I am not convinced that HITH is caused by ANY of the common beliefs. My FH has HITH and he is in a 55 with an M. Callainos and a Jewel cichlid so no stress. WC's and gravel vacs AT LEAST once a week. I have determined mine was caused by the fact that he will eat nothing other than bloodworms. Poor water quality and neglect is used as an excuse when the TRUE reason behind something is not known IMO.