Dirtier Lives May Be Just the Medicine We Need

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    Sep 11, 2012 1:35 PM GMT
    http://online.wsj.com/article/SB10000872396390443686004577633400584241864.html

    Your great-grandparents faced infectious diseases that hardly threaten you today: tuberculosis, polio, cholera, malaria, yellow fever, measles, mumps, rubella, smallpox, typhoid, typhus, tapeworm, hookworm…. But there's also a long list of modern illnesses that your great-grandparents barely knew: asthma, eczema, hay fever, food allergies, Crohn's disease, diabetes, multiple sclerosis, rheumatoid arthritis. The coincidence of the rise in these "inflammation" diseases, characterized by an overactive immune system, with the decline of infection is almost certainly not a coincidence.

    Natural experiments in recent decades support the idea that while modern hygiene defeats infection, it also promotes allergy and autoimmunity. Finns isolated in an impoverished Soviet province had more parasites and fewer allergies than Finns in Finland. Swedes in clean Stockholm had three times as much asthma as Estonians in smoky Estonia. Ethiopians and Gambians got allergies when they lost their intestinal worms. Growing up on a farm greatly cuts allergy risk.

    In a remarkable new book, "An Epidemic of Absence," Moises Velasquez-Manoff draws together hundreds of such studies to craft a powerful narrative carrying a fascinating argument. Infection with parasites prevents or ameliorates many diseases of inflammation. The author briefly cured his own hay fever and eczema by infecting himself with hookworms—before concluding that the price in terms of diarrhea and headaches was too high.

    I've touched on the "hygiene hypothesis" in these pages before. In its cartoon form the argument—that in a clean world our immune system gets bored and turns on itself or on harmless pollen—isn't very convincing. But Mr. Velasquez-Manoff makes a far subtler, more persuasive case. Parasites have evolved to damp our immune responses so that they can stay in our bodies. Our immune system evolved to expect parasites to damp it. So in a world with no parasites, it behaves like a person leaning into the wind when it drops: The system falls over.

    Moreover, just as brains outsource much of their development to the outside world—the visual system is refined by visual input, the language system can only develop in a language-using society—so the immune system seems to have happily outsourced much of its regulation to friendly microbes. Without them, the immune system becomes unbalanced.

    Timing seems to be key. If you pick up Epstein-Barr virus and Helicobacter early in life from your mother pre-chewing your food, they seem to help protect you against inflammation diseases. Catch them later and they may cause multiple sclerosis and stomach cancer, respectively.

    One of Mr. Velasquez-Manoff's most surprising chapters is on autism, a disorder that almost exactly parallels asthma in its recent rise among affluent, urban, mainly male, disproportionately firstborn people. Better diagnosis explains perhaps half the rise, but the brains of people with autism are often inflamed, and there's anecdotal evidence that infection with worms or viruses can tame autistic symptoms, at least temporarily.

    There's also a link between inflammation during pregnancy, caused by allergy or autoimmune disease (or chronic, low-grade infection), and autism in the child. Acute infections during pregnancy, on the other hand, correlate with schizophrenic symptoms, which may be why schizophrenia is growing rarer while autism grows more common.

    Mr. Velasquez-Manoff even raises the possibility that heart disease, diabetes, obesity and even some kinds of cancer and depression may owe something to an unbalanced immune system caused by an impoverished microbial ecosystem. Few doctors are yet willing to recommend deliberate infection with parasites to regulate the immune system, especially not for pregnant women. But that we should all be rearing our kids to be a little bit dirtier—in a healthy, rural, probiotic sort of way—looks more and more like good advice.
  • HottJoe

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    Sep 11, 2012 2:50 PM GMT
    You first, Riddler.
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    Sep 11, 2012 4:55 PM GMT
    HottJoe saidYou first, Riddler.


    I'd be willing to be in the clinical trials for allergies. Given my work and volunteering in east Africa and Asia, I'm guessing I've been exposed to a bit more than you have.
  • HottJoe

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    Sep 11, 2012 5:01 PM GMT
    riddler78 said
    HottJoe saidYou first, Riddler.


    I'd be willing to be in the clinical trials for allergies. Given my work and volunteering in east Africa and Asia, I'm guessing I've been exposed to a bit more than you have.


