Holding sucrose and protein constant, I documented a reaction to starch, though he can certainly tolerate more starch than sucrose. Let's review.
Three macro molecules, each requiring a separate enzyme in the small intestine, evoke reactions in large quantities, while fruits and vegetables, consisting primarily of simple sugars, are virtually free. I was going to title this section "Enzyme Underperformance", but Occam wouldn't allow it. It would be quite rare for one enzyme to mutate in such a way that it sort of works (else the patient would be dead), yet it doesn't work well. Assuming this happens 3 times over, for sucrase protease and amylase, is simply unbelievable. The unifying theme has to be an underproduction of all enzymes across the board. The feedback mechanism, food → enzymes, is week, or limited in its capacity. In other words, enzymes are quickly overwhelmed by large meals, and the excess food is not digested. Starch may be better tolerated because its breakdown begins in the mouth, with amylase in the saliva. In other words, starch has a head start.
"So what?" you might ask. "So you poop out some extra sugar or protein. What's the harm in that?"
This isn't a problem by itself, but nature hates waste. Spread some sugar across your kitchen floor and watch what happens. Nothing, for a while, but leave it there for days, or weeks, and ants will appear, even in the dead of winter. When you finally recognize the connection, and clean up the floor, the ants keep coming, looking for more food. You might even begin to doubt the sugar → ants connection, but stay the course; the ants will eventually give up and go home.
The ants above are a (possibly weak) analogy for bacteria. John might have had excess nutrients in his colon for years, but eventually, perhaps by age 3, an opportunistic microbe found its way into his alimentary canal, survived the acid bath in the stomach, and took up residence in the nutrient rich intestines. But wait - numerous lab tests have never found this putative invader. Switch to explanation B. One of the <400 indigenous species> of gut bacteria evolved to take up the slack. The resulting bacteria looks normal, and is casually dismissed by the lab tech, but if you could read its genes you would know it was an enemy of the state. Bacteria evolve quickly, and it wouldn't take long for one or more species to "learn" how to metabolize all those underutilized nutrients. (If you don't believe in evolution, you need to find a new religion, or go back to school, or move out of Kansas.) These bacteria break down nutrients in the absence of oxygen, and the resulting partial metabolites derail John's brain. Sucrose leads to butyric acid (which I can smell from across the room), and many other compounds that cross the blood brain barrier. Protein also breaks down into novel nitrogenous compounds that drive him insane. These are less volatile, thus harder to smell, but they are there nonetheless.
Ok, does this theory make evolutionary sense? Sure. Our ancestors were rarely sated. They didn't have the luxury of a large meal - not every day. Once in a while a tribe would bring down a large animal, a veritable feast, but this didn't happen very often. Sugar was on the kitchen floor for a while, but it was soon washed away, before the microbes had a chance to evolve. John's biochemical disorder would have gone unnoticed. On a western diet, his genetic predisposition explodes into a condition that is truly maladaptive. Thus there was no selective pressure against his particular mutation(s), until now. In summary, any diagnosis has to satisfy both Occam and Darwin simultaneously, and this one does.
Let's go back in time a few thousand years, to the heart of China. An elderly man gives us some free advice. "There is magic in tea leaves. Tea will ward off evil spirits, and keep you well. Drink tea with every meal." Well you and I know there are no magical spirits in the leaves of plants. Once again I laugh, drink the water, and die in a few months. The magic is in the boiling of the water, not the tea, but the Chinese didn't know that, so they had to make up a compelling story that will encourage the next generation to drink tea. In the same way, Jewish attention to hygiene (while others were content to live in filth) was a divine proclamation, rather than sound medical advice. There was no other way.
Returning to Mr. Tent, I wonder, how did he know? Here is someone who has no medical degree, and no understanding of human physiology, yet he was closer to the mark than any of the physicians we have seen, including the leading experts in metabolic and digestive disorders. No wonder people flock to alternative medicine! But again, how can this be? Here is my theory.
The patients who see Mr. Tent all have a class of maladies that are real (no matter what their doctors say), and are not understood by modern medicine. These people file through his office every day for 30 years. And Mr. Tent is no ordinary man. He has a keen intellect with a flare for pattern recognition. In addition, he may have more input than the rest of us. Perhaps he, and/or his assistant, has an unusually keen sense of smell. I had an officemate like that once at Bell Labs. He said he could walk down the hall and tell which of our female coworkers was on period. "There are two kinds of period smells," he explained, "depending on the person. One is ok; the other I don't like. You can't hide it or mask it, it's always there." I just shook my head and made a mental note to take a shower every morning without fail. Anyways, I think Mr. Tent has learned, over many years, that the kids who look like John, act like John, and (perhaps) smell like John, sometimes benefit from these types of supplements. He has seen the pattern. When asked why, by anxious parents, he has to say something. So he has developed his worm theory, which makes no sense at all. Well - shame on me for throwing the baby out with the bath water. Might enzyme supplements help? I don't know. I'll give it a whirl in 2006. Meantime, we will continue to restrict sucrose, lactose, maltose, starch, protein, oils, and anything else that challenges the digestive system. I tip my hat to you, Mr. Tent. You have no idea what you're talking about, yet you are sometimes right, as desperate patients across Southeast Michigan will attest.