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Think food nutritional interventions in autoimmune diseases

The talk focused on "Nutritional Interventions in Autoimmune Diseases (AD)", the subject being hotly debated and fast progressions taking place. Established guidelines incorporate these findings increasingly as the topic gains prominence in disease prevention/ modification and are of interest to any healthcare professional.

The presentation includes:
- A brief overview of the prevalence and cost of AD,
- Problems with current treatment approaches,
- A short overview of the genesis of AD
- The role our environment (incl. our food) plays
- Finally a solution suggesting an oligoantigenic elimination diet
- A "Paleo Autoimmune Protocol" is proposed and some clinical practice insights are given.

Thanks very much to everybody who attended the talk. I am looking forward to receive your questions, concerns and feedback!

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Think food nutritional interventions in autoimmune diseases

  1. 1. Nutritional Interventions in Autoimmune Diseases Academic talk, Christiaan Barnard Memorial Hospital 24th January 2013Thursday 24 January 2013 1
  2. 2. GOOD MORNING. Who’s talking PAST PRESENT Universities of Helping people to get Düsseldorf and Cape off drugs rather than Town supplying them 2nd pharmacist in Working independently Europe’s biggest mail in own practice - order pharmacy: No disclosures Docmorris Grey Healthcare/ Not favouring any working for particular Supplement® Big Food and Pharma Pfizer Animal Health EUAfME Christoph Lenz Pharmacist & nutritional coach 2Thursday 24 January 2013 2
  3. 3. 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. Diagnosis done by specialists Many patients are not or mis-diagnosedThursday 24 January 2013 3
  4. 4. PREVALENCE of Autoimmune Diseases 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.Thursday 24 January 2013 4
  5. 5. PROGRESS in Health Care $100M $10M Moore’s Law $1M $100k $10k $1k 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Cost of 1GB memory in the 80s ~ $1 000 000 . Analysis of 1 Megabase DNA costs <10 Cents in 2012 National Human Genome Research Institute 24 January 2013 5
  6. 6. COSTS of Autoimmune Diseases NIH estimates annual direct health care costs Runner Autoimmune diseases > $100 billionup Cancer $57 billion Best price Heart and stroke $200 billion AARDA, NCAPG; The Cost Burden of Autoimmune Disease; 2011Thursday 24 January 2013 6
  7. 7. 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.” NIH, Autoimmune Diseases Coordinating Committee, Progress in Autoimmune Diseases Research, Report to Congress 2005Thursday 24 January 2013 7
  8. 8. CAUSAL Factors of Autoimmune Disease Genetic Pollutants/ toxins Infectious agents Microbiome Environmental triggers Food Polyautoimmunity and familial autoimmunity are common What is the red thread?Thursday 24 January 2013 8
  9. 9. Autoimmune diseases >33% already linked to “Leaky gut” 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 “Dietary Mechanisms of Autoimmunity”, Loren Cordain, Ph. DThursday 24 January 2013 9
  10. 10. Autoimmune diseases >33% already linked to “Leaky gut” Disease Organ/ tissue involved Source Hashimoto’s thyroiditis Thyroid Sasso FC et al. Gut 2004, 53, 1878-80 IgG 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, 715-22 Juvenile Arthritis Collagen/ joints Picco P et al. Clin. Exp. Rheumatol. 2000, 18, 773-8 Lupus erythematosis Multiple Apperloo HZ et al. Epidemiol. Infect. 1994, 112, 367-73 Multiple sclerosis Nerve/ brain Yacyshyn B et al. Dig. Dis. Sci. 1996, 41, 2493-98 Pemphigus-diseases Skin Kieffer M et al. Br J. Dermatol. 1983, 108, 673-8 Primary biiary cirrhosis Liver/ gallbladder/ GIT Di Leo V et al. Eur. J. Gastro. Hepatol. 2003, 15, 967-73 Psoriasis Skin Hamilton et al. Q. J. Med. 1985, 56, 559-67 Rheumatoid arthritis Joints Smith MD et al. J. Rheumatol. 1985, 12, 299-305 Rosacea Skin Kendall SN. Exp. Dermatol. 