Doctor Detective with Spencer Nadolsky |

Doctor Spencer Nadolsky and I are connoisseurs of the fantastic food and drink around the Internet. We’re also interested in the science behind food and how that can help you improve your health. We’ve teamed up to bring you a new series on how the science behind food and drink can help you achieve these goals.

Spencer Nadolsky is a doctor of law and a former criminal defense lawyer who now helps people solve their problems. What does this mean? It means he’s an attorney who is also an amateur sleuth. Yes, he solves problems for a living. Try this on for size: you may have a family member that does not take your calls or respond to your e-mails. You could try to find this person on Facebook or LinkedIn but you may be stuck. You could even try to Google it but you may not find anything. In other words, you may be left wondering what the heck happened and feeling like you have no recourse.

Dr. Detective meets a youngster who is constantly weary in this week’s case study. He is anemic, yet he is unable to absorb iron. Continue reading to learn why you are what you digest rather than what you consume.

Eat less calories and exercise more. It’s a fantastic prescription for boosting health and body composition in general. It does not, however, always work.

Even with a great workout routine and a well-balanced diet, some individuals have strange symptoms and complaints, especially considering how much effort they put into their fitness and health.

We know there are just a few specialists on the world to turn to when we encounter customers who have issues that exercise and diet — not to mention their own physicians — can’t seem to cure. Spencer Nadolsky is one of them.

Dr. Nadolsky is an osteopathic physician with a background in exercise physiology and nutrition. He was an academic All-American wrestler in college and is now an enthusiastic exerciser and smart physician who does what he teaches to patients by treating avoidable illnesses with lifestyle changes first (instead of prescription drugs).

Dr. Nadolsky transforms from a happy, athletic doctor to a rigorous, no-holds-barred forensic physiologist when clients have nowhere else to turn. He takes out his microscope and examines blood, saliva, urine, lifestyle – anything it takes to solve the medical puzzle.

We leapt at the opportunity to collaborate with Dr. Nadolsky on a regular case study segment. You’ll learn how a skilled practitioner thinks by following along with these interesting examples. You’ll also learn how to take better care of yourself.

In today’s case, we’ll meet a young football player who just had one concern for Dr. Nadolsky: poor energy. Dr. Nadolsky found insufficient iron levels after additional examination. Isn’t it straightforward? Simply provide him with ferritin and send him on his way.

The customer’s low energy — and iron deficiency — continued, though. He wasn’t processing his meals properly, it turned out. Continue reading to see why, and how Dr. Detective was able to get him back into the game.

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The client

Jake, a 17-year-old football player, visited the sports medicine clinic because he was experiencing “decreased strength and endurance.”

Jake seemed to be a typical high school linebacker, square-jawed and sculpted. We see these youngsters at a sports medicine clinic for injuries rather than illnesses. I immediately went on high alert.

Jake didn’t seem to be in any pain. He didn’t seem to have seen much sun recently, either. My initial thought was that she had mononucleosis since she was pale, weary, and a teenager.

Symptoms and indications of the client

Jake’s tale didn’t seem out of the ordinary. He just didn’t feel as energised as before. He also struggled to complete his team’s fitness program. And it had been approximately a year since he had felt this way.

So much for my first hypothesis! The symptoms of mono would not have lasted as long.

I then inquired about Jake’s sleeping habits. Many teenagers have irregular sleeping patterns, which may have a negative impact on their energy levels. Jake, on the other hand, claimed to stick to a tight routine. He went to bed at ten o’clock and awoke at six o’clock. That’s better than the majority of grownups!

Jake claimed his diet hadn’t altered much in the last several years when questioned about it. However, further investigation showed that he ate a lot of processed foods, including cereal for breakfast, peanut butter and jelly sandwiches for lunch, granola bars for snacks, and spaghetti for supper, along with some meat and maybe a few vegetables.

I had a feeling his food was the source of his issues, but I needed to look into it more. After all, he’d been eating this way for quite some time – yet the symptoms had just recently shown.

His symptoms were also non-specific (i.e., they didn’t point to a particular illness). The following is what Jake described:

Symptoms / Signs	My views on the subject – possible problems
I’ve been exhausted all day.	Thyroid, anemia, sleep problems, overtraining, and depression are all symptoms of thyroid disease.
Endurance decline	Thyroid disease, anemia, and a bad diet

Thyroid issues are characterized by dry hair and skin, as well as constipation. Jake didn’t seem to mind them. That didn’t rule out the possibility of thyroid issues. It just meant that I’d search for other answers first.

What about, for instance? Depression. This may show in unexpected ways, such as extreme exhaustion, especially in adolescents. Fortunately, Jake turned out to be a pretty happy-go-lucky man, according to a depression screening questionnaire. He was just irritated because he was exhausted!

I checked Jake from head to toe after questioning him extensively about his health. He was 6 feet tall, weighed 175 pounds, and had a body fat percentage of about 13%. My osteopathic examination revealed no structural issues (other than the usual rounded shoulders). His tonsils were normal size and his thyroid gland was not swollen. There were no cardiac murmurs to be heard, and his abdomen was slim and non-tender.

