I am the founder and CEO of a new medical practice that focuses on obesity and addiction medicine. I am passionate about helping people and helping to save lives. In the course of my career, I have seen the devastating impact the disease of addiction has on people and their loved ones. I have seen the suffering that occurs when a family is torn apart and when a small business is upended by the addiction of a friend or colleague. I have seen the destructive elements of addiction change people into the most desperate and vulnerable of human beings. I have seen people who are desperately trying to fight the disease of addiction. Sadly, the physical and mental stress of trying to fight addiction is overwhelming and can impact the person’s ability to continue to fight.
Today I was speaking with a Doctor who was diagnosed with terminal cancer. My question to him was, “What did you do? Why did you do it? When did you know you were done living?” He answered, “I couldn’t live without myself. I didn’t live full lives before, but I felt like I was living. I was too tired to be a dad, to do the right thing, to be the man my daughter needed. I felt like I was failing as a man and as a father. I had to switch it up.”
This week, a doctor detective meets a young man with mysterious yellow skin and discovers a scary side effect of a Halloween pumpkin. Is it jaundice and liver dysfunction? Or just too much carotene?
Eat less and move more. All in all, an excellent recipe for improving your health and body composition. However, this does not always work.
Even with an excellent exercise plan and a solid diet, some people suffer from mysterious symptoms and ailments that seem incomprehensible when you consider how much effort they have put into their fitness and health.
When we meet clients whose problems cannot be solved by exercise or diet, let alone their own doctor, we know that there are few experts in the world to whom we can turn. One of them is Spencer Nadolski.
Dr. Nadolski holds a doctorate in osteopathic medicine and has also studied exercise physiology and nutrition. The college wrestler, who won the title of America’s best college wrestler, is still an avid athlete and a brilliant doctor who practices what he preaches to his patients: treat preventable diseases first by changing lifestyle (rather than prescribing drugs).
When clients have no one else to turn to, Dr. Nadolski transforms from a cheerful, athletic doctor into a meticulous, intolerant forensic physiologist. He pulls out his microscope, analyzes blood, saliva, urine, lifestyle – everything you need to solve a medical mystery.
When Dr Nadolski offered to collaborate on a regular article on case studies, we jumped at the chance. After following these fascinating cases, you will see exactly how a talented practitioner thinks. You will also learn how to improve your own health.
In today’s case, we meet a young man who doesn’t like being yellow.
In the fall, Steve, a 24-year-old man, came to me because of yellow skin.
Steve occasionally came to my clinic with strange complaints that were never serious. So when I saw his name in my paper this time, I couldn’t help but smile.
Of course I would treat her problems with the same respect as any other patient. But given our history, I felt it was a question I wanted to ask him to reassure him a bit and move on.
Signs and symptoms of the client
Steve had no real health problems, unless you count mild hypochondria. (This is a disease where the patient thinks they are sick, when in fact they are perfectly healthy). Ironically, Steve was a true fitness fanatic who cared more about his health than 99.9% of the population.
We sat down together and I asked him what the problem was. His skin had turned yellow, he explained, especially the skin on his hands. His friends began to comment on this. Within two months the yellowing became more and more obvious.
I’m afraid of liver failure! he confessed.
That would be something serious! My detective’s nose began to itch.
At first glance, I saw no obvious yellowing of the skin. Compared to one of my patients with pancreatic cancer whose skin had turned as clear as amber, Steve looked perfectly normal. But yellowing of the skin can indicate serious health problems, so I had to take it seriously.
|Signs/Symptoms||My thoughts are potential problems|
|Yellowing of the skin||Sometimes it has to do with the thyroid, sometimes it is the result of eating too many carrots. In many cases it has to do with the liver or the abdomen.|
Steve’s vital signs indicated that he was in perfect health.
Height: 1.90m Weight: 1.85mBreast circumference: 2.75mBlood pressure: 118/75
Pulse Rate : 65
He also had a beautiful smile. I wish all my patients were like him.
I wanted to know more about Steve’s symptoms. Have there been any changes in his lifestyle recently?
Nothing new, he said.
He has not taken any supplements or medication since the skin lesions appeared. And he certainly wasn’t drinking. This rules out the two most obvious reasons. Additives and alcohol can affect the liver and possibly cause yellowing of the skin. But in his case, that was clearly not the case.
Steve reported that he had no abdominal pain, no change in stool color, and no gastrointestinal problems.
I tried my last hypothesis. Do you eat a lot of carrots? I asked. Although it may seem strange, too much carrots can turn the skin yellow. The reason for this is the high concentration of carotene they contain. Normally, the body converts carotene into vitamin A, but it is possible – though rare – to overload the system.
No, he said. I hate carrots.
The history didn’t help me, so I decided to do a physical exam.
Upon closer inspection, I noticed a slight yellow tinge to her skin, especially between her fingers and on the palms of her hands. These were the only places where the color really stood out.
His eyes (sclera) were white, with no yellow tint. This was a relief, as yellowing of the eyes can indicate many serious problems, including cancer and liver damage.
As for the rest of the survey, no remarkable results were found. I applied a lot of pressure to his stomach, especially in the upper right quadrant, where the liver and gallbladder are located. No tenderness. Liver’s not enlarged. Nothing.
