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Gum Disease and Arthritis

Gum Disease and Arthritis

Researcher at the University of Leeds in the UK have completed a four-year study that links gum disease to rheumatoid arthritis.  They found a direct correlation between gum disease and both the severity of and exacerbations of

rheumatoid arthritis.  Various species of the bacteria Streptococcus are the culprits.  When a person with gingivitis

chews or brushes their teeth the bacteria enter the bloodstream.  This activates the immune system to make antibodies.  As it turns out the antibodies that attack the Strep are the same ones that attack joint cartilage.  They are called citrullinated antibodies and measurement of them is one of the diagnostic tests for rheumatoid arthritis.  It probably shouldn’t have been a surprise as the Strep germ that causes Strep throat has a long legacy of causing the autoimmune phenomenon called rheumatic fever which can lead to rheumatic heart disease.  The cartilage in our joints is the same as the cartilage that makes our heart valves. 

Although it wasn’t part of the initial study, the UK scientists found that people with the oral bacteria Porphyromonas gingivalis and gum disease were much more prone to Alzheimer’s disease.  The bottom line is to practice good dental hygiene both at home and with your dentist.    

Dear Dr. K; 

Dear Dr. K; 

I recently heard about a mental technique to help me cope with tinnitus.  But for the life of me I can’t remember what it was, can you help? 

I think so.  I suspect you heard about a form of cognitive behavioral therapy called somatic tracking exercise.    There are good academic studies instantiating its benefit.  It has proven effective not only for tinnitus but for other unpleasant or painful sensory inputs. 

Basically, you pretend you are a non-emotional observer of yourself.   With respect to tinnitus, you describe to yourself the volume, frequency, pitch, and the variance in laterality (right versus left).  You do this with no emotion attached and you tell your brain that this is of no threat.  You do this briefly several times a day and over time you will find the sound decrease on its own. 

This technique can also be used for anxiety, nausea, dizziness and pain.  Remember that unpleasant sensory awareness is the brain’s alarm system to try and protect us.  By being an unemotional remote observer of your own unpleasant sensory input, you can teach the brain that this is nothing to fear.  The

goal of the exercise is not to get rid of the pain/sensation.  In fact, the more you try to accomplish this the worse the symptom becomes.  But the goal is to persuade your brain that its’ safe and therefore no need to continue “sounding the alarm”.  Another way to approach it is to tell yourself that these are just unbridled neurons firing off and you’re going to put a bridle on them.  When you are doing this mental exercise, it is also helpful to use avoidance strategies that lessen or minimalize the pain/sensory sensation. 

Indoor Pollution

Indoor Pollution

In 1986 the World Health Organization (WHO) coined the term “sick building syndrome”.  It was the dawn of understanding that indoor pollution can have health consequences.  WHO has concentrated its research on “the big six”: tobacco smoke, radon gas, carbon monoxide, the volatile organic compounds

(VOC’s) trichloroethylene and benzene and tiny agglomerate particles smaller than 2.5 micrometers (PM 2.5). The average American spends 88% of their time indoors.  The higher the levels of these pollutants the greater the health consequences.  Illnesses linked to indoor pollution include sinusitis, asthma, dermatitis, migraines, cardiovascular disease and cancer. 

Indoor ozone is generated when sunlight coming through windows reacts with certain VOC’s.  Synthetic dyes known as azo dyes can outgas from furniture and drapes, especially ones with darker colors.  Formaldehyde is another VOC that creates a toxic environment.  It outgasses from new carpet, flooring, pressboard cabinets and new furniture.  Another VOC that seems to be particularly irritating is trichloroethylene which outgasses from glues, solvents and cleaning fluids. 

Even cooking can be a source of pollution.  Frying foods generates acrolein, a chemical also released from E-cigarettes and known to be harmful.  A recent study done in gyms found high levels of N-chloraldimines, toxic chemicals generated when bleach cleaners interact with the amino acids found in human sweat.  Aerosol deodorants, cleaners and hair sprays add to the morass. 

What can be done?  Choose safe cleaning products.  Stop using aerosols.  Stop frying foods or at least have a good exhaust fan running.  Allow new carpet and furniture to outgas in the garage before moving indoors.  HEPA filters on the HVAC system remove the PM 2.5 particles.  Smoke outside.  Houseplants help remove a myriad of chemicals.  For those who like data, indoor air quality monitors and radon detectors are readily available. 

