Sepsis is not caused by bacterial infection?

Sometimes I come across something so bizarre, so utterly wrong, that my mind reels in confusion and amazement, not to mention horror, that anyone can actually think or write something something like it. In fact, for a moment I considered offering up this one bit of horrifically inspired craziness up as an installment of Your Friday Dose of Woo, but I decided against it. The reason, I’m afraid, is the same reason that I’ve considered some bits of woo previously for this “honor” but then ultimately declined and covered them as normal posts, dripping with my usual brand of Respectful and not-so-Respectful Insolence.

Do you remember Robert O. Young–excuse me Dr. Robert O. Young or Robert O. Young, Ph.D., D.Sc., both titles that he seems to be especially enamored with? You don’t? Perhaps you remember that he is the guy who thinks that all disease is due to excess acid (due to diet, of course!), that cancer is a “liquid acid,” and that viruses are “molecular acids,” among other complete and total woo. His one-size-fits-all treatment for all disease follows logically from his central thesis, namely that the treatment for all disease is to “alkalinize” the blood through diet and various other means. I say “logical” not because Young is right but because his conclusion does logically flow from his premise. Of course, his premise is utterly wrong, which makes his conclusions wrong. In fact, the pH of the blood is very important for cellular function and health; so not suprisingly, the body has evolved numerous homeostatic mechanisms to keep the pH pretty rigidly controlled between around 7.35 and 7.45.

Indeed, it’s very hard to change the blood pH very much. The body is very good at compensating. Moreover, there are relatively few indications for alkalinizing the blood, which, when it’s indicated, doctors usually do with sodium bicarbonate. A couple of the indications for alkalization include certain types of kidney stones and occasionally very severe acidosis, but in general there isn’t much reason to try to mess with the blood’s pH.

Don’t tell that to Robert O. Young, though. And especially don’t tell him that the acidosis from sepsis is caused by the body’s reaction to massive infection. He apparently won’t believe you, and he’s willing to abuse the memory of Mariana Bridi da Costa, the Brazilian model who recently died of massive sepsis, whose story made the news mainly because doctors amputated her hands and feet in a last ditch effort to control the sepsis. To Young, Bridi da Costa died not of massive bacterial infection, rather of the consequences of too much acid brought on by bad lifestyle choices and, yes, intravenous antibiotics. First, let’s review what actually happened:

In brief, as far as can be reconstructed, Bridi da Costa developed a urinary tract infection, which isn’t so uncommon for a young woman. Apparently in late December she felt ill and was hospitalized but was misdiagnosed with kidney stones. She ultimately became septic from her infection, and went into septic shock so profound that the blood flow to her far extremities led to gangrene of her hands and feet, which ultimately led physicians to amputate them. The causative organism was reported to be Pseudomonas aeruginosa, a nasty bug indeed. Indeed, resistant Pseudomonas is very common, and even sensitive strains of this bug are hard enough to eradicate. Moreover, Pseudomonas can infect virtually every tissue.

Of course, all of this is just my blather to Robert O. Young. To him it couldn’t have been Pseudomonas sepsis that killed Bridi da Costa. To him this is what killed her:

Just last week a young beautiful Brazilian woman died from sepsis or systemic acidosis. This is not a unique nor isolated story. It is happening every day to hundreds of thousands of people around the world! In fact, Shelley and I came very close to losing one of our own children from septic or acidic shock due to antibiotic IV’s.

[…]

Sepsis is the number one cause of death in the world and happens every day at Intensive Care Units, Hospitals and Medical Clinics!

What is sepsis or septic shock and what is the cause?

Sepsis or septic shock is a systemic acidic condition caused by acidic lifestyle choices, including acidic food, drink, and drugs – especially dextrose and/or antibiotic IV’s given at hospitals around the world.

