Richard G. Petty, MD

A New Treatment for Toxoplasmosis

I have talked at some length about the possible link between toxoplasmosis and some forms of mental illness, but there is also another side to toxoplasmosis: the Toxoplasma gondii parasite infects nearly one-third of all humans: more than two billion people worldwide. In the United States alone, congenital toxoplasmosis occurs in an estimated 1 per 5,000 births a year and can cause severe vision loss, brain damage and even death. The human cost is incalculable, and in dollars and cents, it has been estimated that the annual cost of caring for these children may exceed $1 billion.

Toxoplasma gondii is carried by some cats and it is said that an infected cat can excrete up to 20 million oocysts over a period of two weeks, and every single oocyst is infectious. They are tenacious and can remain infectious in water for up to six months and in warm moist soil for a year of more.

Toxoplasma infects humans through three main routes:

• Consumption of undercooked, infected meat
• Ingestion of T. gondii oocysts in food, through accidental contamination from cat litter
• Finally, a newly infected pregnant woman may pass the infection to her fetus, hence the warning that pregnant women should not clean the cat box

Not only is toxoplasmosis the most common parasitic infection in the world, but also it can cause particular problems in people with compromised immune systems, for instance people with cancer, autoimmune disease, AIDS or transplant recipients.

It is even possible for people with normal immune systems to suffer major organ damage from chronic infections. Eye disease leading to loss of sight can be caused both a primary infection and as a result of infection transmitted from mother to child. Damage to other organs has recently caused deaths among otherwise healthy young people during epidemics in Surinam and French Guiana.

The parasites that cause malaria are related to Toxoplasma gondii, and a new drug that will soon enter clinical trials for the treatment of malaria also appears to be 10 times more effective than the current gold-standard treatment of toxoplasmosis, a combination of the drugs pyrimethamine and sulfadiazine.

In the March issue of PLoS Neglected Tropical Diseases, a research team based at the University of Chicago Medical Center reports that the drug, known as JPC-2056, is extremely effective against Toxoplasma gondii, both in cell culture and in mice, and apparently without the toxicity associated with the current standard treatment.

The drug works inhibiting the action of the from of the enzyme dihydrofolate reductase (DHFR) that is produced by the family of parasites that includes those that cause toxoplasmosis and malaria, and in cell culture studies, the drug appears actually to kill the parasite, rather than simply preventing its replication. This is very important: not only do most of the current medications have a good many side effects, they have little effect on Toxoplasma during certain phases of its life cycle. It can hunker down in the quiescent cystic phase and wait until the antibiotics are gone.

Rima McLeod, professor of ophthalmology and specialist in infectious diseases at the University of Chicago said,

"JPC-2056 has the potential to replace the standard treatment of pyrimethamine and sulfadiazine. Taken by mouth, is easily absorbed, bioavailable, and relatively nontoxic. In tissue culture and in mice, it was rapidly effective, markedly reducing numbers of parasites within just a few days."

JPC-2056 is not a new drug. It was developed in the late 1980s by teams led by Wilbur Milhous and Dennis Kyle of the Walter Reed Army Institute for Research and David Jacobus of Jacobus Pharmaceutical Company. The original version was quite toxic, but the researchers found ways to reduce the toxicity and developed an oral version of the drug. Clinical trials using JPC-2056 to treat malaria are scheduled to begin later this year.

A Virus Linking Depression, Aging and Heart Disease

We have known for a long time that there are close links between depression, aging and heart disease, but the nature of the link has remained elusive. Most of the smart money has been on inflammation, but there could be other candidates.

New research in the journal Brain, Behavior and Immunity has linked an increase in two inflammatory proteins in the immune system with a latent viral infection and proposes a chain of events that might accelerate cardiovascular disease. It is possible that the same process may be involved in a number of other ailments that can afflict us, as we get older. The findings also suggest that chronic depression may play a key role in initiating the cascade that can lead to the development of coronary artery disease.

It has been known for some time that increased levels of the proinflammatory cytokines, TNF-α and IL-6, predict mortality and morbidity. High levels of each of them are found in the plasma and in atherosclerotic lesions of people with cardiovascular disease.

The levels of IL-6 in the body increase as the immune system ages. Some of the IL-6 is generated by immune cells - macrophages - that go to the site of an infection or injury. Earlier work by the team also showed that increases in psychological stress and depression could substantially raise the levels of IL-6 and TNF-α in the body.

Increased stress and depression can also trigger latent viruses to reactivate and begin reproducing inside cells. The viruses of greatest interest are some herpes viruses such as the Epstein-Barr virus (EBV). We know that up to 90% of the people in North America have been infected by EBV by the time they are adults.

If EBV begins to multiply in cells in the body, it produces a protein called dUTpase that, in turn, can stimulate macrophages to make yet more IL-6.

The researchers developed a model to test these linkages by using endothelial cells that line the inside of veins in umbilical cord tissue. I spent years working with these cells myself, and they provide an excellent substrate for examining vascular responses and the interaction between blood vessels and macrophages when exposed to the virus as well as the dUTpase protein.

As expected, the production of IL-6, as well as TNF-a, were increased just as they would be as part of the inflammatory process in the body. Such chronic incidents of inflammation are integral to the onset of atherosclerosis and an array of other diseases.

This work suggests a new way of thinking about how vascular diseases develop. We carry around these latent herpes viruses in our bodies virtually all our lives and periodically they can hurt us as we age, develop depression or, perhaps a nutritional imbalance.

Taken together with the recent data on the physical effects of loneliness, if you want to live a long and healthy life:

• Watch you mood: depression can kill you
• Stay socially engaged: loneliness can be fatal
• Maintain a balanced diet
• Take some physical exercise every day
• Learn – and practice! – some simple stress management techniques. You can obtain some at RichardGPettyMD.com

T'ai Chi Ch'uan and Shingles

Shingles can be a particularly nasty problem, and treatment can be tough. It should be called herpes zoster, and it is caused by re-activation of varicella zoster virus (VZV) that causes chickenpox.

A new study  from the Norman Cousins Center for Psychoneuroimmunology at UCLA, has shown that t’ai chi therapy can stimulate the immune system of patients with shingles to levels comparable to those achieved using a vaccine against VZV.

It was a controlled trial in which the researchers randomized 112 healthy adults aged 59 to 86, who had a history of varicella infection, to Tai Chi Chih (TCC, a simplified, standardized form of tai chi) or health education (HE) for 25 weeks. After 16 weeks of intervention, subjects were vaccinated against VZV. The results of blood tests showed that TCC alone increased immunity against VZV by an amount comparable to that induced by varicella vaccine in the HE group.

It was interesting that the effects of the two were additive; TCC, together with varicella vaccine, produced a substantially higher level of immunity against VZV than vaccine alone, raising it to levels usually observed in adults 30 years younger.

The tai chi group also showed significant improvements in scores for physical functioning, bodily pain, vitality, and mental health.

Regular readers will recall another report from this research group, indicating that TCC reduced the activity of the sympathetic nervous system. The two studies both show that there is something special going on: the practice does not only calm the mind and body, it also regulates parts of the body that are normally beyond voluntary control.

There are clearly plenty of reasons for taking up t’ai chi, though now we shall have to see whether other forms of t’ai chi can achieve the same results.

Goldilocks and the, err, Vitamins

We are often told that we should take much higher amounts of many vitamins than the doses that are usually recommended.

The late Linus Pauling was one of the most famous proponents of the idea of using huge amounts to Vitamin C to present colds and an array of other health problems. Over the years I have heard enough recommendations to confuse anyone: and one of my degrees is in biochemistry! The only answer with so many conflicting pieces of advice is to do some good research.

Vitamin A is an important fat-soluble vitamin involved in the maintenance of many of many key systems in the body. The recommended daily allowance for vitamin A is 5000 international units (IU) for adults and 8000 IU for pregnant or lactating women.

Vitamin A deficiency is one of the major nutritional problems worldwide and it threatens the survival and health of millions of children. According to a report published in 2002, 127 million preschool children and 7·2 million pregnant women are deficient in vitamin A.

Vitamin A deficiency can cause night blindness, drying and degeneration of the cornea that can lead on to total blindness, as well as impairment of the immune system.

Children living in regions where vitamin A intake is insufficient need to receive adequate amounts of vitamin A through breastfeeding, together with improved diets, food fortification and supplementation with vitamin A.

Providing vitamin A supplementation in countries where there is a deficiency of the vitamin has been proven to decrease mortality. As a result, most developing countries have adopted a standard World Health Organization (WHO) dosing schedule for vitamin supplementation, which calls for 200,000 IU to mothers early postpartum and then 200,000 IU every 4 to 6 months. For infants, the recommendation is 100,000 IU at 9 months and 200,000 IU at 12 months.

However, in 2002 the International Vitamin A Consultative Group (IVACG) Annecy Accord recommended a new high-dose regimen for mothers and infants which includes a doubling of the initial postpartum dose for mothers, and adding 50,000 IU at 2, 3 and 4 months for infants.

An article just published in the Lancet indicates that this high dose protocol does not have any benefit over the older recommendation.

Professor Andrew Prentice and a team of researchers at the International Nutrition Group at the London School of Hygiene and Tropical Medicine in London and colleagues, studied 220 women-infant pairs in an area of moderate vitamin A deficiency in Gambia. One group received the WHO recommended dose, while the other received the IVACG recommended dose.

They measured blood plasma levels of vitamin A, the incidence of Helicobacter pylori infection, how many of them had pneumococcus in the nasopharynx and the integrity of the infants’ intestines. 

The problem is that too much vitamin A can also create problems, including nausea and vomiting, jaundice, irritability, anorexia, blurred vision and worst of all, increased intracranial pressure that can cause headaches, drowsiness and even death. These are not such big problems in well-nourished adults living in the Western world, but in malnourished infants, particularly if they are also being vaccinated, this can be a big problem.

There is one specific occasion when a high dose of Vitamin A can be helpful: if a child in a deficient area gets severe measles, the WHO recommendation is that two doses of 200,000 IU should be given to the child. It is easy to forget that in some parts of the world measles can be a killer.

The authors of the article, as well as an accompanying editorial suggest that we should be looking at lower, rather than higher doses of vitamin A.

The editorial is by Professor Bernard Brabin of the Child and Reproductive Health Group in Liverpool, England and he finishes by saying,

“Future trials should emphasize the importance of exclusive breastfeeding, because early feeding with formula milk might reduce potential benefits from early supplementation with vitamin A in infants."

This story shows us once again the extreme importance of having just the right amount of a vitamin or nutrient.

If someone claiming to be an expert in nutrition or vitamin therapy tells you to “take as much as you want” of anything, please be careful.

Just remember the story of Goldilocks and the Three Bears….

Resistance Genes in the Food Supply

Your humble reported has been interested in nutrition since he was knee high to a puppy, and he has also been worried about the consequences of pesticides and other artificial chemicals getting into the food chain. He has also been worried about feeding all kinds of artificial potions to animals. Surely they would eventually turn up in humans, and we have little idea about all the things that they may do. It is also a worry that antibiotic resistance in humans could be passed on to bacteria in animals.

Some of these fears were born out at a conference – the 107th General Meeting of the American Society for Microbiology (ASM) - in Toronto this week.

A paper presented by Hua Wang of the Ohio State University suggests that the administration of antibiotics to animals could be contributing to the continuing rise of antibiotic-resistant infections in humans

The problem is a process known as horizontal gene transfer, in which bacteria that are in close proximity to each other can share genetic information, including genes that code for antibiotic resistance. Horizontal gene transfer between disease-causing bacteria has been known for years as an important avenue for the exchange of antibiotic-resistance genes among bacteria in hospitals. We all carry bacteria on and in our bodies. Some are beneficial, and help in things like digestion. Others are simply “passengers,” and we call these “commensal” bacteria.

