Think food nutritional interventions in autoimmune diseases

Nutritional Interventions in Autoimmune Diseases

Academic talk, Christiaan Barnard Memorial Hospital24th January 2013

1Thursday 24 January 2013

Pharmacist & nutritional coachChristoph Lenz

Universities of Düsseldorf and Cape

Town

2nd pharmacist in Europe’s biggest mail

order pharmacy: Docmorris

Grey Healthcare/ working for

Big Food and PharmaPfizer Animal Health

EUAfME

Helping people to get off drugs rather than supplying them

PAST PRESENT

GOOD MORNING. Who’s talking

2

Working independently in own practice -No disclosures

Not favouring any particular Supplement®


Many patients are not or mis-diagnosedDiagnosis done by specialists

DEFINITION of Autoimmune Disease

The basic definition of an autoimmune disease is a disorder caused by an autoimmune response, i.e., an immune response directed to something in the body of the patient. Since autoimmunity can affect any organ in the body

(including brain, skin, kidney, lungs, liver, heart, and thyroid), the clinical expression of the disease depends upon the site affected. In our system of highly compartmentalized medicine, patients with autoimmune disease may be cared

for by physicians in virtually any medical specialty.

The presence of an autoimmune response is signaled by the appearance of autoantibody in the circulation, and so the demonstration of a particular

autoantibody usually constitutes the path to recognize an autoimmune disease.


According to the American Autoimmune Related Diseases Association (AARDA), it is estimated that 50 million Americans have an autoimmune disease. (Cancer 9 million, CVD 22 million)

Autoimmune diseases affect women 75 percent more often than men. The cause of this sex bias is not fully known.

Most autoimmune diseases are relatively rare, and most are not fatal. They never appear on the public "radar screen" as a serious health problem requiring more attention and more funding. Taken together, however, the autoimmune diseases occupy the third or fourth place in the list of prevalent diseases in the US.

PREVALENCE of Autoimmune Diseases


Analysis of 1 Megabase DNA costs <10 Cents in 2012Cost of 1GB memory in the 80s ~ $1 000 000.

National Human Genome Research Institutegenome.gov/sequencingcosts

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

$100M

$10M

$1M

$100k

$1k

Moore’s Law

$10k

PROGRESS in Health Care


http://www.zeit.de/2005/16/Moore_s_Gesetz











NIH estimates annual direct health care costsNIH estimates annual direct health care costs

Autoimmune diseases > $100 billion

Cancer $57 billion

Heart and stroke $200 billion

COSTS of Autoimmune Diseases

AARDA, NCAPG; The Cost Burden of Autoimmune Disease; 2011

Runner up

Best price


NIH, Autoimmune Diseases Coordinating Committee, Progress in Autoimmune Diseases Research, Report to Congress 2005

REPERCUSSIONS of AD

“... patients face a lifetime of illness and treatment. They often endure debilitating symptoms, loss of organ function, reduced productivity at work, and high medical expenses.”


What is the red thread?Polyautoimmunity and familial autoimmunity are common

CAUSAL Factors of Autoimmune Disease

Genetic

Environmental triggers

Infectious agents

Pollutants/ toxins

Food

Microbiome


Disease Organ/ tissue involved Source

Allergies various Liu et al. Acta Paediatrica 2005, 94, 386-93

Ankyllosing Spondylitis Skeletal system Vaile JH et al. J. Rheumatol. 1999, 26, 128-35

Aphthous stomatitis Mouth Veloso FT et al. Hepatogastroenterol. 1987, 34, 36-7

Asthma Lungs Benard A et al. J. Allergy Clin. Immun. 1996, 97, 1173-8

Autism Nerve/ brain White JF. Exp. Bio. Med. 2003, 228, 639-49

Autoimmun gastritis GIT Greenwood DL et al. Eur. J. Pediatr. 2008, 167, 917-25

Autoimmune hepatitis Liver Terjung B Clin. Rev. Allergy Immunol. 2009, 36, 40-51

Morbus Behçet Small blood vessels Fresko I et al. Ann. Rheum. Dis. 2001, 60, 65-6

Celiac disease Gut Schulzke JD et al. Pediatric. Res. 1998,43, 435-41

Chronic fatigue syndrome (CFS) Multiple Maes M et al. Neuroendol. Lett. 2007, 28, 739-44

Crohn’s disease Gut Caradonna L et al. J. Endotoxin. Res. 2000, 6, 205-14

Depression Brain, gut Maes M et al. Neuroendocrinol. Lett. 2008, 29, 117-24

Morbus Duhring (dermatitis herpet.) Skin (men > women) Kieffer M et al. Br J. Dermatol. 1983, 108, 673-8

