Ep. 49 | Hunger Games
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One winter afternoon in early 2015, a doctor at a psychiatric hospital in Boston, Massachusetts was sitting in his office when he heard a knock at the door. Moments later, the door opened and a skinny, very nervous-looking woman walked in. The doctor gestured for the woman to sit down and then waited a moment before asking in a gentle voice how she was doing today. But the woman didn't seem to hear him. Her eyes darted around the room, not focusing on anything.

But finally, she did look at him and when she did, she told the doctor that her problem was a game. The doctor cocked his head to the side, confused, and asked her to explain further. The woman said it was a secret game, but everyone was playing it. Her parents, her classmates, even strangers around town. They thought they could hide it from her, but she knew what they were doing. The doctor nodded. He wanted to make the woman feel at ease, so he told her she'd come to the right place and he promised he would help her.

But the woman didn't react and instead started chattering about something else entirely. Then once she snapped back to reality, she told the doctor that she was fine for now because she had just discovered a way to temporarily stop the game. Then the woman kind of leaned toward the doctor's desk like she was about to share a secret and told him the only thing that stopped the game was not eating, like at all. She said she had barely eaten in two weeks. The doctor sat back in his chair and exhaled slowly.

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From Ballin Studios in Wondery, I'm Mr. Ballin, and this is Mr. Ballin's Medical Mysteries, where every week we will explore a new baffling mystery originating from the one place we all can't escape, our own bodies. So if you like today's story, please crawl inside of the Follow Button's bed and feast on several crunchy granola bars, and then without cleaning up, just remake the bed. This episode is called Hunger Games.

On a late August morning in 2014, a 37-year-old graduate student named Zara Valentine stepped into a university building in Boston, Massachusetts. It was the first day of classes and there was a big welcome event for all the new students. Zara was anxious but also excited. After working for years in human resources, she decided to finally return to school and complete her PhD.

Zara wove her way through the crowd to the sign-in table. She grabbed a name tag, then went into the main hall, where her new classmates were clustered around tables, meeting one another and enjoying some refreshments. But as Zara looked around the room, she couldn't help but notice that she was one of the oldest people in the graduate program. She'd always been a good student, but she'd attended college a long time ago. And so Zara suddenly worried she may not fit in with her much younger-seeming classmates.

Zahra took a deep breath and steadied herself. She knew it didn't do any good to get rattled on the very first day, but just then her stomach rumbled. She had been so focused on the new student orientation this morning that she had forgotten to eat. Zahra made her way to the buffet table, took a plate, and loaded it with some snacks just as the dean of students walked on stage. Zahra listened to a speech about the noble journey of higher education as she snacked furiously on mini sandwiches. Zahra waited until the dean ended his talk before going back for seconds.

One morning, a few months later, Zara sat inside of a lecture hall typing notes into her laptop as her professor went over the latest assignment. All of her classes so far had been inspiring, but also mentally exhausting. Her program covered a lot of ground quickly, and she was determined to keep up. As Zara's fingers flew across her keyboard, her mind was suddenly distracted from her professor's voice by the sound of people whispering. Zara stopped and glanced around her to see who was doing it.

but the students in the row behind her had their heads down taking notes too. Zara turned her attention back to the front, but minutes later, the whispering behind her started again. This time, she spun around much more quickly to catch the gossipers in the act, but it was the same students as before still just totally absorbed in taking notes. They barely even noticed Zara.

Zara stared at them, watching their eyes and hands as they typed. She wasn't sure, but something about their behavior made her feel like her classmates were just pretending to take notes, that they had been whispering and this was all just a ruse. Zara did turn back around to her laptop and did her best to try to reconnect with the lecturer, but now she couldn't focus. She was far too anxious to pay attention. Later that week, Zara was walking back to her apartment near midnight after a long study session at the library.

