Category Archives: autoimmune disease

Chronic Pain: Opiate use can make it worse

For several years a dysfunctional response to opiate prescription medications for chronic pain has been discussed in the medical literature. This dysfunctional response paradoxically makes pain worse! Various animal models have demonstrated “hyperalgesia” (increased pain response to a painful stimulus) in rodents given opiate medications for pain. A process called “central sensitization” occurs in which the nervous system becomes an amplifier (amplifying pain signals to the brain) rather than a muffler (inhibiting pain messages ascending the spinal cord to the brain). Many cellular mechanisms have been identified as potentially contributing to this iatrogenic situation.

A recent study has provided yet another possible contributing mechanism that involves an auto-immune response in which the opiate medication (such has hydrocodone or oxycodone found in NORCO and PERCOCET) chemically combines with a normal protein in human blood. This combination is called a hapten. Haptens have been known to cause a variety of auto-immune diseases including halothane hepatitis and a specific form of hemolytic anemia. Both can be life threatening.

You can view a brief video on the results of the research here:

View this video to understand one of many possible mechanisms causing a paradoxical response to opiate pain medications in which pain is worsened rather than improved.

You can view previous posts related to pain here

https://practical-evolutionary-health.com/2015/03/22/chronic-pain-how-does-it-occur-and-what-can-be-done-about-it/

and here:

https://practical-evolutionary-health.com/category/pain/

Opiate pain medications such as morphine and fentanyl can be profoundly beneficial in the acute settings of trauma and surgery, but chronic use is rarely justified because of side effects, tolerance and addiction. Instead, lifestyle and rehabilitation modalities should be employed. These can have significant beneficial effects in the setting of chronic pain. I presently practice interventional pain management at TPM Medical Clinic, combining allopathic techniques with lifestyle interventions to help patients get off of chronic opiate medications and improve quality of life and functional status.

http://www.tpmclinic.com/

The tpmclinic website is an award winning patient educational website that describes various techniques used to treat chronic pain.

This website is devoted to the effects of nutrition, sleep, stress reduction, exercise, sunshine, circadian rhythm and social connection on health and health-span. But all of these factors influence the experience, suffering and prognosis of chronic pain, no matter what the cause.

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

Chronic Inflammation, the silent killer

I was recently interviewed by a health blogger for his podcast. The topic was chronic inflammation. Here it is.

I prepared some notes for the interview. Here are the questions and answers.

What made you so interested in the topic of chronic inflammation?

Interest in chronic inflammation:

  • Emerging evidence, source of most chronic disease including mental health (depression, etc.) is inflammation
  • family health issues experience personally
  • health care policy interest since graduate school
  •  First started to question USDA dietary advice after reading GOOD CALORIES, BAD CALORIES, by Gary Taubes,
  • Experienced Statin myopathy, researched statin drugs, bad data, financial conflicts of interest. Sought alternative approaches to Coronary Artery Disease prevention.
  • In USA, Profit driven health care system evolved from more benign not-for-profit earlier system in medical insurance and hospital system. Drug and surgery oriented. Corporate ownership of multiple hospitals, concentration of wealth and power in the industry and in society in general
  • Saw this every day: growing obesity, Metabolic Syndrome, DMII, auto-immune disease. Root causes NOT ADDRESSED.
  • While recovering from surgery attended on line functional medicine conference on auto-immune disease, covering diet, sleep, exercise, sunshine, Vitamin D, environmental toxins, gut dysbiosis, intestinal permeability (THE GATEWAY TO AUTOIMMUNITY IS THROUGH THE GUT).
  • Introduced to EVOLUTIONARY BIOLOGY and Paleo Diet by my son

What diseases does chronic inflammation typically lead to? 

  • Cancer
  • Diabetes
  • Obesity epidemic, DIABESITY
  • Hypertension
  • Metabolic Syndrome (3/5: HTN, insulin resistance/high blood sugar, abdominal obesity, high TGs, low HDL),
  • Autoimmune diseases
  • Degenerative arthritis
  • Neurodegenerative disorders (dementia, Parkinson’s, neuropathy, multiple sclerosis)
  • Works of Dale Bredesen (dementia, “The End of Alzheimer’s”), Ron Perlmutter (Grain Brain), Terry Wahls (The Wahls protocol for MS), all FUNCTIONAL MEDICINE looking at root cause of illness, common-overlapping threads.
  • Interplay between sleep, circadian rhythm, exercise, sunlight, stress, environmental toxins, diet, processed foods, nutritional deficiency, gut microbiome, endocrine disruptors, intestinal permeability, oral and skin microbiome, social disruptors, GUT BRAIN AXIS. These are all part of one large ECOSYSTEM.
  • Positive and negative feedback systems requiring a SYSTEMS ENGINEERING approach to understanding root causes.
  • Butyrate is the preferred substrate for colonocytes, providing 60-70% of the energy requirements for colonic epithelial cells1,2Butyrate suppresses colonic inflammation,3 is immunoregulatory in the gut,4 and improves gut barrier permeability by accelerating assembly of tight junction proteins.5,6
  • Improves insulin sensitivity, increase energy expenditure, reduce adiposity, increases satiety hormones,
  • HDAC activity inhibitor, PROTECTS GENES from removal of necessary acetyl groups.
  • Butyrate also influences the mucus layer. A healthy colonic epithelium is coated in a double layer of mucus. The thick, inner layer is dense and largely devoid of microbes, protecting the epithelium from contact with commensals and pathogens alike. The loose, outer layer of mucus is home to many bacteria, some of which feed on the glycoproteins of the outer mucus layer itself. Both of these mucus layers are organized by the MUC2 mucin protein, which is secreted by goblet cells in the epithelium. Supplementation of physiological concentrations of butyrate has been shown to increase MUC2 gene expression and MUC2 secretion in a human goblet cell line.7,8

What are the population groups which have higher risk of chronic inflammation? 

  • Obese
  • Sedentary
  • Poor-urban-polluted environment dwelling (air, water, noise, crowding, violence, racism, oppression)
  • Divergence from ancestral evolutionary biology
  • Working environment: indoors, polluted, oppressive supervisors, no sunlight, noise pollution, air pollution, toxic social situations, repetitive motion, bad ergonomics,
  • night shift, disruption of circadian rhythm
  • both parents working, no time for real food and family interaction, supervision of children.
  • screen time- sedentary behavior, lack of outdoor activity
  • Stress of social inequality, food insecurity, violent neighborhoods, nutritional deserts

What are the “danger signs” or typical symptoms which may signal a chronic inflammation? 

DANGER SIGNS:

  • Waistline (waist to height ratio, BMI)
  • Sarcopenia (muscle as an endocrine organ)
  • Sleep disturbance
  • Pain
  • Headaches
  • Depression
  • Lack of joy.
  • Brain fog, fatigue

What are the typical biomarkers of chronic inflammation?

  • METABOLIC SYNDROME (3 or more of the following: high blood pressure, elevated blood sugar, elevated Triglycerides, low HDL, obesity)
  • CRP predictive of cardiovascular events,
  • ESR associated with arthritis
  • Stress hormones (morning cortisol levels)
  • Resting Heart Rate and Heart Rate Variability

What are the typical sources of systemic chronic inflammation?

