Gut bacteria and AS

Posted by: drizzit

Gut bacteria and AS - 06/13/15 03:09 PM

Dr Rosenbaum from Oregon Health Sciences is a leading researcher on AS and a member of the Spondylitis association of America Medical and Science advisory board just wrote an article in the latest version of Spondylitis plus for the SAA.

He has basically pointed at gut bacteria as the root cause of AS and has applied to the FDA for a clinical trial next year for fecal transplant and AS in portland. He also talks a lot about taking propionic acid as a possible treatment for AS. Diet is mentioned but with the idea that we need more research there.

Great article if you can read it on the SAA site ( I think you have to be a member) The SAA is really pushing some great research into AS right now and has some great research partners that are really changing treatment ideas.

http://www.spondylitis.org/members/current.aspx?login=yes&


a couple of outakes from the article.

"Bacteria produce a number of chemical products that affect the health of our intestines. One of these chemicals, for example, is propionic acid. A change in the microbiome would result in changes in the chemical balance within the gut. Possibly this chemical balance could be restored without actually changing the bacteria. One strategy might be to simply drink propionic acid. A number of laboratories have recently reported exciting data in laboratory animals suggesting that propionic acid or other so called short chain fatty acids could be used to improve the health of the bowel. And while we do not know this for sure, I think that it is very likely that a healthier bowel would be an effective treatment for ankylosing spondylitis."

"I have been studying ankylosing spondylitis for 37 years. Until recently, no one could have convinced me that feces might just be the key to understanding this disease.

I think there is an old retired doc from England that would have told Dr Rosenbaum long ago that feces were the key to understanding AS>


Posted by: Dotyisle

Re: Gut bacteria and AS - 06/13/15 10:02 PM

Thanks Steve for posting this... wish I was member of SAA to read full article.

Tim
Posted by: drizzit

Re: Gut bacteria and AS - 06/13/15 10:06 PM

Tim

Propionic acid is rich in saurerkraut. I know you always said that really helped you
Posted by: MollyC1i

Re: Gut bacteria and AS - 06/14/15 03:28 AM

Drizzit - great. How exciting, that "retired rheumi from England" sure is exonerated <VBG> - all those no-sayers can go eat large slices of `humble` pie...HaHa. Am cock-a-hoop.

All this gut breakthrough seems to have been kick started by the human microbiome research project, then the links are made to the seminal work in AS by our retired English rheumi. YEA !

Will have to renew my American AS association membership - I let it slip as is a tad expensive. But yes, agree, they sure are making huge strides forward in treatment of AS. Thanks for putting that up - will print off and send to a couple of French rheumatologists who refer to diet as `pseudo` science ! Another slice of `humble`...HeHe yes
Posted by: MollyC1i

Re: Gut bacteria and AS - 06/14/15 03:36 AM

Yes, the article is only available through SAA membership. So I put in a search for treating AS with Propionic acid - needs more digging, but here`s a bit of a starter...

Frazers Animal Feeds » Grain Treatment
www.frazersanimalfeeds.com/grain-treatment/ - Similar to Frazers Animal Feeds » Grain Treatment
Propionic Acid treated grain has been successfully fed to cattle, sheep, goats, pigs, poultry and ... Propionic Acid is available from Frazers Animal Feeds in:.
Propionic Acidemia - Medscape Reference
emedicine.medscape.com/article/1161910-overview - Similar to Propionic Acidemia - Medscape Reference
4 Nov 2013 ... Propionic acidemia is a metabolic disorder in which a defective form of the ... A ( CoA) carboxylase results in the accumulation of propionic acid.
Possible ameliorative effects of antioxidants on propionic ...
www.ncbi.nlm.nih.gov › NCBI › Literature › PubMed Central (PMC)
- Similar to Possible ameliorative effects of antioxidants on propionic ...
4 Nov 2013 ... Propionic acid treated group which were given PA at a dose of 250 mg/kg body weight/day for 3 days orally, 3. Clindamycin treated group ...
[PDF]
Propionic acid metabolism during biowaste treatment...
www.iba.kit.edu/download/PropionateMetabolism.pdf
Propionic acid metabolism during biowaste treatment: Comparison of different digester regimes. Propionate accumulates and rapidly decreases after obtaining ...
Posted by: Grumpyally

Re: Gut bacteria and AS - 06/14/15 11:11 AM

Hi,

Thanks for posting thats interesting. I am about to start eating sauerkraut again and am getting ready to make my own!