Research has also already demonstrated that pathogenic bacteria have the ability to engage in horizontal gene transfer with the otherwise harmless bacteria that we all carry in our bodies. What concerns us is that these normally benign commensal bacteria have an enormous and diverse gene pool. That increases the likelihood of gene transfer. Some commensal bacteria exchange genetic information extremely quickly. That was helpful to the bacteria during evolution, but may be producing a boatload of problems for us today.

Dr Hua said:

"We have demonstrated not only that organisms carrying such intrinsic mechanisms have the potential to become an important reservoir for antibiotic resistance genes but, more importantly, that these intermediate organisms can disseminate antibiotic resistance genes in subsequent events much more effectively than the parental donor strain.”

“Once we no longer limit ourselves to food borne pathogens and look at commensal bacteria, we will find that the magnitude of antibiotic-resistant bacterial contamination in the food chain is tremendous.”

In a study published last year, she and her colleagues tested a range of ready-to-eat food samples that they purchased from several grocery chain stores. They included seafood, meats, dairy, deli items and fresh produce. With the exception of processed cheese and yogurt, antibiotic-resistance gene-carrying bacteria were found in many food samples that they examined.

The problem is not just confined to the food supply. Recent studies have shown antibiotic resistance genes in bacteria in the digestive tract of young infants. Since these children were still being breast- or formula-fed and had not yet eaten solid food, they must have acquired these genes somewhere other than the food supply. This suggests that resistance genes from the environment had somehow got into the infants.

Antibiotic resistance is a huge and ever-growing problem. For years now, many of us have worried about the over-prescribing of antibiotics when they are not needed. For example viruses cause the vast majority of sore throats, and few viruses respond to antibiotics. Yet patients often feel cheated if they do not leave a doctor’s office clutching a prescription. The result has been increasing numbers of resistant bacteria. When you really need an antibiotic, it may no longer be effective. Now we have another mechanism by which our actions have caused a problem that could quite literally be the death of us.

It’s Not Just Kissing

Once upon a time Marilyn Monroe is supposed to have said, “So what’s wrong with sleeping with lots of people? You can’t get cancer from it.”

The quotation may be apocryphal, but the facts are not: we now know full well that there are viruses that can be sexually transmitted that may in turn increase the risk of getting cervical cancer. Hence all the talk about Gardasil, the new vaccine against some of the main culprits: strains of the human papillomavirus (HPV) types 16, 18, 6, and 11. HPV types 16 and 18 cause about 70% of HPV-related cervical cancer cases.

It was only a matter of time before someone put two and two together and asked the question whether the viruses might be involved in cancer if they end up in other parts of our anatomy.

After all the revelations concerning a former President, it seems that over the last ten years there has been a sea-change in attitudes. According to surveys, many young people now regard oral sex as nothing more significant than kissing.

On many levels, that is sad.

Anyone able to see the larger picture will be upset to see that complex matters of human relationships, feelings of self-worth and transcendence are being reduced to a branch of gymnastics. This is not at all a puritanical view: any kind of sexual activity is complex and multi-faceted. And now there is some new evidence to suggest that oral sex with multiple partners can carry a substantial risk of developing cancer of the throat.

According to a study published in the New England Journal of Medicine people who have oral sex with 5 or more partners during their lifetime have a much greater chance of having throat cancer, The researchers suspect that the cause is a well known strain of the human papillomavirus (HPV) that is linked to a number of anogenital cancers.

Dr Maura Gillison and a team of collaborators from the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland conducted the research.

Scientists already knew that HPV was doing something at the molecular level to help trigger a type of throat cancer known as oropharyngeal squamous-cell carcinoma, but consistent epidemiological evidence was still missing.

The researchers recruited 100 patients with newly diagnosed oropharyngeal cancer and 200 control patients without cancer in a hospital-based case controlled study. They used a statistical method called logistic regression to look for links between results from the patients' blood and saliva samples and lifestyle variables such as their sexual behavior, consumption of alcohol and smoking habits. Getting honest and accurate lifestyle data is always tough, particularly when asking about sex, so this data was collected using an anonymous questionnaire.

The results showed that:

• Patients who had a lifetime number of 6 or more oral-sex partners were 3.4 times more likely to have oropharyngeal cancer
• Those who had 26 or more vaginal-sex partners during their lifetime were 3.1 times more likely to have oropharyngeal cancer.
• The link became stronger as the number of lifetime oral and vaginal sex partners went up.

Oropharyngeal cancer was linked with oral infection with HPV type 16 (HPV-16), with any of the 37 types of HPV, and with having been exposed in the past to HPV. That was determined by measuring for antibodies to the HPV-16 L1 capsid protein. The statistics were impressive. What is known as the odds ratio for these three events were found to be 14.6, 12.3 and 32.2 respectively.

DNA from HPV-16 was found in 72 per cent of tumor specimens and 64 per cent of patients tested positive for presence of one or more cancer-related proteins produced by HPV-16. (These are known as oncoproteins E6, E7, or both).

The results suggested that once the link with HPV is present, there is no added risk from tobacco use and alcohol consumption, usually regarded as the highest risk factors for this type of throat cancer.

The researchers suggest that HPV "drives" the cancer and once the cell is sufficiently disrupted to cause cancer, the impact of tobacco and alcohol is unlikely to contribute any more risk.

The researchers concluded that:

"Oral HPV infection is strongly associated with oropharyngeal cancer among subjects with or without the established risk factors of tobacco and alcohol use."

In an accompanying editorial, Dr Stina Syrjänen from the University of Turku in Finland suggested that this study raises important clinical and public health issues.

For instance:

• Should heavy smokers and drinkers be screened for HPV-related throat infection?
• Should throat cancers with a suspected HPV origin be treated differently form those with no HPV link and most likely caused by smoking and drinking?
• And the question that must be in the minds of many currently focused on the HPV vaccination debate: would HPV vaccination give people protection against some throat and mouth cancers?

Non-pharmacological and Lifestyle Approaches to Attention-Deficit/Hyperactivity Disorder: 5. Exercise, Environment and Sleep

One of the most valuable things to do to help children or adults with ADHD is to help them to structure their time.

All the approaches that we have already discussed, from medications to diets, herbs and homeopathy are all tools designed to help people get to the point where they can create, accept and maintain more structure in their lives. Exercise, the environment and regular sleep are all essential contributors.

Exercise
Aerobic exercise may be particularly helpful for people who also have a mood disorder or anxiety probably by reducing inflammatory mediators in the blood.

There is a movement therapy called eurythmy that was developed by Rudolf Steiner. It is quite popular in central Europe, and there has been a report that it could help children with ADHD. 


Environment
There is evidence that children with ADHD do better if they are outside, and even being a green room seems to help them. 


There are plenty of anecdotes about children and some adults with ADHD improving if they have classical or New Age music in the background. Paradoxically some like and claim benefit from “heavy metal.” There is recent evidence from New Zealand indicating that music therapy may contribute to the reduction of a range of ADHD symptoms in adolescents, as it does in younger children. With the advent of the iPod, it is easy to make a playlist of music that helps attention and concentration.

The data on the effect of watching television, computer time or playing video games is a mixed bag. There are people who say that children under the age of three should not watch television at all, and the American Academy of Pediatrics recommends that children under the age of 2 years should watch no television, and that television time should be limited to less than 2 hours daily in older children. The research data has not produced a clear answer one way or the other. Some of the most recent research does suggest a link between the amount of time that children spend watching television and attention-deficit/hyperactivity disorder, but it remains unclear as to whether elevated levels of television viewing are the cause or result of ADHD symptoms. Other researchers have failed to find a connection. The best thing is to play safe and to keep television viewing to a minimum: there are so many other things for a child to be doing.
   
There have been questions about whether other environmental factors, particularly lead, mold and Candida could cause ADHD.

Lead toxicity is well-known to cause neurological problems, but studies of a link between lead levels and ADHD have usually failed to find a link, and in a study in which children with minimally elevated lead levels were given a drug – penicillamine - to remove lead, there was no change in ADHD rating scores. So it is unlikely that lead is a factor in most children.

Because of the high rates of allergies in people with ADHD, there have been attempts to see if mold or other environmental pollutants could be causing ADHD. So far the data has drawn a blank.

Another environmental factor that has been look at is the yeast Candida albicans. It can produce nasty infections in people with compromised immune systems. But in addition, some people have claimed that Candida infections can cause an array of medical problems, including ADHD-like symptoms. People who are thought to have Candida have been treated with diets as well as the antifungal agent nystatin, with mixed results. It would be good to do a formal study of Candida in ADHD and see if there is a link and if treatment helps. So far we just do not have one.

Sleep
Sleep disturbances are extremely common in ADHD. They often get better once an individual is treated, but it is still a good idea to practice good sleep hygiene.

1. Stress management
2. Exercise a couple of hours before retiring
3. Keeping mentally stimulated until it is time for bed
4. Though we want to have a regular bedtime and bedtime ritual, to begin with don't go to bed until you are tired
5. No caffeine, alcohol or nicotine after 6pm. (Preferably, of course, no nicotine ever!!) {Remember that many over the counter painkillers contain caffeine, as does chocolate}
6. Try to keep the bedroom atmosphere relaxing, and establish a sleep ritual
7. Keep the room quiet and dark
8. If you like aromatherapy, lavender and chamomile are usually best
9. If you cannot sleep, get up and do something relaxing: struggling to go to sleep is virtually impossible.
10. Do not have a television in the bedroom. Bedrooms should be reserved only for sleep in children and for one other activity in adults
11. Always get up at the same time in the morning, to try and re-set your brain, and as soon as you get up, be exposed to as much bright light as possible

Here Comes the Sun: To Screen or Not To Screen?

I have been worried to see some people - all, I think, without scientific training - proclaiming that there is no need to protect ourselves against the sun because there is no evidence that sulight causes any health problems.

Ultraviolet radiation (UVR) from the sun has been part of the environment since the first cells began to form. When we discuss the effects of UVR on human health and the environment, the range of UV wavelengths is often subdivided into:

• UVA (400–315 nm), also called Long Wave or "blacklight"
• UVB (315–280 nm), also called Medium Wave
• UVC (< 280 nm) also called Short Wave or "germicidal”

The key questions are these:
Can sunlight cause health problems?
Do the benefits of sunlight outweigh their risks?”

UVB is required for the conversion of 7-deoxycholesterol to vitamin D, (the sunshine vitamin!) which is critically important in the maintenance of healthy bones, although there may also be another mechanism by which vitamin D is generated in the body. As we have seen research is making clear that vitamin D has other potential roles in the maintenance of human health. Low levels of vitamin D have been linked to:

• Rickets
• Osteomalacia
• Osteoporosis
• Maintaining the integrity of cell membranes
• Type 2 diabetes mellitus
• Schizophrenia
• Multiple sclerosis
• Pre-eclampsia (hypertension and accompanying problems during the late stages of pregnancy)
• Some types of cancer
• Fibromyalgia-like pains
• Immune deficiency: Africa Americans do not generate enough of a protein needed to ward off tuberculosis. Why? Because the protein needs vitamin D to be activated, and dark skin is inefficient at absorbing and converting UVR. It may also be that we see epidemics of colds and flu in the winter because that is when we have low levels of vitamin D, which allows the viruses to overwhelm our immune defenses.

This does not necessarily mean that taking extra vitamin D will ward off all of these problems.