He did, however, seem abnormally pale. Is it anemia or too much time spent playing video games? My hunch is that it’s the former. Anemia is quite prevalent in adolescent females (because to their menstrual cycles), while it is uncommon in adolescent boys.

The exams and evaluations

In a youngster like Jake, a typical workup for tiredness would consist of a full blood count and a thyroid stimulating hormone test (TSH). However, labwork for individuals who complain of tiredness is often unremarkable.

1st round of testing findings

Panel of blood chemistry

Jake’s early lab results are as follows:

Marker	Result	Reference Range in the Laboratory	Thoughts
Hemoglobin	11.2 g/dL	12.5-17.0	Low – Anemia is a condition in which a person’s blood counts are low.
Hematocrit	33.7%	50.0-36.0 percent	Low – Anemia is a condition in which a person’s blood counts are low.
WBC	6.0 x10E3/uL x10E3/uL x10E3/uL x	4.0-10.5	Normal
MCV	74 fL	80-98	Microcytic anemia is associated with a low blood count.
TSH	uIU/mL = 1.10	0.450-4.5	Right now, there’s no reason to suspect thyroid problems.

Jake was weary because he was somewhat anemic. Further tests revealed a high TIBC (total iron binding capacity) and a low ferritin, indicating iron deficiency anemia.

Why would a teenage guy develop anemia due to iron deficiency? I knew Jake ate a lot of highly processed cereals and grains and didn’t consume much meat, but even processed meals are usually iron-fortified. Nonetheless, my advice to him was straightforward:

1. Increase the amount of meat in your diet.
2. Ferrous sulfate is a good supplement.
3. Return in one month for a follow-up and further testing.

Jake reappeared after a month. It didn’t take long for me to see that my medication hadn’t helped him much. I was first concerned that I had overlooked a thalassemia (a hemoglobinopathy that may lead to an iron shortage diagnosis), but that didn’t make sense since ferritin and TIBC are usually normal in thalassemias. So, what was it that I was missing?

It’s time to go back to work on the case. That meant there would be questions. I can’t stress this enough: a patient’s medical history is much more essential than a physical exam or even lab testing. The history provides you all the information you need to make the proper diagnosis.

I chose to concentrate more on Jake’s gastrointestinal system this time while examining his symptoms. In elderly people, iron deficiency may be a symptom of colon cancer, but Jake had no black or bloody stools. He did acknowledge that his stools had been looser recently, but he assumed that this was because to his anxiety over school or sports. In fact, Jake couldn’t recall the last time his stools had been fully formed.

Hmmmm. I inquired whether he had any inflammatory bowel illness or autoimmune disease in his family. Nope.

Some may diagnose him with irritable bowel syndrome (IBS) and send him on his way at this point. However, his GI problems and iron deficiency anemia indicated that he wasn’t absorbing the iron supplements or even the iron in the meals he was consuming effectively.

Was it time to call it a day and send him to a hematologist (a doctor who specializes in blood) or a gastroenterologist (a doctor who specializes in the gastrointestinal tract)? Not in the case of Dr. Detective! I wasn’t going down without a fight!

Given Jake’s highly processed diet, which consisted mostly of cereals and grains, I began to suspect celiac disease. Celiac disease patients who consume gluten-containing meals damage their intestines to the point where they are unable to absorb essential nutrients.

There are a few more tests to run and another follow-up visit to make.

The findings of the second set of tests are in.

Panel of blood chemistry

Jake’s second set of lab results are as follows:

Marker	Result	Reference Range in the Laboratory	Thoughts
Antibody against tissue transglutaminase anti-IgA	5.8 units	<1.0 units	celiac disease is most likely.
Titer of anti-IgA endomysial antibody	1:00:360 (positive)	1:10	celiac disease is most likely.

Jake’s iron deficiency was understandable. He wasn’t absorbing nearly as much iron as he was consuming! It seems that you are what you digest rather than what you consume.

Jake’s next move

Jake was not pleased when he learned he had celiac disease. He was really upset since he wouldn’t be able to eat any of his favorite cereals and breads.

At this moment, I could have slapped him across the face and ordered him to shut up. Instead, I chose a different path. Jake aspires to play collegiate football one day. That implies he’ll have to add some bulk to his body and work on his performance.

I utilized Awesomeness-Based Coaching instead of berating him. (For more information on ABC, check out our free 5-day course for fitness professionals.) I told him that this was preventing him from becoming great… I suggested a diet that would help him achieve his objectives while also soothing his inflamed digestive tract.

The treatment plan

Fix #1: Each meal should have more protein and no gluten.

This was critical—but how was Jake going to handle it? Here’s some exciting news: He could live normally with a little forethought and preparation. In fact, the methods for doing so are beneficial to anybody attempting to alter their diet.

One for each meal, I proposed four essential methods.

First, identify a few “go-to” meals.