Diabetes Typ I Pancreas Sapone A et al. Diabetes 2006, 55, 1443-49

Eczema Skin Hamilton et al. Q. J. Med. 1985, 56, 559-67

Gut migraine children Gut Amery WK et al. Cephalalgia 1989, 9, 227-9

Autoimmune diseases>33% already linked to “Leaky gut”

“Dietary Mechanisms of Autoimmunity”, Loren Cordain, Ph. D


Disease Organ/ tissue involved Source

Hashimoto’s thyroiditis Thyroid Sasso FC et al. Gut 2004, 53, 1878-80IgG Nephropathy Kidney Rostoker G et al. Nephron. 1993, 63, 286-290.Intrahep. cholestasis of pregn. Liver/ gallbladder/ GIT Reyes H et al. Hepatology 2006, 43, 715-22Juvenile Arthritis Collagen/ joints Picco P et al. Clin. Exp. Rheumatol. 2000, 18, 773-8Lupus erythematosis Multiple Apperloo HZ et al. Epidemiol. Infect. 1994, 112, 367-73Multiple sclerosis Nerve/ brain Yacyshyn B et al. Dig. Dis. Sci. 1996, 41, 2493-98Pemphigus-diseases Skin Kieffer M et al. Br J. Dermatol. 1983, 108, 673-8Primary biiary cirrhosis Liver/ gallbladder/ GIT Di Leo V et al. Eur. J. Gastro. Hepatol. 2003, 15, 967-73Psoriasis Skin Hamilton et al. Q. J. Med. 1985, 56, 559-67Rheumatoid arthritis Joints Smith MD et al. J. Rheumatol. 1985, 12, 299-305Rosacea Skin Kendall SN. Exp. Dermatol. 2004, 29, 297-99Schizophrenia Brain Wood NC et al. Br. J. Psychiatry 1987, 150, 853-6Skleroderma Connective tissue Caserta L et al. Rheumatol. Int. 2003, 23, 226-30Sclerosing Cholangitis Liver Terjung B Clin. Rev. Allergy Immunol. 2009, 36, 40-51Spontanous abortion Uterus Friebe A Int. J. Biochem. Cell Biol. 2008, 40, 2348-52Ulcerative colitis Gut Caradonna L et al. J. Endotoxin Res. 2000, 6, 205-14Urticaria Skin Buhner S et al. Allergy 2004, 59, 1118-23Uveitis Eye Benitez JM et al. Eye 2000, 14(pt 3A), 340-3

“Dietary Mechanisms of Autoimmunity”, Loren Cordain, Ph. D

Autoimmune diseases>33% already linked to “Leaky gut”


Diet shapes gut microbial community structure and function, and the microbiota

adapts in ways that promote nutrient processing; the ability of the microbiota to

process a given diet affects the nutrient and energetic value of that diet. The microbiota

and immune systems co-evolve: malnutrition affects the innate and adaptive immune

systems as well as the microbiota.

Kau etal; Nature; 474(7351): 327–336, 2011

Diet shapes gut microbial community structure and function,

and the microbiota adapts in ways that promote nutrient

processing; the ability of the microbiota to process a given diet affects the nutrient and energetic

value of that diet. The microbiota and immune

systems co-evolve: malnutrition affects the innate and adaptive immune systems as well

as the microbiota.

Kau etal; Nature; 474(7351): 327–336, 2011


A disrupted microbiome has been associated with a lengthening list of problems:

obesity and its opposite, malnutrition; diabetes (both type-1 and type-2);

atherosclerosis and heart disease; multiple sclerosis; asthma and eczema;

liver disease; numerous diseases ofthe intestines, including bowel cancer; and

autism.


Patients are often referred to as “psycho somatic”Resulting in bad compliance

SIDE EFFECTIVE Treatments for AD


Not taking adverse drug events into consideration$25.000 = Disease Modifying drug therapy/a

EFFECTIVENESS of DM Drugs in MS

Ebers, G, Traboulsee A, Li D, et al., Analysis of clinical outcomes according to original treatment groups 16 years after the pivotal IFNB-1b trial. J Neurol Neurosurg Psychiatry, in press, 6 pages.

“The outcomes so far obtained in the prespecified primary analysis suggest a lack of delay in disease progression for

all disease modifying treatments”“Disease progression was worse than that in the untreated

control group”

Boggild M, Palace J, Barton P, Ben-Shlomo Y, Bregenzer T, Dobson C, Gray R., Multiple sclerosis risk sharing scheme: two year results of clinical cohort study with historical comparator. BMJ. 2009, 9 pages.

