Is it Genetic or Environment?

Is it Genetic or Environment?

For a long time it was thought that mapping the human genome would lead to breakthroughs in medicine.

What we are seeing in recent years as the research matures, is environment weighs in heavier than genetics. In fact, environmental factors account for over 90% of what ends up expressing genetically. My teacher uses this phrase to illustrate the connection: “Genes load the gun but environment pulls the trigger.”

Mismatch Theory

This theory explains how evolutionary medicine can influence environmental factors and turn around the epidemic of modern disease. The mismatch between how we evolved to live and how most people are living today is problematic. For example, humans have not evolved to digest grains and the genetic leap that would allow us to is unlikely. However human infants digest lactose and this explains why in some places up to 90% of people have learned to be lactose tolerant as adults. Dairy can be an excellent source of nutrients and some people have adapted to use this as a food source. Genetically this is not such a big leap.

Mismatch theory isn’t only applied to diet but also lifestyle. Consider light, dark cycles and sleep. Insomnia is a real problem and has serious health consequences. Apply an evolutionary approach by dimming lights at night, using amber-coloured glasses if you must use a screen and ensuring adequate exposure to bright daylight for at least an hour during the day. Many people work indoors and forget that daylight anchors our circadian rhythm. Moving regularly during the day is also important and this allows our body to rest at night. Of course it is easy to overdo this as well so finding a balance is key. These lifestyle factors are linked to environment but harness our genetic memory to optimize health. This is how genetics can be applied in a practical day-to-day way.

Genetics: A gene can be present but may not express

Let’s look at the growing list of diseases linked through autoimmunity. Genetically we have been able to associate a group of genes called HLA (human leukocyte antigen) with several autoimmune conditions including juvenile onset of arthritis (1) and other heightened immune responses. Leukocyte refers to white blood cell which is part of any immune response.

Environment: includes all of the non-genetic influences beginning with conception 

Autoimmunity is linked with gut health. A huge proportion of our immune system is housed in the gastrointestinal tract through the GALT (gastro associated lymphatic tissue). New research shows that probiotics stimulate immunity but do not substantially increase populations of good bacteria. Feeding theses bacteria with prebiotics promotes the long term health of the human microbiome by increasing beneficial gut microbes. Not surprising breastmilk is full of prebiotics.(3) A diet high in cellulose from plant foods is also known to feed the good bugs. Acellular or processed carbohydrates leads to an overgrowth of dysbiotic or pathogenic flora. Complete proteins and a nutrient dense diet supports the repair and growth of the gut lining. Good fats help absorption and blood sugar.

Chemical and biotoxin exposure need mentioning as well. Exposure can lead to chronic inflammatory response syndrome in roughly 25% of people. Mold illness has been linked with the HLA gene as well. One person may be unable to clear this biotoxin from their system whereas another might end up in chronic pain.due to the HLA gene. This same person may be able to integrate diet and lifestyle choices that mitigate damage, reduce inflammation and prevent further health complications long term.

I’m working with a 21 year old male who was given high doses of NSAIDS throughout childhood and who now suffers poor gut health as a result. He is committed to lowering stress, changing his diet and repairing his gut. Functional Medicine offers an approach that he never found in conventional medicine where diet was never discussed. He was continually given more medication that never addressed the root cause. NSAIDS damage the gut as do most medications.

The benefit of an evolutionary approach is the simple lens it offers to complex situations. It harnesses the power of our genetics in a very practical way. Choosing the right diet can seem overwhelming but if we think of how we evolved to eat it is much more manageable. The same can be applied to sleep, movement other important lifestyle factors. The momentum of our genetics is thousands of years in the making so even small changes have enormous benefit.

1. http://www.ncbi.nlm.nih.gov/pubmed/14960534

CBD is Changing The Game

CBD is Changing The Game

CBD (cannabinoid) is a natural, safe, and effective. Its affect includes reducing inflammation, pain and seizures.  There is evidence that it may inhibit cancer growth.  It certainly helps with nausea and other side-effects of chemotherapy including loss of appetite.  In my practice I have seen it work on insomnia caused by recalcitrant pain.  I’ve had patients stop opiates and other damaging pain medications after decades of use.

What are the benefits of CBD?

In clinical studies there is evidence that CBD is effective in five areas.

  1. The most established benefit on relieving pain and inflammation. It does this without the serious side effects of opiate drugs and NSAIDS.
  2. Studies have also shown effectiveness with PTSD especially on veterans experiencing social anxiety. Its important to note that in a percent of the population CBD can also increase anxiety.
  3. CBD has successfully treated drug-resistant children who have epilepsy with non of the side-effects of traditional seizure medications. Anti-seizure meds come with the worst side-effects of any drugs.
  4. It works against viruses, fungi, and bacteria as an anti-microbial. Some studies suggest that it may even be effective against superbugs like MRSA and other anti-biotic resistant infections.
  5. CBD is anticarcinogenic. Several studies demonstrate that CBD is antiproliferative and proapoptotic. More research is needed but it may inhibit cancer cell migration and invasion.

