Richard G. Petty, MD

Chloroquine, Insulin and Inflammation

Your humble reporter was fascinated to read about some new research using the anti-malarial agent chloroquine as a potential treatment for the insulin resistance syndrome.

I have a personal reason for being interested. Hypoglycemia (low blood glucose) is an occasional feature of treatment with chloroquine and in 1980 a study first indicated that chloroquine might slow the break down of insulin by the liver. In the early 1980s there were a flurry of papers indicating that chloroquine did some subtle things to insulin and insulin receptors in many tissues. So we came up with the idea of measuring its effects in humans. There was a memorable occasion on which I was doing an outpatient clinic with an intravenous line in my arm. (English doctors are well known for doing experiments on themselves: I had a professor in medical school who said that you should never do to a patient what you haven’t had done to yourself. I shall leave it to you, gentle reader, to wonder if I’ve tried everything….).

So there I am doing my clinic when, around 11AM I begin to feel really strange: my glucose level was almost unrecordable and my insulin level was off the chart. Nothing that couldn’t be solved with a large dollop of sugar, but it made me very sympathetic to people who get hypoglycemic from their regular treatments.

Sometimes Nature does our experiments for us: we did a lot of work on diabetes because it is associated with high rates of vascular disease. So understanding the mechanisms by which diabetes does that may help illuminate some of the cellular disturbances underlying arteriosclerosis in general. We are also interested in the few illnesses in which a single disturbed gene may lead to a definable set of signs and symptoms. There is a rare illness known as ataxia telangiectasia in which sufferers have a high risk of developing some cancers particularly lymphomas and leukemia. People with the illness are very sensitive to ionizing radiation, have a specific type of immune deficiency, degeneration of parts of the brain related to muscle function and coordination and they age prematurely. More than ten years ago it was discovered that a single gene – ataxia-telangiectasia mutated (ATM) gene – was responsible for the illness. The gene is responsible for producing a protein that recognizes damage to DNA. It now seems that ATM may also be linked to metabolic and cardiovascular diseases. It does this by inhibiting a protein called JNK, a stress kinase involved in inflammation with related effects in insulin resistance and atherosclerosis. So to everyone’s surprise a gene that can cause a rare disease can also cause insulin resistance.

In the November issue of Cell Metabolism, researchers at Washington University School of Medicine in St. Louis and St. Jude Children’s Research Hospital in Memphis, Tennessee report that a small dose of chloroquine eased many symptoms of metabolic syndrome in mice, reducing blood pressure, decreasing hardening and narrowing of the arteries and improving blood sugar tolerance. The results suggest we may only need very low and perhaps infrequent doses of chloroquine to achieve similar effects in humans. Both insulin and chloroquine activate the ATM gene.

This adds to the data that some of the metabolic dysfunctions triggered by obesity may be linked to the inflammatory responses that go wrong in autoimmune disorders like arthritis and systemic lupus erythematosus.

And an older treatment for rheumatoid and lupus just happens to be chloroquine.

Chloroquine itself has some side effects, but this is important information that will help us design more effective and carefully targeted holistic treatments for both metabolic disturbances and inflammatory conditions. All in all, very good news indeed.

Another Reason to Eat Your Greens

“Health requires healthy food.”
–Roger Williams (Indian-born American Chemist who did pioneering work on the Vitamin B Complex, 1893-1988)

Earlier this year several news outlets including Time picked up a story that has been causing a great deal of discussion in medical circles.

Most of us have been extolling the virtues of fruits and vegetables for decades, but it’s always nice to have an extra piece of evidence to support what we’ve been saying. The question has been how to go from large-scale epidemiological studies proving the benefits of vegetables to the inner workings of a person’s arteries.

Investigators from Wake Forest University School of Medicine in Winston-Salem, North Carolina published an important study in the Journal of Nutrition. What they did was to study genetically altered mice, who had been bred to have a very high risk of developing rapid arteriosclerosis: the formation of fatty plaques in the arterial wall that can eventually block blood flow and lead to heart attacks and stroke.

Half the mice were fed a vegetable-free diet and half the mice were fed a diet that included broccoli, green beans, corn, peas and carrots.