It would be interesting if the trials are approved but also interesting how they sample people in the trials eg those on medication, those controlling with diet and so on. One of the things I noticed when looking into FMT was that really the gut should be healed first and then 'repopulated'

I know my friends dogs when out like to eat and roll in other animals poo!

x
Posted by: JVentura

Re: Gut bacteria and AS - 06/14/15 11:23 AM

Any other sources of propionic acid besides sauerkraut?
Posted by: drizzit

Re: Gut bacteria and AS - 06/14/15 12:40 PM

Molli This line of research was also triggered by the IL23 and ERAP1 genetic discoveries to AS. These point to the gut and an australian researcher named Dr Brown deserves huge kudos for those discoveries and this line of reasoning as well.

Another bit from the article

"We will also gain more knowledge about how diet affects the microbiome and we will develop ways to restore the health of the bowel, sometimes by replacing or eliminating specific bacteria and sometimes by replacing or eliminating the products that bacteria make or induce within the intestine. In the meantime, FMT, the transplantation of bacteria from feces, is being actively studied to treat inflammatory bowel disease. My colleagues and I hope that by 2016, we will be allowed by the FDA and ethics committees to try the same strategy in a limited number of patients with ankylosing spondylitis."


I will ask the SAA if I can post the article in its entirity here. I respect their $$ spent and their membership though.
Posted by: drizzit

Re: Gut bacteria and AS - 06/14/15 12:41 PM

Originally Posted By JVentura
Any other sources of propionic acid besides sauerkraut?


Kefir also has propionic acid in it. Tried to stay away from the sugary/creamy ones although they taste better. I like the kefir made from coconut milk
Posted by: MollyC1i

Re: Gut bacteria and AS - 06/14/15 03:46 PM

Hi Drizzit - yes know of Dr Brown, he has an excellent reputation in the AS field, very valuable man of science and medicine. Wish we had more of his like. Roll on the day when this research work is openly acknowledged by medicine at large. And hopefully in the lifetime of these great doctors. Meantime, await further developments with this arm of research.

I did wonder of this latest might be linked to IL23 and ERAP1.

Hope the SAA will permit reproduction of the paper...

Thanks Drizzit
Posted by: Sue22

Re: Gut bacteria and AS - 06/15/15 01:34 PM

thanks for the info. not surprising.....to me at least....bowel issues since i was a kid....joint issues not til 35.....and though i've never been able to explain it, not only sauerkraut for me, but cabbage in general, and beans.....i have to have them in my diet daily or i'm constipated, even with the humira......though the humira helps too....the first few days after i take it, i see a huge difference, then its downhill again, till the next shot....but beans and cabbage will help it along.....

i'd love to at least try fecal transplant....my rheumy and i are both convinced that my spondy all started in my gut...probably since birth.....C section also does not bode well for human health....the birth canal doses us with healthy bacteria...and if we don't enter the world that way, we start off life at a disadvantage.

in lieu of a fecal transplant, I'd be cool with trying a supplement that my intestines might be missing...if i could supplement with food, even better.....maybe the clue is in the cabbage and beans? I used to think it was "fiber" but other even more fibrous foods don't do the same thing.....

its all very interesting.

i just hope that they keep it broad for all "spondy", otherwise, undiff spondy or just spondy makes me fall through the cracks.
Posted by: drizzit

Re: Gut bacteria and AS - 06/15/15 01:55 PM

SAA has given permission to share here is the full article


Treasures Come From Unexpected Sources; Lessons For Ankylosing Spondylitis?
By James T. Rosenbaum, M.D.

Summer 2015 Issue of Spondylitis Plus
Dr. Rosenbaum is Chief of the Division of Arthritis & Rheumatic Diseases, and Edward E Rosenbaum Professor of Inflammation Research at Oregon Health & Science University; Richard Chenoweth Chair of Ophthalmology at Legacy Devers Eye Institute in Portland, Oregon; and former Chair & current member of SAA’s Medical and Scientific Advisory Board. You can revisit Dr. Rosenbaum’s article, ”Does the Microbiome Cause Ankylosing Spondylitis,” written for the Winter 2011 issue of Spondylitis Plus, in the Spondylitis Plus archives on our website. (Or by following this link, (http://www.spondylitis.org/members/49.aspx)

Our deepest thanks to Dr. Rosenbaum for this follow-up article on the microbiome.

What is the most disgusting substance you can imagine?

Most of us would say that human feces has to rank right at the top of any list. But life is filled with ironies. Human feces is emerging as a potential treatment for ankylosing spondylitis. Let me explain why.

Ankylosing spondylitis is a disease in which our immune system plays a critical role. Our immune system has many components and many checks and balances. The heart and soul of the immune system is the white blood cell or leukocyte. One type of white cell, the lymphocyte, plays a very prominent role in immune-mediated diseases like ankylosing spondylitis. We know that the immune system is vital in this disease because of studies on pathology in joint tissue, because of studies with laboratory animals, and perhaps most of all, because therapies that are beneficial for ankylosing spondylitis work by affecting some aspect of the immune response.

