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Dear Doc: Wheat, gluten, inflammation — baffling!

Dear Doc: Wheat, gluten, inflammation — baffling!

Dear Dr. K: I’ve had a blood test for gluten sensitivity, allergy tests for wheat and even an intestinal biopsy for celiac. All the tests are negative, but I still feel better when I avoid wheat. What gives?

What gives is that wheat is not good for you. No medical test is perfect. Even “gold standard” tests such as chest X-ray for pneumonia or cardiac catheterization for coronary blockage sometimes fail to demonstrate an existing abnormality. The bottom line is to listen to your body – it almost always gives reliable feedback.

I suspect you feel better wheat-free for one of two reasons: 1.) You are wheat-allergic or gluten sensitive, despite negative tests or, 2.) You are feeling metabolic and inflammatory buffeting from wheat.

Regarding the first possibility, the Mayo Clinic published research data from their GI department. They found that 15 percent of their patients with chronic GI problems improved on a wheat-free diet, despite negative tests for gluten sensitivity. They posited that perhaps a better test for gluten sensitivity needs to be invented.

With respect to the second possibility of metabolic and/or inflammatory problems, this case was probably best summed up by Dr. Daniel Lieberman, a Harvard social anthropologist, in his book, The Story of the Human Body. He maintains that the cultivation of wheat, starting 10,000 years ago, was both the best and worst step for humans. He contends the ability to farm allowed humans to move from sparsely populated hunter-gatherers to the burgeoning population of civilized humans who have covered the globe.

The trade-off, he says, is a dramatic increase in the “civilized” diseases of metabolism and inflammation. Ghrelin, leptin, adiponectin and insulin are crucial to proper metabolism and weight management, and all four are adversely affected by wheat. He points out the phytic acid (phytate) in wheat severely reduces absorption of essential micronutrients and vitamins.

With respect to inflammation, gluten is pro-inflammation; in addition, wheat contains the lectin WGA (wheat germ antibody). Lectins are proteins that bind to the glycoproteins and glycolipids found in many cells in the body. These include: skin, respiratory system, GI tract, nerves, cartilage, connective tissues, prostate, kidneys, pancreas, liver, uterus and thyroid. This binding serves as a promoter of inflammation in these tissues. Lieberman draws a direct parallel between the increased consumption of wheat and the appearance of “modern” diseases such as diabetes, heart disease, autoimmune diseases, allergy and cancer.

Drug hypersensitivity genetic?

Drug hypersensitivity genetic?

The most common cause for drug allergy is from IgE-mediated (allergic) reactions, such as having hives from penicillin. New research is discovering a second mechanism for drug reaction being called “drug hypersensitivity,” as it is mediated by T-lymphocytes. The reactions are different from the arch-typical “allergy” in that they tend to be somewhat delayed and different types of rashes. Examples are measles-type bumps, the life-threatening skin condition Steven-Johnson Syndrome or liver irritation.

Of great interest is that there seems to be a genetic predisposition to react to certain individual drugs. Following is a list of certain HLA (genetic) types and the drug that reacts:

 

Genetic Type

Drug

HLA A 31:01

Tegretol

HLA   A 33:03

Ticlid

HLA   A 68:01

Lamictal

HLA   A 02:06

Cold Medicines

HLA   B 56:02

Dilantin

HLA   B 58:01

Allopurinol

HLA   DRB 1 11:01

Statins

HLA   DRB 1 13:02

Aspirin

HLA   C 04:01

Viramune

 

Because this research is new there are lots of uncertainties. Genetic testing is expensive, and everyone with the implicated gene won’t react to the medicine. It’s too early to recommend across-the-board testing, but an awareness of possibilities, along with finding less expensive ways to do this testing, may soon lead to “genetic profiling” of all of us.

‘Magic Bullet’ antibodies beef up to meet today’s need

‘Magic Bullet’ antibodies beef up to meet today’s need

In the early 1900s, German scientist and Nobel Laureate Paul Ehrlich pioneered an antiserum to help combat diphtheria. His anti-serum saved many lives in the pre-antibiotic era. He also popularized the concept in medicine of a “Magische Kugel” (Magic Bullet).

His idea was to find treatments that were so specific that they only worked on their specific targets without any collateral effect or damage to the body. In 1975 Cesar Milstein and Georges Kohler (also Nobel Laureates) invented hybridoma technology which allows the production of large quantities of antibodies specific for a single target also known as monoclonal antibodies.