Sources of Chronic Inflammation:

Diet

  • N6/N3 FA ratio determined by too much Refined Easily Oxidized Vegetable Oils, not enough marine sources of N3 FA,  grain fed vs grass fed/finished ruminant meat. Loren Cordain research wild game FA composition = grass fed. Margarine vs Butter. Fried foods using Vegetable oils. Oxidized fats/oils, oxy-sterols in diet.
  • Sugar excess leading to insulin resistance
  • Refined carbs leading to insulin resistance (dense acellular….)
  • Disturbance of gut  microbiome from poor nutrition (sugar, refined carbs and vegetable oils all disrupt the microbiome)
  • Gut brain axis.
  • Food ADDITIVES AND PRESERVATIVES
  • Trans Fats (finally banned)

Endocrine disruptors/ BIOACCUMULATION

  • Plastics (microparticles in our fish, food and bottled water)
  • Plastic breakdown products
  • Phthalates added to plastics to increase flexibility ( also pill coatings, binders, dispersants, film formers, personal care products, perfumes, detergents, surfactants, packaging, children’s toys, shower curtains, floor tiles, vinyl upholstery, it is everywhere) 8.4 million tons of plasticizers produced annually. EWG.org
  • Pesticides, herbicides, glyphosate (Monsanto), DIRTY DOZEN, CLEAN FIFTEEN EWG.org
  • Medications
  • ABSORBED skin, eat, drink, breath,
  • BPS is as bad as the BPA it replaced
  • Polychlorinated biphenyls used in INDUSTRIAL COOLANTS AND LUBRICANTS
  • Flame retardants (PBDEs, polybrominated dipheyl ethers) are ubiquitous in furniture and children’s clothing. Also linked to autoimmune disease
  • Dioxins
  • PAHs (polycyclic aromatic hydrocarbons
  • Sunblock
  • CUMULATIVE BURDEN, INTERACTIONS, SYNERGY?

SLEEP DEPRIVATION CHRONIC IN OUR SOCIETY

Eating late vs time restricted eating

Gut Microbiome disrupted by

  • 1/3 of prescribed medications disrupt the microbiome AND increase intestinal permeability
  • Stress
  • Sleep deprivation
  • Sugar
  • Refined carbs
  • Refined veg oils
  • Over exercise and Under exercise, both are bad.
  • Environmental toxins

Gut dysbiosis and infections include (often chronic, low grade, not diagnosed)

  • Pathogenic bacteria, infection or overgrowth/imbalance
  • SIBO
  • Parasites
  • Viruses
  • BAD bugs > good bugs
  • Good bugs make vitamins and SCFAs required for colonocyte energy
  • Gut-Brain axis huge topic, VAGUS NERVE COMMUNICATION both ways, SCFA in gut and in CIRCULATION (butyrate, propionate, acetate), NEUROTRANSMITTER PRODUCTION (SEROTONIN, OTHERS), enterochromaffin cells producing > 30 peptides.
  • Overuse of antibiotics in medicine
  • AND use of antibiotics in raising our food.
  • Vaginal delivery vs C-section
  • Breast feeding vs bottle feeding

INCREASED INTESTINAL PERMEABILITY:

  • Caused by all factors above
  • Leads to higher levels of circulating LPS-endotoxin, bacterial products that create an immune-inflammatory response.
  • Incompletely digested proteins with AA sequences overlapping our own tissue causing autoimmunity/inflammation through molecular mimicry

Heavy Metal toxicity

  • Lead
  • Mercury
  • Cadmium
  • Arsenic

MOLD TOXICITY (> 400 identified mycotoxins, can cause dementia, asthma, allergies, auto-immunity)

  • At home
  • At work

What are the most efficient natural (non-medication) ways to address chronic inflammation?

  • Anti-inflammatory Diet, real whole food that our ancestors ate through evolutionary history (grass fed/finished ruminant meat, free range poultry, antibiotic free, and pesticide free food, wild seafood (low mercury varieties), organic vegetables and fruit, nuts, fermented foods, eggs)
  • Low mercury fish and seafood for omega three fatty acids
  • Sleep hygiene
  • Exercise, not too much, not too little, rest days, out of doors, resistance training, walking, yoga, Pilates, tai chi, chi gong, dancing, PLAYING!!!!!!!!!!!!!
  • Stress reduction: meditation, mindful living, forest bathing, sunlight, Playing, music, praying, SOCIAL CONNECTION, laughter, comedy, quit the toxic job, quit the toxic relationship, SAUNA/SWEAT, heat shock proteins, exercise
  • Vitamin D, sunshine, check levels
  • PLAY, PLAY, PLAY, LAUGH, DANCE, ENJOY, LOVE
  • Be aware of potential dangers of EMF, WiFi, hand held devices, blue tooth headphones.
  • Address environmental justice
  • Address social inequality, food insecurity
  • Tobacco addiction
  • Ethanol
  • Other substance abuse
  • Agricultural subsidies in US distort the food supply
  • Loss of soil threatens food supply
  • Suppression of science (global warming, environment, etc.,) worsens environmental degradation, creating an EXISTENTIAL THREAT.
  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

My Autoimmune Disease: remission with the AIP (and one medication)

In September of 2018 I awakened with swollen, red and painful hands. I could not make a fist. I could not grip a steering wheel without extreme pain. I left dropped items on the floor because it was too painful to pick them up. All of my joints were painful and stiff. My legs were swollen. My wife had to help dress me so I could go to work. The simplest hand techniques to perform nerve blocks were painful. Just putting on sterile gloves caused severe pain. This happened just a few days after a week of camping. I felt weak all over and had trouble sleeping, unable to find a comfortable position.

(My camping vacation included digressions from my typical paleo/ancestral diet. I drank wine, ate some gluten containing foods and some dairy. I ate some wheat and sugar containing deserts.)

As a physician I ordered a variety of blood tests for tick born illness (such as Lyme’s Disease), rheumatoid arthritis, and other disorders that could cause my symptoms. All tests were negative except for an inflammatory marker (hsCRP) which was very high.

I queried physician friends about something I may have overlooked. No suggestions were forthcoming above and beyond what I had already done.

I prescribed myself a non-steroidal anti-inflammatory drug  NSAID. That provided modest relief but I was still suffering severe symptoms.

After 6 stubborn weeks I consulted a rheumatologist and he diagnosed me as having  “sero-negative” rheumatoid arthritis. Given the choice of several pharmaceutical interventions I chose the least toxic and started a drug called hydroxychloroquine. I was told it would take about 3 months to produce results, and in the meantime should continue the NSAID.

I immediately started to follow the Autoimmune Protocol AIP

Within one week of the AIP the redness in the joints of my hands was gone.

Within 2 weeks the pain in my joints was significantly reduced.

Within 3 weeks the swelling in my hands/fingers was completely gone and I stopped the NSAID. I no longer had pain in my hands and fingers while doing every day tasks.

Within 4 weeks I was able to resume my daily yoga and Pilates routine.

Within six weeks I felt in complete remission.

My rheumatologist agreed that I appeared to be in remission at follow up visit (no signs of inflammation, synovitis, etc., on examination with resolution of presenting symptoms) but he was and remains skeptical about the auto-immune protocol.

My clinical response was clearly way ahead of the expected time sequence for hydroxychloroquine. I concluded that the AIP was a major factor in my recovery.

All X-rays and MRI scans of my joints (which have suffered from osteoarthritis) were negative for the typical findings associated with rheumatoid arthritis.

The autoimmune protocol is a combination of lifestyle modifications involving diet, sleep, exercise, and stress reduction. It goes beyond the paleo diet. The paleo (ancestral) diet  eliminates processed/refined foods,  grains, legumes, dairy, added sugar, and refined vegetable oils. It stresses the consumption of a variety of organic vegetables and organic fruit, grass-fed meats, organ meats, free range poultry and eggs, wild seafood. The auto-immune protocol adds further restrictions: no nuts, eggs, nightshades, seeds, spices from seeds, and absolutely no alcohol.

There are many reasons for the added restrictions under the AIP. The added dietary restrictions are important for what they avoid but also important for the resulting increase in other beneficial foods that are allowed. The foods are omitted because they can cause or contribute to: gut irritation, dysbiosis, act as carrier molecules across the gut barrier, increase gut permeability, and/or cause inflammation. In theory, by eliminating those foods (hopefully on a temporary basis) and substituting nutrient dense less potentially harmful foods, we reduce some of the contributing factors to autoimmunity and inflammation.

For a detailed discussion of the AIP I suggest you visit Sarah Ballantyne’s  website and read her book: The Paleo Approach, Reverse Autoimmune disease and Heal Your Body.

Avoiding potentially harmful foods and beverages while increasing healthy nutrient dense foods represents the major focus of many individuals following the AIP. But equally important are the other lifestyle components. These include obtaining adequate  restorative sleep, reducing/managing stress (Stress Reduction and Health), getting reasonable amounts of playful exercise (this should be fun and occur in a green space as much as possible), sunshine, eliminating exposure to  environmental toxins, drinking filtered water, and frequent contact with supportive family and friends. Without addressing all of these areas one is not likely to succeed in achieving remission from an auto-immune disease.

