This article is dedicated to the many thousands of our clients who live and struggle with imperfect health, but who are not ill enough to be diagnosed with anything specific.

Our medical culture is extremely well designed to deal with health emergencies and life-threatening situations. If you have a broken leg, the chances are excellent that you can access a practitioner who has the skills to make sure you heal without lasting problems. If you have a heart attack, your chances of survival today are better than at any time in history, mainly because our health-care providers have gotten progressively smarter about how to deal with this emergency.

But if you struggle with a long-term health problem that is neither acute nor life-threatening, our conventional health-care system can be frustrating. Maybe you feel tired all the time, or you have a chronic cough, you can’t lose weight, your skin never seems to clear up, your digestion is sluggish, you have frequent headaches, it’s hard to focus on your work, and you just never seem to feel good. Any combination of these small but nagging problems can seriously impact your quality of life, but your choices within the traditional health-care world are extremely limited: intrusive and costly testing that may or may not turn up a finding, or a “may as well try this” approach and a prescription for Prozac. Further, a lot of these symptoms may never even get to the point of demanding an expensive and inconvenient visit to the doctor, so you just … live with it.

Essentially it comes to this: if you are sick or injured with something that is acute and well recognized, you can probably find some answers. But if you just don’t feel good—not bad enough to be completely disabled, but bad enough that you know there’s something better—our health-care system simply doesn’t have much to offer you. You’re on your own.

So what do you do now? Obviously, you go online. You look up your symptoms, you visit chat rooms, you try to be proactive about taking care of your health—a monumental effort, when you feel crummy all the time. Maybe you visit a health food store and look in some of their reference books or talk to people there who seem to know what they’re doing. Here is a short list of some of the messages you’re likely to get:

 You have an overgrowth of yeast.

  You have an underproducing thyroid.

  You’re not getting enough protein or iron.

 You’re getting too much protein or iron.

  You’re allergic to your building.

  Your liver is congested; you must detox immediately!

 Your kidneys are congested; you must detox immediately!

  You’re not getting enough sunshine—but be careful, because too much will kill you.

 You are gluten-intolerant.

  You are lactose-intolerant.

  You’re not breathing right; you have carbon dioxide poisoning.

 You have sleep apnea.

  Your mitochondria are clogged.

  You have the wrong bacteria in
your gut.

Are you confused yet? It may sound like I’m being flippant, but in fact I am all in favor of dealing with candidiasis, or recognizing hypothyroidism, or any of the other strategies that are listed above. I have friends and family whose lives were turned around when they dealt with long-standing subtle issues with yeast or gluten. But I take exception when purveyors of products or processes make unsubstantiated and impossibly inflated claims about the efficacy of their wares, or when media outlets oversimplify these challenges with headlines like “Seven Ways to Cure Fatigue Right Now!” (The seven ways, by the way, includes taking a deep breath, drinking a glass of water, walking around the block, and other “groundbreaking” strategies, all of which are absolutely slamdunk-guaranteed to cure fatigue right now.)

Why does this matter? Because, whether we are qualified or not, our clients look to us for advice about their health. We are not only health-care providers in the massage session room, we are often health-care consultants, too. The most successful and productive client-therapist relationships are built on trust, respect, and good listening. So when our client asks us what we think about the “cure” they found online for their troublesome thyroid, or the hundred-dollar footbath they just bought that is guaranteed to pull toxins out of their body, or the magnetic bracelet they found in the mall that will finally help them feel less tired all the time, what can we say?¹

Because this is a pathology column, this is an appropriate place to share descriptions of several situations that can create the symptomatic profile described here. Although the etiologic backgrounds of these conditions are tremendously diverse, their consequences lead to essentially the same results: fatigue, poor stamina, lack of concentration, digestive upset, and a general feeling that things simply aren’t right.

Bacterial imbalance. This is a relatively new field of science that looks not only at the balance between bacteria and yeast, but at the precise species of bacteria that inhabit our gut. It turns out that our personal colonies of bacteria are related to our genetic inheritance and our home environments. Our unique populations of bacteria are easily knocked out of whack, leaving us with limited access to the nutrients that we take in, and inefficient digestion.

Candidiasis. Most readers probably know that this describes a situation where the naturally occurring yeasts that live in the digestive tract have overbalanced the naturally occurring helpful bacteria that should also inhabit the digestive tract. This is often triggered by the use of antibiotics, but some people appear to be prone to overgrowth of yeast simply by the way they chemically process any kind of food that is yeast-friendly. This includes most fruits, anything with vinegar or alcohol, and of course, anything that has yeast or is sweetened. When the yeast become overactive, they get first dibs on whatever food is taken in, and they produce highly irritating waste products.

Celiac disease. Unlike some of the other problems on this list, celiac disease is a well-accepted condition in which a hypersensitivity reaction to gluten (a protein found in wheat and several other grains) damages the villi in the small intestine. The consequence is that absorption of any food type becomes difficult. What is less well-accepted is that celiac disease might appear in a spectrum of severity. Traditionally, diagnosis has been reserved for people who have it so extremely that they are at risk for malnutrition because their villi are virtually nonfunctional; this is a relatively small population. But it seems clear that celiac disease can be low-grade and subtle, which means that a person who eats a typical diet that is heavy in wheat may have discomfort and bloating and gas and fatigue, and never really know why. When gluten-bearing foods are eradicated from the diet, the symptoms disappear. But eradicating gluten is easier said than done: it is in practically every prepared food and vitamin on the grocery store shelf and restaurant-menu item.