In the days before the Industrial Revolution, unless we lived in the frozen North, we had no trouble in getting the amount of vitamin D that we needed. In most of the United States, during the summer months, 10-15 minutes outdoors at midday will generate around 10,000 international units (IU’s) of vitamin D in an average fair-skinned person. This is far in excess of the government’s dietary recommendations of 200 IU’s/day in people up to age 50, 400 IU’s up to age 70 and 600 IU’s in people over 70. Not surprisingly many experts – me included – believe and have provided evidence that these daily requirements are much too low. (Have a look at the comments here.)

Of course many of us do not spend much time outside and don’t take in as much in the way of vitamin D containing foods - such as milk and salmon – as we should. I’ve seen evidence to suggest that we in Atlanta are probably at the Northernmost point in the United States were we could hope to get enough sunshine and therefore vitamin D from modest winter exposure to the sun.

Recent data has suggested that if you spend no time at all in the sun, then you may need as much as 4,000 IU’s of vitamin D/day, though that figure has not yet been widely accepted.

Exposure to UVR, whether of solar or artificial origin, also carries potential risks to human health. UVR is a known carcinogen and excessive exposure, at least to the solar radiation in sunlight, increases the risk of cancer of the lip, basal cell, and squamous cell carcinoma of the skin and melanoma, particularly in fair-skinned populations. There is also evidence that solar UVR increases risk of several diseases of the eye, including cortical cataract, some conjunctival neoplasms, and perhaps also melanoma of the eye.

We have good data for the existence of a threshold amount of UV-B exposure that may lead to the formation of cataracts. The amount needed to cause cataracts depends in part on the amount of pigment in the eye, so albino rats get cataracts with much lower exposures to UV-B.

So what to do?

Sunlight has a definite benefit in preventing or treating many clinical problems and it is no surprise that after 3000 millennia we are adapted to make use of the sun’s largesse. What is less easy to understand is why an excess of sunlight can cause so many problems, unless it is our hairlessness and environmental change that has lead to a loss of the ozone layer.

Some years ago it was suggested that sunscreens may themselves cause skin cancer, but the data has shown that to be false. Indeed modern sunscreens almost certainly reduce melanoma risk.
So how do we balance the positive and negative effects of sunlight? A recent review precisely reflects my own thinking:

• We need some sunlight
• Depending on where you live, you need only a few minutes each day
• Sunscreens confer protection on the skin without blocking all the health benefits
• If you have a medical reason for avoiding sunlight, then your health care provider should measure your vitamin D status.

 

Toxoplasmosis and Behavior

Last August I wrote an article about some extraordinary new evidence implicating Toxoplasma gondii in some psychological and psychiatric illnesses. Latent infection with Toxoplasma gondii is amongst the most prevalent of human infections and it had been generally assumed that it is asymptomatic unless there is congenital transmission or reactivation because a person has an immune system that has become depressed or compromised. That assumption is being completely re-evaluated. 

The article generated some extremely interesting correspondence and some spirited discussions.

Here is a very insightful letter from a physician:

Dear Dr. Petty,

I thought about the concept of psychological illness caused by a virus or other organism. I was wondering what would be the mode of dispersion of such a virus. Upper respiratory tract infections, skin and gastrointestinal infections spread by cough, by touch and hand to mouth respectively. How would such a brain virus or protozoal organism promote itself? Of course it could be by the above methods but it seems that there should some way that the specific disease process is connected to a behavior that helps it to spread itself. 

Then I got to thinking; diseases have learned physical ways to disseminate themselves, I wonder if a disease could change behavior to promote it's own dissemination and survival? I imagine that if that were true, people with the flu would be sociable, people with infectious diarrhea would be sociable and hungry, people with AIDS would have increased libido. I haven't yet seen any data for this. Although I've always felt that there was one disease that did alter behavior in a way that is conducive to disseminating itself, and that is rabies. The host goes from being docile, to seeing all others as the enemy. He then attacks them, bites them and thus passes on the organism. A true mind altering virus, although it's psychology works better with animals than with people. Do you think that there are other diseases that spread purely by behavior, that cause the host to seek out the next host and not just pass the disease from one to another just due to proximity?

This was my response:

What great questions!

And believe it or not, there's quite a lot of empirical research on these very topics.

There is a whole textbook on the behavioral effects of parasites edited by Janice Moore entitled  Parasites and the Behavior of Animals. Here's an interesting one: rats and mice are hard wired to avoid cats. Millions of years of programming have ensured that Tom's very presence would send Jerry packing. Cats carry Toxoplasma gondii and if mice or rats become infected with it, usually by eating cat poop, they lose their fear of felines. So now Tom can have lunch at his leisure.

I've also talked about the way in which people with creativity and schizotypal personality disorder (i.e. carriers of genetic risk) tend to be promiscuous, while people with schizophrenia have fewer children. Both groups tend to get more sexually transmitted diseases than the general population. It would be tempting to think that toxoplasmosis can be spread that way, however there's a 32-year old study in German that showed that Toxoplasma was not transmitted by intercourse. However, cytomegalovirus, a common partner to Toxoplasma may be. And both modulate dopamine activity in the regions of the brain involved in salience.

I have done a very detailed literature search encompassing papers written in all the languages that I can read, and have not been able to find any clear evidence of behavior change induced by HIV, influenza or infectious diarrhea: what interesting and important questions to research.

We do have some more data confirming the effects of Toxoplasma infections on the behavior of rats: they become less anxious and therefore do not respond to environmental threats as quickly as uninfected rodents. An antipsychotic medication (haloperidol), a mood stabilizer (valproic acid) and two chemotherapeutic agents - pyrimethamine or Dapsone – have all been shown to prevent the development of Toxoplasma-induced behavioral change.

Another recent study from the Departments of Parasitology, Microbiology and Zoology, Charles University, the Centre of Reproductive Medicine and GynCentrum, in the Czech Republic also speaks to the significance of latent Toxoplasma infections: the presence of the parasite in the blood of pregnant women increases their chance of giving birth to boys. The increased survival of male embryos in infected women may be explained by Toxoplasmosis infections modulating and suppressing the immune system.

If Toxoplasma plays a part in the development of some psychiatric illnesses, yet a high proportion of the population carries it without any problems, one obvious question is what activates it? Environmental stress might, perhaps, cause the Toxoplasma to become reactivated and play a part in the development of specific psychiatric symptoms.

This story is continuing to develop and I am going to watch it closely. If it is confirmed, it could open up some brand new avenues for helping treat and perhaps even prevent some types of psychiatric illness.

Probiotics: Caveat Emptor Part 2

After I posted about the new data on the apparent importance of intestinal microorganisms and weight management, I received some very helpful comments and emails.

If you look at the "comments" section of the post, you will see this:

"www.Probiotic-Lab.com is manufacturing and distributing Bacteroidetes as a natural bacteria supplement for weight loss."
Posted by an "R.Russell"

Now I have previously reported on a conference in London at which a number of experts expressed concern about some probiotics available in the United Kingdom. So on your behalf, I not only posted the following response, but also emailed the company. First, because there is nothing on their website about marketing probiotics for weight loss and second because it is important to have these questions answered whether they are marketing probiotics for weight loss or for skin care.

This is what I wrote on the blog and also in my email to the company:

On behalf of my many readers may I ask www.Probiotic-Lab.com two questions?
1. In my posting I referred to a short piece that I wrote about a conference in London, at which some of the speakers warned that some products on the market did not contain the active ingredients claimed on the label. How do you guarantee the activity of your preparations?

2. Though I am very familiar with the use of probiotics - I first used them in, I think, 1982 - I am intrigued that you are already distributing Bacteroidetes as a natural bacteria supplement for weight loss. What evidence do you have that they are effective? I could not find anything on your website or from a search of the literature. If you have some data to share I would love to analyze it, and if it's of good quality I will go ahead and write about it, both here and in my articles.

Kind regards,

RP

I wanted to give them time to respond because of the holidays.

But as of today - seventeen days later - there has still been no response to my communications.

I also checked the scientific references on the front page of Probiotic Lab's website. The first does not have anything to do with weight or skin infections, but actually refers to a study of ear infections. The second reference is problematic: it refers to the "American Medical Journal." But sadly I am not familiar with a journal of that name. I have looked at a range of American Medical Journals in case the journal name or date is wrong. But again I can find nothing.

I shall be delighted if someone can help.

I also looked to see if there is any published peer-reviewed literature on the use of probiotics and either weight management or skin disease, and again I have not been able to find anything.

So you can draw your own conclusions.

Should any data come to light I shall report it. Or if the company responds, I shall post what they say.

Parkinson's Disease and Cholesterol

Within the last week we have talked about the association between Helicobacter pylori and Parkinson's disease and the way in which Parkinson's disease may often get better if people are treated with a cocktail of antibiotics. We have also discussed the association between Parkinson's disease, allergies and inflammation.

Now new research from the University of North Carolina at Chapel Hill has  found that people with low levels of LDL cholesterol are more likely to have Parkinson's disease than people with high LDL levels. This is the form of cholesterol sometimes referred to as "bad cholesterol." This study followed the strange observation that people with Parkinson's disease have a lower rates of heart attack and stroke than people who do not have the disease. It is also known that known that cigarette smoking, which increases a person's risk for cardiovascular disease, is also associated with a decreased risk of Parkinson's disease. 

Few scientific stories are clear cut: it usually takes a while to get things right. Just to prove it, a study from the Netherlands found that high total cholesterol levels were associated with lower rates of Parkinson's disease, but only in women.

So what to make of all this: infections, allergies and now cholesterol?

To try and understand this, I think that we need to introduce another actor to the stage. Since the early 1950s the medical community has been concerned about a striking concentration of amyotrophic lateral sclerosis (ALS) and Parkinsonism-dementia among the Chamorro people on the island of Guam. A number of lines of evidence have suggested that this group of illnesses has been caused by some neurotoxic agent in the environment, though nobody has been able to work out exactly what it is. One of the most attractive recent theories is that it might have something to do with toxins from Cycas plants. So the idea is that similar cholesterol-containing neurotoxins can come either from Helicobacter or from eating Cycas plants, or animals that have fed on the plants.

There is a complex inter-relationship between LDL- and HDL-cholesterol, and HDL-cholesterol appears to be anti-inflammatory: high levels of HDL-cholesterol are associated with low levels of inflammation. And it has recently been shown that simvastatin may cut the risk of developing Parkinson's and Alzheimer's diseases. Not just by lowering cholesterol but from its inflammatory activity.

It may also be that low levels of cholesterol may impair the activity of another factor: one that interests me is coenzyme Q10.

From a practical perspective, this new evidence reinforces a point that I made in Healing, Meaning and Purpose and on this blog: "boosting" one component of the blood or lowering another is not sensible. Whether dealing with cholecterol or immunity, we need to moduate and harmonize all the systems of our bodies and our minds.

Follow our systems for modulating the inflammatory mediators in your body and that alone should - theoretically - reduce your risk of many illnesses.

I shall keep you posted as this story continues to develop.

Reducing Your Cancer Risk

“The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.”
-- Thomas Alva Edison (American Inventor, 1847-1931)

I am sure that you will agree that prevention is better than cure. And this is a good time of the year to review where you are in your life and what you want or need to do for yourself and your loved ones.

According to a study reported in the Lancet in November 2005 more than one third of cancer deaths are attributable to nine modifiable risk factors.

To evaluate exposure to risk factors and relative risk by age, sex, and region, the investigators analyzed data from the Comparative Risk Assessment project and from new sources, and they applied population-attributable fractions for individual and multiple risk factors to site-specific cancer mortality provided by the World Health Organization.

