Hmmmm.....

[Guest guest]

Just saw this intriguing article in Todays

San Diego Union Tribune. Talks about bacteria, and

worms - yes worms - and their affect on the gi tract

and immune system. Curious.

Germ-loving experts say

we're too clean

They think bacteria help immune

system

By Stacey Burling

KNIGHT RIDDER NEWS SERVICE

February 9, 2000

PHILADELPHIA -- Your mother probably won't agree,

but some scientists think people in industrialized

countries are too clean.

That's right. Too clean, too worried about germs. Put

away that antibacterial soap. Let your kids play barefoot

in the dirt. Use antibiotics sparingly.

The idea is that humans evolved over millions of years

in a dirty environment. Billions of bacteria live in our

guts and they always have. In fact, there are more

bacteria in our bodies than cells.

Until relatively recently, almost everybody had worms.

Though improved sanitation and antibiotics are

indisputably great public-health triumphs, proponents of

the " hygiene hypothesis " believe we may have gone too

far: Some of these tiny creatures we're killing may play a

vital role in fine-tuning our immune systems, and we'd

do well to understand what they do before further

altering our intestinal flora -- our personal ecology.

Some researchers hypothesize that reduced exposure to

some bugs may have something to do with the rise of

reflux disease, allergies and autoimmune diseases such

as inflammatory bowel disease, rheumatoid arthritis and

multiple sclerosis.

One team is experimenting with giving worm eggs to a

small group of Americans with intestinal diseases that

are rare in developing nations, where almost everybody

has worms. It's far too early to tell for sure, but

researchers were pleasantly surprised that some of the

patients were so happy with the treatment that they asked

for more.

Other scientists are working in the growing fields of

probiotics -- using foods or supplements to deliver good

bacteria -- and prebiotics, altering diets to make the gut

more hospitable to useful bugs.

Many infectious-disease experts are highly skeptical of

these approaches, pointing out that improved sanitation

has clear benefits -- a much-lengthened life span, for one

-- and that there is virtually no proof for the hygiene

theories.

" This is not a mainstream idea, " said Lorber,

chief of infectious diseases at Temple University

Hospital.

Even in the cleaner modern world, humans still are

bathed in microorganisms, he said.

" I don't really believe there's much difference in the bugs

we have in our intestines now and the bugs we had

thousands of years ago, " Lorber said.

Others are not so sure.

" There's this whole society that we live with all our

lives, " said Gordon, a microbiologist at

Washington University School of Medicine who studies

the complex, finely tuned society of microbes that

inhabits human guts. " It's a silent society, but it's critical

to our health. "

Antibiotic resistance, he said, is not the only danger of

indiscriminate use of antibiotics -- what he called

" microbial genocide. " Humans also may be altering the

intricate balance of good and bad bugs in their bodies.

" We may be, in ways that we don't understand yet,

making us more susceptible to diseases whose microbial

basis we do not understand, " Gordon said.

It's not just drugs. It's our diet, the way we raise food,

the way we live.

" It's everything; we've changed everything, " said

Saavedra, a pediatric gastroenterologist and nutritionist

at s Hopkins University, who is studying adding

certain good bacteria to infant formula as well as to the

diets of older people.

Said Blaser, an infectious-disease specialist at

Vanderbilt University: " Our water is clean. Our families

are smaller.

" There's less transmission of bugs. It's my belief that that

has consequences. "

Blaser is studying Helicobacter pylori, a bacterium that

clearly has a dark side but may also do us good.

H. pylori is a significant risk factor for stomach ulcers

and cancer. It has been in decline around the world, and

so have those diseases.

But gastroesophageal reflux disease, which causes

stomach juices to back up, often causing heartburn, is

new to the 20th century and becoming more common.

Cancer of the esophagus, the tube between the mouth

and stomach, has been rising rapidly. Blaser, who got

reflux after eradicating his own H. pylori, espouses the

controversial theory that the bacterium may protect

against reflux and esophageal cancer.

Because of the growing evidence that H. pylori is not all

bad, Metz, a University of Pennsylvania expert on

the bacterium, says doctors should try to get rid of the

bug only in patients with symptoms of H.

pylori-associated diseases which need therapy.

