The letter that Apple's iconic executive, Steve Jobs, released Monday to quell concerns about his ailing health and increasingly frail frame which recently caused a dip in Apple stock had reporters across the country scrambling for answers. What condition could cause the "hormone imbalance that has been robbing [him] of the proteins [his] body needs to be healthy" and result in such dramatic weight loss? And in what scenario would that condition entail a "nutritional problem" whose cure is "relatively simple and straightforward"?
As their phones began lighting up Dr. Robert Lustig, an endocrinologist at the University of California at San Francisco, said he had fielded a dozen calls by midafternoon medical experts nationwide postulated myriad reasons for Jobs' withered appearance: a thyroid problem, a deficiency of human growth hormone or perhaps the lasting effects of Whipple surgery (which involves removing portions of the stomach, pancreas, bile duct and small intestine, and can inhibit digestion), which is a common treatment for pancreatic cancer. The last theory seems to be the leading one at this point (Jobs had surgery to remove a pancreatic tumor in 2004, but he did not say what kind of surgery); even years after a Whipple procedure, it's possible that damage to the intestines could limit absorption of nutrients, a deficiency that can be remedied with a change in diet and enzyme treatments. (See the top 10 medical breakthroughs of 2008.)
While many of these explanations are possible, no diagnosis neatly accounts for the scarce information provided in the letter. "[It] doesn't make a lot of sense," says Lustig. "There are three medical threads that run through this e-mail, but unfortunately those threads don't make a very strong cable." No illness involving a combination of a hormone imbalance and a loss of proteins that causes dramatic weight loss could be remedied with a simple nutritional fix, Lustig says.
Dr. Walter Willett, chair of the department of nutrition at the Harvard School of Public Health, agrees. "They don't fit together for me," he says, while adding, "Nothing is that simple." The two most common hormone imbalances that would result in weight loss, according to Willett, are hyperthyroidism, in which an overactive gland ramps up metabolism, and type 1 diabetes. But while nutrition may certainly play a role in diabetes treatment, it has little to do with curing hyperthyroidism, Willett says.
A hormonal imbalance would indeed suggest an endocrine problem, like diabetes, says Lustig, but many of the conditions that cause the body to lose vital proteins are not endocrine in nature. If a patient were losing the proteins through urine, diabetes could be an explanation, but so could other conditions, including multiple myeloma, a cancer that causes symptoms ranging from bone pain to weight loss.
Pancreatic cancer could also cause protein loss during the digestive process, Lustig says, which would suggest a recurrence of the malignant tumor that Jobs battled 2004. It is unlikely, however, that Jobs' original cancer has spread, Lustig says. Since pancreatic cancer is so swift and deadly, "We have to assume he was cured of that," Lustig says. "If he weren't, he would have been dead years ago." But having developed one endocrine tumor increases the patient's risk for developing a second.
Another explanation for a protein deficiency is that the body is simply not producing enough of them a symptom of conditions including hypothyroidism, in which the body underproduces necessary hormones, or Cushing's syndrome, Lustig says. But both conditions cause weight gain, not loss. Another possible cause is celiac disease, in which a gluten intolerance diminishes the body's ability to absorb nutrients, but that's a digestive order, not the result of a hormone imbalance, Lustig says. What's more, almost none of the hypothesized disorders involving hormone imbalance and protein deficiency can be treated with a basic change in nutrition. "There is no one disease process that encompasses these three medical threads," says Lustig.
Whether or not the cryptic information in Jobs' letter buoys Apple stock, one thing's certain: it's sparked a new conversation about how much the public deserves to know about the health of CEOs who are semi-public officials, perhaps particularly in the midst of an economic crisis. It's one thing to probe the medical records of presidential candidates and other public officials, but "at some point we need to respect people's confidentiality," Willett says.
"This is a puzzle," Lustig says. "And I'm sure Mr. Jobs meant it to be."