Our immune system evolved to protect us from the danger that lurks with invading micro-organisms such as bacteria or viruses. The immune system is so vital to life that even plants and bacteria have evolved clever ways to defend themselves with an immune response.

But the immune system must be selective in its approach. If the immune system attacked all bacteria, the body would be destroyed. For example, bacteria live on your skin, in your mouth, and throughout your digestive system. In fact, you have ten bacteria living in your intestines for every mammalian cell in your body. From this perspective, ninety percent of every living being is bacteria! If our immune system deployed its weapons to destroy the bacteria that happily co-exist with us, wide-spread inflammation would result wherever bacteria are present. In fact, this is the currently accepted theory as to what causes Crohn’s disease and ulcerative colitis, the two most common forms of inflammatory bowel disease. Our immune system attacks some of the bacteria in our intestines, resulting in diarrhea and abdominal pain.

Bacteria need to find a public relations firm to represent them. Most of us hear “bacteria” and we think of infections and the harm, even death that can result from many different bacterial infections. But bacteria are also essential for life. For example, much of the vitamin K produced within our body is made directly by bacteria. One of the most essential roles for bacteria is to educate the immune system. Mice can be raised “germ free” so that no bacteria ever live within the gut. In these germ free mice, an effective immune system never develops. While it’s absolutely true that bacteria can do harm, it’s also true that bacteria are essential for life.

So how does this relate to ankylosing spondylitis? Well, first of all, ankylosing spondylitis and inflammatory bowel disease have a lot in common. In ankylosing spondylitis, the majority of sufferers have microscopic amounts of bowel inflammation that can be detected by colonoscopy. And conversely, in inflammatory bowel disease, some patients develop arthritis in the spine and elsewhere as is characteristic of ankylosing spondylitis. Inflammation inside the eye or uveitis also occurs in both inflammatory bowel disease and ankylosing spondylitis.

Last year, my colleagues and I reported on the gut bacteria in rats that have the human HLA B27 gene, the gene that readers of Spondylitis Plus will recognize as the one that most affects the likelihood to develop ankylosing spondylitis. Our observations appeared in the journal, PLoS One. (PLoS stands for the Public Library of Science. The journal is available for free on the internet.) We found that the bacteria in the rat intestine were altered just by being HLA B27 positive. In March, 2015 scientists from Australia and Italy reported in the journal, Arthritis and Rheumatology, that bacteria in the intestine are also altered in patients with ankylosing spondylitis.

Of course, it’s possible that these changes in bacteria have nothing to do with what is causing ankylosing spondylitis. Except that there are models in rats and in mice in which an illness that resembles ankylosing spondylitis can be induced. And in both the rats and the mice, elimination of the bacteria pretty much eliminates the joint and bowel disease. The crudest way to change your gut bacteria would be through a technique now known as FMT, fecal microbiota transplant. While the idea of ingesting someone else’s bowel movement sounds absolutely disgusting, in 2013 a study in the New England Journal of Medicine showed that FMT could be life saving for a bacterial infection known as C diff colitis. One does not actually ingest poop. Instead the bacteria from the bowel movement are isolated and then swallowed as a capsule or passed directly into the stomach through a tube, or given rectally as an enema. This same approach has been used to treat inflammatory bowel disease, and while it is not universally effective, the results are encouraging.

A more elegant and more appealing approach to fecal transplant would be replacing or changing just a single type of bacteria, as is attempted with a probiotic. The complexity of the bacterial ecosystem in the gut with nearly 100 trillion inhabitants makes it difficult to find a single or limited number of culprits that cause ankylosing spondylitis, but this is a possibility. The progress in this area of research is very encouraging.

Gut bacteria are also very much affected by diet since what we ingest provides the substrate for bacteria to live. Diet is as complicated as the bacterial ecosystem in the gut. We are still learning which foods might have an anti-inflammatory effect. Antibiotics also change the gut microbiota, but this effect is temporary because bacteria quickly develop resistance.

Bacteria produce a number of chemical products that affect the health of our intestines. One of these chemicals, for example, is propionic acid. A change in the microbiome would result in changes in the chemical balance within the gut. Possibly this chemical balance could be restored without actually changing the bacteria. One strategy might be to simply drink propionic acid. A number of laboratories have recently reported exciting data in laboratory animals suggesting that propionic acid or other so called short chain fatty acids could be used to improve the health of the bowel. And while we do not know this for sure, I think that it is very likely that a healthier bowel would be an effective treatment for ankylosing spondylitis. The benefit from sulfasalazine for some patients may come from this basis.

