autoimmune disorders and lifestyle medicinearndt m, et al. role of “western diet” in...
TRANSCRIPT
Autoimmune Disordersand Lifestyle MedicineAMANDA MCKINNEY MD FACLM FACOG CPE
Western Lifestyle and AutoimmunityGenetic Predisposition
Low Concordance rates in Monozygotic Twins
Environmental Factors (modulation of gut bacteria) Hygiene hypothesis
Psychosocial Stress
SmokingAlcohol
Lack of Physical Activity
Excess caloric intakeobesity
Lifestyle Related Autoimmune DisordersInflammatory Bowel Disease
Rheumatoid Arthritis
Multiple Sclerosis
Type 1 Diabetes
Inflammatory Bowel Disease
IBD16 million Americans
70000 new cases annually
80000 children
500100000 persons
Similar Trend in Westernized nations
SulfurEpigenetic modulation via Microbiome
Sulfur containing amino acids (methioninecysteine) and sulfur additives (food preservation)
Fermentative sulfidogenesis produces hydrogen sulfide gas
Linear relationship
Hydrogen SulfideDNA hypomethylation Apoptosis
Crypt architectural distortion
Mucosal Ulceration (cancer pre-cursor)
27mmolday vs 166 mmolday
H2S and UCH2S main factor responsible for UC relapse
Elimination of cowrsquos milk can improve symptomsreduce relapses
Meat consumption = 3 fold risk
Processed meat consumption = 5 fold risk
Alcohol consumption = 27 fold risk
Crohnrsquos DiseaseDramatic increases in Japan over the last century
Strong positive correlation with increases in dietary fat (total animal PUFA) and protein (animal and milk)
Inverse association with vegetable protein
IBD and SucraloseAspartame methanol formaldehyde
Sucralose reduces rsquos of beneficial bacteria
Sucralose mutagenic at high temperatures chloropropanols
Butyrate and IBD Butyrate SCFA produced via carbohydrate metabolism by
beneficial gut microbes Plays an important protective role in intestinal homeostasis
acting in both adaptive immunity and innate immunity
PBD high in fiber promote butyrate producing bacteria
PBD play a role in both prevention and treatment
Fiber Butyrate and UC Topical butyrate (enemas) is effective in UC
treatment
60 grams oat bran daily for 3 months increases butyrate by 36
Effect seen after 4 weeks
No relapse and improved symptoms in intervention group
Diet and Crohnrsquos2 year clinical trial 22 Crohnrsquos patients sp inpatient remission- SVD Remission rates on SVD 100 at 1 year 92 at 2
years
46 omnivores relapsed by end of year 2
Compared to drugs Higher remission rates (614136)
Less expense
No side effects
Additional Therapies2000 IU Vitamin D3
75 nmL = 44 reduced risk of Crohnrsquos related surgery
40 ngml = improved QOL scores and reduced disease activity
Additional TherapiesCurcumin alone 45 with UC remission
1 gram curcumin BID plus sulfasalazine or mesalamine 243 with relapse (5)
839 with relapse for those with no curcumin (20)
Endoscopic improvement in curcumin group
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Western Lifestyle and AutoimmunityGenetic Predisposition
Low Concordance rates in Monozygotic Twins
Environmental Factors (modulation of gut bacteria) Hygiene hypothesis
Psychosocial Stress
SmokingAlcohol
Lack of Physical Activity
Excess caloric intakeobesity
Lifestyle Related Autoimmune DisordersInflammatory Bowel Disease
Rheumatoid Arthritis
Multiple Sclerosis
Type 1 Diabetes
Inflammatory Bowel Disease
IBD16 million Americans
70000 new cases annually
80000 children
500100000 persons
Similar Trend in Westernized nations
SulfurEpigenetic modulation via Microbiome
Sulfur containing amino acids (methioninecysteine) and sulfur additives (food preservation)
Fermentative sulfidogenesis produces hydrogen sulfide gas
Linear relationship
Hydrogen SulfideDNA hypomethylation Apoptosis
Crypt architectural distortion
Mucosal Ulceration (cancer pre-cursor)
27mmolday vs 166 mmolday
H2S and UCH2S main factor responsible for UC relapse
Elimination of cowrsquos milk can improve symptomsreduce relapses
Meat consumption = 3 fold risk
Processed meat consumption = 5 fold risk
Alcohol consumption = 27 fold risk
Crohnrsquos DiseaseDramatic increases in Japan over the last century
Strong positive correlation with increases in dietary fat (total animal PUFA) and protein (animal and milk)
Inverse association with vegetable protein
IBD and SucraloseAspartame methanol formaldehyde
Sucralose reduces rsquos of beneficial bacteria
Sucralose mutagenic at high temperatures chloropropanols
Butyrate and IBD Butyrate SCFA produced via carbohydrate metabolism by
beneficial gut microbes Plays an important protective role in intestinal homeostasis