On the corner of her street, she approached a neighborhood market. Despite the late hour, a couple of people were browsing the bins of fruit out front while a few others were inside buying groceries. Anna Clark stood behind the counter listening to the radio looking bored. Zara knew she didn't have much to eat back at her apartment, so she went inside. Zara walked along the aisles looking at pastas and breads and condiments when a strange urge suddenly gripped her.

She took a box of crackers off the shelf, pretending to read the back of it, and then slipped it into her backpack. She glanced at the clerk, but he seemed to be totally oblivious, still just listening to his radio. An electric thrill suddenly flickered through Zara's body as she realized she had just gotten away with shoplifting.

She tried to play it cool, but she didn't want this feeling to stop. So Zara drifted over to a different aisle and slipped a fancy mustard into her pack too. And after that, some expensive chocolate. She almost laughed at how easy this was. Her brain was buzzing. By now, Zara's bag was feeling heavy with all her stolen items. So she made her way towards the entrance like she had looked around but couldn't find what she wanted. And then as nonchalantly as she could, she walked back out the door onto the street.

And then once outside, she strolled casually down the block. And then when she was out of sight, she gradually sped up until she was full on running. Nobody came after her though. And so Zara was consumed by this feeling of total euphoria. She had never done anything like this before.

Back at her apartment, Zara spread out her haul on the kitchen counter and seeing it all there was kind of surreal. It was amazing but also at the same time she was starting to feel kind of disturbed like she couldn't believe she had done this. And then Zara's euphoric high kind of came crashing down and she suddenly wondered if she should just take all this stuff back and apologize.

But she didn't, and so she just kind of sat there with her feelings, wondering what had come over her. She had never stolen anything before, but it was like tonight some other personality had taken her over. A few weeks later, just before the school went on holiday break, Zara was back in class taking notes during another long lecture. Her mind raced as she did her best to keep up. Just then, she heard a familiar murmuring behind her. Zara tried to ignore it and stay focused on the professor's words, but the voices behind her got louder.

Zara whipped around to scold whoever was being so rude, but when she did, everyone near her had their heads down typing or writing. Nobody was making any noise. But the situation made Zara's blood boil. Here she was doing her best while other students who clearly didn't care were disrupting the whole experience for everybody else and then pretending they weren't as soon as she looked at them.

So Zahra decided she was going to stop this behavior today. Enough was enough. The last time her classmates had interrupted, Zahra had let it slide, but no more. Just because she didn't catch them in the act didn't mean they weren't whispering. She knew what she had heard. And not only that, she was positive they were whispering about her. Whatever they were saying, Zahra felt like she deserved to know.

And so with a loud scraping sound, Zahra in the middle of class abruptly stood up from her chair. The professor heard the noise and stopped talking and looked right up at her. And soon the entire lecture hall was turned towards Zahra. Zahra stared back, scanning the eyes of all the students and the professor, trying to figure out who had been whispering this whole time. Their blank gazes irritated her. They all looked guilty, but Zahra refused to be intimidated.

She told the whole class in a loud, angry voice that she knew what they were up to. They could keep trying to hide it, but she knew they were playing a game and she was sick of it. Zara almost pitied her classmates. How trapped they were in their characters, reciting staged dialogue and acting out their assigned roles. It was all so blatant. She couldn't stand another second of it. Zara snapped her laptop shut, scooped it into her backpack and stormed out of the classroom.

The winter streets of Boston were cold and gray as Zara hurried back towards her apartment. She was eager to get home and away from all these people she couldn't trust. But as she ran down the hallway of her apartment building and approached her unit, she froze. Her front door was already wide open.

Moving slowly in case there was an intruder, Zahra tiptoed to the doorway and peeked inside. Furniture was knocked over, books and clothes were scattered everywhere. The place had been ransacked. Suddenly it hit her. Zahra felt like a fool. Of course she'd been robbed, by her own parents. She'd given them her spare key, and they must have come while she was at class. Zahra knew they were in on the same game as all of her classmates and even her professor.

