Anti-Inflammatory Diet

All health care starts with diet. My recommendations for a healthy diet are here:
Anti-Inflammatory Diet and Lifestyle.
There are over 190 articles on diet, inflammation and disease on this blog
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more articles by Prof. Ayers on Suite101 .

Thursday, April 1, 2010

Helminths, Oligosaccharides and Immunotolerance


Parasitic worms reverse allergies and autoimmune diseases using oligosaccharides to mimic self and silence immune over-responsiveness.

Helminth therapy, i.e. infection with parasitic intestinal worms to provide remission from allergies, inflammatory bowel and other autoimmune diseases, has been examined as a potential therapeutic model to rehabilitate immunological dysfunction.  The surface oligosaccharides of these worms have been found to mimic human oligosaccharides and alter immune responses by binding to carbohydrate-binding, i.e. lectin, receptors.

Immune Tolerance
The essence of allergic and autoimmune diseases is a defect in distinguishing between pathogen, innocuous and self molecules.  Heightened immune reactions as a result of inflammation move the immune system toward production of antibody and T cell receptors specific for antigens.  Those antigens respond to unique receptors on the surface of each B and T lymphocyte.  The lymphocyte population has been previously depleted of cells that can produce receptors that will bind to most self antigens.  This depletion makes the lymphocyte population generally non-responsive, or tolerant to self antigens.  Thus, the immune system is blind to the body.

Regulatory T Cells and Tolerance
Most of the immune cells of the body are present in the lining of the gut.  It is in the gut that various immune cells continue to develop for their various roles, including controlling immune reactions to self antigens and to common food molecules.  Immune cells in the gut are exposed to some food molecules and bacteria that leak through the cells of the intestinal villi.  Responding to these common antigens by inflammation can lead to inflammatory bowel disease.  This pathological over-responsiveness is normally avoided by development of regulatory T cells, Tregs, that suppress immune responses to common food molecules and to surface antigens of common bacteria.

Treg Development Depends on Gut Flora
Gut bacteria are needed for the normal function of the immune system.  Oddly, Helicobacter pylori, Hp, the cause of stomach ulcers and cancer, also stimulates the development of Tregs.  Thus, the pathology of Hp may result not from its presence, but rather from how it is growing.  Since Hp uses hydrogen gas produced by Klebsiella in the lower bowel and hydrogen production is dependent on dietary starch, then it follows that the pathological behavior of Hp may be dependent on dietary starch.  A low starch diet may actually result in Treg stimulation from Hp and a reduction in allergies and autoimmune diseases.

Tregs Enhanced by Heliminths
Immunological tolerance is also stimulated by parasitic worms, Helminths.  Helminth infestations, therefore, reduce allergies and autoimmune diseases and may contribute to the hygiene hypothesis to explain the prevalence of allergies, autoimmune and other inflammation-based degenerative diseases in modern societies.  Examination of worms to find the molecules responsible for inducing immunological tolerance has identified complex surface and secreted oligosaccharides (small sugar chains) as the active molecules.  Helminth oligosaccharides mimic human cell surface oligosaccharides and bind to carbohydrate-binding, lectin, receptors on immune cells to stimulate Treg development.

Lectin Receptors Control Tolerance
There are many implications of the modulation of the immune system via oligosaccharides.  Note that related oligosaccharides are components of human milk and prepare the gut and develop the immune system.  This explains why formula, which lacks these unique oligosaccharides, results in aberrant gut flora, contributes to neonatal necrotizing colitis and supports the development of allergies and autoimmune diseases.  In contrast, judicious use of self or Helminth oligosaccharides may provide a means of restoring the function of damaged immune systems and therapy for allergies and autoimmune diseases.  Also note that the critical use of lectins, which have oligosaccharide-binding sites rich in aromatic amino acids to bind the hydrophobic faces of the sugars, will also bind and provide entry into immune cells for allergens and autoantigens that have triplets of basic amino acids.  The binding sites of lectins should also bind many aromatic phytochemicals.  Immunomodulation by phytochemicals may result from interference with or mimicking the binding of oligosaccharides to lectin receptors.

reference:
van Die I, Cummings RD.  Glycans modulate immune responses in helminth infections and allergy.  Chem Immunol Allergy. 2006;90:91-112.

48 comments:

Jason said...

I've been reading your blog to help me find answers about my condition. I was diagnosed with raynauld's about 6 months ago and my blood showed Positive ANA(640) and Positive ENA to RNP and SSa/60 associated with Mixed connective tissue disease and sjorderns. I have no symptoms of disease apart from the raynauld's, but from my research it usually takes years after raynauld's to develop.

