Lots on Gut Flora, the Fascinating Ethical Placebo, and Human Milk Ice Cream - Articles this week

March 12, 2011

Dear Family,

Some of you ask, “Why does this Diet take so friggin' long?” This is from the FAQs on Natasha Campbell-McBride's website gapsdiet.me:

“1. Why does it take so long to change the bacterial profile in the gut?

“It can be quick to get ill, while healing always takes time. It can take a long time to normalise gut flora in a person with gut dysbiosis because the gut is occupied by thousands of pathogenic species of microbes. They dig themselves in very well in the gut lining, and to drive them out is not easy: the probiotic microbes have quite a fight on their hands. Another problem is that, whether we use fermented foods or commercial probiotic supplements, the numbers of active microbes we introduce are very small. There is no way at the moment (which means we don’t know any way) to flood the gut with probiotics safely, because we don’t know enough about them. Recent scientific data shows that there are hundreds of thousands of various species of microbes in a healthy gut! With our current knowledge we can only introduce a few at a time – those that we know, such as lactobacilli, bifidobacteria and few others. There are a few doctors in the worlds who are trying to copy Nature: they use a procedure called faecal transplant: a stool from a healthy donor is mixed with water and introduced into the gut of the patient (through the tube into the stomach, or into the bowel as an enema). In many patients this fixes the problem, though it does not work for everybody. Faecal transplant introduces the whole immensely complex flora of a healthy gut, without us knowing what species of microbes are there and what other factors we are introducing. I am sure that many of you watched films about animals, where a baby elephant would consume mother’s stool with relish. For us, humans, this looks repulsive and unacceptable, but obviously these animals know something we don’t. Faecal transplant does what these baby elephants do, and maybe this will be the way in the future to restore the gut flora quickly...



Cesarean delivery may affect the early biodiversity of intestinal bacteria

“The gastrointestinal tract of neonates becomes colonized immediately after birth with environmental microorganisms, mainly from the mother; strong evidence suggests that the early composition of the microbiota of neonates plays an important role for the postnatal development of the immune system....”



More on fecal transplants:

“In 2008, Dr. Khoruts, a gastroenterologist at the University of Minnesota, took on a patient suffering from a vicious gut infection of Clostridium difficile. She was crippled by constant diarrhea, which had left her in a wheelchair wearing diapers. Dr. Khoruts treated her with an assortment of antibiotics, but nothing could stop the bacteria. His patient was wasting away, losing 60 pounds over the course of eight months. 'She was just dwindling down the drain, and she probably would have died,' Dr. Khoruts said.

“Dr. Khoruts decided his patient needed a transplant. But he didn’t give her a piece of someone else’s intestines, or a stomach, or any other organ. Instead, he gave her some of her husband’s bacteria.

“Dr. Khoruts mixed a small sample of her husband’s stool with saline solution and delivered it into her colon. Writing in the Journal of Clinical Gastroenterology last month, Dr. Khoruts and his colleagues reported that her diarrhea vanished in a day. Her Clostridium difficile infection disappeared as well and has not returned since.

“The procedure — known as bacteriotherapy or fecal transplantation — had been carried out a few times over the past few decades. But Dr. Khoruts and his colleagues were able to do something previous doctors could not: they took a genetic survey of the bacteria in her intestines before and after the transplant.

“Before the transplant, they found, her gut flora was in a desperate state. 'The normal bacteria just didn’t exist in her,' said Dr. Khoruts. 'She was colonized by all sorts of misfits.'

“Two weeks after the transplant, the scientists analyzed the microbes again. Her husband’s microbes had taken over. 'That community was able to function and cure her disease in a matter of days,' said Janet Jansson, a microbial ecologist at Lawrence Berkeley National Laboratory and a co-author of the paper. 'I didn’t expect it to work. The project blew me away.'

“Scientists are regularly blown away by the complexity, power, and sheer number of microbes that live in our bodies. 'We have over 10 times more microbes than human cells in our bodies,' said George Weinstock of Washington University in St. Louis. But the microbiome, as it’s known, remains mostly a mystery. 'It’s as if we have these other organs, and yet these are parts of our bodies we know nothing about.'...”



A fascinating snippet about gut flora and behavior:

“...Here, we report that colonization by gut microbiota impacts mammalian brain development and subsequent adult behavior...[specifically, concerning]...altered expression of genes known to be involved in second messenger pathways and synaptic long-term potentiation in brain regions implicated in motor control and anxiety-like behavior.”

My take on this, in plain English (please correct me if I'm wrong...), is that these researchers think that the same neuronal pathways, affected by the presence or absence of specific types of gut flora, govern _both_ “motor control” and “anxiety-type” behaviors.