Zara couldn't tell what her parents had stolen, but she was not about to let them get away with this. First, Zara deadlocked her door, and then she began surveying her apartment. She had a feeling that her parents had not only robbed her, but had also contaminated the place with some sort of poison. She rummaged through drawers and cabinets looking everywhere when her eyes suddenly landed on the refrigerator. Zara went into the kitchen and slowly opened the fridge door. Her groceries were still there where she had left them, but she knew something was off.

Zara leaned in and smelled. Then she jumped back and slammed the fridge shut in disgust. She'd have to throw away all her food because everything inside of it had clearly been poisoned. Zara then picked up her phone to call her mother, Antoinette. And after a few rings, her mother answered. And Zara told her mother that if she or her dad ever came anywhere near her apartment again, Zara would hurt them. If they wanted this to get ugly, Zara wouldn't be the one to back down.

Then she warned her mother to never call her again. And then Zara hung up. One month later, on a drizzly winter morning in February, a psychiatrist named Dr. Jonathan Lean prepared to meet with Zara at a Massachusetts psychiatric hospital for the second time. Their first meeting had been one month earlier when Zara had arrived at the hospital accompanied by her very shocked parents and some social workers.

By the end of that very first visit, Dr. Lean had helped Zahra realize that the world was not out to get her. Instead, she was clearly having some sort of mental trouble and really needed professional help. And so Zahra had actually agreed to check herself into that hospital for a full month of inpatient psychiatric care. Dr. Lean diagnosed Zahra as suffering from a psychotic disorder, which is a serious mental condition that causes a person to have trouble staying in touch with reality.

He put her on a regimen of antipsychotic and anti-anxiety medication and ordered extensive blood tests. The blood test results revealed that Zara was not getting enough of several key nutrients. She was also anemic, which is when someone doesn't have enough healthy red blood cells to carry oxygen to the body's tissues. Anemia alone can make a person's behavior erratic, although very rarely to the degree that Zara had shown.

Nevertheless, after that first meeting, Dr. Lean had prescribed Zara a variety of vitamin supplements to combat her anemia, along with the other drugs to help with her mental disorder. And so now, after a full month of care was finally done, Dr. Lean was eager to see how Zara was doing. Tomorrow was her final day of inpatient treatment, and Dr. Lean was hoping that his prescriptions had helped her get back to her usual self. Right on time, there was a knock at the door, and then Zara entered and took a seat.

Dr. Lean's heart sank when he saw her. Zara looked as frail as when she'd arrived. Her skin was pasty and pale, and her hair looked thin and scraggly. Dr. Lean asked Zara how she was feeling, but she just shrugged. She promised she'd been taking all of the vitamins and all the medications that he'd prescribed her, but Dr. Lean wondered if she was actually telling the truth. It didn't make sense to him that the meds wouldn't have any effect. Dr. Lean was very disappointed,

But he had worked in psychiatry long enough to know how incredibly complex mental health really is. Patients respond to treatments at very different rates, and it might just take a bit longer for Zahra to feel the effects of all of these medications. And so, Dr. Lean congratulated Zahra on sticking with her treatment for the full month as promised, but told her that the next day her parents would be coming to take her home. He said he hoped that Zahra would keep taking her medications until she fully recovered. Zahra nodded blankly and stood to leave.

As she did, Dr. Lean reminded Zara that she was always free to call him if she ever needed help, but Zara was already out the door and did not appear to be listening to him. The next day, Zara's mom, Antoinette, held her husband Robert's hand as they walked across the parking lot and into the lobby of the hospital where Zara had been staying. A receptionist at the counter told them that their daughter would be down soon. A few minutes later, Antoinette heard footsteps echoing down the hallway. She turned to see a nurse pushing Zara out in a wheelchair.