The microbiome is a term that is used to describe all the micro-organisms and their products associated with the human body. Intense study of the microbiome has been undertaken for less than a decade. The coming decade should help us discover more specific microbial changes associated with ankylosing spondylitis. We will also gain more knowledge about how diet affects the microbiome and we will develop ways to restore the health of the bowel, sometimes by replacing or eliminating specific bacteria and sometimes by replacing or eliminating the products that bacteria make or induce within the intestine. In the meantime, FMT, the transplantation of bacteria from feces, is being actively studied to treat inflammatory bowel disease. My colleagues and I hope that by 2016, we will be allowed by the FDA and ethics committees to try the same strategy in a limited number of patients with ankylosing spondylitis.

I have been studying ankylosing spondylitis for 37 years. Until recently, no one could have convinced me that feces might just be the key to understanding this disease.
Posted by: lool

Re: Gut bacteria and AS - 06/15/15 03:27 PM

Great article. Thanks.
Posted by: Lindyap

Re: Gut bacteria and AS - 06/25/15 05:27 PM

I've gone through 2 FMT treatments and supplemented with 2 FMT capsules. It definitely improved my condition about 50%, but the results aren't lasting and it did not prevent the major flares I get each month with menstruation (but it at least reduced it from 2-3 flares a month to only one).

I've been wondering if the bad bacteria is just extremely tenacious and returns (despite taking an antibiotic before the procedure, I don't know if it completely destroyed the biofilm).

I also wonder if my intestines are damaged and need repair. I have chronic, long-term constipation that began at the age of 30 (I'm now 40). Nothing seems to alleviate this condition, but the gastro doc said that I have a slight twist in my colon and also muscle atrophy in part of the colon (lazy).

I think FMT needs to really concentrate on 3 angles: destroying bad bacteria completely, replenishing the colon with good bacteria and then maintaining a perfect diet to "grow" the new "forest" in the colon, and repairing the colon completely. I want to know the best ways to do these 3 things!
Posted by: Sue22

Re: Gut bacteria and AS - 06/27/15 09:43 AM

Originally Posted By Lindyap
I've gone through 2 FMT treatments and supplemented with 2 FMT capsules. It definitely improved my condition about 50%, but the results aren't lasting and it did not prevent the major flares I get each month with menstruation (but it at least reduced it from 2-3 flares a month to only one).

I've been wondering if the bad bacteria is just extremely tenacious and returns (despite taking an antibiotic before the procedure, I don't know if it completely destroyed the biofilm).

I also wonder if my intestines are damaged and need repair. I have chronic, long-term constipation that began at the age of 30 (I'm now 40). Nothing seems to alleviate this condition, but the gastro doc said that I have a slight twist in my colon and also muscle atrophy in part of the colon (lazy).

I think FMT needs to really concentrate on 3 angles: destroying bad bacteria completely, replenishing the colon with good bacteria and then maintaining a perfect diet to "grow" the new "forest" in the colon, and repairing the colon completely. I want to know the best ways to do these 3 things!


thanks for this update. sorry it didn't work better for you. but you are the first person i've heard get treated for spondy and say it only temporarily worked.

i'm like you, as you know, with the chronic constipation. though for me, it was on and off til 30, then i had the opposite problem for the next few years, and only sort of permanently chronic the last 5-10 years.

i can't remember if you are on a biologic. but for me humira does help keep things moving. and i have to eat beans and cabbage every day, that's what my gut seems to want. and then of course all the things we've both compared with one another.

i was hoping you would have better success. 1. for you. 2. for hopes for the rest of us....ok me. smile

but as you said, maybe there is a way to do this.

one thing i thought of when i heard how well it worked for c diff patients. they started with a healthy gut, got sick so it was easier to return them to health. but we start with an unhealthy gut. is it because the bad bacteria hide in our appendix, waiting to replenish our gut when its wiped out (they now believe that is the role of the appendix); so maybe those bacteria don't get wiped out by antibiotics? or as you said, maybe we need to heal the gut? but then why would it get better and then worse again? still i believe in healing the gut. i just bought glutamine (recommended by the owner of a GNC franchise who seemed knowledgeable and recommended here).

I still hold out hope for FMT. But good to hear the reality as it stands to day from someone with experience. so, thank you.
Posted by: Grumpyally

Re: Gut bacteria and AS - 07/02/15 05:19 AM

When I was reading up about FMT a while ago I read that you need to should heal the gut first and address what might have caused the leaky gut in the first place and then have the FMT. Also people like us need up 10 to 20 consecutive!

Confession blush I did several home FMT using hubby as donor last year the first was a one off just to see what happened whether it was worth forking out for treatment. It helped but as Lindyap said it was temporary. My poop smelled of his for a while and then went back to how it was. We also did about ten consecutive too but again I am back to square one.

So I feel the gut needs healing then repopulating and being very strict with nourishing the new stuff with the right foods afterwards (who knows what that might be). What I do remember is my tongue went pink for the first time I had noticed (usually white ish and I was warm, usually layered up all the time).