It's interesting that you mention H Pylori because 1 month before my raynauld's, I was tested for H Pylori and was found positive, I then eliminated the Pylori with antibiotics and a few weeks later developed my first symptoms of cold hands. The pylori may indeed was keeping my immune system in check.

I've been following the anti-inflammatory diet you suggest, and raised my vitamin D levels to 50 ng/l, would you recommend anything else that I can do to delay and prevent the onset of symptoms that are associated with my blood work?

Dr. Art Ayers said...

Jason,
You were presenting with some pretty scary autoimmune symptoms, so I would suspect the typical progression of diet-based chronic inflammation leading to suppression of immune tolerance with the development of allergy/autoimmunity.

My current thinking on reversing autoimmunity is by promoting gut flora health. Antibiotics are a typical prelude to gut dysbiosis, disruption of gut flora that leads to yeast overgrowth and constipation (lack of adequate bacteria in stools.) I assume that you have started probiotics, lots of live bacteria yogurt, and prebiotics, pectin-rich apples/tomatoes and inulin-rich leeks/onions. Normal stools should be a measure of a functional diet. I would recommend a low carb (no starch/sugar/HFCS or grains) high fat (saturated fat) diet. I would probably also increase my serum vitD to 90ng/ml and eat plenty of fatty fish. Don't count on flax oil or other short-chain omega-3 oils. It is important to eliminate vegetable oil (use butter, olive oil and coconut oil). I would probably supplement with more than four fish oil capsules per day. You could try increasing the fish oil until you were resistant to the funny fingers of Raynaud's. Make sure the vitD and fish oil are taken with a fatty meal.

Let me know how you progress. Thanks for your comments.

Denny Barnes said...

Dr. Ayers,

I live in China where infection with parasitic intestinal worms is not usually viewed as a good thing. Might we be able to achieve the same positive effects of Helminths therapy by supplementing with oligosaccharides? For example, fructooligosaccharides (FOS) and inulin are popular supplements and food additives. Your thoughts?

Dr. Art Ayers said...

Denny,
Helminths in the wild are pretty nasty compared to the domesticated versions used in human therapy. I wouldn't recommend human parasites and only discuss them here as models of manipulation of the immune system.

Oligosaccharides provide very specific targets for protein receptor recognition. They are not interchangeable. The FOS and soluble fiber polysaccharides that are derived from plant materials are useful for establishing beneficial biofilms, i.e. as prebiotics, but are not useful for signaling involved in immune system development. The Helminth oligosaccharides are made from different sugars with different linkages.

Healthy gut biofilms may provide the needed immunomodulating oligosaccharides, but there are at least 150 species (out of an estimated total of thousands) of gut bacteria contributing to the health of each individual. Millions of bacterial genes are involved and the full spectrum of bacterial oligosaccharides has not been estimated. The relevant immunomodulating oligosaccharides have not been identified.

It will be difficult to synthesize Helminth oligosaccharides, but I expect them to be eventually available as very expensive pharmaceuticals.

I would also expect some bacterial species to produce immunomodulating oligosaccharides as part of their cell walls. These would be very cheap and may already be used as part of traditional cuisine somewhere in the world. My cynical nature predicts that they will be either patented or attacked by the medical/pharmaceutical industry.

Health is very cheap and readily available, but it is not commercially as viable as illness.

Thanks for your comments.

Byron said...

Dear Dr. Ayers,
I would be eager to swallow some eggs from pig whipworms with which some experimental studies are already done here in Germany. But I can´t find any source yet.
Nearly 2 month ago I started supplementing with oligofructose. My persist diarrhea did not better but my asthma enhanced dramatically.
After some weeks I started vitamin K2 and my digestion is now nearly normal! Before this I already take D3, n-3 and probiotics (keto). Do you see some possible connections, oligofructose/asthma, k2/diarrhea or are those results just by accident?
Happy Easter.

steve said...

Doctor Ayers: you appear to recommend pectin for gut health. Does this mean that "an apple a day" is ok despite the high levels of fructose it contains? What are other sources of pectin and for that matter inulin(other than leeks or onions) Thanks.

Jason said...

Thank you for your advise. I will add more apples + leeks into my diet.

In regards to probiotics, do you recommend any particular strands or products that have better immune modulating properties? I've also come across some studies that some bacteria strands actually strengthen the immune system response, wouldn't this make an autoimmune condition worse?

dextery said...

I was reading Stephan's site and he mentions that Oligofructose is similar to inulin, a fiber that occurs naturally in a wide variety of plants. Good sources are jerusalem artichokes, jicama, artichokes, onions, leeks, burdock and chicory root.

http://wholehealthsource.blogspot.com/2010/01/body-fat-setpoint-part-iv-changing.html

I had some fresh raw jicama tonight with a little lemon juice and was delicious. I had forgotten how great this little known root vegetable is.