Processed Foods and Health

Processed Foods and Health

The industrial techniques used to make processed foods not only add unhealthy ingredients but also change the foods themselves and therefore how they interact with our bodies.  In Western countries half the food consumed is processed. 

Over one hundred scientific studies have all shown that diets high in processed foods lead to earlier death, more cancer, inflammatory bowel disease, obesity, dementia, stroke, diabetes and heart attack.  Such diets also compromise immune function. 

It’s not the fat, salt and sugar that are most problematic but rather the removal of fiber, micronutrients and the added chemicals, especially emulsifiers, that cause the greatest harm.  The fiber and micronutrients are essential to a healthy microbiome, which in turn is critical for most of the physiologic processes in our bodies and especially our immune systems.

It is well documented that emulsifiers harm the gut.  Emulsifiers are chemicals that bond fat to water.  Soap is an emulsifier which is why it helps us cleanse oil and grease from our hands.  Our intestines are covered in a layer of mucus which is the nesting ground for all our healthy microbiomes, scrubbing this mucus away with emulsifiers severely disrupts the bacteria.  This in turn can lead to greater gut permeability (leaky gut) and local inflammation.  Carboxymethyl cellulose is one of the worst of the emulsifiers and is found in thousands of processed foods. 

Other chemical additives turn off our normal satiety hormones which tell us we’ve eaten enough and thus leads to overeating.  Curiously, this includes artificial sweeteners. 

Q – Tips:

Q – Tips:

Group Weston has developed a user-friendly micro air screen face mask, Q Mask Pro, that uses a unique accordion pleated design that makes it highly efficient at removing pollen and dust.   Web site www.groupweston.com

With increasing pollution of our planet’s oceans and seas there is a rise in ciguatera fish poisoning which is often mistaken for a food allergy.  The symptoms include nausea, vomiting, diarrhea, itchiness, hot/cold sensitivity and numbness.  The culprit is a dinoflagellate that prospers in polluted waters and is ingested by fish.  Its toxin is not inactivated by cooking. 

XX or XY: For Better or For Worse

XX or XY: For Better or For Worse

Are there sex differences in the human immune system?  Yes, there are.  Women have stronger immune systems than men.  But, similar to a coin this presents two sides.  Women are less likely to catch infections and develop cancer, and if they do the infection tends to be less severe than in men.  This has been well demonstrated during the Covid pandemic.  But, the other side of the coin is that women are more likely to suffer auto-immune diseases than men. 

The two main reasons for the difference are hormones and genes.  Estrogen broadly stimulates immune function.  In terms of infection risk and cancer risk, this is a good thing.  But in terms of auto-immune issues it’s a bad one.  On the other hand, testosterone has a mild immune weakening effect. 

With regards to genes, the X chromosome contains the large majority of the genes that control immune function (over 80% of them).  Women have two X chromosomes; one from their mom and one from their dad.  While, men have a single X chromosome (from their mom).  Now the interesting thing is that women have only one of their X chromosomes active in individual cells, the other one is inactive.  Therefore 50% of a women’s cells have their mom’s X chromosome and 50% of their dad’s.  This is called mosaicism.  This genetic diversity gives women a broader repertoire of immune function.  As the saying goes, there are exceptions to every rule.  And as it turns out not all genes on the inactivated X chromosome are switched off.  Some immune system genes remain functional on both X chromosomes.  An important example is the gene that controls production of toll-like receptor 7 (TLR7).  TLR’s recognize invading microbes and induce the production of inflammatory cytokines and interferons to kill them. 

In terms of auto-immune conditions women are more prone.  Since their immune system is stronger this can be a disadvantage if that strength is not appropriately controlled.  The other issue goes back to this mosaicism.  Going back to fetal life the human immune system is “trained” to recognize

its own cells (self-recognition).  Because women are mosaics of two populations of genetically different cells this “training”    

process is less efficient.  This in turn can lead to accidentally attacking one’s self i.e., auto-immunity. 

Dear Dr. K; I heard something on the news about a Strep germ making allergies bad.  Isn’t Strep what causes sore throats?