Zara looked gaunt and exhausted. Antoinette rushed to give her daughter a hug, and when she did, her daughter's body felt like a bag of bones. Antoinette tried to be grateful that at least her daughter seemed calm rather than hostile like before. She hoped this was maybe the first sign of improvement. Maybe her old self would return once she was settled back at home. Robert grabbed Zara's bag while Antoinette led Zara out of the building towards their car.

But the drive home was very strained. Antoinette at one point tried to make conversation by asking Zara how the food was at the hospital, but Zara just shrugged. She said she hadn't really eaten much while she was there. Antoinette shot a worried look at her husband behind the wheel. And then a moment later, Zara told her parents that the doctors had all been gossiping about her and the only way to stop the game was to stop eating. So she basically threw away most of her meals.

Most days, Zara said she limited herself to a slice or two of bread and some water. Antoinette felt crushed. Zara's delusions had obviously not changed at all. She didn't know what to do or even where to turn for help. Mr. Ball and Collection is sponsored by BetterHelp.

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Eight months later, a primary care physician named Dr. Maggie Portis was studying Zara's file a few minutes before Zara was set to arrive for her appointment. Zara's story really intrigued Dr. Portis. Zara did not drink alcohol, she had never suffered a head injury, and she had no family history of mental health issues. And yet, she'd spent a month at a psychiatric hospital for delusional behavior without showing any signs of getting better. According to her family, her delusions were still as strong as ever.

Since being released from the hospital, Zara had gone to a number of doctors who determined that she had a vitamin deficiency as well as a thyroid issue. Zara was given supplements to boost her iron and vitamin B, and her thyroid issue was treated successfully. But none of those treatments had any effect on her mental health. She was still totally delusional. While Dr. Portis was lost in thought, a nurse notified her that Zara and her mother were waiting for her in an examination room.

Dr. Portis headed down the hall, eager to meet her new patient, but the moment she entered that exam room, she was struck by how hollowed out and desperate Zara looked. Dr. Portis introduced herself, then had Zara undress and step on the scale. Zara weighed only 99 pounds despite being 5'6" tall.

Dr. Portis then had Zara sit on the examination table while a nurse came and tied Zara's arm with a tourniquet, swabbed an area with an alcohol pad, and filled a syringe with her blood. Zara seemed to barely notice any of this. After the nurse left the room, Zara complained to Dr. Portis that she had been taking all of her prescribed vitamins and medications but did not feel any better. Dr. Portis nodded. As Zara talked, the doctor suddenly had a hunch about why Zara was not getting any better.

If her hunch was right, then of course Zara's meds wouldn't have had an effect and her delusions would continue. Choosing her words very carefully, Dr. Portis told Zara that she thought she knew what might be causing her mental problems, but she wouldn't be able to tell for sure unless Zara had a procedure done. Zara's eyes lit up at the idea and she immediately agreed to do whatever it took to make a change. She said she just wanted her old life back.

Dr. Portis felt deep empathy for Zara. It was clear that she was afflicted by something that she really had no control over. Dr. Portis wrote down a name and a phone number on a notepad and handed it to Zara. She explained that it was contact information for a doctor who could perform a biopsy, which is a surgical procedure where tissue is removed from the body and then examined under a microscope. She promised Zara the procedure would be quick and painless, and it might bring her closer to solving her health issues.

Zara clutched the piece of paper with both hands and thanked Dr. Portis. Then she sighed and leaned her head on her mother's shoulder and went limp with exhaustion. Dr. Portis wished Zara luck and then left them to have a moment alone.

Two weeks later, on a cloudless morning, a gastroenterologist, which is a doctor who specializes in diagnosing and treating diseases and conditions that affect the digestive system, named Dr. Simon Reed, shook his head in amazement as he surveyed the biopsy results of a patient's small intestine. In all his years in medicine, he had never seen a case quite like this one. A few minutes later, there was a knock at the door and Zara entered. She looked thin and very nervous.

