Friday, February 26, 2016

Tregs for the Rest of Us: Part 2 Vitamin A & D

Both Vit A and D are involved in the regulation of the immune system and inflammation of tissue. In order to be used by the body, they need to be modified by enzymes.

There are many different kinds of Tregs. for simplicity, I have not specified the types in this review.

Vit A Derivatives and Treg Function

For reference, a derivative is an analogous compound to the vitamin. A metabolite is a compound created in vivo. When I say Vit A (or D3) given to a patient, I am referring to derivatives. I specifically note when I am discussing metabolites.

Vit A can be a problem unless there is the proper level; both too much and too little is problematic.. A deficiency can cause a Treg imbalance (too much Th1 and not enough Th2). A different study showed that too much Vit A in vitro causes development of Th2 cells.

A metabolite of Vit A (ATRA) converts one type of T-cells into Treg cells (again, in vitro). The resulting Treg cells suppressed effector Tcells, particularly in intestinal epithelial cells.  ATRA is also able to prevent the conversion of Treg cells into inflammatory TH17 cells. This provided some protection in a colitis model. There is some evidence that probiotic bacteria and Omega-3 fatty acids affects the functioning of ATRA in the body.

Vitamin D3 Derivatives and Treg Function

UVB exposure as well as a topical Vit D3 treatment can lead to creation of Tregs on the skin. Supplementation has also shown to have a positive effect with brain inflammation and diabetes (in terms of increasing Tregs).

MS patients have lower levels of Vit D3 metabolites, suggesting that the Vit D3 metabolites have a role in controlling inflammation and Treg formation. There is a possibility as well that Vit D3 metabolites affect the stability of Tregs in diabetic patients, but more studies are need to clarify any role they have.

Vit A and Vit D Crosstalk to Maintain Immune Homeostasis

Vit Aand  Vit D's signaling receptors are interconnected. There are two cell signaling pathways which are the same for Vit A and D. These pathways use different macromolecules to signal for either Vit D or Vit A. This leads to the hypothesis that they are both involved in maintaining a healthy balance in the immune system.

My Thoughts

Although it is not uncommon to have Vit D levels checked in a person with allergies, I have not done so for James. We live in an area with a lot of sun and he is outside without sunscreen each day. I have not heard of people testing Vit A levels, although they might. He is offered (but doesn't always eat) a wide variety of fruits and vegetables. I do not give him a multivitamin.

Since too little Vit A skews to too much much Th1 and not enough Th2, one might think that a deficiency would be good for those with allergies. However, I, personally, would not withhold a vitamin in the hopes that it changes the immune system. Vitamins have other functions besides affecting the immune system and if you over-activate the Th1 arm, there are also serious consequences (pot meet fire).

If his levels are low, I would suspect an underlying issue (he can't process Vit D for some reason, not that he doesn't get enough). It is another thing that I may address when he is done with treatment.

Part One

Thursday, February 4, 2016

Allergy Friendly Chinese New Year Collection

Twelve years ago, for the last Year of the Monkey, we were in China, adopting James. Technically, we were there just after the New Year; it's a lunar holiday so the dates move. But this year, the first day of the New Year and the day we adopted James fall on the same day, Feb. 8th.

For years, we had a Chinese New Year's party, with friends, food, and red envelopes. After James's diagnosis with food allergies, we stopped. Pretty much everything we made, had at least one ingredient he couldn't have.

Over the years, I have slowly started cooking Chinese food again. I am not one who creates recipes. However, I've gotten pretty good at adapting. And a hat tip here to Sharon at Nut Free Wok, who has given me the confidence and recipes to begin branching out. So this year, we will again be celebrating Chinese New Year - nut free, peanut free, soy free, and wheat free.

 I have collected here for future years (and others) the recipes we are using and adapting.I hope you enjoy them.

Appetizers and Soups:

Hot and Sour Soup (from Closet Cooking) Adaptations: I will leave out the tofu and double up on mushrooms. I will use coconut aminos for soy sauce. I used to make one low/no heat and one spicy when James was younger, but I think we can skip that step now.