A “go-to” meal is one that you like, one that satisfies your needs, and one that you can prepare quickly and simply over and over again. You don’t have to think about or worry about a “go-to” dinner. It’s a habit that helps with dietary transitions. Having a few “go-to” meals on hand ensures that you will always be able to eat properly, no matter what.

Jake should come up with two easy-to-make breakfasts to serve as his “go-to” morning meals, I said. He may eat a gluten-free bowl of cereal and a protein drink on lifting days. He could eat four eggs with two pieces of turkey bacon/sausage and a V8 juice on non-lifting days.

Plan B: Use your imagination at the café.

Healthy choices are accessible in almost every restaurant or cafeteria. You may simply have to think outside the box. (And you’ll have to believe me since I’m an expert at locating excellent food in hospital cafeterias.)

Jake was used to having ravioli or another pasta dish for lunch every day at school. Fortunately, the hot bar offered grilled chicken sandwiches; all he had to do was avoid the bread. Jake agreed, but a single chicken breast wasn’t going to fill him up. Fortunately, the hot lunch line also offered beans, rice, or both as an alternative to pasta, which Jake enjoyed. I also suggested that he eat a piece of fruit or a vegetable.

Here are a couple gluten-free, hospital cafeteria-foraged meals that I created. (Keep in mind that I’m a big, active guy who is still quite young.) My eating habits closely resemble those of a young male football player. If you’re a tiny girl, elderly, and/or less active, decrease portion sizes and carb portions appropriately!)

Veggies, chicken, and a banana for dessert for a “anytime” meal. People who are less active may simply get rid of the banana.	Eggs, bacon, cottage cheese, and sausage with additional potatoes and fruit for a “post-workout” breakfast

Strategy 3: Look for nutritious snacks… and treat them as though they were “real food meals.”

In my world, “snacks” are the same as “meals.” They may be smaller, more handy, or portable, but they all follow the same nutritional principles. Snack time does not imply “junk food” or “disregarding dietary standards.” The challenge is to come up with “snacks” that satisfy the criteria. (See “go-to” dinners for a similar concept.)

I instructed Jake to replace his regular cereal bars with a protein drink and a piece of fruit. He like apples so much that he requested if he could top them with peanut or almond butter. I, of course, answered yes.

4th strategy: Look for easy alternatives and seek assistance.

Making nutritional adjustments may often be as easy as rearranging the ingredients in an existing meal. And, more often than not, there are resources and individuals who can assist us.

This was the simplest meal to alter since Jake’s parents were in charge of his supper and were worried about his health. I urged them to give him non-processed lean meats instead of gluten-laden pastas, with the odd indulgence of a rice-based pasta.

Fix #2: Keep using ferrous sulfate.

An iron supplement is ferrous sulfate. It’s a nice “in-between” step for now — the “low-hanging fruit,” if you will.

You’ll note that I didn’t promote a lot of fruits or veggies. These are obviously important for Jake’s health, but my priority was to get him on a gluten-free, protein-rich diet before addressing the need for additional veggies.

As readers of this site are well aware, burdening clients with habits or dietary restrictions that they are unsure about leads to bad results. Jake felt confident in his ability to implement the adjustments I recommended, knowing that his energy and muscular mass would benefit as a consequence.

As a health care practitioner, I constantly check for confidence and preparedness before moving forward with basic, easy-to-follow actions that clients are ready to do right now. (If you’re having trouble making changes, you may try this method.)

I also maintained him on his iron pill to help his anemia heal faster. People are more inclined to stick with suggested adjustments if they feel better.

The end result

Jake had already developed some color in only one month. He’d also put on a good 4 pounds. I could see he had more vigor just by chatting to him for a few minutes. He claimed he could bench 225 pounds 12 times (his previous best was 8). When asked how his diet was doing, he said it was going well. He also said that he had discovered some wonderful gluten-free cookies! Since he was attempting to gain weight, I told him he may eat them once or twice a week.

Jake’s hemoglobin, hematocrit, and ferritin levels eventually returned to normal. His performance in the gym and on the field skyrocketed, thanks to his enhanced endurance as well as his newly acquired muscles! Jake found it difficult to give up gluten-containing foods at first, but with a little effort, he was able to avoid them and adhere to his new diet.

Take away

One of the most essential things to remember is that a single symptom may be caused by a variety of factors. If you’re experiencing an unexplained health issue, be creative and inquisitive about the options with a like-minded health care provider.

1. Chronic tiredness is a symptom with a variety of reasons, some of which are physiologic, biochemical, and/or pathologic, as well as some of which are psychological (e.g. depression). It was pathogenic in this case: iron insufficiency. However, before rushing to conclusions, it’s critical to examine all alternatives.
2. Iron deficiency may result from a lack of iron in the diet, blood loss, or malabsorption. Jake was consuming iron but unable to absorb it. What you digest, not necessarily what you consume, makes you who you are.
3. Nutrient deficits are often caused by food intolerance. Celiac disease affects approximately one out of every hundred individuals in the United States, according to various studies. Undiagnosed celiac disease may cause unexplained anemias. Consult your health care physician if you have any concerns about any of these — or any other health issues.

Find out more.

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