Chronic fatigue syndrome. This describes a group of signs and symptoms that frequently appear together, in which debilitating fatigue is the central feature. At one time, it was thought that chronic fatigue syndrome was a situation where the immune system response to mononucleosis simply outlived the infection, but this is no longer accepted as universally true. It is now frequently discussed as a problem with stress response efficiency, possible adrenal gland dysfunction, and some immune system anomalies. Fatigue that is not restored by rest is the centerpiece of chronic fatigue syndrome, but bouts with digestive upset, poor concentration, and general muscle aches and pains are also frequently reported.

Fibromyalgia syndrome. This common and extremely poorly understood condition has traditionally been discussed as a musculoskeletal problem because its main symptoms are pain in the muscles and other soft tissues. Some practitioners propose that the pain and fatigue of fibromyalgia is related to poor mitochondrial function. Many experts now consider this a central nervous system problem rather than a rheumatic one. Its main features are a lack of stage IV sleep, general sensory amplification (especially pain sensation), and painful spots in muscles and fascia called tender points. However, many fibromyalgia patients also experience “fibro fog,” bouts of digestive upset, and debilitating fatigue.

Leaky gut syndrome. The theory behind this condition is that a combination of genetics, poor diet, various kinds of imbalances (especially of bacteria and yeasts, but also possibly parasites) and general bad luck have changed the villi of the small intestine so that a person absorbs substances that should not pass through capillary walls. In other words, particles that haven’t been appropriately broken down, or that really should be excreted instead of absorbed, find their way into the bloodstream and stimulate inflammatory reactions elsewhere in the body. Some practitioners consider leaky gut syndrome as a feature in a variety of seemingly disconnected syndromes, including autism spectrum and autoimmune diseases.

Hypothyroidism. The thyroid gland is a butterfly shaped gland that wraps around the trachea and secretes a variety of hormones, two of which are dedicated to metabolizing fuel (food) into energy (work). If a person is short on thyroid hormones, the food that she eats is more likely to be stored as fat than used as energy. In the meantime, no matter how pristine her diet is, her digestion is sluggish, she gains weight, and she feels cold and tired all the time. Thyroid function is often one of the first things a conventional medical doctor considers when a patient is concerned about fatigue and general malaise. However, the diagnostic criteria for hypothyroidism assume that every person’s “normal range” of hormone secretion is the same. Consequently, a person could have lots of the signs and symptoms of hypothyroidism, but if her blood work indicates that she is in that “normal” range, she may not be considered for treatment.

Obstructive sleep apnea. In this situation, tissues in the throat collapse and close off the airway during sleep, and breathing temporarily stops. When oxygen levels get low, the person suddenly gasps with a deep snort. This is a little different from typical snoring, during which breathing may be labored, but it doesn’t completely stop. A person with obstructive sleep apnea may experience a disruptive oxygen shortage hundreds of times every night, without coming to full wakefulness. Not surprisingly, that person experiences tremendous fatigue in the daytime. This level of fatigue and sleep loss also opens the door to a host of other chronic pain syndromes and disorders.

It is important to emphasize that this is just a short list of things to consider when a person reports chronic, low-grade, long-term sense of not feeling good. Other possibilities include anemia, autoimmune diseases, a variety of nutritional deficiencies, multiple chemical sensitivity syndrome, and, of course, depression and anxiety. These are conditions that may or may not be recognized in conventional medical settings, but they can also cause subtle, under-the-radar, quality-of-life-altering symptoms.

Wouldn’t it be great if there were a short, simple answer for these challenges? If only we could find the right hormone, the perfect vitamin, the missing amino acid, the magic elixir that would set everything else in order, all overnight. Sadly, that almost never happens—in spite of what we might see in the advertisements. Our job as health-care consultants is to be good listeners. It is appropriate to make suggestions with the caveat that those suggestions could be wrong. It is important to recognize when symptoms indicate that clients need to consult their primary care provider in addition to their massage therapist. We can advise patience when our clients are looking for a quick fix. Most of all, we can be cheerleaders for people who are interested enough in their health to do their own research. And we can celebrate that in a situation where serious contraindicating diseases are not a problem, massage is a powerfully positive influence in the life of the person struggling with health.

 Ruth Werner is a writer and educator and is approved by the NCTMB as a provider of continuing education. She wrote A Massage Therapist’s Guide to Pathology (Lippincott Williams & Wilkins, 2009), now in its fourth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com or wernerworkshops@ruthwerner.com.

Note

1. There is no easy or simple answer to this question. In general, I try to be respectful of people’s choices, but I tend to take refuge in research. So when someone comes to me touting a product, I ask for the evidence base. And I particularly look for research that is not conducted by the people who are selling the product. This occasionally makes me look stodgy and closed-minded. I can live with that.