Dr. Reed thanked her for coming in and told her to take a seat and then he asked her how she'd been doing. Zara looked away from the doctor and out the window and then down at her hands. She told the doctor she felt like her real life was behind her now. She used to feel like she was just entering a promising new chapter, being back at school to finish her PhD, enjoying her own apartment in the city and thriving in her studies.

But then everything just kind of went off the rails. She started doing these weird impulsive things without understanding why. It became hard to tell what was real and what wasn't. She couldn't trust anyone anymore either, like her parents, she couldn't trust them, she couldn't even trust herself. Dr. Reed was moved by Zara's story. He could tell that she was desperate for help but didn't know where to turn. Which was why he was so happy to be able to be the bearer of good news.

He told Zahra that her primary care physician, Dr. Portis, had been smart to tell her to go get a biopsy because it led to the breakthrough Zahra had been looking for. The tissue sample they had taken during the biopsy showed that all of Zahra's physiological and mental symptoms were being caused by the same condition, and best of all, it was treatable. Zahra would only have to make one life change: altering her diet.

At the word "diet," Zara's body froze. She narrowed her eyes and squinted at Dr. Reed like she was trying to read his mind. He recognized it as the paranoid behavior detailed in Zara's file. She suffered from the delusion that basically everyone was lying and no one could be trusted. But Dr. Reed promised Zara that he really was telling the truth, that this was the only way for her to get better. If she changed her diet, the delusions she was experiencing would go away.

If she didn't change her diet, her delusions would only get worse. But the look on Zara's face told the doctor that she was not buying any of this. She scowled at Dr. Reed and shook her head in disgust. Then she got to her feet and moved to leave, but then stopped by the door and turned back around. She pointed a finger at Dr. Reed and accused him of being part of the game like everybody else. Another traitor and liar trying to trick her with food. She told him that she wasn't going to fall for it and then slammed the door and stormed out.

Dr. Reed just sat there motionless, unsure what to even do. He was completely stunned by what had just happened. Several months later, on an overcast spring morning, Antoinette Valentine huddled in the front seat of the family car next to her husband, Robert. She felt a sense of dread hanging over them.

Antoinette looked out the window at the familiar silhouette of the state psychiatric hospital, a sight she had seen too many times lately. But she hoped today would be the last. Her daughter Zara was finally being released following a court-ordered three-month confinement. After storming out of Dr. Reed's office six months earlier, Zara's life had totally unraveled.

She stopped picking up phone calls or checking in with anybody. She failed to fill out the forms necessary to continue her PhD program. She quit paying rent on her apartment and soon got evicted. Before long, she was wandering the streets. Antoinette had not heard from her daughter in months until she had showed up at the family home, banging on the door in the middle of the night, acting completely erratic and strange. Antoinette tried to calm Zara down, but there was no reasoning with her.

Robert had no choice but to call the police, who handcuffed Zara and took her away. Later, after Zara made more threats against them, Antoinette and Robert filed a restraining order against their daughter. Weeks after that, the phone rang in the middle of the night, and Antoinette immediately had a bad feeling. It was a nurse from a local emergency room with news that Zara had attempted suicide. She had been found alone and unresponsive, but fortunately, medics had been able to revive her.

Since Zara's mental state was extremely fragile, she was being transferred back to the state psychiatric hospital. And so that was three months ago. But today, finally, Zara was being sent home. Antoinette took a deep breath, braced herself, and held her husband's hand as they walked into the lobby of the hospital. The receptionist told them that their daughter would be out soon. Antoinette could not stop pacing around the lobby as they waited. The last time she'd seen her daughter, Zara had been violent and disturbing.

Antoinette worried that when she saw her daughter again, she would still be emaciated, or that she'd scream and throw a fit and refuse to go home. Antoinette's memory of their last encounter was still a fresh wound in her mind. But just then, there was the sound of footsteps, and Antoinette spun around. It was Zara, and she seemed like her old self, the one Antoinette remembered before all this started. Zara was clear-eyed and smiling sweetly like she really was seeing her parents for the first time in a long time. Antoinette couldn't believe it.