After 16 weeks, the researchers measured the cholesterol content in the blood vessels and estimated that plaques in the arteries of the mice were 38% smaller. Cholesterol, and particularly the “bad” cholesterols VLDL and ILDL fell markedly in the mice on the healthy diet, but these improvements were not on their own enough to explain the improvement in the blood vessels: the anti-atherogenic effects of the vegetable diet remained largely unexplained by the variation in plasma lipoproteins or body weight.

There was a 37% reduction in serum amyloid – a marker of inflammation in mice – suggesting that consuming vegetables may inhibit inflammatory activity. This is line with data from other studies indicating that fruit and vegetables should be key components of an inflammation-lowering program. This is very important: in the last twenty years it has become very clear that arteriosclerosis is intimately associated with inflammation in the arterial wall.

Many inflammatory conditions including rheumatic fever, rheumatoid arthritis, systemic lupus erythematosus and psoriasis, are all associated with an increased risk of developing arteriosclerosis.

Interestingly some years ago Dean Ornish presented evidence indicating that diet and exercise could reverse arteriosclerosis. I’ve always found Dean’s work interesting, well done and persuasive. It surprises me to see how many people remain unconvinced. This new research provides indirect support for his work.

The average person only eats three portions of fruit and vegetables a day: we should all be eating at least five, and they should be of as many different colors and types as possible: there is excellent evidence that combinations of fruits and vegetables are much better for your health than just eating one or two types.

As an aside, I must admit that I’m no fan of animal experiments: I don’t and won’t do them. And every time that I hear about them, I think that we need to say a sincere thank you to the animal kingdom for their sacrifice in helping us.

“God, in His infinite wisdom, neglected nothing and if we would eat our food without trying to improve, change or refine it, thereby destroying its life-giving elements, it would meet all requirements of the body.”
–Jethro Kloss (American Nutritionist and Writer 1863-1943)

“In fresh fruit and vegetables and nuts are all the vitamins and minerals and high grade proteins the human body needs to bring it to a state of physical perfection and to MAINTAIN it in that state indefinitely.”
–Herbert Shelton (English Evolutionary Philosopher, 1820-1903)

“Nothing will benefit human health and increase the chances for survival of life on earth as much as the evolution to a vegetarian diet.”
–Albert Einstein (German-born American Physicist and, in 1921, Winner of the Nobel Prize in Physics, 1879-1955)

Parkinson’s Disease, Allergies and Inflammation

The symptoms of Parkinson’s disease have been reported throughout history, but it was first described in the modern era by the great Scottish neurologist James Parkinson in 1817. Even after all these years, we still do not know all that much about what causes it. There’s an interesting study in the August issue of the journal Neurology, which is the official publication of the American Academy of Neurology.

Investigators from the Mayo Clinic used what is known as a case-control design (196 cases and 196 matched controls). What they found was that people who suffered from hay fever or allergic rhinitis, are 2.9 times more likely to develop Parkinson’s disease over a 20-year period.

The researchers did not find any association with autoimmune illnesses such as lupus, rheumatoid arthritis, pernicious anemia or vitiligo. They also did not find any association with asthma.

In addition, people who developed Parkinson’s disease used anti-inflammatory agents less frequently than controls, although this result was not statistically significant. The results may support the hypothesis that there is an inflammatory component in the causation of Parkinson’s disease.

You may ask, “Why on earth would anyone even look at a link like this?” The answer is that there have been previous reports of an association between the use of non-steroidal anti-inflammatories and lower rates of Parkinson’s disease in men but not in women and Alzheimer’s diseases.

This study does not suggest that hay fever causes Parkinson’s disease: it provides evidence for an association between the two. Parkinson’s is probably a group of illnesses with different causes. However, if chronic inflammation around the upper airways could produce inflammation in the brain, we might have a whole new way of preventing a degenerative brain disease.

In a future posting I’ll talk about some natural methods for reducing the burden of inflammation in your body.

A New Way of Looking at – and Treating – Inflammation

Diseases of both large and small blood vessels are two of the biggest problem facing people with diabetes. Not only is it a huge clinical challenge, but also nature sometimes does our experiments for us. The high rates of coronary and peripheral vascular disease in diabetes can be seen as a kind of experiment of nature: a recognizable set of chemical abnormalities that might shed light on vascular diseases in general. It was those twin factors: a huge clinical problem, and an experiment of nature, that lead me to pick the topic of my research doctorate. 