Of the seven million deaths from cancer worldwide in 2001, approximately 2.43 million (35%) were attributable to nine potentially modifiable risk factors. Of these deaths, 0.76 million were in high-income and 1.67 million in low- and middle-income nations; 1.6 million were in men and 0.83 million deaths were in women.

Smoking, alcohol use, and low consumption of fruits and vegetables were the leading risk factors for death from cancer worldwide and in low- and middle-income countries. In low- and middle-income regions, Europe and Central Asia had the highest proportion (39%) of deaths from cancer attributable to the nine risk factors studied.

For women in low- and middle-income countries, sexual transmission of human papilloma virus (HPV) was also the leading risk factor for cervical cancer. Smoking, alcohol use, and overweight and obesity were the most important causes of cancer in high-income countries.

Between 1990 and 2001 mortality from cancer decreased by 17% in those aged 30 to 69 years and rose by 0.4% in those older than 70 years, according to the authors, but this decline was lower than the decline in mortality rates from cardiovascular disease for men and women. The decline in mortality in men was largely due to reduction in mortality from lung, prostate, and colorectal cancers, while in women, lung cancer increased in the 1990s, and death rates for breast and colorectal cancer decreased. An article published almost ten years ago in the journal Cancer Epidemiology, Biomarkers, and Prevention, it was estimated the worldwide attributable risk for cancer to infectious agents as 16%.

The nine factors were:

1. High body mass index
2. Low fruit and vegetable intake
3. Physical inactivity
4. Smoking
5. Alcohol abuse
6. Unsafe sex
7. Urban air pollution
8. Indoor use of solid fuels
9. Injections from healthcare settings contaminated with hepatitis B or C virus

This all makes good sense, but it is good to see high quality research in reputable journals confirming what we suspected. The research also gives us further compelling reasons for taking a good look at our lifestyles and hopefully the motivation to do something to improve them. And in the case of air pollution and injection of contaminated products, to be active in getting things cleaned up.

“Keep your own house and its surroundings pure and clean. This hygiene will keep you healthy and benefit your worldly life.”
-- Sathya Sai Baba (Indian Spiritual Teacher, c.1926-)

“Length of life does not depend so much on a good physical constitution as it does on the best use of the six non natural things, which if we rule aright, we shall live long and healthy lives: to divide the day properly between sleep and waking; to adjust our air to the needs of the body; to take more or less food and drink according to our age, our temperament and whether we live an active or inactive life; to take exercise or rest according to the quantity of food and whether we are lean or fat; to know ourselves and be able to rule our emotions and subject them to our reason.  Whoever handles these wisely will live long and seldom need a doctor.”
--Giorgio Bagliivi (Italian Physician, Pathologist, Researcher and Author of De Fibra Motrice, 1669-1707)

“The best doctor prevents illness, a mediocre one treats illnesses that are about to occur, and an unskilled one treats current illnesses.”
--Chinese Proverb

Parkinson's Disease, the Intestine and Infections

Early in my career, one of my mentors was the eminent scientist and clinician Robert Mahler. He recently passed away at the age of 81, but in the last two years of his life he was an author on two papers (1, 2) about an ailment with which he struggled for many years: Parkinson's disease.

Despite the best treatment, he was severely incapacitated by the illness, at one stage needing a wheelchair to get from his car to his office. But his fine mind remained undimmed by the illness, and he was intrigued by reports of an association between stomach ulcers and Parkinson's disease and of dramatic improvements in the symptoms of some people with Parkinson's disease who were being treated with antibiotics for gastric ulcers. (Last year Barry Marshall and Robin Warren were awarded the Nobel Prize in Physiology or Medicine for their pioneering work on Helicobacter - a bacterium associated with peptic ulcers. I mentioned in an earlier post that I have a strong sense that there are more prizes to come on the interaction between infectious agents, inflammation, genes, the psyche and the environment.)

Robert was one of the test subjects in a research study and his Parkinsonian symptoms got much better when he was treated with antibiotics. There are now several important pieces of research on the fascinating topic. In some people eradicating Helicobacter may convert rapidly progressive Parkinsonism to a quieter disease, although only a minority of sufferers have evidence of current infection.

There seems to be an interaction between aging, genes and this infectious agent. Clearly not everyone is helped by antibiotic treatment, but this is a whole new line of very promising research.

Stress and the Skin

You have probably noticed how stress can have an impact on some people’s skin. Increasing stress can initiate or worsen skin disorders such as psoriasis and atopic dermatitis. There has also been a lot of discussion about whether stress can also exacerbate acne and cause cold sores to erupt.

A new study published in the December issue of the American Journal of Physiology-Regulatory, Integrative and Comparative Physiology sheds important light on this association.

It is well known that one of the physical effects of stress is to increase levels of a range of steroid hormones called glucocorticoids. The best known glucocorticoid is cortisol or hydrocortisone. So the question was whether the missing link between stress and skin problems might be one or other of the glucocorticoids.

Researchers from the Veterans Affairs Medical Center, San Francisco and the University of California at San Francisco and Yonsei University Wonju College of Medicine, Wonju, Korea decided to study this possible connection.

You may have heard that the skin is the largest organ in the body and provides the critical barrier between the environment and the internal organs. Its most important function is providing a permeability barrier that prevents us from drying out. When we are healthy we are approximately 65-70 percent water. We are able to survive and function in dry environments because the skin forms a permeability barrier that prevents the loss of water.

The physical location of the permeability barrier is in the outermost layer of the epidermis that is known as the stratum corneum. The stratum corneum is composed of dead cells surrounded by lipid membranes. The stratum corneum layer continuously sloughs off, and therefore has to be constantly regenerated. The epidermal cells in the lower epidermis are continuously proliferating to provide new cells, which then differentiate, move toward the surface and ultimately die, to form a new the stratum corneum. This process is going on in your skin right now, though it can be disrupted by damage such as sunburn. If the process becomes overactive, it can lead to the development of thick, hardened skin.

It was already known that psychological stress disturbs this elegantly balanced system by decreasing the proliferation of epidermal cells and inhibiting their differentiation. As a result the function of the permeability barrier is impaired.

To test the hypothesis that glucocorticoids would have adverse effects on skin function, they stressed some hairless mice by putting them in small cages in constant light and forcing them to listen to the radio for 48 hours.

Before being stressed one group of mice was treated with mifepristone, which you may know by its two other names, RU-486, or the “morning after” pill, which blocks the action of glucocorticoids. A second group was given a drug called antalarmin, which blocks glucocorticoid production. A third group was stressed but received neither drug and a fourth group remained unstressed in ordinary cages and without the continuous light and sound to which the other groups were exposed.

The mice that received mifepristone or antalarmin showed significantly better skin function compared to the stressed mice that did not receive either treatment.

The experiment demonstrated the important role that glucocorticoids play in inducing the skin abnormalities brought on by psychological stress. Although we hope that the study will lead to a way to treat people who suffer from these skin conditions, there is still a long way to go. It’s always difficult to extrapolate from mice to people. Second, there may be serious side effects of modulating glucocorticoid activity. Glucocorticoids are essential hormones that play many important roles. Blocking their action could have negative outcomes. This is one of the reasons why we are skeptical about advertisements that claim that some herbal concoction can “cure” cortisol-related obesity. If something could really modify the activity of cortisol or other glucocorticoids in the body, it would likely have many most undesirable effects.

The research team is now looking at the effect of psychological stress on the skin's production of antimicrobial peptides, which play a role in defense against infection. It has long been thought that psychological stress might also reduce the ability of the skin to protect from infections.

I never like to leave a report involving animal experiments without also saying a heartfelt thank you to the animals that participated in the experiments.

This research is interesting and may have a number of spin offs. But I have another rather obvious question: since we already know that there is a link between stress and some skin problems, why not focus on stress management techniques, rather than trying to find new medicines to help counteract the biochemical effects of stress?

Hidden Harbingers of Weight: Salt Intake and Obesity

In Healing, Meaning and Purpose, I discuss some of the evidence for four previously little recognized causes of obesity:

1. Stress
2. Salt intake
3. Pesticides
4. Viruses

Each of these has been widely discussed in the professional literature, but little has percolated out into the general population except in advertisements for agents like Cortislim. I remain skeptical about these products. Tinkering with just one of the 260 hormones and neurotransmitters implicated in the control of weight is unlikely to be crowned with success. And their ingredients may also have the potential for causing problems. Recent advertisements have also mentioned that one of these products may elevate mood. Sad to say, in the last year we have seen two people who developed manic symptoms after taking one of the supplements. We are urging colleagues to see if there are any other cases, or whether these two were just coincidental.

I recently mentioned some of the evidence for viruses as a cause of weight gain.

Now a new publication from the Universities of Helsinki and Kuopio is out in this month's journal Progress in Cardiovascular Diseases, that provides powerful support for the salt hypothesis.

The researchers report that an average 30-35 % reduction in salt intake during 30 years in Finland was associated with an extraordinary 75 % to 80 % decrease in both stroke and coronary heart disease mortality in the population under 65 years. During the same period the life expectancy of both male and female Finns increased by 6 to 7 years.

As expected, reducing salt intake has a beneficial effect on blood pressure.

But in my view the most interesting finding of the study is the close link between salt intake and obesity.

As bartenders, pub landlords and tavern owners have known since the beginning of time, increasing a person's intake of sodium produces a progressive increase in thirst. (You didn't think that those peanuts on the bar were put there out of the goodness of the establishment's heart did you??!)

The progressive increase in the average intake of salt explains the observed increase in the intake of sugar-containing beverages which, in turn, has caused a marked net increase in the intake of calories during the same period in the United States.

Here is an extraordinary statistic: Between 1977 and 2001, energy intake from sweetened beverages increased on the average by 135 % in the United States. During the same period, the energy intake from milk was reduced by 38 %. The net effect on energy intake was a 278 kcal increase per person a day. The American Heart Association has estimated that, to burn the average increase of 278 kcal a day and avoid the development or worsening of obesity, each American should now walk or vacuum 1 hour 10 minutes more every day than in 1977. As we all know, that has not happened.

In the decade from 1976-1980 to 1988-1994 the overall prevalence of obesity increased 61 % among men and 52 % among women. During 1999 to 2002, the prevalence of obesity was 120 % higher among men and 99 % higher among women as compared with the 1976 to 1980 figures. The increased intake of salt, through induction of thirst with increased intake of high-energy beverages has clearly made a significant contribution to the increase of obesity in the United States.

It is also of note that until 1983 the use of salt did not change or even showed a continuous decreasing trend in the United States. The prevalence of obesity was relatively low and remained essentially unchanged from early 1960s to early 1980s.

This new study suggests that a comprehensive reduction in salt intake, which would reduce the intake of high-energy beverages, would be a potentially powerful means in the so far failed attempts to combat obesity in industrialized societies.

There is now conclusive population-wide evidence that indicates that we could achieve powerful beneficial health effects simply by reducing our overall salt intake. These benefits include a decrease in obesity.

As an aside, the population-wide long-term experience from Finland indicated that a remarkable decrease in the salt intake has not caused any adverse effects.

A number of years ago we were engaged in some experiments in which we replaced regular table salt - sodium chloride - with potassium chloride. For the first three weeks food seemed rather tasteless. But then we all suddenly discovered a new universe of flavors that had previously been hidden under a thick coating of salt. So a dietary change does have a temporary effect on your taste buds.

Although the paper doesn't say so, there is also some data that salt may itself increase cortisol release.

The bottom line?

We now have clear, empirical data to support three out of the four points that I made in Healing, Meaning and Purpose, and there is some less robust data for the fourth.

I urge you to try gradually to reduce your personal intake or salt, and to encourage your family and friends to do the same. I mentioned that food may initially seem a little less flavorful, but then things change rapidly and for the better.