She rushed to her daughter and wrapped her arms around her, and this time it felt like there was actually something there to hug. Zara was a healthy, normal weight again. Zara even hugged her mother back. Antoinette stepped back and looked her daughter up and down. She was speechless. Zara had this beautiful outfit on, and her skin had a healthy glow to it. Antoinette couldn't believe such a huge mental and physical transformation was possible in just a few months.

What was even more amazing was that Zara's transformation was the result of something so simple. For the past three months, Zara had been eating only particular foods prepared by the hospital, following the recommendations made by Dr. Reed six months earlier, the one who suggested Zara change her diet. And now Antoinette saw proof that Dr. Reed had been right all along, just by looking at her healthy daughter smiling right in front of her.

Zara's incredible improvement was entirely due to the fact that she stopped eating foods that contained gluten, a protein commonly found in foods like bread, pasta, pizza, and cereal. Dr. Reed had discovered that Zara suffered from celiac disease, which caused her body to have a severe reaction to any foods containing gluten. Though many people are diagnosed with celiac, often as adults, Zara's condition was the worst doctors had ever seen.

Zara's immune system attacked the gluten that she ate so fiercely that it damaged her small intestine. Over time, her intestine became too inflamed to absorb vitamins or iron, no matter how many supplements she took. That's why she was so anemic and thin. But even worse, gluten triggered inflammation in Zara that didn't just affect her intestine, but also her brain too. In Zara's case, inflammation caused her brain to misfire, resulting in delusions and psychosis.

She starved herself intentionally and became wildly suspicious of the people around her while starting to commit crimes herself. Not because she wanted to, but because it was like her brain was malfunctioning. But once Zara started a gluten-free diet, her inflammation subsided and the delusions were gone. Antoinette and Robert were ecstatic to have their sweet daughter back. The drive home from the hospital that day was one of the happiest in their family's history.

Zara was affectionate to her parents and seemed very grateful to be thinking normally again. Zara understood now that gluten really was to blame for her life spiraling out of control, and so now all she wanted to do was make up for more than one year of lost time with her parents. Unfortunately though, their joy as a family was very short-lived. A few months after Zara came home, Zara accidentally ate some food that contained gluten. Her delusions returned, but this time far more intensely.

Once again, Zahra became convinced that her parents were plotting against her, and this time she wanted to do something about it. Driven by her paranoid hallucinations, Zahra went to her parents' house and tried to kill them. Thankfully, police arrived before anybody got hurt, but Zahra was sent to jail. Unfortunately, we have no information on what happened to Zahra after that, but her and her family's life has been forever damaged.

all because of a little protein found in a slice of bread or a plate of pasta.

From Ballin Studios and Wondery, this is Mr. Ballin's Medical Mysteries, hosted by me, Mr. Ballin. A quick note about our stories: we use aliases sometimes because we don't know the names of the real people in the story. And also, in most cases, we can't know exactly what was said, but everything is based on a lot of research. And a reminder: the content in this episode is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

This episode was written by Britt Brown. Our editor is Heather Dundas. Sound design is by Ryan Patesta. Our managing producer is Sophia Martins, and our coordinating producer is Taylor Sniffen. Our senior producer is Alex Benidon. Our associate producers and researchers are Sarah Vytak and Tasia Palaconda. Fact checking was done by Sheila Patterson. For Ballin Studios, our head of production is Zach Levitt. Script editing is by Scott Allen and Evan Allen. Our coordinating producer is Matub Zare.

Executive producers are myself, Mr. Ballin, and Nick Witters. For Wondery, our head of sound is Marcelino Villapondo. Senior producers are Laura Donna Palavoda and Dave Schilling. Senior managing producer is Ryan Lohr. Our executive producers are Aaron O'Flaherty and Marshall Louis for Wondery. Wondery.

The missiles are coming.

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