Monday, February 09, 2009

Multiple Sclerosis and Hydrogen

Thanks to Stephan for getting me re started on this post. Hydrogen matters.

I've been interested in diet and MS for some time. JK has apparently treated a small number of patients and Barry Groves has an interesting section on Second Opinions, mostly discussing a small series of 15 patients treated by Dr Lutz, plus a lady who put her MS in to remission by following the dietary advice in Eat Fat Get Thin.

Lutz is very interesting and cautions against aggressive, sudden onset LC nutrition in this disease as there can be a severe flare. He also mentions this phenomenon in a number of (non MS) sections of Life Without Bread. Being a medic he has the facility to use corticosteroids under these circumstances and did so as needed. There is probably a whole post related to this idea, but I think it holds water.

Anyway, MS appears to be manageable using diet. I'm going to try and look at some of the aspects as to why, though there seem to be several related ways of developing MS, which complicates matters. Intestinal dysbiosis and hydrogen production are probably crucial to development and offer some plausible mechanism for achieveing remission.

As we all know, helicobacter gastritis is facilitated by hydrogen gas produced from carbohydrate fermentation in the colon (or the small intestine if you have adequate dysbiosis). Interestingly helicobacter appears quite happy to colonise both your respiratory system and the calculus on your teeth, presumably given enough hydrogen. The authors of the paper which looked at the role of hydrogen speculated that other infections, particularly of the respiratory tract, might also be facilitated by access to hydrogen.

One other bacterium which appears to be extremely fond of hydrogen is acinetobacter. In its free living guise, just look where you can find it. All you have to do is to give some legumes the equivalent of intestinal dysbiosis by modifying their nitrogen fixing bacteria to "excrete" hydrogen, plant them in a field and there are the acinetobacter, eating it up.

Acinetobacter bacteria are ubiquitous in soil, as commensals on skin/ mucous membranes and as pathogens. The pathogenic species love the respiratory system of critically ill patients and have an initial preference for the sinuses before generalising in to the lungs, blood stream and mortuary.

Respiratory infection, especially sinusitis, has a very long and respectable association with MS. This paper gives the picture:

"MS and chronic sinus infection were also significantly associated in the timing of attacks, in the age at which patients suffered their attacks, and in the seasonal pattern of attacks"

The p value for the association was p<0.0001, quite impressive provided you remember it's an association in a retrospective observational study, not an intervention trial.

I am interested in Prof Ebringer's work on MS and acinetobacter. Prof Ebringer has a systematic technique for seeking out peptides in bacterial proteins which might reasonably be associated with auto immune diseases in humans. Obviously, for MS, you are looking for amino acid sequences in bacterial proteins which resemble a protein in myelin, the one which is targeted for attack by the immune system to give MS. Plus a few other neurological protein targets.

Acinetobacter has such peptide sequences in several rather obscure sounding enzymes. The next question is whether patients with MS have elevated antibodies to acinetobacter bacteria. Yes, they do and they also have elevated antibody counts against synthetic peptides identical to those putative trigger sequences too.

So where does that leave diet? I'm not a great enthusiast for using antibiotics for treating chronic recurrent sinusitis. Drugs are great for acute life threatening problems, or even for acute onset severe sinusitis. Guessing the correct one is part of my job. But bacteria like acinetobacter and its close relative pseudomonas (which shares similar myelin resembling peptides) simply laugh at the pharmaceutical industry's offerings. No, reducing the pathogenicity of these bacteria requires manipulation of their environment.

As an aside on pseudomonas, I was a student in Camden Town just after the IRA bombed the Tower of London in 1974. The many burns patients from this particular episode (which made you quite uncomfortable walking past litter bins in central London) were successfully treated for potentially lethal pseudomonas infections using the vinegar and hair drier technique mentioned above, when all of the antibiotics available at the time were useless. This was cutting edge for our pharmacology lecturers and it certainly taught me something about bacteria.

Back to acinetobacter and respiratory infection. I still get colds. So do my wife and son. LC friends do too. But the chronic persistent gunky nasal discharge, chronic sinusitis or persistent cough (for weeks or even months for some) that used to be a routine sequel to colds are a thing of the past. Respiratory bacteria live in an oxygen rich environment. Hydrogen, as noted by Stephan, Kwasniewski and NASA, is a very high energy molecule in the presence of oxygen. It can power a respiratory infection just as well as it can power an Apollo rocket. No hydrogen means no fuel.

Acinetobacter live everywhere. Having them in your nose is common. We've probably always had them. Converting that balance to a chronic purulent sinus infection is arriving in the modern world.

Getting rid of sinusitis strikes me as one route to removing the most likely trigger factors for MS. Marked reduction of hydrogen production from gut dysbiosis is probably essential to this. That means minimal fibre, minimal fructose, minimal gluten, minimal flatulence. Anything else we can do to normalise our immune function after that will probably help too.

But for someone with MS and a weakness for baked beans, hmmmmmm......



Stephan Guyenet said...


Check this out:

"Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs."

It seems digestion is tied to infections/immunity.

Robert M. said...

Argh, blogger ate my comment. Take two:

Fun factoid: I cut way down on my sinus problems when I learned to plug my nose when shaving with an electric razor. The electrics put off a lot of small particles of hair that, when inhaled into the sinuses, get lodged in the mucus and cause irritation and more mucus production to get rid of them.

