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Both ankylosing spondylitis (AS) and Crohn’s disease (CD) are chronic and potentially disabling interrelated conditions, which have been included under the group of spondyloarthropathies. The results of a large number of studies support the idea that an enteropathic pathogen, Klebsiella pneumoniae, is the most likely triggering factor involved in the initiation and development of these diseases. Increased starch consumptions by genetically susceptible individuals such as those possessing HLA-B27 allelotypes could trigger the disease in both AS and CD by enhancing the growth and perpetuation of the Klebsiella microbes in the bowel. Exposure to increased levels of these microbes will lead to the production of elevated levels of anti-Klebsiella antibodies as well as autoantibodies against cross-reactive self-antigens with resultant pathological lesions in the bowel and joints. Hence, a decrease of starch-containing products in the daily dietary intake could have a beneficial therapeutic effect on the disease especially when used in conjunction with the currently available medical therapies in the treatment of patients with AS and CD.
Hmmmmmmmmmmm. That's mighty interesting, isn't it. According to some of these studies, a high-carb diet should be an invitation to disaster:
A group from Los Angeles had shown that the mean number of faecal Klebsiella concentrations in individuals taking high carbohydrate/low protein diet was forty times higher than in those having low carbohydrate/high protein diet [77]. Similarly, the mean number of Klebsiella was found to be ten times higher when incubated with simple carbohydrate products such as sucrose, lactose, and glucose than with eleven different amino acids [78]. These results indicate that complex carbohydrates such as starch-containing products are necessary for the growth, replication, and persistence of many enterobacterial agents including Klebsiella microbes in the large bowel.
The carb connecton could certainly explain the increased prevalence of these diseases during the past few decades, but if this is a primary cause of Crohn's and AS, why isn't the prevalence of these diseases much higher, in view of the government promotion of, and widespread adoption of, high carb diets over the last 25–30 years? According to all indications, the lion's share of the populations of the developed countries of the world have been eating high-carb diets for many years. Of course, only about 7 % of North Americans have the HLA-B27 gene mutation, but still — only a small fraction of them actually develop one or both of the diseases, even though most of them have almost surely been eating a relatively high-carb diet.
Definitely an interesting article, though.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
why isn't the prevalence of these diseases much higher, in view of the government promotion of, and widespread adoption of, high carb diets over the last 25–30 years?
Because not everyone is infected or colonized with Klebsiella! Once infected, carbs become their fuel.
Read my quote again. It doesn't specify that the subjects in the study were infected or even colonized with Klebsiella. It refers to people on a high-carb diet. It says:
A group from Los Angeles had shown that the mean number of faecal Klebsiella concentrations in individuals taking high carbohydrate/low protein diet was forty times higher than in those having low carbohydrate/high protein diet [77].
Here's the first 2 sentences of the abstract for reference number 77:
A comparison of 13 vegetarian Seventh Day Adventists with 14 nonvegetarian Adventists revealed relatively few statistically significant differences in fecal flora. A separate study involved a comparison of vegetarian Adventists (49 subjects), nonvegetarian Adventists (45), and non-Adventists on a conventional American diet (31).
The entire article is supposed to be available, but for some reason or other, I can't get it to load.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Zizzle & Tex, I do find this very interesting and it also confirms a long standing habit of mine, eating carbs causing an increase in the gut's irritation, D and pain from Crohn's.
For at least the last 7 years, I have been monitoring how carbs, starches and complex carbohydrates affect my sleep. Starting in 2011, once I eliminated all GF foods, all Carbs, starches, soy and 100% of dairy, I did sleep well. This improvemnt did not last long and I am hopeful that I can get a good recipie.
Tex here is a another twist on my Microscpoic Colitis (CC), AS and Crohns. My latest series of chemo which was started in late October finally kicked in at about 12/22 and has provided significant relief from the MG, Crohns and AS since then. I have had all 'normans' and have had no joint pain or D. To date Imuran, Cellcept or Prednisone have not provided the relief that I am currently experiencing due to yjust the MG.
What has surprised me the most was that the symptoms of MC & Crohns are essentialy gone and that the joint pain has all but vanished.
While Rituxina type of chemotherapy, it is designed to be very targeted to a specific cell type and age of the cell, in this case mature B cells only. Before Rituxin, chemo was basically a form of poison that would kill a lot of cell types resulting in a lot of nasty side effects while hopefully not killing the patient.
I would think that Rituxin needs to be prescribed only to those who need it for cancers (such as lymphoma) and if they have MC or Crohns they can look forward to relief from those conditions as well. For me what I struggle with is the daily grind and issues that these diseases, the stresses each one of them. This multiplies all of the stress making everyone worse.
A question for you Tex, Zizzle or anyone with knowledge in this area - How does killing off basically all of the somewhat matured B cells help MC?? No other cell types have been associated with Myasthenia Gravis. Its been like someone has flipped a switch from the pretty awful position to the feeling pretty darn good position; something I have not felt in many years. The long term goal is to go in for a"tune-up" on a as needed basis.