acting in both adaptive immunity and innate immunity
PBD high in fiber promote butyrate producing bacteria
PBD play a role in both prevention and treatment
Fiber Butyrate and UC Topical butyrate (enemas) is effective in UC
treatment
60 grams oat bran daily for 3 months increases butyrate by 36
Effect seen after 4 weeks
No relapse and improved symptoms in intervention group
Diet and Crohnrsquos2 year clinical trial 22 Crohnrsquos patients sp inpatient remission- SVD Remission rates on SVD 100 at 1 year 92 at 2
years
46 omnivores relapsed by end of year 2
Compared to drugs Higher remission rates (614136)
Less expense
No side effects
Additional Therapies2000 IU Vitamin D3
75 nmL = 44 reduced risk of Crohnrsquos related surgery
40 ngml = improved QOL scores and reduced disease activity
Additional TherapiesCurcumin alone 45 with UC remission
1 gram curcumin BID plus sulfasalazine or mesalamine 243 with relapse (5)
839 with relapse for those with no curcumin (20)
Endoscopic improvement in curcumin group
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Lifestyle Related Autoimmune DisordersInflammatory Bowel Disease
Rheumatoid Arthritis
Multiple Sclerosis
Type 1 Diabetes
Inflammatory Bowel Disease
IBD16 million Americans
70000 new cases annually
80000 children
500100000 persons
Similar Trend in Westernized nations
SulfurEpigenetic modulation via Microbiome
Sulfur containing amino acids (methioninecysteine) and sulfur additives (food preservation)
Fermentative sulfidogenesis produces hydrogen sulfide gas
Linear relationship
Hydrogen SulfideDNA hypomethylation Apoptosis
Crypt architectural distortion
Mucosal Ulceration (cancer pre-cursor)
27mmolday vs 166 mmolday
H2S and UCH2S main factor responsible for UC relapse
Elimination of cowrsquos milk can improve symptomsreduce relapses
Meat consumption = 3 fold risk
Processed meat consumption = 5 fold risk
Alcohol consumption = 27 fold risk
Crohnrsquos DiseaseDramatic increases in Japan over the last century
Strong positive correlation with increases in dietary fat (total animal PUFA) and protein (animal and milk)
Inverse association with vegetable protein
IBD and SucraloseAspartame methanol formaldehyde
Sucralose reduces rsquos of beneficial bacteria
Sucralose mutagenic at high temperatures chloropropanols
Butyrate and IBD Butyrate SCFA produced via carbohydrate metabolism by
beneficial gut microbes Plays an important protective role in intestinal homeostasis
acting in both adaptive immunity and innate immunity
PBD high in fiber promote butyrate producing bacteria
PBD play a role in both prevention and treatment
Fiber Butyrate and UC Topical butyrate (enemas) is effective in UC
treatment
60 grams oat bran daily for 3 months increases butyrate by 36
Effect seen after 4 weeks
No relapse and improved symptoms in intervention group
Diet and Crohnrsquos2 year clinical trial 22 Crohnrsquos patients sp inpatient remission- SVD Remission rates on SVD 100 at 1 year 92 at 2
years
46 omnivores relapsed by end of year 2
Compared to drugs Higher remission rates (614136)
Less expense
No side effects
Additional Therapies2000 IU Vitamin D3
75 nmL = 44 reduced risk of Crohnrsquos related surgery
40 ngml = improved QOL scores and reduced disease activity
Additional TherapiesCurcumin alone 45 with UC remission
1 gram curcumin BID plus sulfasalazine or mesalamine 243 with relapse (5)
839 with relapse for those with no curcumin (20)
Endoscopic improvement in curcumin group
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Inflammatory Bowel Disease
IBD16 million Americans
70000 new cases annually
80000 children
500100000 persons
Similar Trend in Westernized nations
SulfurEpigenetic modulation via Microbiome
Sulfur containing amino acids (methioninecysteine) and sulfur additives (food preservation)
Fermentative sulfidogenesis produces hydrogen sulfide gas
Linear relationship
Hydrogen SulfideDNA hypomethylation Apoptosis
Crypt architectural distortion
Mucosal Ulceration (cancer pre-cursor)
27mmolday vs 166 mmolday
H2S and UCH2S main factor responsible for UC relapse
Elimination of cowrsquos milk can improve symptomsreduce relapses
Meat consumption = 3 fold risk
Processed meat consumption = 5 fold risk
Alcohol consumption = 27 fold risk
Crohnrsquos DiseaseDramatic increases in Japan over the last century
Strong positive correlation with increases in dietary fat (total animal PUFA) and protein (animal and milk)
Inverse association with vegetable protein
IBD and SucraloseAspartame methanol formaldehyde
