An Epidemic of Absence By Moises Velasquez-Manoff

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An Epidemic of Absence: A New Way of Understanding Allergies and Autoimmune Diseases
By Moises Velasquez-Manoff
Scribner 2012

Moises Velasquez-Manoff is a science writer who has taken on the job of translating an ambitious scope of research for the non-medical reader. The central thesis is that we humans evolved alongside parasites, mostly insects and worms, and that without their stimulus our immune systems get restless and look for targets which often end up being some part of ourselves. This sort of “friendly fire” expresses itself as allergies, asthma and autoimmune diseases.

It’s important to point out that the many examples in the book are based on correlation, not causality. The correlations are indeed compelling, however. One, for instance, is that mothers who live on farms with animals have children with fewer cases of asthma and allergies. Another correlation links the eradication of malaria in Sardinia to a rapid rise in two autoimmune diseases: multiple sclerosis and type-1 diabetes. An Epidemic of Absence is dense with such examples.

This is a book built on the premise that such immune-mediated disorders “arise in direct proportion to affluence and Westernization” (page 8). We no longer live in the kind of environment that we—including our immune systems—evolved to expect. And that leads to problems: allergies, asthma, autism and autoimmune diseases like lupus, rheumatoid arthritis, and nearly a hundred others. Why is this? The author, a sufferer from both allergy and alopecia (his immune system attacked his hair follicles when he was a boy and he has been bald ever since), has carried out an extensive search for the answer and believes that “. . . much of our immune system evolved precisely to manage the problem of parasites” (page 23). That being so, those parasites aren’t really dispensable and are, in fact, even symbiotic, what he calls “mutualists.” They need us and we need them. The result is a delicate balance for the immune system in which force to control the invaders must not become so much force as to destroy the self. He even claims that “parasites more than any other factor (diet, climate) have influenced our evolution” (page 94). In short, we are their creatures, not the other way around!

The island of Sardinia stands as an example of what can happen when a perennial health problem is eradicated. After World War II, mosquito-bearing malaria was vanquished and the fairly homogenous population of indigenous Sardinians began to develop both multiple sclerosis and type-1 diabetes at an alarming rate. Is the explanation, as proposed here, that “gene variants that helped defend against [malaria]….also increase the chances of developing autoimmune disease” (page 46)? The logic is that people with the genes to deal with malaria lived long enough to reproduce. They didn’t get MS or diabetes because their immune systems were busy dealing with malaria. Without the mosquitoes those fierce genes turned against the self. It almost sounds like a Hollywood horror movie to read the examples from around the world. The human whipworm Trichuris trichiura also seems to protect us humans from MS almost everywhere on the planet.

We’ve seen in the Sardinian example that malaria seems to have discouraged MS and type-1 diabetes, afflictions in which the immune system attacks, respectively, the myelin sheath around nerves or the insulin-producing cells in the pancreas. Malaria in parts of Africa seems also to have discouraged rheumatoid arthritis, which affects joints, and lupus, which can affect organs, joints or nerves, as well as sickle-cell anemia. Apparently, type-1 diabetics, lupus patients and those with celiac disease all fare quite well with malaria. A small group of MS patients in Italy who took the BCG (bacillus Calmette- Guerin) vaccine for tuberculosis found their symptoms diminished. A mycobacterium (M. vaccae) has given relief from asthma, eczema, psoriasis (an autoimmune disease of the skin), and Reynaud’s (an autoimmune problem affecting fingers and toes). Finnish children with the genes disposing them to type-1 diabetes had the benefit of increased resistance to the polio virus. Ankylosing spondylitis, in which the immune system attacks a person’s spine, might save its victim from retroviruses like HIV and hepatitis- C.

What does this bewildering litany mean? One explanation is that those with autoimmune or allergic diseases have inadequate regulatory-T cells, part of the immune battery. Why would evolution put up with these genetic deficiencies? Perhaps because “. . . the tendencies underlying auto-immune disease have a purpose. . . [that] relates to defense. . . . In the context [of] these infections, [which such] variants evolved to handle, scientists repeatedly observe that autoimmunity materializes much less often.” In other words, minus those infections, we see the rise in autoimmune diseases (page 56).

The hygiene hypothesis has been kicking around for a few decades, and many of us have heard that children growing up on farms with animals have fewer allergies than city kids. An allergy is a response to an allergen; an allergen is a protein that is less than 63 percent identical to a human protein. This rules out single-cell bacteria and leaves us with proteins from multi-cell beings: plants, fungi, animals. Most of those that bother us come from parasites like fleas, lice and worms. But when mistakes are made, dust mites, for example, are targeted instead in a “reaction meant to expel worms” (page 96).

Airborne infections, like measles or chicken pox, do not protect against allergies. For this you need orofecal exposure, surely provided on farms! One of the veteran researchers in this area coined another expression for the phenomenon, the “old friend’s hypothesis.” He claims that we evolved with worms, microbes, lactobacilli and our fecal bacteria—not the more recent viruses like measles and the common cold (Graham Rook, page 110). Absence of stimulus? Muscles atrophy, dendrites wither. And “the immune system that finds itself without microbial pressure grows jumpy (allergies) and turns against the self (autoimmunity)” (page 127).