2004, 29, 297-99 Schizophrenia Brain Wood NC et al. Br. J. Psychiatry 1987, 150, 853-6 Skleroderma Connective tissue Caserta L et al. Rheumatol. Int. 2003, 23, 226-30 Sclerosing Cholangitis Liver Terjung B Clin. Rev. Allergy Immunol. 2009, 36, 40-51 Spontanous abortion Uterus Friebe A Int. J. Biochem. Cell Biol. 2008, 40, 2348-52 Ulcerative colitis Gut Caradonna L et al. J. Endotoxin Res. 2000, 6, 205-14 Urticaria Skin Buhner S et al. Allergy 2004, 59, 1118-23 Uveitis Eye Benitez JM et al. Eye 2000, 14(pt 3A), 340-3 “Dietary Mechanisms of Autoimmunity”, Loren Cordain, Ph. DThursday 24 January 2013 10
  11. 11. Diet shapes gut microbial community structure and function, Diet shapes gut microbial community and the microbiota adapts in structure and function, and the microbiota adapts in ways promote nutrient ways that that promote nutrient processing; the ability of the processing; the ability of the microbiota to process a given to process athe nutrient and microbiota diet affects given diet energetic value nutrient andThe microbiota affects the of that diet. energetic value of that diet. The and immune systems co-evolve: malnutrition microbiota and immune affects the innate and adaptive immune systems as well co-evolve: systems as the microbiota. malnutrition affects the innate and adaptive immune systems as well as the microbiota. Kau etal; Nature; 474(7351): 327–336, 2011Thursday 24 January 2013 11
  12. 12. 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 of the intestines, including bowel cancer; and autism.Thursday 24 January 2013 12
  13. 13. SIDE EFFECTIVE Treatments for AD Resulting in bad compliance Patients are often referred to as “psycho somatic”Thursday 24 January 2013 13
  14. 14. EFFECTIVENESS of DM Drugs in MS “The outcomes so far obtained in the prespecified primary analysis suggest a lack of delay in disease progression for all disease modifying treatments” Boggild M, Palace J, Barton P, Ben-Shlomo Y, Bregenzer T, Dobson C, Gray R., Multiple sclerosis risk sharing scheme: “Disease progression was worse than that in the untreated two year results of clinical cohort study with historical control group” comparator. BMJ. 2009, 9 pages. “... it took untreated persons 14.4 years with a 95% Veugelers PJ, Fisk JD, Brown MG, Stadnyk K, Sketris IS, Murray TJ, Bhan V., Disease progression among multiple confidence interval of 12-17.4 years whereas the treated sclerosis patients before and during a disease-modifying patients were estimated to reach EDSS 6 at 18.6 years with drug program: a longitudinal population-based evaluation. Mult Scler. 2009 Nov;15(11):1286-94. a 95% confidence interval of 15.9-21.9 years.” “... 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 Ebers, G, Traboulsee A, Li D, et al., Analysis of treated patients (those on betaseron for over 80% of clinical outcomes according to original treatment groups 16 years after the pivotal IFNB-1b trial. J the time) reaching EDSS 6 in the same time interval.” Neurol Neurosurg Psychiatry, in press, 6 pages. $25.000 = Disease Modifying drug therapy/a Not taking adverse drug events into considerationThursday 24 January 2013 14
  15. 15. MTX Actions and REACTIONS Mode of Action Methotrexate 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 ADE Rash, nausea, vomiting, thrombocytopenia, dizziness Severe ADE Pericardial 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 Complimentary drugs are prescribed to counteract ADE Are we really surprised if the liver fails?Thursday 24 January 2013 15
  16. 16. Treat the PATIENT, not a Disease - 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 significantly less expensive.therapeutically effective and non-drug interventions are Relman As. Your doctor’s drug problem. The New York Times, November 18, 2003 How much can we change a patients environment? Healthcare spendings need to invest in prevention an patient educationThursday 24 January 2013 16
