How to distinguish a real endocrinologist from a charlatan. Signs of a good doctor. Non-existent diagnoses in endocrinology. Non-working treatment in endocrinology. Restless Adrenal Syndrome.
How not to lose money, time and health due to the consultation of an endocrinologist
I am a practicing endocrinologist and I often find that people who call themselves my colleagues give patients non-existent diagnoses and prescribe non-working treatments.
I will tell you by what signs you can check an endocrinologist so as not to lose money, time, and sometimes health, what diagnoses do not exist in endocrinology and how you should not be treated.
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Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Rely on our point of view or not – you decide.
Why charlatans come to endocrinology
When I was in residency, the teachers said that endocrinology is the queen of sciences. But for some reason, we were not told that it is she who is most often used by doctors of alternative medicine: charlatans establish endocrine diagnoses and prescribe endocrine tests. There are several reasons why this happens.
The complexity of the specialty I am not saying that endocrinology is the most difficult area of medicine. The point is that it is incredibly difficult for non-medical people to understand: long chains of biochemical transformations, several levels of hormone regulation, and simply hard-to-pronounce terms. Pseudohypoparathyroidism or hypogonadotropic hypogonadism is hard to read and even harder to dive into. This is what scammers use for their own purposes.
General complaints without localization. Most doctors have their own organ: ophthalmologists have eyes, dermatologists have skin, cardiologists have a heart. Endocrinologists have endocrine glands, but the symptoms of their diseases are often too general.
For example, a lack of thyroid hormones is accompanied by weakness and lethargy, and an excess of the pituitary hormone prolactin is accompanied by headache and fatigue. Even healthy people have such complaints, so alternative doctors easily convince clients that they have endocrine diseases.
Ignorance of patients about endocrine diseases. Most people are unaware of any endocrine disease other than diabetes. But even he is shrouded in many myths. So, many people believe that diabetes appears due to excess sugar in food.
Even less is known about other diseases. It is significant that men more than once tried to take off their pants in response to a request to palpate the thyroid gland. And this ignorance is also often used by charlatans.
Below I will tell you what signs give out a doctor who is better not to contact.
To find a suitable doctor, any means are used: from word of mouth to reviews on the Internet. And if the patient can really count on the first method, then the second does not inspire confidence due to the abundance of purchased assessments. In addition, it is difficult to focus on comments about a doctor online, because they do not always allow you to evaluate the professionalism of a doctor – only how pleasant it was to interact with him.
Signs of fake reviews should be especially alert: if a doctor or clinic buys reviews, they can hardly be trusted.
A "pack" of reviews with the same publication date. Usually, laudatory comments are ordered immediately by a group, so the publication of a large number of positive reviews with a difference of one or two days looks alarming.
Same writing style. Purchased ratings are usually posted by one person, which means that the style of writing reviews will be approximately the same.
Template reviews. “High-class specialist”, “wonderful clinic”, “now only to him” – these blanks are often used by performers when writing.
Reviews without errors. Purchased reviews are usually written without errors or typos, although it happens that real patients write correctly. But still, usually people are not so attentive and do not always proofread their reviews, correcting all the mistakes.
Some endocrine diseases are obvious after a detailed medical history and examination, but laboratory diagnostics puts an end to the diagnosis. It seems that laboratory data is a reinforced concrete factor that excludes deceit and ties the hands of false doctors, but they also skillfully use laboratory indicators for their own purposes.
Evaluate what is meaningless to evaluate. There are thousands of laboratory indicators. Some are used only for scientific activities, others – only for the diagnosis of very rare diseases. The alternatives are changing these rules and prescribing "bundles" of unnecessary tests to patients. I will give a few examples.
Insulin Resistance – National Institute of Diabetes, Gastrointestinal and Kidney Diseases USA
Insulin for an overweight patient. Most likely, in a fat person, insulin is really elevated: the larger the mass of a person, the more insulin is required to normalize glucose levels. The condition is called insulin resistance. In this case, the cells of the body cease to respond to the action of insulin, in response, the pancreas produces it even more. This is the first step to the development of diabetes, however, as well as obesity.
The treatment for insulin resistance is weight loss through proper nutrition and physical activity. It turns out that the recommendations for the obese patient do not depend on the analysis of insulin.
In routine practice, insulin does not use. In some cases, the analysis is relevant to exclude an insulinoma – tumor, which excessively produces insulin, but even then specialists are focused on special diagnostic samples, for example, the sample with starvation: with this disease, the level of glucose will be very reduced, if carbohydrates do not come to the body.
