My patient, a pastor, was visiting a prison several months ago when a sudden, severe pain in his left hip pulled him up short. Had he been attacked by an inmate? He glanced around and then down at his hip. Everything looked fine, but the ache was intense. When I saw him in my office a week after it happened, he was concerned that his hip might be broken. I didn't believe that anyone could be walking around on a broken hip, certainly not for a week. Still, based on what I knew of his history, I was worried.
When we first met several years earlier, he was only 57, but he had the severe forward bend in his back of an older man. The curvature in his midspine had evolved painlessly, he said, over the previous 5 to 10 years. As we shook hands, I noticed something else: His palms were yellowish orange. Excessive carotene, which comes from eating too many carrots or other foods rich in carotenoids, can cause this discoloration.
"No," he replied, "but I do eat a lot of brussels sprouts."
"Do you eat a lot of carrots?" I asked.
That vegetable is another plentiful source of carotene. I told him that he could correct this innocuous problem by changing his diet. The problem in his spine was harder to address. I suspected it was the result of severe osteoporosis and multiple compressed vertebrae; X-rays had confirmed it. Yet why would a man in his mid-fifties have such severe bone loss?
Building a sturdy skeleton begins with adequate nutrition and exercise during childhood and adolescence. As calcium accumulates in the bone matrix over time, the skeleton hardens. By the time people reach their midtwenties, their bones are as dense as they're ever going to be. Although osteoporosis is much more common among women as they age, men still account for 20 percent of the cases. But when men's bones grow brittle, the cause is often something other than age-related osteoporosis.
Twenty different conditions crossed my mind. My patient said he had no serious illnesses as a child, so I quickly ruled out many rare, congenital causes. What about steroid use? These drugs can hasten bone loss if they're taken for a prolonged period. But my patient denied using them. My suspicions then turned to hormone disorders that can affect bone metabolism, certain diseases of the bowel that disrupt the gut's ability to absorb calcium, and kidney disorders that can thin the bones. I therefore arranged for him to have blood and urine tests.
When the lab results came back, they were completely normal. I was perplexed. I flipped through the reports, wondering what I was missing. Gradually that question gave way to a new question: What was he missing?
After reviewing the test results with him, I asked, "What else do you like to eat besides brussels sprouts?"
"Almonds," he replied.
"Good. What else?"
"Water," he added.
"OK. And . . .?" I queried.
"That's about it. Almonds, brussels sprouts, and water."
When I asked about meat, dairy, and fish, about other foods, he replied: "Oh, my system can't take that. They all give me cramps, and I just feel terrible." When asked how long he'd been living on just almonds, brussels sprouts, and water, he answered: "Oh, years. Many years."