And from Wikipedia...Jícama is high in carbohydrates in the form of dietary fiber. It is composed of 86-90% water; it contains only trace amounts of protein and lipids. Its sweet flavor comes from the oligofructose inulin (also called fructo-oligosaccharide).

So now the questions is: Is it better to have fiberous jicama in the digestive system to ferment to maintain good gut flora....or is it injurious to consume fructose that spikes my sugar...inducing an insulin response that my brain doesn't register?

Dr. Art Ayers said...

Dextery,
There are many carbs that contain fructose. The problem with fructose is its metabolism in the liver and the production of advanced glycation end products. These problems result from the simple molecules of fructose after they are transported into the lining of the small intestines and are circulated in the blood.

The short chains of fructose in oligofructosides and the long chains in inulin are not touched in the small intestines, but are broken down (hydrolyzed) to fructose in the walls of bacteria present in the colon. The fructose that is released is transported into those bacteria and does not reach the blood. The colon bacteria metabolize the fructose and produce a variety of compounds, including butyric acid that is the major nutrient for colon cells and gases.

So, sucrose, high fructose corn syrup, fruit juices and honey have readily available fructose that can cause damage. I try to avoid all of these. I think that lactose is better, but you have to maintain a healthy gut flora or you can become lactose intolerant. It is, however, relatively easy to reverse lactose intolerance by cultivating gut bacteria that can metabolize lactose without producing gas.

Thanks for the comments/questions.

Dr. Art Ayers said...

Jason,
I don't know which probiotics are best. I think that the probiotic approach is in its infancy and only provides a fraction of the 150 species needed in each person to support health. The current probiotics just nudge the gut flora in the right direction and diet has to do the rest to help to form a healthy bacterial community.

I don't think that strengthening the immune system is ever a problem. The problem with autoimmunity seems to be the result of missing regulatory cells to make the immune system reasonable. A healthy gut flora supports immunotolerance, which is the opposite of allergy or autoimmunity.

Thanks for your comments.

Dr. Art Ayers said...

Steve,
I think that the fructose in whole fruit is less of a problem than processed sources, because the fruit soluble fiber supports the growth of bacteria that can metabolize the fructose. Sucrose in fruit may also be less of a problem than sugar added by the spoonful.

See below for additional examples of inulin-rich food. Pectin is also available for use in making jams and jellies.

Thanks for the comments.

Dr. Art Ayers said...

Byron,
I think that your observations make sense. Since the gut and gut bacteria are involved in so many processes required for health, it should not be a surprise that supplements that enhance the gut or gut flora can have far reaching results.

Even a single use of some supplements can have long term effects, because they can change the immune system or change the way that the gut absorbs nutrients. The opposite is the broad and unpredictable consequence of antibiotic use. Many of the diseases that have increased in the last half century may be a indirect impact of antibiotic use.

Thanks for your comments.

malpaz said...

please expand on the overcoming lactose intolerance!!! i cant tolerate raw cheese without constipation and acne...digestion is fine in al other departments... :)

Dr. Art Ayers said...

Malpaz,
Lactose intolerance results from a combination of the natural shut down of infant lactase that occurs in most humans and reduction in the consumption of milk, which results in a gradual loss of bacteria that use lactose as a nutrient. For most people, lactose intolerance merely reflects a change in gut bacteria, which can be readily reversed in a few weeks by eating probiotics and supporting lactose-digesting bacteria by eating lactose.

Thus, lactose intolerance can be eliminated by just eating increasing amounts of a yogurt containing live bacteria (all of which naturally use lactose) and lactose. This yogurt should be just plain and reveal the presence of carbs by looking at the label. Two weeks later lactose intolerance should be gone. The presence of pectin and inulin are just happy bonuses for gut flora health.
reference:
He T, Priebe MG, Zhong Y, Huang C, Harmsen HJ, Raangs GC, Antoine JM, Welling GW, Vonk RJ. Effects of yogurt and bifidobacteria supplementation on the colonic microbiota in lactose-intolerant subjects. J Appl Microbiol. 2008 Feb;104(2):595-604. Epub 2007 Oct 9.

CONCLUSIONS: The results suggest that supplementation modifies the amount and metabolic activities of the colonic microbiota and alleviates symptoms in lactose-intolerant subjects. The changes in the colonic microbiota might be among the factors modified by the supplementation which lead to the alleviation of lactose intolerance. SIGNIFICANCE AND IMPACT OF THE STUDY: This study provides evidence for the possibility of managing lactose intolerance with dietary lactose (yogurt) and probiotics via modulating the colonic microbiota.
PMID: 17927751

Thanks for your comments.

