The book "The collapse of hygiene. How the war with microbes destroys our immunity "

The human body is a huge zoo, and in its diversity of species it will not yield to the forests of the Amazon. Imagine only: for each human cell in our body, there are ten “cohabitants,” that is, microorganisms. And they all play their part in a concert of our health.

No one argues that adherence to the principles of hygiene is one of the most important achievements of civilization. But it seems that the war with microbes has become an end in itself of medicine, and the situation has already gotten out of control. We believed in disinfection, armed with antibiotics and vaccines, and destroyed viruses and bacteria, without noticing that we thereby cause irreparable damage to ourselves. Will the man of the XXI century be able to stop the pharmageddon, which the doctors who are dishonest on their hands have raised on their banners, and to protect their natural immunity?

Bert Ehgartner - Austrian independent scientific journalist, winner of the prize of the German environmental organization (DUH) for the best journalistic work. In the sphere of his professional interest, health care problems and modern medicine, both official and alternative, invariably turn out to be. In the middle of March a Russian-language translation of his book is published in our publishing house.

ALL DISEASES BEGIN IN THE INTESTINE

In addition to the use of antibiotics, many other fundamental issues related to medicine are currently being discussed. It seems that after long years of silence, some obstacles in the thinking sphere have collapsed. The discovery of the microbiome has acted as a catalyst, which made it possible to look at certain phenomena from a new point of view. Hippocrates, the father of modern medicine, 2500 years ago wrote that "all diseases begin in the intestines." He had no idea about the hundred trillion microbes that live there, but the fact that he was right in his views is becoming more and more obvious.
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Many people advocate for nature and for the preservation of diversity of species. However, it took a very long time for people to begin to understand that each of us carries biotopes (parts of space inhabited by living organisms) that are also under threat. In the meantime, researchers experiment, including on themselves, and experiment with different diets, observing their effects on bacteria.

Jeff Leach, a scientist with whom I recently met, lives many months a year in Tanzania, in the savannah, along with a small Hadza people, to explore how the human microbiome changes if it lives like in the Stone Age. The lich himself is an object of his own experiment - he lives like a Hadza, hunts with them, eats the same prey as they, honey and berries, and for dessert - fatty insect larvae. He even began to smoke again, as Hadza has a custom - in the evenings, sit everyone together and smoke certain herbs.

Other researchers used themselves and other volunteers as guinea pigs to study in detail the effects of various antibiotics on the intestinal flora. It turned out that the antibiotic clindamycin has a destructive effect, especially on the group of bacteroids , and dramatically reduces their biological diversity. Bacteroids are among the most important and most numerous species in the colon. But even two years after the course of antibiotic treatment, their composition has not recovered.

The antibiotic ciprofloxacin , which is mainly used to treat urinary tract infections and inflammations of the paranasal sinuses, for three days greatly reduces the diversity of species in the intestine. Alanna Collen, a British researcher, in her interesting book Silent Power of Microbes even reports a study of children whose scientists could not find any bacterial DNA after taking several antibiotics. This means that the microbiome, which many now consider to be their own organ, was completely destroyed in these young children.

BABY DIABETES

All of these research questions relate to the pressing problems of our time, such as the tremendous increase in the number of autoimmune diseases, including type I diabetes, in which the immune system destroys the endocrine pancreatic cells in the so-called Langerhans islets. The incidence of type I diabetes in developed countries doubles every 20 years. The most affected age group is children under five years old. The diabetic's daily life is filled with math: you have to constantly give yourself injections, measure blood sugar levels, weigh each portion of pasta or sauces, convert all food carbohydrates into bread units and calculate the corresponding amount of insulin.

Parents of diabetic children do not have a night to sleep. They should wake up late at night, measure blood sugar to prevent sugar levels from rising or anything else more dangerous. If diabetics mistakenly get an excessive amount of insulin, they are threatened with “hypo” (hypoglycemia), that is, a sharp drop in sugar, which can lead to loss of consciousness and coma - the so-called hypoglycemic shock . Numerous studies show that the state of "hypo" dramatically increases the risk of developing senile dementia, as the brain is very sensitive to periods of hypoglycemia.

The cause of type I diabetes is a “loose” immune system that attacks your own body. But why is the immune system going crazy? Maybe because the body has lost good bacteria? Or too few regulatory T-cells have been formed, and the relationships would be limited, but we still don’t know about it? The microbes that live in us together have about 20 million genes, through which they interfere with the body. So it takes a lot of work to understand even the most important connections.

