet]. 5th ed. Georg Thieme Verlag; 2014. Available from: https://books.google.at/books?id=MtFmAwAAQBAJ&dq=wie+many+lactobacillus+species+are+there&source=gbs_navlinks_s