“... it took untreated persons 14.4 years with a 95% confidence interval of 12-17.4 years whereas the treated patients were estimated to reach EDSS 6 at 18.6 years with a 95% confidence interval of 15.9-21.9 years.”

Veugelers PJ, Fisk JD, Brown MG, Stadnyk K, Sketris IS, Murray TJ, Bhan V., Disease progression among multiple sclerosis patients before and during a disease-modifying

drug program: a longitudinal population-based evaluation. Mult Scler. 2009 Nov;15(11):1286-94.

“... 38.6% of untreated patients (those on betaseron for less than 10% of the time) reached EDSS 6 within

the past 16 years. This compares with 35.7% of treated patients (those on betaseron for over 80% of the time) reaching EDSS 6 in the same time interval.”


Are we really surprised if the liver fails?Complimentary drugs are prescribed to counteract ADE

MTX Actions and REACTIONS

Mode of ActionMethotrexate is an antimetabolite that interferes with DNA synthesis, repair, and cellular replication by inhibiting DHF reductase.Tissues with high proliferation rate are affected: neoplasms, bone marrow, fetal cells, buccal and intestinal mucosa, urinary bladder

Common ADERash, nausea, vomiting, thrombocytopenia, dizziness

Severe ADEPericardial effusion, thromboembolic disorder, epidermal necrolysis, GI hemorrhage, stomatitis, aplastic anemia, malignant lymphoma, myelosuppression, liver cirrhosis/ fibrosis, hepatitis, liver failure, encephalopathy, neurotoxicity, seizure, nephrotoxicity, interstitial pneumonia, infectious diseases


-Many chronic diseases are very responsive to dietary and lifestyle interventions

- Agents of the industry teach about drugs to persuade doctors to use the newest and most expensive medications - even in the absence of scientific evidence that they are any better than older, less costly ones.

- In fact, many non-drug interventions are therapeutically effective and significantly less expensive.

Treat the PATIENT, not a Disease

Relman As. Your doctor’s drug problem. The New York Times, November 18, 2003

Healthcare spendings need to invest in prevention an patient educationHow much can we change a patients environment?


Infections and Microbiotai.e. Epstein Barr Virus, chlamydia pneumoniae, measals, rubella

GeographyRisk increases with distance from the equatorSunlight, UV, vitamin D

TraumaOperations, psychological stress, environmental toxins, heavy metals, smoking

VaccinationsWhich adjuvants were used?

FoodCertain triggers compromise gut integrity.

Poser C. M. Clin. Neurol. Neurosurg. 2006, 108, 227-33Hafler D.A. et al. Nat. Rev. Immunol. 2005, 5, 83-91

Willer C. et al. Proc. natl. Acad. Sci. 2003, 100, 12877-12882

Dr. Terry Wahls

INFLUENCE the Factors You Can

Genetics and epigeneticsMost AD “run in families”


PATHOGENESIS of Autoimmune DiseaseEpithelial cells are targeted

One of the hottest research topics currentlyLeaky gut


1. Miscommunication between innate and adaptive immunity

2. Molecular mimicry or bystander effects alone don’t entirely explain the complex events involved.

Continuous stimulation by environmental triggers is necessary to perpetuate the process. ... the

autoimmune response can theoretically be stopped and perhaps reversed if the interplay between genes

predisposing individuals to the development of autoimmunity and environmental triggers is prevented

or eliminated.

3. In addition to genetic predisposition and exposure to triggering nonself-antigens, the loss of the protective

function of mucosal barriers that interact with the environment (mainly the gastrointestinal and lung

mucosa) is necessary for autoimmunity to develop.


TRUTH

MYTH

One major environmental factor that modifies gene expression is the individual’s nutritional status. Both macro- and micronutrients can

influence the expression of genes, the translation of the genetic message into active protein, and that protein’s ultimate influence in controlling

metabolic function.

Autoimmune diseases are hereditary and a patients genetic and metabolic makeup far outweighs the role of environmental

factors in disease

Are Autoimmune Diseases HEREDITARY?

Desiere F. Towards a systems biology understanding of human health: interplay between genotype, environment and nutrition. Biotechnol Annu Rev. 2004; 10:51-84

Masson LF, McNeill G, Avenell A. Genetic variations and the lipid response to dietary intervention: a systematic review. Am J Clin Nutr. 2003;77:1098-111.