Sucralose reduces rsquos of beneficial bacteria
Sucralose mutagenic at high temperatures chloropropanols
Butyrate and IBD Butyrate SCFA produced via carbohydrate metabolism by
beneficial gut microbes Plays an important protective role in intestinal homeostasis
acting in both adaptive immunity and innate immunity
PBD high in fiber promote butyrate producing bacteria
PBD play a role in both prevention and treatment
Fiber Butyrate and UC Topical butyrate (enemas) is effective in UC
treatment
60 grams oat bran daily for 3 months increases butyrate by 36
Effect seen after 4 weeks
No relapse and improved symptoms in intervention group
Diet and Crohnrsquos2 year clinical trial 22 Crohnrsquos patients sp inpatient remission- SVD Remission rates on SVD 100 at 1 year 92 at 2
years
46 omnivores relapsed by end of year 2
Compared to drugs Higher remission rates (614136)
Less expense
No side effects
Additional Therapies2000 IU Vitamin D3
75 nmL = 44 reduced risk of Crohnrsquos related surgery
40 ngml = improved QOL scores and reduced disease activity
Additional TherapiesCurcumin alone 45 with UC remission
1 gram curcumin BID plus sulfasalazine or mesalamine 243 with relapse (5)
839 with relapse for those with no curcumin (20)
Endoscopic improvement in curcumin group
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
IBD16 million Americans
70000 new cases annually
80000 children
500100000 persons
Similar Trend in Westernized nations
SulfurEpigenetic modulation via Microbiome
Sulfur containing amino acids (methioninecysteine) and sulfur additives (food preservation)
Fermentative sulfidogenesis produces hydrogen sulfide gas
Linear relationship
Hydrogen SulfideDNA hypomethylation Apoptosis
Crypt architectural distortion
Mucosal Ulceration (cancer pre-cursor)
27mmolday vs 166 mmolday
H2S and UCH2S main factor responsible for UC relapse
Elimination of cowrsquos milk can improve symptomsreduce relapses
Meat consumption = 3 fold risk
Processed meat consumption = 5 fold risk
Alcohol consumption = 27 fold risk
Crohnrsquos DiseaseDramatic increases in Japan over the last century
Strong positive correlation with increases in dietary fat (total animal PUFA) and protein (animal and milk)
Inverse association with vegetable protein
IBD and SucraloseAspartame methanol formaldehyde
Sucralose reduces rsquos of beneficial bacteria
Sucralose mutagenic at high temperatures chloropropanols
Butyrate and IBD Butyrate SCFA produced via carbohydrate metabolism by
beneficial gut microbes Plays an important protective role in intestinal homeostasis
acting in both adaptive immunity and innate immunity
PBD high in fiber promote butyrate producing bacteria
PBD play a role in both prevention and treatment
Fiber Butyrate and UC Topical butyrate (enemas) is effective in UC
treatment
60 grams oat bran daily for 3 months increases butyrate by 36
Effect seen after 4 weeks
No relapse and improved symptoms in intervention group
Diet and Crohnrsquos2 year clinical trial 22 Crohnrsquos patients sp inpatient remission- SVD Remission rates on SVD 100 at 1 year 92 at 2
years
46 omnivores relapsed by end of year 2
Compared to drugs Higher remission rates (614136)
Less expense
No side effects
Additional Therapies2000 IU Vitamin D3
75 nmL = 44 reduced risk of Crohnrsquos related surgery
40 ngml = improved QOL scores and reduced disease activity
Additional TherapiesCurcumin alone 45 with UC remission
1 gram curcumin BID plus sulfasalazine or mesalamine 243 with relapse (5)
839 with relapse for those with no curcumin (20)
Endoscopic improvement in curcumin group
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
SulfurEpigenetic modulation via Microbiome
Sulfur containing amino acids (methioninecysteine) and sulfur additives (food preservation)
Fermentative sulfidogenesis produces hydrogen sulfide gas
Linear relationship
Hydrogen SulfideDNA hypomethylation Apoptosis
Crypt architectural distortion
Mucosal Ulceration (cancer pre-cursor)
27mmolday vs 166 mmolday
H2S and UCH2S main factor responsible for UC relapse
Elimination of cowrsquos milk can improve symptomsreduce relapses
Meat consumption = 3 fold risk
Processed meat consumption = 5 fold risk
Alcohol consumption = 27 fold risk
Crohnrsquos DiseaseDramatic increases in Japan over the last century
Strong positive correlation with increases in dietary fat (total animal PUFA) and protein (animal and milk)
Inverse association with vegetable protein
IBD and SucraloseAspartame methanol formaldehyde
Sucralose reduces rsquos of beneficial bacteria