The reason for Jeff Litch's own experiment was the illness of his daughter, who since three has suffered from this auto-aggressive form of diabetes. Jeff is an anthropologist with a London Hygiene Degree. Due to his daughter's illness, his attitude towards the profession changed, and he made the fascinating world of microbes the object of his research activities. “Something in our Western way of life was completely out of control - with our medicine, our food, with our immune functions,” Leach said during one of our conversations, which he led to me from savannah via Skype, via satellite . “In my work here, living as a Stone Age man, I hope to find answers that I can take home with me.” Home is to his daughter, who is now studying in Canada. “I thought a lot about what we did wrong with her. As a little girl, she was sick a lot and constantly took antibiotics. I often ask myself the question: if I then had my current knowledge, would we have done so with its microbiome? ”

CONNECTION BETWEEN THE STOMACH AND BRAIN

Increasingly, the MGB axis, indicating a strong link between the three most important areas in the body, is at the very center of medical research. The abbreviation MGB means “microbiota, intestine, brain” (microbiota, gut, brain), that is, it postulates the connection of the microbiome and the intestine, the largest and most important organ of the immune system, with the nervous system and brain. Microbes regulate bowel function and health. There is increasing evidence that they also affect the immune and nervous systems and the flow of information in all directions. This happens unnoticed for us while we are healthy. But how is the regulation carried out in numerous diseases, during which at least temporary inflammatory processes affecting the brain can occur? There is much evidence that the MGB axis plays a crucial role here too.

Currently, diseases are being studied in different countries, which at first glance are not related in any way, but may have common roots. These include autism, ADHD (attention deficit hyperactivity disorder), multiple sclerosis and various mental disorders.

The connection between the brain and the intestines seems at first glance absurd. But it is not by chance that in colloquial German, the terms “solution from the intestine” or “stomach sense” (reminiscent of Russian by “gut I smell”) are sometimes used. Nowhere in the body, except for the brain and spinal cord, there is no such accumulation of nerve cells. The “abdominal brain” of a person contains 500 million nerve cells — about the same amount as a dog’s brain. The evolutionary “abdominal brain” is much older than the brain, but is very similar to it neurochemically, that is, according to cell types, hormones and receptors. The intestine serves the brain and communicates with it. Communication takes place in both directions - intestinal bacteria also have something to say.

For example, it occurs during the formation of serotonin neurotransmitter, which plays an important role in various cognitive processes, such as learning, but also responsible for good mood and restful sleep. 80% of serotonin in our body is produced in the intestine under the supervision and with the help of bacteria.

In addition, microbes produce other chemicals necessary for the functioning of the nervous system, in particular, water-insoluble lipids of molecular size, the so-called gangliosides. They are used to build the outer membrane (sheath) of nerve cells.

It is possible that antibiotics may affect this sensitive structure, for example, by preventing the formation of serotonin or gangliosides. “In adults, this influence may be insignificant,” says Martin Blaser, “but for a child whose brain is actively developing, it can cause significant harm. For example, many studies show that autistic children often have abnormal serotonin levels. ”

Crohn's disease and ulcerative colitis

With these inflammatory bowel diseases, the immune system attacks its own intestines. The reasons for this are unknown. Perhaps the lack of a microbial field destroyed by antibiotics plays a role. However, it is the latter that are used in the treatment of Crohn's disease and ulcerative colitis, along with various new medications aimed at calming the immune system.

One of the largest studies on this topic was conducted in Denmark. Over the past thirty years, the prevalence of ulcerative colitis among children under the age of 15 has more than doubled. And outbreaks of Crohn's disease affect 15 times more children today than in the mid-1980s. Thus, there are more than enough reasons for searching for possible triggers.

Between 1995 and 2003, 577,000 children were born in Denmark. All medicinal purposes of these children were registered, as well as all cases of inflammatory bowel disease for six years. Such a large sample allowed scientists to investigate including rarely occurring relationships.

In total, over six years, 117 children were infected with ulcerative colitis and Crohn's disease. On average, at the time of diagnosis, they were about three and a half years old. And here again there was a massive correlation with antibiotics, especially in cases of Crohn's disease. The risk of disease in children who took antibiotics before making this diagnosis was three times higher. There was also a clear connection with the doses: each extra prescribed course of antibiotics increased the risk by 18%. Children who received antibiotics seven times or more had a seven times greater risk of developing intestinal inflammation compared with children who did without this remedy.

These conclusions and figures paint us a picture that deserves our closest attention. “And when was the last time you heard from your doctor that the next prescription of antibiotics carries the risk of developing asthma or Crohn’s disease in a child?” Asked Martin Blazer. The answer is never.

More recently, Blazer was present at a conference where similar issues were discussed. “Suddenly, a doctor rose, whom I did not know, and demanded, given all the information received, to introduce a“ warning in black frame ”for anti-biotics.”

This is the most stringent and conspicuous warning form that can be administered by medical authorities for prescription drugs. It received its name because of the black frame that draws attention to itself, inside which a warning is written. Such warnings relate, for example, to possible bleeding when using blood thinners, or that this remedy should never be consumed in the presence of oncological diseases, since it may contribute to tumor growth. In the case of Germany, this would be a “red-handed letter,” in which pharmacists and various medical departments and departments convey important information. A remarkable symbol - the red hand on the front side of the letter - warns physicians who are exhausted by the constant stress of throwing the envelope aside and disregard it. “Such methods seem necessary to convey the seriousness of the situation to the people,” says Blazer. By “people,” he means primarily colleagues who steadfastly ignore his opinion about the use of antibiotics.