    That's really cool! I've never been overseas, so you guessed right. I'm a little surprised you'd willingly expose yourself to hookworms though?! I'd rather have hay fever than parasites.icon_eek.gif
  • HottJoe

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    Sep 11, 2012 8:10 PM GMT
    After thinking more about this, I still have to say we're better off now. I mean toilet paper is a recent invention, and anyone who uses it couldn't imagine living without it. Also, no one has been able to prove that modern amenities cause more harm than good. In fact, it's the opposite if you look at how people died of nasty diseases before indoor plumbing and clean water. It's been said that more died of dysentery in the Civil War than died in battle. I think I'd rather go down fighting than shit myself to death.icon_confused.gif
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    Sep 11, 2012 8:36 PM GMT
    MuchMoreThanMuscle saidThat's quite interesting. But it sounds like simply trading one type of ailment and side effects for another or another set of problems.

    It doesn't really sound like one or the other is better. And there are also eventual consequences from having parasites that can be of grave concern in a person's future in the long run.

    I have to scoot for now but I will contribute more later. But at this time I'd rather have allergies than some parasite feeding off of me in my intestines.


    From what I've read elsewhere, there are investigations as to why this is to develop pharmaceuticals that cause the body to kick up your immune system without some of the nasty side effects... but given the persistence of allergies... again I would consider doing a round of hookworms if it meant I could get rid of them forever (since there is a simple enough cure for hookworms).

    More here:
    http://www.nytimes.com/2012/09/11/science/an-epidemic-of-absence-review-seeing-hygiene-as-driver-of-disease.html

    Clearly, if true, the hygiene hypothesis is the single greatest medical story of our time, undercutting a century of putative progress. Is it true? Probably some of it is. But Mr. Velasquez-Manoff’s ambitious compendium of data and supposition — a great dense fruitcake of a book whose 680 endnotes, the author notes apologetically, refer to only a minority of the 10,000 studies he consulted — spins it all out in the most positive possible way with an energy, eloquence and desire to believe that is both breathtaking and a little scary.

    A human being, the proponents of the hypothesis argue, is not really an individual. Instead, each person is a “superorganism,” a large creature subsuming many billions of smaller ones, most of them intestinal microbes. Thriving in the colon, these “old friends” that have been with us since time immemorial are as important to our health as a limb or an organ. Altering their numbers, whether with sanitary measures, antibiotics or deworming pills, is analogous to fooling around with the liver or the spleen.

    And that doesn’t just mean that antibiotics may cause ruinous diarrhea. The microbes in the intestine, the hypothesis holds, educate the immune cells that travel all over the body, and any major alteration in the intestine sends some wild and crazy cells out there to wreak havoc unpoliced.

    The genetic and immunologic details behind these assertions are immensely complex, but enough experimental confirmation exists to keep scientists at prestigious institutions around the world deeply engaged in sorting it out.

    Other data are equally intriguing. Among them: Allergic and autoimmune conditions are far more frequent in rich countries than poor ones, even among genetically identical populations (West Germany far outpaced East Germany in their frequency, as does Finland compared with an impoverished adjacent territory under Russian control). Societies where intestinal parasites are the rule seem to lack them completely.

    A misfiring immune response has long been known to explain conditions like multiple sclerosis and Crohn’s disease, a chronic inflammation of the intestine. But some preliminary observations extend the immune connection to illnesses usually considered to be unrelated, obesity and depression among them.
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    Sep 12, 2012 12:28 AM GMT
    riddler78 said
    HottJoe saidYou first, Riddler.


    I'd be willing to be in the clinical trials for allergies. Given my work and volunteering in east Africa and Asia, I'm guessing I've been exposed to a bit more than you have.
    Here.. Ill play your 'game'..
    I KNOW I've been exposed to a bit more than you have. icon_wink.gif

    (figure it out!)icon_rolleyes.gif
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    Sep 12, 2012 12:46 AM GMT
    I've learned of this in school and agree that we are an overly sanitized society. Supposedly you WANT a variety of bacteria colonizing your gut, and this is one of the reasons you may want to avoid having to take antibiotics unless you have to because they select for whichever bacteria survive the antibiotic.

    That said, in food service, you have to sanitize because you may be serving to a population of people on chemotherapy or with AIDS.