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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.
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.

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


majkinetor said...

Very interesting and not entirely unexpected.

You can rule out placebo effect if you keep it rolling long enough - if it exists, placebo diminishes over time. After 6 months or so, it no longer applies especially when procedure goes into the routine and you no longer think about it.

I don't know if you tried it, but vit C is antihistaminic and you can find all sorts of papers on that. Its mild, but probably good enough in larger, more frequent doses. It totally behaves like antihistaminic , including the mild drying of the esophagus. I have read papers in all sorts of circumstances including sea sickness.

If you didn't try it yet, the protocol could be:
- 2g x 5 ascorbic acid powder
- 200mcg x 2 chromium picolate
- in some mineral water
- on empty stomach

If that doesn't make a change I would suggest to switch from powder to liposomal form of vitamin C. In this moment it becomes far more expensive then your water solution, but if water effect fades away you have something else to try on.

Now, what would happen if you use both ? I imagine ascorbic acid will nullify the effect of water because it will make stomach acid barrier more acidic (that is, bring it to the pH by design) and thus eliminate "pathogens" before entering the small intestines.

Puddleg said...

I think it would have to be very high doses, and probably calcium ascorbate would be best. However, it's the immune tolerance one really needs; the condition is pretty much permanent, if seasonal, so the outlay on ascorbate for the rest of ones life would be taxing (if it worked - and gram doses didn't).

If the effect wore off, that might just be some adaptation of the immune system, just as the probiotics stopped working, or came to work unreliably, in the first place... or a seasonal variation in the triggers.
Generally, hygiene hypothesis interventions late in life don't seem to be as effective as early ones. But I am hoping a "broad spectrum" approach to the problem is one solution, rather than relying on a single organism.

majkinetor said...

You can't dose vitamin C like that - the best way to know the dose is bowel tolerance. If you didn't approach it, results are often next to null. Dosing would reduce after some time (anecdotal ofc). Its very hard to get the dosage right in my experience. Its not that simple as taking 1,2,5 or 10 grams per day. Now, I take from 1 to 150g per day depending on context and my dosing regime is highly individualized, so patience is important.

Also, you risk exposure to some serious pathogen in your current solution. Your well is far from wells from 50 years ago.

The scenario of "ascorbate to the rest of ones life" is not something megadosers are concerned with. It similar to complain as if you said that you have to put sugar in each coffee during the day and hence is better not to use sugar then depend on it entire life...

Multi-gram doses, if you believe the vitamin industry (I didn't make mind myself) could be replaced with single gram of liposomal C (or few grams). In some scenarios they say its equally effective as IV C since it has 100% bioavailability (C has 5-10 percents in its normal form when megadosing).

Puddleg said...

I'm pretty sure my well is pristine, with no possibility of human or livestock contamination. I am actually more worried about allelopathic plant toxins than about pathogens.

Ascorbate is great for short-term problems that will resolve - respiratory and other acute viruses, sepsis, opioid withdrawal - however histamine is not the whole story in hay fever.

Another alternative I want to try is the respiratory pathogen oral vaccine, Buccaline Berna. There is a possibility this could also be effective.

Puddleg said...

More hygiene hypothesis related stuff - Good Vaccines:

Over the years case-control studies have found that vaccination against some types of infection reduces the risk of developing melanoma later in life.

Children vaccinated against smallpox (with vaccinia), or against T.B. (with B.C.G.) developed fewer melanomas during their lives than those who were not vaccinated. If both vaccines were given, the reduction was greater: up to 60%. It was also found that those who were vaccinated and developed melanoma survived longer than those who were not.

One reason for the benefit is that these vaccines contain an antigen similar to that found in 95% of melanomas. This antigen is HERV-K-MEL

A recent study published in the journal Vaccine found that vaccination against yellow fever also reduces the development of melanoma but the effect is not seen for 10 years. The yellow fever vaccine also contains HERV-K-MEL.

Vaccinia and B.C.G. are not used in Australia but the yellow fever vaccine is available. Only 1 in 100,000 people vaccinated develops an adverse reaction.

Puddleg said...

Not strictly a medical subject is the Andamanese reaction to sneezing which has been described as follows

They [the Andamanese] have no peculiar ideas in reference to yawning, hiccoughing, spitting, or eructating, and hissing is unknown.

To sneeze is auspicious, and therefore regarded with favour. When any one sneezes the bystanders ask, "Who is thinking of you?" to which the person replies by naming some absent friend, or, should he be alone when he sneezes, he says, "Here I am at ---" (naming the place).

It is certainly an odd - and as far as the author is aware largely unexplained and unresearched - fact that most (all?) human cultures react to sneezing with standardized remarks, often wishes for good health ("Gesundheit", "Santé") or religious expressions ("Bless you").

I am loving the book this comes from:

John said...

Hi George,

You mentioned Otto VB's biography as a case study of overeating on meat/fat: care to provide a quick summary? Is it simply a short section in the book?

Puddleg said...

"There is always another dish" - Otto Von Bismark
During the seige of Paris, Bismark was sent game and preserves from admirers and his estates, and ate dish after dish; a compulsive over-eater of high-protein, fatty food (mostly meat and fish, some sweets and champagne) he became fat quite slowly, suffered many health problems, but no photo shows him with a modern type of obesity.
He was placed on an all-fish diet and lost much of the weight.
He lived into his 80s.

i think he would make a rewarding medical case study for the posthumous pathologists of great men, and tell us something about the metabolic effects of long-term high-protein, high-fat overfeeding.

"FOOD AND DRINK In his younger days, gastronomy was Bismarck's ruling passion. Once he started attending the Diet his intake increased even more. In 1878 Bismarck presided over the division of Africa by the colonial powers at the Conference of Berlin while eating pickled herrings with both hands. By 1883 he was very bloated, over 17 stone, which made him ill and very bad tempered so for months he lived on a diet of herrings. By 1885 he was down to 14 stone.
A chronic insomnia sufferer, the Iron Chancellor would nightly devour caviar to give him a thirst for strong beer to help him to sleep. His favorite tipple was Black Velvet, a mixture of champagne and Guinness. He was also partial to burgundy wine."

John said...

Hmm, I'm not quite sure what an all fish diet is, but I wonder if a poorly designed high meat intake gives too much Fe and perhaps a poor amino acid balance.

Puddleg said...

In the menus I've seen, way too much protein for any man not in olympic contention. Venison follows sausage follows pheasant follows ham, all washed down with champagne and seasoned with caviar. Charles Laughton as Henry the 8th (or maybe as Charles Laughton). The fish diet was real thing; there is a palindrome about it -
Doc note, I dissent. A fast never prevents a fatness. I diet on cod.