Malauhog said...

Hi Dr Art Ayers

Regarding lactose intolerance. I read in another blog about wheat being the culprit of lactose intolerance?

You mean by plain yoghurt = without sugar? The yoghurt here in my country the carbohydrate content is 7grams per cup. Is this alright?

Dr. Art Ayers said...

Malauhog,
I don't understand how gluten intolerance can be the same as lactose intolerance. I think that is simply wrong, but gluten intolerance does produce massive changes in the gut and gut flora.

By plain yogurt, I mean without sugar added. It is not a big deal, but it is simpler if the carbs present are just from the milk and therefore lactose. The ingredients should say if sugar has been added. You have to also make sure that living bacteria are still present and the yogurt has not be pasteurized.

Thanks for your comments.

Malauhog said...

Dr Ayers

The commercial yoghurt available in my country is all pasteurized but have live active culture seal. Is pasteurized yoghurt bad?

This is the blog I read about wheat and lactose.

-----------------------------------
http://high-fat-nutrition.blogspot.com/2008/01/wheat-and-lactose.html

As a classic example, many many people are lactose in tolerant. They get gut rot when they drink milk. They may well avoid all dairy for the rest of their lives. However, it's pretty obvious from this thread that eating wheat trashes the brush border, where lactase is produced. This happens in NORMAL animals (and people). So it's impossible to genuinely say a human is lactose intolerant while they are eating wheat.

Humans are mammals after all, lactase is produced on demand whenever lactose is present, why should we be lactose intolerant?

If we have sub clinical coeliac disease then the loss of lactase is very straight forward. And very reversible.

My argument is that no one is likely to be tolerant of WGA. The effects on the gut lining do not require allergy, they are intrinsic to the nature of the lectin WGA and the glycosylation of the gut lining cells. Undoubtedly allergy will make matters much worse (and may give you a positive blood test, thus providing an ad lib supply of gluten free junk foods from the NHS).

Anyone unable to correctly digest fat, a specific protein or certain carbohydrates should really be thinking about wheat.

It's a metabolic poison.
-----------------------------------

Dr. Art Ayers said...

Malauhog,
I think that the yogurt is made from pasteurized milk, but is not always pasteurized after the bacteria are added to make yogurt. The result is that the yogurt on the shelf still contains live bacteria and those live bacteria have all grown using the lactose in the milk as a nutrient.

I should have recognized that Peter, the crazy vet from Hyperlipid, was your source. I trust his work. I would still argue that gluten rather than WGA is the problem, but celiac seems to be another contributor to lactose intolerance. I think that mucins protect the intestines from WGA. There is still a dominant contribution of gut flora to the metabolism of lactose. It would also appear that probiotics plus lactose can reduce celiac and lactose intolerance.

It would make sense for those who suffer from lactose intolerance to stop eating grains and begin eating live yogurt with lactose.

Thanks for the comments.

Malauhog said...

Thanks Dr Ayers.

From now on i will be eating sugar free yoghurt. Back then i ate flavored yogurt and the sides of mouth crack. Maybe because of the added sugar.

Susanne said...

Good day,

I am a rosacea sufferer(female). I am in my twenties. I read the posts on rosacea in your blog but have problems understanding it all. English is not my first language.
Can you advise me some steps you recommend to get my rosacea under control.
I would appreciate it a lot.
Regards,
Susan

Susanne said...

I forgot to mention that my rosacea symptoms(redness, flushing) appeared after I took Accutane for acne. I also sometimes have swollen fingers, however only on the right hand .
I had tests to see if i maybe have Raynauds, results came back negative.

Chris Kresser said...

Hi Dr. Ayers,

Fascinating post. I have Crohn's disease and a few years ago I tried helminth therapy after discovering its potential in my research. (For those looking for a source, visit http://ovamed.org. They are the lab in Germany that has supplied the helminths used in all of the research studies.)

Unfortunately it had no effect on me, even after completing 1.5 full courses. Indeed, many of the therapies that help people with Crohn's either don't work for me or make me worse. This and other data have led me to the conclusion that the pathomechanism and etiology for AI diseases in general, and even for a single AI disease like Crohn's, are diverse.

I agree that bacterial dysbiosis probably plays a significant contributing role. I took a lot of antibiotics as a kid for sinus infections, which trashed my gut flora and compromised my immune system.

In my case, restoring proper gut flora through a grain-free, specific carbohydrate diet (GAPS) and massive amounts of fermented foods (kefir, yogurt, sauerkraut, kombucha, fermented cream, etc.) has enabled me to live an active, full life without any of the immune-suppressing medications often prescribed to Crohn's patients.

