Extreme Medical Tourism

In this post Jasper Lawrence describes a trip to Cameroon to infect himself with hookworms. Here’s how it begins:

As my asthma got worse I became increasingly reliant on inhalers, pills and antihistamines as well as upon the oral steroid prednisone to stay out of hospital. I tried all the drugs and therapies available. As it was by the time I was in my late 30s I was a frequent visitor to the emergency room. As anyone who has experienced a severe asthma attack can tell you they are terrifying.

My use of prednisone increased, and as you may know the side affects of prednisone are quite horrible, particularly with long-term use. I started to suffer from some of these side affects, particularly obesity, and despite all this these drugs were only marginally effective in controlling my asthma.

Soon I was denied health insurance and so now I had the added burden of paying for all my medical care.

On a trip in the summer of 2004 to visit relatives in England I learned of a BBC documentary about the connection between a variety of intestinal parasites and various autoimmune diseases.

In Cameroon:

Cameroon has no tourism infrastructure, its people being so poor (your pocket change represents two or three months wages) and the insane corruption make for a very challenging environment for a western traveler, particularly a conspicuous white one. You are a walking pile of cash, a visitor from another, much wealthier, planet. One feels very vulnerable and exposed. It can be very wearing and the danger of being robbed is constant. . . . With the driver’s help (I told everyone of my quest) I was able to visit a variety of villages and with practice learned to identify where the locals would defecate.

Worm therapy.

Bay Area Fermentation

Yesterday’s San Francisco Chronicle had an article on fermented foods in the Bay Area: the fermentation festival, sauerkraut, kimchi, and so on. (No discussion of yogurt.) I especially liked this:

Leaving foods unrefrigerated for two weeks or more can be disturbing to those who weren’t raised with a crock of pickles in the hallway. But U.S. Department of Agriculture research service microbiologist Fred Breidt says properly fermented vegetables are actually safer than raw vegetables, which might have been exposed to pathogens like E. coli on the farm.

“With fermented products there is no safety concern. I can flat-out say that. The reason is the lactic acid bacteria that carry out the fermentation are the world’s best killers of other bacteria,” says Breidt, who works at a lab at North Carolina State University, Raleigh, where scientists have been studying fermented and other pickled foods since the 1930s.

Breidt adds that fermented vegetables, for which there are no documented cases of food-borne illness, are safer for novices to make than canned vegetables. Pressurized canning creates an anaerobic environment that increases the risk of deadly botulism, particularly with low-acid foods.

Nothing about fermented — also called aged – meat. The last taboo. I believe we like umami flavor so that we will eat more bacteria-laden protein. (Glutamate, which produces the umami flavor, is a protein breakdown product.) All meat producers, as far as I know, age their product 2-3 weeks to improve the flavor. Understandably, they don’t like to talk about it.

Thanks to Ashish Mukharji.

A Book About the Value of Fermented Foods

Handbook of fermented functional foods, second edition, 2008.

Presenting new findings and interpretations that point even more clearly to the important role fermented foods play in our diet and overall health, this second edition demonstrates the current knowledge of fermented food production and reflects the growing credibility of probiotics in health maintenance.

You can read a lot of it online.

More Benefits of Fermented Foods

A study published last year in Oncology Reports found that fermented noni (an Asian fruit) juice fights cancer in rats.

Noni (Morinda citrifolia) has been used in traditional Polynesian folk medicine for more than 2,000 years. Recently, researchers have discovered that Noni juice has the ability to destroy cancerous tumors. . . .

The researchers evaluated Noni’s ability to both prevent and treat cancer. In the prevention study, female mice were injected with one of three substances: fNE, a phosphate-balanced solution (PBS, which is similar to saline solution), or lipopolysaccharides (LPS, a natural toxin found in bacteria and in fermented Noni juice) for three days. Then the researchers injected the mice with lung cancer and sarcoma cells. In the treatment study, the mice were first injected with the cancer cells, and then treated with three doses of fNE [fermented noni exudate], LPS [lipopolysaccharides], or PBS [phosphate balance solution].

