A Big Time Parkinson’s Brood

As I sit here this morning, the rain is heaving down outside.  It is dark and dismal and reminds me of my trip to the UK last week.  (Except that it’s 30 degrees warmer here!)

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This of course brought to mind some of the events of that trip…which included finding out that yet another friend, also around 50 years old, has just been diagnosed with Parkinson’s.  That’s already the 3rd for me, diagnosed with what used to be called an old man’s disease.  (Men are more likely to develop Parkinson’s than women.)

Ironically, over dinner and before he told me the news, I’d commented that I have been very upset lately, watching all my friends – all 50ish, give or take a few years either way – become sick.  For the women, it’s mainly reproductive cancers and Hashimoto’s (autoimmune thyroid disease).  For the men, it’s Parkinson’s and IBD.  The list also includes severe allergies, cardiovascular illnesses, migraines, other digestive illnesses, depression, and anxiety issues.

I told my friend that if he were going to get the diagnosis of Parkinson’s, this was the week to do it.  So said his neurologist, funnily enough.  As you all know if you’ve been reading my blog regularly, an astounding number of seminal papers have been published recently.

I looked up the rates of Parkinson’s, curious to see if it too is increasing in frequency, like so many other inflammatory illnesses.  According to the Parkinson’s Disease Foundation[i], “As many as one million Americans live with Parkinson’s disease…” and “Approximately 60,000 Americans are diagnosed with Parkinson’s disease each year…”  Holy cow.  Almost exactly a year ago, an article[ii] was published in JAMA  Neurology that states that yes, the incidence between 1976 and 2005 more than doubled in older men. (It does not, however, state whether or not the incidence is increasing in younger men too, only that it’s more common in older than younger.)  And their suggested cause of this enormous increase?  The decrease in smoking rates.  Apparently, smoking is associated with a reduced risk of Parkinson’s.  I’m sure I don’t need to state the obvious here…but I will anyway, ‘cause I can never resist a good bit of sarcasm to amuse myself.  Is the medical solution then to the increased rate of Parkinson’s disease to start encouraging smoking?! Because that’s going to work out well for everyone.

What with the fact that in the last 3 months, research has pretty clearly suggested that Parkinson’s starts with a negative alteration of the gut biome; that this chronic “infection” leads to increased production and eventual aggregation and distortion (folding) of the immune protein, alpha-synuclein…which then travels from the gut to the brain via nerves, causing an autoimmune response in the brain leading to the destruction of dopamine producing cells…well, once again, doesn’t common sense dictate that working on the health of the gut biome would at least help…and certainly not hurt?

I mean, call me crazy but….

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[i] http://www.pdf.org/parkinson_statistics

[ii] Savica, Rodolfo, et. al.  Time Trends in the Incidence of Parkinson’s Disease.  JAMA Neurology. 2016;73(8):981-989.

Your Brain on Intestinal Bacteria

I got back from the UK on Sunday night.  I had a wonderful time talking helminths with practitioners from all over the world at the International Congress on Naturopathic Medicine…and of course, having a pint in the pub!

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With one of my BFFs, Marc.  (And yeah, ok – I’m only having a half pint.  I’m a lightweight!)

 

Now I feel overwhelmed in that I have so much to catch you all up on, in terms of biome research. Honestly, who’d have thought even a few years ago that so much could happen in just one week in the world of our intestinal old friends!

So, to pick one of the high points:

A new study[i] was just published looking at how the composition of the gut microbiota affects human emotions.  Researchers at the University of California took fecal samples from 40 healthy women between 18 and 55 years old.  They noted that the microbiota composition fell into 2 distinct groupings, with one have more Bacteroides species and the other having more Prevotella species.  The women were giving MRIs to examine their emotional responses while looking at pictures designed to provoke positive, negative or neutral emotions.