As a healthcare practitioner, I have used this same strategy to help many others with AI and gastrointestinal disorders.

Although helminth therapy may someday be a practical solution, currently it is too expensive to be of use for most people. A single course can run upwards of $3,000 and it's of course not covered by insurance.

My understanding is that the introduction of bacteria through probiotic consumption has a similar immunomodulatory effect, and while it may not be as powerful, the benefits accumulate over time.

Chris

J said...

Hi Dr. Ayers –

Am I correct in my understanding that soluble fibers such as psyllium or pectin are broken down into fructose within the colon (as opposed to the small intestine) and thus metabolized by the colonic bacteria. As a result, the fructose would never enter the bloodstream and thus would not increase blood sugar levels. Also, since the fructose would not be metabolized by the liver there would be no risk of fatty liver disease or increased cholesterol levels. I am trying to clarify this as I would like to begin supplementing with either apple pectin or psyllium so long as I am not putting myself at risk for problems related to the liver or insulin resistance. Thanks. Love your post!

Jeff A.

westie said...

This is extremely interesting post and stuff that I've been reading lately. Immune system is very important and if the balance gets lost deadly infection or cancer might develop.

It is quite interesting that H.Pylori will stimulate Treg production. Linoleic acid derived PGE2 does the same thing and I guess that might explain cancer & linoleic acid connection. What do you think about that? LA derived PGE2 may be one main culprit in alzheimer also since AD brain has too active Treg activity and increased amount of AA.

Art, what do you think/know about endotoxin tolerance? Could it have somekind of role in the development of T2DM and/or heart disease?

Anonymous said...

Sería tan amable de recomendarme un aceite de pescado de calidad? Muchas gracias

dextery said...

Anonymous said...
Sería tan amable de recomendarme un aceite de pescado de calidad? Muchas gracias

Carlson's Fish Oil
http://www.vitacost.com/Carlson-The-Very-Finest-Fish-Oil

dextery said...

Dr Art,
I ran across this interview/video
"A converstion with Robert Sapolsky" regarding Toxoplasma parasites.

These parasites seem to help the gut as well as ruining the health of others.

http://www.edge.org/3rd_culture/sapolsky09/sapolsky09_index.html

Dr. Art Ayers said...

Dextery,
Thanks for your omega-3 recommendations.

I became interested in Toxoplasmosis about four or five years ago when I found that it had some interesting heparin-binding properties. I first ran into the behavior modification by Toxo when I read an editorial piece that recommended Toxo cures to rid the world of war.

I think that the interesting aspects of Toxo are how it modifies the host to produce tolerance of infections and how Toxo cells can migrate to the amygdala. Parasites have some amazing adaptations that expose the cell biology for study.

Thanks again for your interesting input.

Vince said...

Dr Ayers,

Fascinating post. Our 3 yr old daughter recently tested positive for H Pylori, as well as two intestinal parasites, Strongyloides and Trichuris Trichiura. She complains often of gut pain, and has severe eczema. After anti-parasitics and antibiotics, (and continual probiotics, vit D, fish oil) she has no change in symptoms. We are retesting this week, but are unsure we are even going about this correctly. I hesitate to take grains out of her diet and cause her greater stress. We eat very little if any sugar and high saturated fat, but do include grains and dairy. Is grain elimination imperative in restoring her gut health? Thanks!

Becky

Dr. Art Ayers said...

Becky,
I would be surprised if either the Hp or the parasites were causing gut discomfort. That leaves some kind of gut inflammation. Even though you don't want to shift your family away from grains/high starch, I think that is your best solution. I think that you need to build up the rest of the gut flora with pectin (e.g. apples) and inulin (leeks). You could also try lactulose.

It will take a while for her gut to recover from the antibiotics. Get her used to eating lots of different types of veggies. It is supposed to take just three weeks of persistent eating of a new food for it to become typical food.

Let me know how she is doing.

Anonymous said...

Dr. Ayers,

My 5 month old baby is exclusively breastfed (I'm on the GAPS diet), and it appears he has a moderate milk protein allergy. Even when I only eat butter oil (ghee), about 20-40 min after I nurse he starts fussing in pain, projectile vomits, and won't sleep more than 40 min at a time. He also has ear wax build up, red-rimmed eyes,and eczema. How long do you think I would need to cut out dairy products for his gut to heal before slowly introducing ghee again? Are there any probiotics (such as L. Reuteri?) that would help with this? Would feeding him a teaspoon of gelatin from a homemade bone broth help him digest it?