Yes indeed, to Young it has to be those evil doctors who killed this beautiful young model with their reductionistic science, pumping her full of IV fluids containing 5% dextrose (which many IV fluids do) and antibiotics! Damn them and their inability to see the truth! Of course, the doctors must have been aided and abetted by Bridi da Costa’s apparently bad lifestyle in which she must have eaten what Young considers to be pure evil, namely “acid” foods:

When someone is over-acid and becomes tired, sick and/or injured and nothing is done to buffer or neutralize the excess environmental, dietary, metabolic, and/or cellular degenerative acids, then death from acidosis or sepsis becomes inevitable.

Most people believe that sepsis or acidosis is an infection. It is not!

It is an out-fection from personal acidic lifestyle and dietary choice. An out-fection, in the body, is the cell breaking down from the inside out from an emotional or physical stress or disturbance giving rise to increased acidity. Dietary and/or metabolic acids are generally the cause of all out-fections or cellular transformations – not the infection from some harmless bacterium and/or yeast. And, a bacterium and/or yeast present in the blood or tissues is the evidence of sepsis or an acidic state that gives rise to biological transformation or the birth of bacteria, yeast or mold.

This it typical alt-med idiocy. Basically, they take a valid idea based on science (in this case, that lifestyle and diet can predispose to disease) and extrapolate it to the point where they run right off into the deep end of the stupid pool with it. Indeed, after they’re through with the idea, it’s pretty much unrecognizable as being science any more. Robert O. Young is no different; in fact, he is a master at doing this. Here, he is once again denying germ theory, sounding in fact a bit like Bill Maher, channeling arguments that date back to the late 1800s to Antoine Béchamp, Louis Pasteur’s rival.

For those not familiar with him, Béchamp is the hero of germ theory denialists. Rejecting an external cause of infectious disease, he argued that “the soil is everything.” There’s no doubt that the “soil” is important; if the body is weakened or its defenses breached through, for instance, trauma, then it is more susceptible to infection. But that’s not how Béchamp saw things. Specifically, he postulated “pleomorphic theory,” which argued that bacterial growth in the body is a consequence, not a cause, of disease arising from the tissues and that bacteria in essence arise from the diseased tissue and change their form (the “pleomorphism”) to scavenge the dying tissue. This theory, although somewhat plausible sounding back in the 1870s, given the relatively primitive microscopes of the time (compared to 20th century instruments), the much less sophisticated knowledge about how to grow and stain bacteria, and the newness of germ theory, was abandoned in the face of the massive amounts of evidence that Pasteur and others ultimately marshaled in favor of the germ theory of infectious disease. That doesn’t deter woo-meisters, though, who seem, to prefer science that is at least 100 years old, and preferably abandoned long ago in favor of hypotheses and theories supported by actual experimental and observational evidence, so that it seems to be “challenging the existing paradigm.” Béchamp’s theory sure does that, and woo-meisters love him so much that they’ve even promulgated a myth that Pasteur “recanted” on his deathbed and that his last words were that that Béchamp was right after all. Too bad Béchamp was demonstrably wrong, and too bad for germ theory denialists that Pasteur never “recanted” germ theory on his deathbed.

Not that any of this stops our intrepid quack from sounding like Béchamp on acid and mushrooms, with a dash of whiskey and pot thrown in for good measure:

Most people believe that sepsis or acidosis is an infection. It is not!

It is an out-fection from personal acidic lifestyle and dietary choice. An out-fection, in the body, is the cell breaking down from the inside out from an emotional or physical stress or disturbance giving rise to increased acidity. Dietary and/or metabolic acids are generally the cause of all out-fections or cellular transformations – not the infection from some harmless bacterium and/or yeast. And, a bacterium and/or yeast present in the blood or tissues is the evidence of sepsis or an acidic state that gives rise to biological transformation or the birth of bacteria, yeast or mold.

