The Autoimmune Epidemic: Bodies Gone Haywire in a World Out of Balance--and the Cutting-Edge Science that Promises Hope (No Series) (32 page)

In research on those with Crohn’s disease, elimination diets helped symptoms to abate in a third of patients who tried them. Irritable bowel syndrome, or IBS—a gastrointestinal syndrome characterized by abdominal pain and cycles of intense diarrhea and constipation—has been found to be inflammatory in nature, says Mullin. In a recent scientific paradigm shift, IBS is now becoming classified as an inflammatory bowel disorder—though whether it is autoimmune in nature and there are autoantibodies involved that attack the body tissue itself has not yet been fully investigated or answered. It is, however, says Mullin, a very good question to ask. Could it be that an overgrowth of bacteria in the small intestine—which is often found to be an issue in patients with irritable bowel syndrome—triggers the inflammatory response in the same way that bacteria triggers the autoimmune response in Crohn’s disease and ulcerative colitis? We may yet find, posits Mullin, that in irritable bowel syndrome, the body sees the bacterial overgrowth occuring in the small intestines as foreign, and as the immune system strikes out against that infection, the immune system generates not just inflammation but sets off an autoimmune response against the gut.

Meanwhile, patients with irritable bowel syndrome—which affects one in five women in America—respond profoundly to changes in their day-to-day diet. In one study, 75 percent of patients with irritable bowel syndrome found that their symptoms improved with dietary changes alone. Clearly, for someone suffering from an inflammatory bowel disorder, shifting toward a diet that eliminates foods that increase inflammation can help to repair the gut and reestablish the balance of healthy intestinal microflora. Individuals who want more information about elimination diets should have no difficulty finding it. Literally scores of books have been written on elimination diets, and many are available on the Internet. But be sure to discuss any such plan with your doctor.

It may also prove helpful to undergo testing for food allergies and food sensitivities. Food allergies (versus sensitivities or intolerances) are divided into two major categories: IgE mediated and T-cell mediated allergies. IgE allergic reactions are immediate; after being exposed to the food, your body quickly overproduces what is called immunoglobulin E antibodies, or IgE. You begin to experience fairly immediate symptoms—tingling of the extremities, wheezing, coughing, tightening of the throat, nausea, abdominal cramps, and diarrhea—within hours of having ingested the food. More severe anaphylaxis (a sudden, severe, potentially fatal systemic allergic reaction that can involve the skin, respiratory tract, gastrointestinal tract, and cardiovascular system) can occur after eating nuts, shellfish, fish, peanuts, and tree nuts. A second type of food allergy—known as a T-cell mediated allergy—occurs when T cells within the intestinal mucosa see a food as foreign and the immune system reacts to the presence of that food. T-cell mediated food allergies—which are more common in children—usually occur four to twenty-eight hours after ingestion of a food.

As if all this weren’t complex enough, allergists are now examining the possibility of a third type of hyperreactive response to food, referred to as an IgG food sensitivity. With IgG food sensitivities, the body slowly begins to produce immunoglobulin G antibodies, and the resulting symptoms—which can take up to three days to appear—can be more subtle and more difficult to detect than an IgE reaction. Many patients remain unaware of their food sensitivities—after all, if you are frequently consuming a food you’re having a delayed sensitivity to, then you’ll never notice a direct correlation. Although the concept of IgG food sensitivities is still controversial, many doctors believe that IgG mediated food reactions increase inflammation in the body and can worsen disease symptoms. Many autoimmune experts believe food sensitivities may be even more prevalent in autoimmune-disease patients, who tend to have higher rates of allergies in general. In fact, in one new study at Children’s Hospital and Regional Medical Center and the University of Washington, researchers found that allergic reactions may contribute to the triggering of autoimmune diseases, though they are not yet sure of the mechanism by which this occurs. Studies confirm that for some patients with rheumatoid arthritis, food sensitivities worsen their symptoms, and avoidance of these foods helps their symptoms to abate. For this reason, Mullin recommends asking your doctor to run blood tests that will help to pick up not only foods to which you have an allergic reaction, but also foods to which you might be sensitive or intolerant.