Thanks for any opinions/educated guesses/theories you can give! Sarah

Dr. Art Ayers said...

Anonymous,
Here are my first impressions:

Babies at 5 months of age have primarily their mother's immune system, i.e. passive immunity obtained in utero or through milk. This suggests that allergies at this stage would be unexpected, because the baby wouldn't pick up the needed IgEs from the mother.

The symptoms your baby has are not consistent with being exclusively breastfed. After the initial dark bowel movements, has your baby always had yellow and white yogurt-like bowel movements? [It is not unusual for hospital staff to slip in bottles of formula for their convenience, even with babies clearly designated as breastmilk only.]

I don't know how your baby could be exposed to cow's milk proteins that you eat. They don't pass through the intestines and then they also aren't transferred into your milk. Most of the transferred molecules from your diet to your milk are fat soluble. Most drugs don't transfer and certainly not proteins. There is also very little protein in ghee.

I hope that this helps, but something is missing from your description. Get back to me.

Anonymous said...

Dr. Ayers,

Thank-you for your quick reply. If you look at this LLL article, http://www.llli.org/ba/Nov98.html, it has several references for papers written on cow's milk and egg proteins passing through the mother's milk. It is easy to find quite a bit written about it through a quick google search. However, it is just starting to be publicized. I have talked to quite a few women who have said that after eliminating all dairy, their baby was completely different.

That being said, my son was never in a different room from me after birth except for his circumcision so no formula was ever given him. His stools have always (after the initial ones) been like yellow yogurt. He has since birth spit up a lot and had bad gas and has never slept during the day for longer than 40 min without waking up to fuss.

He was sleeping well at night until about 4 months when he started waking up with intestinal discomfort and gas or spit up every 45 min. I went on the GAPS diet to see if that would help, but it did not. One woman suggested I eliminate the yogurt and butter. After about 4 days, he was less fussy during the day, his eczema almost completely disappeared, and his spit up was clear instead of chunky and decreased in volume. Then I tried only butter oil, and he fussed all morning and projectile vomited multiple times throughout the morning.

While he has never had formula he has had a couple bites of egg yolk and a sip of homemade meat broth. His older brother was also very fussy and woke up constantly at night, although he did not spit up or have bad gas.
Also, I'm not sure your opinion on vaccines, but he did have the 2 and 4 month vaccines. My husband has bad allergies to dust and pollen, and I have no allergies.

Thanks, Sarah

Tanya said...

Sarah

My second daughter had similar symptoms...I toyed with the dairy connection but just couldn't let it go on long enough to determine if that would help. There was no way she was keeping enough down to thrive. My pediatrician thought I was 'crazy' and just didn't want to nurse (my 1st and third were nursed for a year, pumped at work, although they did have formula a few times). He gave us a trial of nutramigen, a pre-digested formula. She was a different baby, and after a couple of feedings refused to nurse at all. Anyway, because the ped. was laughing at me, I researched it. If I remember correctly, it was called 'galactosmeia' and had to do with galactose opposed to lactose. I was on progesterone only bcp so I could nurse and not get pregnant and felt the best I felt ever in my adult life. Not sure if this helps at all but thought I'd chime in.

The downside was she suffered with ear infections until age four (had to have surgery at 11 mos old to open her tear ducts due to excess tissue in the nose and they put tubes in at same time, but still infxns off and on). She still complains of ear pain off and on. Wondering if it is a drainage issue too, aggravated by inflamation.

Had I known...but she really was miserable and not being well nourished, and I was exhausted to say the least.

Dr. Art Ayers said...

Sarah,
I will stop quibbling over my disagreement with the cell biology of protein transit across the intestinal lining. I am familiar with the claims in the literature and am unconvinced that protein transfer is the source of the immunological reaction that you are observing.

The bottom line is that something in milk products and also in the extreme case of ghee, is transferred into your breastmilk or alters the composition of your breast milk, so that your son has a vigorous reaction (presumably histamine release from IgE-triggered mast in the gut.)

If this is immunological as it seems, then you have to avoid dairy until your son's immune system matures enough to suppress this reaction. Your son may respond the same way to beef products until then. How did he respond to the beef broth? I don't think that feeding anything but breastmilk for a while will be helpful.

I doubt that vaccines made a difference.

I was just review colitis in Ruth and Robert Lawrence's "Breastfeeding, a guide for the medical profession", 5th ed., and there is a provocative notation of cow's milk colitis, via the mother, that is triggered by the mother shifting to high beef during her pregnancy after being a vegetarian. I think that the mother was producing antibodies to the sialic acid derivative that decorates most mammal proteins, but not humans. A cow's milk protein containing that sialic acid derivative was passed to the mother's milk and the baby responded. Something along those lines may be happening in your sons.