Then there's the worm theory.

A University of Iowa research team believes that worms,

long considered disgusting intruders, may be good for

their human hosts.

Weinstock's team there has been studying worms

and inflammatory bowel disease, or IBD, which includes

Crohn's disease and ulcerative colitis.

IBD is almost unheard of in developing nations, where

people routinely have worms, but has been growing

significantly in the United States and other industrialized

countries.

Worms are 'part of us'

Research has shown that worms modulate the immune

system, preventing it from responding so intensely to

pathogens. Without worms, Weinstock's team guessed,

the immune system might be more likely to overreact, as

it does in autoimmune diseases such as IBD.

" They've become part of us, " Weinstock said of the

worms that have lived in our guts through the millennia.

" We're the first population never to experience these

worms. Suddenly, our immune system is out of

balance. "

To test the theory, Weinstock, a gastroenterologist,

asked six patients with intractable IBD to quaff a potion

of Gatorade and worm eggs, specifically the eggs of

Trichuris suis, a whipworm normally found in pigs.

The study was meant only to show that ingesting worm

eggs is safe, but a curious thing happened. Within about

two weeks, five of the six patients went into remission

-- for up to five months. The patients were begging for

more worms. They responded to retreatment as well.

The study was small, Weinstock said, and patients knew

they were getting the experimental treatment, so this

may have caused a placebo effect. Soon, the team will

begin a new study in which patients will not know

whether they are receiving worm eggs.

ph Urban, a U.S. Department of Agriculture

microbiologist and worm expert who works with

Weinstock's group, said the treatment could have some

risk. In some people, he said, the dampening effect of the

worms on the immune system could make it easier for

bad bacteria to grow.

" You have to be very careful with the worms to make

sure you don't push the balance too far in the other

direction, " he said.

Three trains of thought made the worm theory jell for

Weinstock.

He had spent years studying the impact of worms on the

immune system. Then, he edited a book on parasites

which got him thinking about the scientific tenet that " a

successful parasite provides the host with a survival

advantage. " And, finally, there was the fascinating

history of Crohn's disease, an incurable digestive

disorder that causes persistent diarrhea and abdominal

pain.

Started in the 1930s

" Up until the 1930s, Crohn's disease didn't exist, "

Weinstock said.

It first appeared in this country among wealthy Jews in

New York, he said, and was thought to be a Jewish

disease. Then it began to spread. Doctors thought it was

a white disease, then a disease of the North.

Now, Crohn's crosses all boundaries in the United

States. It has become eight to 10 times more common in

the last 30 years and is virtually at epidemic levels in

Canada, Japan and South Korea.

In Israel, Jews get it, but Arabs don't, Weinstock said. In

South Africa, whites get it, but blacks don't.

" This all points to environment, environment,

environment, " he said.

Weinstock and his fellow researchers put it all together

and wondered whether successful efforts to eradicate

worms might have led to the rise of this disease.

Of course, there may be other factors, such as a genetic

predisposition, at work as well. Other researchers also

are studying the effect of bacteria on IBD.

" Obviously, life is a lot more complicated than worms, "

Weinstock said.

Interestingly, Weinstock said, intestinal problems are

increasing in animals as well. Pigs, which are now raised

in clean pens, are getting sick. So are some species of

captive monkeys.

Baldassano, director of the Center for Pediatric

Inflammatory Bowel Disease at Children's Hospital of

Philadelphia, said he is seeing an " alarming " increase in

inflammatory bowel disease.

Ten years ago, the disorder began in adolescence or

young adulthood. Now, it is common to diagnose it in

children under 10 -- and the center is following about

100 children under the age of 5.

As a member of the board of the Crohn's and Colitis

Foundation of America, Baldassano has helped finance

Weinstock's work.

" I think it's a great idea, " he said.

He is not ready to give up other therapies, though.

" We're sort of at the third inning of a nine-inning

ballgame, " he said.

But Baldassano, who has Crohn's, thinks sufferers will

have few qualms about using worms if further studies

prove their value.

" If worms work, people would go for it, " he said. " They

may not tell everybody they're doing it. "