The group with more Bacteroids had thicker grey matter in their frontal cortex, which is the area of the brain that processes complex information.  They also had a larger hippocampus, which is your memory center.  (It’s the area of the brain most affected in Alzheimer’s.)  The women with more Prevotella had a smaller frontal cortex and hippocampus, and showed greater connections between emotional, attentional and sensory regions of the brain. This latter group reported “greater levels of anxiety, distress and irritability when looking at negative images.”[ii]

The authors of the paper point out that the hippocampus regulates emotions, so with it being smaller in the Prevotella group, they may have less ability to contain emotions:  “Reduced hippocampal engagement to negative imagery may be associated with increased emotional arousal.”

The implications of this are obviously tremendous, especially when you consider the staggering rates of “mental illness” in the industrialized world, ranging from depression and anxiety disorders to autism.  This is possibly the first time that gut microbiota have been proven to affect not only the physical composition of the brain, but how humans think and feel.  Amazing!

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[i] Tillisch, K, et. al. Brain structure and response to emotional stimuli as related to gut microbial profiles in healthy women.  Psychosomatic Medicine. 2017. doi: 10.1097/PSY.0000000000000493

[ii] http://www.huffingtonpost.co.uk/entry/gut-bacteria-really-do-affect-your-emotions_uk_595b6434e4b05c37bb7ffeda

More Exciting News on Parkinson’s Research

Well, it looks like researchers have finally cracked the Parkinson’s/autoimmune puzzle.  For years, it’s been suspected that there was an autoimmune component.  Now, finally, it’s confirmed.

Says Dr. David Sulzer at Columbia University, one of the lead researchers on the study[i] just published in Nature, “Our findings show that two fragments of alpha-synuclein, a protein that accumulates in the brain cells of people with Parkinson’s, can activate the T cells involved in autoimmune attacks.”

This study found that “T cells can be tricked into thinking dopamine neurons are foreign by the buildup of damaged alpha-synuclein proteins.”

Remember that just a week ago or so, research[ii] came out of Duke University showing that the damaged alpha-synuclein protein found in both Parkinson’s and Alzheimer’s, seems to originate in the endocrine cells of the gut.  Scientists were amazed to find that the gut endocrine system establish connection with nerves.  “…the endocrine cells – which are not nerves…are able to communicate directly with the nervous system and brain.”

The question then becomes, of course, will treating Parkinson’s with anti-inflammatory pharmaceuticals and/or natural treatments make a difference?  Can the deterioration be halted or even reversed?

In other news, I probably will miss a week of posting on my blog as I’m leaving for the UK on Sunday night.  On Tuesday I may be filmed by a major network news team (ugh! nerves!) and on  Wednesday, I’ll be spending the afternoon with a reporter from The New Scientist talking helminths.  I’ll also be attending a big, international conference on naturopathic medicine. I will write all about my adventures when I get back!

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[i] https://www.sciencedaily.com/releases/2017/06/170621132904.htm

[ii] https://www.sciencedaily.com/releases/2017/06/170615100616.htm

Autism, the Biome and Extreme Frustration

Fortunately, it’s a beautiful summer day outside and Alex has had a great few days… or else, I’d really be in one of my moods.  Why?  “Experts have called for large-scale studies into altering the make-up of bacteria in the gut, after a review showed that this might reduce the symptoms of Autism Spectrum Disorder (ASD).  Until now, caregivers have relied on rehabilitation, educational interventions and drugs to reduce ASD symptoms, but now researchers suggest that treating this condition could be as simple as changing their diet.”[i]

Ah!!!!! Now that experts have declared that diet may help, it must be so.

The fact is parents, me included, have been telling (screaming from the rafters, actually) the scientific and medical communities this for decades

One of the scientists involved in this cutting-edge research (that was sarcastic), Dr. Qinrui Li, is quoted saying, “Our review look looked at taking probiotics, prebiotics, changing the diet…and faecal matter transplants.  All had a positive impact on symptoms.”

Well, like, duh.