I live in a town with very cold and very dry winters. After I switched to low carb, I have, as you say no case of the sniffles. If I go for a walk in -30 ^C weather I have to blow my nose once when I go inside and then I'm good. I also don't get chapped lips.

The field of periodontics has a lot of information about mouth flora. Everyone has a unique set of bacteria in them. Whether you get periodontal disease or not depends on what type of bacteria you have in your mouth. It won't surprise you to learn that vegetarians/vegans are at significantly higher risk for periodontal disease.

Anonymous said...

Very interesting. This my first winter after a year of paleo style dieting and same thing - I get colds but they are incredibly mild with very little or no mucus.

I'm curious how much of the benefit in LC stems not from the macronutrient ratios but instead from eating foods that are likely to be more easily digestible - and removing foods like wheat, sugars, etc that may cause digestion problems.

Pasi said...

Interesting post!

Stephan and Peter,

I've had my one and only pneumonia after having high levels of work related stress. I wonder if the severity of stress has something to do with gastric acid concentration and/or digestion of dietary sugars??

I have two friends who are diagnosed with MS so I'm very interested about this issue (too)...

gunther gatherer said...

Toddhargrove and Peter,

There is also evidence that heavily cooked foods cause an immune system reaction. If you're looking for more easily digestible foods, there's nothing more stomach-friendly and devoid of allergens than paleo foods eaten in their natural state.

I agree that the benefits to paleo eating (not necessarily LC) show no matter what my macronutrient ratios are. I haven't had a cold for six months, since the day I started eating most of my foods raw.

Peter said...

Hi Stephan, I'd forgotten all about that abstract, had it lying around for a while but dumped it... I was thinking along the line of loss of defense due to the proton pump inhibition but it could be as simple as acid reflux is a marker of severe dysbiosis. You tend to think the chronic pharyngitis and cough from acid reflux is just from acid burns, but maybe H2 and opportunistic infection could be involved.... Mind you the cough goes with PPIs, so maybe not.

There is another post brewing about the innate immune system in the gut and superinfection following broad spectrum antibiotics. It's not as simple as it seems!


Peter said...

Robert, yes blogger does that occasionally! As you say, no surprise re plant based diets and oral health...

Todd and Gunther,

I think there is a lot in this. I would agree that LC could well work by junk elimination rather than macronutrient ratios, until you get to specific ketone derived effects. Because I'm LC based I tend to see things from this slant but limiting the stuff you eat to Food might work, but currently I stick with what I know works. There's obviously scope to expand food choices but I feel many people would happily live with Groves or Lutz's diets where as mostly raw paleo might be harder. Maybe that's just me...

Westie, what comes to mind is stress = cortisol = insulin resistance = raised glucose = immune dysfunction = pneumonia.... Or could be as simple as cortisol = vacation time for the immune system!


GK said...

This is off-topic, but I wanted to confirm a similar experience as commenter toddhargrove. In my second year of paleo-dieting I had four colds instead of my usual one, but they were very mild.

David said...

I have a friend who has Charcot-Marie-Tooth disease (CMT), which is similar in some ways to MS. I wonder how this line of thought would apply in this instance? Good thoughts.

Peter said...

Hi David,

I had a quick google at CMT and it looks like the demyelination is more metabolic than immune mediated. Obviously metabolic problems just call out for a trial of modest ketosis to see if there is a simple metabolic lever available. Nothing to lose.

It's also common too, which suggest that the defect, whatever that is, is not very strongly selected against. I'm always suspicious that either a traditional diet or a ketogenic diet might help in relatively common genetic diseases, especially if there are numerous ways of getting the same problem (a bit like the way in which there are many forms of FH, all with similar phenotypes).

Just a guess, but ketones seem worth a try...


Bloggeier said...

Is this review of any interest?

Peter said...

Yes, very. What keeps coming back to me is the role of diet in immune competence, and whether the diet which allows chronic infection also triggers the neurodegenerative problems. Most of the conditions discussed in the paper have been looked at and seem to respond to ketosis or normoglycaemia, combined with normal digestive function. Are the bugs causal or opportunistic?

But interesting.


Linda said...

Hello Peter,

Off topic I'm afraid - I'm about to start my mom on a low carb - high fat diet, she's been trying to shed 10kgs or so for ages. She was about to start a R1500 diet with TLC, but I've convinced her to try this diet first. :) She also has problems with blood suger (borderline) and is on cholesterol and high blood pressure medication.

I'm using Protein Power as a "template" diet, tweaking for a more high fat emphasis.
Wish me luck!

Just wanted to thank you again for a great blog, as this is one of the best sites I've seen to explain why this way of eating works.

Peter said...

Hi Marz, you are welcome and good luck to your mother. Keeping to Food might be a good slant, I think Michael Eades is mostly real food based...


David said...

Regarding the chronic infections...

I had neuroborreliosis from Lyme disease for years, and during treatment I responded extremely well to a ketogenic diet. It wasn't the total answer for complete treatment, but it made me feel loads better.

Peter said...

Very interesting. I think this goes back to Lutz, LC and having an immune system which actually works. Must try and dig out some of the references.