Tuesday, 6 November 2012
Eat shit and live! The hygiene hypothesis n=1
Ever since I was a teenager I've been a hay fever sufferer. For months at a time my nose is irritated by pollen, perfume, cheese, and bright sunlight, my eyes made gritty by cobwebs and house dust. I sneeze not once or twice but unstoppably. This syndrome may seem trivial, but it can be endlessly distracting and exhausting. When I was young I took antihistamines such as Actifed, but this just made me feel worse in a different way (my skin crawled instead of my nose).
Antihistamine use correlates with elevated suicide risk; this doesn't surprise me. http://www.ncbi.nlm.nih.gov/pubmed/22075102
More recently I've found I can get some relief by smoking cannabis to dry out my nose and mouth, but of course this is a drug that has other effects that might not always be appropriate to one's lifestyle.
During the years I was heavily addicted to opioids my hay fever was in remission. Opioids tend to deplete histamine by releasing it indiscriminately, often causing itching as a consequence, but never hay fever. Sadly, I had to throw out this particular baby with all that dirty bathwater.
A few years back I had an enlightening experience. My family was staying over summer with the whanau at a camping ground on their marae (look it up). This kind of communal living close to nature and other people is deeply rewarding on all sorts of levels, but the facilities are of necessity undeveloped, there are little kids with dirty hands everywhere and no clean running water (we drank bottled water). We left with a case of mild diarrhea, and I stopped at the nearest town to get some probiotics; my partner and I also suffering badly from hay fever. I bought L. rhamnosus plus L. reuterii for some reason. Which quickly stopped the GI symptoms but also remarkably put a stop to our hayfever. A pretty amazing effect that lasted for some time afterwards.
But later on, the probiotics weren't a reliable cure; sometimes they even seemed to make it worse. High doses of grape seed extract (200mg OPC before meals) attenuated the cheese reaction (maybe because grape polyphenols bind to casien; this effect is used in wine fining), but there was little, maybe nothing I could reliably do when the fever was really bad (except smoke dope, which I am increasingly reluctant to do).
A few weeks ago now I read "An Epidemic of Absence" by Moises Velasquez-Manoff
"Allergic and autoimmune conditions are far more frequent in rich countries than poor ones, even among genetically identical populations (West Germany far outpaced East Germany in their frequency, as does Finland compared with an impoverished adjacent territory under Russian control). Societies where intestinal parasites are the rule seem to lack them completely."
Now, I don't have access to whipworms and hookworms, but maybe there is something I can do to test this hypothesis?
What if - all good hypotheses must start "what if" - what if the favourable effect my partner and I obtained from probiotics that past summer was in fact also due to the bacteria causing the gastro-intestinal upset? What if bacteria not usually part of our gut flora, plus probiotics, supplied what I might call a broad-spectrum immune tolerance effect? For geeks of this stuff (and I know more about it now than I'm going to let on here - looking into immunology will quickly take you down the rabbit hole and through the looking-glass and should not be indulged in lightly), I mean supplying a variety of PAMPs with activity across a wide enough range of TLRs to mimic an everyday ancestral exposure.
How to replicate this? Eating dirt? Swallowing my goat's droppings? (Bear Grylls considers deer droppings a desirable supplement.) These options suggested themselves, but did not recommend themselves.
Fortunately I have a well in my backyard; it's fed by mountain rainfall, seeps down through the soil and rock and up through mud, weeds and algae. I know it's full of saprophytic bacteria (feeding on decayed plant matter) because if I let it stand it soon becomes brackish. I drink it often with no ill-effects, but I've never drunk it constantly or looked for a correlation with my hay fever symptoms.
Experiment - to drink the well water often enough (at least 3 times a day) that the pseudocommensals (non-probiotic, non-pathogenic bacteria, algae, etc. consumed with food and water) it contains are always in my gut; to avoid treated water or bottled water and see what happens. To also notice if taking or not taking probiotics makes any difference.
Results: Hay fever has not returned (it is November in the Southern Hemisphere and my partner, who's not drinking the water, is complaining of, I mean reporting, symptoms). I sneeze every few days but only once at a time; the double sneeze has only happened once, and there is never long-lasting irritation. Most convincingly, I can clean cobwebs with absolutely no eye irritation. My cobweb allergy is not seasonal in any way, so this is unlikely to be co-incidence. And it wasn't actually part of the original hypothesis as I never considered it to be hay fever.
Not only do I react to cheese less, I crave cheese less, and eat less of it, which is an interesting observation for this long-time fan of Richard Mackarness. http://www.independent.co.uk/news/obituaries/obituary-dr-richard-mackarness-1303347.html
I would rate my symptoms now, as a percentage of what they usually are at this time:
sensitivity to pollen and perfume: 10%
sensitivity to sunlight: 0%
duration of irritation: 5%
sensitivity to cobwebs: 0%
sensitivity to cheese: 30%
Probiotics don't seem to be required for these benefits.
I am on tour at the moment and away from my well, without access to safe "raw water". We'll see if any symptoms return in the few days I'm away.
It's also possible I'm a bit happier and more contented, less irritable and distracted, now. It's hard to be sure as life is a journey and you can never drink the same water twice. We'll see.
This was an n=1 experiment and placebo effects are no doubt considered possible. But I have to admit to being something of a placebo skeptic. When you're a drug addict people are always trying to give you placebos and you soon lose any ability to be fooled by your expectations.
Placebos in RCTs seem to be more about controlling for the circumstances of the test (white coat syndrome) by making them as identical as possible, than about any magical effect of mind over matter.
My partner hasn't yet drunk from the well, nor will my children go near it. This seemed crazy to me, avoiding a healthful water source that our ancestors would have been lucky to have. But it also makes sense; the instinct to always prefer the very cleanest water, and distrust everything else, has made sense in evolutionary terms - until very recently.
Video: Dr Richard Mackarness - father of Paleo, from 1958