
Gut Germs Appear to Play Role in Multiple Sclerosis - how-about-this
https://www.scientificamerican.com/article/gut-germs-appear-to-play-role-in-multiple-sclerosis/?print=true
======
TuringNYC
Please allow me go offtopic and ramble for a bit. This article feels like a
punch in the gut.

So before my tech career, I did a 1.5yr Fellowship at a renowned research lab
-- The Rockefeller University. Our entire programme of research was around the
possible causes of multiple sclerosis. One of the reasons I decided to pursue
Computer Science rather than clinical research was the slow discovery cycle in
clinical research. I got so much faster (albiet smaller) victories in Computer
Science.

That was 1996. This is 20 years later and sadly we're still trying to
determine the etiology of the disease. My research advisor passed away, the
other is deep in retirement. We're still trying to figure out the mess of
genetic and environmental factors which cause MS (our theory was Human Herpes
Virus 6.)

I owe so much respect to individuals who pursue clinical research for a
generation despite how slow progress can be. I was pulling my hair out in 1996
when I worked on this, because it was so slow with so little signal to
success/failure. ...In the meantime, I get antsy if my build takes longer than
two minutes or if a scrum sprint goes over by a day.

PS this is also why I admire Craig Venter
([https://en.wikipedia.org/wiki/Craig_Venter](https://en.wikipedia.org/wiki/Craig_Venter))
so much -- he worked so hard to institute the practices of automation into
biomedical research. It is also why im so excited by Mousera/Vium

~~~
Balgair
Its only gotten worse in the last 2 decades. There are a myriad of articles
that pop up on HN about how bad bio had gotten. No one can replicate anything
anyone else is doing and it seems like ~45% of published research these days
is p-hacking to graduate students. It used to be 'publish or perish' but now
its 'funding or famine'. Why not fudge the results, who is ever going to
check, let alone prove p-hacking? The researchers have mortgages, college-
funds, and college debt too. _Nature_ came out and said that a P of 0.005 (not
.05) is the way to fix it. Like, guys, the culture is rotten from the core on
up, you need to fix that, not add a 0. It makes sense, the funding is (long-
term) drying up relative to the number of researchers, there is less money to
go around, so we get to see who is swimming naked.

------
caublestone
Bacteriophages lost out to antibiotics in the 1950s. Designing bacteriophages
for specific microbes is fairly straight forward so you could design a
probiotic loaded with good bacteria to be delivered with a bacteriophage
against bad bacteria to quickly adjust the microbiome ecology towards a
desired state. The nice thing is that bacteriophages are dietary supplements
so you don't need drug approval (unless cure claims are made).

~~~
indomitable
I think this story was shared on HN a couple months ago about phages. Didn't
sound that straightforward :
[http://m.huffpost.com/us/entry/us_5913414de4b05e1ca203f7d4/a...](http://m.huffpost.com/us/entry/us_5913414de4b05e1ca203f7d4/amp)

------
Mz
_the gut immune system has 70– 80% of the body 's immune cells._

[http://m.ajpgi.physiology.org/content/277/5/G922](http://m.ajpgi.physiology.org/content/277/5/G922)

It seems like a pretty obvious connection once you know that detail. If you
have any kind of chronic medical condition, you would likely benefit from
improving your gut health. (Hint: Dietary changes are a good place to start.)

~~~
jryan49
What kind of changes? I have a hard time searching google about gut health
without feeling like none of it's scientific, and all a scam for advertising
or selling products.

~~~
lrem
I've recently watched a ton of Ted talks on the subject (thank you, autoplay),
so you can call me a proper internet know-it-all. The consensus seems to be:
nobody knows, but the SAD certainly is not the right answer. As diverse as you
can get and as little processed as you stand seem to be popular ideas too.
Dropping sugar and milk seem commonly recommended, but they can pry my ice-
cream from my cold, dead fingers.

~~~
colordrops
Small amounts of animal protein and lots of raw greens and vegetables, tubers
and roots. Everything else is extra. Be careful though about making any
specific recommendations here or else someone with a different idea will
attack you for not backing it up with scientific data. Because you shouldn't
try to figure out what to eat until you get a PhD.

~~~
shanev
What’s the value in raw vs cooked vegetables? I thought cooking makes their
nutrients more bio-available. Do you really eat tubers raw? I can't imagine
eating a potato raw. Our ancestors even always cooked them.

~~~
BurningFrog
Yeah, this books makes the case against raw diets very well:

[https://www.amazon.com/Catching-Fire-Cooking-Made-
Human/dp/0...](https://www.amazon.com/Catching-Fire-Cooking-Made-
Human/dp/0465013627)

That's the thing with diets. There is a real well reasoned argument for and
against most anything...