Leptin. An example similar to insulin. Leptin is a hormone of adipose tissue. What is more, the levels above. How to reduce it? Reduce weight. This recommendation works without analysis.
The possible reason for the estimation of leptin is the clarification of the causes of amenorrhea, that is, the lack of menstruation, after long-term intensive physical exertion, stress, starvation, anorexia. In these cases, it is the reduced leptin that becomes the cause of the so-called hypothalamic amenorrhea. It regulates the secretion of hormones that are responsible for the menstrual cycle.
Blood cortisol in the morning to exclude its excess, that is, hypercorticism. The level of this hormone changes during the day, and in the early morning watches it is the highest. But some specific level of cortisol, above which he should not climb in the morning, does not exist: it is impossible to determine if we see physiological or pathological lifting it.
Diagnosis of hypercorticism – American neurosurgeon society
In addition, the indicator is associated with stress: even the puncture of the skin for taking blood causes the emission of cortisol. Therefore, it is difficult to correctly interpret this analysis.
To eliminate excess cortisol, blood is not used, but estimate its level either in saliva at 23:00, or in the urine collected during the day. So exclude stress from the injection, and there is also no impact of the morning increase in hormone.
Track and reduce indicators whose level does not affect anything. The most beloved alternatives indicator – antibodies to thyareroxidase of the thyroid gland, or at to TPO. These antibodies are really tightly connected with autoimmune thyroiditis, or ait, common disease of the thyroid gland. If with simple words, then with this disease, the immune system on one slave one has begins to "eat" the thyroid gland.
In order for the doctor to diagnose the "autoimmune thyroiditis", we need three mandatory conditions:
- Hypothyroidism, that is, a lack of hormones of the thyroid gland.
- Data ultrasound.
- Increased AT to TPO – it is necessary to exclude other reasons for the disorders of the thyroid gland.
That is, one of the two real reasons to determine the level of antibodies to thyroperoxidase – confirmation of the diagnosis of autoimmune thyroiditis. Another reason is the identification of autoimmune thyroidity in pregnant women. They have the presence or absence of AT to the TPO can affect pregnancy.
In both cases, the doctor only looks at whether the level of antibodies is increased or not. The value in the analysis does not play the role.The indicator can be increased by one unit or ten times – this does not affect the tactics of treatment of autoimmune thyroidit. That is why it is meaningless to evaluate it in the dynamics.
Regardless of the level of AT to the TPO with hypothyroidism on the background of the AIT, replacement therapy is needed by hormones. Dosage preparations also does not depend on this indicator.
However, doctors alternatives argue that it is AT to TPO and "eat" the thyroid gland, and therefore, if they need to rise in every possible way. To track the indicator, they are prescribed to patients with autoimmune thyroiditis regular unnecessary tests.
Social networks literally die recommendations to reduce AT to TPO, and this is the pain of all honest endocrinologists. To do this, diets, vitaminotherapy, special devices and even plasmapheresis – procedure for cleaning blood plasma through special filters.
By the way, 10-15% of healthy people are "carriers" of these antibodies. The probability of the development of autoimmune thyroiditis in these patients is higher than that of the rest of the population, but not every owner of elevated AT to the TPO will appear.
One patient suffers to autoimmune thyroidit nine years old. About a year ago, according to the recommendations of the "endocrinologist" refused to traditional treatment of hypothyroidism – substitution therapy, instead actively reduced the AT to the TPO according to the individual protocol proposed by an alternative doctor.
During the year, the figure was estimated four times: before the start of therapy and then as control. If the first control measurements showed a slight decrease, the last level exceeded even the initial value. The hormones of the thyroid gland have been reduced, there were appropriate complaints. The patient was convinced of the ineffectiveness of alternative methods and returned to official medicine.
Recommend the maximum possible number of analyzes. The more indicators are evaluated, the more deviations can be found. Contrary to expectations, harm in long lists of analyzes is greater than good.
First of all, it is financially expensive. For example, alternative doctors can ask for more than 20 parameters in front of their primary reception. The list already mentioned insulin, AT to TPO and a number of other unnecessary indicators.
Among them and the AT to the receptor of the thyrotropic hormone. The assessment is required only to patients with already proven excess hormones of the thyroid gland. If this state is not, then the study is an empty waste of money.
Another reason to refuse to evaluate dozens of analyzes without symptoms of certain diseases is the very concept of laboratory references, that is, regulatory values.