 

How does CBD work?

All mammals have receptors for CBD. This is called the the endocannabinoid system. It regulates a variety of functions including mood, appetite, sleep, hormone production, and immune system response.  For patients with autoimmunity causing pain I’ve seen excellent clinical results.  This may be because of the link between the gut and autoimmune conditions.

Interestingly the gut, which is part of the nervous system, has many endocannabinoid receptors.  This is why CBD can be a game changer for people with IBS, IBD, and other GI issues like nausea.  This may be part of why it is such an effective remedies for insomnia.

What forms is it taken?

CBD is available in several different forms and ratios.  THC is needed to activate the CBD but it can be a minute amount.  The psychoactive component does not appeal to most patients I talk to (if not all).  It can be purchased as capsules, liquid extracts, sprays, vapours and topical salves or creams. CBD taken internally is best for reducing pain and insomnia, whereas a topical is best for treating skin conditions and relieving musculoskeletal pain.

Is it legal?  What other challenges are there?

CBD is generally well tolerated.  There are however a few potential contraindications. Like some other botanicals CBD may interact adversely with pharmaceuticals.  This is because it inhibits cytochrome P450. This enzyme in the liver metabolizes many drugs so it may increase the effects.  A medical herbalist is trained in understanding which drugs are potentially affected and its important to discuss this with your prescribing doctor.

The potential that it may increase anxiety must be taken into account as well.  A major issue right now in Canada, is that it is difficult to get a reliable source with the proper ratios.  Legalization will hopefully lead to more standardization in products.  The right ratio is important depending on what is presenting.  I’ve had some patients respond very well 4:1 whereas others report uncomfortable psychoactive properties. This may be due to product inconsistency or individual response. 20:1 is more difficult to find but this is a much lower dose of THC and is indicated for neurological disorders.

We always start with a low dose and build up slowly.  In the US patients can purchase these products from reputable labs and companies so they know what they are getting.  It is legal in the US without a prescription. Within the next fews years I expect to see reliable sources.

 

 

 

Kids are at Risk

Kids are at Risk

Given the trends that we see in the general population towards a sedentary lifestyle it’s not surprising our kids are less active than ever before. What are the health implications exactly? What can we do to change this?

Do It Yourself

Kids pick up on everything so when they see us trying new things, being active, and getting outside they develop their own love of movement and learning. It’s predicted that our children are likely to have shorter life spans than us unless we make these changes.

Autoimmunity

A study published in the Scandinavian Journal of Medicine demonstrates that high physical activity has positive effects on children’s immunity and may decrease the risk of autoimmune disease. This research has significant implications for long-term health of kids given that autoimmunity is on the rise in younger populations.

Lifestyle Medicine

Physical activity not only reduces the risk of autoimmunity in children but also decreases cardiovascular risk factors, improves lung function, enhances motor skill development, and increases defenses against inflammatory diseases.

Nature and Play

Humans need unstructured play time, adults included.  Reconnecting with nature is one way we can improve our sense of well-being and enjoy some much needed play time. Digitally detoxifying is an important aspect of this. Having a few weeks every year where screens are turned off is crucial for recalibrating.

 

 

 

Getting to the Root of Autoimmunity

Getting to the Root of Autoimmunity

The root is the gut.  I’m going to tackle some of the most common autoimmune conditions by looking at the latest research.  What is significant for all autoimmune disease is that conventional treatments fall short.  New approaches are badly needed.  Good results are being found with an anti-inflammatory diet like the autoimmune paleo reset along with prebiotic fibres that nourish beneficial bacteria.  I also use herbs to soothe the intestinal lining and further reduce inflammation.  Other therapies like low dose naltrexone have been very helpful for my patients.

Genetics and environment play an important role in autoimmunity.  An ancestral diet with significantly more fibre and no processed foods has excellent outcomes.  It is naturally lower in carbohydrate.  Processed grains and grains in general were introduced recently in our evolution.  Our biology does not tolerate these foods especially in the quantities they are being consumed.  The high carb, low fat diet has led to many problems including overeating.  Higher fat whole foods are more satiating and safe as long as they aren’t combined with refined sweeteners.

Blood Sugar Solutions

Diabetes is on the rise in both children and adults.  In this disease the immune system attacks the pancreas preventing it from producing insulin by attacking it.  A study done this year found an association between  inflammation and microbial imbalances in those with type 1 diabetes (T1D).  In biopsies of patients with T1D, two specific strains of bacteria associated with gut inflammation were out of balance.  The study concluded that those with TID have a disrupted gut microbiome which plays a role in the disease 1.