When I was working on my research doctorate in the mid 1980s, I came across a lot of old research that seemed to show links between inflammatory and autoimmune conditions like systemic lupus erythematosus and rheumatic fever, and the eventual development of coronary artery disease. There was also a lot of old and largely forgotten research about the link between some viral infections and the development of coronary artery disease and acute coronary artery occlusions, because some infections can make blood more “sticky.” Inflammation evolved as one of the body’s defence mechanisms.

So I made the proposal – revolutionary at the time – that diabetes, coronary artery disease and a range of other illnesses might be inflammatory rather than degenerative. I soon found inflammatory markers in people with diabetes, that helped predict when someone was running into trouble with their eyes, kidneys or heart.  Even with stacks of data, I had to spend a lot of time defending that position, because it also implied that some illnesses thought to be irreversible might not be.

With the passage of time, it has tuned out that I was probably correct. Chronic inflammation, wherever it starts, mat have long-term effects on the body and on the mind. Chronic inflammation increases the risk of diseases of many blood vessels, as well as causing anemia, organic depression and cognitive impairment. Here is a partial list of common conditions in which inflammation is a prominent factor:
1.  Rheumatoid arthritis
2.  Systemic lupus erythematosus
3.  Fibromyalgia
4.  Chronic infections
5.  Insulin resistance or metabolic syndrome
6.  Arteriosclerosis
7.  Diabetes mellitus
8.  Hypertension
9.  Asthma
10. Inflammatory bowel disease
11. Psoriasis
12. Migraine
13. Peripheral neuropathy
14. Alzheimer’s disease
15. Autism
16. Gingivitis
17. Cystitis

The reason for raising the issue is not to say “told you so!”

It is instead that we need to think about inflammation a little differently. There is a mountain of information about the physical aspects of inflammation. We can stop at the simple description of inflammation as a condition in which part of the body becomes reddened, swollen, hot, and usually painful, or we can look below the surface: we can examine inflammation not only as a physical problem, but also as a psychological, social, subtle and spiritual problem. Why bother? Because the deeper approach allows us to understand and to treat and transcend inflammation as never before.

I am going to write some more about specific ways to address inflammation and what it means in future articles. I would also like to direct you to the book Healing, Meaning and Purpose, in which I talk about specific approaches in more detail.

But I would like to start with this.

In Ayurvedic and homeopathic medicine, inflammation is a sign of an imbalance in the vital forces of the body, and the traditional Chinese system agrees: here inflammation is usually a manifestation of an excess of Yang Qi, or a deficiency of Yin Qi. Most of our lives are seriously out of balance: Yang Qi is like a rampaging lion that has been stimulated by:
Acidic foods;
Environmental toxins;
Unwanted sexual stimulation:
Discordant music:
Constant demands from others:
Toxic relationships;
Years spent in front of television sets and limitless multi-tasking.

It should be no surprise to learn that all of these inflammatory conditions are increasing rapidly throughout the Western world. Not because we are getting better at identifying them, or we are living longer, but genuinely increasing.

It is wrong to put all the blame on poor diets or inadequate exercise. The problem is more subtle and is a reflection of distorted Information being fed to our bodies, minds, relationships, subtle systems and spiritual relationships.

The great news is that this simple conceptual shift gives us a whole load of new tools for handling these problems, and for using them as catalysts to growth.

In the next few weeks, I am going to drill down and give you some specific guidance that ties into the material in Healing, Meaning and Purpose and the next two that are on the launch pad.

Fasten your seat belt!

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Lupus Question

I had a very nice letter from a gentleman who posed the following question, which I have slightly edited in order to maintain confidentiality:

"A friend of mine, a 36 year old female has been diagnosed with Lupus.Healing by her doctors is not an option. Treatment yes. That’s not good enough. Any recommendations on how to heal it, who to see, what to read?"

It is always difficult for a health care practitioner to make precise recommendations about an individual whom they have not seen. That’s why we get so frustrated by some of the people who sell “cure alls” on their websites or infomercials. And when they are challenged say “but I’m not a doctor.” In which case, why are you giving advice??