I should also add that I didn't make him eat a strict diet beforehand which may be important too though he is a healthy eater I feed him after all but not quite as healthy eating as me as he doesn't have my problems!

I know my gut hasn't healed as I recently had a bout of iritis. So I am now trying a gut healing protocol to see if that works.
Posted by: Staffy

Re: Gut bacteria and AS - 07/02/15 05:24 AM

What is your gut healing protocol please?
Posted by: Grumpyally

Re: Gut bacteria and AS - 07/02/15 07:45 AM

Hi,

I have been reading The Gut Health Protocol (for which there is a facebook group) which talks about a kill phase (four weeks or so) where you take biofilm disruptors to stop any bad stuff from hiding and kill supplements to kill the bad stuff, followed by a healing and maintenance phase.

http://www.theguthealthprotocol.com/wp/

To give you an idea of the long list https://docs.google.com/document/d/14oT_qVwXtABV2V3wsHHBnDAY017_ycdS3RkOQJkwIrg/edit?pli=1

I have also read Terry Wahls book which is very much food based. Both emphasise bone broths, kefir sauerkraut etc as being the most important. Terry Wahls is not so much about healing the gut specifically. John Herrons book is more about SIBO and SIFO and leaky gut caused by it than autoimmune problems as such. I am hoping to combine the two though dietwise I am doing it pretty much already.

I am not a fan of supplements but diet doesn't seem to be enough at the moment I am either eating something that triggers me (non starchy) or I have something else that is stopping me from healing.
I have pared down for the moment what I am taking because of cost and my reluctance which may be a bad thing ie not doing it as full on as I should so its wasted.

Everyone is different and I chose these from the many mentioned in the book. I have just started taking Lactoferrin and NAC as my biofilm disruptors, S Boulardii for possible not tested though candida, it also helps heal the gut and olive leaf extract to target the klebsiella. I am looking to maybe add a couple more 'kill' supplements to rotate that might target the klebsiella. I am avoiding oregano oil for the moment as that kills everything.

So far for when I get to the healing phase I am going to take l'glutamine and colostrum and possibly boron which has good reviews for arthritis type conditions and zinc carnousine though then it gets complicated with needing other things for absorbtion etc.

This is of course in addition to the no starch diet and if I can manage it AIP protocol (no nuts and nightshades etc). Plus coconut oil, EVO and ACV ferments etc. I have just started making raw milk kefir (technically dairy but 48 hour ferment) and I think that is doing me good. I am also trying coconut kefir but my first batch was a bit to sour for me.

I will keep people posted if I find it is helping and I am not just pouring money down the drain.
x
Posted by: Grumpyally

Re: Gut bacteria and AS - 07/02/15 08:41 AM

I have just come across this interesting view on why FMT sometimes doesn't work:

http://thepowerofpoop.com/why-fmt-doesnt-always-work/

It even mentions AS!

Also talks about biofilms and not embarking on it without supervision to target the right thing maybe consequences a bit like the overuse of antibiotics frown ho hum still going round in circles impossible to find someone over here recommended that would treat the whole body and not just 'medically' that you could trust as it would cost loads for the tests etc, sigh.

x
Posted by: Sue22

Re: Gut bacteria and AS - 07/02/15 01:59 PM

Originally Posted By Grumpyally
I have just come across this interesting view on why FMT sometimes doesn't work:

http://thepowerofpoop.com/why-fmt-doesnt-always-work/

It even mentions AS!

Also talks about biofilms and not embarking on it without supervision to target the right thing maybe consequences a bit like the overuse of antibiotics frown ho hum still going round in circles impossible to find someone over here recommended that would treat the whole body and not just 'medically' that you could trust as it would cost loads for the tests etc, sigh.

x


thank you for that; that was really informative smile
Posted by: MollyC1i

Re: Gut bacteria and AS - 07/02/15 05:01 PM

Good article, well spotted Grumpally. Thanks for posting
Posted by: Robin_H

Re: Gut bacteria and AS - 05/28/17 05:03 AM

Hi All!

Regarding poop transplants (FMT -- fecal microbiota transplant)...

The bottom line of my following post is that a fecal transplant could be short lived so long as a person's body likes killing the "good guys".

I did not read all the referenced articles but http://thepowerofpoop.com/why-fmt-doesnt-always-work/ had the scoop on the poop! Besides checking the health of the donor and their poop I did not see anything about "donor matching" to avoid rejection. I wonder how important that would be. Trying the feces from just any healthy donor might just be too much of a crap-shoot after all the time and preparation in the protocol. The healthy donor microbiome may not even be compatible with the recipient!