In addition to Sarah’s Ballantyne’s book and website, if you have an auto-immune disease I recommend Dr. Terry Wahl’s website and book. Dr. Wahl’s, a medical school faculty physician, teacher and researcher,  was wheelchair bound with Multiple Sclerosis and facing death having failed all available medical treatments as well as some experimental drug protocols. She read about functional medicine, paleo nutrition and evolutionary biology in order to create her own treatment plan. One year latter she was in remission and riding her bike 20 miles. She subsequently raised money to do clinical research using her version of the AIP and has published a successful clinical trial.

There have been few controlled clinical trials of the AIP for auto-immune disease, largely because it does not involve drug research (no profits to be made) and because the NIH does not like to fund studies that alter multiple parameters at one time. Unfortunately, NIH funding has followed a drug and surgery model of medical treatment and does not look favorably on lifestyle interventions (one exception being the Mediterranean diet). I hope that bias changes in the future. In the meantime, physicians and scientists like Terry Wahls MD and Dale Bredesen MD, PhD (neurologist/researcher/author, The End of Alzheimer’s) remain pioneers in functional medicine and lifestyle interventions, being left to start their own foundations and raise money to fund medical research.

Both of these physicians have conducted clinical trials of lifestyle interventions (see below) that have produced revolutionary results, largely ignored by major medical societies and medical organizations. Progress occurs slowly, today’s iconoclasts are often tomorrows Nobel laureates.

Sometimes, despite significant clinical improvement with the AIP, some medication remains necessary with an auto-immune disease. If the auto-immune disease has been present for a long time, permanent damage may be present. That does not represent failure. If one can reduce drug doses, eliminate one or more drugs from a complicated medical regimen, and improve symptoms beyond what drugs alone achieve, I would call that success. Anecdotal reports from many patients (including my own) with auto-immune disease, suggest that it is not a cure-all, and those that show significant clinical improvement demonstrate various time responses ranging from weeks to several months in order to see results. But there are no down-sides to the AIP, no bad side-effects, no dangerous drugs, and only potential for clinical improvement. That seems like a no-brainer to me.

After eight weeks of strict dietary adherence, having achieved remission and appearing to be stable, I slowly added back small amounts of eggs, nuts and some nightshades (one at a time, observing for negative responses). I have been successful with that approach. I have not suffered any symptoms of rheumatoid arthritis since my initial remission. I remain on a paleo/ancestral diet and remain very cautions with regards to sleep habits, exercise, stress reduction, and social support. I try to laugh frequently and continue to engage in meaningful work. All of these components are essential to the AIP and to healthy living in general.

The following are links to published studies on the auto-immune protocol as well as links to a similar lifestyle intervention for Alzheimer’s disease. Another link is an editorial on inflammatory bowel disease and diet. The Autoimmune Protocol has been studied for Inflammatory Bowel Disease. In a peer reviewed published clinical trial it improved symptoms and inflammation seen on endoscopy, even producing remission in some patients. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647120/) It has also been studied for Hashimoto’s Thyroiditis and found to be effective .(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592837/)

Efficacy of the Autoimmune Protocol for Hashimoto’s Thyroiditis

Efficacy of the Autoimmune Protocol for Inflammatory Bowel Disease

Randomized control trial evaluation of a modified Paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: a pilot study.

Multimodal intervention improves fatigue and quality of life in subjects with progressive multiple sclerosis: a pilot study.

Diet and Inflammatory Bowel Disease

A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis.

Reversal of cognitive decline in Alzheimer’s disease.

Inhalational Alzheimer’s disease: an unrecognized – and treatable – epidemic.

A colleague and scientist (Pedro Bastos), after reading my post, sent the following links to related articles (two by Loren Cordain, and a Master’s Thesis by one of his graduate students). For those interested in understanding the theories of molecular mimicry as triggers and mechanisms in autoimmune disease, Cordain’s work is outstanding.

Cereal grains, double-edged sword, Loren Cordain, 1999, Evolutionary Aspects of Nutrition and Health.

Rheumatoid Arthritis, molecular mimicry, dietary lectins, Loren Cordain, 2000, British Journal of Nutrition

Master’s Thesis, auto-immune disease and Paleo Diet, Trevor Connor

Eat clean, sleep well, exercise out-doors, get sunshine, love and laugh.

Bob Hansen MD

Agent Orange AND glyphosate in our food? Scott Pruitt Strikes again

Scott Pruitt and the EPA has approved wider use of Dow Chemical’s new pesticide “Enlist Duo”.

The following is taken from the Center for Food Safety’s recent notification.

“Enlist Duo is a combination of glyphosate (the main ingredient in Roundup) and 2,4-D (one of the active ingredients in “Agent Orange”). This is the first time this novel pesticide cocktail will be sprayed directly over-the-top of corn, cotton, and soybeans that are genetically engineered (GE) by Dow specifically to be sprayed with both.

National Cancer Institute scientists highlighted 2,4-D specifically as associated with two- to eight-fold increases in non-Hodgkin’s lymphoma. The International Agency for Research on Cancer of the World Health Organization classified 2,4-D as a possible carcinogen to humans and glyphosate as a probable carcinogen to humans.

Despite these harms, EPA dramatically expanded its approval of Enlist Duo for use on more crops and over more acres in 2017. In fact the U.S. Department of Agriculture conservatively estimates that use of Enlist Duo on just corn and soybeans will increase 2,4-D use by 200 to 600%.”

I have discussed the dangers of glyphosate many times before.

Now the toxicity of glyphosate has been combined with an active ingredient from agent orange which was used during the VietNam war. Many VietNam veterans attribute various chronic illnesses to agent orange exposure. I have frequently heard complaints about nerve damage, chronic pain, memory problems, cognitive impairment, etc., during my consultation visits with Vietnam veterans exposed to agent orange.

“The government of Vietnam says as many as 3 million people have suffered illnesses because of Agent Orange.[3]”

“The aftermath of the use of Agent Orange in Vietnam resulted in massive legal consequences. The United Nations ratified United Nations General Assembly Resolution 31/72 and the Environmental Modification Convention. Lawsuits filed on behalf of both US and Vietnamese veterans sought compensation for damages.”

Scott Pruitt has been busy turning the EPA upside down and reversing the recommendations made by the EPA’s own scientists.

EPA scientists recently re-evaluated the harmful effects of organophosphate pesticides on children’s brain health and behavior. They concluded that  Chlorpyrifos (an organophosphate pesticide) is unsafe and the EPA scheduled a ban on the use of this toxic agent. Scott Pruitt stepped in and canceled the ban! The EPA then announced that it would not finish it’s safety analysis for chlorpyrifos until 2022. Even Dr. Oz and his journalistic partner Dr. Mike Rosen  (Director of the Health and Wellness Center at Cleveland Clinic) have commented on the danger of that decision in their “Health and Spirit” newspaper column.

From Wikipedia:

“Chlorpyrifos is considered moderately hazardous to humans by the World Health Organization.[7] Exposure surpassing recommended levels has been linked to neurological effects, persistent developmental disorders and autoimmune disorders. Exposure during pregnancy may harm the mental development of children, and most home use was banned in 2001 in the U.S.[8] In agriculture, it is “one of the most widely used organophosphate insecticides” in the United States, and before being phased out for residential use was one of the most used residential insecticides”

“Chlorpyrifos exposure may lead to acute toxicity at higher doses. Persistent health effects follow acute poisoning or from long-term exposure to low doses, and developmental effects appear in fetuses and children even at very small doses. [16]”

Organophosphates are used as pesticides and in chemical warfare. Organophosphate pesticide use in agriculture causes an estimated 3 million poisonings per year resulting in 200,000 deaths per year.

Be  careful out there. Make wise choices. Eat organic vegetables and fruits whenever possible and pay attention to the EWG’s list of the Dirty Dozen.

Doctor Bob

Anti-inflammatory diet, are 9 servings of vegetables per day possible?