(Oops.  I guess I’m in a mood after all!)

You really do have to wonder, how much further along autism research would be right now, if the scientific community paid the slightest bit of attention to what those living with autism say.  Dr. Li acknowledges that “To date there are no effective therapies to treat this range of brain developmental disorders,” and that “The number of people being diagnosed with ASD is on the rise.”   His conclusion, though, in my opinion, is everything that is currently wrong with science:  “We are encouraged by our findings, but there is no doubt that further work needs to be carried out in this field….For now, behavioral therapies remain the best way to treat ASD.”

Right.  So, you can put your 2 year old newly-diagnosed child on a special diet (especially the  Specific Carbohydrate Diet, in my opinion!), probiotics and prebiotics and hopefully normalize his gut flora thereby possibly improving his autism symptoms…or you cannot, because the medical establishment has not yet totally conclusively decided it can help.

It sure as hell can’t hurt though, can it?

If you ask me – and unfortunately no one does! – any doctor who sees a child with autism and does not tell the parents to use diet, and other gut microbiota interventions, is guilty of negligent malpractice.

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[i] https://www.sciencedaily.com/releases/2017/06/170619101834.htm

Alzheimer’s – Nurture Versus Nature

Shortly after my son, Alex, was diagnosed with autism, I began to understand that while there may be a genetic fragility that made him more prone to the illness, it was meaningless without the right environmental triggers.  I’ve written before about his “perfect storm,” so this idea isn’t new to you.  It just came to mind again when I read this week how a poor diet, combined with a genetic propensity, may lead to Alzheimer’s Disease.[i]

Researchers at the University of South Carolina compared the effects of a poor diet (high in cholesterol, unhealthy fat and sugar) on groups of mice that have a gene that is highly associated with the development of Alzheimer’s.

“Part of what the results are saying is that risk doesn’t affect everybody the same, and that’s true for most risk factors….Your genes have a big role in what happens to you, but so does your environment and your modifiable life-style factors.  How much you exercise becomes important and what you eat becomes important.”

The mice fed the equivalent of a modern western diet quickly gained weight, became pre-diabetic, and developed the signature brain plaques of Alzheimer’s.

And of course, the modern western diet is also highly associated with a decrease in microbiome diversity.

As I was typing the above, and simultaneously snooping around on the Internet, I came across an article published on Wednesday entitled, “Gut bacteria might one day help slow down aging process.”[ii]  Using the laboratory worm, C. elegans, researchers tested thousands of bacterial genes and compounds to see what would happen.  The results demonstrated that various bacterial genes and compounds had a huge effect, ranging from increasing the worms’ lifespans to protecting them from tumor growth to preventing the accumulation of amyloid-beta, which make up the plaques in Alzheimer’s.

The good news, of course, is that this means we all have a measure of control – at least to some extent.  It’s a little comforting to know that our futures aren’t completely set in stone.

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[i] https://www.sciencedaily.com/releases/2017/06/170613102059.htm

[ii] https://phys.org/news/2017-06-gut-bacteria-day-aging.html

More on the Microbiome, Personalized Medicine and Nutrition

In my last post, I wrote about personalized nutrition based on the composition of the gut flora.  That is, your gut flora dictates which foods tend to be healthier for you.  In that same vein, I spotted an article this morning entitled “Healthy Diet? That Depends on Your Genes.”[i]  The study of how our genes interact with food is called nutrigenomics:  “Based on one’s ancestry, clinicians may one day tailor each person’s diet to her or his genome to improve health and prevent disease.”

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So while I’m still rattling on about amazing medical advances of the future, I thought I should also mention a 2nd article[ii] I found on another important, and related, topic.  It turns out that the same way various gut bacteria differently metabolize food, so too do they differently metabolize medications.  As we all know, people respond very differently to the same treatments.  A couple of months ago, there was a lot in the media about how gut bacteria determine response to cancer medicines.