Sucralose mutagenic at high temperatures chloropropanols
Butyrate and IBD Butyrate SCFA produced via carbohydrate metabolism by
beneficial gut microbes Plays an important protective role in intestinal homeostasis
acting in both adaptive immunity and innate immunity
PBD high in fiber promote butyrate producing bacteria
PBD play a role in both prevention and treatment
Fiber Butyrate and UC Topical butyrate (enemas) is effective in UC
treatment
60 grams oat bran daily for 3 months increases butyrate by 36
Effect seen after 4 weeks
No relapse and improved symptoms in intervention group
Diet and Crohnrsquos2 year clinical trial 22 Crohnrsquos patients sp inpatient remission- SVD Remission rates on SVD 100 at 1 year 92 at 2
years
46 omnivores relapsed by end of year 2
Compared to drugs Higher remission rates (614136)
Less expense
No side effects
Additional Therapies2000 IU Vitamin D3
75 nmL = 44 reduced risk of Crohnrsquos related surgery
40 ngml = improved QOL scores and reduced disease activity
Additional TherapiesCurcumin alone 45 with UC remission
1 gram curcumin BID plus sulfasalazine or mesalamine 243 with relapse (5)
839 with relapse for those with no curcumin (20)
Endoscopic improvement in curcumin group
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Hydrogen SulfideDNA hypomethylation Apoptosis
Crypt architectural distortion
Mucosal Ulceration (cancer pre-cursor)
27mmolday vs 166 mmolday
H2S and UCH2S main factor responsible for UC relapse
Elimination of cowrsquos milk can improve symptomsreduce relapses
Meat consumption = 3 fold risk
Processed meat consumption = 5 fold risk
Alcohol consumption = 27 fold risk
Crohnrsquos DiseaseDramatic increases in Japan over the last century
Strong positive correlation with increases in dietary fat (total animal PUFA) and protein (animal and milk)
Inverse association with vegetable protein
IBD and SucraloseAspartame methanol formaldehyde
Sucralose reduces rsquos of beneficial bacteria
Sucralose mutagenic at high temperatures chloropropanols
Butyrate and IBD Butyrate SCFA produced via carbohydrate metabolism by
beneficial gut microbes Plays an important protective role in intestinal homeostasis
acting in both adaptive immunity and innate immunity
PBD high in fiber promote butyrate producing bacteria
PBD play a role in both prevention and treatment
Fiber Butyrate and UC Topical butyrate (enemas) is effective in UC
treatment
60 grams oat bran daily for 3 months increases butyrate by 36
Effect seen after 4 weeks
No relapse and improved symptoms in intervention group
Diet and Crohnrsquos2 year clinical trial 22 Crohnrsquos patients sp inpatient remission- SVD Remission rates on SVD 100 at 1 year 92 at 2
years
46 omnivores relapsed by end of year 2
Compared to drugs Higher remission rates (614136)
Less expense
No side effects
Additional Therapies2000 IU Vitamin D3
75 nmL = 44 reduced risk of Crohnrsquos related surgery
40 ngml = improved QOL scores and reduced disease activity
Additional TherapiesCurcumin alone 45 with UC remission
1 gram curcumin BID plus sulfasalazine or mesalamine 243 with relapse (5)
839 with relapse for those with no curcumin (20)
Endoscopic improvement in curcumin group
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
H2S and UCH2S main factor responsible for UC relapse
Elimination of cowrsquos milk can improve symptomsreduce relapses
Meat consumption = 3 fold risk
Processed meat consumption = 5 fold risk
Alcohol consumption = 27 fold risk
Crohnrsquos DiseaseDramatic increases in Japan over the last century
Strong positive correlation with increases in dietary fat (total animal PUFA) and protein (animal and milk)
Inverse association with vegetable protein
IBD and SucraloseAspartame methanol formaldehyde
Sucralose reduces rsquos of beneficial bacteria
Sucralose mutagenic at high temperatures chloropropanols
Butyrate and IBD Butyrate SCFA produced via carbohydrate metabolism by
beneficial gut microbes Plays an important protective role in intestinal homeostasis
acting in both adaptive immunity and innate immunity
PBD high in fiber promote butyrate producing bacteria
PBD play a role in both prevention and treatment
Fiber Butyrate and UC Topical butyrate (enemas) is effective in UC
treatment
60 grams oat bran daily for 3 months increases butyrate by 36
Effect seen after 4 weeks
No relapse and improved symptoms in intervention group
Diet and Crohnrsquos2 year clinical trial 22 Crohnrsquos patients sp inpatient remission- SVD Remission rates on SVD 100 at 1 year 92 at 2
years
46 omnivores relapsed by end of year 2