“Human breast milk ice cream on sale in London...”



I honestly and largely dislike news coverage like this, for the ways in which it is sensational and gives credit to hot shot doctors while neglecting the ones who do most of the work in healing sick kids: the parents. But, gut flora in the news is gut flora in the news, after all...


Speaking of, I'm about to read this article that Jeff G. passed along, from “Scientific American”: http://www.scientificamerican.com/article.cfm?id=do-gut-bacteria-worsen…

This is especially interesting to me because of Ben's incredibly picky diet before GAPS, and the ways that it was surely deficient in micro and macronutrients:

“...One possible explanation for why only some malnourished children fall prey to kwashiorkor is that differences in gut bacteria might affect how susceptible people are. Gut bacteria can change how people absorb iron, zinc and vitamins from their food, and have been linked to obesity (see 'Fat people harbour 'fat' microbes')...”



Why Our Immune Systems Require Good Gut Flora:

“...The intestinal microflora is a positive health asset that crucially influences the normal structural and functional development of the mucosal immune system. Mucosal immune responses to resident intestinal microflora require precise control and an immunosensory capacity for distinguishing commensal from pathogenic bacteria. In genetically susceptible individuals, some components of the flora can become a liability and contribute to the pathogenesis of various intestinal disorders, including inflammatory bowel diseases. It follows that manipulation of the flora to enhance the beneficial components represents a promising therapeutic strategy. The flora has a collective metabolic activity equal to a virtual organ within an organ, and the mechanisms underlying the conditioning influence of the bacteria on mucosal homeostasis and immune responses are beginning to be unravelled. An improved understanding of this hidden organ will reveal secrets that are relevant to human health and to several infectious, inflammatory and neoplastic disease processes...”



Just some unpleasant news about our local watershed...TAKE HEED: if you care about drinking water, wherever you live--and especially if you live anywhere near the so-called “Marcellus Shale”, or have ever heard your local politicians discussing “hydrofracking.”



“Agroecological farming can double food production in 10 years:

“...To feed 9 billion people in 2050, we urgently need to adopt the most efficient farming techniques available. Today’s scientific evidence demonstrates that agroecological methods outperform the use of chemical fertilizers in boosting food production where the hungry live—especially in unfavorable environments. “



If you've ever wondered about the fantastic little microbial beasties that inhabit kefir...then wonder no more!


Here are some FASCINATING articles concerning the placebo response, ethics, and whether a placebo medicine can cause tangible effects if you KNOW it's a fake (turns out, it can).:


“Antidepressants are supposed to be the magic bullet for curing depression. But are they? I used to think so. As a clinical psychologist, I used to refer depressed clients to psychiatric colleagues to have them prescribed. But over the past decade, researchers have uncovered mounting evidence that they are not. It seems that we have been misled. Depression is not a brain disease, and chemicals don't cure it.

“My awareness that the chemical cure of depression is a myth began in 1998, when Guy Sapirstein and I set out to assess the placebo effect in the treatment of depression. Instead of doing a brand new study, we decided to pool the results of previous studies in which placebos had been used to treat depression and analyze them together. What we did is called a meta-analysis, and it is a common technique for making sense of the data when a large number of studies have been done to answer a particular question.

“It is rare for a study to focus on the placebo effect--or on the effect of the simple passage of time, for that matter. So where were we to find our placebo data and no-treatment data? We found our placebo data in clinical studies of antidepressants. All told, we analyzed 38 published clinical trials involving more than 3,000 depressed patients. What we found came as a big surprise. It turned out that 75 percent of the antidepressant effect was also produced by placebos - sugar pills with no active ingredients that are used to control the effects of hope and expectation in clinical trials. In other words, most of the improvement seen in patients given antidepressants was a placebo effect.

“Worse yet, it seemed that even the small seeming drug effect might have really been a placebo effect. These studies were supposed to be double-blind. That means that neither the patients nor their doctors were supposed to know whether they had been given the real drug or a placebo. As it turned out, most of them were able to figure out which they were given, especially those who had been given the real drug. Antidepressants have side effects, and when a patient experiences these side effects, they know that they are in the drug group rather than the placebo group. That knowledge could be responsible for the small apparent advantage of drug over placebo.

“As you might imagine, our study was very controversial. How could these drugs, which account for about 15 percent or all prescriptions in the US, be placebos? The antidepressants we studied had been approved by the FDA. If they were just placebos, why did the FDA approve them?