Each person will support a different family of microbiomes. Depending on the season, what a person is eating, who gave them their first French kiss, what their boss is like, each person's microbiome will vary within the family that their immune system has learned to accept in the beginnings of life.

Furthermore, there may be no more "matches" since the recipients system has become very rejectful.

We can't assume that we have "bad bacteria" that we want to get of; it's a partial truth. Something may have changed in some of us that has made us unfriendly to certain good guys. I was exposed to things ranging from industrial toxins at work to viruses and bacteria from sea water in a scuba diving mishap that my body has never seen before thus possibly triggering my immune system to attack the good guys that reduce inflammation (put in its simplest terms.); the problem is not necessarily having entities that directly increase levels inflammation. I've recently read that there are considerations to recategorize AS as an auto-inflamatory disease instead of an auto-immune disease. But if the immune system is attacking bacteria that we need then I would consider that auto-immune, and a consequence is inflammation.

If my body does not "unlearn" its hatred for the good guys then I would have to take large doses of probiotics on a life-long basis. My immune system would be busy killing them, but for as long as I take the probiotics the good guys are there providing me with the benifical effect. A fecal transplant would be short lived so long as my body likes killing the good guys.

My hope is that if the triggers are removed for long enough and my body repairs itself then my immune system would have had long enough to forget its hatred for the good guys. This could be possible in rare instances but we are more likely going to need medicine.

But still... maybe the microbiome is not the problem but their byproducts are. I can not clearly bring the effects of starch into this picture.

PS: I was in remission for a period of time while taking a brand of probiotics that had single doses of 50 billion CFUs. There were many other factors that I was doing then and many of which I am doing now but are not working. I long to get those probitoics again.
Posted by: DavidP

Re: Gut bacteria and AS - 05/28/17 07:46 AM

In AS there don't appear to be any readily identifiable antibodies formed that are associated with disease (compared to RA which has Rheumatoid Factor (Abs) and Anti-CCL). Instead in AS the innate arm of the immune system (also called cell mediated immune system) is causing the problem. The innate immune system is designed to make a rapid response to an infectious threat - no antibodies are produced. By contrast, the humoral immune system is slower acting and is characterised by the production of antibodies (hence also called antibody mediated immunity). It is for this reason that some people refer to AS as an auto-inflammatory disease.

Once the body 'decides' that a component of the microbiome which it once tolerated, but which it has subsequently come to regard as a pathogen, then this can't be 'unlearned'. Unfortunately, there are cells called memory T cells which never forget - they are just waiting to see that bacteria again before unleashing an inflammatory storm.

Removing starch is probably putting the offending bacteria into dormancy so that the immune system sees nothing that offends it - until the next donut comes along.

Cheers David
Posted by: Georgina_C

Re: Gut bacteria and AS - 05/28/17 11:25 AM

Hello, I'm wondering how you make coconut kefir? I tried using water kefir grains and it tasted awful. If using milk grains, do they need to be refreshed in dairy milk periodically? Used to drink lots of water kefir but have been advised to stop due to the residual sugar, just in case. Similarly have stopped kombucha and JUN.
Posted by: Robin_H

Re: Gut bacteria and AS - 05/29/17 03:35 AM

Thank you for the clarification David even though it burst my bubble! HAHAHA

So, the behavior of AS is due to the innate immune system which will not unlearn that there are inhabitants in my gut that feed on the broken down starch, produce cytotoxins that get into my blood stream causing certain tissue types to become inflamed. Or something like that; close enough. Is it only the adaptive immune system that can forget?

But why do I need booster shots for tetanus or rabies but don't need booster shots for hepatitis? Why do people sometimes loose allergies? Can some part of the immune system "forget"?

Peace!
Kevin
Posted by: DavidP

Re: Gut bacteria and AS - 05/30/17 06:19 AM

Hi Kevin,

The adaptive immune system doesn't forget either.

Just how the innate immune system causes AS is still not understood. Forty years of intense efforts by immunologists have come up with some theories, but it's fair to say that the biochemical pathway leading to disease is far more complicated than anyone could have imagined.

Courtesy Wikipedia : The type of vaccination for tetanus (which is caused by Clostridium, an anaerobic bacteria) is called artificial active immunity. This type of immunity is generated when a dead or weakened version of the disease enters the body causing an immune response which includes the production of antibodies. This is beneficial to the body because this means that if the disease is ever introduced into the body, the immune system will recognize the antigen (due memory cells present in very low numbers) and produce antibodies more rapidly (by rapid clonal expansion).

Your question is a good one - having said that the immune system has memory cells that never forget and can quickly relaunch antibody production - then why the need for a ten year booster - I don't know - it seems that eventually the adaptive immune does forget - but that may take 10 or more years.