I often recommend a specific diet to decrease inflammation, decrease pain, and improve healing of tissue. I have been asked by patients to post this nutritional plan on my website so here it is (see below). In addition to this post, I will place the diet on a separate page along with recipes for vegetable soup and bone broth.

The recipes (vegetable soup and bone broth) meet the anti-inflammatory diet guidelines and also follow the more restrictive “Autoimmune Protocol”. This nutritional approach provides an array of micro nutrients that fight inflammation, support tissue repair, decrease the risk of chronic disease, and help maintain  a healthy gut flora (good bacteria in the intestines).

When I recommend 9 servings per day of vegetables patients often tell me it is impossible to achieve.  But it is not impossible, nor is it impractical. Every Sunday afternoon I make a large pot of vegetable soup that will keep all week in the refrigerator. I bring  generous servings to work every day for breakfast, brunch, and/or lunch and add some meat or seafood prepared the evening before (left-overs) on the side. The key to eating 9 servings per day is to have a variety of vegetables at every meal. The vegetable soup makes that goal not just achievable but convenient.

The anti-inflammatory diet described below provides ample fiber to feed your healthy gut bacteria and avoids the sugar and refined starches that can produce gut dysbiosis (unhealthy balance of bacteria in the intestines). Vegetables provide five times the amount of fiber per calorie compared to grains. You do not need to eat bread or cereal to get fiber.

So here is the anti-inflammatory diet. it is consistent with the Mediterranean diet as well as an Ancestral-Paleo diet.

Caution: if you have diabetes and are taking medications, this diet reduces carbohydrates and eliminates added sugar so adjustments in diabetes medications are necessary to avoid potentially dangerous low blood sugars. So consult your physician or primary care practitioner.

9 SERVINGS  OF NON-STARCHY VEGETABLES PER DAY, 3 SERVINGS FROM EACH OF THREE CATEGORIES. Organic as much as possible. (Read about the Dirty Dozen here: Dirty Dozen | EWG’s 2017 Shopper’s Guide to Pesticides in Produce )

  1. DARK GREEN LEAFY VEGETABLES, 3 SERVINGS PER DAY EQUALS 3 CUPS MEASURED COOKED OR 6 CUPS MEASURED RAW
  • Arugula, Beet Greens, Bok Choy, Chard all colors, Chicory, Cilantro
  •  Dandelion Greens, Endive, Escarole, Kale-all kinds, Parsley, Radicchio
  • Radish leaves, Spinach, Turnip Greens, Watercress
  1. Colored vegetables, 3 cups daily:
  • GREEN: Artichoke, Asparagus, Avocado (FRUIT), Cabbage (red and green) Celery, Cucumber with skin, Okra, Olives, Peppers, Zucchini with skin
  • RED: Beets, red cabbage, red peppers, cooked tomatoes (fruit)
  • YELLOW: Carrots, Pumpkin, Squash-summer and winter, Sweet potato,
  1. SULFUR RICH VEGETABLES, 3 CUPS DAILY: Some leafy greens are also sulfur rich so there is overlap in these categories
  • Arugula, Asparagus, Bok Choy, Broccoli, Brussel sprouts, Cabbage, Cauliflower, Collard Greens, Garlic, Kale, Kohlrabi, Leeks, Mushrooms, Onions red-yellow-white, Radishes, Scallions, Shallots, Turnip Greens, Watercress.

Berries (any kind) ½ cup per day. This can be substituted for one serving of vegetables.

OMEGA-3 rich fish-seafood (at least 16 ounces per week)

  • Anchovies, clams, herring, mackerel, mussels, oysters, salmon, sardines, trout, calamari (squid), saltwater fish should be wild, shellfish farmed OK, farmed trout OK.

Meat ideally grass fed and grass finished, hormone and antibiotic free.

Poultry and eggs free range, any wild game meat or poultry.

Drink only filtered water, coffee, tea, bone broth (homemade is best) and kombucha.

No grains, cereal, bread, pasta, no food made from flour, no oats, wheat, barley, corn etc.

No legumes (beans), no peanuts

No dairy except Ghee for cooking (optional)

No processed food made with added sugar or hydrogenated oils (which contain trans-fats)

No “vegetable oils” (soy oil, corn oil, etc.)

Use only extra-virgin olive oil, coconut oil, avocado oil and ghee. Limit EVOO to low heat cooking or add after food is cooked. The other oils on this list have higher smoke points.

Do not use store-bought salad dressing which usually has added sugar and inflammatory vegetable oils. Make your own salad dressing with EVOO and vinegar or lemon juice.

For more information about the AIP (Autoimmune protocol)  I suggest you visit these websites:

Autoimmune gut-repair diet – Autoimmune protocol | Dr. K. News

The Autoimmune Protocol – The Paleo Mom

The Autoimmune protocol is more restrictive than the anti-inflammatory diet and is beneficial for individuals with autoimmune disease.

Live clean, sleep well, exercise outside in the sunshine, love and laugh.

Dr. Bob

GMOs are dangerous, no doubt. Roundup and glyphosate are bad players.

 

I have discussed the dangers of GMO foods and Roundup before.

The evidence continues to mount.

“A peer-reviewed article, published  November 7, 2017, in the International Journal of Human Nutrition and Functional Medicine, demonstrates that GMOs are likely taking a heavy toll on our health. And a survey of 3,256 people who avoided them reported astonishing improvements in 28 health conditions.”

You can find a summary of the salient points from this scientific article here.

But I suggest you read the first few pages of the full article here.

The first few pages of this article describe the history of GMOs and how the warnings of  FDA scientists were silenced by regulatory executives who were shills for the likes of Monsanto and other dangerous players in this sad history.

11 genetically modified food crops are currently grown for commercial consumption. The six major crops are soy, corn, cotton, canola, sugar beets and alfalfa which are used to feed humans and animals. Cottonseed and canola are also processed into “food-grade” oils and sugar beets are refined to make sugar.

  • All six major GMOs are engineered to be herbicide tolerant, to survive spray of weed killer (such as Roundup)
  • 89% of GMOs grown in the US are herbicide tolerant
  • The most common herbicide involved is Roundup
  • 94% of soybeans grown in the US are Roundup Resistant (RR)
  • Some varieties of corn and cotton have genes inserted that produce a toxic insecticide called Bt toxin.
  • 76% of corn grown in the US is both Bt-producing and herbicide tolerant, 80% of cotton are both Bt and herbicide tolerant.

Roundup is not only used to kill weeds, but it is now sprayed heavily on crops immediately before harvest as a desiccant (drying agent) and large measurable amounts are found in the foods that you purchase in the supermarket.

In 1998 the FDA was sued by the Alliance for Bio-integrity and forced to turn over tens of thousands of pages of internal memos related to GMOs. FDA scientists repeatedly warned their superiors that GMO foods could create serious health risks such as allergies, toxins, antibiotic resistant diseases and nutritional problems. Michael Taylor, the former outside attorney for Monsanto and subsequent vice president of government and regulatory affairs for Monsanto was the political appointee in the FDA charged with overseeing GMOs!

On May 8, 2009,, the American Academy of Environmental Medicine published their policy paper on GMOs citing animal studies that revealed:

  • infertility,
  • immune dysregulation,
  • accelerated aging,
  • dysregulation of genes associated with cholesterol synthesis,
  • faulty insulin regulation, cell signaling and protein formation,
  • changes in the liver, kidney, spleen and gastrointestinal system

The AAEM recommended that the US government implement a moratorium on all GM foods and urged physicians to prescribe non-GMO diets.

But Monsanto prevailed and FDA officials ignored the warnings of their own scientists.

The three general categories of GMO danger include:

  1. consequences of the GMO transformation process
  2. the Bt toxin found in GMO corn and cotton
  3. the herbicides-particularly Roundup, that are sprayed on most GMO foods and consumed by those who eat GMO food.

A study of Monsanto’s RR corn revealed 117 proteins and 91 small molecule biochemicals significantly different from natural corn. Some of those differences “enhance the effects of histamine, thus heightening allergic reactions” and two of the polyamines in the GMO corn have been implicated in the formation of carcinogens (nitrosamines).