And your body will love you for the change!

Medicine and the Transformation of Illness

Something important has been happening in the medical field over the last century. And like most important concepts, once I mention it, everyone says, “Oh, that’s obvious.” Yet I have seen little discussion of it except in an occasional book or speculative paper.

The concept is this: modern medicine has been transforming the nature of illness in far-reaching ways. There are many illnesses that once were fatal, and which have now been transformed into chronic problems. Yet most conventional health care providers are still wedded to the short-term resolution of symptoms.

Let me give you three examples:

1. The first is diabetes mellitus. There are two main types, and at least ten subtypes. Type 1 diabetes is what used to be known as juvenile onset diabetes or insulin-dependent diabetes. It usually comes on in childhood or adolescence, is associated with severe damage to the beta cells in the pancreas that produce insulin. People with this problem usually become very sick very quickly and need insulin to keep them alive. Until 1922, when the first patient was treated with insulin derived from cows, the illness was usually fatal. Insulin transformed it into a chronic illness. People were kept alive, but now we saw the emergence of diabetic eye disease (cataracts and retinopathy), disease of the blood vessels supplying the limbs, heart and kidneys, kidney failure, infections and many other chronic problems. In 1935 Sir Harold Himsworth, the father of a friend of mine, identified a second type of diabetes. He published a classic paper on his discovery of insulin resistance in 1936. This is what is now known as Type 2 diabetes, and used to be called maturity onset diabetes. This is a more chronic illness, but carries many of the same complications. The point about these two types of diabetes is not just that they have disturbances of glucose and lipid metabolism. That on its own matters little. It is the long-term consequences of the elevated glucose and lipids that causes all the problems.
2. The second is hypertension. Again, this often used to be a fatal illness. Until the invention of the sphygmomanometer most people did not know that they had high blood pressure, and most often would die of strokes. Hypertension is now also a chronic illness. The problem is not the blood pressure itself, but the long-term consequences of an elevated blood pressure. That is why most physicians are now trying to prevent the damage to the heart, eyes and kidneys, instead of just focusing on the blood pressure numbers themselves.
3. The third is Lyme disease. This is a bacterial illness that is acquired by being bitten by a tick. It is said to be the fastest growing infectious disease in the United States, primarily because we are spending more time venturing into the wilderness, and the deer population – a major carrier of the tick – is increasing in most Eastern states. Lyme disease can make people very ill. We identify acute and chronic types. The acute can usually be treated if identified quickly and if the correct treatment is given. But sometimes identification can be very difficult, and inadequate or even inappropriate treatment may lead to the chronic form. We have even seen people who have been treated exactly as the experts say, but have still developed the chronic form of Lyme disease. The biggest problem with Lyme disease is that it is a great masquerader: it can look like so many other illnesses, from multiple sclerosis and rheumatoid arthritis to chronic fatigue syndrome and syphilis.

We could pick out other examples. I have mentioned some of the problems of thinking that attention deficit disorder is just a problem with getting good grades in school. When in reality the problem is that inadequately treated ADD is associated with a range of long-term problems that occur outside of school hours.

For many years now some practitioners have been warning about the long-term consequences of symptomatic treatment alone. One of the most eloquent critics of this way of treating people is the Greek homeopath and teacher George Vithoulkas. I like and respect George, but he takes a militant view, saying that conventional treatment simply suppresses illnesses, rather than treating them. His solution is to use homeopathy for everything. He is a genius and also a natural healer, so he can probably get away with that. Most of us cannot.

So the fundamental tenets of Integrated Medicine include medical treatment to deal with the acute problem, but a combination of approaches to prevent the problem from becoming chronic. Or if it has become chronic, then how to change its course over time.

As I’ve said before: Combinations are Key. Not randomly giving an antibiotic as well as a homepoathic remedy, but precisely tailoring the combination to the individual.

Climate Change and Civilization

I have several times now sounded warnings about the impact of climate change on health and the re-emergence of some infectious diseases.

Today I’d like to tell you about a remarkable theory that could have profound implications for how we see ourselves and our place in the world.

Dr. Nick Brooks from the Tyndall Centre for Climate Change Research at the University of East Anglia has recently proposed a remarkable hypothesis. It has long been assumed that civilization started where is did because conditions had become very hospitable, but people banded together for mutual protection and for hunting and agriculture.

By contrast, Nick Brooks proposes that severe climate change was the primary driver in the development of civilization. He proposes that without climate changes thousands of years ago, we might have remained farmers, herders and hunter-gatherers.

The early civilizations of Egypt, Mesopotamia, South Asia, China and northern South America were founded between 6000 and 4000 years ago when global climate changes, driven by natural fluctuations in the Earth’s orbit, caused a weakening of monsoon systems resulting in increasingly arid conditions. These first large urban, state-level societies and monumental architecture such as the pyramids, emerged because diminishing resources forced previously transient people into close proximity, in areas where water, pasture and productive land was still available.

It is certainly remarkable that all of these places where the first urban civilizations developed, arose in once humid and productive environments that are now largely covered by desert. One theory has been that many of these deserts, as well as the Sahara desert, were the result of over-grazing by goats.

In a presentation to the British Association Festival of Science earlier this month, Dr. Brooks said, “Civilization did not arise as the result of a benign environment which allowed humanity to indulge a preference for living in complex, urban, ‘civilized’ societies. On the contrary, what we tend to think of today as ‘civilization’ was in large part an accidental by-product of unplanned adaptation to catastrophic climate change. Civilization was a last resort - a means of organizing society and food production and distribution, in the face of deteriorating environmental conditions.”

He added something that we now see all over the world: for many, if not most people, the development of civilization meant a harder life, less freedom, and more inequality. The transition to urban living meant that most people had to work harder in order to survive, and suffered increased exposure to communicable diseases. Health and nutrition are likely to have deteriorated rather than improved for many.

The new research challenges the widely held belief that the development of civilization was simply the result of a transition from harsh, unpredictable climatic conditions during the last ice age, to more benign and stable conditions at the beginning of the Holocene epoch some 10,000 years ago.

This work also presents some profound philosophical implications, because it challenges deeply held beliefs about human progress, the nature of civilization and the origins of political and religious systems that have persisted to this day. It suggests that civilization may not be our natural state, but the unintended consequence of adaptation to climatic deterioration - a condition of humanity “in extremis.”

Dr Brooks said: “Having been forced into civilized communities as a last resort, people found themselves faced with increased social inequality, greater violence in the form of organized conflict, and at the mercy of self-appointed elites who used religious authority and political ideology to bolster their position. These models of government are still with us today, and we may understand them better by understanding how civilization arose by accident as a result of the last great global climatic upheaval.”

This is an extraordinary throwback to the ideas of romantic philosophers like Jean-Jacques Rousseau  who contended that Man is good by nature, but it corrupted by society and civilization.

Though we need to continue to be very alert to the dangers inherent in climate change, could it be that it is actually an invitation to evolve?

A Valuable History Lesson

“Those who cannot remember the past are condemned to repeat it.”
--George Santayana (Spanish-born American Philosopher, Humanist and Poet, 1863-1952

I’m a bit of a history buff, and like most armchair historians who know something about medicine, it’s always interesting to try and work out why some civilizations underwent rapid collapse. Was the decline of Rome really due to malaria, lead pipes or societal malaise? Why did the huge Khmer Empire in Southeast Asia vanish in just a few years? Was it ecological failure, disease or pollution? The list goes on.

The map shows some of the major empires in Eurasia around A.D.1200. See how few still exist. (Click on it for a larger view)

One of these historical puzzles seems to be close to solution, and provides important lessons for us today. In the second year of the Peloponnesian war, the city state of Athens was devastated by an epidemic known as the Plague of Athens. Historians and scientists have been debating the cause of the Plague for years. When I was a young schoolboy, the debate was already a century old.

According to historical records, the plague began in Ethiopia and passed through Egypt and Libya to Greece in 430-426 B.C.E. It forever changed the balance of power between Athens and Sparta, effectively ending the Golden Age of Athenian dominance in the ancient world. It is thought that up to one third of the Athenians, including their leader, Pericles, dies in the epidemic. Most of our knowledge about the Plague came from the fifth century B.C.E. Greek historian Thucydides, who himself was taken ill with the plague but recovered. Though Thucydides gave a detailed description, researchers have not managed to agree on the identity of the plague. Several diseases have been suggested, including bubonic plague, smallpox, anthrax and measles.

Now a study in the International Journal of Infectious Diseases helps answer this question that has puzzled historians for decades: What destroyed ancient Athens, the cradle of democracy? Analysis carried out by Manolis Papagrigorakis and colleagues from the University of Athens, using DNA collected from teeth obtained from an ancient Greek burial pit points to typhoid fever as the disease responsible for this devastating epidemic. Typhoid fever (or enteric fever) is an illness caused by the bacterium Salmonella Typhi. It is common throughout the world, more so in tropical and semitropical climates. It is transmitted by ingestion of food or water contaminated with feces from an infected person.

There are some classic physical symptoms of typhoid: In the first phase there is coughing, a fever, sweating and a rash of “rose spots,” particularly on the abdomen. Typhoid has a unique feature: normally when you get a fever your pulse rate increases. In typhoid the pulse slows. In the second phase of the illness people get severe headaches muscle pain and diarrhea. And it is the diarrhea that usually dehydrates and kills people. You may have heard about typhoid in the last few days after publication that a well-known terrorist was supposed to have died from it.

It is humbling to realize that entire civilizations have been put to the sword, not by force of arms, but by microbes. Climate change or a breakdown in sanitation of food inspection can all lead to a reappearance of typhoid: within the last hundred year there have been outbreaks all over the Western world, and it is endemic in many less developed countries.

I mention in Healing, Meaning and Purpose that one of the reasons for the persistence of the gene for cystic fibrosis is thought to be that carriers of the gene are resistant to typhoid.

We must never forget the power of micro-organisms and how rapidly they can re-appear if we let down our guard or if we neglect the impact of climate change on their growth and viability.

It is no coincidence that H.G. Wells vanquished the Martians not with guns, but with microbes.

Vaccinating Against the Snivels?

I’m using a deliberately provocative title for a story that is quite serious, both medically and ethically.

We have today heard about two new developments. Researchers from the University of Rochester Medical Center announced that they are starting trials of a new vaccine aimed at eliminating childhood ear and sinus infections as well as many cases of bronchitis in adults. Second, and on the same day, the University of Rochester announced that it had won a $3.5 million grant from the National Institute of Deafness and Communication Disorders, one of the divisions of the National Institutes of Health, to develop the new vaccine. The team at Rochester helped to develop the vaccine marketed by Wyeth as Prevnar. It is used to protect infants and toddlers against some strains of bacteria that can cause pneumonia, meningitis and ear infections.

The vaccine will target Nontypeable Haemophilus influenzae or NTHi, which is the main remaining cause of ear and sinus infections and bronchitis, now that vaccines exist for various forms of streptococcal bacteria and Haemophilus influenzae B, the previous leading causes. NTHi is now the leading cause of ear and sinus infections, and of bronchitis in adults.

But why this news is so important for all of us, is that unlike virtually all other vaccines on the market, this one will not be aimed at saving lives, but at preventing what are usually nuisance illnesses. But please note my use of the word “usually.”

Dr. Michael Pichichero, a professor of microbiology, immunology, pediatrics, and medicine at the University of Rochester Medical Center who is leading the trial, was quoted as saying, “While ear infections are never fatal, they can cause serious damage in some children.” He went on to say that “83 percent of U.S. children experience one or more ear infections by age 3 and in some cases hearing loss becomes permanent.”

