The hygiene hypothesis suggests a correlation between what Sandage refers to as “western society’s obsession with sterile, germ-free environments” and the rise of allergic and autoimmune diseases. Simply put, being too clean makes us sick. Ironically, the solution offered by this hypothesis is to re-introduce parasites and bacteria into our body.

There are no cures for any autoimmune disease yet, and most treatments are partial at best (often with dangerous side-effects). Despite the unappealing idea of ingesting pig whipworm eggs, I have no doubt that many of the millions of people affected by autoimmune diseases would consider doing just that if it is truly viable.

Current research seems to be supporting it’s efficacy. Sandage sites the article, “The Worm Returns” (Nature, November 8, 2012) by Joel V. Weinstock, M.D. of Tufts University that documented “a significant reduction in exposure to helminths has eliminated a natural mechanism in our bodies that prevents the onset of certain autoimmune disorders.” He also points out that the FDA and similar European Agencies have recently approved further testing for “crohn’s disease, multiple sclerosis, autism, and others set to begin in ulcerative colitis, psoriasis, type 1 diabetes, and other immune-mediated diseases.”

With my background in multiple sclerosis research, I was very excited to see the results of a new study at the University of Wisconsin published in the Multiple Sclerosis Journal in 2011, Fleming et al. The study concludes that “TSO [Trichuris suis ova, or pig whipworm eggs] was well tolerated in the first human study of this novel probiotic in RRMS [relapsing–remitting multiple sclerosis], and favorable trends were observed in exploratory MRI and immunological assessments.”

There was also an excellent editorial published in the Journal of Neuroimmunology (2011, 233: 3–5) entitled “Helminths and multiple sclerosis: Will old friends give us new treatments for MS?” The article sites a few other studies, dating back to 1966, which have “demonstrated a dramatic beneficial effect of helminth infections on the course of their MS subjects clinically, radiologically, and immunologically.”

*You can find my previous posts on the subject here:

More Reasons to Get Dirty (Hygiene Hypothesis)

More on the Hygiene Hypothesis and the Terrifying Treatment

The Hygiene Hypothesis: A Plausible Explanation for the Rise of Allergic and Autoimmune Diseases

Whether to circumcise your boy is one of the most difficult decisions expectant parents in the U.S. have to make right now. Twenty years ago it wasn’t even something most parents here thought of—circumcision was routine. And in many other countries in Europe, South America, Southern Africa and Asia it is not something parents usually think about because circumcision is rarely practiced.

So why is it suddenly a consideration for American parents-to-be? Globalization and the realization that circumcision is something not practiced in most of the world, especially the “developed countries,” we are now questioning whether it should be routine in the United States. (WHO estimates that only about 30% of males are circumcised in the world—primarily Muslims).

History

Circumcision has a very interesting past and has been a significant part of many for thousands of years, if not longer. The first records of circumcision come from ancient Egypt in 2400 B.C. (Egypt is still one of the countries with the highest male, and female, circumcision rates in the world). It has a long history in the Jewish and Muslim religions as well. Circumcision is also practiced widely in many East African cultures as part of a rite of passage into manhood. While there are many theories as to why it initially emerged in various regions and became part of the religion, I think it was most likely due to living in a warm environment where dirt and sand got below the foreskin and with limited bathing contributed to life-threatening infections.

It was not until the 19th^th century that males were circumcised for non-religious reasons. Circumcision was thought to prevent a number of medical problems—from alcoholism to syphilis—and social ills such as masturbation. It did not become popular in the United States until the 1930s. The U.S. military began circumcising the soldiers for sanitary reasons and along with the institutionalization of childbirth circumcision rates increased rapidly. (Some theorists argue that hospitals were incentivized to perform the surgeries because insurance became widespread and covered the expensive procedure after World War II).

Present-Day

In 2012 the American Academy of Pediatrics released a statement in support of circumcision for newborn boy babies. According to their website “a comprehensive review of the scientific evidence, the American Academy of Pediatrics found the health benefits of newborn male circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision.”

Most other countries in the world do not agree with advocating circumcision for reasons such as the following:

- not enough research and qualified studies that proves circumcision drastically reduces STDs
- circumcision has many complications, like the risk of infection
- the human body is not defective at birth and therefore does not need to be altered
- severe pain and suffering
- reduction or loss of sexual functioning
- it is a violation of a children’s rights

Anti-circumcision activists point out that that the U.S., Somalia, and South Sudan are the only three UN members that have not ratified the UN declaration of the rights of the child. In Germany, for instance, circumcision is considered illegal. According to the BBC article, “German Court Rules Circumcision is Bodily Harm,” the court said that a child’s right to physical integrity trumps religious and parental rights.