ANTIBIOTIC TEST

Most doctors have learned from their university years that antibiotics should be used for bacterial infections. More recently, a young doctor told me that the failure to assign antibiotics for inflammation of the tonsils or middle ear was considered, in the opinion of his professor, a serious professional error. These old training methods are firmly entrenched in the head, and the mere mention that it is about something "bacterial" is an obvious prerequisite for prescribing an antibiotic.

How can you tell if an infection is viral or bacterial?

Manufacturers of medical equipment made it easier. A child comes with a temperature to the clinic. There is a suspicion of a bacterial infection of the respiratory tract, or inflammation of the middle ear, or appendicitis - immediately in a well-equipped office, the so-called CPR test is taken. CPR, or C-reactive protein, is a marker of inflammation, the value of which increases much faster with an acute bacterial infection than with a viral one. The analysis requires only one drop of blood, which is taken by minimal puncture of the finger. Within a few minutes, a special device shows the measurement result. When an infection rate rises to a value of from five to ten milligrams per liter.

In this case, the situation for many parents looks depressing. They hold in their arms a sick, feverish child, which causes acute pity, and then comes the confirmation of an “objective” test, that there is obviously a strong inflammation in the child’s body. And again, the doctor, based on scientific methods, is confident in the correct decision, prescribing an antibiotic. Even if parents are critical of antibiotics, in this case, of course, they will take a prescription. The diagnosis of "bacterial infection" sounds too scary to resist medical recommendations.

FIRE FIGHTING

And what is this C-reactive protein? C-reactive proteins (CRP) are produced in the liver and then released into the blood. They got their name in 1930, when their discoverers noticed that proteins attacked pneumococci, linking them with the so-called C-polysaccharide and then dissolving them with calcium ions.

CRPs are not only associated with bacteria, but are also involved in the processing of dead and dying cells. They are in contact with phagocytes and control some other important mechanisms of the nonspecific immune system. As soon as the body signals the development of an infection, the liver releases a large amount of protein within a few hours. Usually this process is much faster than the development of a feverish state. In short, CRPs are the “firefighters” of our immune system that are actively involved in the process of curing the disease.

In children, this process functions particularly well, and with a number of banal infections, the level of C-reactive proteins grows rapidly. However, here the measurement method can play a trick on us. It would seem that if a high level of CRP shows that the immune system functions perfectly and is ready to cope with the disease on its own, why prescribe antibiotics?

But this method is not always perfect. For example, sometimes very serious meningococcal infections initially cause only a low CRP response.

As a justification for this test, it is often mentioned that as a result he is prescribed fewer antibiotics. Rune Aabenhus and his co-workers at the University of Copenhagen decided to test this and, on the request of an independent Cochrane group, conducted a study of cases in which the CRP test was used for respiratory infections. At the same time, it turned out that general practitioners who used the test device prescribed 22% fewer antibiotics than their counterparts, who wrote prescriptions only on the basis of their own experience. At the worst.

Of course, due to the high CRP level, people are more often hospitalized. But there were no measurable effects of speeding up the healing process in either case. This is not surprising, given that numerous studies have shown that children after respiratory infections quickly recover with or without antibiotics.

WHO DOES APPOINTMENTS?

An Austrian study conducted by the Department of Family Medicine at the University of Vienna reveals how patients or their parents arbitrarily react to medical recommendations. Project manager Catherine Hofman has collaborated with 30 general practitioners, who for at least 2.5 years have documented the results of their CRP tests and drugs prescribed in accordance with them. CRP values ​​were divided into three groups: at normal levels, antibiotics were prescribed only in 9.2% of cases, at a slightly elevated level - at 71.7%, with a strongly elevated level - in 98.7% of cases. Thus, the decision of the doctors depended mainly on the result of the device.

Their charges, however, were rather restless. Hofman analyzed how many of the prescriptions were actually bought out later in pharmacies, and found that in groups with a normal test result and limited prescription of antibiotics were not 9.2%, but still 30.8% were somehow able to get a prescription. Most likely, referring to another, more compliant doctor.

Interestingly, in the opposite case, the same thing happened: 36% of parents whose children had a high CRP value, and had a prescription for them, did not take antibiotics at the pharmacy.

According to the numbers of insurance policies, Hofman checked the consequences of this. “It was especially interesting,” she writes in her report, “that none of these patients went to the hospital later.” The fact that they did not follow the recommendations of the doctors had no serious consequences.

The influence of parents on the use of antibiotics is truly enormous. In one Swedish study, a survey was conducted of parents about their attitude to infectious diseases. The higher their level of anxiety was, the more often they found themselves in the doctor's office with the children for the purpose of the examination, and the more often their children seemed to be sick, even if they had no temperature or other objective reasons for anxiety. And if these parents were also positively disposed towards antibiotics, then the doctors respectively prescribed them much more often.

»More information about the book can be found on the publisher's website.