This is the point, and also why the National Institute of Deafness and Communication Disorders has chipped in. Most of these infections get better on their own, so an initial reaction might be to say, “why bother with this at all?” The trouble is that not only can they lead to long-term problems with hearing, I have seen more than one person develop a cerebral abscess as a result of a severe infection: the illness is not always innocuous.

Another problem is that infections of the sinuses and ears bring children to clinics and emergency rooms, and are the leading reason for antibiotic prescriptions. Even though many of the infections are viral, and viruses do not, of course, respond to antibiotics. Every expert agrees that antibiotics are overused in the United States, which wastes money and also helps the evolution of bacteria that ultimately resist all antibiotics.

What’s the downside of these announcements?

1. We have already run into a great many problems with previous vaccinations. Some long-term and some subtle; so we desperately need long-term safety data.I know many natural healers who blame many of our health woes on vaccinations.
2. I hope that the researchers have built into the contract a clause to allow them to report efficacy and safety data without having to clear everything with the study’s sponsor.
3. We are facing major resource problems, not just in the provision of health care, but also in the funding for research. So should we be diverting resources into these kinds of problems while every 30 seconds another child dies of malaria?
4. There has been a great deal of discussion about what is often called the “hygiene hypothesis:” the idea that the increasing rates of some allergic illnesses and asthma are a result of children having avoided minor infections early in life, that would have stimulated their immune systems. The hypothesis is not proven, but there is a great deal of circumstantial evidence.
5. If successful, would the vaccine create a host of secondary problems ten or twenty years from now?

Peripheral Neuropathy

Treating peripheral neuropathy can be one of the toughest problems facing a clinician. Peripheral neuropathy simply means disease affecting the peripheral nerves.

There are a great many cause of peripheral neuropathy. This is just a partial list to give you an idea of the things that a clinician has to think about before starting treatment:

1. Metabolic illnesses: Diabetes mellitus; porphyria; chronic renal failure; amyloidosis and disturbances in circulating proteins
2. Vitamin deficiencies: Vitamins, B1, B3, B6 and B12
3. Drugs and chemicals: Alcohol; Heavy metals like arsenic, lead and mercury; organic pesticides; several drugs used in cancer chemotherapy; isoniazid; nitrofurantoin
4. Infections: Lyme disease; Herpes zoster (shingles); Diphtheria; Brucellosis; Leprosy; Tetanus; Botulism
5. Malignant illnesses
6. Inflammatory and autoimmune illnesses: Rheumatoid arthritis; Systemic lupus erythematosus; Polyarteritis nodosa; Sarcoidosis; Guillain-Barre syndrome; Celiac disease
   
7. Physical injury: Trauma, stretching and compression of nerves, which can include things like carpal tunnel syndrome.
8. Congenital illnesses

Many causes of peripheral neuropathy, particularly diabetes, may also damage the autonomic nervous system that controls the heart, blood pressure, swallowing, intestinal and bladder function.

Neuropathic symptoms typically start in the feet, because the nerves running down there are longer and more vulnerable than the ones going to the hands.
The most common symptoms are:

1. Numbness
2. Tingling
3. Abnormal sensations called dysesthesias
4. A characteristic form of pain, called neuropathic pain or neuralgia: people usually describe it as “pins and needles,” a steady burning sensation or “electric shocks.” These pains can be difficult to describe: typically pains, like stubbing your toe or stepping on something sharp, are transmitted through pain fibers. Neuropathy also involves other neurological pathways, so that the brain receives impressions that it cannot process.

There has been a revolution in out understanding of neuropathic pain in recent years. It is now considered to be a disease rather than a symptom. Normal pain is designed to protect you: you put your foot on a hot plate and you pull it away immediately. Neuropathic pain is different: it is non-protective and it persists and therefore behaves like a disease.

Multiple different classes of medications have been shown to be effective in some people with neuropathic pain, though most are not approved for use by the Food and Drug Administration:

1. Lidocaine patches and creams
2. Capsaicin creams
3. Opioid analgesics
4. Tricyclic antidepressants
5. Serotonin-norepinephrine reuptake inhibitors (SNRIs)
6. Anticonvulsants: Carbamazepine; gabapentin; pregabalin

Earlier this week, data presented at the European Federation of IASP (International Association for the Study of Pain) Chapters (EFIC) indicated that an innovative combination of painkillers might hold the key to unlocking the severe and relatively untreatable pain of peripheral neuropathy.

Dr Magdi Hanna, Director of Pain Clinical Research Hub at King's College Hospital in London, has been studying the combination of the strong opioid oxycodone (OxyContin) with gabapentin (neurontin) in over 300 patients with severe diabetic neuropathy. This combination demonstrated a significant 33% improvement on top of the best pain relief achievable using the maximum tolerated dose of gabapentin as monotherapy. The study was part funded by one of the medicine manufacturers.

This study is good news, but even in this study there were a great many people who were not helped. In another blog item, I’m going to talk about some of the unorthodox approaches that have helped some people.

Stopping Malaria with a Sugared Mousetrap

When I was an active clinician I saw several people die of malaria and it’s one of those things that you don’t forget. Nobody likes losing a patient, particularly to a potentially preventable disease. I would often think of the millions of people infected by this parasite. There are 300 million clinical cases of malaria each year, and around the world over one million people die of the illness each year. It has been calculated that a child dies of malaria every 30 seconds, with the largest number of deaths occur among young children in Africa.

We know that cleaning up water supplies and appropriate insecticides would make a huge dent in that terrible clinical toll, and hats off to the Bill and Melinda Gates Foundation for its massive attempts to do things that make sense for helping eradicate malaria and a score of other problems.

There are academics and some pharmaceutical companies that are working on malaria vaccines, and I wish them well. But I wonder about the practicality of paying for vaccines for hundreds of millions of people, when for a fraction of the cost, clean water would do a much better job, and without all the potential problems that might be associated with vaccination.

Global climate change will likely make the range of malaria-carrying mosquitoes much greater in the years to come: it was recently suggested that malaria might in our lifetimes spread as far North as England.

I was very interested to read of an entirely new approach to targeting malaria that could be cheap and easy. It’s also so obvious that I’m sure that there are scientists the world over who are slapping their foreheads this weekend.

I a study reported in the International Journal for Parasitology a team from Hebrew University was able to devastate a local mosquito population by spraying acacia trees with a sugar solution spiked with an insecticide.

The Plasmodium parasites that cause malaria are spread by female Anopheles mosquitoes. The female mosquitoes need blood to develop their eggs, but they also need large amounts of sugar to support their metabolism, so they need large amounts of sweet plant nectar.

What the Israeli team did was to spray acacia trees in an oasis in Southern Israel with a sugar solution containing the insecticide Spinosad. This area was chosen because there were few other plants from which the mosquitoes could obtain sugar. After spraying, the mosquito population was decimated.

Clearly this technique is going to be most valuable in areas with limited plant growth, so the mosquitoes aren’t just going to be able to go next door for food. Though that being said, Anopheles mosquitoes are fussy eaters and only visit a limited number of plant species. So now one suggestion is to plant mosquito attracting plants and spraying them with insecticide. Naturally enough, one worry is that the mosquitoes will learn to go to plant sources that they normally wouldn’t touch, or that they will develop resistance to the pesticides. And though Spinosad is supposed to be an environmentally friendly insecticide that doesn’t effect other insects, birds or animals, we have to keep an eye on the possibility that it may not be all that benign.

This work is going to need to be replicated, but it is an encouraging new approach to a horrible illness that is second only to tuberculosis in the number of people that it kills each year.

It’s Not Just Spinach!

The news yesterday of E. coli contaminated spinach must have been enough to make Popeye weep.

According the Centers for Disease Control and Prevention in Atlanta, as of today, 102 people have been infected with the outbreak strain of E. coli O157:H7 have been reported to CDC from 19 states, and one person in Wisconsin has perished.

Just to re-iterate what you’ve probably heard on the news already: E. coli is often a nasty resistant little bug that is not always killed by cooking. So the best advice is to throw away any spinach that may be suspect. The bacterium can make you very sick. You may have heard that one person has already died and at least a dozen more are in the hospital.

Several years ago there was an egg-borne Salmonella outbreak in the United Kingdom, and we’ve heard of several outbreaks of hepatitis A related to food contamination. There are outbreaks of food poisoning every now and then. And then there is the constant worry about “Mad cow disease,” that led to the wholesale slaughter of animals in the United Kingdom a couple of years ago.

Overall, Secretary Johanns and his team at the United States Department of Agriculture are doing a good job of protecting us.

Be aware, though, that apart from food, there are many other places that bacteria and occasionally viruses can lurk:

1. Makeup: the ingredients in makeup can make good breeding grounds for some bacteria. Don’t keep makeup for too long, particularly if it’s been in a hot damp place
2. People carry a lot of bugs. That doesn’t mean that you have to become worried about being around them, but it’s best not to get in an elevator is someone’s coughing or sneezing. I’d like to say the same thing about planes, but that’s usually not practical. I’ve many times had to use homeopathic remedies after a flight to prevent a cold – or worse – from emerging. Others have even taken antibiotics after a long flight next to someone nursing a cold. A bit illogical in my view: most upper respiratory tract infections are viral.
3. Many bacteria and a few viruses get transferred to hands and doorknobs. You cannot spend your life being terrified of such things: it ruined the life of Howard Hughes, and in real life Adrian Monk would really be suffering. But you can wash you hands – with soap – in warm water for one minute whenever you get the chance. Studies have shown that most people don’t wash their hands properly. And I like those little sterilizing towels that you can carry with you.
4. Change your toothbrush every 2-3 weeks.
5. If you can afford them, those Ionic Breeze devices do seem to help keep the air cleaner.
6. And I’m sure that I do not need to remind you, gentle reader, of the importance of carefully washing your hands after visiting a rest room.

Plague: A Follow Up

I've had a lot of very positive feedback about my article about global warming and the risk of Plague.

One person said that he didn't want to think about something scary like that. Which reminded me a bit of our new kitten, who has still not worked out that if she can't see you, then maybe you can still see her. She hides her head in a large stand of Pampas grass and assumes that she's now invisible....

As the conversation with Mr. Head-In-the-Sand continued, I had a sudden flashback to the Hitchhiker's Guide to the Galaxy, in which the "Ravenous Bugblatter Beast of Traal" was described as "so mind-bogglingly stupid that it assumes that if you can't see it, then it can't see you."

I just received this report from the Centers for Disease Control (CDC) in Atlanta.

As you will see, there have been very few cases of Plague in the United States and the CDC keeps a close watch for us. The article also lists some of the key clinical featres of the illness.

Climate Change and Plague

I’ve talked before about one of the reasons that I worry about climate change: it’s the potential for it to unleash illnesses that have been rarely seen in recent centuries. In the Middle Ages, the Black Death, killed a third of the population of Europe, or more than 25-30 million people. The most widely held theory is that the Black Death was Plague: a disease caused by the bacterium Yersinia (Pasteurella) pestis that is most often carried by fleas. In recent years one scholar has suggested that the Black Death was actually caused by anthrax, and in 2001, two epidemiologists raised the possibility that the Black Death was caused by an Ebola-like virus rather than a bacterium.

A paper in today’s Proceedings of the National Academy of Sciences, was written by an international team of scientists, who focused their research on Kazakhstan. Why look in central Asia? This seems to be the original center of the illness. The desert regions of Central Asia are known to contain natural foci of plague where the great gerbil (Rhombomys opimus) is the primary host of the Yersinia-carrying fleas.

