Auto-immune disease HLA-B27, client pain free on no starch, paleo diet

In August 2010 I met Tab, an energetic 28 year old, through CrossFit Auckland where I work as a nutrition coach. Tab had a goal to lose weight. As we went through her medical issues Tab told me she had an auto-immune disease, non specific, but linked with the HLA-B27 gene. As a result she suffered back pain which was at times debilitating, and she swallowed voltarin to keep it at bay. It was always present and she could no longer run without a lot of discomfort. Another symptom of this auto-immune disease for Tab was iritis which flared up every few months, also eczema. She also said that she had problems with some foods that caused IBS symptoms; sugar, corn, dairy and mushrooms had been identified as causing problems for her.

When anyway even breathes the word auto-immune disease, my first response is a strict  paleo diet, and possibly removing eggs and nightshades as well. Loren Cordain has written extensively about the connection of agricultural foods triggering auto-immune disease. I suggested Tab trial a strict Paleo diet.

But what about this specific gene HLA-B27? I’ve seen clients with this before. HLA-B27 is strongly associated with ankylosing spondylitis (AS). 95% of people with AS have this gene, although only a small percentage of people (10 – 20%) with HLA-B27 develop AS. It is also associated reactive arthritis (Reiter’s Syndrome), inflammatory eyes disorders, uveitis and iritis, psoriatic arthritis and ulcerative colitis and irritable bowel syndrome (IBS).

There are several theories as to why people with this gene develop auto-immune diseases. With respect to AS sufferers, they also have HLA-B27 gene plus IBS, suggesting a gut problem may contribute. (Although Tab has never had a positive diagnosis of AS, she had relatives with it, and her back pain suggested it). As only a small percent of people with the gene develop AS, this suggests an environmental trigger. (As Matt Ridley says in Nature via Nurture says “Nature loads the gun, environment pulls the trigger”) Dr Alan Ebringer, at Middlesex Hospital, London noticed this link and began researching a possible trigger, which he thought might be a microbe. The hypothesis was that a certain percentage of people were infected by a microbe that possessed molecules resembling the blood group HLA-B27, when a person becomes infected by this microbe, and develops anti-bodies against it, these same anti-bodies attacked their own similar tissue.

After testing different microbes in rabbits (injected with HLA-B27 lymphocytes) a bowel microbe called Klebsiella was identified. Klebsiella appeared to have molecules that resembled the HLA-B27 blood group and also the collagens found in the spine and large joints. Klebsiella microbes are a normal component of human bowel flora, but AS patients tested were found to have greater amounts in their stools. Elevated levels of antibodies to Klebsiella were found in AS patients, especially during the active phase of the disease, i.e during flare-ups. Further studies in other countries also found elevated anti-bodies to klebsiella in AS patients. The next problem was getting rid of the klebsiella. Antibiotics will kill it, however reinfection is likely. The answer came, like many discoveries, by accident. One of Ebringer’s patients wanted to lose weight, and asked for a diet plan that would work. He devised an unconventional plan. As much steak and tomatoes as you can eat, plus a bottle of red wine a day! When he next saw the doctor he remarked “Not only have I lost weight, but my joint and back pains have disappeared!” The penny dropped for Ebringer, the diet lacked starch, the klebsiella must be living in the gut feeding on undigested starch. Tests on patients confirmed this, and he found several nutrition studies that demonstrated bacterial growth in the colon is fed by dietary starch. Ebringer tested a no starch diet on hundreds of AS patients at the Middlesex Hospital in London. These patients continued their medication, however he found he could achieve therapeutic effects with much lower levels of drugs. The low starch diet was found to be particularly effective for those with early stages of the disease, before irreversible spine and joint damage. It is also pertinent to note that he found not all AS patients respond to a no starch diet, but it is worth trying as it usually makes a difference.

Carol Sinclair, who suffers IBS, back and other joint pain, wrote a very accessible book on her own search to find a cure for what seemed like multiple health problems. Subsequent tests showed she had the HLA-B27 gene which led her to the research by Dr Ebringer. She experimented with a starch free diet, and found her IBS resolved and her pain disappeared.