Compared to drugs Higher remission rates (614136)
Less expense
No side effects
Additional Therapies2000 IU Vitamin D3
75 nmL = 44 reduced risk of Crohnrsquos related surgery
40 ngml = improved QOL scores and reduced disease activity
Additional TherapiesCurcumin alone 45 with UC remission
1 gram curcumin BID plus sulfasalazine or mesalamine 243 with relapse (5)
839 with relapse for those with no curcumin (20)
Endoscopic improvement in curcumin group
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Crohnrsquos DiseaseDramatic increases in Japan over the last century
Strong positive correlation with increases in dietary fat (total animal PUFA) and protein (animal and milk)
Inverse association with vegetable protein
IBD and SucraloseAspartame methanol formaldehyde
Sucralose reduces rsquos of beneficial bacteria
Sucralose mutagenic at high temperatures chloropropanols
Butyrate and IBD Butyrate SCFA produced via carbohydrate metabolism by
beneficial gut microbes Plays an important protective role in intestinal homeostasis
acting in both adaptive immunity and innate immunity
PBD high in fiber promote butyrate producing bacteria
PBD play a role in both prevention and treatment
Fiber Butyrate and UC Topical butyrate (enemas) is effective in UC
treatment
60 grams oat bran daily for 3 months increases butyrate by 36
Effect seen after 4 weeks
No relapse and improved symptoms in intervention group
Diet and Crohnrsquos2 year clinical trial 22 Crohnrsquos patients sp inpatient remission- SVD Remission rates on SVD 100 at 1 year 92 at 2
years
46 omnivores relapsed by end of year 2
Compared to drugs Higher remission rates (614136)
Less expense
No side effects
Additional Therapies2000 IU Vitamin D3
75 nmL = 44 reduced risk of Crohnrsquos related surgery
40 ngml = improved QOL scores and reduced disease activity
Additional TherapiesCurcumin alone 45 with UC remission
1 gram curcumin BID plus sulfasalazine or mesalamine 243 with relapse (5)
839 with relapse for those with no curcumin (20)
Endoscopic improvement in curcumin group
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
IBD and SucraloseAspartame methanol formaldehyde
Sucralose reduces rsquos of beneficial bacteria
Sucralose mutagenic at high temperatures chloropropanols
Butyrate and IBD Butyrate SCFA produced via carbohydrate metabolism by
beneficial gut microbes Plays an important protective role in intestinal homeostasis
acting in both adaptive immunity and innate immunity
PBD high in fiber promote butyrate producing bacteria
PBD play a role in both prevention and treatment
Fiber Butyrate and UC Topical butyrate (enemas) is effective in UC
treatment
60 grams oat bran daily for 3 months increases butyrate by 36
Effect seen after 4 weeks
No relapse and improved symptoms in intervention group
Diet and Crohnrsquos2 year clinical trial 22 Crohnrsquos patients sp inpatient remission- SVD Remission rates on SVD 100 at 1 year 92 at 2
years
46 omnivores relapsed by end of year 2
Compared to drugs Higher remission rates (614136)
Less expense
No side effects
Additional Therapies2000 IU Vitamin D3
75 nmL = 44 reduced risk of Crohnrsquos related surgery
40 ngml = improved QOL scores and reduced disease activity
Additional TherapiesCurcumin alone 45 with UC remission
1 gram curcumin BID plus sulfasalazine or mesalamine 243 with relapse (5)
839 with relapse for those with no curcumin (20)
Endoscopic improvement in curcumin group
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Butyrate and IBD Butyrate SCFA produced via carbohydrate metabolism by
beneficial gut microbes Plays an important protective role in intestinal homeostasis
acting in both adaptive immunity and innate immunity
PBD high in fiber promote butyrate producing bacteria
PBD play a role in both prevention and treatment
Fiber Butyrate and UC Topical butyrate (enemas) is effective in UC
treatment
60 grams oat bran daily for 3 months increases butyrate by 36
Effect seen after 4 weeks
No relapse and improved symptoms in intervention group
Diet and Crohnrsquos2 year clinical trial 22 Crohnrsquos patients sp inpatient remission- SVD Remission rates on SVD 100 at 1 year 92 at 2
years
46 omnivores relapsed by end of year 2
Compared to drugs Higher remission rates (614136)
Less expense
No side effects
Additional Therapies2000 IU Vitamin D3
75 nmL = 44 reduced risk of Crohnrsquos related surgery
40 ngml = improved QOL scores and reduced disease activity
Additional TherapiesCurcumin alone 45 with UC remission