Immunity and Lupus

Gut bacteria serve as immune protection against pathogens but in some cases they have taken over and contributed to transmission of a disease.  This in unusual but is what happens in Lupus.  Again it is an imbalance in specific strains of bacteria against others that contribute to the disease.  By supplementing with the anti-inflammatory strains of lactobacillus​ and bifidobacterium​ symptoms of Lupus were reduced.  In animal studies both lymphadenopathy and glomerulonephritis were affected by this simple intervention. Treatment with just bifido prevented the immune system from becoming over activated.2  A disrupted gut microbiota is associated with decreased DNA replication and repair.  Impaired carbohydrate and amino acid metabolism have also been associated with gut dysbiosis.  Therefore, we see dysbiosis epigenetically harming the body’s repair system and metabolism.

Rheumatoid Arthritis and Oral Microbiome Health

Increased levels of aggregatibacter actinomycetemcomitans​ (​Aa​) in oral cavities due to peridontitis may be connected to rheumatoid arthritis. ​Research suggests that the oral microbe ​Aa​ may trigger autoimmunity in rheumatoid arthritis.​ Therapies that treat Aa infection and improve the health of the oral microbiome may be valuable in the treatment of RA. Confirming the presence of Aa and then treating it would be the first step. Dietary interventions to reduce inflammation and probiotics specific to the oral microbiome would ideally be part of treatment.

 

 

 

 

 

 

Gluten, Genetics & Gut Health

Gluten, Genetics & Gut Health

Why are these 3 G’s so damn important right now?  One out of every six people in North America suffer from an autoimmune condition.  By 2050, it’s predicted that 600,000 kids will have type 1 diabetes given the current rate.  This is alarming and I really think we can do better for our children.

Autoimmunity is complex and has many causes.  In this article I discuss three diseases and the research connecting gut health to autoimmunity.  Today I’ll focus on a specific genetic marker present in some autoimmune conditions and the strain of bacteria associated with it.  We’ll also discuss how a lower carb, ancestral type diet is indicated.

Gluten increases inflammation even in those who are non reactive.  It is also a filler food meaning its highly processed and modified.  It lacks any nutrient value unless it is fortified which can actually cause more problems.  For those who are reactive, gluten leads to several disease processes including neurological issues, joint problems, malabsorption and yes, autoimmune disease.

What about HLA?

HLA means human leukocyte antigen. Leukocytes are the white blood cells. They protect the body from infection and foreign substances.  Antigen means the protein on the surface of immune cells. Genes determine which proteins are present on the surface of the immune cells.  HLA is a highly polymorphic gene, meaning there are many different possible gene set variants, or haplotypes.

Humans have incredibly adaptive immune systems because of the number of haplotypes available.  However, certain haplotypes predispose a person to specific immune system diseases.  HLA-DQ haplotypes have also been associated with celiac disease (1), while HLA-DRB1 has been associated with rheumatoid arthritis (2).  Mold illness may affect one person and not another due to the individual’s haplotype.

HLA-B27 in Autoimmunity

Crohn’s disease, ulcerative colitis, psoriasis, reactive arthritis, ankylosing spondylitis (AS) and uveitis are all associated with HLA-B27.  Fusion of the spine in AS is the most common condition associated with this haplotype. An estimated 88 percent of people with AS are HLA-B27 positive.  Some subtypes of this gene are protective against AS while others increase the risk of developing the disease.  Keep in mind that you can have this haplotype and never develop an autoimmune condition.

Klebsiella and Ankylosing Spondylitis

A connection has been made between Klebsiella and HLA-B27 since 1980.  Studies have found that this gut bacteria has two molecules that closely resemble HLA-B27 (34). The immune system naturally produces antibodies against Klebsiella in an effort to remove it, but these antibodies can also bind to HLA-B27.

Low-starch Diet?

Studies have shown that Klebsiella does not grow on cellulose from plant starches but can grow on simple sugars (5). Simple sugars are absorbed in the small intestine whereas some starch makes it to the colon where bacteria live.  Klebsiella can manufacture an enzyme called pullulanase, a starch-debranching which allows it to break down starch into simple sugars for energy and growth (6).

Human studies confirm that a high protein, low carbohydrate diet significantly reduces klebsiella in fecal samples (7). Another study found that a low-starch diet reduced the immune response in AS patients (8). The majority of these patients reported remission or at least a reduction in symptoms.

And Finally Back to Gluten

In four out of 5 randomized, double blind trials gluten showed to increase symptoms in patients.  The patients who received the rice pill instead of the gluten pill continued to have symptoms improvement.  This doesn’t mean that all people need to be strictly gluten free but it does mean that up to 80% of people who are struggling with chronic illness are reactive to gluten.  I explain to patients who want to get better that removing gluten is an excellent starting place given the medical literature.  Most testing available to the public only looks at alpha gliadin and wheat.  More accurate testing is available.  It covers 24 markers.  I highly recommend this if you are questioning whether or not to remove gluten from your diet.  Remember that diet and environment turn on genes that would otherwise be dormant.  One step to preventing autoimmunity can be as simple as eating more vegetable and eliminating gluten for 2 weeks to see if you feel better.

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