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Month: August 2021

Dear Dr. K; I received BCG treatments for my bladder cancer. Now I hear it is being used for diabetes. Is that true?

Dear Dr. K; I received BCG treatments for my bladder cancer. Now I hear it is being used for diabetes. Is that true?

The one second answer is “yes”, but there is an over 100-year-old story behind that.  BCG, properly called Bacillus Calmette-Guerin is a live attenuated (weakened) form of tuberculosis.  The vaccine has been around for 100 years and is routinely given to children in nearly all non-Western countries to prevent TB.  Not long after the vaccine was developed in the 1920’s scientists noted a significant decrease in childhood death rates not only from TB but from many unrelated infections.  More recent studies in elderly patients showed a marked reduction in all forms of respiratory infections in mature adults receiving BCG as compared to a placebo shot. 

These observations have led to a broader scope of research on BCG around the globe.  Here in the US, Harvard Medical School is a front runner in this research.  As weird as it may seem it turns out that BCG can not only boost good immunity but paradoxically can also calm an overactive immune system that is causing auto-immune disease.  The Harvard team found that BCG triggers the immune system to produce TNF-alpha which does two important jobs.  TNF-alpha fights all types of bacterial and viral infections but it also helps the body make T-regulatory cells (T-regs) which act as

“referees” to prevent collateral damage during immune responses. 

Unlike type II diabetes, which is due to obesity causing insulin resistance with very high insulin levels, Type I diabetes is due to a lack of insulin production by the pancreas because of an auto-immune destruction of the cells that produce insulin.  BCG given as type I diabetes is developing can save some of the pancreas cells that produce insulin before they are all destroyed. 

Alzheimer’s disease is currently viewed as an auto-immune disease in the brain where chronic inflammation leads to the amyloid plaque (scar tissue) that disrupts nerve connections.  A research group in Israel recently reported on a large cohort of people with bladder cancer.  Those who received BCG as a treatment for their bladder cancer had a 2.4 percent occurrence of Alzheimer’s years later versus an 8.9 percent occurrence in a group who did not receive BCG. 

This observation has sparked ongoing trials of using BCG in treating early Alzheimer’s and also in MS (multiple sclerosis) another auto-immune brain disease.  Other ongoing areas of research using BCG include preventing Covid 19 infection, treating eczema and asthma. 

The United States and some other Western nations have never adopted the use of BCG as a prevention for TB, opting instead to treat individual cases as they occur.  Pending the outcome of these recent research trials, that policy might change. 

IgG Food Testing

IgG Food Testing

IgG food testing (also known as food sensitivity testing) was recently discussed in an editorial from Yale in the Annals of Allergy, Asthma and Immunology.   The physicians at Yale sited the American Academy of Allergy and Immunology and the European Academy of Allergy and Clinical Immunology in recommending strongly against the use of IgG food testing. 

IgG (Immunoglobulin G) is one of the main immune proteins in humans.  It serves both “recognition” and “protection” functions.  Homeland Security might serve as a reasonable metaphor.  The latter has an extensive database of all individuals residing within and entering into the United States.  It also can serve to protect from terrorists.  Similarly, our immune system makes IgG antibodies of recognition against all substances that enter our bodies including the foods that we eat.  Hence, we all have a myriad of IgG antibodies directed toward/recognizing these foods. 

When a patient has IgG food testing done there is typically a long list of “positive foods” which are rated from mildly to strongly positive.  Unfortunately, this list is used as a guide for food elimination to try and treat clinical symptoms. 

Since food allergy (10% of the population) and food intolerances (20% of the population) are so common, it is often the luck of the draw with an avoidance of many foods that the patient will actually feel better.

But this clinical improvement comes at the cost of an often nutritionally poor diet and is due to the interdiction of one food (among many) that might actually be an allergen or an intolerance and not because the IgG antibody is causing the allergy or intolerance.

Allergy is caused by a different immune protein (IgE) Immunoglobulin E.  And food intolerance is caused by digestive enzyme deficiencies or other physiologic issues with the gastro-intestinal tract. 

Companies/laboratories that offer IgG food testing make claims that the test can help with a variety of medical problems including IBS (irritable bowel syndrome), joint pain, migraines, fatigue, and skin rash.  IgG food testing and associated elimination diets can lead to an emotional burden and negative health consequences. 

A too strict elimination of foods can cause nutritional deficiencies.  Also, insurance companies usually do not

cover the cost of the tests (which are significant) because medical insurers recognize it as a non-standard process.

In 2004 the Mayo Clinic did a study in people with IBS.  Half of the group had IgG food testing and were told to avoid the positive foods; the other half of the study group were placed on a sham diet not based on any testing.  The clinical outcome was the same in both groups. 

Covid-19 and Immunocompromised Patients

Covid-19 and Immunocompromised Patients

There is still much to learn about Corona virus.  One area that is particularly problematic is how to protect patients that are immunocompromised (roughly 5% of the US population) due to organ transplant, auto-immune/rheumatic diseases, cancer, and dialysis. 

It has been long understood that the efficacy of many vaccines is attenuated in immunocompromised patients and this also seems to be the case for Covid-19 vaccines.  Timing of the vaccine is important and it should be administered between chemotherapy cycles.  For patients with stable rheumatology conditions suspending daily doses of mycophenolate and methotrexate for 1 to 2 weeks is advised. 

A very small study has been done on administering a third dose of the m-RNA vaccine or administering the Johnson & Johnson vaccine to patients who already received two doses of an RNA vaccine.  In the patients who had only very low antibody titers after their first two m-RNA vaccines, 100% developed excellent titers after a 3rd vaccine.  However, in the patients with no detectable antibodies after their first two m-RNA vaccines, only 25% developed high antibody titers.  Much larger study trials are underway to better address this issue.  For the time being as America is unmasking, the previous guidelines for mask wearing and social isolation are still advised for immunocompromised patients.