Food, stress, toxins, allergens, pollutionToday’s environment

"we are the heirs of inherited characteristics accrued over millions of years; the vast majority of our biochemistry and physiology is tuned to life conditions that existed before the advent of agriculture some 10,000 years ago. Genetically our bodies are virtually the same as they were at the end of the Paleolithic era some 20,000 years ago."

PRIMAL body

Eaton SB, Eaton SB 3rd, Konner MJ (1997). "Paleolithic nutrition revisited: a twelve-year retrospective on its nature and implications"European Journal of Clinical Nutrition 51 (4): 207–16


http://en.wikipedia.org/wiki/Melvin_Konner

http://en.wikipedia.org/wiki/Melvin_Konner

http://www.nature.com/ejcn/journal/v51/n4/pdf/1600389a.pdf

http://www.nature.com/ejcn/journal/v51/n4/pdf/1600389a.pdf

Clinical Practice


FUNCTIONAL Roles of the GUT

Digestion/ absorption

Intestinal permeability

Gut microbiota

Immune Regulation

Nervous System

“Gut Feelings “


Rx. 5R FRAMEWORK

–Remove

–Replace

–ReInoculate

–Repair

–Re-Balance

Targeted, individualised interventionaiming to normalise critical gut functions


REMOVE...

... refers to the elimination of factors such as:

-Pathogenic microflora (e.g., bacteria, fungi, parasites)

-Foods to which an individual is sensitive, intolerant, or allergic

-Environmental stressors such as pollutants

-Stress

Clinical approaches may include:

-Oligoantigenic elimination diet - Paleo Autoimmune Protocol

-Botanical antimicrobials or bacteriostatic/bacteriocidal phytonutrients

-Antibiotics/Antifungals

-Stress management


REPLACE...

... refers to the replacement of factors that may be inadequate or lacking.


-Digestive enzymes (HCL, pancreatic enzymes, ox bile)

-Intrinsic secretions

-Soluble fiber to support transit and general GI function

-Vit D, B vitamins, selenium, magnesium, zinc, antioxidants, ...


REINOCULATE...

... refers to the reintroduction of desirable GI microflora (prebiotics, probiotics, FMT) to obtain a more desirable balance to the intestinal milieu


-Bifidobacteria strains

-Lactobacillus strains

-Saccharomyces Boulardii

-Inulin or fructooligosaccharides (FOS)

-Soluble fibers

-Arabinogalactans


REPAIR...

... refers to providing nutritional support for healing of the GI mucosa


-Nutrients important for GI repair: Glutamine, arginine, vitamins A D C, zinc, phosphatidylcholine

-Mucosal secretion protectants: phosphatidylcholine, plantain, polysaccharides

-Support for GALT (Gut-Associated Lymphoid Tissue) function (e.g., lactoferrin, lactoperoxidase, whey immunoglobulins)

-Antioxidants known to function in the GI (e.g. catechins)

-Micronutrients shown to support healing (e.g., pantothenic acid, vitamin E, carotenoids, ...)

-Nutritional anti-inflammatories (e.g., curcumin, EPA and DHA)


REBALANCE...

... refers to providing support for restorative processes in a patients life


-‘Scheduling’ and relaxation

-Mindful eating and better choices for ‘difficult’ situations

-Heart Rate Variability, BioFeedback

-Yoga, meditation, Tai Chi, prayer, breathing or other centering practices

-Psychotherapy, life counceling


Which type are you?Nutrition should meat your needs ;)

Olive oil. Virgin coco. Unleaded. Diesel. Super.


Low dose naltrexone

sub blabla

ALTERNATIVE Treatments

Ozone therapy

Bioresonance therapy

Tai Chi/ Qi Gong

Walking

Acupuncture


http://www.ncbi.nlm.nih.gov/pubmed/

http://www.functionalmedicine.org

http://www.thepaleomom.com

http://robbwolf.com/

http://whole9life.com/

http://www.westonaprice.org

http://thinkfood.co.za/

The Autoimmune Epidemic, by D. Jackson Nakazawa

Minding My Mitochondria, Terry Wahls

The Paleo Solution, by Robb Wolf

Good Calories, Bad Calories, by Gary Taubes

Why we got fat, by Gary Taubes

Food Rules: An Eater’s Manual, by Michael Pollan

Food, Inc. (documentary film)

The Future of Food (documentary film)

Further Reading




http://robbwolf.com

http://robbwolf.com

http://whole9life.com

http://whole9life.com



http://mb-house.co.za

http://mb-house.co.za

Thank you for your attention. Any QUESTIONS?

... feedback is welcome!


Think food nutritional interventions in autoimmune diseases

Health & Medicine

Transcript of Think food nutritional interventions in autoimmune diseases