Roughly 10 years later the first therapeutic antibody was made: monoclonal antibodies (muromonals), with a target of the CD-3 receptor on T -lymphocytes. You see, by inactivating CD-3, it prevents rejection of organ transplants, and it revolutionized transplant medicine by allowing better survival with less need for high-dose steroids.

Since 1985 the floodgates have opened up with more than 35 monoclonal antibodies that have been approved by the Food & Drug Administration (FDA) for use in medicine. Hundreds more are being researched. These antibodies are used to treat a variety of diseases. Some examples which include the antibody, the target and the disease follow.

 

Drug

Target

Condition

Infliximab

TNF-a

Rheumatoid arthritis

Adalimumab

TNF-a

Crohn’s disease

Omalizumab

IgE

Asthma

Rituximab

CD20

Lymphoma

Abciximab

Gp11b/111a on platelets

Prevent clots

after coronary stenting

Trastuzumab

HER2receptor

Breast cancer

 

Two other strategies being worked on are using monoclonal antibodies as vaccines and making an antibody-drug conjugate. The idea is to couple an antibiotic or an anti-cancer drug to the “magic bullet” so only the target receives the medicine. This would allow high concentrations of the drug to be used.

As far as vaccine therapy goes, there actually is one already in use: palivizumab, which targets the F protein found on RSV (Respiratory Syncytial Virus). It is given once a month to high-risk infants to prevent their catching RSV.

Similar efforts are underway to develop a vaccine for HIV, and also one for influenza.

Q – Tips: • Buteyko

Q – Tips: • Buteyko

  • Buteyko is a Russian breathing technique to improve control of asthma through respiratory exercises. Basically, it consists of daily sessions of progressively incremental breath holding. Research studies have shown improvement in asthma and even reduction in medication.
Q – Tips: • Vogt-Koyanagi-Harada syndrome

Q – Tips: • Vogt-Koyanagi-Harada syndrome

  • Vogt-Koyanagi-Harada syndrome is an autoimmune eye problem that starts with recurrent bouts of “pink” or “red eye”. Eventually it can cause the eyelashes to turn white and the retina to detach. Proper diagnosis by an ophthalmologist is key to anyone suffering repeated bouts of “red eye.”
First “pro,” now add “pre” for even more gut benefits

First “pro,” now add “pre” for even more gut benefits

Over the past five years this newsletter has offered numerous articles about the health benefits of probiotics.

We have learned that because 80 percent of the immune cells in the human body are found lining the GI tract, it is critical that these cells see a normal, healthy microbiome (like a micro-ecosystem in the body.) Altering healthy gut flora leads to both a pro-inflammatory and a pro-allergic state, predisposing to auto-immune and allergic disorders.

Ingesting healthy microbes in the form of probiotics has proven to help. Now, new research is extending this approach to the use of prebiotics — foods that contain oligosaccharides (certain carbs with a few simple sugars) and fiber. These promote the establishment and flourishing of healthy gut bacteria. Some of the best in this category are:

dandelion greens       chicory root

asparagus       garlic           leeks        beans

banana           berries          artichokes

Interesting research on aboriginal peoples in New Guinea and Australia, whose diets are replete in prebiotics, shows almost no problems with autoimmune or allergic diseases.

Flu vaccine meets new booster

Flu vaccine meets new booster

 

Recent research done at St. Jude Children’s Research Hospital in Memphis led to an unusual discovery!

Rapamycin, a drug normally used to suppress the immune system was found to bolster the powers of the flu vaccine.

Rapamycin was originally discovered in a soil sample taken on Easter Island (whose Polynesian name is Rapanui; hence, “rapamycin).” Early on it was found to have antifungal properties, but additional research revealed it to also have immunosuppressant and anti-tumor properties. Giving low doses to healthy mice, it actually increases their life span.

Its main use in humans is to prevent kidney transplant rejection. Taken in small amounts with the flu vaccine, it allows the immune cells in experimental animals to make high-level and broad-spectrum antibodies.

If human results prove similar, we may all end up taking a small amount of Rapamycin prior to our then once-every-10-years flu shot.

When managing iron supplements, turns out that less is more

When managing iron supplements, turns out that less is more

We are obligate aerobic creatures requiring constant, good oxygenation. Allergic individuals sometimes have less than ideal oxygen delivery because of nasal obstruction or asthma.

If, in addition, they are anemic, then oxygen delivery to the tissues is reduced for a second reason.