The first epidemic originated in Asia and was apparently transmitted to Europeans in 1347. A Turkish army besieging a Genoese trading post in the Crimea allegedly catapulted plague-infested corpses into the town. The Plague spread from the Mediterranean ports and ravaged all of Europe between 1347 and 1351. Those outbreaks coincided with both warmer and increasingly wet weather. There were renewed outbreaks in 1361–63, 1369–71, 1374–75, 1390, and 1400. For more than two centuries, everything remained quiet, but then there were further outbreaks in Italy in 1629-1631, London in 1665, and Vienna in 1679. There was another Pandemic in Asia from1855-1870 that claimed the lives of millions, and again coincided with wetter and increasingly warm weather.

Fleas become active when the temperature exceeded 10C (50F), so a warm, frost-free spring has led to an early start to breeding. Over the last two years, the flea population has continued to grow when the spring was followed by a wet, humid summer.

We don’t need to be unnecessarily alarmist, but the evidence indicates that climatic changes could lead to more outbreaks of bubonic plague among human populations. And who knows what other illnesses are waiting in the wings as our climate changes, we travel more and our physical resilience declines?

“Humankind has not woven the web of life. We are but one thread within it. Whatever we do to the web, we do to ourselves.  All things are bound together. All things connect.”
--Chief Seattle (Native American Leader of the Suquamish and Duwamish Tribes who became a Roman Catholic and Cooperated in Creating Peaceful Relations with European Settlers, c. 1786-1866)

Toxoplasmosis, Behavior and Mental Illness

This title may seem odd, but this item may actually turn out to have enormous implications for all of us.

A couple of years ago I read a fascinating book: Parasites and the Behavior of Animals, in which the author – Janice Moore from Colorado State University – cataloged some of the extraordinary ways in which parasites can impact the behaviors of a vast array of animals. As difficult as it is to interpret studies of parasites in humans, I kept coming back to some odd observations about an illness with which I’ve been involved for more than 30 years: schizophrenia. I kept wondering if some of the odd observations made over the years could be explained by the parasites?

What kind of odd observations?

1. Reports of mental illness have been found throughout history, yet this strange illness that we now call schizophrenia seems to have been very rare until about 1750, when it increased dramatically throughout Western Europe. I have had the privilege of working at the Bethlem Royal Hospital from which got the word “bedlam.” I know of the incredible records kept there. Something began to change in some of the types of patients being admitted at that time. I have also had the opportunity to look at some of the records at the Philip’s Hospital in Southern Germany, which has been in existence since 1533. Again the records show the sudden appearance of many cases of something that had been quite rare until then. 1750 marked the early years of the industrial revolution in Europe and the mass migration of people from the countryside to the new and very crowded cities
2. There has been recent evidence that being born and raised in a city increases your chance of developing schizophrenia.
3. There is increasing evidence that acute episodes of psychosis, mania and depression are associated with increases in circulating inflammatory mediators. There is also intriguing new data that both psychosis and depression can be improved by giving people COX2 inhibitors.
4. There has also been the strange observation that bipolar disorder may have been becoming more common in recent years, over and above our greater ability to recognize the illness.

Several years ago the well-known psychiatrist E. Fuller Torrey first suggested that a small protozoal parasite called Toxoplasma gondii might be responsible for all of these observations. Cats can carry it, which is why pregnant mothers are advised not to pet their cats during pregnancy.

The idea that such a complex disease as schizophrenia might sometimes be caused by a parasite caught the media’s attention, but in recent years the story – but not the ongoing research – died down a bit.

There was an excellent and provocative blog item by Carl Zimmer about this almost three weeks ago, but I wanted to check everything out before responding. He gave a brief review of a new paper published in the Proceedings of the Royal Society, by Kevin Lafferty from the University of California in Santa Barbara. Lafferty has attempted to correlate the varying rates of Toxoplasma in different countries with predominant personality traits and therefore – since our societies are aggregates of all our personalities, cultural characteristics.

That may all sound far-fetched, but I don’t think that it is. And I don’t think that the Proceedings would have taken a completely half-baked proposition.

I have also found a report published in the journal the Proceedings of the Biological Society. Four eminent authors, including Torrey, revisited the while issue of Toxoplasmosis and mental illness. When the parasite gets into the nervous system it can alter behavior: Rats are normally programmed to avoid cats, but once infected they are attracted to cats. Over the last few days I’ve been plowing the world literature, and I’ve learned some very interesting things that support the idea that Toxoplasma may be playing a role in several different types of psychiatric illness.

There is strong evidence that schizophrenia, bipolar disorder and major depressive disorder lie on a spectrum. The illnesses are not the same, but people often switch from one type of clinical presentation to another. The precise type if illness would be determined by the interaction of genes, physical and Intrapsychic environment. Nobody would be sufficiently naïve to try and reduce the whole of psychiatric illness to a single bug. Mental illness is a great deal more than just a physical problem, and apart from anything else, the rates of Toxoplasma infections show remarkable variations around the globe, while the rates of major mental illness are much the same everywhere.

So what have I learned?

1. There are a remarkable numbers of studies showing that many people with schizophrenia have antibodies to Toxoplasma, including people having their first attack of the illness
2. Blood donors infected with Toxoplasma have decreased levels of novelty-seeking
3. In women who become infected, there are some marked changes in personality.
4. Toxoplasma affects the dopamine systems of the brain that we know are intimately involved in mood, cognition, movement and motivation.
5. Some drugs used to treat psychosis (haloperidol) and mood disorder (valproic acid) inhibit the replication of Toxoplasma gondii. The valproic acid already does it at concentrations lower than we normally aim for when treating humans.
6. There is some intriguing work going on into the use of antibiotics to kill Toxoplasma and reverse its behavioral effects.

In the last few years, so many illnesses have turned out to have infectious origins, from peptic ulcers to arteriosclerosis and some cancers. Perhaps some mental illnesses will be next.

Last year Barry Marshall and Robin Warren were awarded the Nobel Prize in Physiology or Medicine for their pioneering work on Helicobacter. I have a strong sense that there are more prizes to come on the interaction between infectious agents, inflammation, genes, the psyche and the environment.

Perhaps the reason that some antipsychotics and mood stablizers can reverse some of the neurological damage associated with schizophrenia and bipolar disorder is becuase they are killing off the causative agents and allowing the brain to repair itself.

I shall keep you posted!

Global Warming

My interest in global warming is three-fold: the first is scientific: is this all just a political bandwagon, driven by a misunderstanding of normal climatic cycles? Secondly, if it is a real phenomenon, then we have a responsibility to future generations: a part of what we refer to as a central philosophical plank: “Legacy.” Third is the impact of global warming on patterns of illness, in particular infectious and environmental pathogens, and how we can build resistance and resilience to them.

Some of the more recent evidence had a good airing on the Scientific American website.

My own view is that global is now clearly proven: I have just seen too much evidence, from walking the balmy streets of Stockholm in dead of winter when the temperatures should have been tens of degrees lower to an analysis of changing patterns not just of temperature, but of disease. The warming is a consequence of a lack of balance and harmony: too much Yang activity overwhelming the Yin necessary to stabilize the world. Or, in the language of spiral dynamics, too many people and social structures being stuck at the levels of the Red and Orange Memes.

The only thing that I find a little irksome is the number of people who lecture us about global warming while continuing to engage in all kinds of activities that contribute to the problem. Your humble reporter first became interested in installing solar panels while still living in England. Not practical in a country where once the sun rarely shone very much, and where the panels used to be prohibitively expensive.

We plan to install some next year, while continuing drastically to conserve other resources. And to try and anticipate the impact of global climate change on illness.

Cranberries and the Inflammation Associated With Severe Gum Disease

There is an interesting study from a team of researchers from Quebec, Canada. The findings, published in the Journal of Antimicrobial Chemotherapy, reveal that natural compounds in cranberries may help ward off periodontitis, or severe gum disease, by serving as a powerful anti-inflammatory agent. This anti-inflammatory effect may be attributed to unique compounds in the fruit that prevent the bacterium P. gingivalis from adhering to the teeth below the gum line. Though it is early days, this new research offers promise for the estimated 67 million Americans affected by periodontitis, the primary cause of tooth loss in adults.

The reason for the study was that cranberries have what are known as "anti-adhesion" activity. This helps guard the body from certain harmful bacteria that cause urinary tract infections (UTIs), gastric ulcers and gum disease. This anti-adhesion activity is primarily due to molecules called proanthocyanidins (PACs) found naturally in cranberries and other foods. Cranberry PACs contain a unique A-type structure that is responsible for this anti-adhesion mechanism of action, while most other foods contain only the more-common B-type PACs.

Researchers discovered that cranberry compounds can reduce the growth of P. gingivalis and subsequent plaque development -- the initial step in the development of periodontitis. Periodontitis occurs when inflammation or infection of the gums is left untreated or treatment is delayed. Infection and inflammation spreads from the gums to the ligaments and bones that support the teeth and eventually leads to tooth loss.

In a paper in the Journal of Dental Research the same researchers had previously shown that cells treated with cranberry juice showed significantly less inflammation than cells that were not treated.

Not only can cranberry compounds decrease the growth of P. gingivalis, they may also prevent certain oral bacteria from directly destroying gum tissue itself -- another major factor contributing to periodontitis. This may have more widespread implications as recent studies have also linked severe gum disease with an increased likelihood for heart disease and stroke.

The study was part funded by the Ocean Spray agricultural cooperative that sells cranberry juice.

Brushing, flossing and regular professional cleaning reduces the risk of developing periodontitis by helping to prevent the onset of gingivitis, or gum infection. Cranberries may provide an interesting ingredient in the development of new therapeutic approaches for treatment of periodontitis.

Technorati tags: Cranberries Dental disease Heart disease Urinary tract infection Inflammation

Brushing Your Teeth is Good for Your Heart

This was the title of an article in Time magazine and something that I’ve been meaning to discuss for a while now.

We have known for some years now that there can be a link between periodontal bacteria and heart disease, but a new study from the Department of Health Sciences in Kristianstad University, in Sweden and published in the Journal of Periodontology.

The researchers found the presence of specific bacteria in periodontal pockets, which are those areas of tissue surrounding teeth, that might be an explanation for the relationship between periodontal disease and acute coronary syndrome (ACS). ACS is the term used to describe insufficient blood supply to the heart muscle that results in heart disease.

The investigators compared 161 subjects diagnosed with ACS with a control group of people who did not have cardiovascular disease. They found that the bacterial burden - the amount of oral bacteria –was twice as high in the ACS group for the combination for the bacteria streptococci, and three less common bacteria: P. gingivalis, T. forsythia and T. denticola. These findings suggest that this combination of bacteria is the link between periodontitis and ACS.

The periodontal bacteria cause an inflammatory response that elevates the white blood cell count and increases one of the key inflammatory markers: high sensitivity C-reactive protein levels in the blood, a factor which has been linked in past studies to heart disease.

Alveolar bone loss—atrophy of the bones that support your teeth—was also found to be significantly greater among subjects with ACS. The extent of bone loss was more severe in the ACS group than in the non-ACS group with 77%of the participants in the ACS group afflicted with periodontitis versus 42% in the control group.

The study highlights the importance of routine periodontal examinations and at-home dental care, particularly if you have a personal or family history of heart disease.

Technorati tags: Periodontal disease Heart disease Inflammation Dental hygiene

Homeopathy as a Part of a Comprehensive Treatment Plan

I have been using homeopathic remedies for over 25 years, and I have often found them to be extremely helpful.

I part company from many of my friends who are classical homeopaths who insist that using any form of conventional medicine "suppresses" illnesses, rather than curing them, and so should all be avoided like the plague.

As we started rolling out the new integrated model of healthcare, which integrated conventional medicine, lifestyle changes and homoeopathy, many people objected violently on the grounds that ANY use of other, non-homeopathic treatments would prevent the homeopathic remedies from working.