My Choice

In 2012 my husband and I were faced with this decision with our first child. After months of consideration, we chose not to circumcise our son. Ultimately it was a hard decision because we saw the pros and cons to both options and were not dramatically swayed either way. After all my research, however, the evidence was not strong enough for us to dramatically change the body of our newborn son. But for the parents that choose circumcision, there isn’t much evidence to prove there is harm in that choice.

2013 will be different.

2012 was full of traveling throughout Mexico, Southeast Asia, Northern Europe, and Egypt. I also had the great opportunity to edit a memoir mentioned in this New York Times article featuring the author. Much of the rest of my time was spent learning Polish in Gdansk, Poland.

Two of the most important events of my lifetime also occurred last year—a wedding and a baby. To add to the life changes, in July my husband and I moved across the Atlantic from his home country of Poland to my home country—the United States.

Lucky enough to travel extensively last year, I was subsequently affected by the experiences I had in many other cultures. After the birth of our son, I can’t help but think deeply about the differences in raising children across cultures. Therefore, many of the blog posts going forward will focus on issues of children’s health in different cultures. In academic terms, my research and writing is considered “applied pediatric anthropology.” My goal is to help us all learn how to raise healthier children—mentally and physically.

My blog entries will explore topics such as:

Delivery in hospitals in the U.S. vs. in the savannas of Kenya

Perspectives on circumcision: A cross-cultural comparison of the U.S., Europe, and the Middle East

Where in the world is co-sleeping the norm, where are cribs the norm?

How often do we carry our children in the U.S. vs. in rural Thailand?

Please tell me…

What has surprised you to learn about raising children in a culture other than your own?

Are there practices that you think we, as Westerners, should incorporate into our own culture?

I asked a rheumatologist in Oaxaca why he often used intramuscular NSAIDs for his patients with autoimmune diseases–his response: to protect the stomach. This is very important for patients with autoimmune diseases who are typically taking many other medications, such as prednisone, that wreak havoc on the intestines. Adding oral NSAIDs that are also processed via the stomach, only adds to the damage (both short-term discomfort and long-term complications).

Therefore, the idea of taking IM NSAIDs for pain and inflammation in autoimmune diseases seems novel, yet obvious.

So I wondered; Why haven’t doctors in the U.S. prescribe IMs more often? And particularly; why not NSAIDs for autoimmune patients?

Instead, rheumatologists in the U.S. prescribe large doses of oral NSAIDs, then have to prescribe other medications (like proton pump inhibitors) to treat stomach symptoms. Why not just avoid the stomach irritation in the first place by replacing oral NSAIDs with intramuscular NSAIDs?

The problem: SYRINGES

IM medications require syringes, and with a little digging I uncovered an alarming amount of problems associated with the widespread use of syringes.

–Expense
–Inconvenience (need to have someone else–preferably a trained professional–administer medication)
–Complications at the injection site (pain, bruising, infection, hematoma, etc…)
–Increased risk of disease transmission (sharing unsterilized needles)
–Environmental contamination

Despite the potential advantage for some individuals, overall it seems that injectable medications are being dangerously overused in Mexico. That being said, I think this is just another example of the importance of anthropology in the medical world. Perhaps Mexican doctors and patients should curtail the use IM medications when unjustifiable, whereas U.S. doctors and patients can learn to use such a treatment in select cases, like NSAIDs for autoimmune patients, with proper administration.

Syringes in Mexico…

After a doctor’s appointment, patients are given a slip of paper with the name and dosage of the injectable medication.

That’s it.

No instructions on where to get the syringes, who should inject it, how to inject it, side effects, warnings, or how to properly dispose of the syringes. Nor do the pharmacies give the obligatory information sheets required in the U.S. Just provide a box of liquid medication. It is then your job to figure out how to get it into a syringe, then into your body.

Luckily the supermarkets have isles full of syringes, usually just next to the shampoo. You have your choice of a variety of sizes and brands. Once you purchase a box, again, you will not find any detailed instructions included. Just a simple 5-step process on the box–from washing your hands to putting pressure on the site afterward. And that’s it. About the same amount of instruction you will find for how to apply conditioner to your hair after shampooing. Scary.