Iron deficiency anemia is fairly common, especially in growing children and menstruating females. The usual therapy for this is oral iron supplementation. Until recently, this was recommended on a daily basis. However, recent research published in the Journal Blood is altering this advice.

It seems that within a few days of starting oral iron therapy our bodies make a peptide called hepcidin which inhibits intestinal iron absorption.  And so the very act of taking iron can put on the brakes, so to speak, of absorbing it. Trying twice or thrice a day dosing only increases the hepcidin levels more.

Luckily the researchers found a simple solution:  take the iron every other day.  This keeps hepcidin levels low and iron absorption high.

Battle plan for repeat sinus infections

Battle plan for repeat sinus infections

Dear Dr. K: I don’t seem capable of getting just one sinus infection. Once I get the first one, I seem to get two or three more before it’s all over. Can anything be done?

At the risk of sounding smart-alecky, first and foremost, don’t get the first infection. By this I mean try to avoid catching colds or URIs (upper-respiratory infections). In general people don’t “catch” a sinus infection; it usually occurs as a sequel to a viral cold/URI that sets the stage. Beyond that, the usual advice applies: avoid exposing yourself to people who are acutely ill, use good handwashing technique, etc.

Regarding the repeated nature of your sinus infections, it actually may be one of two scenarios. First: You actually do get back-to-back-to-back infections. Second: You never fully get over the first infection.

Let’s tackle Scenario No. 2 first. It would be like the old Smoky the Bear forest fire ads: “Be sure the fire is completely out.” For most infections there are standard regimens such as 10 days of penicillin for strep throat. This is not true for sinusitis as it tends to be based more on a clinical response sliding scale. Often, sinus infections require 14 or even 21 days of therapy to eradicate.

It is generally best to continue therapy until the symptoms have resolved and mucus is clear in color.

Scenario No.1 is a little tougher. The two main culprits are: a polymicrobial infection or altered anatomy/physiology. In the first case the individual has two or more microbes causing the infection. This could be two or more bacteria, or a bacteria and a fungus. The person improves initially when the first pathogen dies, but if the second bacteria or fungus isn’t killed, it then flourishes to cause the “recurrent” infection.

In people prone to recurrent infections this is when obtaining a culture can be of great help. Cultures generally aren’t necessary and add to the cost of treatment, but if the polymicrobe scenario is suspected, then a culture can expose this issue.

 

“. . . By “altered anatomy/physiology” I mean the initial infection

either narrows or blocks the sinus entrance. . .”

 

The best way to get a sinus culture is during rhinoscopy by an ENT (Ear, Nose and Throat) doctor, but a close second is a simple nasal swab.

By “altered anatomy/physiology” I mean the initial infection either narrows or blocks the sinus entrance, or it alters the self-cleaning sinus membrane.

In the first instance, if the original infection leads to narrowing of the sinus entrance or the development of a polyp that blocks the entrance, you have a “closed space” situation. As the sinuses are not sterile spaces, if their opening is blocked, it’s just a matter of time before the native bacteria multiply to the point of infection.

Avoid this by seeking prompt treatment. If allowed to smolder, the original infection is more likely to lead to the tissue inflammation that can block the sinus. Also, use steroids systemically or topically to reduce this inflammation and restore openness. Finally, short (three-days’) use of a topical inhaled decongestant such as Afrin can sometimes pop open the sinus.

By “self-cleaning” sinus membrane I’m referring to the fact that our sinus cavities are lined with tiny cilia that beat in a way that moves bacteria out of our sinuses. Unfortunately, just as a second-degree burn causes the top layer of our skin to slough off, so too does an infection cause this ciliated epithelium to peel off. Just as our skin regrows, so does our sinus membrane — but it can take four-to-six weeks.

In the meantime, your sinuses are sitting ducks for the next virus/bacteria you’re exposed to. The best way out of this dilemma is sinus irrigation with saline solution. By rinsing your sinuses several times a day you provide a surrogate cleaning mechanism, and thus avoid re-infection during this susceptible period.

Q – Tips: venom

Q – Tips: venom

  • Stanford researchers found an interesting paradox: Individuals with venom allergy (bees, wasps, etc.) are less likely to die from the toxic poison effect of venoms, such as from hundreds of bee stings or snake bites (!) Reason: The chemicals released by mast cells (the allergy cells that cause allergic symptoms), inactivate the biologic poison of the venom.