Just as the farm protects, so does day care. All those babies sharing their microbes helps educate the infant immune system. So do unpasteurized dairy products. What happens at birth? The baby picks up a lot of maternal microbes. This may explain why mothers in China traditionally don’t bathe for several months after giving birth. They are educating their babies’ immune systems via introductions to microbes. Some researchers have wondered why the babies of non-allergic mothers develop peanut allergies. An interesting theory points to the inclusion of peanut and related soy oils in many baby skin balms. The skin does not provide the usual introduction to proteins, especially not through inflamed diaper rash: “eating proteins. . . usually leads to tolerance. . . . An approach via the skin, however, is much less ambiguous. It signifies invasion” (page 287).

When it comes to weaning, we have Gerber; but our ancestors did not. What they did was pre-masticate hard food for babies, as a mother bird would for her offspring. This is another opportunity for immune education. What shall we give baby today? One virus often passed on is Epstein-Barre (EBV). If you don’t get it as a toddler, you will probably get it after puberty in the form of mononucleosis, because it travels through saliva. This might not matter so much if a correlation between mono as a teenager hadn’t been linked to a threefold increase in MS. So put aside your squeamishness and start chewing up food for that baby you love! You will also help significantly to protect against allergies developing by age five. What does this EBV virus do? Apparently it insinuates itself in the B cells of the immune system and, if acquired before age two, will strengthen the immune system; but if it arrives late, it appears “to strengthen aggressive tendencies,” aggression that may turn against the self (page 204). Some optimistically envision an EBV vaccine to eradicate MS. Or, should we take the other tack and try to work with nature rather than against her? After all, manmade antibiotics before age one result in 50 percent more asthma, according to a survey of twenty studies.

Velasquez-Manoff definitely has a way with words. Consider this: we have “a genome dramatically sculpted by worms” (page 94). All those prehistoric wormy sculptors predisposed mankind to our current immune responses, one of which is immunoglobulin E, an antibody formerly kept occupied by the hookworm. However, the better equipped you are to cope with hookworm, the worse your allergies will be when you don’t have it. As with allergies, so with asthma. Researchers have found a consistent inverse relationship between asthma and hookworm infection. “By subverting the host’s immune response, worms prompted tolerance to third party proteins. Hookworms incidentally taught people to tolerate dust mites” (page 87). Blood flukes might help, too, but there’s a catch. Too heavy a worm load and your defenses may not be able to handle bacterial or other health challenges and you will suffer as a result.

Once again, Nature shows us the value of moderation and balance. Too much hookworm or too little? Similarly, you can have too much Helicobacter pylori, leading perhaps to ulcers and stomach cancer, but, if you don’t have enough you will be prone to asthma. This particular bacterium—which resides in all of our stomachs— comes in varying degrees of virulence. There is one strain that, more than others, predisposes us to stomach cancer. What else does H. pylori do? It helps regulate stomach acidity to protect itself from competitor bacteria and, coincidentally, reduces our chances of GERD, gastro-esophageal reflux disease. In a very big epidemiological study called NHANES, H. pylori correlated inversely with allergic disease. It may also protect against autoimmune diseases “. . . insofar as the bug elicits damaging inflammation, it will worsen health. But to the degree that it strengthens immune regulation, it will prevent diseases of immune dysregulation. It can do both” (page 161). Here is more argument against using antibiotics recklessly—and away with hand sanitizers!

Back to autoimmunity. If you have one of these diseases, you might be willing to try a dose of hookworm. The author did. He was additionally motivated by the prospect of having a child and wondered about the genes he might be handing on. I will leave it to you to read his story and those of others who have thus infected themselves to varying degrees of satisfaction. The microbes and parasites in question kept the immune system busy, so it didn’t cause trouble or engage in “friendly fire” against the self. You will find in the hookworm underground chapter a website to investigate online. Barring that, what else should you do? Avoid alkalizing the skin with soap and keep proteins away from inflamed skin: remember the peanut oil in the diaper rash cream. Avoid the antibacterial, antifungal chemical triclosan. Visit a cowshed or a pigpen with your baby. Drink unpasteurized milk. Avoid central air conditioning.

Here you will find an intelligent, detailed, eye-opening, and indeed fascinating account of recent research into the links between parasites and immune problems. However, I’m disappointed that Lyme disease is not even mentioned. Could it be that this East Coast scourge will have its silver lining? If we carry some of those spirochetes around will we be less prone to allergy and auto-immune diseases? Apart from that, I recommend this book to anyone motivated enough to dig in. I haven’t even mentioned the chapters on autism or inflammatory illnesses like cancer and heart disease. There is a lot of meat here for any reader to chew on.

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Spring 2013.

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