For many these words are just concepts, but not at the Myelin Repair Foundation (MRF). In 2003 we embarked upon a very innovative and radical mission. Millions of people are suffering with MS around the world without an effective treatment, and the MRF was formed to solve this problem. The solution was not an easy one, however, which is probably why the problem has remained since the disease was first recognized in 1868.

Scott Johnson, President and Founder of the MRF, came up with the solution: pull together a team of the most brilliant scientists in the field of myelin repair and ask them to develop a drug target to treat MS within five years. The top experts in the area of myelin repair were at five different universities, so Scott asked them to collaborate. This was a ground-breaking way of organizing research.

The MRF has successfully challenged the way medical research is being done—and we believe that the model is having a significantly positive impact on the field—but we want to push the boundaries of innovation in medical research even further. We want to help generate solutions to accelerate drug discovery and development in all areas of medical research, for all diseases, and all patients.

That is why the Robert Wood Johnson Foundation (RWJF) recently granted the MRF an investment of $189,000. Nancy Barrand, Senior Program Officer of the pioneer portfolio fund at the RWJF, explains that the investment was made to “organize two virtual forums to engage innovators both inside and outside the medical research field to explore ideas and strategies like the MRF model that could lead to more effective and efficient ways to fund and conduct research.”

The MRF is working with Institute for the Future in Palo Alto, CA to develop this virtual forum, or game. The game will use “crowd sourcing” technology to discuss solutions to problems that currently limit the development of patient treatments.

Jane McGonigal, Ph.D., game designer and Director of Games Research and Development at the Institute for the Future (ITFT), believes people that play games, or “gamers,” have the capability to solve the world’s most difficult problems. Unlike most parents, she recommends spending more time in front of video games in order to accomplish great things in the real world.

Dr. McGonigal’s theory is summarized in her twenty-minute TED talk. She believes that it is imperative to harness gamer qualities like “blissful productivity, “desire for epic meaning,” and “urgent optimism” to solve the world’s biggest problems.

MRF’s game will be played by approximately 300 participants in August or September and will include a diverse cross-section of participants. According to Carol Menaker, Director of Communications at the MRF, this is a “unique way of having a broad-based conversation on a topic we think is very important.”

At the MRF we know collaboration is crucial to solving any major problem, and isn’t open-source the ultimate form of collaboration? As Dr. McGonigal says, “games challenge players to tackle real-world problems, through planetary-scale collaboration.”

For years, fish continued to win the gold for healthiest food. But now we have to be weary of fish—and only eat certain types that are raised in certain places and are not contaminated with certain chemicals like mercury.

Smoking, since I was born, has always been considered one of the most detrimental habits. Almost everything you read about “being healthy” includes something about managing your weight and not smoking. It would be outrageous for a doctor to prescribe nicotine, or tell a patient to keep smoking.

Or would it?

I just returned from the ABDA (American Behcet’s Disease Association) Medical Conference in Orlando with a new perspective about smoking. My first clue that smoking might be pushing its way back into society should have been the extremely large number of the participants that smoked. During breaks, instead of sitting inside checking email like most medical conference attendees, I found many people outside in the hot Florida sun inhaling cigarettes.

Talking to patients outside I heard comments like, “I tried to stop smoking but my symptoms got worse.” Or, “My doctor doesn’t believe me, but I am so much healthier when I smoke.”

Then some of the non-smokers would chime in, “I know. I quit smoking and I’m trying to manage my symptoms with prescribed medications, but I still don’t feel as good.”

This was surprising to me, but not as shocking as the news that Dr. Yusuf Yazici, rheumatologist and researcher at NYU, presented during his lecture; “The Latest Treatments for Behcet’s Disease.”

Behcet’s disease is an autoimmune disease that results from damage to blood vessels throughout the body, particularly veins, and according to Dr. Yazici, “Nicotine patch therapy should be used more as a treatment.” He went on to discuss other new treatments for Behcet’s such as cytokine therapy and biologics as if there was nothing controversial about his earlier comment.

Can smoking really be good for your health?

There are many contradictions but few seem so paradoxical. Apparently the good side of this bad drug has been known for quite some time. Autoimmune disorders, like Behcet’s, are treated with immunosuppressants, of which nicotine is one. Logically, then, it would follow that nicotine would help. I wonder why this is “new” news then.

