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In January 2016, NBC News medical contributor Natalie Azar reported a segment for the Today show that highlighted six medical screenings that can purportedly be done at home. One of these screenings, the bad breath test, served as the original basis for a series of largely erroneous (but viral) health posts on dubious websites. We will collectively refer the claims made based on this information as the spoon test. The Breath Part of the Spoon Test The original test, as described by Azar, relies on factual science, which suggests that odors in one's breath can be indicative of systemic health issues: The use of a spoon to test breath odor has long been used as a way to get a rough sense of a person’s own breath, which is normally not readily perceptible to the person creating the odor. The method, as an example, is described in a 1996 review paper in the Journal of the American Dental Association: Placing the spoon under the light presumably serves to increase the odor causing potential of the material sampled by the spoon. The notion that some odors can be indicative of conditions outside of dental hygiene, as well, is not controversial. The Today Show writeup of the test links to an entry on the NIH’s Medline website that describes various causes of bad breath, including the items referenced in the test: These facts (while not controversial) do not mean that such observations would have any diagnostic or screening value, because the conditions they describe would be so far progressed by the point that they would show up on your breath that you would already be well aware of serious health problems, or they would be caused by highly noticeable things like excessive vomiting or a tube in your throat. Joseph Wolfsdorf, a professor of pediatrics at Harvard Medical School and Director of the Diabetes Program at Boston Children’s Hospital, told us that diabetic ketoacidosis would produce a fruity odor, but that this would be a sign of severe and pronounced illness that should already have produced more noticeable symptoms: The case is the same for that fishy odor on the breath — there is a connection between kidney failure and ammonia-breath, but this would be an extremely late manifestation of an already obvious and serious condition. We reached out to Azar multiple times through multiple channels to get more information on the scientific rationale behind her test, but have not yet received a response. The Stain Portion of the Spoon Test Perhaps as a result of the lackluster utility of the test as originally described, a variety of dubious websites like davidwolfe.com and Brightside.me added additional diagnostic features to the test inspired, it appears, by the largely unverified claims made by traditional Chinese medical practitioners. This mishmash of information has resulted in a viral but wholly useless video that includes a section on how to analyze the colors left on the spoon after the bad breath test. David Avocado Wolfe — one of the Internet’s worst offenders when it comes the mass production of incorrect medical information and illogical aphorisms -- added these details to the test, which also appeared in the Brightside.me video: First, it should be noted that these claims (accuracy aside) all refer to a discoloration on the tongue itself, and none of the material used by Wolfe to defend the claims actually discuss a spoon or a light. In support of the claim regarding a yellow discoloration, Wolfe linked to a page on holisticprimarycare.net offering the unsourced claim that in a low thyroid state, conversion stagnates and beta carotene builds up, causing a yellow tint in palmar and plantar surfaces. While medical literature does support the notion that a buildup of carotene caused by hypothyroidism may result in a yellowish discoloration on the palms of the hands (palmar surfaces) or feet (plantar surfaces), it is unclear why this information has been re-interpreted as applicable to the tongue, especially when a yellow tongue discoloration is a common (and usually benign) symptom related to a variety of non-thyroid issues. Such a discoloration could also occur, Wolfe claimed three bullet points down with a similar lack of evidence, as a result of kidney diseases through the same dubious carotenoid buildup mechanism. In other words, a yellow tongue on its own, even by the incorrect logic presented in Wolfe’s post, tells you next to nothing. In support of the claim that purple stains could be indicative of poor blood circulation or high cholesterol levels, Wolfe linked to a post by the Daily Mail which provided the commentary of naturopaths and traditional Chinese herbalists (again, with no supporting evidence or links) about what various colors on the tongue might mean. There is no hard evidence to support a purple tongue (let alone a purple stain on a spoon caused by a purple tongue) as being indicative of poor blood circulation or high cholesterol levels. Chronic bronchitis, similar to claims made of breath odor, would be readily apparent to the sufferer without the use of a tongue test. If the spoon produces white stains, Wolfe says, you may be suffering from a respiratory infection. (We feel that we should point out here that bronchitis is also a respiratory infection, which Wolfe claims should produce a purple stain in his preceding bullet point.) Wolfe also suggested in his first bullet point that white stains could also be thyroid gland dysfunction. In fact, a white tongue can be caused by a large number of conditions (and also no condition whatsoever), including over sixty respiratory issues that would already be apparent to the screener, making it effectively useless outside of its dubious scientific rationalization. All told, claims made relating the breath portion of the spoon test are generally rooted in factual connections between mouth odor and internal health, but are effectively useless as a screening or diagnostic tool. Claims made of the stain portion of the spoon test are created by conflating unproven or confused claims borrowed from traditional Chinese medical practices or from misinterpreted and sparsely sourced websites to create an equally useless screening test. Thus, we rank claims made of the spoon test as mostly false.
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