~~~
fpoling
Does the book really present evidence that a raw diet is worse for human
health than cooked food? From the table of content and introduction it seems
to present a strong case that cooking affected human evolution. But that does
not mean that it made humans healthier. For example, cooking could have made
long-term health worse, but other benefits coming from increased food
availability and shortening time to get it outweighed that.

~~~
BurningFrog
It's not the main point of the book, but it does describe how it's very hard
to live a healthy life on only raw food. I remember it pointing out that about
half of women on such diets stop menstruating.

This is something our bodies do out of pretty desperate lack of nutrients, and
it's of course devastating from an evolutionary standpoint.

The thesis of the book is that we've cooked food for so long that our
digestive system is adapted to it. It even speculates that the shrunken
digestive system made our bigger brains possible. All that is far from
uncontroversial, but it's a well written and argued text.

------
jobu
This seems like the key thing:

 _There was another intriguing connection: Acinetobacter are molecular mimics
of proteins found in myelin, the nerve cell coating that the immune system
attacks in MS._

It sounds like a very similar situation to PANDAS and PANS:
[http://www.pandasnetwork.org/understanding-
pandaspans/what-i...](http://www.pandasnetwork.org/understanding-
pandaspans/what-is-pans/)

Some bacteria have evolved to trick our immune system into ignoring them, but
an overactive immune system will attack that bacteria and the human cells
they're trying to mimic.

------
Havoc
Much of the auto-immune related diseases seem to be vaguely arriving at a
similar conclusion lately.

~~~
shanev
Auto-immune diseases and their link to gut bacteria is not new. The
relationship between MS and gut bacteria alone goes back to at least 2006 [1].

To learn more about auto-immune diseases and gut bacteria, I highly recommend
the book An Epidemic of Absence [2]. It's an impressively well researched book
that doesn't skimp on the science.

I managed to get my eczema under control by learning about the relationship
between gut, food, inflammation, and auto-immunity.

[1]:
[https://scholar.google.com/scholar?q=multiple+sclerosis+gut+...](https://scholar.google.com/scholar?q=multiple+sclerosis+gut+bacteria&btnG=&hl=en&as_sdt=0%2C33&as_vis=1)

[2]: [https://www.amazon.com/Epidemic-Absence-Understanding-
Allerg...](https://www.amazon.com/Epidemic-Absence-Understanding-Allergies-
Autoimmune-ebook/dp/B0061P2L5U)

~~~
Havoc
>I managed to get my eczema under control by learning about the relationship
between gut, food, inflammation, and auto-immunity.

And what did you do? Everyone seems to agree that dietary changes are the
answer. What exact seems to vary.

~~~
shanev
What to do varies because human bodies, environment, and gut bacteria
composition varies. It's more than diet. Inflammation due to lack of sleep,
stress, or smoking is also a huge factor.

That said, the biggest factor for me was eliminating dairy. I used to drink
more than a gallon of milk a week. I saw results after about two weeks of
eliminating dairy. My dermatologist was shocked. She refused to believe
there's any correlation between diet and eczema. Patches didn't start
completely going away until I also eliminated wheat. They are basically gone
when I regularly eat fermented foods, take a soil-based probiotic, and get
good sleep.

You might want to try an elimination diet (starting with dairy, then
wheat/gluten). If you want something more structured check out an auto-immune
paleo protocol like Whole30. I wish that existed when I got started. Had to
learn the hard and slow way on my own.

~~~
thomas11
Do you have a recommendation for a soil-based probiotic? I've been looking
recently and found them somewhat hard to research among all the lacto ones.

~~~
shanev
My research led me to Prescript-Assist:
[https://www.amazon.com/dp/B0049NRWHS](https://www.amazon.com/dp/B0049NRWHS).
Here's a study validating it for IBS patients:
[https://www.ncbi.nlm.nih.gov/pubmed/16117982](https://www.ncbi.nlm.nih.gov/pubmed/16117982).

I also recommend a gut bacteria test like uBiome to see how it alters your
composition. Do a before test, then another one after a month or two of use.

~~~
ipunchghosts
I would recommend against spending your money doing a uBiome tests. The
research is showing that where you sample in the stool highly affects the
results.

------
vvpan
While some searching might clear it up, the fact that the article doesn't even
mention which type of MS they are talking about is a little vexing.

~~~
dmix
Can you expand on this for people not familiar with the types of MS that might
exist?

