Possible Underlying Factors of ITP - Edward Conley 10 years 1 month ago #28637
This is one of the best articles available discussing a natural approach to dealing with ITP. The PDSA newsletter article was published back in '06 titled "Possible Underlying Factors of ITP". For those with ITP, it is very important to understand what this article is trying to convey.
The article can be uploaded as part of the Spring 2006 PDSA issue newsletter here:
Spring, 2006 - 24-pages. “Possible Underlying Factors of ITP”, “Clinical Trials”, “Are Platelets Released in Your Lungs?”, “Essay: Help Prevent ITP”, “Environmental Triggers of ITP (Letters)”, “Indoor Pollution”, “Treating Refractory Chronic ITP in Children with Rituximab”, “A Different View - Unusual Success Stories From our Mailbox” and more. $5.00
Here's a preview:
I think this article should be pinned to the top of this forum. It is essential reading IMO. I hope the moderator of this forum considers doing this.
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Possible Underlying Factors of ITP - Edward Conley 10 years 1 month ago #28640
John - if you can copy and paste the whole article in this thread, I'll take a look at it and see if the information still applies. It's a pdf and I can't copy and paste it (I have partial computer illiteracy).
Possible Underlying Factors of ITP - Edward Conley 10 years 1 month ago #28641
Ok, here it is - with all the embellishments as in the original article.
Possible Underlying Factors of ITP
By Edward Conley, DO
No one knows the exact cause of ITP. In my work with over 5000 patients with autoimmune disease I have come to believe that the underlying causes are a combination of genetic and environmental factors. Why some people develop lupus when exposed to the same environmental factors that may trigger someone else to develop ITP would seem to point to underlying genetic predisposition. What I do is focus on the possible environmental causes or underlying triggers of autoimmunity and, if possible, improve or correct those underlying factors to see if the immune system will calm down. This may reduce (or occasionally) eliminate the need for powerful medications that may cause unwanted side effects.
I focus on the factors that increase (up-regulate) the immune system. There are several environmental triggers that we know cause an immune challenge and may upregulate immunity on a chronic basis. Unfortunately these factors are often over-looked or not adequately evaluated in all people with ITP. These factors include, but are not limited to, chronic allergies and chronic infection.
We know through countless medical studies that allergies up-regulate the immune system. What I look for, in the patients I see, are chronic “hidden” food allergies that may cause this upregulation. The person with ITP is usually unaware that they have these allergies and therefore continues to expose him/herself to the offending agent.
Many people have had the traditional skin testing for IgE inhalant allergies including dust mite, dog, cat, and mold. Some people have had skin testing for food allergies as well. IgE skin testing detects immediate (or fast acting) allergies. Many patients I have interviewed have been told by the allergist that their test was negative yet when they got home and went to get in the shower discovered that their back was a mass of red blotches. These people may have food allergies but reacted more slowly than the allergist expected. In my experience these food allergies can decimate health.
It is very rare that I see a patient with an autoimmune disease who doesn’t have some significant food allergies. What is often over-looked by most allergists are delayed food hypersensitivities caused by IgG (IgG is a slower acting immune globulin that may respond in minutes to hours as opposed to the fast acting IgE which may cause a response in seconds to minutes). A typical IgE response would be difficulty breathing due to exposure to shellfish. This response is usually immediate (seconds) and severe. A typical IgG response could be abdominal pain due to eating wheat. This response may occur within minutes but may take hours. This makes identification of the allergy more difficult since obviously you know that the shellfish caused your breathing problem but if your stomach is aching this afternoon you don’t think back and connect that ache to the bread you ate at lunch.
These hidden food allergies are usually caused by the foods you eat most often. In the U.S. the most common food allergies are: milk, eggs, wheat, corn and citrus. That having been said, any food that you eat a lot of may be an offending agent. (If you only eat a food a few times per year or if you dislike a food then it is very unlikely you are allergic to that particular food regardless of how common it is in everybody else).
Every patient with ITP or any autoimmune disease seen in my clinic will get extensive testing for both types of food allergy IgE and IgG. (We will not go into detail the exact mechanism of how food allergy increases inflammation and up-regulates the immune system. Elevated immune globulins trigger the inflammatory cascade through their upregulation of several inflammatory cytokines. Chronic elevation of these inflammatory cytokines will upregulate the immune system day after day, year after year until the offending food is removed from the diet).
Remember your body now attacks these food particles as if they were foreign substances producing large amounts of inflammatory intermediates which upregulate immunity and over the course of time may contribute to your body losing its ability for self recognition.
It has long been suspected that parasitic infections can be a triggering event in the development of autoimmunity. Due to improper hygiene parasitic infections were common, yet we tend not to think of parasites in modern America. In the U.S. parasitic infections are far more common than we think. In my practice I see three reasons for this: 1. Food preparation is usually one of the lowest jobs available, therefore it is common for people from the third world to take these jobs upon arriving in the U.S. If these people have parasites and do not wash their hands properly they may infect many people (even at very expensive restaurants). 2. Americans are traveling to the second and third world in record numbers. Asia, Latin America, Mexico, and Africa are all very hot destinations for American tourists and if they are not careful and make one mistake they can become infected. 3. Resort cabins: Many people have resort cabins on lakes where the well water has become contaminated by sewage and they pick up a parasite from their water.