A fter the mice were injected with fNE, they developed greater numbers of immune cells such as granulocytes (a type of white blood cell) and natural killer (NK) cells, indicating that fNE had stimulated their immune system. A month after receiving fNE for sarcoma treatment or prevention, more than 85 percent of the mice were not only alive, but also cancer-free. fNE also was effective against lung cancer tumor cells, although the tumor prevention rate was slightly lower (62 percent). Meanwhile, all of the mice that received PBS or LPS died.

Emphasis added. It is telling that they used fermented noni juice rather than plain noni juice; apparently plain noni juice is less effective. Fermented juice has many more bacteria than plain juice; it makes a lot of sense that the fermented bacteria stimulate the immune system.

Thanks to Peter Spero.

Yogurt Power

My interest in fermented food started in January, at the Fancy Food Show in San Francisco, where I had a theoretical idea: The pleasure we get from sour, umami, and complex flavors had the effect, when it evolved, of increasing bacteria intake. This suggests we need to consume plenty of bacteria to be healthy. Three things happened at that convention that supported these ideas: (a) Someone trying to make a high-end non-alcoholic drink said he found it impossible to get enough complexity without fermentation. (b) I remembered that after a trip to Japan, I had started eating lots of miso soup. Miso (fermented soy beans) is an unusually effective flavoring agent. (c) A Stonyfield Farms employee told me that her health improved a lot when she started eating yogurt every day two years ago. (Stonyfield Farms makes yogurt.)

Recently I learned more about the health improvement. She started eating more yogurt about two years ago because she changed jobs — from an architecture firm in Boston to Stonyfield, in New Hampshire, where the employee kitchen has a refrigerator full of free yogurt. In Boston, she ate yogurt about once/week; at Stonyfield, she eats it once/day (for breakfast).

When she moved to New Hampshire, she also changed her diet in other ways. She now eats more foods that are “natural and organic” and less fast food. She doesn’t eat anything with aspartame any more; she also avoids caffeine. She eats more fruits and vegetables. Maybe the biggest change is that she eats three good meals every day instead of one meal on the run. Other changes in her life include less stress, a different atmosphere, and more exposure to nature.

In Boston, she had lots of colds and sinus infections, maybe 3-4/year. When she got sick it took a long time — 2 weeks — to get better. She also felt sick to her stomach a lot. In Boston she got mononucleosis; it took six months to completely recover. In New Hampshire, she’s had only 1 cold in the past year and it only lasted 3-4 days. No other illnesses. Another change she’s happy about is that she gained weight. In Boston she weighed about 90 pounds; now she weighs about 110. (She’s 5′ 4″ and 30 years old.)

She’s noticed that Stonyfield employees are healthier than other places she’s worked (as this study suggests). Fewer people are sick and when they’re sick they aren’t sick as long. Everyone eats the free yogurt, except the lactose-intolerant. Stonyfield yogurt contains less than half the lactose of milk; for some lactose-intolerant people that’s low enough, for others it isn’t low enough. (Stonyfield makes a soy yogurt without lactose.)

Microwaves and Microbes

Here is an interesting article about the danger of microwaved food:

Comparing the blood chemistry of people after eating food cooked in conventional and microwave ovens, a dismayed Hertel explained that “blood cholesterol levels are less influenced by cholesterol content of the food than by stress factors.” . . .

So was the blood chemistry of consumers. These abrupt measurable changes included a decrease in high-density lipoprotein (good cholesterol) and a sharp rise in low-density lipoprotein (bad cholesterol) levels following the consumption of microwaved food.

The two researchers also discovered marked declines in the number of red blood cells that carry oxygen to the tissues and collect carbon dioxide, as well as in white blood cells that fight infections.

The researchers say these bad effects happen because microwave heating makes cells “easy prey for viruses, fungi and other micro-organisms.” The author adds, “bad bugs are everywhere.”