1 gram curcumin BID plus sulfasalazine or mesalamine 243 with relapse (5)
839 with relapse for those with no curcumin (20)
Endoscopic improvement in curcumin group
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Fiber Butyrate and UC Topical butyrate (enemas) is effective in UC
treatment
60 grams oat bran daily for 3 months increases butyrate by 36
Effect seen after 4 weeks
No relapse and improved symptoms in intervention group
Diet and Crohnrsquos2 year clinical trial 22 Crohnrsquos patients sp inpatient remission- SVD Remission rates on SVD 100 at 1 year 92 at 2
years
46 omnivores relapsed by end of year 2
Compared to drugs Higher remission rates (614136)
Less expense
No side effects
Additional Therapies2000 IU Vitamin D3
75 nmL = 44 reduced risk of Crohnrsquos related surgery
40 ngml = improved QOL scores and reduced disease activity
Additional TherapiesCurcumin alone 45 with UC remission
1 gram curcumin BID plus sulfasalazine or mesalamine 243 with relapse (5)
839 with relapse for those with no curcumin (20)
Endoscopic improvement in curcumin group
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Diet and Crohnrsquos2 year clinical trial 22 Crohnrsquos patients sp inpatient remission- SVD Remission rates on SVD 100 at 1 year 92 at 2
years
46 omnivores relapsed by end of year 2
Compared to drugs Higher remission rates (614136)
Less expense
No side effects
Additional Therapies2000 IU Vitamin D3
75 nmL = 44 reduced risk of Crohnrsquos related surgery
40 ngml = improved QOL scores and reduced disease activity
Additional TherapiesCurcumin alone 45 with UC remission
1 gram curcumin BID plus sulfasalazine or mesalamine 243 with relapse (5)
839 with relapse for those with no curcumin (20)
Endoscopic improvement in curcumin group
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Additional Therapies2000 IU Vitamin D3
75 nmL = 44 reduced risk of Crohnrsquos related surgery
40 ngml = improved QOL scores and reduced disease activity
Additional TherapiesCurcumin alone 45 with UC remission
1 gram curcumin BID plus sulfasalazine or mesalamine 243 with relapse (5)
839 with relapse for those with no curcumin (20)
Endoscopic improvement in curcumin group
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Additional TherapiesCurcumin alone 45 with UC remission
1 gram curcumin BID plus sulfasalazine or mesalamine 243 with relapse (5)
839 with relapse for those with no curcumin (20)
Endoscopic improvement in curcumin group
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Rheumatoid Arthritis
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
(Epi)genetics of RAHLA-DR4 70 of RA patients
30 of general population
Subtypes = 90
Monozygotic concordance rate 15
Smoking triggers HLA production and seroconversion to HLA positive RA
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Microbes and RARole of microbial infections in rheumatic disease GAS in rheumatic fever
Spirochetal infections in Lyme disease
Campylobacter Salmonella Shigella Yersinia and Chlamydia in reactive arthritis
Nowhellipoccult Proteus UTI and RA
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Microbes and RAP mirabilis amino acid sequence resembles type XI collagen
Isolation rates of P mirabilis in RA patients is double that of E coli
Proteus isolated in 6350 of RA patients compared to 3211 controls
Urine from RA patients have elevated levels of Proteus antibodies
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
RA TreatmentProteus is a member of the Bacteroidesenterotype (associated with animal food diets)
Prevotella enterotype (associated with plant based diets)
Shifting from animalfoods to PBD reduces risk of occult Proteus UTI
AND reduces anti-Proteus antibodies
PBD also increases urine lignans which are anti-microbial
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
PBD for RA Treatment1999 randomized trial
13 months 27 intervention
26 controls
1227 intervention patients with 50 reduction in symptoms (responders)
226 control ldquorespondersrdquo
Intervention group 13 pound weight loss
Improved sed rate CRP and WBC count
After the intervention period patients were allowed to change diet however all rdquorespondersrdquo stayed with the diet and half of all ldquonon-respondersrdquo as well
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Turmeric and RA2012- 8 week randomized pilot 45 patients2 groups
Group 1 500mg curcumin BID
Group 2 500 mg curcumin and 50mg diclofenac BID
Group 3 50mg diclofenac BID
Primary endpoint reduction in disease activity and joint swellingtenderness