A 2004 study published in the Clinical and Diagnostic Laboratory Immunology concluded that “Tobacco smoking suppresses the immune system…Interestingly, smokers have a lower incidence of some diseases, including ulcerative colitis, sarcoidosis, endometriosis, uterine fibroids, farmers’ lung, pigeon breeders’ disease, Parkinson’s disease, and Sjögren’s syndrome. Many of these diseases are inflammatory in nature or have an inflammatory component.” (1)

Even though there is new, compelling evidence that nicotine therapy reduces symptoms of autoimmune diseases, like Behcet’s, we should know by now that nothing is that simple when it comes to your health (especially treating an autoimmune disease).

Do your research, and of course “talk to your doctor,” before running to the corner store for a pack of smokes if you think nicotine might benefit your condition, because limited knowledge is dangerous. Understanding all of the previous dietary and medicinal suggestions for your illness, for instance, can provide a framework and healthy skepticism for the newest health advice. Just like knowledge of history reveals that mistakes are often made, proving the benefit of discernment today and tomorrow.

History can also remind us that:

Many of the ingredients in a cigarette are still undeniably bad for the body. Thus, nicotine patches—not cigarettes themselves—are being suggested. See the 2004 paper published in the Journal of Investigative Dermatology, entitled, “Nicotine and Biochanin A, but Not Cigarette Smoke, Induce Anti-Inflammatory Effects on Keratinocytes and Endothelial Cells in Patients with Behçet’s Disease” for more information. (2)

We cannot assume that nicotine helps with all symptoms because “the efficacy in the treatment and prevention of other systemic manifestations of BD is not proven,” according to a recent study published in March 2010 in the Oxford Journal of Rheumatology. This study does conclude, though, that “Both smoking and nicotine-replacement therapy may be efficacious not only on oral aphthae, but also on other mucocutaneous manifestations”—major Behcet’s symptoms.

The research is still contradictory. For instance, Behcet’s is a type of vasculitis. Vasculitis simply means inflammation of the blood vessels. And therefore there is a logical argument stated on the website of Arthritis Research UK which says “Avoid smoking. It makes the blood vessels constrict (become narrower inside) and can therefore make vasculitis symptoms worse.”

I mentioned that this idea, the hygiene hypothesis, has become a plausible explanation for the high incidence of autoimmune and allergic diseases in the developed countries–as opposed to countries where lack of healthcare and sterile environments is typically seen as a problem. A study at Northwestern University led by Thom McDade, Ph.D. and an associate professor of anthropology, added proof to this theory. His results showed that too much hygiene can also result in cardiovascular problems as an adult. McDade’s evidence is based on levels of C-reactive proteins, which is a protein in the blood that increases as a result of inflammation. As I mentioned previously, inflammation and C-reactive protein levels are critical in autoimmune and allergic diseases, as well as cardiovascular diseases.

In the March 24, 2010 Chicago Tribune article, “NU Study: Dirt’s Good for Kids,” Dade is quoted as saying “there is such a thing as being too clean. The contrarian theory, known as the hygiene hypothesis, is gaining traction in some medical circles.”

Read my previous blog entries on this topic:

More on the Hygiene Hypothesis and the Terrifying Treatment

The Hygiene Hypothesis: A Plausible Explanation for the Rise of Allergic and Autoimmune Diseases

There has. Perhaps the most sited study was lead by Dr. Alan Kristal, DPH, MPH at the Fred Hutchinson Cancer Research Center. The 2005 study, which included 15,500 people age 45-55, reported that yoga can help prevent weight gain.

But exactly how is still somewhat of a mystery. One theory suggests that the strong mind-body connection yoga develops, helps you become aware of what it feels like to be full — and therefore when to stop eating. Dr. Kristal’s slightly different opinion suggests that “regular yoga practice is associated with mindful eating…which helps change the relationship of mind to body, and eventually to food and eating.”

I find the most interesting and scientifically viable explanation that of Rebecca Brenner. She holds a Ph.D. in nutrition and is the owner of Park City Holistic Health in Utah. In a recent article published in Yoga Journal, which also cites Dr. Kristal’s study, Rebecca explains that yoga strengthens the digestive system — in addition to the muscles we typically think of when we hear the word strength.  “Digestive health is essential to all health,” states Rebecca. “It will affect the way you break down and assimilate food, vitamins and minerals. If you are not digesting properly, your body will trick you into cravings that can affect your weight loss.”

I also find it extremely interesting that when I was searching for research regarding the weight-loss benefits of yoga, I found an article quoting my cousin, Rebecca Brenner!

In my yoga class last Saturday lead by Nanci Conniff (who teaches yoga to students and sports teams at Stanford), she mentioned a recent study at Ohio State University which proves the positive effects yoga has on inflammatory conditions. Nanci spends her career teaching Stanford athletes how to incorporate yoga into their training regimens — for both physical and mental benefits. I often laugh picturing 300lb football players doing the cat pose.