Isn’t that what happens to food when it spoils? Bacteria, yeast and mold appear as the food is spoiling and are not the cause of the spoiling. Food spoils from the inside out not the outside in. Human or animal cells spoil from the inside out not the outside in. This is why I call cellular transformation from a healthy state to an unhealthy state an out-fection not an infection…..because germs are born in us and from us from spoiling or decaying cells. And, germs do not cause dis-ease or disease!

Oddly enough, Young is sort of correct about one thing. Sort of. What he’s arguably not unreasonable about is saying that sepsis itself is not an infection. That’s sort of true, although in reality it’s probably more semantics than anything else. Sepsis can actually be viewed as the body’s response to massive infection, not the infection itself. However, the infection itself causes the septic response. In the face of toxins released by bacteria in the bloodstream, the blood vessels dilate, causing blood pressure to drop; the heart starts pumping much harder, increasing cardiac output; and a number of other physiologic derangements occur that can lead to dysfunction of the clotting system, the liver, the lungs, the kidneys, and the GI tract. If several of these organs start to shut down at the same time, it used to be called multisystem organ failure, although now it’s called multiple organ dysfunction syndrome, and if three or more organs shut down this way the mortality is at least 80%. That sepsis is the response to a massive bacterial infection can be inferred from the existence of a sepsis-like syndrome from which no infectious agent is ever isolated. This syndrome, called the systemic inflammatory response syndrome (SIRS), looks all the world like sepsis but may not be caused by an infection. On the other hand, the definition of sepsis these days is generally stated: “Sepsis = SIRS + Infection.” In other words, massive infection is part of the definition of sepsis.

The reason that sepsis activates a systemic inflammatory response is that overwhelming bacterial infection activates the same sort mechanisms that generalized inflammation does–with the same sorts of physiological changes in terms of vascular dilation, increased cardiac output, and metabolic derangements that lead to inadequate organ and tissue perfusion and oxygen utilization, which in turn lead to acidosis, the common end result of metabolic needs outstripping perfusion. Actually, it’s a bit more complicated than that in that oxygen delivery usually increases in SIRS/sepsis, but the cells can’t utilize it properly. The details are too complicated (and some of them controversial) to be discussed properly here. Be that as it may, in the case of Brida da Costa, we know she had sepsis because (1) she had a diagnosed urinary tract infection; (2) she clearly had a life-threatening SIRS-type response; and (3) an infectious agent was isolated in the context of that SIRS-type response. Infection plus SIRS equals sepsis, and Brida La Costa had severe sepsis.

Not that Young believes it. He confidently brings home the stupid with more flair than any other crank besides perhaps Mike Adams:

Ms. Bridi da Costa, at the young age of 20 died from systemic acidosis from the lack of proper alkaline treatment. Acidic drugs, such as antibiotics and metabolic acids ravaged her body which forced doctors to perform amputations of her extremities and extract part of her stomach as well as both kidneys. I strongly believe that Ms. Bridi da Costa would be alive, healthy and strong today, if, the prevailing 19th Century germ theory medical dogma and subsequent acidic treatment protocols of antibiotics would have been simply replaced with alkaline fluids of sodium, magnesium and potassium bicarbonate and alkaline water and foods.

Actually, the pleomorphism theory that Young clings to is the 19th century theory–a 19th century theory that was correctly discarded based on science. Germ theory, although it originated in the 19th century, has advanced considerably since then. Alt-med quacks like Young remind me of creationists in a way in their obtuse refusal to recognize that the 19th century theory that they hate has moved on since it was first proposed. Charles Darwin and Louis Pasteur suffer the same sort of abuse at the hands of pseudoscientists spewing burning flames of stupid in geysers that obliterate any sign of intelligence, reason, or science. In this case, Robert Young is throwing the gasoline on that fire.

I was going to quit here, but Young said something that reveals the full, dangerous depths of his ignorance, and here it is:

Currently, medical science perceives there is no early diagnostic test nor effective treatment for sepsis and severe sepsis or over-acidity. But this is not true! There is a diagnostic test!