What follows is a short list of foods that Mullin and many nutritionists believe may help to quiet down autoimmune activity. In terms of a general diet, consider eating a low-inflammatory diet of range-fed beef, lamb, chicken, and turkey; fish with a low mercury content (wild salmon, mackerel, sardines, flounder, red snapper, and tilapia); hormone-free eggs; all vegetables (avoiding eggplant and tomatoes); avocados; all fresh fruits; unsweetened yogurt (if you are not dairy allergic or sensitive); freshly made whole-grain breads from alternative nongluten grains; brown rice; beans; nuts, seeds, and sprouts; and raw honey or stevia (in moderation); organic butter; olive, flaxseed, cod liver, and sesame oils; and seasonings such as rosemary, thyme, and oregano.

Conversely, avoid wheat, rye, and barley (these contain gluten, which can be a common source of food sensitivities and cause severe reactions in those with the autoimmune disorder, celiac disease), refined carbohydrates, including potato chips, donuts, pastries, commercial cereals, and commercial breads (especially white breads); potatoes and eggplant (which have inflammatory properties); fast food, hydrogenated oils; safflower, sunflower, cottonseed, and corn oils; instant foods; microwaved foods (heating food in the microwave can deplete it of essential nutrients); canned fruit; lunch meats with nitrates; commercial salad dressings; artificial flavors, colorings, and MSG; aspartame, high-fructose corn syrup, and sucralose; yeast; genetically modified grains; and commercially fried foods.

In one recent study of seven hundred children between the ages of seven and eighteen living on the island of Crete, those who consumed a diet rich in fish; fruits such as red grapes, oranges, and apples; fresh vegetables twice a day; olive oil; and nuts three times a week were significantly less likely to suffer from allergic responses, including allergic asthma, allergic rhinitis, and skin allergies.

CHOOSING ORGANIC FOODS

As you shop for healthy foods, buy organic. One recent study brings home how genetically vulnerable some of us may be to the damaging effects of exposure to pesticides. Investigators recently looked at 130 Latinas and their newborns living in California’s Salinas Valley, an agricultural community where organophosphate pesticides are widely used. Overall, 82 percent of the women had had some exposure to pesticides while they were pregnant—mostly because they were living with agricultural workers.

Researchers looked at blood samples taken from these women and measured them for levels of an enzyme known as paraoxonase 1, or PON1, which is able to break down the toxic metabolites of organophosphate pesticides. That’s an important function for your body to have: those who have a certain type of the PON1 enzyme are much more protected against the damaging health effects of pesticides. Having this protective feature of the PON1 enzyme depends on whether you have the Q or R form of the PON1 gene. People with what is known as the QQ genotype have two copies of the Q variant of the PON1 enzyme (one from each parent), which is significantly less efficient at helping the body to detoxify following exposure to organophosphate pesticides. People with the RR genotype have two copies of the R variant of the PON1 gene, producing a PON1 enzyme that is more resistant to pesticide exposure because the enzyme helps to break down and eliminate pesticides from the body.

The PON1 enzyme also varies by ethnicity. Approximately 50 percent of whites have the QQ genotype, compared with 25 to 35 percent of the Latino population and 10 to 20 percent of African Americans—making Caucasians most susceptible to the ill effects of pesticides.

In studies of mice, those that lacked the PON1 enzyme died after being exposed to low levels of organophosphate pesticides, while the same low dose of pesticides elicited no symptoms in mice that possessed normal levels of the enzyme. That’s how important an enzyme it is—and whether or not you have it in healthy abundance matters a lot in how exposure to pesticides will affect you.