Results Group 1 445 improvement
Group 2 444 improvement
Group 3 421 improvement
Adverse events only in diclofenac groups
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Multiple Sclerosis
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
MS DistributionMost diagnosed ages 20-40
400000 in US and 25 million globally
Prevalence increases with distance from equator
57-78100000 below 37th parallel
110-140100000 above it
Higher incidence in colder climates and people of Northern European descent regardless of where they live
Women men 21
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
(Epi)genetics of MS
1-3 chance of MS if you have a sibling or parent with MS
Monozygotic concordance rate of 30 Roy Swank at OHSU hypothesized that the
distribution might be because people in northern latitudes tend to eat more animal foods
1952 study Frequency of MS in Norway directly related to amount of saturated animal fat consumed
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Vitamin D and MSThose in northern latitudes also get less sun exposure
MS patients have lower 125(OH)2D levels at time of relapse
In Norway inland MS is higher than in fishing villages
Oily fish may compensate for relative lack of UV expsoure
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Vitamin D and MS125(OH)2D moderates demyelination remyelination and stops oligodendrocyte apoptosis
Upreglates genomic activity on the strongest susceptiblility allele
Homozygosity of the CYP27B1 gene causes a form of rickets
3 individuals in Norway with this genetic rickets also developed MS
Heterozygosity increases risk of MS by 47 times
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Dairy and MSMolecular mimicry between butyrophilin and myelin oligodendrocyte glycoprotein
Anti-BTN antibodies attack myelinated structures in the CNS and have been isolated in those with MS
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
MS TreatmentSafe and effective treatments are elusive
Interferon Side effects
$30000 per year
No evidence of a reduction in diabilityprogression
Mitoxantrone NNH 8 for irreversible systolic dysfunction and
123 for therapy-related acute leukemia
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Dr Swank1951- 100 patients limited to 10-15 grams of saturated animal fat per day
3 frac12 year 5 frac12 year 7 year 20 year 34 year and 50 year follow up reports
After 34 years (1990) 95 of the patients were without progression of their disease
Increase in fat to 25-42gday was accompanied by increased disability and 3-fold increased risk of death to 79
In 2000 15 patients identified (50 year follow up) All could care for themselves independently
15 could ambulate as needed 13 truly ambulatory
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
MS TreatmentStudy on Vitamin D treatment in MS did not look at clinical outcomes
High dose Vitamin D supplementation did reduce helper T cells believed to be major contributors in immunopathogenesis of MS
Dose was 10400 IU daily and 21 of had to stop because of adverse effects
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Type 1 Diabetes
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Molecular Mimicry
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Genetic Factors -alone cannot explain etiology
Environmental Factors- Cowrsquos milk antigens-Viruses
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
bull Enterovirusbull Coxackievirus Bbull Rotavirusbull Mumpsbull CMVbull Congenital Rubella
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
MYCOBACTERIUM PARATUBERCULOSISHSP 65
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
PBD in T1DType 1rsquos can develop insulin resistance with a high fat diet
PBD can reduce insulin requirements by 30-50
PBD can reduce risk of diabetic comorbidities
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Latent autoimmune diabetes Adult onset non-obese Present without ketoacidosis and weight loss Anti-body positive Gradual insulin-dependence
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
Thank you
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
ReferencesArndt M et al Role of ldquoWestern Dietrdquo in Inflammatory Autoimmune Diseases Curr Allergy Asthma Rep 2014 Jan 14(1) 404 doi 101007s11882-013-0404-6
Thorburn AN Macia L Mackay CR Diet metabolites and western-lifestyle inflammatory diseases Immunity 2014 Jun 1940(6)833-42 doi 101016jimmuni201405014
Loftus EV Update on the incidence and prevalence of inflammatory bowel disease in the United States Gastroenterol Hepatol 2016 Nov 12(11)704-707