I didn’t expect to find anything, but I told Steve we’d do a quick liver test just to be sure. He made a follow-up appointment and left.
Tests and classifications
In light of Steve’s presentation, I wanted to run tests on his liver and bile ducts. So I ordered a CMP (Comprehensive Metabolic Panel) and several other liver tests.
Biochemical blood analysis
Here are Steve’s lab results:
|Marker||Result||Laboratory reference area||Considerations|
|Fast glucose||82 mg/dl||65-99||No signs of insulin/glucose problems.|
|ACT||21 IU/L||<35||There are no signs of inflammation/liver damage.|
|ALT||19 IU/L||10-35||There are no signs of inflammation/liver damage.|
|Albumin||4.5||3,5-5 g/dl||There are no signs of inflammation/liver damage.|
|Alkaline phosphatase||68 IU/L||44-147||No signs of biliary obstruction.|
|GGT||30 IU/L||15-80||There are no signs of inflammation/liver damage.|
|Plaques||280 x10^9/L||150-400||Good liver function.|
|Direct bilirubin||0,2 mg/dl||<0.4||Normal. This means that the yellowing is not related to the bilious system.|
|Total bilirubin||0,5 mg/dl||0.3-1||Normal. This means that the yellowing is not related to the bilious system.|
|Prothrombin time||12.5 seconds||11.4-14.2||Normal. It is an indicator of the quality of blood clotting, but since protombin is made in the liver, it can indicate liver function.|
These numbers told me that Steve did not have true jaundice, which is caused by high bilirubin levels.
Bilirubin is a breakdown product of blood. People become yellow (or yellowish) when bilirubin levels rise in the body due to disorders of the biliary system or increased breakdown of blood products. Steve has never had an experience like this. That’s great news!
But if jaundice isn’t the problem, what is? Why were his fingers yellow?
Maybe someone tricked him by putting self tanner in the soap?
It’s time to solve this crazy case! I had to meet the patient in person to discuss the test results and see if I could find any other clues.
Steve’s second visit
Steve was both nervous and excited when he told me his results. I was happy to reassure him that his liver was perfectly fine.
But I swear he looked almost disappointed – like he wanted something to be wrong!
If it’s not my liver, he said, then what’s wrong with me?
To be honest, I didn’t know. So I went back to the theory that had already been rejected. It could be carotenosis, I said.
Carotenosis or carotenemia is the scientific name for a condition in which the accumulation of carotenoids in the body leads to yellowing of the skin.
But I already told you I hate carrots!
We sat there for a minute, mutually confused.
Then his face lit up, like mine does when the waiter brings my favorite porterhouse.
And the pumpkin? he said.
Since it’s fall and canned pumpkin is everywhere, Steve is apparently making yummy pumpkin cocktails every day. Yes, you read that right. Not once or twice a week, but every day.
Aha! That explains everything. Pumpkin, like carrots, orange sweet potatoes and winter squash, is a bright orange vegetable. These vegetables owe their beautiful color to their high concentration of carotenoids.
A nutritional powerhouse, rich in vitamins and antioxidants, pumpkin is also delicious – baked, boiled, fried, roasted, in the form of cakes and muffins – and, yes, as a superfood cocktail. But most people eat it once a year, at Thanksgiving.
Like a good detective, I should have asked about the pumpkin when Steve first visited, but honestly, the possibility of an overdose didn’t occur to me. I didn’t think people (except me) would eat it in large quantities.
I told Steve to stop eating so much pumpkin if he wanted the yellowing to go away.
Is it dangerous to eat a lot of it?
No. I replied. Unless you think self-tanners are dangerous.
He laughed and said he was going to eat less pumpkin.
A nourishing concentrate, rich in vitamins and antioxidants. However, too much of it can cause yellowing of the skin.
Steve’s recipe was simple: Eat less pumpkin. This reduces the amount of carotene entering the body.
Although carotenosis is a harmless problem, some people are concerned about the appearance of their skin. If Steve was suffering from mild yellowing, all he had to do was reduce his consumption of orange vegetables. The yellowing usually disappears after a few months.
Three months later, Steve came in for a second checkup. After he reduced his pumpkin consumption (he only ate one glass a week), his skin became more aesthetically pleasing.
Winner! He enjoyed all the health benefits of pumpkin without the specific side effects.
Satisfied with this balance, he wanted to do nothing more.
So what can we learn from Steve’s story?
- Jaundice is not the only possible cause of yellowing of the skin, but if you think your skin is yellowing, you should consult your doctor. Yellowing of the skin can indicate very serious problems that should not be ignored.
- Going yellow from too much carotene spares your sclera (the white of your eyes). There will be no jaundice.
- Vegetables are good for your health and it is good to eat a lot of them. But too much of anything, even a healthy vegetable, can overload your body. Pay attention to the variety and quantity of vegetables.
- Also, be careful what else you can take. Many people who take multivitamins already take large amounts of beta-carotene (look for it on the label under vitamin A). A can of pumpkin and a daily serving of carotene-rich vitamins can also make you look like an Oompa-Loompa.
- If you want to get a tan, eat lots of carrots and pumpkins.