I’m always on the lookout for cutting-edge research which will help us lead healthier lives, so I looked up the study and want to spread the news. If we ever doubted yoga’s health benefits and used it as an excuse not to partake in the activity, we can’t run any longer!

Last month, Dr. Janice Kiecott-Glaser and her team at Ohio State University published a study which showed that regular yoga practice strongly reduces the amount of Interleukin-6 in our bodies (by 41% in their particular study). Cytokine Interleukin-6 plays a large role in our bodies inflammatory system. Too much, though, can lead to diseases such as stroke, type-2 diabetes, autoimmune conditions, and heart disease – to name a few.  This study proves that yoga allows us to regulate and reduce the production of Interleukin-6 in our bodies, thereby reducing chronic inflammation — and improving the quality of our lives! View the study published on PubMed.

The Mayo Clinic website published an article shortly after entitled: Yoga, Tap Into the Many Health Benefits

According to the article, yoga has the ability to reduce stress and increase fitness (not very surprising). Managment of chronic health conditions is also mentioned, perhaps as a result of the Ohio State study. I was surprised to read, though, that yoga can contribute to weight loss. It does not say how, exactly, just that “If you’re overweight or have binge-eating disorder, yoga may help you make the healthy lifestyle changes necessary to gain control of your eating and drop those extra pound.” Maybe this should be the next study…

Okay, no excuses for me this morning, I have twenty minutes to get to Yoga!

Sound familiar?

Perhaps washing our hands all of the time may not be such a great idea, if there is any truth to the hygiene hypothesis.

Like most people in the U.S., and other developed countries, I’ve been taught that germs are bad. I even read a book to my niece recently called, Germs Make Me Sick! (I’m not kidding, you can find it on Amazon for $5.99).

Since I was old enough to clean (which was pretty young in my family), we spent weekends waging war on germs in our own little microcosm of the world (our house). I learned how to spray and scrub the bathroom with all sorts of disinfectants, washed my clothes with extra-strength detergent, and scrubbed every little bit of food particle off of my dishes with antibacterial dish-washing soap.

Then, after all of that cleaning, I had to clean myself. I always spent an extra long time in the shower after a hard day of cleaning, just to make sure that I killed any of the bad germs that might have leapt onto me from my sponges or mops.

If you grew up in the U.S. you can probably relate to this.

Few of my habits have changed since childhood. My shower is still my safe haven against germs (once it’s been scrubbed with Comet, of course). Like the products that reside under the kitchen and bathroom sinks, I have an equally vast pharmacy of cleansing products in my shower for myself: different kinds of cleansers for my face, hair, and body. And often numerous types for each part of my body–most accumulated out of boredom, really, while waiting 30-minutes at Walgreens for prescriptions.

So, the idea that being too clean can make you sick is fascinating–and scary.

It’s extremely ironic to think that simply growing up in a developing country–with the “highest” medical care, and cleanliness–can actually cause us to grow up to be very sick. The radical idea that the hygiene hypothesis proposes suggests that our habits of cleanliness, sterilization, vaccination and antibiotics may cure us from the common cold but can leave us fighting severe allergies or a devastating disease for the rest of our life.

And the cure is even scarier.

Perhaps just as disturbing as the idea that we are getting sick from our efforts to avoid illness, is the treatment. In order to cure our lack of exposure to parasites and other infectious agents, hygiene theorists are testing cures by purposefully injecting people with the larvae of a parasitic worm (or helminth). This treatment, referred to as Helminthic therapy, has proved to be promising in research studies.

I could probably get used to the idea of not showering or cleaning as much (okay, I could definitely get used to not cleaning), but I’m not sure I would be able to knowingly ingest parasites, like hookworms, into my body.

Ironically, if this hypothesis holds true what many of us in the industrialized world have been taught to fear would be our cure.

So maybe the next time you ride the subway touch all of the poles. Then go home and take out the trash, making sure to adequately touch the lid of the trashcan. Next, scrub your toilet with the kitchen sponge. Then pick up some food you find on the floor (check under the oven or the refrigerator) and eat it. At no point should you wash your hands.

If someone looks at you in disgust, say, “Hey, I’m just trying not to get sick.”

What do you do now in order to prevent yourself from getting sick?

Would you change some habits if we found out that the hygiene hypothesis was true?

What would be the hardest “cleanliness” habit to break?