I have an aunt with MS and got excited by this article, but still wasn't aware
that it might be limited to a subset?

~~~
alfon
You might also want to have her CSF independently tested for nematode worms.
(what I mean by this is to put it under a microscope). it surely won't hurt,
as some pathologists (although not published yet in the medical literature
AFAIK) are finding them in all the samples they have tested for.

More information:
[https://youtu.be/aTPU87CKQLQ?t=6m30s](https://youtu.be/aTPU87CKQLQ?t=6m30s)

If this proves to be the case for your aunt, the good news is that anti-
helmintics like Ivermectin, could efficiently treat the underlying cause.

You also might benefit from performing Metagenomic tests ( such as Digital
Culture by Karius - kariusdx.com) to look for insidious pathogens that might
play a role in her illness.

In other words, there are many different things that might cause the
symptomatology described as "Multiple Sclerosis", Lyme disease actually being
one of them,
[https://youtu.be/Fy0ViOX7xNk?t=9m37s](https://youtu.be/Fy0ViOX7xNk?t=9m37s)

------
randomstudent
This is very interesting, and I particularly like the causal test of inducing
sensitization to the antigens present in the bacteria through exposure. It's
probably the strongest causal link you're going to get in humans (you can't
infect them with the bacteria to see if it induces nerve damage for real!).

The problem here seems to be that this doesn't measure how feasible it is to
reverse the tendency for the immune system to attack the nerves. Even if you
erradicate the causative bacteria, once the immune system has started to
attack the nerves, it's possible that it won't stop. Maybe the presence of the
antigens (the proteins that are attacket) in the bacteria is needed as the
trigger that starts the attack, but once that's gone, the low level presence
of the same antigens in the nerves might be enough to sustain the attack. On a
more optimistic note, maybe the erradication of the bacteria leads to a lack
of simulation that causes the aggressive cells tow ither and die. This must be
tested experimentally.

If the autoimmune ttack doesn't stop after erradication of bacteria, maybe a
case can be made for aggressive prevention with testing for those bacteria
periodically, ,especially in families predisposed to the disease, and prompt
erradication once they appear. Maybe there are correlations between diet and
the presence of such bacteria, which we can exploit.

I think the long term impact of these studies will depend on how reversible
the "state of war" between the immune system and the nerves is.

------
darkerside
> Acinetobacter are molecular mimics of proteins found in myelin, the nerve
> cell coating that the immune system attacks in MS. That suggests the
> bacteria might trigger immune attacks that hit myelin, too, as when soldiers
> who inadvertently resemble the enemy get hit by friendly fire.

If this is true, could high dose antibiotics eliminate the gut bacteria and
thereby halt the immune reaction associated with that type of MS?

------
mhkmhk
the researchers never heard of the Wahls protocol???? professor Terry Wahls
was is a wheelchair with MS and cured herself. Now she is heading a hospital
department where they cure MS

------
Gatsky
It is very easy to find correlations between phenotypic traits (getting MS,
developing cancer, autism etc) and "your favourite biological variable". See
John Ioannidis talking about microRNA studies for example. Part of the reason
for this is that high throughput data like gene expression measures, gene
methylation or microbiome sequencing gives you p << n data which invariably is
also low dimensional ie a few factors explain most of thr variation. It is
therefore easy to find a variable or a 'signature' which correlates with one
of these explanatory factors and the phenotype, but doesn't tell you anything
much about what is going on, or how to treat the disease. But it does allow
thousands of papers to be published with pvalues <0.05.

Not to downplay this data, but caution is required not to over interpret the
results, and avoid making the sane mistakes over and over again.

~~~
_of
Researchers in genomics are aware of this and that is why researchers are
expected to correct their p-values for multiple testing, for example using
q-values.

~~~
Gatsky
No that isn't the point. These variables are often associated with an outcome
or phenotype in a statistically rigorous manner. The point is that knowing
this doesn't get us anywhere.

~~~
_of
Get us anywhere? That is research, small pieces to the larger puzzle. Biology
is complex, a lot of molecules doing different things. We don't have perfect
tools to study those molecules or their interactions. Genomics and statistics
offer one path to their study, and they complement already existing methods.

~~~
Gatsky
I don't understand what you are trying to say. My point is also that the tools
are imperfect, particularly when it comes to generating useful insights, as
opposed to just correlations.

~~~
_of
If your tools don't generate useful insights, then you are not using them
right. A properly designed study, employing high-dimensional genomics data,
can for sure generate mechanistic insights, not just correlations. It's all
about your study design.

~~~
Gatsky
Some tools will never give you useful insights because they have inherent
limitations, or the model being studied doesn't lend itself to an informative
study design. Results get published anyway. Which is fine. My point was that
many high throughput studies do not materially contribute to the advancement
of knowledge. This is entirely compatible with your point that well designed
high throughput studies can contribute.

------
emmelaich
A good read:

    
    
       Gut, by Giulia Enders
    

[https://www.goodreads.com/book/show/23013953-gut](https://www.goodreads.com/book/show/23013953-gut)

------
basicplus2
Makes me wonder if this could be related to leaky gut due to wheat protein
and/or Glysophate

------
capkutay
I wonder if there's a similar correlation between the gut and something like
ALS.