Let me know how it works out.

Dr. Art Ayers said...

Tanya,
Thanks for your help for other readers and providing your own experiences. I think that most of us help others so that they don't have to live through what we have because of inadequate information or knowledge. We do the best that we can and our kids turn out well even when the system lets us down.

Thanks for the support.

Anonymous said...

Dr. Ayers and Tanya,

Thank-you both for your help. I will cut out milk and soy for a month and perhaps egg white. He is slowly growing worse, and is having a harder time than my first son who grew out of it around 18months. My hope is to find something that will help without having to resort to Neocate.

I appreciate the suggestion about colitis, Dr. Ayers. As I was researching it online, I came across the connection between ulcerative colitis/Crohn's disease and Ashkenazi Jews. My mother (although not my father) is a pure Ashkenazi Jew, and I am thinking that is a nudge in the right direction.

Best Regards, Sarah

Dr. Art Ayers said...

Sarah,
I would expect that the genetic predisposition is related to the antigen presentation MHCII system. This is consistent with my model of inflammation and antigen presentation as the initiator of allergies and autoimmune diseases.

I would also expect that traditional diets of the Ashkenazi would provide protection against expression of the predisposition.

It is also true that the pregnancy and birth process is based on inflammation. I would not be surprised if you only produce anti-cow's milk antibodies during pregnancy and in response to cow's milk.

It remains surprising that there is so little research on human milk production and the development of baby immune systems.

Szara said...

What are your thoughts on using Helminths as a treatment for an auto-immune disease like Rhuematoid Arthritis? Is it possible that a small infection of hookworm could down-regulate the immune system enough to provide relief?

Dr. Art Ayers said...

Szara,
I think that the right helminth infection could reverse arthritis. An anti-inflammatory diet, such as I describe in my blog, and re-establishing a fully functional gut flora could have the same effect.

Thanks for the question.

Anonymous said...

Hello Dr.Ayers,
I'm a very frustrated mother of 9 y.o. with food (fish, eggs, nuts,etc) and environmental allergy since day 1, then 2 years ago she developed AI disease Chron's and Colitis, pretty severe one. We had to do blood transfusion 2 months ago, then elemental diet, then steroids. She keeps losing weight (3 lbs 6 oz in 10 days), and her anemia pretty consistent.
She is currently on soft diet,Pentasa,Zyrtec,Singular, Flagil, Prednisone, and doctors are discussing to put her on Remicade, which I'm trying to avoid and to find an alternative way. In respect to supplements, we were taking Vit D3 2000 IU, DHA from Algae, probiotics, plant enzymes, flax oil and glutamene.
I'm reading your blog, and learn a lot of good information. My frustration is that she still has flare-ups, and I don't know where to start in terms of diet and maybe to revisit supplements.
Please guide me in my journey, I trully believe that I can treat her without going too conventional.
Thank you in advance!

Tanya said...

Anonymous...I am not the Doc but I suggest you look into Low dose naltrexone.

Dr. Art Ayers said...

Mother of 9 yo with Crohn's disease,
I had to ask for practical advice from one of my thoughtful readers who has CD. He answered immediately with this:

Art I have to tell you it strikes a nerve in me when I hear of kids with this disease. From a perspective of coping with the disease I recommend that she visits, searches and posts questions on a site like this: http://www.healingwell.com/community/default.aspx?f=17
She MUST keep in mind that there are fools, the desperate, quacks and thieves all over the net ready to exploit us. On a forum she can check to see if a suggested treatment has given results to other patients.

Right now I am interested in the helminthic therapy (worms). Also LDN Low Dose Naltrexone has some folks saying they feel better. The remicade has been literally a life saver for me but it is not a cure and will eventually stop working I believe. The therapies above I will wait and watch to see how other folks make out.

How much she goes after these dramatic treatments should be contingent on how badly the boy is flaring or not. Most say that a maintenance regimen is needed to prevent continued micro damage building up in the intestine.

Ah diet! Very individual. Keeping a food diary is probably a good idea that I never followed. Having a flare just once after a food type is no proof but if she finds that every time the boy eats Twinkies he get's ill then hide the Twinkies. Some can't eat beef and some, like me, eat plenty of red meats. Popcorn seems to be ALMOST universally a bad thing. Clearly a healthy diet is EXTRA essential in a growing boy with this disease. A recent article said that the fiber in plantains and broccoli is helpful for CD. Very ripe fried plantain is a treat to kids and healthy too. They say processed foods and polysorbate 80 is bad for CDers. This is just one study. A less processed anti inflammatory diet should play a part in trying to avoid more dramatic treatment. Remicade is supposed to reverse some damage that would otherwise require surgery and so is LDN but LDN is not yet accepted by the general medical community.