Then last week, I read that the same goes for treatments for inflammatory bowel disease.  Researchers from MIT and Harvard noticed that those with similar microbiomes responded to an antibody-based drug while those with different microbiome profiles did not.  “The findings showed that doctors may be able to predict the efficacy of treatments for IBD before they’re even prescribed, all on the basis of analyzing the microbial population of the patient’s gut.”

It will be quite some time, of course, before we have the data necessary to make microbiome analysis before selecting a treatment the norm, but still – it’s something to look forward to, I think.

By the way, remember my days (and days and days…) of raving and ranting about Dr. Mercola’s claim that helminths are an unnecessary and undesirable risk?  One of the researchers involved in this study, commenting on why this type of research is so important, points out that, “… the therapy for IBD is still not optimized, even though there are different medications…. The success rate is still not as good as we’d like — probably only 45 to 55 percent have achieved remission on their current medications. Efficacy for medications is still not optimized yet.”

I reckon that the 50% of people who do not respond to medications might want to keep their options open.

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[i] https://www.sciencedaily.com/releases/2017/06/170612153554.htm

[ii] http://www.healthline.com/health-news/gut-microbiome-helps-with-ibd-treatments#4

The Best Idea Since Sliced Bread: Personalized Nutrition and the Microbiome

In the future, when we’re all living like the Jetsons and flying cars are the norm , it’s likely that medicine and nutrition will be highly personalized. (Hell, Forbes projects flying cars in the next 5 years[i] so maybe this isn’t in some far-off futurity!)  I’ve been reading more and more about this concept:  for example, creating personalized probiotic blends for people based upon their genetics, disease, current microbiome state, etc.

future city flat illustration.

I spotted an interesting article[ii] yesterday that looked at individual response to eating bread.  This was a randomized trial of 20 people:  they all increased their bread consumption to about 25% of their total daily calories, some eating packaged white bread, some eating whole wheat sourdough.  After 2 weeks, the groups were reversed.  During the study, many health effects were measured including glucose levels, levels of the minerals calcium, iron and magnesium; fat and cholesterol; kidney and liver enzymes; markers for inflammation and tissue damage; the makeup of the participants’ microbiomes before, during and after.

Interesting, there was no clinical differences in any of the measured parameters.  However, since it has already been established that people have different glycemic responses to the same food, the researchers decided to measure this as well.  And what they found is that “…about half the people had a better response to the processed, white flour bread, and the other half had a better response to the whole wheat sourdough.”

The microbiomes of all the participants, no matter which bread they ate, remained very stable.  What would have been really interesting – and I’m sure will be the subject of future work – is to look at the similarities and differences in the microbiomes of those with a larger glycemic response to whole wheat versus those who had the larger response to white bread.

As the authors’ conclude:  “Understanding the interpersonal variation in the effect of bread, one of the most-consumed staple foods, would allow the personalization of bread-related nutritional recommendations and optimization of food choices worldwide.” [iii]

So yeah – maybe in 5 years time, I’ll be munching on my personalized-health sandwich while sitting in my self-driving flying car.  Now that I think about it, George Jetson’s daughter was Judy…coincidence?

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[i] https://www.forbes.com/sites/sarwantsingh/2017/06/05/flying-cars-from-fiction-to-reality/#19ee6d804b46

[ii] Korem, et. al. Bread Affects Clinical Parameters and Induces Gut Microbiome-Associated Personal Glycemic Responses.  Cell Metabolism. 2017;25, 1243-1253.

[iii] https://medicalxpress.com/news/2017-06-white-wheat-bread-healthier-person.html#jCp

Parkinson’s Disease, the Microbiome… and Things You Can Do Now

By now, you all know that I am particularly interested in Parkinson’s disease (PD) research as I have two friends who are both suffering from it – both diagnosed  early (one in his 40s, one in his 50s).   I’ve been following the research on the gut-brain connection, and have written several times about his already.