I hope you have a great weekend and thanks for all of your inputs today.
That's interesting Joe. It suggests MC may truly be an autoimmune disease (with ties to RA, Lupus, etc), not just a food-intolerance mediated-disease.
Many people with Dermatomyositis are starting to use Rituxan infusions, yet DM is not mentioned as a possible disease it treats.
I note that Epstein Barr Virus is a potent transformer of B cells. I have long-believed that EBV is the reason the immune system (namely the B cells) goes haywire in these AI conditions. I think a certain HLA haplotype is required for this transformation to persist in a chronic state (as well as stress and other immune system-weakening exposures), which is why not all EBV-infected develop AI diseases.
Here is a published theory:
Abstract
I hypothesize that human chronic autoimmune diseases are based on infection of autoreactive B lymphocytes by Epstein-Barr virus (EBV), in the following proposed scenario. During primary infection, autoreactive B cells are infected by EBV, proliferate and become latently infected memory B cells, which are resistant to the apoptosis that occurs during normal B-cell homeostasis because they express virus-encoded anti-apoptotic molecules. Genetic susceptibility to the effects of B-cell infection by EBV leads to an increased number of latently infected autoreactive memory B cells, which lodge in organs where their target antigen is expressed, and act there as antigen-presenting cells. When CD4(+) T cells that recognize antigens within the target organ are activated in lymphoid organs by cross-reactivity with infectious agents, they migrate to the target organ but fail to undergo activation-induced apoptosis because they receive a co-stimulatory survival signal from the infected B cells. The autoreactive T cells proliferate and produce cytokines, which recruit other inflammatory cells, with resultant target organ damage and chronic autoimmune disease.
Joe, do you have the HLA DQ2 celiac gene? And more specifically, so you know if you have the HLA DQ2.5 haplotype?
Epstein-Barr virus (EBV) is an extremely successful virus, infecting more than 90% of the human population worldwide. After primary infection, the virus persists for the life of the host, usually as a harmless passenger residing in B cells. However, EBV can transform B cells, which can result in the development of malignant lymphomas.
It's great to hear that the treatment is providing such broad relief of symptoms.
Regarding the mechanism by which Rituximab suppresses inflammation associated with many/most AI syndromes, here is how I believe it works:
By destroying mature B cells, the activation of CD4(+) and CD8(+) T cells is impaired, the production of cytolytic (killer) T cells is disabled, and the production of cytokines is significantly reduced. If the claim that MC and Crohn's are T cell-driven syndromes is correct, then the elimination of the production of killer T cells should be sufficient to stop a reaction and bring remission. Here's a link to a reference abstract:
Please be aware that unless I'm misreading that research abstract, the researchers also concluded that destroying B cells can allow existing cancer cells to develop. Of course we already knew that, but it reminds us of the risks involved with the destruction or downregulation of certain lymphocytes. Enjoy your remission, but please stay alert.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Hello Jean, I hope you are doing well this winter. We have had a mild winter with minimal sbnow, but plenty of cold air.
Zizzle the results at least in my case seem to support your theory. Of course I did not make the decision to take Rituximab based on just treating the MC or Crohns as those can be well controlled with a diet that avoids my trigger ingredients.
Such as:
Gluten (in any form)
Soy
Dairy
....other trigger foods
Your righ Tex one must be diligent when taking meds like this and the benefits must outweigh the risks. The reason I chose this medication is not to control the GI symptoms, but help mitigate the risk of not breathing. Over the past 12 months I have been in the hospital 3 times due to asphxiation as a result of the diaphram muscle weakening from the Myasthenia Gravis.
It should akso be mentioned here that the use of medications like Rituxin to treat only MC and / or the Crohn's would not be the best decision.
In summary the best treatment for the MG also happens to work well for MC and othere
Joe wrote:The reason I chose this medication is not to control the GI symptoms, but help mitigate the risk of not breathing. Over the past 12 months I have been in the hospital 3 times due to asphxiation as a result of the diaphram muscle weakening from the Myasthenia Gravis.
Yes, I definitely realize that, and I agree that it's not only a good choice for that purpose, but downright essential, under the circumstances. And the extra benefits for MC and Crohn's that you pointed out are also rather nice, to say the least. But I do agree with you that it probably wouldn't be a good choice for treating IBDs, in the absence of MG.
I hope it continues to work well for you, so that the MG (and everything else, for that matter) will stay under control.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Interesting article, I just found out through a Genova Stool test that I have a High level of Klebsiella in my gut. So if I try a low starch diet maybe I can starve it out?
Donna wrote:So if I try a low starch diet maybe I can starve it out?
If you have no clinical symptoms, I see no reason why that shouldn't work.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Donna,
In addition to low sugar and starch I would consider some natural antibiotics (or regular ones?). Talk to your doc about oregano oil and other natural antibiotics that it might be sensitive to. Can't want for my CDSA result. Calling my doc tomorrow!!
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