Vitamin D is a great supplement for us both directly in fighting the disease and also to keep you from catching colds when taking immuno suppressant drugs. The suggested amount of Vitamin D is 400 iu but they are about to raise that dramatically I believe. I take 1000iu in the morning and another 1000 in the eve plus I get a lot of sun in my work daily. Amount for a child????????????

Mornings tend to be worse for most of us with symptoms easing through the day. Avoid ibuprofen. There is so much Art but I have written a book for you here already and will stop here. Sorry.

I think we are close to figuring out this disease and the future looks good for the young CDers.

Glad to see you are OK and I look forward to your facinating blog posts in the future. I check your site often and soak up as much as I can.

Anonymous said...

To mother of 9yo w/Chron's disease

Some reviewers of this book on Amazon have cured Chron's disease with the Specific Carbohydrate Diet:

http://www.amazon.com/Breaking-Vicious-Cycle-Intestinal-Through/dp/0969276818/ref=sr_1_2?ie=UTF8&qid=1287200053&sr=8-2

Dr. Art Ayers said...

Anonymous,
The book that you site uses a kind of specific carbohydrate/sugar diet that is based on the idea that some plant polysaccharides are causing the problems and that by avoiding them, the flares of CD can be avoided. To some extent this is true and is analogous to the thinking that avoiding an allergen will avoid the symptoms of allergy.

In both cases of food intolerance and allergy, the problem is a defective immune system and the the defect originates in the gut. Inappropriate gut-flora interactions are the problem and since diet determines the flora, then diet has to be part of the cure.

In CD, half of the hundred and fifty different species of bacteria that compose the healthy gut flora are missing. Absence of bacteria to digest diverse plant polysaccharides will produce food intolerances.

Simplified diet focus on starch as the only plant polysaccharide eaten, because your body produces the enzymes to digest most of starch (except for the branching sugars used by Klebsiella.) This is also the major polysaccharide used by intestinal yeast.

The cure for CD must include a reestablishment of the healthy gut flora, but as with many chronic diseases, it is unknown how to construct a diet that will lead to renewed gut flora complexity. Most new combinations of gut flora in response to new foods lead to flare ups. Fecal transplants may be the ultimate answer, because they supply all of the needed bacteria at once.

It should be noted that since family members and caregivers are the major source of gut bacteria for CD sufferers through casual contact, those people should focus on developing their own healthy gut flora with an anti-inflammatory diet as presented on this blog. People with CD should stay away from anyone using antibiotics or who has constipation.

Medjoub said...

@Dr Ayers -

This is very interesting -- to what extent in a family can those that eat well (anti-inflammatory diet, etc.) influence the immunity of those that don't? I'm thinking of my family growing up, in which my father was never sick and my mother and sister very often sick. Immunity seems such an inborn characteristic, though clearly it isn't. I, of course, have allergies and digestive issues (as I've discussed here) though am NEVER sick, and my wife is constantly sick with no digestive problems.

You say those with CD should people on antibiotics or that have constipation -- is that because the bacteria present are the "wrong" kinds and can foster continuing poor immunity? If this is the case, it seems like city living would be less than ideal, considering the current standards of eating/living in the West (due to the "shared" bacteria)? HOW important is all this?

Just interested in this idea - this is such an excellent and thought-provoking blog. Too bad the medical community at large is so divorced from this incredibly important information...

Olga said...

Hello Dr.Ayers and other members,
This is mom of 9 yo. My name is Olga.
Thank you so very much for your responses.
I did lots of other reading on Fecal Transplant, and am convinced to proceed, however I have two obstacles:
One - I'm afraid to do it myself, I need a doctor's close supervision or clinic.
Two - My daughter is in flare up right now, she has bloody diarrhea, which tells me she has open wounds inside and I'm scared that it will cause her more infection??
She finished Flagyl last week and continue to be on steroids, but seems like it didn't help much.
Please let me know what you think about it? And, if you can recommend someone proffesional?
We live in Colorado. I was able to find couple of names in Minnesota and Oklahoma, but both cases are for C-Diff bacteria and for adults. Nothing on pediatric site or IBD.
I didn't have a chance to talk to GI, but knowing him for a while, I doubt he will fall for it.
Please advise,
Sincerely O.

Apoptosis Detection said...

Hello friends,

Thank you so much for sharing it. Immune tolerance is selective in that the immune system disregards molecules native to the host and responds aggressively to remove foreign molecules, which is to protect the host from foreign materials...