Infants are at particular risk of not being able to break down pesticides, since the level of PON1 enzyme in newborns is one-third of what it is in adults, and it takes six months to two years for a baby to develop mature levels of PON1. In looking at infants born to Latinas who were exposed to these pesticides, researchers found that infants who inherited the QQ genotype were 50 times more susceptible to pesticide exposure than newborns with the RR genotype, because babies with the QQ genotype do not possess the ability to break down the toxic metabolites. This is particularly frightening given that animal studies show that exposure to organophosphates tampers heavily with normal neurodevelopment, and studies in infants show that pesticide exposure is related to abnormal reflexes as early as in the first few days of life. Combined exposure to mixtures of pesticides is also related to significantly higher rates of asthma in children under the age of two. Most to the point, as we have seen in earlier chapters, organophosphate pesticides—which are also endocrine disruptors—are linked in animal studies to risks of developing the autoimmune disease lupus, and farmers who mix their own pesticides stand a greater likelihood of developing lupus. Although researchers are only now beginning to look at how such genetic differences to susceptibility to pesticides lead to the development of autoimmunity in humans, the glimmers of knowledge we already have are very sobering indeed: some infants do not possess the genetic ability to break down and detoxify their bodies after exposure to pesticides; infants have lower levels of these enzymes in general; pesticides are implicated in the development of neurological disorders and autoimmune disease; and autoimmune-disease rates, as well as other immune-mediated disorders such as asthma and allergies, are rising rapidly among children. The idea that some individuals might be more immune to the effects of environmental contaminants—while others, given their genetic codes, are the proverbial canaries in the mine—is rarely taken into account when government agencies examine environmental exposures to chemical agents and establish safety rules about their use. Until we see change in this arena, buy pesticide-free fruits and vegetables for yourself and for your children.

Indeed, one recent study funded in part by the Centers for Disease Control and Prevention found that eating organic foods substantially lowers children’s dietary exposure to organophosphate pesticides. Investigators measured the exposure to several organophosphate pesticides in twenty-three children between the ages of three and eleven over a fifteen-day period. They had children eat a conventional, nonorganic diet for three days, followed by a five-day diet of all organic foods, and then a seven-day diet of conventional nonorganic foods. During the five days in which children ate an organic diet there was a “dramatic and immediate” drop in their levels of pesticides, going as low as zero during the organic food phase. Pesticide levels increased five-or sixfold—and in some cases substantially more—when children began to eat a nonorganic diet again.

Remember to also wash all fruits and vegetables well—even organic ones—before you eat them. According to new data from the Centers for Disease Control and Prevention, produce accounts for 12 percent of all food-borne illnesses—a number that has been on the rise of late. Illnesses from leafy greens such as spinach and lettuce have been particularly worrisome: between 1996 and 2006, there were twenty-four such outbreaks, according to FDA records. Unlike the meat, egg, milk, and processed-food industries, the fresh produce industry is not regulated or monitored for safety by government agencies.

Food-borne illnesses have been linked to developing Guillain-Barré syndrome, the worsening of Crohn’s disease, and sparking autoimmune disease flares. To avoid food contamination, use common sense: wash produce including leafy greens well (one autoimmune disease specialist suggests washing all leafy greens three times); be sure to refrigerate all cut, peeled, or cooked fresh fruits and vegetables within two hours; wash cutting boards and peelers well; use separate cutting boards for produce versus meats; throw away fruits or vegetables that have touched raw meat, poultry, seafood, or their juices; and cut away bruised or damaged portions of fruits and vegetables before eating them.

THE QUEST FOR SAFE FOODS AND SUPPLEMENTS

It’s important to read labels and carefully choose foods that are chemical and additive free, and if you choose to use dietary supplements, ask your doctor to corroborate that they are from a reputable source. Several past cluster outbreaks of autoimmune disease still haunt scientists because of the rapid and insidious way in which thousands of individuals were struck ill with autoimmune reactions seemingly overnight, not from contact with unseen chemicals but from impurities in the processed food products, drugs, and supplements they consumed.

In May 1981, for instance, food product salesmen in Spain sold a rapeseed oil to stores that, unbeknownst to them, contained trace ingredients derived from an oil diverted from industrial use. The oil derivatives were erroneously used while the oil was being refined into a consumer product. This rapeseed oil made it to the tables of tens of thousands of consumers, and “toxic oil syndrome” burst onto the scene. Twenty thousand individuals fell ill with a lupuslike autoimmune disease, and 1,200 people died.