The norm is averaged indicator. If the patient has no complaints, but one of the indicators for several tenths exceeds the reference, this does not mean the presence of a disease. The result can be the error of a laboratory, an individual norm or a one-time "random" increase.However, representatives of alternative medicine will interpret it as a disease and begin treatment, for example, using a special bid reception protocol.
The main thing is to remember about the procedure for diagnostic actions: First of all, the doctor must put a preliminary diagnosis based on a survey and inspection, and only then confirm it with assays. A competent doctor confirms his guesses with research, and not at random appoints dozens of analyzes.
Criticize official laboratory norms. Despite the efforts of fallenocrators, a number of patients have no complaints or deviations in analyzes. In this case, charlatans claim that the reference limits that are used in official medicine are incorrect.
Representatives of alternative medicine referred to Western colleagues that allegedly use other norms, but this is not true.
More often than others artificially overestim the rate of vitamin D. The reason is that it is really often reduced, especially in residents of the middle strip of Russia.
But its normalization is simple and relatively fast: it is enough to take the drug vitamin D according to a special scheme appointed by the doctor. In order for the treatment process to be longer and financially more profitable, alternatives increase the boundaries of the norms for vitamin D.
The tactics of charlatans are simple: they convince patients in their presence of diseases that allegedly deny the doctors of official medicine.
The most frequent endocrine "disease" is tired adrenal glands. Charlatans argue that such complaints as weakness, lethargy and sleep problems are related to the fact that the adrenal glands literally "tired of living this life" and the hormones cannot be allocated due to overwork.
Is it worth saying that there is no one in the international classification of diseases. Full-fledged studies that could prove such a diagnosis either.
ICD-10 – to verify the existence of a diagnosis
As a treatment, alternative doctors propose to normalize sleep and wake mode, eat correctly, minimize stress. With all disrespect for the mythical diagnosis, these recommendations really improve the state of the person. However, for this it is not necessary to have some kind of disease, quite ordinary fatigue.
Drug therapy of the tired adrenal glands requires separate attention. Alternatives usually recommended schemes that include trace elements, vitamins, vegetable preparations, biologically active additives.
If treatment with grass and badoes is unlikely to harm, then recommendations use serious hormonal drugs in terribly huge dosages can seriously undermine health. And such drugs are prescribed – because it is believed that in the syndrome of the tired adrenal glands, they produce less hormones than necessary.
Adrenal hormone deficiency does happen, but with a completely different, real diagnosis – adrenal insufficiency. This condition develops after damage to the adrenal glands or pituitary gland – a gland located in the brain and controls their activity – for example, due to a tumor or injury.
Adrenal Insufficiency – National Institute of Diabetes, Gastrointestinal and Kidney Diseases USA
Adrenal insufficiency is manifested by a drop in blood pressure, weight loss, severe weakness and other symptoms. It has nothing to do with the fictitious diagnosis.
With tired adrenal syndrome, there is no hormone deficiency. On the contrary, their intake leads to the development of drug hypercortisolism, that is, an excess of steroid hormones. And it, in turn, leads to unpleasant changes in appearance, in addition to them, diabetes mellitus, severe arterial hypertension, and infertility in women can develop.
I had a patient in her 30s with numerous complaints: high blood pressure, lack of menstruation, constant fatigue. Her face was full, "moon-shaped", with a red blush, there were sparse dark hairs above the upper lip and on the chin. During the examination, I noticed a redistribution of adipose tissue: thin arms, a large belly and burgundy stretch marks on the sides, forearms and thighs. The diagnosis was obvious, but I ordered additional tests that confirmed hypercortisolism. It arose from the use of steroid hormones to "treat" a non-existent adrenal fatigue syndrome.
Psychosomatics. Indeed, there is a connection between psychological factors and some bodily diseases. Endocrinologists are well aware that stress is a risk factor for a number of diseases, such as diabetes.
Lump in throat – NHS
Another interesting example is the "feeling of a lump in the throat." Patients who experience serious psycho-emotional stress for a long time often complain of discomfort in the neck, pressure or inability to breathe.
However, alternative medicine specialists have brought psychosomatics to the point of absurdity. They state that, for example, type 1 diabetes mellitus arises from a patient's long-term conflict with other people. Even the fact that the disease often develops in young children does not bother the alternatives: they argue that in this case the disease is the result of a long conflict with someone of the mother of the sick person.
In addition, charlatans claim that diabetes is curable, for this you just need to work out conflicts. Of course, not for free.
New German medicine – a relatively new and very "concentrated" direction of alternative psychosomatics. "Revolutionary breakthrough" – so say the adherents of this theory.