Dear Dr. K; I heard something on the news about a Strep germ making allergies bad.  Isn’t Strep what causes sore throats?

Yes, Strep causes sore throats but there are many types of Strep.  Strep is short for Streptococcus which is the genus of the family.  And then there are many species of Streptococcus.  In fact, there are so many species in the family tree they are in groups from “A” to “H”.  Streptococcus pyogenes is the specific organism that causes “Strep throat” but it also causes impetigo.  Streptococcus pneumonia causes ear, sinus, bronchial and lung infections.  Streptococcus faecalis causes urinary infections. 

But the Strep that I think you heard about is Streptococcus salivarius.  As the “species” name implies this is actually part of the normal microbiome in our saliva, in our mouths.  However, when it jumps borders and colonizes the nose and sinuses it can cause mischief.  Researchers at the NIH found that patients with allergic rhinitis who also had the Strep salivarius in their nasal membranes had worsening of their underlying allergies.  Getting rid of the Strep salivarius led to significant improvement in their allergic rhinitis.  It seems that when the Strep salivarius resides in the nose (but not when only in the mouth) it produces inflammatory proteins that work synergistically with the inflammatory mediators produced by allergy.  The end result is a “double whammy”.  The NIH is researching a bacterial selective treatment that will only remove the nasal Strep and not affect the rest of the microbiome.  Stay tuned.

Difelikefalin

Difelikefalin

The New England Journal of Medicine recently published a research article on a drug trial of difelikefalin (who comes up with these names?) to treat Notalgia paresthetica.  Notalgia paresthetica is an allergic mimic; it is actually a form of localized neuropathy.  It is sometimes called the itch that rashes.  It is characterized by chronic recurrent localized itching (usually unilateral) in the interscapular paravertebral area.  (i.e., the shoulder blade). 

It is felt to be due to dysfunction of the cutaneous branches of thoracic spinal nerves.  Because the itch is so intense it leads to excessive scratching which in turn leads to the skin both thickening and darkening.  It is resistant to therapies such as antihistamines and topical anti-itch creams and topical steroid creams. 

Difelikefalin is a selective kappa opioid receptor agonist.  It has been known for many years that the sense of itch is carried in our sensory pain fibers.  Think back to a skin injury or cut that was painful at the onset but itched as it was healing.  Opioids of all forms have been used to treat pain.  The selective kappa receptor on pain fibers has been shown to suppress itch when it is stimulated.  Hence the development of Difelikefalin. 

The drug study had a small enrollment (126 people) but the 8-week trial showed excellent results.  The main side effects were nausea and constipation.  A larger study is underway to try and obtain FDA approval.

MRGPRX2 in Drug Allergy

MRGPRX2 in Drug Allergy

True or classic drug allergy is mediated by the drug activating the allergic protein (IgE) which in turn causes Mast cells in the skin and throughout the body to release histamine.  However, it has been known for quite some time that some drug reactions are not mediated by IgE.  These have been referred to as pseudo-allergic reactions or anaphylactoid (as opposed to anaphylaxis). 

Then comes the discovery of Mas-related G protein – coupled receptor X2 (MRGPRX2) which sits on the surface of Mast cells (primarily Mast cells in the skin).  When this receptor is stimulated it too causes Mast cells to release histamine.  The most common drugs that do this are:  Leupron, Firazyr, Cetrotide, neuromuscular blocking agents (used in anesthesia), opiates, fluoroquinolones and vancomycin. 

The one good thing about MRGPRX2 receptor is it is “low-affinity” i.e., it requires a high concentration of drug to be activated.  This is in contrast to the IgE receptor which is high affinity.  A practical example is opiate.  If the dose is kept low enough many people can tolerate these drugs without reaction. 

Virovores

Virovores

A recent article in the Proceedings of the National Academy of Sciences discussed the discovery of a bacteria whose only diet is viruses; hence the name virovore.  Actually, the scientific one is Halteria ciliate.

These bacteria were first discovered in fresh water ponds.  In the lab, each Halteria organism consumed 1 million viruses daily, but when studied in their natural element they consumed 1 quadrillion viruses daily.  Since Halteria do not seem to be pathogenic to humans there is ongoing research to see if there might be a way to use Halteria as a treatment for human viral infections.