I’d read this book some years ago and when Tab told me of her medical problems, which mirrored Carol Sinclairs, it seemed to me that she might benefit from a starch free diet, in addition to an anti-autoimmune paleo diet, and I suggested she read Carol’s book. She immediately read both “The IBS Low Starch Diet” and “The Paleo Diet”, and altered her diet. The Paleo diet cuts out all gut irritating foods, that cause leaky gut. A leaky gut allows fragments of bacteria and other partially digested proteins to get through to the bloodstream, and if these are similar to our own tissues, like the klebsiella bacteria, an  auto-immune reaction is set up. So in theory, a dietary approach that allows the gut to heal, and also decreases the food source to the offending bacteria, should reduce the auto-immune reaction.

Here is Tab’s own story:
“My name it Tab and I started Paleo eating at the end of August when I meet Julianne through CrossFit, I was tired of being overweight and needed to get a handle on my fitness before returning to work. I am 5’10″ weighed in at 98.8kgs on August 21st, I now weigh 88.3kgs, and I’m at least a dress size smaller. (15 December 2010)

I have an Auto-immune disease not specifically diagnosed, however I’m HLA-B27 positive and I get iritis in alternative eyes when I’m stressed, and my back constantly gave me pain causing me to chew through pain killers. I’ve always been told that there was no cure and that all we can do is manage the pain. Julianne put me onto the IBS diet book which had some interesting information about being HLA-B27 positive, I felt like the book was written about me. The book suggested that starch could cause these problems, through leaky gut and my body attacking itself. So I decided to remove all starch from my diet. And wow would you know it……… my pain reduced within 3 days.
At first it was difficult to remove bread and rice and pasta and other starches from my diet as I felt like I was missing out, but with advice and encouragement from my Husband and Julianne I have managed it. In November I was still getting some pain, and I discovered quite by accident that the Vitamins* I was taking were also adding to my pain, as once they ran out my pain completely disappeared, returning occasionally.

I still occasionally struggle to maintain Paleo eating and have occasional moments where I think I’ll be okay and eat some potato or something only to discover that my pain is back, however I’m still slowly losing weight, pain free and enjoying experimenting with natural foods. Another result was that my eczema cleared up.”

*The Vitamins were Usana Essential Multivitamin and Mineral tablets. Here is a list of the “Other Ingredients” contained in the supplement.
MICROCRYSTALLINE CELLULOSE, PREGELATINIZED STARCH, CROSCARMELLOSE SODIUM, COLLOIDAL SILICON DIOXIDE, ASCORBYL PALMITATE, DEXTRIN, DEXTROSE.

A quick search and on http://celiacdisease.about.com/od/medicalguidelines/a/medications.htm found this statement “…any starch ingredient (including “pregelatinized starch” and “sodium starch glycolate”) not labeled specifically as coming from a gluten-free source — for example, corn, potato, tapioca — should be a cause for alarm. In addition to starch, other inactive ingredients that might come from wheat or barley include — but are not limited to — dextrates, dextrins, dextri-maltose, and maltodextrin.”

Either the starch or gluten derived filler (Tab discovered she was also extremely sensitive to gluten) in the multivitamin was enough to cause an ongoing level of chronic pain. Without this multivitamin Tab experienced complete relief from back pain and was able once again to run without discomfort.

Further reading and resources:

THE CROSS-TOLERANCE HYPOTHESIS, HLA-B27 AND ANKYLOSING SPONDYLITIS
BY ALAN EBRINGER

http://www.kickas.org/as_dietary_primer.shtml

The Bacterial Connection to other Chronic and auto-immune conditions.

There is growing interest in the theory that bacterial (or other biological agents), can trigger diseases in susceptible people. Ebringer’s research also found people with Rheumatoid arthritis, who have the HLA-DR4 gene, have anti-bodies to proteus bacteria. And that ‘molecular mimicry’ may contribute or cause this auto-immune disease also.

Rheumatoid arthritis is caused by Proteus: the molecular mimicry theory and Karl Popper.
Ebringer A, Rashid T.
Front Biosci (Elite Ed). 2009 Jun 1;1:577-86.

Another resource on the treatment of rheumatic diseases with antibiotic therapy here:

http://roadback.org