The GMO process can produce a host of unintended changes in RNA, DNA,  proteins and genes. And these changes can migrate and hybridize with non-GMO foods when the wind blows seeds from GMO plants into fields planted with non-GMO plants.

Altered Genes (transgenes) from GMO foods may “horizontally transfer” to humans or other organisms including the gut bacteria in humans that control much of our physiology.

Studies of rats fed GMO potatoes demonstrated adverse effects on every organ in young rats. Most changes occurred within 10 days. Disruption of organ growth, immune suppression and damage to organs of the immune system, thickening of the stomach and intestinal lining were noted.

Monsanto’s own data show that GM soybeans contain up to seven times the level of a natural allergen (trypsin inhibitor which also impairs protein digestion) and a doubling of soy lectin which impairs nutrient absorption. These were unintended consequences of the GMO process.

Monsanto’s MON810 Bt corn has 43 genes significantly altered in levels of expression. One of these genes which is normally switched off in non-GMO corn is switched on in the GMO version and it produces an allergenic protein.

Glyphosate is the major antibiotic in Roundup (yes Roundup is classified as an antibiotic). I have discussed the great hazards of glyphosate before. On October 24, 2017 JAMA published a study of the increase in measurable levels of glyphosate in humans.

The researchers compared urine excretion levels of glyphosate and aminomethylphosphonic acid (AMPA) in 100 people living in a Southern California community who provided samples during five clinic visits that took place between 1993 to 1996 and 2014 to 2016.

“What we saw was that prior to the introduction of genetically modified foods, very few people had detectable levels of glyphosate,” . “As of 2016, 70 percent of the study cohort had detectable levels.”

In July 2017, glyphosate was listed as a carcinogen by California.

A 2014 review concluded that:

Evidence is mounting that glyphosate interferes with many
metabolic processes in plants and animals and glyphosate residues have been detected in both.
Glyphosate disrupts the endocrine system and the balance of gut bacteria, it damages DNA and is a driver of mutations that lead to cancer.

There are many reasons to follow an organic, GMO-free, whole foods ancestral diet. Contamination with Roundup presents yet another compelling reason to choose your food wisely.

Some folks prefer videos to research articles, so below you will find both.

 

Here are a few links that will take you to articles related to this topic and quoted above.

Survey Reports Improved Health After Avoiding Genetically Modified Food

Genetically engineered crops, glyphosate and the deterioration of health in the United States of America

Environmental and health effects of the herbicide glyphosate. – PubMed – NCBI

Glyphosate: environmental contamination, toxicity and potential risks to human health via food contamination. – PubMed – NCBI

Aluminum and glyphosate can synergistically induce pineal gland pathology: connection to gut dysbiosis and neurological disease

GMO crops increase pesticide use

The high cost of pesticides: human and animal diseases

Is roundup the toxic chemical that’s making us all sick

Scientists Back Up WHO’s Classification of Glyphosate as “Probably Carcinogenic”

Food for thought: Are Herbicides a Factor for the Increase in Allergies and Autism?

Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance

Glyphosate, pathways to modern diseases III: Manganese, neurological diseases, and associated pathologies

Glyphosate, pathways to modern diseases IV: cancer and related pathologies

Glyphosate pathways to modern diseases V: Amino acid analogue of glycine in diverse proteins

GMOs, herbicides, and public health

Glyphosate induces human breast cancer cells growth via estrogen receptors

Glyphosate‐based pesticides affect cell cycle regulation

Glyphosate-based herbicides are toxic and endocrine disruptors in human cell lines

Environmental and human health impacts of growing genetically modified herbicide‐tolerant sugar beet: a life‐cycle assessment

Unidentified inert ingredients in pesticides: implications for human and environmental health

The possible link between autism and glyphosate acting as glycine mimetic—A review of evidence from the literature with analysis

Eat organic fruits and vegetables, avoid GMOs, enjoy better health.

Dr. Bob

The Broken Brain Docuseries is now re-running

Due to popular demand the producers of this terrific series are making it available again  on line this weekend. If you have not taken advantage of this information you can do it here:

Replay (YouTube) | Broken Brain

Enjoy

Bob Hansen MD

Endocrine Disrupting chemicals in food, containers and environment results “in a range of human diseases and abnormalities.”

The findings of four articles recently published in the Journal of Clinical Endocrinology and Metabolism were presented on March 5 at a press briefing held at the Endocrine Society’s annual meeting, ENDO 2015, Despite the incredible public health implications of these four studies little has been reported in the popular press.

I have previously discussed the Environmental Working Group’s list of the Clean Fifteen and the Dirty Dozen toxic chemicals | Practical Evolutionary Health as well as the impact of environmental toxins on our epidemic of auto-immune disease Babies born with more than 200 toxic chemicals in their blood | Practical Evolutionary Health .

The press briefing and the findings of these four studies were reported on-line Endocrine Disruptors Cause Range of Diseases; Cost 157 Billion Euros

The estimated health effects of pesticides, chemicals used in personal care products, aluminum can liners, flame retardants in clothing, mattresses, furniture,  etc., included the following

From pesticides:

  • 59,300 infants born with intellectual disability
  • 28,200 people aged 50-64 years with type 2 diabetes
  • 13 million lost IQ points in each EU country

From Phtalates used in food wraps, cosmetics, shampoos, vinyl flooring

  • 24,800 deaths among 55-64 year old men
  • 618,000 additional assisted-reproductive technology procedures to treat infertility
  • excess of obesity and diabetes among women aged 50 to 64

Flame retardants in electronics, furniture, mattresses:

  • 3290 intellectually disabled children
  • 873,000 lost IQ points
  • 6830 cases of testicular cancer
  • 4615 children born with undescended testes

Other estimates from endocrine disruptors included:

  • 316 autistic 8 year olds EACH YEAR
  • 31,200 ten year olds with ADHD

Here are some snippets from the on-line Medscape report.The economic costs are reported in Euros since this was a study of European data. Bear in mind that the European Union has more stringent environmental protection than the United States. As a result, a study using US data would likely show even greater damage.

The papers cover overall costs of selected disorders attributed to specific endocrine-disrupting chemicals, as well as more detailed analyses of costs related to endocrine-disrupter–linked obesity and diabetes, neurobehavioral deficits/disease, and male reproductive disorders/diseases.

“Limiting our exposure to the most widely used and potentially hazardous endocrine-disrupting chemicals is likely to produce substantial economic benefit,” lead author of the overview study, Leonardo Trasande, MD, from New York University, said at the briefing.

The European Union defines an endocrine-disrupting chemical as an “exogenous substance that causes adverse health effects in an intact organism or its progeny, secondary to changes in endocrine function.”

With exposures occurring via pharmaceuticals, industrial solvents, personal-care products, aluminum-can linings, plasticizers, pesticides, and environmental pollutants, chemicals known to be endocrine disrupting include diethylstilbestrol, polychlorinated biphenyls (PCBs) , dioxins, perfluoroalkyl compounds, solvents, phthalates, bisphenol A (BPA), dichlorodiphenyldichloroethylene organophosphate/organochlorine pesticides, and polybrominated diphenyl.

Affected hormones include estrogen, androgen, thyroid, retinol, aryl hydrocarbon, and the peroxisome proliferator-activated receptor (PPAR) pathway. In all, 13 chronic conditions have strong scientific evidence for causation by endocrine-disrupting chemicals, Dr Trasande said.

“There are safe and simple steps that families can take to limit their exposure to endocrine-disruptive chemicals. They can avoid microwaving plastic. They can avoid eating from aluminum cans or drinking fluids from aluminum cans. They can eat organic. Or even simply air out their homes every couple of days to remove some of the chemical dust…that can disrupt hormones in their bodies.”

Using estimates based on the literature and established statistical methods adapted from those used by the Intergovernmental Panel on Climate Change, Dr Trasande led a 12-member scientific steering committee, which determined that there was probable causation of endocrine-disrupting chemicals for IQ loss and associated intellectual disability, autism, attention-deficit/hyperactivity disorder (ADHD), childhood obesity, adult obesity, adult diabetes, cryptorchidism, male infertility, and mortality associated with reduced testosterone.