This has come up recently with several common problems: using homeopathic "vaccinations" in place of the real thing; using homeopathic remedies for influenza, to the exclusion of conventional treatments. And now we hear of people being advised to use homeopathy for malaria prohylaxis. This worries me: I have seen people die of malaria, and it isn't pretty. Homeopathy may be a useful adjunctive treatment and it may also help with any side effects of conventional treatment.

Please don't play Russian Roulette with your health.

I thought that it would be a good idea to reproduce the following brief article:

Alternative malaria treatment may not work from PhysOrg.com
British health authorities are urging tourists not to rely on alternative treatment such as homeopathy to fight malaria. [...]

Technorati tags: Homeopathy Integrated medicine Malaria

A New Way of Looking at – and Treating - Inflammation

Diseases of both large and small blood vessels are two of the biggest problem facing people with diabetes. Not only is it a huge clinical challenge, but also nature sometimes does our experiments for us. The high rates of coronary and peripheral vascular disease in diabetes can be seen as a kind of experiment of nature: a recognizable set of chemical abnormalities that might shed light on vascular diseases in general. It was those twin factors: a huge clinical problem, and an experiment of nature, that lead me to pick the topic of my research doctorate. 

When I was working on my research doctorate in the mid 1980s, I came across a lot of old research that seemed to show links between inflammatory and autoimmune conditions like systemic lupus erythematosus and rheumatic fever, and the eventual development of coronary artery disease. There was also a lot of old and largely forgotten research about the link between some viral infections and the development of coronary artery disease and acute coronary artery occlusions, because some infections can make blood more “sticky.” Inflammation evolved as one of the body’s defence mechanisms.

So I made the proposal – revolutionary at the time – that diabetes, coronary artery disease and a range of other illnesses might be inflammatory rather than degenerative. I soon found inflammatory markers in people with diabetes, that helped predict when someone was running into trouble with their eyes, kidneys or heart.  Even with stacks of data, I had to spend a lot of time defending that position, because it also implied that some illnesses thought to be irreversible might not be.

With the passage of time, it has tuned out that I was probably correct. Chronic inflammation, wherever it starts, mat have long-term effects on the body and on the mind. Chronic inflammation increases the risk of diseases of many blood vessels, as well as causing anemia, organic depression and cognitive impairment. Here is a partial list of common conditions in which inflammation is a prominent factor:
1.  Rheumatoid arthritis
2.  Systemic lupus erythematosus
3.  Fibromyalgia
4.  Chronic infections
5.  Insulin resistance or metabolic syndrome
6.  Arteriosclerosis
7.  Diabetes mellitus
8.  Hypertension
9.  Asthma
10. Inflammatory bowel disease
11. Psoriasis
12. Migraine
13. Peripheral neuropathy
14. Alzheimer’s disease
15. Autism
16. Gingivitis
17. Cystitis

The reason for raising the issue is not to say “told you so!”

It is instead that we need to think about inflammation a little differently. There is a mountain of information about the physical aspects of inflammation. We can stop at the simple description of inflammation as a condition in which part of the body becomes reddened, swollen, hot, and usually painful, or we can look below the surface: we can examine inflammation not only as a physical problem, but also as a psychological, social, subtle and spiritual problem. Why bother? Because the deeper approach allows us to understand and to treat and transcend inflammation as never before.

I am going to write some more about specific ways to address inflammation and what it means in future articles. I would also like to direct you to the book Healing, Meaning and Purpose, in which I talk about specific approaches in more detail.

But I would like to start with this.

In Ayurvedic and homeopathic medicine, inflammation is a sign of an imbalance in the vital forces of the body, and the traditional Chinese system agrees: here inflammation is usually a manifestation of an excess of Yang Qi, or a deficiency of Yin Qi. Most of our lives are seriously out of balance: Yang Qi is like a rampaging lion that has been stimulated by:
Acidic foods;
Environmental toxins;
Unwanted sexual stimulation:
Noise;
Discordant music:
Constant demands from others:
Toxic relationships;
Years spent in front of television sets and limitless multi-tasking.

It should be no surprise to learn that all of these inflammatory conditions are increasing rapidly throughout the Western world. Not because we are getting better at identifying them, or we are living longer, but genuinely increasing.

It is wrong to put all the blame on poor diets or inadequate exercise. The problem is more subtle and is a reflection of distorted Information being fed to our bodies, minds, relationships, subtle systems and spiritual relationships.

The great news is that this simple conceptual shift gives us a whole load of new tools for handling these problems, and for using them as catalysts to growth.

In the next few weeks, I am going to drill down and give you some specific guidance that ties into the material in Healing, Meaning and Purpose and the next two that are on the launch pad.

Fasten your seat belt!

Technorati tags: Inflammation Aging Alzheimer's disease Arteriosclerosis Neuropathy Autism Arthritis Systemic lupus erythrmatosus Fibromyalgia Inflammatory bowel disease Gingivitis 

Climate Change and Your Health

When I hear the continuing arguments about climate change, I often fancy that I can in the far distance hear Nero playing his lyre while Rome burns. In March the BBC reported faster than expected warming of the Antarctic over the last 30 years. This report was based on a paper in the journal Science by a team from the British Antarctic Survey.

Gradual climate change is drawing particular attention in Europe, where the climate is exquisitely dependent on the Gulf Stream. In some places records have been kept for centuries, and there seem to have been genuine changes in a short space of time. A few years ago I was in Stockholm in the week before Christmas, and it was so warm that I was able to walk around in my shirtsleeves. That made it the warmest December in almost 800 years. People notice things like that, and governments and populations are eager to do something before the Arctic is reduced to a puddle.

Even if we are just seeing a natural climatic cycle, the consequences could be disastrous. Leaving aside the obvious matter of a rise in sea level, there is also the impact of global climate change on health. Earlier this year the BBC reported a speech by Professor Paul Hunter from the University of East Anglia in Norwich, to the Society of Applied Microbiology at the Royal Society in London. He pointed out that global warming, with hotter summers and more frequent and heavy rainfall and storms, would create the right conditions for an increase in food poisoning and other gastrointestinal upsets caused by microorganisms.

Global warming could also create conditions favorable for a return of malaria to the United Kingdom. Professor Hunter has published papers on this important topic before. He is no alarmist, and his work underscores the way in which our environment and we are closely interlinked, and even small climatic changes may have major effects on illness.

We could discuss this topic in a great deal of detail. Suffice to say that it is more important than ever for all of us to get into the habit of washing our hands, ensuring the cleanliness of food, and even more so of the water that we use, and that we do all that we can to build our resilience.

There is also another matter of equal importance, and that is the dwindling supply of fresh water around the world. The number of us is growing fast and our water use is growing even faster. A third of the world's population now lives in water-stressed countries, and it is expected that this will rise to two-thirds by the year 2025. The cruelty of the situation is that there is altogether more than enough water available for everyone's basic needs. The water is in the wrong places and much of it is unusable.

The United Nations recommends that people need a minimum of 50 liters of water a day for drinking, washing, cooking and sanitation. Global water consumption rose six-fold between 1900 and 1995 - more than double the rate of population growth - and goes on growing as farming, industry and domestic demand all increase.

As important as quantity is quality - with pollution increasing in some areas, the amount of useable water declines. Each year, more than five million people die from waterborne diseases, which is 10 times the number killed in wars around the globe. Most of the victims are children.

Seventy percent of the water used worldwide is used for agriculture. Much more will be needed if we are to feed the world's growing population, which is predicted to rise from about six billion today to 8.9 billion by 2050. And consumption will further increase as more people expect Western-style lifestyles and diets. Here is a useful statistic: one kilogram of grain-fed beef needs at least 15 cubic meter of water, while a kilo of cereals needs only up to three cubic meters. Many futurists are already predicting that water will become as much of a strategic issue as oil is today, with wars being fought over the water supply.

As of today, we should all start thinking about ways in which we can reduce our own water consumption and make provision to collect and purify water ourselves.

“Everybody talks about the weather but nobody does anything about it.” -- Charles Dudley Warner (American Author, 1829-1900)

Technorati tags: global warming, water, Environment, Climate Change, pollution

Viruses and Weight Gain

Another discussion in Healing, Meaning and Purpose revolved around the evidence that in addition to toxins, viruses have been attracting a great deal of attention as causative agents of obesity in humans. There are currently seven viruses known to cause obesity in animals and three in humans. This work began almost twenty years ago when a Dr. Nikhil Dhurandhar was working in India and discovered that viruses could cause obesity. It started with a chance observation: thousands of chickens were dying, and when they did, they were found to be abnormally heavy. He then discovered that people who had been exposed to a chicken adenovirus called SMAM-1 were consistently fatter than those who had had no exposure. He later moved to the U.S., and has collaborated with other researchers to study whether human adenoviruses, which are common throughout the human population, could be having a similar effect. This led to the discovery that the human adenovirus Ad-36 caused significant fat increases in animals, and furthermore was associated with obesity in humans. Now we have a new report from Leah Whigham and her team at the University of Wisconsin in Madison who tested several human adenoviruses for their ability to increase fat in both live chickens and in cell culture.

It is not at all far-fetched to suggest that there may in the future be vaccines to prevent one of the many causes of obesity. But for now, follow simple rules of hygiene and do everything that you can to improve your own resistance to infection. Which gets us straight back to Healing, Meaning and Purpose!

Technorati tags: weight gain, Nikhil Dhurandhar, virus,

Fungal Contamination of Pillows

I recently came across a study from colleagues at the University of Manchester in the United Kingdom, that was published in the journal Allergy.

Fungal contamination of bedding was first studied seventy years ago, but there have been no reports in the last seventy years. In this new study, researchers sampled ten pillows with between 1.5 and 20 years of regular use. Each pillow was found to contain a substantial fungal load, with four to 16 different species being identified per sample and even higher numbers found in synthetic pillows. One of the most worrying things was that the microscopic fungus Aspergillus fumigatus was particularly common in synthetic pillows. And fungi as diverse as bread and vine moulds and those usually found on damp walls and in showers were also found in the pillows. Aspergillus is a very common fungus, carried in the air as well as being found in cellars, household plant pots, compost, computers and ground pepper and spices. I have treated many people with invasive Aspergillosis, a sometimes nasty illness that occurs mainly in the lungs and sinuses, although it can spread to other organs including the brain. It can be very difficult to treat, and as many as 1 in 25 patients who die in modern European teaching hospitals have the disease. In France and Germany, this is one of the occasions when unorthodox medicine is often used at the same time as high doses of antibiotics: proper integrated medicine.

Aspergillosis is a particular problem in people with compromised immune systems. Hospital pillows have plastic covers and so are unlikely to cause problems, but patients being discharged home - where pillows may be old and fungus-infected - could be at risk of infection. Aspergillus can also worsen asthma, particularly in adults who have had asthma for many years, and it can cause allergic sinusitis in patients with allergic tendencies. Constant exposure to fungus in bed could be problematic.

The moral of this story is be extra aware that pillows may harbor fungi that can cause or exacerbate allergies and more serious problems in people with other illnesses. If you have allergies, it is best to use foam rather than feather pillows. If you have synthetic pillows, wash them regularly in warm water and with a non-allergenic detergent. Dip the pillow one small section at a time in the solution and squeeze through the pillow. Once the pillow is clean, rinse it out at least three times to remove all of the soap and residue. Then lie the pillow out flat to dry, and turn it frequently. To fluff the pillow, take a couple of tennis balls and put them in the dryer with the pillow and air dry for about 30 minutes.

Technorati tags: fungus, integrated medicine, allergies, asthma