Case Study: Tom Presents Arthritis, fatigue, Diabetes
Tom, a 60-year-old businessman, attended one of my community lectures and approached me afterwards to express concern about his health. At 59 years of age, Tom had been diagnosed with Type II diabetes mellitus, which he was able to control with diet and exercise, so that he had not developed any of the known complications. Since his teenage years he also suffered from a chronic lack of energy which prevented him from performing vigorous exercise, though he was able to walk at a moderate pace for one-half hour approximately five days per week. Because of his fatigue, his family doctor checked his testosterone level, which was low, but several injections of testosterone made no difference to his condition.
Tom also had problems with osteoarthritis of his knees. He had no problems with blood pressure and he had given up smoking cigarettes when he was 35 years old. His cholesterol had never been elevated. When I asked about exposure to toxic substances, I learned that Tom had worked in a service station for two years and had significant exposure to leaded gasoline. Also, he had spent a lot of recreational time with motorboats, which would also have exposed him to leaded gasoline.
At 56 years old, Tom had most of his mercury amalgams removed. Because of his British heritage (see more about this in Chapter 9), together with his low testosterone level, diabetes mellitus, and arthritis, I advised him that we should make sure he was screened for iron overload. And because of his history of exposure to leaded gasoline, I recommended an EDTA challenge test.
My examination of Tom revealed many changes in his skin caused by sun exposure in the past. His blood pressure was excellent. There was no evidence of complications from diabetes mellitus, and his right knee had changes compatible with chronic osteoarthritis. I ordered some investigations which showed that his fasting blood sugar was borderline elevated (5.9 mmol/L with normal being 3.3 - 6.0). The test to look at blood sugar control over three months (Hb A1c) was good at 5.7 percent (with normal being less than 7 percent). He had no excessive protein in his urine, and his homocysteine, highly sensitive C-reactive protein, cholesterol indices, and chemistry reports were well within normal limits.
However, the picture changed when we measured Tom’s ferritin (the storage form of iron) and transferrin (the carrier protein for iron in the blood). His ferritin level was high (636 microgram/L, with normal being 30 – 300). Ferritin is the storage form of iron. His transferrin saturation was borderline elevated (55 percent, with normal being 20-55 percent). His serum iron was in the higher end of normal (28 micromol/L, with normal bein 10 – 33). Genetic testing showed that he was homozygous for the C282Y genetic mutation for hemochromatosis, which means that he had a copy of this mutation from each of his parents. (See more about this in Chapter 9). Finally, an EDTA chelation challenge test showed a very elevated lead level (23 micrograms, with normal being less than 5). His mercury was mildly elevated (5.5, with normal being less than 3), and nickel also was elevated (20 with normal less than 10).