Using mid-point estimates for probability of causation, the panel calculated a median cost of €157 billion, or 1.23% of the EU gross domestic product, with a lower median range of €119 billion and a high end estimate of €270 billion.

Dr Trasande summarized results from the four papers at the briefing, including these data points:

  • By health effect, the greatest cost was for neurological problems, including ADHD, at €132 billion. By endocrine-disrupting chemical type, pesticides were the most costly, accounting for €120 billion.
  • Pesticides accounted for 13 million lost IQ points in each EU country, costing €124 billion in earning potential. They were also responsible for 59,300 infants born with intellectual disability (€24.6 million), and 28,200 people aged 50-64 years with type 2 diabetes, at a cost of €835 million.
  • Phthalates, used in food wraps, cosmetics, shampoos, and vinyl flooring, resulted in 24,800 additional deaths among 55- to 64-year-old men, costing €7.96 billion in lost economic productivity; and 618,000 additional assisted-reproductive-technology procedures, costing €4.71 billion, Dr Trasande reported. Phthalates also accounted for an excess of obesity and diabetes among women aged 50 to 64, totaling more than €15.6 billion.
  • Flame retardants used in electronics, furniture, and mattresses resulted in 873,000 lost IQ points, leading to €8.4 billion in lost earning potential; 3290 intellectually disabled children, costing an additional €1.9 billion; 6,830 new cases of testicular cancer, at €850 million; and 4615 children born with undescended testes, at €130 million.
  • Other estimates of burden and disease and costs include 316 autistic 8-year-olds each year from multiple endocrine disrupting chemicals, costing €199 million; 31,200 10-year-olds with ADHD (also from multiple endocrine-disrupting chemicals), at €1.7 billion; and BPA used in aluminum-can linings and thermal-paper receipts, being associated with 42,400 obese 4-year-olds at an annual cost of €1.54 billion.

Dr Trasande said that a similar analysis for the United States would be “the logical next step” and that he would anticipate analogous findings, although there are some differences. Brominated flame retardants are more stringently limited in Europe, for example, but levels of phthalates have decreased 17% to 37% in the United States between 2001 and 2010.

Keep in mind that these studies were published in the peer-reviewed Journal of Clinical Endocrinology and Metabolism. They do not represent a governmental agency report, which is frequently tainted by the influence of lobbyists and scientists with conflicts of interest. Whether the European governments respond to this data in a meaningful way remains to be seen. Given the Republican majority in both the US Congress and US Senate as well as the sad state of journalism in the US it is likely that this scientific data will fall on deaf ears.

Nevertheless, we all have the opportunity to educate ourselves about these dangers to the health of our families and make changes in our daily lives that might limit the damage to our personal health and the health of those we love.

Do not drink water from plastic bottles. Do not drink soda or fruit juices from plastic or aluminum containers. Do not microwave food in plastic containers or store warm food in plastic containers. Eat organic vegetables and fruits whenever possible and avoid especially non-organic produce from the Dirty Dozen

Despite the manufacturers claims to the contrary, BPA used to line aluminum cans is not safe, same for BPA used in thermal paper receipts. “BPA free” hard plastic containers and metal containers lined with BPA replacements will likely prove to be unsafe in the future.

That “new-car” smell and “new-furniture” smell may contain endocrine disrupting flame retardants off-gassing. So open your windows and get rid of those odors, use HEPA air-filters at home. Consider having your old furniture reupholstered instead of buying new furniture. Apply only safe personal care products to your body (visit the EWG website for more information)Consumer Products | Environmental Working Group

Live clean, eat clean.

BOB

Babies born with more than 200 toxic chemicals in their blood

The  Environmental Working Group (EWG) is a non profit organization devoted to protecting the public from one of our greatest health threats, pollution in all of it’s forms. The EWG supported a study in which newborn infants were tested for known industrial and agricultural toxic chemicals. All of the infants had > 200 and some up to 300 toxic chemicals found circulating in their blood at birth. These babies were not born to parents living in or near toxic waste dumps, or working in dangerous industrial environments. They were born to parents living like you and me. You can read about this and many other issues here.

The 1976 Toxic Substances Control Act grandfathered >70,000 industrial and agricultural chemicals already in use as “safe” and provided for no effective standardized testing requirements for the introduction of new chemicals. Heather White, Executive Director of the EWG was recently interviewed for an  Autoimmune Summit. I have attended this health related summit on-line while recovering from my surgery and was shocked to hear and then read about out environmental exposure and lack of protection.

We often think about pollution and environmental toxins as contributing to cancer, birth defects, asthma and similar problems but auto-immunity is another problem with links to our toxic exposure.

During the Auto-Immune Summit Aristo Vojdani, Ph.D., M.Sc., M.T. scientist and editor of a peer-reviewed journal on auto-immunity, estimated that 60% of auto-immune diseases are “triggered” by environmental toxins, 30% triggered by dietary components, and 10% triggered by infectious disease. He distinguished triggers from predisposing factors which represent the physiologic milieu that leads to auto-immunity. This terminology of triggers vs. predisposing factors may seem confusing and arbitrary. In a nutshell, underlying the molecular mimicry theory of auto-immunity is “leaky gut”.  The “gateway to autoimmunity” is “leaky gut” (increased intestinal permeability) which allows foreign substances to cross the intestinal barrier, enter the circulation and challenge our immune system. Leaky gut  has many contributing factors including but not limited to diet, stress, gut dysbiosis and infections.  Although the % of auto-immune disease that is “triggered by” environmental toxins (versus diet and infections) remains speculative, there is mounting evidence that all of these factors contribute to greater or lesser degrees in various patients.

The paleo community has often stressed the importance of eliminating specific foods and replacing sugar laden flour foods with nutrient dense foods. But emphasis has also been placed on eating organic foods to avoid pesticides, herbicides and hormones.

Dr Vojdani has suggested that in addition to the gut-immune related mechanisms of molecular mimicry, environmental toxins, especially heavy metals, BPA and organic solvents,  act not only has foreign invaders stimulating the immune system but also stimulate the immune system by causing tissue damage directly and thereby presenting damaged or transformed tissue to the immune system as foreign. Environmental toxins do not require a leaky gut to enter our bodies. Many are absorbed through our lungs and skin, and many are directly absorbed through our guts even in the absence of a “Leaky gut”. Heavy metals including mercury, lead and cadmium do not require a leaky gut for intestinal absorption, nor do pesticides, herbicides or hormones administered to the animal we consume. They wreak havoc not only by directly damaging our organs but also by altering our immune system.

Dr Noel Rose, Director of Center for Autoimmune Research (John’s Hopkin’s University) and Dr. Ahmet Hoke, Director, Division of Neuomuscular Disease (John’s Hopkins NIMH Center) opine that our rising rates of auto-immune disease are the result of our “unsuccessful adaptation to new environmental agents”. (See Forward written in Last Best Cure | Donna Jackson Nakazawa.)

The  Government Accountability Office (GAO) is the Federal Government’s internal watchdog agency. A GAO report ( U.S. GAO – Environmental Justice: EPA Needs to Take Additional Actions to Help Ensure Effective Implementation) revealed that 85% of the new chemicals introduced into our environment are not accessed for safety. The  Environmental Protection Agency receives 90 days notice prior to the introduction of new chemicals (industrial, agricultural, etc). Industry does not have the burden of proof relative to safety. Instead, the EPA must determine, within 90 days, if a new chemical is “safe”. Shouldn’t it be the other way around?

Beyond that issue we have the problem of multiple  low grade simultaneous exposures. If a given level of toxin is “safe” based on short term studies of animals or humans, how do we know that a combination of hundreds or thousands of toxins over many years are “safe”. Likewise, if  air concentrations or water concentrations of a single toxin are deemed “safe” how can we possible test the combined effects of hundreds and thousands of environmental toxins in our air, water, soil and food?

The EPA, created under the Nixon administration, was decimated during the Bush administration when budget cuts resulted in the loss of > 50% of it’s senior scientists. With that executive action most of the EPA’s institutional memory was lost and along with it many of the already limited safeguards we had in place.