Cheers again - David
Posted by: DavidP

Re: Gut bacteria and AS - 05/30/17 06:32 AM

Hi Kevin,

Below I've pasted in a some more detailed comments drawing distinctions between the innate and adaptive immune systems.

The innate immune system represents a critical host response operational as the first line of defence against pathogens and a system that precedes the adaptive immune response. Whilst the adaptive immune system has elegant specificity and recall potency the system is sluggish in the face of an urgent invasion by a pathogen. The innate immune system on the other hand offers a predefined or prefabricated immediate response to the challenge, and it is critically dependent upon non-variant, genetically encoded receptors for highly conserved microbial structures known as pathogen associated molecular patterns (PAMP). These innate immune system receptors are called pattern-recognition receptors (PRR). The innate immune system also affects the outcome of infection by promoting in a complementary sense the generation of an adaptive immune response by the up-regulation of co-stimulatory molecules.

Among the PRR, toll-like receptors (TLR’s) play a central role. Once microbes have breached physical barriers such as the skin or intestinal tract mucosa, they are recognized by TLR’s and an immune response initiated. TLR’s are membrane surface receptors that recognize molecules that are broadly shared by pathogens but distinguishable from host molecules. They are present in vertebrates and invertebrates, as well as plants, and thus appear to be one of the most ancient conserved components of the immune system.

Because the specificity of Toll-like receptors (and other innate immune receptors) cannot easily be changed in the course of evolution, these receptors recognize molecules that are constantly associated with threats and are highly specific to these threats, that is, cannot be mistaken for self molecules. Pathogen-associated molecules that meet this requirement are usually critical to the pathogen’s function and cannot be eliminated or changed through mutation; they are said to be evolutionarily conserved.

In 2010 it was shown by peripheral whole blood cell gene expression profiling of AS patients that there was an up regulation of TLR4 and TLR5, supporting the importance of these TLR subtypes in AS pathogenesis, in particular the TLR sub-types responsible for the innate immune response against Gram-negative bacteria.

Lipopolysaccharide (LPS) in the outer membrane of Gram-negative bacteria is the main ligand of TLR4 and the main ligand for TLR5 is flagellin, a primary component of bacterial flagella that extends from the outer membrane of Gram-negative bacteria.
Posted by: Robin_H

Re: Gut bacteria and AS - 05/31/17 03:43 AM

Hi David,

it is interesting that TLR4 and TLR5 are up-regulated in the blood of AS patients, likely implicating LPS from Gram-negative bacteria (Klebs and cousins). Obviously there could be other sources of LPS, such as just foods (cooking with oils, processed foods, certain high fat diets that create "rafts" to help LPS into the the blood stream, etc.) and those LPS macromolecules easily get through a leaky gut. But are there other TLR's, or other PRR's in general, that are associated with the inflammation in AS; i.e, TLR2 associated with fungi and TLR8 (in intestinal epithelium like TLR4 & 5)? Did the article possibly exclude other TLRs that your excerpts came from?

In all I have read, which is still too little, there is obvious interplay between the innate (the inflammation) and adaptive immune system. My first impression is that cytokine and chemokine production, dendritic cells alterations, fibroblast behaviour, and changes in the connective tissue play the largest parts in how we feel and autoimmunity. It is a messy web of interconnections with feedbacks and pleiotropic properties that really confuse cause and effect; fundamental physics is easier!

Aside from all that, perhaps there is a quorum sensing effect on AS flare-ups. Sometimes I feel that there are microbes that are naturally in my gut but have had the occasional opportunity to get from my gut and into my organs and stay there, just waiting for messages from the outside (coming from the gut lumen). And over the years the microbes in the organs slowly gain ground, protected in their biofilms. This could increase sensitivity to starch even though the gut has not worsened. A factor in aging might be that as we get older the growing biofilms increasingly disrupt metabolic balances and simply wear us out, weaken us, and we eventually die from "natural causes." But I digress.

One flare up mechanism I imagine that can be caused by starch is how microbes communicate using quorum sensing signalling molecules. Perhaps when we eat starch the bacteria in our gut just become very active and/or their populations will temporarily swell. The quorum sensing signalling molecules rise in concentration. If the signalling molecules pass through healthy gut membranes with ease in comparison to the bacteria themselves or their exotoxins then the signalling molecules can change the behaviour of bacteria that have colonized organs or interstitial areas hence increasing the intensity of the immune system. This can explain why the 30% or so of people having AS without gut issues may be effected by diet starch. This also can explain why some people report that continual use of antibiotics reduces their symptoms. For those that do not feel better when removing starch then perhaps their load of organ microbes is very high but not high enough for detection or noticeable organ damage; or there is a different factor that is sustaining their flare up.