  17. 17. INFLUENCE the Factors You Can Genetics and epigenetics Most AD “run in families” Infections and Microbiota i.e. Epstein Barr Virus, chlamydia pneumoniae, measals, rubella Geography Risk increases with distance from the equator Sunlight, UV, vitamin D Dr. Terry Wahls Trauma Operations, psychological stress, environmental toxins, heavy metals, smoking Vaccinations Which adjuvants were used? Food Certain triggers compromise gut integrity. Poser C. M. Clin. Neurol. Neurosurg. 2006, 108, 227-33 Hafler D.A. et al. Nat. Rev. Immunol. 2005, 5, 83-91 Willer C. et al. Proc. natl. Acad. Sci. 2003, 100, 12877-12882Thursday 24 January 2013 17
  18. 18. PATHOGENESIS of Autoimmune Disease Epithelial cells are targeted Leaky gut One of the hottest research topics currentlyThursday 24 January 2013 18
  19. 19. Thursday 24 January 2013 19
  20. 20. 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.Thursday 24 January 2013 20
  21. 21. Are Autoimmune Diseases HEREDITARY? MYTH Autoimmune diseases are hereditary and a patients genetic and metabolic makeup far outweighs the role of environmental factors in disease TRUTH 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. 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.Thursday 24 January 2013 21
  22. 22. PRIMAL body "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." Today’s environment Food, stress, toxins, allergens, pollution 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): 207–16Thursday 24 January 2013 22
  23. 23. Clinical PracticeThursday 24 January 2013 23
  24. 24. FUNCTIONAL Roles of the GUT Digestion/ absorption Intestinal permeability Gut microbiota Immune Regulation Nervous System “Gut Feelings “Thursday 24 January 2013 24
  25. 25. Rx. 5R FRAMEWORK Targeted, individualised intervention aiming to normalise critical gut functions –Remove –Replace –ReInoculate –Repair –Re-BalanceThursday 24 January 2013 25
  26. 26. 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 managementThursday 24 January 2013 26
  27. 27. REPLACE... ... refers to the replacement of factors that may be inadequate or lacking. Clinical approaches may include: -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, ...Thursday 24 January 2013 27
  28. 28. REINOCULATE... ... refers to the reintroduction of desirable GI microflora (prebiotics, probiotics, FMT) to obtain a more desirable balance to the intestinal milieu Clinical approaches may include: -Bifidobacteria strains -Lactobacillus strains -Saccharomyces Boulardii -Inulin or fructooligosaccharides (FOS) -Soluble fibers -ArabinogalactansThursday 24 January 2013 28
  29. 29. REPAIR... ... refers to providing nutritional support for healing of the GI mucosa Clinical approaches may include: -zinc, phosphatidylcholine repair: Glutamine, arginine, vitamins A D C, Nutrients important for GI -polysaccharides protectants: phosphatidylcholine, plantain, Mucosal secretion -lactoferrin, lactoperoxidase, whey immunoglobulins) function (e.g., Support for GALT (Gut-Associated Lymphoid Tissue) -Antioxidants known to function in the GI (e.g. catechins) -E, carotenoids, ...) to support healing (e.g., pantothenic acid, vitamin Micronutrients shown -Nutritional anti-inflammatories (e.g., curcumin, EPA and DHA)Thursday 24 January 2013 29
  30. 30. REBALANCE... ... refers to providing support for restorative processes in a patients life Clinical approaches may include: -‘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 councelingThursday 24 January 2013 30
  31. 31. Olive oil. Virgin coco. Unleaded. Diesel. Super. Which type are you? Nutrition should meat your needs ;)Thursday 24 January 2013 31
  32. 32. ALTERNATIVE Treatments Ozone therapy Acupuncture Bioresonance therapy Walking Tai Chi/ Qi Gong Low dose naltrexone sub blablaThursday 24 January 2013 52
  33. 33. Further Reading 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)Thursday 24 January 2013 32
  34. 34. Thank you for your attention. Any QUESTIONS? ... feedback is welcome!Thursday 24 January 2013 33