The concept of “eating clean” minimizes exposure to the potentially harmful effects of anti-nutrients  and immune stimulants (harmful plant lectins and saponins, excess phytic acid, excess omega 6 fatty acids) and more importantly encourages the consumption of nutrient dense foods (lots of colorful vegetables, grass fed meats, wild seafood). But “eating clean” also requires avoiding environmental toxins, including pesticides and herbicides.

To achieve that goal within a budget you can consult the EWG’s lists of foods that have the most and the least amount/variety of pesticides/herbicides. These lists are called the “dirty dozen” and the “clean fifteen”.

To avoid heavy metal exposure (especially mercury) eat seafood that is low on the food chain (less opportunity to accumulate mercury in their tissue). Many people do not realize that most of the mercury in our seafood comes from burning coal. Multiple heavy metals are present in coal. When coal is burned to generate electricity the heavy metals are released into the air and are then washed into our rivers, streams, lakes and oceans where they can accumulate in fish. As the heavy metals work up the food chain they accumulate in tissues. The best/safeest sources of healthy omega three fats are in smaller cold water fish (sardines, anchovies, small mackeral, salmon, trout). And do not forget oysters, scallops,  mussels,  and clams which may have less amounts of omega 3 fats but are safe with respect to heavy metals being low down on the food chain.

The concept of “living clean” involves more than being selective about food and cooking techniques. It involves avoiding exposure to toxic chemicals which can be found in our water (drinking and bathing), air, soil, clothing, furniture, make-up, deodorant, toothpaste and household cleaners. You can learn about these exposures at the EWG’s website. Consumer Guides | Environmental Working Group

Here is a fact that might get your attention, 90% of red lipstick has mercury in it. That’s right, 90%. Every day women around the world are painting their lips with lipstick that has mercury. The average American uses 10-12 personal care products per day which exposes us to 120 or more toxic ingredients. The law that regulates personal care products was written in 1938 (after a woman became blind from using mascara). It needs to be updated and there is much lobbying against better regulation (lots of money in personal care products an make-up). In the meantime we need to be more aware about what we put on and in our bodies.

Our environment is filled with “endocrine disruptors” which mimic and interfere with our hormones. The most common one is BPA (plastic) which has estrogen like effects.

What are our greatest exposures to BPA? Answer: plastic lids on coffee/tea to-go cups, plastic bottles of soda and plastic bottles containing citrus juices. Heat and acid both leech BPA (and probably other toxins) out of plastic into the liquids we drink. The most acidic beverage by far is SODA (as low as pH 2.2). So toxic chemical exposure is yet another reason to avoid soda. Do not serve your guests soda or water in plastic containers at parties. Set an example. Store your foods in glass containers and especially do not put warm or hot food into plastic containers. Get a water filter for your drinking water. Some even go so far as to get a water filter for their showers and baths.

Finally, flame retardants (furniture and clothing) required by law represent major health hazards by filling the air of our homes and exposing our skin to toxic substances. Mothers and toddlers have an estimated 3 times greater risk for this exposure which has been linked to neuro-development disorders, ADHD and endocrine disruption. Firefighters have very elevated levels of toxic chemicals derived from flame retardants. Some patients with a variety of illnesses have seen improvement in symptoms by having their furniture re-upholstered with coverings that do not contain flame retardants (anecdotal reports). Consider getting a HEPA air filter for your home and office. Remember hurricane Katrina? Remember the great number of illnesses reported by families made homeless by Katrina who were relocated to live in temporary portable housing. Those buildings were releasing formaldehyde and other toxic chemicals and produced illness within just a few days.

In my next post I will provide the “dirty dozen” and “clean fifteen” lists to help you make decisions about organic food purchases if you cannot afford to purchase 100% organic. In the meantime check out the EWG website. Also coming soon is a recipe for tumeric-ginger tea/marinade as an anti-inflammatory alternative to NSAIDs.

Live Clean and Prosper

Bob Hansen MD.

The Bacteria in your Gut are essential to your health Part I

Our human body consists of about 100 trillion cells but we carry about 1000 trillion bacteria in our intestines, that represents 10 times the amount of our own cells. (1) These bacteria are variously called our micro-flora, microbiome, gut flora, etc, along with viruses and other organisms that co-exist and co-evolved with us. Advances in rapid gene identification have enabled an explosion of knowledge related to our micro-flora, health and disease. We each carry an estimated 500 to 1000 different species of bacteria in our intestines and the balance/mix of these bacterial species can have profoundly positive or negative affects on our health. Patterns of micro-flora have been identified for a variety of human disorders including obesity, diabetes type I, several kinds of cancer and  inflammatory bowel disease to name a few. The issue of association vs. causation remains to be resolved but the beneficial and therapeutic effects of pro-biotics and fecal transplant (in rodent and human studies) in a variety of situations along with the observed deleterious effects of interrupting our micro-flora speak in favor of a causative or contributory role. (2) (3)

Accumulating evidences indicate that some diseases are triggered by abnormalities of the gut microbiota. Among these, immune-related diseases can be the promising targets for probiotcs. Several studies have proved the efficacy of probiotics for preventing such diseases including cancers, infections, allergies, inflammatory bowel diseases and autoimmune diseases. Lactobacillus casei strain Shirota (LcS) is one of the most popular probiotics, benefits of which in health maintenance and disease control have been supported by several science-based evidences.(2)

Early microbial colonization of the gut reduces the incidence of infectious, inflammatory and autoimmune diseases. Recent population studies reveal that childhood hygiene is a significant risk factor for development of inflammatory bowel disease, thereby reinforcing the hygiene hypothesis and the potential importance of microbial colonization during early life. (3)

Early-life environment significantly affects both microbial composition of the adult gut and mucosal innate immune function. We observed that a microbiota dominated by lactobacilli may function to maintain mucosal immune homeostasis and limit pathogen colonization. (3)

The human GI tract starts with the mouth and ends with the rectum. In between lay the esophagus, stomach, and intestines which consist of the duodenum, jejunum, ileum, and colon.

The surface area of the intestines equals that of a tennis court providing a huge area for absorption, digestion and interaction between our immune system and the micro-flora. This large surface area is the result of the intestinal micro-villi which produce an undulating surface resembling a series of peaks and valleys. The constant interplay between our immune system (4) and our micro-flora from birth to death along with the signaling and communication that occurs between our micro-flora and our nervous system (5,6,7) present two physiologic mechanisms for potential symbiosis (mutually beneficial interaction) vs dysbiosis (disease causing relationship).

Before birth the mouth, skin and intestine of the fetus is sterile. The first major introduction of bacteria to the infant occurs with birth  when the infant swallows bacteria in the mother’s birth canal and the infant’s skin becomes colonized by the mother’s bacteria. Infants born by cesarean section lack this initial exposure and they suffer increased risk of allergic and auto-immune disease (8). The rate of cesarean section in the US is now about 30 % and along with that increase there has been an observed increase in allergy, auto-immune and other diseases.

The second major addition to human gut and skin flora occurs with breast feeding and again breast-fed infants show decreased rates of allergy and auto-immune disease as well as decreased infections compared to bottle fed infants.

The interaction between the micro-flora and the immune system presents many complex relationships and interactions. Immune tolerance allows the immune system to recognize “self” and “friendly bacteria”  limiting the development of auto-immune disease and enhancing anti-inflammatory processes. At the other extreme recognition of “non-self”  allows for the recognition and disposal of “foreign” invaders such as infections or mutated cancer cells.

“The Old Friends Hypothesis”
Common organisms interact with dendritic cells in the GI tract, leading to increased maturation of dendritic cells. When there is interaction with these organisms again, the dendritic cells increase Treg maturation; not Th1 or Th2. This increases the baseline amount of anti-inflammatory cytokines, producing a Bystander Suppression. Another consequence of the increased number of mature dendritic cells is as they interact with self antigens, they increase the number Treg specific to these antigens. This is referred to as Specific Suppression. Together these two arms lead to tolerance of both self antigens as well as those of helpful gut organisms. (8)

Translation:  Treg or Regulatory T cells regulate the immune system and help prevent auto-immune disease and allergic reactions. Th1 and Th2,  T helper cells , on the other hand, increase inflammation and help our bodies defend against infection. The balance between Tregs and Th1, Th2 cells governs inflammatory responses.