I was particularly excited then to come across an article yesterday entitled, The gut-brain axis in Parkinson’s disease:  Possibilities for food-based therapies.[i]  You also all know I get pretty pumped when research actually suggests treatment that can be instituted NOW.  This one made my day.

The writers emphasize that Parkinson’s “…symptoms go beyond motor dysfunction, since PD patients very often develop non-motor symptoms, including cognitive impairment…pain, depression, tiredness…and most commonly, gastrointestinal (GI) dysfunction.”  What was new to me is that these symptoms may appear years before the classic motor issues that lead to diagnosis and more than that –“…their occurrence in otherwise healthy people has been associated with an increased risk of developing PD.”

Research is showing pretty conclusively that PD likely starts in the nose or the gut, our gateways to the outside world.  The pathological process that appears to cause PD may start with a toxin, a pathogen or a negative change to the microbiome. The exact cause is still not known.  (Still, it seems like an awfully good idea to me to work on maintaining the health of your biome.  I may have mentioned that before…)

There is so much information in this article that I almost don’t know where to start.  A few of the highlights then, to not have this post be excessively long:

  1. Constipation is the most common gut complaint among those with PD and may precede motor symptoms by 10 years or more.  87% of those subsequently diagnosed with PD had constipation beforehand:  “…constipation is assumed to be a harbinger and is associated with an increased risk of developing PD.”  So for all of you who think constipation is not a big deal (which, in my experience as a nutritionist is a hell of a lot of people), think again.
  2. PD patients have increased intestinal permeability (leaky gut) and gut inflammation. The toxic byproducts of inflammatory gut species disrupt the blood-brain barrier, facilitating “…neuroinflammation and injury in the SN [subtantia nigra – the part of the brain most affected in PD]…”
  3. The evidence for an altered microbiome in PD is mounting rapidly. Just one example:  those with PD have lower levels of the species Prevotella, which subsequently leads to lower levels of short chain fatty acids (SCFAs), and reduced ability to synthesize thiamine (vitamin B1) and folate.  This leads to higher levels of systemic inflammation.
  4. SIBO (small intestine bacterial overgrowth) is exceedingly common in PD. And while those with PD suffering from it do not necessarily have worse GI symptoms than those without, their motor dysfunction is measurably worse.  How wild is that?!

So, what can be done now to potentially ameliorate some of the symptoms of PD and/or slow down the progression of the disease?

  1. Specific nutrients can help, including those that are important in the formation and maintenance of neuronal membranes:  uridine (a component of RNA), the omega 3 fatty acid DHA, and choline (a phospholipid) – all of which can be bought commercially.
  2. Also important: cofactors in the synthesis of phospholipids, including B-vitamins, vitamin C and E, selenium.
  3. Prebiotics – have a beneficial effect on both the immune system and on the microbiome, increasing levels of anti-inflammatory species (those that produce SCFAs) and reducing levels of pro-inflammatory ones
  4. Probiotics

Of course, I’d personally add helminths to this list, for both their direct anti-inflammatory effect (since inflammation and oxidative stress are both crucial in the development of PD) and their effect on the bacterial microbiome.

By the way, one last really important point:  the GI dysfunction found in PD causes poor absorption of l-dopa, the primary medication to treat the symptoms of the disease. Over time, l-dopa causes monstrous side effects and also, eventually stops working altogether. Improved GI function would allow doctors to have to prescribe less l-dopa…reducing side effects and making it effective for longer.

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[i] Perez-Pardo, P, Kliest, T, Dodiya, HB, Broersen, LM, Garssen, J, Keshavarzian, A, Kraneveld, AD. The gut-brain axis in Parkinson’s disease: Possibilities for food-based therapies.  European Journal of Pharmacology. 2017. http://dx.doi.org/10.1016/j.ejphar.2017.05.042.