Whereas I believe the opposite: The problem with microwaved food, when there is one, is that it is too sterile. The article later reports an experiment in which E. coli. grew much faster on microwaved milk than conventionally heated milk. I interpret that to mean the microwaved milk was more sterile: less competition for the E. coli.

Note I don’t mean to say don’t use your microwave. I use mine all the time to heat water and defrost stuff. It’s the experimental data and their interpretation that interested me

Can Probiotics Prevent Asthma?

From a UCSF press release:

In the first effort of its kind in the United States, researchers at the University of California, San Francisco have launched a study to determine whether giving active probiotic supplements to infants can delay or prevent asthma in children.

The intervention is a novel method for the primary prevention of asthma with enormous potential to have a public health impact, said Michael Cabana, MD, chief of the Department of General Pediatrics at UCSF Children’s Hospital and principal investigator for the study. There currently are no known ways to prevent asthma, he said.

“It would be a great thing to be able to prevent asthma,” Cabana said. “We believe that using probiotics is a safe and effective way to do that.”

The press release is from May 2006; the three-year study should be almost finished.

Thanks to Steve Hansen.

Worm Therapy

One reason I believe we are vastly bacteria-deprived (and thus greatly benefit from fermented foods) is the efficacy of hookworm therapy: Hookworm parasites can reduce autoimmune diseases. Hookworms, like fermented foods, stimulate the immune system in a chronic, harmless, low-level way. Here is a good introduction to the subject:

Musician Scott Richards and artist Debora Wade are two Bay Area patients on the hookworm treatment. Richards and Wade both suffer from an inflammatory bowel disease called Crohn’s. When faced with using a parasite as therapy, both patients felt they had nothing to lose. . . . Both Richards and Wade say they didn’t have to wait long to feel relief. Richards [described] waking up and the pain suddenly gone. For Wade, she needed to be reinfected, but today said she can eat foods that patients with Crohn’s could never eat: pizza & Thai food for example.

Related story.

What Causes Asthma? Not What the Tovars Think

From Joyce Cohen’s The Hunt column:

For reasons unknown, Florida didn’t agree with little Noah Tovar. Since his toddler years, Noah, now 7, had suffered terribly from asthma. His parents, Jari and Selene Tovar, moved their family several times, trying to escape the mold or pollen or whatever it was that caused his breathing problems. Nothing helped much.

Noah’s parents didn’t know, I can tell, about a 1992 study of childhood asthma and allergies in Germany. Maybe childhood asthma is caused by air pollution, the researchers thought. Let’s test that idea by comparing a clean West German city (Munich) with a dirty East German one (Leipzig). Here’s one of the results:

The lifetime prevalence of asthma diagnosed by a doctor was 7.3% (72) in Leipzig and 9.3% (435) in Munich.

Less asthma in the dirty city! It wasn’t a significant difference but similar differences, such as hay fever and rhinitis (runny nose), were in the same direction and significant. Hay fever was much rarer in Leipzig.

Noah’s asthma cleared up, to his parents’ surprise, on a trip to New York. So the family moved to New York.

Even though “everyone was under the impression that New York would cause him more distress, it was just the opposite,” Mrs. Tovar said. “Not one doctor nor myself can explain what it is.”

Mrs. Tovar’s doctors are badly out of date. The hygiene hypothesis has been around since the 1990s, supported by plenty of data that, like the German study, shows that childhood allergies are better in dirtier environments. Noah is better in New York because New York air is dirtier than Florida air — that’s the obvious explanation.

In The Probiotic Revolution (2007) by Gary Huffnagle with Sarah Wernick, which I’ve mentioned earlier, Dr. Huffnagle, a professor of immunology at the University of Michigan, describes a self-experiment he did:

Could probiotics relieve something as tenacious as my lifelong allergies and asthma? I decided to take a probiotic supplement and make a few simple changes to my diet to my diet, just to see what happened. Yogurt became my new breakfast and my new bedtime snack. I also upped my intake of fruits and vegetables. Whenever possible, I substituted whole grains for processed ones. And I tried to cut back on sugar. [Why he made the non-probiotic changes is not explained. In another part of the book he says he also increased his spice intake.] No big deal.