Devkota S Chang EB Interactions between diet bile acid metabolism gut microbiota and inflammatory bowel diseases Digestive Diseases 2015 33(3)
Ijssennagger N et al Sullfide as a mucus barrier-breaker in inflammatory bowel disease Trends in Molecular Medicine 2016 22(3)190-99
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
ReferencesR Wright S C Truelove A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis Br Med J 1965 Jul 17 2(5454) 138ndash141 S C Trulove Ulcerative Colitis Provoked by Milk Br Med J 1961 Jan 21 1(5220) 154ndash160 A H Rowe A Rowe Jr Chronic ulcerative colitis--atopic allergy in its etiology Am J Gastroenterol 1960 Jul3449-66
Silva JPB et al Protective Mechanisms of butyrate on inflammatory bowel disease Curr Pharm Des 201824(35)415mdash66 doi 1021741381612824666181001153605
Patel H Lissoos T Rubin DT Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohns disease in the United States PLoS One 201712(4)e0175099 Published 2017 Apr 20 doi101371journalpone0175099
Raftery T Martineau AR Greiller CL Ghosh S McNamara D Bennett K Meddings J OSullivan M Effects of vitamin D supplementation on intestinal permeability cathelicidin and disease markers in Crohns disease Results from a randomised double-blind placebo-controlled study United European Gastroenterol J 2015 Jun3(3)294-302
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
ReferencesS K Garg not listed) S Kumar V Ahuja M J Sankar A Kumar A C Moss Curcumin for maintenance of remission in ulcerative colitis Cochrane Database Syst Rev 2012 Oct 1710CD008424
Diaz-Pena R Castro-Santos P Genetics of rheumatoid arthritis a new boost is needed in Latin American populations Rev Bras Reumatol 201656(2) httpdxdoiorg101016jrbre201510004
Rashid T Ebringer A Autoimmunity in rheumatic diseases is induced by microbial infections via crossreactivity or molecular mimicry Autoimmune Dis 2012 2012 539282
Gorvitovskaia A Holmes SP Huse SM Interpreting Prevotella and Bacteroides as biomarkers of diet and lifestyle Microbiome 2016 415
B Chandran A Goel A randomized pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis Phytother Res 2012 26(11)1719 - 1725
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
ReferencesJ Kjeldsen-Kragh Rheumatoid arthritis treated with vegetarian diets Am J Clin Nutr 1999 Sep70(3 Suppl)594S-600S
Swank RL et al Multiple Sclerosis in rural Norway Its geographic and occupational incidence in relation to nutrition NEJM 1952 246(19)
Shirani A et al Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis JAMA 2012 Jul 18 308(3)
J J Marriott J M Miyasaki G Gronseth P W OConnor Evidence Report The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology 2010 74(18)1463 - 1470
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
ReferencesR L Swank B B Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis Lancet 1990 336(8706)37 - 39
Swank MS Foundation 2009 Dr Roy Laver Swank
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Multiple sclerosis Twenty years on low fat diet Arch Neurol 1970 23(5)460 - 474
R L Swank Treatment of multiple sclerosis with low-fat diet AMA Arch Neurol Psychiatry 1953 69(1)91-103
R L Swank Multiple sclerosis a correlation of its incidence with dietary fat Am J Med Sci 1950 Oct 220(4)421-430
M A Kadoch Is the treatment of multiple sclerosis headed in the wrong direction Can J Neurol Sci 2012 39(3)405
R L Swank J Goodwin Review of MS patient survival on a Swank low saturated fat diet Nutrition 2003 19(2)161 - 162
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)
ReferencesLempainen J et al Interaction of enterovirus infection and cowrsquos milk based formula nutrition in type 1 diabetes-associated autoimmunity Diabetes Metab Res Rev 201228(2)177-85
Vaarala O Is the origin of type 1 diabetes in the gut Immunology and Cell Biology (2012) 90 271ndash276
Atreya R et al Facts myths and hypotheses on the zoonotic nature of Myobacterium avium subspecies Paratuberculosis Int J Med Microbiol 2014 304(7)858-67
Hesam Shariati S Alaei A Keshavarz R Mosavari N Rabbani A Niegowska M Sechi LA Feizabadi MM (2016) Detection of Mycobacterium avium subsp paratuberculosis in Iranian patients with type 1 diabetes mellitus by PCR and ELISA J Infect Dev Ctries 10857-862 doi 103855jidc7473
Niegowska M et al Type 1 Diabetes at-risk children highly recognize Mycobacterium aviumsubspecies paratuberculosis epitopes homologous to human Znt8 and Proinsulin Scientific Reports 20166(22266)