If the quorum sensing hypothesis is correct, and is a significant contributor to inflammation in AS, then I would think that in addition to healing the gut barrier and its functioning that reducing the colony sizes of microbes in the organs is essential. The long-time-established microbes probably protect themselves well in cysts, biofilms and the like. My 93 year-old GP told me that if I have an infection then it would show up in the blood as puss. I disagree because it is known that infections can suppress the immune system without killing the host, just keeping the host alive for its own benefit. In the case of biofilms then perhaps the consumption of biofilm disruptors along with a healthy lifestyle will eventually bring remission. But this approach may not help in cases where viruses or other processes modified connective tissues or their progenitors, like fibroblast, that are now hypersensitive if the quorum sensing molecules directly effect the immune system even when microorganisms have been cleared out.

I am finding that old injuries are slowing being effected by AS. It seems that muscle damage or other soft tissue damage that happened to me at a younger age takes longer to start to suffer from pain and inflammation. I injured my left shoulder half a year ago and it immediately was effected with burning and pain and rarely settles down. I partially tore ligaments and tendons in my knee 40 years ago and it is only just being effected but mildly and intermittently so. I think that proximity of connective tissue to lymph drainage has a strong influence. I.e, the effect on the sacrum is due to proximity to lymph drainage from infection-like gut activity or the high levels of bacteria that can be in the rectum.

In my case there is high probability that there were a series of environmental triggers and there continues to be environmental triggers which can be reduced.

In my 20s the symptoms were between the spine which may have been due to frequent bronchial infections in life. Then the next place the spine was effected was at the based of the skull after a massive infection that creeped there from the sinuses, eustachian tubes and nasal area after a SCUBA diving mishap. There was even a strange inflammation in the throat after the scuba incident that doctors could not explain. Then finally the lumbar and sacrum has been effected through gut damage after daily and long term use of ibuprofen to reduce the pain and inflammation in the earlier effected spinal areas.

I think I obsess about the relationship between microbes and AS because the two rhumatologists I saw, that work closely together (I think one was the student of the other) both strongly believe, and one has clearly stated to me many times, "there is no association between AS and bacteria!"

I found a good website (AK lectures) that has lecutres on immunology for those that would like a course on it.
http://www.aklectures.com/subject/biology/#173-Immune%20System

Sorry to be so long winded. Just some food for thoughts.

Kevin
Posted by: Sue22

Re: Gut bacteria and AS - 06/04/17 06:44 AM

I think a lot of scientists are finding that many chronic diseases are actually infectious diseases. Here is just one example:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4894645/

Which bacteria or bacterium cause which disease can be the challenge.
Posted by: Robin_H

Re: Gut bacteria and AS - 06/07/17 04:32 AM

Thanks for the article Sue.

What stood out to me was the issue of reinfection. But perhaps that shouldn't always be a concern if a person has developed immunity to it or other mitigating circumstances are no longer present that allowed the pathogen to get in.

Also, each person will have a different set of triggers and so cause and effect will not be one-to-one but instead many-to-many.

I worked in biodiagnostics 15 years ago and saw the potential for AI/machine-learning solving these problems. It was very exciting. I hope it takes off exponentially in the near future.

Cheers!
Kevin
Posted by: jay_bharat

Re: Gut bacteria and AS - 06/17/17 01:27 AM

Hi Grumpyally,

Did you try "The Gut Health Protocol". How effective it was.

Jay
Posted by: j87x

Re: Gut bacteria and AS - 09/10/17 11:37 PM

Found this 3 part blog
https://fixyourgut.com/klebsiella-cause-rheumatoid-arthritis-alkalizing-spondylosis-part-1/

Thinking of trying this arabinogalactan prebiotic, supposedly only feeds good bacteria. This and GOS seem to be the safest prebiotics.
https://fixyourgut.com/arabinogalactan-lesser-known-prebiotic-may-help-digestive-health/
Posted by: j87x

Re: Gut bacteria and AS - 10/03/17 02:08 PM

What do you guys think of this idea?
If the klebseilla is living in the small intestine, what if I were to get some enteric coated capsules and fill them with substances that kill bacteria like xylitol, manuka honey, cinnemon oil, etc. Would this make sense?
Posted by: DragonSlayer

Re: Gut bacteria and AS - 10/04/17 12:48 PM

Hello, j87x:

I think treating SIBO with antibiotics is a better approach, but the enteric coated capsules are a cool idea--You can already obtain enteric-coated oregano oil, but it might open up later than necessary. Another Kp-killer is Tanalbit (tannins)...so acorn flour may be good. There are many possible agents and Mercola likes colloidal silver in combination with antibiotics but in combination with all kinds of things might help--black walnut hulls, wormwood, bitter melon, etc. Good Luck with whatever You try and please let us know if You are able to get hold of enteric-coated capsules that can be filled and resealed.

HEALTH,
John