Chicken Potstickers (from Nut Free Wok) with the GF wrapper recipe from Food & Wine Adaptations: Replace soy sauce with coconut aminos.

Egg Rolls (from Steamy Kitchen) Adaptations: Replace soy sauce with coconut aminos. Leave out the meat for a vegetarian dish. Replace the egg roll wrappers with rice paper wrappers.

Char Siu Bao Adaptations: Use the Char Siu recipe below, with coconut aminos, cornstarch, some cha siu marinade, sugar, and green onions for the filling. I have made gluten free bao before but have not perfected my recipe. It's close enough to work but still in progress. If I get it perfected, I will share.

Main Dishes:

Roasted Braised Duck (from The Woks of Life) Adaptations: Replace soy sauce with coconut animos. Wish me luck as I have never cooked a duck before!

Char Siu (from Nut Free Wok) Adaptations: Replace soy sauce with coconut aminos. Replace black bean paste with ketchup.

Desserts (100% non-traditional):

Chocolate cupcakes: The recipe is from The Cake Mix Doctor Bakes Gluten Free (affiliate link). I plan to decorate them with red frosting with yellow piped characters.

Fortune Cookies (from Honest Cooking) Adaptations: I plan to dip them in white chocolate and add red sugar sprinkles.

Monday, February 1, 2016

Tregs for the Rest of Us: Part 1 Probiotics

Treg, or Regulatory T cells, have the job of regulating the immune system. Many treatments of allergies have been found to influence the Treg population (DBV's peanut patch, FAHF-2 (Chinese Herbal Medicine in trial with the same doctor James is seeing, OIT, and SLIT  (the SLIT research I found regarding Tregs was for environmental allergies, not food).

T cells are made in the bone marrow. Depending on chemical influences, a T cell, when made, will either become a Treg cell or a Teff (effector) cell. Everyone has both types of cells, but in different ratios. Increasing Tregs is a part of the puzzle on how to increase tolerance.

I ran across an article, "Influence of Dietary Components on Regulatory T Cells," from the Biotech Research and Innovation Centre in Copenhagen. Fair warning, it is dense. I've done my best to summarize it below, but if you find the information interesting, you should take a stab yourself.

It is a literature review, so there are many other articles referenced if there's an area you are particularly interested in and want to dig further.

Probiotics in the Gut

There are dendritic cells (a type of immune cell, not related to neurons) in the gut that help to balance immunity and tolerance. Dendritic cells can both activate effector T cells and promote non-inflammatory T cells, such as Treg. If Tregs are low in the gut, it can result in chronic inflammation.

With the exception of H. pylori (and the point of the experiment was to induce inflammation using H. pylori and then use Tregs to reduce it), all experiments reviewed showed a positive reaction of the intestinal disease with the use of probiotics.

Probiotics Outside of the Gut

Probiotics have been shown help with asthma, arthritis, and other inflammatory diseases. There needs to be more research on different organs to see how the Tregs in the gut can influence them.

It is important to note that different probiotics behave differently and some can be inflammatory. There appears to be evidence that different probiotics work with different dendritic cells in the gut and this may account for the differences.

Probiotic Caveats

Some studies have shown that probiotics can cause or contribute to inflammatory illnesses. The studies are not standardized, with different probiotics, doses, and type of administration. Additionally, genetics may play a role in the differing results. How any treatment behaves in vivo, with all the complications of an entire system can differ from results found in vitro.

There is the possibility that Tregs are increased simply by exposure to bacteria, and that any probiotic results are due more to the general bacteria load verses something special about any particular probiotic strain.

The data is not clear enough to allow a statement that all probiotics are protective.

My Thoughts - Or, the more I learn, the less I know

James does not take a probiotic, for a couple reasons. The first is that I would like some clarity that the probiotics available on the market are beneficial. The second is that he already takes so many pills (some of which have research to support that they affect Tregs) that I hesitate to add any more pills.

After he is weaned (someday) from Dr. Li's protocol, I will likely find a probiotic for him daily, under the "it can't hurt' philosophy.

Part 2