Premature infants have an increased risk of a developing a very severe illness called necrotizing enterocolitis. Human studies have demonstrated significant risk reduction for this problem with the administration of pro-biotics to infants in neonatal intensive care units. (9)

Similarly, administration of pro-biotics during the first few years of life (to mother and child)  have been associated with decreased risk of eczema in children. While some studies suggest reduction of allergies and asthma in children, the regular use of probiotics remains undecided relative to preventing food allergies or asthma (10, 11).

Due to the recent exponential increase in food allergies and atopic disorders, effective allergy prevention has become a public health priority in many developed regions. Important preventive strategies include the promotion of breastfeeding and vaginal deliveries, judicious use of perinatal antibiotics, as well as the avoidance of maternal tobacco smoking. Breastfeeding for at least 6 months and introduction of complementary solids from 4-6 months are generally recommended. Complex oligosaccharides in breast milk support the establishment of bifidobacteria in the neonatal gut which stimulate regulatory T lymphocyte responses and enhance tolerance development…Perinatal supplementation with probiotics and/or prebiotics may reduce the risk of atopic dermatitis, but no reliable effect on the prevention of food allergy or respiratory allergies has so far been found. A randomized trial on maternal fish oil supplementation during pregnancy found that atopic dermatitis and egg sensitization in the first year of life were significantly reduced, but no preventive effect for food allergies was demonstrated. (10)

Thus birth by cesarean section increases risk and  breast feeding decreases risk of immune related problems (allergies, auto-immune disease and infection ). Use of probiotics for mother and child decrease the risk of eczema but the use of probiotics in preventing asthma or food allergy remains unsettled. There are a host of possible probiotics available that include various combinations of “healthy bacteria”. Future posts will discuss some of these.

Our micro-flora are constantly exposed to potential changing agents. Known influences include antibiotics (as medications or in the foods that we eat), stress, sleep, and diet. Because of the ubiquitous use of antibiotics in agriculture and animal husbandry, and the sometimes excessive use of antibiotics in medicine our microbiome is frequently changed by external factors. Many experts on the microbiome  consider these influences harmful and attribute the rising rates of several diseases as consequences of disruption in our gut flora.

Clostridium Difficile Colitis , a serious infection or overgrowth of the bacterium Clostridium difficile in the intestine occurs most commonly as a result of antibiotic administration to treat infections. This serious problem responds to anti-biotic treatment (ironically both the cause and cure) 90% of the time with the first round of treatment but there is a high incidence of recurrence due to the fact that C-difficile spores are resistant to antibiotics and can cause recurrent infection. In refractory or recurrent C-difficile cases a fecal transplant (FMT or fecal microbiota transplant) from a healthy human results in a 90 to 95% cure rate with the first treatment.

Antibiotic usage disrupts the normal gut flora and leads to an increased predisposition to CDI. The risk of recurrent CDI after initial treatment of the first infection is approximately 20–25% [Kelly and Lamont, 2008; Khanna et al. 2012g] and is further increased up to 60% with the use of additional systemic antibiotics and subsequent CDI recurrences [Hu et al. 2009]. The pathophysiology of recurrent CDI involves ongoing disruption of the normal fecal flora and an inadequate host immune response. Standard CDI treatment with antibiotics such as metronidazole and vancomycin further disrupts colonic microbial communities that normally keep expansion of C. difficile populations in check. Since C. difficile spores are resistant to antibiotic therapy for CDI, they can germinate to vegetative forms after treatment has been discontinued and lead to recurrent CDI. (12)

The authors of this study review the data for fecal microbiota transplant and summarize by stating:

Therefore, existing literature suggests that fecal transplant is safe and effective with over 500 cases of recurrent CDI with no serious adverse events reported to date. FMT appears to be an appropriate treatment option for multiple CDI recurrences and may be considered for refractory moderate to severe C. difficile diarrhea, failing standard therapy. The FDA had recently announced that an Investigational New Drug Application would be required for use of FMT for CDI, but this was later changed to the use of an informed consent process to ensure communication of potential risks.

In the area of obesity rodent studies have demonstrated that fecal transplants from thin to obese subjects results in significant weight loss. Measurable differences in the microbiome of obese vs thin humans have been identified.

The prevalence of obesity and related disorders such as metabolic syndrome has vastly increased throughout the world. Recent insights have generated an entirely new perspective suggesting that our microbiota might be involved in the development of these disorders. Studies have demonstrated that obesity and metabolic syndrome may be associated with profound microbiotal changes, and the induction of a metabolic syndrome phenotype through fecal transplants corroborates the important role of the microbiota in this disease. (13)

The issue of gut flora and obesity deserves a dedicated post. Multiple research articles and review articles have been published on the topic of fecal transplantation in relation to obesity, diabetes, metabolic syndrome, autoimmune disease and cancer. (14,15,16)

Diabetes, obesity, allergy, auto-immune disease, infections, psychiatric disorders and cancer represent examples of the potential interplay between the human microbiome, human health and disease. Multiple sources of information suggest a cause and effect relationship. The results of fecal transplantation in human and rodent studies, manipulation of the gut flora with pro-biotics and pre-biotics, data on the effects of vaginal vs cesarean delivery, and the benefits of breast feeding all proclaim the importance of our micro-flora.

Most traditional cultures have one or more forms of fermented foods. Examples include yogurt, kefir, sauerkraut, kim chee, beet kvass, kombucha. Almost any food can be fermented to produce health promoting probiotics and there is a growing movement for home-fermentation and/or consumption of purchased fermented foods. In addition to the pro-biotic nature of fermented foods and beverages, fermentation offers other potential health benefits. These include reduction of the anti-nutrients found  in various neolithic  foods (such as mineral binding phytic acid found in grains and legumes, digestive enzyme inhibitors found in soy and other legumes). Other potential health benefits include the production of Vitamin K2 found in many fermented foods.

This discussion barely scratches the surface of gut flora, health and disease. Future posts will address how our gut bacteria produce essential nutrients and affect mental health as well as physical health. Other important topics include how our activity, food, sleep and stress affect the our gut ecology. The system is dynamic with effects going in both directions.

Following the references below you will find links to NPR discussions of related topics. You can choose to read the articles and/or listen to the NPR interviews and reports.

Peace, happiness and longevity.

BOB

(1) Microbes in Gastrointestinal Health and Disease

(2) Probiotics as efficient immunopotentiators: Translational role in cancer prevention

(3) Environmentally-acquired bacteria influence microbial diversity and natural innate immune responses at gut surfaces.

(4) Has the microbiota played a critical role in the evolution of the adaptive immune system?

(5) It’s a Gut Feeling – how the gut microbiota affect… [J Physiol. 2014] – PubMed – NCBI

(6) Metabolic tinkering by the gut microbiome: Impl… [Gut Microbes. 2014] – PubMed – NCBI

(7) The gut-brain axis rewired: adding a functional vaga… [FASEB J. 2014] – PubMed – NCBI

(8) Cesarean versus vaginal delivery: long-term infant outcomes and the hygiene hypothesis.

(9) Probiotics for prevention of necrotizing enterocolitis in preterm infants.

(10) Preventing atopy and allergic disease.

(11) Gut microbiota and allergic disease: new findings.

(12) Clostridium Difficile Colitis ,

(13) Gut microbiome, obesity, and metabolic dysfunc… [J Clin Invest. 2011] – PubMed – NCBI

(14) Fecal microbiota transplantation: indications, methods, evidence, and future directions.

(15) Fecal microbiota transplantation: past, present and future.

(16) Therapeutic potential of fecal microbiota transplantation.

Here are the NPR and other links.

Interview: Martin Blaser, Author Of ‘Missing Microbes’ : NPR

FDA Backs Off On Regulation Of Fecal Transplants : Shots – Health News : NPR

Human Microbiome Project – Home | NIH Common Fund

Staying Healthy May Mean Learning To Love Our Microbiomes : Shots – Health News : NPR

Gut Bacteria Might Guide The Workings Of Our Minds : Shots – Health News : NPR

Worried That Your Baby’s Sick? There May Be An Upside : Shots – Health News : NPR