~~~
randomstudent
Probably not. Unlike MS, which is an autoimmune disease, ALS is not
autoimmune. The exact cause is only known in some cases, but it seems to stem
from problems with the machinery inside the cell, not an aggression by the
immune system from outside the cell.

~~~
amelius
How about CFS?

~~~
randomstudent
Do you mean CSF instead (Cerebrospinal fluid)? I'm not qualified to answer
that, sorry. But my best guess is that the problem is almost 100%
intracellular.

------
miguelrochefort
Do we actually need gut bacteria? Do they serve other purposes that breaking
down fibers?

~~~
msbroadf
I had my large intestine entirely removed about 8 years ago, so no gut
bacteria for me! And i haven't noticed any change

~~~
tudorw
Glad you've not noticed a change, that is probably good right! I think the Gut
microbiome extends further than just the large intestine, you've probably got
some bugs hiding out somewhere in the system :)
[https://www.newscientist.com/round-
up/microbiome/](https://www.newscientist.com/round-up/microbiome/)

------
BrandiATMuhkuh
My wife was recently diagnosed with MS. Luckily she studied biochemistry and
is now a data scientists. She spoke immediately with a professional
nutritionist at the hospital. Apparently at the current moment the best is to
keep your PH value in the body neutral. It's particularly important to prevent
"acidity". Which is not easy as a lot of food we eat is acidic. The reason why
you want to not be acidic is: MS causes inflammation and acidity makes it
worse. Or in other words, it slows down the bodies self healing "power".

~~~
randomstudent
> Apparently at the current moment the best is to keep your PH value in the
> body neutral. It's particularly important to prevent "acidity"

If you're talking about a neutral pH as in pH = 7.0 (the usual accepted
definition of neutral), these claims are contradictory. The pH of the human
blood is usually between 7.35 and 7.45. This is usually way less acicic than
the neutral pH of 7.0. Furthermore, a pH of 7 is usually associated with very
serious disease (and yes, it is causal: if you inject/ingest enough acid to
make the pH drop to 7.0 you're in pretty bad shape, especially because it
means the regulatory mechanisms aren't working as they should). I don't know
who that "professional nutritionist" is, but this sounds like crackpot-level
science.

Also, to the best of my knowledge, it's extremely hard to change the blood's
pH with diet... The body has a multi-layered system specifically dedicated to
keeping the pH in the normal range (7.35-7.45), and that's independent of what
you eat. Maybe you're mistaking it for changing the urine's pH, which is much
easier to do, and can be achieved through diet alone. Unfortunately, changing
the urine's pH doesn't seem to achieve much beyond preventing some inds of
kidney stones...

~~~
beggi
I second the fact that this is crackpot-level science - you can basically only
change the acidity of your urine with dietary modifications - not your blood.
Btw changing the PH value of your body thing is endorsed by various charlatans
for all kinds of stuff - from curing the flu to cancer.

~~~
andy_ppp
Hmmm, a brief search reveals this;
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195546/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195546/)

I'm not really equipped to review, but it does make some interesting points
that while the body strongly maintains blood PH of between 7.35 and 7.45 the
mechanisms of doing this can cause more stress on other systems in the body
depending on your diet. It's also interesting that we used to have pre
agriculture a 10:1 rather than a 1:3 K:Na balance.

Anyway, the article is an interesting read - maybe supply some counter
evidence that Alkaline diets have zero supporting evidence.

~~~
randomstudent
The K:Na balance is very interesting, especially because pre-agriculture
societies usually have very low levels of hypertension, and this is probably
the cause. Na+ and K+ balance does have something to do with acid-base
regulation, because of urinary excretion of HCO3- and H+, but the benefits of
a low sodium diet seem to be related to hypertension and not to acid-base
regulation.

I haven't read the study, and I don't want to claim that Alkaline diets have
zero supporting evidence. I just wanted to argue against the claim that your
pH is "too acidic" or "too alkaline" or whatever. Any potential benefits of an
alkaline diet are surely independent of the pH variation they induce, because
the variation will be close to 0 in any case, if your body's working properly.
The stress hypothesis is interesting (I'm not saying it's even remotely
correct! only that it's an interesting twist on the crackpot claims I've heard
elsewhere), but you'll never be able to gauge how stressed your regulation
mechanisms are just by measuring the blood's pH. You'll have to find some
upstream biomarker that measures "stress" directly.