“To answer these questions, my colleagues and I used the Freedom of Information Act to get the data that the drug companies had sent to the FDA in the process of getting their medications approved. What we found was even more shocking that what our 1998 study had shown. The difference between drug and placebo was even smaller in the data sent to the FDA than it was in the published literature. More than half of the clinical trials sponsored by the pharmaceutical companies showed no significant difference at all between drug and placebo. What they did find was differences in side effects, like nausea and sexual dysfunction, produced by antidepressants; and the FDA later determined that SSRIs, the most common type of antidepressants, actually increases the risk of suicide for children, adolescents and young adults...”


“The medical establishment’s ethical problem with placebo treatment boils down to the notion that for fake drugs to be effective, doctors must lie to their patients. It has been widely assumed that if a patient discovers that he or she is taking a placebo, the mind/body password will no longer unlock the network, and the magic pills will cease to do their job.

“Now, however, a group of leading placebo researchers — including Irving Kirsch at the University of Hull in England (who I interview at length below) and Ted Kaptchuk at Harvard — has produced a little bombshell of a study that makes these assumptions obsolete. For “Placebos Without Deception,” the researchers tracked the health of 80 volunteers with irritable bowel syndrome for three weeks as half of them took placebos and the other half didn’t. A painful, chronic gastrointestinal condition, IBS is serious business. It’s one of the top ten reasons why people seek medical care worldwide, accounting for millions of dollars a year in health care expenditures and lost work-hours.

“In a previous study published in the British Medical Journal in 2008, Kaptchuk and Kirsch demonstrated that placebo treatment can be highly effective for alleviating the symptoms of IBS. This time, however, instead of the trial being “blinded,” it was “open.” That is, the volunteers in the placebo group knew that they were getting only inert pills — which they were instructed to take religiously, twice a day. They were also informed that, just as Ivan Pavlov trained his dogs to drool at the sound of a bell, the body could be trained to activate its own built-in healing network by the act of swallowing a pill.

“In other words, in addition to the bogus medication, the volunteers were given a true story — the story of the placebo effect. They also received the care and attention of clinicians, which have been found in many other studies to be crucial for eliciting placebo effects. The combination of the story and a supportive clinical environment were enough to prevail over the knowledge that there was really nothing in the pills. People in the placebo arm of the trial got better — clinically, measurably, significantly better — on standard scales of symptom severity and overall quality of life. In fact, the volunteers in the placebo group experienced improvement comparable to patients taking a drug called alosetron, the standard of care for IBS.

“Meet the ethical placebo: a powerfully effective faux medication that meets all the standards of informed consent.

“The study is hardly the last word on the subject, but more like one of the first. Its modest sample size and brief duration leave plenty of room for followup research. (What if 'ethical' placebos wear off more quickly than deceptive ones? Does the fact that most of the volunteers in this study were women have any bearing on the outcome? Were any of the volunteers skeptical that the placebo effect is real, and did that affect their response to treatment?) Before some eager editor out there composes a tweet-baiting headline suggesting that placebos are about to drive Big Pharma out of business, he or she should appreciate the fact that the advent of AMA-approved placebo treatments would open numerous cans of fascinatingly tangled worms. For example, since the precise nature of placebo effects is shaped largely by patients’ expectations, would the advertised potency and side effects of theoretical products like Placebex and Therastim be subject to change by Internet rumors, requiring perpetual updating?...

Other supporting articles:





This abstract is fascinating--note my emphasis in the final sentence (I can't help extrapolating--would autism spectrum disorders, etc., also fall into this category??):

“...Although placebos have long been considered a nuisance in clinical research, today they represent an active and productive field of research and, because of the involvement of many mechanisms, the study of the placebo effect can actually be viewed as a melting pot of concepts and ideas for neuroscience. Indeed, there exists not a single but many placebo effects, with different mechanisms and in different systems, medical conditions, and therapeutic interventions. For example, brain mechanisms of expectation, anxiety, and reward are all involved, as well as a variety of learning phenomena, such as Pavlovian conditioning, cognitive, and social learning. There is also some experimental evidence of different genetic variants in placebo responsiveness. The most productive models to better understand the neurobiology of the placebo effect are pain and Parkinson's disease. In these medical conditions, the neural networks that are involved have been identified: that is, the opioidergic–cholecystokinergic–dopaminergic modulatory network in pain and part of the basal ganglia circuitry in Parkinson's disease. Important clinical implications emerge from these recent advances in placebo research. First, as the placebo effect is basically a psychosocial context effect, these data indicate that different social stimuli, such as words and rituals of the therapeutic act, may change the chemistry and circuitry of the patient's brain. Second, the mechanisms that are activated by placebos are the same as those activated by drugs, which suggests a cognitive/affective interference with drug action. Third, _if prefrontal functioning is impaired, placebo responses are reduced or totally lacking, as occurs in dementia of the Alzheimer's type._”



Hurrah for young farmers! May I have the strength to become one of them someday, before I'm old...


Sarabeth :)