Let me first say something about lupus. Systemic lupus erythematosus (SLE) is one of the so-called non-organ specific autoimmune diseases. What that means is that it can attack virtually any organ that has a DNA “command center.” And immune complexes can attack the skin, joints, kidneys, lymph nodes and so on. The autoimmune diseases show us how unwise it is for folk to advise us to “boost” our immune systems. SLE is an example of an overly boosted immune system. We should aim to balance our immune systems.

There is a lot of evidence that SLE has been becoming more common in recent years. Though we always have to be careful when we are told that an illness is becoming more common. That apparent increase may also be accounted for by other factors:

  1. More physicians may be becoming familiar with the illness: I saw this happen some years ago after I published an account of the first British case of a very rare type of headache. Within months, several other cases had been found. In each case doctors wrote to me saying that they had been treating the sufferer without success for many years, but after my report, understood what the problem had been, and, following my rules, had cured their patients.
  2. Diagnostic tests are becoming more sensitive, so more cases are turning up.
  3. Specialists are very good at changing the diagnostic criteria for an illness, or the level at which treatment is required: the “when is a difference a disease?” issue. Skeptics are forever saying that the only reason for doing so is so that drug companies can sell more drugs. But that’s a real misunderstanding: it’s actually the other way round. We change criteria once we have evidence that treatment may do some good. A good example is blood pressure. The levels at which we recommend treatment have been falling in recent years, because we now know that even minor hypertension can increase the risk of heart disease. Or diabetes mellitus, where the diagnostic blood sugar levels have been reduced for this reason: even small elevations of blood glucose increase the chance of damage to some blood vessels. It’s not the glucose itself that’s the problem, but the consequences of an elevated glucose level.

The reason for this preamble is this: if SLE is becoming more common, it is difficult to explain using conventional medical models. Some years ago, there was a report that more than half of all sufferers carried an organism called mycoplasma, and that this might be the cause of the illness. Nobody was ever able to replicate that finding, so the idea of an infectious cause is firmly on the back burner.

So let’s look at the illness from the perspective of physical, psychological, social, subtle and spiritual factors, for all come into play in someone dealing with SLE. The key to treatment is to have a healing synergy between all of the interlinked aspects of our lives.

On the physical front, conventional medicines have a great deal to offer, but as you said, for treatment rather than cure. They are also used to help protect organs against damage. One potential reason for the increase in the prevalence of SLE, is that there is a close link between the amount of fat in the abdomen and the production of some classes of inflammatory mediators. So question one: does the sufferer have an excess of intra-abdominal fat? If yes, diet and much gentle exercise as the illness will allow. What kind of a diet? Balanced, and following the principles which I outlined in the final part of the Healing, Meaning and Purpose.

There have been countless reports of people with SLE and other forms of inflammatory arthritis, especially rheumatoid, having food sensitivities particularly to dairy or to alfalfa. The research base is weak, but it is always worth exploring. There has been growing interest in the use of DHEA and foods high in omega-3 fatty acids. Some people have also reported some benefit from Vitamins C and E, and selenium. The treating physician can help with doses. There are also some herbal and homeopathic remedies that may be helpful. I quite like The Arthritis Bible by Craig Weatherby and Leonid Gordin as an overview of some of these approaches.

Next is psychological. Sunlight, stress, fatigue and lack of sleep can all make the condition worse, and I would urge the person to follow some of the plans that I outline on the CDs and in the book. An awful lot of people suffer from illnesses like this as a consequence of psychological factors. So it is a really good idea to use the approaches to see if there are any emotional, cognitive or relationship problems which have triggered or are perpetuating the autoimmune process.

Next is the subtle systems that underlie the physical and psychological. These may need to be re-programmed using acupuncture, or Reiki, or Thought Field therapy, or even high potency homeopathic remedies.

Finally the spiritual. I cannot over-emphasize the importance of this in all our lives. Again, I have made some suggestions in the program. It would not be right for me to tell others what or how to practice, but keeping in touch with, and strengthening the contact with your spiritual essence provides a wellspring of healing energy and support.

There is a final point that I would like to make. Not all illnesses can be made to disappear, and sometimes our focus has to change to one of helping the individual understand, learn from and coexist with the illness.

Who to see? Any health care professional that will respect all five domains, and help the individual to help themselves.

Now, back to you: does that help?

+ Are there others out there who would like to share their experiences?

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