Detection of parasites is much more difficult than you would think. Often routine stool tests do not detect the parasites and in depth stool studies are needed. That’s why I do extensive specialized stool studies on all patients with autoimmune disease. Even these special tests, done by the best lab in U.S only find a minority of the parasites that may be there. Estimates are that regular hospital labs may miss the majority of the parasites that are in the bowel. The reasons for this are many fold including: They are looking for a “needle in a haystack” there is a lot of stool and parasites are small and easily missed. Second it’s not the most sought after job in the lab and therefore the person doing the studies may not have the experience or expertise required. In addition to visual stool evaluation I also order parasite EIA studies on the stool. The EIA detects antigen to certain parasites that although you don’t see the actual parasite, if you find antigen it’s a good bet that the person is infected.
Another common and tragically overlooked infection of the bowel is pathogenic bacteria or yeast overgrowth. We know that many species of yeast have been shown to up-regulate immunity. Many researchers now believe we have a symbiotic relationship with the yeast in our bowel. A small amount of yeast may actually help our health since it improves our immunity and may help us fight off other more serious infections. What happens however is too much of a good thing. Yeast or fungal overgrowth may cause over stimulation of the immune system. This chronic up-regulation combined with certain genetic factors may trigger the immune system to start attacking you, the person it was meant to protect, and in some people the system that gets attacked are the platelets.
What causes yeast/fungal overgrowth in the bowel? For the vast majority of Americans it is due to over use of antibiotics. Antibiotics are not evil but they are also not species specific, they kill all bacteria that are sensitive to them good or bad. While they are reducing the bacteria we want to kill, let’s say in your lungs, they are also killing the good bacteria that your bowel needs to be healthy. It is these good bacteria that help control other possible pathogenic “bad” bacteria and yeast. So if you have had repeated courses of antibiotics or have had strong antibiotics for a prolonged period of time (several weeks) for a serious infection your bowel bacteria can become decimated.
The reduced amount of “good” bacteria in the bowel allows other “bad” bacteria and/or yeast to overgrow. Your body then recognizes this as an infection and attacks the pathogenic bacteria and yeast producing large amounts of inflammatory cytokines which upregulate your immune system. Since a large percentage of your immune cells are centered near your bowel this attack can be powerful. Our immune system has trouble killing these tough “bad” bacteria and yeast so you can wind up with a chronic immune stimulation that releases large amounts of inflammatory cytokines causing chronic immune upregulation and eventually contributing to autoimmunity.
The overgrowth of yeast/fungus in the bowel is controversial since we were not taught about it in medical school or residency yet since baby boomers were the first generation routinely exposed to antibiotics this is a relatively new phenomenon. If you have had multiple courses of antibiotics or have had long term antibiotics for acne or other infections then in my opinion you should have evaluation for pathogenic bacteria and/or yeast overgrowth of the bowel and appropriate therapy where indicated.
The appropriate evaluation by a physician experienced in the evaluation of bowel overgrowth and the treatment of that overgrowth, if present, is extremely important. Most people can proceed with this evaluation and treatment of parasitic, bacterial or fungal bowel infections while they are on other medications which are required to control their ITP.
Research done on patients with bowel inflammation suggests that gluten may be a significant trigger of autoimmunity. Of the thousands of people I have seen with autoimmunity most have not been adequately screened for gluten intolerance/sensitivity. I have also seen other patients that have “borderline” positive gluten antibodies yet their doctors did not recommend removal of gluten from their diet.
In my opinion every person with ITP must have a work up for gluten sensitivity. If the antibodies are positive, borderline, or even high positive a gluten free diet should be given a several month clinical trial. In my experience one must watch the platelet count for several months after instituting a gluten free diet to determine the success or failure of this intervention. Gluten appears to be an increasing source of immune stimulation in the U.S. and the elimination of gluten (if warranted) may prove to be an important step in down regulating immunity in the person with ITP.
In my opinion evaluation of food allergies, bowel dysbiosis (overgrowth of abnormal bacteria or yeast) and gluten intolerance should be considered in every person with autoimmune disease. This evaluation can be completed without altering the patient’s current therapy and, if found, treatment can be instituted without withdrawing the patient from medications.
In my clinical experience reducing these possible immune triggers from the environment often reduces immune stimulation, therefore reducing the production of pro-inflammatory cytokines. This, when combined with ongoing immune therapy, may produce a more desirable outcome than medications alone.
This is especially valuable in the difficult to control case of autoimmunity or ITP. Diagnostic procedures would include a complete digestive stool analysis, IgE and IgG food allergy evaluation, and anti-gliadin antibodies looking for gluten sensitivity. All of these studies are easily done and in experienced hands can provide a tool for evaluation and reduction of possible immune triggers that could exacerbate or be an underlying factor in the development of ITP.
Dr. Edward Conley is an Assistant Clinical Professor of Medicine, Michigan State University and Medical Director of the Fatigue, Fibromyalgia, and Autoimmune Clinic of Michigan. Phone: 810-230-8677 Web: www.cfids.com
Now faith is the substance of things hoped for, the evidence of things not seen. - Hebrews 11:1
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