Because I doubted this little experiment would work, I didn’t mention it to anyone, not even my wife. And I didn’t bother to record my allergy symptoms. . . My “aha” moment came after about a month: I’d spent the evening writing a grant proposal, a box of tissues at my side. After all these years, I knew to be prepared for the inevitable sneezing and runny nose caused by my mold allergies, which kicked up at night. But when I finished working and cleared the table, I realized I hadn’t touched the tissues. And as I looked back on the previous month, I could see other changes. This wasn’t my first sneeze-free evening; I hadn’t needed my asthma inhaler for several months. To my astonishment, the experiment had been a great success.

This is a great and helpful story. Only after I read it did I realize I’d had a similar experience. I’ve never had serious allergies but I used to sneeze now and then in my apartment and my nose would run a lot; I went through more than one box of Kleenex in a month. Maybe 4 in one morning. In January, I made just one change: I started to eat lots more fermented foods (yogurt, kimchi, kefir, etc.). My sneezing and Kleenex use are now almost zero.

The Tovars can live wherever they want, I’m sure, if they feed their son plenty of fermented food.

Previous post about childhood allergies and fermented food.

More After the column appeared, someone wrote to the Tovars:

Funny, same thing happened to me. I moved from England where I had chronic asthma, to New York City where I had none. Stayed in NY for twenty years asthma free, then moved back to England with my wife for the last ten years and my asthma has returned all the time I’ve been back.

Probiotics and Resistance to Illness

A 2005 study compared workers who did and did not consume a daily straw of probiotic liquid. During the 3-month study, workers who got the probiotics were sick half as often as those who didn’t. Here are details:

262 employees at TetraPak in Sweden (day-workers and three-shift-workers) that were healthy at study start were randomised in a double-blind fashion to receive either a daily dose of 100,000,000 Colony Forming Units of L. reuteri or placebo for 80 days. The study products were administered with a drinking straw. 181 subjects complied with the study protocol, 94 were randomised to receive L. reuteri and 87 received placebo. In the placebo group 26.4% reported sick-leave for the defined causes during the study as compared with 10.6% in the L. reuteri group (p < 0.01). The frequency of sick-days was 0.9% in the placebo group and 0.4% in the L. reuteri group (p < 0.01). Among the 53 shift-workers, 33% in the placebo group reported sick during the study period as compared with none in the L. reuteri group(p < 0.005).

The paper gives no reason to think the probiotic dose was optimal. (How the dose was chosen isn’t explained.) A larger dose might have had a bigger effect.

When science writers tell about the “miracle” of antibiotics, they tell stories like this one, from The Probiotics Revolution (2007) by Gary Huffnagle with Sarah Wernick:

When my daughter was five, she pricked her left hand on a rosebud thorn in our garden. . . . The next day she ran a fever. . . . Doctors diagnosed an acute bacterial infection. Half a century ago, a child might have died from such an infection. But my daughter received antibiotics. After a day of intravenous treatment, she was better. . . . Antibiotics are true miracle drugs.

What goes unnoticed in these “miracle” accounts is the possibility that the person got so sick because their immune system wasn’t working well. (It wasn’t working well, I propose, because the infected person didn’t get enough bacteria in their food.) A child gets sick from an ordinary plant scratch? That child’s immune system has a lot of room for improvement. Huffnagle and Werrick say nothing about this.

Dr. Huffnagle is a professor of internal medicine, microbiology, and immunology at the University of Michigan. If the child of such a parent — well-off, well-educated, health-conscious, specializing in immunology — has a weak immune system, and the parent doesn’t realize this is possible, there is enormous room for improvement.

The Probiotics Revolution is 90% filler but the 10% substance makes it worth skimming.