Gut Bugs and Metabolic Syndrome

According to JAMA (Journal of the American Medical Association), 35% of Americans now have metabolic syndrome (and 50% of those over 60 years old).[i]  Holy cow!  How’s that for incredible (and depressing) statistics?!  Well, how interesting for us gut-bug-lovers to learn that it looks very likely that bad gut bacteria may be the culprit.

By the way, in case you’re not familiar with the term metabolic syndrome, it refers to “…a cluster of conditions – increased blood pressure, high blood sugar, excess body fat around the waist and abnormal cholesterol or triglyceride levels – that occur together, increasing your risk of heart disease, stroke and diabetes.”[ii]  With about a third of Americans now being obese, it’s not surprising to learn that metabolic syndrome is dramatically on the rise…and with all that diabetes and cardiovascular illness around, I can’t even imagine the costs to society in every regard.

Anyway, it turns out that alterations to the gut bacteria have already been associated with metabolic syndrome but the mechanism by which this caused the health issues was unknown.  It turns out that the bad bacteria breach the epithelium (the wall of the intestine) causing inflammation that interferes with the normal action of insulin.[iii]

Thus far, the researchers have not identified the particular types of bacteria at fault, nor have they suggested a solution.

This research though reminds me yet again of one my favorite sayings of my friend, Dr. Sidney Baker (the eminent functional medicine doctor):  “Inflammation is inflammation.”  That is, while localized inflammation may be evident (for example when you bang your leg and it swells), the chemicals of inflammation are circulating throughout your body via your blood stream.  If your gut is inflamed, your body is inflamed and your brain is inflamed.  Thus, for example, there is a well-established connection between metabolic syndrome and depression.[iv]

To sum up:  it’s an awfully good idea to maintain a healthy body weight and take care of your biome…in case you didn’t know.

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[i] https://www.sciencedaily.com/releases/2015/05/150519121529.htm

[ii] http://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/home/ovc-20197517

[iii] https://www.sciencedaily.com/releases/2017/05/170530122341.htm

[iv] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584197/

The gut bacteria affect the brain’s blood vessels

I’m obsessing on some research[i] I read about last week.

 “A study in mice and humans suggests that bacteria in the gut can influence the structure of the brain’s blood vessels, and may be responsible for producing malformations that can lead to stroke or epilepsy.  The research…adds to an emerging picture that connects intestinal microbes and disorders of the nervous system.”

Scientists from the University of Pennsylvania, who were studying cerebral cavernous malformations (CCMs – which are clusters of dilated, thin-walled blood vessels that can cause blood to leak into the surrounding brain tissue causing strokes and seizures), noticed that when gut bacteria were eliminated, the number of lesions was greatly lessened.

The researchers observed that the mice with gut abscesses that contained a certain kind of bacteria had far more lesions in the brain.  These gram-negative bacteria produce a molecule called lipopolysaccharides (LPS) that actives the immune system.  (Remember my post on the metabolome? – the metabolites produced by your gut bacteria?)  When the scientists injected mice genetically susceptible to CCMs with LPS they developed markedly more lesions.  When they removed the receptors (TLR4) to LPS the mice no longer formed lesions.  That is – the metabolites of the gut bacteria were the variable factor that led to the same genetic fragility having a greater or lesser negative impact.

Hmmm.

The first thought that went through my head when I read this:  “It is estimated that up to 80% of children with autism may experience seizures.  We know that the gut bacteria is altered in autism.  Is this research relevant?”  I have no idea…but the idea is certainly intriguing.

Apparently there is a drug already being tested that blocks TLR4 and these scientists are now hoping to study humans with the genetic mutations which can cause CCM.  The same mutation can lead to vastly different outcomes in people, after all.  Is this the result of variability in their microbiomes?  And – can improving the quality of the microbiome improve the quality of the brain’s vasculature?

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[i] https://medicalxpress.com/news/2017-05-brain-blood-vessel-lesions-intestinal.html