If psychosomatics experts are more loyal and argue that only some diseases have a relationship with a psychological state, then Novogermans believe that any disease, from oncology to fungus on nails, is a consequence of transferred stress. Accordingly, it is again enough to work conflict, and the disease will leave.
This approach may be very dangerous to human health. For example, such symptoms like blood in the discharges or necrosis of tissues, the specialists of the new Germanic medicine are regarded as a sign of the phase of recovery or active conflict. Although in fact it is a formidable complaint that indicates dangerous processes in the body.
Homeopathy – Treatment method without proven effectiveness. It implies the use of insignificantly small doses of drugs, which in large doses cause signs of illness in a healthy person. The active ingredient is so strongly divined that mathematical calculations argue its complete absence in the medicine. But this does not interfere with charlatans.
Homeopathy is a profitable view of alternative medicine, such drugs in large quantities are sold in conventional pharmacies. For example, in 2016, Russians spent 8 billion rubles on homeopathy. And the reception of the homeopath in the cost is not inferior to the consultation of a qualified ver. So, in Moscow for the visit you will have to give from 2000 p, and the average price is in the range of 4000-5000 p.
This sign is on the border of common sense and the Criminal Code, which does not prevent unscrupulous swelling to reveal on people who have deprived of hope for recovery. And often it is patients who have no chance to cure, turn to alternatives.
For example, alternative endocrinologists offer to treat diabetes of the first type without insulin destination. The disease is based on the insufficiency of own insulin: pancreatic cells cease to produce this hormone, which is necessary to maintain a normal level of glucose in the blood. Its raising is destroying for the body, and a long-term excess leads to severe and often lethal complications.
First-type diabetes – American Center for Disease Control and Prevention
The only method of treatment is the replenishment of insulin from the outside. But there is one feature. There is a "honeymoon" – the initial stage of the disease, when a part of the pancreatic cells still continues to produce insulin, so substitution therapy is needed in a minimum volume or not needed at all.
It was at such moments that a patient with a diabetes mellitus of the first type and charlatan can lead to fatal consequences. Yesterday, a healthy person denies the disease, besides, it seems to be perfectly without insulin. Fraudsters convince him that insulin will not need further. At such a moment, a person is able to believe in any nonsense, if she promises his former life without constant injection and counting carbohydrates in food.
For example, one of my already adult patients with a long history of type 1 diabetes mellitus claimed that he had almost cured the disease: “I do a maximum of one or two injections of insulin per day.” But the patient did not measure the glucose level, claiming that he knew for sure that "sugar is normal."
The man practically excluded carbohydrate food from the diet, exhausted himself with physical activity and performed various obscurantist practices. The result of the refusal of injections and glucose control is a strong weight loss, repeated hospitalizations and many complications of diabetes: the eyes, kidneys and nervous system have already suffered.
The concept of "diet" in the modern interpretation has no right to exist. Initially, it meant a way of life, a diet. However, now this term refers to the rejection of various groups of products – for example, for weight loss or for other purposes. Often they offer a strict exclusion from the diet of a particular food, in reality this only leads to breakdowns and subsequent weight gain.
Trendy Diets – British Dietetic Association
The only way to lose weight without harm to your health is to modify your diet. You need to eat right without strict rejection of your favorite foods, even if they are sweets.
Refusing certain foods can only be justified for people with certain medical conditions. Examples are confirmed lactose or gluten intolerance.
autoimmune protocol. This diet option is unreasonably recommended for patients with autoimmune pathologies, in particular autoimmune thyroiditis, which I have already mentioned. It's based on another trendy diet, the paleo diet. Her followers suggest asking yourself before eating, “Would a caveman eat this?”
The creators of the autoimmune nutrition protocol went further. They recommend eliminating foods that allegedly cause inflammation and overload the immune system: potatoes, tomatoes, all grains, eggs, nuts, tea, dairy products, and a number of others. The effectiveness of the protocol has not been proven, and nutrition in this mode often becomes stressful for the patient.
Refusal of dairy products. Representatives of alternative medicine are convinced that dairy products reduce immunity, cause hormonal disorders, and negatively affect the state of the gastrointestinal tract.
In fact, dairy products are a good source of complete animal protein, vitamin D, and calcium.
Calcium deficiency can lead to impaired skeletal development in children, impaired circulation in adults, and reduced bone density in the elderly. And a lack of vitamin D can disrupt the immune system and impair calcium absorption. Proven lactose intolerance is the only reason to restrict or avoid dairy products.