The early diagnostic test is simple, inexpensive and accurate. All you need to do is test the pH of the urine and saliva with litmus paper. If the urine and saliva is dropping from a normal 7.2 pH or higher to under 7 and then into the low 6’s, 5’s and then 4’s, you are headed toward sepsis or systemic acidosis!

As I said, this is nothing more than the purest quackery. Does this moron think that if there was such a simple test to predict sepsis that physicians wouldn’t be interested–nay, eager!–to study and validate it? What bothers me the most about Young is that he is actually convincing enough that he fools people into believing his quackery, and the result can clearly kill. For example, if a patient develops fever and symptoms suggestive of a significant bacterial infection, but foregoes antibiotics in favor of lots of alkaline treatments to raise his saliva and urine pH to the levels Young advocates, that patient runs the risk of being a corpse with alkaline urine and saliva.

Brida da Costa is an incredibly tragic case. Any time someone so young dies unexpectedly of what is now an uncommon cause of death in the young and healthy (sepsis from a urinary tract infection), we naturally want to know how this could possibly have happened. After all, Pseudomonas usually doesn’t cause infection in a healthy young person. There usually has to be some sort of preexisting wound, inflammation, or immune suppression decreasing the body’s ability to keep the Pseudomonas that naturally lives on it and in it in check. Indeed, that’s one reason why Pseudomonas is such a problem in burn patients; the protective barrier of the skin is broken down over a large surface, and Pseudomonas love to grow in the burn eschar. I remember my days in the burn unit, where I could smell the Pseudomonas on many patients. The bacteria produce a very distinctive and not entirely unpleasant fruity smell and also can make a greenish fluid.

None of this means that Brida da Costa must have been immunosuppressed before she got sick. Probably what happened is that she got a urinary tract infection, possibly due to a different bug or possibly due to Pseudomonas. Although it’s not clear whether she did or did not have kidney stones when she was initially treated, a kidney stone can certainly reduce the urinary tract’s natural defenses by causing injury to the lining of the ureter, as well as stasis of urine in the ureter and a nidus for bacteria to stick to. To me, it would make sense if Brida La Costa had a kidney stone, and that predisposed her to a UTI. In any case, the infection progressed; and when it got serious it probably resulted in sufficient immune suppression to pave the way for Pseudomonas to go from being just a localized bladder or kidney infection to becoming a systemic infection in the bloodstream. Assuming doctors isolated Pseudomonas from her blood, she was clearly septic–very septic. Another huge blow to germ theory denialists in this story is that it shows that a bacterial infection can cause an infection that can kill a young, healthy adult. Germ theory denialists will often argue otherwise, particularly with influenza.

When it comes to figuring out what alt-med quack brings home the stupid, Robert O. Young is always near the top of my list. Even Mike Adams may not be “up” to his standard, given that Adams appears mostly to parrot other people’s woo and add his special brand of conspiracy nuttery to it to produce a toxic brew of antiscience. Every time I see something from Robert O. Young, it’s more disturbing and further off the reservation than before. His “logic,” such as it is, is unrelentingly circular. If you tell him, for instance, that massive quantities of bacteria or fungus were isolated and cultured from a septic patient’s blood, he would say that it was evidence that the body’s function was deranged to let the organisms grow because bacteria can’t cause disease in and of themselves, which means that when they are found in a site of infection they must be an epiphenomenon, not the cause. Of course, when it’s pointed out that alkalization is of no benefit in sepsis except possibly in the case of very severe acidosis (and even that’s controversial), he would probably say that the body’s acid-base balance was just too deranged or that doctors simply don’t alkalize vigorously or early enough. That way, he can look at an unfortunate death such as that of Brida da Costa’s and sadly, with great confidence and self-righteousness, say that this poor young woman would be alive today if doctors only accepted his “wisdom” as scientific and medical truth.

Truly, I fear Young’s next effort that reaches my attention will turn my brain into one of his acid liquid viral tumors.